Anesthesiology Commons^™

Evidence-Based Recommendations For The Use Of Neostigmine Versus Sugammadex In Patients Undergoing Thoracic Surgery, Ostap Dvorakevych

Doctor of Nursing Practice Scholarly Projects

Neuromuscular blocking agents play a vital role in the safe delivery of modern anesthetic practice. These medications provide patient paralysis for anesthesia staff to perform tracheal intubation and for surgeons to have a motionless surgical field. At the end of surgery, the effects of these paralytic agents must be fully reversed by reversal agents. Incomplete reversal impairs the patient’s ability to maintain an airway, which can lead to various postoperative pulmonary complications such as respiratory failure, pneumonia, and atelectasis. Patients undergoing thoracic surgery are at high risk for this incomplete reversal due to deep levels of paralysis required to keep …

Evidence-Based Recommendations For The Use Of Neostigmine Versus Sugammadex In Patients Undergoing Thoracic Surgery, Ostap Dvorakevych

Doctor of Nursing Practice Scholarly Projects

Neuromuscular blocking agents play a vital role in the safe delivery of modern anesthetic practice. These medications provide patient paralysis for anesthesia staff to perform tracheal intubation and for surgeons to have a motionless surgical field. At the end of surgery, the effects of these paralytic agents must be fully reversed by reversal agents. Incomplete reversal impairs the patient’s ability to maintain an airway, which can lead to various postoperative pulmonary complications such as respiratory failure, pneumonia, and atelectasis. Patients undergoing thoracic surgery are at high risk for this incomplete reversal due to deep levels of paralysis required to keep …

Adductor Canal Regional Anesthetic Placement In Pediatric Patients For Knee Arthroscopy: Defining The Optimal Location And Analysis Of Other Trends, Isaac Jin, Christine Song, Sujay Deshpande, Andrew Yang, Ethan Schollaert, Neha Divi, Aysha Hasan Md

Tower Health Research Day

No abstract provided.

Differential Susceptibility To Propofol And Ketamine In Primary Cultures Of Young And Senesced Astrocytes, Liang Huang, Ferit Tuzer, Abigail Murtha, Michael Green, Claudio Torres, Henry Liu, Shadi Malaeb

Department of Anesthesiology Faculty Papers

The adverse effects of general anesthesia on the long-term cognition of young children and senior adults have become of concern in recent years. Previously, mechanistic and pathogenic investigations focused on neurons, and little is known about the effect of commonly used intravenous anesthetics such as propofol and ketamine on astrocytes. Recently, astrocyte dysfunction has been implicated in a wide range of age-related brain diseases. In this study, we examined the survival and viability of both young and senescent astrocytes in culture after adding propofol and ketamine to the media at varying strengths. Oxidative stimulus was applied to commercially available fetal …

Local Anesthetic Systemic Toxicity (Last): Provider Education, Alexis Johnson

Scholars Week

Abstract

Background: Local Anesthetic Systemic Toxicity (LAST) is a rare but serious complication due to accumulation of local anesthetics. If not treated quickly, LAST can cause detrimental complications such as seizures and cardiac arrest. Therefore, it is important that anesthesia providers are well versed in preventing, recognizing, and treating this adverse event.

Methods: A LAST flowchart written by The American Society of Regional Anesthesia and Pain Medicine (ASRA) was printed and placed in each operating room in a small suburban hospital. Anesthesia staff were also educated on recognizing signs and symptoms, onset time, high risk patients, and prevention.

Results: Ten …

Governmental Affairs Update: Dental Medicaid, Neema Katibai Jd

The Journal of the Michigan Dental Association

The MDA spearheads an initiative to enhance Medicaid anesthesia services reimbursement, aiming to address the disparity between current rates and commercial standards. Despite recent improvements in Medicaid dental benefits, access to care remains hindered by low anesthesia reimbursement rates. The MDA advocates for a substantial investment to increase reimbursement to 85% of commercial rates, garnering support from various medical associations. This collaborative effort marks a significant stride towards achieving equitable Medicaid reimbursement. Grassroots advocacy is pivotal in influencing state budget decisions, urging constituents to engage with legislators via MDA text alerts.

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Anesthetic And Multidisciplinary Management Of A 2-Staged Liver Transplant​, Kasey Brooks, Lisa Conley, Brandon Layton

Posters

We present a case of a 2 staged liver transplant on a 12-month-old 8kg male with newly diagnosed mitochondrial depletion syndrome causing acute liver failure, refractory lactic acidosis, and cardiopulmonary collapse requiring ECMO. The patient’s past medical history at the time of presentation included history of prematurity at 32 weeks, developmental delay, and a brother with an undiagnosed pancreatic disorder. The patient was brought in by parents to the emergency department with a cough, minimal PO intake for 5 days, and increased fatigue who was found to be URI positive. Initial labs were concerning for anemia, elevated bilirubin, elevated AST/ALT, …

Alkindi Sprinkle For Pediatric Patients With Primary Adrenocortical Insufficiency: A Narrative Review, Alan D. Kaye, Munira E. Khaled, Kristin Nicole Bembenick, John Lacey, Anamika Tandon, Rucha A. Kelkar, Alyssa G. Derouen, Corrado Ballaera, Debbie Chandler, Shahab Ahmadzadeh, Sahar Shekoohi, Giustino Varrassi

School of Medicine Faculty Publications

Adrenocortical insufficiency, also known as adrenal insufficiency (AI), is an endocrine disorder characterized by inadequate production of adrenal hormones, including glucocorticoids and mineralocorticoids (MCs). The condition can be categorized as primary, secondary, or tertiary AI, depending on the location of the defect. Classical symptoms of AI include weakness, fatigue, abdominal pain, tachycardia, hypotension, electrolyte imbalances, and hyperpigmentation. In children, the most common cause of AI is classical congenital adrenal hyperplasia, which results from a deficiency in the 21-hydroxylase enzyme. The 21-hydroxylase enzyme produces all steroids, such as cortisol and aldosterone. AI management primarily involves hormone replacement therapy, typically with oral …

Hif Expression In Clear-Cell Renal Cell Carcinoma (Ccrcc) Tumors Of Adults With And Without Obstructive Sleep Apnea (Osa), Olivia Heppell, Carlos Guerra Londono, Nilesh Gupta

Medical Student Research Symposium

Introduction: Upregulation of hypoxia-inducible factors (HIF) is an important pathological feature shared by clear cell renal cell carcinoma (ccRCC) and obstructive sleep apnea (OSA). However, it is unclear whether OSA alters the pathogenesis of ccRCC via HIF expression.

Methods: A retrospective cohort of adults undergoing nephrectomy for ccRCC was identified electronically (IRB#16040-1). The diagnosis of OSA was established with preoperative STOP-BANG scores or polysomnography. A consecutive sample of 20 individuals with and 20 without OSA was selected. Clinical characteristics and pathology results were reviewed. Resected tumor sections were immunohistochemically stained for HIF-1& HIF-2 at antibody dilutions of 1:150. Intensity and …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Variation In Transcript Reports Among Residency Applicants: An Anesthesia Program’S Perspective, Alex M. Hendon, Imani Thornton

HCA Healthcare Journal of Medicine

Background

With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review.

Methods

Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript …

A Case Report And Review On The Anesthetic Considerations Of Anterior Mediastinal Masses, Carter A. Schulz, Joshua D. Mohs, Andrew M. Reuter

Aesculapius Journal (Health Sciences & Medicine)

Case summary: A 15-year-old female presented with chest pain, dyspnea, and weight loss. A chest X-ray and subsequent CT scan revealed a large anterior mediastinal mass with cervical lymphadenopathy and pericardial effusion. Two biopsies under general anesthesia were performed, with the latter confirming classic Hodgkin lymphoma, nodular sclerosis subtype.

Discussion: This case underscores the significant clinical challenges posed by anterior mediastinal masses due to their proximity to vital cardiovascular and respiratory structures. Physiologic changes during general anesthesia can exacerbate these challenges. Preoperative assessment, including imaging and symptom evaluation, is crucial to guide operative planning. It is key to individualize the …

Probiotic Limosilactobacillus Reuteri Dsm 17938 Changes Foxp3 Deficiency-Induced Dyslipidemia And Chronic Hepatitis In Mice, Erini Nessim Kostandy, Ji Ho Suh, Xiangjun Tian, Beanna Okeugo, Erin Rubin, Sara Shirai, Meng Luo, Christopher M. Taylor, Kang Ho Kim, J. Marc Rhoads, Yuying Liu

School of Medicine Faculty Publications

The probiotic Limosilactobacillus reuteri DSM 17938 produces anti-inflammatory effects in scurfy (SF) mice, a model characterized by immune dysregulation, polyendocrinopathy, enteropathy, and X-linked inheritance (called IPEX syndrome in humans), caused by regulatory T cell (Treg) deficiency and is due to a Foxp3 gene mutation. Considering the pivotal role of lipids in autoimmune inflammatory processes, we investigated alterations in the relative abundance of lipid profiles in SF mice (± treatment with DSM 17938) compared to normal WT mice. We also examined the correlation between plasma lipids and gut microbiota and circulating inflammatory markers. We noted a significant upregulation of plasma lipids …

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

Is Long-Term Survival Higher In Patients Who Receive Propofol-Based Total Intravenous Anesthesia During Colorectal Cancer Surgery Compared To Volatile Anesthesia, Shad Anthony Mitchell

Theses, Dissertations and Capstones

The study reviewed several retrospective cohort studies that examined the impact of propofol-based total intravenous anesthesia (TIVA) versus volatile anesthesia (VA) on the long-term survival of colorectal cancer (CRC) surgery patients. Eight studies found no significant difference in mortality between the two anesthesia types, while three studies indicated a significant decrease in all-cause mortality favoring propofol TIVA. The studies had varying follow-up periods, with some extending to five years. Notably, two studies controlled the type of volatile anesthetic used, specifically sevoflurane and desflurane. The findings suggest a potential survival advantage for propofol TIVA, warranting further investigation.

Aortic Dissection Flap Recreates Left Coronary Cusp, Brandon Cunningham, Jon Halling

South Atlantic Division GME Research Day 2024

No abstract provided.

Ultrasound-Guided Erector Spinae Plane Block: An Objective Structured Clinical Examination For First-Year Anesthesia Providers, Andrew Edwards, Jonathan Mardis

Doctoral Projects

The use of ultrasound-guided regional anesthesia (UGRA) in anesthetic practice is an invaluable tool for anesthesia providers to implement into their daily practice. One of these regional techniques is the erector spinae plane block (ESPB) which has anesthetic implications in numerous surgical procedures including cervical spine, thoracolumbar spine, thoracic wall, and chest wall procedures. Because of the novelty of this regional anesthetic technique, it is important to educate first-year anesthesia providers about the implications, skillset, and complications of the ESPB.

To bridge the gap between didactic knowledge and clinical practice in first-year anesthesia providers, an objective structured clinical examination (OSCE) …

Tracheal Bleed With A Laryngectomy From An Innominate Artery Fistula, Cherry Liu, James West, Hunter Brooks, Jennifer Gilbert, Gabe Scally, Sara Hajizadeh Barfjani, Siddharth Singh

Far West Division GME Research Day 2024

No abstract provided.

Squamous Cell Carcinoma Of The Oral Cavity During Intubation, Cherry Liu, Amanda Sniadach, Michael Dinh, Christian Park, Rodd Rezvani

Far West Division GME Research Day 2024

No abstract provided.