Anesthesiology Commons^™

Glucose-Lowering Agents Developed In The Last Two Decades And Their Perioperative Implications, Basavana Goudra, Geno Merli, Michael Green

Department of Anesthesiology Faculty Papers

The last two decades have provided far more options f both patients and their physicians in the treatment of diabetes mellitus. While dipeptidyl peptidase-4 inhibitors (DPP-4is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been approved for nearly two decades, sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are relatively new. Of interest to perioperative physicians, these drugs present specific perioperative concerns, prompting many societies to issue guidelines. Retained gastric contents due to slow gastric emptying is a significant drawback of GLP-1RAs, increasing the risk of aspiration. Recommendations include withholding GLP-1RAs for a predefined period of time, performing gastric ultrasound to evaluate gastric …

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Improving Anesthesia Technician Workflow: Implementation Of A Standardized Checklist And Formal Handoff Communication Tool To Enhance Management Of The Pediatric Portable Anesthesia Lockers Recommendation, Megan Shayna Sosnick Msel, Rn

Master's Projects and Capstones

Objective: The surgical department of a well-known Bay Area medical center faces substantial challenges in supply management. These challenges include inconsistent stocking, disorganized storage, and an inefficient ordering process. These logistical issues impact patient care negatively, increase supply costs, and weaken team morale and communication. U.S. hospitals spend $83 billion annually on medical supplies, with $25.4 billion wasted on preventable material expenses (Balkhi et al., 2022). Aim and Methods: This quality improvement project aims to train 80% of anesthesia technicians in proper stocking procedures for portable pediatric anesthesia lockers within three months. Interventions include the implementation of a standardized …

Evaluation Of Pain Control In Lobectomies: Before And After The Removal Of Liposomal Bupivacaine From Formulary At An Academic Health System, Kelly Cheng Pharmd, Michael Guerra Pharmd, Rebecca Pulk Pharmd, Ms, Bsp, Amber Zaniewski Pharmd, Mba, Bcps, Ryan Brown Pharmd, Bcps

Posters

• Liposomal bupivacaine is an extended-release formulation of the long-acting traditional local anesthetic, bupivacaine.
• Yale New Haven Health system (YNHHS) removed liposomal bupivacaine from formulary in March 2024.
• This decision was based on primary research and meta-analyses showing little to no clinical or statistical benefit of liposomal bupivacaine over traditional bupivacaine in morphine milligram equivalent use (MME) and median pain score in all surgeries including lobectomies.

Point Of Care Ultrasound For Gastric Residual: An Objective Structured Clinical Examination, Brandon Quinn, Kaitlyn Gray

Doctoral Projects

Point of care ultrasound (POCUS) has become an invaluable tool in modern medical practice offering real-time diagnostic and procedural guidance for anesthesia providers. POCUS is a non-invasive assessment tool that gives anesthesia insight into a quantitative assessment of gastric residuals. Furthermore, POCUS assessments are useful in preventing anesthetic complications that can cause major morbidity and mortality such as aspiration pneumonia. Despite the growing relevance, formalized training on POCUS for assessing gastric residuals remains limited in many nurse anesthesia programs. The University of Southern Mississippi currently lacks a standardized curriculum for teaching student registered nurse anesthetists how to utilize gastric ultrasound …

Plasma Transfusion In The Intensive Care Unit, Maite M. T. Van Haeren, Senta Jorinde Raasveld, Sanne De Bruin, Merijn C. Reuland, Claudia Van Den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% …

Management Of Adult Sepsis In Resource-Limited Settings: Global Expert Consensus Statements Using A Delphi Method, Louise Thwaites, Prashant Nasa, Brett Abbenbroek, Vu Quoc Dat, Simon Finfer, Arthur Kwizera, Lowell Ling, Suzana M. Lobo, Robert Sinto, Wangari Siika

Anaesthesiology, East Africa

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.

Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include …

Comparison Of Two Learning Methodologies: Virtual Reality And Osce Simulation, Connor Blackwell, Tabor Mcgee

Doctoral Projects

Anesthesia education has evolved immensely over the past twenty years, and with the new virtual reality (VR) simulations created by SIMVANA, the exponential growth can continue. The anesthesia program at The University of Southern Mississippi (USM) currently utilizes an educational platform known as the Objective Structured Clinical Examination (OSCE) for their students’ clinical curriculum. With the development of technology and education models, the purpose of the doctoral project is to determine if VR simulation can produce more effective learning than the OSCE modules. To determine the effectiveness, pharmacologic lessons for intraoperative hypotension were administered through both platforms and then tested …

A Comprehensive Analysis Of In-Hospital Adverse Events After Scopolamine Administration: Insights From A Retrospective Cohort Study Using A Large Nationwide Inpatient Database, George Sun, Marc Torjman, Kevin Min

Department of Anesthesiology Faculty Papers

BACKGROUND: Scopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions.

METHODS: A large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to …

Anesthesia For Bronchoscopy-An Update, Basavana Goudra, Lalitha Sundararaman, Prarthna Chandar, Michael Green

Department of Anesthesiology Faculty Papers

The field of interventional pulmonology has grown immensely and is increasingly recognized as a subspecialty. The new procedures introduced in the last decade pose unique challenges, and anesthesiologists need to readapt to their specific demands. In this review, we extensively discuss the pathophysiology, technical aspects, preprocedural preparation, anesthetic management, and postprocedural challenges of many new procedures such as navigational bronchoscopy, endobronchial valve deployment, and bronchial thermoplasty. Majority of these procedures are performed under general anesthesia with an endotracheal tube. Total intravenous anesthesia with rocuronium as a muscle relaxant seems to be the standard US practice. The easy availability and proven …

Perioperative Outcomes And Risks For Patients With Prinzmetal Angina Undergoing Abdominal Surgery, George Sun, Md, Matt Owrey, Md, Kevin Min, Md

Department of Anesthesiology Posters

Background

- Prinzmetal angina is a transient, reversible form of acute coronary syndrome

• Characterized by coronary artery spasms that can lead to myocardial ischemia
• Hypothesized that this phenomenon is secondary to coronary hyperreactivity from endothelial or smooth muscle dysfunction¹

- Patients with Prinzmetal angina are at high risk during surgery

• Up to 50% of patients may experience myocardial infarction, fatal arrhythmia, or unstable angina during non-cardiac surgery²
• Limited data looking at postoperative outcomes in patients with Prinzmetal angina

- Goal: Evaluate whether individuals with Prinzmetal angina are at greater risk of mortality, myocardial infarction, and arrhythmia during abdominal surgery

Association Between Mri Findings Of Facet Arthropathy And Synovitis With Health-Related Outcome And Pain Scores Following Therapeutic Lumbar Facet Injections, Michael Stuart Green, Michele Van Hal, Matthew Onimus, Christopher R. Hoffman, Dhruv K. C. Goyal, Valeria Potigailo, Khuram S. Kazmi

Department of Anesthesiology Faculty Papers

Low back pain is a common complaint among adults. The facet joint is a major source of lumbar pain, and therapeutic facet injections have gained popularity as a minimally invasive treatment option. In addition, magnetic resonance imaging (MRI) utilization for diagnosing low back pain has increased significantly over the past few decades. Facet synovitis is an entity characterized by edema and inflammatory changes affecting the facet joints, adjacent bone marrow, and surrounding soft tissues. Although its underlying etiology remains poorly understood, recent reports suggest a high incidence in patients with arthropathy and arthritis. It is essential to explore potential correlations …

Association Between Neuromuscular Blocking Agents And Outcomes Of Emergency Tracheal Intubation: A Secondary Analysis Of Randomized Trials, Stephanie C. Demasi, Wesley H. Self, Neil R. Aggarawal, Michael D. April, Luke Andrea, Christopher R. Barnes, Jason Brainard, Veronika Blinder, Alon Dagan, Brian Driver, Kevin C. Doerschug, Ivor Douglas, Matthew Exline, Daniel G. Fein, John P. Gaillard, Sheetal Gandotra, Kevin W. Gibbs, Adit A. Ginde, Stephen J. Halliday, Jin H. Han, Taylor Herbert, Kevin High, Christopher G. Hughes, Akram Khan, Andrew J. Latimer, Amelia W. Maiga, Steven H. Mitchell, Derek J. Vanderhaar, James E. Walker, Et Al

School of Medicine Faculty Publications

Study objective: To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU. Methods: We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt …

2024 Eacts/Eactaic Guidelines On Patient Blood Management In Adult Cardiac Surgery In Collaboration With Ebcp, Filip Casselman, Marcus Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Gerhardus Haumann

Anaesthesiology, East Africa

Clinical practice guidelines consolidate and evaluate all pertinent evidence available at their time of formulation on a specific topic, the goal being to assist physicians in determining the most effective management strategies for patients with a particular condition. These guidelines assess the impact on patient outcomes and weigh the risk–benefit ratio of various diagnostic or therapeutic approaches. Although not a replacement for textbooks, they provide supplementary information on topics relevant to current clinical practice, becoming an essential tool to support physicians' decision making in daily practice. Nonetheless, it is crucial to understand that these recommendations are intended to guide but …

Intraoperative Status Asthmaticus In A Morbidly Obese Preteen Undergoing Concomitant Vertical Sleeve Gastrectomy And Orthotopic Liver Transplant, Abigail Pint, Neal Campbell, Preethi Tumati

Posters

10-year-old morbidly obese male with cirrhotic ESLD secondary to vertically transmitted Hepatitis C presented for liver transplantation and concomitant vertical sleeve gastrectomy. Other history included moderate persistent asthma, OSA, and presumed HPS with baseline SpO2 of 94%. Induction was smooth; intubation with an armored ETT was easy. During invasive monitor placement, bronchospasm worsened SpO2. Continuous albuterol nebulization provided reasonable reversal, and all stakeholders agreed to proceed. Postoperative course was complicated by status asthmaticus and dramatic extubation on POD3 when patient bit and kinked armored ETT. To date, patient has good graft function and a 16% reduction from his peak BMI.

Characterization Of Pancreatic Collagen-Expressing Fibroblasts In Mouse Acute Pancreatitis, Amy Qin, Kevin Shi, Rachel R. Tindall, Jiajing Li, Binglu Cheng, Jing Li, Baibing Yang, Qiang Yu, Yinjie Zhang, Bangxing Hong, Balveen Kaur, Mamoun Younes, Qiang Shen, Jennifer M. Bailey-Lundberg, Yanna Cao, Tien C. Ko

School of Medicine Faculty Publications

Background and Aims: Pancreatic stellate cells (PSCs) are critical mediators in chronic pancreatitis with an undefined role in acute pancreatitis (AP). PSCs consist of a heterogenous group of cells and are considered interchangeable with pancreatic fibroblasts. This study explored the heterogeneous nature of PSCs by characterizing pancreatic collagen-expressing fibroblasts (PCFs) via lineage tracing in mouse normal and AP pancreas and determining the effect of PCF depletion in AP. Methods: Tandem dimer Tomato (tdTom+) PCFs in collagen type 1 (Col1)a2CreERtdTomato (Tom) mice receiving tamoxifen were characterized via fluorescence, Oil Red staining, and flow cytometry. AP was induced by cerulein, AP injury …

Long-Term Neurodevelopmental Outcomes Post-Chronic Midazolam Exposure During Early Life, Nghi M. Nguyen

Theses & Dissertations

In recent decades, the rising number of neonates born in the Neonatal Intensive Care Unit (NICU) due to prematurity has raised concerns about their overall well-being and development. Premature neonates are at higher risk of health complications and often require invasive procedures. These invasive procedures often induce stress and agitation, prompting physicians and healthcare providers to provide sedation or general anesthesia to manage discomfort. Epidemiological studies of human patients have revealed a correlation between childhood exposure to general anesthetic and sedative agents and subsequent cognitive deficits. This association is also supported in animal models, which shows that exposure to anesthetics …

Sedation For Gi Endoscopy In The Morbidly Obese: Challenges And Possible Solutions, Lalitha Sundararaman, Basavana Goudra

Department of Anesthesiology Faculty Papers

With the increasing prevalence of obesity and morbid obesity, this subgroup's contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as the insertion of an intragastric balloon or one or more unrelated procedures such as a screening colonoscopy and (or) diagnostic/therapeutic endoscopy. Regardless of the procedure, these patients pose significant challenges in terms of choice of sedatives, dosing, airway management, ventilation, and oxygenation. An understanding of dissimilarity in the handling of different groups of medications used by an …

A Case Of Herpes Zoster In An Immunocompetent 19-Year-Old Female, Martin Nguyen, Jennifer Read, Emma Filary, Aaron Mcguffin

Marshall Journal of Medicine

This case report describes the unusual presentation of herpes zoster in a fully vaccinated teenage patient and highlights management considerations. The patient is a 19-year-old female who presented with pain in her left lower back, side, and upper thigh for approximately 3 days, which was then followed by the eruption of a vesicular rash along the L2 dermatome consistent with herpes zoster. Herpes zoster is predominantly observed only in elderly and immunocompromised individuals, primarily due to the widespread use of the varicella-zoster virus vaccine for children since 1995, when it became part of the routine immunization schedule. However, this case …

A Comparison Of Tracheal Intubation Using Direct Laryngoscope And Video Laryngoscope In The Sellick And Trendelenburg Position With That Using Direct Laryngoscope In The Supine Sniffing Position: A Randomized Controlled Trial, Yun-Jeong Chae, Jung-Yoon Moon, Min-Gyu Lee, Han-Bum Joe

Faculty, Staff and Student Publications

Background: Tracheal intubation in the Sellick and Trendelenburg position (ST position) can prevent pulmonary aspiration but increase the difficulty of tracheal intubation. We compared tracheal intubation using video and direct laryngoscopy in the ST position with direct laryngoscopy in the supine sniffing position to evaluate the overall intubation performance. Methods: One hundred and twenty patients were randomly assigned to three groups: direct laryngoscope in the supine sniffing position (control), direct laryngoscope in the ST position (ST direct), and video laryngoscope in the ST position (ST video). The primary outcome was the intubation time; secondary outcomes included the first …