Anesthesiology Commons^™

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 …

Temperature Management Guidelines, J. W. Hammon, L. Shore-Lesserson, T. A. Dickinson

Journal Articles

No abstract provided.

The Society Of Thoracic Surgeons, The Society Of Cardiovascular Anesthesiologists, And The American Society Of Extracorporeal Technology: Clinical Practice Guidelines For Cardiopulmonary Bypass-Temperature Management During Cardiopulmonary Bypass, R. Engelman, R. A. Baker, D. S. Likosky, A. Grigore, T. A. Dickinson, L. Shore-Lesserson, J. W. Hammon

Journal Articles

To improve our understanding of the evidence-based literature supporting temperaturemanagement during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.

Effects Of Ondansetron 4 Milligrams Compared With Ondansetron 8 Milligrams On The Incidence Of Post-Operative Nausea And Vomiting In Patients With Body Mass Index Greater Than 30kg/M2 Undergoing Mastectomy, Diego Alejandro Arroyo

Theses, Dissertations and Capstones

Introduction: Post-Operative Nausea and Vomiting (PONV) is a recurrent and frequent issue for the patient, the anesthesia team, and Post Anesthesia Care Unit (PACU) team. Both pharmacologic and non-pharmacologic recommended modalities have been utilized for both the prevention and treatment of PONV in the surgical-anesthesia setting. The 5-HT3-receptor antagonist ondansetron is one of the many known pharmacological modalities commonly utilized by anesthesia providers in preventing PONV.

Methodology: The design used for this research was a quantitative, retrospective case control study that evaluated existing data enclosed in the Electronic Medical Records (EMR) from Charleston Area Medical Center (CAMC), which is …

Inhalation Anesthesia Vs. Total Intravenous Anesthesia For Ambulatory Dental Surgery In Children, Kristin D. Neal

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to compare inhalation anesthesia with sevoflurane versus Total Intra Venous Anesthesia (TIVA) with propofol infusion as it relates to the quality of recovery including postoperative pain, Post Operative Nausea and Vomiting (PONV), and Post Anesthesia Care Unit (PACU) Length Of Stay (LOS) in pediatric patients undergoing ambulatory dental surgery. Introduction: Pediatric dental procedures are increasingly performed in an outpatient setting under general anesthesia due to inadequate cooperation, circumstantial anxiety, and other behavioral and health issues. Commonly used inhalation anesthetics, such as sevoflurane, can induce hyperalgesia in children. While sevoflurane increases the risk PONV, …

Developing Local Guidelines For Management Of Sepsis In Adults: Sepsis Guidelines For Pakistan (Sgp), Madiha Hashmi, Fazal Hameed Khan, Sarwar Zubairi, S. Tipu Sultan, Saeeda Haider, Sadqa Aftab, Javed Husain, Anwar Ul Haq, Zahid Akhtar Rao, Amin Khuwaja, Syed Farjad Sultan, Zunairah Rais, Roohina Baloch, Naseem Salahuddin, Aslam Khan, Faisal Sultan, Kamran Chima, Amjad Ali, Gohar Ali

Department of Anaesthesia

Background: The purpose of developing ‘Sepsis Guidelines for Pakistan’ (SGP) is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign (SSC) tailored to available resources. These recommendations are not meant to replace the SSC Guidelines.
Methodology: SGP is an initiative of Pakistan Society of Critical Care Medicine (PSCCM). Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committee i.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, …

Perioperative And Acute Care Transesophageal Echocardiography (Toe), Madiha Hashmi

Department of Anaesthesia

In Pakistan perioperative transoesophageal echocardiography (TOE) during cardiac surgery is available in a few centers with reliance on cardiologists and cardiac technicians and its use in noncardiac surgery and intensive care units is very limited. In view of the increasing popularity of TOE based on obvious benefits this review is presented with an aim to evaluate the current indications and potential benefits of using TOE during anesthesia for cardiac and non-cardiac surgery and the intensive care units and compare TOE with pulmonary artery catheter (PAC) and transthoracic echocardiography (TTE) as an hemodynamic monitor in the acute care setting.

A Report From The First Regional Pain Medicine Symposia In East, Central And Southern African Region. (Ecsa-R)-“The Rhino Model In Pain Education In Africa”, Thikra Sharif, John Bugo

Anaesthesiology, East Africa

The 1st Regional pain medicine symposia were held between the 14th and 18th of November 2011 in 3 cities (Nairobi, Mombasa and Dar-es-salaam), across 2 countries, Kenya and Tanzania. It was funded by the International Association for the Study of Pain (IASP), through the IASP developing country education grant for 2011 and The Aga Khan University Hospital Nairobi (AKUHN). It was organized by faculty from the Pain Management Unit (PMU) AKUHN. The Pain medicine educators were from PMU, AKUHN and from Specialists in Pain International Network (SPIN).

The aims of the symposia were to introduce the Rhino model concept, the …

Job Stress Among Female Residents During Postgraduate Training At A University Hospital In Karachi, Pakistan, Madiha Hashmi, Fauzia A. Khan, Khan S, Ali S. K

Department of Anaesthesia

Background: Postgraduate medical training is a stressful experience for both male and female doctors but previous studies have shown that stress might be more prevalent amongst female residents. Since women make up 70-80% of medical graduates in Pakistan we conducted this study to determine the prevalence of stress among female residents during postgraduate training and identify the most common stressors.

Methodology: All female residents enrolled in postgraduate training programmes at the Aga Khan University meeting the inclusion criteria were recruited and informed written consent was obtained. Job Stress Inventory (JSI) was used to identify symptoms and sources of job stress. …

Remote Video Auditing With Real-Time Feedback In An Academic Surgical Suite Improves Safety And Efficiency Metrics: A Cluster Randomised Study, F. J. Overdyk, O. Dowling, S. Newman, D. Glatt, M. Chester, D. Armellino, B. Cole, G. S. Landis, D. Schoenfeld, J. F. Dicapua

Journal Articles

IMPORTANCE: Compliance with the surgical safety checklist during operative procedures has been shown to reduce inhospital mortality and complications but proper execution by the surgical team remains elusive. OBJECTIVE: We evaluated the impact of remote video auditing with real-time provider feedback on checklist compliance during sign-in, time-out and sign-out and case turnover times. DESIGN, SETTING: Prospective, cluster randomised study in a 23-operating room (OR) suite. PARTICIPANTS: Surgeons, anaesthesia providers, nurses and support staff. EXPOSURE: ORs were randomised to receive, or not receive, real-time feedback on safety checklist compliance and efficiency metrics via display boards and text messages, followed by a …

Planning A Safe Exit: A Multidisciplinary Approach, Srijaya K. Reddy, Nina Deutsch

E-Learning Modules

This resource is a problem-based learning discussion (PBLD) case addressing the challenges and approach to planning and safely executing an EXIT procedure. It is primarily aimed at pediatric anesthesiologists but also applies to healthcare providers in fetal medicine and surgery.

The clinical scenario involves a fetus with a large cervical neck mass requiring an EXIT procedure for tracheal obstruction. This case highlights the challenges and implications of a procedure involving a multidisciplinary team. After presentation of the case stem, the instructor moderates a student-focused group discussion using a series of questions that build upon the case and a review of …

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. Pseudocholinesterase deficiency genetically is transmitted in an autosomal recessive pattern with the frequency of apnea from a genetic abnormality of pseudocholinesterase between 1:480 and 1:3200 people (Ok et al., 2013). An extended period of neuromuscular blockade results from these medications than what is clinically expected. The signs and symptoms which occur are apnea and paralysis hours longer. This condition is rare but must be known and understood by the clinician in order to provide …

Ultrasound-Guided Interscalene-Supraclavicular Block For An Intramedullary Nailing Of A Pathologic Humeral Fracture: Practical Application Of Ultrasound-Guided Regional Anesthesia, Christian Falyar

Christian R Falyar

Fractures of the proximal upper extremity present a challenge to the anesthesia provider when administering a regional anesthetic because the dermatomal distribution of the upper extremity requires more local anesthetic coverage than any single brachial plexus nerve block can provide. A 60-year-old woman underwent intramedullary nailing of a pathologic humeral fracture using a combination of regional and general anesthesia. This case study shows how ultrasound guidance permitted the performance of both an interscalene and supraclavicular nerve block for a single procedure without the increased volume of local anesthetic that would normally be required, while still providing complete coverage of the …

Perioperative Diabetes Management, Vasudev Magaji

Vasudev G Magaji MD, MS

No abstract provided.

Cesarean Sections, Buprenorphine, Intrathecal Opioids & Pain Control – What To Do?, Madeel A. Abdullah, Md, Michelle Beam, D.O., H. Jane Huffnagle, D.O., Suzanne Huffnagle, D.O., Michelle Mele, Md, Eugene R. Viscusi, Md

Department of Anesthesiology Faculty Papers

Introduction

Suboxone^® is becoming a popular alternative to methadone maintenance in opioid abstinence. This population will likely expand in the future presenting a challenge for perioperative analgesia. Conventional pharmacology suggests that buprenorphine has a high binding affinity for the mu-opioid receptor (MOR), displacing any other opioid; and, only overcome by extremely high opioid doses. Hence recommendations are usually that buprenorphine should be discontinued before surgery so the MOR is available perioperatively. Buprenorphine is considered to have a “ceiling” analgesic effect rather than a classic opioid dose-response curve; it should not be effective for postoperative analgesia. This case supports an …

Existing Clinical Quality Gaps, Michael Pasquale

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Pre-Operative Risk Assessment And Risk Reduction: Improving The Process, Bruce Feldman

Bruce A. Feldman DO

No abstract provided.