Anesthesiology Commons^™

Game Theory And The Surgeon, Alan P. Marco

Anesthesiology Faculty Publications

How the controversial study of strategic decision-making plays out in our profession.

Implementation Of An Antibiotic Nomogram Improves Postoperative Antibiotic Utilization And Safety In Patients Undergoing Coronary Artery Bypass Grafting, Thomas J. Papadimos, Jennifer L. Grabarczyk, Daniel F. Grum, James P. Hofmann, Alan P. Marco, Sadik A. Khuder

Anesthesiology Faculty Publications

Background

Routine, initial, empiric vancomycin dosing by clinicians in postoperative coronary artery bypass grafting (CABG) patients was identified as a potential patient safety issue in the Cardiovascular Intensive Care Unit (CVICU) because the rate of postoperative acute renal insufficiency (ARI) and average patient Body Mass Index (BMI) > 35 kg/m2 were significantly higher in our institution than those of the Society of Thoracic Surgeons (STS) database. A vancomycin dosing nomogram was derived from the local patient population in the attempt to improve patient safety by convincing clinicians to use an evidence-based approach to vancomycin prescription.

Methods

We analyzed two different treatment …

A Preliminary Study Of 24-Hour Post-Cesarean Patient Controlled Analgesia: Postoperative Pain Reports And Morphine Requests/Utilization Are Greater In Abstaining Smokers Than Non-Smokers, Alan P. Marco, Mark K. Greenwald, Michael S. Higgins

Anesthesiology Faculty Publications

Previous clinical studies have not examined the relationship between nicotine abstinence and opioid use for postoperative analgesia. This may be important because tobacco smokers are routinely required to abstain from smoking just before and during acute post-surgical recovery. This study investigated IV morphine self-administration [patient controlled analgesia (PCA)], subjective pain/drug effects and other measures during post-operative (elective Cesarean section) recovery.

These preliminary data suggest that a history of nicotine use and/or short-term nicotine abstinence can modulate morphine use and analgesia during post-operative recovery. These procedures provide a model for studying patterns and determinants of analgesic self-administration in medical settings.

The Obligation Of Physicians To Medical Outliers: A Kantian And Hegelian Synthesis, Thomas J. Papadimos, Alan P. Marco

Anesthesiology Faculty Publications

Background

Patients who present to medical practices without health insurance or with serious co-morbidities can become fiscal disasters to those who care for them. Their consumption of scarce resources has caused consternation among providers and institutions, especially as it concerns the amount and type of care they should receive. In fact, some providers may try to avoid caring for them altogether, or at least try to limit their institutional or practice exposure to them.

Discussion

We present a philosophical discourse, with emphasis on the writings of Immanuel Kant and G.F.W. Hegel, as to why physicians have the moral imperative to …