IARS: Poster Session E

Sun, 5/19: 12:30 PM  - 2:00 PM 
IARS Poster Session 
1.5 
The Fairmont Queen Elizabeth 
Room: Place du Canada / Square Dorchester  

Presentations

E001. Comparison of Neck Circumference to Thyromental Distance Ratio with Modified Mallampati Score for Prediction of Difficult Intubation in Obese Patients

Potentially difficult airway is a critical aspect of preoperative assessment which foresees difficult intubation. A difficult airway can be defined as one where an experienced anesthesia provider anticipates or encounters difficulty with any or all of face mask ventilation, direct or indirect laryngoscopy, tracheal intubation, Supraglottic device use, or surgical airway.1 Difficult tracheal intubation is one of the major concerns and challenges for anaesthetists and contributes to perioperative morbidity and mortality.2 Therefore, airway assessment and prediction of "difficult airway" are essential skills of an anaesthetist. Major complications of airway management are rare but can be amongst the most life-threatening in medicine such as hypoxic brain injury and death.3, 4 

Submissions


Poster Presenter

Dr. Amreen Awan, MBBS, FCPS

E002. Difficult Airway in Acromegaly Patient

Acromegaly patients present a particular airway management challenge. Up to 26% of these patients have been reported to have difficult laryngoscopy in planned surgery. 1 Abnormalities of airway anatomy result from soft tissue hypertrophy and bony alterations. Macroglossia, soft palate redundancy, hypopharyngheal narrowing, laryngeal soft tissue abnormalities such as true and false vocal cord edema or arytenoid and aryepiglottic fold prolapse, bony alterations such as increase mandibular height, prognathia, reduced cervical spine mobility are all possible anatomic alterations that could negatively impact intubation attempts.2,3 Awareness of possible alterations and preoperative preparation are crucial for airway management. 

Submissions


CoAuthor

Dr. Risa Wolk, MD

Poster Presenter

Dr. Jin Chen, MD

E003. Doubling the Dose of Ketamine in Combination of Ketamine+ Dexmedetomidine Provides Lesser Discomfort and Recall of Procedure after Fiber-Optic Intubation

Flexible fiber-optic intubation is considered to be the gold standard for management of difficult airway. Fiber-optic intubation does require effective sedation and blunting of airway reflexes for which various drug regimes have been utilized for the same in past. In a quest to find the noble drug combination we combined ketamine and dexmedetomidine in two different doses, to evaluate the patient satisfaction score and recall of procedure, 24 hours after naso-tracheal flexible fiber- optic intubation in difficult airway. 

Submissions


CoAuthor(s)

Dr. Arun Kumar, MBBS
Dr. TANMAY TIWARI, MD PDCC
Dr. SATEESH VERMA, MD

Poster Presenter

Dr. SATISH DHASHMANA, MD

E004. A Modified Infant Face Mask Provided Nasal CPAP/PCV to Maintain Oxygenation in a Morbidly Obese OSA Patient with Advanced Lung Cancer during Outpatient Fob Resection of Endobronchial Tumor Under Mac

Patients under MAC often receive IV sedation and nasal cannula (NC) O2. Over-sedation or airway obstruction may cause severe O2 desaturation, especially in obese patients with obstructive sleep apnea (OSA). A nasal PAP mask assembly using a pediatric face mask and existing anesthesia equipment/machine was shown to maintain spontaneous nasal ventilation and improve oxygenation in sedated obese OSA patients (1-5). 

Submissions


CoAuthor(s)

Dr. Sylviana Barsoum, MS, MD
Hosana Tordecilla, CRNA
Dr. James Tse, PhD, MD

Poster Presenter

Ms. Cara Esser, MD

E005. The Safety and Efficacy of Laryngeal Mask Airway Insertion in Prone Position

The laryngeal mask airway (LMA) is a supraglottic device which is used for general anesthesia [1]. Peripheral nerve injury as well as patient malposition, waste of manpower and time, especially in obese patients are considered as major reasons for LMA insertion in prone rather than supine position [2]. Also, The LMA insertion in prone patients can be lifesaving in case of unintentional extubation [3]. The present study aimed to evaluate the safety and efficacy of LMA insertion in prone position. 

Submissions


CoAuthor(s)

Dr. Mina Abdolahi, Ph.d.
Dr. Hamed Abdollahi, Doctorate of Medicine
Ms. Nahid Azimi, Bachlor
Dr. Mehrdad Behzadi, Doctorate of Medicine
Dr. Afshar Etemadi-Aleagha, Doctorate of Medicine
Dr. Arash Jafarieh, Doctorate of Medicine
Dr. Nader Ali Nazemian Yazdi, Doctorate of Medicine
Abolghasem yoosefi, Doctorate of Medicine

Poster Presenter

Dr. Fatemeh Hajimohamadi, Doctorate of Medicine

E006. Effects of Histones on Endothelial Barrier Function and Vascular Permeability of the Lungs

The normal functioning of vasculature depends on integrity of endothelial barrier, while disruption of endothelial barrier function in the lungs leads to edema, inflammation and respiratory failure culminating in acute respiratory distress syndrome (ARDS). Histones are nuclear proteins forming chromatin, but they can release into the extracellular space when cells undergo severe injury, generating immunostimulatory and cytotoxic effects in both sepsis and ARDS (1,2). However, cellular and molecular mechanisms of pathogenic effects triggered by extracellular histones remain unclear. This study investigated effects of extracellular histones on lung endothelial cell (EC) permeability in vitro and vascular endothelial barrier function in the lungs. 

Submissions


CoAuthor(s)

Dr. Ramasubramanian Baalachandran, MD.
Dr. Konstantin Birukov, MD, PhD
Dr. Anna Birukova, MD
Dr. Junghyun Kim, MD
Dr. Yue Li, MD, PhD

Poster Presenter

Dr. Yunbo Ke, PhD

E007. An Airway Management Tool for General Anesthesia during Caesarean

The rate of failed orotracheal intubation in obstetrics has remained unchanged over the past four decades (1). The American Society of Anesthesiologists Task Force has developed and has revised guidelines for the management of the difficult airway (2-4). Recent studies have proposed (5-9) or have studied difficult airway decision-tree algorithms under simulation emergencies (10). The purpose of this retrospective study was to review all Caesareans who underwent general anesthesia and develop a prediction tool for predicting increasing attempts at orotracheal intubation (11). 

Submissions


CoAuthor(s)

Dr. Philip Boysen, M.D.
Dr. Kirbie Broughton, Medical Doctor
Dr. Allison Clark, MD
Dr. Hussam Ghabra, MD
Dr. Bobby Nossaman, MD

Poster Presenter

Mr. Andrew King, MS

E008. A Randomized Controlled Trial Comparing the Clinical Perfomance of Ambu Auragain and I-Gel in Young Pediatric Patients

Supraglottic airway devices have been increasingly used worldwide because of their several advantages, which include smooth induction of anesthesia with minimal hemodynamic instability and easier and faster insertion compared to endotracheal intubation. Several previous studies have shown that the small-sized supraglottic airways including the i-gel (Intersurgical, Wokingham, Berkshire, UK) provides safe and effective ventilation for young pediatric patients under general anesthesia. However, a study suggested that i-gel had a tendency of sliding out from the appropriate position in paediatric patients, thus this device should be used with caution in this population. Ambu AuraGain (Ambu, Ballerup, Denmark) is a relatively novel supraglottic airway device, but only few studies have reported the use of AuraGain in pediatric patients. Therefore, we aimed to compare the clinical performance of AuraGain and i-gel in young children. 

Submissions


CoAuthor(s)

Ha-Jung Kim, MD
Hee-Sun Park, MD
Young Jin Ro, MD
Hong-Seuk Yang, MD

Poster Presenter

Dr. Won Uk Koh, MD

E009. Effect of Endotracheal Tube Lubrication on Cuff Pressure Increase during General Anesthesia using Nitrous Oxide: A Prospective Randomized Controlled Trial

Increases in cuff pressure of an endotracheal tube (ETT) due to diffusion of nitrous oxide (N2O) into the cuff have been well documented [1]. Cuff pressure should be maintained lower than the capillary perfusion pressure of the tracheal mucosa [2]. Thus, monitoring the cuff pressure of an ETT during general anesthesia should be performed carefully, particularly if N2O is used. We previously demonstrated that lubrication of an ETT cuff with K-Y™ jelly (Johnson & Johnson, New Brunswick, NJ, USA) strongly and significantly inhibited the increase in cuff pressure during N2O exposure in vitro [3]. However, it is likely that this effect is affected by critical differences between some influential factors, such as the amount of lubricant retained on the cuff, and studied temperature differences between laboratory and clinical conditions [3]. Consequently, it is unclear how lubrication influences the N2O-induced cuff pressure increase in the clinical settings. Therefore, we sought to determine whether the inhibitory effects of K-Y™ jelly [3] hold true in the clinical settings in this study. 

Submissions


CoAuthor

Dr. Tomio Andoh, MD, PhD

Poster Presenter

Dr. Yukihide Koyama, MD, PhD

E010. Best Practices in Endotracheal Intubation for Pediatric Patients with Difficult Airway Due Micrognathia

Among different conditions associated with difficult endotracheal intubation micrognathia (MG) is the most common physical features which may be isolated or associated with other anomalies. Of those with associated craniofacial malformations, patients with Robin sequence (RS) are known to have an increased risk for difficult intubation1. While various intubating devices and techniques have been studied in some of these groups of patients with MG, systematic research to delineate the best approach based on physical features is lacking.2 To identify trajectories for successful airway attempts and factors associated with successful intubation in patients with MG we evaluated the data of Pediatric Difficult Intubation Registry. 

Submissions


CoAuthor(s)

Dr. Agnes Hunyady, MD.
Dr. Nathalia Jimenez, MD, MPH

Poster Presenter

Dr. Vera Sergeeva, MD

E011. Evaluation of Patient Comfort Score and Recall of Procedure during Retrograde Intubation with Two Different Doses of Dexmedetomidine Infusion

Retrograde Intubation for the management of difficult airway in low resource setting without flexible fibreoptic bronchoscopy is a well-known fact. Proper patient selection and sedation are prerequisites for the successful management of airway using the retrograde technique. We utilized the sedative properties of the dexmedetomidine, a novel alpha-2 agonist and compared two different doses of dexmedetomidine infusion on patient comfort score and recall of procedure during retrograde intubation. 

Submissions


CoAuthor(s)

Dr. SATISH DHASHMANA, MD
Dr. Ashish Walian, MD

Poster Presenter

Dr. TANMAY TIWARI, MD PDCC

E012. Conventional bronchoscope is more controllable than disposable bronchoscope for oral tracheal intubation

Flexible fiber-optic intubation is a reliable approach to manage difficult airway. However, this technique involves two difficult steps: locating the glottis and inserting an endotracheal tube over the fiberscope. Disposable fiber-optic bronchoscopes (FOB) are recently being used in operating and emergency rooms and in intensive care units. This study aimed to evaluate whether disposable FOB [Ambu® aScope™ 3 Regular (3 Regular)] was equally useful for oral tracheal intubation compared with reusable conventional FOB [Olympus® LF-GP (LF-GP)]. 

Submissions


CoAuthor(s)

Dr. Tomoko Fukada, M.D.
Dr. Hiroko Iwakiri, M.D.
Dr. MInoru Nomura, M.D.
Dr. Makoto Ozaki 33538111, MD, PhD
Dr. Chiara Sonnino, M.D.
Ms. Akiko Zaitsu, C.E.

Poster Presenter

Ms. Yuri Tsuchiya, D.D.S.

E013. Insertion pressure necessary for inadvertent endotracheal placement of a gastric tube in a simulated, intubated trachea

Orogastric and nasogastric tube placement is routinely performed in the operating room for gastrointestinal decompression. Complications are generally rare but can include accidental insertion into the trachea, even despite a fully inflated, cuffed endotracheal tube [1-3]. The purpose of this study was to determine the degree of force necessary for a duel lumen stomach tube to move past an endotracheal cuff. 

Submissions


CoAuthor

Dr. Kevin Blaine, MD

Poster Presenter

Dr. David Wallace, MD

E014. Does the Use of Intravenous Patient Controlled Analgesia (IVPCA) Increase Opioid Consumption and Side Effects in Fast Track Orthopedic Procedures?

Major orthopedic cases such as total knee arthroplasty (TKA) surgery is associated with moderate to severe postoperative pain which can contribute to immobility-related complications, delay in hospital discharge, and interfere with functional outcomes. Effective postoperative pain relief is a prerequisite for successful "fast-track" recovery1,2. The standard method of administrating IV opioid for these patients is the use of Patient Controlled Analgesia (PCA) via IVPCA pumps. Side effects of opioid drugs including constipation, nausea, vomiting, dizziness, pruritus, urinary retention, insomnia, sedation, mood irritability3,4, are a very common reason for patient complaints and contribute to delayed hospital discharge and patient dissatisfaction5. The present study aimed to compare the use of IVPCA versus the delivery of pain relief (per oral medications and IV as rescues analgesia) on an as needed basis within a well-defined fast track protocol that includes multimodal analgesia for patients who are undergoing elective primary knee replacement surgery. The proposed study postulated that patients who are included in the fast track protocol with a multimodal analgesia regimen may not require IVPCA and the use of IVPCA may be associated with an increased consumption of postoperative opioid, opioid related side effects and increase length of stay in the hospital. 

Submissions


CoAuthor(s)

David Backstein, MD, MED, FRCSC
Dr. Zeev Friedman, MD
Mrs. Jaclyn Ricci, Registered Nurse
Dr. Naveed Siddiqui, Associate professor Anesthesia
Xiang Y. Ye, MSc

Poster Presenter

Dr. Sameh Abdelghany, MD, Msc. Anesthesia, Doctorate degree (PhD), Anesthesia (Ain Shams University, Cairo, Egypt).

E015. Average Opioid Consumption and Pain Scores During First Postoperative Week After Outpatient Orthopedic Surgery

Opioid medications are commonly prescribed for postoperative pain in the US. The widespread use of long term opioids has raised safety concerns. Recent studies suggest that long term opioid use is associated with more frequent emergency department attendance, an increased incidence of side effects, risk of opioid diversion and abuse, overdose and deaths. Our primary objective was to determine patterns of postoperative (POD) daily opioid use and postoperative pain scores for seven days after three common outpatient orthopedic surgeries: anterior cruciate ligament (ACL) repair, rotator cuff repair (RCR), and meniscectomy. 

Submissions


CoAuthor(s)

Pushpaben Rathod, MBBS
Dr. Ashley Shilling, MD

Poster Presenter(s)

Dr. Sunny Chiao, MD
Dr. Amanda Kleiman, MD

E016. High Rates of Postoperative Opioid Overprescription Following Minimally Invasive Ambulatory Surgery

The United States has seen a surge in opioid use disorder, and postoperative opioid prescriptions are a major risk factor for initiation of and dependence on opioids. At the same time, minimally invasive surgical techniques, including laparoscopic, robotic, and laparoscopic- or robotic-assisted with mini-laparotomy are lauded for having benefits over open surgery including decreased postoperative pain and faster time to recovery. At our institution, after minimally invasive surgery, many patients are discharged home the same day. We hypothesize that these patients, despite undergoing a surgical technique that by design minimizes postoperative pain and functional deficits, are still prescribed postoperative opioids at a high rate. We aimed to measure the prevalence of and factors influencing ambulatory minimally-invasive post-surgical opioid overprescription. 

Submissions


CoAuthor(s)

Dr. Christina Inglis-Arkell, MD
Dr. Solmaz Manuel, MD

Poster Presenter

Dr. Anjali Dixit, MD, MPH

E017. Outcomes in Outpatient vs. Inpatient Laparoscopic Hysterectomy: Is it the Type of Setting or the Patient Characteristics That Matters?

Selection criteria for ambulatory surgery are not well defined. It is generally believed that overnight hospitalization would be safer for patients with multiple comorbidities. It is not clear whether adverse outcomes after ambulatory surgery are the result of patient characteristics (e.g., obesity), the associated comorbidities, or the surgical setting (inpatient vs. outpatient). We hypothesize that 1) after controlling for patient characteristics, postoperative outcomes are not different in outpatient settings compared with inpatient settings and 2) that increasing body mass index (BMI) is not associated with worsening outcomes rates in outpatients compared with inpatients (i.e., there is no significant interaction between BMI and surgical setting). We used laparoscopic hysterectomy as the index procedure for the study. 

Submissions


CoAuthor

Dr. Girish Joshi, MB BS, MD, FFARCSI

Poster Presenter

Dr. Eric Rosero, MD, MSc

E018. LONG-LASTING SENSORY BLOCKADE PRODUCED BY QUATERNARY LIDOCAINE DERIVATIVES: A PRECLINICAL STUDY ON THE COMPARATIVE EFFICACY AND SAFETY OF QX-314, QX-572, AND QX-222 IN MICE

Local anesthetics (LAs) are among the most effective non-opioid options for postoperative analgesia. However, conventional LAs are limited by their duration and toxicity, and there exists an ongoing need for the development of new agents that produce long-lasting sensory blockade after a single injection and possess a high therapeutic index. We have previously shown that QX-314, one of several experimental quaternary derivatives of the prototypical LA, lidocaine, produces long-lasting sensory blockade with a delayed onset in animals, with an approximately ten-fold increased duration compared to the mother compound[sup]1,2[/sup]. However, subsequent animal studies on intrathecal and systemic administration have raised concerns about toxicity due to QX-314[sup]3,4[/sup]. In the present study, we sought to explore the comparative actions of two other quaternary lidocaine derivatives, QX-572 and QX-222. Our hypothesis was that these compounds similarly produce long-lasting sensory blockade, albeit with a favorable toxicity profile. 

Submissions


CoAuthor(s)

Dr. Hye Kim, M.D.
Dr. Bernard MacLeod, M.D.
Dr. Ernest Puil, Ph.D.
Dr. Stephan Schwarz, M.D., Ph.D., FRCPC

Poster Presenter

Mr. Desmond Fung, B.Sc.

E019. Effects of propofol and its components on neutrophils migration and macrophages obtained from lung and adipose tissue of obese rats: An in vitro study

Obesity is associated with changes in immune cell migration. During the perioperative period, anesthetic agents can modulate neutrophil migration and macrophage gene expression of inflammatory markers. Although propofol is known to have immunomodulatory properties, to date, no study has evaluated which of its components – propofol itself (2,6-diisopropylphenol, 2,6-DIPP) or its lipid carrier (LIP-EXP) – is responsible for its effects on immune cells. We aimed to compare the effects of a propofol (PRO) formulation and its main components (2,6-DIPP and LIP-EXP) individually on lung and adipose tissue neutrophil migration and macrophage gene expression of inflammatory markers obtained from bronchoalveolar fluid (BALF) and adipose tissue. 

Submissions


CoAuthor(s)

Soraia Abreu, PhD
Lais Agra, PhD Student
Mariana Antunes, PhDD
Rebecca Bose, Student
Dr. Fernanda Cruz, PhD
Cassia Lisboa, PhD Student
Paolo Pelosi, Professor
Patricia Rocco, Professor of Physiology
pedro Silva, Professor

Poster Presenter

Dr. Luciana Heil, Master Degree

E020. A sevoflurane binding site in ryanodine receptor 1

Ryanodine receptor 1 (RyR1) is a structurally massive calcium channel embedded in the sarcoplasmic reticulum whose dysfunction underlines a variety of muscle disorders, most importantly including malignant hyperthermia (MH) [1]. In the presence of at least one of many disease causative mutations and certain anesthetic drugs, RyR1 is biased open, allowing inappropriate calcium ion flow. The metabolic demand required to clear these calcium ions is excessive, resulting in the clinical phenomena of MH. Little is known about the biophysical basis of this process: where on the channel do anesthetics bind, and how can there be such a large number of mutations that synergize with such binding to result in a common clinical endpoint? Here, we present molecular dynamics simulations of RyR1 demonstrating in atomic detail a specific sevoflurane binding site in the transmembrane domain of RyR1, and predict its binding affinity in this site; these results corroborate preliminary photoaffinity labeling data using the photoaffinity ligand azi-sevoflurane. 

Submissions


CoAuthor(s)

Grace Brannigan, PhD
Roderic Eckenhoff, MD
Dr. Kellie Woll, PhD

Poster Presenter

Dr. Thomas Joseph, MD, PhD

E021. Nonlinear pharmacokinetic behavior of high dose propofol in swine.

Propofol is known to influence the kinetics of some other drugs by decreasing clearance, perhaps by inducing hemodynamic changes. The aim of this study was to explore whether or not propofol influences its own kinetics. We hypothesized that propofol would exhibit non-linear pharmacokinetics at high doses. 

Submissions


CoAuthor(s)

Dr. Talmage Egan, MD
Dr. Ken Johnson
Dr. Olinto Linares-Perdomo, Dr.
Nathan Pace, MD
Greg Peterson, Dr.

Poster Presenter

Dr. Tae Kyun Kim, Ph.D.

E022. Sevoflurane enhances inhibitory and reduces excitatory inputs to cortical layer IV neurons in the thalamocortical network of murine brain slices

The mechanisms of anesthetic-induced loss of consciousness (LOC) are still a matter of scientific discussion. Volatile anesthetics are supposed to have multiple molecular as well as anatomic targets to modulate synaptic neurotransmission (1). Because of its key role in sensory perception the thalamocortical (TC) network is a promising target for anesthetics to induce LOC. In this study, we investigated the effects of sevoflurane (SEV) on synaptic transmission within the TC network using optogenetic and electric stimulation in acute murine brain slices. 

Submissions


CoAuthor(s)

Dr. Rainer Haseneder, M.D.
Dr. Stephan Kratzer, MD
Dr. Matthias Kreuzer, PhD
Dr. Gerhard Schneider, MD

Poster Presenter

Dr. Claudia Kopp, DVM

E023. PROSPECTIVE EVALUATION OF A PROTOCOL FOR ROCURONIUM BLOCK AND NEOSTIGMINE OR SUGAMMADEX REVERSAL

Postoperative residual neuromuscular blockade (PRNB) is defined as train-of-four ratio (TOFR) <0.9 on arrival to the post-anesthesia care unit (PACU). It is a frequent postoperative complication, reported in 34-57% of patients who receive non-depolarizing muscle relaxants (NDMR) and it is associated with increased morbidity and mortality. The new reversal agent, sugammadex, might be more effective in reducing PRNB, however, at our institution its acquisition cost is $89 compared with $19 for neostigmine with glycopyrrolate. The aim of this study was to evaluate a protocol for management of rocuronium blockade and reversal, with choice of reversal agent based on the depth of block. We hypothesized that the protocol would be associated with a low incidence of PRNB. We also hypothesized that it would be cost-saving compared to universal sugammadex use. 

Submissions


CoAuthor(s)

Dr. Sanjay Bhananker, M.D., F.R.C.A.
Kevin Cain, BS
Tinny Liang, BS
Dr. Stephan Thilen, MD
Dr. Miriam Treggiari, MD, PhD, MPH

Poster Presenter

Mr. Timothy Kruse, MD Candidate

E024. GABAA Receptor Actions of ABP-700 and its Carboxylic Acid Metabolite CPM-Acid: Implications for Toxicological Studies and Clinical Development

ABP-700 is an ultrashort acting "soft" analog of etomidate that retains etomidate's favorable cardiorespiratory profile, but has a context-insensitive half-life and does not suppress adrenocortical function.[sup]1-4[/sup] It acts as a positive allosteric modulator of the GABA[sub]A[/sub] receptor and is rapidly metabolized by non-specific esterases to CPM-acid (Fig 1). During toxicity studies using high dose (10x clinical) ABP-700 infusions lasting 2 hours, 4 (out of 14) Beagle dogs had EEG-confirmed convulsive seizures. These seizures occurred during the final 5 minutes of the 2-hr infusions or (more commonly) in the minutes to hours afterward, and were electroencephalographically distinguishable from the involuntary muscle movements (i.e. myoclonus) which occurred during ABP-700 infusion. The late timing of the seizures along with the extremely high plasma CPM-acid concentrations achieved during these studies (mean ± SD: 600 ± 350 µM) suggested that the seizures were caused by the metabolite (i.e. CPM-acid) rather than the parent anesthetic ABP-700 whose concentrations were 10x lower and has been shown to be an anticonvulsant.[sup]5[/sup] Although necropsy findings failed to reveal an etiology for these seizures and no seizures were reported in clinical studies involving >350 humans, establishing the likely mechanism(s) for these seizures in dogs and assessing ABP-700's potential for causing seizures in humans is critical for the future development and adoption of ABP-700 as a therapeutic drug. More broadly, defining the cause of these seizures may be important for guiding the design and development of other novel sedative-hypnotic agents that target the GABA[sub]A[/sub] receptor. To advance towards these goals, we defined the GABA[sub]A[/sub] receptor modulatory actions of ABP-700 and CPM-acid. 

Submissions


CoAuthor(s)

Dr. Douglas Raines 7240343, MD
Mrs. Beatrijs Valk, BS

Poster Presenter

Ms. Megan McGrath, BS

E025. Reasons Selected to Transfuse Outside Laboratory Test-Based Guidelines in Whole Hospital and Cardiac Surgery Cohorts

Electronic medical records provide an automated way of 'prompting' an ordering provider when transfusing outside laboratory test-based guidelines. These 'Best Practice Advisories (BPAs)' have encouraged evidence-based practice and reduced unnecessary transfusions along with their associated risks and costs. Presented here are the reasons that providers select for transfusing outside laboratory test-based guidelines in cardiac surgery and whole hospital cohorts in a tertiary academic center, which have important implications when performing chart review audits for transfusion appropriateness. 

Submissions


CoAuthor(s)

Dr. Promise Ariyo, MD, MPH
Dr. Steven Frank, MD
Mr. Tymoteusz Kajstura, BA
Dr. Charlie Slowey, MB, BCh, BAO
Ms. Mereze Visagie, BA
Dr. Brad Winters, Ph.D., M.D.

Poster Presenter

Dr. Connie Chaudhary, MD

E026. Efficacy and safety of ε-aminocaproic acid in open and minimally invasive cardiac surgery

According to the STS/SCA (Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists) practice guidelines on blood conservation, intraoperative use of lysine analogs; ε-aminocaproic (EACA) and tranexamic acid, is a class IA recommendation in cardiac surgery requiring cardiopulmonary bypass (CPB) (1). Lysine analogs inhibit fibrinolysis by acting on the step where plasminogen is converted to plasmin by reversibly blocking the lysine binding sites of plasminogen (2). Since antifibrinolytics may introduce side effects in lower risk patients with minimal benefit, we sought to evaluate whether transfusion requirements are decreased in different categories of cardiac surgical patients receiving EACA. Our secondary objective was to determine if EACA is associated with major morbidity and in hospital mortality. 

Submissions


CoAuthor(s)

Dr. Eugene Blackstone, MD
Dr. Marc Gillinov, MD
Dr. Douglas Johnston, MD
Dr. Anand Mehta, MD
Dr. Shiva Sale, MD
Ms. Lucy Thuita, MS

Poster Presenter

Dr. Marta Kelava, MD

E027. Massive Transfusion in Lung Transplantation - Association Between Ratio of Fresh Frozen Plasma to Packed Red Blood Cells and Survival

In 2007 Borgman et al. [1] showed improved survival in combat victims requiring massive transfusion who received higher rates of fresh frozen plasma (FFP). A recent study by Mesar et al. [2] questioned this conclusion as some patients might actually benefit from a more restrictive use of fresh frozen plasma. In the field of lung transplantation no data regarding the optimal transfusion ratio of FFP to packed red blood cells (PRBC) in massive transfusion is currently available. 

Submissions


CoAuthor(s)

Dr. Dieter Adelmann, MD
Dr. Martin Dworschak, MD, MBA
Dr. Peter Jaksch, MD
Mr. Stefan Koch, -

Poster Presenter

Dr. Johannes Menger, MD

E028. An Effective and Efficient Testing Protocol for Diagnosing and Managing Iron Deficiency Anemia Preoperatively

Anemia is commonly encountered in perioperative settings. Numerous observational studies have shown an association between untreated anemia and increased mortality and morbidity, as well as the need for transfusion. [sup]...[/sup]1, 2, 3 Timely diagnosis and initiation of treatment are important. Traditional preoperative practices require multiple visits for laboratory testing to diagnose and fully evaluate patients with anemia. This can delay diagnosis and treatment. In 2017, the Preoperative Anemia Clinic (PAC) was created at our academic, tertiary care institution to screen patients and treat anemia before non-emergency surgeries. The main objective of this study was to evaluate the effectiveness and efficiency of the PAC processes focusing on a testing protocol termed a "Pre-procedure Anemia Evaluation" (PPAE), to diagnose iron deficiency anemia (IDA). The traditional approach involves a complete blood count (CBC), and if anemia is noted, patients return for additional laboratory testing to determine the etiology of anemia. In contrast, for the PPAE testing, 2 tubes of blood are drawn. If anemia is noted on the CBC, then a reflex of additional tests, including iron, ferritin, total iron binding capacity (TIBC), transferrin saturation (TSAT), reticulocyte count, thyroid stimulating hormone (TSH), creatinine, and Vitamin B12, are done. 

Submissions


CoAuthor(s)

Michael Avram, Ph.D
Hardik Dand, B.Sc
Dr. Bobbie Jean Sweitzer, MD, FACP

Poster Presenter

Dr. Obianuju Okocha, M.D.

E029. 4-Factor Prothrombin Complex Concentrate Administration Does Not Alter the Amount of Fresh Frozen Plasma Transfused in a 24-Hour Period

Four-factor Prothrombin Complex Concentrate (4F-PCC) is a synthetic formulation of factor II, VII, IX, and X that is FDA approved to stop major bleeding in patients with a vitamin K antagonist (VKA) induced coagulopathy. It is also used off-label to treat bleeding in patients with other types of coagulopathy. Despite its higher cost, 4F-PCC is frequently prescribed to avoid the higher volume of fresh frozen plasma (plasma) that would be needed to provide the same amount of coagulation factors. The purpose of this study is to compare the number of plasma units administered to patients who received and did not receive 4F-PCC. We hypothesized that 4F-PCC is associated with a lower requirement for plasma transfusion. 

Submissions


CoAuthor(s)

Dr. Mary Berg, MD
Dr. Milo Engoren, M.D.
Elizabeth Jewell, M.S.
Dr. Michael Maile, MD
Dr. Sammie Roberts, M.D.

Poster Presenter

Dr. Paul Pokrandt, MD

E030. RBC Transfusion Prescribing Trends by Provider Type in an ICU Setting Pre- and Post-Epic Implementation

Introduction: Blood utilization in the intensive care unit (ICU) is high, with approximately 44% of patients receiving transfusions. With restrictive transfusion now widely adopted even in the ICU, there has been an emphasis for evidence-based hemoglobin (Hb) transfusion triggers and single-unit red blood cell (RBC) transfusions. We tested the hypothesis that transfusion guideline compliance rates differ among provider types and that implementing the Epic© electronic medical record with best practice advisories resulted in improved guideline compliance. 

Submissions


CoAuthor(s)

Dr. Connie Chaudhary, MD
Dr. Steven Frank, MD
Mr. Tymoteusz Kajstura, BA
Ms. Mereze Visagie, BA

Poster Presenter

Dr. Charlie Slowey, MB, BCh, BAO

E031. Reducing Unnecessary Preoperative Blood Orders and Associated Costs for Open and Robotic Radical Prostatectomy

Radical prostatectomy (RP) is one of the most common surgical procedures performed in men. Prior studies have shown that robot-assisted laparoscopic radical prostatectomy (RALRP) is associated with decreased blood loss and transfusions compared to open RP (ORP). Accounting for this difference, an updated maximum surgical blood order schedule (MSBOS) was phased in at a tertiary care hospital to optimize preoperative blood ordering. Based on actual blood utilization trends prior to 2012, the MSBOS recommended preoperative type and screen (T/S) only for ORP and no preoperative blood orders, "no sample" (NS) for RALRP. The actual impact of this change in practice, however, has never been investigated. Therefore, we sought to compare preoperative blood ordering and associated costs in the pre- and post-MSBOS time periods for patients undergoing ORP and RALRP. 

Submissions


CoAuthor(s)

Dr. Trinity Bivalacqua, MD
Dr. Steven Frank, MD
Dr. Natasha Gupta, MD
Mr. Tymoteusz Kajstura, BA

Poster Presenter

Ms. Mereze Visagie, BA

E032. Continuous Erector Spinae Plane Block Facilitates Opioid Sparing after VATS Surgery: A Case Series

There is no gold-standard regional anesthetic technique for video-assisted thoracoscopic surgery (VATS); most commonly, intravenous and oral opioids are used in lieu of more invasive regional/neuraxial approaches.1 However, multimodal opioid-sparing approaches are especially desirable in this patient population. We hypothesized that the newly described erector spinae plane block would be a useful regional anesthetic adjunct and lead to a reduction in opioid consumption after VATS surgery. 

Submissions


CoAuthor(s)

Dr. Thomas D'Amico, MD
Dr. Rebecca Klinger, MD, MS

Poster Presenter

Dr. Rebecca Anderson, M.D.

E033. Effect Of Low Dose 6% Hydroxyethyl Starch (130/0.4) And Renal Function In Cardiac Surgical Patients.

Maintenance of volume status is essential to support cardiac output and is critical in management of patients undergoing cardiac surgery. This study was aimed to determine if low dose (5-10 ml/kg) of 6% hydroxy-ethyl starch (HES)(130/0.4) has any detrimental effect on renal function in cardiac surgery. 

Submissions


CoAuthor(s)

Dr. Kumar Belani, MBBS, MS
Mohana Murali, MBBS, DA
Dr. Manjunath udresh, MBBS, MD

Poster Presenter

Dr. Muralidhar Kanchi, MBBS, MD, MBA

E034. Severe Cardiac Clot Burden in Pulmonary Embolism: Evaluation by Transesophageal Echocardiography

We present a case of a mildly symptomatic and normotensive patient who was found to have extensive clot burden within his bilateral atria and pulmonary arteries, who underwent emergent pulmonary embolectomy, complicated by severe RV dysfunction and recurrent thrombi, followed by eventual excellent recovery. 

Submissions


CoAuthor

Dr. Isaac Wu, MD

Poster Presenter

Dr. Brad Moore, MD

E035. Encephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES-CANADA) Study in Cardiac Surgery Patients: a Pragmatic, Randomized Clinical Trial

Postoperative delirium (POD) is a geriatric syndrome characterized by an acute onset of confusion, disorganization and inattention, with a fluctuating course1. POD is frequent in the cardiac surgery population, with a reported incidence between 11 and 50%2-6, and associated complications such as increased risk of falls, prolonged hospital stay, functional/cognitive decline and increased morbidity and mortality 7-12. Risk factors for POD are often non-modifiable, such as older age, male sex, underlying cognitive impairment and psychiatric conditions13-18, while risk factors more specific to the cardiac surgery population include the type of surgery, cardiopulmonary bypass time, transfusions, and mechanical ventilation time15-18. Recent studies suggest that the use of a processed EEG for titration of anesthesia can reduce the incidence of POD across various surgical populations19-24. Burst suppression more specifically, or the pathological patterns of high-voltage electrical activity alternating with periods of quiescence (Figure 1) may be associated with POD26-31. Our primary objective is to demonstrate whether guiding anesthesia depth using an EEG monitor to avoid episodes burst suppression can result in a decreased incidence and/or severity of delirium in the cardiac surgery population. Secondly, we want to examine contributing risk factors and the downstream health sequelae of delirium. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Kai Chen, MD
Dr. Alain Deschamps, PhD, MD
Dr. george djaiani, md
Debbie Dumertonshore, -
Ms. Andrea Alicia Dumont, BSc
Dr. Renée El-Gabalawy, MA, PhD
Dr. Eric Jacobsohn, MBChB, MHPE, FRCPC
Mrs. Fatine Karkri, MD
Dr. Morvarid Kavosh, MD, M.Sc
Mrs. Angela Mickle, Masters of Epidemiology
Mr. Jordan Oberhaus, BS
Dr. Charles Overbeek, MD
Nicole Relke, MD
Tarit Saha, MD
Simon Schreiber, MD
Rob Tanzola, MD
Laura Vogler, MD

Poster Presenter

Mrs. Jennifer Palermo, MDCM

E036. LMA® Gastro™ Airway seen through the eyes of a cardiac anesthesiologist.

The anesthesia management of percutaneous closure of patent foramen ovale (PFO) relies mainly on short-acting drugs, transesophageal echocardiography (TEE) probe placement, endotracheal intubation and muscle relaxation. Alternative airway management techniques consisting of combined oral placement of a first generation supraglottic airway device (SAD) and a TEE probe have been described. However, the success rate of this technique relied entirely on the favorable buccal anatomy of the patient. 1, 2 LMA® Gastro™Airway is a second-generation SAD with a separate channel for esophageal intubation and a separate channel with terminal cuff for lung ventilation. It has proven its efficacy in upper gastrointestinal endoscopy. 3 We report the successful possibility of inserting a TEE probe in the channel for esophageal intubation of the LMA® Gastro™ in patients undergoing a percutaneous closure of PFO. 

Submissions


CoAuthor(s)

Dr. Adel Aminian, Md
Dr. Anne Daper, MD

Poster Presenter

Dr. Sarah Saxena, MD

E037. AORTIC INTRAMURAL HEMATOMA COMPLICATING A ROUTINE CARDIAC SURGERY

Ascending aorta is the preferred site for arterial cannulation, an essential prerequisite for initiation of cardiopulmonary bypass (CPB)1. Several potential complications are associated with this step including the occurrence of 'acute aortic syndrome', a spectrum that is characterized by acute disruption of aorta which includes aortic dissection (AD) and intramural hematoma (IMH) (Table 1). While the incidence of AD has been reported, that of IMH is largely unknown. We report a case of intraoperative IMH involving the aortic root complicating a routine coronary artery bypass graft (CABG) surgery. 

Submissions


CoAuthor(s)

Dr. Johan Dorfling, MBBS
Dr. Harish Ram, MD

Poster Presenter

Dr. Andrew Weaver, MD

E038. Comparing the efficacy of the novel iron chelator, DIBI, with different classical iron chelators in murine poly-bacterial sepsis

Both, the initial infection and the following dysregulated immune response are responsible for the pathogenesis of sepsis. Therefore, the ideal therapy targets both detrimental events. Iron is crucial for bacterial growth and production of reactive oxygen species (ROS) – a main mediator of the dysregulated immune response. Iron chelators are potentially capable of reducing bacterial growth and restricting iron availability for ROS production. Based on our promising results in toxin models of sepsis, our goal was to compare the efficacy of the novel iron chelator, DIBI, with different classical iron chelators in experimental poly-bacterial sepsis. 

Submissions


CoAuthor(s)

Kayle Dickson, BSc (present)
Bruce Holbein, PhD
Dr. Christian Lehmann, MD PhD FRCPC
Juan Zhou, PhD (present), BSc

Poster Presenter

Ms. Maral Aali, PhD Student, BSc

E039. Diaphragmatic thickness in patients receiving PRVC ventilation and SIMV: A randomized controlled trial

Ventilator induced diaphragmatic atrophy is of utmost clinical importance as diaphragmatic function is a major determinant of successful weaning from mechanical ventilation. We designed this study to compare the effect of assist/controlled mode (PRVC) and assisted mode (SIMV) with pressure support on diaphragmatic atrophy in patients with acute respiratory failure. The primary endpoint of the study was to compare the change in diaphragmatic thickness at day 3 between patients on PRVC ventilation & SIMV- PS ventilation. 

Submissions


CoAuthor(s)

Dr. Dalim Baidya, MD, EDIC
Dr. Ravinder Batra, MD
Dr. Souvik Maitra, MD, DNB, EDIC

Poster Presenter

Dr. Sulagna Bhattacharjee, MD, DNB, DM

E040. Assessing Sleep Quality and Delirium Prevalence in Cardiac ICU patients

Sleep disruption in hospital patients remains a problem, particularly in the intensive care unit (ICU) population (1). Sleep interruption may lead to development of delirium which is associated with complications including prolonged hospital stay, increased mortality, and development of cognitive deficits (2). To better assess sleep quality (SQ), a time-limited single center trial of Richard Campbell Sleep Questionnaire (RCSQ) (3) implementation was conducted in two 10-bed units at our institution: the cardiac care unit (CCU) and the cardiothoracic unit (CTU). Here we report and compare patient- (P-RCSQ) and nurse- (N-RCSQ) perceived sleep quality in CCU and CTU patients, and prevalence delirium as a secondary outcome 

Submissions


CoAuthor(s)

Dr. Dana Arekat, MD
Dr. Andrea Tsai, MD
Dr. Ina Zaimi, MD, MSc

Poster Presenter

Dr. Claudia Bruguera, MD

E041. Cardiac arrest secondary to R-on-T phenomenon caused by temporary epicardial pacemaker following cardiac surgery

R-on-T phenomenon (R-on-T) is a ventricular depolarization superimposing on the previous beat's ventricular repolarization, causing ventricular extrasystole. R-on-T can occur spontaneously or due to a paced beat. R-on-T due to pacemakers can be caused by undersensing, asynchronous pacing, or inappropriate pacing (1,2). It is important to keep R-on-T in mind while adjusting ventricular pacemaker settings. While it is rare, the consequences can be fatal. 

Submissions


CoAuthor

Dr. Tichaendepi Mundangepfupfu, MD, MRes

Poster Presenter

Dr. Michelle Chen, MD

E042. Lower oxygen delivery is associated with delirium and death in a single center retrospective cohort study of 1,452 patients

Maintaining the delivery of oxygen throughout the perioperative period is essential in preventing end-organ injury associated with cardiac surgery. To this end, novel approaches to the management of cardiopulmonary bypass (CPB) employ Goal Directed Perfusion (GDP) techniques to optimize tissue oxygenation during extracorporeal support for cardiac surgery. The concept of GDP initially gained momentum after a landmark study by Ranucci et al. demonstrated a clear association between oxygen delivery (DO2i) during CPB and postoperative acute kidney injury (AKI). The group demonstrated a critical DO2i threshold of 272 ml/min/m2 below which the risk of AKI increased dramatically, and that anemia from hemodilution during CPB could be overcome by increasing pump flow to maintain DO2I (1). While perfusion physiology during CPB is unique, the concept of DO2I as it relates to changes in blood flow and oxygen carrying capacity are fundamentally unchanged. Therefore, we hypothesize that the application of GDP concepts beyond the CPB period may help guide both intraoperative and postoperative management, such as titration of inotropes and optimal transfusion practices. Here, we present data from 1,452 patients from a single center who had a pulmonary artery catheter in place to allow for the calculation of body surface area indexed oxygen delivery (DO2I) and we compare patients who experienced delirium or death during their hospital encounter. 

Submissions


CoAuthor(s)

Dr. Benjamin Abrams, MD
Dr. Nathaen Weitzel, MD

Poster Presenter

Dr. Nathan Clendenen, MD

E043. Chronic Opioid Dependence After Isolated Traumatic Brain Injury: A Cross-Sectional Study with Longitudinal Outcome

Traumatic brain injury contributed to 2.8 million emergency department visits, hospitalizations and deaths in the United States in 2013[sup]1[/sup] and is a major source of morbidity, mortality, and social and economic burden. Patients with TBI are at increased risk for suicide, post-traumatic stress and other mood disorders and substance abuse, including opioid use disorder. In hospital exposure to opioids increases risk for chronic opioid dependence among surgical patients; however; few studies have examined the risk for chronic opioid dependence in the ICU setting among traumatic brain injured patients exposed to opioids for analgesia and sedation. The aim of this study is to determine the incidence and risk factors for chronic opioid use patients with TBI. 

Submissions


CoAuthor(s)

Joyce Chung, BS
Marcel Durieux, MD, PHD
Shenghao Fang, MD
Mark Hanak, BS
Chris Lacomis, BS
Dr. Bhiken Naik, MBBCh
Justin Palmer, BS
Caroline Ruminski, MD
Dr. Alexander Skojec, MD
Dr. Samantha Smith, MD
Sarah Spangler, MSc
Dr. Davis Taylor, MD
Siny Tsang, PhD
Tony Wang, MD

Poster Presenter

Dr. Lauren Dunn, MD, PhD

E044. RAGE-Dependent Group 2 Innate Lymphoid Cell Expansion Causes Type 2 Immune Dysfunction in Hemorrhagic Shock

Type 2 immune dysfunction contributes to acute lung injury and lethality following hemorrhagic shock (HS) and trauma. Group 2 innate lymphoid cells (ILC2) play a significant role in the regulation of type 2 immune responses. However, the role for ILC2 in post-HS acute lung injury and the underlying mechanism have yet been elucidated. 

Submissions


Poster Presenter

Dr. Xiangming Fang, MD

E045. Effect of Angiotensin II on Vasopressor Dose and Safety in Patients with Severe Vasodilatory Shock

A randomized, placebo-controlled, double-blind study of patients with severe vasodilatory shock who remained hypotensive despite fluid and vasopressor therapy (ATHOS-3) demonstrated that the addition of angiotensin II to standard vasopressors significantly increased mean arterial pressure and decreased catecholamine burden. Reducing the dose of vasopressors is known to be important considering dose-related toxicity associated with their use. Therefore, we investigated the effect of angiotensin II treatment on norepinephrine equivalent dose (NED) reduction and the associated adverse events (AEs). 

Submissions


CoAuthor(s)

Paula Ferrada
Damian Handisides
Dr. Caleb Mackey, MD
John Prowle
Aaron Strumwasser
Jonathan Wilkinson
Dr. Alexander Zarbock, MD

Poster Presenter

Dr. Ashish Khanna, MD, FCCP, FCCM

E046. Coughing Induced Cardiac Arrest after Superior Vena Cava Stent Placement: A Case Report

Coughing and bucking results in significant physiologic changes, especially in patients with serious cardiopulmonary abnormalities. Despite this, many anesthesia providers view coughing and bucking as a relatively benign process and may not be aware of its possible catastrophic consequences. This case report will review the changes and complications that inadequately paralyzed patients are at risk for in the perioperative period. 

Submissions


Poster Presenter

Dr. Kevin Min, MD

E047. Rescue TEE for differentiating and managing shock in Critically ill patient

Cardiac surgery poses a significant physiologic stress which could lead to various shock etiologies perioperatively. Our patient presented with multiple shock etiologies– cardiogenic, vasoplegic, hypovolemic and obstructive – in the immediate postoperative period. Management was guided by the use of transesophageal echocardiography (TEE) and invasive monitoring; using inotropes, vasopressors, blood products and fluids; mechanical circulatory support; and drainage of pericardial effusion 

Submissions


CoAuthor

Dr. Vaibhav Bora, MBBS

Poster Presenter

Dr. Estuardo Saravia Fernandez, MD

E048. Vasopressor Dosing in Septic Shock Clinical Trials: A Systematic Review and Meta-analysis

Despite assessment of patient factors such as serum creatinine, presence or absence of vasopressors and Sequential Organ Failure Assessment (SOFA) score, there is large unexplained variation in mortality rate across septic shock clinical trials [1]. We hypothesized that differences in vasopressor inclusion criteria may help to explain this variation in mortality. 

Submissions


CoAuthor(s)

Dr. Nicholas Bosch, MD
Ruxandra Pinto, PhD
Dr. Allan Walkey, MD, MSc
Dr. Hannah Wunsch, MD, MSc

Poster Presenter

Dr. Bijan Teja, MD, MBA

E049. PREDICTIVE FACTORS FOR CATHETER-RELATED BLOODSTREAM INFECTIONS: AN ANALYSIS OF PATIENT RECORDS OVER 5 YEARS IN THE INTENSIVE CARE UNIT OF A UNIVERSITY HOSPITAL

Since July 2013, we have implemented several preventative measures to reduce catheter-related bloodstream infections (CRBSIs). Monitoring started for CRBSIs when we joined the Japanese Healthcare Associated Infection Surveillance (JHAIS) survey. While nationwide overall infection rates from the JHAIS are available, factors associated with CRBSIs are not presented in this survey. Moreover, there have been few detailed reports on CRBSIs in Japan. Therefore, we analyzed data that may be associated with CRBSIs in the intensive care unit (ICU) at our hospital, and our findings were reported at International Anesthesia Research Society (IARS) annual meetings in 2016 1)and 2017 2). Five years have now passed since we started our survey and compiled our data. 

Submissions


CoAuthor(s)

Dr. Kiyoshi Moriyama, MD., PhD.
Dr. Akira Motoyasu, Dr.
Dr. Joho Tokumine, MD

Poster Presenter

Dr. Tomoko Yorozu, MD., PhD.

E050. Puzzle-Based Ultrasound Education for Healthcare Trainees Lays the Foundation for Future US Skills

Introduction: The use of Ultrasound (US) in the medical field is ubiquitous and has a range of diagnostic and therapeutic uses.1 However, US is not uniformly taught in health profession schools. We postulate that by integrating basic ultrasound education into the pre-clinical curriculum, trainees will initiate the development of ultrasound skills that will continue to develop through further training. The puzzles are designed to highlight different aspects of ultrasound probe skills, including object recognition, alignment, depth, and tilt. Early exposure to these skills is hoped to allow overall improvement of US skills in our trainees. 

Submissions


CoAuthor(s)

mariyah bower, PA student
Ms. Lydia Chen, BA
Dr. Mada Helou, MD
Ryan Nazemian, MD
Dr. Peggy Seidman, MD

Poster Presenter

Dr. Luna Chaaban, MD

E051. Resource Utilization in Implementation of a POCUS curriculum for resident training in Anesthesiology

Anesthesiology residents need to demonstrate competency in multiple skills to achieve board certification in the specialty. The ACGME mandates that residents need to be competent in using ultrasound for invasive procedures and to evaluate pathology (Section IV.A.5.a) (1). There is a drive to introduce Point of Care Ultrasound (POCUS) training into the curriculum of anesthesia residents (2). Training a novice in POCUS is time-consuming and requires large amount of resources However, no data exists on the costs of introduction of such a curriculum in an academic setting. We aim to describe the process of faculty training, resident training, resource utilization and costs of such an endeavor in a tertiary care academic department over the course of one year. 

Submissions


CoAuthor(s)

Christine Baer, BA
Dr. Ranjit Deshpande, MBBS
Garrett Sendlewski, BFS

Poster Presenter

Dr. Viji Kurup, MD

E052. Faculty gender specific academic advancement in US anesthesiology teaching programs and examination of contributing factors based on publicly available data

Gender equality and equal opportunity is an unsolved challenge in the US workplace. Medical specialties are no exception, and within the specialty of Anesthesiology- currently a male-dominated field- many questions remain. In this study, our aim was to determine the gender distribution among faculty at senior academic ranks in US anesthesiology teaching programs and investigate the impact of anesthesiology departmental and program factors. 

Submissions


CoAuthor(s)

Dr. David Moss, MD
Dr. Roman Schumann, MD
Dr. Farhad Zahedi, MD
Dr. Ina Zaimi, MD, MSc

Poster Presenter

Dr. Brenda Lee, MD

E053. Gender Bending: A National Perspective on Leadership Amongst Female Anesthesiologists in Canada

Despite the "feminization' of Medicine and the increasing number of female anesthesiologists in Canada,1 women remain underrepresented in the higher echelons of Medicine and in leadership positions.2,3 Stipulations to explain the pipeline effect have been described, but research in gender equity and equality in anesthesiology remains scarce. To address the gender disparity problem, elucidation of barriers and facilitators to leadership positions for female anesthesiologists is essential. We sought to determine facilitators and enablers to leadership positions in female anesthesiologists as well as concepts around gender as expressed by these women. 

Submissions


CoAuthor

Dr. Alana Flexman, MD

Poster Presenter

Dr. Gianni Lorello, BSc, MD, MSc (Med Ed), CI, FRCPC

E054. Reporting preclinical anesthesia study (REPEAT): evaluating the quality of reporting in the preclinical anesthesiology literature

Poor reporting quality may contribute to irreproducibility of results and failed 'bench-to-bedside' translation. Consequently, guidelines have been developed to improve the complete and transparent reporting of in vivo preclinical studies. To examine the impact of such guidelines on core methodological and analytical reporting items in the preclinical anesthesiology literature, we sampled a cohort of studies. Preclinical in vivo studies published in Anesthesiology, Anesthesia & Analgesia, Anaesthesia, and the British Journal of Anaesthesia (2008-2009, 2014-2016) were identified to assess reporting before and after guideline implementation. 

Submissions


CoAuthor(s)

Dr. Marc Avey, PhD
Dr. Dean Fergusson, PhD
Ms. Grace Fox, BSc
Dr. Manoj Lalu, MD, PhD, FRCPC
Mr. Neil Wesch, MASc

Poster Presenter

Dr. Ryan McGinn, MD, MSc

E055. Root-Cause Analysis for First Case Start Cancellations: Is it the Preoperative Clinic's Fault?

First case start delays or cancellation have a significant impact on operating room economics and is a common source of frustration. 1,2 While some studies have indicated the benefit of an anesthesiologist-directed preoperative evaluation clinic, others have questioned the cost-benefit ratio by implying preoperative clinics as non-essential.3,4 The aim of our study was to identify the causes of first start cancellations in our institution as a root-cause analysis for optimization of the institutional surgical operations flow. Our hypothesis was that the majority of first case cancellations were caused by incomplete presurgical screening and that a better compliance with anesthesia screening requirements would reduce the cancellation frequency. 

Submissions


CoAuthor(s)

Dr. Dung Nguyen, MD
Dr. Annette Rebel, MD
Dr. Lindsey Van Drunen, M.D.

Poster Presenter

Dr. Thomas McLarney, M.D.

E056. The New APPLIED Exam Format: Does the Exam Sequence Matter?

Background: Starting in 2017, the American Board of Anesthesiology (ABA) modified the primary certification process by adding a multi-station objective standardized clinical exam (OSCE) to the standardized oral exam (SOE) to elevate the degree of competency assessment of the applicants. Due to the administrative process of the exam, applicants are randomly assigned to take the SOE before the OSCE, or vice versa. The aim of this investigation was to assess if the exam sequence may have an impact on exam performance. 

Submissions


CoAuthor(s)

Ms. Amy DiLorenzo, MS
Dr. Jeremy Dority, MD
Dr. Dung Nguyen, MD
Dr. Annette Rebel, MD

Poster Presenter

Dr. Bjorn Olsen, MD

E057. An Altmetric Impact Analysis of Social Media Use, Download Activity, and Online Readership on Citation Frequency of Regional Anesthesia Articles

Social media has been gaining popularity as an international platform for doctors to discuss new ideas, research, and experiences. Recently, a strong push has been made for the use of Twitter as a primary platform, owing to its accessibility, the immediacy of dissemination of information, and the ability to reach large audiences quickly (1). Other platforms however also exist, including Mendeley (a desktop and web-based program designed around the collecting and sharing of journal articles), and they too allow for peer influenced discovery and dissemination of articles. Some publishers have begun reporting "altmetrics" of articles (details on how many people are viewing, sharing, and downloading an article) along with "Attention Scores" as calculated by proprietary algorithms with the aim of highlighting popular articles. We have traditionally weighed the impact and importance of articles by how often they are cited in further research – so the question arose, how close are these metrics correlated to the impact of an article? 

Submissions


CoAuthor

Dr. Sabrina Dhillon, M.D.

Poster Presenter

Dr. Astrid Overholt, M.D.

E058. Gender differences in US authorship of original research articles in two major anesthesiology journals: a 40-year analysis, 1977-2017

Publication of original research articles in the peer-reviewed literature is essential for progressing in rank, earning tenure, and acquiring leadership positions in traditional academic pathways. Underrepresentation of women in senior ranks and leadership positions is linked to differences in scholarship between men and women. Gender-based differences in research article authorship have not been quantified in anesthesiology. We analyzed authorship of US research articles published in Anesthesiology and Anesthesia and Analgesia from 1977 to 2017 to determine time-dependent changes in research scholarship of women in anesthesiology. 

Submissions


CoAuthor(s)

Dr. Julie Freed, MD, PhD
Dr. Graham Hill, DO
Dr. Cynthia Lien, MD

Poster Presenter

Dr. Paul Pagel

E059. Reducing operating room delays: one institution's search for the Holy Grail

The operating room (OR) is considered the major avenue of cost and revenue for hospitals. Multiple factors contribute to OR delays and impact patient safety, patient satisfaction scores, and hospital financial performance (1-3). Reduction of OR delays allows time to better accommodate the necessities of the OR, staff and patients, improve patient outcomes and operating costs. Several studies have aimed to identify different techniques to achieve this goal however limited data and data analysis exist (4-6). The objective of this initial study was to identify factors currently documented in the electronic health record (EHR) that may contribute to or be indicators of OR delays. 

Submissions


CoAuthor(s)

Dr. Andrew Casabianca, M.D.
Dr. Sadik Khuder, Ph.D.
Dr. Soroush Merchant, M.D.
Mr. Christopher Nam, BS
Dr. Thomas Papadimos, MD
Dr. Sonya Rygielski, M.D.

Poster Presenter

Dr. Scott Pappada, Ph.D.

E060. How Do Patients Who Respond to Anesthesia Satisfaction Surveys Differ from Patients Who Choose to Not Respond?

Results of patient satisfaction surveys have become an important healthcare quality measure in the U.S. Measures of patient experience are included in public reporting programs and were incorporated into the Medicare Hospital Value-Based Purchasing Program.[sup]1,2[/sup] However, response rates to surveys on patient satisfaction with anesthesia may be variable and little is known about the characteristics of patients who choose to fill out those surveys, limiting the generalizability of satisfaction survey results. We analyzed a large U.S. multistate database to better understand the differences between patients who responded to a survey on their experience with anesthesia care vs. those who did not. 

Submissions


CoAuthor(s)

Dr. Richard Dutton, MD, MBA
Dr. David Glick, MD, MBA
Dr. Avery Tung, MD, FCCM
Anum Wazir, B.A.

Poster Presenter

Ms. Anastasia Pozdnyakova, B.S.

E061. Global Medical Missions -Airway Management Working with what you have!

Global medical missions involving surgical interventions pose increased risk with limited resources in emerging countries. Both surgeons and anesthesiologist should be prepared to treat complex cases considering alternatives strategies when typical devices and technology are not available. In the case of airway management, the usual airway adjuncts, new innovative direct laryngoscopy devices may not be available and the rapidity at which the health care team can address complications in airway management can be compromised to the point of life altering consequences. Techniques and training in airway management, including alternative modes of intubation and ventilation are essential to minimize hypoxic injury and complications. 

Submissions


CoAuthor(s)

Dr. David Cuesta Peraza, MD
Dr. Fatoumata Kromah, Doctor of Medicine

Poster Presenter

Dr. Alice Coombs, MD, MPA, FCCP

E062. The African Surgical OutcomeS-2 (ASOS-2) pilot trial: a mixed-methods implementation study of a systems intervention for increasing postoperative surveillance in high-risk surgical patients.

The first African Surgical Outcomes Study (ASOS) found that African surgical patients were twice as likely to die following surgery, compared to the global average.1,2 The increased risk of death was associated with failure-to-rescue. This is likely due to limited high-care facilities and a shortage of perioperative specialists. Correcting this deficit will take many years; an intervention is needed that reduces failure-to-rescue without requiring an increase in resources. The African Surgical OutcomeS-2 (ASOS-2) trial aims to direct post-operative surveillance towards patients at higher risk of complications and death. The effectiveness of the proposed ASOS-2 intervention at reducing perioperative mortality will depend on the fidelity of implementation. The ASOS-2 pilot trial was conducted with the objectives of measuring i) the completeness of data collected, ii) the fidelity of implementation,3 and iii) the acceptability, appropriateness and feasibility of the intervention.3 

Submissions


CoAuthor(s)

M Sani Chaibou, MD
Dr. Veekash Gobin, MD
Hyla-Louise Kluyts, MMed
Dolly Munlemvo, MD
Dr. Akinyinka Omigbodun, FWACS, FMCOG
Dr. Eugene Zoumenou, MD

Poster Presenter

Dr. Leon du Toit, MMed

E063. Preeclampsia management in Central America: Moving towards multidimensional care?

Preeclampsia remains a leading cause of maternal mortality worldwide and in Mesoamerica.1,2 International recommendations emphasize magnesium sulfate administration, but minimally state the need for end-organ dysfunction recognition and monitoring to fully address patient survival.3 The Salud Mesoamérica Initiative (SMI) is a public-private partnership that focuses not only on single interventions but also on improving multidimensional quality of care to reduce maternal mortality for the poorest populations of Mesoamerica. In this study, we examine magnesium sulfate administration, as well as a key set of complementary measures to manage preeclampsia, including clinical exams, laboratory tests, and antihypertensive therapy. These interventions were implemented by SMI for preeclampsia management in this region (2013-2015). 

Submissions


CoAuthor(s)

Dr. Bernardo Hernandez, DSc, MS
Ms. Casey Johanns, MA
Ali Mokdad, PhD
Ms. Erin Palmisano, MA
Mr. Diego Rios-Zertuche, MPA

Poster Presenter

Dr. Aruna Kamath, MD MPH

E064. Water Pollution and Environmental Concerns in Anesthesiology

Medications administered by anesthesia health care providers and subsequently excreted into the water supply system have the potential to negatively affect ecological systems. However, there is presently a lack of literature examining which medications or metabolites enter the waste stream. This study explores the environmental externalities of perioperative services. 

Submissions


CoAuthor(s)

Lesley-Ann Dupigny-Giroux, PhD
Dr. Tsai Mitchell, MD, MMM
William Paganelli, M.D., Ph.D.
Donna Rizzo, PhD
Christine Vatovec, PhD

Poster Presenter

Mr. Marc Kostrubiak, M.A.

E065. A Prospective Observational Study of Postoperative Complications at a Non-profit, Internationally Supported Surgery Center in Guatemala

Global surgical access is unequally distributed with the greatest surgical burden in low- and middle- income countries where care is often supplemented by nongovernmental organizations. Quality, outcomes, and follow-up data from organizations providing this care frequently goes unreported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala is unique in that it offers a perpetually staffed, freestanding pediatric surgical center. Visiting surgical teams supplement this permanent team, providing a broad range of pediatric specialty surgical and anesthesia care. The aim of this study was to collect and report outcome measures at this non-profit, internationally supported surgery center to estimate the incidence of completed postoperative follow-up visits and postoperative complications over a minimum of twelve months. 

Submissions


CoAuthor(s)

Christy Crockett, M.D.
Ligia Figueroa, M.D., Master's Degree
Caleb Hayes, MPH, MA
Dr. J Matthew Kynes, MD
Dr. Kelly McQueen, MD, MPH
Christelle Samen, M.D.
Dr. Laura Zeigler, MD

Poster Presenter

Dr. Katheryne Lawson, M.D.

E066. Post-surgical neuropathic pain associates with the risk of coronary heart disease: A population-based matched cohort study

Chronic stress is identified as a potential trigger factor for coronary heart disease (CHD) (Tsai et al. 2015). Post-surgical neuropathic pain (PSNP) is a status of chronic stress (Eisenberg. 2004). We examined whether PSNP is a risk factor for CHD. 

Submissions


CoAuthor

Dr. Chun-Jen Huang, MD, PhD

Poster Presenter

Dr. Pei-Shan Tsai, PhD

E067. Patient Outcomes following Orthotopic Liver Transplant: Impact of Anesthesiologist Training Model

Clinical experience of the anesthesiologist has been demonstrated to have positive impact on patient outcomes in complex operative procedures including orthotopic liver transplantation (OLTx).1, 2 We sought to validate our institutional training model for liver transplant anesthesiologists and explore its impact on patient outcomes. Our non-fellowship training model consists of working as a dyad with a senior mentor for eight OLTx before independent practice. 

Submissions


CoAuthor(s)

Dr. James Fleming, PharmD
Dr. Latha Hebbar, MD, FRCA
Dr. Robert Mester, MD
Dr. Joel Sirianni, MD
Dr. David Stoll, MD
david taber, pharmD

Poster Presenter

Dr. Joseph Abro, MD

E068. Age as a predictor of long-term outcome after liver transplantation

Liver transplant grafts are a scarce resource and allocation in the US and many other countries is prioritized by severity of illness, i.e. MELD score. The goal of transplantation is to provide long-term survival and quality of life. Age is not included as a variable for graft allocation but may significantly affect long –term survival. While older recipients may have good long-term outcomes, the effect of age on outcome after liver transplantation has not been assessed. 

Submissions


CoAuthor(s)

Ms. Erin Hittesdorf, BS
Ms. Tara Richter-Smith

Poster Presenter

Dr. Gebhard Wagener, MD

E069. Resolution of hyponatremia after liver transplantation and its effect on outcome

Liver failure is associated with hyponatremia and sodium levels are now integrated into the MELD score as an allocation tool for liver transplantation. However, little is known how rapidly hyponatremia resolves and if persistent hyponatremia, or rapid changes of sodium, are associated with worse outcome. 

Submissions


CoAuthor

Ms. Erin Hittesdorf, BS

Poster Presenter

Dr. Gebhard Wagener, MD

E070. Unexpected Complete Tracheal Rings in a Pediatric Patient presenting for Elective Surgery.

Complete tracheal ring is a rare congenital condition, leading to tracheal stenosis, and is often diagnosed in infancy. Most present early in life with a severely compromised airway (1). We present the incidental diagnosis of complete tracheal rings in an asymptomatic 3 year old patient during elective surgery. 

Submissions


CoAuthor(s)

Jasleen Kaur
Pamela Mudd

Poster Presenter

Dr. Claude Abdallah, MD, MSc

E071. Near Miss - Surgical Site Mark Transfer Leads to Wrong Limb Being Prepped and Draped

According to the Joint Commission Center for Transforming Healthcare Project, it is estimated that as many as 50 wrong site (defined as wrong patient, wrong side, or wrong procedure) surgeries are performed every year in the United States. Their report identifies a safety framework whereby such catastrophic errors may be minimized. This near miss case underscores the persistent potential for wrong site surgery even when guidelines are followed. The aim is to encourage continued provider vigilance in this regard. 

Submissions


CoAuthor

Dr. Sarah Armour, MD

Poster Presenter

Dr. Trygve Armour, MD

E072. Right Ventricular Failure and Acute Respiratory Distress Syndrome after Drowning Managed with Right Atrial to Pulmonary Artery Extracorporeal Membrane Oxygenation

Drowning is one of the leading causes of accidental deaths. Young patients are at the highest risk due to lack of supervision (1). Aspiration of seawater causes an intense inflammatory response in the airways (3). Both fresh and salt water wash away the surfactant. Bronchospasm also arises and in some cases acute emphysema due to alveolar rupture(4). All this can lead to acute respiratory distress syndrome (ARDS). Radiological studies can also lag behind the pathological effect and be normal(5). Computed Tomography shows ground-glass opacities with or without associated reticular opacities and centrilobular nodules (6) . Cardiac effects of drowning mostly cause arrhythmias secondary to the hypoxic event. Both right and left heart failure and stunned myocardium can be seen. If oxygenation fails the use extracorporeal oxygenation (ECMO) can be initiated. The overall survival using ECMO was seen to be 51.4%( 7). 

Submissions


CoAuthor(s)

Dr. RAFAEL ARCINIEGAS FLORES, MD
Dr. Valerie Hart, DO
Dr. Srikar Jonna, MD
Dr. Ning Lu, MD
Dr. Ricardo Martinez Ruiz, MD
Dr. Anna Schuerner, MD
Dr. Arnaldo Vera-Arroyo, MD
Dr. Richard Zack-Guasp, MD

Poster Presenter

Dr. CHRISTIAN BALABANOFF ACOSTA, MD

E073. Independent Lung Ventilation as a Rescue Strategy Following Unilateral Lung Transplantation: A Case Report.

Independent lung ventilation (ILV) is most commonly used for lung isolation in thoracic surgical procedures. Early use of ILV in the intensive care unit (ICU) was in the treatment of unilateral lung disease leading to refractory hypoxic respiratory failure. There are limited reports of its use post-transplantation. 

Submissions


CoAuthor

Dr. Victor Davila, MD

Poster Presenter

Dr. Amar Bhatt, MD

E074. Opioid-Sparing Anesthetic for Pediatric Posterior Spinal Fusion

Interest in multimodal perioperative analgesia is growing as clinicians work to improve post-operative acute pain, decrease the risk of chronic pain, and reduce opioid-related adverse events. 

Submissions


CoAuthor

Dr. Thomas Anderson, PhD, MD

Poster Presenter

Dr. Michael Cook, Doctor of Medicine

E075. Management of a patient with placenta previa and Von Willebrands Disease undergoing neuraxial anesthesia and caesarean section: a case report.

This case demonstrates a unique situation where a patient with Von Willebrand's Disease presents with a hemorrhagic emergency due to placenta previa and undergoes caesarean section under neuraxial anesthesia. Management of the combined disease processes is described with a successful result. This case report provides a valuable insight into rare situations as is present in this case. No other published case report details management of a patient with such a situation. By presenting this case, the knowledge of the anesthesia provider would be expanded and aid in managing such a situation if it were to arise. 

Submissions


Poster Presenter

Mr. Chris Cullom, MD

E076. Superior Vena Cava Syndrome from Cannula Malposition during Femoro-Femoral Veno-Venous ECMO

A 37-year-old female with history of cystic fibrosis (CF), mild pulmonary hypertension, and chronic hypoxemic hypercapnic respiratory failure on home oxygen (6-10 L/min) and nocturnal BiPAP was admitted to undergo bilateral pulmonary transplant. Femoro-femoral veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated after induction and prior to incision for hypercarbia. Her intraoperative course was complicated by hemodynamic instability that required transition to VVA-ECMO by addition of a femoral arterial cannula, as well as significant surgical bleeding needing transfusion. The patient was transitioned back to VV-ECMO at the end. She arrived to the ICU on inhaled nitric oxide, and inotropic and vasopressor support. Her course was complicated by significant postoperative bleeding that required bedside exploration, washout, and packing on her first postoperative day (POD). On POD 2 the patient was noticed to have significant head, neck, and upper extremity edema concerning for superior vena cava (SVC) syndrome, possibly from obstruction by surgical packing, so bedside TEE was performed. The TEE revealed absence of external SVC compression, no pericardial effusion, and normal biventricular function. Interestingly, the ECMO reinfusion cannula was observed at the SVC-RA junction (Fig.1A) with retrograde blood flow in the SVC (Fig. 1B), likely explaining her SVC syndrome. The re-infusion cannula was withdrawn under direct TEE visualization and positioned in the right atrium (RA) with flow directed towards the interatrial septum (Fig. 1C and D). Over the following 24 hours after cannula repositioning, the patient's head and neck edema resolved. On POD 3 she was successfully weaned from VV-ECMO and decannulated. The patient continued to progress and was discharged home on POD 16. 

Submissions


CoAuthor

Dr. Elvedin Lukovic, MD, PhD

Poster Presenter

Dr. Juan Diaz Soto, MD

E077. Opioid Induced Hyperalgesia Treated with Concurrent High Dose Lidocaine and Ketamine Infusions

The escalation of opioid prescribing and administration is know a known problem throughout the united states and the side affects and lack of compelling evidence of their long term effectiveness is controlling chronic pain is now well chronicled. One of many concerns of escalating opioid use is opioid induced hyperalgesia [OIH], which is defined as a state of nociceptive sensitization with exposure to opioids resulting in increased sensitivity to painful stimuli. Here we demonstrate a case of opioid induced hyperalgesia, due to treatment for a congenital disease, successfully treated with high dose ketamine and lidocaine infusions while facilitating opioid detoxification. 

Submissions


CoAuthor(s)

Dr. Stephen Krazit, MD
Dr. Biral Patel, MD

Poster Presenter

Dr. Ahmed Embabi, MD

E078. Surgical Stress and the Patient with Carnitine Palmitoyltransferase II (CPT II) Deficiency

Carnitine palmitoyltransferase II (CPT II) is part of a chain of enzymes responsible for making fatty acids available for use by skeletal muscle as an energy source. Deficiencies in this enzyme and others along the chain result in myalgias, metabolic acidosis and even rhabdomyolysis during periods of stress, exercise, prolonged fasting, infection and depletion of glucose stores in susceptible patients. Certain medications like valproic acid, ibuprofen and high doses of diazepam are also known exacerbators of CPT II crises. CPT II deficiency is an autosomal recessive disease that exists in 3 forms: the lethal neonatal form, infantile hepatocardiomuscular form and the adult myopathic form. The adult myopathic form is the most common disorder of lipid metabolism affecting skeletal muscle and is also the most frequent cause of hereditary myoglobinuria. To date, there is little data on the ideal anesthetic management of these patients. 

Submissions


CoAuthor

Dr. Harendra Arora, MD, MBA

Poster Presenter

Dr. Candy Ezimora, MD, MBA

E079. Respiratory Compromise due to Electromyographic Endotracheal Tube Intraoperative Structural Damage - An Unusual Airway Situation: How Do I Deal With It?

Injury to the recurrent laryngeal nerve (RLN) during anterior cervical discectomy and fusion is a potential complication. For this reason, Electromyographic Endotracheal Tubes (EmET) are often used to monitor RLN integrity intraoperatively [1, 2]. EmET is fitted with four stainless steel wire electrodes which are embedded in the silicone structure of the main shaft. Anesthesia provider need to be aware of a potential risks of using EmET. One of them is a structural wire electrode disintegration by biting or other forces resulting in a loss of airway patency. An exceptionally sturdy bite block kept in situ until extubation is paramount to prevent this complication [3]. Airway blockage by loss of EmET structural integrity should always be considered in case of intraoperative desaturation or difficult ventilation. 

Submissions


CoAuthor(s)

Dr. Deniz Oguz, MD
Dr. Sergey Pisklakov, MD

Poster Presenter

Dr. Jacquelyn Francis 6679055, MD

E080. Airway Management in a Pediatric Patient with Langer's Mesomelic Dysplasia, a Rare Form of Severe Dwarfism

Langer's Mesomelic Dysplasia is a rare form of severe disproportionate dwarfism, with less than one hundred reported cases in the literature. It is believed to be the most extreme manifestation of a spectrum of syndromes associated with mutations of the short stature homeobox gene (1). Inheritance is autosomal recessive and patients have a normal life span (2). Given the severity of their short stature, children with this syndrome may present challenges with airway management. 

Submissions


Poster Presenter

Dr. Aimee Gasior Bejar, MD

E081. Intraoperative Management of Stable Ventricular Arrhythmia During Right Carotid Endarterectomy

Carotid arterial atherosclerosis is a common cause of stroke, causing approximately 20% of ischemic strokes.[1] Randomized controlled trials have established that carotid endarterectomy (CEA) is safe and effective in reducing risk of stroke in symptomatic patients.[2] Recent data recommends CEA in patients with recent symptomatic carotid stenosis of 70-99%, life expectancy of at least 5 years, surgically accessible lesion, absence of severe comorbidities and no prior endarterectomy of the same side.[3] Although this procedure may decrease the risk of a fatal/debilitating stroke, there are perioperative hemodynamic considerations. 

Submissions


CoAuthor(s)

Dr. Ai-Lin Shao, MD
Dr. Risa Wolk, MD

Poster Presenter

Dr. Hanna Hussey, MD

E082. ANESTHESIA IN SPACE

In this day and age, human beings have yet to perform any type of surgery in space. One of the main reasons for this is the difficulty of controlling anesthesia in extreme environments with limited resources and equipments. Supply of goods and remote medical support also can not be expected. An anesthesia used on a space mission should be simple and practical. Inhalation anesthesia is much safer than intravenous anesthesia, since anesthetic agents (isoflurane or sevoflurane) are non-flammable and have low toxicity, and depth of anesthesia is regulated through respiration. Furthermore, it is only recyclable drugs. It can be said that inhalation anesthesia is extremely useful for the space mission, however, it was required a source of electricity and gas piping equipment, and had poor portability (weight exceeds 100 kg). To solve this, a 3D printable inhalation anesthesia aid device was invented which, by fitting to a conventional bag valve mask (BVM), allows the addition of key functions of inhalation anesthesia systems: (1) vaporization of anesthetic; (2) automatic ventilation; and (3) removal of anesthetic gas. The silicone bag of the existing manual ventilator was used to simulate a large vaporization space, and a method of nebulizing the anesthetic with a syringe or spray bottle within the bag was used. LEARNING OBJECTIVE: Inhalation anesthesia can be safely performed in an enclosed zero gravity environments. 

Submissions


Poster Presenter

Dr. Naoyuki Ishikita, Chief Pediatrician

E083. Perpendicular and turbulent flow after aortic valve replacement: Observe or repair on extra cardiopulmonary bypass?

Cardiovascular anesthesiologists occasionally find small leakage and backflow jets originating from the central coaptation point, the fabric-covered sites of stent post, the region between the stent post and the sewing ring,1 and/or commissures between biological valves2 after weaning from cardiopulmonary bypass (CPB). These jets are identified as transvalvular leakages (TVLs) that generally only require follow-up monitoring. On the other hand, paravalvular leakage (PVL) is associated with morbidity3,4 and mortality,5 and needs to be immediately repaired on extra CPB, especially if more-than-moderate regurgitation is detected after weaning from CPB. 

Submissions


CoAuthor(s)

Dr. Keisuke Nakazawa, M.D., Ph.D.
Dr. MInoru Nomura, M.D.
Dr. Makoto Ozaki 33538111, MD, PhD
Dr. Sumire Yokokawa, M.D.

Poster Presenter

Dr. Shihoko Iwata, M.D.

E084. Spawning Demons with Tramadol and Venlafaxine: An Atypical Case of Hallucinosis

Chronic pain and depression frequently co-exist. The reasons behind this relationship may be multi-factorial. Depression is more likely to develop in patients demoralized by failed treatment. Pain and depression may also share common underlying neurobiological mechanisms [1]. Clinically, patients receiving concurrent pharmacotherapy for these conditions present unique challenges. Prescribing options may be limited by the potential for adverse drug reactions. Such adverse events include hallucinations, which can result from combined therapy with tramadol and antidepressants [2]. 

Submissions


CoAuthor(s)

Dr. Keith Candiotti, Miami
Melvin Gitlin, MD, FACPM

Poster Presenter

Mr. Yuel-Kai Jean, DO

E085. Chordal entrapment of MitraClip requiring emergency surgical mitral valve repair

Mitral regurgitation (MR) is the second most common valvular heart disease. While surgical repair is recommended for many patients with severe degenerative MR (DMR), as many as 49% of patients do not qualify as they are at high surgical risk (1). The percutaneous MitraClip implantation can be seen as a viable option in high surgical risk patients. We report the case of chordal entrapment of MitraClip. 

Submissions


CoAuthor(s)

Mr. Toufan Bahrami, MD
Dr. Katarina Lenartova, MB ChB
Dr. Sarka Moravcova, MB ChB

Poster Presenter

Dr. Kiranjit Khazan Singh, MB ChB, FRCA

E086. A Frozen Brain and a Broken Heart; A Case of Takotsubo in the Setting of Catatonia

Catatonia has a long-standing association with schizophrenia, but, more recently, catatonia also has been linked to withdrawal from psychotropic medications (1). Additionally, the same anxiety-provoking setting that can lead to the catatonic state (2), may also be present in patients with Takotsubo cardiomyopathy. This association has only rarely been reported in the literature (3). While the precise pathophysiology is not well understood, the likely common thread between these two distinct disease processes is a sudden decrease in GABA signaling during benzodiazepine withdrawal (4). In regard to catatonia, this decreased signaling may have a profound effect given the pre-existing downregulation of GABA receptors in the CNS. Similarly, this acute physiologic change may contribute to overwhelming catecholamine release and resulting stress-induced cardiomyopathy (4, 5, 6). 

Submissions


CoAuthor(s)

Dr. Megan Jaynes, PharmD, BCCCP Janynes, PharmD, BCCCP
Dr. Edward Misulis, MD
Dr. Jeremy Walco, MD

Poster Presenter

Dr. Nicole King, MD

E087. Delayed Presentation of Traumatic Cardiac Tamponade

Blunt chest trauma leading to cardiac tamponade is a rare event usually associated with cardiac rupture or injury to the great vessels. We present a case of a 56-year-old man that suffered significant blunt chest trauma after a high-speed motorcycle collision resulting in multiple rib fractures and peri-aortic hematoma. The patient was stable until 16 hours after his accident at which point he went into a cardiac arrest requiring cardiopulmonary resuscitation. Immediately following the return of spontaneous circulation, a transthoracic echocardiogram showed a small pericardial effusion that grew in size over the next hour. The patient decompensated and required emergent median sternotomy for evacuation of pericardial hematoma. This case is unique in that the patient developed a rapidly expanding hemopericardium following chest compressions without an identifiable source of extravasation during surgical evacuation and exploration of the pericardium. 

Submissions


CoAuthor

Dr. Joanna Schindler, M.D.

Poster Presenter

Dr. Daniel Machado, MD

E088. Case series of ex-vivo resections in patients with hepatic tumors with extension into inferior vena cava and right atrium

Ex-vivo liver resection followed by auto-transplantation (ELRA) was first described in 1990 by Pichlmayr as an alternative for conventionally unresectable tumors where transplantation is questionable, and requires neither organ donor nor immunosuppressive agents. Lesions that are candidates for these resections often involve extension into the cardiac chambers. While anesthetic considerations remain similar between ELRA and traditional liver transplantation, they are compounded by a need for attention to traditional cardiovascular surgery concerns. In this case series, we present the unique challenges of managing patients undergoing ELRA with concomitant cardiac surgery due to extension of the primary lesion. As the incidence of liver cancers continue to increase despite optimal medical therapy and critical care advances improve perioperative survival, these cases will become more routine and managing both cardiac and hepatic anesthetic concerns will remain paramount for successful outcomes. 

Submissions


CoAuthor(s)

Dr. Meneka Dave, MD
Dr. Taylor Johnston, MD
Dr. Avanish Reddy, M.D.

Poster Presenter

Dr. Rebecca Martinez 4251848, MD

E089. Experience of liver transplantation for hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is characterized by arteriovenous malformations that involve the pulmonary, hepatic and cerebral circulations without clinical symptoms, although it may lead to biliary ischemia and portal hypertension, resulting in portopulmonary hypertension (PPH). The indications for liver transplantation in such cases are still unclear. We report here liver transplantation for a woman with hereditary hemorrhagic telangiectasia (HHT) with severe pulmonary shunting. 

Submissions


CoAuthor(s)

Dr. kazumasa Hiroi, Master
Ryuji Kaku, MD, PhD
Dr. Hiroshi Morimatsu, MD, PhD

Poster Presenter

Dr. takashi matsusaki, MD, PhD

E090. Epidural Catheter and Cardiac Catheterization- a case report

Epidural catheters for post-operative analgesia remains a critical component for many procedures, including thoracic surgeries and upper and lower abdominal surgeries. The incidence of a peri-operative cardiovascular event varies depending on the patient's risk factors and type of procedure being performed, with several risk stratification models calculating this risk (1). When acute myocardial ischemia/infarction is suspected, cardiac catheterization and revascularization along with dual antiplatelet therapy (DAPT) is often the gold standard (1). Management of epidural catheters in the setting of emergent DAPT is not well established. We report on a 65 year old male who received an epidural for a pneumonectomy and subsequently developed ST elevation on post-operative day (POD) 1 requiring emergent cardiac catheterization. 

Submissions


CoAuthor(s)

Dr. Daniel Sehrt, MD
Dr. Jillian Vitter, MD

Poster Presenter

Dr. Keleigh McLaughlin, MD

E091. Anesthetic Management for Treatment of a Large Intrapericardial Cyst Compressing the Superior Vena Cava and Main Pulmonary Artery

Mediastinal masses present with a wide array of symptoms including cough, shortness of breath, dysphagia, facial swelling, and other symptoms related to compression of adjacent structures in the mediastinum. While the differential for mediastinal masses often includes various types of solid tumors, lymphomas, or enlargement of vascular structures, more rare causes include benign cysts. The majority of these cysts are bronchogenic in nature, while very few are pericardial in origin. Intrapericardial cysts occur in about 1 in 100,000 patients, and often present with symptoms of shortness of breath due to compression on the right side of the heart as they most commonly occur at the cardiophrenic angle. While treatment is largely interventional, there is little published in the literature aside from case reports in treating these types of cysts. Although these pericardial cysts are benign, recurrence can occur if the entire structure is not resected. We present the case of a woman with a recurrence in her symptoms from a previously percutaneously drained pericardial cyst that was compressing her superior vena cava. She underwent video assisted thoracoscopy for treatment of the cyst. 

Submissions


CoAuthor(s)

Dr. Joseph Cerasuolo, M.D.
Dr. Andrea Tsai, MD

Poster Presenter

Dr. Oran Mehrnia, D.O.

E092. Multifactorial Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially fatal endocrine emergency resulting from uncontrolled diabetes mellitus. The development of DKA has been linked to a number of precipitating factors such as infectious process, ischemia, medications, and other medical-surgical illnesses which either aggravate pre-existing or unmask latent glucose dysregulation. 

Submissions


CoAuthor(s)

Dr. Babar Fiza, MD
Dr. Amit Prabhakar, MD
Ceressa Ward, PharmD

Poster Presenter

Dr. Vanessa Moll, MD

E093. Left Ventricular Assist Device and Laparoscopic Sleeve Gastrectomy- A Multidisciplinary Approach to Perioperative Management

Cardiac transplant is contraindicated in morbidly obese patients due to increased morbidity and mortality (1). Bariatric surgery has been recognized as a feasible weight loss reduction strategy in patients with ACC/AHA stage D heart failure (HF), including those requiring left ventricular assist device (LVAD) support. Laparoscopic sleeve gastrectomy (LSG) is the procedure of choice in this patient population. Current enhanced recovery (ERAS) protocols for bariatric surgery may not sufficiently meet the needs of this unique subset of patients and evidence-based guidelines for perioperative management have not yet been established. 

Submissions


CoAuthor(s)

Dr. Judith Aronsohn, MD
Daniel Lazar, MD

Poster Presenter

Dr. Joseph Mongone, MD

E094. Otorhinolaryngologic surgery in a child with Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a progressive myopathic disorder resulting from a defect in the dystrophin gene, and it is characterized by worsening muscle weakness from muscle fiber degeneration. Anesthetic management of these patients can be challenging due to pulmonary insufficiency, cardiac muscle fiber involvement, a potentially difficult airway, and contraindications to common anesthetic medications. We present the case of a 7-year-old male with a history of DMD, presenting for multiple otorhinolaryngologic surgeries. 

Submissions


CoAuthor(s)

Dr. Titilopemi Aina, MD, MPH
Dr. Monica Chen, MD

Poster Presenter

Dr. Elizabeth Rossmann Beel, MD

E095. Misplacement of a right subclavian dialysis catheter into the spinal canal in a patient on veno-venous Extracorporeal Membrane Oxygenation: A case report

Central venous catheter insertion is a routinely performed procedure in critically-ill patients with an overall low rate of significant complications. Patients on extra-corporal-membrane-oxygenation (ECMO) represent a very fragile and challenging population for central venous access due to increased risks for hemodynamic and hemorrhagic complications. We report a case of a patient on veno-venous extra-corporal-membrane-oxygenation (vvECMO) who suffered from an inadvertently placed dialysis catheter into the spinal canal via the subclavian vein. 

Submissions


CoAuthor(s)

Dr. Roman Dudaryk, MD
Dr. Jack Louro, MD

Poster Presenter

Dr. Anna Schuerner, MD

E096. One lung ventilation in a pediatric patient in a resource limited setting in Rwanda

One lung ventilation (OLV) is necessary for various clinical scenarios, but it can be challenging in developing countries with limited resources and equipment. This case report describes the successful use of a left endobronchial intubation without fiberoptic guidance for a pediatric patient in Rwanda, a developing country. 

Submissions


CoAuthor(s)

Dr. Eric Brumberger, M.D.
Zachary Turnbull, MD
Dr. Stephanie Vecino, M.D.

Poster Presenter

Dr. Harmandeep Singh, MD

E097. Management of Erroneous Epinephrine Administration in a Patient with Hypertrophic Obstructive Cardiomyopathy

Hypertrophic Obstructive Cardiomyopathy (HOCM) is a disease of autosomal dominant inheritance that is characterized by interventricular septal enlargement, which results in decreased left ventricular end-diastolic volume 1. Changes in contractility, ventricular volume, and afterload are common in patients undergoing anesthesia. However those same parameters lead to obstruction of the left ventricular outflow tract (LVOT) in patients with HOCM, making providing anesthesia to these patients challenging. Here we present a case where an erroneous administration of epinephrine led to the worsening of HOCM pathophysiology requiring emergent intervention. 

Submissions


CoAuthor(s)

Dr. Thomas Papadimos, MD
Dr. Scott Pappada, Ph.D.
Dr. Sooraj Yermal, MD

Poster Presenter

Dr. Francisco Solorio, MD

E098. Acute Biventricular Heart Failure with Intraventricular Thrombus Formation Following Pericardiocentesis in a Patient with Newly-Diagnosed Metastatic Lung Cancer

The purpose of this case report is to describe a case of a rare but known phenomenon of acute cardiac decompensation after pericardiocentesis. This case is unique in that the patient developed biventricular failure with a large clot burden in both the right and left ventricles. 

Submissions


CoAuthor(s)

Dr. Abhinav Goyal, MD, MHS
Dr. Adam Mitchell, MD

Poster Presenter

Ms. Diana Tiwari, MD

E099. A pediatric mask maintained spontaneous ventilation/oxygenation with CPAP in a deeply-sedated patient with tracheostomy during emergency FOB retrieval of a foreign body in the right mainstem bronchus

Patients under procedure sedation often receive O2 via nasal cannula (NC). Over-sedation and/or airway obstruction may cause severe desaturation. A simple nasal PAP mask assembly using a pediatric face mask and existing anesthesia equipment and machine has been shown to maintain spontaneous ventilation and improve oxygenation in sedated obese patients with obstructive sleep apnea (Fig. 1)(1-5). An infant face mask secured over a tracheostoma has been shown to maintain spontaneous ventilation and oxygenation in a frail patient during EGD (Fig. 2) (6). We used this technique in a cancer patient with tracheostoma during flexible fiberoptic bronchoscopic (FOB) retrieval of a foreign body (FB). 

Submissions


CoAuthor(s)

Dr. Antonio Chiricolo, MD
Dr. Esther Ogunyemi, MD

Poster Presenter

Dr. James Tse, PhD, MD

E100. A novel modified pediatric face mask provided nasal PCV/oxygenation while teaching medical student to perform intubation in a high-risk patient with cystic fibrosis undergoing endoscopic sinus surgery

Patients with cystic fibrosis (CF) are prone to severe O2 desaturation during induction of general anesthesia (GA). A pediatric face mask has been shown to improve oxygenation by delivering nasal CPAP in sedated obese patients and patients during GA induction and endotracheal intubation (ETI) (1-5). We used a modified pediatric face mask (Fig. 1) to provide nasal CPAP pre-oxygenation and pressure-controlled ventilation (PCV) in a CF patient during GA induction. 

Submissions


CoAuthor(s)

Dr. George Barsoum, MD
Dr. Sylviana Barsoum, MS, MD
Dr. Benjamin Gorbaty, MD
Ms. Mary Vanderveen, BA

Poster Presenter

Dr. James Tse, PhD, MD

E101. Anesthetic Implications for a Patient with Active Tuberculous Vertebral Osteomyelitis (Pott's Disease) Undergoing Corpectomy with Posterior Fusion

Although rare in the United States, tuberculosis (TB) has a prevalence of 9 million cases per year worldwide. 10-35% of all extra-pulmonary cases are skeletal tuberculosis with vertebral osteomyelitis (Pott's disease) the most common(1). Here, we discuss the case of a patient with Pott's disease and the anesthetic implications for a patient with active TB on anti-TB therapy undergoing surgery. 

Submissions


CoAuthor

Dr. Aaron Lim, MD

Poster Presenter

Dr. Kent Vu, MD

E102. Spatial extent of visually evoked gamma oscillations is modulated by anesthetic brain state in mice

Much of our understanding of sensory processing is based on recordings of single units or small groups of neurons in primary sensory cortices. Remarkably, even when perception is absent (e.g. under anesthesia), individual neurons in primary sensory cortices reliably represent sensory information1–3. This suggests that the breakdown of perception is related to the inability of activity within the visual system to effectively integrate with other cortical circuits. The long range integration of cortical signaling can often be seen as a complex response to external stimuli that long outlast stimulus presentation and cover large swaths of cortical surface4,5. Yet, the circuit mechanisms that allow for the generation and maintenance of such spatiotemporal responses remain largely unknown. Moreover, how this response is related to the anesthetic induced brain state has not been studied. 

Submissions


CoAuthor(s)

Connor Brennen, BS
Dr. Diego Contreras, MD/PhD
Dr. Max Kelz, MD, PhD
Dr. Alexander Proekt 6404568, MD, PhD
Ms. Brenna Shortal, B.S.

Poster Presenter

Ms. Adeeti Aggarwal 9806860, BA

E103. Pan-neuronal Tracking of Neuronal Activity in Anesthetized C. elegans

There is a gulf in resolution that exists between the sub-cellular search for a receptor mechanism for anesthetic agents, and studies of neuronal interactivity at the resolutions permitted by EEG and fMRI. We hypothesize that the mechanism of action of volatile anesthetics exists at the level of neuronal circuits, whose baseline function and subsequent dysregulation should be elicited through imaging techniques that operate at the resolution of the individual neurons. We previously demonstrated that fluorescent labeling of the neurons in C. elegans is sufficient to allow the activity of multiple individual neurons to be captured while exposed to isoflurane[1]. We now describe the functional imaging of progressive induction and emergence from anesthesia with isoflurane, via the extraction of neuronal activity from 150 neurons in parallel, made possible by significant advances in imaging and computing. 

Submissions


CoAuthor(s)

Dr. Christopher Connor, MD PhD
Christopher Gabel, PhD
Mr. Greg Wirak, Bachelors of Science

Poster Presenter

Mr. Mehraj Awal, Bachelors of Science

E104. Excitatory and inhibitory imbalance may contribute to the propofol-induced developmental neurotoxicity through the dysregulated signaling network between microRNAs and mRNAs

Increasing animal studies show evidence of anesthetic-induced developmental neurotoxicity (AIDN), leading to long-term cognitive deficits for exposed subjects. Some epidemiological studies have found similar results in human populations as well. However, mechanisms behind this phenomenon are largely unknown. One hypothesis lies in a balance in the excitatory and inhibitory (E/I) synaptic networks which form the basis of information transfer in the brain. Such alterations in the E/I ratio have previously been associated with several brain disorders linked to cognitive dysfunction (e.g., autism). We hypothesized that neonatal propofol exposure induces long-term E/I imbalance in mice, and this imbalance might contribute to AIDN. 

Submissions


CoAuthor(s)

Thiago Arzua, BS
Zeljko Bosnjak, PhD
Congshan Jiang, Ph.D
Xiaojie Liu, MS
Qingsong Liu, PhD
Ms. Sarah Logan, BS
Mr. Yasheng Yan, BS

Poster Presenter

Dr. Xiaowen Bai, PhD

E105. Introducing a Novel Evoked EEG index to Detect Recall Under Sedation A Proof of Concept Study

Awareness under general anesthesia (GA) is a dreadful complication 1,2. Various EEG-based technologies (such as BIS) were developed in order to identify this condition 3. However, BIS was proven to be unable to detect awareness and influenced by the effect of muscle activity 4-7. Due to the very low % of recall under GA it is difficult to validate the effectiveness of awareness monitors 8,9. Conversely, sedation often involves a greater prevalence of recall, which enables evaluation of awareness, with lower sample size 9-10. Since BIS analyzes only prefrontal electrodes, it might be susceptible to EMG/EOG effect, thus less effective under sedation 11-12. It was previously described that alpha activity anteriorizes under anesthesia, thus the process of anteriorization might imply on the depth of anesthesia 13-16. We developed a novel index, anteriorization /posteriorization (A/P) index, based on analyzing auditory evoked EEG signal from anterior and posterior EEG channels (F3, F4, O1, O2) 17-20. In this pilot study, we hypothesized that the new index would differentiate between patients with or without recall under sedation, whereas BIS measurements would not. 

Submissions


CoAuthor(s)

Dr. Andrew Baker, MD
Dr. Violina Chenosia, MD
Gregory Hare, MD, PhD
Nikhil Mistry, MSc
Dr. Leonid Priven, MD
Dr. Goded Shahaf, MD PhD

Poster Presenter

Dr. Dana Baron Shahaf, MD PhD

E106. Development and Validation of a Bedside Functional Connectivity Imaging System in Acute Stroke Recovery using Diffuse Optical Tomography

Given the enormous impact of stroke on global health, the rapid evolution of stroke during acute recovery, and known stroke related functional connectivity (fc) disruptions demonstrated with MRI [1,2], this study develops a bedside imaging technique utilizing Diffuse Optical Tomography (DOT) to measure clinically relevant fc changes in patients during acute ischemic stroke recovery (first 72 hours). 

Submissions


CoAuthor(s)

Dr. Karla Bergonzi, PhD
Ms. Tracy Burns-Yocum, BS
Dr. Joseph Culver, PhD
Dr. Raj Dhar, MD
Dr. Adam Eggebrecht, PhD
Dr. Silvina Ferradal, PhD
Mr. Andrew Fishell, BS
Dr. Gyanendra Kumar, MD
Dr. Jin-Moo Lee, MD, PhD
Ms. Arefeh Sherafati, BS

Poster Presenter

Dr. Broc Burke 2802292, MD, PhD

E107. Voluntary Exercise rescues the spatial memory deficit associated with early life Isoflurane exposure in Rats

Early life anesthesia exposure causes lifelong cognitive deficits in animals as diverse as rodents and primates. In this study we asked whether exercise as an intervention later in life could rescue this perinatal insult in a rodent model. Previously we showed that environmental enrichment, which includes social housing, a stimulating environment and voluntary exercise, could rescue this deficit(1). Here we tested whether exercise is sufficient. 

Submissions


CoAuthor(s)

Dr. Jeffrey Sall, PhD, MD
Dr. Jennifer Sasaki Russell, PhD

Poster Presenter

Dr. Gregory Chinn, MD PhD

E108. Metabolipidomic analysis of cerebrospinal fluid reveals increased arachidonic acid-derived lipids and specialized pro-resolving mediators 24 hrs and 6-weeks following surgery and anesthesia

Older patients are at risk of developing perioperative neurocognitive disorders such as postoperative cognitive dysfunction (POCD), a syndrome of postoperative thinking/memory deficits associated with increased morbidity and mortality. POCD has been hypothesized to be caused by postoperative neuroinflammation, but little work has examined the role of pathways involved in resolving neuroinflammation after surgery in patients. Since inflammation is terminated by specialized pro-resolving molecules (SPMs), which are decreased in the brains of Alzheimer's patients and in patients with worse cognitive function (1), we posited that lower levels of cerebrospinal fluid (CSF) SPMs might be associated with POCD. Here, we describe preliminary evidence of dynamic changes in lipid mediators within the arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) metabolomes in the CSF before, 24 hours after, and 6 weeks after surgery in 20 patients. 

Submissions


CoAuthor(s)

Dr. Miles Berger, MD, PhD
Cliburn Chan, PhD
Ms. Mary Cooter, MS
Dr. Krishna Rao Maddipati, PhD
Dr. Joseph Mathew, MD
Dr. Niccolo Terrando, PhD

Poster Presenter

Dr. Michael Devinney, MD, PhD

E109. Understanding Functional Connectivity Contributions to Digital Cognitive Pre-Operative Screening Tests: Digital Clock Drawing Test (dCDT) Graphomotor Features

The clock drawing test is a classic neuropsychological tool of global cognitive functioning where participants are asked to 'draw the face of a clock, put in all the numbers, and set the hands to 10 after 11'. The clock drawing test was recently digitized (dCDT), allowing for the investigation of the process by which a drawing is completed. The purpose of this study was to examine associations between two common dCDT behaviors (clock face area/size, and number of pen strokes) and two resting state functional connectivity networks: 1) the Salience Network (SN) which is associated with the detection of behaviorally relevant stimuli¹ and involves connections between the bilateral anterior insula and the dorsal anterior cingulate cortex – brain regions susceptible to atrophy in older age, and 2) the Default Mode Network (DMN) which is associated with self-referential thought. Classical neuropsychological research shows that graphomotor metrics can assess frontal functions². For these reasons, our working hypothesis was that two graphomotor behaviors of clock construction - clock face size and frequency of pen stroke – would associate with connectivity of the SN, but not the DMN. 

Submissions


CoAuthor(s)

Ms. Shawna Amini, BS
Penney Dana, Ph.D.
Dr. Randall Davis, PhD
Mingzhou Ding, Ph.D.
Cheshire Hardcastle, MSc
Hua Huang, PhD
Dr. Catherine Price, PhD, ABPP/CCN
Dr. Jared Tanner, Ph.D.
Ms. Margaret Wiggins, M.S.

Poster Presenter

Ms. Catherine Dion, B.A.

E110. Synaptic ultrastructure in adolescent rhesus monkeys exposed to sevoflurane in infancy

Several human epidemiological studies have shown an increased risk of learning disability and other behavioral changes following multiple general anesthesia exposures in early life (before the age of 4) [1-3]. Animal studies indicate widespread neural and glial apoptosis from anesthetic exposure early in development, including synapse loss and mitochondrial damage. We have been investigating the behavioral impact of repeated exposure to sevoflurane anesthesia in infant rhesus monkeys, and have found elevated anxiety and impaired visual recognition memory later in life [4-6]. The long-term impact of anesthesia exposure in infancy on synaptic ultrastructure has not been thoroughly studied. In the present study, we use electron microscopy with unbiased stereological sampling to investigate synapse structure in hippocampal region CA1 in monkeys repeatedly exposed to sevoflurane in infancy, and matched controls, at the age of ~4 years (corresponding approximately to 12 years of age in humans). 

Submissions


CoAuthor(s)

Dr. Mark Baxter, PhD
William Janssen, BS

Poster Presenter

Tristan Fehr, BS

E111. Accuracy and safety of BIS monitoring using a novel interface device connecting conventional needle electrodes and BIS sensors for forehead surgical approach

Bispectral index (BIS) monitoring is widely used to assess the depth of anesthesia. Currently, BIS sensors are designed to be placed on the forehead to measure frontal lobe electroencephalogram (EEG). Therefore, in the events of surgeries requiring a frontal approach or concurrent regional oxygen saturation (rSO2) monitoring, optimal montage of the electrode may not be possible to achieve a proper BIS measurement. EEG responses are topographically dependent: Surgical stimulations may be detected by EEG responses from frontal areas but not from central, parietal, temporal, or occipital areas. Accordingly, BIS has been shown also to be topographically dependent. It is currently considered that the use of other areas for the sensor attachment is not easily interchangeable and requires very much caution. The most and only reliable area of the sensor adhesion is the forehead, for where BIS system has been developed and validated. In the present study, we assessed safety and clinical performance of a novel interface device, which connects BIS Vista™ system to conventional EEG needle electrodes, aiming to achieve reliable BIS monitoring without obstructing frontal surgical procedure or rSO2 monitoring. 

Submissions


CoAuthor

Dr. Miyuki Tauchi, Ph.D. & D.V.M.

Poster Presenter

Dr. Hideki Harada, MD

E112. Validation of an Angiographic Global Cerebral Vasospasm Score in Aneurysmal Subarachnoid Hemorrhage - A Feasibility Study

Cerebral vasospasm (CV) is a common and devastating complication of aneurysmal subarachnoid hemorrhage. Angiographic and radiographic diagnostic criteria for CV are not well-defined. Recently, a Global Cerebral Vasospasm Score (GCVS) has been proposed, similar to angiographic evaluation of coronary vessels, based on the perceived reduction in arterial lumen size for 17 standard intracranial arterial vessel segments. This GCVS, however, has not been validated and no assessment of inter-rater reliability has been performed. We, therefore, conducted this preliminary retrospective study to evaluate the feasibility of determining the inter-rater reliability of the GCVS from retrospective analysis of angiographic images. 

Submissions


CoAuthor(s)

Abdulnasser Alhajeri
Justin Fraser
Dr. Stephen Grupke, MD
Abhisek Patel
Arnold Stromberg
Leon Su

Poster Presenter

Dr. Kevin Hatton, MD

E113. Duration of isoflurane-induced electroencephalographic suppression does not predict cognitive deficit following emergence

Burst suppression manifests as low voltage electroencephalographic (EEG) signal punctuated by higher amplitude activity. The presence of EEG suppression has been associated with poor neurological outcomes, such as delirium (1-4). Whether characteristics of EEG suppression are predictive markers for cognitive impairment following general anesthesia remains unknown. We assessed if the total duration of EEG suppression predicted cognitive impairment during emergence from anesthesia. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Dr. Mathias Basner, MD PhD
Dr. Max Kelz, MD, PhD
Nan Lin, PhD
Rachel Mak-McCully, PhD
Dr. George Mashour, MD, PhD
Dr. Ben Palanca, MD PhD
Dr. Alexander Proekt 6404568, MD, PhD
Ms. Brenna Shortal, B.S.
Wei Wang, PhD.

Poster Presenter

Mr. Leonard Hickman, BA

E114. Effectiveness of Cell Extract from mouse adipose-derived stem cells and dedifferentiated fat cells for peripheral nerve regeneration.

Cell extracts (CE) of mesenchymal stem cells (MSCs) and adipose-derived stem cells (ADSCs) contain several angiogenesis-related factors and were reported to improve the regeneration of cardiac muscle and salivary gland following injury.[sup]1-3[/sup] However, there is no report on the use of CE for peripheral nerve regeneration. The purpose of this study is to evaluate the usefulness of CE derived from ADSCs or dedifferentiated fat cells (DFATs) on peripheral nerve regeneration. 

Submissions


CoAuthor(s)

Dr. Kenji Seo, DDS, PhD
Dr. Jun-ichi Tanuma, DDS, PhD
Dr. Simon Tran, DMD, PhD, FRCDC
Dr. Manabu Yamazaki, DDS, PhD

Poster Presenter

Dr. Naotaka Kishimoto, DDS, PhD

E115. 5-HT modulation of cortical oscillations are similar in freely moving rats and in rat brain slices.

The electroencephalogram (EEG) is a commonly used measure of electrical activity in the brain and has proven useful for monitoring anesthetic effects. Furthermore, synchronous rhythmic activity and modulation of oscillations with behavior has been shown to be important for complex processing of stimuli in the normal brain. For example, we recently demonstrated that movement related theta activity was strongly suppressed by activation of ascending 5-HT inputs. Even fast wheel running movements, induced by posterior hypothalamic stimulation, were instantly stopped by co-applied median raphe (5-HT) stimulation, and theta activity was also strongly modulated. Different frequencies of oscillatory activity have been induced in rodent neocortical slices by mimicking cholinergic inputs to the cortex during attention and increased glutamatergic excitation during active behaviors. This exploratory study looked at oscillations in the neocortical layer II/III of coronal rat brain slices and modulation of this activity by 5-HT. We hope to develop brain slices models of EEG activity to better understand anesthetic sites and mechanisms of action for these clinically essential agents. 

Submissions


CoAuthor

Brian Bland, PhD

Poster Presenter

Dr. Bruce Maciver, PhD

E116. The Neurobics Trial - Perioperative Cognitive Protection: Baseline Participant Characteristics.

Postoperative delirium (POD) is characterized by impaired attention, altered level of consciousness and disorganized thinking with acute onset after surgery. Advanced age, preexisting cognitive impairment, and use of narcotic medications are predisposing factors for POD. The Neurobics Trial is a prospective, single-blind, randomized, controlled study with the objective to evaluate the effectiveness of preoperative cognitive exercise on lowering the incidence of POD in elderly patients. The trial has been actively recruiting subjects since March 2015, with 242 patients having provided consent until September 2018 from the required 358. We aim to assess baseline demographics and cognitive assessments of patients currently enrolled in this study, and compare cognitive scores between patients in two age groups (<70 and ≥70 years) and between patients who had or had not used opioids preoperatively. 

Submissions


CoAuthor(s)

Dr. Sergio Bergese, MD
Mr. Alan Esparza Gutierrez, BS
Dr. Michelle Humeidan, MD, PhD
Joshua-Paolo Reyes, BS
Cory Roeth, BS
Nicholas Turner, Student
Alix Zuleta-Alarcon, MD

Poster Presenter

Dr. Ana Mavarez-Martinez, MD

E117. Optimizing the visual detection of EEG alpha oscillations in the perioperative setting

Intraoperative neuromonitoring can help avoid unnecessarily high administered doses of anesthesia, which is a risk factor for the occurrence of perioperative neurocognitive disorders (PNDs) (1). Previous studies demonstrated that not only the delivered dose of anesthetic, but also the presence or absence of certain EEG patterns are correlated with the incidence of PNDs. In particular, pronounced alpha oscillations in the frontal EEG during maintenance of and emergence from anesthesia appear to be predictors for favorable neurocognitive outcomes (2). Against this backdrop, Koch and Spies recently suggested to use a density spectral array (DSA) of the EEG to guide general anesthesia and maximize power in the alpha band (3, 4). Elderly patients show a general decrease in EEG power (5, 6), which renders visual inspection of the alpha band a more challenging task. As a potential means of improvement, adjusting the power sensitivity may come to mind. However, increasing the overall gain will obviously amplify theta band activity as well, again hindering a distinct detection of the alpha band. Therefore, here we propose a simple, yet effective approach to optimize the visual detection of EEG alpha activity in the perioperative setting. 

Submissions


CoAuthor(s)

Mr. Sebastian Berger, Dipl.-Ing.
Dr. Paul Garcia, MD, PhD
Dr. Matthias Kreuzer, PhD
Dr. Gerhard Schneider, MD
Dr. Jamie Sleigh, MBChB, MD

Poster Presenter

Mr. David Obert, MD

E118. Anesthetic Hysteresis Collapses on a Timescale Unrelated to Pharmacokinetics

Anesthetic hysteresis has been demonstrated for all inhalational anesthetics. The concentration at which emergence from anesthesia occurs is consistently lower than the concentration sufficient to induce anesthesia. Yet, the processes that give rise to anesthetic hysteresis remain poorly understood. We previously reported (1) that stochastic state-switching occurs at constant isoflurane concentration, and mathematically demonstrated that these fluctuations are sufficient for anesthetic hysteresis. This theoretical framework predicts that hysteresis should collapse on a time scale given by the equilibration of the stochastic process rather than by pharmacokinetics. Here, we look at whether stochastic state switching at constant anesthetic concentration occurs and if the prediction of hysteresis collapse holds true across inhaled anesthetics. 

Submissions


CoAuthor(s)

Mr. Benjamin Harrison, High School (candidate for B.A.)
Dr. Max Kelz, MD, PhD
Ms. Bo Ku
Ms. Paula Kwasniewska
Dr. Andrew McKinstry-Wu, MD
Ms. Juliette Palermo
Dr. Alexander Proekt 6404568, MD, PhD

Poster Presenter

Mr. Andrzej Wasilczuk, B.S.

E119. Inadequate Spinal Anesthetic in Parturient with Marfan's Syndrome Undergoing Caesarean Section

Marfan's syndrome is a connective tissue disorder that complicates the management of obstetric patients. An elective cesarean section with neuraxial anesthesia is common for management, however a reported complication in this population is inadequate or failed spinal anesthesia due to dural ectasia(1,2). We describe a patient with Marfan's syndrome who received a combined spinal-epidural in which the spinal anesthetic was inadequate. 

Submissions


CoAuthor

Dr. Jay Sanford, DO

Poster Presenter

Dr. Gregory Blaufuss, MD

E120. [Withdrawn] Intraabdominal Pressure in Non-Labouring Parturients Scheduled for Elective Lower Segment Caesarean Section under Spinal Anaesthesia

Occurrence of intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) is associated with an increase in mortality as well as impairment of cardiovascular, renal, splanchnic and neurological functions.¹ There is limited data evaluating Intra-abdominal pressure (IAP) in pregnant women.² ³ The few studies evaluating IAP in pregnant women scheduled for cesarean section have noted them to be in the range that is conventionally defined as IAH, i.e. ≥ 12 mmHg. Whether the elevated IAP during pregnancy is merely a physiological change consequent to the gravid uterus or is associated with impairment of organ function is not known. We could not locate any evidence evaluating effect of the elevated IAP during pregnancy on organ functions. This prospective observational study aimed to establish in non-labouring patients with term pregnancy scheduled for elective LSCS under spinal block, the normative IAP values in supine and 10º left lateral position, and also a cut-off value beyond which organ dysfunction or failure is present, if applicable. The primary objectives will be to measure IAP in supine (IAPs) as well as left lateral tilt (10º ) (IAPtilt) positions, and assess their correlation with total SOFA score. As secondary objective correlation between IAPs and IAPtilt with incidence of intra-operative hypotension was also evaluated. 

Submissions


CoAuthor(s)

Dr. Mahendra Kumar, D.A, M.D.
Dr. ASHA TYAGI, MD

Poster Presenter

Dr. Devansh Garg, MBBS

E121. Evaluation of ultrasound-guided vena cava diameter measurement to predict hemodynamic changes after labor epidural analgesia

Administration of local anesthetic and opioid medications into the epidural space is a common practice in obstetric anesthesia. The hemodynamic effect of the sympathetic block caused by these anesthetic/analgesic techniques may lead to significant maternal and fetal end-organ perfusion compromise. However, the magnitude of drop in venous return and blood pressure resulting from the combination of physiologic changes of pregnancy and the superimposed autonomic effects of neuraxial anesthesia/analgesia is difficult to anticipate. This study aims to test the hypotheses that inferior vena cava (IVC) diameter measure via ultrasound can predict hypotension after labor analgesia (epidural or combined spinal-epidural) in full-term pregnant patients. 

Submissions


CoAuthor(s)

Mr. Justin Dumrongkulraksa, Medical Student
Dr. Alexander Rocuts, MD
Dr. MARIA SANCHEZ, MD

Poster Presenter

Dr. Efrain Riveros Perez, MD

E122. Management of Obstetric Anesthesia in a Parturient with Dysautonomia

Dysautonomia is a disorder of the autonomic nervous system (ANS) which is characterized by changes to the normal activity of the sympathetic or parasympathetic nervous system (1). While dysautonomia is commonly associated with decreased activity of the ANS, over activity can also occur. Patients with dysautonomia develop symptoms involving multiple organ systems innervated by the ANS. This has important implications for the Anesthesiologists caring for an obstetric patient with dysautonomia. Particular care is necessary to manage perturbations in the cardiovascular, pulmonary, gastrointestinal, and thermoregulatory systems (2). 

Submissions


CoAuthor(s)

Dr. Suzanne Mankowitz, MD
Dr. Alon Shertzer, MD

Poster Presenter

Dr. Takashi Sakano, MD, PharmD

E123. ARDS in Monoamniotic, Monochorionic Pregnancy

Acute respiratory distress syndrome (ARDS) is characterized by acute onset of hypoxemic respiratory failure and bilateral opacities identified on chest radiograph in the absence of congestive heart failure. There is limited data regarding the management of ARDS specific to the pregnant population but fetal heart monitoring and consideration for delivery in the setting of fetal or maternal distress needs to be considered. 

Submissions


CoAuthor

Dr. Kathryn Breslin, MD

Poster Presenter

Dr. Eric Worrall, DO

E124. Lumbosacral Radiculopathy: Inciting Events and their Association with Epidural Steroid Injection Outcomes

Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There is limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes. A top research priority recognized by the U.S. National Institutes of Health is the growing need to identify factors associated with epidural steroid injection treatment response given the increasing volume of procedures performed. This study explores patient-reported etiologies for lumbosacral radiculopathy, and whether these causes might affect epidural steroid injection outcomes. 

Submissions


CoAuthor(s)

Winfred B. Abrams, MD
Peju Adekoya, MD
Dr. Yian Chen, M.D.
Zared Cohen, Student
Steven Cohen, M.D.
Cathy He, MD
Bryan Marascalchi, M.D.
Indy Wilkinson, M.D.
Ada Lyn Yao, MD

Poster Presenter

Dr. Alyson Engle, M.D.

E125. Development of a Pharmacodynamic Assessment Tool for Cannabis Analgesia

In the United States, pain is one of the most common conditions for which cannabis is recommended (1). However, due to the historic difficulties in conducting research with cannabis, there exists insufficient evidence on appropriate dosing paradigms and overall efficacy of cannabis for specific pain types. Recent developments in policy have increased the ability to conduct cannabis related research but there remain significant gaps in knowledge, namely the ability to accurately and objectively assess cannabis related analgesia. The research discussed in this abstract presents efforts to rectify this problem by developing a method and approach for the objective assessment of cannabis analgesia. This novel approach utilizes a non-noxious neurospecific stimulus to elicit a dilation of the pupil via activation of nociceptive pathways. Using a neurospecific signal allows us to query three specific nerve fiber types C, Aδ, and Aβ fibers (2), a significant improvement over other approaches to pain assessment. This approach is paired with the use of an infrared pupillometer which allows for the measurement (3–6) and quantification of the induced pupillary reflex dilation (nPRD). Comparisons can then be made prior to and following an intervention, in this study cannabis was used, to determine fiber specific modulatory effects of an intervention. As with any other drug, the effects of cannabis can vary widely based on dose, concentration and many individual factors (7, 8). Research has demonstrated that while there is evidence to support the use of cannabis as an analgesic (9, 10), there may also be the opportunity to exacerbate the issue by inducing hyperalgesia (11). For these reasons the method and approach discussed in this abstract would also be a valuable tool to guide dosing paradigms in the instances where cannabis is indicated. 

Submissions


CoAuthor(s)

Emily Blum, MD
Dr. Julia Finkel, M.D.
Mr. Luka Vujaskovic, BSPH
Brent Yeung, MD

Poster Presenter

Mr. Kevin Jackson, BA

E126. Carpel Tunnel Release Surgery - A Systematic Review of Open and Endoscopic Approaches

Purpose of Review: Options for surgical management of Carpal Tunnel Syndrome (CTS) include endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). A recent Cochrane Review found that ECTR and OCTR were equally effective for symptom relief and restoration of function. Furthermore, ECTR resulted in fewer minor complications and a faster return to activity. The purpose of our study was to review literature published through May 2018, an update of the Cochrane Review which looked at studies through November 2012. 

Submissions


CoAuthor(s)

Dr. Vwaire Orhurhu, MD
Sebastian Orman, BA

Poster Presenter

Dr. Jacquelin Peck, MD

E127. Effects of the ABCB1 c.3435C>T (rs1045642) polymorphism on heat pain perception in adults with chronic pain

The adenosine triphosphate-binding cassette, subfamily B, member 1 gene (ABCB1) is located in the chromosomal region 7q21.12.1 The ABCB1 gene encodes P-glycoprotein (P-gp) which is an efflux transporter localized to the lumen-facing epithelia cells of various organs including the endothelial cells of the brain vasculature. A widely investigated ABCB1 polymorphism is c.3435C>T (rs1045642) which is a synonymous polymorphism (C to T) at nucleotide 3435.2 In preclinical and clinical pain studies, the influence of c.3435C>T on pain perception and analgesic responses to opioids have been mixed.3, 4 Thus, the primary aim of this study was to investigate the effects of the ABCB1 polymorphism c.3435C>T (rs10454642) on heat pain (HP) perception, pain intensity, and opioid use in a cohort of adults with chronic pain. 

Submissions


CoAuthor

Dr. Michael Hooten, MD

Poster Presenter

Dr. Emily Pollard, M.D.

E128. Improving Chronic Pain Outcomes and Access to Cognitive Behavioral Therapy (CBT) in Children with Sickle Cell Disease

Pain in sickle cell disease (SCD) is associated with increased morbidity and high health care costs. Episodic, acute pain is the hallmark of this disorder; however, there is an increasing awareness that chronic pain is part of the pain experience of these patients. Furthermore, assessment and treatment modalities are remarkably different. Unidimensional pain scores are typically used to assess acute pain and treatment with opioids is appropriate in the setting of acute crisis pain. In contrast, multidimensional assessments and functional outcomes are critical in assessment of chronic pain. Evidence-based practice suggests that a multidisciplinary approach utilizing a combination of non-opioid therapies including cognitive behavioral therapy (CBT) leads to more favorable outcomes in patients with chronic pain. In addition, the growing opioid crisis, highlights the importance of maximizing non-opioid therapies for the treatment of pain. There is a pressing need for effective, non-pharmacologic interventions to treat chronic pain. In our experience at the Children's Hospital at Montefiore (CHAM), it is common for patients to be denied coverage for non-opioid therapies including CBT and non-opioid medications. Additionally, it is difficult to find providers who are trained to provide CBT for pain management. Our overarching goal is to improve access to CBT. Additionally, we will refine the definition of patients at risk for chronic pain in pediatric SCD so we can better identify patients who will benefit from early implementation of multidisciplinary therapies. 

Submissions


CoAuthor

Dr. Veronica Carullo, M.D.

Poster Presenter

Dr. Benjamin Portal, M.D.

E129. Which patients for yoga? Investigating differential effects of a six-week daily yoga intervention on pain, catastrophizing, and sleep among women with fibromyalgia

Fibromyalgia (FM) is characterized by chronic widespread pain, sleep disturbance, fatigue, and catastrophizing. This pilot study explored whether gentle, daily yoga-based exercise practice could improve pain and sleep quality, and whether certain patient phenotypes were associated with greater improvement. 

Submissions


CoAuthor(s)

Robert Edwards, PhD
Ms. Alexandra Koulouris, BS
Asmina Lazaridou, PhD

Poster Presenter

Dr. Kristin Schreiber, MD, PhD

E130. Desire for painless surgery and underestimation of prescription opioid related risks prevalent in perioperative patients

The pursuit of painless surgeries has resulted in increased opioid prescriptions and multiple studies have shown that undergoing surgery is associated with an increased risk of postoperative chronic opioid use [1-4]. With the advocation of pain free surgeries, patients may have unrealistic expectations for postoperative pain management. Although the medical society has come to realize that prescription opioids are not as safe as initially believed, patients are likely less well informed. Patient's desire for painless surgery and underestimation of prescription opioid associated risks may be important but under-explored driving factors for postoperative chronic opioid use. In this study, we surveyed patient's expectation of postoperative pain management and knowledge of opioid-related risks and side effects. Patient's demographic information was collected and analyzed to identify factors that affected expectations and knowledge. 

Submissions


CoAuthor

Dr. Linda Le-Wendling, MD

Poster Presenter

Dr. Soleil Schutte, MD

E131. Perceived Barriers to Implementation of Current Guidelines on Long-Term Opioid Therapy: Results of an Opioid Post-Course Survey

Opioids prescribed long-term for chronic pain have met with varied success in the past two decades.1 Opioids for long-term therapy of chronic noncancer pain (CNMP) have seen recent guidelines that recommend reduced opioid doses, risk stratification, patient monitoring and caution for prescribing.2,3 These guidelines strongly endorse physician opioid education to change provider practice.4 The aim of this study was to evaluate changes to practice that physicians plan to implement following a 3-day opioid education course, and any perceived barriers to implementation of current opioid guidelines for CNMP. 

Submissions


Poster Presenter

Dr. Paul Sloan 5524403, MD

E132. Human v. Machine: A Comparison of Satisfaction with Two Different Foreign Language Interventions at Emergence for Subjects Who Do Not Speak English as a First Language

As patient populations in the US become increasingly diverse, healthcare providers are encountering a growing number of patients for whom English is not the native language. There is evidence that, in bilingual patients, a single language can be selectively inhibited by general anesthesia¹ ² ³. In two independent studies, our group has previously demonstrated that bilingual patients emerging from general anesthesia preferentially respond to verbal commands in their native language whether prerecorded by a family member or played from a machine translation software app (Google Translate). It is not known which method of language translation is associated with higher subject satisfaction. 

Submissions


CoAuthor(s)

Shreya Dhar, N/A
Dr. David Glick, MD, MBA
Mr. Yaman Kherallah, BS
Mr. Nicholas Lyon, BA

Poster Presenter

Mr. Christopher Awounou, BA

E133. Validation of Point-of-Care Hemoglobin Testing in Anemic Adult Patients

Point of care and indirect testing of hemoglobin has been proposed as a means of improving patient care in perioperative and critical care environments. While validated measures such as the complete blood count and arterial blood gas analysis are currently used as the gold-standard, obtaining results can be time consuming, and may take up to 45 minutes to obtain, during which time a rapidly deteriorating patient's status may have changed. When clinicians make decisions to transfuse blood products, one of the criteria is that the patient have anemia. The risk of blood transfusion to patients includes increased risk of organ dysfunction,immunomodulation,transfusion reactions, thromboembolism, and death. There is currently not enough information to recommend the use of one device over another for point of care testing of hemoglobin. While studies have validated individual point of care hemoglobin testing instruments in isolated settings, few studies have validated such instruments in patients with moderate to severe anemia. To our knowledge, this is the first study to simultaneously compare the accuracy of the Hemocue, EPOC, and i-STAT in anemic patients in the operative and intensive care setting. 

Submissions


CoAuthor

Dr. Ryan Lett, Medical Degree

Poster Presenter

Mr. Alan Chan, MD

E134. Post Operative Rspiratory Failure following Intracranial and Spine Surgeries

Respiratory complications are among the most common causes of morbidity and mortality following neurosurgery1. Respiratory failure has been associated with several factors including neurological deficits, absence of gag reflex due to cranial nerve dysfunction, extubation failure due to airway swelling, development of atelectasis and pneumonia. Post operative respiratory failure is associated with significantly increased hospital length of stay, increased hospitalization cost, morbidity and mortality2,3. Patient safety indicator 11 (PSI 11) was established by Agency for Healthcare Research and Quality(AHRQ) to identify patients who developed respiratory failure in the post operative period according to data from administrative coding. AHRQ software identifies the PSI 11 cases using International Classification of Diseases (ICD) codes4. The positive predictive value of the diagnoses is only 62-75%. To date we have not found any studies identifying the accuracy of the data in patients undergoing intracranial and spine surgeries.. The study was designed to identify PSI 11 patients and determine whether there were any preventable risk factors associated with respiratory failure and PSI 11 event. We hypothesized that patients undergoing intracranial and spine surgery have increased rate of non-respiratory complications leading to PSI 11 as a result of inherent nature of surgeries. 

Submissions


CoAuthor(s)

Dr. Eric Chanowski, MD
Dr. Dhimant Dani, MD
Dr. Ajit Krishnaney, MD
Dr. Bryan Lee, MD
Dr. Piyush Mathur, MD
Dr. Steven Shook, MD

Poster Presenter

Dr. Jagan Devarajan, MD, MBA, FASA

E135. A Deep Learning Model for Predicting 30-Day Postoperative Mortality

Postoperative mortality is a common and potentially avoidable problem affecting approximately 1% to 2% of patients who undergo major inpatient surgery, yet current prediction tools produce static risk estimates that do not reflect shifting patterns of risk associated with surgical stress and physiological perturbations. We therefore sought to construct an algorithm predicting postoperative thirty-day mortality using preoperative and repeated-measures intraoperative data. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Arbi Ben Abdallah, PhD
Dr. Yixin Chen
Mr. Zhicheng Cui
Mr. Yujie He
Dr. Christopher King, MD, PhD
Mr. Alexander Kronzer, BA
Mr. Muhan Zhang

Poster Presenter

Dr. Bradley Fritz, MD

E136. Intraoperative factors that improve risk prediction of postoperative acute kidney injury in general surgery patients

Intraoperative management plays a role in the development of postoperative acute kidney injury (AKI) and recent literature focuses on the association between hypotension and AKI (1). However, other intraoperative factors may affect AKI risk but the relationships between these and AKI have not been clearly delineated. 

Submissions


CoAuthor(s)

Dr. Ravi Kiran, MD
Guohua Li, MD, DrPH

Poster Presenter

Dr. Minjae Kim, MD, MS

E137. Assessing Methods of Medication Error Monitoring for Quality Improvement

Medication safety during the perioperative period requires constant vigilance and may be enhanced with monitoring systems to ensure accuracy. Our institution collects data on adverse events for all pediatric patients receiving general anesthesia through self-reporting by the anesthesia provider into a quality assessment (QA) database (1). This adverse event database includes collection of data on medication errors. Separately, we have conducted surveys of faculty pediatric anesthesiologists to solicit information specifically on medication errors during two three months periods: before and after implementation of standardization medication trays as a part of a quality improvement initiative. This study compares the incidence of reported rates of medication errors in our survey with the rates obtained from the adverse events database during the same time period. 

Submissions


CoAuthor(s)

Dr. Gracie Almeida-Chen, MD
Dr. Manon Haché, M.D.
Dr. Lena Sun, MD, MPH

Poster Presenter

Dr. Albert Lin, MD, MPH

E138. Preoperative anesthesiologist-led clinic and multi-disciplinary team clinic

After admission to a hospital, preoperative anesthesia assessment is sometimes not done until the day of the surgery or one day before the surgery by an anesthesiologist assigned to the case. Since preadmission consultation has been reported to be effective for increasing patient safety and efficacy of perioperative management, a preoperative anesthesiologist-led clinic (PAC) has been established in many hospitals[sup]1[/sup]. To optimize this further, especially for patients at high surgical risk, we recently introduced a preoperative multi-disciplinary team clinic (PMC) that involves a 10-min review of preoperative medication by a pharmacist, 30-min instruction of the perioperative course by a nurse and one-hour dental evaluation and treatment by dentists/dental hygienists/technician as well as the usual 20-min consultation by an anesthesiologist (PAC) for each case[sup]2[/sup]. We requested surgeons to refer patients undergoing elective surgical procedures to either clinic at their earliest convenience. In this study, rates of referral to these clinics and characteristics of referred patients were investigated in our tertiary care center of 500 beds. 

Submissions


CoAuthor(s)

Hidekuni Hidaka, M.D.
Mr. Masuya Sato, No degree

Poster Presenter

Dr. Kazumi Ono, M.D.

E139. Endotracheal Tube Cuff Pressures: How much is too much?

Inappropriate endotracheal tube (ETT) cuff inflation pressure may pose a risk to intubated patients and is associated with significant compilations. Despite such evidence standardization of cuff inflation in the operating has been lacking. The seal between the endotracheal tube (ETT) cuff and the trachea allows practitioners to appropriately ventilate and oxygenate their patients. To achieve the proper seal, it is imperative that the ETT cuff is inflated within 20-30 cmH2O, which is a narrow window that mitigates the complications of under- and over-inflation. Under the 20 cmH2O threshold patients are at risk for aspiration and hypoventilation. In scenarios where the ETT cuff is over-inflated, patients may be subjected to post-operative sore throat, hoarse voice, tracheal esophageal fistula formation and tracheal rupture. We have hypothesized that without standardized measurement ETT cuff pressures in the operating room are not in the goal range. Furthermore, we evaluated the use of a manometer (Ambu Cuff Pressure Gauge) to measure cuff volumes and pressures intra-operatively. The study further investigated the association of various providers, surgical case types, and patient demographics with ETT cuff pressures. 

Submissions


CoAuthor(s)

Angela Chang, BS
Dr. Roman Dudaryk, MD
Connor Funsch, MD
Dr. Paul Potnuru, MD

Poster Presenter

Dr. Bansi Patel, DO

E140. Evaluation of perioperative safety behaviors at a multidisciplinary level

Neonates are highly vulnerable to iatrogenic events due to their immature physiology.(1) This increases care complexity and decreases neonates' ability to tolerate small deviations in care. Increased risk factors in perioperative care of neonates that requires interdisciplinary teams from the neonatal intensive care unit (NICU) and pediatric operating rooms (OR) to orchestrate their complex care. In this study we use the Safety Organizing Scale (SOS), a validated 9-item survey developed to measure safety organizing behaviors in complex socio-technical organization, to measure these properties in perioperative teams. The objective was to apply the SOS, for the first time, to interdisciplinary teams to characterize safety organizing within and between NICU and OR teams and among perioperative provider types. 

Submissions


CoAuthor(s)

Dr. Marty Blakely, MD
Daniel France, PhD
Peter Grubb, MD
Dr. Christoph Lehmann, MD
Dr. Amanda Lorinc, MD
Dr. Timothy Vogus, PhD

Poster Presenter

Ms. Emma Schremp, BS

E141. Enhanced monitoring of hypoxemia and hypoventilation reduces postoperative cardio-pulmonary complications in patients undergoing bariatric surgery: A retrospective observational cohort study.

Obstructive sleep apnea (OSA) is highly prevalent in the bariatric surgery population, and known to be associated with increased frequency of recurrent post anesthesia care unit (PACU) respiratory events leading to increased postoperative cardio-respiratory complications.[1,2] There is increased interest to evaluate the effectiveness of enhanced respiratory monitoring on the prevention of adverse postoperative outcomes to minimize resource utilization and hospital cost. The main objective of this retrospective, observational study was to evaluate the impact of the use of a distant, continuous, non-invasive respiratory monitoring system on postoperative cardio-pulmonary complications in patients undergoing elective bariatric surgery. 

Submissions


CoAuthor(s)

Dr. Frances Chung, MBBS, LMCC, FRCPC
Dr. Najia Hassan, MD
Dr. Laura Hawryluck, MD
Dr. Julie Hudson, PhD
Dr. George Tomlinson, PhD
Dr. Jean Wong, MD

Poster Presenter

Dr. Mandeep Singh, MBBS, MD, MSc

E142. Educational Interventions to Prevent Perioperative Syringe Swaps of High-Alert Medications

Perioperative medication administration is not subject to the same quantity or rigor of safety checks seen in other settings [1]. As such, anesthesia clinicians may be more highly susceptible to administration errors. Despite the introduction of safety measures, such as barcode-assisted syringe labeling and electronic alerts, medication errors continue to occur with the potential to cause lasting morbidity. A recent adverse event at a large tertiary care academic medical center involving a swap of calcium chloride and epinephrine, highlighted the need to improve safety practices. In a root cause analysis, it was determined that the look-alike nature of these medications and the absence of syringe labels contributed to the event. We sought to determine if enhanced education could reinforce knowledge of labeling and workstation safety measures. 

Submissions


CoAuthor(s)

Dr. Aalok Agarwala, MD, MBA
Mr. Douglas Choe, B.Sc
Ms. Allison Doney, MHA
Ms. Kathy Kong, M.P.H.
Dr. Jeremi Mountjoy, M.D.
Dr. May Pian-Smith, MD, MS
Mr. Leo Tabayoyong, PharmD

Poster Presenter

Dr. Jamie Sparling 6736116, M.D.

E143. Solutions for Management of Angiotensin Converting Enzyme Inhibitor-Induced Angioedema in a High Risk Population: A Single Center Retrospective Observational Study

Angioedema is a side effect of ACE therapy.With ACE inhibitors indicated for the management of several conditions, the number of patients taking this medication is high and rising.Angioedema has become the most dominant allergy resulting in hospitalization in the USA, with ACE inhibitor induced angioedema accounting for 20-40%.This adverse effect occurs in 0.1-0.7% of all patients taking the medication, with a higher incidence found in new users, as well as in African Americans, older adults, and females. In most cases, the episode of angioedema resolves with discontinuation of the medication.Some cases require intubation or emergent tracheostomy.Though there have been studies published that reveal incidences of ACE inhibitor-induced angioedema, a literature search failed to reveal studies reporting the incidence or rate of rise of ACE inhibitor-induced angioedema. No studies were found that discussed involvement of anesthesiologists in airway management of ACE inhibitor-induced angioedema.The purpose of this retrospective study is two-fold-to determine the incidence and rate of rise of ACE inhibitor-induced angioedema in our high risk patient population and determine the involvement of anesthesiologists in the management of these patients. 

Submissions


CoAuthor(s)

Dr. Alexandra Bastien, MD
Dr. Singh Nair, PhD
Dr. Dahlia Townsend, MD

Poster Presenter

Dr. TRACEY Straker, MD MS MPH FASA

E145. INCIDENCE OF PATIENT SAFETY EVENTS ASSOCIATED WITH PROLONGED EXTUBATION.

Prolonged extubation has been defined as a time interval from end of surgery (EOS) to airway extubation (AE) longer than 15 minutes (1). Unplanned prolonged extubation affects OR workflow (2) and may compromise effective utilization of personnel and patient throughput (3). The patient safety implications of prolonged extubation are not well understood. It is currently unknown if prolonged extubation is associated with patient safety events such as immediate reintubation and the administration of naloxone and flumazenil. In our study we defined "immediate reintubation" as the placement of an EGA or a tracheal tube after a previous extubation in the OR, and before transition to recovery care. The administration of reversal agents for opioids and benzodiazepines may have patient safety implications. Focusing on immediate reintubation is relevant as this event is directly related to the patient assessment and management by the anesthesia team. The present analysis is part of a larger study of the incidence and risk factors for prolonged extubation after general anesthesia. Here, we assessed whether prolonged extubation is associated with patient safety events 

Submissions


CoAuthor(s)

Dr. Laura Cavallone, MD
Dr. Daniel Helsten, MD
Dr. Dorina Kallogjeri, MD, MPH
Mr. Kevin Prifti, BS
Isabella Rossi, MD
Dr. Anne Sebastiani, MD

Poster Presenter

Dr. Andrea Vannucci, MD

E146. Distraction as a means of providing procedural anxiolysis for a three year old with severe biventricular cardiomyopathy

Children presenting for surgical interventions that, while generally performed under anesthesia, may be precluded by the severity of underlying cardiopulmonary disease requiring the anesthesiologist to use alternative means of providing procedural analgesia while maintaining patient comfort and anxiolysis. Distraction techniques are beneficial when the risk of anesthesia is deemed excessive and the intervention is not deferable. Described is a patient requiring inguinal hernia repair for recurrent incarceration who was suffering from severe biventricular cardiomyopathy. Audiovisual distraction techniques were used to provide anxiolysis for a regional anesthetic that enable avoidance of general anesthesia. 

Submissions


Poster Presenter

Dr. Adam Adler, MD, MS, FAAP

E147. Association between Hypothermia and PACU Length of Stay in Pediatric Patients Undergoing MRI with General Anesthesia

Perioperative hypothermia is a common issue in pediatric patients undergoing general anesthesia(1). In the OR, there are a number of methods that can be employed to regulate body temperature; however, the only efficient measure to avoid unintentional hypothermia is active patient warming (2). To our knowledge, there is no MRI safe forced air warmer and thus hypothermia may be a more substantial problem for these patients. One of the consequences of perioperative hypothermia is increased PACU length of stay (LOS) which is potentially expensive because PACU costs are similar to those in the ICU (3). In this study, we evaluated whether hypothermia in pediatric patients undergoing GA for MRI is associated with increased PACU LOS. 

Submissions


CoAuthor(s)

Dr. Michael Fiedorek
Dr. Chris Fiedorek
Dr. Humphrey Lam, MD
Ashley LeFevre, MD

Poster Presenter

Dr. Thomas Austin, MD, MS

E148. Pediatric rhabdomyolysis: an analysis of demographics, risk factors, and outcomes

Rhabdomyolysis, the breakdown of striated muscles, presents heterogeneously, ranging from asymptomatic elevation of creatinine kinase to acute renal failure, disseminated intravascular coagulation, and sudden death [1-2]. Etiologies of rhabdomyolysis include trauma, viral infection, exercise, and exposure to certain drugs, including anesthetics, in susceptible individuals [3-4]. There are no population-based studies of rhabdomyolysis in children. The goal of our study is to identify potential risk factors for rhabdomyolysis and outcomes following development of rhabdomyolysis in pediatric patients using the Kids' Inpatient Database (KID). 

Submissions


CoAuthor(s)

Dr. Teeda Pinyavat, MD
Dr. Lena Sun, MD, MPH

Poster Presenter

Mr. James Damiano, B.A.

E149. Prediction of Blood Product Transfusion in Patients Undergoing Craniofacial Surgery Using Machine Learning Based on the Pediatric Craniofacial Collaborative Group Registry Dataset

Craniosynostosis is the premature fusion of one or more cranial sutures that often requires surgical intervention. Surgery often involves extensive osteotomies which can lead to substantial blood loss. Stricker et al reported in children less than 24 months at a rate of 30%, 11% and 5% receive intraoperative erythrocyte contain blood cell transfusion greater than 40 ml/kg, greater than 60 ml/kg and greater than 80 ml/kg respectively. Determining when and the quantity of blood product to administer to a patient undergoing craniofacial surgery is difficult. The anesthesiologist considers many indices including patient hemodynamics and volume status, end organ perfusion and on-going blood loss. Hence, the aim of this study is to apply machine learning modeling on pre-operative data collected in the Pediatric Craniofacial Surgery Perioperative Registry (PCSPR) in order to predict the need for blood transfusion. 

Submissions


CoAuthor(s)

Luis Ahumada, PhD
Dr. Jim Fackler, MD
Mr. Ali Jalali, PhD
Dr. Mohamed Rehman, MD
Dr. Paul Stricker, MD
Dr. Lillian Zamora, MD

Poster Presenter

Dr. Allison Fernandez, MD, MBA

E150. PCEA vs IV PCA - A Randomized Controlled Trial Assessing Pain Control following Minimally Invasive Repair of Pectus Excavatum.

Pectus excavatum is a cartilaginous deformity that is the most common congenital anterior chest wall defect in children. The Nuss procedure or minimally invasive repair of pectus excavatum (MIRPE) is the most common minimally invasive procedure in use today to correct this condition and is the current standard of surgical practice. MIRPE involves placing an intrathoracic brace through small lateral chest wall incisions aided by thoracoscopy. Similar to bracing the teeth, the procedure avoids osteotomies or rib cartilage resections. Optimal pain control remains a major issue in the perioperative period as patients may require weeks to months of oral narcotics before becoming pain-free after correction of the pectus. A prospective multicenter study reported peak pain scores of 8 on a 0-10 scale in the postoperative period and a mean score of 3 at discharge. Pain management following MIRPE has been institution specific without a consensus approach. This is a randomized controlled trial comparing IV PCA to epidurals in the treatment of pain following MIRPE. 

Submissions


CoAuthor(s)

Dr. Darrell Cass, MD
Dr. Mark Mazziotti, MD
Dr. Kim Nguyen, MD
Dr. Nihar Patel, MD
Dr. Michael Zelisko, MD

Poster Presenter

Dr. Chris Glover, MD, MBA

E151. Endotracheal tube cuff inflation using closure of the flow volume loop. Test of this novel method in a model of the pediatric airway.

Overinflating endotracheal tube (ET) cuffs may exert excessive pressure on the tracheal mucosa and lead to morbidity, hoarseness, stridor, mucosal ulcerations, and possibly tracheal perforation (1). Traditional methods of inflating the ET cuff and checking for seal by palpating the pilot balloon, listening for disappearance of leak or auscultating (2) have been shown to be unreliable in preventing the development of excess pressures (i.e. > 30 cm H2O). The only reliable method to ensure acceptably low cuff pressures is measurement of the pressure (3). It is known that inspection of the flow-volume loop by spirometry allows detection of a leak around the ET (4). One study in adults found that using pressure volume loop closure to identify a seal of the ET required a lesser amount of intracuff air volume with lower cuff pressure and resulted in lower airway related complications compared to leak occlusion just to seal (5). While the use of cuffed ETs has increased considerably in pediatric patients the method of using information derived from flow-volume loops to establish an effective seal without excessive cuff pressure has not been studied in pediatric patients. 

Submissions


CoAuthor

Mr. Sammy Jreige, BHSc, RRT, CCAA

Poster Presenter

Dr. Thomas Hackmann, MD

E152. A Survey on Discharge Practices for Former Term and Preterm Infants at Risk for Post-Operative Apnea Following General Anesthesia

Apnea after general anesthesia remains a significant concern in neonates and infants. Presently, there is no guideline on safe discharge of infants (term or preterm) after a routine, uncomplicated anesthetic. The most recent study of apnea after anesthesia concluded only that "extended monitoring should be considered for at least those children who are premature and those who have early postoperative apnea." Without consensus, there is likely wide variation in discharging infants after anesthesia. Our study aims to better elucidate clinicians' decisions surrounding this topic. 

Submissions


CoAuthor(s)

Ashwani Chhibber, MD
Dr. Lynnie Correll, MD, PhD
Dr. Anna Rabinowitz, MD
Dr. John Schroeder, MD

Poster Presenter

Dr. Matthew Hirschfeld, MD

E153. Unclear Etiology of Profound Respiratory Failure Requiring ECMO After PA Reconstruction and Repair of Tetralogy of Fallot with Pulmonary Atresia, and Major Aortopulmonary Collateral Arteries

Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCAs) is a rare type of congenital heart defect with an incidence of 0.7 per 10,000 live births. Pulmonary blood flow (PBF) is supplied by either a patent ductus arteriosus (PDA), MAPCAs or both. MAPCAs are vessels that arise from the aorta or its branches, and connect to the pulmonary vasculature to supply pulmonary blood flow. Surgical management involves unifocalization and intracardiac repair, though it is not always possible to perform this in one procedure. These patients may need staged procedures and further operations to treat stenotic PA branches and unifocalized collaterals. Reperfusion pulmonary edema leading to respiratory failure is a known complication following these surgeries. The incidence of reperfusion pulmonary edema in TOF/PA/MAPCA patients undergoing unifocalization or PA reconstruction is upward 50%, with only 1 reported case requiring ECMO after unilateral unifocalization. We report a case of severe respiratory failure, potentially from reperfusion injury, following pulmonary artery reconstruction and intracardiac repair in a 2-year-old boy with TOF/PA/MAPCAs. 

Submissions


CoAuthor

Dr. Anthony Clapcich, MD

Poster Presenter

Dr. Richard Jin, MD

E154. A novel anaesthetic technique for laparoscopic inguinal hernia repair in infants and neonates

Inguinal hernia repair (IHR) is one of the most commonly performed surgical procedures in infants (1). Recently, the laparoscopic approach to IHR in small children has gained in popularity, with purported advantages including the diagnoses and repair of the contralateral patent processus vaginalis (PPV) (2,3). While the traditional, "open" approach is typically performed under general anaesthesia (GA) with an endotracheal tube and a caudal block, the use of a caudal or spinal block with minimal sedation has been promising (4,5). Avoiding a GA could potentially avoid anaesthetic-related neurotoxicity (6), complications of tracheal intubation (7) and possibly reduce the risk of postoperative apnoeas in high-risk patients (8). This anesthetic technique has not been described for the laparoscopic approach. In this paper, we present a retrospective chart review describing the novel technique and quantifying relevant outcomes of caudal blockade, combined with intravenous (IV) sedation and spontaneous respiration with supplemental oxygen via nasal prongs (NP) for laparoscopic IHR in infants. 

Submissions


CoAuthor(s)

Dr. Robert Baird, FRCSC
Dr. Stephan Malherbe, MB ChB MMed FCA(SA) FRCPC
Dr. Simon Whyte, MBBS, FRCA, FRCPC

Poster Presenter

Dr. Prakash Krishnan, FRCA MD MBBS

E155. Perioperative temperature regulation in pediatric surgical patients- Too warm for comfort

Maintenance of perioperative normothermia is challenging for children. To prevent hypothermia, we recently implemented temperature control guidelines and a large-scale audit to study practice patterns and temperature profile of paediatric surgical patients (ClinicalTrials.gov ID NCT03770364). With guideline-enforced rigorous monitoring, we noticed some patients had core temperatures going beyond 38 ⁰C during the intra-operative and immediate postoperative period. We assessed the incidence of inadvertent hyperthermia and risk factors associated with it. 

Submissions


CoAuthor(s)

Dr. Choon Bong, MBChB FRCA
Dr. Yew Siow, MBBS
Dr. Rehena Sultana, MSc (Statistics)

Poster Presenter

Dr. Shu Ying Lee 2762, MBBS, MMed, FANZCA

E156. [Withdrawn] Spinal Anesthesia in Neonates Presenting for Infraumbilical Surgeries Can Improve Operating Room Utilization In Addition to Reducing Risk for Postoperative Apnea and Hemodynamic Fluctuations

After postoperative apnea was reported in high-risk and preterm infants receiving general anesthesia (GA) in the 1980s, spinal anesthesia (SA) was reintroduced as an alternative to GA based on evidence that SA can reduce the risk of postoperative apnea, the severity of postoperative desaturation, and the incidence of bradycardia in this patient population. Recently, concern has been raised about the unknown neurodevelopmental effects of both intravenous and inhaled anesthestic agents, making SA attractive as it often bypasses the need for additional anesthetics and sedatives. SA has also been shown to reduce the severity of intraoperative hypotension compared to GA, another possible factor contributing to long-term neurocognitive outcomes. Over the last decade, SA has become a useful technique in infraumbilical and lower limb surgeries in infants at a number of specialized pediatric institutions. In our case series, we describe a number of high-risk preterm infants undergoing infraumbilical surgical procedures under SA in lieu of GA at the Massachusetts General Hospital for Children (MGHfC). We hypothesize that in addition to the known advantages, SA can also improve OR efficiency and Post-Anesthesia Care Unit (PACU) discharge times compared to GA. 

Submissions


Poster Presenter

Dr. Chang Amber Liu, MD MSc FAAP

E157. Intranasal Midazolam with Xylocaine for Pediatric Pre Op Sedation in Ambulatory Myringotomy and Tube Placement Surgery: A Randomized Controlled Trial

Intranasal Midazolam (INM) sedation for children is associated with side effects, (1,2) Could the addition of Xylocaine reduce adverse effects without negatively affecting efficacy or discharge time? Few studies address this issue. 

Submissions


CoAuthor(s)

Melissa Scribani, Masters
Jennifer Victory RN, Bachelors of Nursing

Poster Presenter

Dr. David Ullman, MD

E158. Complications and Consequences of Anesthetic Technique for Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA): Implications from a Retrospective Study

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) is a minimally invasive and highly accurate technique for sampling intrathoracic masses and lymph nodes to diagnose non-malignant and malignant pulmonary diseases. While various methods of procedural sedation during EBUS-TBNA have been assessed, little is known regarding how various methods of general anesthesia influence procedural outcomes or what effect pre-existing respiratory disease may have on outcomes under general anesthesia.[sup]1-3[/sup] In this study, patients undergoing EBUS-TBNA under general anesthesia were assessed for major and minor complications. The primary objective was to quantify the incidence of and risk factors for complications in these patients, with a special focus on anesthetics used intraoperatively and how selection and dosage of agent may influence procedural complications. 

Submissions


CoAuthor(s)

Ms. Emily Bergbower, Ph.D.
Miranda Gibbons, B.S.
Dr. Peter Rock, MD, MBA, FCCM
Ashutosh Sachdeva, MBBS

Poster Presenter

Dr. Megan Anders, MD

E159. Continued analysis of the Optimal Surgical Utilization With Minimal Cancellations and Complications (OSUWMC2) quality initiative in microvascular breast reconstruction patients

Based on enhanced recovery protocols shown to reduce length of stay (LOS) and improve patient care in certain types of surgeries, the Departments of Anesthesiology, Plastic Surgery and specialty nursing at the James Cancer Hospital implemented the OSUWMC2 protocol for flap-based micro-vascular breast reconstruction. Pilot data showed successful reductions in length of stay (LOS) and use of opiates for postoperative analgesia, and the protocol was continued. The initial protocol utilized placement of an indwelling catheter in the abdominal incision to deliver local anesthetic as part of a multi-modal pain management strategy. To further facilitate prompt ambulation and activity, reduce the number of invasive catheters and promote readiness for discharge, a 6 month trial of intraoperative single shot liposomal bupivacaine at the abdominal flap incision site, in lieu of the continuous local anesthetic catheter, was completed. 

Submissions


CoAuthor(s)

Mr. Mahmoud Abdel-Rasoul, MS, MPH
Mr. Erik Abel, RPh
Emma Alden, MD
Dr. Ronald Harter, MD
Dr. Michelle Humeidan, MD, PhD
Susan Moffatt-Bruce, MD, PhD, MBA
Ms. Christina Pennington, CRNA
Dr. Juan Rendon, MD, PhD
Cory Roeth, BS
Dr. Roman Skoracki, MD
Diana Wang, BS

Poster Presenter

Mr. Jaume Borrell-Vega, MD

E160. Focused Transthoracic Echocardiography and Peri-operative Cardiac Arrest: Feasibility Study

As ultrasound becomes more portable and more affordable, echocardiography is no longer limited to cardiologists. Critical care physicians are bringing echocardiography to the bedsides of their patients to assess for and treat potentially reversible causes of acute physiologic instability. American Heart Association (AHA) guidelines suggest focused transthoracic echocardiography (FoTE) can be useful in pulseless electrical activity (PEA) arrest because it can identify a variety of possible causes, such as hypovolemia, pulmonary embolism, pericardial effusion and ventricular dysfunction. An algorithm proposed in 2007 incorporated FoTE into the 10-second pulse check of ALS, and three years later, another study demonstrated the efficacy of focused echocardiographic evaluation in life support (FEEL) in distinguishing true PEA (without wall motion) from pseudo- PEA (with wall motion) in patients undergoing cardio-pulmonary resuscitation (CPR). This study, which looked at out-of- hospital cardiac arrest, also showed it was possible to identify treatable conditions such as hypovolemia and pericardial effusion with a focused exam. As anesthesiologists, we primarily work in the inpatient setting, so our institution has been examining the feasibility and results of anesthesiology residents performing FEEL in cases of peri-operative and in-hospital cardiac arrest. 

Submissions


CoAuthor(s)

Dr. Susan Herrick, MD
Dr. Aliaksei Pustavoitau, MD
Dr. Kevin Roberts, MD
Dr. krishnaveni Sirigaddi, MD

Poster Presenter

Dr. Nibras Bughrara, MD

E161. The Association of Primary Anesthesia Type with Postoperative Outcomes Following Neurointerventional Treatment of Acute Ischemic Stroke: A Retrospective Cohort Analysis

General anesthesia (GA) and monitored anesthesia care (MAC) are two modalities of primary anesthesia available to physicians caring for patients undergoing intra-arterial neurointervention following acute ischemic stroke (AIS). Although GA and MAC each demonstrate well-defined perioperative advantages and disadvantages, the anesthetic type associated with less postoperative morbidity remains controversial due to the lack of evidence from randomized control trial data. We aimed to investigate the effects of each anesthesia type on postoperative stroke recovery in order to better understand and improve the clinical management of patients experiencing AIS. 

Submissions


CoAuthor

Rodney Gabriel, MD

Poster Presenter

Mr. Bryan Cozart, Bachelor of Science

E162. An 'Enhanced Recovery After Surgery' bundle for head and neck free flap reconstructive surgery improves post-operative pain and reduces length-of-stay

The ERAS Society debuted a head and neck pathway in 2017 to provide evidence based guidelines for perioperative care.1 In other surgical settings, ERAS protocols have decreased healthcare-associated infections, opioid consumption, and length-of-stay, while also improving overall patient satisfaction.2-4 However, outcomes for the head and neck bundle are limited at this time.5 Free flap reconstruction surgery for head and neck cancers are a challenging and heterogenous surgical condition where care protocolization has uncertain value. 

Submissions


CoAuthor(s)

Dr. Kevin Blaine, MD
Dr. Michael Kim, DO
Dr. Yaroslava Longhitano, MD PhD
Dr. Mark Swanson, M.D.
Dr. Christian Zanza, MD-PhD

Poster Presenter

Dr. Shane Dickerson, M.D.

E163. Real World Utilization Patterns of Perioperative Neuromuscular Blockade Reversal in the United States: A Retrospective Observational Study from the Multicenter Perioperative Outcomes Group.

Residual neuromuscular blockade (NMB) remains a persistent problem(1–3) and is associated with postoperative pulmonary complications (PPCs).(4–7) Sugammadex may decrease the incidence of residual NMB and PPCs,(8) however its application is limited by economic concerns, unknown patterns of use, and lack of evidence-based guidelines. This study aims to identify differences in NMB reversal agent use and factors associated with their use after FDA approval of sugammadex in the US on December 15, 2015. 

Submissions


CoAuthor(s)

Shelley Housey, MS
Dr. Sachin Kheterpal, MD, MBA
Dr. Leif Saager, MD, MMM, FCCM, FCCP
Dr. Nirav Shah, MD

Poster Presenter

Dr. Timur Dubovoy, MD

E164. Sevoflurane attenuates natural killer cell activity and decreases apoptosis of target tumor cells

Natural killer (NK) cells play a major role in tumor immunosurveillance.1,2 They are known to be primarily responsible for catching and destroying circulating tumor cells (CTC). Anesthesia per se has been hypothesized to interfere with NK cells activity, but previous studies analyzing the effect of sevoflurane on these cells have yielded conflicting results. Degranulation is the primary mechanism of action of NK cell-induced target cell killing. Thus, the aim of this study was to determine the role of the volatile anesthetic sevoflurane on NK cell-induced apoptosis of tumor cells as well as the possible involvement of degranulation in this process. 

Submissions


CoAuthor(s)

Dr. Beatrice Beck-Schimmer, MD
Dr. Richard Minshall, PhD
Dr. Suellen Oliveira, PhD
Dr. Martin Schlapfer, MD, MSc

Poster Presenter

Ms. Valerie Fehr, MMed

E165. The impact of cannabis use disorder on perioperative outcomes in major elective surgeries: results from a nationally representative sample

While cannabis has been used in the United States since the 1800s, recent changes regarding the legality of its recreational and medical use have led to an increase in its consumption. The 2016 American National Survey on Drug Use and Health showed that among the 7.4 million individuals with an illicit drug use disorder, the most common substance used was cannabis (4.0 million people).1 An estimated 24.0 million Americans aged 12 or older in 2016 admitted to using cannabis in the last year.1 Medical cannabis is currently legal in the District of Columbia and 33 states.1 Given that the prevalence of cannabis use is expected to continue to grow, healthcare providers are likely to encounter the sequelae associated with its use. Recent literature has highlighted potential detrimental effects associated with cannabis use such as increased bronchial reactivity, cerebrovascular accidents (CVA) and myocardial infarctions (MI).2-8 Surgical patients with a history of cannabis use disorder may be at an increased risk of adverse outcomes given the potential for psychoactive and hemodynamic effects within the perioperative setting. No large cohort study has yet evaluated the perioperative outcomes of patients with cannabis use disorder. In order to anticipate and prevent postoperative complications, perioperative healthcare providers need to be aware of the associated risks of cannabis to ensure that appropriate counseling, safeguards, and monitoring can be applied. We therefore conducted a retrospective cohort study to (1) describe national trends in the prevalence of cannabis use disorders in patients presenting for major elective operations and (2) identify whether patients with a history of cannabis use disorder experienced worse postoperative outcomes. We hypothesized that they would have a higher risk of post-operative complications and higher resource utilization. 

Submissions


CoAuthor(s)

Dr. Brian Bateman, MD, MSc
Dr. Hance Clarke 4574262, MD, PhD
Dr. Naheed Jivraj, MBBS, MSc.
Dr. Karim Ladha, M.D.
Dr. Brandon McGuinness, M.D.
Dr. Duminda Wijeysundera, MD, PhD, FRCPC

Poster Presenter

Dr. Akash Goel, M.D.

E166. Incidence of Preoperative Cardiac Stress Test Rates Decreased in Patients Undergoing Elective Total Hip and Knee Arthroplasty from 2008 – 2015

The American College of Cardiology/American Heart Association guidelines for preoperative cardiac evaluation for non-cardiac surgery recommend stress tests should not be performed in patients with zero Revised Cardiac Risk Index (RCRI) factors.[sup]1[/sup] Previous studies have identified significant inappropriate testing and a trend toward higher preoperative stress test rates.[sup]2,3[/sup] Our aim was to determine the overall incidence of stress testing and adherence to the guidelines in an intermediate risk procedure such as hip and knee arthroplasty. We evaluated for trends, patient characteristics, and geographic variation in the use of preoperative cardiac stress tests. 

Submissions


CoAuthor

Dr. Daniel Rubin, MD

Poster Presenter

Mr. Robert Hughey, MD Candidate

E167. Persistent increase in neurodegeneration markers and immunoaberration after elective heart surgery

There is a well-established evidence suggesting that surgery and anesthesia have a significant impact on the patients' neurocognitive recovery(1-3). What is debatable is the connection between the long-term cognitive functioning and surgery related inflammation for several years after exposure to a para-surgical insult (2, 3). Prior studies showed an increase in serum neurodegeneration markers up to 72 hours after surgery(4, 5). At the same time activation of the immune system after surgery may persist. Here, we investigated the effect of heart surgery on the persistence of inflammatory markers for 3 months after surgery and the concomitant emergence of immune-aberrancy. 

Submissions


CoAuthor(s)

Dr. Ramon Diaz-Ariasta, MD
Mr. Matthew DiMeglio, B.S.
Dr. Saumil Patel, MD

Poster Presenter

Dr. Krzysztof Laudanski, MD, PhD

E168. Quantifying the Impact of Physician Supervision on Nurse Anesthetists' Risk-Adjusted Antiemetic Prophylaxis

Anesthesiologists' supervision of nurse anesthetists remains controversial[1,2]. Few investigations of physician-nurse interaction are electronic medical records (EMR) driven. Precise and valid assessment of provider performance and supervision effects on performance of the supervised remain elusive. We propose risk-adjusted[3], antiemetic prophylaxis as an individual provider metric, derived from the EMR, to investigate the effects of physician supervision. Our model provides an individual provider metric4, useful also to elucidate the interaction of supervision with social determinants of health (SDH)[5,6]. 

Submissions


CoAuthor

Dr. Michael Andreae, MD

Poster Presenter

Mr. Stephan Maman, BS

E169. An EMR-derived individual anesthesia provider metric to measure risk-adjusted adherence with perioperative prophylactic bundles for health systems science and disparity research

Measuring provider performance precisely and accurately is valuable for individualized feedback and for health services science, e.g. predictive clinical decision support (CDS). Based on simulated data, we previously proposed an electronic medical record (EMR)-derived, individual provider metric of risk-adjusted adherence to perioperative prophylactic bundles or guidelines.[1] We now instantiate our proposed individual provider performance metric with actual clinical data on risk-adjusted utilization of antiemetic interventions to demonstrate feasibility and precision. 

Submissions


CoAuthor

Dr. Michael Andreae, MD

Poster Presenter

Mr. Stephan Maman, BS

E170. Identifying risk factors for failure to rescue in people with myocardial infarction after non-cardiac surgery: a cohort study

Perioperative myocardial infarction (PMI) occurs in approximately 2% of non-cardiac surgeries (1) with a 30-day mortality rate of up to 40% (2). This is a significant global burden given that 312 million people undergo surgery each year (3) Compared to other perioperative complications, failure to rescue (FTR; i.e., death after suffering a complication) is highest after PMI (4). However, the risk factors for FTR following PMI have not been identified. The purpose of our study was to identify preoperative, intraoperative and postoperative factors that were significantly associated with FTR in individuals who experienced PMI after intermediate to high-risk non-cardiac surgery. 

Submissions


CoAuthor(s)

Dr. W. Scott Beattie, MD, PhD, FRCPC
Dr. Dean Fergusson, PhD
Dr. Manoj Lalu, MD, PhD, FRCPC
Dr. Daniel McIsaac, MD, MPH, FRCPC

Poster Presenter

Ms. Sasha Mazzarello, MSc Epidemiology

E171. Association of Colloid Choice and Bleeding Following Musculoskeletal Surgery: A Retrospective Cohort Study and Natural Experiment

Surgery on the musculoskeletal system, primarily lower-extremity joint replacement, is the most common major surgical procedure performed in the United States.1 Perioperatively, intravenous (IV) fluid therapy is administered to maintain hydration, increase cardiac output, and replace blood loss.2 In general, the choice of IV fluids varies, but many patients receive colloids in addition to crystalloids.3,4 Among colloids, the two most widely used in musculoskeletal surgery are synthetic hydroxyethyl starch (HES) and human-derived albumin solutions,4 but controversy surrounds the use of HES in particular clinical settings because of safety concerns.5,6 In patients with sepsis and in patients undergoing cardiac surgery, meta-analyses of randomized controlled trials comparing albumin versus HES have found that fewer patients are transfused with RBCs when albumin is used as resuscitation fluid, compared to HES.7,8 Due to a concern for excess bleeding, as well as reports of increased risks of renal replacement therapy and mortality in critically ill adults, the United States Food and Drug Administration (FDA) issued a black box safety warning on HES solutions on June 24, 2013 for patients with critical illness, pre-existing renal dysfunction, and for those undergoing open-heart surgery.9 HES solutions continue to be used worldwide in a variety of other clinical settings, including for postpartum hemorrhage,6,10 in US combat casualties with hemorrhagic shock11, and during surgery4. The safety of HES solutions in these settings remains unknown. To help address this gap, we measured the association of albumin, compared to HES, with the risk of major bleeding during hospitalization for elective musculoskeletal surgery in the United States. To support causal inference, we made a direct comparison and also took advantage of a natural experiment stemming from the 2013 FDA warning. 

Submissions


CoAuthor(s)

Dr. M Brookhart, PhD
Dr. Julien Cobert, MD
Alan Ellis, Ph.D., MSW
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Peter Lindenauer, MD, MSc
Dr. Brian Nathanson, PhD
Dr. Karthik Raghunathan, MD, MPH
Dr. Mihaela Stefan, MD, PhD

Poster Presenter

Dr. Duncan McLean, MBChB

E172. Thoracic Epidural vs Intercostal Nerve Blocks with Liposomal Bupivicaine for Post-operative Pain Control in Patients Undergoing Video-Assisted Thoracoscopic Surgery

Thoracic epidurals are often used as part of multi-modal analgesia to reduce postoperative pain in video-assisted thoracoscopic surgery (VATs). Thoracic epidurals have been shown to reduce opioid consumption and postoperative pulmonary complications. Intercostal nerve blocks with liposomal bupivacaine have been used more recently, although with conflicting evidence about whether this affects postoperative opioid requirements and pain scores. The goal of this study was to compare the outcomes between patients receiving thoracic epidurals and surgeon-performed intercostal nerve blocks with liposomal bupivacaine. 

Submissions


CoAuthor

Dr. Ying Hui Low, MD

Poster Presenter

Dr. Linzi Moss, MD

E173. Using Pharmacy Data Surrogates to Track Efficacy of a Corneal Protection Protocol

Corneal abrasion is the most frequent ophthalmologic complication of anesthesia care. (1,2) While the injury is uncommon with typically transient symptoms, it remains a significant source of dissatisfaction for patients, surgeons and perioperative staff. After several closely spaced corneal abrasions were identified, a previously described corneal protection protocol (3) was recommended to our department's clinicians. This QI project was established to determine if the rate of corneal abrasion has changed after these new recommendations were made. 

Submissions


CoAuthor(s)

Dr. Adam Sima, Ph.D.
Mr. John Stansfield, Candidate for Ph.D.
Dr. Michal Vascak, Ph.D.

Poster Presenter

Dr. W. Paul Murphy, M.D., F.A.S.A.

E174. Association between perioperative crystalloid fluid volume and outcome in Enhanced Recovery After Surgery (ERAS) protocol: Risk-adjusted analysis data from an administrative database

Judicious perioperative fluid administration is an important part of the Enhanced Recovery After Surgery (ERAS) protocols. However, there is paucity of evidence to guide physicians for administration of optimal crystalloid volume for most ERAS protocols and recommendations are mainly made based on the available literature in other types of operations (1,2). Therefore, in this study using a large administrative database, we aim to investigate the association between volume of crystalloid fluids administered on the day of surgery and perioperative outcomes in surgeries for which ERAS guidelines are available. We also aim to test if the previously reported "U-Shaped" association between crystalloid volume on the day of surgery and adverse outcome (3,4) exists in surgeries that data from randomized controlled trials (RCT) are not available. 

Submissions


CoAuthor(s)

Alan Ellis, Ph.D., MSW
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Karthik Raghunathan, MD, MPH

Poster Presenter

Dr. Mohammad Rasouli, MD

E175. Association of preoperative spirometry with cardiopulmonary fitness and postoperative outcomes in surgical patients

Spirometry and cardiopulmonary exercise testing (CPET) can help inform risk stratification for postoperative complications (1). In prior research, the association of measures from spirometry with postoperative complications (2,3) has been inconsistent, the underlying reason for which remains unclear. We therefore conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study (4) to examine the hypothesis that associations of spirometry with postoperative outcomes are confounded by cardiopulmonary fitness. 

Submissions


CoAuthor(s)

Andrea Gershon, MD MSc
John Granton, MD
Kevin Thorpe, MMath
Dr. Duminda Wijeysundera, MD, PhD, FRCPC

Poster Presenter

Dr. Ashwin Sankar, MD

E176. Daily prediction of delirium in hospitalized patients using boosted trees

Delirium effects between 11-42% of hospitalized patients[1] and is associated with increased morbidity and mortality [2]. The annual healthcare costs attributable to delirium is estimated at 150 billion USD/year [3]. A cost-effective and efficient method for the pre-emptive identification of patients at high risk for delirium is expected to reduce the healthcare costs associated with delirium and to significantly improve patient outcomes. We have developed a system for providing a daily (pre-rounding) prediction of delirium risk for hospitalized patients from data (i.e., physiological parameters, laboratory data, clinical assessments) that is readily available in the electronic medical record (EMR). 

Submissions


CoAuthor(s)

Dr. Oluwaseun Akeju, MD
Dr. Eyal Kimchi, M.D. Ph.D.
Dr. Michael Westover, MD Ph.D.

Poster Presenter

Dr. Kendrick Shaw, M.D. Ph.D.

E177. The Pattern of Perioperative High-Density Lipoprotein Particle Loss is Independently Associated with Acute Kidney Injury After Cardiac Surgery

Acute kidney injury (AKI) after cardiac surgery occurs in 25% of patients and independently predicts progression of chronic kidney disease and death.[sup]1[/sup] A higher preoperative high-density lipoprotein (HDL) concentration is associated with a lower risk of AKI after cardiac surgery.[sup]2[/sup] HDL particles might attenuate AKI by entering the perivascular space and reducing oxidative stress. We measured plasma isofuran concentration, an [i]in vivo[/i] marker of oxidative stress, and HDL particle concentration throughout the perioperative period to test the hypothesis that perioperative HDL concentration changes are associated with oxidative stress and AKI. 

Submissions


CoAuthor(s)

Dr. Frederic Billings, MD, Mac
Dr. MacRae Linton, MD
Dr. Alan Remaley, MD, PhD
Dr. Derek Smith, DDS, PhD

Poster Presenter

Dr. Loren Smith, MD, PhD

E178. Impact of intraoperative use of sequential peristaltic pneumatic compression device on fluid requirement during general anesthesia.

Hypotension is commonly associated with induction of general anesthesia (GA). We hypothesize that intermittent pneumatic compression of lower extremity might increase venous return and help to maintain hemodynamic targets which in turn help to restrict fluid requirement during general anesthesia. 

Submissions


CoAuthor(s)

Dr. Ankit Agarwal, MD
Dr. Shivendra Dwivedi, MD
Dr. Masaipeta Kesari, MD

Poster Presenter

Dr. Mukesh Tripathi, MD, FAMS

E179. Serratus Anterior Plane Block for Pediatric Thoracoscopy

The use of Serratus anterior plane (SAP) blocks in the pediatric population is in its infancy and literature is sparse. In the SAP block, the lateral cutaneous branches of the intercostal nerves are targeted, providing analgesia to the chest wall. This block is being performed with increasing frequency in the adult population for thoracic procedures obviating the need for higher risk neuraxial techniques. In this case report, a SAP block was performed at the end of a thoracoscopic decortication in a pediatric patient for postoperative analgesia and tolerance of 2 chest tubes. 

Submissions


CoAuthor(s)

Dr. Donna Bracken, MD
Suparna Dang, MD
Danielle Lindenmuth, MD
Dr. Audra Webber, MD

Poster Presenter

Dr. Katsiaryna Bellaousov, MD

E180. Ultrasound Guided Supraclavicular vs. Retroclavicular Block of the Brachial Plexus: Comparison of Impact on Ipsilateral Diaphragmatic Function

The ultrasound-guided retroclavicular approach to blocking the brachial plexus may be an alternative to conventional infraclavicular approaches, potentially allowing equivalent anesthetic efficacy and distribution, while allowing superior needle visibility[1-5]. One commonly assumed and cited advantage of more distal brachial plexus blocks (e.g. axillary) over more proximal blocks (e.g. supraclavicular) is the lower incidence of phrenic nerve block[3,6-7]. However, the incidence of phrenic nerve block has not been formally investigated for the retroclavicular approach. 

Submissions


CoAuthor(s)

Dr. Philipp Lirk, MD PhD
Dr. Kristin Schreiber, MD, PhD
Dr. Kamen Vlassakov, MD
Dr. Jose Zeballos, MD

Poster Presenter

Dr. Paige Georgiadis, MD

E181. What is the value of a 2nd and 3rd intercostal nerve blocks for axillary pain after shoulder surgery?

Blockade of the brachial plexus at the level of the roots or trunks for shoulder surgery can provide effective analgesia and reduce opioid consumption(1-3). However, at our institution, we observed that despite a preoperative cervical paravertebral or interscalene block, a number of patients complain in the post-anesthesia-care-unit (PACU) of pain under the medial arm or axilla. Pain in the medial arm and axilla is not adequately covered by blockade of the brachial plexus since cutaneous innervation is from the intercostobrachial nerve (ICBN), the medial brachial cutaneous nerve and possibly the 3rd intercostal nerve. The Intercostobrachial nerve most commonly (90.6%) originates from the second intercostal (T2) nerve, though connections to the 1st, 3rd, and 4th intercostal nerves and to the medial brachial cutaneous nerve (MBCN) are not uncommon (4-7). The MBCN originates from the medial cord of the brachial plexus and is often not anesthetized when performing a cervical paravertebral or interscalene blocks (6, 8). The purpose of the case report is to describe the use of 2nd and 3rd intercostal nerve blocks in the management of axillary pain following arthroscopic shoulder surgery. 

Submissions


CoAuthor(s)

Dr. Barys Ihnatsenka, MD
Dr. Linda Le-Wendling, MD
Dr. Yury Zasimovich, MD

Poster Presenter

Dr. Erik Helander, MBBS

E182. The role of pectoralis-II myofascial block in breast cancer surgery: A systematic review and meta-analysis of the absolute and relative analgesic efficacy

Thoracic paravertebral block (PVB) is the preferred analgesic technique for breast cancer surgery (BCS), but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II (PECS-II) block is a promising analgesic technique and potential alternative to PVB, but evidence of its absolute and relative efficacy versus systemic analgesia (Control) and PVB, respectively, is conflicting. This meta-analysis evaluates the analgesic efficacy of PECS-II versus Control and PVB for BCS. 

Submissions


CoAuthor(s)

Dr. Faraj Abdallah, MD, MSc
Dr. Richard Brull, MD, FRCPC Professor
Dr. Michael Essandoh, MD, FASE
Mr. Nicolas Kumar, BSc
Dr. Colin McCartney, MBChB, PhD, FRCA, FRCPC

Poster Presenter

Dr. Nasir Hussain, MD, MSc

E183. IARS Late-Breaking Abstract Submission - 2156

General anesthesia and spinal anesthesia can both be used effectively and safely in patients undergoing total knee arthroplasty (TKA). Recent studies have reported the potential advantages of spinal anesthesia over general anesthesia in orthopedic patients. However, little is known about the relationship between acute kidney injury (AKI) after TKA and anesthetic technique. This study aimed to identify the influence of anesthetic technique on AKI using propensity score matching. We also evaluated whether the choice of anesthetic technique affected other clinical outcomes. 

Submissions


CoAuthor(s)

Ha-Jung Kim, MD
Hyung-tae Kim, MD, PhD
Dr. Won Uk Koh, MD
Young-jin Ro, MD, PhD

Poster Presenter

Ms. Hwa-young Jang, MD

E184. Effects of Lidocaine on Breast Cancer Cells and the Potential Role of Transient Receptor Potential Melastatin 7 (TRPM 7)

Local anesthetics have been shown to affect proliferation, migration and invasion of cancer cells (1). We found that high concentrations (>1 mM) of Lidocaine are toxic to breast cancer cell lines including MDA-MB-231 and MCF-7 (2). However, the pharmacological mechanism that underlies the effect is unknown. Lidocaine is known to suppress glioma cell proliferation by inhibiting Transient Receptor Potential Melastatin 7 (TRPM 7) channels (3). TRPM 7 channels are thought to be overexpressed in cancer cells and, being Ca2+ and Mn2+ permeable, may interfere with Ca2+ homeostasis. In this study, we test the hypothesis that Lidocaine suppresses breast cancer cells by inhibiting TRPM7 channels and further explore the mechanism underlying the effect of TRPM7 on cancer cells. 

Submissions


CoAuthor(s)

Dr. James Dilger, PhD
Dr. Jun Lin, MD, PhD
Mr. Hengrui Liu, Master of Chinese materia medica in Chinese Pharmacology
Dr. Jiaxin Liu, MD

Poster Presenter

Dr. Zhaosheng Jin, MBBS

E185. Pectoral block vs Paravertebral block: a systematic review and meta-analysis

Pectoral (PECs) block was first described by Blanco et al for postoperative analgesia in breast surgery. It was introduced as an easier and safer alternative to thoracic epidural or paravertebral block (PVB) (1). In this systematic review and meta-analysis, we will compare the perioperative analgesic efficacy and adverse events associated with the two regional anesthesia techniques 

Submissions


CoAuthor(s)

Dr. Tong Joo (TJ) Gan, MD, MHS, FRCA, MBA
Dr. Ru Li, PhD
Dr. Jun Lin, MD, PhD
Dr. Jiaxin Liu, MD

Poster Presenter

Dr. Zhaosheng Jin, MBBS

E186. Safety and Efficacy of a Regional Anesthetic Protocol Performed by General Anesthesiologists for Total Knee Arthroplasty in a Rural Community Hospital

Successful regional anesthetic blocks provide postoperative pain relief for patients and may minimize the use of narcotics (1). This is particularly important for total knee arthroplasty (TKA) patients. However, regionally-trained anesthesiologists may not be present at rural community hospitals; therefore, general anesthesiologists may have to perform blocks (2). It has been shown that different types of blocks may be successfully performed by general anesthesiologists for TKA patients (3). We sought to determine the success, efficacy, and quality of a regional anesthetic protocol using femoral nerve block (FNB) and spinal block performed by general anesthesiologists for total knee arthroplasty (TKA) patients at a rural community hospital. 

Submissions


CoAuthor(s)

Dr. Yvon Bryan, MD
Dr. Matthew Bullock, D.O.
Dr. Daniel Forest, M.D.
Ms. Hannah Harris, B.S.
Dr. Melissa Laxton, M.D.
Dr. Jordan Rejeski, M.D.

Poster Presenter

Ms. Hannah Harris, B.S.

E187. Preoperative Pregabalin Prolongs Spinal Anesthesia for Total Knee Arthroplasty

Pregabalin has recently gained popularity in perioperative pain management. Pregabalin is a lipophilic analogue of gamma-aminobutyric acid and binds to the alpha-2-delta-1 subunit of voltage-gated calcium channels of "over-excited" pre-synaptic neurons, reducing release of excitatory neurotransmitters, such as glutamate, calcitonin and substance P [1]. Pregabalin also has been used to treat epilepsy, neuropathic pain, and anxiety disorder [2]. Pregabalin is commonly used as a part of multimodal pain management perioperatively. Perioperative use of pregabalin reduces opioid consumption in patients who received general [3], regional, spinal and epidural anesthesia [4-6]. This is a retrospective study investigating duration of spinal anesthesia for elective total knee arthroplasty (TKA) in patients who received pregabalin preoperatively 

Submissions


CoAuthor

Dr. Sergey Pisklakov, MD

Poster Presenter

Dr. Deniz Oguz, MD

E188. COMPARISON OF POST OPERATIVE ANALGESIA AND INCIDENCE OF CHRONIC PAIN IN QUADRATUS LUMBORUM BLOCK AND TRANSVERSUS ABDOMINIS PLANE BLOCK IN PATIENTS UNDERGOING ELECTIVE INGUINAL HERNIA SURGERY

Incidence of chronic pain after inguinal hernia repair, a commonly performed surgery(1) more so in males(2) is variously reported as 0.7-36.7% to 15-53%(3,4) with a frequency of up to 50%, at one year after surgery.(5,6) Transversus abdominis plane block (TAP) provides somatic analgesia and has shown to reduce the incidence of chronic pain after inguinal hernia surgery.(7) However it provides minimal or no visceral blockade with the conventional approach. The Quadratus Lumborum block (QLB) provides better quality of analgesia along with visceral cover for abdominal surgeries.(8) The dermatomal coverage of QLB (T6-L1) being wider than TAP (T9-12) with additional visceral analgesia may be a better alternative to prevent chronic pain. As there were no randomized controlled trials comparing QLB and TAP in inguinal hernia repair under spinal anesthesia, we planned to study their effect on postoperative pain relief, incidence of chronic pain and analgesic consumption after inguinal hernia surgery. 

Submissions


CoAuthor(s)

Dr. Karthikeyan Alagumalai, MBBS; MD
Dr. Vasudevan Arumugam, MBBS; MD

Poster Presenter

Dr. Adinarayanan S, MBBS; DA; DNB; BCCPM; MNAMS

E189. A Report on 105 Outpatient Total Knee Arthroplasties

The number of outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) can be expected to increase dramatically over the next decade (Figs. 1 and 2), and interest in them will increase as part of value-based care and early recovery protocols. We report on the outcomes of implementation of an outpatient arthroplasty protocol at a tertiary care academic medical center. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Barys Ihnatsenka, MD
Dr. Linda Le-Wendling, MD
Dr. Olga Nin, MD
Dr. Hari Parvataneni, M.D.
Mr. Luis Pulido, MD

Poster Presenter

Dr. Cameron Smith, MD, PhD

E190. Is Extrapolation of Animal Data for Intraneural Injection to Humans Valid?

Animal models have been used to study peripheral nerve injury and central spread during nerve blocks. Our aims were to study the microstructures of nerves in commonly used species and to explore the validity of extrapolating these findings to humans. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Erik Helander, MBBS
Dr. Miguel Reina, Md, PhD
Dr. Xavier Sala-Blanch, MD
Dr. Anna Server, MD
Dr. Steven Vose, MD, MS

Poster Presenter

Dr. Cameron Smith, MD, PhD

E191. Non-invasive Respiratory Volume Monitoring in the Perioperative Management of OSA patients in an Ambulatory Setting

The complicated interplay between surgery, anesthesia, and obstructive sleep apnea (OSA) makes perioperative management, especially in the ambulatory setting, a challenge. As a result, the clinical course for ambulatory surgical patients with OSA often includes an extended post anesthesia care unit (PACU) stay of 2 to 5 hours, additional monitoring, higher acuity care and/or an admission. (1) Pulse oximetry and respiratory rate (RR) are generally used to assess respiratory competence in these patients, serving as surrogates for measuring true ventilation.(2) As a part of a quality initiative, we developed a protocol for patient diagnosed with OSA. We directly measured minute ventilation, using a non-invasive Respiratory Volume Monitor (RVM), to differentiate those at risk for postoperative respiratory depression that require additional monitoring from the larger group of patients who can be safely and efficiently cared for with a more timely PACU discharge. 

Submissions


CoAuthor(s)

Dr. Elena Chung, MD
Mrs. Jennifer Dang, RN
Ryan Depakakibo, RN
Dr. Peggy Duke, M.D.
Dr. Diana Laplace, MD
Dr. Atef Morkos, MD
Stephen Moy, MD
Jennifer Naughton, B.S.
Dr. Vu Nguyen, MD
Dr. Chunyuan Qiu, MD, MS
Dr. Shawn Winnick, MD

Poster Presenter

Dr. Vimal Desai, MD

E192. [Withdrawn] Correlation between lung mechanics parameters during abdominal surgery and plasma levels of biomarkers of lung injury

Several studies on mechanical ventilation have included the analysis of plasma levels of biomarkers of lung injury to provide mechanistic insight to their clinical findings both in critical care[sup]1,2[/sup] and surgical[sup]3,4[/sup] patients. The relationship between lung mechanics parameters and plasma levels or ratios (changes over time) of biomarkers of lung injury during abdominal surgery is still unclear. We hypothesized that optimized parameters of end-expiratory transpulmonary pressure (P[sub]tp_ee[/sub]), respiratory system compliance (C[sub]RS[/sub]) and driving pressure (ΔP) during abdominal surgery would correlate with reduced plasma ratios of selected biomarkers of lung injury (epithelial, endothelial, inflammation). 

Submissions


CoAuthor(s)

Dr. Karsten Bartels, MD, PhD
Carolina Kosour, PhD
Dr. Juraj Sprung, MD, PhD
Dr. Marcos Vidal Melo
Dr. Toby Weingarten, MD

Poster Presenter

Dr. Ana Fernandez-Bustamante, MD, PhD

E193. Retrospective study of extubation time following surgery for extrapleural pneumonectomy and pleurectomy/decortication under desflurane anesthesia

The number of deaths due to mesothelioma is increasing in Japan.[sup]1[/sup] In the multimodal treatment paradigm, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are the surgical treatments for malignant pleural mesothelioma (MPM).[sup]2,3[/sup] Postoperative aspiration might be fatal for patients with a single or an injured lung. Additionally, a prolonged air leak may follow P/D due to lung vulnerability after resecting the entire visceral and parietal pleurae. We especially consider that rapid recovery of spontaneous respiration and good post-anesthetic emergence are essential for protecting the lung by avoiding mechanical ventilation and decreasing pulmonary complications postoperatively. In Japan desflurane (DES) was approved in 2011. To our knowledge, a study on the anesthetic management of surgery for MPM using DES is still lacking. We used DES in the maintenance of general anesthesia for these aggressive surgical procedures and evaluated its usefulness in the clinical settings. 

Submissions


CoAuthor

Dr. KAZUNORI OKABE, Director

Poster Presenter

Dr. KEISUKE KAWATA, MD

E194. Perioperative Risk Factors for Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a breathing disorder characterized by changes in the upper airway affecting ventilation during sleep. [1] Obesity has been associated with OSA, increased difficult airway management, and changes in transpulmonary pressures creating additional challenges for anesthesiologist. [2-5] Published literature advising on preoperative criteria to identify how OSA patients could be at higher risk for pulmonary complications is scarce. [6] The primary aim of this study was to assess the incidence of respiratory failure events, identified as O2 desaturation ≤ 90% or RR ≤ 8 breaths/min for ≥ 3 min, in patients with low and high risk for OSA undergoing elective non-cardiac surgery. 

Submissions


CoAuthor(s)

Dr. Sergio Bergese, MD
Mr. Alan Esparza Gutierrez, BS
Dr. Juan Fiorda-Diaz, MD
Ms. January Kim, BS
Marilly Palettas, MS
Dr. Nicoleta Stoicea, MD, PhD

Poster Presenter

Dr. Alberto Uribe, MD

E195. Effect of Cardiac Surgery On Post-operative Sleep Patterns: An Observational Study

Sleep impairment (problems falling asleep, staying asleep, and reduced rapid eye-movement (REM) sleep) is prevalent in the post-operative period following cardiac surgery;1 however, few electroencephalography (EEG) studies have been performed in this population. The absence of adequate, restorative REM and deep sleep can lead to episodic hypoxemia, sleep disordered breathing, and hemodynamic instability.2 Additionally, lack of sleep has been implicated in the development of psychological and neurologic dysfunction, including post-operative delirium. Post-operative delirium is an independent predictor for the development of dementia within 5 years following cardiac surgery.3 This prospective observational study aimed to investigate sleep changes following cardiac surgery using EEG. We hypothesized that following cardiac surgery, sleep, particularly REM and deep sleep, would be significantly reduced compared to baseline. 

Submissions


CoAuthor(s)

Dr. Lauren Dunn, MD, PhD
Ms. Jane Gui 3158083, MD (expected this May)
Dr. Julie Huffmyer, MD
Dr. Edward Nemergut, MD
Dr. Eryn Thiele, MD

Poster Presenter

Dr. Amanda Kleiman, MD

E196. Evaluation of Micropore's SpiraLith Absorbents into Anesthesia Breathing Circuits

The use of CO2 absorbents is essential in circle systems to assure the safe rebreathing of gases, thus conserving the amount of volatile anesthetics used. Several absorbents are clinically available. Those with calcium hydroxide as the main constituent are considered the current standard of care. Dräger makes CO2 absorbents with decreased amounts of strong bases, which are implicated in the production of carbon monoxide and Compound A, including Drägersorb® 800 Plus and Drägersorb® Free. Newer absorbents such as Spiralith® are free of strong bases and contain lithium hydroxide rather than calcium hydroxide. Lithium hydroxide has a long history of use in aerospace and in the military due to its high capacity and efficiency in the removal of CO2. Other advantages of Spiralith include lack of desiccation and generation of toxic byproducts. In this prospective, randomized, double blind study, we compared the duration of use of the new CO2 absorbent Spiralith® versus Drägersorb® 800 Plus and Drägersorb® Free. 

Submissions


CoAuthor(s)

Dr. Anna Korban, MD
Dr. Andrea Perales, MD, MPH
George Tewfik, MD

Poster Presenter

Dr. Raksha Bangalore, MD

E197. [Withdrawn] Comparing hemorrhage in human physiology simulation tools: how they stack up against expected human physiology and each other

A novel approach to medical simulation is the adaptation of advanced mathematical simulation and modeling, seen in systems biology, into educational tools for healthcare simulation training.(1) Several different whole-body physiology simulation tools (PST) using modeling techniques are now available, but these novel technologies lack objective analysis from an independent organization. We hope to establish which PST provides the truest whole-body simulation of hemorrhage, a commonly simulated scenario which is relevant to the anesthesia community, for implementation into simulation education technologies. We also aim to help build toward better defining evaluation processes of whole-body simulation tools. 

Submissions


CoAuthor(s)

Dr. Jon Keller, MD
Dr. Kenneth Kiberenge, MD
Dr. Mojca Konia, MD, PhD

Poster Presenter

Dr. John Barnes III, MD

E198. Impact of preload changes on tissue and cerebral oxygenation values

Measuring tissue oxygen saturation based upon near infrared spectroscopy (NIRS) allow reliable measurements of cerebral and regional circulations. We hypothesized that continuous tissue oximetry can detect changes in preload during leg raise test and Valsalva maneuvers.1 

Submissions


CoAuthor(s)

Aymen Alian, MD
Dr. Mona Ganash, Md
Dr. Mai Khairy, Md
Dr. somaia Mohamed, MD
Dr. Samar Seleem, Md
Dr. Abdallah Yassin, MD

Poster Presenter

Dr. Anna-Maria Eid, Doctor of Medicine

E199. Preoperative left ventricular energy loss in the operating theater reflects subjective symptoms in patients with chronic aortic regurgitation

Left ventricular energy loss is one of the new quantitative indices that reflect aortic regurgitation severity. We hypothesized that energy loss in patients with chronic aortic regurgitation reflect their subjective symptoms more clearly than other conventional metrics. 

Submissions


CoAuthor(s)

Dr. Koichi Akiyama, MD, PhD
Dr. Maki Ishii, M.D.
Dr. Mao Kinoshita, M.D., Ph.D.
Dr. Yoshifumi Naito, M.D.
Dr. Junya Ohara, bachelo’s degree
Dr. Teiji Sawa, M.D., Ph.D.
Dr. Masaru Shimizu, M.D., Ph.D.

Poster Presenter

Dr. Atsushi Kainuma, M.D.

E200. Transcutaneous measurement of volatile anesthetic gas: A Preliminary Study

There is an urgent unmet clinical need to cost-effectively improve the safety of surgical anesthesia in the developing world (1,2). In order to address this unmet need we developed a transcutaneous isoflurane biosensor device that can accurately measure volatile anesthetic gas concentration in blood, at a low cost/unit. 

Submissions


CoAuthor(s)

Mr. Shekhar Bhansali, PhD
Dr. Carla Cordova, MD
Dr. Robert Fiala, MD
Mr. Ahmed Jalal, PhD
Mr. Yogeswaran Umasankar, PhD

Poster Presenter

Dr. Ernesto Pretto JR, MD, MPH

E201. Glucose Measurements in Blood-Free Balanced Salt Solutions with Three Devices (i-STAT®, Glucose Test Strips and ACCU-CHEK® Aviva)

Accurate glucose measurements are critically important, and differences between actual values and those measured by a device can have serious implications in the clinical arena as well as in basic science research. Hemoglobin-free salt solutions commonly used in in-vitro or ex-vivo preparations may pose an additional challenge for devices. The aim of this study was to test three different clinically used glucose measuring devices for accuracy of the glucose concentration in a balanced salt solution in the absence and presence of bovine serum albumin (BSA). 

Submissions


CoAuthor(s)

Dr. Claudius Balzer, MD, MS
Mr. William Cleveland, BS
Ms. Josephine Hees, N/A
Ms. Felicia Lotze, Cand Med
Mr. Johannes Pille, Cand Med
Ms. Michele Salzman, MS

Poster Presenter

Dr. Matthias Riess, MD, PhD

E202. Diagnosing respiratory obstruction with continuously recorded tidal breathing flow volume loops using a non-invasive respiratory volume monitor

Flow-volume loops (FVLs) are used to diagnose and monitor the progression and treatment of lung disorders such as COPD and asthma. The gold standard for generating FVLs is a spirometry-based forced vital capacity test, which requires the use of a mouthpiece or facemask and patient cooperation to generate maximum effort breaths. These tests cannot be performed by young children and adults unable to follow instructions. For these patients, the use of tidal breathing flow-volume loops (TBFVLs) has been proposed but has not been widely adopted due to lack of a reliable, non-invasive, technological solution. An impedance-based respiratory volume monitor (RVM) non-invasively measures minute ventilation and can be used to generate TBFVLs. The objectives of this study were: 1) to use a spirometer to evaluate TBFVLs measured by the RVM in healthy volunteers, 2) to monitor TBFVLs in post-operative patients using only the RVM over an extended period of time, and 3) to demonstrate the potential of TBFVL in identifying episodes of obstructed or depressed respiration. 

Submissions


CoAuthor(s)

Man Ching Cheung, PhD
Dr. Peggy Duke, M.D.

Poster Presenter

Dr. Wael Saasouh, MD

E203. Background Music Contributes to Error in the Operating Room

In the Operating Room (OR), the anesthesiologist constantly maintains multiple cognitively demanding tasks, including communication. However, the OR's auditory environment is frequently busy with alarms, background noise, speech, and music. Each of these sound sources may impact the anesthesiologist's cognitive processing and thereby the clinical performance in the OR. The auditory environment is two-sided, as is the case with background music. Background music, whose genre and volume are commonly selected by the surgeon, can improve the surgeon's performance and reduce stress [1-3]. However, in other studies the addition of music interferes with communication and performance in the OR [4-7]. Our study focuses on music's impact on the anesthesiologist while using multitasking to better simulate the OR setting. Specifically, this study investigated the effects of background music on speech intelligibility. 

Submissions


CoAuthor(s)

Ms. Kendall Burdick 5071370, BA
Dr. Clayton Rothwell, PhD
Alexandra Bruder, BS

Poster Presenter

Dr. Joseph Schlesinger, MD

E204. Validation of Non-invasive Beat-to-beat Finger Arterial Pressure Measured Ipsi- and Contra-laterally of the Radial Artery Blood Pressure

Noninvasive continuous finger blood pressure (BP) monitoring is an attractive alternative for intra-arterial measurement in selected cases. In the current literature, validation of finger cuff BP monitoring has been done several times with various results and wide methodological variety. It is a matter of debate whether during validation the finger cuff should be placed ipsi- or contralaterally to the arterial line. An ipsi-laterally placed finger cuff could underestimate BP since the cannula in the radial artery obstructs the blood flow in the finger artery. A contra-laterally placed cuff does not account for possible interbrachial pressure differences. In this study we tested whether ipsi- or contra-lateral validation is more accurate. 

Submissions


CoAuthor(s)

Dr. Bart Geerts, MD MSc PhD MBA
Dr. Julia Heusdens, PhD
Dr. Lotte Terwindt, Dr.
Dr. Denise Veelo, M.D. Ph.D.

Poster Presenter

Dr. Rogier Immink, M.D. Ph.D.

E205. The role of microtubule instability in the Histone-induced endothelial barrier dysfunction

Extracellular histones belong to a group of danger-associated molecular patterns (DAMPs) and serve as mediators of inflammation, tissue injury and organ dysfunction (1). Among the various histones, histone H3 induces profound endothelial barrier dysfunction. Disturbances in endothelial cell (EC) barrier regulation are critically dependent upon rearrangements of EC actin cytoskeleton and microtubule network. Control of microtubule assembly and disassembly determines the organization and function of microtubule arrays in living cells. The dynamic instability of individual microtubules enables the cell to rapidly reorganize the microtubule cytoskeleton (2). We investigated whether opening of intercellular gaps after Histone (H3) treatment is associated with increased disassembly of microtubules at the cell periphery and/or with H3-induced changes in the microtubule growth rate. 

Submissions


CoAuthor(s)

Dr. Konstantin Birukov, MD, PhD
Dr. Anna Birukova, MD
Dr. Junghyun Kim, MD
Dr. Kenichi Tanaka, MD
Dr. Chenou Zhang, MD

Poster Presenter

Dr. Boyoung Cha, Ph.D.

E206. Sevoflurane is Associated with Worse Clinical Outcomes and Altered Inflammatory Markers in Blunt Trauma Patients: Pharmacogenomic Association with Single Nucleotide Polymorphisms rs4715332 and rs1695

Anesthetics can impact inflammation, which in turn impacts the pathophysiology of traumatic injury. Given the routine use of anesthetics for trauma patient care, we hypothesized that anesthetics may alter clinical outcomes following blunt trauma patients. We examined potential associations among sevoflurane, previously associated sevoflurane-related single nucleotide polymorphisms (SNPs) rs4715332 and rs1695, systemic inflammation, and post-injury clinical outcomes in a 453-patient cohort of blunt trauma patients. Additionally, we investigated the impact of sevoflurane administration in a mouse model. 

Submissions


CoAuthor(s)

Dr. Timothy Billiar, MD
Markus Huber-Lang, MD
Dr. Ata Kaynar, MD, MPH
Dr. Rami Namas, MD
Lukas Schimunek, MD
Yoram Vodovotz, PhD

Poster Presenter

Dr. Maria Cohen, MD

E207. Predicting Need for trauma center admission emergency Intubation: Comparison of field Glasgow Coma Scale with In-flight Patient Vital Signs.

Airway management is vitally important in the management of critically ill trauma patients. The aim of this study was to evaluate the prediction power for trauma center admission emergency intubation by using field Glasgow Coma Scale GCS, initial patient vital sings (VS) and continuously recorded VS during the helicopter transfer. 

Submissions


CoAuthor(s)

Dr. Doug Floccare, MD
Dr. Samuel Galvagno, MD
Chien-Yu Lin, PhDc
Colin Mackenzie, MD
Dr. Catriona Miller, PhD
Dr. Peter Rock, MD, MBA, FCCM
Dennis Winans, BS
Dr. Shiming Yang, PhD

Poster Presenter

Dr. Peter Hu, PhD

E208. Intraoperative Management of a Trauma Patient with Suspected Malignant Hyperthermia, Hemorrhagic Shock, and Acute Pulmonary Edema Necessitating ECMO: A Case Report

Managing trauma patients poses unique challenges to the anesthesiologist. Potential challenges include hemodynamic instability(1), unknown injuries, time constraints, and difficult airway management(2). Patients are at high risk for developing pulmonary complications(3), metabolic derangements(4), and cardiac arrest(1). We present a unique case of a trauma patient with suspected malignant hyperthermia (MH) and acute respiratory failure necessitating ECMO in the setting of hemorrhagic shock and massive transfusion. 

Submissions


CoAuthor(s)

Dr. Steve Hyman, MD
Dr. Amy Robertson, MD

Poster Presenter

Dr. Andreas Plackis, MD

E209. Circulating Plasma miRNAs Trigger Innate Immune Activation in a Mouse Model of Polytraumatic Injury

Inflammatory responses frequently follow severe traumatic injury and are, in part, a consequence of innate immune activation by endogenous immune triggers such as extracellular- and micro- (mi) RNAs [sup]1–3[/sup] recognized by the pattern recognition receptor Toll-like receptor 7 (TLR7) [sup]4,5[/sup]. We have recently reported that a few highly upregulated uridine-rich miRNAs detected in circulation following sepsis are able to generate a strong immune response [sup]4–6[/sup]. It is known that uncontrolled triggering of the immune response leads to inappropriate systemic inflammation that contributes to the development of multiple organ failure [sup]7,8[/sup]. In this study, we analyzed plasma small RNAs using RNA sequencing (RNAseq) technology in mouse models of sham or polytraumatic injury and tested the proinflammatory function of miRNAs. 

Submissions


CoAuthor(s)

Dr. Wei Chao, MD, PhD
Rosemary Kozar, MD
Dr. Catriona Miller, PhD
Dr. Sheng Wang, PhD
Dr. Lin Zou, MD, Ph.D

Poster Presenter

Dr. Andrew Suen, MD

E210. Comparison of Simultaneous Saturation Readings From Finger and Ear Pulse Oximetry Probes

Pulse oximetry (PO) is a standard of care during general anesthesia (GA) and monitored anesthesia care (MAC). Sometimes, decreased oxygen saturation (SpO2) requires diagnostic and/or therapeutic interventions by the anesthesiologist. When desaturation occurs during MAC, the first response of anesthesiologists may be to decrease the dose of a sedative(s). However, if the SpO2 is falsely low, decreasing sedation may result in patient movement that impairs performance of the procedure, unnecessary awareness and/or pain. When SpO2 decreases during GA, there may be more serious concerns. When SpO2 decreases, the anesthesia provider may place a second PO probe in a different location. If the second probe confirms a higher saturation, it is usually interpreted as confirmation that the SpO2 from the first PO probe is falsely low. The goal of this study is to determine if there are significant differences between PO readings obtained with oximeter probes placed on a finger versus the ear. 

Submissions


CoAuthor(s)

Alyson Dennis, BS
Dr. Jeremy Dennis, MD
Dr. David Kramer, MD
Dr. Sakina Nayaz, MD
Dr. Gabriela Samayoa, MD
Ms. Malka Stohl, M.S.

Poster Presenter

Dr. Sheldon Goldstein, MD