Anesthesia: Overview and Physical Therapy Implications

A Capstone Project by: Kathryn Lambert, SPT

 

Background and Statement of Need

Over the course of schooling, I found myself drawn to the higher complexity of patient needs and interdisciplinary collaboration required in acute care and inpatient settings.  Once I began my acute care rotation, one of the things that surprised me most was the attention I had to give during chart review to the type of anesthesia a patient had received, the implications this might have for mobility during the session, and a patient’s potential for timely discharge.

As I continued to ask my CI more and more questions about different kinds of anesthesia and its impacts, I realized that this was a topic that had not been addressed in our curriculum.  And yet, mode of anesthesia became an important part of every initial evaluation I conducted in the hospital for patients who had undergone elective orthopedic, medical, or emergency surgeries.  With that said, I felt that it was critical to produce a project that would serve as a useful addition to our program’s curriculum and would help future students feel better prepared to manage these complexities in their clinical rotations.

 

Overview and Purpose

The purpose of this Capstone project is to provide education to future DPT students that describes different kinds of anesthesia, its use in several different settings, and its side effects and implications for mobility with Physical Therapy.  To achieve this, I created a narrated lecture presentation in the form of a VoiceThread, which aims to guide the students from start to finish in thinking through application of these concepts during patient evaluation.  This is followed by a short quiz with question types that emphasize synthesis and clinical application of lecture material and includes feedback in response to each answer choice, as well as a survey that students can use to evaluate the presentation and provide their thoughts.

Additionally, over the course of Capstone planning, I learned that our program has a need for mock clinical cases of increased complexity that simulate the acute care setting.  With this charge before me, I also produced a mock case intended for use with more advanced students, which incorporates anesthesia-related elements and complications for the students to navigate.

 

Products

Link to the VoiceThread presentation for future UNC DPT students: https://unc.voicethread.com/share/19956309/

 

Link to the quiz: https://www.surveymonkey.com/r/DZX5B2V

These questions were created based on objectives from the lecture presentation. The format of many of these is “select any of the following…” rather than multiple choice, as I felt this lent itself better to critical thinking scenarios over simple information recall.

Quiz feedback with full explanations for each correct or incorrect answer is located here: Anesthesia-Quiz-Answers-for-Students

 

Mock clinical case: To maintain and ensure academic integrity, a copy of this case will not be posted here.  It is a case designed to assess DPT2 students prior to beginning an acute care clinical rotation.  It provides a case description of a patient including the procedure performed, PT orders, and some information from the nursing staff.  It also includes information for professor use that explains how to play the part of the patient throughout the evaluation in terms of presentation, behavior, and impairments.  It finishes with a number of follow-up questions that can be used to further assess the student’s decision-making process and clinical judgment.

 

Evaluation

The evaluation component of my Capstone consists of two items:

1) A survey that the students can fill out after going through the lecture material and completing the quiz to rate the effectiveness of different aspects of the presentation, linked here: https://www.surveymonkey.com/r/YDHHXHW

For a PDF version of the survey that can be printed, click here: Anesthesia Lecture Evaluation Survey

in combination with

2) The short content quiz for the students, including feedback on correct/incorrect answers, which may more realistically assess student understanding and demonstrate whether the presentation was effective in teaching the intended material.  Linked above under “Products.”

 

Self-Assessment

I found this endeavor to be a rewarding learning experience for myself, even as I created materials intended for others.  I am most interested in treating patients in either an acute care or inpatient rehab setting upon graduation, and I found this work relevant to my own professional development and future clinical practice.  My own acute care rotation took place in a more rural area with a hospital that was limited in its anesthetic options and capacity for complex surgical procedures.  With the research and learning I’ve put into developing this Capstone, I feel much more confident going into professional practice having a more comprehensive grasp on anesthesia and its implications across settings, whether acute, obstetric, or in ambulatory surgeries.

I have appreciated having consistent access to feedback from my primary advisor and committee members, who have offered valuable input into this project based on their own extensive experience as clinicians and professors.  Applying their suggestions has helped me not only to ensure clinical relevance, but also to improve my teaching skills in ensuring that I work to address different learning styles.  I have not yet had the opportunity to seek feedback from future  students/the intended audience, but I am optimistic that students and professors alike will find this material to be a useful addition to UNC’s DPT curriculum.

 

Special Thanks

To Lisa Johnston, PT, MS, DPT: For seeing merit in my idea and agreeing to be my primary advisor when I suddenly requested a phone call during my acute care clinical rotation, for illuminating what information is truly relevant for students when I get bogged down in details, and for leveraging your own teaching experience to help me best cater to students with varied learning styles.

To Jyotsna Gupta, PT, PhD, Committee Member: For your expertise in mock administration and in helping me understand how to develop a case description, instructions, and targeted questions appropriate for both the students and the professors.

To Corinne Murray, PT, DPT, Committee Member: For your cheery enthusiasm throughout this project, for your unique insights and feedback as a practicing acute care clinician, and for raising the bar and confirming the value of my material to future students.

 

References – Lecture Material

1. Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246-1258. doi:10.1213/ANE.0000000000003668
2. Smith G, D’Cruz JR, Rondeau B, et al. General Anesthesia for Surgeons. [Updated 2021 Oct 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493199/
3. Pincus E. Regional Anesthesia: An Overview. AORN J. 2019;110(3):263-272. doi:10.1002/aorn.12781
4. Löser B, Petzoldt M, Löser A, Bacon DR, Goerig M. Intravenous Regional Anesthesia: A Historical Overview and Clinical Review. J Anesth Hist. 2019;5(3):99-108. doi:10.1016/j.janh.2018.10.007
5. Hansen J, Rasmussen LS, Steinmetz J. Management of Ambulatory Anesthesia in Older Adults. Drugs Aging. 2020;37(12):863-874. doi:10.1007/s40266-020-00803-9
6. Stewart J, Gasanova I, Joshi GP. Spinal anesthesia for ambulatory surgery: current controversies and concerns. Curr Opin Anaesthesiol. 2020;33(6):746-752. doi:10.1097/ACO.0000000000000924
7. Rabinstein AA, Keegan MT. Neurologic complications of anesthesia: A practical approach. Neurol Clin Pract. 2013;3(4):295-304. doi:10.1212/CPJ.0b013e3182a1b9bd
8. Ardon AE, Prasad A, McClain RL, Melton MS, Nielsen KC, Greengrass R. Regional Anesthesia for Ambulatory Anesthesiologists. Anesthesiol Clin. 2019;37(2):265-287. doi:10.1016/j.anclin.2019.01.005
9. Wiederhold BD, Garmon EH, Peterson E, Stevens JB, O’Rourke MC. Nerve Block Anesthesia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 3, 2021.
10. Rodziewicz TL, Stevens JB, Ajib FA, et al. Sciatic Nerve Block. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470391/
11. Ilfeld BM. Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities. Anesth Analg. 2017;124(1):308-335. doi:10.1213/ANE.0000000000001581
12. Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73 Suppl 1:61-66. doi:10.1111/anae.14141
13. Buddeberg BS, Bandschapp O, Girard T. Post-dural puncture headache. Minerva Anestesiol. 2019;85(5):543-553. doi:10.23736/S0375-9393.18.13331-1
14. Agarwal D, Mohta M, Tyagi A, Sethi AK. Subdural block and the anaesthetist. Anaesth Intensive Care. 2010;38(1):20-26. doi:10.1177/0310057X1003800105
15. Frank BJ, Lane C, Hokanson H. Designing a postepidural fall risk assessment score for the obstetric patient. J Nurs Care Qual. 2009;24(1):50-54. doi:10.1097/01.NCQ.0000342937.99036.7b
16. Thompson K, Haddad L, Smith S. Reliability and validity of the postepidural fall risk assessment score. J Nurs Care Qual. 2014;29(3):263-268. doi:10.1097/NCQ.0000000000000043
17. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91.
18. Walsh MT. Improving outcomes in ambulatory anesthesia by identifying high risk patients. Curr Opin Anaesthesiol. 2018;31(6):659-666. doi:10.1097/ACO.0000000000000653
19. Fosnot CD, Fleisher LA, Keogh J. Providing value in ambulatory anesthesia. Curr Opin Anaesthesiol. 2015;28(6):617-622. doi:10.1097/ACO.0000000000000255
20. Lavand’homme P. Rebound pain after regional anesthesia in the ambulatory patient. Curr Opin Anaesthesiol. 2018;31(6):679-684. doi:10.1097/ACO.0000000000000651