Anesthesiology Commons^™

Impact Of Perioperative Organ Injury On Morbidity And Mortality In 28 Million Surgical Patients, Felix Kork, Yafen Liang, Adit A Ginde, Xiaoyi Yuan, Rolf Rossaint, Hongfang Liu, Alex S Evers, Holger K Eltzschig

Faculty, Staff and Student Publications

Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated …

A Comprehensive Analysis Of In-Hospital Adverse Events After Scopolamine Administration: Insights From A Retrospective Cohort Study Using A Large Nationwide Inpatient Database, George Sun, Marc Torjman, Kevin Min

Department of Anesthesiology Faculty Papers

BACKGROUND: Scopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions.

METHODS: A large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to …

Potential S1 Nerve Root Blocks Associated With Sacroiliac Joint Injections, Andrew Ng, Jesse Lou, Dajie Wang

Department of Anesthesiology Faculty Papers

BACKGROUND: Sacroiliac (SI) joint dysfunction is a common cause of lower back pain. The diagnosis of SI joint pain remains challenging. Sacroiliac joint injection remains the gold standard of diagnosis of SI joint pain as well as providing therapeutic effect. One complication related to SI joint injection is temporary numbness and weakness of the leg.

OBJECTIVES: To evaluate the anatomy of the SI joint and the flow of the contrast in the sacroiliac joint and to understand how local anesthetic can affect the nerve roots and cause temporary weakness and numbness of the leg.

METHODS: Patients who underwent SI joint …

Celecoxib-Tramadol Co-Crystal In Patients With Moderate-To-Severe Pain Following Bunionectomy With Osteotomy: Secondary Analyses By Baseline Pain Intensity And Use Of Rescue Medication Of A Phase 3, Randomized, Double-Blind, Factorial, Active- And Placebo-Controlled Trial, Eugene R. Viscusi, Oscar De Leon-Casasola, Jesús Cebrecos, Adam Jacobs, Adelaida Morte, Esther Ortiz, Mariano Sust, Anna Vaqué, Ira Gottlieb, Stephen Daniels, Derek Muse, Michael E. Kuss, Sebastián Videla, Neus Gascón, Carlos Plata-Salamán

Department of Anesthesiology Faculty Papers

BACKGROUND: In the randomized, phase 3, SUSA-301 trial, celecoxib-tramadol co-crystal (CTC) provided significantly greater analgesia compared with celecoxib, tramadol, or placebo in adults with acute, moderate-to-severe, postoperative pain. This post hoc, secondary analysis further evaluated the use of rescue medication and the incidence of treatment-emergent adverse events (TEAEs).

METHODS: Patients (N = 637) were randomized 2:2:2:1 to receive oral CTC 200 mg twice daily (BID; n = 184), tramadol 50 mg four times daily (QID; n = 183), celecoxib 100 mg BID (n = 181), or placebo QID (n = 89). Post hoc analyses were conducted on the use of …

Early Short Course Of Neuromuscular Blocking Agents In Patients With Covid-19 Ards: A Propensity Score Analysis., Gianluigi Li Bassi, Kristen Gibbons, Jacky Y Suen, Heidi J Dalton, Nicole White, Amanda Corley, Sally Shrapnel, Samuel Hinton, Simon Forsyth, John G Laffey, Eddy Fan, Jonathon P Fanning, Mauro Panigada, Robert Bartlett, Daniel Brodie, Aidan Burrell, Davide Chiumello, Alyaa Elhazmi, Mariano Esperatti, Giacomo Grasselli, Carol Hodgson, Shingo Ichiba, Carlos Luna, Eva Marwali, Laura Merson, Srinivas Murthy, Alistair Nichol, Mark Ogino, Paolo Pelosi, Antoni Torres, Pauline Yeung Ng, John F Fraser

Department of Anesthesiology Faculty Papers

BACKGROUND: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis.

METHODS: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 …

Serum Gamma Glutamyltransferase (Ggt) In Coronary Artery Disease: Exploring The Asian Indian Connection, Kunal K Singh, Aditya Kapoor, Roopali Khanna, Ankit Sahu, Vishwas Kapoor, Sudeep Kumar, Naveen Garg, Satyendra Tewari, Pravin Goel

Faculty, Staff and Student Publications

BACKGROUND: There is a need to identify novel markers for CAD, independent of traditional CV risk factors. One of these is gamma-glutamyl transferase (GGT), a marker of increased oxidative stress. Given the high prevalence of CAD in Asian Indians, the link of GGT and CAD in them needs to be studied.

AIM: To assess GGT in patients with angiographically documented CAD.

METHODS AND RESULTS: Two hundred patients aged 58.1 ± 9.95 years, 73% males, hypertension 56%, diabetes 40% were included. Mean GGT was 63.6 ± 44.33 (10–269 U/L). The levels of GGT progressively increased in those with single/double or triple-vessel …

Mepivacaine Versus Bupivacaine Spinal Anesthesia For Early Postoperative Ambulation., Eric S. Schwenk, Vincent P. Kasper, Jordan D. Smoker, Andrew M. Mendelson, Mathew S. Austin, Scot A. Brown, William J. Hozack, Alexa J. Cohen, Jonathan J. Li, Christopher S. Wahal, Jaime L. Baratta, Marc Torjman, Alyson C. Nemeth, Eric E. Czerwinski

Department of Anesthesiology Faculty Papers

BACKGROUND: Early ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.

METHODS: This randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, …

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Adverse Drug Effects And Preoperative Medication Factors Related To Perioperative Low-Dose Ketamine Infusions., Eric S. Schwenk, Stephen F. Goldberg, Ronak D. Patel, Jon Zhou, Douglas R. Adams, Jaime L. Baratta, Eugene R. Viscusi, Richard H. Epstein

Department of Anesthesiology Faculty Papers

High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions …

Successful Implementation Of A Packed Red Blood Cell And Fresh Frozen Plasma Transfusion Protocol In The Surgical Intensive Care Unit, Benjamin E. Szpila, Tezcan Ozrazgat-Baslanti, Jianyi Zhang, Jennifer Lanz, Ruth Davis, Annette Rebel, Erin Vanzant, Lori F. Gentile, Alex G. Cuenca, Darwin N. Ang, Huazhi Liu, Lawrence Lottenberg, Peggy Marker, Marc Zumberg, Azra Bihorac, Frederick A. Moore, Scott Brakenridge, Philip A. Efron

Anesthesiology Faculty Publications

BACKGROUND: Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU).

STUDY DESIGN: We performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression …

The Dose-Response Of Nitrous Oxide In Postoperative Nausea In Patients Undergoing Gynecologic Laparoscopic Surgery: A Preliminary Study., Boris Mraovic, Tatjana Simurina, Zdenko Sonicki, Neven Skitarelic, Tong J. Gan

Department of Anesthesiology Faculty Papers

BACKGROUND: Whether nitrous oxide (N(2)O) increases the incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynecologic surgery is still controversial, which may be due to the administration of different concentrations of inspired N(2)O. We investigated whether N(2)O results in a dose-response increase in PONV. METHODS: Patients undergoing gynecologic laparoscopic surgery were randomized to receive 30% oxygen with air (G0, n = 46), 50% N(2)O with oxygen (G50, n = 46), or 70% N(2)O with oxygen (G70, n = 45). A standardized general anesthetic was used with no PONV prophylaxis. Known risk factors for PONV were controlled. Metoclopramide was used …