Anesthesiology Commons^™

Opioid Free Anesthesia In Arthroscopic Knee Surgery: A Feasible Approach To Patient Care, Carson Gifford, Denise Vidal, Dail Kim, Austin Goff, Paul Reynolds

HCA Healthcare Journal of Medicine

Background

The opioid epidemic has prompted exploration of opioid-free anesthesia (OFA) techniques, but the optimal approach is still debated. While some OFA protocols substitute opioids with other agents, these alternatives can introduce their own risks. The objective of this study was to investigate whether eliminating intraoperative opioids without analgesic substitution in arthroscopic knee procedures affects postoperative pain control and opioid requirements.

Methods

We conducted a retrospective analysis of 205 patients who underwent arthroscopic knee procedures between August and November 2023. Patients were divided into 2 groups: those who received intraoperative fentanyl (25-200 mcg, n = 144) and those who received …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

Quality Improvement Initiative To Improve Adherence To Ob Hemorrhage Policy And Standardize Pitocin Administration During Cesarean Sections To Reduce Postpartum Hemorrhage Risk, Lauren R. Litz, Monica Blauser

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, and Pitocin administration is an important component of hemorrhage prevention and management during cesarean delivery. Variation in Pitocin timing, dosing, method of administration, and adherence to evidence-based recommendations may compromise patient safety and create barriers to standardized obstetric anesthesia care. The purpose of this Doctorate of Nurse Anesthesia Practice quality improvement project was to evaluate current anesthesia provider practices for Pitocin administration during cesarean delivery, compare observed practices with the California Maternal Quality Care Collaborative hemorrhage toolkit and Society for Obstetric Anesthesia and Perinatology Enhanced Recovery After Cesarean recommendations, …

Transfusion Intensity In The Icu: Reasons And Triggers, Merijn Reuland, Senta Raasveld, Jimmy Schenk, Claudia Oord, Sanne Bruin, Caroline Schaap, Andrew Flint, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background The reasons and physiological triggers for blood transfusion in critically ill patients are not well characterized. Beyond hemoglobin levels, hemodynamic instability is frequently cited, but its role across clinical contexts remains unclear.

Aims (1) To determine whether reasons and triggers for RBC transfusion differ across intensive care unit (ICU) days with varying transfusion intensity. (2) To describe reasons for non-RBC transfusions across these intensity groups.

Methods This sub-study of the prospective International Point Prevalence Study of Intensive Care Unit Transfusion Practices (InPUT) classified ICU days by transfusion intensity: nonmajor (1 RBC unit), major (≥2 units), and massive (≥6 units …

An Update On The Role Of Multimodal Analgesia In Perioperative Pain Management, Whitney N. Kuwamoto, Grace C. Eddy, Edward R. Mariano, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide …

Exploration Of The Vein To Vein Blood Transfusion System In Three Kenyan Counties: A Qualitative Study, Linda Barnes, Jennifer Makin, Jose Paiz, Jana Macleod, Cindy Makanga, Tecla Chelagat, Alejandro Munoz-Valencia, Ejemai Eboreime, Robert Kaburu, Carolyne Njoki

Anaesthesiology, East Africa

Background Severe shortages of blood for transfusion are a persistent global health crisis, with the burden disproportionately concentrated in low-income countries. Diverse stakeholder perspectives on blood availability might inform improvements. We aimed to use a comprehensive approach to identify the challenges, facilitators, and innovations within the blood transfusion continuum (BTC) in three different Kenyan settings.

Methods In this qualitative study, we interrogated the BTC in Siaya, Nakuru, and Turkana counties as part of the Pathways for Innovation in Blood Transfusion Systems in Kenya (PITS Kenya) mixed methods research study. We used purposive sampling, and through interviews and focus group discussions, …

Characteristics Of Intensive Care Unit Registries - Findings From The Global Registry Icu Datasets (Grid) Survey, Luigi Pisani, Paola Lecce, Cornelius Sendagire, Vrindha Pari, Carlo Olivieri, Rabiul Uddin, Diptesh Aryal, Priyantha Athapattu, Sean Bagshaw, Wangari Siika

Anaesthesiology, East Africa

Background: Intensive care unit registries, which aim to improve the quality of intensive care unit care through benchmarking and quality improvement initiatives, are active worldwide, with considerable dishomogeneity. We aimed to map core datasets, additional variables, and research activities of these registries.

Methods: A cross-sectional survey was disseminated to registry leads between October 2023 and June 2024. The survey was structured into four main topics: registry characteristics and coverage, core dataset features, additional modules, and registry-enabled research.

Results: Leads of 34/42 national registries responded (response rate 81%), covering 3,337 intensive care units, with a larger representation from …

Improving Iv Access Outcomes In Obstetric Care Through A-Diva Scale Utilization And Point-Of-Care Ultrasound, Parth S. Patel, Matthew T. Komorowski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric (OB) patients frequently present physiological changes, including edema, obesity, and peripheral vasoconstriction, that increase the risk of difficult intravenous access (DIVA). Multiple IV attempts can delay time-sensitive therapies in obstetric emergencies and increase patient discomfort and provider workload. Research studies have supported the use of the Modified Adult Difficult Intravenous Access (A-DIVA) scale to assess patients for DIVA, and the use of point-of-care ultrasound (POCUS) guided peripheral intravenous access (PIVA). In 2025, a preceding Doctor of Nurse Anesthesia Practice (DNAP) project implemented A-DIVA in the Labor & Delivery (L&D) unit of an OB department and found that 35% of …

Integration Of Intraoperative Data In Interpretable Machine Learning Models To Predict Postoperative Aki In Noncardiac Surgery Patients, Justin Do, Karan H. Shah, Melissa Xu, Andrew Hyunwoo Kim, Vivaswat Suresh, Nidhir Guggilla, Michael Li, Rishi Kothari

Department of Anesthesiology Faculty Papers

OBJECTIVES: We aimed to (1) quantify changes in discrimination when adding intraoperative data to preoperative data and (2) compare tabular machine learning with feature engineering against a time-aware LSTM-based model.

MATERIALS AND METHODS: Retrospective cohort of 46 204 adults undergoing 57 055 eligible noncardiac surgery in the INSPIRE database. We extracted 38 preoperative and 49 intraoperative variables; acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria and modeled as stage 2/3 postoperative AKI. Models were trained on preoperative-only and combined pre- and intraoperative data. Intraoperative series were summarized using eight statistical features for tabular models or integrated directly …

Updated 2026 Comprehensive Evidence-Based Guidelines For Facet Joint Interventions In The Management Of Chronic Spinal Pain: American Society Of Interventional Pain Physicians (Asipp) Guidelines, Laxmaiah Manchikanti, Mahendra R. Sanapati, Sheri L. Albers, Alan D. Kaye, Vinita Singh, Nebojsa Nick Knezevic, Rajesh Naidu Janapala, Amol Soin, Annu Navani, Adam M. Kaye, Ahad Mussarat, Alexander Bautista, Dajie Wang, Paul J. Christo, Maged Mina, Daneshvari R. Solanki, Devi Nampiaparampil, Gerard Limerick, John Manor, Kris Ferguson, Lynn Cintron, Michael Bottros, Shirley Chen, Shivam S. Shah, Vahid Grami, Douglas P. Beall, Shalini Shah, Sairam Atluri, Mittal S. Prajapati, Alaa Abd-Elsayed, Salahadin Abdi, Steve Aydin, Sanjay Bakshi, Joseph Cabaret, Aaron K. Calodney, Kenneth D. Candido, Christopher G. Gharibo, Mayank Gupta, Michael Harned, Standiford Helm Ii, Sachin Sunny Jha, Radomir Kosanovic, Vidyasagar Pampati, Ramarao Pasupuleti, Bradley W. Wargo, Hermant Kalia, Gary Schwartz, Joshua A. Hirsch

Department of Anesthesiology Faculty Papers

BACKGROUND: Chronic axial spinal pain is a major contributor to disability and healthcare expenditures, with facet joints recognized as one of the established sources of pain.

OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions.

METHODS: A multidisciplinary panel of experts from various medical and pharmaceutical disciplines, convened by the American Society of Interventional Pain Physicians (ASIPP), reviewed the available evidence, considered patient perspectives, and formulated recommendations for facet joint interventions in the management of chronic pain.The methodology included the development of key questions with evidence-based statements and recommendations. Grading of the evidence and recommendations followed …

Implementing Preoperative Anxiety Screening To Enhance Patient-Centered Care: A Quality Improvement Initiative, Adam Chaban, Abigail Limary, Amir Ghafarian, Joyce Li, George Mckelvey, Wael Saasouh

Medical Student Research Symposium

Background: Preoperative anxiety affects 40–80% of surgical patients and is associated with poorer perioperative experiences. Despite evidence linking preoperative anxiety to increase postoperative pain, sleep disturbances, morbidity and delayed recovery, structured anxiety assessment is not routinely integrated into outpatient pre-anesthesia workflows. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a validated tool that quantifies patient anxiety and information needs. This quality improvement (QI) project aims to implement APAIS screening in a Pre-Anesthesia Testing (PAT) clinic and evaluate its feasibility, workflow integration, and acceptability.

Methods: This QI initiative will be conducted in adult elective surgery patients at the Detroit Medical …

From Learners To Leaders: A Peer-Led Simulation Program For Anesthesia Procedural Skills Training In Medical Students, Noah S. Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, Dr. John D. Mitchell Md

Medical Student Research Symposium

Title: From Learners to Leaders: A Peer-Led Simulation Program for Anesthesia Procedural Skills Training in Medical Students

Authors: Noah Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, John D. Mitchell, M.D.

Background: Procedural skill competency is vital in medical education, but limited faculty availability poses challenges. We implemented a peer-led simulation program teaching peripheral IV insertion (PIV) and endotracheal intubation, with a focus on student leadership.

Methods: Sixteen peer educators, trained by attendings, conducted monthly workshops from July-October 2025. Students practiced at PIV and intubation stations, assessed via validated rubrics (17 items for PIV, 21 for intubation; 5-point scale). …

Optimizing Patient-Facing Ai Chatbot Questions To Improve Readability And Actionability In Anesthesia Education, Sarah Kadado, Bianca Elias, Roy Soto

Posters

In anesthesia, high patient anxiety and limited counseling time increase the need for clear, usable information. Artificial intelligence (AI) chatbots (e.g., ChatGPT) are increasingly used for patient anesthesia education. Many AI-generated responses exceed the recommended 6th-8th grade reading level for patient education information. Responses also often lack actionable guidance for patients. This study quantifies how optimizing patient-facing prompts improves readability, understandability, and actionability.

Anatomy Of Teamwork: Leveraging Peer Feedback To Build A Bespoke Team Charter Assignment, Emily Tenniswood, Stefanie Attardi

Posters

Post-COVID-19, students in our M1 Anatomical Foundations of Clinical Practice (AFCP) courses increasingly request faculty guidance or intervention in managing intra-dissection team conflict.

Brief Review: Does Red Hair Phenotype Affect Propofol Pharmacokinetics Or Pharmacodynamics?, James Espinosa, Frank Wheeler, Robin Lahr, Sergey Medlenov, Alan Lucerna

Rowan-Virtua Research Day

Background: A persistent belief within Emergency Medicine and perioperative culture suggests that individuals with red hair require altered anesthetic dosing. While early studies demonstrated increased requirements for certain volatile anesthetics in red-haired individuals, this association is frequently generalized to propofol without clear supporting evidence.

Objective: To review current literature regarding the relationship between red hair phenotype (and MC1R variants) and propofol pharmacokinetics (PK) and pharmacodynamics (PD).

Methods: A focused narrative review of controlled human studies and relevant clinical outcome data evaluating propofol PK and PD in red-haired individuals.

Results: Evidence supporting altered anesthetic requirement in red-haired individuals primarily derives from …

The Comparative Efficacy Of Perioperative Pharmacological And Non-Pharmacological Strategies In Reducing Post-Anesthesia Cognitive Impairment Among Elderly Patients: A Literature Review, Mehnaz Islam Khan, Natalie Santos De La Torre, Christine Cherian, Shreya Shah

Rowan-Virtua Research Day

Older adults (≥65 years) are at increased risk for postoperative cognitive impairment, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), which contribute to prolonged recovery, increased morbidity, and mortality. Preventive strategies include pharmacological interventions and non-pharmacological approaches such as cognitive training; however, these approaches are typically studied in isolation. The purpose of this literature review was to compare the effectiveness of perioperative pharmacological and non-pharmacological interventions in reducing postoperative cognitive impairment in elderly surgical patients. A review of six studies, including randomized controlled trials and cohort studies, was conducted in patients undergoing cardiac, spinal, and noncardiac surgeries. Cognitive outcomes, …

Implementation Of Evidenced Based Practice Guidelines For Reducing Emergence Delirium In Elderly Patients Undergoing A Total Hip Replacement, Luke D. Kleinfelder

Doctor of Nursing Practice Scholarly Projects

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the …

Proposed Evidence-Based Practice Guidelines For Using Esmolol To Blunt The Sympathetic Stress Response To Laryngoscopy And Intubation, Maya Kurdi

Doctor of Nursing Practice Scholarly Projects

Direct laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review …

Enhancing The Diversity And Number Of Certified Registered Nurse Anesthetists: A Proposed Pipeline Program For Underrepresented Students, Alexis Lamoreaux

Doctor of Nursing Practice Scholarly Projects

The underrepresentation of minority groups in the Certified Registered Nurse Anesthetist (CRNA) profession impacts healthcare providers’ diversity and cultural competence. This Final Scholarly Project (FSP) proposes a pipeline program to increase diversity within the CRNA field by providing academic support, mentorship, and clinical exposure to students from underrepresented backgrounds. Given the shortage of anesthesia providers, especially in underserved areas, improving access to the CRNA profession for minority students is critical for enhancing patient outcomes. This FSP suggests establishing mentorship and skill development concepts through a 12-month structured program that targets minorities, first-generation college students, or those from rural backgrounds. The …

Impact Of Intracranial Pressure Monitoring On 30-Day Mortality In Severe Traumatic Brain Injury: A Retrospective Cohort Study In Kenya, George Ongas, Idris Chikophe, Jacqueline Mavuti, David Olunya, Mubashir Qureshi, Beverly Cheserem, Edwin Mogere

General Surgery, East Africa

OBJECTIVE The objective of this study was to evaluate 15-year trends in epidemiology, baseline severity, management, and outcomes of severe traumatic brain injury (sTBI) at a Kenyan tertiary center, and to determine the impact of invasive intracranial pressure (ICP) monitoring on 30-day mortality in a low- and middle-income country (LMIC) context.

METHODS A retrospective quasi-experimental cohort analysis of consecutive sTBI admissions (postresuscitation Glasgow Coma Scale [GCS] score ≤ 8, age ≥ 13 years) from January 1, 2010, to December 31, 2024, was conducted. This time period was divided into two eras: era 1 (2010–2014), premonitoring, and era 2 (2015–2024), routine …