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Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32087
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Browsing Other by Author "Hamby, Tyler"
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Item Hyperkalemia in Adolescent Idiopathic Scoliosis Patients with Tranexamic Acid Administration(2023) Craddock, Germain; LaMont, Lauren; Hamby, Tyler; Reyes, KristyIntroduction: Tranexamic acid (TXA) is used intraoperatively to reduce blood loss in various fields such as obstetrics, spine, and major joint replacement surgeries. Between May and June 2022, we identified more than three cases of intraoperative hyperkalemia that we believed to be influenced by TXA administration in our adolescent idiopathic scoliosis posterior spinal fusion (AISPSF) patient population. Methods: A systematic review of our intraoperative hyperkalemia patients was conducted and narrowed to three patients with minimal pharmacodynamic, metabolic, or pathological influences. Each patient’s timeline of intraoperative hyperkalemia was charted along with medical interventions to reduce patient’s potassium levels. Results: Patients 1-3 received a bolus of 5000 mg TXA an hour prior to the initial incision. Their maintenance doses were set to 10 mg/kg/hr, with infusion rates ranging from 4.95 mL/kg – 8.93 mL/kg. TXA administration was halted when potassium levels exceeded 5.5 mmol/L, and anesthetic intervention ensued to ensure patients rapidly reduced intraoperative potassium and avoided any unnecessary untoward effects of hyperkalemia. Of note, most interventions involved the administration of 10% CaCl, four puffs of (45 mcg/act) Levalbuterol, and an increase in ventilation in addition to cessation of TXA administration. Cessation of TXA administration alone was able to reduce hyperkalemia as well. Conclusion: Upon initial review, we could not identify preoperative factors or intraoperative changes that could have led to hyperkalemia. To prevent potential complications associated with acute intraoperative hyperkalemia, we are currently working on a retrospective review of institutional TXA administration for AISPSF cases and matching patients that did and did not suffer from episodes of intraoperative hyperkalemia by age, gender, diagnosis, levels of surgery, length of procedure, and preoperative potassium to better identify the influence TXA administration plays on AISPSF intraoperative hyperkalemia.Item Single Agent Opioid vs Combination Agent Opioids in Postoperative Pain Control(2023) Aishat, Muhammad; Segovia, Alicia; Hamby, Tyler; Campbell, Throy; Brooks, Meredith; Gandhi, ArteeIntroduction: Treating post-surgery pain in pediatric populations often involves combination opiates, commonly hydrocodone and oxycodone. Unfortunately, this approach can lead to confusion for parents and concerns for overdose, as half of pediatric opioid prescriptions are considered high-risk. An opioid stewardship committee was established to oversee prescribing guidelines at Cook Children’s Medical Center (CCMC). This large-scale retrospective study examined whether educational interventions increased the likelihood of single-agent opioid prescriptions for post-surgery pain. This practice allows providers to more freely utilize NSAIDs and acetaminophen for postoperative pain. Methods: This was a retrospective single-center quality improvement (QI) project of all patients, who were prescribed opioids after surgery at CCMC in Fort Worth, TX between 3/1/2018 and 2/28/2022. Logistic regression was used to determine whether likelihood of single-agent (vs. combination) opioid prescriptions differed by intervention and department. Results: There were 5227 (38.30%) pre-intervention procedures and 8419 (61.70%) post-intervention procedures. Post-intervention procedures (vs. pre-intervention) were statistically significantly more likely to result in single-agent, rather than combination, opioid prescriptions (88.10% vs. 8.84%, OR=79.62, p<0.0001), and likelihood of single-agent opioid prescriptions significantly differed by department (p<0.0001). The proportion of single-agent opioids prescribed increased post-intervention in all 7 departments examined, and the proportion increased by 70% in the 3 departments with the most procedures: orthopedics, urology, and otolaryngology. Conclusion: Ongoing educational efforts by the Opioid Stewardship Committee have resulted in a sustained change in prescribing practices in multiple surgical departments from the use of combination to single-agent opioids.