Surgical Procedures, Operative Commons^™

Effects Of Dexmedetomidine As An Adjunct To General Anesthesia On Postoperative Pain And Opioid Consumption In Major Abdominal Surgery, Ahmad H. Elrefahy

Rowan-Virtua Research Day

This review examines the impact of dexmedetomidine, an alpha-2 adrenergic receptor agonist, on postoperative pain and opioid consumption in major abdominal surgery. Dexmedetomidine, known for its sedative, analgesic, and opioid-sparing properties, is increasingly used as an adjunct to anesthesia. Analyzing existing literature, the review found that dexmedetomidine administration alongside general anesthesia significantly improves postoperative pain management and reduces opioid consumption. Patients receiving dexmedetomidine reported decreased postoperative pain ratings and required fewer opioids during the recovery phase. Additionally, intraoperative dexmedetomidine use correlated with reduced postoperative pain severity and increased patient satisfaction compared to control groups. However, potential side effects such as …

Minoxidil Weakens Newly Synthesized Collagen In Fibrotic Synoviocytes From Osteoarthritis Patients, Stefan Sarkovich, Peter P. Issa, Andrew Longanecker, Davis Martin, Kaitlyn Redondo, Patrick Mcternan, Jennifer Simkin, Luis Marrero

School of Medicine Faculty Publications

Purpose: Synovial fibrosis (SFb) formation and turnover attributable to knee osteoarthritis (KOA) can impart painful stiffness and persist following arthroplasty. To supplement joint conditioning aimed at maximizing peri-operative function, we evaluated the antifibrotic effect of Minoxidil (MXD) on formation of pyridinoline (Pyd) cross-links catalyzed by Plod2-encoded lysyl hydroxylase (LH)2b that strengthen newly synthesized type-I collagen (COL1) in fibroblastic synovial cells (FSCs) from KOA patients. MXD was predicted to decrease Pyd without significant alterations to Col1a1 transcription by FSCs stimulated with transforming growth factor (TGF)β1. Methods: Synovium from 10 KOA patients grouped by SFb severity was preserved for picrosirius and LH2b …

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Comparison Of Clinical And Radiographic Efficacy Of Particles Versus Nbca/Onyx In Middle Meningeal Artery Embolization For Chronic Subdural Hematoma, Jane Khalife, Mohamed Salem, Victoria Wong, Allen Karimov, Brian Jankowitz, Jan Karl Burkhardt, Hamza Shaikh, Daniel Tonetti, Pratit Patel, Tudor Jovin, Ajith Thomas

Rowan-Virtua Research Day

Different embolic materials are utilized in MMA embolization of chronic subdural hematoma per operators’ discretion. We aim to compare the clinical and radiographic efficacy of different embolic materials in a pooled retrospective cohort of two US centers.

Chewed Versus Swallowed Ticagrelor In P2y12 Inhibitor-Naïve Patients Undergoing Percutaneous Coronary Intervention, Thomas F. Wilson, Muddasir Ashraf, M. Fuad Jan, Tonga Nfor, Louie Kostopoulos, Joaquin Solis, Jayant Khitha, Ahmad Khraisat, Anthony C. Defranco, Tanvir Bajwa, Suhail Q. Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose: Dual antiplatelet therapy is standard for patients undergoing percutaneous coronary intervention (PCI) with stents. Traditionally, patients swallow the loading dose of a P2Y12 inhibitor before or during PCI. Time to achieve adequate platelet inhibition after swallowing the loading dose varies significantly. Chewed tablets may allow more rapid inhibition of platelet aggregation. However, data for this strategy in patients with stable ischemic heart disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) are less robust.

Methods: In this single-center prospective trial, 112 P2Y12-naïve patients with stable ischemic heart disease or NSTE-ACS on aspirin therapy and who received ticagrelor after coronary angiography but …

Efficacy Of Kidney Reperfusion Treatments Relative To Function And Survival Rates After Transplantation, Mitchell Rohr

Senior Honors Theses

Donor kidneys are damaged upon circulatory death before being preserved with machine perfusion until transplantation. During machine perfusion, blood is pumped back into the vasculature of the kidney, causing damage called ischemic reperfusion injury. The two forms of machine perfusion are hypothermic machine perfusion and normothermic machine perfusion. Different methods of treatment can be used during either hypothermic machine perfusion or normothermic machine perfusion to prevent ischemic reperfusion injury. Each of the treatment methods that were reviewed showed potential for preventing ischemic reperfusion injury, with hypothermic treatments having higher average levels of feasibility than normothermic treatments. The effect of the …

A Modern Multimodal Pain Protocol Eliminates The Need For Opioids For Most Patients Following Total Knee Arthroplasty: Results From A Retrospective Comparative Cohort Study, Leland Van Deventer, Amy Bronstone, Claudia Leonardi, Matthew Bennett, Peter Yager, Vinod Dasa

School of Medicine Faculty Publications

Purpose: Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. Methods: Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data …

Therapies For Mitochondrial Disorders, Kayli Sousa Smyth, Anne Mulvihill

SURE Journal: Science Undergraduate Research Experience Journal

Mitochondria are cytoplasmic, double-membrane organelles that synthesise adenosine triphosphate (ATP). Mitochondria contain their own genome, mitochondrial DNA (mtDNA), which is maternally inherited from the oocyte. Mitochondrial proteins are encoded by either nuclear DNA (nDNA) or mtDNA, and both code for proteins forming the mitochondrial oxidative phosphorylation (OXPHOS) complexes of the respiratory chain. These complexes form a chain that allows the passage of electrons down the electron transport chain (ETC) through a proton motive force, creating ATP from adenosine diphosphate (ADP). This study aims to explore current and prospective therapies for mitochondrial disorders (MTDS). MTDS are clinical syndromes coupled with abnormalities …

Rna Isolation In Duchenne Muscular Dystrophy (Dmd) Mice Models, Salem Abu Al-Burak

Undergraduate Student Research Internships Conference

Fibrosis is a progressive and typically irreversible disease process characterized by the excessive deposition of collagen in organs and in tissues of the musculoskeletal (MSK) system^1,2. This process, which causes loss of organ and tissue function, can be initiated by micro-traumas³, an excessive and/or prolonged immune response¹, the activation and proliferation of fibrosis-inducing progenitor cells⁴, and a pro-fibrotic extra-cellular microenvironment⁵. In parallel with the events that initiate fibrosis, genetic or environmental influences may cause cells and tissues to become predisposed to fibrosis development prior to initiation. This suggests that these …

Intraoperative Post Partum Hemorrhage In A Patient With Dengue Fever, Usama Ahmed, Asiyah Aman

Department of Anaesthesia

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient's dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms …

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

MSU Graduate Theses

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

The Utility Of Hyperbaric Oxygen Therapy In Post-Transplant Cyclophosphamide-Induced Hemorrhagic Cystitis: A Case Report And Review Of The Literature., Moayed Ibrahim, Kshama Bhyravabhotla, Basil Khalaf, Keith Van Meter, Nakhle S Saba, Hana Safah, Francisco Socola

School of Medicine Faculty Publications

Background: To date, there are only a few case reports of cyclophosphamide (Cy)-induced hemorrhagic cystitis (HC) in adult or pediatric allogeneic stem cell transplant (SCT) patients treated successfully with hyperbaric oxygen (HBO). In all the reported cases, Cy was used as a part of the conditioning regimen, rather than post-transplant for graft-versus-host-disease (GVHD) prophylaxis. More recently, the risk of HC in allogeneic SCT is further increased by the widespread use of post-transplantation cyclophosphamide (PTCy) as a highly effective strategy for GVHD prophylaxis. This is the first case reported of PTCy-induced HC successfully treated with HBO to the best of our …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

A Comparison Of 4-Year Total Medical Care Costs, Adverse Outcomes, And Opioid/Prescription Analgesic Use For 3 Knee Osteoarthritis Pain Treatments: Intra-Articular Hyaluronic Acid, Intra-Articular Corticosteroids, And Knee Arthroplasty., John Mackowiak, John T Jones, Vinod Dasa

School of Medicine Faculty Publications

To compare the medical costs associated with treatments for knee osteoarthritis (OA): intra-articular corticosteroids (ICS) and intra-articular hyaluronic acid (IHA) primarily, and ICS/IHA vs knee arthroplasty (TKA) secondarily. This was a retrospective analysis of an insurance claims database. Eligible members had diagnosed OA and no claims for ICS, IHA, or TKA during the 6–18-month look-back period. Cohorts of interest over the 4-year observation period were: patients who received ICS only, those who received IHA only, and those who received TKA only. Outcomes assessed included: (1) total allowed medical costs, (2) claims for pre-specified, treatment-related adverse outcomes and costs, and (3) …

Chlorhexidine Gluconate Vs Povidone-Iodine In The Prevention Of Clean-Contaminated Surgical Site Infections, Erin Layne, Abigail Stone

Physician Assistant Capstones, 2016 to 2019

Abstract

Background:

A patient’s skin is the major source of pathogens that can cause post-operative complications such as surgical site infections (SSIs). Optimization of pre-operative skin antisepsis is obtained with chlorhexidine gluconate (CG) and povidone-iodine (PI). These two solutions are the most widely used antiseptics for pre-operative purposes.

Objective:

Among surgical patients greater than 18 years of age undergoing clean-contaminated surgery, which antiseptic, iodophors or chlorhexidine gluconate, is more effective at reducing postoperative surgical site infections?

Methods:

A search was done in PubMed utilizing the terms chlorhexidine, infection control, iodophors, and surgical site infection. The limits applied included randomized …

Pediatric Surgery Opioid Prescription Follow-Up, Gadison Quick, Nathaniel Aviles, Gabriel Melgarejo, Hunjung Choi, Elizabeth Edmundson

Posters

This quality improvement project is assisting general and orthopedic surgeons in gaining greater clarity when prescribing opioids for specific surgical procedures. Additional surgical services are being added to the project fall of 2019. Opioid prescribing patterns are, and will continue to be, key to all prescribing providers within our organization.

Ethical Implications Of Treatment For Gender Dysphoria In Youth, Kelsey Hayes

Journal of Health Ethics

This manuscript explores ethical implications on treatment for youth with diagnosed gender dysphoria. The ethical considerations outlined and analyzed in this essay involve illuminating an understanding of whether the administration of pubertal suppression with GnRH agonists, and cross-sex hormones to children with gender dysphoria is morally justified as treatment to manage their psychological distress, or if safer more understood alternatives exist. This essay emphasizes that as health care professionals we must ensure youth with gender dysphoria receive adequate medical treatment and care however, this essay concludes through extensive literature review, that the use of inconclusive and under researched methods to …

Refrigerated Stability Of Diluted Cisatracurium, Rocuronium, And Vecuronium For Skin Testing After Perioperative Anaphylaxis, Kristen Dinsmore, Bethany Campbell, Timothy Archibald, Greg Mosier, Stacy Brown Phd, Alexei Gonzalez-Estrada Md

Appalachian Student Research Forum

Rationale: The purpose of this study is to investigate the stored stability of dilutions of neuromuscular blocking agents (NMBAs), namely cisatracurium, rocuronium, and vecuronium, for skin prick/intradermal testing.

Methods: Concentrations of NMBAs were monitored by liquid chromatography-mass spectrometry (LC-MS/MS) for a period of 14 days. Dilutions of NMBAs were prepared in saline by factors of 10x, 100x, 1,000x, 10,000x, and 100,000x as sensitivity of the assay allowed. Diluted drug products were stored in a laboratory refrigerator until sampling. On sampling days, aliquots of each dilution were removed and compared to a freshly prepared set of reference dilutions.

Results: The results …

Enhancing Clot Properties Through Fibrin-Specific Self-Cross-Linked Peg Side-Chain Microgels, Nicole Welsch, Ashley C. Brown, Thomas H. Barker, L. Andrew Lyon

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Excessive bleeding and resulting complications are a major cause of death in both trauma and surgical settings. Recently, there have been a number of investigations into the design of synthetic hemostatic agents with platelet-mimicking activity to effectively treat patients suffering from severe hemorrhage. We developed platelet-like particles from microgels composed of polymers carrying polyethylene glycol (PEG) side-chains and fibrin-targeting single domain variable fragment antibodies (PEG-PLPs). Comparable to natural platelets, PEG-PLPs were found to enhance the fibrin network formation in vitro through strong adhesion to the emerging fibrin clot and physical, non-covalent cross-linking of nascent fibrin fibers. Furthermore, the mechanical reinforcement …

Antimicrobial Hydroxyapatite-Gelatin-Silica Composite Pastes With Tunable Setting Properties, Vuk Uskoković, Shreya Ghosh, Victoria M. Wu

Pharmacy Faculty Articles and Research

Bone grafting is one of the commonest surgical procedures, yet all bone substitutes developed so far suffer from specific weaknesses and the search for a bone graft material with ideal physical and biological properties is still ongoing. Calcium phosphate pastes are the most frequently used synthetic bone grafts, yet they (a) often take an impractically long time to set, (b) release the drug content too fast, and (c) do not form pores large enough to accommodate host cells and foster osseointegration. To make up for these deficiencies, we introduced gelatin and silica to pastes composed of 5–15 nm sized hydroxyapatite …

Portosystemic Shunts In Cats: Management And Care, Rachael E. Konke

Master of Arts in Professional Writing Capstones

Portosystemic Shunts in Cats: Management and Care is an informative technical manual developed for veterinary professionals and caretakers of cats with portosystemic shunts. A portosystemic shunt is a complex and rare circulatory deformity in which unfiltered blood bypasses the liver and circulates throughout the body causing serious complications. Portosystemic Shunts in Cats: Management and Care details portosystemic specifics, symptoms, treatment, and proper everyday care for cats with portosystemic shunts.

Rectal Colonic Mural Hematoma Following Enema For Constipation While On Therapeutic Anticoagulation., Rebecca M. Rentea, Charles H. Fehring

Manuscripts, Articles, Book Chapters and Other Papers

Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy.

A Rare Case Report Of Probable Indigotindisulfonate Sodium-Induced Cardiac Arrest, Andrew P. Smith, Catherine A. Millares-Sipin, Henry Cohen, William Lois

Touro College of Pharmacy (New York) Publications and Research

Background: Indigotindisulfonate (Indigo Carmine, American Regent, Shirely, NY) is a blue dye that is commonly used for localizing ureteral orifices during surgery. In general, it is safe and biologically inactive, with the package insert citing only rare idiosyncratic reactions and mild pressor effects in some patients. We report a case of a severe life-threatening anaphylactoid reaction due to indigotindisulfonate following intravenous administration.

Case Report: We describe a case of a 42-year-old female admitted for a total abdominal hysterectomy. Upon arrival to the operating room, her heart rate (HR) was 80/min, blood pressure (BP) was 135/75 mm Hg, and …

Effects Of Pringle Maneuver And Partial Hepatectomy On The Pharmacokinetics And Blood–Brain Barrier Permeability Of Sodium Fluorescein In Rats, Mohammad K. Miah, Imam H. Shaik, Ulrich Bickel, Reza Mehvar

Pharmacy Faculty Articles and Research

Liver diseases are known to affect the function of remote organs. The aim of the present study was to investigate the effects of Pringle maneuver, which results in hepatic ischemia–reperfusion (IR) injury, and partial hepatectomy (Hx) on the pharmacokinetics and brain distribution of sodium fluorescein (FL), which is a widely used marker of blood–brain barrier (BBB) permeability. Rats were subjected to Pringle maneuver (total hepatic ischemia) for 20 min with (HxIR) or without (IR) 70% hepatectomy. Sham-operated animals underwent laparotomy only. After 15 min or 8 h of reperfusion, a single 25-mg/kg dose of FL was injected intravenously and serial …

Use Of Swine Small Intestine Submucosa As A Dermal Suture, Paige E. Black

PCOM Biomedical Studies Student Scholarship

The purpose of this preliminary study is to determine if swine small intestine submucosa (SIS) can be used to create a suture that will perform comparably to commercially available chromic gut sutures when placed into a wound in rat dermis. This study is part of an ongoing collaboration that has explored SIS as a biologic scaffold in various tissues and surgical procedures. In this study, eight Sprague-dawley rats were divided into two groups, each receiving a full thickness skin wound between the scapula, made by a 5mm biopsy punch. The wound was then closed with commercially available chromic gut suture, …

Synthesis Of Near-Infrared Heptamethine Cyanine Dyes As Biological Imaging Agents, Jordan L. Malray

Georgia State Undergraduate Research Conference

No abstract provided.

An Evaluation Of Warfarin Use And 30-Day Hemorrhage In Bariatric Surgery, Amanda M. Curry, Richard Boorse Md, Peter J. Bechtel Md, Cathy Fuhrman Rn, Msn, Cathleen Webber Rn, Mshs, Suzanne L. Smith Mba, Rrt, Tas

Department of Surgery

No abstract provided.