Medicine and Health Sciences Commons^™

Point-Of-Care Versus Central Testing Of Hemoglobin During Large Volume Blood Transfusion., Justin Herman, Brian Park, Bharat K. Awsare, Frances Mae West, Denine Crittendon, Lilah Evans, Mary Harach, Julie Karp, Alexis R. Peedin, Marianna Lanoue, Barbara Goldsmith, Eugene P. Warnick, Michael Baram

Division of Pulmonary and Critical Care Medicine Faculty Papers

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.

METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min …

In Vivo Investigation Of The Tissue Response To Commercial Teflon Insulin Infusion Sets In Large Swine For 14 Days: The Effect Of Angle Of Insertion On Tissue Histology And Insulin Spread Within The Subcutaneous Tissue., Gabriella Eisler, Jasmin R. Kastner, Marc C. Torjman, Abdurizzagh Khalf, David Diaz, Alek R. Dinesen, Channy Loeum, Mathew L. Thakur, Paul Strasma, Jeffrey I. Joseph

Department of Anesthesiology Faculty Papers

Objective: This study investigated the effects of the inflammatory tissue response (ITR) to an insulin infusion set (IIS) on insulin bolus spread over wear time, as well as the effect of cannula insertion angle on the ITR, bolus shape, and pump tubing pressure.

Research design and methods: Angled or straight IISs were inserted every other day for 14 days into the subcutaneous tissue of 11 swine and insulin was delivered continuously. Prior to euthanasia, a 70 µL bolus of insulin/X-ray contrast agent was infused while recording a pressure profile (peak tubing pressure, p_max; area under the pressure curve, …

Emergent Airway Management Outside Of The Operating Room - A Retrospective Review Of Patient Characteristics, Complications And Icu Stay., Uzung Yoon, Jeffrey Mojica, Matthew Wiltshire, Kara Segna, Michael Block, Anthony Pantoja, Marc Torjman, Elizabeth Wolo

Department of Anesthesiology Faculty Papers

BACKGROUND: Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.

METHODS: We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.

RESULTS: 336 intubations were performed in 275 patients during the six-month period. The majority of …

Operating Room First Case Start Times: A Metric To Assess Systems-Based Practice Milestones?, Christopher Ryan Hoffman, Jay Horrow, Shreyas Ranganna, Michael Stuart Green

Department of Anesthesiology Faculty Papers

BACKGROUND: Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention.

METHODS: Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, …

Transdermal Lidocaine For Perioperative Pain: A Systematic Review Of The Literature., Jordan Smoker, Alexa Cohen, Mohammad R Rasouli, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

PURPOSE OF REVIEW: The purpose of this review is to provide a summary of the perioperative studies that have examined transdermal lidocaine (lidocaine patch) as an analgesic and put the evidence in context of the likely overall benefit of transdermal lidocaine in the perioperative period.

RECENT FINDINGS: Several randomized controlled trials have been published in the past 4 years that concluded transdermal lidocaine can reduce acute pain associated with laparoscopic trocar or cannula insertion. Transdermal lidocaine may reduce short-term pain after surgery in selected surgery types and has a low risk of toxicity but its overall clinical utility in the …

Induction Techniques That Reduce Redistribution Hypothermia: A Prospective, Randomized, Controlled, Single Blind Effectiveness Study., Jonathan V. Roth, Leonard E. Braitman, Lacy H. Hunt

Student Papers, Posters & Projects

BACKGROUND: While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia.

METHODS: Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately …

Does Perioperative Use Of Renin-Angiotensin System Inhibitors Improve Patient Outcomes In Cardiac Surgery?, Qian Ding, Mark Berguson, Zugui Zhang, Hong Liu, Huang Nie, Jordan E. Goldhammer, Rohinton J. Morris, Jianzhong Sun

Department of Anesthesiology Posters

• 2011 ACCF/AHA Guidelines for CABG: Uncertain about the safety of the preoperative administration of ACE inhibitors or ARBs in patients on chronic therapy and the safety of initiating ACE inhibitors or ARBs before hospital discharge
• 2014 ESC Guidelines: ACE inhibitors might be stopped 1 to 2 days before CABG to avoid the potential deleterious consequences of perioperative hypotension
• Guidelines state that ACE inhibitors or ARBs should be initiated postoperatively in CABG patients who were not receiving them preoperatively if they have an LVEF ≤40%, hypertension, diabetes, or CKD (Level of Evidence: A)
• There is still a lack of large clinical …

Targeted Epidural Blood Patches Under Fluoroscopic Guidance For Incidental Durotomies Related To Spine Surgeries: A Case Series., Andrew K. Wong, Mohammad Rasouli, Andrew Ng, Dajie Wang

Department of Anesthesiology Faculty Papers

Introduction: Incidental durotomies are usually managed conservatively. However, 1.8% of patients require surgical dural repair for CSF leak. There are limited data available regarding the use of epidural blood patches (EBP) for persistent CSF leaks secondary to incidental durotomies. This case series aims to evaluate the efficacy of targeted EBPs under fluoroscopic guidance in the treatment of incidental durotomies.

Methods: Four patients with incidental durotomies after spine surgeries (one cervical decompression, one revision of L5-S1 decompression and fusion, and two lumbar decompressions) were included in this series. These patients did not respond to conservative management and subsequently underwent EBPs. Magnetic …

Teaching An Old Pain Medicine Society New Tweets: Integrating Social Media Into Continuing Medical Education., Kellie M Jaremko, Eric S Schwenk, Amy C S Pearson, Jonathan Hagedorn, Ankeet D Udani, Gary Schwartz, Nabil M Elkassabany, Anne Snively, Edward R Mariano

Department of Anesthesiology Faculty Papers

No abstract.

Continuation Of Angiotensin Converting Enzyme Inhibitors On The Day Of Surgery Is Not Associated With Increased Risk Of Hypotension Upon Induction Of General Anesthesia In Elective Non-Cardiac Surgeries., U. Yoon, A. J. Setren, A. Chen, T. Nguyen, M. C. Torjman, T. L. Kennedy

Department of Anesthesiology Faculty Papers

No abstract provided.

Perioperative Use Of Renin-Angiotensin System Inhibitors And Outcomes In Patients Undergoing Cardiac Surgery., Qian Ding, Zugui Zhang, Hong Liu, Huang Nie, Mark Berguson, Jordan E. Goldhammer, Nilas Young, Douglas Boyd, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Faculty Papers

It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one …

Htx-011 Reduced Pain Intensity And Opioid Consumption Versus Bupivacaine Hcl In Bunionectomy: Phase Iii Results From The Randomized Epoch 1 Study., Eugene R. Viscusi, Joseph S. Gimbel, Richard A. Pollack, Jia Hu, Gwo-Chin Lee

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: There is a need for local anesthetics that provide consistent analgesia through 72 hours after surgery. This study evaluates the use of HTX-011 (bupivacaine and meloxicam in Biochronomerpolymer technology), an extended-release, dual-acting local anesthetic, in reducing both postoperative pain over 72 hours and postoperative opioid use when compared with bupivacaine hydrochloride (HCl) and saline placebo. Inclusion of low-dose meloxicam in HTX-011 is designed to reduce local inflammation caused by surgery, potentiating the analgesic effect of bupivacaine. Previously, significant synergy has been observed with bupivacaine and meloxicam with both given locally together.

METHODS: EPOCH 1 was a randomized, …

Coaching Operating Room To Pacu Handoff With A Standardized, Multidisciplinary Checklist, Courtney L. Devin, Md, Kathleen Grife, Rn, Ms, Marissa Weber, Md, Richard F. Schmidt, Md, Megan P. Lundgren, Md, Scott W. Cowan, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Special Considerations For Clinical Trials In Fibrodysplasia Ossificans Progressiva (Fop)., Edward C Hsiao, Maja Di Rocco, Amanda Cali, Michael Zasloff, Mona Al Mukaddam, Robert J Pignolo, Zvi Grunwald, Coen Netelenbos, Richard Keen, Genevieve Baujat, Matthew A Brown, Tae-Joon Cho, Carmen De Cunto, Patricia Delai, Nobuhiko Haga, Rolf Morhart, Christiaan Scott, Keqin Zhang, Robert J Diecidue, Clive S Friedman, Fredrick S Kaplan, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Clinical trials for orphan diseases are critical for developing effective therapies. One such condition, fibrodysplasia ossificans progressiva (FOP; MIM#135100), is characterized by progressive heterotopic ossification (HO) that leads to severe disability. Individuals with FOP are extremely sensitive to even minor traumatic events. There has been substantial recent interest in clinical trials for novel and urgently-needed treatments for FOP. The International Clinical Council on FOP (ICC) was established in 2016 to provide consolidated and coordinated advice on the best practices for clinical care and clinical research for individuals who suffer from FOP. The Clinical Trials Committee of the ICC developed a …

Letter To The Editor: Ketamine For Pain Management: Let's Not Neglect Practical Concerns, Steven P. Cohen, Eric S. Schwenk, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

We read with interest the recent article on ketamine by Bell and Kalso.1 In recent years, the use of ketamine to treat chronic pain and depression has exploded, and this article represents an easy-to-follow overview of this often misunderstood medication.

Cuff-Less Methods For Blood Pressure Telemonitoring., Dylan M. Bard, Jeffrey I. Joseph, Noud Van Helmond

Department of Anesthesiology Faculty Papers

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This …

Intravenous Meloxicam For The Treatment Of Moderate To Severe Acute Pain: A Pooled Analysis Of Safety And Opioid-Reducing Effects., Eugene R. Viscusi, Tong J. Gan, Sergio Bergese, Neil Singla, Randall J. Mack, Stewart W. Mccallum, Wei Du, Sue Hobson

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: To describe the safety and tolerability of intravenous meloxicam compared with placebo across all phase II/III clinical trials.

METHODS: Safety data and opioid use from subjects with moderate to severe postoperative pain who received ≥1 dose of intravenous meloxicam (5-60 mg) or placebo in 1 of 7 studies (4 phase II; 3 phase III) were pooled. Data from intravenous meloxicam 5 mg, 7.5 mg and 15 mg groups were combined (low-dose subset).

RESULTS: A total of 1426 adults (86.6% white; mean age: 45.8 years) received ≥1 dose of meloxicam IV; 517 (77.6% white; mean age: 46.7 years) …

The Accuracy Of Blood Pressure Measurement By A Smartwatch And A Portable Health Device, Vignesh Murali, Noud Van Helmond, Cecilia G. Freeman, Christina Hahnen, Nilanjan Haldar, Jacquelyn N. Hamati, Dylan M. Bard, Geno J. Merli, Jeffrey I. Joseph

Phase 1

Introduction: Hypertension is a leading cause of mortality. Proper blood pressure (BP) control can be achieved by lifestyle modification, pharmacotherapy, and frequent measurements. With the growing popularity of cuffless blood pressure monitors, it is important to independently validate their accuracy.

Objective: We evaluated two cuffless blood pressure monitors, The Everlast TR10 fitness watch and the BodiMetrics Performance Monitor, for their accuracy and precision in BP measurements.

Methods: Using a protocol derived from the ANSI/AAMI/ISO 2013 standard for evaluating automated sphygmomanometers, we measured the blood pressures of 85 patients recruited from the Thomas Jefferson University Hospital Preadmission Testing Center with two …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …