Anesthesiology Commons^™

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

Effect Of Lipid-Lowering Medications In Patients With Coronary Artery Bypass Grafting Surgery Outcomes, Chunxia Shi, Zugui Zhang, Jordan E Goldhammer, David Li, Bob Kiaii, Victor Rudriguez, Douglas Boyd, David Lubarsky, Richard Applegate, Hong Liu

Department of Anesthesiology Faculty Papers

Background: Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

Methods: After IRB approval, we …

Maximising Access To Timely Trauma Care Across Population Of Karachi And Its Districts: A Geospatial Approach To Develop A Trauma Care Network, Muhammad Nabeel Ashraf, Mohammad Salman Khalil, Ahwaz Akhtar, Lubna Samad, Asad Latif

Department of Anaesthesia

Objectives: To develop and propose a cost-effective trauma care network for Karachi, Pakistan, by calculating maximum timely trauma care (TTC) coverage achieved with the addition of potential designated private and public level 1 and level 2 trauma centres (TCs).
Setting: A lower middle-income country metropolis, Karachi is Pakistan's largest city with a population of 16 million and a total of 56 hospitals as per government registry data.
Participants: 41 potential TCs selected using a two-level, contextually-relevant TC designation criteria adapted from various international guidelines.
Primary and secondary outcome measures: Maximum TTC coverage achievable with the addition of potential TCs. Proposed …

The Anxiolytic Effects Of Aromatherapy On Preprocedural Anxiety: An Integrated Review, Rebekah Smith

Senior Honors Theses

Anxiety before procedures can negatively impact patients by increasing cortisol levels which delays wound healing and increases infection risk, increasing pain and sedation medication needs, and increasing hospitalization time. This review was conducted to find how inhaled essential oils affect pre-procedural anxiety of adults in acute care settings. Nine databases and some gray literature were searched within the past ten years, and documented using the PRISMA flow chart. Ten articles fitting the inclusion criteria were retrieved. Nine of the articles found a significant difference between the aromatherapy group and control group and pre- and post- intervention anxiety scores, and none …

Comparison Of Liposomal Bupivacaine Versus Bupivacaine With Epinephrine Versus The Combination In Postoperative Pain Management Following Spinal Surgery, Arianne Dagdag

Annual Research Symposium

No abstract provided.

Anesthetics Affect Peripheral Venous Pressure Waveforms And The Cross-Talk With Arterial Pressure, Ali Z. Al-Alawi, Kaylee R. Henry, Lauren D. Crimmins, Patrick C. Bonasso, Md Abul Hayat, Melvin S. Dassinger, Jeffrey M. Burford, Hanna K. Jensen, Joseph Sanford, Jingxian Wu, Kevin W. Sexton, Morten O. Jensen

Biomedical Engineering Faculty Publications and Presentations

Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two pediatric cohorts were studied to test the effect of anesthetic agents on the PVP waveform and cross-talk between peripheral veins and arteries: (1) dehydration setting in a pyloromyotomy using the infused anesthetic propofol and (2) hemorrhage setting during elective surgery for craniosynostosis with the inhaled anesthetic isoflurane. PVP waveforms were collected from 39 patients that received propofol and 9 that received isoflurane. A multiple analysis of variance test determined if anesthetics influence the PVP waveform. A prediction system was built using k-nearest neighbor (k-NN) …

The Demographics Of Pain After Spinal Cord Injury: A Survey Of Our Model System., James J Bresnahan, Benjamin R Scoblionko, Devon Zorn, Daniel E Graves, Eugene R Viscusi

Department of Anesthesiology Faculty Papers

STUDY DESIGN: Survey OBJECTIVES: Better understand the demographics of pain after spinal cord injury (SCI).

SETTING: Academic Level 1 trauma center and SCI Model System.

METHODS: A survey including general demographic questions, questions of specific interest to the authors, the standardized SCI Pain Instrument (SCIPI), International SCI Pain Data Set, Basic form (ISCIPDS:B), Patient Reported Outcomes Measurement Information System (PROMIS) neuropathic 5a (PROMIS-Neur), and PROMIS nociceptive 5a (PROMIS-No).

RESULTS: 81% of individuals with SCI experience chronic pain and 86% of individuals with pain have neuropathic pain. 55% of individuals had shoulder pain. Females and those who recall >5/10 pain during …

Senior Academic Ranks In Us Anesthesiology Programs: Differences Between Women And Men And Examination Of Independent Factors For Success, Brenda Lee, Farhad Zahedi, Ina Zaimi, Roman Schumann

Journal of Maine Medical Center

Introduction: Gender equality among faculty is a challenge in academic medicine, including anesthesiology. We investigated the likelihood that several factors were associated with academic success in the United States (US), defined as having achieved a senior academic rank (SAR) in a US anesthesiology training program.

Methods: We collected data available on the Internet on 131 anesthesiology programs, including faculty academic rank, gender, number of faculty, graduate status from an American medical school, fellowship training status, number of residents, number of program fellowships, and geographic location. SAR was defined as either associate professor or professor. Data were analyzed with logistic regression. …

Surgical Management During The Covid-19 Era At A Private Tertiary Care Hospital Of Karachi, Pakistan: A Cross-Sectional Study, Nida Zahid, Erum Baig, Gulzar S. Lakhani, Hasnain Zafar, Asad Latif, Syed Ather Enam

Department of Surgery Docs

Background: The coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.
Methodology: This is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply …

Implementation Of The Comprehensive Unit-Based Safety Program To Improve Infection Prevention And Control Practices In Four Neonatal Intensive Care Units In Pune, India, Julia Johnson, Asad Latif, Bharat Randive, Abhay Kadam, Uday Rajput, Aarti Kinikar, Nandini Malshe, Sanjay Lalwani, Tushar B. Parikh, Umesh Vaidya

Department of Anaesthesia

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.
Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate …

One Block: Two Bridges To Analgesia, William Wall, Casey Wilson

South Atlantic Division GME Research Day 2022

No abstract provided.

Anesthesia With Mitochondrial Disease, Ethan Mosley, Cameron Killmer, Saptarshi Biswas

South Atlantic Division GME Research Day 2022

No abstract provided.

Performance Of The Universal Vital Assessment (Uva) Mortality Risk Score In Hospitalized Adults With Infection In Rwanda: A Retrospective External Validation Study, Riley Hazard, Danstan Bagenda, Andrew J. Patterson, Julie T. Hoffman, Steven J. Lisco, Olivier Urayeneza, Polyphile Ntihinyurwa, Christopher C. Moore

Journal Articles: Anesthesiology

BACKGROUND: We previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda.

METHODS: We performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified …

Methamphetamine Induces The Release Of Proadhesive Extracellular Vesicles And Promotes Syncytia Formation: A Potential Role In Hiv-1 Neuropathogenesis, Subhash Chand, Catherine Demarino, Austin Gowen, Maria Cowen, Sarah Al-Sharif, Fatah Kashanchi, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Despite the success of combinational antiretroviral therapy (cART), the high pervasiveness of human immunodeficiency virus-1 (HIV)-associated neurocognitive disorders (HAND) poses a significant challenge for society. Methamphetamine (meth) and related amphetamine compounds, which are potent psychostimulants, are among the most commonly used illicit drugs. Intriguingly, HIV-infected individuals who are meth users have a comparatively higher rate of neuropsychological impairment and exhibit a higher viral load in the brain than infected individuals who do not abuse meth. Effectively, all cell types secrete nano-sized lipid membrane vesicles, referred to as extracellular vesicles (EVs) that can function as intercellular communication to modulate the physiology …

Periocular Manifestation Of Obstructive Sleep Apnea As A Novel Perioperative Screening Tool, Megan Folsom, James Gigantelli, Brent Timperley, Kurtis Johnson, Danstan Bagenda, Huiling Pang, Sheila Ellis

Journal Articles: Anesthesiology

PURPOSE: Obstructive sleep apnea (OSA) presents perioperative challenges with increased risk for complications. Floppy eyelid syndrome (FES) is associated with OSA yet has not been addressed perioperatively. The current standard for perioperative OSA screening includes assessing patient risk factors or the STOP-BANG tool, which requires an active participant. We aimed to confirm a connection between FES and OSA in presurgical patients and develop a screening method appropriate for patients with perioperative OSA risk.

MATERIALS AND METHODS: 162 presurgical pre-anesthesia clinic patients were enrolled. Screening questions determined eligibility. Those who were pregnant or aged < 19 were excluded. Control group included those with a STOP-BANG score < 3. Experimental group included those with BMI > 35 and OSA diagnosis. Examiners photographed participants' …

Effect Of Combined Methamphetamine And Oxycodone Use On The Synaptic Proteome In An In Vitro Model Of Polysubstance Use, Daniel Meyer, Pranavi Athota, Austin Gowen, Nghi M. Nguyen, Victoria L. Schaal, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

Polysubstance use (PSU) generally involves the simultaneous use of an opioid along with a stimulant. In recent years, this problem has escalated into a nationwide epidemic. Understanding the mechanisms and effects underlying the interaction between these drugs is essential for the development of treatments for those suffering from addiction. Currently, the effect of PSU on synapses-critical points of contact between neurons-remains poorly understood. Using an in vitro model of primary neurons, we examined the combined effects of the psychostimulant methamphetamine (METH) and the prescription opioid oxycodone (oxy) on the synaptic proteome using quantitative mass-spectrometry-based proteomics. A further ClueGO analysis and …

Distinct Synaptic Vesicle Proteomic Signatures Associated With Pre- And Post-Natal Oxycodone-Exposure, Katherine E. Odegaard, Gabriel Gallegos, Sneh Koul, Victoria L. Schaal, Neetha N. Vellichirammal, Chittibabu Guda, Andrea P. Dutoit, Steven J. Lisco, Sowmya V. Yelamanchili, Gurudutt Pendyala

Journal Articles: Anesthesiology

The current opioid crisis, which has ravaged all segments of society, continues to pose a rising public health concern. Importantly, dependency on prescription opioids such as oxycodone (oxy) during and after pregnancy can significantly impact the overall brain development of the exposed offspring, especially at the synapse. A significant knowledge gap that remains is identifying distinct synaptic signatures associated with these exposed offspring. Accordingly, the overall goal of this current study was to identify distinct synaptic vesicle (SV) proteins as signatures for offspring exposed to oxy in utero (IUO) and postnatally (PNO). Using a preclinical animal model that imitates oxycodone …

Utilizing Virtual Reality Goggles During Pediatric Laceration Repairs To Reduce Perceived Pain In Pediatric Patients, Emily C. Bozzer

Graduate Theses/Dissertations

In pediatric emergency departments, several providers assess pediatric patients in need a laceration repair, require procedural sedation in order to ensure compliance and complete the laceration repair. This study explored one safe alternative to procedural sedation during pediatric laceration repairs by assessing what pain scores pediatric patients report when undergoing a laceration repair utilizing virtual reality goggles. Pediatric patients ages 6-17 years old perceived pain scores utilizing FACES pain scale was documented. This study found a majority of patients reported lower pain scores during the laceration repair in comparison to their baseline pain score.

The Slow Rhythm Of Midodrine: A Peculiar Case Of Profound Bradycardia, Larissa Check, Louis Tsichlis, Mohamed Faris

South Atlantic Division GME Research Day 2022

No abstract provided.

Efficacy Of Dexmedetomidine As An Opioid Sparing Adjunct To Regional Anesthesia For Shoulder Surgery, Matthew Austin

Nurse Anesthesia MSNA Student Capstones

Regional anesthetics are often the preferred route for patients who are having orthopedic shoulder procedures (Rai & Bhutia, 2017). Traditionally, plain local anesthetics, like bupivacaine or ropivacaine, are used as the local anesthetic of choice because of their fast onset and relatively predictable duration of action. However, several different additives have been trialed to prolong the duration or improve the density of regional blocks. When looking at additives to regional anesthetic techniques, side effects and duration of the block can be unpredictable and unpleasant. For example, additives like fentanyl, morphine, and dexamethasone have been trialed in regional techniques and have …

Do The Benefits Of Sugammadex Outweigh Its Higher Cost Compared To Neostigmine?, Ashley Mcdonald

Nurse Anesthesia MSNA Student Capstones

Neuromuscular blocking agents (NMBAs) are frequently utilized in anesthetic practice to relax the vocal cords in preparation for endotracheal intubation and to facilitate optimal operating conditions for various surgical procedures. Residual muscle paralysis in the postoperative period is a serious consequence of NMBAs that can lead to severe consequences including airway obstruction, hypoxia, reintubation, aspiration, and pneumonia. Neuromuscular blockade (NMB) is overcome either by spontaneous recovery or, in most cases, with the use of a reversal agent. Two of the most common reversal agents are neostigmine, a cholinesterase inhibitor, and sugammadex, a modified gamma-cyclodextrin. Of the two medications, sugammadex is …

The Impact Of Dexmedetomidine Use In Patients Over The Age Of 60 Undergoing General Anesthesia On Postoperative Delirium Incidence, Elaina Branco

Nurse Anesthesia MSNA Student Capstones

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are of concern in the elderly population undergoing an anesthetic due to increased mortality and decreased quality of life that can ensue. Sui et al. (2021) reported a 15-50% incidence of POD in elderly surgical patients. Dexmedetomidine is a highly selective, alpha-2 agonist with sedative, analgesic, and anxiolytic properties that mimics a sleep-like state and causes bradycardia and hypotension but not respiratory depression. Dexmedetomidine has neuroprotective properties, including anti-apoptosis and anti-inflammation (Wu et al., 2019). A current review of the literature revealed that dexmedetomidine use can decrease POD incidence in the aged …

Comparing Intravenous And Inhalation Anesthetics For Intraoperative Anesthesia In Adult Patients With An Acute Traumatic Brain Injury, Natasha K. Moody

Nurse Anesthesia MSNA Student Capstones

As research and science has progressed to further analyze the effects of anesthetics on cerebral physiology, the margin of safety for each anesthetic is reassessed to enhance patient outcomes and recovery. The purpose of this review is to strategically examine and provide updated information on the impact of specific anesthetics administered during the intraoperative period as it applies to patients with acute traumatic brain injury (TBI). In efforts to preserve the cerebral physiology of the patient, current research has identified benefits of administering intravenous over inhalation anesthetics to reduce secondary injuries that have been linked to chronic TBI, morbidity, and …

The Effect Of Clonidine On Hyperbaric Bupivacaine And Opioid In Cesarean Section Women Under Spinal Anesthesia, Novisi Abba

Nurse Anesthesia MSNA Student Capstones

Pain is undoubtedly one of the most undesirable outcomes associated with cesarean section in parturients. The most effective post-cesarean section pain relief option should prioritize maternal, fetal, and neonatal safety, with minimal to no medication transfer to the fetus and neonate. In obstetric anesthesia, neuraxial approaches, with the inclusion of adjuncts like clonidine for pain management may provide some additional benefits. Consequently, obstetric anesthesia practitioners have increasingly used intrathecal clonidine to alleviate post-cesarean section pain. This manuscript examines whether intrathecal clonidine, when combined with hyperbaric bupivacaine and/or opioids (fentanyl and/or preservative-free morphine), has a sustained analgesic effect in parturients following …

Management Of Perioperative Anticoagulation In A Patient With Antiphospholipid Antibody Syndrome Undergoing Cardiac Surgery: A Case Report, Sanjana A Malviya, Yi Deng, Sayyed O Gilani, Alec A Hendon, Melissa A Nikolaidis, Micah S Moseley

Faculty, Staff and Students Publications

Patients with Antiphospholipid syndrome (APLS) are at high risk for both bleeding and thrombotic complications during cardiac surgery involving cardiopulmonary bypass (CPB). In this case we present a patient with APLS and Immune Thrombocytopenic Purpura who successfully underwent aortic valve replacement (AVR) with CPB despite recent craniotomy for subdural hematoma evacuation. Anticoagulation for CPB was monitored by targeting an Activated Clotting Time (ACT) that was 2× the upper limit of normal. A multidisciplinary approach was essential in ensuring a safe and successful operation.

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 …

Epidural Anesthesia For Cesarean Section For Parturient With Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report, Ashie Kapoor, Jon Halling

HCA Healthcare Journal of Medicine

Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance …

Endotracheal Tube Dislodgment In A High Risk Pulmonary Hypertensive Patient Due To Undiagnosed Tracheomegaly: A Case Report, Andrew Peck, Tammer N. Ghaly, Austin J. Adams, Daniel W. Johnson, Rebecca A. Aron

Graduate Medical Education Research Journal

Introduction

Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.¹ Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.²

Case

This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O₂ who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, …

Beyond The Raskin Protocol: Ketamine, Lidocaine, And Other Therapies For Refractory Chronic Migraine., Jeffrey J. Mojica, Eric S. Schwenk, Clinton Lauritsen, Stephanie J. Nahas

Department of Anesthesiology Faculty Papers

PURPOSE OF REVIEW: The purpose of this review is to discuss the available evidence and therapeutic considerations for intravenous drug therapy for refractory chronic migraine.

RECENT FINDINGS: In carefully monitored settings, the inpatient administration of intravenous lidocaine and ketamine can be successful in treating refractory chronic migraine. Many patients with refractory chronic migraine have experienced treatment failure with the Raskin protocol. The use of aggressive inpatient infusion therapy consisting of intravenous lidocaine or ketamine, along with other adjunctive medications, has become increasingly common for these patients when all other treatments have failed. There is a clear need for prospective studies …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …