FAR EASTERN UNIVERSITY INSTITUTE OF NURSING SY 2009 2010

EVIDENCE-BASED NURSING

Submitted by: Cruz, Jennica Dianne C. BSN 106 GROUP 24

Submitted to: Prof. Oliver V. Sanidad RN, MAN (Clinical Instructor) January 29, 2010

I.

Clinical Question

Is the use of combined lumbar spinal and thoracic high-epidural regional anesthesia to those high risk patients who underwent gastrointestinal and colorectal surgery effective to relief pain? II. Citation Combined Lumbar Spinal and Thoracic High-Epidural Regional Anesthesia as an Alternative to General Anesthesia for High-Risk Patients Undergoing Gastrointestinal and Colorectal Surgery III. Study Characteristics Patients Included The patients who were included with this are 12 high risk patients who underwent 13 gastrointestinal/colorectal surgical procedures. They considered high risk based on the anesthetic assessment (ASA score of 3 or 4). Interventions Compared The only interventions made in this study are: categorization of high risk patients underwent 13 gastrointestinal/colorectal surgical procedures (ASA score of 3 or 4) informed consent complications monitoring after the surgical procedure with the patient Outcomes Monitored There will be a relief of pain in using the combined anesthesia after surgical procedure done. There will be no complications that will accumulate after the surgical procedure and the combined anesthesia will be effective to the patients involved especially in emergency situation. Does the study focus on a significant problem in the clinical setting? Yes, the study focuses on a significant problem in the clinical setting because the use of kind anesthesia/s that will be use is one of the factors that affects and how it will work from the pre-operative up to the post operative stage of a patient. IV. METHODOLOGY/DESIGN Methodology used

The methods use in this study was categorizing the patients who underwent 13 gastrointestinal/colorectal procedures surgical procedures that were considered high risk due to several surgical procedures that they underwent based on the anesthetic assessment (score of 3 or 4). Design The designs of the studies are comparative, descriptive and experimental. The researcher compared and described the effects of the use of combined lumbar spinal and thoracic high-epidural regional anesthesia to those patients who are considered high risk after several surgical procedures done from those high risk patients who were not included in the study who used general anesthesia. Likewise, the study is experimental because of the use of combined lumbar spinal and thoracic high-epidural regional anesthesia with those 12 qualified patients. Settings The study took place at North Middlesex University Hospital in London, UK. Data sources The data was gathered through interview, observation and experimentation during whole study period from the pre-operative up to the post-operative stage of the patients included in the study. Subject Selection Inclusion Criteria The criteria for considering a patient to be included in this study are high risk based on anesthetic assessment (American Society of Anesthesiologists (score 3 or 4), undergone 13 gastrointestinal/colorectal surgical procedures, 6 patients are men as well the woman and no age in particular but the median of the age use in this study was 86 years. Exclusion Criteria Patients who are not are not qualified based on the standards of the researcher/s who conducted this study. Has the original study been replicated? No, because this is the original copy of the study. It was recently conducted from 2004 to 2006.

 What are the risks and benefits of the nursing action / intervention tested in
the study? The benefits of the nursing actions done are informed consent is very important because the patient can sue you because the procedures done are invasive, explanation to what will happen and what is the reason behind the procedure gives the client the knowledge about the procedure and religious monitoring is vital because any changes is a sign of complications. On the other hand, the risk done is only few are involved in the study and not all patients will respond the same as those patients tested. V. Result of the Study All of the patients alleged their postoperative pain was relief and effective. None of them were required for intubation after using the combined analgesia as well as there is low morbidity and mortality of high risk patients who used the general anesthesia for the procedure done. Ten patients were presented as emergency cases and only three patients elective procedures. Only one patient who was delayed ITU admission due to respiratory result. There were only two patients in 30-day mortality both of these patients refused initial treatment. There were only two patients who had minor complications and two patients with major complications occurred and one patient had a delayed complication to date. The patients only stayed at the hospital for seven days (median) and two patients were delayed at the hospital for social reasons. VI. Authors Conclusions/ Recommendation What contribution to client health status do the nursing action/ intervention make? All the nursing interventions help the client to recover easily and avoid complications. It makes the client to feel comfortable and avoid apprehensions before and after the surgical procedures. Establishing rapport and a good clientnurse relationship (professionally speaking) spice up the way to wellness. What overall contribution to nursing knowledge does the study make? This study provides a functional knowledge about the effectiveness of the use of anesthesia in a surgical procedure. The kinds of the anesthesia that will be used to our patients greatly affect the whole process of the procedure. Anesthesia may have an adverse effect before, during or after the surgical procedure. Anesthesias can be combined or use as a general dependent on the institutions protocol and the clients preference. Combination of anesthesia needs a thorough research and study to avoid its adverse effects that might be fatal if complications occurred. The use of anesthesia needs a high skilled doctor as well as religiously follow the preparations needed before administering to the patient. The use of anesthesia is a great aid to lessen the pain that our patient that will feel as well as to relief. VII.Applicability

 Does the study provide a direct enough answer to your clinical question in terms of type of patients, intervention and outcome? Yes, the study provides a direct enough answer to my clinical question in terms of the type of patients, intervention and outcome because the study proves the effectiveness of the combined lumbar spinal and thoracic highepidural regional anesthesia as an alternative to general anesthesia. Patients verbalized relief of pain, not that high numbers of complications and short period of time staying at the hospital after the surgical procedure. Is it feasible to carry out the nursing action in the real world? Yes, the nursing actions are feasible in the real world because those interventions that were applied are the usual nursing interventions that are done in the whole process of a surgical procedure. We, nurses are one of the responsible medical practitioners in handling our clients lives. VIII. Reviewers Conclusion/ Commentary

The use of anesthesia is very vital in any surgical procedure in the clinical setting. Anesthesia relief the pain that our patients might feel or feels. It lessens the complications that might occur during the surgical procedure. The combination of lumbar spinal and thoracic high-epidural regional anesthesia as an alternative to general anesthesia is a brilliant experimentation because it greatly help those patients who are high risk as considered by the ASA. Even though only few subjects were involved in this study it is a good sign that we should explore more to help our patients to achieve wellness. Further study and larger populations must be involved to investigate the effectiveness of those anesthesias and it will help more the patients to recover easily.