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Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller 2018 Thomas Jefferson University; Nemours/Alfred I. duPont Hospital for Children

Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller

Department of Anesthesiology Faculty Papers

No abstract provided.


Sts/Sca/Amsect Clinical Practice Guidelines: Anticoagulation During Cardiopulmonary Bypass, L. Shore-Lesserson, R. A. Baker, V. Ferraris, P. E. Greilich, D. Fitzgerald, P. Roman, J. Hammon 2018 Zucker School of Medicine at Hofstra/Northwell

Sts/Sca/Amsect Clinical Practice Guidelines: Anticoagulation During Cardiopulmonary Bypass, L. Shore-Lesserson, R. A. Baker, V. Ferraris, P. E. Greilich, D. Fitzgerald, P. Roman, J. Hammon

Journal Articles

© 2018 American Society of Extra-Corporeal Technology. All Rights Reserved. Despite more than a half century of "safe" cardio-pulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup. This ...


The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor 2018 Virginia Commonwealth University

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier ...


Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam IV 2018 Virginia Commonwealth University

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity ...


Assessing Baseline And Post-Discharge Risk Factors In Subjects With And Without Sleep Apnea Undergoing Endoscopy With Deep Sedation, Mercedes E. Weir 2018 Virginia Commonwealth University

Assessing Baseline And Post-Discharge Risk Factors In Subjects With And Without Sleep Apnea Undergoing Endoscopy With Deep Sedation, Mercedes E. Weir

Theses and Dissertations

ABSTRACT

ASSESSING BASELINE AND POST-DISCHARGE RISK FACTORS IN SUBJECTS WITH AND WITHOUT SLEEP APNEA UNDERGOING ENDOSCOPY WITH DEEP SEDATION

Background: Outpatient procedures encompass over 60% of all surgeries in the United States, and the prevalence of obstructive sleep apnea (OSA) remains high among adult surgical ambulatory patients. Ambulatory surgery poses problems for patients with OSA because narcotics and anesthetics used during surgery can complicate the negative effects of OSA, leading to cardiac events, brain hypoxia, and even death. This study was designed to evaluate the prevalence of cardiopulmonary risk factors among post endoscopic patients with diagnosed and undiagnosed sleep apnea ...


Effectiveness Of Tranexamic Acid Administration On Intraoperative Blood Loss In Elective Craniofacial Surgery, Kimberly Marie Vance 2018 Marshall University

Effectiveness Of Tranexamic Acid Administration On Intraoperative Blood Loss In Elective Craniofacial Surgery, Kimberly Marie Vance

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if intraoperative use of tranexamic acid (TXA) was associated with estimated blood loss in patients who underwent elective craniofacial surgery.

Introduction: Intraoperative blood loss has been shown to significantly contribute to postoperative morbidity and mortality in patients undergoing surgical procedures. It is the responsibility of the anesthesia clinician to accurately assess and actively replace ongoing blood loss, as well as employ strategies to curtail perioperative hemorrhage. While numerous methods exist to minimize surgical blood loss, such as mild hypothermia and controlled hypotensive techniques, these interventions can prove hazardous in pediatric patients ...


Is Preoperative Administration Of Celecoxib And Pregabalin Associated With Decreased Intraoperative And Postoperative Opioid Consumption In Patients Undergoing Total Hip Or Knee Arthroplasty?, Cierra Treadway 2018 Marshall University

Is Preoperative Administration Of Celecoxib And Pregabalin Associated With Decreased Intraoperative And Postoperative Opioid Consumption In Patients Undergoing Total Hip Or Knee Arthroplasty?, Cierra Treadway

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if a preoperative dose of celecoxib and pregabalin in patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) was associated with less opioid consumption intraoperatively and postoperatively compared to those who did not receive this regimen.

Introduction: THA and TKA have been associated with a high incidence of postoperative pain. Historically, this pain has been managed with opioids; however, these drugs have negative side effects associated with their use. Consequently, anesthesia providers have begun utilizing multimodal non-opioid analgesics. Recently, a specific combination has been utilized, which includes a ...


Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin 2017 The University of Southern Mississippi

Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin

Doctoral Projects

Anesthesia practice is learned in a stressful environment, and these stressors may lead to the students’ development of maladaptive coping mechanisms. Despite significant improvements in our understanding of addiction and our approaches to combat this problem, the risk of substance misuse remains high in nurse anesthesia students. Education and intervention are imperative when taking preventative measures. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether delivery method of chemical dependency/wellness educational program effects the level of understanding of anesthesia providers and substance misuse and the development of healthy coping mechanisms.

In determining whether the ...


Revisiting The Applicability Of Adult Early Post-Operative Nausea And Vomiting Risk Factors For The Paediatric Patient: A Prospective Study Using Cotinine Levels In Children Undergoing Adenotonsillectomies, Destiny F. Chau, Arundathi Reddy, Patrick Breheny, Anna Rebecca Young, Eric Ashford, Megan Song, Christina Zhang, Tammy Taylor, Abbas Younes, Turaj Vazifedan 2017 University of Kentucky

Revisiting The Applicability Of Adult Early Post-Operative Nausea And Vomiting Risk Factors For The Paediatric Patient: A Prospective Study Using Cotinine Levels In Children Undergoing Adenotonsillectomies, Destiny F. Chau, Arundathi Reddy, Patrick Breheny, Anna Rebecca Young, Eric Ashford, Megan Song, Christina Zhang, Tammy Taylor, Abbas Younes, Turaj Vazifedan

Anesthesiology Faculty Publications

Background and Aims: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. Methods: After Institutional Review Board approval, 213 children aged 3–10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS ...


Dealing A Neonate With Charge Syndrome: Anaesthesia Perspective Of Perioperative Care, Khalid M Siddiqui, Muhammad Ali Asghar, Amjad Nadeem 2017 Aga Khan University

Dealing A Neonate With Charge Syndrome: Anaesthesia Perspective Of Perioperative Care, Khalid M Siddiqui, Muhammad Ali Asghar, Amjad Nadeem

Department of Anaesthesia

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring.


Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance 2017 University of Southern Mississippi

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified ...


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.


The Efficacy Of Peripheral Opioid Antagonists In Opioid-Induced Constipation And Postoperative Ileus: A Systematic Review Of The Literature., Eric S. Schwenk, Alexander E. Grant, Marc C. Torjman, Stephen E. McNulty, Jaime L. Baratta, Eugene R. Viscusi 2017 Thomas Jefferson University

The Efficacy Of Peripheral Opioid Antagonists In Opioid-Induced Constipation And Postoperative Ileus: A Systematic Review Of The Literature., Eric S. Schwenk, Alexander E. Grant, Marc C. Torjman, Stephen E. Mcnulty, Jaime L. Baratta, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in ...


Efficiency Of Spinal Anesthesia Versus General Anesthesia For Lumbar Spinal Surgery: A Retrospective Analysis Of 544 Patients., John T. Pierce, Guy Kositratna, Mark A. Attiah, Michael J. Kallan, Rebecca Koenigsberg, Peter Syre, David Wyler, MD, Paul J. Marcotte, W. Andrew Kofke, William C. Welch 2017 University of Pennsylvania

Efficiency Of Spinal Anesthesia Versus General Anesthesia For Lumbar Spinal Surgery: A Retrospective Analysis Of 544 Patients., John T. Pierce, Guy Kositratna, Mark A. Attiah, Michael J. Kallan, Rebecca Koenigsberg, Peter Syre, David Wyler, Md, Paul J. Marcotte, W. Andrew Kofke, William C. Welch

Department of Anesthesiology Faculty Papers

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.

MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 ...


Right Ventricular Perforation: A Rare Complication Of Pulmonary Artery Catheterization, Khalid Ahsan, Mohammad Hamid, Saulat H. Fatimi, Ijaz Hidayat 2017 Aga Khan University

Right Ventricular Perforation: A Rare Complication Of Pulmonary Artery Catheterization, Khalid Ahsan, Mohammad Hamid, Saulat H. Fatimi, Ijaz Hidayat

Saulat Fatimi

A 70 years old male underwent Coronary Artery Bypass and Graft (CABG) surgery. After induction, a Pulmonary Artery Catheter (PAC) was inserted via right IJV with some difficulty in achieving PA tracing. During distal RCA anastomosis, surgeon noticed PAC tip coming out of Right Ventricular (RV) surface. Resistance was felt on trying to pull PAC, so it was left there. Cardiac surgeon then opened the Right Atrium (RA) and pulled out the catheter. Multiple attempts during insertion of PA catheter should always raise the suspicion of PAC tip slipping back into the RV. It should be closely monitored during surgery ...


Dilemma During Ultrasound-Guided Internal Jugular Venous Catheterization, Sanjay Dwarakanath, Monica Cheriyan, Annette Rebel 2017 University of Kentucky

Dilemma During Ultrasound-Guided Internal Jugular Venous Catheterization, Sanjay Dwarakanath, Monica Cheriyan, Annette Rebel

Anesthesiology Faculty Publications

The presence of Internal Jugular Valves can pose a diagnostic and procedural challenge during ultrasound-guided cannulation. After ruling out dissection, thrombus, or ultrasound artifacts, it can still be accessed and successfully cannulated with appropriate precautions including use of Live ultrasound, positioning, use of soft-tipped catheters, and minimizing duration of catheter placement.


Unplanned Prolonged Postanaesthesia Care Unit Length Of Stay And Factors Affecting It, Khalid Samad, Mueenullah Khan, Hameedullah, Fauzia A. Khan, Mohammad Hamid, Fazal Hameed Khan 2017 Aga Khan University

Unplanned Prolonged Postanaesthesia Care Unit Length Of Stay And Factors Affecting It, Khalid Samad, Mueenullah Khan, Hameedullah, Fauzia A. Khan, Mohammad Hamid, Fazal Hameed Khan

Fazal Hameed Khan

Objective: To identify the factors that prolong the length of stay in the post anaesthesia care unit (PACU). Methods: This audit was conducted in the PACU of a university hospital. A special form was designed and filled for those patients who stayed unplanned in the PACU for more than two hours. All patients who were admitted to the PACU after surgery were included. Patients undergoing cardiothoracic surgery, those directly shifted to ICU and cases done under local anaesthesia were excluded. Data was collected for 20 months by a designated recovery nurse for all included patients including those admitted outside the ...


Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, R. I. Khan, Fazal Hameed Khan, H .I Naqvi 2017 Aga Khan University

Respiratory Arrest In A Child After Flushing Of Pancuronium From The Dead Space Of Intravenous Cannula, R. I. Khan, Fazal Hameed Khan, H .I Naqvi

Fazal Hameed Khan

It is common practice for patients admitted to Intensive Care Units to have indwelling intravenous cannulae. Sometimes these cannulae are used only for the administration of drugs and are closed otherwise. Residual drugs in the deadspace of these intravenous cannulae as well as connected stoppers or 3-way stopcocks can later be flushed unknowingly. We would like to report a case in which inadvertent flushing of residual pancuronium caused complete muscle paralysis and respiratory arrest in a young child.


To Compare The Accuracy Of Prayer's Sign And Mallampatti Test In Predicting Difficult Intubation In Diabetic Patients, Mirza Mudassir Ali Baig, Fazal Hameed Khan 2017 Aga Khan University

To Compare The Accuracy Of Prayer's Sign And Mallampatti Test In Predicting Difficult Intubation In Diabetic Patients, Mirza Mudassir Ali Baig, Fazal Hameed Khan

Fazal Hameed Khan

Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS ...


Haemodynamic Response To Tracheal Intubation Via Intubating Laryngeal Mask Airway Versus Direct Laryngoscopic Tracheal Intubation, Naveed Tahir Siddiqui, Fazal Hameed Khan 2017 Aga Khan University

Haemodynamic Response To Tracheal Intubation Via Intubating Laryngeal Mask Airway Versus Direct Laryngoscopic Tracheal Intubation, Naveed Tahir Siddiqui, Fazal Hameed Khan

Fazal Hameed Khan

Objective: To compare the haemodynamic response to tracheal intubation using either direct larygoscopy or Intubating Laryngeal Mask Airway. Methods: This was a prospective randomized controlled trial. One hundred adult ASA-I and ASA - II patients coming to the Anaesthesia Department of Aga Khan University Hospital were randomly divided into two groups. In group- I endotracheal intubation was done with the help of Macintosh laryngoscope while in group-II patients were intubated with the help of the Intubating Laryngeal Mask Airway. Systolic, diastolic, mean arterial blood pressure and heart rate were recorded at baseline, at laryngoscopy and at 1 minute interval for 10 ...


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