Anesthesiology Commons^™

Postoperative Delirium After Major Orthopedic Surgery., Michael K. Urban, Mayu Sasaki, Abigail M. Schmucker, Steven K. Magid

Student Papers, Posters & Projects

BACKGROUND: Postoperative delirium (POD) is one of the most common complications in older adult patients undergoing elective surgery. Few studies have compared, within the same institution, the type of surgery, risk factors and type of anesthesia and analgesia associated with the development of POD.

AIM: To investigate the following three questions: (1) What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital? (2) Does surgical procedure influence incidence of POD after non-ambulatory orthopedic surgery? And (3) For POD after non-ambulatory orthopedic surgery, what are modifiable risk factors?

METHODS: A retrospective cohort study was conducted …

Adverse Drug Effects Related To Multiday Ketamine Infusions: Multicenter Study., Andrew M. Mendelson, Lynn Kohan, Joseph Okai, Mariam Wanees, Joseph C. Gonnella, Marc C. Torjman, Eugene R. Viscusi, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

No abstract provided.

B Cells Migrate Into Remote Brain Areas And Support Neurogenesis And Functional Recovery After Focal Stroke In Mice, Sterling B. Ortega, Vanessa O. Torres, Sarah E. Latchney, Cody W. Whoolery, Ibrahim Z. Noorbhai, Katie Poinsatte, Uma M. Selvaraj, Monica A. Benson, Anouk J. M. Meeuwissen, Erik J. Plautz, Xiangmei Kong, Denise M. Ramirez, Apoorva D. Ajay, Julian P. Meeks, Mark P. Goldberg, Nancy L. Monson, Amelia J. Eisch, Ann M. Stowe

Neurology Faculty Publications

Lymphocytes infiltrate the stroke core and penumbra and often exacerbate cellular injury. B cells, however, are lymphocytes that do not contribute to acute pathology but can support recovery. B cell adoptive transfer to mice reduced infarct volumes 3 and 7 d after transient middle cerebral artery occlusion (tMCAo), independent of changing immune populations in recipient mice. Testing a direct neurotrophic effect, B cells cocultured with mixed cortical cells protected neurons and maintained dendritic arborization after oxygen-glucose deprivation. Whole-brain volumetric serial two-photon tomography (STPT) and a custom-developed image analysis pipeline visualized and quantified poststroke B cell diapedesis throughout the brain, including …

Anesthesia For The Patient With A Recently Diagnosed Concussion: Think About The Brain!, Mohammed R. Rasouli, Michelle Kavin, Stephen Stache, Michael E. Mahla, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Some patients require emergent, urgent, or elective surgery in the time period immediately following diagnosis of concussion. However, changes in brain homeostatic mechanisms following a concussion and concern for secondary brain injury can complicate the decision as to whether or not a surgery should proceed or be postponed. Given the paucity of available evidence, further evaluation of the use of anesthesia in a patient with concussion is warranted. This article summarizes what is currently known about the relevant pathophysiology of concussion, intraoperative anesthesia considerations, and effects of anesthesia on concussion outcomes in an attempt to help providers understand the risks …

Comparison Of Multi-Lesion Geometry And Bovine Tissue Impedance Change Between Radiofrequency Ablation Devices, Forrest Shooster, Reena John Do, Scott Macdougall, Christian Gonzalez

Anesthesiology

No abstract provided.

Peripheral Nervous Stimulator Reduces Refractory Pain In Patient With Chronic Lower Extremity Pain, Adlai Pappy Md, Vinita Singh Md

Anesthesiology

No abstract provided.

Sevoflurane Pre-Conditioning Ameliorates Diabetic Myocardial Ischemia/Reperfusion Injury Via Differential Regulation Of P38 And Erk., Dina Xie, Jianli Zhao, Rui Guo, Liyuan Jiao, Yanqing Zhang, Wayne Bond Lau, Bernard Lopez, Theodore Christopher, Erhe Gao, Jimin Cao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Diabetes mellitus (DM) significantly increases myocardial ischemia/reperfusion (MI/R) injury. During DM, cardioprotection induced by conventional pre-conditioning (PreCon) is decreased due to impaired AMP-activated protein kinase (AMPK) signaling. The current study investigated whether PreCon with inhaled anesthetic sevoflurane (SF-PreCon) remains cardioprotective during DM, and identified the involved mechanisms. Normal diet (ND) and high-fat diet (HFD)-induced DM mice were randomized into control and SF-PreCon (3 cycles of 15-minute period exposures to 2% sevoflurane) groups before MI/R. SF-PreCon markedly reduced MI/R injury in DM mice, as evidenced by improved cardiac function (increased LVEF and ±Dp/dt), decreased infarct size, and decreased apoptosis. To determine …

Endoscopic Rhizotomy For Chronic Lumbar Zygapophysial Joint Pain., Yuntao Xue, Tao Ding, Dajie Wang, Jianli Zhao, Huilin Yang, Xiaofeng Gu, Dehong Feng, Yafeng Zhang, Hao Liu, Fenglin Tang, Wanyi Wang, Miao Lu, Chao Wu

Department of Anesthesiology Faculty Papers

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis.

METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar …

Two-Needle Technique For Lumbar Radiofrequency Medial Branch Denervation: A Technical Note, K. B. Chapman, F. Schirripa, T. Oud, P. S. Groenen, R. R. Ramsook, N. Van Helmond

Journal Articles

© 2020, American Society of Interventional Pain Physicians. All rights reserved. Background: Radiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint–related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing …

Chronic Post-Surgical Abdominal Pain Treated With Percutaneous Peripheral Nerve Stimulation Of Iliohypogastric And Ilioinguinal Nerves, Harnek Bajaj, Denise Lester

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Chronic pelvic and lower abdominal pain can be a severely debilitating condition that affects between 7% to 24% of the general population (4). The anterior rami of L1 and T12 give contributions to the ilioinguinal and iliohypogastric nerves which provide sensory innervation to the lower abdomen and pubic regions (3). Entrapment or damage of these nerves can occur due to a variety of mechanisms, and common treatment options have included medications (2), nerve blocks (1), and in rare cases, surgical resection of the involved nerve. In this case, a 47 year old morbidly obese female with history of chronic left …

Development And Performance Of A Web-Based Tool To Adjust Urine Toxicology Testing Frequency: Retrospective Study, K. B. Chapman, M. M. Pas, D. Abrar, W. Day, K. C. Vissers, N. Van Helmond

Journal Articles

Background: Several pain management guidelines recommend regular urine drug testing (UDT) in patients who are being treated with chronic opioid analgesic therapy (COAT) to monitor compliance and improve safety. Guidelines also recommend more frequent testing in patients who are at high risk of adverse events related to COAT; however, there is no consensus on how to identify high-risk patients or on the testing frequency that should be used. Using previously described clinical risk factors for UDT results that are inconsistent with the prescribed COAT, we developed a web-based tool to adjust drug testing frequency in patients treated with COAT. Objective: …

Electrophysiology Practice During Covid-19 Pandemic: A New York Tertiary Hospital Experience, D. Anca, O. Reyes, R. L. Mitra, L. M. Epstein, L. Shore-Lesserson

Journal Articles

© 2020 Elsevier Inc. As hospitals became overwhelmed during the Covid-19 pandemic in March-May in New York, Cardiology and Electrophysiology (EP) departments rapidly developed protocols for case selection as well modifying the practice of managing the cases. Recommendations by the AHA/HRS as well as American Society of Anesthesiology (ASA) were considered in the multidisciplinary collaborative approach to patient care and personnel safety and the anesthesiology team had an integral role in developing protocols for workflow, care, recovery and transport during these challenging times.

Dorsal Root Ganglion Stimulation Lead Fracture Within The Superficial Fascial Layers In 4 Cases, K. B. Chapman, K. V. Patel, N. Van Helmond, G. C. Chien

Journal Articles

We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism underlying lead …

Unilateral Dorsal Root Ganglion Stimulation Lead Placement With Resolution Of Bilateral Lower Extremity Symptoms In Diabetic Peripheral Neuropathy., K. B. Chapman, B. W. Van Roosendaal, N. Van Helmond, T. A. Yousef

Journal Articles

Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that can target specific dermatomes to obtain better coverage of the distal extremity. Previously proposed mechanisms of action for DRG-S focused on the dorsal root ganglion (DRG) itself, without consideration of orthodromic effects in the dorsal horn and antidromic effects on the nerve root and sympathetic chain. Diabetic peripheral neuropathy (DPN) is an axonal neuropathy that affects around half of all patients with diabetes mellitus, causing severe pain and sensory impairment in the distal extremities. We present a case of a patient with DPN in both feet, in addition to …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

The President's Emergency Plan For Aids Relief And Adult Mortality: A Replication Study Of Hiv Development Assistance Effects In Sub-Saharan African Countries, Nicholas A. Hein, Danstan Bagenda, Jiangtao Luo

Journal Articles: Anesthesiology

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President's Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis …

Mesenchymal Stem Cell-Derived Extracellular Vesicles: Challenges In Clinical Applications, Austin Gowen, Farah Shahjin, Subhash Chand, Katherine E. Odegaard, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Stem cell therapy has garnered much attention and application in the past decades for the treatment of diseases and injuries. Mesenchymal stem cells (MSCs) are studied most extensively for their therapeutic roles, which appear to be derived from their paracrine activity. Recent studies suggest a critical therapeutic role for extracellular vesicles (EV) secreted by MSCs. EV are nano-sized membrane-bound vesicles that shuttle important biomolecules between cells to maintain physiological homeostasis. Studies show that EV from MSCs (MSC-EV) have regenerative and anti-inflammatory properties. The use of MSC-EV, as an alternative to MSCs, confers several advantages, such as higher safety profile, lower …

Preventing Hiv And Hsv-2 Through Knowledge And Attitudes: A Replication Study Of A Multi-Component Community-Based Intervention In Zimbabwe, Fang Yu, Nicholas A. Hein, Danstan S. Bagenda

Journal Articles: Anesthesiology

INTRODUCTION: Approximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12-24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could …

Transdermal Lidocaine For Perioperative Pain: A Systematic Review Of The Literature, Alexa Cohen, Jordan Smoker, Mohammad R. Rasouli, Eric S. Schwenk

Phase 1

Introduction: Recent data have shown that the risk of taking chronic opioids after surgery increases after about 5 days of postoperative opioid therapy. Alternatives to opioids are desirable, and transdermal lidocaine is one such perioperative multimodal agent. This review provides a summary of the perioperative studies that have examined transdermal lidocaine as an analgesic in the perioperative period.

Methods: We conducted searches of PubMed and Scopus databases. Studies involving patients who were undergoing surgery and were given either transdermal lidocaine, placebo, or active comparator in the perioperative period with the primary endpoint of improvement in pain were included in …

Device For The Capture And Extraction Of Waste Anesthetic Gas, Jonathan Karp, Cary Hess, Delara Kiani, Corey Jameson, Robert S. Pugliese, Michael E. Mahla, Dietrich Gravenstein, Mary Herman

Phase 1

Background: Leaks occur often throughout the process of delivering inhaled anesthesia prior to and during surgery. Leaks typically occur around the patient’s mouth, nose, and eyes. Potent inhaled anesthetics (PIAs) include halothane, sevoflurane, desflurane, and isoflurane. All PIAs, to one degree or another, pose hazards to human health. PIAs are associated with reproductive toxicity, spontaneous miscarriages in pregnant persons as well as an increased risk of congenital abnormalities in offspring. In other words, PIAs are thought to be both abortifacients as well as teratogens. PIAs are also associated with hepatotoxicity, neurotoxicity, cognitive impairment, as well as increased incidence of malignancy. …

Scavenger Of Waste Anesthetic, Cary Hess, Jonathan Karp, Delara Kiani, Corey Jameson, Michael E. Mahla, Mary Herman, Dietrich Gravenstein, Robert S. Pugliese

Phase 1

Waste anesthetic gases (WAGs) are associated with spontaneous miscarriages in pregnant persons, an increased risk of congenital abnormalities, hepatotoxicity, neurotoxicity, and cognitive impairment. Through monitoring anesthesiologists we found levels of WAGs to be 5-10x the current standard inside the OR. Currently, no solutions exist for the mitigation of WAG release. Remora is a solution to removing WAGs that fits on top of existing anesthesia masks. A flexible skirt is joined to a rigid ring, which deforms under hand pressure to facilitate effective hand-to-mask placement. The suction system is plugged into an unused suction port to create an area under the …

Assessment Of A Wearable Device For Minute Ventilation In Detecting Different States Of Ventilation, Michael Morano, Yash Patel, Marc J. Torjman, Phd, Indupriya Eedara, Ms, Moeness Amin, Phd, Channy Loeum, Jeffrey Joseph, Do

Phase 1

Introduction: Minute ventilation (MV) and breathing status are valuable vital signs to measure in patients clinically such as in detecting opioid induced respiratory depression. However, there are few devices capable of continuously monitoring MV in an accurate fashion. RTM Vital Signs, LLC and TJU are developing a non-invasive wearable Tracheal Sound Sensor to determine if a device can accurately and continuously measure respiratory rate (RR), tidal volume (TV), MV, and changes in ventilation patterns based on sound recordings of breathing.

Methods: Tracheal breathing sounds were recorded in six researchers using a prototype sensor placed on the skin above the sternal …

The Needs At 48 Hours Of Immediate Family Members Of Patients Admitted To The Intensive Care Unit At The Aga Khan University Hospital, Nairobi, Maalim Fahad

Master of Medicine in Anaesthesiology

Background: Family members of patients admitted to Intensive Care Unit (ICU) have been shown to have important needs. Inability of the critical personnel to interrelate appropriately with relatives of critically unwell patients, or to recognize or meet their needs, may lead to increased anxiety, misconception and distrust from relatives. Aim: To determine the needs of immediate family members of adult patients admitted to ICU at 48 hours at the Aga Khan University Hospital, Nairobi. Methods: This was a cross-sectional descriptive study. The Critical Care Family Needs Inventory questionnaire was employed to identify the needs of the immediate relatives of adult …

Zero Tolerance – Mitigating The Opioid Epidemic Amongst Minimally Invasive Urologic Patients, Daniella Wong, Thenappan Chandrasekar, Md, Costas Lallas, Md

Phase 1

Introduction: Opioids are routinely prescribed following minimally invasive surgery (MIS), yet the majority of medication remains unused. However, the literature is lacking evidence for non-narcotic analgesia in MIS urologic procedures. The purpose of this study is to evaluate the efficacy of a non-narcotic postoperative pain management regimen in reducing opioid use following MIS urologic procedures.

Methods: In this prospective study, 51 MIS urologic patients were recruited over two months. Patients in the first month cohort (P1) were managed with the established pain management standard-of-care, while patients in the second month (P2) followed a non-narcotic postoperative pain management protocol that …

The Effects Of Total Intravenous Versus Inhalational Anesthesia On Fluid Balance For Patients Undergoing Pancreaticoduodenectomy, Jaime Eberle-Singh, David Maguire, Md, Harish Lavu, Md

Phase 1

Introduction: Pancreaticoduodenectomy (PD), the most common surgical treatment for pancreatic cancer, is a complex procedure with a morbidity of 45-60%. Recent studies indicate that intraoperative use of total intravenous anesthesia (TIVA) may reduce post-operative complications for PD patients, when compared to inhalational anesthesia (INHA). We hypothesized that patients who receive TIVA may have a more favorable fluid balance, which is known to reduce postoperative complications in PD patients.

Methods: We carried out a retrospective analysis of patients who underwent PD at Thomas Jefferson University Hospital and were administered TIVA or INHA during surgery between April 2017 and January 2019. …

Leading Well: Anesthesiology Program Directors As Servant Leaders And Their Development Of Resident Wellness Programs, Amy Noel Dilorenzo

Theses and Dissertations--Education Sciences

Anesthesiology residents are at significant risk of developing serious issues during training including burnout, depression, and substance abuse. Recent accreditation requirements mandate that these well-being issues be addressed by residency training programs. Program directors, as the leaders of residency programs, are charged with protecting the wellness of residents and leading wellness initiatives. The program director role can be well-described in a servant leadership construct because they are charged with caring for the individual needs of their residents.

This dissertation is a report of a mixed-methods study that explores anesthesiology program directors’ self-perceptions as servant leaders and their efforts to lead …

Anthropogenic Suffering Of Farmed Animals: The Other Side Of Zoonoses, Jean-Jacques Kona-Boun

Animal Sentience

Wiebers & Feigin’s (W&F’s) target article warns of the zoonotic threat to human health from factory farming and urges phasing out meat production and consumption, for the benefit of both human and nonhuman animals. This commentary focuses on the physical and emotional suffering of farmed animals. This varies by species, production system and geographic location, but suffering is there throughout all stages of production — breeding, housing, transport, usage and slaughter. Ubiquitous monitoring of all facilities where farmed animals are kept, with surveillance cameras recording all phases of production would help reduce some forms of suffering. Other forms are caused …

Three Cases Of Covid-19 Pneumonia That Responded To Icosapent Ethyl Supportive Treatment, Winston Suh, Ivan Urits, Omar Viswanath, Alan D. Kaye, Haresh Patel, Wade Hall, Jonathan P. Eskander

Ellmer School of Nursing Faculty Publications

BACKGROUND Icosapent ethyl, a form of eicosapentaenoic acid with anti-inflammatory activity, has been approved as an adjunctive treatment with statins in patients with hypertriglyceridemia. Icosapent ethyl is currently undergoing clinical trials to determine its anti-inflammatory effects in patients with coronavirus disease 2019 (COVID-19). This report describes 3 intensive care unit (ICU) patients with moderate to severe COVID-19 pneumonia treated with icosapent ethyl as part of their supportive care who had favorable outcomes.

CASE REPORT Case 1 was a 75-year-old man with a past medical history of hyperlipidemia, hypertension, type 2 diabetes mellitus, obesity, and benign prostatic hyperplasia. Case 2 was …

Perioperative Acute Kidney Injury, Sam D Gumbert, Felix Kork, Maisie L Jackson, Naveen Vanga, Semhar J Ghebremichael, Christy Y Wang, Holger K Eltzschig

Faculty, Staff and Students Publications

Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various …

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 …