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Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini 2017 University of Southern Mississippi

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more common and may aid in reducing recovery and discharge times from the postoperative anesthesia care unit (PACU) as well as reducing overall costs. A retrospective chart review (N=176; 88 in propofol group and 88 in benzodiazepine and opioid group) was performed to determine if propofol sedation did reduce discharge times and decrease overall costs for the patient. Patients included in this study ...


Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid 2017 Aga Khan University

Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid

Department of Anaesthesia

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was ...


Pharmacology, Pharmacokinetics, And Metabolism Of The Dna-Decoy Ayx1 For The Prevention Of Acute And Chronic Post-Surgical Pain, Julien Mamet, Scott Harris, Michael Klukinov, David C. Yeomans, Renee R. Donahue, Bradley K. Taylor, Kelly Eddinger, Tony Yaksh, Donald C. Manning 2017 Adynxx, Inc.

Pharmacology, Pharmacokinetics, And Metabolism Of The Dna-Decoy Ayx1 For The Prevention Of Acute And Chronic Post-Surgical Pain, Julien Mamet, Scott Harris, Michael Klukinov, David C. Yeomans, Renee R. Donahue, Bradley K. Taylor, Kelly Eddinger, Tony Yaksh, Donald C. Manning

Physiology Faculty Publications

Background: AYX1 is an unmodified DNA-decoy designed to reduce acute post-surgical pain and its chronification with a single intrathecal dose at the time of surgery. AYX1 inhibits the transcription factor early growth response protein 1, which is transiently induced at the time of injury and triggers gene regulation in the dorsal root ganglia and spinal cord that leads to long-term sensitization and pain. This work characterizes the AYX1 dose-response profile in rats and the link to AYX1 pharmacokinetics and metabolism in the cerebrospinal fluid, dorsal root ganglia, and spinal cord.

Results: The effects of ascending dose-levels of AYX1 on mechanical ...


Subanesthetic Ketamine For Pain Management In Hospitalized Children, Adolescents, And Young Adults: A Single-Center Cohort Study, K A. Sheehy, C Lippoid, A L. Rice, R Nobrega, Julia C. Finkel, Zenaide Quezado 2017 George Washington University

Subanesthetic Ketamine For Pain Management In Hospitalized Children, Adolescents, And Young Adults: A Single-Center Cohort Study, K A. Sheehy, C Lippoid, A L. Rice, R Nobrega, Julia C. Finkel, Zenaide Quezado

Anesthesiology and Critical Care Medicine Faculty Publications

1Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s Research Institute, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 2Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, USA *These authors contributed equally to this work Background: Subanesthetic doses of ketamine, an N-methyl-D-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid ...


Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai 2017 Aga Khan University

Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai

Department of Anaesthesia

No abstract provided.


Robert Reynolds Macintosh, M.D. (1897-1989): Forefather Of Anesthesiology, Advocate For Patient Safety., Haig Minassian, Scott W. Cowan, Charles J. Yeo 2017 Thomas Jefferson University

Robert Reynolds Macintosh, M.D. (1897-1989): Forefather Of Anesthesiology, Advocate For Patient Safety., Haig Minassian, Scott W. Cowan, Charles J. Yeo

Department of Surgery Gibbon Society Historical Profiles

No abstract provided.


The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’ayi, Gerald Yonga 2017 Aga Khan University

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’Ayi, Gerald Yonga

Anaesthesiology, East Africa

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and ...


Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai 2017 Aga Khan University

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head ...


Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar 2017 Aga Khan University

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.


Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl 2017 Hospital of the University of Pennsylvania

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical ...


Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy 2017 Loma Linda University, School of Medicine

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.


Microvascular Response To Transfusion In Elective Spine Surgery, J. Matthias Walz, Ottokar Stundner, Federico P. Girardi, Bruce A. Barton, Aimee R. Kroll-Desrosiers, Stephen O. Heard, Stavros G. Memtsoudis 2017 University of Massachusetts Medical School

Microvascular Response To Transfusion In Elective Spine Surgery, J. Matthias Walz, Ottokar Stundner, Federico P. Girardi, Bruce A. Barton, Aimee R. Kroll-Desrosiers, Stephen O. Heard, Stavros G. Memtsoudis

Open Access Articles

AIM: To investigate the microvascular (skeletal muscle tissue oxygenation; SmO2) response to transfusion in patients undergoing elective complex spine surgery.

METHODS: After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3 level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume (SV), cardiac output (CO), cardiac index (CI), and stroke volume variability (SVV) was performed. To measure skeletal ...


Application Of Incident Command Structure To Clinical Trial Management In The Academic Setting: Principles And Lessons Learned, Penny S. Reynolds, Mary J. Michael, Bruce D. Spiess 2017 Virginia Commonwealth University

Application Of Incident Command Structure To Clinical Trial Management In The Academic Setting: Principles And Lessons Learned, Penny S. Reynolds, Mary J. Michael, Bruce D. Spiess

Anesthesiology Publications

Background

Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the ‘gold standard’ management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We ...


Anaesthesia Error In United States: Reasons For Mismanagement, Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, Ben Lundberg 2017 Creighton University

Anaesthesia Error In United States: Reasons For Mismanagement, Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, Ben Lundberg

Posters and Presentations: College of Public Health

A poster from the UNMC Undergraduate Public Health Workshop


Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate With Increased Use Of Vasopressors During Posterior Lumbar Interbody Fusion Versus Those Not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study, Joshua Ross 2017 Marshall University

Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate With Increased Use Of Vasopressors During Posterior Lumbar Interbody Fusion Versus Those Not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study, Joshua Ross

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to evaluate if patients who took Angiotensin Converting Enzyme (ACE) inhibitors the morning of surgery for Posterior Lumbar Interbody Fusion (PLIF) required more treatment for intraoperative hypotension.

Introduction: PLIF is a surgical procedure used to correct spinal disorders that include compression, instability, pathological lesions, deformities, and pain. PLIF is completed utilizing the prone position for optimal access to the lumbar spine. Complications associated with prone position have included Post-Operative Vision Loss (POVL), compression of abdominal vessels, and head and neck venous compression resulting in neurologic injury. Currently, there are no set recommendations on ...


The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield 2017 Marshall University

The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.

Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively with ...


Does Rotem-Guided Therapy Influence Postoperative Chest Tube Output In On-Pump Cabg?, Preston Franklin Woodburn-Camp 2017 Marshall University

Does Rotem-Guided Therapy Influence Postoperative Chest Tube Output In On-Pump Cabg?, Preston Franklin Woodburn-Camp

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to identify the association between ROTEM-guided therapy and chest tube output in patients who have undergone elective on-pump CABG.

Introduction: In open heart surgery, there are a variety of ways that coagulation disturbances occur, such as hemodilution of coagulation factors and platelets, a reduction in coagulation factors due to the use of cardiopulmonary bypass the administration of the anticoagulant heparin, and altered temperature. Severe bleeding is frequently associated with open-heart surgery, especially on-pump coronary artery bypass grafting (CABG). Thromboelastometry using rotational thromboelastometry (ROTEM) is a point-of-care testing that can show specific defects in ...


Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan 2017 Aga Khan University

Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan

Department of Anaesthesia

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the ...


Intraoperative Administration Of Intravenous Acetaminophen At Induction Or End Of Surgery And Its Relationship With Opioid Consumption And Pain Scores, Spencer Davis Greenwood 2017 Marshall University

Intraoperative Administration Of Intravenous Acetaminophen At Induction Or End Of Surgery And Its Relationship With Opioid Consumption And Pain Scores, Spencer Davis Greenwood

Theses, Dissertations and Capstones

Obesity has become increasingly prevalent in the United States. Bariatric surgeries have increased as the prevalence of obesity has risen, providing an effective alternative to weight loss. Intravenous acetaminophen (IVA) is a safe and effective non-opioid medication that can be given without the risk of respiratory or cardiac complications. Research has shown that the use of IVA during surgery can improve postoperative pain scores, reduce opioid requirements, and improve patient satisfaction.

A retrospective cohort study of 200 patients (100 per group) undergoing laparoscopic bariatric surgery (LBS) was performed. Statistical analysis was used to determine the relationship between those who received ...


An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan 2017 Aga Khan University

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke ...


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