Anesthesiology Commons^™

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 …

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 …

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 …

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, …

Model Prediksi Mortalitas Pembedahan Pasien Usia Lanjut Yang Menjalani Pembedahan Elektif Di Rumah Sakit Cipto Mangunkusumo, Fitria Djafar, Noto Dwimartutie, Susilo Chandra, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Introduction. Elderly patients are at high risk of mortality after elective surgery. The aim of this study was to obtain and evaluate the performance of a mortality prediction model for elderly patients undergoing elective surgery.

Methods. The design of this study was a retrospective cohort using medical record data from 747 elderly subjects who underwent elective surgery in the period January 2015–December 2017 at Cipto Mangunkusumo Hospital (RSCM), Jakarta. This study used multivariate analysis with logistic regression to determine significant predictors that were included in the prediction model. The performance of the prediction model was assessed using the …

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R. Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H. Gomez, Mamoun Younes, Qiang Shen, Jennifer M. Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W. Jim Zheng, Tien C. Ko

School of Medicine Faculty Publications

Abstract: The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). …

Beyond The Airway, Volume 1, Issue 1, May 2024

Beyond the Airway

Table of Contents

3 - Foreword from the Editors-In-Chief

4 - A message from Dr. Eric S. Schwenk

5 - An Interview with Dr. Rishi Kothari

7 - Anesthesia Considerations for Patients on Semaglutide

9 - An Interview with Dr. Jeffrey Mojica

11 - The National Resident Matching Program (NRMP) Match: Is Anesthesiology Becoming More Competitive?

13 - An Interview with Dr. Katherine Dillon and Dr. Matteo Petrera

15 - History of Ketamine in Anesthesia

17 - Editorial Staff

Randomized Controlled Trial Of Enhanced Recovery After Surgery Protocols In Live Kidney Donors: Eraskt Study, Jacob Saks, Uzung Yoon, Natalie Neiswinter, Eric Schwenk, Stephen Goldberg, Linh Nguyen, Marc Torjman, Elia Elia, Ashesh Shah

Department of Anesthesiology Faculty Papers

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function.

METHODS: In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis …

Reversal Of Propofol-Induced Depression Of The Hypoxic Ventilatory Response By Bk-Channel Blocker Ena-001: A Randomized Controlled Trial, Simone Jansen, Maarten Van Lemmen, Erik Olofsen, Laurence Moss, Joseph Pergolizzi, Thomas Miller, Robert Colucci, Monique Van Velzen, Philip Kremer, Albert Dahan, Rutger Van Der Schrier, Marieke Niesters

Department of Medicine Faculty Papers

BACKGROUND: The use of anesthetics may result in depression of the hypoxic ventilatory response. Since there are no receptor-specific antagonists for most anesthetics, there is the need for agnostic respiratory stimulants that increase respiratory drive irrespective of its cause. The authors tested whether ENA-001, an agnostic respiratory stimulant that blocks carotid body BK-channels, could restore the hypoxic ventilatory response during propofol infusion. They hypothesize that ENA-001 is able to fully restore the hypoxic ventilatory response.

METHODS: In this randomized, double-blind crossover trial, 14 male and female healthy volunteers were randomized to receive placebo and low- and high-dose ENA-001 on three …

Peripheral Nerve Stimulation Of The Shoulder: A Technical Primer, Sailesh Arulkumar, Elisa E. Neuchat, Eric Ly, Austin Ingwei Ly, Kiana Fahimipour, Mehul J. Desai

School of Medicine Faculty Publications

Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment …

Fake Xanax: Designer Emerging Benzodiazepine Epidemic Linked To Morbidity And Mortality A Narrative Review, Alan D. Kaye, Joseph P. Tassin, William C. Upshaw, Camille M. Robichaux, Mark V. Frolov, Mark M. Dupaquier, Julia E. Fox, Jeffrey Sterritt, Jibin Mathew, Sahar Shekoohi, Adam M. Kaye, Amber N. Edinoff

School of Dentistry Faculty Publications

Etizolam is a thienodiazepine derivative which produces an anxiolytic effect similar to benzodiazepines such as alprazolam (Xanax). Like classic benzodiazepines, etizolam has a high affinity towards the GABAA receptor, and allosterically potentiates the effects of GABA resulting in neuronal hyperpolarization related to chloride influx. When taken in therapeutic doses, etizolam produces a similar effect to Xanax. Counterfeit Xanax tablets contain variable amounts of etizolam. Tablets with high amounts of etizolam can cause toxicity if ingested, especially when combined with other substances. When toxic symptoms occur in patients, they may include severe sedation, unconsciousness, and depression of the medullary respiratory center. …

Ventilation Method During Intensive Care Unit Transport After Cardiac Surgeries; When Should We Use A Ventilator?, Francis Anderson, Do, Kent Berg, Md, Marc Torjman, Phd, Yoshihisa Morita, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Manual ventilation with AMBU bag is utilized mostly for transporting post cardiac surgery patients to the intensive care unit, but some patients need mechanical ventilation due to concern for oxygenation, ventilation, and cardiac function.

Also, transport can be a critical moment because of limited hemodynamic information and suboptimal environment for therapeutic intervention.

Thus, risk stratification for appropriate ventilation is necessary for safe transport. •

Project AIM: We assessed biventricular function (with a hand-held echocardiography), arterial blood gas, and hemodynamics pre and post transport in manual and mechanical ventilation groups.

Interactive Distraction Techniques Versus Midazolam In Anxiolysis In Pediatric Patients: A Systematic Review And Meta-Analysis, Uzay Cagatay, Jon Elias, Alexander King

Rowan-Virtua Research Day

Background: Many pediatric patients experience high levels of anxiety prior to undergoing surgery. Midazolam is currently one of the most commonly used sedative drugs in the pediatric preoperative environment. A number of studies have evaluated the use of non-pharmacological methods of relaxing pediatric patients prior to surgery, known as ‘Interactive Distraction’. These techniques involve using various methods of distracting the child from the preoperative anesthetic procedures. Some examples of these methods involve giving the patient an iPad with which they can play video games. There have yet to be any systematic reviews comparing the usage of Midazolam alone against utilizing …

Does Esketamine In Cesarean Delivery Increase Postoperative Adversities And Related Diseases?, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Esketamine has emerged as a promising treatment option, particularly noted for its effectiveness in reducing postpartum depression, alleviating pain, and promoting faster recovery. Despite its therapeutic benefits, recent research has raised concerns regarding potential adverse effects associated with high doses of esketamine in patients. Specifically, there is growing interest in understanding the potential risks linked to the administration of esketamine during cesarean delivery, given its increasing use in obstetric anesthesia.

This comprehensive review aims to investigate the potential associations between the use of esketamine during cesarean delivery and the subsequent risk of related diseases or physiological disorders. The goal is …

Preventing Postoperative Cognitive Dysfunction Through Preoperative Exercise, John Andre Socci

Rowan-Virtua Research Day

Introduction: Postoperative cognitive dysfunction (POCD) is a common problem in the elderly population after undergoing anesthesia that results in sometimes irreversible cognitive and physical impairment that can increase mortality and decrease quality of life.

Methods: To see the relationship between preoperative fitness capacity and how this relates to postoperative cognitive ability a literature review was performed. Studies that were included involved populations older than sixty years old that had undergone anesthesia. Additionally, animal studies were included to show inflammatory marker levels and how they increased in relation to physical activity.

Results: Various fitness scales were used such as the Timed …

Impact Of Sphenopalatine Ganglion Block On Septoplasty: A Meta-Analysis, Ayman Khatib, Jonathan Elias, Sami Dakhel, Piotr Domaszewski, Andrew Atschinow, Alexander King

Rowan-Virtua Research Day

Objective: This Meta-Analysis aims to explore the impact of sphenopalatine ganglion block on intraoperative blood loss, duration of surgery, and postoperative pain.

Background: Sphenopalatine ganglion block (SPGB) is a form of regional anesthesia that could be coupled with general anesthesia in Septoplasty. Septoplasty is one of the three most common procedures Otolaryngologists perform, which is commonly performed endoscopically. There is lack of research on benefits of Sphenopalatine ganglion block on septoplasty. One of the most common complications of septoplasty is excessive bleeding which may impact endoscopic visualization. Additionally, postoperative pain management is vital to decreasing hospital stay and …

Effects Of Dexmedetomidine As An Adjunct To General Anesthesia On Postoperative Pain And Opioid Consumption In Major Abdominal Surgery, Ahmad H. Elrefahy

Rowan-Virtua Research Day

This review examines the impact of dexmedetomidine, an alpha-2 adrenergic receptor agonist, on postoperative pain and opioid consumption in major abdominal surgery. Dexmedetomidine, known for its sedative, analgesic, and opioid-sparing properties, is increasingly used as an adjunct to anesthesia. Analyzing existing literature, the review found that dexmedetomidine administration alongside general anesthesia significantly improves postoperative pain management and reduces opioid consumption. Patients receiving dexmedetomidine reported decreased postoperative pain ratings and required fewer opioids during the recovery phase. Additionally, intraoperative dexmedetomidine use correlated with reduced postoperative pain severity and increased patient satisfaction compared to control groups. However, potential side effects such as …

Near-Surface Dose Correlates With Moist Desquamation And Unplanned Reconstructive Surgery In Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy, Patrick Thrasher, Ronald Levitin, Bryan S. Squires, Allison J. Hazy, Michael J. Maywood, Anthony P. Delise, Muayad F. Almahariq, Nayana Dekhne, Lauren Oliver, Peter Y. Chen, Kailee J. Walters, Diane Dudley, Joshua T. Dilworth

Posters

Postmastectomy radiation therapy (PMRT) utilized as part of a breast cancer treatment regimen reduces the risk of disease recurrence in appropriately selected patients.1,2,3,4,5 However, PMRT increases risk of radiationrelated toxicities that can interfere with breast reconstruction post-mastectomy.6 Following mastectomy, implant-based reconstruction can increase patient satisfaction and quality of life7,8; complications induced by PMRT such as infection and tissue contracture, though, increase risk for implant loss and may ultimately require further surgeries for the patient.

PMRT is delivered based on treatment plans that are optimized to provide appropriate radiation dosages to tissues along the chest wall while simultaneously limiting exposure of …