Anesthesiology Commons^™

Assessing Baseline And Post-Discharge Risk Factors In Subjects With And Without Sleep Apnea Undergoing Endoscopy With Deep Sedation, Mercedes E. Weir

Theses and Dissertations

ABSTRACT

ASSESSING BASELINE AND POST-DISCHARGE RISK FACTORS IN SUBJECTS WITH AND WITHOUT SLEEP APNEA UNDERGOING ENDOSCOPY WITH DEEP SEDATION

Background: Outpatient procedures encompass over 60% of all surgeries in the United States, and the prevalence of obstructive sleep apnea (OSA) remains high among adult surgical ambulatory patients. Ambulatory surgery poses problems for patients with OSA because narcotics and anesthetics used during surgery can complicate the negative effects of OSA, leading to cardiac events, brain hypoxia, and even death. This study was designed to evaluate the prevalence of cardiopulmonary risk factors among post endoscopic patients with diagnosed and undiagnosed sleep apnea. …

Is Homocystinuria A Real Challenge For Anesthetist? Are We Making A Difference?, Muhammad Umar Slote, Karima Karam Khan,, Ausaf Ahmed Khan, Mohsin Nazir Butt

Department of Anaesthesia

No abstract provided.

Intravenous Lidocaine And Postextubation Laryngospasm, Muhammad Faisal Khan, Ullah Saleem

Department of Anaesthesia

No abstract provided.

A Reliable Alternative Of Fiberoptic Bronchoscope Inunanticipated Difficult Airway: Flexible Fiberoptic Cystoscope, Muhammad Sohaib, Khalid Maudood Siddiqui, Muhammad Faisal Khan

Department of Anaesthesia

No abstract provided.

Pediatric Critical Incidents Reported Over 15 Years At A Tertiary Care Teaching Hospital Of A Developing Country, Shemila Abbasi, Fauzia Anis Khan, Sobia Khan

Department of Anaesthesia

Background and Aims: The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Material and Methods: Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University …

Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller

Department of Anesthesiology Faculty Papers

No abstract provided.

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity …

Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin

Doctoral Projects

Anesthesia practice is learned in a stressful environment, and these stressors may lead to the students’ development of maladaptive coping mechanisms. Despite significant improvements in our understanding of addiction and our approaches to combat this problem, the risk of substance misuse remains high in nurse anesthesia students. Education and intervention are imperative when taking preventative measures. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether delivery method of chemical dependency/wellness educational program effects the level of understanding of anesthesia providers and substance misuse and the development of healthy coping mechanisms.

In determining whether the delivery …

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified registered nurse …

Revisiting The Applicability Of Adult Early Post-Operative Nausea And Vomiting Risk Factors For The Paediatric Patient: A Prospective Study Using Cotinine Levels In Children Undergoing Adenotonsillectomies, Destiny F. Chau, Arundathi Reddy, Patrick Breheny, Anna Rebecca Young, Eric Ashford, Megan Song, Christina Zhang, Tammy Taylor, Abbas Younes, Turaj Vazifedan

Anesthesiology Faculty Publications

Background and Aims: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. Methods: After Institutional Review Board approval, 213 children aged 3–10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, …

Anaesthetic Management Of Nesidioblastosis In Two Infants, Muhammad Saad Yousuf, Mohsin Nazir, Fauzia Khan

Department of Anaesthesia

Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth. Second case was a 4-month-old female child who again presented with …

Dealing A Neonate With Charge Syndrome: Anaesthesia Perspective Of Perioperative Care, Khalid M Siddiqui, Muhammad Ali Asghar, Amjad Nadeem

Department of Anaesthesia

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring.

Anaesthetic Management Of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach, Faraz Shafiq, Fahad Salim, Ather Enam, Jai Parkash, Mohammad Faheem

Department of Anaesthesia

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length …

Disruption Of Hippocampal Multisynaptic Networks By General Anesthetics., Min-Ching Kuo, L Stan Leung

Physiology and Pharmacology Publications

BACKGROUND: Previous studies showed that synaptic transmission is affected by general anesthetics, but an anesthetic dose response in freely moving animals has not been done. The hippocampus provides a neural network for the evaluation of isoflurane and pentobarbital on multisynaptic transmission that is relevant to memory function.

METHODS: Male Long-Evans rats were implanted with multichannel and single electrodes in the hippocampus. Spontaneous local field potentials and evoked field potentials were recorded in freely behaving rats before (baseline) and after various doses of isoflurane (0.25 to 1.5%) and sodium pentobarbital (10 mg/kg intraperitoneal).

RESULTS: Monosynaptic population excitatory postsynaptic potentials at the …

The Efficacy Of Peripheral Opioid Antagonists In Opioid-Induced Constipation And Postoperative Ileus: A Systematic Review Of The Literature., Eric S. Schwenk, Alexander E. Grant, Marc C. Torjman, Stephen E. Mcnulty, Jaime L. Baratta, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in …

Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Efficiency Of Spinal Anesthesia Versus General Anesthesia For Lumbar Spinal Surgery: A Retrospective Analysis Of 544 Patients., John T. Pierce, Guy Kositratna, Mark A. Attiah, Michael J. Kallan, Rebecca Koenigsberg, Peter Syre, David Wyler, Md, Paul J. Marcotte, W. Andrew Kofke, William C. Welch

Department of Anesthesiology Faculty Papers

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.

MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 …

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …

Dilemma During Ultrasound-Guided Internal Jugular Venous Catheterization, Sanjay Dwarakanath, Monica Cheriyan, Annette Rebel

Anesthesiology Faculty Publications

The presence of Internal Jugular Valves can pose a diagnostic and procedural challenge during ultrasound-guided cannulation. After ruling out dissection, thrombus, or ultrasound artifacts, it can still be accessed and successfully cannulated with appropriate precautions including use of Live ultrasound, positioning, use of soft-tipped catheters, and minimizing duration of catheter placement.

Higher Midazolam Clearance In Obese Adolescents Compared With Morbidly Obese Adults., Anne Van Rongen, Margreke J E Brill, Janelle D Vaughns, Pyry A J Välitalo, Eric P A Van Dongen, Bert Van Ramshorst, Jeffrey S Barrett, Johannes N Van Den Anker, Catherijne A J Knibbe

Anesthesiology and Critical Care Medicine Faculty Publications

Background

The clearance of cytochrome P450 (CYP) 3A substrates is reported to be reduced with lower age, inflammation and obesity. As it is unknown what the overall influence is of these factors in the case of obese adolescents vs. morbidly obese adults, we studied covariates influencing the clearance of the CYP3A substrate midazolam in a combined analysis of data from obese adolescents and morbidly obese adults.

Methods

Data from 19 obese adolescents [102.7 kg (62–149.5 kg)] and 20 morbidly obese adults [144 kg (112–186 kg)] receiving intravenous midazolam were analysed, using population pharmacokinetic modelling (NONMEM 7.2). In the covariate analysis, …

Data On The Effect Of Sex On The Size, Cellular Content, And Neuronal Density Of The Developing Brain In Mice Exposed To Isoflurane And Carbon Monoxid, L Wang, A Wang, W W. Supplee, K Koffler, Y Cheng, Z M.N. Quezado, R J. Levy

Anesthesiology and Critical Care Medicine Faculty Publications

The data presented here detail the changes in size, cellular content, and neuronal density of the developing brain over time with respect to sex in C57Bl/6 mice following neonatal exposure to isoflurane, carbon monoxide, or their combination. Specifically, brain weight- and brain volume-to-body weight ratios are presented, representative immunoblots of whole brain cell-specific protein content are depicted, and quantification of the number of neurons in the primary somatosensory cortex and CA3 region of the hippocampus are shown. Three discrete postnatal time points are represented: P7 (prior to exposure), P14 (one-week post exposure), and P42-56 (5–7 weeks post exposure). Major findings …

Local Anesthesia Toxicity, Nicole Mccleery

Nursing Student Class Projects (Formerly MSN)

Local anesthesia (LA) provides a way to relieve temporary pain in a small part of the body and has been used for over 100 years (Fencl, 2015). LA also prevents the passage of surgical stimuli into the central nervous system (CNS) making a surgical procedure less painful for the patient (Noble, 2015). According to Noble, “altering the passage of stimuli from smaller diameter neurons in a confined area with lower drug dosages is called LA, such as the injection of LA around a surgical incision” (Noble, 2015, p.325). LA can be used in a variety of settings, such as in …

Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Mohammad Hamid, Mohammad Irfan Akhtar, Hamid Iqil Naqvi, Khalid Ahsan

Department of Anaesthesia

Objective: To observe the incidence and pattern of thrombocytopenia in cardiac surgery patients.
Methods: This prospective, cohort study was conducted at the Aga Khan University Hospital, Karachi, from November 2014 to April 2015, and comprised adult cardiac patients. Patients with platelet count less than 150,000 x 109/L, history of malignancy, immune thrombocytopenic purpura and on chemo or radiotherapy were excluded. All information including demographics, platelet count, heparin doses, total cardiopulmonary bypass time, cross-clamp time, blood products transfused, any thromboembolic complication and the presence of infection were recorded on a pre-designed proforma. SPSS 19 was used for data analysis..
Results: Of …

Hypertonic Saline Versus Mannitol To Improve Brain Relaxation In Craniotomy: A Case Study, Morgan Cornell

Nurse Anesthesia Student Capstones

In neurosurgical procedures, including craniotomy for tumor, neurosurgeons often require a reduction of brain swelling to optimally perform the surgery. The reduction of brain swelling is termed brain relaxation. The anesthesia professional can accomplish brain relaxation using multiple techniques. One such technique is the infusion of certain intravenous fluids to change the osmotic pressure within the cranial vault thereby reducing brain edema (Jaffe, 2014). Highly osmolar fluids such as mannitol and hypertonic saline can be infused to decrease brain edema. Currently, mannitol remains the gold standard for medical treatment of intracranial pressure in neurosurgical procedures (Marko, 2012). This review seeks …

The Impact Of Intraoperative Goal-Directed Fluid Therapy, Marc Yacovone

Nurse Anesthesia Student Capstones

Anesthetists provide intra-operative fluid therapy by utilizing a variety of different methods. Deciding on the appropriate method is multifaceted, and the choice of method is a determinate of safe and effective outcomes. Camach-Navarro et al. (2015) determined that postoperative complications are linked to either giving too much or too little fluid. Unfortunately, the deleterious effects of improper fluid therapy are often overlooked.

Minor surgical procedures which result in little to no blood loss, often lead to positive outcomes using the fixed volume calculation approach to fluid therapy. However, when major surgical procedures are performed on sick patients a fluid management …

The Role Of Platelet Rich Plasma In Pain Management And Decrease In Opioid Use, Sara Cunha

Nurse Anesthesia Student Capstones

Platelet-rich plasma, also known as PRP, has become increasingly popular for the treatment of orthopedic injuries and symptomatic pain that results from such injuries. By promoting a localized inflammatory response, PRP injections increase blood flow to the injured area and expedite the healing process, thereby leading to pain relief. PRP has the potential to be a key player in the future of pain management. However, current evidence of the impact of PRP on pain relief is controversial. This paper aims to review the most current randomized controlled trials evaluating the efficacy of PRP in pain relief in a variety of …

Neurotoxic Effects Of Anesthesia On The Developing Brain, Nicole Hachey

Nurse Anesthesia Student Capstones

Each year, thousands of neonates receive anesthesia and/or sedation for various surgical procedures. With advancements in neonatal care and surgical techniques, the number of infants receiving anesthesia globally will continue to increase. A relatively large and growing body of literature suggests that exposure to general anesthetics can be detrimental to the developing brain. Based upon various animal studies, it is thought that exposure of the immature brain to anesthetic agents may result in apoptosis, neurodegeneration and ultimately long-term cognitive deficiencies (Walters & Paule, 2016). This information presents a dilemma for practitioners when caring for a neonate requiring a surgical procedure, …

Thoracic Epidural Versus Continuous Intercostal Catheter For Patients Undergoing Video Assisted Thoracoscopic Surgery (Vats), Brittany Guilmet

Nurse Anesthesia Student Capstones

Advances in technology have pushed many practitioners towards the implementation of minimally invasive surgery. Many different specialties have rapidly adopted this new approach and patient outcomes have improved as a result of this transition. One specialty, thoracic surgery, has evolved with this change through the development of video assisted thoracoscopic surgery (VATS). Despite improved patient outcomes, thoracic surgery remains one of the most painful procedures that a patient can endure. Although there are many different analgesic modalities available, the gold standard for post-operative analgesia in this patient population remains unknown. The aim of this literature review is to compare the …

Regional Anesthesia And Breast Cancer Recurrence, Michael Dunnington

Nurse Anesthesia Student Capstones

Breast cancer is the most common type of cancer in women in the United States, and surgical resection is the definitive treatment. However, cancer recurrence and metastasis remains a concern for the lifetime of the patients affected. Therefore, much interest has been focused on how anesthetic technique may impact the rates of cancer recurrence and metastasis following breast cancer surgery. In this review, the potential for regional analgesia to reduce the recurrence rate of breast cancer post-operatively is discussed. Supporting evidence from multiple studies is presented, along with a discussion of potential areas of future research that is needed. At …

Dexmedetomidine In The Prevention Of Emergence Delirium In Children, Lauren Anderson

Nurse Anesthesia Student Capstones

This review examines the use of intravenous dexmedetomidine in the role of decreasing or preventing emergence delirium in pediatric patients undergoing ambulatory surgery. The included randomized controlled trials evaluated the administration of dexmedetomidine, whether as a bolus, infusion, or in combination, and its effectiveness in preventing or reducing emergence delirium. The analysis scales for emergence delirium varied between studies, and it was noted that multiple scale components overlapped with pain scale components used in the trials. It has also been noted that differentiating between pain and emergence delirium can be challenging for clinicians (Somaini, Engelhardt, Fumagalli & Ingelmo, 2016). To …