Anesthesia and Analgesia Commons^™

Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman

Doctoral Projects

Metastasis following the surgical resection of primary site breast cancer is a medical issue, which plagues mastectomy patients. The intention of this project was to synthesize current literature in order to make a presentation and disseminate it to Certified Registered Nurse Anesthetists (CRNAs) in southern Mississippi and assess the providers' willingness to change practice. CRNAs took part in a Qualtrics survey after viewing a PowerPoint presentation of evidence regarding anesthesia and metastasis. The presentation illustrated the anesthetic techniques and pharmacological agents utilized, which either mitigate or potentiate a patient's risk for metastasis. The survey assessed for a willingness to change …

A Comparison Of The Features And Functions Available In Electronic Health Records, Kathryn Marie Tetreault

Doctoral Projects

The Institute of Medicine (IOM) (2007) estimates that medical errors transpire at a rate of 1.5 million per year. The IOM (2000), approximates 7,000 deaths per year are related to preventable medication errors, which are the leading cause of medical errors. Adverse drug events (ADE) occur due to medication errors, which are 100% preventable. Annually, approximately $21 billion dollars are spent to care for patients’ who experience ADE due to medication errors (IOM, 2007).

This doctoral project evaluates the current features and available functions for pediatric medication administration within the electronic health record (EHR). This comparison explored the EHR functionalities …

Regional Anesthesia Introduced Into An Emergency/Trauma, Jennifer Bryant Covalt

Doctoral Projects

Emergency rooms across the United States have an incredibly large number of shoulder dislocations that need to be manipulated and reset on a daily basis. A cost-benefit analysis in this Doctor of Nursing Practice Project will demonstrate a new form of care for shoulder dislocations in the emergency room with certified registered nurse anesthetists (CRNA) providing regional anesthesia with local lidocaine injections into the shoulder joint. A level II trauma center in Mississippi with many shoulder dislocations was the location that was used to evaluate conscious sedation, length of procedure, and pain scores. A retrospective chart review was performed at …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Zombies, Predatory Wasps And Consciousness, James K. Peterson

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Urinary Tissue Inhibitor Of Metalloproteinase-2 And Insulin-Like Growth Factor-Binding Protein 7 For Risk Stratification Of Acute Kidney Injury In Patients With Sepsis., Patrick M Honore, H Bryant Nguyen, Michelle Gong, Lakhmir S. Chawla, Sean M Bagshaw, Antonio Artigas, Jing Shi, Olivier Joannes-Boyau, Jean-Louis Vincent, John A Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Objectives:

To examine the performance of the urinary biomarker panel tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with sepsis at ICU admission. To investigate the effect of nonrenal organ dysfunction on tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in this population.

Method:

In this ancillary analysis, we included patients with sepsis who were enrolled in either of two trials including 39 ICUs across Europe and North America. The primary endpoint was moderate-severe acute kidney injury (equivalent to Kidney Disease Improving Global Outcome stage 2–3) within 12 hours of enrollment. We assessed biomarker …

Awareness Regarding Application Of Endotracheal Tube (Ett) Cuff Pressure Measuring Gauge In Anesthesia Practice; Acritical Step To Avoid Postintubation Tracheal Stenosis In Critically Ill Patients On Prolonged Mechanical Ventilator, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Common Chronic Conditions Do Not Affect Performance Of Cell Cycle Arrest Biomarkers For Risk Stratification Of Acute Kidney Injury, Michael Heung, Luis Ortega, Lakhmir S. Chawla, Richard G. Wunderink, Wesley H. Self, Jay Koyner, Jing Shi, John A. Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Background Identification of acute kidney injury (AKI) can be challenging in patients with underlying chronic disease, and biomarkers often perform poorly in this population. In this study we examined the performance characteristics of the novel biomarker panel of urinary tissue inhibitor of metalloproteinases-2 (TIMP2) and insulin-like growth factor-binding protein 7 ([IGFBP7]) in patients with a variety of comorbid conditions.

Methods We analyzed data from two multicenter studies of critically ill patients in which [TIMP2]•[IGFBP7] was validated for prediction of Kidney Disease: Improving Global Outcomes (KDIGO) Stage 2 or 3 AKI within 12 h. We constructed receiver operating characteristic (ROC) curves …

Acute Appendicitis: Transcript Profiling Of Blood Identifies Promising Biomarkers And Potential Underlying Processes, Lakhmir S. Chawla, Ian Toma, Danielle L. Davison, Khashayar Vaziri, Juliet Lee, Raymond Lucas, Michael G. Seneff, Aobhinn Nyhan, Timothy A. Mccaffrey

Anesthesiology and Critical Care Medicine Faculty Publications

Background

The diagnosis of acute appendicitis can be surprisingly difficult without computed tomography, which carries significant radiation exposure. Circulating blood cells may carry informative changes in their RNA expression profile that would signal internal infection or inflammation of the appendix.

Methods

Genome-wide expression profiling was applied to whole blood RNA of acute appendicitis patients versus patients with other abdominal disorders, in order to identify biomarkers of appendicitis. From a large cohort of emergency patients, a discovery set of patients with surgically confirmed appendicitis, or abdominal pain from other causes, was identified. RNA from whole blood was profiled by microarrays, and …

Clinical Adjudication In Acute Kidney Injury Studies: Findings From The Pivotal Timp-2*Igfbp7 Biomarker Study, Kathleen D. Liu, Anitha Vijayan, Mitchell H. Rosner, Jing Shi, Lakhmir S. Chawla, John A. Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Background The NEPROCHECK test (Astute Medical, San Diego, CA, USA) combines urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) to identify patients at high risk for acute kidney injury (AKI). In a US Food and Drug Administration registration trial (NCT01573962), AKI was determined by a three-member clinical adjudication committee. The objectives were to examine agreement among adjudicators as well as between adjudicators and consensus criteria for AKI and to determine the relationship of biomarker concentrations and adjudicator agreement.

Methods Subjects were classified as AKI 3/3, 2/3, 1/3 or 0/3 according to the …

Renal Stress Testing In The Assessment Of Kidney Disease, Lakhmir S. Chawla, Claudio Ronco

Anesthesiology and Critical Care Medicine Faculty Publications

As part of human evolutionary development, many human organ systems have innate mechanisms to adapt to increased “work demand” or stress. This reserve capacity can be informative and is used commonly in cardiology to assess cardiac function (e.g., treadmill test). Similarly, the kidney possesses reserve capacity, which can be demonstrated in at least 2 of the following renal domains: glomerular and tubular. When appropriate stimulants are used, healthy patients with intact kidneys can significantly increase their glomerular filtration rate and their tubular secretion. This approach has been used to develop diagnostics for the assessment of renal function. This article reviews …

Comparison Of Spinal Anesthesia Dosage Based On Height And Weight Versus Height Alone In Patients Undergoing Elective Cesarean Section, Khalid Maudood Siddiqui, Muhammad Asghar Ali, Hameed Ullah

Department of Anaesthesia

Background: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens.Methods: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted …

Effects Of Bupivacaine Infiltration On Postoperative Tramadol Consumption In Elective Day Care Unilateral Inguinal Hernia Repair, Rehan Muhammad Qureshi, Fauzia Anis Khan

Department of Anaesthesia

Objective: To determine the difference in analgesic requirement in terms of mean postoperative narcotic consumption and mean postoperative pain score in patients undergoing unilateral inguinal hernia repair with or without bupivacaine infiltration as day-care patients.Methods: The randomised controlled trial was conducted at Aga Khan University Hospital, Karachi, from June to December 2011, and comprised patients who were randomly divided into groups A and B. Tramadol 1.5 mgkg-1 was used as intraoperative analgesia. At the time of closure of surgical incision, 20ml of bupivacaine 0.25% plain was infiltrated in the subcutaneous tissue sub-facially and in the deeper layers along the incision …

Inhibition Of Human Α7 Nicotinic Acetylcholine Receptors By Cyclic Monoterpene Carveol, Yusra Lozon, Ahmed Sultan, Stuart J. Lansdell, Tatiana Prytkova, Bassem Sadek, Keun-Hang Susan Yang, Frank Christopher Howarth, Neil S. Millar, Murat Oz

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Cyclic monoterpenes are a group of phytochemicals with antinociceptive, local anesthetic, and anti-inflammatory actions. Effects of cyclic monoterpenes including vanilin, pulegone, eugenole, carvone, carvacrol, carveol, thymol, thymoquinone, menthone, and limonene were investigated on the functional properties of the cloned α₇ subunit of the human nicotinic acetylcholine receptor expressed in Xenopus oocytes. Monoterpenes inhibited the α₇ nicotinic acetylcholine receptor in the order carveol>thymoquinone>carvacrol>menthone>thymol>limonene>eugenole>pulegone≥carvone≥vanilin. Among the monoterpenes, carveol showed the highest potency on acetylcholine-induced responses, with IC₅₀ of 8.3 µM. Carveol-induced inhibition was independent of the membrane potential and could not be …

Postoperative Pain Management In Children Of Hispanic Origin: A Descriptive Cohort Study, Rebecca Brown, Michelle A. Fortier, Sheeva Zolghadr, Padma Gulur, Brooke N. Jenkins, Zeev N. Kain

Psychology Faculty Articles and Research

BACKGROUND:

It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations.

METHODS:

This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits.

RESULTS:

Despite the high (70%; 99% confidence interval [CI], 57%–82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, …

Utilizing Electronic Health Records To Predict Acute Kidney Injury Risk And Outcomes: Workgroup Statements From The 15th Adqi Consensus Conference, Scott M. Sutherland, Lakhmir S. Chawla, Sandra Kane-Gill, Raymond K. Hsu, Andrew A. Kramer, Stuart A. Goldstein, John A Kellum, Claudio Ronco, Sean M. Bagshaw, On Behalf Of The 15 Adqi Consensus Group

Anesthesiology and Critical Care Medicine Faculty Publications

The data contained within the electronic health record (EHR) is “big” from the standpoint of volume, velocity, and variety. These circumstances and the pervasive trend towards EHR adoption have sparked interest in applying big data predictive analytic techniques to EHR data. Acute kidney injury (AKI) is a condition well suited to prediction and risk forecasting; not only does the consensus definition for AKI allow temporal anchoring of events, but no treatments exist once AKI develops, underscoring the importance of early identification and prevention. The Acute Dialysis Quality Initiative (ADQI) convened a group of key opinion leaders and stakeholders to consider …

Micrornas Are Involved In The Development Of Morphine-Induced Analgesic Tolerance And Regulate Functionally Relevant Changes In Serpini1., Jenica D. Tapocik, Kristin Ceniccola, Cheryl L. Mayo, Melanie L. Schwandt, Matthew Solomon, Bi-Dar Wang, Truong V. Luu, Jacqueline Olender, Thomas Harrigan, Thomas M. Maynard, Greg I. Elmer, Norman H. Lee

Pharmacology and Physiology Faculty Publications

Long-term opioid treatment results in reduced therapeutic efficacy and in turn leads to an increase in the dose required to produce equivalent pain relief and alleviate break-through or insurmountable pain. Altered gene expression is a likely means for inducing long-term neuroadaptations responsible for tolerance. Studies conducted by our laboratory (Tapocik et al., 2009) revealed a network of gene expression changes occurring in canonical pathways involved in neuroplasticity, and uncovered miRNA processing as a potential mechanism. In particular, the mRNA coding the protein responsible for processing miRNAs, Dicer1, was positively correlated with the development of analgesic tolerance. The …

A Randomized Controlled Trial Of Anesthesia Guided By Bis Vs. Standard Care And Effects On Cognition, Zohn Centimole

Theses and Dissertations--Nursing

Postoperative cognitive dysfunction (POCD) occurs frequently in individuals undergoing major surgery with general anesthesia. POCD adversely affects morbidity and health-related quality of life. Derived electroencephalographic (EEG) monitoring is utilized to guide the anesthesia provider in titration of volatile anesthetics. POCD has been associated volatile anesthetic neurotoxicity. EEG monitors are known to reduce a patient’s total cumulative dose exposure to volatile anesthetics. There is currently little evidence to support utilization of EEG monitors as a guide to reduce the incidence of POCD.

The purpose of this dissertation was to develop and test a technique of general anesthesia, delivered by anesthesia providers …

Is Non-Nutritive Sucking An Effective Method Of Providing Analgesia To Newborns Undergoing Painful Procedures?, Eric B. Hooper

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: “The objective of this selective EBM review is to determine whether or not nonnutritive sucking is an effective method of providing analgesia to infants undergoing painful procedures.”

STUDY DESIGN: A systematic review of three blinded randomized-controlled trials (RCT’s), published from 2011 to 2013. All were published in English, one of which was translated from its original Spanish version to an English publication. DATA

SOURCES: Three RCT’s were found using the PubMed database and all were published in peer-reviewed journals.

OUTCOMES MEASURED: The incidence and severity of pain were measured during procedures using the Premature Infant Pain Profile (PIPP) and/or …

Whole Body Cryotherapy Vs. Cold Water Immersion, Brett M. Johnson

Physician Assistant Scholarly Project Posters

In this country a significant percentage of the population present to clinics with generalized musculoskeletal disorders related to pain. More than one-quarter of Americans (26%) age 20 years and over, or an estimated 76.5 million Americans report a problem with general musculoskeletal disorders related to pain that persisted for more than 24 hours in duration. The treatment for various musculoskeletal disorders related to pain are anti-inflammatory agents or opioid analgesics. Another form of anti-inflammatory /analgesia for such ailments is cold therapy.

The purpose of this literature review is to compare Whole Body Cryotherapy (WBCt) to Cold Water Immersion (CWI) in …

Recognizing Pain Using Novel Simulation Technology, Justin C. Grace

Honors Undergraduate Theses

Effective pain management and time to treatment is essential in patient care. Despite scientific evidence supporting the need to treat pain and an emphasis on addressing pain as a priority, pain management continues to be an unresolved issue. As a member of the health care team, nurses are integral to optimal pain management. Currently, nursing schools have limited innovative or alternative methods for teaching pain assessment and management. Simulation in nursing education provides a unique opportunity to expose students to realistic patient situations and allow them to learn and make mistakes without causing harm. However, modern low- and high-fidelity simulation …

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital, Syed Shabbir Ahmed, Mohammad Irfan Akhtar, Rehana Kamal

Department of Anaesthesia

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

The Effect Of Neurostimulation On Ischemic Pain And Methods Of Assessing Pain, Kaylee Keck

Biomedical Engineering

Peripheral arterial disease (PAD) impacts approximately eight million people in the United States [1]. Disease progression leads to chronic ischemic pain, hindering quality of life. Pharmaceuticals are a typical treatment for pain associated with PAD; but as few as 30% of patients have a significant reduction of pain (≥50%) [2].

Neurostimulation is commonly used as a treatment for various diseases and injuries, including Parkinson’s disease and sports-related back and knee injuries [2]. The objective of the study was to explore neurostimulation and its effect on pain and paresthesia for a model of acute peripheral ischemia in young college students.

Pain …

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

Track Extubation In Pediatric Congenital Heart Disease Open Heart Surgical Patients In Pakistan, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Anesthesia For Deep Brain Stimulation In Traumatic Brain Injury-Induced Hemidystonia., Jill M Jani, Chima O Oluigbo, Srijaya K Reddy

Anesthesiology and Critical Care Medicine Faculty Publications

Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.

Anaesthetic Consideration In A Cannabis Addict, Karima Karam, Shemila Abbasi, Fauzia Anis Khan

Department of Anaesthesia

This case report describes the anaesthetic management of a patient addicted to Bhang(cannabis) for 20 years. Cannabis use has implication in the anaesthetic management of a patient because of its effects on the cardiovascular system, respiratory system, and central nervous system and its interaction with anaesthetic drugs.

Renal Angina: Concept And Development Of Pretest Probability Assessment In Acute Kidney Injury, Lakhmir S. Chawla, Stuart L. Goldstein, John A. Kellum, Claudio Ronco

Anesthesiology and Critical Care Medicine Faculty Publications

The context of a diagnostic test is a critical component for the interpretation of its result. This context defines the pretest probability of the diagnosis and forms the basis for the interpretation and value of adding the diagnostic test. In the field of acute kidney injury, a multitude of early diagnostic biomarkers have been developed, but utilization in the appropriate context is less well understood and has not been codified until recently. In order to better operationalize the context and pretest probability assessment for acute kidney injury diagnosis, the renal angina concept was proposed in 2010 for use in both …