Anesthesiology Commons^™

A Retrospective Analysis Of Opioid Consumption Among Different Orthopedic Surgeons For Total Joint Replacement, Costas J. Gioules, Hayden B. Rockson, Russell M. Flatto, Arnel J. Almeda, Anthony L. Schwagerl

Senior Scholars Program

Background: Throughout the world, baby boomers reaching their sixth, seventh, and eighth decade of life are requiring a significant number of joint replacements—hips and knees. Due to the increasing number of joint replacements, it is important to find a multi-modal approach (MMA) to control pain, reduce the amount of opioid consumption, and improve patient satisfaction.

Purpose: The purpose of this study was to evaluate the intraoperative, postoperative, and total opioid consumption of patients undergoing total hip and knee replacements in an effort to develop a multi-modal approach to decrease opioid consumption, minimize adverse effects secondary to narcotic administration, and ...

Root Causes Of Intraoperative Hypoglycemia: A Case Series., Eric S. Schwenk, Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, Richard H. Epstein

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To describe the root causes of intraoperative hypoglycemic events.

DESIGN: Retrospective analysis.

SETTING: Large academic teaching hospital.

MEASUREMENTS: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

MAIN RESULTS: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

CONCLUSION: Intraoperative hypoglycemia was rare, but ...

Alternative Methods To Teach History Of Anesthesia, Manisha S. Desai, Sukumar P. Desai

Anesthesiology Publications and Presentations

Background:

History of Anesthesia [HOA] may be taught through lectures, small group discussions, or by one-on-one teaching. HOA competes for scarce time in a busy didactic schedule and for coverage in mainstream medical journals devoted to anesthesiology. These efforts are hampered by the fact that HOA does not have any direct impact on the delivery of modern anesthesia, and the fact that these topics do not appear in written or oral board examinations.

We describe three additional modalities to teach HOA to anesthesia residents that have been successfully employed by the Department of Anesthesiology at the University of Massachusetts: 1 ...

Diastrophic Dwarf With A Difficult Airway And Malignant Hyperthermia For Urgent Cesarean Section, Tanya Lucas

Anesthesiology Publications and Presentations

The patient is a diastrophic dysplasic dwarf presenting emergently for primary cesarean section for breech presentation. DD (Diastrophic dysplasia) is a disorder of cartilage leading to short stature and scoliosis. The patient had difficult intubations reported in seven previous anesthetics and an episode consistent with malignant hyperthermia. The severe curvature of her spine precluded use of regional anesthesia. She was sedated with midazolam and propofol while maintaining spontaneous ventilation. Multiple fiberopitc intubation attempts failed and a #4 LMA was placed. With the patient breathing spontaneously anesthesia was maintained with propofol and nitrous oxide. She delivered a healthy male and suffered ...

Horace Wells Memorials In The City Of Hartford, Connecticut, Antonio Aponte-Feliciano, Sukumar P. Desai, Manisha S. Desai

Anesthesiology Publications and Presentations

Introduction: Hartford, capital city of Connecticut was where Horace Wells conducted most of his work on the only anesthetic gas still used in clinical practice since the 19th century – nitrous oxide. Wells was born and raised in Hartford, Vermont, studied dentistry in Boston and established his practice in Hartford, Connecticut. Various icons celebrating Wells’ unique contributions in discovering the analgesic properties of nitrous oxide are located throughout this city.

Materials and Methods: We consulted staff at Connecticut Historical Society (CHS) and at Hartford Medical Society to help identify sites and artifacts in Hartford that honor Horace Wells. Thereafter, we visited ...

Duration Of Cpr: How Long Is Too Long? A Positive Outcome After 90 Minutes Of Cpr, Laura Cohen, Shubjeet Kaur

Anesthesiology Publications and Presentations

INTRODUCTION: Survival and neurologic function following prolonged cardiopulmonary resuscitation (CPR) are often poor and currently there lacks a formal recommendation for the maximum duration of resuscitative efforts. However, there have been multiple case reports of positive neurological outcomes following prolonged CPR. This case presentation helps to support and encourage the continuation of CPR in the appropriate setting and with available resources including intra-arrest percutaneous intervention (PCI) and extracorporeal membrane oxygenation (ECMO).

CONCLUSION: Prolonged CPR can result in favorable patient outcomes if done promptly and effectively, utilizing all available resources including intra-arrest PCI and ECMO.

Model-Based Cost-Consequence Analysis Of Postoperative Troponin T Screening In Patients Undergoing Noncardiac Surgery, Giovanna Al Lurati Buse

Open Access Dissertations and Theses

Introduction: Globally, more than 200 million patients undergo major non-cardiac surgery each year and more than 10 million patients will be exposed to postoperative myocardial ischemia, a condition strongly associated with 30-day mortality. The majority of these events go undetected without postoperative Troponin screening. Methods: We conducted a model-based cost-consequence analysis comparing a postoperative Troponin T screening vs. standard care in patients undergoing noncardiac surgery. In a first model, we evaluated the incremental number of detected perioperative myocardial infarctions and the incremental costs. A second model assessed the effect of the screening and consequent treatment on 1-year survival and the ...

The Use Of Ultrasound To Measure The Depth Of Thoracic Epidural Space, Issam Khayata, Gustavo Angaramo, Robert Lee, Costin Catalin Negroiu, Alexandr Zilber, Patricia M. Amelin

Anesthesiology Publications and Presentations

Introduction: The use of ultrasound to aid in regional blocks has increased in recent years as a result of improvement in ultrasound technology. There have been many studies to evaluate the use of ultrasound to measure the depth of the epidural space in the lumbar region1-9,10,11,12. Studies have shown a strong correlation between the depth of the lumbar epidural space measured by ultrasound and the distance of the needle from the skin after establishing the loss of resistance in the epidural space3,6,7. This study looked at the epidural space in the thoracic space to evaluate ...

Mobile Anesthesia: Ready, Set, Pack, And Go, Issam Khayata, Jesse Bourque

Anesthesiology Publications and Presentations

Introduction: Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might happen in areas where access of a regular operating room might be hours away or not available at all.

Golden Hour: Delivering mobile ...

Anesthesia Of The Geriatric Equine, Reza Seddighi Dvm, Ms, Phd, Dip Acva, Cvma

Reza Seddighi

Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.

Anesthesia Of The Geriatric Equine, Reza Seddighi Dvm, Ms, Phd, Dip Acva, Cvma

Large Animal Clinical Sciences Publications and Other Works

Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.