Anesthesiology Commons^™

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 …

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 …

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 …

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.

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 …

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 …

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …