Anesthesiology Commons^™

Procalcitonin As A Biomarker Of Acute Kidney Injury In Patients With Suspected Bacterial Sepsis In The Acute Care Setting, Austin Kantola, Jose Navas Blanco, Jacob Keeley

Posters

Acute kidney injury (AKI) is a common, life-threatening complication in patients with sepsis and septic shock.→ Approximately one-half of patients with sepsis experience an AKI.4 → One-third of all acute kidney injuries are related to sepsis.4 → Sepsis-associated AKI raises in-hospital mortality eightfold and the risk of chronic kidney disease development threefold.1,2,3. Early identification of AKI could save time and resources, lower costs, improve patient outcomes. Therefore, a biomarker for earlier AKI detection in patients with sepsis would serve an outstanding role in health care.In the setting of bacterial infection, an upregulation of innate immune system gene transcription and translation …

Effects Of Changing The Frequency Of Epidural Steroid Injections For Elderly Patients With Lumbar Radiculopathy/Lumbar Spinal Stenosis, Nitin Venkatesh, Rebecca Clemans, Roy Soto

Posters

Lower back pain is highly prevalent and a significant cause of disability.

50-84% of adults experiencing back pain at some point.

Previously, patients with chronic lumbar radiculopathy received a maximum of 6 injections a year (q8w).

On Dec 2021, Medicare Coverage of ESIs was updated to limit ESIs to a max of 4 a year (q12w).

Implementation Of An Opioid Free Pediatric Hernia Repair Protocol, Corey Shafer, Antonela Muca, Randy Hilleary, Kristin Lemarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

A Case Of A Massive Right Atrial Thrombus Removal Under Transesophageal Echocardiographic Guidance, Justin Phillips, Max Kabolowsky, Alex M. Hendon, Samantha Arzillo

HCA Healthcare Journal of Medicine

Background

With the advent of catheter guided interventions, practitioners have added another tool alongside chemical lysis and surgical removal to reduce the clot burden of patients with large emboli and thrombi. Due to comorbid conditions, many patients are poor candidates for surgical or chemical clot treatment but may present optimally for catheter-based thromboembolectomy. In this case, we highlight the benefits of mechanical thrombectomy with transesophageal echocardiographic guidance to reduce the clot burden of a patient who would otherwise be considered a poor candidate for surgical or chemical treatment.

Case Presentation

This case follows a 78-year-old man with a past medical …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …

Diabetes Mellitus And Associated Vascular Disease: Pathogenesis, Complications, And Evolving Treatments, Kazi Islam, Rahib Islam, Ivan Nguyen, Hassan Malik, Humza Pirzadah, Barsha Shrestha, Isabella B. Lentz, Sahar Shekoohi, Alan D. Kaye

School of Medicine Faculty Publications

Diabetes mellitus is a metabolic disorder, characterized by elevated blood sugar levels (hyperglycemia) and insulin dysregulation. This disease is associated with morbidity and mortality, including significant potential vascular complications. High levels of hyperglycemia lead to not only elevated levels of reactive oxygen species but also advanced glycation end products, which are detrimental to the vascular endothelium and reduce protective compounds such as nitric oxide and prostacyclin. This damage contributes to the development of both macrovascular and microvascular complications. The present investigation explores the pathophysiological mechanisms of diabetic vascular complications and evaluates current management strategies, including lifestyle modifications, pharmacological treatments, and …

Impact Of Perioperative Organ Injury On Morbidity And Mortality In 28 Million Surgical Patients, Felix Kork, Yafen Liang, Adit A Ginde, Xiaoyi Yuan, Rolf Rossaint, Hongfang Liu, Alex S Evers, Holger K Eltzschig

Faculty, Staff and Student Publications

Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated …

The Effect Of Abdominal Insufflation On Transversus Abdominis Plane (Tap) Block Efficacy In Laparoscopic Gynecologic Surgery, Hussein A. Bazzi, Justin Hruska M.D., Christopher Kliethermes M.D., Anne Thomas, Wael Saasouh M.D.

Medical Student Research Symposium

Introduction:

Approximately 15 million laparoscopic procedures are performed annually worldwide, with 4.8 million (32%) occurring in the United States. Laparoscopy is widely used for procedures such as bilateral tubal sterilizations, hysterectomies, and treatments for endometriosis and adhesions. During gynecologic laparoscopic surgeries, the abdomen is inflated with pressurized carbon dioxide for surgical visualization. Pain management typically involves a transversus abdominis plane (TAP) block, which provides intermediate postoperative pain relief (lasting 12–24 hours). This study evaluates the efficacy of TAP blocks performed during insufflation to improve postoperative pain outcomes compared to the traditional technique.

Methods:

This patient-blinded study included female gynecologic patients …

The Effect Of A M-Health Application Compared To Standard Of Care On Adherence To Preoperative Fasting Instructions Among Adult Patients Undergoing Elective Surgery: A Randomized Controlled Study, Ivy Njeri Wanyoike

Master of Medicine in Anaesthesiology

Background: Preoperative fasting has been a pillar of the practice of anaesthesiology with the main aim of enhancing patient safety by reducing the risk of aspiration. Current clinical guidelines on preoperative fasting guidelines encourage shorter durations of fasting in keeping with current evidence that shows better patient outcomes while maintaining patient safety. Despite this, adherence to preoperative fasting instructions remains universally poor, with patients enduring long fasting periods. Advances in mobile technology, improving internet access and the widespread availability of smartphones have made mobile health a useful tool in patient care. mHealth applications are being increasingly used in perioperative …

Advancing Provider Knowledge On Precedex Use To Prevent Postoperative Delirium Through Targeted Education, Brian Gibbs

Scholars Week

Postoperative delirium (POD) is a serious and multifactorial complication commonly affecting elderly surgical patients. POD is associated with increased morbidity, longer hospital stays, and higher mortality rates. The use of benzodiazepines and opioids during the perioperative period is a significant modifiable risk factor for POD. Despite the potential of Dexmedetomidine (Precedex) to reduce POD incidence due to its sedative, and analgesic properties, it is not widely available in many operating rooms (OR). This project aimed to educate anesthesia providers on the benefits of Precedex and its role in reducing POD in patients over 65 years old. A quality improvement project …

Adverse Health Effects Of Waste Anesthetic Gases (Wags): A Scoping Review Of Genetic, Immunotoxic, And Reproductive Impacts, Cozette Wilkins

Student Works

1 Background/Introduction: Occupational exposure to Waste Anesthetic Gases (WAGs) is a well-known concern for healthcare workers, especially those working in high-risk areas like the operating room (OR). Despite the implementation of safety measures such as WAG scavenging systems, there remains ongoing concern about the potential adverse health effects linked to exposure. This scoping review aims to map the existing evidence on the health risks associated with repeated WAG exposure, specifically focusing on genetic, immunotoxic, and reproductive health impacts. By synthesizing available data, this review seeks to better understand the extent of these risks and identify key gaps in the literature …

Glucagon-Like Peptide-1 Receptor Agonists: Exciting Avenues Beyond Weight Loss, Lalitha Sundararaman, Divakara Gouda, Anil Kumar, Sumithra Sundararaman, Basavana Goudra

Department of Anesthesiology Faculty Papers

The last two decades have proffered many remarkable choices in managing type 1 and type 2 diabetes mellitus. Leading the list are glucagon-like peptide-1 receptor agonists (GLP1RAs), the first of which, exenatide, was approved by the FDA in 2005. Two other major classes of drugs have also entered the market: dipeptidyl peptidase-4 (DPP-4) inhibitors, commonly known as gliptins and approved in 2006, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, with the first approval occurring in 2013. These drugs have revolutionized the treatment of diabetes. Additionally, on the horizon, the once-weekly basal insulin analog insulin icodec and the once-weekly combination of insulin icodec …

Interdisciplinary Management Of A Patient With Developmental Disabilities Under General Anesthesia In An Academic Dental Surgery Center: A Case Report, Kevin R. Adams, Tim Verceles, Fatima Mashkoor, Jesse W. Manton

Pacific Journal of Health

Background: Individuals with intellectual and developmental disabilities may require dental care to be delivered while under general anesthesia, albeit there is often greater need for these services than hospital capacity allows.

Case Description: This case report presents a 19-year-old male with intellectual and developmental disabilities and numerous comorbidities who was able to be treated under general anesthesia in an academic dental surgery center by an interdisciplinary team. The accompanying discussion identifies strategies that dental teams and academic centers can consider to effectively provide care to patients with intellectual and developmental disabilities who require general anesthesia.

The Efficacy Of The Minimally Invasive Lumbar Decompression (Mild®) Procedure: A Prisma-Compliant Systemic Review And Meta-Analysis, Xin-Yu Zhang, Jian-Li Zhao, Ya-Jing Wang, Jie Luan, Hong-Qi Lin, Dajie Wang

Department of Anesthesiology Faculty Papers

BACKGROUND: Lumbar spinal stenosis is the most common cause for spinal surgery of older adults. It is associated with pain in the legs and back as well as impaired ambulation. Minimally Invasive Lumbar Decompression (MILD®, Vertos Medical) is a percutaneous, image-guided lumbar decompression technique for central canal stenosis secondary to a hypertrophied ligamentum flavum. However, whether MILD can achieve adequate beneficial results in patients with lumbar spinal stenosis remains undetermined.

OBJECTIVE: To assess the efficacy and complications of MILD for lumbar spinal stenosis.

STUDY DESIGN: A systematic review and meta-analysis.

METHODS: Electronic databases were searched to identify all clinical trials …

Blind Nasal Intubation As A Rescue Strategy In Difficult Airway Management, Riaz Chowdhury, Ashalatha K. Nair, Dheeraj Kamalam, Rohit Jaishankar

HCA Healthcare Journal of Medicine

Background

Airway management in emergency situations poses significant challenges, particularly in patients with difficult airway anatomy or comorbid conditions. Blind nasal intubation has been explored as a rescue technique when conventional methods fail. Masseter muscle rigidity (MMR), characterized by significant jaw muscle stiffness, is a recognized complication following succinylcholine administration that can complicate traditional approaches to securing an airway.

Case Presentation

A 75-year-old man with multiple comorbidities, including hypertension, prior stroke with paralysis, dementia, and a seizure disorder, presented with acute hypercapnic hypoxemic respiratory failure requiring emergent intubation. Orotracheal intubation failed due to trismus despite etomidate, succinylcholine, and rocuronium. Nasal …

A Review Of Gut Failure As A Cause And Consequence Of Critical Illness, Danielle E. Soranno, Craig M. Coopersmith, Jessica F. Brinkworth, Faith N. F. Factora, Julia H. Muntean, Monty G. Mythen, Jacob Raphael, Andrew D. Shaw, Vidula Vachharajani, Jeannette S. Messer

Department of Anesthesiology Faculty Papers

In critical illness, all elements of gut function are perturbed. Dysbiosis develops as the gut microbial community loses taxonomic diversity and new virulence factors appear. Intestinal permeability increases, allowing for translocation of bacteria and/or bacterial products. Epithelial function is altered at a cellular level and homeostasis of the epithelial monolayer is compromised by increased intestinal epithelial cell death and decreased proliferation. Gut immunity is impaired with simultaneous activation of maladaptive pro- and anti-inflammatory signals leading to both tissue damage and susceptibility to infections. Additionally, splanchnic vasoconstriction leads to decreased blood flow with local ischemic changes. Together, these interrelated elements of …

Anesthesia And Pain Management In Conflict-Affected Regions: Addressing Global Health Barriers To Access And Quality Of Care​, Naeel Uddin, Sierra Brown, Maria Easler, Ayanda Mkhize, Marwa Hamdam, Chandu Goli, Lauren Draper

Annual Research Symposium

This poster examines how to deliver safe, effective anesthesia and pain control in areas with limited resources and ongoing security threats. Focusing on portable technology, ketamine-based protocols, and telemedicine, we highlight ethical considerations, training needs, and global collaborations. Our findings outline a pathway to reduce suffering and improve surgical outcomes in vulnerable populations by addressing challenges unique to conflict settings.

Validation Of A Novel Landmark-Guided Intra-Articular Postero-Medial Surgeon-Administered Injection Technique, Nicolas S. Piuzzi, Andrew I. Spitzer, Jason Mussell, Ignacio Pasqualini, Stan Dysart, Jeffrey Gonzales, Michael A. Mont, Jess H. Lonner, William Mihalko

School of Medicine Faculty Publications

Background: This study aimed to define an intra-articular surgeon-administered technique that may be comparable to ultrasound (US)-guided adductor canal block (ACB). Methods: Five cadaver lower limbs were examined. An anesthesiologist administered a US-guided ACB using 20 mL of dilute indocyanine dye. An orthopedic surgeon performed a medial parapatellar arthrotomy and introduced an 18-gauge needle 1-2 cm proximal to the palpated adductor tubercle angled posteromedially. Needle position and dye spread were fluoroscopically documented. Results: This technique consistently reached the infrapatellar branch of the saphenous nerve, nerve to the vastus medialis muscle, and posterior capsule, with minimal proximal dye spread. Conclusions: This …

Evidence Based Quality Improvement For Prescribing Stewardship In Icu (Equips-Icu): Protocol For Type Iii Hybrid Implementation-Effectiveness Study, Duncan Wagstaff, John Amausi, Sumaiya Arfin, Diptesh Aryal, Mohd Basri Mat Nor, Joseph Bonney, Arjen Dondorp, David Dongelmans, Layoni Dullawe, Wangari Siika

Anaesthesiology, East Africa

Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unnecessary side-effects and drives population-level antimicrobial resistance, the prevalence and consequences of which are greatest in low- and middle-income countries. However, the implementation of interventions to improve the appropriateness of antimicrobial prescribing has been variable and requires further study..

Untreated Hyperthyroidism And A Mediastinal Mass: To Remove Or Not To Remove?, Jennifer M. Alvis, Olga Suarez-Winowiski, Faizaan Khan

Anesthesiology Publications

CASE PRESENTATION: J.W. was seen by the PACE (Preoperative Assessment, Communication and Education) Center prior to a mediastinal mass resection. Medical history includes well-controlled rheumatoid arthritis, anxiety and a recent diagnosis of hyperthyroidism. Labs were significant for TSH DISCUSSION: Untreated GD is rarely correlated with thymic hyperplasia; however the pathogenesis is not well understood. Regardless of the association, contextualization of this patient's history and lab values prompted the provider to seek specialized management. This finding was then communicated with the surgical team, who often rely on PACE providers to screen patients with the ultimate goal of risk reduction and optimization …