Anesthesiology Commons^™

Intravenous Magnesium Sulfate Use In Hip Arthroscopy Patients And Anesthesia Provider Satisfaction With Patient Care At An Ambulatory Surgery Center, Naomi Song, Erica Yi, Julianne Bagley

Doctor of Nursing Practice (DNP) Projects

Hip arthroscopy patients experience high levels of postoperative pain. Intravenous (IV) magnesium sulfate is widely used in anesthesia practice as a multimodal analgesic but is infrequently utilized at Penn Presbyterian Medical Center (PPMC). Does the option of adding intravenous magnesium sulfate to the current pain pathway increase provider satisfaction with patient care and magnesium use? The purpose was to add IV magnesium sulfate to the multimodal analgesic pathway for hip arthroscopy patients to evaluate anesthesia provider satisfaction and use of IV magnesium sulfate. The Middle Range Theory of Acute Pain was used to provide a theoretical framework. The conceptual framework …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Essential Package Of Palliative Care For Women With Cervical Cancer: Responding To The Suffering Of A Highly Vulnerable Population, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Development Of Stress-Induced Cardiomyopathy After Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Saad Ahmed Naved, Sadiq Shoukat Parpia, Huma Shoukat Ali

Medical College Documents

Pseudomyxoma Peritonei, a massive mucinous peritoneal collection due to a rare epithelial neoplasm, can be effectively treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). A 43-year-old female, previously treated for mucinous ovarian carcinoma with CRS-HIPEC, and total abdominal hysterectomy and bilateral salpingo-oophorectomy, presented with new-onset abdominal distension and early satiety. She was diagnosed with Pseudomyxoma Peritonei. After 48 hours of treatment with CRS-HIPEC, she presented haemodynamically unstable with acute chest pain. Electrocardiogram showed broad complex tachycardia with ST depression in leads V3-6. Severe systolic dysfunction with Ejection Fraction (EF) of 20% along with severe pulmonary hypertension, visualized on Echocardiography. …

Ratio Of Height To Thyromental Distance: A Comparison With Mallampati And Upper Lip Bite Test For Predicting Difficult Intubation In Pakistani Population, Saman Tauheed Ali, Khalid Samad, Syed Amir Raza, Muhammad Qamarul Hoda

Department of Anaesthesia

Objective: To compare the accuracy of three diagnostic tests in predicting difficult laryngoscopy using Cormack and Lehane grade as the gold standard.
Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from August 2014 to August 2015, and comprised patients who required endotracheal intubation for elective surgical procedures. The primary investigator used ratio of height to thyromental distance, upper lip bite test and the modified Mallampati test for assessing the airway correlated with laryngoscopic view based on Cormack and Lehane grading. Data was analysed using SPSS 19.
Results: Of the 383 patients, 59(15.4%) were classified as …

Safety And Effectiveness Of Ultrasound Guided Peripheral Nerve Blocks: Audit At Tertiary Care Hospital, Asma Abdus Salam, Riffat Aamir, Robyna Irshad Khan, Aliya Ahmed, Azhar Rehman

Department of Anaesthesia

Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients who received peripheral nerve blocks as part of anaesthesia care between January 2015 and January 2017. The data included outcomes of peripheral nerve block effectiveness, complications and limb conditions after the block. Peripheral nerve block effectiveness was assessed by monitoring pain scores at rest and on movement, and the requirement of co-analgesia. Complications, like numbness, motor block, metallic taste, hypotension and respiratory depression, were also assessed. Data was …

Medication Safety In The Operating Room, Tzvi Grossman, Michael Glick, Alexandra Mulholland, Febina Padiyath, Fred Balzer

House Staff Quality Improvement and Patient Safety Conference (2020-)

The operating room is an area where a significant number of adverse drug events occur. Anesthesia providers administer potentially dangerous medications with very little oversight. We looked for a way to decrease the likelihood that a lethal dose of phenylephrine (10mg) would be given to a patient.

Post-Operative Pain Management Modalities Employed In Clinical Trials For Adult Patients In Lmic; A Systematic Review, Gauhar Afshan, Robyna Irshad Khan, Aliya Ahmed, Ali Sarfraz Siddiqui, Azhar Rehman, Syed Amir Raza, Rozina Kerai, Khawaja Mustafa

Department of Anaesthesia

Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade.
Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal …

Operative Management Of Symptomatic, Metachronous Carotid Body Tumors Involving The Skull Base And Its Neurological Sequelae, Roberto G. Aru, Rony K. Aouad, Justin F. Fraser, Amanda M. Romesberg, Kevin W. Hatton, Sam C. Tyagi

Otolaryngology--Head & Neck Surgery Faculty Publications

A 44-year-old morbidly obese woman with a history of right carotid body tumor (CBT) resection presented with a symptomatic, nonfunctional, left Shamblin-III CBT. Abutment of the skull base precluded distal internal carotid artery control for arterial reconstruction, favoring parent vessel sacrifice after an asymptomatic provocative test. She underwent CBT resection with anticipated sacrifice of cranial nerves X and XII and the common carotid artery and its branches, developing baroreceptor failure syndrome and sequelae of cranial nerve sacrifice. When facing a symptomatic, metachronous CBT abutting the skull base, upfront operative intervention with adjuvant radiation for residual tumor optimizes curative resection.

Eras Protocol For Lower Extremity Orthopedic Procedures, Tyler Mcdonald, Joshua Vaughn

Doctor of Nursing Practice Projects

The demand for total knee arthroplasty (TKA) and total hip arthroplasty (THA) will continue to rise as life expectancy increases. Coupling increased age with the increased prevalence of both obesity and osteoarthritis, the need for total joint arthroplasties is likely to increase (Oseka & Pecka, 2018). The frequency of arthroplasty procedures and the associated recovery period lead to heavy economic demands felt by most healthcare systems (Stowers et al., 2016). To address this burden, enhanced recovery after surgery (ERAS) protocols have been implemented at institutions and are designed to improve patient outcomes while simultaneously limiting cost and reducing readmission rates …

Automatic Data Collection System And Video Laryngoscope Database, Gabrielle Hoyer

Utah Space Grant Consortium

The aggregate intubation data collected by a network of video laryngoscopes can be processed to understand the quality of an individual’s or a group of individual’s practice(s). Currently, all data surrounding intubations is self-reported and not understood on an aggregate basis. We are developing a technology which can enable monitoring and benchmarking of intubations across a wide variety of practices.

Predicting Propofol-Induced Burst Suppression Using An Individualized Model-Based Approach Over Repeated Treatments, Jason C. Huang

Utah Space Grant Consortium

Our group is investigating the antidepressant effects of high-dose propofol, but dosing propofol to induce standardized changes in EEG activity (“burst suppression”) is challenging due to limited knowledge of each subject’s pharmacokinetics (PK) and pharmacodynamics (PD). In this paper, we approximated PK-PD models for propofol-induced burst suppression (PIBS), based on multiple subjects over repeated treatments. We then applied these models to predict BSR in each subject’s repeated treatment, then evaluate their predictive performances. We hypothesized that predicting BSR from a greater number of previous treatments would improve performance, but our current results are not conclusive enough to validate the hypothesis. …

Cervical Cancer-Associated Suffering: Estimating The Palliative Care Needs Of A Highly Vulnerable Population, Eric L. Krakauer, Xiaoxiao Kwete, Khadidjatou Kane, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa, C R Beena Devi C R Beena Devi

Department of Anaesthesia

Purpose: To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.
Methods: We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying …

Thyrotoxic Hypokalemic Periodic Paralysis: A Success Story Of A Diagnostic Challenge, Mohsin Nazir, Malika Hameed, Rizwana Shehzad

Department of Anaesthesia

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but life-threatening complication of hyperthyroidism seen predominantly in males. It is generally characterized by hypokalemia and skeletal muscle paralysis requiring intensive care admission. Hypokalemia occurs due to the massive intracellular shift of potassium because of the hyperactivity of the sodium-potassium adenosine triphosphates pump (Na⁺ K⁺ ATPase). Its differential diagnosis from the other common causes of hypokalemic paralysis is essential to provide targeted therapy. We present a rare case of THPP in a female patient with no prior history of thyroid disease. THPP in this patient was precipitated by trauma and …

Measuring The Decrement Times Of Volatile Anesthetics In Drosophila Melanogaster Using Gas Chromatography-Mass Spectrometry, Jason Tolley

Scholar Week 2016 - present

Presentation Location: Warming House, Olivet Nazarene University

Abstract

Background

Model organisms are widely used in research, especially in the context of complex situations. One model organism that has been widely used is the common fruit fly, Drosophila melanogaster (D. mel). D. mel are most commonly used in the context of genetics, but they have also been widely used in research focusing on general anesthetics. One value that has not been measured in D. mel, however, as it relates to general anesthetics, is the decrement times. This is what was the present research set out to determine. …

Efficacy And Safety Of Dotinurad In Hyperuricemic Patients With Or Without Gout: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials, Ayman Iqbal, Kinza Iqbal, Eisha Farid, Ali Ishaque, Muhammad Hasanain, Taha Bin Arif, Shajeea Arshad Ali, Sawai Singh Rathore, Mehreen Malik

Department of Anaesthesia

Introduction: A systematic review and meta-analysis of the available randomized controlled trials (RCTs) were conducted to investigate the efficacy and safety of dotinurad in hyperuricemic patients with or without gout. Dotinurad is a novel selective urate reabsorption inhibitor (SURI) that increases uric acid excretion by selectively inhibiting urate transporter 1 (URAT1). To the best of our knowledge, this is the first meta-analysis conducted to gauge the efficacy and safety of dotinurad.
Methods: Electronic databases (PubMed, the Cochrane Library, and ClinicalTrials.gov) were searched from inception till March 2, 2021, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis …

A Case Of Abdominal Compartment Syndrome In Cardiac Surgery: A Rare, Potentially Fatal Complication., Michelle Chen, K. Gage Parr

Anesthesiology and Critical Care Medicine Faculty Posters and Presentations

No abstract provided.

Implementation Of An Infant Male Circumcision Programme, Pakistan, Shazia Moosa, Ammar Ali Muhammad, Sohail Asghar Dogar, Sundus Iftikhar, Walter Johnson, Asad Latif, Lubna Samad

Section of Paediatric Surgery

Objective: To retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.
Methods: Based on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1-92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing …

Extracellular Vesicles From Infected Cells Are Released Prior To Virion Release, Yuriy Kim, Gifty A. Mensah, Sarah Al Sharif, Daniel O. Pinto, Heather Branscome, Sowmya V. Yelamanchili, Maria Cowen, James Erickson, Pooja Khatkar, Renaud Mahieux, Fatah Kashanchi

Journal Articles: Anesthesiology

Here, we have attempted to address the timing of EV and virion release from virally infected cells. Uninfected (CEM), HIV-1-infected (J1.1), and human T cell leukemia virus-1 (HTLV-1)-infected (HUT102) cells were synchronized in G₀. Viral latency was reversed by increasing gene expression with the addition of serum-rich media and inducers. Supernatants and cell pellets were collected post-induction at different timepoints and assayed for extracellular vesicle (EV) and autophagy markers; and for viral proteins and RNAs. Tetraspanins and autophagy-related proteins were found to be differentially secreted in HIV-1- and HTLV-1-infected cells when compared with uninfected controls. HIV-1 proteins were …