Anesthesiology Commons^™

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Improvement In Patient Safety Through “Irrigation Time-Outs” During Turp Procedures, B. L. Deiling, Do, E. Kilmartin, Md, T. L. Kennedy, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

During any surgical procedure, clear and standardized communication among surgeons, anesthesiologists and operating room nursing staff is a necessity for all aspects of patient safety. During TURP procedures, the perioperative staff must alert team members of the signs and predictors for the potential of TURP syndrome or NSS overload. The goal of our quality improvement project is to increase communication and diagnostic actions based on irrigation fluid amounts among surgeons, anesthesiologists, and the operating room nurses in order to decrease complications in TURP patients at Jefferson over the next six months.

Awareness During An Intensive Care Unit Procedure: A Root Cause Analysis And Creation Of The D5 Handoff Tool, Elise Strickler, Do, Bryan Lutman, Do

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

The objectives of this study are to:

1. perform root cause analysis of the systemic causes of an incident of awareness that occurred during bedside EGD and
2. create a handoff tool that is easily remembered that conveys the essential information about ICU intubations.

Misplaced Central Venous Catheter In Carotid Artery During Emergency Surgery For The Total Correction Of Tetralogy Of Fallot Of An Adolescent Boy, Shabbir Ahmed, Faisal Junejo, Fazal Wahab Khan

Department of Anaesthesia

Ultrasound-guided central venous cannulation is now considered as the standard of care, and this has largely replaced blind central venous cannulation using anatomical landmarks. We are reporting a case of inadvertent placement of central venous catheter in the right common carotid artery with the use of ultrasound guidance during emergency surgery for the total correction of Tetralogy of Fallot (ToF). This patient luckily had a favourable outcome despite this inadvertent catheter placement which was not recognised even after completion of surgery .The patient also received drug infusions of inotropes and vasopressors through this malplaced central line into the aorta. The …

Pre-Anaesthetic Assessment Of Intracranial Pressure Using Optic Nerve Sheath Diameter In Patients Scheduled For Elective Tumour Craniotomy, Faraz Shafiq, Muhammad Asghar Ali, Fauzia Khan

Department of Anaesthesia

Background: The objective of study was to determine the pre-anaesthetic status of intracranial pressure (ICP), using ultrasonographic measurement of optic nerve sheath diameter (ONSD) inpatient scheduled for elective tumour craniotomy. The secondary objective was to compare the diagnostic accuracy of ONSD guided rise in ICP with clinical and radiographic parameters. This is prospective observational study, conducted at single neurosurgical theatre of The Aga Khan University over a period of one year.
Methods: After getting ethical approval and informed consent patient fulfilling inclusion criteria and planned for elective tumour craniotomy were enrolled in study. The clinical and radiographic signs predicting the …

Ultrasound-Guided Peripheral Nerve Blocks In High-Risk Patients, Requiring Lower Limb (Above And Below Knee) Amputation, Faisal Shamim, Malika Hameed, Nadeem Ahmed Siddiqui, Shemila Abbasi

Department of Anaesthesia

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Practice Of Ventilation In Middle-Income Countries (Provent-Imic): Rationale And Protocol For A Prospective International Multicentre Observational Study In Intensive Care Units In Asia, Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Areef Ahsan, Abigail Beane, Kaweesak Chittawatanarat, Abul Faiz, Rashan Haniffa, Reza Hashemian, Madiha Hashmi

Department of Anaesthesia

Introduction: Current evidence on epidemiology and outcomes of invasively mechanically ventilated intensive care unit (ICU) patients is predominantly gathered in resource-rich settings. Patient casemix and patterns of critical illnesses, and probably also ventilation practices are likely to be different in resource-limited settings. We aim to investigate the epidemiological characteristics, ventilation practices and clinical outcomes of patients receiving mechanical ventilation in ICUs in Asia.
Methods and Analysis: PRoVENT-iMIC (study of PRactice of VENTilation in Middle-Income Countries) is an international multicentre observational study to be undertaken in approximately 60 ICUs in 11 Asian countries. Consecutive patients aged 18 years or older who …

The Corticosteroid Compounds Prednisolone And Vamorolone Do Not Alter The Nociception Phenotype And Exacerbate Liver Injury In Sickle Cell Mice., Luis E F Almeida, Jesse M Damsker, Sarah Albani, Nina Afsar, Sayuri Kamimura, Drew Pratt, David E Kleiner, Martha Quezado, Heather Gordish-Dressman, Zenaide M N Quezado

Anesthesiology and Critical Care Medicine Faculty Publications

Clinicians often hesitate prescribing corticosteroids to treat corticosteroid-responsive conditions in sickle cell disease (SCD) patients because their use can be associated with complications (increased hospital readmission, rebound pain, strokes, avascular necrosis, acute chest syndrome). Consequently, SCD patients may receive suboptimal treatment for corticosteroid-responsive conditions. We conducted a preclinical trial of dissociative (vamorolone) and conventional (prednisolone) corticosteroid compounds to evaluate their effects on nociception phenotype, inflammation, and organ dysfunction in SCD mice. Prednisolone and vamorolone had no significant effects on nociception phenotype or anemia in homozygous mice. Conversely, prednisolone and vamorolone significantly decreased white blood cell counts and hepatic inflammation. Interestingly, …

Refrigerated Stability Of Diluted Cisatracurium, Rocuronium, And Vecuronium For Skin Testing After Perioperative Anaphylaxis, Kristen Dinsmore, Bethany Campbell, Timothy Archibald, Greg Mosier, Stacy Brown Phd, Alexei Gonzalez-Estrada Md

Appalachian Student Research Forum

Rationale: The purpose of this study is to investigate the stored stability of dilutions of neuromuscular blocking agents (NMBAs), namely cisatracurium, rocuronium, and vecuronium, for skin prick/intradermal testing.

Methods: Concentrations of NMBAs were monitored by liquid chromatography-mass spectrometry (LC-MS/MS) for a period of 14 days. Dilutions of NMBAs were prepared in saline by factors of 10x, 100x, 1,000x, 10,000x, and 100,000x as sensitivity of the assay allowed. Diluted drug products were stored in a laboratory refrigerator until sampling. On sampling days, aliquots of each dilution were removed and compared to a freshly prepared set of reference dilutions.

Results: The results …

Palliative Surgical Gastrostomy Under Ultrasound‑Guided Bilateral Rectus Sheath Blocks In A Head And Neck Cancer Patient, Saima Rashid, Faisal Shamim,, Maha Khan, Robyna Khan

Department of Anaesthesia

No abstract provided.

Factors Affecting Reintubations After Cardiac And Thoracic Surgeries In Cardiac Intensive Care Unit Of A Tertiary Care Hospital, Khalid Maudood Siddiqui, Khalid Samad, Faisal Jonejo, Muhammad Faisal Khan, Khalid Ahsan Khalid Ahsan

Department of Anaesthesia

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.
Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation …

Ketamine And Remote Hyperalgesia, Steven B. Porter, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

No abstract provided.

Occupational Exposure To Hiv In A Developing Country: Assessing Knowledge And Attitude Of Healthcare Professional Before And After An Awareness Symposium, Samina Ismail, Safia Awan, Rubaba Naeem, Sarfraz Siddiqui, Badar Afzal, Bushra Jamil, Uzma Rahim Khan

Department of Anaesthesia

Objective: Health care providers (HCPs) are at risk of occupational exposure to HIV infection. In developing world these exposure occur due to general lack of awareness, education and structured training of HCPs. The objective of the study was to asses if continuing medical education symposium can be used as an effective educational tool to improve attitude, awareness and knowledge regarding occupational exposure to HIV infection. This quasi-experimental study was conducted among HCPs from Karachi, Pakistan. After assessing the baseline knowledge, awareness, and attitude by means of pretest; HCPs were reassessed with posttest after an education symposium on occupational exposure to …

Haemodynamic Assessment And Support In Sepsis And Septic Shock In Resource-Limited Settings, David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W. Dünser, Arjen M. Dondorp, Marcus J. Schultz, Global Intensive Care Working Group†, Of The European Society Of Intensive Care Medicine (Esicm) And The Mahidol Oxford Tropical Medicine Research Unit (Moru) In Bangkok, Thailand

Anaesthesiology, East Africa

Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking.

Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind.

Results: We suggest using capillary refill time, skin mottling scores and skin temperature gradients; suggest …

Bladder Distension As A Cause Of Abdominal Compartment Syndrome, Muhammad Yasir, Muhammad Qamarul Hoda, Tauseef Ahmed

Department of Anaesthesia

Abdominal compartment syndrome (ACS) is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture. We present a case of 40-year female who underwent emergency cesarean section and developed abdominal compartment syndrome due to urinary bladder distension secondary to blockade of urinary catheter …

Systematic In Vivo Evaluation Of The Time-Dependent Inflammatory Response To Steel And Teflon Insulin Infusion Catheters., Jasmin R. Hauzenberger, Julia Münzker, Petra Kotzbeck, Martin Asslaber, Vladimir Bubalo, Jeffrey I. Joseph, Thomas R. Pieber

Department of Anesthesiology Faculty Papers

Continuous subcutaneous insulin infusion (CSII) catheters are considered the weak link of insulin pump therapy. Wear-time considerably varies between patients and the choice of catheter material is based on personal preferences rather than scientific facts. Therefore, we systematically assessed and quantified the inflammatory tissue response to steel versus Teflon CSII catheters over a maximum wear-time of 7 days in swine. Tissue surrounding catheters was analysed using histopathology and quantitative real-time PCR. The area of inflammation increased significantly over time independent of material which was confirmed by an increase in CD68 expression and an increase in mononuclear and neutrophil cell infiltrate …

Analgesic Effect Of Bilateral Subcostal Tap Block After Laparoscopic Cholecystectomy, Karima Karam Khan, Robyna Irshad Khan

Department of Anaesthesia

Background: Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i.e., Subcostal-TAP block technique with ultrasound guided Posterior-TAP block for postoperative pain management in patients undergoing laparoscopic cholecystectomy under …

Sts/Sca/Amsect Clinical Practice Guidelines: Anticoagulation During Cardiopulmonary Bypass, L. Shore-Lesserson, R. A. Baker, V. Ferraris, P. E. Greilich, D. Fitzgerald, P. Roman, J. Hammon

Journal Articles

© 2018 American Society of Extra-Corporeal Technology. All Rights Reserved. Despite more than a half century of "safe" cardio-pulmonary bypass (CPB), the evidence base surrounding the conduct of anticoagulation for CPB has not been organized into a succinct guideline. For this and other reasons, there is enormous practice variability relating to the use and dosing of heparin, monitoring heparin anticoagulation, reversal of anticoagulation, and the use of alternative anticoagulants. To address this and other gaps, the Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), and the American Society of Extracorporeal Technology (AmSECT) developed an Evidence Based Workgroup. …

Effectiveness Of Tranexamic Acid Administration On Intraoperative Blood Loss In Elective Craniofacial Surgery, Kimberly Marie Vance

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if intraoperative use of tranexamic acid (TXA) was associated with estimated blood loss in patients who underwent elective craniofacial surgery.

Introduction: Intraoperative blood loss has been shown to significantly contribute to postoperative morbidity and mortality in patients undergoing surgical procedures. It is the responsibility of the anesthesia clinician to accurately assess and actively replace ongoing blood loss, as well as employ strategies to curtail perioperative hemorrhage. While numerous methods exist to minimize surgical blood loss, such as mild hypothermia and controlled hypotensive techniques, these interventions can prove hazardous in pediatric patients …

Is Preoperative Administration Of Celecoxib And Pregabalin Associated With Decreased Intraoperative And Postoperative Opioid Consumption In Patients Undergoing Total Hip Or Knee Arthroplasty?, Cierra Treadway

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to determine if a preoperative dose of celecoxib and pregabalin in patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) was associated with less opioid consumption intraoperatively and postoperatively compared to those who did not receive this regimen.

Introduction: THA and TKA have been associated with a high incidence of postoperative pain. Historically, this pain has been managed with opioids; however, these drugs have negative side effects associated with their use. Consequently, anesthesia providers have begun utilizing multimodal non-opioid analgesics. Recently, a specific combination has been utilized, which includes a …

Does Prophylactic Administration Of Ondansetron Prior To Spinal Anesthesia Decrease Spinal-Anesthesia Induced Hypotension In Obstetric And Non-Obstetric Patients?: A Literature Review, Quinnton Rees

Theses, Dissertations and Capstones

Introduction: Neuraxial (spinal) anesthesia is a favored modality in the care of obstetric patients undergoing a cesarean-section (C-section). Spinal anesthesia is additionally popular as an alternative method for various surgical procedures in non-obstetric patients allowing practitioners to avoid potential risks associated with the use of general anesthesia. Spinal anesthesia-induced hypotension (SAIH) is a common side effect that presents status post-initiation of spinal anesthesia. The source of the hypotension produced after the initiation of spinal anesthesia is due to inhibition of the sympathetic nervous system (sympathectomy) and bradycardia caused by stimulation of the Bezold-Jarisch Reflex. A relatively new intervention that …

First Uses Of Haart 300 Rings For Aortic Valve Repair In Poland – 4 Case Studies, Jacek H. Juscinski, Andrzej Koprowski, Magdalena Kotackowska, Maciej M. Kowalik, Jan A. Rogowski, James S. Rankin

Faculty & Staff Scholarship

Introduction: Aortic valve reconstructions using geometric an- nuloplasty rings HAART 300/200 open new era in aortic valve surgery. The HAART technology resizes, reshapes, stabilizes and simplifies aortic valve repair. The HAART aortic repair rings are designed to be implanted directly into aortic annulus (un- der aortic valve leaflets).

Aim: We present first in Poland 4 cases of aortic valve recon- structions using geometric annuloplasty rings HAART 300. Material and methods: Two patients had type IA aortic insuf- ficiency (due to El-Khoury classification) – they were treated by HAART 300 ring insertion and ascending aorta prosthesis implantation. Third patient, Marfan with …

Teaching Third-Year Medical Students To Address Patients’ Spiritual Needs In The Surgery/Anesthesiology Clerkship, Holly G. Atkinson, David Fleenor, Susan M. Lerner, Edward Poliandro, Joseph Truglio

Publications and Research

Introduction: Despite many patients wanting physicians to inquire about their religious/spiritual beliefs, most physicians do not make such inquiries. Among physicians who do, surgeons are less likely than family and general practitioners and psychiatrists to do so.

Methods: To address this gap, we developed a 60-minute curriculum that follows the Kolb cycle of experiential learning for third-year medical students on their surgery/anesthesiology clerkship. The session includes definitions of religion/spirituality, an overview of the literature on spirituality in surgery, a review of the FICA Spiritual History Tool, discussion of the role of the chaplain and the process of initiating a chaplain …

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of …

Comparison Between Intravenous Boluses Versus Infusion Of Tranexamic Acid (Txa) To Reduce Bleeding In Paediatric Cyanotic Congenital Heart Disease (Chd) Surgeries, Faisal Junejo, Mohammad Irfan Akhtar, Mohammad Hamid, Syed Shabbir Ahmed, Fauzia Minai, Muneer Amanullah

Department of Anaesthesia

Objective: To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid (TXA) to reduce postoperative bleeding in cyanotic congenital heart disease surgeries. Study Design: Single-blinded randomised clinical trial. Place and Duration of Study: Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017.
Methodology: Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass (CPB), were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg …

Urinary Retention In Unilateral Total Knee Arthroplasty: Comparison Between Continuous Epidural Analgesia And Single-Shot Femoral Nerve Block, Ausaf Ahmed Khan, Robyna Irshad Khan

Department of Anaesthesia

Objective: To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing total knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block.
Study design: Randomized controlled study.
Place and duration of study: Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015.
Methodology: Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken at …

Fluid Choice During Perioperative Care In Children: A Survey Of Present‑Day Proposing Practice By Anesthesiologists In A Intertiary Care Hospital, Muhammad Faisal Khan, Khalid Maudood Siddiqui, Ali Asghar

Department of Anaesthesia

Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists.

Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the

current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.

Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions

was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.

Results: Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in

this survey. Majority of …

A Randomized Control Trial Comparing Train Of Four Ratio > 0.9 To Clinical Assessment Of Return Of Neuromuscular Function Before Endotracheal Extubation On Critical Respiratory Events In Adult Patients Undergoing Elective Surgery At A Tertiary Hospital In Nairobi, Isaac Adembesa, Vitalis Mung’Ayi, Zul Premji, Dorothy Kamya

Anaesthesiology, East Africa

Background: There is increasing evidence that the incidence of postoperative residual paresis after using neuromuscular blockers ranges from 24 to 50% in post anaesthesia care unit (PACU) and is associated with postoperative complications such as critical respiratory events as evidenced by hypoxia, hypoventilation and upper airway obstruction. Quantitative neuromuscular monitoring (such as the assessment of Train of four (TOF) ratio) and reversal of neuromuscular blockers has been shown to reduce postoperative residual paresis. There are very few outcome studies on effect of residual paresis in PACU. There is a paucity of published randomized controlled trials investigating whether using a TOF …

A Comparison Of The Quality Of Care And Cost Efficiency Between Anesthesia Providers, Daniel A. Carter

Honors Undergraduate Theses

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study …