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    Development of a Protocol for Using Alkalinized Intrucuff Lidocaine for General Endotracheal Anesthesia

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    Author
    Witham, Katharine Christine
    Issue Date
    2020
    Keywords
    Anesthesia
    cough
    Endotacheal tube
    Intracuff lidocaine
    sore throat
    Advisor
    Torabi, Sarah
    
    Metadata
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    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    Patient coughing and bucking during a surgical procedure, as well as post-operative sore throat (POST) and emergence phenomena cough, can be detrimental to patients after general endotracheal tube anesthesia. The use of alkalinized intracuff lidocaine as opposed to air as the medium for inflation of the endotracheal tube cuff is an evidence-based method to alleviate coughing intraoperatively as well as POST and emergence phenomena cough. This method is already being practiced by a faction of anesthesia providers for electrophysiology (EP) procedures, especially those using jet ventilation, at a large teaching hospital in Tucson, AZ, but this practice lacked an evidence-based protocol within the facility. Therefore, a protocol was written through a systematic process and evaluated by two anesthesia providers (Group 1) trained in the use of the DELBI tool to assess its overall quality (Siering, Eikermann, Hausner, Hoffmann-Eßer, & Neugebauer, 2013). The overall assessment of the protocol was rated to be 79%, which is considered high quality per the tool standards (AGREE, 2017). Following this finding, a presentation at the target hospital took place, which introduced the new protocol and explained the recommendations. A feasibility survey was administered to CRNAs in attendance (Group 2) to determine the clarity and feasibility of the protocol (n=10) as well as assess if any noted barriers were present (n=4). The results of the survey showed clarity at 97.5% and feasibility at 90%. The only stated barriers to the protocol were drug accessibility within the operating rooms (Pyxis) and/or receiving drugs in a timely manner from the pharmacy (n=3) and notification/agreement of the physician anesthesiologists (n=1). Therefore, the newly written protocol was recommended for use by the anesthesia providers at the project facility to safely and effectively use alkalinized intracuff lidocaine to prevent intraoperative cough as well as POST and emergence phenomena.
    Type
    text
    Electronic Dissertation
    Degree Name
    D.N.P.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Nursing
    Degree Grantor
    University of Arizona
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