Date of this Version

12-4-2024

Document Type

DNP Project

Rights

default

Abstract

Abstract:

Background: The use of neuraxial anesthesia has allowed surgeons to facilitate numerous surgical procedures without the use of general anesthesia. While limiting the complications associated with a general anesthetic, the risk of complications remains prevalent due to the associated sympathectomy seen in neuraxial anesthesia use. The hemodynamic compromise seen in neuraxial anesthesia has significant implications for parturients as well as elderly patients with minimal reserves. While current practice continues to insist that crystalloid fluids should be administered to blunt the hypotension seen in neuraxial use, recent evidence suggests colloids fluids are much more efficacious.

Method: After completing a literature review, an educational module was created to assess the knowledge of CRNAs practicing with neuraxial anesthesia use regularly, regarding the efficacy of colloid over crystalloid fluid usage in the population receiving such interventions. An educational module was presented, as well as a pretest and posttest questionnaire to understand the current knowledge base of anesthesia providers regarding the usage of colloid fluid administration in patients receiving neuraxial anesthesia.

Results: A total of 8 survey respondents completed the pre-test and post-test. A total of 10 questions were asked to assess the knowledge of the CRNA regarding the usage of colloid fluid in neuraxial anesthesia. Of the 10 questions asked, CRNAs answered 3 more questions correctly on average after presentation of the educational module compared to the provided answers on the pretest analysis. After the presentation of the educational module, the greatest change in provided answers included the shift of providers stating they would be willing to utilize colloids in the presence of neuraxial anesthesia. Submitted answers shifted from 3 total responders claiming they would be likely or somewhat likely to use them, to 6 responders claiming they will be likely to utilize these products.

Discussion: Along with an inherent increase in knowledge regarding the physiology and side effect profile seen in colloid fluid usage, the receptiveness of the surveyed providers to change upon the presentation of recent data is encouraging for healthcare. The increase in surveyed responders claiming their willingness to utilize colloid fluids in the presence of neuraxial anesthesia administration indicates the lack of hemodynamic stability and the association of implied risks seen in the current practice of crystalloid fluid administration. As previously discussed, limitations of the educational module include the inability for responders to truly note the associated costs involved in utilizing colloid over crystalloid fluid usage.

Keywords: Sympathectomy, Colloid fluids, neuraxial anesthesia, hemodynamic stability, crystalloid fluids, vasopressor administration.

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