Anesthesiology Commons^™

Ultrasound Guided Motor Sparing Knee Blocks For Postoperative Analgesia Following Total Knee Arthroplasty, Olawale A. Sogbein

Electronic Thesis and Dissertation Repository

Postoperative total knee arthroplasty (TKA) pain is severe and can inhibit patients’ rehabilitation. We devised a single injection motor sparing knee block (MSB) by targeting the adductor canal and lateral femoral cutaneous nerve with a posterior knee infiltration under ultrasound. Our primary objective was to evaluate the duration of the MSB compared to a standard periarticular infiltration (PAI) using time to first rescue analgesia as the end point. We randomized 82 patients undergoing TKA to receive either preoperative MSB or intraoperative periarticular infiltration. Duration of analgesia was significantly longer in the MSB group with a mean difference of 8.8 hours. …

Turning Up The Heat On Malignant Hyperthermia, Katie Carroll

Nursing Student Class Projects (Formerly MSN)

Surgeries are common, everyday procedures within the walls of America’s hospitals. According to Orser, Mazer, and Baker (2008), more than forty million patients in North America are given anesthetics annually. One of the major complications of anesthesia is malignant hyperthermia: a hyper-metabolic state that affects skeletal muscles. If left uncontrolled, malignant hyperthermia can cause multiple reactions within the body leading to metabolic and respiratory acidosis, cardiac dysrhythmias, kidney failure, coagulopathy, neurologic injury, and ultimately death (Seifert, Wahr, Pace, Cochrane, & Bagnola 2014). The incidence of this condition is estimated to be 1:15,000 in children and 1:20,000-50,000 in adults (Redmond, 2001). …

Prophylactic Methylprednisolone To Reduce Inflammation And Improve Outcomes From One Lung Ventilation In Children: A Randomized Clinical Trial., Mary C. Theroux, Alicia Olivant Fisher, Maria E. Rodriguez, Robert P. Brislin, Kirk W. Reichard, Suken A. Shah, Matt Mccoy, Melinda Brown, Kirk W. Dabney, William G. Mackenzie, Douglas A. Katz, Thomas H. Shaffer

Department of Anesthesiology Faculty Papers

BACKGROUND: One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury.

OBJECTIVE: We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60 min prior to lung collapse would minimize injury from OLV and improve physiological stability.

METHODS: Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for …

Anesthesia For Deep Brain Stimulation In Traumatic Brain Injury-Induced Hemidystonia., Jill M Jani, Chima O Oluigbo, Srijaya K Reddy

Anesthesiology and Critical Care Medicine Faculty Publications

Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.

A Randomized Controlled Trial Comparing Haemodynamic Stability In Elderly Patients Undergoing Spinal Anaesthesia At L5, S1 Versus Spinal Anaesthesia At L3, 4 At A Tertiary African Hospital., Vitalis Mung’Ayi, Karen Mbaya, Sharif Thikra, Dorothy Kamya

Anaesthesiology, East Africa

Background: Spinal anaesthesia is a routinely used anaesthetic technique in elderly patients (> 60 years) undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia including stable haemodynamic variables, less blood loss, less post-operative pain, faster recovery time and less post-operative confusion. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible strategy for …

Successful Implementation Of A Packed Red Blood Cell And Fresh Frozen Plasma Transfusion Protocol In The Surgical Intensive Care Unit, Benjamin E. Szpila, Tezcan Ozrazgat-Baslanti, Jianyi Zhang, Jennifer Lanz, Ruth Davis, Annette Rebel, Erin Vanzant, Lori F. Gentile, Alex G. Cuenca, Darwin N. Ang, Huazhi Liu, Lawrence Lottenberg, Peggy Marker, Marc Zumberg, Azra Bihorac, Frederick A. Moore, Scott Brakenridge, Philip A. Efron

Anesthesiology Faculty Publications

BACKGROUND: Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU).

STUDY DESIGN: We performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression …

Gait Analysis And Therapeutic Application Of Carbon Monoxide In A Rodent Model Of Complex Regional Pain Syndrome Type-1, Hussein Abdo

Electronic Thesis and Dissertation Repository

Complex regional pain syndrome type-I (CRPS-I) is a debilitating pain disorder often occurring secondary to distal extremity trauma. Its pathophysiology is not well understood; however, microvascular dysfunction is proposed as an important factor in its development and maintenance. Using a rodent model, we tested an automated gait analysis system (CatWalk™) to examine functional changes. In addition, the use of carbon monoxide releasing molecule-3 (CORM-3), a compound known to be a potent vasodilator and anti-inflammatory agent, was also tested as a treatment of CRPS-I-like symptoms. Using the CatWalk™ system, we observed significant changes in gait parameters post-injury, several of which persisted …

Does The Addition Of Dexamethasone To Local Anesthetic Used For Peripheral Nerve Block Prolong Analgesia In The Surgical Patient?, Janice M. Oliveira

Nurse Anesthesia Student Capstones

Pain after orthopedic surgery can be intense. Many anesthesia providers and orthopedic surgeons support the use of peripheral nerve blockade to assist in decreasing the amount of pain a patient may experience post operatively. Select medication adjuncts are being added to peripheral nerve blocks to prolong analgesia. The research presented here focuses on the addition of dexamethasone to peripheral nerve blocks to prolong analgesia. Dexamethasone is a synthetic glucocorticoid that acts as an anti-inflammatory. It has been shown to inhibit the release of inflammatory mediators such as, interleukins and cytokines, facilitating the release of anti-inflammatory mediators, decreasing postoperative pain. Recent …

Minimal Opioid Anesthetic In Patient With History Of Substance Abuse: A Case Study, Sarah E. Varney

Nurse Anesthesia Student Capstones

More than half of the population in the United States of America drinks alcohol regularly. Thousands of deaths annually are linked to drug overdoses, and that number continues to rise. Anesthesia professionals can expect to see patients in various levels of substance abuse and recovery during their practice. This case study is presented to discuss a minimal narcotic technique given in a patient with a history of prescription drug abuse, who had been substance free since successfully been through a recovery program years prior.

Detection And Treatment Of Hemorrhage In The Postoperative Patient, Vanessa M. Derosby

Nurse Anesthesia Student Capstones

Hemorrhage is a devastating event that can occur in the perioperative period. It is estimated that 2.35 in 1000 patients will experience hemorrhage associate with surgery. Adverse outcomes affecting patient morbidity, mortality and quality of life are associated with hemorrhage. Timely detection, diagnosis and appropriate intervention in the setting of hemorrhage are imperative to reduce adverse outcomes of shock such as end organ damage, chronic disability or death. Anesthesia practitioners hold the charge of monitoring and managing the patient’s hemodynamic status and play an integral role in the detection and management of the hemorrhaging patient.

Assessment Of The Preoperative Assessment: A Case Study, Steven James Birchenough

Nurse Anesthesia Student Capstones

The geriatric population defined as individuals 65 years of age or older is expected to increase to 20% of the total population by the year 2020. This population currently makes up one-third of the surgical population and is projected to double by 2020. The perioperative risks for this population are also increased and pose significant increases in morbidity and mortality. The need for a detailed preoperative assessment is crucial in any surgical patient. It is increasingly imperative for the geriatric surgical patient as assessment is vital for the surgical team to make decisions regarding the projected necessity, plan and desired …

Certain General Anesthetics Used In Pediatrics Hinder Neurological Development In Infants, Michael R. Hirschi

Selected Honors Theses

General anesthetics act by either blocking N-methyl-d-aspartate (NMDA) receptors or over stimulating γ-aminobutyric acid (GABA) receptors.^1–3 The actions of these receptors are responsible for the anesthetized state and are also crucial in the neurological development of infants.^2,4–8 Animal studies, although limited, provide vital information about general anesthesia’s neurotoxicity its hindrance of neurological development. Exposure to general anesthesia can severely hinder proper neuronal migration, synaptogenesis, and can drastically increase neuronal apoptosis in infant animals.^9–16 General anesthetics are more neurotoxic to infant animals in combination compared to individually.^10,16,17 Additionally, multiple exposures to general anesthesia tend to have compounding …

Understanding And Treating Emergence Delirium, Peter Currie

Nurse Anesthesia Student Capstones

This paper examines our current understanding of the phenomena of emergence delirium, which can occur following general anesthesia. Much research has been conducted to elucidate the causative factors of this condition, with findings ranging from anxiety to volatile agents and the neurodevelopment of the brain (Aono, Ueda, & Mamiya, 1997; Kain et al., 2004; McLott, Jurecic, Hemphill, & Dunn, 2013). While much of our understanding of emergence delirium has come from studying children, who are more prone to this condition, we can attempt to learn even more by examining the increased incidence of emergence delirium that occurs in those with …

Anaesthetic Consideration In A Cannabis Addict, Karima Karam, Shemila Abbasi, Fauzia Anis Khan

Department of Anaesthesia

This case report describes the anaesthetic management of a patient addicted to Bhang(cannabis) for 20 years. Cannabis use has implication in the anaesthetic management of a patient because of its effects on the cardiovascular system, respiratory system, and central nervous system and its interaction with anaesthetic drugs.

Postoperative Glycemic Variability In Diabetic And Non Diabetic Patients, Boris Mraovic, Md, Brian Hipszer, Md, Zvi Grunwald, Md, David Gratch, Do, Charles J. Yeo, Md, Jennifer Lessin, Rn, Kathleen O'Malley, Rn, Angela Gulino, Md, Peter Simpson, Meng, Jeffrey Joseph

David Gratch, DO

Objectives: Glycemic variability increases oxidative stress and may trigger the inflammation and coagulation cascades. Variability may be associated with increase morbidity and mortality in ICU patients. We analyzed glycemic variability after major surgery in diabetic (DM) and non-diabetic (NDM) patients using an automated intravenous blood glucose monitor (IVBG).

Opioid-Induced Hyperalgesia, Lisa Nieder

Nurse Anesthesia Student Capstones

Opioids are a fundamental part in the treatment of pain especially within the perioperative setting. While opioids are routinely administered by nurse anesthetists for the treatment of pain, they can be associated with several undesirable side effects including opioid- induced hyperalgesia (OIH). OIH is a complex phenomenon that has a significant impact on the successful treatment of pain in a surgical setting. While there have been many advances in recent years into the topic of OIH, the mechanisms are complex and remain incompletely understood. OIH is believed to occur from changes in both the peripheral and central nervous systems that …

Buprenorphine And The Anesthesia Considerations: A Literature Review, Elizabeth E. Stern

Nurse Anesthesia Student Capstones

Buprenorphine is a unique pharmaceutical in the management of chronic pain and opioid use disorder (OUD). Buprenorphine is a semisynthetic partial opioid agonist at the mu opioid receptor and an antagonist of the kappa opioid. Buprenorphine Maintenance Therapy (BMT) is utilized for the long-term treatment of patients with OUD. The attraction to this methadone alternative is increased safety profile, more convenient patient access to the drug, as well as increase of ease for the provider. The particular formula used in the US, Suboxone, has properties to discourage intravenous injection to prevent abuse and prevent negative secondary effects of intravascular injections …

Chiral Symmetry Breaking And Chiral Polarization: Tests For Finite Temperature And Many Flavors, Andrei Alexandru, Ivan Horváth

Anesthesiology Faculty Publications

It was recently conjectured that, in SU(3) gauge theories with fundamental quarks, valence spontaneous chiral symmetry breaking is equivalent to condensation of local dynamical chirality and appearance of chiral polarization scale Λ_ch. Here we consider more general association involving the low-energy layer of chirally polarized modes which, in addition to its width (Λ_ch), is also characterized by volume density of participating modes (Ω) and the volume density of total chirality (Ω_ch). Few possible forms of the correspondence are discussed, paying particular attention to singular cases where Ω emerges as the most versatile …

Resting-State Functional Network Disruptions In A Rodent Model Of Mesial Temporal Lobe Epilepsy (Tle), Ravnoor Singh Gill

Electronic Thesis and Dissertation Repository

Mesial temporal lobe epilepsy (TLE) is the most common form of drug-refractory epilepsy. The clinical application of non-invasively mapped networks using resting-state functional magnetic resonance imaging (rsfMRI) in humans has been rather limited due to heterogeneous (varying etiology, drugs, onset, latent period, etc.) patient groups. We employed a pharmacological (kainic acid) rodent model of TLE to measure the extent of functional network disruptions using rsfMRI, and study selected behaviors and olfactory to hippocampus transmission. Graph theoretical network modelling and analysis revealed significant increase in functional connectivity connectivity to the temporal lobe (hippocampus) in epileptic-rats compared to controls in the limbic …

Prehospital Use Of Plasma In Traumatic Hemorrhage (The Pupth Trial): Study Protocol For A Randomised Controlled Trial, Penny S. Reynolds, Mary Jane Michael, Emily D. Cochran, Jacob A. Wegelin, Bruce D. Spiess

Anesthesiology Publications

Background

Severe traumatic injury and haemorrhagic shock are frequently associated with disruptions of coagulation function (such as trauma-induced coagulopathy TIC) and activation of inflammatory cascades. These pathologies may be exacerbated by current standard of care resuscitation protocols. Observational studies suggest early administration of plasma to severely-injured haemorrhaging patients may correct TIC, minimise inflammation, and improve survival. The proposed randomised clinical trial will evaluate the clinical effectiveness of pre-hospital plasma administration compared with standard- of-care crystalloid resuscitation in severely-injured patients with major traumatic haemorrhage.

Methods/design

This is a prospective, randomized, open-label, non-blinded trial to determine the effect of pre-hospital administration of …