Anesthesia and Analgesia Commons^™

Developmental And Cultural Perspectives On Children’S Postoperative Pain Management At Home, Brooke N. Jenkins, Michelle A. Fortier

Psychology Faculty Articles and Research

Outpatient surgery is extremely common in children, and approximately 4 million children experience significant pain after surgery in the USA each year. Management of children's postoperative pain in the home setting is suboptimal and is impacted by characteristics of children and parents, as well as the larger family and cultural context. In particular, developmental status of the child, parental beliefs regarding pain expression and analgesic use in children, cultural values and language barriers can affect management of children's postoperative pain. Targeting the myriad barriers to children's pain management by capitalizing upon the use of tailored interventions may help bridge the …

Derivation And Validation Of Cutoffs For Clinical Use Of Cell Cycle Arrest Biomarkers, Eric A.J. Hoste, Peter A. Mccullough, Kianoush Kashani, Lakhmir S. Chawla, Michael Joannidis, The Sapphire Investigators

Anesthesiology and Critical Care Medicine Faculty Publications

Background

Acute kidney injury (AKI) remains a deadly condition. Tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein (IGFBP)7 are two recently discovered urinary biomarkers for AKI. We now report on the development, and diagnostic accuracy of two clinical cutoffs for a test using these markers.

Methods

We derived cutoffs based on sensitivity and specificity for prediction of Kidney Disease: Improving Global Outcomes Stages 2–3 AKI within 12 h using data from a previously published multicenter cohort (Sapphire). Next, we verified these cutoffs in a new study (Opal) enrolling 154 critically ill adults from six sites in the …

Intravenous Angiotensin Ii For The Treatment Of High-Output Shock (Athos Trial): A Pilot Study, Lakhmir S. Chawla, Laurence Busse, Ermira Brasha-Mitchell, Danielle L. Davison, Jacqueline R. Honig, Ziyad Alotaibi, Michael G. Seneff

Anesthesiology and Critical Care Medicine Faculty Publications

Introduction: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown.

Methods: In total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N?=?10) or placebo (N?=?10) plus standard of care. ATII was started at a dose of 20?ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65?mmHg. The infusion (either ATII or …

Development Of A Short Version Of The Modified Yale Preoperative Anxiety Scale, Brooke N. Jenkins, Michelle Fortier, Sherrie H. Kaplan, Linda C. Mayes, Zeev N. Kain

Psychology Faculty Articles and Research

BACKGROUND: The modified Yale Preoperative Anxiety Scale (mYPAS) is the current “criterion standard” for assessing child anxiety during induction of anesthesia and has been used in >100 studies. This observational instrument covers 5 items and is typically administered at 4 perioperative time points. Application of this complex instrument in busy operating room (OR) settings, however, presents a challenge. In this investigation, we examined whether the instrument could be modified and made easier to use in OR settings.

METHODS: This study used qualitative methods, principal component analyses, Cronbach αs, and effect sizes to create the mYPAS-Short Form (mYPAS-SF) and reduce time …

Predictors Of Pain Relief Following Spinal Cord Stimulation In Chronic Back And Leg Pain And Failed Back Surgery Syndrome: A Systematic Review And Meta-Regression Analysis, Rod S. Taylor, Mehul J. Desai, Philippe Rigoard, Rebecca J. Taylor

Anesthesiology and Critical Care Medicine Faculty Publications

We sought to assess the extent to which pain relief in chronic back and leg pain ( CBLP) following spinal cord stimulation ( SCS) is influenced by patient-related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. The primary outcome was pain relief following SCS, we also sought pain score (pre- and post- SCS). Multiple predictive factors were examined: location of pain, history of back surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow-up, …

Heart Attack And Kidney Attack: Evolution Of Lay And Clinical Terms For Spontaneous, Acute Organ Injury Syndromes, Claudio Ronco, Peter A. Mccullough, Pupulan Iyngkaran, Lakhmir S. Chawla

Anesthesiology and Critical Care Medicine Faculty Publications

No abstract provided.

Renal Recovery, Stuart L. Goldstein, Lakhmir S. Chawla, Claudio Ronco, John A. Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Acute kidney injury (AKI) research in the past decade has mostly focused upon development of a standard AKI definition, validation of early novel biomarkers to predict AKI prior to serum creatinine rise and predict AKI severity, and assessment of aspects of renal replacement therapies and their impact on survival. Given the independent association between AKI and mortality in the acute phase, such focus makes imminent sense. More recently, the recognition that AKI is associated with subsequent development of chronic kidney disease and end-stage renal disease, with the attendant increase in mortality, has led to interest in the clinical epidemiology and …

International Clinical Rotations During U.S. Residency Training: Creating An Accreditation Council For Graduate Medical Education-Approved Rotation, Jeffrey S. Berger, Deborah Jeon, Eric P. Chiang, Daniel Asay, Huda M. Ayas

Anesthesiology and Critical Care Medicine Faculty Publications

Healthcare professionals increasingly report interest in global health and participation in international healthcare delivery. Growth opportunities exist for trainees to improve knowledge, skills and attitudes through international experiences. Professional development via international medicine may have lasting effects on patient care and practice patterns following training. In 2010, the first resident took part in an international, exchange elective between The George Washington University’s Department of Anesthesiology in Washington, DC and La Universidad de San Francisco’s Department of Anesthesiology in Quito, Ecuador. This resident elective rotation resulted from a strategic partnership, initiated in 2008, between two training institutions with an established track …

Anesthesia For Ambulatory Surgery In A Child With Hyposensitivity To Pain, Claude Abdallah

Anesthesiology and Critical Care Medicine Faculty Publications

Congenital hyposensitivity to pain is a condition with predisposition to injury. In patients with congenital hyposensitivity to pain/Hereditary sensory and autonomic neuropathy (HSAN), knowledge regarding anesthetic requirements and complications derives from individual case reports, or small case series. Different categories of HSAN have been described. Complications in the immediate perioperative period have been described such as mild hypothermia and cardiovascular events, mostly bradycardia and hypotension. The majority of patients with hyposensitivity to pain reported in the literature have received standard anesthesia for surgery. Immobilization, prevention of autonomic reflexes, anxiolysis, and sedation are equally important aspects of the anesthetic management in …

Considerations In Perioperative Assessment Of Valproic Acid Coagulopathy, Claude Abdallah

Anesthesiology and Critical Care Medicine Faculty Publications

Valproic acid (VPA) is one of the widely prescribed antiepileptic drugs in children with multiple indications. VPA-induced coagulopathy may occur and constitute a pharmacological and practical challenge affecting pre-operative evaluation and management of patients receiving VPA therapy. This review summarizes the different studies documenting the incidence, severity and available recommendations related to this adverse effect.

Apoptotic Neurodegeneration In The Developing Human Brain: Possible Role Of General Anesthetics In Its Genesis, And Of L-Carnitine In Its Reversal, Yisroel Yitzchok Rosenfeld

The Science Journal of the Lander College of Arts and Sciences

Recent studies suggest that general anesthetic (GA) agents administered to developing rats, through its mechanism as an NMDA antagonist or a GABAa mimetic, may damage developing neural cells by inducing a higher rate of programmed cell death (apoptosis). Similar heightened degeneration was also apparent in higher primates such as the monkey. This warrants strong concern, as every year thousands of pregnant women and children below 1 year of age undergo a surgical procedure in which GAs are used. A spike in neuroapoptosis may lead to long term cognitive deficiencies lingering into adulthood. Are humans vulnerable to these affects? Different pathways …

Factors That Predict Incident Reporting Behavior In Certified Registered Nurse Anesthetists, Nicole K. Damico

Theses and Dissertations

Improving patient safety through reduction of medical errors is a national priority. One of the strategies widely utilized to address this issue is the use of incident reporting systems. The purpose of this study was to describe factors that predict the likelihood that Certified Registered Nurse Anesthetists (CRNAs) will use incident reporting systems, guided by the theory of planned behavior (Ajzen, 1991). A non-experimental, correlational research design was utilized to achieve the study aims. Following IRB approval, a cross-sectional survey was administered electronically to a random sample of practicing CRNAs. Correlational analyses and a standard logistic regression were utilized to …

Anesthesia For Cardiac Catheterization Procedures, A Hamid

Department of Anaesthesia

Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure. Anyone who is exposed to radiation environment is expected to protect himself from the exposure and must also wear a dosimeter for cumulative exposure tracing.There is no ideal …