Anesthesiology Commons^™

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 …

Potential S1 Nerve Root Blocks Associated With Sacroiliac Joint Injections, Andrew Ng, Jesse Lou, Dajie Wang

Department of Anesthesiology Faculty Papers

BACKGROUND: Sacroiliac (SI) joint dysfunction is a common cause of lower back pain. The diagnosis of SI joint pain remains challenging. Sacroiliac joint injection remains the gold standard of diagnosis of SI joint pain as well as providing therapeutic effect. One complication related to SI joint injection is temporary numbness and weakness of the leg.

OBJECTIVES: To evaluate the anatomy of the SI joint and the flow of the contrast in the sacroiliac joint and to understand how local anesthetic can affect the nerve roots and cause temporary weakness and numbness of the leg.

METHODS: Patients who underwent SI joint …

Remimazolam And Its Place In The Current Landscape Of Procedural Sedation And General Anesthesia, Matthew Brohan, Janette Brohan, Basavana Goudra

Department of Anesthesiology Faculty Papers

Remimazolam was derived from its parent compound by adding an ester linkage into its structure so that the drug becomes a substrate for ester metabolism. As a result, it undergoes organ-independent ester hydrolysis, although the clinical benefits in terms of shorter recovery are not uniformly observed in clinical practice. Remimazolam is mainly tested in procedural sedation. In comparison to propofol, the current gold standard for procedural sedation, its proposed attractiveness is shorter wake-up times and a clear-headed recovery. Its clear advantages over propofol are better hemodynamic stability, lack of pain on injection and availability of a reversal agent in the …

Setting Up An Ambulatory Gi Endoscopy Suite In The Usa-Anesthesia And Sedation Challenges, Basavana Goudra

Department of Anesthesiology Faculty Papers

Gastrointestinal endoscopy units, both freestanding and associated with ambulatory surgical centers, are on the increase, and the trend is likely to continue. The concept is relatively new, and there are insufficient guidelines and a general dearth of information for prospective planners and physicians. Debate continues in areas such as the selection of patients, appropriateness of procedures, and access to tertiary care. Leaders often scramble to address both critical and non-critical issues, often after the center has opened to the public. They often encounter issues which were not anticipated. In this review, we have provided comprehensive and concise information on the …

Serum From Patients With Cirrhosis Undergoing Liver Transplantation Induces Permeability In Human Pulmonary Microvascular Endothelial Cells, Michael Bokoch, Fengyun Xu, Krishna Govindaraju, Elliot Lloyd, Kyle Tsutsui, Rishi Kothari, Dieter Adelmann, Jérémie Joffre, Judith Hellman

Department of Anesthesiology Faculty Papers

INTRODUCTION: Patients with cirrhosis undergoing liver transplantation frequently exhibit systemic inflammation, coagulation derangements, and edema, indicating endothelial dysfunction. This syndrome may worsen after ischemia-reperfusion injury of the liver graft, coincident with organ dysfunction that worsens patient outcomes. Little is known about changes in endothelial permeability during liver transplantation. We hypothesized that sera from these patients would increase permeability in cultured human endothelial cells

METHODS: Adults with cirrhosis presenting for liver transplantation provided consent for blood collection during surgery. Sera were prepared at five time points spanning the entire operation. The barrier function of human pulmonary microvascular endothelial cells in culture …

Celecoxib-Tramadol Co-Crystal In Patients With Moderate-To-Severe Pain Following Bunionectomy With Osteotomy: Secondary Analyses By Baseline Pain Intensity And Use Of Rescue Medication Of A Phase 3, Randomized, Double-Blind, Factorial, Active- And Placebo-Controlled Trial, Eugene R. Viscusi, Oscar De Leon-Casasola, Jesús Cebrecos, Adam Jacobs, Adelaida Morte, Esther Ortiz, Mariano Sust, Anna Vaqué, Ira Gottlieb, Stephen Daniels, Derek Muse, Michael E. Kuss, Sebastián Videla, Neus Gascón, Carlos Plata-Salamán

Department of Anesthesiology Faculty Papers

BACKGROUND: In the randomized, phase 3, SUSA-301 trial, celecoxib-tramadol co-crystal (CTC) provided significantly greater analgesia compared with celecoxib, tramadol, or placebo in adults with acute, moderate-to-severe, postoperative pain. This post hoc, secondary analysis further evaluated the use of rescue medication and the incidence of treatment-emergent adverse events (TEAEs).

METHODS: Patients (N = 637) were randomized 2:2:2:1 to receive oral CTC 200 mg twice daily (BID; n = 184), tramadol 50 mg four times daily (QID; n = 183), celecoxib 100 mg BID (n = 181), or placebo QID (n = 89). Post hoc analyses were conducted on the use of …

Perioperative Cannabis Use In Bariatric Patients: A Review Of Outcomes And Proposed Clinical Pathway For Management, Meghan H. Maceyko, Marc Neff, Jonathan Halevy, Marguerite Dunham

Jefferson Health - New Jersey Papers

Legalization of marijuana has led to increased prevalence of medical and recreational cannabis use, underscoring the importance for anesthesiologists, surgeons, and perioperative physicians to understand the effects of this drug in patient care. Bariatric surgical patients represent a unique target population to understand peri-operative cannabis use and its effects as these patients undergo an extensive preoperative psychological and nutritional evaluation. Standardized guidelines on cannabis use in bariatric surgery are lacking and many clinicians remain uncertain on how to handle cannabis use in the peri-operative period. Here, we summarize the data on cannabis use in bariatric patients, specifically exploring anesthetic considerations, …