Anesthesia and Analgesia Commons^™

Low Unintended Dural Puncture Rate Using A Flush-Measure-Check-Advance Technique To Perform Combined Spinal-Epidural Anesthesia In Parturients: A Quality Improvement Clinical Series, James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton

School of Medicine Faculty Publications

Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s. Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm. Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) …

Clinical Pharmacokinetics, Pharmacodynamics, And Drug Interactions Of Remimazolam, Derek E. Murrell, Sam Harirforoosh

Pharmacy Faculty Articles and Research

Remimazolam, an ultrashort-acting benzodiazepine, has emerged as a promising sedative agent for procedural sedation and general anesthesia. It combines the favorable properties of traditional benzodiazepines with a rapid onset and offset of action, largely due to its unique metabolism via hepatic carboxylesterases rather than cytochrome P450 enzymes. This metabolism allows for predictable pharmacokinetics, reducing the risk of prolonged sedation and drug accumulation, particularly in patients with hepatic or renal impairment. Clinically, remimazolam demonstrates non-inferiority to midazolam and propofol, with advantages including a lower incidence of hypotension and respiratory depression. Multiple randomized controlled trials have shown its efficacy in various procedural …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

Supra Inguinal Fascia Iliac Versus Peng Block For Post-Operative Pain Management Of Hip Arthroplasty: A Narrative Review, Shahab Ahmadzadeh, Megan S. Walker, Mary O'Dell Duplechin, Drake P. Duplechin, Charles J. Fox, Sahar Shekoohi, Alan D. Kaye

School of Medicine Faculty Publications

Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block have become the new point of focus as opposed to traditional methods previously used. This narrative review compares the SIFIB and the PENG block in their efficacy to treat post-operative pain management. Mechanism of action, safety, patient outcomes, and clinical applications are compared between the two blocks for evaluation. Clinical studies have indicated that both blocks reduce …

Consideration Of Anesthesia Techniques For Deep Brain Stimulation Implantation In The Treatment Of Drug-Resistant Epilepsy: A Narrative Review, Alan D. Kaye, Benjamin Esneault, Shreya Deshpande, Joseph Wentling, Shahab Ahmadzadeh, Pooja Potharaju, Sahar Shekoohi

School of Medicine Faculty Publications

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, affecting millions worldwide. While anti-seizure medications serve as first-line treatment, approximately one-third of patients develop drug-resistant epilepsy (DRE), necessitating alternative interventions. Deep brain stimulation (DBS) has emerged as a promising therapy for DRE, particularly for patients who are ineligible for resective surgery. DBS involves stereotactic implantation of electrodes into target brain regions, such as the anterior nucleus of the thalamus (ANT), centromedian nucleus (CMT), and hippocampus (HC), to modulate aberrant neural activity and to reduce seizure frequency. Anesthesia plays a critical role in DBS implantation, influencing both patient safety and …

5x-Multiplier Vs 3-Tier Model For Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Wei Qiao, Jose A. Karam, Surena F. Matin, Larissa A. Meyer, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background

Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.

Objective

The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at …

Temperature Monitoring In The Cardiac Operating Room, Abby Pint, Clint Humpherys, Dave Stubler, Nathaniel Lata

Research Days

Background: The goal of this project is to improve the accuracy of temperature readings in the cardiac operating room and, in turn, improve patient safety.

Methods: The project obtained nasopharyngeal, tympanic, and bladder/rectal temperature measurements from twenty CPB cases. Measurements were obtained at six critical points: time of incision, initiation of CPB, aortic cross clamping, removal of aortic cross clamping, CPB termination, sternal closure. Data was analyzed to determine discrepancies among methods of measuring temperature for each type of probe utilized. Plan: Tympanic probes are unreliable and provide lower temperature measurements when compared to other probes Do: Temperatures recorded from …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Early Celiac Plexus Block In Metastatic Pancreatic Cancer, Brian Fardman, Christina Sheedy, Joshua Raymond

Rowan-Virtua Research Day

Both Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management.

Volatile Anesthetic Exposure During Organogenesis (Weeks 6-9): Implications For Fetal Brain Development, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Organogenesis, particularly during gestational weeks 6 through 9, represent a critical window for fetal brain development. During this period, neurogenesis, neural tube closure and synaptic organization are actively occurring. Disruption of these processes, especially from exogenous agents, can result in lasting developmental consequences.

The U.S Food and Drug Administration has issued warnings regarding the use of anesthetic agents such as isoflurane, sevoflurane, and desflurane. Noting the potential risk of neurotoxic effects on the developing brain. This warning is particularly highlighted when administered drugs are present for long periods of time or during repeated procedures. The goal of this literature review …

Pain Management In Pregnant Women With Opioid Use Disorder: A Systematic Review, Adeena Javed

Rowan-Virtua Research Day

Background: The prevalence of opioid use disorder (OUD) among pregnant individuals has risen significantly, posing challenges in managing labor and postpartum pain. Factors such as opioid tolerance, opioid-induced hyperalgesia, and concerns about relapse complicate analgesic strategies. Despite these complexities, evidence-based guidelines for pain management in this population remain limited.

Hypothesis: Pregnant women with OUD experience disparities in pain management during labor and postpartum periods, leading to suboptimal outcomes.

Methods: A systematic review was conducted, analyzing peer-reviewed studies from databases including PubMed and Embase. Inclusion criteria encompassed studies focusing on pain management in pregnant women with OUD. Data extraction focused on …

Carbon Footprint Of Inhaled Anesthetics – Do The Risks Outweigh The Benefits?, Liam Kerrick, Joseph Moschella

Rowan-Virtua Research Day

Global warming presents many challenges to the healthcare system. Not only does the increasing global temperature have detrimental health effects itself, but the healthcare sector is also a huge contributor to global warming. One big contributor to global warming is the use of inhaled anesthetics, which possess global warming potentials up to 2,000 times greater than carbon dioxide. Recent proposals, such as a prospective ban of desflurane in 2026 by the European Commission, demonstrate the need to reevaluate many of the common practices within anesthesiology. This review looks to investigate the environmental impact, cost, and clinical efficacy of various anesthetic …

Frequency Modulation Of Deep Brain Stimulation Targeting The Periaqueductal Gray: Effects On Pain Perception And Autonomic Regulation, Jack Hennen, Avneet Chawla, Jared Garfinkle, Wen Hao Luo

Rowan-Virtua Research Day

Introduction:

The periaqueductal gray (PAG) is a midbrain structure, and effective target for deep brain stimulation (DBS), involved in the modulation of a multitude of sensory and autonomic processes. It has distinct functional columnar organization, with each column playing its own role in alteration of the body’s ability to respond to pain and stressful stimuli.

Background:

Research regarding the effects of DBS on the PAG has shown the four main subregions of the PAG: the dorsomedial PAG (dmPAG), dorsolateral PAG (dlPAG), lateral PAG (lPAG), and ventrolateral PAG(vlPAG), produce various physiologic outputs when stimulated. These outputs are region and frequency dependent. …

Exploring The Effects Of Target Race, Gender, And Weight On Pain Perception, Catherine Awad, Theresa Miller, Azer Tuerxuntuoheti, Peter Mende-Siedlecki

Rowan-Virtua Research Day

Healthcare equity is an essential right, and while the quality of care is assumed to be uniform, notable disparities in care are associated with factors of race, gender, and weight-particularly in the domain of pain evaluation and care. In experimental work, target race and gender have varying, and interacting effects on visual thresholds for perceiving painful expressions. Racial bias in pain perception is well established as participants see pain on black faces less readily than pain on white faces; gender also impacts pain treatment, where women are susceptible to having their pain discredited. Across two experiments, the influence of weight …

Addressing Pain Management Practices And Potential Under-Medication Of Women During Iud Insertion Procedures, Malgorzata Zembrzuska

Rowan-Virtua Research Day

Intrauterine devices (IUDs) are among the most effective and safe contraceptive options available to women, yet their utilization often remains limited due in part to fear of pain, lack of adequate pain management during insertion, and absence of standardized clinical guidelines. This literature review explores current pain management strategies for IUD insertion and examines the potential under-medication of women during this procedure. Ten sources were reviewed, including randomized controlled trials, a clinical trial, linear regression analyses, and meta-analyses, with inclusion criteria focusing on pain interventions for IUD insertion in women over the past decade. Findings reveal that commonly used interventions—such …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …

Adverse Health Effects Of Waste Anesthetic Gases (Wags): A Scoping Review Of Genetic, Immunotoxic, And Reproductive Impacts, Cozette Wilkins

Student Works

1 Background/Introduction: Occupational exposure to Waste Anesthetic Gases (WAGs) is a well-known concern for healthcare workers, especially those working in high-risk areas like the operating room (OR). Despite the implementation of safety measures such as WAG scavenging systems, there remains ongoing concern about the potential adverse health effects linked to exposure. This scoping review aims to map the existing evidence on the health risks associated with repeated WAG exposure, specifically focusing on genetic, immunotoxic, and reproductive health impacts. By synthesizing available data, this review seeks to better understand the extent of these risks and identify key gaps in the literature …

Use And Benefits Of A Therapeutic Hypnosis Interactive Media Program For Chronic Pain Management: A Pilot Study, Mark P. Jensen, Joy F. Chan, Owen Gottlieb, Laurence I. Sugarman, Emily Stensland

Articles

Chronic pain is a common condition that has significant negative effects on individuals and society. Opioids continue to be the primary treatment provided to the billions of individuals with chronic pain, despite their general lack of efficacy and significant negative side effects. A growing body of research supports the potential of therapeutic hypnosis for helping individuals better manage their chronic pain. However, access to this treatment is limited. The availability of a hypnosis digital therapeutic has the potential to address this access problem. The current study was designed to evaluate the feasibility of a digital therapeutic hypnosis prototype (not yet …

Comparing Postoperative Opioid Use In Primary And Revision Lumbar Fusion: A Propensity-Matched Analysis, Jonathan Dalton, Jarod Olson, Nicholas B. Pohl, Rajkishen Narayanan, Omar Tarawneh, Yunsoo Lee, Michael V. Carter, Gokul Karthikeyan, Logan Witt, Aayush Mehta, John J. Mangan, Mark F. Kurd, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.

METHODS: Patients who underwent primary or revision 1-2 level lumbar fusion (2017-2021) were included in this study. The state Prescription Drug Monitoring Program was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were substratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.

RESULTS: The final …

Increasing Awareness And Use Of The Emergency Manual In The Operating Room, Joshua Danback, Annie Depenaloza, Logan Johnston

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Operating room emergency manuals function as cognitive aids, facilitating evidence-based treatment, error reduction, and better patient outcomes in diverse patient care and equipment-related emergencies. A concerning amalgam of stress, infrequent occurrence, and lack of standardized response hinders anesthesia providers’ practical experience during unexpected crises, potentially leading to errors and safety concerns.

Purpose: The purpose is to increase anesthesia providers’ utilization of the digital Stanford Emergency Manual (SEM).

Methods: All anesthesia providers at the project sites were invited to complete pre-intervention and post-intervention surveys throughout the project timeline. Surveys assessed participants’ awareness of the digital …

Exploring Microrna Pathways And Metformin's Anti-Inflammatory Potential In Osteoarthritis, Quang D La, Benjamin Tangkamolsuk, David F Lo

Rowan-Virtua School of Osteopathic Medicine Departmental Research

No abstract provided.

Do Patients Who Receive Dexmedetomidine As An Adjunct To Spinal Anesthesia For Cesarean Delivery Achieve Longer Block Duration Compared To Those Who Receive Spinal Anesthesia With Local Anesthetic Alone?, Liana S. Garrison

Theses, Dissertations and Capstones

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used …

Ballistics Gel Model To Teach Ultrasound Guided Pericapsular Nerve Group (Peng) Block, Nicholas Murphy, Matthew Carr, Taryn Hoffman, Leily Naraghi

South Atlantic Division GME Research Day 2025

No abstract provided.

Comparison Of Transversus Abdominis Plane Block Versus Intrathecal Clonidine In Lower Segment Caesarean Section - A Prospective Observational Study, Christy Maria Paul, Dr Somsundar R G Associate Professor, Dr Archana B N Assistant Professor, Dr. Shivakumar G Pofessor And Hod

Digital Journal of Clinical Medicine

Comparison of Transversus Abdominis Plane Block versus Intrathecal Clonidine in Lower Segment Caesarean Section - A Prospective Observational Study

Background and Objective: In the majority of abdominal procedures, transverse abdominis plane block, one of the fascial plane blocks, has been used extensively to treat post-operative pain. Ultrasound has gained popularity in the management of cesarean patients due to its ease of use and reduced adverse effects.To assess the effectiveness of ultrasound guided transverse abdominus plane block with intrathecal clonidine for post surgical pain control in lower segment cesarean patients.

Material and Methods: This prospective observational study was done in …

Hypnosis And Mindfulness Audio Recordings For Reducing Fatigue In Individuals With Multiple Sclerosis: A Randomized Controlled Study, Mark P. Jensen, Susan Robles, Michael G. Nash, Susanne May, Dwan M. Ehde, Melissa A. Day, Owen Gottlieb, Laurence I. Sugarman, Kevin N. Alschuler

Articles

Background

Fatigue is a common problem in individuals with multiple sclerosis (MS).

Objective

The objective was to evaluate the effects on fatigue of having 4 weeks of

access to audio recordings of therapeutic hypnosis (HYP) and mindfulness meditation

(MM) practices.

Methods

A total of 333 individuals with MS and fatigue were randomly assigned to

one of the three treatment conditions for 28 weeks: (1) access to therapeutic HYP audio

recordings, (2) access to MM audio recordings, or (3) no access to recordings

(treatment as usual or TAU). Fatigue impact (primary outcome) and other outcomes

were assessed at 4, 16, and …

Pericapsular Nerve Group (Peng) Block Vs. The Fascia Iliaca Compartment (Fic) Block For Patients With Isolated Hip Fractures In The Emergency Department, Daniel Dagenhart, Taryn Hoffman, Matthew Carr, Martin Wegman

South Atlantic Division GME Research Day 2025

No abstract provided.

The Effects Of Propofol On Doppler Echocardiographic Values Of The Aorta, Main Pulmonary Artery, And Mitral E Wave In New Zealand White Rabbits, Mehmet Alper Çetinkaya, Mahir Kaya

The Thai Journal of Veterinary Medicine

The aim of this study was to determine the effects of propofol on acceleration time (AT), ejection time (ET), AT / ET ratio obtained from the aorta (Ao) and main pulmonary artery (MPA) and Doppler echocardiographic values of mitral E wave (E) in New Zealand white rabbits. Echocardiographic evaluation was performed in 40 conscious rabbits and repeated after propofol administration. The baseline mean values were 0.028±0.006 second (s) for Ao-AT, 0.116±0.017 s for Ao-ET, 0.24±0.036 for Ao-AT / ET, 0.05±0.01 s for MPA- AT, 0.137±0.018 s for MPA-ET, 0.38±0.037 s for MPA-AT/ET, 84.13±18.26 cm/s for E peak velocity, 3.06±1.38 mmHg …

Impact Of Supply Organizational Culture Within A Surgical Unit, Irene T. Peng

Master's Projects and Capstones

Objective: This quality improvement project aims to propose an intervention that helps anesthesia technicians improve communication efforts, reduce delays in care, and reduce medical waste. Aim: At least 80% of the anesthesia technicians are educated on properly stocking the pediatric anesthesia medical lockers utilizing the standardized checklist and handoff report tool to reduce waste and increase timely patient care after three months of implementation. Methods: Assessment surveys were used to identify the surgical unit’s current issues and Hospital A’s staff's opinions of pediatric medical anesthesia C-lockers. Resources such as the GANTT Chart, Fishbone Analysis, Budget Analysis, SWOT Analysis, and PDSA …

Evaluating The Superiority Of Multimodal Analgesia Over Opioid-Based Analgesia In Postoperative Pain Management For Total Knee Arthroplasty: A Comprehensive Integrative Review, Janna Smith, Mahdi Mofazali, Nya-Qien Smith

Master's Projects

With total knee arthroplasty (TKA), postoperative pain management is so important for optimal recovery and patient outcomes. This integrative review evaluates the effectiveness of multimodal analgesia (MMA) compared to traditional opioid-based analgesia in reducing pain and opioid consumption post-TKA. Research shows that MMA is very effective at providing adequate pain relief, reducing side effects, and also decreasing opioid use. MMA also addresses both the specific needs of individual patients and the broader public health issue of opioid dependence. However, a significant barrier to widespread adoption is the absence of standardized protocols. This review sets forth the importance of coming up …

Association Between Mri Findings Of Facet Arthropathy And Synovitis With Health-Related Outcome And Pain Scores Following Therapeutic Lumbar Facet Injections, Michael Stuart Green, Michele Van Hal, Matthew Onimus, Christopher R. Hoffman, Dhruv K. C. Goyal, Valeria Potigailo, Khuram S. Kazmi

Department of Anesthesiology Faculty Papers

Low back pain is a common complaint among adults. The facet joint is a major source of lumbar pain, and therapeutic facet injections have gained popularity as a minimally invasive treatment option. In addition, magnetic resonance imaging (MRI) utilization for diagnosing low back pain has increased significantly over the past few decades. Facet synovitis is an entity characterized by edema and inflammatory changes affecting the facet joints, adjacent bone marrow, and surrounding soft tissues. Although its underlying etiology remains poorly understood, recent reports suggest a high incidence in patients with arthropathy and arthritis. It is essential to explore potential correlations …