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Anesthesia and Analgesia Commons

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Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye 2019 Harvard Medical School

Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye

Senior Scholars Program

Purpose of Review: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general U.S. adult population is 10-30%, and the lifetime prevalence of U.S. adults is as high as 65-80%.

Recent Findings: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, and spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is ...


Ibuprofen Is A Safe And Effective Alternative To Opioid Analgesics In Dermatologic Surgery, Brittny Call Ahrendes 2019 Lynchburg University, VA

Ibuprofen Is A Safe And Effective Alternative To Opioid Analgesics In Dermatologic Surgery, Brittny Call Ahrendes

Lynchburg Journal of Medical Science

Patients undergo dermatologic surgery for a variety of reasons. Cases may be minor excisions with simple repair or extensive Mohs micrographic surgery (MMS) requiring involved flap reconstruction. Many patients develop some level of postoperative pain (POP) requiring oral analgesia and traditional methods of pain control include oral acetaminophen (Ac), or an opioid such as Ac + codeine. Opioids are associated with unpleasant adverse events such as nausea, pruritus, constipation, altered mental status, and potential for addiction, thus requiring judicious use. Alternatively, ibuprofen (Ibu), a non-steroidal anti-inflammatory (NSAID), has a proven efficacy and tolerability profile, but its use is often discouraged by ...


Npo Or Ama? Patients Allowed Clear Liquids Up To 2 Hours Pre-Procedure Have Equivalent Aspiration Risk And Increased Patient Satisfaction, Erich Smith 2019 University of Wayne State Medical School

Npo Or Ama? Patients Allowed Clear Liquids Up To 2 Hours Pre-Procedure Have Equivalent Aspiration Risk And Increased Patient Satisfaction, Erich Smith

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Itou K, Fukuyama T, Sasabuchi Y, et al. Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial. Journal of Anesthesia. 2012;26(1):20-27. doi: 10.1007/s00540-011-1261-x.


Non-Human Animals Providing Rescue In Medical Emergencies, Rainer Spiegel 2019 University of Tuebingen (Germany), BG Trauma Hospital Tuebingen

Non-Human Animals Providing Rescue In Medical Emergencies, Rainer Spiegel

Animal Sentience

In their target article, Chapman & Huffman challenge the quotation of Sir William Osler that the desire to take medication distinguishes humans from non-human animals. They provide examples of self-medication in non-human animals. Based on these examples, it can be inferred that non-human animals practice at least some form of medicine for symptom control. I would like to extend this view by showing that non-human animals not only provide self-medication, but also rescue others facing emergencies.


Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell 2018 The University of Southern Mississippi

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at ...


The Impact Of Joint Commission International Accreditation On Time Periods In The Operating Room: A Retrospective Observational Study, Takenori Inomata, Ju Mizuno, Masao Iwagami, Shiori Kawasaki, Akie Shimada, Eiichi Inada, Tina Shiang, Atsushi Amano 2018 Juntendo University

The Impact Of Joint Commission International Accreditation On Time Periods In The Operating Room: A Retrospective Observational Study, Takenori Inomata, Ju Mizuno, Masao Iwagami, Shiori Kawasaki, Akie Shimada, Eiichi Inada, Tina Shiang, Atsushi Amano

Open Access Articles

The Joint Commission International (JCI) is responsible for upholding standards in healthcare and organizations in compliance receive accreditation. JCI requires quality improvement on patient safety goals, but requirements may prolong the total procedure/surgery time and reduce efficiency. Here, we evaluate the impact of JCI requirements on time periods in the operating room. We included patients who received elective and emergency surgeries under general anesthesia at Juntendo University Hospital between December 2014 and June 2016. Patients were classified as before and after JCI accreditation on December 12, 2015. The primary outcome was total procedure/surgery time. Secondary outcomes include five ...


Adaptation Of Microelectrode Array Technology For The Study Of Anesthesia-Induced Neurotoxicity In The Intact Piglet Brain, Emily D. Geyer, Prithvi A. Shetty, Christopher J. Suozzi, David Z. Allen, Pamela P. Benavidez, Joseph Liu, Charles N. Hollis, Greg A. Gerhardt, Jorge E. Quintero, Jason J. Burmeister, Emmett E. Whitaker 2018 The Ohio State University

Adaptation Of Microelectrode Array Technology For The Study Of Anesthesia-Induced Neurotoxicity In The Intact Piglet Brain, Emily D. Geyer, Prithvi A. Shetty, Christopher J. Suozzi, David Z. Allen, Pamela P. Benavidez, Joseph Liu, Charles N. Hollis, Greg A. Gerhardt, Jorge E. Quintero, Jason J. Burmeister, Emmett E. Whitaker

Neuroscience Faculty Publications

Every year, millions of children undergo anesthesia for a multitude of procedures. However, studies in both animals and humans have called into question the safety of anesthesia in children, implicating anesthetics as potentially toxic to the brain in development. To date, no studies have successfully elucidated the mechanism(s) by which anesthesia may be neurotoxic. Animal studies allow investigation of such mechanisms, and neonatal piglets represent an excellent model to study these effects due to their striking developmental similarities to the human brain.

This protocol adapts the use of enzyme-based microelectrode array (MEA) technology as a novel way to study ...


Dexmedetomidine (Precedex) Induced Fever, Patrick DeAlmeida DO, Michael Matrale DO 2018 Rowan University SOM

Dexmedetomidine (Precedex) Induced Fever, Patrick Dealmeida Do, Michael Matrale Do

Stratford Campus Research Day

Precedex is an intravenous, α-2 receptor agonist broadly used for analgesia, maintenance of sedation, and alcohol withdrawal treatment in the intensive care unit (ICU).

The most commonly reported adverse effects associated with precedex are hypotension and bradycardia1.

Fever has been reported with a 5-7% incidence rate. Our case shows a very impressive pyrexia in a 49 year old patient most likely associated to Precedex. When compared to the previously three reported cases his fever reached the largest value (T= 107ºF).

As its use becomes more and more common in the ICU, clinicians should be aware of this adverse effect especially ...


The Corticosteroid Compounds Prednisolone And Vamorolone Do Not Alter The Nociception Phenotype And Exacerbate Liver Injury In Sickle Cell Mice., Luis E F Almeida, Jesse M Damsker, Sarah Albani, Nina Afsar, Sayuri Kamimura, Drew Pratt, David E Kleiner, Martha Quezado, Heather Gordish-Dressman, Zenaide M N Quezado 2018 George Washington University

The Corticosteroid Compounds Prednisolone And Vamorolone Do Not Alter The Nociception Phenotype And Exacerbate Liver Injury In Sickle Cell Mice., Luis E F Almeida, Jesse M Damsker, Sarah Albani, Nina Afsar, Sayuri Kamimura, Drew Pratt, David E Kleiner, Martha Quezado, Heather Gordish-Dressman, Zenaide M N Quezado

Anesthesiology and Critical Care Medicine Faculty Publications

Clinicians often hesitate prescribing corticosteroids to treat corticosteroid-responsive conditions in sickle cell disease (SCD) patients because their use can be associated with complications (increased hospital readmission, rebound pain, strokes, avascular necrosis, acute chest syndrome). Consequently, SCD patients may receive suboptimal treatment for corticosteroid-responsive conditions. We conducted a preclinical trial of dissociative (vamorolone) and conventional (prednisolone) corticosteroid compounds to evaluate their effects on nociception phenotype, inflammation, and organ dysfunction in SCD mice. Prednisolone and vamorolone had no significant effects on nociception phenotype or anemia in homozygous mice. Conversely, prednisolone and vamorolone significantly decreased white blood cell counts and hepatic inflammation. Interestingly ...


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 2018 East Tennessee State University

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 ...


Morphine Versus Fentanyl Patient-Controlled Analgesia For Postoperative Pain Control In Major Hepatic Resection Surgeries Including Living Liver Donors: A Retrospective Study, Eman M. Nada, Abdulmajeed Alabdulkareem 2018 University of Massachusetts Medical School

Morphine Versus Fentanyl Patient-Controlled Analgesia For Postoperative Pain Control In Major Hepatic Resection Surgeries Including Living Liver Donors: A Retrospective Study, Eman M. Nada, Abdulmajeed Alabdulkareem

Open Access Articles

Background: Liver resection surgery results in significant postoperative pain. However, it is still not clear which opioids used by patient-controlled analgesia (PCA) provides the best pain control and results in the least side effect in a patient with impaired liver function. Our hypothesis was that fentanyl is a better choice than morphine as it is a potent analgesic that its elimination half-life does not depend on the hepatic uptake and metabolism.

The Study Purpose: Is to compare morphine and fentanyl PCA in liver resection patients as regards the degree of pain control, the consumption of opioids, and the side effects ...


Clinical And Economic Burden Of Procedural Sedation-Related Adverse Events And Their Outcomes: Analysis From Five Countries, Rhodri Saunders, Jason A. Davis, Peter Kranke, Rachel Weissbrod, David K. Whitaker, Jenifer R. Lightdale 2018 Coreva Scientific GmbH & Co KG, Germany

Clinical And Economic Burden Of Procedural Sedation-Related Adverse Events And Their Outcomes: Analysis From Five Countries, Rhodri Saunders, Jason A. Davis, Peter Kranke, Rachel Weissbrod, David K. Whitaker, Jenifer R. Lightdale

Pediatric Publications and Presentations

Background: Studies have reported on the incidence of sedation-related adverse events (AEs), but little is known about their impact on health care costs and resource use.

Methods: Health care providers and payers in five countries were recruited for an online survey by independent administrators to ensure that investigators and respondents were blinded to each other. Surveys were conducted in the local language and began with a "screener" to ensure that respondents had relevant expertise and experience. Responses were analyzed using Excel and R, with the Dixon's Q statistic used to identify and remove outliers. Global and country-specific average treatment ...


Urinary Retention In Unilateral Total Knee Arthroplasty: Comparison Between Continuous Epidural Analgesia And Single-Shot Femoral Nerve Block, Ausaf Ahmed Khan, Robyna Irshad Khan 2018 Aga Khan University

Urinary Retention In Unilateral Total Knee Arthroplasty: Comparison Between Continuous Epidural Analgesia And Single-Shot Femoral Nerve Block, Ausaf Ahmed Khan, Robyna Irshad Khan

Department of Anaesthesia

Objective: To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing total knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block.STUDY Design: Randomized controlled study.PLACE AND DURATION OF STUDY: Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015.METHODOLOGY: Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken ...


Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood 2017 The University of Southern Mississippi

Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood

Doctoral Projects

Post-operative pain creates burdens for the patient and their family members while also drastically increasing the price of cost to the healthcare system. The Institute of Medicine Committee on Advancing Pain Research, Care, and Education states that the annual economic cost of chronic pain in adults is $560-630 billion (IOM, 2011). Regional anesthesia has been shown to provide potent analgesia that often times leads to a reduction in systemic analgesic requirements, opioid related side effects, general anesthesia requirements, and possibly the incidence of chronic post-operative pain. There are several adjunct medications that can be combined with peripheral nerve blocks to ...


Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass 2017 University of Southern Mississippi

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated ...


Effects Of Lower Extremity Aerobic Exercise And Conditioned Pain Modulation On Evoked Shoulder Pain, Logan Lumpkins, Craig Wassinger 2017 East Tennessee State University

Effects Of Lower Extremity Aerobic Exercise And Conditioned Pain Modulation On Evoked Shoulder Pain, Logan Lumpkins, Craig Wassinger

Undergraduate Honors Theses

Background: Emerging evidence suggests that aerobic exercise and conditioned pain modulation may be advocated in treating patients with musculoskeletal pain. The effects of lower extremity aerobic exercise and conditioned pain modulation on evoked shoulder pain are not known.

Purpose: To determine the acute effects of lower extremity aerobic exercise and conditioned pain modulation on outcomes of evoked shoulder pain from pain pressure threshold measurements.

Study Design: Repeated measures.

Methods: Thirty (30) healthy volunteers were tested over the course of two sessions. Session 1 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a conditioned pain ...


Peri-Operative Regional Nerve Blocks (Pnb) In The Treatment Of Pain In Patients Undergoing Operative Fixation Of Lower Extremity Fractures, Joshua K. Radi 2017 Western Michigan University

Peri-Operative Regional Nerve Blocks (Pnb) In The Treatment Of Pain In Patients Undergoing Operative Fixation Of Lower Extremity Fractures, Joshua K. Radi

Dissertations

This research explores current approaches to managing pain control in patients undergoing operative fixation of lower extremity fractures. As opioid use in the U.S. and abroad increases, alternative methods of treating and preventing opioid requirements are being examined. Patients with lower extremity fractures are susceptible to nonunion when anti-inflammatories are consumed, so alternative approaches are warranted. One such alternative, a peri-operative regional nerve block (PNB), is accomplished by injecting local anesthetic adjacent to one or more peripheral nerves supplying the area of the fracture to decrease pain (Fowler, Symons, Sabato, & Myles, 2008). The goal of this research was to ...


Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan 2017 Aga Khan University

Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan

Department of Anaesthesia

No abstract provided.


Higher Midazolam Clearance In Obese Adolescents Compared With Morbidly Obese Adults., Anne van Rongen, Margreke J E Brill, Janelle D Vaughns, Pyry A J Välitalo, Eric P A van Dongen, Bert van Ramshorst, Jeffrey S Barrett, Johannes N van den Anker, Catherijne A J Knibbe 2017 George Washington University

Higher Midazolam Clearance In Obese Adolescents Compared With Morbidly Obese Adults., Anne Van Rongen, Margreke J E Brill, Janelle D Vaughns, Pyry A J Välitalo, Eric P A Van Dongen, Bert Van Ramshorst, Jeffrey S Barrett, Johannes N Van Den Anker, Catherijne A J Knibbe

Anesthesiology and Critical Care Medicine Faculty Publications

Background

The clearance of cytochrome P450 (CYP) 3A substrates is reported to be reduced with lower age, inflammation and obesity. As it is unknown what the overall influence is of these factors in the case of obese adolescents vs. morbidly obese adults, we studied covariates influencing the clearance of the CYP3A substrate midazolam in a combined analysis of data from obese adolescents and morbidly obese adults.

Methods

Data from 19 obese adolescents [102.7 kg (62–149.5 kg)] and 20 morbidly obese adults [144 kg (112–186 kg)] receiving intravenous midazolam were analysed, using population pharmacokinetic modelling (NONMEM 7 ...


Data On The Effect Of Sex On The Size, Cellular Content, And Neuronal Density Of The Developing Brain In Mice Exposed To Isoflurane And Carbon Monoxid, L Wang, A Wang, W W. Supplee, K Koffler, Y Cheng, Z M.N. Quezado, R J. Levy 2017 George Washington University

Data On The Effect Of Sex On The Size, Cellular Content, And Neuronal Density Of The Developing Brain In Mice Exposed To Isoflurane And Carbon Monoxid, L Wang, A Wang, W W. Supplee, K Koffler, Y Cheng, Z M.N. Quezado, R J. Levy

Anesthesiology and Critical Care Medicine Faculty Publications

The data presented here detail the changes in size, cellular content, and neuronal density of the developing brain over time with respect to sex in C57Bl/6 mice following neonatal exposure to isoflurane, carbon monoxide, or their combination. Specifically, brain weight- and brain volume-to-body weight ratios are presented, representative immunoblots of whole brain cell-specific protein content are depicted, and quantification of the number of neurons in the primary somatosensory cortex and CA3 region of the hippocampus are shown. Three discrete postnatal time points are represented: P7 (prior to exposure), P14 (one-week post exposure), and P42-56 (5–7 weeks post exposure ...


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