Anesthesiology 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, Allergy, 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, …

Concurrent Discitis And A Spinal Epidural Abscess Following Transforaminal Epidural Steroid Injection Arising From An Unlikely Bacterial Species, Adlai Pappy Ii, Vinita Singh Md

Anesthesiology

No abstract provided.

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, …

Effect Of Removal Of Auraonce™ Laryngeal Mask In Awake Or Deep Anaesthesia: A Randomized Controlled Trial, Ronald Ombaka, Vitalis Mung’Ayi, David Nekyon, Samina Mir

Anaesthesiology, East Africa

Background: The manufacturer Ambu® recommends that the AuraOnce™ laryngeal mask be removed once the patient is fully awake. Studies have shown benefit in removal of the laryngeal mask airway while a patient is deeply anaesthetized. Current evidence is inconclusive, as to which approach is preferable and safer in adults.

Methods: one hundred and sixteen adult patients were randomly assigned to two groups of 58. For the deep arm; The AuraOnceTM laryngeal mask was removed after attaining an end tidal minimum alveolar concentration of Isoflurane of 1.15%. Occurrence of airway complication(s) (One or more of the following; Airway obstruction requiring airway …

Effect Of Target Controlled Propofol Infusion Versus Intermittent Boluses During Oesophagogastroduodenoscopy: A Randomized Controlled Trial, Catherine Ndosi, Vitalis Mung’Ayi, Ednah Gisore, Samina Mir

Anaesthesiology, East Africa

Background: Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Target controlled infusion (TCI) can be employed for this purpose.

Methods: 176 adults were randomly allocated into two groups of 88 patients. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Intervention group: Received an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated by 0.5mcg/ml from baseline infusion rate as needed. Oxygen saturation, blood pressure and heart rate were evaluated immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Oxygen …

Hypertension As A Reason For Cancellation Of Elective Surgical Cases On Day Of Surgery: A Five Year Audit Report From The Aga Khan University Hospital Karachi, Abdul Monem, Amjad Nadeem, Fauzia Khan

Department of Anaesthesia

Objective: To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue.
Methods: The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered.
Results: Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) …

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 …

Peripheral Nerve Stimulator For Treating Nummular Headaches And Occipital Neuralgia, Bruce Dixon Do, Stephen Pyles Md, Ettore Crimi Md

Anesthesiology

No abstract provided.

Spinal Cord Stimulator For Treating Pudendal Neuralgia, Bruce Dixon Do, Stephen Pyles Md, Ettore Crimi Md

Anesthesiology

No abstract provided.

A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson Md, Su Min Oon

Anesthesiology

69M with a PMH of parotid gland carcinoma status post resection and radiation therapy with extensive reconstruction, G-tube placement, COPD, multiple tracheostomies with takedowns (with refusal permanent tracheostomy over objections of family members) presented for CTR and ulnar tunnel exploration. With plans of MAC, an axillary block was placed and maintained on minimal propofol infusion. After administration of 50 mcg fentanyl due to pain, he was noted to be apnic. Ventilation via mask and #3 LMA failed, as well as placement of an 6 mm ET tube. Eventually, patient was ventilated via emergency surgical cricothyroidotomy. He was discharged on POD4.

Intraabdominal Fire During Emergency Laparotomy, Heather Christopherson Md, Alan Kroll Md

Anesthesiology

72 yo obese male presented to ED for 2 day history abdominal pain: sharp, radiating bilateral upper quadrants, n/v/constipation. Patient took entire bottle magnesium citrate, pain became unbearable. On arrival SaO2 88% RA, other vitals stable, Lactic Acid 1.85 mg/dl, CT abdomen massive free air. Taken to OR, intubated, general anesthesia, peritoneal cavity entered with cautery device. Upon entering peritoneum abdomen, flames erupted from the cavity. Flames spontaneously extinguished. No thermal injury sustained by patient. Surgeon’s eyebrows where singed, no other injuries sustained by OR staff. Patient remained hemodynamically stable, surgery proceeded without incident.

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 …

Just Another Labor Epidural, Whitney King Do, William B. Smith

Anesthesiology

A 32 year-old healthy pregnant patient with no significant past medical history who presented to the hospital for delivery of fetus status post intrauterine fetal death. Vaginal delivery with epidural placement was initially the mother’s preference. Fetal movement last felt 4 days prior. The patients H&P and laboratory findings revealed early stages DIC. Patient underwent Caesarean delivery with general anesthesia, the OB physician found the patient to have Couvelaire uterus, a form of placental abruption. The patient’s uterus was atonic requiring multiple units of blood products. Case assessed indications for epidural placement versus general anesthesia.

Severe Bradycardia During A Spinal Cord Stimulator Procedure, Marc Blanchard Md, Ettore Crimi Md, Stephen Pyles Md

Anesthesiology

We report a case of severe bradycardia during spinal cord implantation. A 43 year old female with a history of chronic refractory lumbar back pain presented for revision of spinal cord stimulator. Preoperative assessment was positive only for bilateral lower extremity radiculopathy. During the procedure, surgeon’s attempt to advance the lead through scar tissue elicited severe bradycardia (HR 28) resolved with glycopyrrolate. Compression of spinal cord secondary to difficult lead placement could be the cause of this cardiovascular event. Anesthesiologists need to be aware that severe bradycardia can occur during spinal cord implantation.

Anesthetic Management Without The Use Of Neuromuscular Blocking Agents In Myasthenia Gravis Patient Undergoing Coronary Artery Bypass Grafting And Thymectomy, Katarina Kapisoda, Ettore Crimi Md, Omeni Osian

Anesthesiology

We describe a novel and effective anesthetic management of a 67 year old male with myasthenia gravis (MG) who underwent combined coronary artery bypass graft and thymectomy. Induction of general anesthesia with endotracheal intubation was performed with propofol and remifentanyl without use of any neuromuscular blocking agents (NMBA). General anesthesia was then maintained with inhaled isoflurane and continuous intravenous infusion of sufentanyl and dexmedetomidine. In ICU, trachea was extubated within two hours from admission and no complications occurred during the following 24 hours ICU stay. Avoidance of NMBA may improve outcomes by decreasing the risks associated with their use.

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 …

Review Of The Effects Of Anesthetic Agents Used As Premedication For Patients Undergoing Electroconvulsive Therapy With Diagnoses Of Bipolar Disorder Or Major Depression On Convulsion, Recovery Period, And Hemodynamic Parameters, Volkan Ozen, Mehmet Emin Orhan

Journal of Mind and Medical Sciences

Objective: The aim of this study was to examine the effects of anesthetic agents used as premedication in patients undergoing electroconvulsive therapy (ECT) for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Method: This retrospective study was carried out by screening the anesthesia forms of patients in a psychiatry clinic in Turkey. Results: Researchers reviewed 104 patient files, of which 39 fit the inclusion criteria. 26 patients were given premedication; 13 patients were not given premedication. The study found a significant difference between the group to which dexmedetomidine was given …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Developing A Local Anesthetic Systemic Toxicity Protocol In A Mississippi Hospital, James Dearman, Terry J. Tieman

Doctoral Projects

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some …

A Market Analysis Of Pay Rates For New Graduate Certified Registered Nurse Anesthetists, Zachary Halliwell

Doctoral Projects

The profession of Certified Registered Nurse Anesthetists (CRNA) is a thriving occupation. In their national Occupational Outlook Handbook, the Bureau of Labor Statistics (U.S. Department of Labor, 2018), reported the national market for CRNAs is predicted to continue its steady growth through 2026. The Bureau of Labor Statistics (BLS) provides numerous statistics, as previously mentioned, on their website. However, the stats available include CRNAs of varying experience levels. The Mississippi Department of Employment Security (MDES) has a few statistics, online, regarding the market for CRNAs. The data provided by MDES, while appreciated, is lacking in numerical significance, given the minuscule …

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.

Evidence-Based Best Practice Policy Recommendation For Postoperative Sore Throat, Corey Gambrell

Doctoral Projects

Airway management is a fundamental aspect of patient care when general anesthesia is being administered. Unfortunately, tracheal intubation can lead to the development of postoperative sore throat (POST) in the recovery room. POST is a minor yet preventable consequence of manipulation and injury of the airway mucosa. POST is routinely considered a minor postoperative complication; however, the occurrence of POST can have a negative influence on patient satisfaction as well as their perception of the perioperative experience. The etiology of POST is multifactorial, but evidence indicates that prevention is possible when evidenced-based practices are employed by anesthesia providers. A targeted …

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 …

Critically Ill Obstetric Patients In Resource-Limited Settings, Samina Ismail, Muhammad Sohaib

Department of Anaesthesia

No abstract provided.

Obstetric Patients Requiring Critical Care: Retrospective Study In A Tertiary Care Institute Of Pakistan, Samina Ismail, Muhammad Sohaib

Department of Anaesthesia

Background: The outcome of obstetric patients admitted to the intensive care unit (ICU) depends on the number of factors. The objective of this study is to review the outcomes of these patients with regard to pregnancy status, source of admission, and their presenting illness at time of admission to ICU.
Materials and Methods: A retrospective study was undertaken for all obstetric patients admitted to the ICU of a private tertiary care hospital of Pakistan from 2014 to 2018. The data were reviewed thorough ICU log sheet, electronic medical records, and online laboratory data. The data included patient demographics, pregnancy status, …