Anesthesiology Commons^™

Increasing Doses Of Intraoperative Hydromorphone Do Not Reduce Postoperative Pain, Craig S. Curry, Michael B. Henry, Wendy Craig, Janelle M. Richard, Denham S. Ward

MaineHealth Maine Medical Center

Introduction:

• Intermediate and long acting opioids are given intraoperatively to reduce pain during emergence from anesthesia.

• Recent evidence suggests that intraoperative opioids have inconsistent effects on nociception and pain in the immediate postoperative period.

• Multiple potent, short-acting opioids such as remifentanil, sufentanil and fentanyl have been shown to produce dose-related increases in pain scores and opioid consumption in the immediate postoperative recovery period.

• Intraoperative doses of longer acting opioids such as morphine and methadone6 have been shown to reduce pain scores and narcotic requirements in the immediate postoperative period.

• Hydromorphone is an intermediate duration narcotic …

Cuff-Less Methods For Blood Pressure Telemonitoring., Dylan M. Bard, Jeffrey I. Joseph, Noud Van Helmond

Department of Anesthesiology Faculty Papers

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This …

Changing Healthcare Provider And Parent Behaviors In The Pediatric Post‐Anesthesia‐Care‐Unit To Reduce Child Pain: Nurse And Parent Training In Postoperative Stress (Np‐Tips), Brooke N. Jenkins, Michelle Fortier, Robert S. Stevenson, Mai Makhlouf, Paulina Lim, Remy Converse, Zeev N. Kain

Psychology Faculty Articles and Research

Background

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.

Methods

In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents …

Perioperative Antimicrobial Prophylaxis In Vascular Surgery: A Quality Assessment And Improvement Project, Brian Torres

Dissertations

Introduction: Prophylactic antimicrobial selection and administration for the prevention of surgical site infections in vascular surgery is a recommended best practice. Non-adherence to published guidelines on the selection and administration of antimicrobials has been observed and may lead to reduced efficacy of antimicrobial prophylaxis.

Methods: An observational, descriptive design was used to study clinician knowledge and behavior and included a retrospective patient record review and provider knowledge survey. A clinical education intervention targeting providers responsible for the selection and administration of antimicrobial prophylaxis was conducted. A repeat patient record review and knowledge survey was completed following the education intervention.

Results: …

Management Of Parturient With Triplet Pregnancy And Placenta Percreta: Importance Of Multi-Disciplinary Approach, Samina Ismail, Akbar Azizullah

Department of Anaesthesia

Obstetric conditions like placenta percreta and multiple pregnancies can be extremely challenging as they pose a high risk for both the mother and infants. In placenta percreta, placental villi penetrate through the wall of uterus into the surrounding organs including the bladder and carry a risk of massive maternal bleeding. Multiple pregnancies have greater complication rate than that in singleton pregnancy. Successful management of such challenges are best done by a multidisciplinary teamwork, where all members of a perinatal team are involved in decision making and management. We report the successful management of a triplet gestation associated with placenta percreta.

Perfect Recipes For Obstetric Anesthesia: Need Of Caution In The Resource Constraint Environment, Samina Ismail, Malika Hameed

Department of Anaesthesia

No abstract provided.

National Approach To Standardize And Improve Mechanical Ventilation, Yaseen M. Arabi, Zohair Al Aseri, Tareef Alaama, Abdulrahman Alqahtani, Abdulrhman Alharthy, Abdullah Almotairi, Eman Al Qasim, Abdullah A. Alzahrani, Mohammed Al Qarni, Asad Latif

Department of Anaesthesia

NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and …

Response To A Case Report Titled: Anaesthetic Management Of A Patient With Left Ventricular Non-Compaction Undergoing Laparotomy, Faraz Shafiq, M Irfan Ul Haq, Anwar Ul Huda

Department of Anaesthesia

No abstract provided.

The Oculocardiac Reflex And Depth Of Anesthesia Measured By Brain Wave., Robert W Arnold, Aleah N Bond, Melissa Mccall, Leif Lunoe

Articles, Abstracts, and Reports

BACKGROUND: The oculocardiac reflex (OCR), bradycardia that occurs during strabismus surgery is a type of trigemino-cardiac reflex (TCR) is blocked by anticholinergics and enhanced by opioids and dexmedetomidine. Two recent studies suggest that deeper inhalational anesthesia monitored by BIS protects against OCR; we wondered if our data correlated similarly.

METHODS: In an ongoing, prospective study of OCR/TCR elicited by 10-s, 200 g square-wave traction on extraocular muscles (EOM) from 2009 to 2013, anesthetic depth was estimated in cohorts using either BIS or Narcotrend monitors. The depth of anesthesia was deliberately varied between first and second EOM tested.

RESULTS: From 1992 …

Sleeping Pattern Before Thoracic Surgery: A Comparison Of Baseline And Night Before Surgery, Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

Background: Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome.
Methodology: Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked …

Intravenous Meloxicam For The Treatment Of Moderate To Severe Acute Pain: A Pooled Analysis Of Safety And Opioid-Reducing Effects., Eugene R. Viscusi, Tong J. Gan, Sergio Bergese, Neil Singla, Randall J. Mack, Stewart W. Mccallum, Wei Du, Sue Hobson

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: To describe the safety and tolerability of intravenous meloxicam compared with placebo across all phase II/III clinical trials.

METHODS: Safety data and opioid use from subjects with moderate to severe postoperative pain who received ≥1 dose of intravenous meloxicam (5-60 mg) or placebo in 1 of 7 studies (4 phase II; 3 phase III) were pooled. Data from intravenous meloxicam 5 mg, 7.5 mg and 15 mg groups were combined (low-dose subset).

RESULTS: A total of 1426 adults (86.6% white; mean age: 45.8 years) received ≥1 dose of meloxicam IV; 517 (77.6% white; mean age: 46.7 years) …

The Utility Of Neutrophil Gelatinase-Associated Lipocalin (Ngal) As A Marker Of Acute Kidney Injury (Aki) In Critically Ill Patients, Shabnum Khawaja, Lena Jafri, Imran Siddiqui, Madiha Hashmi, Farooq Ghani

Department of Pathology and Laboratory Medicine

In current clinical practice, Serum Creatinine (SCr) is a commonly used marker for the diagnosis of acute kidney injury (AKI). Unfortunately, due to a delayed increase in SCr, it is unable to accurately estimate the timing of the injury. The purpose of this study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict AKI in critically ill adult patients. The study was conducted at the Section of Chemical Pathology, Department of Pathology& Laboratory Medicine in collaboration with Department of Anesthesiology, at Aga Khan University Hospital in Karachi, Pakistan. Subjects in the age groups of18 to …

The Accuracy Of Blood Pressure Measurement By A Smartwatch And A Portable Health Device, Vignesh Murali, Noud Van Helmond, Cecilia G. Freeman, Christina Hahnen, Nilanjan Haldar, Jacquelyn N. Hamati, Dylan M. Bard, Geno J. Merli, Jeffrey I. Joseph

Phase 1

Introduction: Hypertension is a leading cause of mortality. Proper blood pressure (BP) control can be achieved by lifestyle modification, pharmacotherapy, and frequent measurements. With the growing popularity of cuffless blood pressure monitors, it is important to independently validate their accuracy.

Objective: We evaluated two cuffless blood pressure monitors, The Everlast TR10 fitness watch and the BodiMetrics Performance Monitor, for their accuracy and precision in BP measurements.

Methods: Using a protocol derived from the ANSI/AAMI/ISO 2013 standard for evaluating automated sphygmomanometers, we measured the blood pressures of 85 patients recruited from the Thomas Jefferson University Hospital Preadmission Testing Center with two …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

Correlation Of Trainees' Selection Scores With Their Subsequent Performance During Specialty Training In Anesthesiology, Aliya Ahmed, Rashida Ahmed

Department of Anaesthesia

Objective: To determine the correlation of trainee selection scores (TSS) with subsequent performance in anesthesiology trainees at a university hospital.
Study Design: Descriptive analytical study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017.
Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores.
Results: Weak correlation was found between TSS and overall assessment …

Applying Quality Improvement Methods To Neglected Conditions: Development Of The South Asia Burn Registry (Sabr), Nukhba Zia Nukhba Zia, Asad Latif, Saidur Rahman Mashreky, Ehmer Al-Ibran, Madiha Hashmi, A. K. M. Fazlur Rahman, Sazzad Khondoker, Mohammed Saeed Quraishy, Adnan A. Hyder

Department of Anaesthesia

Objective: South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.
Results: The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. …

A Randomized, Double-Blinded Trial Comparing The Effectiveness Of Tranexamic Acid And Epsilon-Aminocaproic Acid In Reducing Bleeding And Transfusion In Cardiac Surgery, J. Leff, A. Rhee, S. Nair, D. Lazar, S. Sathyanarayana, L. Shore-Lesserson

Journal Articles

© 2019 Annals of Cardiac Anaesthesia. Objectives: To compare the effectiveness of epsilon aminocaproic acid (EACA) to tranexamic acid (TA) in reducing blood loss and transfusion requirements in patients undergone cardiac surgery under cardiopulmonary bypass. Design: Randomized, double blinded study. Outcome variables collected included; baseline demographic characteristics, type of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood products administered, 30 day mortality and morbidity and length of stay. We analyzed the data using parametric and non-parametric tests as appropriate. Setting: Single center tertiary-care university hospital setting. Participants: 114 patients who had undergone cardiac surgery under …

Anticoagulation Management And Heparin Resistance During Cardiopulmonary Bypass: A Survey Of Society Of Cardiovascular Anesthesiologists Members, R. M. Sniecinski, E. Bennett-Guerrero, L. Shore-Lesserson

Journal Articles

We surveyed Society of Cardiovascular Anesthesiologists members regarding anticoagulation practices for cardiopulmonary bypass and attitudes on heparin resistance. Of 550 respondents (18.5% response rate), 74.9% (95% CI, 71.3%-78.5%) used empiric weight-based dosing of heparin, and 70.7% (95% CI, 66.9%-74.5%) targeted an activated clotting time of either 400 or 480 seconds to initiate cardiopulmonary bypass. Of note, 17.1% (95% CI, 13.9%-20.2%) of respondents reported activated clotting time targets lower than those recommended by recent 2018 Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology guidelines or failed to monitor heparin effects at all. When heparin resistance was encountered, 54.2% …

Assessment Of Volume Status During Prone Spine Surgery Via A Novel Point-Of-Care Ultrasound Technique, Jeremy Hensley, Hong Wang

Faculty & Staff Scholarship

Background Operations performed with the patient in the prone position can pose a significant challenge to the anesthesiologist. Hypotension is a commonly encountered complication. Intravascular volume depletion and decreased cardiac output secondary to decreased preload are thought to be the most likely cause of hypotension in the prone position. Measurement of inferior vena cava (IVC) diameter via point-of-care ultrasound examination (POC_US) has been used to provide an estimate of intravascular volume status. However, this measurement is most often obtained with the patient in the supine position. Materials and methods In this study, we describe a technique for evaluating IVC diameter …

Master Of Science In Anesthesia Fort Lauderdale, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.