Semester

Fall

Date of Graduation

2022

Document Type

Thesis

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Mike Frame

Committee Co-Chair

John Caputo

Committee Member

Matthew Coleman

Committee Member

Kesheng Wang

Abstract

Background: Laryngoscopy and endotracheal intubation are routine procedures that occur within the surgical setting. Fentanyl is currently administered for attenuating the hemodynamic response to intubation. Opioid-sparing alternatives have been identified with aims of improving patient outcomes, such as esmolol. Purpose: The project’s purpose was designed to improve anesthesia provider familiarity, perception, and consideration of esmolol as a non-narcotic alternative for attenuating the hemodynamic response to intubation and prompt an increase of esmolol administration within this setting. Interventions: Surveys were conducted before and after an educational in-service, offered to anesthesia providers, demonstrating esmolol as an efficacious alternative to fentanyl. Additionally, an audit was completed identifying esmolol administration rates during the induction phase of the anesthetic. Methods: Certified registered nurse anesthetists (CRNAs) and anesthesiologists were asked to complete pre- and post-education surveys. These surveys consisted of seven Likert-scale responses, two multiple choice questions and one open-text question. An audit was completed to determine if education increased provider utilization of non-narcotic alternatives clinically. A statistical analysis was performed comparing pre-and post- survey and audit results. Results: The in-service and corresponding surveys were completed by 16 anesthesia providers. Comparing mean responses between pre- and post-survey Likert-scale responses, four of the seven questions regarding esmolol as an alternative to fentanyl and perceived barriers to use yielded improved scores. The mean comparison of correctness of two knowledge-based questions also improved. Respondents perceived barriers to implementing esmolol within this clinical setting included need for further education, cultural pushback, and concern for adverse outcomes of esmolol use. The audit of esmolol administration rates did not yield any statistically significant findings. Conclusion: After implementation of an educational in-service, anesthesia providers knowledge, understanding, familiarity and acceptance of esmolol use for attenuating the hemodynamic response to laryngoscopy and endotracheal intubation improved. Despite this improvement, practitioners lacked the translation of the learnings into practice. Continued barriers exist when implementing such narcotic sparing techniques and need to be further addressed.

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