Anesthesiology Commons^™

Airway Management In Patients With Vocal Cord Paralysis: A Review Of Intubation Techniques, Intraoperative Challenges, And Outcomes., Rayyan Bhutta, Ali Osman, Tala Maya, Justin Ma, Ali Al Saeed, Sumit Sidhu, Mariya Wood, Bilal Akhtar, Sirimas Lau, Matthias Franzen

Surgery Articles

Vocal cord paralysis (VCP) presents with unique challenges when managing airways, particularly during endotracheal intubation. This literature review explores the effects of unilateral and bilateral VCP on intubation technique, first-pass success, extubation safety, and perioperative airway planning. While video laryngoscopy (VL) is becoming increasingly favored for its superior airway visualization, it does not always confirm successful placement in patients with VCP. Complications such as airway edema, aspiration risk, and cuff misplacements are increased in this patient population, and they may be more vulnerable to post-extubation complications, especially without the use of steroid prophylaxis or intensive post-operative planning. A comparison of …

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 …

Utilizing Simulation Training To Understand Maternal Cardiac Arrest Precipitated By Amniotic Fluid Embolism: A Quality Improvement Project, Erica L. Wright, Megan L. Tiernan, Michael W. Neft, Paige Spagiare, Erica Coffin

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Background and Problem: Maternal cardiac arrest precipitated by amniotic fluid embolism is among the leading direct causes of death among laboring women (Enomoto et al., 2022). Because it presents suddenly without any immediate apparent cause and lacks specific diagnostic tests, frontline obstetric caregivers must be vigilant, competent, and prepared to handle this potentially catastrophic emergency. Coordination among multiple disciplines is paramount since two lives, not just one, are at risk. Unfortunately, the rarity of maternal cardiac arrest significantly limits opportunities for staff to learn how to identify and manage these events successfully. Method: This quality improvement project established a simulation-based …

Improving Intraoperative Antibiotic Stewardship To Reduce Surgical Site Infections: A Quality Improvement, Allyson Nichelle Heard

Doctor of Nursing Practice (DNP) Manuscripts

Purpose: Surgical site infections (SSIs) have been associated with poor pre-surgical incision antibiotic and intraoperative redosing practices and are the leading cause of postoperative readmissions and healthcare-acquired infections. A Quality Improvement (QI) project was developed to evaluate SSIs rates and pre-surgical incision antibiotic dosing and intraoperative redosing practices of anesthesia providers at a Level 1 trauma center in the Midwest. Methods: A pre- and post-intervention knowledge, attitudes, and practices (KAP) survey addressing intraoperative antibiotic stewardship was administered to 138 anesthesia providers. Interventions included education, a reference sheet, and a clinical pathway. Data analysis for surgical procedures involving anesthesia services, …

2024 Eacts/Eactaic Guidelines On Patient Blood Management In Adult Cardiac Surgery In Collaboration With Ebcp, Filip Casselman, Marcus Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Haumann, Anders Jeppsson

Anaesthesiology, East Africa

No abstract provided.

Development And Implementation Of An Ob/L&D Sbar Framework To Enhance Communication Between Obstetric Nurses And Anesthesia Providers: A Quality Improvement Initiative, Jenna E. Bigam, Laina J. Uzarski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication between obstetric (OB) nurses and anesthesia providers is critical to ensure patient safety during epidural placements in labor and delivery (L&D) settings. At a large teaching hospital, communication gaps were identified when OB nurses requested anesthesia for epidural placements without consistently providing vital patient information. The lack of structured communication can result in important details being overlooked, which may lead to delays in care and potential patient harm. To address this, the SBAR (Situation, Background, Assessment, Recommendation) communication framework was implemented to standardize and improve information exchange. This Doctorate of Nurse Anesthesia Practice (DNAP) project aimed to enhance …

The Effect Of Tranexamic Acid On Blood Coagulation In Primary Total Hip Arthroplasty Using Rotational Thromboelastometry: A Randomized Controlled Trial, Uzung Yoon, David Beausang, Elia Elia, Marc Torjman, Jeffrey Mojica, James J. Purtill, David Nazarian, P. Maxwell Courtney, Yoogoo Kang

Department of Anesthesiology Faculty Papers

BACKGROUND: Tranexamic acid (TXA), is commonly administered prophylactically to reduce blood loss in patients undergoing total hip arthroplasty (THA). However, its effect has never been studied. We hypothesized that no difference exists in the degree of fibrinolysis and blood loss between patients receiving prophylactic TXA and placebo.

METHODS: This double-blinded randomized-controlled trial included 50 patients undergoing primary THA in 2021-2023. Clinicaltrials.gov (NCT03897621). Rotational-thromboelastometry (ROTEM) were performed to test blood coagulability using non citrated whole blood (NATEM) and blood treated with TXA (T-APTEM). The intervention group received TXA intravenously. The placebo group received 0.9% sodium chloride solution. The primary outcome measure …

Beyond The Airway, Volume 2, Issue 1, 2024-2025

Beyond the Airway

Table of Contents

1 - Foreword by Dr. Eric Schwenk

2 - Foreword by Bhavana Thota

3 - Interview with Dr. Jaime Baratta

5 - FAER MSARF Summer Research Fellowship

8 - Interview with Dr. Natasha Sinai-Hede

11 - Sugammadex vs. Neostigmine/Glycopyrrolate

14 - Interview with Dr. Angelica Pinninti

16 - Women in Anesthesiology

20 - Editorial Staff

Anesthetic Management For Delivery In Parturients With Heart Disease: A Narrative Review, Shahab Ahmadzadeh, Drake P. Duplechin, Paris D. Bailey, Dillon T. Duplechan, Alexia J. Enache, Peyton Moore, Sahar Shekoohi

School of Medicine Faculty Publications

Cardiac disease remains a leading cause of maternal morbidity and mortality, particularly in developed countries where improved survival has increased the number of pregnant patients with congenital heart disease. The physiological changes of pregnancy, such as increased blood volume, cardiac output, and hypercoagulability, can exacerbate preexisting cardiac conditions, posing significant anesthetic challenges during cesarean delivery. This review outlines anesthetic strategies for parturients with structural or functional cardiac disease, emphasizing individualized, multidisciplinary care. We examine general and regional anesthesia approaches, intraoperative monitoring, and hemodynamic goals, including fluid balance, venous return optimization, and myocardial oxygen demand reduction. Preoperative risk stratification and coordination …

A Case Report Of Disseminated Intravascular Coagulation After Intrauterine Fetal Demise., Gabrielle A Agcaoili, Kyriaki V Schooley, Elizabeth Johnson-Gray, Vincent Relli-Dempsey, Greeshma Allareddy

Women’s Health Articles

Disseminated intravascular coagulation (DIC) is a rare, life-threatening complication of pregnancy in which a hypercoagulable state develops secondary to the contact of tissue factor with circulating blood and causes widespread abnormal clotting. This pathological process disrupts normal blood flow, which can cause multi-organ dysfunction and is associated with very high maternal morbidity and mortality. Occurring in two phases, DIC begins with overactive clotting, which leads to the formation of blood clots within the vessels, and ultimately, the overactive clotting process uses up the body's stores of platelets and clotting factors. The most common obstetric cause of DIC is placental abruption, …

Telogen Effluvium And Anesthesia Considerations: A Case Report., Elizabeth Johnson-Gray, Samantha A Currier, Hanen Fernandez, Matt Brown, Matthias Franzen

Ambulatory and Primary Care Articles

Telogen effluvium is a form of non-scarring hair loss characterized by premature shedding of hair. Pathophysiologically, telogen effluvium occurs when a significant number of hair follicles prematurely enter the telogen phase, resulting in excessive shedding. The exact mechanism is unclear, but it is believed to involve alterations in the hair follicle's growth cycle, possibly mediated by illness, infection, major surgery, low protein intake, or hormonal changes. Some medications can also be linked to this disease, such as beta blockers, carbamazepine, and vitamin A. When affected hairs are in the resting phase, noticeable hair shedding occurs. Our patient was a 61-year-old …

Airway Management During Emergent Laparotomy In A Patient With Subglottic Stenosis And Unilateral True Vocal Cord Paralysis: A Case Report., Rayyan Bhutta, Ali Osman, Connor Henn, Hameed H Salah, Samir Patel

Surgery Articles

This case report describes the airway course of a 52-year-old male who required emergent exploratory laparotomy for suspected gastrointestinal perforation. The patient had underlying subglottic stenosis and unilateral vocal cord paralysis, as well as a history of significant cardiopulmonary disease. Attempts at intubation using standard tube sizes were unsuccessful. A 6.0 endotracheal tube was eventually passed beyond a point of resistance, allowing the operation to proceed. He remained intubated after surgery and was successfully extubated several days later. The report emphasizes the need for adaptable airway plans and highlights the constraints that may arise during urgent operative care.

Impact Of A Multidisciplinary Pulmonary Embolism Response Team (Pert) At A Quaternary Referral Center, Sabrina Mangal, Kristina Pratt, Jennifer Nagel, Juan N Pulido, Jun Vic L. Obaob, Tabitha Weinbrenner, George P Pappas, Paul P Huang, Eric J Lehr

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Microlearning As An Education Strategy In Perianesthesia, Kaelyn Burgett

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Investigation Of Endotracheal Tube Versus Laryngeal Mask Airway Emergence Times For Surgical Patients., Samir M Patel, Rayyan Bhutta, Michelle Pershing, John Dillis, John O Elliott, Matthias J Franzen

OhioHealth Research Institute Articles

During surgical procedures requiring general anesthesia, an airway device is often placed to allow for adequate ventilation of the patient. Most commonly, endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) are placed by the anesthesia provider. The difference between these two methods of ventilation is based on the location; ETTs pass through the glottis into the trachea, whereas the LMA sits above the glottis. This difference in placement may lend benefit to LMAs over ETTs, one of which includes a faster removal of the airway device. That is, after the surgical procedure is completed, there is a period when the …

Utility Of Readily Available Sugammadex For Emergent Neuromuscular Blockade Reversal., Theodore Renner, Kevin Varner, Austin Shaffer, Elizabeth Johnson-Gray, Noah Le, Matthias Franzen

Surgery Articles

INTRODUCTION: Anesthesia providers are often called upon to assist with other providers during can't intubate, can't ventilate (CICV) scenarios. The current availability of doses of sugammadex sufficient to provide emergent reversal of neuromuscular blockade in an operating room environment requires visits to multiple operating rooms at our institution. The Anesthesiology Department at OhioHealth Doctors Hospital sought to evaluate the practicality of administering a rescue dose of sugammadex (16 mg/kg) in a CICV scenario. The current storage of sugammadex is six 200 mg vials maximum per operating room, which would provide insufficient dosing for emergent reversal dosing for most adult patients. …

When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald

Journal of Shock and Hemodynamics

The incidence of right heart failure (RHF) during durable left ventricular assist device (LVAD) surgery ranges from 9% to 42%, depending on the definition. RHF can be divided into three peri-implantation categories: early acute, early, and late. Despite many available risk models, predicting RHF before durable LVAD implantation has been difficult. Preemptive right-sided temporary mechanical circulatory support can improve outcomes; however, if intraoperative RHF is not suspected, early recognition and appropriate intervention after surgery are important.

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 …

Sugammadex For Reversal Of Neuromuscular Blocking Agents Versus Neostigmine - Safety Comparison, Amanda K. Butler, Daniel Belu, Bailey Accardo, Courtney Ayana Bullard, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Sugammadex and neostigmine are two common drugs used to reverse neuromuscular blockade in anesthesia, but they differ in mechanism of action, side effects, and cost.

Sugammadex provides rapid reversal, has fewer side effects, and has a lower risk of bradycardia than neostigmine. This scoping review examines the frequency of bradycardia in adult surgical patients receiving sugammadex versus neostigmine.

Methods

A scoping review was completed of peer-reviewed articles comparing the incidence of bradycardia in adult surgical patients after the administration of sugammadex and neostigmine for neuromuscular blockade reversal. Findings indicate that sugammadex resulted in fewer adverse events, including bradycardia, than …

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Ultrasound-Guided Epidural Placement Vs. Conventional Technique - Evaluating Effectiveness: A Scoping Review, Skylar R. Kuehn, Bsn, Rn, Ccrn-Cmc, Jacob B. Morphis, Bsn, Rn, Sarah D. Price, Bsn, Rn, Katherine E. Pritchard, Msn, Rn, Jordan Isaac Dnp, Crna, Sharon Little Dnp, Aprn, Fnp-Bc, Tracy Mcclinton

Doctor of Nursing Practice Projects

Purpose/Background

Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia.

Methods

This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, …

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 …

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 …

Procalcitonin As A Biomarker Of Acute Kidney Injury In Patients With Suspected Bacterial Sepsis In The Acute Care Setting, Austin Kantola, Jose Navas Blanco, Jacob Keeley

Posters

Acute kidney injury (AKI) is a common, life-threatening complication in patients with sepsis and septic shock.→ Approximately one-half of patients with sepsis experience an AKI.4 → One-third of all acute kidney injuries are related to sepsis.4 → Sepsis-associated AKI raises in-hospital mortality eightfold and the risk of chronic kidney disease development threefold.1,2,3. Early identification of AKI could save time and resources, lower costs, improve patient outcomes. Therefore, a biomarker for earlier AKI detection in patients with sepsis would serve an outstanding role in health care.In the setting of bacterial infection, an upregulation of innate immune system gene transcription and translation …

Effects Of Changing The Frequency Of Epidural Steroid Injections For Elderly Patients With Lumbar Radiculopathy/Lumbar Spinal Stenosis, Nitin Venkatesh, Rebecca Clemans, Roy Soto

Posters

Lower back pain is highly prevalent and a significant cause of disability.

50-84% of adults experiencing back pain at some point.

Previously, patients with chronic lumbar radiculopathy received a maximum of 6 injections a year (q8w).

On Dec 2021, Medicare Coverage of ESIs was updated to limit ESIs to a max of 4 a year (q12w).

Implementation Of An Opioid Free Pediatric Hernia Repair Protocol, Corey Shafer, Antonela Muca, Randy Hilleary, Kristin Lemarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

A Case Of A Massive Right Atrial Thrombus Removal Under Transesophageal Echocardiographic Guidance, Justin Phillips, Max Kabolowsky, Alex M. Hendon, Samantha Arzillo

HCA Healthcare Journal of Medicine

Background

With the advent of catheter guided interventions, practitioners have added another tool alongside chemical lysis and surgical removal to reduce the clot burden of patients with large emboli and thrombi. Due to comorbid conditions, many patients are poor candidates for surgical or chemical clot treatment but may present optimally for catheter-based thromboembolectomy. In this case, we highlight the benefits of mechanical thrombectomy with transesophageal echocardiographic guidance to reduce the clot burden of a patient who would otherwise be considered a poor candidate for surgical or chemical treatment.

Case Presentation

This case follows a 78-year-old man with a past medical …