Anesthesiology Commons^™

Intraoperative Dexmedetomidine Administration Effects On Postoperative Pain Scores And Opioid Medication Requirements: Pain Management Expectations Among Crnas, Dorilynn Nicol, Melissa Gheen, Matthew Bodine

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Opioid pain medications are currently viewed as a standard part of pain control in the vast majority of surgical procedures. However, opioid pain medications can have harmful effects on patients leading to increased length of hospital stay, unplanned readmission, and contribution to relapse or development of opioid use disorder. An opportunity for improved practice of pain management lies within opioid alternative pain medications such as dexmedetomidine. Evidence-based literature reviews have shown that dexmedetomidine has promise as an analgesic medication within the perioperative period with fewer harmful side effects. Barriers to more widespread use of this medication include staff unfamiliarity …

Progressive Acceleration Of Insulin Exposure Over 7 Days Of Infusion Set Wear, Jasmin R. Kastner, Timothy S. Bailey, Poul Strange, Leon Shi, Keith A. Oberg, Paul J. Strasma, Jeffrey I. Joseph, Douglas B. Muchmore

Department of Anesthesiology Faculty Papers

Insulin exposure varies over 3 days of insulin infusion set (IIS) wear making day-to-day insulin dosing challenging for people with diabetes (PWD). Here we report insulin pharmacodynamic (PD) and pharmacokinetic (PK) data extending these observations to 7 days of IIS wear. PWD (A1C ≤8.5%, C-peptide tmax (P < 0.001), Cmax (P < 0.05), and mean residence time (P < 0.0001). Area under the insulin concentration curve (AUC0–300) declined by ∼24% from days 0 to 7 (P < 0.05). These results confirm/extend previous observations showing progressive acceleration of insulin exposure over IIS wear time. This may have implications for PWD and designers of closed-loop algorithms, although larger studies are necessary to confirm this. The study was registered in clinicaltrials.gov (NCT04398030).

Objective Structured Clinical Examination For Intraoperative Hypotension And Hypertension Management, Andrew Mcginity, James David Ingram

Doctoral Projects

Managing intraoperative hypotension and hypertension is a non-technical skill anesthesia providers need to maintain patient safety. Upon transitioning from didactic training to clinical training, SRNAs may find it difficult to manage a patient’s blood pressure intraoperatively. The ultimate consequence of the delayed or improper treatment of intraoperative blood pressure perturbations is end-organ damage at the patient’s expense. Unintentionally causing a patient harm will lead to an SRNA losing confidence in their abilities. This OSCE is intended to increase SRNA confidence and competence regarding intraoperative hypotension and hypertension management before entering the clinical arena.

The hypotension and hypertension management tools and …

Pregabalin May Reduce Neuropathic Pain In Burn Victims, Caroline Nikolaidis

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Gray P, Kirby J, Smith MT, et al. Pregabalin in severe burn injury pain: a double-blind, randomized placebo-controlled trial. Pain. 2011;152(6):1279-1288. https://doi.org/10.1016/j.pain.2011.01.055

for a patient with burn injury pain.

Tuberculous Salpingitis - Possible Cause Of Salpingo-Enteric Fistula, Shayan Sirat Maheen Anwar, Anam Khan, Fahd Haroon, Frawa Mohsin

Department of Radiology

Salpingo-enteric fistula is a rare disease causing infertility. It occurs when there is a connection between fallopian tube and the intestine. It can be accurately diagnosed with hysterosalpingography. Fistulas mostly occur as a consequence of obstetric complications, however, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, iatrogenic causes, and trauma are other potential causes. The possibility of tuberculous salpingitis as a possible cause of salpingo-enteric fistula should always be considered in the developing countries where tuberculosis is endemic.

Preparing For The Applied Exam: The Orals And Osce, Roy G. Soto

Conference Presentation Abstracts

No abstract provided.

The Development And Implementation Of Evidence-Based Preanesthesia Assessment Tools For Lvad Patients Undergoing Non-Cardiac Procedures, Tracey Rooney, Casey Weimer, Eileen Giardino, Kerry Shanklin, Pete Pelletier, Audrey Rosenblatt

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Abstract

A university-affiliated tertiary medical center with a newly developed Advanced Heart Failure and Mechanical Circulatory Support program identified the need to implement a more systematic approach to the preanesthesia assessment process for patients with a Left Ventricular Assist Device (LVAD) undergoing noncardiac procedures and standardized guidelines to determine the best blood pressure monitoring system for patients with an LVAD during these noncardiac procedures. A multidisciplinary panel of clinical experts developed an LVAD Preanesthesia Toolkit using standard recommendations identified via evidence-based literature and expert opinion. The Toolkit included an LVAD Preanesthesia Assessment (VaPA) tool and an LVAD Blood Pressure Monitoring …

Evaluation Of Medial Branch Blocks For Lumbar Facet Joint Radiofrequency Ablation: What Is The Role Of The Second Diagnostic Block?, Alexandra Bartholomew, Noah Hoffman, David Provenzano, Todd Sitzman

Medical Student Research Poster Symposium

Lumbar medial branch (LMB) radiofrequency ablation (RFA) is a commonly performed procedure to treat facet joint-mediated pain. One of the challenges associated with LMB RFA is appropriately selecting patients for the procedure. Currently, patient history, physical examination, and diagnostic studies inadequately select patients for RFA. Therefore, diagnostic local anesthetic blocks are often recommended, yet the type and number of blocks needed to appropriately select patients for LMB RFA are debated. Success rates have been shown to be higher when dual blocks are employed; however, there are additional costs, humanistic factors, and risks of excluding individuals that may benefit from RFA. …

Fibrodysplasia Ossificans Progressiva And Pregnancy: A Case Series And Review Of The Literature, Alexandra D Forrest, Danielle M Vuncannon, Jane E Ellis, Zvi Grunwald, Frederick S Kaplan

Department of Anesthesiology Faculty Papers

Objective: To evaluate maternal and fetal outcomes in pregnant patients with fibrodysplasia ossificans progressiva (FOP; OMIM#135100), an ultrarare genetic disorder characterized by progressive heterotopic ossification of soft tissues and cumulative disability.

Methods: This is a retrospective case series of three patients with FOP who were admitted to Grady Memorial Hospital in Atlanta, Georgia, from to February 2011 to July 2021.

Results: Three women delivered preterm infants at our institution. These cases posed unique anesthetic and obstetric technical challenges, particularly when securing the airway and performing cesarean delivery. Importantly, each patient received perioperative glucocorticoids for prevention of further heterotopic ossification.

Conclusion: …

A Case Of Intractable Hyperhidrosis In Spinal Cord Injury: Role Of Stellate Ganglion Block, Soun Sheen, Hemant Kalia, Victoria Kung

Advances in Clinical Medical Research and Healthcare Delivery

Objective:

Autonomic dysreflexia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. Hyperhidrosis can also occur without an identifiable etiology. There are no standard treatment guidelines for refractory hyperhidrosis in the setting of persistent noxious stimulation. Stellate ganglion blockade may prevent hyperhidrosis by inhibiting profound sympathetic surge and vasoconstriction.

Case:

58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital for episodes of profuse sweating in the setting of autonomic dysreflexia secondary to underlying T7-8 discitis. Despite conservative treatment of discitis, patient continued experience 50-60 episodes of profuse sweating daily. Stellate ganglion block was …

Conversion Of Dissertations To Publications At The Aga Khan University Kenya: An Exploratory Study Of Residents Perceptions And Experiences, Brigette Macharia

Theses & Dissertations

Background: The successful completion and submission of a dissertation is a fundamental milestone for many residency programs worldwide. Publication of a dissertation in a peer-reviewed journal makes it more accessible and is impactful within the scientific context. It contributes to the global outlook of total burden of disease, for which significant geographical variation exists. Publication of residents’ research is a convenient surrogate marker for research training and experience. However, the preparation of a manuscript, successful submission and acceptance in a peerreviewed journal is challenging for both residents and their supervisors.

Justification: Aga Khan University (AKU) invests heavily in infrastructure to …

Complications Of Tavr From An Anesthesia Perspective, David R. Kingery Jr., Alex Roberts, Derek Horstemeyer, Russell Stahl

HCA Healthcare Journal of Medicine

Transcatheter aortic valve replacement (TAVR) has become the predominant technique for aortic valve replacement in the United States. Initially approved for high surgical risk patients, TAVR is now approved for most patients requiring valve therapy, including younger, lower-risk patients. The procedure is ideally performed in a hybrid operating room equipped with fluoroscopic equipment and transesophageal echocardiogram (TEE) imaging that can be viewed simultaneously by the operating team. The operating room should also be equipped to allow initiation of cardiopulmonary bypass, if necessary. Cardiac anesthesia teams are often involved with the management of these patients. This mini-review is designed to summarize …

Association Between The Baseline Gene Expression Profile In Periapical Granuloma And Periapical Wound Healing After Surgical Endodontic Treatment, Muhammad Adeel Ahmed, Fizza Nazim, Khalid Ahmed, Muhammad Furqan Bari, Abdulaziz Abdulwahed, Ahmed A. Almokhatieb, Yaseen Alalvi, Tariq Abduljabbar, Muhammad Nouman Mughal, Syed Hani Abidi

Department of Biological & Biomedical Sciences

In this study, we have investigated the association between the baseline gene expression profile in periapical granuloma and periapical wound healing after surgical endodontic treatment. Twenty-seven patients aged between 15 and 57 years underwent periapical surgery. The retrieved periapical tissue sample was used for mRNA expression analysis of COL1A1, VTN, ITGA5, IL-4, TNF, ANGPT, VEGFA, and CTGF. All patients were recalled after 6 and 12 months for periapical healing evaluation. Healing was then correlated with baseline gene expression. Healing was observed in 15 patients at the end of 6 months, which increased to 21 patients after 12 months. Six patients …

Gene Therapy For Fibrodysplasia Ossificans Progressiva: Feasibility And Obstacles, Elisabeth M W Eekhoff, Ruben D De Ruiter, Bernard J Smilde, Ton Schoenmaker, Teun J De Vries, Coen Netelenbos, Edward C Hsiao, Christiaan Scott, Nobuhiko Haga, Zvi Grunwald, Carmen L De Cunto, Maja Di Rocco, Patricia L R Delai, Robert J Diecidue, Vrisha Madhuri, Tae-Joon Cho, Rolf Morhart, Clive S Friedman, Michael Zasloff, Gerard Pals, Jae-Hyuck Shim, Guangping Gao, Frederick Kaplan, Robert J Pignolo, Dimitra Micha

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare and devastating genetic disease, in which soft connective tissue is converted into heterotopic bone through an endochondral ossification process. Patients succumb early as they gradually become trapped in a second skeleton of heterotopic bone. Although the underlying genetic defect is long known, the inherent complexity of the disease has hindered the discovery of effective preventions and treatments. New developments in the gene therapy field have motivated its consideration as an attractive therapeutic option for FOP. However, the immune system's role in FOP activation and the as-yet unknown primary causative cell, are crucial issues …

Pharmacological Interventions For The Treatment And Control Of Shivering In Adult Patients Undergoing Elective Surgery Under Regional Anaesthesia: A Systematic Review And Meta-Analysis, Malika Hameed, Naureen Akber Ali, Khalid Ahsan, Mohsin Nazir

Department of Anaesthesia

Intraoperative shivering is quite common after regional anaesthesia, which not only increases the total body oxygen requirement but also causes discomfort to the patients. The aim of this systematic review is to determine the effectiveness of pharmacological agents administered intra-operatively for treating shivering in adult patients who are undergoing elective surgery under regional (i.e., central neuraxial) anaesthesia so that an optimal choice of an agent can be recommended for clinical application. A literature search was carried out using PubMed, Cochrane Library, CINAHL databases, and hand searches to identify relevant studies. After literature screening and information extraction, a systematic review was …

Case Report On Peri-Operative Surgical And Anaesthetic Management Of Ruptured Humongous Lung Abscess, Khalid Maudood Siddiqui, Akbar Azizullah, Muhammad Saad Yousuf

Department of Anaesthesia

Introduction: Early thoracic empyema is usually treated through video-assisted thoracoscopic (VATS) decortication. Patient selection is important for decortication if an effective surgical outcome is required. Lung isolation techniques are required to provide anesthesia for these patients to facilitate the surgeon while operating on the affected lung. The ultimate target is to protect the non-diseased contra-lateral lung from contamination.
Presentation of case: We are presenting a unique case of 20-year-old female, resident of Karachi, who was brought to the emergency room (ER) with signs of sepsis, hypotension, and multi-organ failure. She was brought to the operating room to undergo video-assisted thoracoscopy …

Modified Jaw Thrust I-Gel Insertion Technique In Adults: A Case Series, Dileep Kumar

Department of Anaesthesia

Background: The I-gel is a second-generation supraglottic airway device that is built with a noninflatable elliptical gel material cuff and has a wide semirigid stem. The I-gel supralaryngeal seal has shown promising efficacy for both spontaneous and controlled ventilation under general anesthesia. The recommended, standard I-gel insertion technique is relatively challenging due to its shape and cuff size. Usually, the I-gel becomes entrapped at the oral cavity and requires excessive force to negotiate across the oropharynx, resulting in insertion resistance, tongue obstruction, insertion failure, and intraoral trauma. This case series evaluated a modified jaw thrust I-gel insertion technique because it …

Innovative Use Of Biotrace Tempo Pacemaker Lead Following Cardiac Surgery, Jordan E Goldhammer, Regina E Linganna, Douglas S Pfeil, Scott D Witzeling, Alec Vishnevsky, Nicholas Ruggiero, T. Sloane Guy

Department of Anesthesiology Faculty Papers

The Tempo® Temporary Pacing Lead is a temporary, transvenous, active fixation pacemaker lead used exclusively in structural heart and electrophysiology procedures since regulatory approval in 2016. We utilized the Tempo lead for four patients undergoing redo-robotic cardiac surgery in which surgical epicardial leads could not be placed. No failure-to-pace events were encountered and patients were able to participate in various levels of physical activity without limitation.

Reflection Of Mentors And Mentees At Initiation Of Faculty Mentorship Program At Aga Khan University: A Perspective, Rehana Rehman, Fauzia Khan, Naila Kayani, Tazeen Saeed Ali

Department of Biological & Biomedical Sciences

Objectives: To explore perception of mentors and mentees about 'Mentorship Program at Aga Khan University Medical College (AKU-MC) from a structured feedback form.
Methods: A retrospective study was conducted for evaluation of mentorship program at AKU-MC during the period from Jan 2019 to March, 2021. Responses on validated "Pre-intervention Probe Forms", from forty-seven mentors and fourteen mentees inducted in the program were reviewed. Confidentiality and anonymity of data were deliberated. All replies to each question were entered in a separate worksheet to determine the frequency and percentage of answers. Responses conveying same message, but worded differently were then grouped.
Results: …

Implementation Of An Advanced Operating Room Schedule To Increase Compliance With Clinical Practice Guidelines For Preoperative Antibiotic Selection And Timing: A Quality Improvement Project, Shelby Lynne Adams

DNP Scholarly Projects

Surgical site infection (SSI) is a major cause of morbidity and mortality in operative patients worldwide. The American Society for Health-System Pharmacists (ASHP) published the most recent clinical practice guidelines for antimicrobial prophylaxis in surgery. These guidelines are based upon the available evidence and provide a standardized approach for the safe and effective selection, dosing, and administration of antibiotics for the prevention of SSI (Bratzler et al., 2013). This Doctor of Nursing Practice (DNP) project aimed to determine if incorporating an advanced operating room (OR) schedule, inclusive of ASHP presurgical antibiotics, increased compliance with ASHP standards of antibiotic selection and …

Podium Presentation: Continuous Labor Epidural Placement Trends Among Parturients: An Evidence-Based Practice Project, Aleksandr A. Lyakhov, Teresa Bigand, Amanda Affleck, Kenn Daratha, Kris Daratha

2022 Providence Nurse Research Conference

Background:

Childbirth is very painful, and unmanaged pain may reduce patient satisfaction or lead to other complications. Evidence indicates that pain severity is lower among parturient women administered analgesia via a continuous labor epidural (CLE) and that maternal request is sufficient indication for CLE placement to manage labor pain. In some cases, a medical induction of labor may be scheduled, offering an opportunity for proactive pain management from hospital staff. Yet, trends on timing of CLE placement among parturient women with scheduled labor induction versus spontaneous labor in hospitals in Eastern Washington at one health system are unclear.

Purpose:

The …

Identifying Skin Integrity Issues In The Post Anesthesia Care Unit: A Qualitative Improvement Project, Lori Patten

2022 Providence Nurse Research Conference

No abstract provided.

A Prospective Study Investigating The Relationship Between Diagnostic Lumbar Medial Branch Blocks And The Use Of Sedation, Hannah C. Milad, Nimesh Patel Md, Ashwin Vaidyanathan Md, Katherine A. Nowak Phd, Rohit C. Aiyer Md

Medical Student Research Symposium

INTRODUCTION: Diagnostic medial branch blocks (MBB) confirm whether the origin of lower back pain is the facet joint, but are prone to false positive results. This study investigates the effects of midazolam sedation on perceived intensity of pain relief following lumbar MBB and determines the frequency of positive results in sedated patients for the corresponding treatment, radiofrequency thermocoagulation (RFTC).

METHODS: This prospective observational study compares pain scores between patients who undergo the MBB procedure with midazolam sedation (treatment) and without (control). Participants reported baseline and post-injection NRS pain scores, and 4, 8 weeks post-RFTC. If >80% pain relief was achieved …

How Do Anesthesiologists Prefer To Reduce Preoperative Anxiety In Pediatric Patients?, Arif Musa, Jahan Tajran, Rana Movahedi, Jeffrey C. Wang, David Safani, Christopher Cooke, Guillaume Farah, Syed F. Hussain, Brendan Lynch, Gligor Gucev

Medical Student Research Symposium

250 or less

False-Positive Serum Igm/Igg To Sars-Cov-2 In A Rare Pulmonary Neuroendocrine Carcinoma With Ocular Metastasis: A Case Report, Irandi P. Pratomo, Gatut Priyonugroho, Aris Ramdhani, Dian Zamroni, Thariqah Salamah, Yayi D.B Susanto, Ramdinal A. Zairinal, Annisa N. Witjaksono, Dita Aditianingsih, Jamal Zaini

The New Ropanasuri Journal of Surgery

The Coronavirus disease 2019 (COVID-19) pandemic impacts pulmonary cancer management since it shares similar clinical features and creates fear among patients to visit hospitals due to possible in-hospital disease transmission. We report a patient who presented with a rare case of a pulmonary neuroendocrine tumor with an ocular involvement, which, unfortunately, experienced a delay in diagnostics. The first hospitalization was due to superior vena cava syndrome, pleural and pericardial effusions, and swollen left eye. The patient was diagnosed with pulmonary cancer, released after the symptoms were relieved, and expected to visit a referral hospital for further diagnostics and treatments. The …

Validation Of A Whole Genome Methylation Profiling Classifier For Central Nervous System Tumors, Lucas Santana-Santos, Kwok Ling Kam, David Dittman, Stephanie De Vito, Matthew Mccord, Pouya Jamshidi, Hailie Fowler, Xinkun Wang, Alan Aalsburg, Daniel Brat, Craig Horbinski, Lawrence Jennings

Conference Presentation Abstracts

Whole genome methylation profiling is proving to be an incredibly powerful tool to diagnose tumors that are otherwise difficult to classify by histopathology and sequencing. The reference library of tumor DNA methylation data, using a machine learning-based tumor classifier, was developed by the German Cancer Research Network (DKFZ), and is available publicly on a research basis. However, medical institutions desiring to implement that classifier for routine clinical care need to import, adapt, and validate the classifier internally. We did this for our own DNA methylation-based classifier of central nervous system (CNS) tumors, using the same training and validation datasets as …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Evaluation Of The Nasopalatine Canal (Npc) In A Subset Of Pakistani Population, Using Cone Beam Computed Tomography (Cbct), Madiha Khan, Saqib Habib, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate variations in the shape, diameter, length and width of the nasopalatine canal along with the width of the buccal cortical bone anterior to it, using cone beam computed tomography imaging.
Methods: The retrospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September to October 2020, and comprised pre-existing cone beam computed tomography scans taken between 2015 and 2020 of patients of either gender aged 18-60 years who had maxillary central incisors present. The shapes and dimensions of the nasopalatine canal were observed along with the buccal bone anterior to the nasopalatine canal. …

Early Short Course Of Neuromuscular Blocking Agents In Patients With Covid-19 Ards: A Propensity Score Analysis., Gianluigi Li Bassi, Kristen Gibbons, Jacky Y Suen, Heidi J Dalton, Nicole White, Amanda Corley, Sally Shrapnel, Samuel Hinton, Simon Forsyth, John G Laffey, Eddy Fan, Jonathon P Fanning, Mauro Panigada, Robert Bartlett, Daniel Brodie, Aidan Burrell, Davide Chiumello, Alyaa Elhazmi, Mariano Esperatti, Giacomo Grasselli, Carol Hodgson, Shingo Ichiba, Carlos Luna, Eva Marwali, Laura Merson, Srinivas Murthy, Alistair Nichol, Mark Ogino, Paolo Pelosi, Antoni Torres, Pauline Yeung Ng, John F Fraser

Department of Anesthesiology Faculty Papers

BACKGROUND: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis.

METHODS: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 …

Identifying Facilitators And Barriers For A Successful Student Registered Nurse Anesthetist’S Clinical Experience, James Clancy, Adam Bruinius

Doctor of Nursing Practice Projects

Student registered nurse anesthetists experience a wide variety of barriers and facilitators to their clinical education; often rotating through several clinical sites during their nurse anesthesia educational program (NAEP) tenure. Existing evidence suggests SRNAs must be proficient in seeking, accepting, and utilizing feedback from clinical preceptors (Algiraigri, 2014). Accepting constructive criticism may be challenging for SRNAs as they are highly skilled, competent nurses who are now entering rigorous NAEPs as novices. Reverting from preceptor to preceptee can be a difficult transition for SRNAs. This project aimed to identify barriers and facilitators to a successful SRNA clinical education through a literature …