Anesthesiology Commons^™

The Influence On Morbidity And Mortality When Blood Products Are Transfused Using Conventional Coagulation Tests Versus Teg Or Rotem In Trauma Patients Perioperatively, Teresa Diana Kelley

Theses, Dissertations and Capstones

Abstract: Coagulopathy in trauma patients occurs due to tissue injury, hemodilution (dilution of hematocrit and clotting factors), infusion of hypo-coagulable blood products (e.g., packed red blood cells), acidosis, hypothermia, continued blood loss, and depletion of clotting factors. The onset of coagulopathy begins with the initial tissue injury and evolves rapidly. Many factors need consideration when determining resuscitative treatment for the trauma victim. These factors include the amount of time for extraction from the field, transport time to a trauma center, associated weather, and treatment provided in route. This study compared two clinical laboratory pathways (Conventional Coagulation test and Rotational Thromboelastometry …

Anaesthesia Error In United States: Reasons For Mismanagement, Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, Ben Lundberg

Posters and Presentations: College of Public Health

A poster from the UNMC Undergraduate Public Health Workshop

Multi-Organ Dysfunction Secondary To Yellow Scorpion Sting, Muhammad Faisal Khan, Hameed Ullah

Department of Anaesthesia

Scorpion stings are common in tropical and subtropical regions. The history and clinical manifestation warrant urgent recognition and treatment. The incidence of scorpion stings in Pakistan is not known as there is no published data available in literature. We report our experience of a yellow scorpion sting victim who required intensive care admission after developing multi-organ dysfunction.

Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan

Department of Anaesthesia

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the …

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new …

An Evaluation Of Critical Resources In Nurse Anesthesia Educational Programs, Lois E. Stewart

Theses and Dissertations

Advanced practice nurses fill a vital need in the U.S. by increasing access to needed healthcare. Certified Registered Nurse Anesthetists (CRNAs) are one type of advanced practice nurse with a long history of safe and effective peri-anesthetic care. Nurse anesthetists have a rich tradition of providing anesthetic care for rural and underserved communities, and are a primary provider of anesthesia for active and retired military personnel. CRNAs comprise over one-half of the actively practicing U.S. anesthesia workforce currently, and are able to function in any anesthetic care model. Nurse anesthesia educational programs (NAEPs) are the single source for new graduate …

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus …

Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo

Doctoral Projects

Laparoscopic capability provides numerous benefits to patients requiring abdominal surgical procedures. However, the use of these techniques has presented the anesthesia provider with a unique set of challenges in terms of perioperative management and postoperative pain reduction. No standardized method has existed to reduce postoperative pain and improve recovery following these procedures. There were three primary goals of this project. The first goal was to conduct a meta-analysis of randomized controlled trials to determine the benefit of the use of intravenous lidocaine infusions to reduce postoperative pain in laparoscopic abdominal surgery. Twelve articles were included in the meta-analysis that pertained …

Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman

Doctoral Projects

Metastasis following the surgical resection of primary site breast cancer is a medical issue, which plagues mastectomy patients. The intention of this project was to synthesize current literature in order to make a presentation and disseminate it to Certified Registered Nurse Anesthetists (CRNAs) in southern Mississippi and assess the providers' willingness to change practice. CRNAs took part in a Qualtrics survey after viewing a PowerPoint presentation of evidence regarding anesthesia and metastasis. The presentation illustrated the anesthetic techniques and pharmacological agents utilized, which either mitigate or potentiate a patient's risk for metastasis. The survey assessed for a willingness to change …

Coexisting Cardiac And Hematologic Disorders., Jordan E. Goldhammer, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Patients with concomitant cardiac and hematologic disorders presenting for noncardiac surgery are challenging. Anemic patients with cardiac disease should be approached in a methodical fashion. Transfusion triggers and target should be based on underlying symptomatology. The approach to anticoagulation management in patients with artificial heart valves, cardiac devices, or severe heart failure in the operative setting must encompass a complete understanding of the rationale of a patient's therapy as well as calculate the risk of changing this regimen. This article focuses common disorders and discusses strategies to optimize care in patients with coexisting cardiac and hematologic disease.

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Systemic-To-Pulmonary Artery Pressure Ratio As A Predictor Of Patient Outcome Following Liver Transplantation, Annette Rebel, Dung Nguyen, Brooke Bauer, Paul A. Sloan, Amy Dilorenzo, Zaki-Udin Hassan

Anesthesiology Faculty Publications

AIM To assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant (OLT).

METHODS A retrospective data analysis was performed and data (mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit (ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/mPAP ratio, 2 hemodynamic responses were …

The Evaluation Of An Information Booklet In The Use Of Effective Patient Communication In The Setting Of Thoracic Anesthesia, Camille Guillot Miss, Gerry Keenan Dr

Patient Experience Journal

Effective communication is crucial in assuring a good patient experience during an in-hospital stay. In some settings, such as thoracic anaesthesia, patients are given a heavy load of new complex information, in a very limited space of time. Written information, such as patient information booklets, could help as an aid memoir and improve patient’s subjective understanding and preparedness for procedures. This study aims to produce a booklet, specifically targeted at thoracic anaesthesia, and to evaluate it using a linguistics framework in relation to the patient experience and clinical communication. For the study, a booklet was produced in the context of …

Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt

Theses & Dissertations

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists …

Isolated Prehospital Hypotension Correlates With Injury Severity And Outcomes In Patients With Trauma, Clayton D. Damme, Jiangtao Luo, Keely L. Buesing

Journal Articles: Anesthesiology

Objective Patients normotensive in the trauma bay despite documented prehospital hypotension may not be recognized as significantly injured. The purpose of this study was to determine whether isolated prehospital hypotension portends poor outcomes and correlates with injury severity.

Methods Prospective cohort study conducted at a level 1 university trauma center. The lowest recorded prehospital systolic blood pressure (SBP) and the first recorded SBP on hospital arrival were used to divide patients into either the normotensive (NP) or hypotensive (HP) group. Patients who failed to achieve normotension on hospital arrival were excluded. Hypotension was defined as SBP≤110 mmHg.

Results Compared to …

Long-Term Clinical Outcome Of Peripheral Nerve Stimulation For Chronic Headache And Complication Prevention, Linqiu Zhou, Avi Ashkenazi, Joseph W. Smith, Na Jen, Timothy R. Deer, Chen Zhou

Department of Anesthesiology Faculty Papers

Background: Subcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation. Objectives: Here we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique. Patients and Methods:We searched our database for patients with chronic refractory headacheswhohad undergone PNS. Patients were assessed before …

Cognitive Aid Use Improves Transition Of Care By Graduating Medical Students During A Simulated Crisis, Brooke Bauer, Annette Rebel, Amy Dilorenzo, Randall M. Schell, Jeremy S. Dority, Faith Lukens, Paul A. Sloan

Anesthesiology Faculty Publications

Background: Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate.

Objective: The aim of the project was to assess: 1) graduating medical students' ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality.

Methods: The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one …

Malignant Hyperthermia, Aaron Roth

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia is a rare disease trait and can take place in a variety of settings. If not treated in a timely manner, the consequences will be dire. It is recommended that nurses and other healthcare personnel be properly educated on MH crises. By detecting the signs and symptoms associated with the disease, providers can efficiently remedy the crisis and save patient lives (Seifert, 2014). Since the discovery of dantrolene in 1975 and the advancement of genetics regarding MH, death rates dropped from about 80% to about 5% (Schneiderbanger et al., 2014). Today there is a MH group called the …

Adverse Drug Effects And Preoperative Medication Factors Related To Perioperative Low-Dose Ketamine Infusions., Eric S. Schwenk, Stephen F. Goldberg, Ronak D. Patel, Jon Zhou, Douglas R. Adams, Jaime L. Baratta, Eugene R. Viscusi, Richard H. Epstein

Department of Anesthesiology Faculty Papers

High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions …

Awareness Regarding Application Of Endotracheal Tube (Ett) Cuff Pressure Measuring Gauge In Anesthesia Practice; Acritical Step To Avoid Postintubation Tracheal Stenosis In Critically Ill Patients On Prolonged Mechanical Ventilator, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

A Randomised Controlled Trial Comparing Weight Adjusted Dose Versus Fixed Dose Prophylactic Phenylephrine Infusion On Maintaining Systolic Blood Pressure During Caesarean Section Under Spinal Anaesthesia, Lucy Mwaura, Vitalis Mung’Ayi, Jimmie Kabugi, Samina Mir

Anaesthesiology, East Africa

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient. A prophylactic phenylephrine infusion combined with a fluid co-load is proven to be an effective and safe method of maintaining maternal hemodynamic stability. While most published studies have …

Managing Opioid-Tolerant Patients In The Perioperative Surgical Home., John T. Wenzel, Eric S. Schwenk, Jaime L. Baratta, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.

Comparison Of Weight Adjusted Dose Versus Fixed Dose Ondansetron In Preventing Shivering Following Spinal Anesthesia For Cesarean Deliveries, Moses Kimuri Gicheru

Master of Medicine in Anaesthesiology

Background: Spinal anesthesia is an effective regional anesthesia technique, which is preferred in almost 86% of cesarean sections in the United States and United Kingdom. Eighty percent of cesarean sections done at the Aga Khan University hospital are under spinal anesthesia. Shivering is a common complication of spinal anesthesia, it occurs in 40%-64% of patients after neuraxial anesthesia. Shivering may cause maternal and fetal hypoxemia, maternal discomfort and a problem to the anesthesiologists when it comes to monitoring the patient during cesarean sections. Ondansetron a 5-HT3 receptor antagonist is effective in treatment and prevention of post spinal anesthesia shivering. In …

Effect Of Laryngeal Mask Airway Manometry On Post-Operative Sore Throat In Spontaneously Breathing Adult Patients Presenting For Surgery At Aga Khan University Hospital, Nairobi, David Njoroge Waruingi

Master of Medicine in Anaesthesiology

Background: Laryngeal mask airways (LMAs) are widely used in anaesthesia and are considered to be generally safe. Postoperative sore throat (POST) is a frequent complication following LMA use and can be very distressing to patients. The use of an LMA cuff pressure of between 30 and 32cm of H20 in alleviating postoperative sore throat has not been investigated. Primary objective: To compare the occurrence of POST between the intervention group in which LMA cuff pressures will be adjusted to 30-32cm of H20 and the control group in which only monitoring of LMA cuff pressures will be done. Secondary Objectives: To …

Effect Of Low-Dose Ketamine Versus Fentanyl On Attenuating The Haemodynamic Response To Laryngoscopy And Endotracheal Intubation In Patients Undergoing General Anaesthesia At The Aga Khan University Hospital, Nairobi, Angela Ongewe

Master of Medicine in Anaesthesiology

Background: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. Current evidence is conflicting concerning the best agent and optimal dose for this purpose. In the majority of cases, Fentanyl is widely utilized to attenuate haemodynamic responses. Ketamine, an established available drug, has been scarcely studied in this regard at low doses and against varying doses of other common agents. Objective: The primary objective was to compare the overall occurrence of hypertension and tachycardia immediately pre-intubation (post-induction) until 10 minutes post intubation between the study group receiving …

Effects Of Preoperative Aspirin On Major Outcomes In Graded High-Risk Patients Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Jordan E. Goldhammer, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Among patients with cardiovascular disease, nearly 70% take preventive aspirin.¹
• The benefits of aspirin are greater as a patient’s risk of cardiovascular events increases; patients with a lower risk of cardiovascular events derive less of a benefit from aspirin.²
• The effect of aspirin in surgical patients has not yet been investigated, in particular if there is an optimal effect based on operative risk when undergoing cardiac surgery.

Objective:

To determine the effects of preoperative aspirin on major outcomes after cardiac surgery in patients with low, medium, and high predicted operative mortality as determined by the EuroSCORE risk …

Effects Of Diabetes Mellitus And Chronic Kidney Disease On Major Outcomes In Patients Undergoing Cardiac Surgery, Mark W. Berguson, Jordan E. Goldhammer, Hong Liu, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). CKD typically manifests in late stages of DM.

• DM and CKD are prevalent in patients with cardiovascular disease.

• The impact of concurrent DM and CKD on major adverse cardiocerebral events (MACE) in patients undergoing cardiac surgery remains unclear.^1,2

Objective:

To determine the effect of DM and CKD on major outcomes in patients undergoing cardiac surgery.

Preoperative Aspirin And Major Perioperative Outcomes In Patients With Hypertension Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Hypertension is prevalent in patients undergoing cardiac surgery and associated with a higher incidence of cardiovascular complications.
• Aspirin has been shown to prevent cardiovascular events in patients with a high risk of cardiovascular disease.
• Very few studies have investigated aspirin and hypertension, particularly its effects on major outcomes in hypertensive patients undergoing cardiac surgery.^1,2

Objective

To determine the effects of preoperative aspirin on postoperative outcomes for patients with hypertension undergoing cardiac surgery.

To examine the impact of chronic kidney disease and heart failure superimposed with hypertension on outcomes after cardiac surgery.

Renal Stress Testing In The Assessment Of Kidney Disease, Lakhmir S. Chawla, Claudio Ronco

Anesthesiology and Critical Care Medicine Faculty Publications

As part of human evolutionary development, many human organ systems have innate mechanisms to adapt to increased “work demand” or stress. This reserve capacity can be informative and is used commonly in cardiology to assess cardiac function (e.g., treadmill test). Similarly, the kidney possesses reserve capacity, which can be demonstrated in at least 2 of the following renal domains: glomerular and tubular. When appropriate stimulants are used, healthy patients with intact kidneys can significantly increase their glomerular filtration rate and their tubular secretion. This approach has been used to develop diagnostics for the assessment of renal function. This article reviews …