IARS: Poster Session D

Sat, 5/18: 1:00 PM  - 2:30 PM 
IARS Poster Session 
1.5 
The Fairmont Queen Elizabeth 
Room: Place du Canada / Square Dorchester  

Presentations

D001. The Completeness of Intubation Documentation in Urgent and Emergent Non-Operating Room Settings between Different Record Formats

Urgent and Emergent intubations (UEIs) on the hospital floor are commonly accomplished by anesthesia clinicians. While clinical management guidelines exist 1, there is no universally agreed upon standard that ascertains complete documentation of the event 2-3. Frequently, intubation documentation is inadequate 3-4 and at the clinician's discretion with limited usefulness to colleagues. We conducted a single center study to assess and compare the quality of UEI documentation in the context of evolution over time from paper-based (PB) to electronic free text (EFT) and electronic template (ET). 

Submissions


CoAuthor(s)

Dr. Dana Arekat, MD
Dr. Edward Hong, MD
Mr. Jacob Ludington, BSc
Dr. David Moss, MD
Dr. John Adam Reich, MD
Dr. Roman Schumann, MD
Natalia Stamas, MD
Dr. Andrea Tsai, MD

Poster Presenter

Dr. Claudia Bruguera, MD

D002. Posterior tracheal diverticulum in a right lung transplant

Tracheal diverticulum is a rare condition, usually asymptomatic and diagnosed incidentally by radiologic imaging as paratracheal air collections. (1) Clinically, these diverticulum can present as respiratory infection that can often be medically managed. (2, 3) In patients undergoing surgery, tracheal diverticulum can be challenging as there is a risk during tracheal intubation that the endotracheal tube is inadvertently placed within the diverticulum without the provider's knowledge. (4) Here we describe the management of single and double lumen intubation in a patient undergoing lung transplantation with a posterior tracheal diverticulum. 

Submissions


CoAuthor(s)

Dr. Taylor Johnston, MD
Dr. Andrea Miltiades, MD
Dr. Joseph Pena, MD

Poster Presenter

Dr. Patrick Hussey, MD

D003. Induction of Endothelial Barrier Dysfunction by Serum Factors of Traumatic Brain Injury in Rat

Mild to severe acute respiratory distress syndrome (ARDS) can be induced by traumatic brain injury (TBI)(1,2), but the molecular mechanism remains unknown and no effective drug-based therapeutics are available. In order to gain insight about the potential mechanistic link between traumatic brain injury (TBI) and acute respiratory distress syndrome (ARDS), we have adopted a unique approach to characterize the endothelial barrier dysfunction, a key feature of ARDS, induced by serum factors of traumatic brain injury from model rats(3). 

Submissions


CoAuthor(s)

Dr. Konstantin Birukov, MD, PhD
Dr. Anna Birukova, MD
Dr. Gary Fiskum, Ph.D
Dr. Junghyun Kim, MD
Juliana Medina, BS
Dr. Catriona Miller, PhD
Julie Proctor, MS

Poster Presenter

Dr. Yunbo Ke, PhD

D004. Left molar approach intubation for a complex emergency airway in a patient with achondroplasia and know difficult airway.

Patients with achondroplasia, pose a significant challenge for anesthesiologists. These patients have an increased incidence of sleep apnea, cervical spine instability, and difficult airway secondary to skeletal deformities. A large tongue, small maxilla, large mandible, and stenotic airway all contribute to difficult ventilation and intubation. Despite these known anatomic abnormalities, airways can be unpredictable in this patient population. We present a patient with achondroplasia and known difficult airway who was emergently brought to the operating room for intubation secondary to hypoxic-hypercapnic respiratory failure. Prior consultation to cardiothoracic surgery and otolaryngology concluded a surgical airway would never be a viable option in this patient secondary to unfavorable anatomy; therefore, our only resort was successful orotracheal intubation. 

Submissions


CoAuthor(s)

Dr. Brian Cocchiola, MD
Dr. Sergio Navarrete, DO

Poster Presenter

Dr. Adrianne Lazer, MD

D005. Laryngeal mask airway with an in-built endotracheal tube

Laryngeal mask airway (LMA) is a commonly used airway device by anesthesiologists in various elective and difficult airway situations. There are different types of laryngeal masks available including the intubating LMA's for endotracheal intubation. Currently available intubating LMAs require insertion of a separate endotracheal tube. After the intubation, removal of the LMA is cumbersome and requires disconnection of the breathing circuit. This process is associated with varying periods of apnea and hypercapnia. To overcome this difficulty, we have created a new airway device prototype called "Laryngeal airway (LA) Plus". 

Submissions


CoAuthor(s)

Dr. Divya Cherukupalli, MD DGO
Dr. Susan Herrick, MD
Dr. Neil Mathur, MD

Poster Presenter

Dr. Sridhar Musuku, MD FRCA

D006. Do the changes in the amount of lubrication and temperature affect the inhibitory effects of lubrication on the increase in the endotracheal tube cuff pressure during nitrous oxide exposure in vitro?

We previously demonstrated that the application of K-Y™ jelly (Johnson & Johnson, New Brunswick, NJ, USA) on the ETT cuff surface inhibited an increase in cuff pressure during N2O exposure in vitro [1]. However, this effect may be affected by several critical differences in the study conditions between our previous laboratory study and clinical conditions [1]. We have chosen two potential factors to be assessed in this study. First, the amount of K-Y™ jelly retained on the cuff may be reduced during tracheal intubation, suggesting that the inhibitory effect of lubrication may decrease in clinical settings. Second, since all experiments in our previous study were conducted at a room temperature of 24℃ [1], it is unclear how lubrication influences the N2O-induced cuff pressure increase at body temperature. Therefore, in this study, we sought to study how a reduction in the amount of K-Y™ jelly and a rise in temperature affect the inhibitory effects of lubrication on cuff pressure increase during N2O exposure in vitro. 

Submissions


CoAuthor(s)

Dr. Tomio Andoh, MD, PhD
Dr. Yukihide Koyama, MD, PhD

Poster Presenter

Dr. Hiroyuki Oshika, MD

D007. Protecting the Airway and Physician: Lessons from 214 Cases of Endotracheal Intubation Litigation

Medicolegal examination of an intervention as common as endotracheal intubation may be valuable to physicians in many specialties. Our objectives were to comprehensively detail factors raised in litigation in order to better educate physicians on strategies for minimizing liability and augmenting patient safety. 

Submissions


CoAuthor(s)

Dr. Molly Amin, MD
Dr. Jean Eloy, MD
Dr. Jean Daniel Eloy, MD
Dr. Anna Korban, MD
Dr. Peter Svider, MD

Poster Presenter

Dr. Andrea Perales, MD, MPH

D008. Dexmedetomidine For The Prevention Of Fentanyl - Induced Cough In Patients Undergoing General Anesthesia. A Double-Blind Randomized And Placebo Controlled Study

Fentanyl is a drug that is commonly used during induction of general anesthesia. It is characterized by its rapid onset, short duration of action, profound dose-dependent analgesia, and cardiovascular stability mainly during laryngoscopy and endotracheal intubation (1, 2). However, fentanyl induced cough(FIC) is an undesirable side effect and results in increases in intracranial, intra-abdominal and intra-ocular pressure (1, 2). The incidence of FIC during induction of general anesthesia ranges between 28 to 60% (1,2). FIC can be spasmodic , explosive and may warrant immediate emergency intervention(3). Clonidine and Tizanidine have already been shown to reduce cough, whether injected into the nucleus tractus solitarius (cNTS) and caudal ventral respiratory group (cVRG), or intravenously in the rabbit (4).The alpha 2 adrenoreceptor agonist, dexmedetomidine in a dose of 1mcg/kg or 0.5mcg/kg suppressed FIC from 61% to 18% and 40% respectively after injecting fentanyl 4mcg/kg in less than 2 seconds,without any significant hemodynamic changes(2). Many pharmacological and nonpharmacological interventions have been tried to prevent(FIC), lidocaine,NMDA receptor antagonists,propofol, alpha 2 agonists, and priming dose of fentanyl were effective,but atropine and benzodiazepines were not(5). Our study is a double-blind randomized and placebo-controlled study that aims to identify the optimal dose of dexmedetomidine that can prevent FIC without any significant hemodynamic changes after a fentanyl bolus dose of 2mcg/kg given over 5 seconds. 

Submissions


CoAuthor(s)

Dr. Mabelle Baissari, MD
Dr. Mayyas Msheik, MD
Dr. Patricia Nehme, MD
Dr. Samar Taha, MD

Poster Presenter

Dr. Alia Dabbous, MD

D009. High Rates of Postoperative Opioid Overprescription Following Ambulatory Breast Surgery

The opioid epidemic in the United States is widespread, and surgery is a major risk factor for initiation of opioid use and subsequent abuse.1,2 The perioperative period is an important time during which opioid-naïve patients with post-surgical pain may be exposed to opioids for analgesia; however, this period also serves as a potential starting point for opioid tolerance, dependence, abuse, and/or diversion.3,4 For patients with cancer, it may be particularly difficult to balance management of cancer pain with the risk of long-term opioid-related adverse outcomes. Retrospective studies have shown persistent opioid use in 10% of patients following curative-intent oncologic surgery such as mastectomy and/or reconstructive flap after mastectomy.5,6 At our institution, patients undergoing mastectomy, breast biopsy, or breast reconstruction are often discharged home on the same day. We hypothesized that these patients – despite undergoing surgery with minimal expected postoperative pain – are prescribed postoperative opioids at a high rate. We aimed to measure the prevalence of and risk factors for opioid overprescription following ambulatory breast surgery. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Anjali Dixit, MD, MPH

D010. Dexmedetomidine vs. midazolam for medical thoracoscopy- Randomized, noninferiority trial

Thoracoscopy is an outpatient procedure done under sedation.1-5 The patient may be uncooperative due to anxiety, pain and lateral decubitus positioning during the procedure. So, patient`s cooperation is of paramount importance for the successful completion of this procedure. Patient and pulmonologist's satisfaction during thoracoscopy has never been studied in the past. Therefore, we did this study to evaluate pulmonologist`s overall satisfaction during thoracoscopy under sedation with dexmedetomidine and midazolam. 

Submissions


CoAuthor(s)

Sachidanand Jee Bharti, MBBS, MD, DM
Dr. Sushma Bhatnagar, MBBS, MD
Dr. Rakesh Garg, MBBS, MD
Dr. Nishkarsh Gupta, MBBS, MD, DNB, MNAMS, PGCCHM,
Vijay Hadda, MD
Karan Madan, MD DM
Dr. Seema Mishra, MD
Dr. Anant Mohan, MD DM
Dr. Prashant Sirohiya, MD

Poster Presenter

Dr. Vinod Kumar, MBBS, MD

D011. Reasons for postoperative inpatient admissions after ambulatory surgery- a single center retrospective study

Development and expansion of minimally invasive surgical technologies and improvements in the field of anesthesiology have expanded the role and utilization of ambulatory surgical facilities. Stand-alone surgical centers provide excellent surgical and diagnostic care to the community.1, 2 Although medical advances have made ambulatory surgery a safe option, preventable postoperative inpatient admissions and emergency department (ED) visits persist. Accordingly, we sought to systematically access the rate and cause of unplanned inpatient admissions and ED visits within 0-7 days following ambulatory procedures in our health system. 

Submissions


CoAuthor(s)

Dr. David Adams, M.D.
David Bennett, BS
Akshay Bhatt, MD
Dr. Curtis Choice, MD

Poster Presenter

Dr. Singh Nair, PhD

D012. Should Laboratory Tests be Obtained Before Outpatient Gastrointestinal Endoscopic Procedures in Cancer Patients?

A routine test is defined by the American Society of Anesthesiologists (ASA) as "a test ordered in the absence of a specific indication or purpose". An indicated test, however, is defined as "a test that is ordered for a specific clinical indication or purpose". (1) Previous studies involving ambulatory patients undergoing surgery show that routine preoperative tests do not decrease perioperative adverse events.(2-6) The patient population at our tertiary cancer center, however, may be more likely to have comorbidities and abnormal laboratory values that would compromise their safety than patients in a typical outpatient endoscopy practice. Our objective is to compare the demographics and outcomes between patients with laboratory variables recorded and patients whose laboratory data were not collected for patients undergoing outpatient endoscopies under general anesthesia (propofol iv infusion with or without intubation and inhalational agents) in the gastroenterology suite. We hypothesize that routine preoperative laboratory tests are unnecessary for a safe outpatient endoscopic procedure under general anesthesia at a cancer hospital. 

Submissions


CoAuthor(s)

Dr. Juan Cata, MD
Dr. Katherine Hagan, MD
Dr. Shannon Hancher-Hodges, M.D.
Dr. Piotr Kwater, MD
Shrina Parikh, MD
Laura Rubin, MS

Poster Presenter

Dr. Linh Nguyen, MD

D013. Outcomes After Laparoscopic Cholecystectomy: Does the Surgical Setting Matter?

Laparoscopic cholecystectomy is one of the procedures that have experienced a extensive shift from inpatient to outpatient settings. Patients with multiple comorbidities are often denied ambulatory surgery because it is generally believed that overnight hospitalization would be safer as it allows early diagnosis and treatment of potential complications. However, there are limited data validating that that inpatient settings offers improved safety. The aim of the study was to investigate whether after controlling for patient demographic and clinical factors, the inpatient setting allows superior postoperative outcomes after laparoscopic cholecystectomy as compared with the outpatient settings. 

Submissions


CoAuthor

Dr. Girish Joshi, MB BS, MD, FFARCSI

Poster Presenter

Dr. Eric Rosero, MD, MSc

D014. Total Intravenous Anesthesia with a Novel Formulation of Isoflurane Perfluorocarbon-based Nano-emulsion: Safety, Efficacy and Toxicity in Dogs

Despite multiple research efforts to bioengineer safe and stable injectable volatile anesthetic emulsions, these efforts have failed due primarily to problems with long-term stability of the emulsion or toxicity of the ingredients¹. Our group has developed and successfully tested in small animals (rodents) an ultra-stable perfluorocarbon-based isoflurane emulsion². In this study our aim was to explore the clinical safety, efficacy, and toxicity of general anesthesia with intravenous (IV) delivery of our nano-emulsion as the sole agent in large animals (beagles). 

Submissions


CoAuthor(s)

Dr. Christopher A. Fraker, PhD
Fernando L Garcia-Pereira, DVM, MS
Dr. Ernesto A. Pretto, MD

Poster Presenter

Dr. behrouz ashrafi 2162495, MD

D015. Anesthetic sensitivities in the zebrafish

Over the past two centuries, the discovery and application of anesthesia has revolutionized surgery. A variety of structurally distinct drugs are used to induce and maintain the state of general anesthesia (GA). Despite advances in defining anesthetic mechanism, we still have an incomplete understanding of which genes induce GA. To validate known gene targets and to discover new genes, we are employing the larval zebrafish as our model. The zebrafish is an ideal model organism to study these medications in that they possess a central nervous system and display complex behaviors. The embryos develop externally and are transparent, allowing visualization of neurons and their development. Within five days of egg fertilization, the larvae have a developed brain and neural system. Finally, drug uptake is mostly diffusional, largely eliminating the complexities of pharmacokinetics in mammalian models. 

Submissions


CoAuthor(s)

Jayce Breig, BS
Roderic Eckenhoff, MD
Dr. Max Kelz, MD, PhD
Dr. Micheal Pack, MD

Poster Presenter

Dr. Victoria Bedell, MD PhD

D016. Effect of Propofol on in vitro Functions of Breast Cancer Cell lines

Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that the type of anesthesia administered during oncological surgery may influence patient outcome. Propofol, the widely used intravenous anesthetic agent, may lead to better outcomes compared to volatile anesthetics. Here we examined the effects of propofol on cell viability and cytotoxicity in a panel of breast cancer cell lines. 

Submissions


CoAuthor(s)

Dr. Yujie Huang, PhD
Dr. Ru Li, PhD
Dr. Jun Lin, MD, PhD

Poster Presenter

Dr. Zhaosheng Jin, MBBS

D017. Effect of Sevoflurane and Propofol on the phenotype of lung cancer cell in vitro, preliminary findings

Lung cancer is one of the leading causes of death in the US, with more than 200,000 new cases diagnosed every year. In recent years, there has been increasing recognition that anesthesia may alter the phenotype of cancer cells and long-term outcomes after cancer surgery. A number of in vitro studies have reported interaction between anesthetic agent, cancer and the immune system (1-4). In this study, we investigated the effect of propofol and sevoflurane on the cell viability and migration of a lung cancer cell line in vitro. 

Submissions


CoAuthor(s)

Ms. Michelle Jaromy, B.S.
Dr. Ru Li, PhD
Dr. Jun Lin, MD, PhD
Mr. Hengrui Liu, Master of Chinese materia medica in Chinese Pharmacology

Poster Presenter

Dr. Zhaosheng Jin, MBBS

D018. Mixtures of general anesthetics act synergistically only if they act on different binding sites on synaptic GABAA Receptors; a study in tadpoles

Most general anesthetics act on three distinct binding sites on synaptic γ-Aminobutryic Acid Type A Receptors to enhance inhibition and cause anesthesia [1,2]. The pairs etomidate and azi-etomidate, R-mTFD-MPAB and R-mCF[sub]3[/sub]-MPAB, and alphaxalone and 3α,5β-pregnanolone each bind exclusively to distinct orthosteric sites [3,4]. In vitro, when a selective anesthetic binds it allosterically enhances the affinity of the other two sites for their selective anesthetics [5,6,7]. We hypothesized that in vivo, the potency of two anesthetics binding orthosterically to the same site would be additive, while the potency of two agents acting allosterically on separate sites would be synergistic, and by extension three agents binding to their separate sites would be even more synergistic. 

Submissions


CoAuthor

Dr. Keith Miller, PhD

Poster Presenter

Mr. Daniel Kent 9326794, Undergraduate

D019. Effects of incubating packed red blood cells with common infusion crystalloids and medications on red blood cell lysis, aggregation and deformability

Hospital policy mandates that packed red blood cells (PRBC) must be administered through a dedicated intravenous catheter. This broad-scope declaration, although widely accepted, has little support in literature. Mandating a dedicated intravenous catheter in critically ill patients with multiple comorbidities (including peripheral vascular, cardiopulmonary and end-stage renal disease) who already require peripheral and/or central venous access for continuous infusions of multiple medications might be a burden for both the healthcare team and the patients, requiring additional resources and increasing procedural risks. In this study we question the historically accepted requirement for a dedicated infusion line for PRBC. Available literature suggests that red blood cell lysis may occur after 30 min incubation with 5% dextrose in water (D5W) and clotting may occur during incubation with lactated Ringer's solution (LR), but neither occurs when incubated with normal saline (NS, 0.9% NaCl). (1,2) A more insidious effect on cell membrane integrity has not been evaluated. We assess PRBC for cell lysis, cell aggregation and cell membrane deformability after 5 min incubation with various crystalloid solutions, with and without common catecholamines or propofol. 

Submissions


CoAuthor(s)

Dan Berkowitz, MBBCh
Joan Boyd, BS
Patricia Brunker, MD DrPhil MS
Jeffrey Dodd-o, MD PhD
Thomas Kickler, MD
Courtney Lawrence, MD MS
Enika Nagababu, MS PhD
Paul Ness, MD
Kristine Yarnoff, BS

Poster Presenter

Dr. Domagoj Mladinov, MD, PhD

D020. Derivation of Formula for Average Hematocrit under Isovolemic Conditions

Estimated blood loss (EBL) during surgery has been approximated through various modalities in the medical literature.(1) These methods can be roughly grouped into two categories: direct volumetric/gravimetric measurements and formulas based on hematocrit (Hct) or hemoglobin (Hb) changes. More recent equations (1-3) initially calculate red blood cell volume (RBCV) or hemoglobin (Hb) lost and subsequently determine the EBL by a conversion utilizing either initial or averaged linear hematocrit (Hct)/Hb concentration as follows: EBL = RBCV(lost) / Hct [or] Hb(lost) / Hb concentration (1) Thus, the choice of denominator in Equation 1 can significantly affect the blood loss estimate and can be quite variable if the divisors diverge from one another. 

Submissions


CoAuthor(s)

Dr. Susana Cruz Beltran, MD
Dr. Brett Escarza, MD
Dr. Chris Fiedorek
Dr. Michael Fiedorek
Dr. Humphrey Lam, MD

Poster Presenter

Dr. Thomas Austin, MD, MS

D021. Platelet Functionality is Decreased After Infusion Through a Rapid Infusion System

Rapid infusion systems (RIS) are commonly used to warm and rapidly infuse blood products during massive transfusion for exsanguinating hemorrhage. Manufacturer recommendations and current guidelines from the American Association of Blood Banks (AABB) recommend avoiding platelet transfusion through RIS;[sup]1-2[/sup] however, literature supporting this stance is scarce. Furthermore, the use of whole blood transfusions, now favored in civilian centers, inevitably commits platelets to passage through an RIS in such instances. Data regarding the impact of warming and rapid infusion of whole blood platelets is similarly scarce. Platelet functionality was not decreased after passing through a blood warmer.[sup]3[/sup] To address this knowledge gap, we constructed two massive transfusion protocol scenarios to assess the impact of RIS infusion on platelet quantity and functional quality. 

Submissions


CoAuthor(s)

Dr. Nikolaus Gravenstein, MD
Dr. Ilan Keidan, Medicine
Dr. Joshua Sappenfield, MD
Dr. Jeffrey White, MD

Poster Presenter

Mr. Shahrukh Bengali, B.S.

D022. Novel Circulating Metabolic Markers Improve Discrimination of Metabolic Health Independent of Weight

A growing body of evidence suggests traditional metabolic health (MH) assessment tools, often relying heavily on BMI and the clustering of cardiometabolic risk factors seen in metabolic syndrome, poorly correlate with patient risk of adverse events, leading to incomplete CVD risk prediction models and difficulty in identification of those individuals at greatest need for early intensive therapeutic interventions. Evolving molecular technologies have enabled quantification of biomarkers that may serve as more granular reporters on metabolic health. Thus, in this study, we sought to determine if metabolites identified from our prior studies of obesity, insulin resistance and cardiovascular disease would improve traditional measures of metabolic health in predicting risk of adverse events, independent of weight. 

Submissions


CoAuthor(s)

James Bain, PhD
Nathan Bihlmeyer, PhD
Mr. Damian Craig, MS
William Kraus, MD
Lydia Kwee, PhD
Dr. Svati Shah, MD

Poster Presenter

Dr. Stephen Ellison, MD, PhD

D024. MILRINONE DECREASES LATE APOPTOSIS IN H9c2 CARDIOMYOCYTES THROUGH A NON-DEPENDENT ATP PATHWAY

Cardiomyocyte apoptosis occurs in different pathologic states including heart failure, ischemic heart disease, reperfusion injury and chemotherapy induced cardiomyopathy (1). Interestingly, phosphodiesterase 3 inhibitors (PDE3i) such as milrinone are able to suppress apoptosis in different tissues and models; for instance, it reduce apoptosis in lung tissue after a warm ischemia-reperfusion sequence (2), protect neurons from several forms of neurotoxic stressors such as hypoxia, hypoglycemia (3), protects liver tissue during ischemia and reperfusion (4) and also may be involved in cardioprotection in several models of ischemia (5, 6). We hypothesized that PDE3i can protect cardiomyocytes from apoptosis induced by hypoxia/reoxygenation (H/R) In Vitro. We previously showed a significant decrease in the number of caspase positive E18 c57/BL5 mouse cardiomyocytes exposed to hypoxia and 100 µM milrinone compared to only hypoxia (data not published) (7). In the present study, we evaluated whether milrinone can mitigate the H/R induced apoptosis of H9c2 cardiomyocytes In Vitro. We also identified if the cardiomyocyte apoptosis protection is mediated through the maintenance of intracellular ATP levels. 

Submissions


CoAuthor(s)

Dr. Sachin Gupte, M.D., Ph.D
Dr. June Rim, MD

Poster Presenter

Dr. jose Montoya-Gacharna, MD

D025. Intraventricular Pressure Difference assessment from color M-mode image using transesophageal echocardiography

The intraventricular pressure difference (IVPD) during early diastole is known to be well correlated with the Tau index, which is the gold standard of diastolic function. Greenberg et al. established and validated the non-invasive method of estimating IVPD from a color M-mode (CMM) echocardiographic image in 2001. However, previous studies have only reported the quantification of IVPD using transthoracic echocardiography (TTE). Here, we present one method to assess IVPD with transesophageal echocardiography (TEE) and provide the validation data comparing IVPD using TTE and TEE. 

Submissions


CoAuthor(s)

Dr. Keiichi Itatani, M.D., Ph.D.
Dr. Ruiping Ji, MD, PhD
Dr. Atsushi Kainuma, M.D.
Dr. Aaron Mittel, MD
Dr. Yasufumi Nakajima, M.D., Ph.D.
Dr. Teiji Sawa, M.D., Ph.D.
Dr. Eric Stöhr, PhD
Dr. Hiroo Takayama, MD, PhD
Dr. Isaac Wu, MD

Poster Presenter

Dr. Koichi Akiyama, MD, PhD

D026. Higher Qp/Qs Ratio is Associated with Lower Cerebral rSO2 in Patients with Ventricular Septal Defect

Cerebral regional oxygen saturation (rSO2) monitored by near-infrared spectroscopy (NIRS) is often used to detect changes in cerebral perfusion during cardiac surgery. Cerebral rSO2 can indicate the balance of regional O2 supply and demand because 70% to 80% of cerebral blood is venous blood, correlating with jugular vein saturation. (1-3) Thus, interpreting rSO2 in congenital heart disease can be more complicated yet meaningful because rSO2 values differ depending on patient hemodynamics specifically cardiac output. (4,5) With regards to ventricular septal defects (VSD), Kussman et al. documented an increase of rSO2 postoperatively. (4) To the best of our knowledge, however, the relationship of rSO2 and the preoperative status of VSD patients or the hemodynamic insights of NIRS have not previously been investigated. We hypothesized that a higher pulmonary blood flow/systemic blood flow (Qp/Qs) ratio may correlate with lower preoperative rSO2 in VSD surgical closure candidates, because these patients have lower systemic output resulting in decreased jugular vein saturation. 

Submissions


CoAuthor(s)

Dr. TATSUO IWASAKI, M.D
Dr. TOMOYUKI KANAZAWA, M.D
Dr. Hiroshi Morimatsu, MD, PhD
Dr. Kazuyoshi Shimizu, M.D

Poster Presenter

Ms. Aya Banno, M.D.

D027. Factor VIII Inhibitor Bypass Activity (FEIBA) for the Reduction of Transfusion in Cardiac Surgery: A Randomized Double Blind Placebo Controlled Pilot Trial

Transfusions are associated with adverse outcomes in cardiac surgery.1 Specifically, surgical procedures involving the aorta with long cardiopulmonary bypass (CPB) have higher risk of coagulopathy. When transfusion does not control coagulopathy, common practice is rescue therapy with prothrombin complex concentrates (PCC). 2-4 Factor eight inhibitor bypassing activity (FEIBA) is a PCC with Factor VIII coagulant antigen as well as factors II, IX and X, in non-activated form, and activated factor VIIa. We conducted a pilot study evaluating feasibility and safety of prophylactic administration of FEIBA after CPB in cases with anticipated coagulopathy. 

Submissions


CoAuthor(s)

Jaishankar Raman, MD
Victor Rodriguez, MD
Valerie Sera, MD
Howard Song, MD, PhD, MPH
Frederick Tibayan, MD
Dr. Miriam Treggiari, MD, PhD, MPH

Poster Presenter

Dr. Ann Bingham, MD

D028. Preoperative radial artery diameter can help predict radial-to-femoral pressure gradient and vasoactive agent requirements

A radial-to-femoral pressure gradient occurs in about one third of patients undergoing cardiopulmonary bypass and can lead to inappropriate use of vasopressors[1,2]. In previous studies, we found that patients with radial-to-femoral pressure gradients tend to be of smaller stature, undergo longer procedure and require more vasoactive agents. Based on those potential risk factors, we hypothesized that these variables could in fact be markers for smaller radial artery diameter[2-4]. In this study, we investigate whether preoperative radial artery diameter can be a predictor for radial-to-femoral pressure gradient. We also investigate if monitoring intraoperative blood pressure using a femoral arterial line has a clear clinical impact as opposed to using a single radial arterial line. 

Submissions


CoAuthor(s)

Dr. Pierre Couture, Medicine
Dr. Andre Denault, MD PhD
Dr. Alain Deschamps, PhD, MD
Dr. Georges Desjardins, Medicine
Dr. Philippe Pérusse, Medicine

Poster Presenter

Dr. Vincent Bouchard-Dechene, Medicine

D029. [Withdrawn] Post-burn malnutrition and associated cardiomyopathy

It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy under-nutrition. 

Submissions


CoAuthor(s)

Frances Brown, BS
Dr. Alexis McQuitty, MD
Dr. Nikul Patel, MD

Poster Presenter

Dr. Michelle Grata, MD

D030. Correlation Of Bi-Spectral Index With End-Tidal Anesthetic Concentration And Body Temperature During Off-Pump CABG

There is a dynamic balance between anesthetic dose and the effect site concentration of hypnotic and analgesic drugs1. The intensity of surgical stimulation will influence the required dose to achieve a certain anesthetic depth. The aim of this study was to determine the relationship between bi-spectral index (BIS) and clinically directed end-tidal anesthetic concentration at different temperatures attained during the care of patients requiring off pump coronary artery bypass grafting (CABG). 

Submissions


CoAuthor(s)

Dr. Kumar Belani, MBBS, MS
Dr. Priya Nair, MBBS, DNB
Dr. Manjunath udresh, MBBS, MD

Poster Presenter

Dr. Muralidhar Kanchi, MBBS, MD, MBA

D031. Large Right Ventricular Outflow Tract Tumor: Anesthetic Management and Evaluation by Transesophageal Echocardiography

We present a case of a mildly symptomatic and normotensive patient who was found to have a large intraluminal mass in the right ventricular outflow tract (RVOT) protruding through the pulmonary valve with extension into bilateral pulmonary arteries (PA), who underwent elective tumor resection and pulmonary valve replacement. Due to malignant diagnosis and extensive tumor involvement, palliative resection was performed, with postoperative course complicated by prolonged vasoplegia and RV dysfunction. 

Submissions


CoAuthor

Dr. Steven Miller, MD

Poster Presenter

Dr. Brad Moore, MD

D032. Bacterial sepsis increases fibrillary amyloid load and neuroinflammation in a mouse model of Alzheimer's disease pathology

Patients who survive a critical illness in the intensive care unit are at increased risk for long-term cognitive problems1, but whether the worsening of an underlying neurodegenerative process such as Alzheimer's disease (AD) underlies these changes is unknown. Sepsis, one of the leading causes for hospitalization in the intensive care unit, is a distinct entity that leads to acute neurologic changes and chronic cognitive dysfunction in survivors2. Similar neuropathological changes are present in the cognitive decline associated with both septic encephalopathy and AD, including neuroinflammation, neuronal death, and synaptic loss3-5. Increasing evidence exists that the pathological changes of AD, especially the deposition of the amyloid β peptide (Aβ) into plaques, begin years prior to clinical presentation6. The brains of many patients afflicted with sepsis therefore likely already possess evidence of AD and may be more vulnerable to damage in the setting of a critical illness. In this study, we hypothesized that the brain's response to sepsis will modulate AD-related neurodegenerative changes by driving amyloid plaque deposition and neuroinflammation. We addressed this hypothesis by using a bacterial sepsis model in a mouse model of AD pathology to assess for changes in plaque load and neuroinflammation. 

Submissions


CoAuthor(s)

Lucy Cohen, BA
Dr. Erik Musiek, MD, PhD
Collin Nadarajah, BS
Patrick Sheehan, BA

Poster Presenter

Dr. Jacob Basak, MD, PhD

D033. Therapeutic Effects of High Molecular Weight Hyaluronic Acid in Ex Vivo Perfused Marginal Human Lungs Injured with Pseudomonas Aeruginosa

Pseudomonas aeruginosa (PA) is one of the most common Gram-negative pathogen to cause ventilator associated pneumonia, especially in the intensive care unit. Hyaluronan or hyaluronic acid (HA) is synthesized as a high molecular weight (> 1000 kDa) non-sulfated glycosaminoglycan and is one of the chief component of the extracellular matrix and critical for maintaining the normal structure of alveolar air-blood barrier and homeostasis. In acute lung injury (ALI), HA undergoes degradation by lysosomal hyaluronidases, reactive oxygen and nitrogen species and inflammatory mediators¹. In a previous study, we demonstrated that intravenous administration of high molecular weight hyaluronic acid (HMW HA) as a therapeutic improved indices of ALI from severe Escherichia coli (E.coli) bacterial induced pneumonia in the ex vivo perfused human lung in part by reducing pulmonary edema and inflammation and decreasing bacterial counts in the injured alveolus. In this current study, we investigated whether HMW HA would have similar therapeutic properties in ALI from severe PA103 bacterial pneumonia in our ex vivo perfused human lung preparation. 

Submissions


CoAuthor(s)

Dr. Qi Hao, Ph.D.
Dr. Jae Woo Lee, M.D.
Dr. Michael Matthay, MD
Dr. Yoshifumi Naito, M.D.
Dr. Xiwen Zhang, M.D.
Li Zhou, M.D.

Poster Presenter

Dr. Shinji Sugita, MD

D034. Hyperoxic Resuscitation Following Canine Cardiac Arrest Increases Cerebellar Purkinje Neuronal Damage and Inflammatory Microglial Activation

Animal studies indicate that maintaining physiologic oxygen levels (normoxia) immediately after restoration of spontaneous circulation (ROSC) from cardiac arrest (CA) results in less hippocampal neuronal death compared to animals ventilated with 100% oxygen. The neuropathology performed in these resuscitation studies is limited by the fact that they have focused on the hippocampal neuronal death. It is possible that the benefits of normoxic reperfusion seen in the hippocampus may not be reproduced in other brain regions. Moreover, there could be brain regions, e.g., the cortex, substantia nigra, and cerebellum, that undergo greater post-ischemic hypoperfusion than the hippocampus and therefore might profit from exposure to hyperoxia. This study tested the hypothesis that when compared to hyperoxic reperfusion, pulse-oximetry guided resuscitation following ventricular fibrillation (VFib) CA reduces short-term cerebellar neuronal injury and inflammatory microglial activation. 

Submissions


CoAuthor(s)

Ms. Da Lee, BS
Julie Proctor, MS
Dr. Robert Rosenthal, MD

Poster Presenter

Dr. Gary Fiskum, Ph.D

D035. Therapeutic Effects of Hyaluronic Acid in E.coli Bacterial Pneumonia In the Ex Vivo Perfused Human Lungs

Recent studies have demonstrated that extracellular vesicles (EV) released during acute lung injury (ALI) were critical for inducing inflammation in part through the transfer of its cargo, containing bioactive molecules such as proteins, mRNAs, and microRNAs, to target cells. Hyaluronan or hyaluronic acid (HA) is synthesized as a high molecular weight (> 1000 kDa) non-sulfated glycosaminoglycan and is one of the chief component of the extracellular matrix and critical for maintaining the normal structure of alveolar air-blood barrier and homeostasis. In acute lung injury (ALI), HA undergoes degradation to low-molecular weight HA (< 500 kDa) which can decrease endothelial cell barrier function and induce increased expression of inflammatory mediators (1). Surprisingly, based primarily due to its molecular size, HMW HA has the opposite properties of LMW HA. The current study was undertaken to test the role of EVs released in severe [i]Escherichia coli[/i] ([i]E.coli[/i]) pneumonia in the pathogenesis of ALI and to determine whether high molecular weight hyaluronic acid (HMW HA) administration would suppress lung injury induced by [i]E.coli[/i] EV or from [i]E.coli[/i] bacterial pneumonia. 

Submissions


CoAuthor(s)

Dr. Qi Hao, Ph.D.
Dr. Hideya Kato, M.D.
Dr. Jaehoon Lee, M.D.
Dr. Airan Liu, MD
Dr. Michael Matthay, MD
Dr. Jeonghyun Park, MD
Dr. Shinji Sugita, MD
Dr. Xiwen Zhang, M.D.

Poster Presenter

Dr. Jae-woo Lee, MD

D036. A systems immunology approach to characterize lung immune response to hyperoxia

High concentrations of inspired oxygen are often administered to anesthetized or critically ill patients. However, increasing evidence suggests that prolonged exposure to hyperoxia has deleterious effects on the lung, provoking inflammation and alveolar injury. Hyperoxic lung injury, resulting in high rates of lethality in experimental animal models, is thought to be immune cell-dependent (1). Contributions of monocytes, macrophages, natural killer T cells (NKT) and neutrophils have been implicated in separate studies. However, an integrative analysis of cellular responses across all immune populations of the lung exposed to hyperoxia has not yet been undertaken. As a result, the complex immunologic component of hyperoxic lung injury remains incompletely characterized. To address this gap and to identify new potential therapeutic targets, we pursued an unbiased, systems immunology approach utilizing time-of-flight mass cytometry (CyTOF). This cutting-edge technology allowed us to simultaneously analyze all immune populations of normal and injured lung. 

Submissions


CoAuthor(s)

David Gallo, MS
Joshua Keegan, MS
James Lederer, PhD
Dr. Yasutaka Nakahori, MD
Jennifer Nguyen, BS
Leo Otterbein, PhD
Dr. Simon Robson, MD, PhD

Poster Presenter

Dr. Dusan Hanidziar, MD PhD

D037. The Role of miR-147 in Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome (ARDS) occurs in 200,000 patients annually in the United States and has a high rate of mortality.[sup]1[/sup] Currently, there exist no specific therapies for ARDS and there is great need to identify novel treatments. Past work has shown that HIF1a is a protective mediator during ARDS models.[sup]2,3[/sup] Here we hypothesized that Hif1a-dependent miRNAs might have an important role in regulating inflammation during ARDS. 

Submissions


CoAuthor(s)

Dr. Holger Eltzschig, MD, PhD
Dr. Yanyu Wang, PhD
Dr. Xiaoyi Yuan, PhD

Poster Presenter

Mr. Nathaniel Berg 9529709, BSE

D038. ROTATIONAL THROMBOELASTOMETRY IS MORE PREDICTIVE OF MORTALITY IN TRAUMATIC BRAIN INJURY THAN CONVENTIONAL COAGULATION TESTING

According to the CDC, in 2010 alone TBIs were responsible for 2.2 million ED visits, 280,000 hospitilizations and 50,000 deaths. The NIH defines TBI as a form of acquired brain injury, that occurs when a sudden trauma causes damage to the brain. Prediction of outcomes in TBI is difficult and many factors have been shown to predict mortality. The purpose of our study was to retrospectively evaluate patients dignosed with TBI, who also recived a ROTEM, to determine if ROTEM is a better predictor of mortality than conventional coagulation testing. 

Submissions


CoAuthor(s)

Dr. William Beck, MD
Dr. Avi Bhavaraju, MD
Dr. Donald Crabtree, DO
Dr. Benjamin Davis, MD
Dr. Mary Kimbrough, MD
Dr. Anna Privratsky, DO
Dr. Ronald Robertson, MD
Dr. Kevin Sexton, MD
Dr. John Taylor, MD

Poster Presenter

Dr. Daniel Bingham, MD

D039. Adverse Outcomes Associated with Absent or Delayed ß-Blocker Administration after Cardiac Surgery

Perioperative ß-blockade is an important therapy and quality marker for patients undergoing cardiac surgery[sup]1[/sup]. Postoperative withdrawal of ß-blockers is associated with increased mortality in patients who undergo cardiac and non-cardiac surgeries[sup]2[/sup]. The optimal time to administer ß-blockers after cardiac surgery is currently unknown[sup]3[/sup]. We administer ß-blockers to prevent postoperative atrial fibrillation once our patients are hemodynamically stable after cardiac surgery[sup]4[/sup]. We hypothesize that absent or delayed administration of ß-blockers after cardiac surgery leads to adverse outcomes. 

Submissions


CoAuthor(s)

Ms. Germaine Cuff, PhD
Aubrey Galloway, MD
Dr. Samir Kendale, MD
Dr. Mark Nunnally, MD, FCCM

Poster Presenter

Dr. Emily Chanan, MD

D040. Meta-analysis of lipid emulsion therapy in animal models demonstrates pig-dependent bias

Anesthesiologists utilize lipid emulsion therapy to treat local anesthetic toxicity (1), with prior meta-analysis demonstrating a homogenous benefit in animal models of local anesthetic toxicity (2). In critical-care, clinicians use lipid as an adjuvant for refractory hypotension due to xenobiotic overdose (e.g. tricyclic antidepressants, calcium-channel blockers, beta-blockers, etc). In non-local anesthetic models, the impact of lipid remains uncertain with model-specific concerns given pig's allergic reactions to lipid (3). The current study investigated the role of lipid emulsion in animal models of toxicity and the impact of pig models on outcome. 

Submissions


Poster Presenter

Dr. Michael Fettiplace, MD PhD

D041. Utilizing Surgical Embolectomy for Acute Massive Pulmonary Embolism

A diagnosis of acute massive pulmonary embolism (AMPE) carries a high mortality of 30-50% [1]. The critically ill patient with AMPE often presents with severe hypoxia and variable degree of hemodynamic compromise due to the obstructing thrombus in the right ventricular (RV) outflow tract and pulmonary artery (PA) vasculature. Unstable patients need rapid resuscitation in a multidisciplinary care setting. We describe successful resuscitation of an unstable patient with AMPE who underwent emergent surgical embolectomy with extracorporeal membrane oxygenation (ECMO). 

Submissions


CoAuthor(s)

Dr. Kimberly Burcar, MD
Dr. Jayanta Mukherji, MD

Poster Presenter

Dr. Adam Freilich, DO

D042. The Attributable Mortality from Bleeding Complications Exceeds the Attributable Mortality from Thrombotic Complications

Venous thromboembolism (VTE) is a well-recognized cause of morbidity and mortality. There is a growing body of evidence that pharmacologic prophylaxis leads to a dramatically decreased incidence of VTE in surgical inpatients and, considering this evidence, the percentage of patients receiving VTE prophylaxis is rapidly increasing. There have been concerns, however, that VTE prophylaxis may be associated with an increased risk of perioperative bleeding. While the odds ratio is commonly used in the perioperative literature to compare risk in exposed patients, it fails to account for the magnitude of this effect. Attributable mortality (AM) is commonly used by epidemiologists to take this into account. The aim of this study is to analyze a large, heterogeneous national cohort of patients undergoing non-cardiac surgery to compare the rates and AM of thrombotic complications, as compared to bleeding complications over time. We hypothesize that, as pharmacologic prophylaxis has been increasingly utilized over the past decade, AM of bleeding complications is likely rising more than the AM of thrombotic complications. 

Submissions


CoAuthor(s)

Dr. Melissa Bellomy, MD
Dr. Milo Engoren, M.D.
Dr. Frederick Lombard, MBChB
Ms. Barbara Martin, RN, MBA
Ms. Yaping Shi, MS
Dr. Matthew Shotwell, Ph.D

Poster Presenter

Dr. Robert Freundlich, M.D., M.S.

D043. Magnesium sulfate significantly alleviates the development of right ventricular dysfunction in monocrotaline-treated rats

Inflammation plays a crucial role in mediating the development of right ventricular dysfunction secondary to pulmonary hypertension (Sydykov A et al., 2018). Our recent data confirmed the potent anti-inflammation capacity of magnesium sulfate (MgSO4) (Chang YY et al., 2018). This study elucidated whether MgSO4 can significantly alleviate the development of right ventricular dysfunction in pulmonary hypertension rats induced by monocrotaline. 

Submissions


Poster Presenter

Dr. Chun-Jen Huang, MD, PhD

D044. Modifiable risk factors of prolonged dependence on vasopressors after cardiac surgery: a retrospective cohort study

Cardiac surgery performed with cardiopulmonary bypass (CPB) is frequently complicated by hemodynamic [1] instability due either to an inflammatory response [2] or to cardiac dysfunction during or immediately after the weaning from CPB [3]. In some cases, hypotension became resistant to vasoconstrictor agents and required more prolonged and higher dose use of those vasopressors. There are limited studies on the incidence and the risk factors of prolonged vasopressor dependence following cardiac surgery [4]. The objective of the study was to identify risk factors related to prolonged dependence on vasopressors after weaning from bypass. 

Submissions


CoAuthor(s)

Denis Babin, MSc
Dr. Vincent Bouchard-Dechene, Medicine
Dr. Andre Denault, MD PhD
Matthias Jacquet-Lagrèze, MD
Yoan Lamarche, MD
Sylvie Levesque, MSc
Antoine Rochon, MD
Dr. William Souligny, MD

Poster Presenter

Dr. LOAY KONTAR, MD

D045. Trends in Tracheostomy Utilization After Severe Acute Brain Injury in the United States

Severe Acute Brain Injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the United States, as well as to examine factors associated with tracheostomy utilization following SABI. 

Submissions


CoAuthor(s)

Dr. Claire Creutzfeldt
Dr. Abhijit Lele, MBBS, MD, MS
Dr. Karthik Raghunathan, MD, MPH
Dr. Monica Vavilala, MD

Poster Presenter

Dr. Vijay Krishnamoorthy, MD, PhD

D046. Incidence and diagnoses of "short-stay" critical care admissions from the emergency department.

Emergency department (ED) and intensive care unit (ICU) bed space and clinical capacity are limited resources that can be inter-dependent. The purpose of this study was to perform a descriptive analysis of the admitting diagnoses for patients admitted to the ICU from the ED who stayed in the ICU less than 48 hours. 

Submissions


CoAuthor(s)

Mengyu Di, BS
Dr. Deepa Patel, MD
Dr. Justin Schrager, MD, MPH

Poster Presenter

Dr. Layne Madden, MD

D047. Spontaneous esophageal rupture with stridor after partial resection of the right lung

Spontaneous esophageal rupture (SER) sometimes presents with nonspecific symptoms, leading to a delay in diagnosis and poor prognosis. We reported the case of a patient with SER with stridor after right upper lobectomy, who was successfully managed with conservative treatment. 

Submissions


CoAuthor(s)

Dr. Akira Katayama, MD
Dr. Hiroshi Morimatsu, MD, PhD
Dr. Ryu Nakamura, MD
Dr. Kazuyoshi Shimizu, M.D
Dr. Yohei Takano, M.D.
Dr. Naoto Tomotsuka, M.D.

Poster Presenter

Dr. Yuto Matsuoka 61059680, MD

D048. In Hospital Mortality, Complications , and ICU Length of Stay After Ventricular Assist Device Implantation: A Single Center Case Review

Ventricular assist device (VAD) improve long-term survival in patients with end-stage heart failure. However, in hospital mortality, complications, and length of stay after surgery are less well studied. In this study assess in hospital mortality, complications and factors that may affect ICU length of stay (LOS) in patients implanted with a durable VAD in a single center over a 4 year period. 

Submissions


CoAuthor(s)

Dr. Abdulaziz Almehlisi, M.D.
Dr. Albert Nguyen, MD
Dr. Kimberly Robbins, M.D.
Dr. Ulrich Schmidt, MD, PhD, MBA
Dr. Andrea Yoder, M.D.

Poster Presenter

Dr. Rachael Mintz-Cole, M.D., Ph.D.

D049. [Withdrawn] Role of Syndecan-1 and disruption of glycocalyx in critically ill patients with ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO)

Patients dependent on and supported with veno-arterial (VA) or veno-venous (VV) ECMO, left ventricular assist device LVAD and/or right ventricular assist device RVAD have a high risk for hemorrhage given the need for anticoagulation and antithrombotic therapy. Predicting who is going to bleed or not is still unknown (1,2). Syndecan-1 is a class 1 transmembrane protein with extracellular and transmembrane cytoplasmic domains out of the group of heparin sulfate proteoglycans (HSPG) and a main player of the endothelial glycocalyx. Intact glycocalyx is essential for endothelial integrity and barrier function as well as for thrombocyte adhesion initiating coagulation cascade. Inflammation is a trigger for glycocalyx breakdown. Exposure to foreign material like device tubing and cardiovascular disease are known states of high inflammatory protein expression (3,4). 

Submissions


CoAuthor

Mr. T. McKai Wood, BS

Poster Presenter

Dr. Dorothea Rosenberger, MD PhD

D050. Gut Microbiome Short-Chain Fatty Acid Levels Can Regulate Lung Inflammatory Responses in Mice

The human body coexists with a vast commensal microbiome that is increasingly recognized to play important roles in human health, physiology, and disease (1–5). Interactions between the microbiome and host are best understood at specific interfaces, such as the gut, oral cavity and the skin. Seminal work over the past decade has revealed the manner in which a healthy gut microbiome is tolerated by adjacent intestinal epithelium and submucosa. Additionally, there appears to be a prominent role for gastrointestinal dysbiosis and pathobionts in the etiology of inflammatory bowel disease, other intestinal disorders, and critical illness in general (3). We previously reported that the gut microbiome influences lung inflammatory responses , in this study, we sought to identify gut microbiome factors that regulate lung immune homeostasis. 

Submissions


CoAuthor(s)

Dr. Judith Hellman, MD
Dr. Arun Prakash, MD, PhD

Poster Presenter

Dr. xiaoli Tian, PhD

D051. Massive Tongue Swelling Preventing Extubation

Massive tongue swelling has many potential etiologies, including angioedema, masses, and venous congestion. More importantly, macroglossia causes significant issues in the setting of respiratory failure, complicating the decision to proceed with tracheal extubation. 

Submissions


CoAuthor

Jeffrey Gotts, MD, PhD

Poster Presenter

Dr. Thanh-Giang Vu, MD

D052. Low-Cost ECMO Troubleshooting Simulation Improves Provider Confidence and Preparedness in Managing Life-Threatening Circuit Complications.

Extracorporeal Membrane Oxygenation (ECMO) is an increasingly-utilized support option for patients with respiratory or cardiac failure refractory to conventional management strategies. Problems with the ECMO circuit may occur rapidly with life-threatening consequences. Simulating common complications encountered in patients on ECMO may improve provider comfort and confidence, leading to more rapid identification and management (1) of problems in a busy cardiothoracic ICU within an ECMO referral, quaternary care teaching hospital. Additionally, ECMO simulation has been shown to reduce errors in ECMO emergencies (2). Effective simulation is often limited by high cost models requiring specialized or proprietary equipment. It is worth considering whether a very low cost model could improve provider's confidence in dealing with common and life-threatening complications relating to the ECMO circuit. 

Submissions


CoAuthor(s)

Kiley Hodge, B.S. in Respiratory Therapy
Michael Stentz, MD

Poster Presenter

Dr. Matthew Wiepking, MB BMedSc BAO BCh (Hons)

D053. Lipid emulsion containing omega3 (n3) fatty acids beneficially affect insulin signaling and glucose uptake in the beating rat heart

Lipid emulsions commonly used in patients requiring total or partial parenteral nutrition elicit insulin resistance and adverse metabolic effects on glucose metabolism. It is currently unknown whether acute exposure to n3 fatty acids-containing fish oil-based lipid emulsion Omegaven® as opposed to the n6 fatty acids-containing soybean oil-based lipid emulsion Intralipid® is more favorable in terms of insulin signaling and glucose uptake in the intact beating heart. 

Submissions


Poster Presenter

Dr. Michael Zaugg, MD MBA FRCPC

D054. Assessing the Readability of Anesthesia-related Patient Education Materials

The National Institutes of Health (NIH), American Medical Association (AMA) and the US Department of Health and Human Services (USDHHS) recommend that patient education materials (PEMs) be written between the 4th to 6th-grade reading level to ensure comprehension by the average American. In this study, we examine the reading levels of online patient education materials from major Anesthesiology organizations. 

Submissions


CoAuthor(s)

Dr. Faraz Chaudhry, MD
Dr. Jean Daniel Eloy, MD
Dr. Anna Korban, MD

Poster Presenter

Dr. Raksha Bangalore, MD

D055. Individualized Resident Physician Feedback Decreases Intraoperative Hypotensive Events

Increasing evidence demonstrates that intraoperative hypotension contributes to postoperative acute kidney injury (AKI), myocardial injury after noncardiac surgery (MINS), and increased thirty-day mortality.(1-3) Salmasi et al. demonstrated that postoperative AKI and MINS were associated with both decreases in mean arterial blood pressure (MAP) based on relative thresholds (>20% reduction from baseline MAP) and absolute thresholds (MAP < 65 mm Hg), suggesting that a baseline blood pressure measurement does not need to be determined to provide appropriate care. Additionally, Sun et al. found an association between AKI and sustained intraoperative hypotension (e.g., MAP < 55 for greater than 10 minutes and MAP < 60 for greater than 20 minutes).(3) We hypothesized that reviewing these data with residents and providing individualized quantitative feedback regarding blood pressure management would result in decreased intraoperative hypotension. 

Submissions


CoAuthor(s)

Marcel Durieux, MD, PHD
Dr. Katherine Forkin, MD
Dr. Bhiken Naik, MBBCh

Poster Presenter

Dr. Sunny Chiao, MD

D056. Project Pandemic: Efficient and Effective Teamwork and Communication Skills Training Using a Tabletop Game

Effective teamwork is critical in medicine, and high-fidelity simulation (HFS) is currently the predominant education modality for team training.[sup]1[/sup] However, HFS is equipment-, labor- and time-intensive, and may not be generalizable across specialties. The collaborative board game Pandemic® has been described in human factors literature as a possible low-fidelity, game-based method of teamwork training.[sup]2[/sup] Our hypothesis is that a game-based education intervention in a nonclinical setting is efficacious in developing non-technical teamwork skills among anesthesia trainees. 

Submissions


CoAuthor(s)

Dr. Carol Diachun, MD, MSEd
Dr. Cindy Ku, MD
Dr. John Mitchell, MD
Vanessa Wong, BS

Poster Presenter

Dr. Cullen Jackson, PhD

D057. Geography and Program Reputation are Key Factors that Influence Residency Match.

Introduction: The purpose of our survey is to determine the factors that influences how medical students rank anesthesia programs. A survey performed at Duke University from 2008 to 2010 revealed many factors that influence residency match choices including the fact that the culture of the institution was very important to resident applicants. It also revealed that different specialties valued reputation of the program more than others (1). Our survey specifically targeted applicant applying into anesthesia programs. From the data we hope to improve recruitment by understanding the factors that influence medical student to choose one anesthesia program over the other. 

Submissions


CoAuthor(s)

Ms. Germaine Cuff, PhD
Mr. William Kim
Dr. James Mckeever, MD
Dr. Michael Wajda, MD

Poster Presenter

Dr. Jung Kim, MD

D058. The Ontology of Leadership: A Simulation-Based Introduction

The Trait Theory of Leadership has been described as an effective means of studying leadership, however its use in teaching leadership may be less effective. Perhaps this is because while the trait theory of leadership encourages mimicking of selected traits, it does not train the leader in the acquisition of traits required for leadership. The "being" of leadership, i.e. the ontology of leadership, results from one's natural self-expression rather than emulation of noted leaders. Epistemologic mastery leads to knowing; ontologic mastery leads to being. We employed simulation scenarios to a group of fourth-year medical students to provide a "first-person" learning experience, supplemented by the standard "third-person" format. Experiencing leadership issues on a first person, of "as-is" basis can be likened to "being in the game" as opposed to being a spectator. 

Submissions


CoAuthor

Dr. Philip Boysen, M.D.

Poster Presenter

Ms. Annandita Kumar, MD

D059. Representation of Women on the Editorial Board of the Canadian Journal of Anesthesia

The National Academy of Sciences and Institute of Medicine placed a call for "reasonable representation of women on editorial boards and in other significant leadership positions."1 However, previous research has demonstrated that women are underrepresented on the editorial boards of other anesthesia journals, despite increasing numbers of women in anesthesiology. The proportion of women on the editorial board of the Canadian Journal of Anesthesia (CJA) over time has not been described. Our study objectives were to describe the gender composition of both (i) CJA editorial board members over the past decade; (ii) authorship of editorial articles published in the CJA during the same time period. 

Submissions


CoAuthor

Dr. Alana Flexman, MD

Poster Presenter

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

D060. Impact of Anesthesia Type on Patient Satisfaction with Anesthesia Care

An increasing focus of healthcare quality is assessment of patient-reported outcomes such as satisfaction. Results of patient experience surveys are incorporated into hospital performance scores, highlighting the relevance of patient satisfaction to healthcare quality.[sup]1[/sup] However, little is known about the impact of anesthesia type on patient satisfaction with anesthesia. We analyzed a large U.S. multistate database of patient satisfaction surveys to clarify the relationship between anesthesia type and patient satisfaction. 

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.

D061. Economic Evaluations of Sugammadex for Reversal of Neuromuscular Block in Surgical Procedures: A Systematic Review

Sugammadex is a first-in-class selective relaxant binding agent for the reversal of neuromuscular block (NMB). To understand its economic impact, we conducted a systematic review of economic evaluations of sugammadex. 

Submissions


CoAuthor(s)

Dr. Lori Bash, PhD, MPH
Ms. Ishita Doshi, MPH
Dr. Sumesh Kachroo, PhD

Poster Presenter

Dr. Amit Raval, PhD

D062. Resident Physician Perspective on Women As Leaders

In April, 2018 at an annual meeting we presented data aimed at identifying the perspective of millennial physicians entering graduate medical education programs on leadership within their training. We employed the modified Delphi technique (Rand Corporation), aimed at developing consensus on an important issue amongst involved individuals. Initially individuals responded to the word/trigger "leadership." Subsequent consideration followed in smaller sub-groups after which the entire group collaborated to prioritize perspectives conglomerating in a list of leadership traits. The moderated discussion following our presentation encouraged junior physicians to further address the particular issue of women as leaders. Subsequently we repeated the exercise, with similar results--with the same resident cohort we instituted the Delphi process, but using the prompt "women leaders." We purposely did not limit the response to women in medicine, seeking a broader response base. 

Submissions


CoAuthor(s)

Dr. Philip Boysen, M.D.
Dr. Joseph Koveleskie, M.D.

Poster Presenter

Dr. Karlyndsay Sitterley, M.D.

D063. Cognitive resilience: predicting a robust cognitive status after major non-cardiac surgery

Post-operative delirium (POD) is recognized as contributing to morbidity, hospital length of stay, and deficits in cognitive performance. POD is a syndrome of fluctuating changes in attention and level of consciousness that occurs in approximately 10%–40% of patients >60 years of age after surgery and hospitalization. Although the cause is uncertain, a number of risk factors have been identified, both predisposing (e.g., age, pre-morbid cognitive impairment, depressive symptoms, etc.) and precipitating (e.g., hemodynamic instability, type of surgery, and possibly anesthetic depth). In addition, a number of preventive and treatment strategies have been evaluated, including initiating/limiting certain medications, consultation with geriatric specialists in-hospital/post-operatively, and early mobilization strategies, with varying degrees of success.(1) Little attention has been paid to cognitive resilience, or patients who have a robust cognitive status after surgery. The objective of this study is to identify factors which might be associated with cognitive performance that did not decline at 30 days after surgery compared with preoperative measurements. 

Submissions


CoAuthor(s)

Dr. Jacqueline Leung, MD, PhD
Mr. Devon Pleasants, BS
Dr. Laura Sands, PhD
Ms. Sanam Tabatabai, BS
Mr. Christopher Tang, BS
Ms. Yueyao Wang, MS

Poster Presenter

Dr. Christopher Choukalas, MD, MS

D064. Postoperative Delirium After Major Cardiac Surgery is Associated with High Protein Levels of TIMP-1 and IL-6

Delirium is an acute brain dysfunction characterized by disturbances in attention, awareness, and cognition.[1] It is associated with increased mortality, prolonged hospitalization, prolonged institutionalization, and long-term cognitive deficits.[2,3] Conditions associated with delirium are characterized by activation of the inflammatory cascade with the acute release of inflammatory mediators into the bloodstream.[2,4] Postoperative delirium is prevalent after major cardiac surgery. However, the extent to which activation of the inflammatory cascade is associated with postoperative delirium after major cardiac surgery remains unclear. 

Submissions


CoAuthor(s)

Ms. Breanna Ethridge, Bachelors of Science
Jacob Gitlin, BS
Eunice Hahm
Reine Ibala, BS
Dr. Oluwaseun Johnson-Akeju, MD
Jason Qu, MD

Poster Presenter

Ms. Jennifer Mekonnen, MS

D065. Depth of Sedation as an Interventional Target to Reduce Postoperative Delirium: Mortality and Functional Outcomes of the STRIDE Randomized Clinical Trial

Introduction: The Strategy to Reduce the Incidence of Post-operative Delirium in the Elderly (STRIDE) trial tested the hypothesis that limiting sedation during spinal anesthesia decreases in-hospital postoperative delirium (POD) following hip fracture repair. This abstract reports the STRIDE trial secondary outcomes including mortality and function. 

Submissions


CoAuthor(s)

George Bigelow, Ph D
Dr. Allan Gottschalk, MD, Phd
Karin Neufeld
Esther Oh, MD, Ph D
Dr. Jean Pierre Ouanes, DO
Naeyuh Wang, Ph D

Poster Presenter

Dr. frederick sieber, md

D066. Beers Criteria in the perioperative period: Incidence of perioperative diphenhydramine, midazolam and scopolamine use in elderly surgical patients.

Postoperative delirium is associated with increased morbidity and mortality, results in longer lengths of stay, greater costs and use of healthcare resources and leads to compromised functional recovery(1). Additionally, with the growth of the older adult population, there is a push to refocus on outcomes that matter most to this subset of patients as targets for surgical quality improvement, including postoperative delirium(2). The Beers Criteria of the American Geriatric Society identify certain medications that are known to contribute considerably to the risk of postoperative delirium in older patients, also referred to as potentially inappropriate medications (PIM)(3,4). In particular, medications with high anticholinergic properties and benzodiazepines are such medications that are commonly administered by anesthesia providers but are known to increase the risk of delirium(3,4). The aim of this study was to examine the use of perioperative diphenhydramine, midazolam and scopolamine in elderly patients at our institution as an assessment of possible future interventions. 

Submissions


CoAuthor(s)

Dr. Lee Fleisher, MD
Dr. Sushila Murthy, MD
Dr. Gurmukh Sahota, MD, PhD

Poster Presenter

Dr. Audrey Spelde, MD

D067. The "just right" amount of oxygen: reducing hypoxemia and hyperoxia in a Rwandan emergency department

Oxygen is a World Health Organization essential medication but is inconsistently available in resource-constrained settings.(1, 2) Hypoxemia is associated with increased morbidity and mortality.(1-4) Mounting evidence suggests that hyperoxia may also be associated with adverse outcomes.(5-9) While conducting a previous study in a tertiary care hospital in Rwanda, we found that 12.0% of inpatients were hypoxemic, and that 60.3% of these patients received inadequate oxygen (SpO2<90%) during at least one inpatient day.(2, 10)We hypothesized that hyperoxia, in the context of high oxygen consumption, in the Emergency Department (ED) was common, and that over-utilization of oxygen for some patients might contribute to oxygen shortages and hypoxemia for other patients. We further hypothesized that an educational intervention could improve oxygen utilization and availability. 

Submissions


CoAuthor(s)

Dr. Lise Kabeja, MD
Dr. Victor Moriau, MD
Elisabeth Riviello, MD MPH
Dr. Daniel Talmor, MD, MPH
Dr. Theogene Twagirumugabe, MD;PhD

Poster Presenter

Dr. Tori Sutherland, MD MPH

D068. Effects of intraoperative fluid management on postoperative acute kidney injury in liver transplantation: a retrospective cohort study.

Liver transplantation is increasingly performed but remains at high risk of postoperative complications.(1-3) AKI is a common complication following liver transplantation (13-71%) and has been associated with intraoperative events, increased burden of care and mortality.(4-7) Restrictive intraoperative fluid management has been associated with improved postoperative outcomes in major abdominal surgery, but with an increased risk of acute kidney injury (AKI). (8,9) The role of intraoperative fluid management has not been thoroughly investigated in liver transplantation. We conducted a retrospective cohort study to evaluate the association between intraoperative fluid management and AKI in liver transplant recipients. 

Submissions


CoAuthor(s)

Dr. Marc Bilodeau, MD
Michaël Chassé, MD PhD
Martin Girard, MD
Dr. Luc Massicotte, MD

Poster Presenter

Dr. François Carrier, MD

D069. Goal-Directed Fluid Therapy versus Low Central Venous Pressure strategy during Major Liver Resections (GALILEO): a Patient and Surgeon-Blinded Randomized Controlled Trial

A recent worldwide survey confirmed that low central venous pressure (Low-CVP) is the current clinical standard during major liver resections, aimed at reducing blood loss and a good quality of the surgical field. Possible complications of the restrictive fluid regimen required to achieve Low-CVP, however, include hemodynamic instability and acute kidney injury. In recent years, goal-directed fluid therapy (GDFT) has shown to reduce postoperative morbidity in many types of high-risk abdominal surgery, but evidence in major liver resections is lacking. The aim of this study was to assess the potential benefits of GDFT compared with Low-CVP in patients undergoing major liver resection. 

Submissions


CoAuthor(s)

Dr. Marc Besselink, M.D. Ph.D. Prof.
Dr. Bart Geerts, MD MSc PhD MBA
Dr. Markus Hollmann, M.D., Ph.D., Prof.
Dr. Rogier Immink, M.D. Ph.D.
Mr. Timothy Mungroop, MD
Mr. Martin Rutten, MD
Ms. Zehra Uz, MD
Dr. Thomas van Gulik, M.D. Ph.D. Prof.
Dr. Denise Veelo, M.D. Ph.D.

Poster Presenter

Ms. Iris Jongerius, MD

D070. Hemodynamic Changes With Autologous Flushing Of Donor Graft During Orthotopic Liver Transplantation.

Reperfusion syndrome (RPS) is a known challenge during reperfusion of the donor graft during orthotopic liver transplantation and can result in cardiopulmonary arrest and death. Our liver transplant service instituted a flushing method of the donor graft with autologous blood to reduce the severity of RPS. 

Submissions


CoAuthor(s)

Dr. Ari Cohen
Dr. Gabrielle Frisenda, DO
Dr. Bobby Nossaman, MD
Dr. John Seal
Dr. Dennis Sonnier, MD
Dr. Tim Ziethen, MD

Poster Presenter

Dr. Susan Smith, MD

D071. The Role of Sarcopenia and Frailty in Predicting Outcomes in Orthotopic Liver Transplantation.

Sarcopenia and frailty have shown to be predictive of outcomes in orthotopic liver transplant (OLT) recipients. We aimed to investigate if sarcopenia as measured by total Psoas area (TPA) and frailty as measured by the Karnofsky's Performance Scale were significant predictors of hospital LOS (hLOS), ICU LOS, number of ventilator hours, blood products (BPs) administered in the operating room, complications and death within 90 days and death within one year in our patients receiving OLT. 

Submissions


CoAuthor(s)

Daniel Canter
Ms. Elizabeth Cohen, PharmD, BCPS
Dr. Gabrielle Frisenda, DO
Ritika Johal
Dr. Nick Morrazzo
Dr. Bobby Nossaman, MD
Dr. Richard Tupler

Poster Presenter

Dr. Susan Smith, MD

D072. PEEP Titration Via Esophageal Balloon Monitoring in a Super Morbidly Obese Patient During a Robotic Radical Nephrectomy

Positive end-expiratory pressure (PEEP) is commonly used during mechanical ventilation in surgery to prevent atelectasis and small airway collapse throughout the respiratory cycle.(1-3) However, it is difficult to titrate PEEP to prevent alveolar over-distension while also preventing atelectasis in the absence of knowing pleural pressures.(4,5) There has been some success in estimating transpulmonary pressure (TPP) to titrate PEEP and optimize oxygenation in the critical care environment,(6,7) although debate continues on its effectiveness.(8,9) The surgical patient population can also present a unique challenge to ventilation, such as patient positioning, abdominal insufflation, and patient body habitus. Similar to the critical care environment, the surgical setting would also benefit from more accurate estimations of pleural pressure. In this case review, we report on measuring TPP via an esophageal balloon monitor (EBM) during robotic surgery to optimize oxygenation in a super morbidly obese patient. 

Submissions


CoAuthor(s)

Maung Hlaing, MD
Dr. Janet Kukreja, MD
Dr. Naveen Kukreja, MD
Mr. Jerome Piccoli RRT,CPFT, AS
Dr. Tim Tran, MD

Poster Presenter

Dr. Nicholas Alvey, MD, MPH

D073. Critical Care Management of Culture Negative Endocarditis due to Bartonella

Culture-negative infective endocarditis (IE) is defined as failure to culture the causative organism after incubation for 5 days of at least 3 standard blood culture samples. This presents a diagnostic and treatment dilemma. Prompt antimicrobial therapy is key along with surgical intervention when indicated. Empiric therapy should be tailored to epidemiological risk factors. The intensive care (ICU) management of these patients varies with the degree of underlying heart disease. 

Submissions


CoAuthor(s)

Dr. RAFAEL ARCINIEGAS FLORES, MD
Mr. Miguel Cobas, MD, FCCM
Dr. Daniela de Lima Corvino, MD
Dr. Anmary Fernandez Betances, MD
Dr. Alexander Fort, MD
Dr. Srikar Jonna, MD
Dr. Ricardo Martinez Ruiz, MD
Dr. Anna Schuerner, MD
Dr. Richard Zack-Guasp, MD

Poster Presenter

Dr. CHRISTIAN BALABANOFF ACOSTA, MD

D074. Veno-Venous Extracorporeal Membrane Oxygenation used to bridge the Obtainment of an Emergent Airway

Extracorporeal membrane oxygenation (ECMO) provides the means for gas exchange, oxygenation and ventilation and maintenance of hemodynamics. There are two types of ECMO. Veno-arterial (VA) ECMO in which hemodynamic support is provided and Veno-Veno (VV) ECMO in which respiratory support is provided. Indication and contraindications for VV-ECMO vary but recovery from the underlying disease has to be possible. As like cardiopulmonary bypass is used for heart surgeries to obtain a bloodless surgical field and for hemodynamic and ventilatory support, VV-ECMO can be used in cases that an airway cant be obtained. In critical airway stenosis ECMO has been used to bridge patients till a definitive airway can be obtained. 

Submissions


CoAuthor(s)

Dr. RAFAEL ARCINIEGAS FLORES, MD
Dr. Saskya Byerly, MD
Dr. Srikar Jonna, MD
Dr. Jack Louro, MD
Dr. Anna Schuerner, MD
Ilya Shnaydman, MD
Dr. Arnaldo Vera-Arroyo, MD
Dr. Richard Zack-Guasp, MD

Poster Presenter

Dr. CHRISTIAN BALABANOFF ACOSTA, MD

D075. Successful treatment of a patient who developed propofol-induced neuroexcitation with intravenous lipid emulsion

Propofol-induced neuroexcitation (PNE) is a rare event. Abnormal movements range from increased extensor muscle tone, rhythmic involuntary movements, opisthotonus (1) to seizures (1-4). They alternate with periods of unresponsiveness and altered mental status (1-4). They can last hours to days (3-4). It has been noted to occur anytime during propofol sedation (1). Case reports, reviews and retrospective studies have reported previously attempted yet unsuccessful treatments consisting of supportive measures, sedatives, anticholinergics, and even anticonvulsants (2-3). We used intravenous lipid emulsion (ILE) successfully in a patient who developed PNE. 

Submissions


CoAuthor(s)

Dr. Adeline Kim, MD
Dr. James Tse, PhD, MD

Poster Presenter

Dr. Sylviana Barsoum, MS, MD

D076. Use of Remifentanil for Monitored Anesthesia Care Involving a Patient with Severe Valvular Disease

Transesophageal echocardiogram (TEE) is a procedure often provided in a non-operating room setting in potentially critically ill patients. Monitored anesthesia care (MAC) is frequently provided to facilitate the procedure and to address patient pain and anxiety. A combination of remifentanil and midazolam has been described as an option for MAC in stable outpatients1. The goal of this case report is to describe remifentanil as a treatment option in order to provide anesthesia in a non-operating room setting involving a critically ill patient. 

Submissions


CoAuthor

Dr. Stephen Krazit, MD

Poster Presenter

Dr. Jennifer Davis, MD

D077. A Prostate for an Eye: Preventing Major Comorbidity through Careful Preoperative Evaluation

Patients often present for surgery with other comorbidities that may or may not be relevant to the procedure of the day. It is within the anesthesiologist's scope of practice to elucidate all aspects of a patient's history and evaluate them within the context of the upcoming surgery. Here is presented a case of a patient with severe glaucoma who presented for an unrelated robotic prostatectomy for prostate cancer. Glaucoma can be a devastating disease, leading to blindness in patients with severe presentation. Acute increases in intraocular pressure above 20mmHg can result in markedly decreased retinal artery perfusion, leading to a lack of necessary neurotrophin delivery to the retina. The trendelenberg position increases intraocular pressure, which is worsened if the surgery concurrently requires pneumoperitoneum. The patient in this case was undergoing necessary surgery, but under conditions that created a high risk of postoperative visual loss. 

Submissions


CoAuthor

Dr. Sachin Jha, MD

Poster Presenter

Dr. Derek Djavaherian, MD

D078. Acute Intrathecal Opioid Pump Malfunction with No Symptoms of Withdrawal

Intrathecal pumps (ITPs) are an invasive treatment indicated for certain chronic pain and spasticity syndromes which can often provide significant improvement to patient's daily pain levels and ability to function independently. However, complications from both the pump itself or the medications being released into the intrathecal space can result in significant risk. The most common issues such as catheter kinking, catheter migration, or pump malfunction can result in patients receiving an acutely decreased dose of medication. Whether this medication is baclofen or an opiate, the withdrawal can be significant. While an overdose of medication through the pump is even more concerning with considerable possible morbidity or even mortality, fail-safes built into these pumps make that scenario increasingly rare. A literature search shows a wide range of ITP opiate withdrawal symptoms ranging from expected symptoms such as hyperalgesia, anxiety, tremors, tachycardia, hypertension which can extend to disorientation, hallucination and significant autonomic instability. Interestingly, our patient, who had been on continuous high dose intrathecal opioid therapy for years that was abruptly and acutely discontinued did not develop any such symptoms or even a change in overall pain scores. 

Submissions


CoAuthor

Dr. Amr Hegazi, MD

Poster Presenter

Dr. Ahmed Embabi, MD

D079. Successful multidisciplinary anesthetic management of a pediatric patient with congenital fiber type disproportion myopathy, congenital scoliosis and severely diminished pulmonary function.

Children with neuromuscular diseases present unique challenges in providing safe and appropriate anesthetic care. This population often requires multidisciplinary care from pediatricians, pulmonologists, neurologists and pain specialists to coordinate with surgeons and anesthesiologists when these patients present for surgery. Congenital fiber type disproportion (CFTD) is a rare type of myopathy characterized by progressive muscle weakness, motor delay, feeding difficulties, joint contractures, severe scoliosis often pulmonary restriction and hypoplasia due to scoliosis. Herein we present the multidisciplinary anesthetic management of an 18 year old male patient with CFTD, severe scoliosis with pulmonary restriction and 30% expected pulmonary function. 

Submissions


CoAuthor(s)

Dr. J Matthew Kynes, MD
John Meyer, MD

Poster Presenter

Dr. Adam Forshaw, MD

D080. An Accidental Intrathecal Baclofen Overdose Resulting in Altered Mental Status and Hemodynamic Instability in a Pediatric Patient

Spasticity is a motor disorder characterized by increased muscle tone and can lead to interference with mobility, activities of daily living, and sleep (1). Patients are commonly prescribed baclofen, a selective GABA-B receptor agonist, as a muscle relaxant and antispasticity drug. The intrathecal delivery of baclofen results in a cerebrospinal drug concentration higher than that achievable via the oral route with significantly smaller doses (1). The implantation of a programmable intrathecal baclofen pump allows for continuous administration of the drug, accurate dose adjustment, and dose variation throughout the day (2). However, complications such as overdose or withdrawal can occur as a result of refilling and programming errors or pump malfunction (3). 

Submissions


Poster Presenter

Dr. Aimee Gasior Bejar, MD

D081. Rapid Detection and Transport by ECMO Team Improved Outcomes of Severe Acute Pancreatitis Sequelae

Acute respiratory distress syndrome (ARDS) is a severe complication of acute pancreatitis in approximately 39% of diagnosed patients, with an average survival rate of approximately 44.3%.[1] Cases of acute pancreatitis induced-ARDS treated with extracorporeal membrane oxygenation (ECMO) have been successfully reported in the United Kingdom as well as the United States.[1,2] With time, mobile ECMO transport teams have safely and successfully transported patients for up to 16 hours.[3,4] We present a case of a patient with respiratory failure refractory to mechanical ventilation who was placed on VV ECMO and successfully transported to our institution by our ECMO team. We demonstrate how instilling protocols that allow for early detection and rapid ECMO placement by the peripheral hospital leads to earlier notification by the receiving institution to mobilize its ECMO team. 

Submissions


CoAuthor(s)

Cecilia Canales, MD, MPH
Vadim Gudzenko, MD
Natan Hekmatjah, BS Candidate
Paul Helland, MD
Sumit Singh, MD

Poster Presenter

Ms. Mariana Gomez, MD/MBA Candidate

D082. Carcinoid crisis presenting as severe bronchospasm during anesthetic induction in a pregnant patient

Carcinoid tumor is a form of neuroendocrine tumor, a hormone producing tumor most typically originating from gastrointestinal track (about 60%) and lungs (about 27%)(1). Carcinoid tumors can produce and release many vasoactive hormones, most notably Serotonin. A patient's initial presenting signs and symptoms depend on the location of the primary tumor. If the primary tumor is located in the gastrointestinal tract, debilitating diarrhea is often a presenting symptom. If the primary tumor is located in the lungs, progressively worsening bronchospasm and right heart valvular disease can develop. Common systemic symptoms that are associated with carcinoid tumor include diarrhea, episodic flushing, venous telangiectasia, bronchospasm and fibrosis of right sided heart valves. We report a case of severe bronchospasm during induction of anesthesia in a pregnant patient with a carcinoid tumor. 

Submissions


CoAuthor(s)

Jennifer Macpherson, MD
Dr. Tichaendepi Mundangepfupfu, MD, MRes

Poster Presenter

Dr. Kyung Ji, MD

D083. Anesthetic Management of Metastatic Chondrosarcoma to the Right Atrium in the setting of a Right-to-Left Intracardiac Shunt

A chondrosarcoma is a primary bone tumor that often occurs in the pelvis and femur. A metastatic chondrosarcoma lesion will very rarely be found in the heart. Typically, metastases occur in the lung, liver, kidney, or brain and treatment is with surgical resection. Adjuvant cryosurgical or radiation therapy may be necessary.1,2 Local recurrence of chondrosarcoma is a risk factor for metastatic disease and death. Anesthetic management of right-sided heart tumors are a challenge for anesthesiologists because patients can rapidly become hemodynamically unstable and difficult to resuscitate. This case report describes the hemodynamic management of the resection of a large right atrial (RA) chondrosarcoma metastasis in a patient with a right-to-left (R-L) shunt across a patent foramen ovale (PFO). 

Submissions


CoAuthor(s)

Dr. Mary Rhee, MD
Dr. Avanthi Tudor, MD

Poster Presenter

Dr. Daryl Kerr, MD

D084. ACUTE HEART FAILURE RELATED TO CARBON MONOXIDE INTOXICATION: A CASE REPORT

Carbon Monoxide (CO) is a colorless, odorless, tasteless and non-irritating gas, produced as a result of incomplete combustion of any type of organic fuel1. Acute CO poisoning is a common cause of morbidity and mortality in United States it is responsible for 40-50,000 Emergency Department visits per year and about 500 deaths annually1,2. The cardiotoxic effects of CO mimic those of coronary artery disease (CAD)3. Therefore, any patient who is suspected CO poisoning warrants a thorough evaluation for possible myocardial damage and injury. The mechanism of injury for carbon monoxide is the competitive binding of hemoglobin to CO (COHb) instead of Oxygen, leading to hypoxia that leads to cardiac myocyte injury and acute heart failure (AHF).1,2,4,5,6,9 

Submissions


CoAuthor(s)

Dr. Jack Berger, MS, MD, Ph.D.
Dr. Francesco Franceschi, MD
Dr. Yaroslava Longhitano, MD PhD
Dr. Christian Zanza, MD-PhD

Poster Presenter

Dr. Michael Kim, DO

D085. Cannabinoid hyperemesis syndrome in the ambulatory setting: a case report

Cannabis is the most commonly used illicit substance in the United States. Coinciding with increased access to cannabis after legalization has been a clinical condition known as Cannabinoid Hyperemesis Syndrome (CHS), characterized by severe cyclical episodes of abdominal pain, nausea and vomiting.(1) While a fairly new syndrome, CHS has gained increased clinical significance due to the rising observed incidence in clinical settings. A study published in 2016 demonstrated that ED visits for symptoms of CHS, had doubled since the legalization of cannabis.(2) This increasing incidence has translated to the perioperative setting and perioperative health care providers should understand how to manage this clinical syndrome. 

Submissions


CoAuthor

Dr. Dhamodaran Palaniappan, MD

Poster Presenter

Dr. Peter Lam, MD

D086. Iatrogenic Intrahepatic Thoracostomy Tube in the Intensive Care Unit

Chest tube insertion, or tube thoracostomy, is the insertion of a catheter into the pleural cavity for drainage of air or fluids. They are frequently used in intensive care unit (ICU) settings. There are many complications associated with chest tube insertion given proximity to many vital organs, including perforation of visceral organs. Our case report reviews an intrahepatic thoracostomy tube insertion in a 57 year-old female in the anesthesiology ICU following a left radical nephrectomy, and subsequent management strategies. 

Submissions


CoAuthor

Dr. Shihab Sugeir, M.D.

Poster Presenter

Dr. Jeremy Laney 4629485, M.D.

D087. Assessment of Hemopericardium after Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is offered to intermediate to high risk patients with aortic valve pathology and dysfunction, mostly commonly for aortic valve stenosis (AS). Short and long-term outcomes are superior to medical therapy and at least equivocal to surgical aortic valve replacement (1). An aortic balloon valvuloplasty (PBV) is performed, followed by placement and balloon inflation/expansion of a bioprosthetic valve; these two procedures are performed during rapid ventricular pacing. Potential complications are many and include myocardial infarction, heart failure, arrhythmias, heart block/conduction delays, stroke, hemopericardium, valve embolization, aortic regurgitation, disruption of the mitral apparatus and mitral regurgitation, aortic dissection, aortic rupture, and death (2). 

Submissions


CoAuthor

Dr. Maurice Joyce III, MD, EdM

Poster Presenter

Dr. Danielle Lovett-Carter, MD

D088. Secondary Ultrasound Use in a Post-Operative Patient with Hypotension

Hypotension is a common phenomenon in the post-operative anesthesia care unit. While there are many potential etiologies to hypotension, a concern for bleeding should be near the top of any list of differential diagnoses in a post-operative patient who is hypotensive. We present here a case of post-operative hemorrhage who initially presented with a negative FAST exam. Within an hour, further deterioration of hemodynamics prompted a second FAST exam which was positive, demonstrating the importance of repeat FAST exams in accordance with changing clinical findings. 

Submissions


CoAuthor(s)

Dr. Oliver Panzer, MD
Dr. Julia Sobol, MD
Dr. Albert Yen, MD

Poster Presenter

Dr. Rebecca Martinez 4251848, MD

D089. Wrong Place, Right Time- Avalon Catheter Migration and Point of Care Ultrasound

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has become a successful intervention in many patients with severe respiratory failure. The Avalon(™) dual-lumen catheter allows for single-site cannulation, reducing blood recirculation and allowing for easier patient mobilization. Complications from Avalon catheters include pneumothorax, insertion site bleeding, cardiac tamponade, and cannula migration resulting in impaired blood flow and cardiac output. Point of care ultrasound (POC US) is widely used in the critical care unit, allowing for rapid diagnosis and interventions. We report on a 64 year old female with stage IV COPD who was admitted for acute COPD exacerbation, requiring VV-ECMO via right internal jugular (IJ) Avalon catheterization who subsequently decompensated when returning to the Cardiothoracic ICU. Bedside POC US demonstrated migration of the Avalon catheter into the right ventricle and the patient was taken back to the OR immediately for repositioning. 

Submissions


CoAuthor

Dr. Tim Tran, MD

Poster Presenter

Dr. Keleigh McLaughlin, MD

D090. Myotonic dystrophy diagnosed by respiratory distress after general anesthesia - a case report.

Myotonic dystrophy (MD) patients are at risk of respiratory failure after general anesthesia due to weakness of respiratory and pharyngeal muscles and increased susceptibility to anesthetics [1]. It has been controversial whether muscle relaxants can be used for MD patients. In the past, minimum muscle relaxants usage was recommended to avoid residual blockade and myotonic response induced by neostigmine; however, recent research has reported muscle relaxants can be used safely with sugammadex [2]. In the present case, MD had not been diagnosed before the surgery and noticed by respiratory impairment after general anesthesia although neuromuscular blockade was antagonized with sugammadex. 

Submissions


CoAuthor(s)

Dr. Motomu Kobayashi, M.D., Ph.D.
Yoshikazu Matsuoka, MD, PhD
Dr. Hiroshi Morimatsu, MD, PhD
Dr. Kazuyoshi Shimizu, M.D
Dr. Makiko Tani, MD, PhD

Poster Presenter

Dr. Yusuke Mizobuchi, M.D.

D091. Regional Anesthesia Considerations For A Multigravid Patient with Pectus Excavatum Undergoing Elective Repeat Cesarean Section

Regional Anesthesia for a multigravid patient with pectus excavatum has not been widely discussed throughout the Anesthesiology literature and presents its own set of challenges. It is discussed in the literature that this condition is associated with many different syndromes including Marfans and Ehler-Danlos syndrome as well as mitral valve prolapse and regurgitation. In this case study, we describe our experience with a multigravid patient with pectus excavatum undergoing elective repeat cesarean section. Consent was obtained from the patient to present this case report. 

Submissions


CoAuthor

Dr. Rovnat Babazade, MD

Poster Presenter

Dr. John Ngo, M.D.

D092. Perioperative Management of Pediatric ROHHAD-NET Syndrome for Paraganglioma Removal: A Case Report

Rapid-onset obesity, hypothalamic-dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare cause of central alveolar hypoventilation. The cardinal symptoms include sudden onset obesity, hypothalamic irregularities, central diabetes insipidus, and autonomic dysregulation with characteristic pupillary abnormalities, strabismus, chronic GI dysmotility, diaphoresis, hypertension, tachyarrhythmias or bradyarrhythmias (1). Since first categorized in the 1960's, roughly 100 cases have been identified. Average age of diagnosis is between 2-4 years of age, and children are notably normal prior to onset of symptoms. Thirty-to-forty percent of cases present with neural crest tumors, and is further designated ROHHAD-NET (1,2). We present a case of a 2 year-old male who presented for surgical removal of a pelvic mass, permanent tracheostomy placement, and gastrostomy-jejunostomy (G-J) tube placement, in the setting of suspected ROHHAD-NET syndrome. 

Submissions


CoAuthor(s)

Dr. Michael Baker, MD
Dr. Matthew Hoyt, MD

Poster Presenter

Dr. Elizabeth O'Brien, MD

D093. Anesthetic Management in the Resection of Giant Retroperitoneal Liposarcoma

Retroperitoneal liposarcoma (RPS) is a rare malignant tumor with incidence of 2.5 per 1 million individuals. It has an insidious clinical presentation and often diagnosis is delayed until the tumor has significantly enlarged. Surgical resection is the primary treatment of this disease and 5 year survival ranges between 50-80%. However, even after complete macroscopic excision local recurrence of RPS affects 60–70% of patients. The anesthetic management of this procedure is complicated by hemodynamic derangements secondary to compression of intraabdominal vessels, frequent renal invasion and dysfunction and high risk of bleeding. 

Submissions


CoAuthor

Dr. Peter Roffey, MD

Poster Presenter

Dr. Ergit Paparisto 2393134, MD

D094. A Rare Case of Plastic Bronchitis in an Adult Patient: Anesthetic Challenge

Plastic Bronchitis is a rare and potentially life-threatening pulmonary disease characterized by production of obstructive and cohesive casts filling the airways leading to hypoxic respiratory failure. Most plastic bronchitis cases are reported in pediatric literature, especially those with single-ventricle, Fontan physiology.1 In adult populations, plastic bronchitis has been reported after cardiopulmonary bypass, potentially arising from an intense inflammatory response and resulting in airway secretion of mucus or proteinaceous material.2 Another reported case describes a patient with acute on chronic heart failure on systemic anticoagulation for placement of ventricular assist device.3 Due to poorly understood physiology behind plastic bronchitis, its treatment strategies vary. Therapeutic options can include inhaled tissue plasminogen and heparin, improvement of cardiac output, as well as strategies to improve airway clearance. In cases arising from lymphatic anomalies, which result in thoracic duct connection to the lungs, percutaneous embolization or surgical ligation of thoracic duct have been shown to be effective.4 In this report, we present a case of a patient with plastic bronchitis who had a challenging perioperative course upon emergence from general anesthesia. 

Submissions


CoAuthor

Dr. Max Kelz, MD, PhD

Poster Presenter

Dr. Yangseon Park, MD

D095. Rare Complication of "Denver" Peritoneovenous Shunt, Clinically Reminiscent of Anaphylactoid Syndrome of Pregnancy

Traditional treatments for malignant ascites based on fluid and salt restriction, and diuretic therapy are often not enough to contain neoplastic ascites. Thus these patients must undergo multiple abdominal paracentesis, which can cause progressive waste syndrome from plasma protein loss. An alternative way to relieve ascites is a peritoneovenous shunt (PVS) implantation, which is useful to improve the patient's condition, quality of life, reduce repeated hospital admissions, and avoid plasma protein loss of repeated paracentesis. Non-fatal postoperative complications may occur up to 50-60% of patients undergoing shunt placement. These can include occlusion of shunt, local wound hemorrhage, disseminated intravascular coagulopathy (DIC) and sepsis. However, bizarre complications have been rarely reported in the literature. Below, we describe a complication of the Denver shunt which includes progressive hypoxemia, airway edema, DIC, and cardiovascular collapse which is clinically reminiscent of anaphylactoid syndrome of pregnancy. 

Submissions


CoAuthor(s)

Dr. Ronsard Daniel, MD
Dr. Michael Fowler, MD
Dr. Sergio Navarrete, DO

Poster Presenter

Dr. Rishi Patel, MD

D096. Mast Cell Activation Syndrome in a Patient Undergoing Arthroscopic Repair of an Unstable Left Shoulder

Mast Cell Activation Syndrome (MCAS) is a disorder characterized by the inappropriate release of mast cell mediators with resulting symptoms demonstrating multi-organ involvement that can be life-threatening. It is one of a broader category of mast cell activation disorders and is characterized by mast cell degranulation in the absence of a known inciting cause. This leads to the release of preformed mediators, causing a constellation of systemic symptoms that include urticaria and flushing of the skin; nausea, vomiting, and diarrhea; hypotension and tachycardia; wheezing and angioedema (1, 2). Although rare, a patient with MCAS presents particular challenges to the Anesthesiologist and special considerations are necessary throughout the perioperative setting. 

Submissions


CoAuthor(s)

Dr. Jennifer Danielsson, MD
Dr. Bahaa Daoud, MD

Poster Presenter

Dr. Takashi Sakano, MD, PharmD

D097. Spontaneous hemopericardium with fatal tamponade physiology in ESRD patient on warfarin

Cardiac tamponade (CT) is a medical emergency. Although frequently challenging, timely clinical diagnosis and efficient management are essential elements of successful treatment (1). Prognosis depends on acuity, which is determined by the fluid volume within the pericardial sac, the accumulation rate and pericardial compliance (1). Pertinent literature identifies malignant, infectious, idiopathic, hypertensive, ischemic and trauma-related pericardial effusions among the most frequent underlying causes of CT (2). However, in end-stage renal disease (ESRD) patients, uremic (3) and iatrogenic (following a medical or surgical treatment) (4) effusions are rendered higher in the differential. 

Submissions


CoAuthor

Dr. Gerardo Rodriguez, MD

Poster Presenter

Dr. Melina Shoni, MD

D098. Patient Behavior in PACU After Uneventful EGD: This Seems Odd!

A postoperative seizure in a patient with no seizure history, and following non-craniotomy surgery, is a rare events.1 When it does occur, the etiology is often a metabolic or neurologic event. The differential diagnosis for postoperative seizure activity includes psychogenic non-epileptic seizures. Psychogenic non-epileptic seizures (pseudoseizures) are also a rare postoperative event. These sudden cognitive disturbances easily mimic epileptic seizures. Early diagnosis and management may prevent iatrogenic injury.2 The purpose of this case report is to present a patient for elective esophagogastroduodenoscopy (EGD) who presented early in the recovery room with apparent generalized seizure activity. The final diagnosis, treatment, and differential diagnosis of postoperative seizure are discussed. 

Submissions


Poster Presenter

Dr. Paul Sloan 5524403, MD

D099. Emergency Anesthetic Considerations of a patient with Stiff Person Syndrome

Stiff Person Syndrome is a rare neurologic disorder characterized by persistent muscle spasms and rigidity, precipitated by movement or emotional upset. There are antibodies against glutamic acid decarboxylase, which leads to a decrease in GABAergic input, subsequently causing hyperactivity of the motor neuron system and progressive muscle rigidity. Here, we report the successful anesthetic management of a patient with Stiff Person Syndrome undergoing an emergent left inguinal hernia repair with strangulated bowel. We will also discuss the risk of prolonged postoperative hypotonia associated with general anesthesia. 

Submissions


Poster Presenter

Dr. Lisa To, MD

D100. Dexmedetomidine Use in a Patient With a History of Acute Intermittent Porphyria Undergoing Abdominal Resection of a Neuroendocrine Tumor

Background: Porphyria is a broad term used to describe a group of metabolic disorders that arise from alterations in the enzymatic pathways required for the production of heme. Symptoms vary based on the enzymatic dysfunction 1,2. We are presenting patient with history of Acute Intermittent Porphyria (AIP) undergoing elective abdominal resection of a neuroendocrine tumor. In addition to AIP, the patient also carried a diagnosis of Erythropoetin Protoporphyria (EPP), caused by alterations in the ferrochelatase enzyme, which manifests with cutaneous photosensitivity 1. It is well described in the literature that certain medications used in the practice of anesthesiology may induce a porphyric crisis. These include barbiturates, certain benzodiazepines, ketamine and etomidate 3. There are no recommendations regarding the use of dexmedetomidine in patients with AIP. 

Submissions


CoAuthor

Dr. Annette Rebel, MD

Poster Presenter

Dr. Bradley Withers, M.D.

D101. A rare case of repeated interventions for idiopathic congenital mitral valve stenosis: a case report

Congenital mitral valve stenosis (CMS) is a relatively rare disease that usually develops in the neonatal period and coexists with other intracardiac abnormalities such as atrial septal defect, ventricular septal defect, and aortic valve stenosis in most cases. In infants undergoing surgical intervention for CMS with other complex lesions, there is often an early need for valve replacement. However, the incidence of idiopathic CMS without cardiac abnormalities is unclear, and little is known about how these patients should be managed. Here we report an infant case of idiopathic CMS in which prosthetic mitral valve replacement was finally needed after performing mitral valve repair twice due to relapse of heart failure caused by re-stenosis in a short period of time. 

Submissions


CoAuthor(s)

Dr. Waso Fujinaka, MD PD
Dr. Hiroki Omiya, MD
Dr. Makoto Takatori, MD
Dr. Kenji Uehara, MD

Poster Presenter

Dr. Tsubasa Yoshida, MD

D102. Hemoconcentration as an indicator of intraoperative superior mesenteric vein stenosis during pancreaticoduodenectomy

Unrecognized iatrogenic stenosis of the superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD) can lead to serious post-operative complications secondary to vascular outflow obstruction and bowel ischemia. 

Submissions


CoAuthor(s)

Dr. Judith Aronsohn, MD
Dr. Jeffrey Deygoo, M.D.
Dr. Madina Gerasimov, M.D.

Poster Presenter

Dr. Masha Zeltsman, D.O.

D103. GFAP expression in the visual cortex is increased in juvenile non-human primates that were exposed to anesthesia during infancy

Exposure to anesthetics causes acute injury in the developing brain of young animals, including non-human primates. This acute injury involves several structural changes including apoptosis of neurons and glia and morphological alterations of axons, dendrites, and synapses. When observed long-term after early-life exposure to anesthetics these animals present with distinct functional impairments. However, it is unclear whether early-life exposure to anesthetics also causes long-lasting structural changes in the brain. Glial cell activation (gliosis) is common to several types of brain injury including trauma, ischemia, and neurodegenerative conditions like Alzheimer's disease. Glial fibrillary acidic protein (GFAP) is a cytoskeletal protein in astrocytes that is increased during gliosis and remains elevated for an extended period of time, making it a useful marker of prior brain injury. We hypothesized that anesthesia exposure during infancy results in long-lasting structural changes that can be assessed by increased GFAP expression in the brain 2 years after exposure when these animals are juveniles. 

Submissions


CoAuthor(s)

Dr. Ansgar Brambrink, MD, PhD
Dr. Marjorie Grafe, M.D.; Ph.D.
Dr. Jose Perez-Zoghbi 7432522, PhD

Poster Presenter

Dr. Viola Neudecker, MD

D104. The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Neurocognitive Dysfunction and Delirium in Older Adults

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) occur in up to 40% of older adults and are each associated with increased mortality (1) and decreased quality of life (2). However, the mechanism behind these disorders is not clearly understood. One potential cause of POCD and POD is postoperative neuroinflammation (3). Previous studies have found that pro-inflammatory cytokines increase in both serum and CSF following surgery (4). Further, we have recently demonstrated that a decrease in monocyte chemoattractant protein (MCP-1) receptor expression on monocytes at 24 hours after surgery is seen in patients who later develop POCD (5). Neuroinflammation can also affect the default mode network (DMN) (6), an interconnected set of brain regions that is active during internally focused tasks (7). Disrupted resting state functional connectivity in DMN regions have been observed in patients with POCD (8). The objective of the INTUIT study is to characterize the relationship between postoperative neurocognitive function, CSF inflammatory biomarkers (including monocytes and downregulation of MCP-1 receptors), and DMN activity/connectivity (measured by fMRI). 

Submissions


CoAuthor(s)

Dr. Miles Berger, MD, PhD
Dr. Jeffrey Browndyke, PhD
Dr. Roberto Cabeza, PhD
Cliburn Chan, PhD
Dr. Harvey J Cohen, MD
Ms. Mary Cooter, MS
Dr. Michael Devinney, MD, PhD
Dr. Joseph Mathew, MD
Dr. Eugene Moretti, MD, MHSc
Dr. David Murdoch, M.D.
Ms. Deborah Oyeyemi, BA
Dr. Leslie Shaw, PhD
Dr. Kent Weinhold, PhD
Dr. Heather Whitson, MD
Dr. Marty Woldorff, PhD

Poster Presenter

Mr. Thomas Bunning, BS

D105. The Left Angular Gyrus and Dorsal Anterior Cingulate Cortex: Key Regions for Pre-Post Operative Functional Resting State Decline?

Connectivity of The Default Mode (DMN) and Salience (SN) Resting State Networks (RSNs) change in non-demented older adults after elective total knee replacement surgery with anesthesia (Huang and Tanner, 2018). These networks represent functional connectivity between specific brain regions: DMN involves medial prefrontal cortex, bilateral temporal cortex, posterior cingulate cortex, bilateral angular gyrus; SN involves the bilateral insular cortex and dorsal anterior cingulate cortex. The current study explored how regions within the RSNs change with anesthesia and surgery. We expected brain regions or "nodes" within the DMN and SN may be more vulnerable to the effects of surgery with general anesthesia. 

Submissions


CoAuthor(s)

Mingzhou Ding, Ph.D.
Hua Huang, PhD
Dr. Hari Parvataneni, M.D.
Dr. Catherine Price, PhD, ABPP/CCN
Dr. Jared Tanner, Ph.D.

Poster Presenter

Cheshire Hardcastle, MSc

D106. Imaging Cortical Activity During General Anesthesia: Insights into Cortical Pain Processing in Mice

General anesthetics work in a concentration-dependent manner on the central nervous system (CNS) to induce loss of consciousness and block the experience of pain. Interestingly, however, during nitrous oxide anesthesia and the initial stages of ether and isoflurane anesthesia, analgesia can be produced independently of loss of consciousness. Despite advances in our understanding of the molecular mechanisms of general anesthetics, how anesthetics alter CNS functioning to abolish the perception of pain is not well understood. In the present studies in the mouse, we monitored, over time, the in vivo activity of hundreds of individual cortical neurons during the induction to, and emergence from, general anesthesia. Furthermore, we compared the effects of isoflurane on bulk neural activity (pan-neuronally) versus isolated somatostatin-expressing (SST+) neurons, a molecularly-defined subpopulation of cortical inhibitory interneurons. Our objective is to uncover the mechanisms through which a major volatile anesthetic, isoflurane, not only produces loss of consciousness, but also analgesia. 

Submissions


CoAuthor(s)

Dr. Allan Basbaum, PhD
Ms. Mollie Bernstein, BA

Poster Presenter

Dr. Jarret Weinrich, Ph.D.

D107. Dexmedetomidine prevents lipopolysaccharide (LPS)-induced neuroinflammation and cognitive decline through an α2A adrenoceptor mechanism in mice

Delirium is a frequent accompaniment of both surgical intervention (especially in elderly patients) and in the setting of severe medical illness. Recently, we reported on the clinical efficacy of dexmedetomidine(DEX) for postoperative delirium (POD). Using the damage-associated molecular pattern (DAMP), HMGB1, to induce POD (2), we reported that the target for DEX's ameliorative properties appeared to be due to its imidazole ("I") receptor-mediated vagomimetic action that promotes neural resolution of inflammation (3). Delirium following medical illness can be simulated in mice using the pathogen-associated molecular pattern (PAMP), lipopolysaccharide (LPS). As the engagement of the innate immune response by PAMPs differs from that of DAMPs we wondered whether DEX was efficacious in preventing LPS-induced neuroinflammation and cognitive decline in mice and, if so, by which adrenoceptor mechanism using pharmacological antagonists for the α-1 adrenoceptor (prazosin; PRZ), the α-2 adrenoceptor (yohimbine; YOH) and the α-2 + imidiazoline ("I") receptors (atipamezole; ATI). 

Submissions


CoAuthor(s)

Mr. Kit Lai, BS
Dr. Rong Li, MD

Poster Presenter

Dr. Mervyn Maze, M.B., Ch.B.

D108. Central Venous Catheter Placement has No Impact on Venous Air Embolism Severity, Duration or Morbidity in Seated Cervical Laminectomy Patients

Central venous catheter (CVC) placement in seated neurosurgical cases was initially used for both diagnostic and therapeutic purposes in the event of a venous air embolism (VAE). The advent of precordial Doppler and transesophageal echocardiography (TEE) supplanted CVC use for VAE diagnosis, but remains in widespread use for VAE therapy to aspirate air from the heart. CVC efficacy for VAE treatment, specifically reduction of severity, duration and VAE-related morbidity has never been demonstrated in a large clinical trial. This study examines CVC efficacy for reducing these specific effects in patients undergoing cervical laminectomy in the seated position. 

Submissions


CoAuthor(s)

Dr. John Atkinson, MD
Dr. Jeffrey Pasternak, MD
Dr. William Perkins, MD
Dr. Jamie Van Gompel, MD

Poster Presenter

Dr. Arnoley Abcejo, MD

D109. A Novel Evoked two EEG Complementary indices for Identifying Stroke and Evaluating the Potential for Salvageable Brain Tissue in Patients under Anesthesia.

Perioperative stroke incidence in high risk surgical patients is 2-5% with associated mortality of up to 60% 1-3. Currently, there is no accepted brain monitoring for identification of stroke under anesthesia 4. We developed two new evoked EEG based indices 5-8; 1. Interhemispheric synchronization (IS) for correlation between the left and the right frontal hemispheres 9. 2. Global synchronization (GS) index for correlation between whole brain regions. The IS and GS indices, are in the range of [0,1], where 1 indicates complete synchronization and 0 indicates complete desynchronization. Due to the low incidence of stroke in the operating room, we selected a special population: the acute ischemic stroke (AIS) patients who undergo endo-vascular thrombectomy (EVT), and thus exhibit 3 clinical brain conditions during the procedure under anesthesia; Global penumbra, resolved stroke (NIHSS < 4), definitive stroke 10. The objectives were: 1. Using the IS index for identification of definitive stroke under anesthesia 2. Using the GS index for differentiating between global penumbra and normal control under anesthesia. 

Submissions


CoAuthor(s)

Dr. Eitan Abergel, MD
Gregory Hare, MD, PhD
Dr. Goded Shahaf, MD PhD
Dr. Rotem Sivan-Hofman, MD

Poster Presenter

Dr. Dana Baron Shahaf, MD PhD

D110. Considerations for Individuals with Parkinson's Disease: Basal Nucleus of Meynert Resting State Connectivity Associates with Executive Deficits

Individuals with PD are at increased risk for post-operative cognitive complications. Understanding how type of cognitive impairment may indicate underlying structural/functional vulnerabilities is therefore relevant to anesthesiologists. The present investigation examined the relationship between functional integrity of the basal nucleus of Meynert (BNM), a nucleus involved in cortical cholinergic dissemination, and type of cognitive impairment in PD . We hypothesized that certain cognitive profiles of PD would show atypical BNM to whole brain functional connectivity. 

Submissions


CoAuthor(s)

Mingzhou Ding, Ph.D.
Dr. Catherine Price, PhD, ABPP/CCN
Katie Rodriguez, B.S.
Dr. Jared Tanner, Ph.D.

Poster Presenter

Mr. Sam Crowley, MS

D111. Intraoperative Electroencephalogram Suppression Mediates the Relationship Between a Preoperative "Vulnerable Brain" Phenotype and Postoperative Delirium

Postoperative delirium is a common complication. Multiple publications have recently highlighted an association between intraoperative electroencephalogram (EEG) suppression and postoperative delirium,[1,2] but it remains unclear whether reducing EEG suppression in vulnerable patients will affect their delirium risk or if these patients are at elevated risk regardless of how they are managed in the operating room. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Arbi Ben Abdallah, PhD
Dr. Christopher King, MD, PhD
Nan Lin, PhD

Poster Presenter

Dr. Bradley Fritz, MD

D112. LOW ALPHA POWER FROM ELECTROENCEPHALOGRAPHIC ACTIVITY IS ASSOCIATED WITH THE DEVELOPMENT OF ACUTE CONFUSIONAL STATE

Postoperative acute confusional state (PACS) is a frequent complication in elderly patients (1,2). This disorder may manifest as postoperative delirium (POD), or as a milder disorder called postoperative subsyndromal delirium (POSSD). Both types of delirium are associated with poor outcomes (3,4). Intraoperative electroencephalogram (EEG) may be capable of identifying patients at risk for PACS during surgery. The goal of this study was to characterize and differentiate intraoperative EEG markers in the frequency domain in patients who developed PACS and those who did not. 

Submissions


CoAuthor(s)

Mrs. Constanza Briceño, Professional Degree
Dr. Jose Ignacio Egaña, MD, PhD
Isidora Lavado, Student
Dr. Antonello Penna, MD, PhD
Fernando Reyes, MD
Mr. Ivan Saez, Professional degree
Mariana Venegas, Student

Poster Presenter

Dr. Rodrigo Gutiérrez, MD

D113. Mind the gap: Using the electroencephalogram (EEG) to uncover potential emergence during cardiac surgery.

Of all types of surgery, cardiac surgery has one of the highest incidence rates of unintended awareness events. Brain-based 'depth of anaesthesia' monitors have shown an some utility in avoiding awareness events primarily at points of transition where the direct measurement of anesthetic consumption is not available [sup]1,2[/sup]. Such transitions occur during cardiac anesthesia when the patient is put on, and then taken off, cardiopulmonary bypass, and volatile anesthetic consumption cannot be easily measured. Over this transition period, changing patient temperature and low blood flow through the lungs also make it difficult to accurately estimate volatile anesthetic requirements and dosing. The frontal EEG pattern of a patient returning to connected consciousness (during emergence following the end of surgery) typically shows a loss of theta (4 – 8 Hz) power occurring at the same time as an increase in alpha (8 – 12 Hz) oscillation frequency, changes which can be most easily observed in a spectrogram [sup]3,4[/sup]. It is not currently known how often emergence–like EEG patterns occur over the course of transition periods during cardiac surgery, nor if 'depth of anesthesia' index values reflect these specific spectral changes. The goal of this preliminary analysis is to (i) quantify changes in theta power and alpha frequency in a case study, (ii) see if the Narcotrend Index® reflects the spectral changes observed, and (iii) estimate the occurrence of such EEG phenomena at transition periods during cardiac surgery. 

Submissions


CoAuthor(s)

Dr. Balthasar Eberle, MD
Dr. Heiko Kaiser, MD
Dr. Markus Luedi, MD
Dr. David Reineke, MD

Poster Presenter

Dr. Darren Hight, PhD

D114. Correlation between cognitive deficits and amyloid-load independent of sex or anesthesia in a mouse model of Alzheimer's disease

The aim of this study was to investigate mechanisms regarding the effect of general anesthesia on a pre-existing cognitive impairment in a mouse model of Alzheimer's Disease (AD) with respect to sex. 

Submissions


CoAuthor(s)

Dr. Manfred Blobner, MD
Dr. Bettina Jungwirth, MD
Dr. Laura Preis, M.D.
Dr. Sebastian Schmid, MD
Dr. Gerhard Schneider, MD

Poster Presenter

Mr. Christoph Pötzl, cand. med.

D115. Isoflurane and Xenon Reserve the Effect of Aβ1-42 on MEGF10-dependent Synapse Elimination by Astrocyte

Anaesthetic have been hypothesised to accelerate or trigger the pathogenesis of Alzheimer's disease (AD). Synapses loss is regarded as one key cause of dementia in AD. Aβ1-42 was reported to be related to synaptic loss, and responsible for the decrease of dendritic spine density (DSD). Multiple EGF-like domains 10 (MEGF10) is one of the phagocytic receptors which helps the elimination of silent synapses mediated by astrocytes. However, the influence of anaesthetics and Aβ1-42 on MEGF10-dependent synaptic pruning and phagocytic function has not been investigated yet. Here we used Aβ1-42 (50mM), isoflurane (370µM) and xenon (1.9mM) to investigate how they interact with MEGF10-dependent synapse elimination. 

Submissions


CoAuthor(s)

Dr. Jochen Herms, Prof Dr
Ms. Tatjana Neumüller, MSc
Mrs. Francisca Seeser, Dr
Ms. Dai Shi, Dr
Dr. Kaichuan Zhu, Dr

Poster Presenter

Dr. Gerhard Rammes, Prof Dr

D116. Dexmedetomidine Causes Age-Dependent Differences in the EEG Compared to NREM Sleep in B6 Mice

Dexmedetomidine (dex) is an alpha 2A adrenergic receptor agonist that is used clinically as a sedative.[sup]1[/sup] One possible mechanism of dex-induced sedation is disinhibition of the preoptic area[sup]2[/sup] which is similar to what occurs during non-rapid eye movement (NREM) sleep. In addition, human[sup]3,4,5[/sup] cat[sup]6[/sup] and rat[sup]7,8[/sup] electroencephalogram (EEG) studies have shown similarities between NREM sleep and dex induced sedation in slow wave and spindle activity.[sup]9[/sup] Therefore, we tested the hypothesis that dex induces changes in the EEG that are similar to natural NREM sleep in young adult and old B6 mice. 

Submissions


CoAuthor(s)

Dr. Emery Brown, MD, PhD
Mr. Mohsen Hozan, MA
Mr. Jonathan Kenny, BS
Christa Van Dort, Ph.D.
Mr. Matthew Wilson, PhD
Mr. Daniel Zachs, MA

Poster Presenter

Mr. Morgan Siegmann 8310786, BS

D117. Ventilator Mode Does Not Influence Blood Loss or Transfusion Requirements During Major Spine Surgery: A Retrospective Stud

Blood loss during adult spinal deformity surgery is multifactorial. Anesthetic-related factors, such as the mode of mechanical ventilation may contribute. The aim of this study was to determine the influence of ventilator mode and parameters on intraoperative blood loss and transfusion requirements in patients undergoing prone position spine surgery. 

Submissions


CoAuthor(s)

Dr. Randal Blank, MD, PhD
Ching-Jen Chen, MD
Dr. Lauren Dunn, MD, PhD
Marcel Durieux, MD, PHD
Lucas Fernandez, MD, Dsc
Mark Hanak, BS
Dr. Bhiken Naik, MBBCh
Dr. Edward Nemergut, MD
Dr. Davis Taylor, MD
Siny Tsang, PhD
Christopher Wiedle, BS

Poster Presenter

Dr. Priyanka Singla, MD

D118. Evaluation of the effect of implementation of Enhanced Recovery after Surgery program in spinal surgical procedures (MSDRG S454 and S455): A retrospective study

Enhanced Recovery after Surgery (ERAS) protocols are multimodal and multidisciplinary perioperative care strategies, and have been demonstrated to be associated with facilitated functional recovery process, improved patient experience and outcomes, as well as reduced cost and length of hospital stay (LOS). Even with increasing evidences of success in many major surgical procedures, there is limited data related to ERAS programs on the spine surgery (1,2). In addition, implementation of new practices is difficult, and has been suggested that change in clinical practice occurs 15 yrs after clear evidence is available (3). In this retrospective analysis, we tested the hypothesis that implementation of ERAS protocol would contribute to decrease LOS, increase hospital flow and decrease cost structure after spinal fusion procedures. 

Submissions


CoAuthor(s)

Mr. Bryan Croft, BA MS
Mrs. Rachel Fridman, MSC
Julian Gold, MD
Dr. Sang Kim, MD
Tiffany Perry, MD
Dr. Alexandre Rasouli, MD
Mr. Eric Robertsen, MBA, MHM
Dr. Harry Sax, MD
Dr. Jeff Smith, MD, JD, MMM
Dr. Steve Sun, MD, JD, MBA
Dr. Zhaoyi Tang, M.D.
Mr. Kristoffer Thordarson, BS
Dr. Stephan Yang, MD
Roya Yumul, MD, PhD

Poster Presenter

Dr. Jun Tang, M.D.

D119. The Lower Limits of Neonatal Cerebral Autoregulation During Congenital Cardiac Surgery

Almost half of neonates who have heart surgery develop neurological injury due to inadequate or excessive perfusion. Cerebral autoregulation is the physiologic mechanism that maintains cerebral blood flow despite changes in cerebral perfusion pressure. The neonatal brain is vulnerable to perturbations in cerebral blood flow, particularly during congenital cardiac surgery. Hypoperfusion with low blood pressure or hyperperfusion with elevated blood pressure can lead to neurologic injury. Consequently, blood pressure management is challenging. With this retrospective study, we sought to characterize neonatal cerebral autoregulation during congenital heart surgery in a tertiary pediatric heart center. Our goal was to generate autoregulation curves in this susceptible population to determine the lower limit of autoregulation (LLA) as it relates to age. The hemoglobin volume index (HVx) is a metric of autoregulation where negative values correspond to instances of intact autoregulation and positive values correspond to instances of impaired autoregulation. We hypothesized that autoregulation curves utilizing the HVx could be derived during neonatal cardiac surgery, and the LLA increases with age. 

Submissions


CoAuthor(s)

Dean Andropoulos, MD
Dr. Ken Brady, MD
Dr. R. Easley, MD
Craig Rusin, PhD
Dr. Brendan Smith, MD

Poster Presenter

Dr. Eric Vu, MD

D120. Understanding functional connectivity contributions to digital cognitive pre-operative screening tests: The digital Maze (dMaze)

The classic planning and decision-making test, the Porteus Maze Test, has been digitized to allow recording of total completion time and total pen lifts. This test has proven useful for rapidly understanding frontal function, but the digitized version has yet to be validated. The purpose of this study was to examine the association between the resting state functional connectivity of major cognitive networks and digital maze behaviors. Specifically, we hypothesized that total completion time even in the easy condition would associate with the functional connectivity of the salience network (SN) during resting state, but not the default mode network (DMN). SN is associated with detection, integration, and inhibition of stimuli (1), whereas the DMN is associated with autobiographical memory and self-referential processes. 

Submissions


CoAuthor(s)

Penney Dana, Ph.D.
Dr. Randall Davis, PhD
Mingzhou Ding, Ph.D.
Ms. Catherine Dion, B.A.
Cheshire Hardcastle, MSc
Hua Huang, PhD
Dr. Catherine Price, PhD, ABPP/CCN
Dr. Jared Tanner, Ph.D.

Poster Presenter

Ms. Margaret Wiggins, M.S.

D121. Contingency planning to overcome critical shortages of hyperbaric bupivacaine for obstetric anesthesia care

Early in 2018, critical shortages of bupivacaine had begun to affect the practice of obstetric anesthesia in an unprecedented way. Some centers reported zero availability of hyperbaric 0.75% bupivacaine (HBB), the preferred local anesthetic for spinal anesthesia for Cesarean delivery (CD). The proposed reasons for this shortage are related to pharmaceutical maneuvers with Pfizer, the sole producer of HBB in North America, deciding to close the main manufacturing plant in North America.[sup]1[/sup] At Columbia University Medical Center (6500 annual deliveries, 35% CD rate), at least 50% of CD are performed with a spinal anesthetic, and the preferred local anesthetic has long been HBB because the onset is short and reliable, and the duration of action of the anesthetic is predictable. We were informed mid-February that our institution was affected by drug shortages and that we had less than one month's supply of HBB in stock. An [i]ad hoc[/i] committee of obstetric anesthesiologists and pharmacists began discussing a few key questions, chief among them being: 1. How could we maintain the safety of our current and future patients? 2. Are there alternatives to HBB for spinal anesthesia for CD? 3. Should we use up our stock of HBB before moving to an alternate local anesthetic preparation, or would it be better to move to the alternate local anesthetic immediately, conserving the HBB for certain cases? We quickly identified 0.5% isobaric bupivacaine (IBB) as a best possible replacement for HBB. Studies of IBB versus HBB in spinal anesthetics for CD have failed to demonstrate differences in level of block, need for vasopressors, side effects, or failure of the block. [sup]2,3[/sup] The one potential downside to IBB is that 2 studies have found a minimally faster time to T4 level with HBB as compared to IBB. 

Submissions


CoAuthor(s)

Dr. Ruth Landau, MD
Ms. Beatriz Raposo Corradini, MA
Dr. Xiwen Zhang, M.D.

Poster Presenter

Laurence Ring, M.D.

D122. Acute Pulmonary Edema In A Pregnant Patient With Moyamoya Disease And Undiagnosed Mitral Regurgitation Induced by Emotional Distress.

There are case reports that suggest that pulmonary edema may be precipitated in certain individuals without evidence of heart disease if there is an appropriate trigger such as idiosyncratic emotional stress, sexual intercourse or exercise (1,2). We are presenting a case of a 38 year old female who was 28 weeks pregnant with a history of Moyamoya Disease who suffered acute pulmonary edema after an episode of panic attack leading to emergency Cesarean section under general anesthesia, postoperative ventilator support and ICU care. Echocardiogram of the heart in the ICU showed undiagnosed moderate mitral regurgitation with normal left ventricular function. 

Submissions


CoAuthor(s)

Dr. Priya Gupta, MD
Dr. Andrew Wright, MD

Poster Presenter

Dr. Indranil Chakraborty, MD

D123. A prospective randomized comparison of low dose Ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia.

Introduction: Two methods of local anaesthetic administration into the epidural space in natural delivery pain management are compared in the article. Methods compared are programmed intermittent epidural bolus and continuous infusion. Patient-controlled epidural analgesia was provided simultaneously in all cases. 

Submissions


CoAuthor(s)

Dr. Stanislav Aleksandrovich
Dr. Yana Guseva
Dr. Oksana Ryazanova

Poster Presenter

Dr. Alexander Ioscovich, MD

D124. Genetic Associations of Perinatal Pain and Depression

Underlying biological factors, such as genetic influences, may significantly influence perinatal pain, postpartum depression, or both. We investigated the role of 59 single nucleotide polymorphisms (SNP) on 20 quantitative traits measured in perinatal women. 

Submissions


CoAuthor(s)

Lia Farrell, B.S.
Kelsea LaSorda, MPH
Lora McClain, PhD
David Peters, PhD

Poster Presenter

Dr. Grace Lim, MD, MSc

D125. Optimal dose of Dexmedetomidine Sedation following Spinal Anesthesia: Postpartum Versus Non-pregnant Women

This study was designed to investigate the optimal dose of dexmedetomidine for sedation in 2 groups of patients: (a) postpartum patients who underwent Cesarean section (CS) and (b) non-pregnant women who underwent lower abdominal surgery. We also explore the unique characteristics of dexmedetomidine which make it especially suitable for use in perioperative anesthetic management in parturients. 

Submissions


CoAuthor(s)

Dr. Jean Daniel Eloy, MD
Dr. Ming Xiong, MD, MS, PhD
Dr. Bo Xu, MD

Poster Presenter

Dr. Somdatta Gupta, MD

D125. [Withdrawn] Usage of ′Big-Data′ analysis for choosing the optimal timing of epidural analgesia in primi- and multiparae in a retrospective electronic medical record (EMR) based study

Obstetric Epidural Analgesia (EA) has been in use since 1923 [1] and is the most efficient intrapartum analgesia [2]. Metaanalyses[3,4] have dogmatized that EA does not prolong the 1st stage of labour and prolongs the 2nd by 15 minutes. These summaries focused attention on increased instrumental labour with EA, without an increase in caesarean sections or neonatal morbidity [5]. The question of EA timing remains open. Various studies examined 'early' vs . 'late' administration [6], focusing chiefly on primiparas. Our objective was to utilize 'Big Data' analysis to determine whether EA prolongs the labour stages differentially in primi- and multiparas and whether EA timing (cervical dilation (CD) at administration) correlates with stages lengths and obstetric outcomes. 

Submissions


CoAuthor(s)

Sarah Cohen, MPH
Mr. Joshua Guedalia, MBA
Mrs. Michal Lipschuetz, RN, MPH-MSc
Dr. Ron Unger, PhD
Dr. Simcha Yagel, MD

Poster Presenter

Dr. Eshel Nir, MD-MSc

D126. The epigenetic mechanism of chronic nicotine in pain perception in an animal model

It has been demonstrated that patients who smoke have more postoperative pain than non-smokers (1, 2). Genetic pain studies have shown that smoking is an independent predictor of postoperative pain (3). Nicotine is a major chemical in tobacco, affecting the nervous system leading to addiction. Does perioperative smoking cessation participate in postoperative hyperalgesia? What has changed in the pain-related neural pathway in long-term smoking? Answering these questions has guiding significance for perioperative analgesia and treatment in smokers. In this study, rats were used to examine the effects and mechanisms of chronic nicotine exposure and nicotine withdrawal on pain sensation. 

Submissions


CoAuthor(s)

Dr. Yiliam Rodriguez Blanco, MD
Mr. Alec Sevilla, B. Sc
Mr. Robert Weller, M. Sc.
Dr. Yanping Zhang, PhD

Poster Presenter

Dr. Keith Candiotti, Miami

D127. BIASED PROPERTIES OBSERVED WITH OPIOID REWARD AND RELAPSE IN THE PRESENCE OF INCISIONAL INJURY IN MICE

The immense impact of the current opioid epidemic in the US has directed recent research into characterizing novel G-protein biased mu-opioid receptor (MOR) agonists. Some studies suggest the biased MOR agonist TRV 130 is a more potent analgesic than morphine but may be less rewarding. However, the rewarding effects of conventional MOR agonists like morphine in comparison to TRV 130 within the context of surgical injury is unknown. The purpose of this study was to examine how incisional injury affects the rewarding properties of MOR agonists using a conditioned place preference paradigm including reinstatement of preference, an index of drug relapse. Also addressed was whether these behavioral effects were associated with enhanced prodynorphin mRNA expression in the medial prefrontal cortex and nucleus accumbens, key substrates of the brain's reward circuitry. 

Submissions


CoAuthor(s)

Dr. David Clark, MD, PhD
Xiao You Shi, MS

Poster Presenter

Dr. Chinwe Nwaneshiudu, MD PhD

D128. Opioid Therapy Algorithm For Chronic Non-Cancer Pain Based on APS, AAPM, CDC, ASA and ASRA Guidelines and Position Statements

Chronic opioid therapy for chronic non-cancer pain is a controversial topic in medicine that has been responsible for the devastating epidemic of 165,000 overdose related deaths from 1999-2014 with an estimated 249 million opioid prescriptions written by healthcare providers in 2013. The American Pain Society (APS) in conjunction with the American Academy of Pain Medicine (AAPM) completed an evidence review of chronic opioid therapy for chronic non-cancer pain and had a multidisciplinary expert panel help formulate guidelines for their use in 2009, which was followed by the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic non-cancer pain in 2016. The American Society of Anesthesiologists (ASA), American Academy of Pain Medicine (AAPM), and American Society of Regional Anesthesia & Pain Medicine (ASRA) published official position statements in 2016 in response to the CDC guidelines. However, despite the guidelines and position statements that have been published, a chronic opioid therapy algorithm has not been published yet to further assist physicians across all specialties in the appropriate initiation and management of chronic opioid therapy for non-cancer pain. This algorithm encompasses all of the evidence and recommendations from the APS, AAPM, CDC, ASA, and ASRA to further assist and guide physicians in responsible opioid prescribing in order to combat the opioid epidemic. 

Submissions


CoAuthor(s)

Dr. Akwasi Amponsah, M.D.
Dr. Jason Lefkof, D.O
Mr. Konstantinos Sarantopolous, M.D., Ph.D.

Poster Presenter

Dr. Ethan Chambers, M.D

D129. An Earlier Educational Intervention in Residents Improves Knowledge of Non- Opioid Acute Pain Management in the In -Patient Hospital Setting.

Opioids in late 1990s were marketed as a safe pain control agent however; opioid addiction has turned into a national health crisis that affects public health and social and economic welfare. More than 115 people die in United States daily from opioid overdosing. The number of opioid prescriptions has risen dramatically in the last decade. Interestingly, the nonmedical opioid drug abusers most often obtain their drugs from a doctor's prescription. To achieve success in reducing opioid prescriptions, some level of training and awareness is necessary in regard to detecting and predicting the potential for opioid abuse. Moreover, knowledge of current prescribing patterns is essential to measure the efficacy of training that aims to reduce the number of opioid prescriptions. Our hypothesis is that our educational initiative will enhance understanding and awareness of non-opioid medications for acute pain management. Educational awareness about non-opioid pain management medications will increase the usage of non-opioid pain management medications in resident physicians following the educational intervention. 

Submissions


CoAuthor(s)

Dr. Ravneet Bhullar, MD
Dr. Melissa Ehlers, M.D.
Dr. Jennifer Knuth, MD
Dr. Henry Nagle, MD
Dr. Anthony Ocon, MD
Ms. Yi Zhou, Pharm D

Poster Presenter

Dr. Harpreet Dhiman, DO

D130. Association between Preoperative Opioid and Benzodiazepine Use and Postoperative Outcomes in Joint Arthroplasty

Preoperative opioid use is associated with poor outcomes including increased length of stay, greater readmission rate, increased costs, and increased complications. , There have also been rising trends in benzodiazepine prescriptions in the United States. Opioids used in combination with benzodiazepines may particularly increase risk for morbidity. In this study we examined the effect of preoperative benzodiazepine and opioid use on surgical outcomes in total hip and knee arthroplasty. 

Submissions


CoAuthor(s)

Shirley Avraham, MD
Adam Gover, MD
Dr. Samir Kendale, MD
Bijan Osmani, MD
Kristoffer Padjen, MD, PhD
Jawad Rashid, MD

Poster Presenter

Dr. Lisa Doan, M.D.

D131. [Withdrawn] Postoperative Motivational Interviewing Based Opioid Tapering to Promote Opioid Cessation in Adults Undergoing Orthopedic Surgery: A Randomized Clinical Trial

Various states have instituted limits on the quantity or duration of opioids for acute pain treatment.1 While immediate postoperative opioid prescribing has significantly decreased,1 more remote opioid prescribing beyond 30 days appears unchanged.2 Research is needed to develop optimal mechanisms for postoperative opioid tapering.3 We conducted a randomized trial of postoperative opioid tapering in patients undergoing total hip or knee arthroplasty followed for 1 year postoperatively. 

Submissions


CoAuthor(s)

Ian Carroll, MD, MS
Heather Hilmoe, B.S.
Partha Krishnamurthy, PhD, MBA
Dr. Sean Mackey, MD, PhD

Poster Presenter

Dr. Jennifer Hah, MD, MS

D132. Effect of catechol-O-methyltransferase (rs4680) single nucleotide polymorphism on opioid induced hyperalgesia in adults with chronic pain

The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been associated with alterations in pain perception but the influence of the polymorphism on pain perception in patients with chronic pain receiving daily opioid therapy has not been previously reported. The primary aim of this study was to investigate the effects of the COMT Val158Met polymorphism on heat pain (HP) perception in a cohort of adults receiving daily opioid therapy for chronic pain. 

Submissions


Poster Presenter

Dr. Danqing Hu, MD, PhD

D133. Effect of fentanyl infusion on postoperative pain in patients after craniotomy

Patients undergoing craniotomy sometimes experience severe pain during the postoperative period. However, opioids are not frequently used in those patients due to the sedative effects of these medications. In most previous studies, the effects of non-opioid analgetics were investigated. Thus, we investigated the effect of fentanyl infusion in patients undergoing craniotomy on postoperative pain control. 

Submissions


CoAuthor(s)

Sena Hara, MD
Dr. Hideki Nakatsuka, M.D.
Dr. Yuichiro Toda, MD, PhD

Poster Presenter

Ms. Yuki Ishii, MD

D134. Association and predictors of opioid discontinuation after surgery among chronic opioid users in Ontario

Previously opioid naïve patients can sometimes develop new chronic opioid use after undergoing surgery. However, many patients are already using opioids chronically even prior to their surgery; it is unclear if surgery alters the trajectory of opioid consumption in these patients. We sought to determine if surgery is associated with opioid discontinuation among chronic users, and the factors associated with opioid discontinuation. 

Submissions


CoAuthor(s)

Ms. Jennifer Bethell, PhD
Ms. Tara Gomes, PhD, MHSc
Ms. Andrea Hill, PhD
Ruxandra Pinto, PhD
Dr. Damon Scales, MD, PhD
Dr. Duminda Wijeysundera, MD, PhD, FRCPC
Dr. Hannah Wunsch, MD, MSc

Poster Presenter

Dr. Naheed Jivraj, MBBS, MSc.

D135. Social Isolation Stress Prevents Norepinephrine-mediated Inhibition of TRPV1 Activation in Mouse Sensory Neurons

Chronic pain is difficult to manage, but pain in a depressed and/or anxious patient is even more difficult to control. Similar to chronic pain, stress-related psychiatric disorders, such as depression and anxiety, are highly prevalent with poorly understood pathophysiology. Chronic pain and stress lead to maladaptive changes that share significant overlapping pathophysiology such that serotonin/norepinephrine reuptake inhibitors and tricyclic antidepressants are effective in treating chronic pain. Thus, norepinephrine (NE) is likely one of the key neurotransmitters in the regulation neurons involved in processing pain and stress. Recent studies showed that the activation of alpha 2-adrenergic receptors in the dorsal root ganglion (DRG) and spinal cord, inhibited the activity of transient receptor potential cation channel subfamily V member 1 (TRPV1), a polymodal molecular integrator in the pain pathway that expressed in Aδ and C fiber nociceptors. 

Submissions


CoAuthor(s)

Dr. Ream Al-Hasani, Ph.D
Jordan McCall, PhD., MPH

Poster Presenter

Dr. Loc Thang, M.D., Ph.D

D136. Sustaining the gains - A 6 year follow through of the impact of a Hospital Wide Patient Safety Strategy on Global and Anesthetic Patient Safety Outcomes

Adverse events(AEs) are a challenge in healthcare with reported rates of 3-17%, half of which are preventable[1]. Previous patient safety strategies were mainly implemented in subspecialty settings and did not involve changing the practices of an entire tertiary hospital[2]. We report the implementation and effect of a top down bottom up approach in improving patient safety involving a tertiary institution, on hospital wide and anesthesia outcomes. 

Submissions


CoAuthor(s)

Dr. Sophia Ang, MMED anaesthesia
Dr. Mohan Kumar Bhuvaneshwari, MBBS
Dr. Sophia Chew, MBBS
Sandhya Mujumdar, MBBS
Dr. Lian Kah Ti, MBBS

Poster Presenter

Dr. Ming Ann Sim, MBBS

D137. Patient-Reported In-hospital Complications and Self-Reported Cognitive Function 1-Year After Surgery

Postoperative complications are common, with reports indicating that nearly 16% of surgical patients develop in-hospital complications [1]. In addition to increased in-hospital mortality and cost, surgical complications have been associated with worse long-term psychosocial outcomes including mental quality of life [1-3]. We investigated the relationship between patient-reported in-hospital complications and cognitive functioning at 1-year after surgery. 

Submissions


CoAuthor(s)

Ms. Noor Al-Hammadi, MPH
Dr. Amrita Aranake-Chrisinger, MD, MSCI
Dr. Michael Avidan, MBBCh

Poster Presenter

Dr. Thomas Kannampallil, PhD

D138. A MICROBIOLOGICAL ASSAY OF COMMON OPERATING ROOM TAPES - DEVELOPING A CULTURE FOR PATIENT SAFETY

A medical adhesive tape is a ubiquitous and essential piece of equipment that is used in almost all of the patients admitted to the hospital. As a medical equipment, adhesive tapes are unique as it is almost never washed or sterilized after the initial opening of the package.While we would hope and expect that grossly contaminated rolls of tape would be discarded, but there are no existing practices or methods to ensure cleanliness, sterility, or prevent cross-contamination. The authors hypothesized that a roll of tape may become colonized by organisms, increasing the risk of 

Submissions


CoAuthor(s)

Dr. SAMVID DWIVEDI, DO
Dr. ROBERT TIBBETTS, Ph.D. D(ABMM), F(CCM)
Dr. AMAN UPADHYAY, MD

Poster Presenter

Dr. GAURAV CHAUHAN, MD

D139. Improving adherence to intraoperative administration of surgical antimicrobial prophylaxis: A single center experience

Timely and appropriate administration of antibiotics during surgery has been recommended by national guidelines to prevent surgical site infections (SSI)(1, 2). Despite the universal practice of administering antibiotics prior to surgery, the incidence of surgical site infections has not changed(3). Our previous analysis showed that the standard practice of fulfilling the administrative responsibility of antibiotic administration did not necessarily meet adherence to national guidelines(4). The goal of this quality improvement project was to improve compliance with all aspects of antibiotic administration based on national guidelines(1) at a tertiary care academic center using multidisciplinary interventions. 

Submissions


CoAuthor(s)

Dr. Kunal Karamchandani, MD, FCCP
Mr. Stephan Maman, BS
Dr. Jansie Prozesky, MBChB

Poster Presenter

Ms. Victoria Haney, BS

D140. Comparing the incidence of low minute ventilation, low tidal volume and low respiratory rate on the general hospital floor

Opioids are often used to manage postoperative pain, but can also decrease patient ventilation resulting in opioid-induced respiratory depression (OIRD). Current monitoring techniques for OIRD include pulse oximetry and respiratory rate (RR) monitoring, both of which are indirect measurements of ventilation. Respiratory depression (hypoventilation) can only be directly measured by measuring minute ventilation (MV) and detecting episodes of Low MV. Since MV is a product of tidal volume (TV) and RR, adequate MV hinges on both TV and RR. Hypoventilation can be the result of any of the following: low TV with a RR in normal range, low RR coupled with adequate TV, or the combination of both low TV and low RR. Here we set off to tease out the individual contributions of both TV and RR on post-operative hypoventilation. We simultaneously measured MV, TV and RR using a respiratory volume monitor (RVM), identified patients at risk of respiratory depression, and determined the individual contributions of both TV and RR as causes of the depression. 

Submissions


CoAuthor(s)

Mr. David Chelnick, BS
Dr. Barak Cohen, MD
Dr. Hani Essber, MD
Dr. Jasmin Imsirovic, PhD
Dr. Wael Saasouh, MD

Poster Presenter

Dr. Alparslan Turan, MD

D141. The Use of the Federal Aviation Administration's Crew Resource Management Techniques to Identify Hazardous Attitudes in Crew Resource Management Among Anesthesiology and Surgery Residents

INTRODUCTION: Many parallels exist between the aviation industry and the peri-operative environment, particularly in the patient safety-based approach to modern anesthesia practice. Crew Resource Management (CRM) is a set of organized training procedures involving interpersonal communications, decision making, and leadership for use in environments where human error can have devastating effects. The Federal Aviation Administration (FAA) identifies five Hazardous Attitudes that lead to team failure in a crisis: InVulnerability (V), Anti-Authority (A), Macho (M), ImPulsivity (P) and Resignation (R). A self-assessment survey is used to identify attitudes to which one may be susceptible. We applied this methodology to a multidisciplinary CRM workshop involving anesthesiology and surgery residents. 

Submissions


CoAuthor(s)

Dr. Robert Greenberg, M.D.
Dr. Adam Schiavi, PhD, MD

Poster Presenter

Dr. Christina Miller, MD

D142. Risk factors for acute kidney injury after primary total correction of coarctation of the aorta(COA) and transposition of the great arteries(TGA) in infants: a retrospective cohort study

The incidence of acute kidney injury (AKI) in pediatric cardiac patients is higher than in adult, ranging between 20% and 64% with heterogeneous diagnoses. Postoperative AKI is associated with increased morbidity, longer hospital or intensive care unit (ICU) stays, longer duration of mechanical ventilation and higher mortality. Primary correction for COA and TGA usually includes circulatory arrest below the descending aorta during anastomosis and this kind of surgery can be itself a risk factor for AKI. Thus, the purpose of this study was to investigate the risk factors for postoperative AKI in infants undergoing surgery for COA and TGA. 

Submissions


CoAuthor(s)

Dr. Jae Moon Choi, M.D., Ph.D.
Mijeung Gwak, M.D., Ph.D.
Dr. Minjeong Jang, M.D.
Dr. Won-Jung Shin, M.D., Ph.D.
Dr. In-Kyung Song, M.D.
Jihion Yu, M.D.

Poster Presenter

Ms. SOOYOUNG KIM, MD

D143. To tube or not to tube: laryngeal mask airway vs. endotracheal tube for airway management during general anesthesia in severely obese children

One troubling consequence of the obesity epidemic is the increasing proportion of children who are severely obese (1). A predictable result of this secular trend in obesity is that many children undergoing elective surgery will be overweight, obese or severely obese. Airway management may be more challenging in these patients, with higher rates of difficult mask ventilation and possibly slightly increased rates of difficult tracheal intubation (2). The laryngeal mask airway (LMA) is an alternative device with potential benefits, including ease of placement and lower rates of airway perturbation. However, concerns remain that their use in obese patients may increase the risk of complications (3). Recent data suggests that use of LMA compared to an endotracheal tube (ETT) is associated with lower rates of perioperative airway adverse events in infants and older children (4,5). Given that a secure airway with minimal device-related complications is highly desirable, clinicians often face the dilemma of choosing between an LMA or ETT in obese children. To date, rates of use and complications associated with LMA vs. ETT use in severely obese children undergoing general anesthesia (GA) have not been studied. Therefore, our objective in this retrospective study was to compare the rates of LMA vs. ETT use in clinically severely obese children undergoing GA at a tertiary hospital. We also compared the frequency of perioperative critical airway obstruction (PCAO – laryngospasm or bronchospasm) between ETT vs. LMA in these patients. We hypothesized that the incidence of PCAO associated with LMA use during GA in severely obese children is not systematically different from that associated with ETT. 

Submissions


CoAuthor

Dr. Olubukola Nafiu, MD, FRCA, MS

Poster Presenter

Dr. Sung Choi, M.D.

D144. Safety of Prophylactic Antifibrinolytics in Children Undergoing Spinal Fusion

Prophylactic administration of antifibrinolytic drugs appears to be safe and effective in reducing blood transfusions in pediatric scoliosis surgery.1-6 However, none of the studies published to date were designed to assess the safety of antifibrinolytic agents in children.7 As prophylactic administration of antifibrinolytics, particularly tranexamic acid (TXA), is becoming standard practice in the management of scoliosis surgery, large quality improvement databases provide a promising opportunity to examine the incidence of rare adverse events.8 The aim of this study was to use the American College of Surgeons National Surgical Quality Improvement Project – Pediatric (NSQIP-P) to examine the occurrence of adverse events associated with the use of antifibrinolytic therapy in pediatric patients undergoing spinal fusion. 

Submissions


CoAuthor(s)

Dr. David Faraoni, MD
Dr. Minjae Kim, MD, MS
Dr. Lena Sun, MD, MPH

Poster Presenter

Dr. Lisa Eisler, MD

D145. Are pediatric patients with PHACE syndrome at high risk for anesthetic complications?

PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, aortic coarctation, and eye abnormalities) is a rare neurocutaneous syndrome first described by Frieden et al in 1996.[1-3] 70% of patients with large segmental hemangiomas have at least one extracutaneous manifestation and 42% have at least two.[4] Hemangiomas can be found intracerebral, airway (supraglottic, subglottic, tracheal), facial, or cutaneous. Most common anomalies among these patients are cerebrovascular (57%) followed by cardiovascular (43%), eye (16%), ventral developmental defects (21%) and endocrine abnormalities (6%).[5,6] There is a void in the literature describing the perioperative outcomes in these children. The purpose of this retrospective series was to determine perioperative risks and complications in children with PHACE syndrome at a large pediatric academic tertiary referral center.  

Submissions


CoAuthor(s)

Dr. Thomas Austin, MD, MS
Dr. Susana Cruz Beltran, MD
Dr. Humphrey Lam, MD

Poster Presenter

Dr. Brett Escarza, MD

D146. Identifying Unnecessary Blood Transfusions in Patients Undergoing Craniofacial Surgery Using National Craniosynostosis 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 al1 reported that 26%, 9.4% and 4.1% receive intraoperative erythrocyte contain blood cell transfusion greater than 40 ml/kg, greater than 60 ml/kg and greater than 80 ml/kg respectively in the Pediatric Craniofacial Collaborative Group (PCCG) dataset. Determining when and quantity to administer blood product to a patient undergoing craniofacial surgery is difficult. Ali et al demonstrated that the average blood loss was 61 ml/kg. Low postoperative hemoglobin levels is associated with morbidity and mortality in the adult literature. the relationship between intraoperative blood transfusion and post-operative outcomes has been investigated. Goobie et al2 found that children undergoing non cardiac surgery who received red blood transfusion volume greater than 40- 59 ml/kg and greater than 60 ml/kg had 7.3% and 11.2% increased 30 day mortality respectively. Goobie et al3 found body weight less than 10 kg, ASA 3 or 4, erythrocyte transfusion greater than 60 ml/kg and occurrence of an intraoperative complication were significant predictors of postoperative cardiorespiratory events requiring an intensive care unit admission in the craniofacial population. To date no transfusion strategies have been established for the intraoperative period. The intensive care literature supports a restrictive blood transfusion strategy rather than a liberal transfusion strategy as presented by Lacroix4,5 The aim of this study is to use the PCCG dataset to compare blood transfusion use for patients undergoing craniosynostosis repairs in order to identify patients that were potentially inappropriately transfused and compare the risk factors for postoperative events established by Goobie et al.3. The broader aim is to decrease the amount of inappropriate transfusions. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Allison Fernandez, MD, MBA

D147. Preventing Spinal Cord Injury & Infarction in Patients with Mucopolysaccharidosis During Non-spine Surgery

Kyphosis and scoliosis of spine are common in MPS patients rendering the spinal cord "at risk" for injury even when the surgical procedure does not involve the spine[1]. Monitoring for spinal cord integrity during non-spine procedures is essential in preventing injury to the spinal cord[1-3]. To illustrate this we present the case of a MPS VI patient for who we prevented spinal cord injury by employing neuromonitoring guided intervention.   

Submissions


CoAuthor(s)

Dr. Anthony Dinardo, DC, D.ABNM
Dr. Phoebe Fisher, MD
Dr. William Mackenzie, MD
Dr. MARY THEROUX, MD

Poster Presenter

Dr. Jonathan Halem, DO

D148. A Neonatal Cardiac Arrest - What Could be Happening?

Neonatal cardiac arrest is a catastrophic event under anesthesia. We provide a medically challenging case that describes a cardiac arrest in a 2.3 kg infant that most likely occurred through an intravascular trocar insertion during a laproscopic gastrostomy tube placement, and resultant air/CO2 embolism. We describe our intraoperative sequence of management, and postoperative course that lead to this conclusion, including MRI findings months following the event. Sudden neonatal cardiovascular collapse under anesthesia must prompt immediate differential diagnoses including anaphylaxis to administered medications, local anesthetic systemic toxicity, inadequacy of ventilation, and air or carbon dioxide embolization. This is an important discussion topic for all anesthesiologists, as it highlights the systematic management of all these differentials through the cardiac arrest. 

Submissions


CoAuthor(s)

Ana Crnkovic, M.D.
Dr. Melissa Ehlers, M.D.

Poster Presenter

Dr. Adnan Khan, M.D.

D149. Adenotonsillectomies in Pediatric Patients with Severe Obstructive Sleep Apnea

Perioperative management of patients with obstructive sleep apnea (OSA) continues to remain a challenge for pediatric anesthesiologists. In children, adenotonsillectomies are one of the most common surgical procedures performed, and those with OSA are at higher risk for respiratory complications. While studies have demonstrated that a select group of patients should be admitted, recommendations from various sources including the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery differ on which patients require inpatient admission (1,2,3). Furthermore, no studies have identified where these patients should be admitted and which patients should be admitted to the Pediatric Intensive Care Unit (PICU). 

Submissions


CoAuthor(s)

Branden Engorn, MD
Connie Mun-Price, DO
Dr. Patrick Ross, MD
Dr. Kathleen Than, DO

Poster Presenter

Dr. Makoto Nagoshi, MD

D150. Unanticipated Admissions During the Perioperative Period: Summary of Data from the Wake Up Safe

Most pediatric surgeries are performed as outpatient procedures. Health care organizations have robust algorithms to determine which patients are candidates for outpatient procedures. Overall, outpatient procedures have low unanticipated admission rates but the data is generally reported from single centers. With the creation of the Wake Up Safe Database, which collects data from over 25 tertiary care pediatric hospitals in the United States, we wanted to determine the characteristics of the patients who had unanticipated admissions to an inpatient ward or to an intensive care unit after a procedure. 

Submissions


CoAuthor(s)

Dr. Thomas Austin, MD, MS
Dr. Humphrey Lam, MD
Dr. Amanda Lorinc, MD

Poster Presenter

Dr. Thanh Nguyen, MD

D151. Intranasal Insulin Prevents Anesthesia-induced Cognitive Impairment in Juvenile Mice

Anesthetics administered at the extremes of age trigger long-term morphological and functional changes in the brain. Pre-clinical studies in rodents and non-human primates correlate early-life, repeated or prolonged general anesthesia (GA) with neurotoxicity and sustained neurobehavioral deficits. This is in-line with pediatric epidemiological studies that associate longer or repeated anesthesia with cognitive and behavioral problems including: neurodevelopmental delay, learning disabilities, and attention deficit/hyperactivity disorder. Moreover, anesthetic and sedative agents were cited in 2016 and 2017 updates of the U.S. FDA Drug Safety Communication, warning they may negatively impact brain development when administered to young children. The mammalian brain is rich in insulin receptors. Insulin administered intranasally to healthy and cognitively-impaired adults has been shown to increase regional brain perfusion, hippocampal function, and verbal memory. We developed a mouse model to determine how early-life intranasal insulin treatment could mitigate anesthetic-induced neurotoxicity on cognition during adulthood. We hypothesized that insulin administered intranasally to juvenile mice prior to anesthesia exposure would exert a neuroprotective effect to prevent anesthesia-induced cognitive impairment during adulthood. 

Submissions


CoAuthor(s)

Mr. Mehdi Hooshmandi, PhD Neuroscience
Dr. Arkady Khoutorsky, PhD
Dr. YOSUKE NAKADATE, MD, PhD
Dr. Tamaki Sato, MD
Dr. Hiroaki Sato, M.D., Ph.D.
Linda Wykes, PhD
Ms. Shelly Yin, BSc Neuroscience

Poster Presenter

Dr. Patricia Roque, MD, PhD C

D152. Temporal Changes in the Frequency of Intraoperative Hypotension in Children

Blood pressure is used as a surrogate for organ perfusion, and volatile anesthetics (VA) reduce it in a dose-dependent manner. Retrospective studies suggest that VA may harm the developing brain. In adults, hypotension has been consistently identified as a risk factor for multiple adverse outcomes. To contextualize retrospective neurocognitive studies, we sought to identify whether blood pressure management and VA dosing have changed recently as compared to when an anesthesia information management system (AIMS) was instituted in 2007 at our academic medical center. 

Submissions


CoAuthor(s)

Dr. Bishr Haydar, MD
Dr. Shobha Malviya, MD
Dr. Olubukola Nafiu, MD, FRCA, MS
Mrs. Aleda Thompson, MS

Poster Presenter

Dr. Jonathan Sohn, MD

D153. PREVENTION OF 'EMERGENCE AGITATION' WITH PROPOFOL OR FENTANYL IN CHILDREN UNDERGOING BELOW UMBILICAL SURGERIES UNDER SEVOFLURANE ANAESTHESIA

Emergence agitation (EA) has been defined as a dissociated state of consciousness in which the child is inconsolable, irritable, uncompromising or uncooperative, typically thrashing, crying, moaning, or incoherent.EA has been a recognized entity for many years, but after observations of Smessaert et a7and publication of a large clinical survey by Eickenhoff et al in 1960's did it receive wide spread attention. For the next few decades it became less of a clinical concern as older anaesthetic agents (ether, ketamine, cyclopropane) were gradually discontinued and halothane became the predominant anaesthetic agent in children. This phenomenon has again gained prominence after the introduction of newer inhalational anaesthetic agents allowing for rapid emergence from anaesthesia. If one considers the sheer volume of studies published about a given clinical entity as an indicator of its importance, EA clearly represents a significant issue for pediatric anaesthesiologists worldwide.Inspite of ample amount of published literature on this subject little is known about its actual incidence, pathophysiology, causal factors and appropriate remedy for this phenomenon. Consequently, interpretation of the current literature is confounded with significant limitations, contradictions and inconclusive outcomes and explains the wide margin of reported prevalence in literature. Emergence agitation in children after sevoflurane anaesthesia is a common postoperative problem with incidence ranging 10 - 80%.Different strategies have been suggested to decrease the incidence and severity of EA, such as administering sedative medication before induction, a change in the maintenance technique of anaesthesia or pharmacological agents administered at the end of the anaesthesia18-20. Among these strategies the use of pharmacological agents at the end of anaesthesia is thought to be the most convenient and easily applicable method in clinical situations, since it does not rely on the nature of the anaesthetic agents used during induction and maintenance or duration of anaesthesia. Thus this study was designed to compare the effects of propofol with fentanyl administered at the end of sevoflurane anaesthesia on EA in children undergoing below umbilical surgeries. In addition characteristics of anaesthesia recovery and incidence of adverse effects have been compared. 

Submissions


CoAuthor

Dr. Sunil Sinha, MBBS, MD`

Poster Presenter

Dr. Sangeet Tanwar, MD Anesthesia

D154. The electroencephalographic signature of spinal anesthesia in infants: a multi-center pilot study

Infant spinal anesthesia (SA) has many benefits such as robust cardiopulmonary stability, avoidance of the need for airway instrumentation and supplemental oxygen, and avoidance of parenteral opioids. Though SA has been performed in children for more than 100 years, the effects of SA on infant neurophysiology remain poorly understood. In particular, some infants that receive SA with bupivacaine alone become highly sedated. Prior studies of this sedation state after SA with electroencephalography (EEG) are limited by the use of frontal, post-processed monitors (bispectral index, cerebral state index) employing algorithms not validated in infants. (1,2,3) One reported burst suppression after SA. (2) The purpose of this study was to characterize the nature of sedation under SA in infants via analysis of full-head, montage EEG before and after induction of SA. 

Submissions


CoAuthor(s)

Dr. Jerry Chao, MD, MSc
Dr. Gregory Holmes, MD
Dr. Alan Legatt, MD, PhD
Dr. Robert Williams, MD
Dr. Elissa Yozawitz, MD

Poster Presenter

Dr. Emmett Whitaker, MD

D155. Functional near-infrared spectroscopy (fNIRS) during newborn circumcisions- a pilot study

As recently as the 1980s, it was believed that infants did not feel or experience pain.1 We now realize that infants demonstrate behavioral, physiological, and neurological responses to painful events. In addition, untreated pain in the newborn period can lead to increased pain sensitivity later in life.2, 3 Cortical neuronal activity is closely coupled to brain hemodynamics. This neuro-vascular coupling can be detected with functional near-infrared spectroscopy (fNIRS). Previous studies using fNIRS for infant pain assessment have placed the sensor on the somatosensory parietal cortex, which does not evaluate the elaboration and encoding of pain that occurs in the prefrontal cortex (PFC). The primary objective of this pilot study is to assess PFC-fNIRS in newborns undergoing elective circumcision. We hypothesize that fNIRS on the prefrontal cortex will also be able to detect changes in oxyhemoglobin and deoxyhemoglobin as a response to painful stimuli. 

Submissions


CoAuthor(s)

Dr. Arjunan Ganesh, MBBS
Dr. Kurtulus Izzetoglu, PhD
Mr. William Landis, BS
Dr. Janell Mensinger, PhD
Dr. Olivia Nelson, MD
Mrs. Bingqing Zhang, MPH

Poster Presenter

Dr. Ian Yuan, MD

D156. Intravenous cannula placement in children in the operating room for induction of general anesthesia: prospective audit and identification of success factors

In pediatric anesthesia, approaches to induction of anesthesia vary widely between institutions. The use of an oral sedative premedication and inhalational induction is the most commonly used technique in the United States.[sup]1[/sup] In recent years, total intravenous anesthesia (TIVA) has become increasingly popular due to many potential advantages over inhalational anesthesia,[sup]2[/sup] including reduced postoperative nausea and vomiting,[sup]3[/sup] reduced risk of perioperative respiratory adverse events,[sup]4[/sup] and growing evidence in adult cancer patients that it improves the overall survival rate.[sup]5[/sup] The predominant practice in our anesthesia department is the use of TIVA, without anxiolytic premedication; this method requires the placement of an intravenous (IV) cannula in an awake child. The purpose of this study was to understand the key components of the local IV induction bundle (including parental presence, local analgesic cream, age appropriate distraction, and healthcare team buy-in); specifically, to identify the success rate of IV cannula placement in ≤2 attempts, prior to induction of anesthesia. 

Submissions


CoAuthor(s)

Dr. James Chen, FRCPC, MD
Ms. Celine Hügel, BSc (cand)
Mr. Andrew Poznikoff, BSc
Dr. Eleanor Reimer, FRCPC, MD

Poster Presenter

Dr. Matthias Görges, PhD

D157. Preoperative Gabapentinoids Increase Risk of Postoperative Opioid-Related Respiratory Depression in Adult Patients Undergoing Total Hip and Knee Arthroplasties

Gabapentinoids (GBPs) have become increasingly prescribed as adjuncts for perioperative pain control due to their opioid-sparing effects [1-4]. GBPs are currently recommended by the American Pain Society prior to any major surgery [5]. However, specific trials assessing the benefits of GBPs in total hip (THA) and total knee arthroplasty (TKA) patients have shown mixed results in reducing pain and opioid consumption. Additionally, recent studies have proposed a link between perioperative GBPs and respiratory depression due to synergism with concomitantly-prescribed opioids [6-8]. This retrospective study evaluated for associations between preoperative GBPs and postoperative respiratory depression in patients undergoing TKA and THA using a large multicenter dataset. We also assessed for beneficial associations of GBPs with length of stay (LOS) and opioid consumption in an effort to help clarify the risk-benefit profile in this population. 

Submissions


CoAuthor(s)

Dr. Raquel Bartz, MD, MMCI
Dr. William Bryan, PharmD
Alan Ellis, Ph.D., MSW
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Tetsu Ohnuma, M.D., M.P.H.
Dr. Marc Pepin, PharmD
Dr. Srinivas Pyati, M.D., M.B.B.S.
Dr. Karthik Raghunathan, MD, MPH
Dr. John Whittle, M.B.B.S., M.D.

Poster Presenter

Dr. Sean Moore, M.D., M.B.A.

D158. Epidemiology of Surgical Site Infection in Spinal Fusion Surgery and Patterns of Discordance with Surgical Antibiotic Prophylaxis: A Retrospective Case-Level Analysis

Surgical site infection (SSI) following spinal fusion surgery is a devastating outcome due to the extensive use of implanted hardware, barriers to reoperation for source control, and need for prolonged antibiotic treatment. Despite a sustained focus on the prevention of SSI, national infection rates remain on the order of 3-5%,(1-3) suggesting that a more fundamental examination of contributing factors is warranted. Gram-negative organisms have been reported as a frequent cause of hardware infection,(1-4) however current national guidelines for antibiotic prophylaxis in spine surgery have a limited spectrum of activity against this class of bacteria.(5) Using perioperative data from Harborview Medical Center in Seattle, WA (a regional referral center for spinal fusion with an estimated volume of 1,000 cases/year), we sought to characterize the microbial epidemiology of spinal fusion SSI, including patterns of antimicrobial resistance and discordance with surgical prophylactic antibiotic spectrum of activity. 

Submissions


CoAuthor(s)

Dr. Chloe Bryson-Cahn, MD
Dr. Jeannie Chan, PharmD, MPH
Dr. John Lynch, MD, MPH

Poster Presenter

Dr. Dustin Long, MD

D159. Effects of acetaminophen, NSAIDs, gabapentinoids and their combinations on the day of surgery in total hip and knee arthroplasties

After total hip arthroplasty (THA) and total knee arthroplasty (TKA), appropriate acute pain control is essential to improve early mobilization and participation in physical therapy (1,2). Multimodal analgesia involving the use of non-opioid medications has gained widespread popularity to minimize opioid related adverse events in this setting (3). However, no prior large-scale multicenter study has evaluated whether specific analgesic combinations are more beneficial than others. The aim of this study was to assess the association of three commonly used analgesics and their combinations on the day of surgery with respiratory outcomes and opioid consumption. 

Submissions


CoAuthor(s)

Dr. Raquel Bartz, MD, MMCI
Dr. William Bryan, PharmD
Alan Ellis, Ph.D., MSW
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Marc Pepin, PharmD
Dr. Srinivas Pyati, M.D., M.B.B.S.
Dr. Karthik Raghunathan, MD, MPH
Dr. John Whittle, M.B.B.S., M.D.

Poster Presenter

Dr. Tetsu Ohnuma, M.D., M.P.H.

D160. The impact of nutraceutical pre-habilitation and postoperative treatment with ecoisapentanoic acid (EPA) and acetylsalicylic acid (aspirin) on a novel animal model of recovery after surgery.

Every year thousands of patients undergoing major abdominal surgery worldwide fail to recover adequately after surgery.1 While an exaggerated inflammatory has been indicated as a main driver of failed postoperative recovery, the mechanisms that govern resolution of inflammation after surgery remains poorly understood.2 Recent data from our group suggest that specialized proresolvin molecules of inflammation (SPMs) might play a significant role in postoperative recovery.3 The eicosapentaenoic acid (EPA) is a natural donor of SPMs that when it is co-administered in presence in of cyclooxygenase 2 acetylator such as aspirin (ASA) enhance the formation of SPMs.4 The goal of our research was to develop surgical animal model to understand recovery after surgery to then, test the efficacy of preoperative (pre-habilitation) and postoperative oral treatment with EPA in combination with ASA on recovery.5 First, we hypothesized that the integration of clinically relevant domains of recovery after surgery could be used to understand it in an animal model. Second, we tested the hypothesis that pre-habilitation and postoperative oral feeding with EPA+ASA could accelerate the functional recovery of animals that had abdominal surgery. 

Submissions


CoAuthor(s)

Dr. Ruben Agudelo-Jimenez
Peter Grace
Carin Hagberg
Dr. Michael Lacagnina
Dr. Miguel Patino Montoya, M.D.
Imad Shureiqi

Poster Presenter

Dr. Juan Cata, MD

D161. Deep immune profile of preoperative glucocorticoid administration in patients undergoing surgery

Novel therapeutic interventions that improve pain and accelerate functional recovery after surgery while minimizing opioid exposure are of high priority. Glucocorticoids (GCs) have attracted significant attention as a means to improve recovery after major surgery. Studies in total knee and hip arthroplasty (TKA and THA) suggest that perioperative GCs may mitigate post-surgical pain and functional impairment. However, concerns have been raised regarding their dosage and adverse effects, necessitating a better understanding of how GCs modulate the immune response to surgery. Here, a deep immune profiling approach using high-dimensional mass cytometry was employed to comprehensively characterize the effects of perioperative administration of high-dose methylprednisolone (MP) on the surgical immune response in patients undergoing THA. 

Submissions


CoAuthor(s)

Mr. Nima Aghaeepour, Ph.D.
Dr. Martin Angst, MD
Dr. Anthony Culos, PhD
Mr. Jakob Einhaus, BS
Dr. Ramin Fallahzadeh, PhD
Dr. Edward Ganio, PhD
Dr. Henrik Kehlet, MD, PhD
Dr. Viktoria Lindberg-Larsen, MD, PhD
Dr. Kristen Rumer, MD, PhD
Dr. Natalie Stanley, PhD
Ms. Amy Tsai, BA

Poster Presenter

Dr. Brice Gaudilliere, MD, PhD

D162. Identification of optimal anesthetic depth with sevoflurane using different stimuli for a movement free intravenous cannulation in children

The ideal time for intravenous cannulation following inhalational induction with sevoflurane in children is debatable. Loss of eyelash reflex or centralization of eyeballs (1, 2) has been recommended to assess adequate depth for painless cannulation but occasional patient may still respond to pain. Trapezius squeeze test (TST) is a non-invasive, simple test in which 1-2 inches of full thickness trapezius muscle is squeezed for 1-2 seconds and toe/body movement is recorded if the patient feels pain (3). We tested the hypothesis that the loss of response to TST under sevoflurane anesthesia would give a more accurate prediction of optimal depth for movement-free intravenous cannulation. 

Submissions


CoAuthor(s)

Dr. Nikhil Gosalia, MBBS, MD
Dr. Naresh Kaul MBBS,MD, MD, FICA
Dr. Rashid Khan, MBBS, MD

Poster Presenter

Dr. Hassan Al-Salmi, MD. OMSB

D163. Understanding Provider Variability in the Use of Neuromuscular Blocking Agents

High doses of neuromuscular blocking agents (NMBA) are associated with increased odds of postoperative respiratory complications and hospital readmission (1,2). It is possible that high variability in NMBA dose at an institutional and provider level may be contributing. We hypothesized that both the hospital and the provider are significant sources of variability in NMBA dosing. 

Submissions


CoAuthor(s)

Dr. Matthias Eikermann, MD PhD
Dr. Timothy Houle, PhD
Mr. Denys Shaydenfish, cand. med.
Ms. Maria Silva Dias Santos Patrocinio, Medical Doctor
Dr. Xinling Xu, Ph.D.

Poster Presenter

Ms. Friederike Althoff, Medical Student

D164. Incidence of Persistent Opioid Use in Children After Surgery

Chronic opioid use is a public health concern in the United States and a growing number of countriesThose who use opioids chronically are more likely to have worsened health, require more medical care, and have increased risks for developing hyperalgesia, central sleep apnea, ataxic respiration, constipation, sexual dysfunction, decreased testosterone, anxiety, depression, obesity, smoking, greater healthcare utilization, readmission after hospitalization, and death.[1] Opioid-naïve adult patients who undergo surgery are at increased risk of becoming persistent opioid users.[2-4] However, there is limited information on the risks of persistent opioid use in pediatric patients who undergo surgery. The results of one study that examined a limited, older pediatric patient population suggest that persistent opioid use in pediatric patients after surgery may be as high as 5%.[5] As more than five million inpatient and outpatient pediatric surgical procedures take place in the U.S. each year, it is imperative to understand the risk of persistent opioid use in this vulnerable and understudied population and to design and evaluate interventions to decrease this risk. We investigated the incidence of new persistent opioid use in pediatric patients from 0 to 18 years of age from a national insurance provider database who underwent surgery. 

Submissions


CoAuthor(s)

Dr. Nicholas Bambos, PhD
Dr. Beth De Souza, PhD
Dr. Daniel Miller, PhD
Ellen Wang, MD
Mr. Andrew Ward 5222978, PhD

Poster Presenter

Dr. Thomas Anderson, PhD, MD

D165. Intraoperative awareness with explicit recall: a patient centered survey-based cohort study

Unintended intraoperative awareness with explicit recall (AWR) is a potential complication of general anesthesia. Patients may report recollections of being unable to breathe, hearing conversations, pain, paralysis and panic (1). AWR can be caused by inadequate delivery of anesthesia, which can occur because of hemodynamic instability, unintended failure to administer sufficient agents, underestimation of a patient's anesthetic requirement, or equipment failure (2). The aim of our study was to administer a broad survey for AWR to a large number of patients from an unselected surgical population followed by a specific detailed assessment for AWR. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Shagun Mathur, MD
Dr. Anshuman Sharma, MD
Dr. Andrea Soares, MD
Dr. Troy Wildes, MD

Poster Presenter

Dr. Anna Maria Bombardieri, MD PhD

D166. Systematic Review of Cognitive Screening Tests to Predict Postoperative Delirium

Post-operative delirium (POD) is a significant health and financial burden, which may be avoided if risk factors are properly identified. Preoperative screening tools such as psychometric tests or checklists may be used to predict which patients are at a higher risk for POD. Stratifying patients based on the risk for development of POD may help implement measures to avert POD as well as subsequent complications. A variety of screening tools for predicting POD have been investigated but it is unclear which test is most effective at predicting POD and most feasible for use in a clinical setting. Our objective was to summarize the studies on psychometric tests and checklists that may predict POD to guide further research and clinical practice. 

Submissions


CoAuthor(s)

Farrah Ayob, MBBS
Dr. Frances Chung, MBBS, LMCC, FRCPC
Mr. George Ho, BSc
Enoch Lam, student
Dr. Jean Wong, MD

Poster Presenter

Dr. Maria Garstka, MD

D167. Quality of recovery in patients with pancreatic or common bile duct cancer receiving curative surgery: comparison with TIVA and inhalation anesthesia using QOR-40 questionnaire

Both Total Intravenous Anesthesia (TIVA) and Inhaled anesthesia are commonly used anesthetic methods. Previously, we demonstrated that TIVA shows better quality of recovery score than inhalation anesthesia in female patients with thyroid cancer receiving thyroidectomy1). For surgeries more invasive than thyroidectomy, such as surgeries for pancreatic cancer or common bile duct (CBD) cancer, better quality of recovery seems to be imperative for further adjuvant therapies. In this prospective, randomized trial, we aimed to compare the quality of recovery between TIVA and inhalation anesthesia in pancreatic and CBD cancer patients 

Submissions


CoAuthor(s)

Dr. Chang Moo Kang, MD, PhD
Dr. Jeong Rim Lee, MD, PhD

Poster Presenter

Ms. Young Eun Joe, MD

D168. Intraoperative Analgesia Patterns at an Academic Tertiary Medical Center During the 2018 Parenteral Opioid Shortage

In the wake of the United States Federal Drug Administration's limits on opioid production to combat the opioid epidemic as well as the announcements between July 2017 and January 2018 by a major pharmaceutical company's production delays for multiple essential parenteral opioids, including fentanyl, hydromorphone, and morphine, hospitals nationwide have implemented various strategies to ration their existing supplies of intravenous opioids and to encourage use of nonopioid analgesics. Perioperative pain management has been particularly affected by these interventions. As the intravenous opioid shortage alleviated in the second half of 2018 due to drug production improvements and increased manufacturing from smaller companies, it remains unclear if anesthesiologists have retained their newfound strategies for intraoperative analgesia, or returned to pre-shortage practices. 

Submissions


CoAuthor

Dr. Cliff Schmiesing, MD

Poster Presenter

Dr. Richard Kim, MD MSc

D169. Serum Fructosamine versus Hemoglobin A1c for Glycemic Control in Diabetic Patients Undergoing Surgery

Diabetes mellitus (DM) is an established risk factor for negative outcomes in surgical patients. Perioperative hyperglycemia is associated with increased frequency of adverse events, including cardiovascular events, surgical site infection, and longer hospital stays. Hemoglobin A1c (HbA1c) is the most common test use to measure glycemic control, which reflects blood glucose over the past 120 days. For surgical patients, a poor correlation between HbA1c and perioperative blood glucose levels has been reported. Fructosamine is a measure of the total amount of serum protein that is bound by glucose and reflects the glycated serum protein over the past 2-3 weeks. When compared to HbA1c, Fructosamine is relatively inexpensive and provides a short-term assessment of blood glucose control. 

Submissions


CoAuthor(s)

Alicia Gonzalez-Zacarias, MD
Ms. January Kim, BS
Dr. Barbara Rogers, MD
Dr. Nicoleta Stoicea, MD, PhD

Poster Presenter

Dr. Ana Mavarez-Martinez, MD

D170. Laparoscopic specimen bags study

Video-assisted thoracoscopic surgery (VATS) and laparoscopic surgery are complicated by the removal of the often large specimen through a small port site [1]. This may be influenced by different specimen retrieval bag (SRB) designs.Our objectives were to evaluate the force required to remove an SRB during VATS or laparoscopic surgery and to create a bench test to analyse force required to remove specimens using different SRBs. 

Submissions


CoAuthor

Dr. Matthew Molyneux, MbChB

Poster Presenter

Ms. Asha Mohammed, MbChB

D171. A Perioperative Education Intervention Designed to Reduce Cost and Turnover to Surgeon Time

Modern surgery and anesthesia require significant preparation of patients. As a result, the immediate preoperative period is filled with activity. Our Pre-Surgical Unit (PSU) team places American Society of Anesthesiologists (ASA) standard monitors (1) to allow monitoring from the PSU, through the operating room (OR), and into the Post-Anesthesia Care Unit (PACU). These monitors are often positioned inappropriately for OR use, incurring direct costs (new monitors) and indirect costs (longer OR time) when adjusted or replaced to accommodate OR needs. 

Submissions


CoAuthor(s)

Mr. Prem Darji, B.S.
Mr. William Johns, B.S.
Dr. Jan Pasnak, DNAP
Ms. Amanda Williams 7943000, B.S

Poster Presenter

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

D172. Reducing Costs by Eliminating Unnecessary Preoperative Urine Cultures

To reduce the risk of surgical site infection (SSI), surgeons at the institution had requested the Perioperative Surgical Home (PSH) to perform urinalyses (UAs) and screen urine cultures for the diagnosis and preoperative treatment of asymptomatic bacteriuria prior to non-urologic and non-gynecologic clean surgical procedures. Cessation of this PSH practice was recommended. Preoperative screening for asymptomatic bacteriuria is recommended only prior to urologic and gynecologic procedures to allow diagnosis and antibiotic treatment of infection based upon the results of cultures. Performing UAs and screening urine cultures prior to other surgical procedures introduces unnecessary care and may lead to inappropriate antibiotic prescribing and surgical delays. A quality improvement assessment of the incidence of SSI following craniotomy, laminectomy, spinal fusion, hip and knee replacement procedures before and after cessation of UAs and urine culture screening was recommended to verify the lack of adverse association with this intervention on SSI incidence. 

Submissions


CoAuthor(s)

Dr. Wendelyn Bosch, MD
Daniela Haehn, MD
Walter Hellinger, MD
Dr. Joan Irizarry-Alvarado, MD

Poster Presenter

Dr. Sher-Lu Pai, MD

D173. A Pilot Feasibility Trial of Physical and Cognitive Prehabilitation to Improve Outcomes in Surgical Patients

Surgery, and its accompanying period of acute illness, is associated with postoperative functional decline that may result in prolonged disability.(1) Postoperative cognitive dysfunction is also prevalent (2) and linked to worse functional status. Further, activities that integrate strength, cognition, and endurance require a longer recovery period than more basic tasks. Preoperative functional impairment and cognitive dysfunction are associated with prolonged and worsened disability after surgery.(1)(3) Physical therapy interventions to improve functional status prior to surgery, termed prehabilitation, have demonstrated success in reducing time to recovery of baseline function.(4) We hypothesized that prehabilitation with both physical and cognitive exercises is feasible and would be associated with improved postoperative functional and cognitive outcomes. 

Submissions


CoAuthor(s)

Dr. Christopher Hughes, MD
Dr. Jim Jackson, PsyD
Dr. Nitin Mehdiratta, MD
Dr. Pratik Pandharipande, MD, MSCI
Kristin Swygert, PhD, DPT
Susan Vanston, MS, PT

Poster Presenter

Dr. Kimberly Rengel, MD

D174. Post-operative oral oxycodone and hydromorphone: a comparison of opioid consumption and side effects

Opioids can produce distressing side effects such as post-operative nausea and vomiting (PONV), pruritus, delirium and sedation. Patients rank PONV as the most undesirable post-operative experience (1). Previous studies estimated the incidence of nausea associated with oxycodone to be 31-57% (2, 3, 4, 5, 6) and 9-28% for hydromorphone (7). Our objective was to compare oral oxycodone and hydromorphone in terms of opioid consumption and side effect profile. We hypothesize that oral hydromorphone is superior to oxycodone for post-operative pain. 

Submissions


CoAuthor(s)

Dr. Faraj Abdallah, MD, MSc
Dr. Richard Brull, MD, FRCPC Professor

Poster Presenter

Dr. Emily Spence, BA BM BCh FRCA

D175. Comparison of Sugammadex and Neostigmine for Reversal of Rocuronium Neuromuscular Blockade on the Incidence of Postoperative Pulmonary Complications: A Randomized Controlled Trial

Postoperative residual paralysis has been linked to impaired respiratory muscle function(1) and multiple postoperative pulmonary complications(2). Sugammadex provides faster neuromuscular blockade reversal than neostigmine with more dependable efficacy and is associated with less residual paralysis(3). We conducted a randomized trial to test the hypothesis that sugammadex reduces the incidence of postoperative pulmonary complications, compared to neostigmine reversal. 

Submissions


CoAuthor(s)

Dr. Michael Aziz, MD
Ms. Janna Higgins, MSW
Dr. Miriam Treggiari, MD, PhD, MPH
N David Yanez, PhD

Poster Presenter

Dr. Brandon Togioka, MD

D176. Perioperative Multimodal Analgesic Regimens Decrease Hospital Length of Stay and Expedite Recovery Following Spinal Fusion Surgery

Despite data that perioperative protocols utilizing nonopioid multimodal analgesic agents (NMAs) expedite recovery after surgery,1 few centers have examined this approach for complex spine surgeries.2-3 NMAs with evidence for improving postoperative outcomes include acetaminophen, gabapentin, intravenous (IV) lidocaine, IV ketamine, and IV magnesium.1,3 We describe the use of these agents for multilevel spine fusion surgery in a tertiary teaching center in the United States and examine their association with postoperative recovery. 

Submissions


CoAuthor(s)

Dr. Lee-lynn Chen, MD
Jeremy Lieberman, MD
Dr. Solmaz Manuel, MD

Poster Presenter

Dr. Andrew Vargas, MD

D177. Association between postoperative myocardial injury phenotypes and disability-free-survival in patients undergoing non-cardiac surgery

Postoperative myocardial injury (PMI), defined as troponin elevation, has been associated with postoperative morbidity and mortality (1–3). PMI may be caused by perioperative myocardial ischemia and infarction. However, PMI has also been related to cardiovascular events including heart failure and arrhythmias, and to non-cardiac complications, such as pulmonary embolism, sepsis and respiratory- and renal failure (4,5). The patient centered impact of these associated non-cardiac adverse events has not been compared to PMI. Therefore, we examined the independent prognostic effects of PMI phenotypes and non-cardiac adversity on death and disability following non-cardiac surgery. 

Submissions


CoAuthor(s)

Dr. W. Scott Beattie, MD, PhD, FRCPC
Simon Feng, MD
Matthew Machina, MSc
Michael McKenny, MD
Hendrik Nathoe, MD, PhD
Dr. Linda Peelen, PhD
Dr. Wilton van Klei, MD PhD
Judith van Waes, MD, PhD
Dr. Duminda Wijeysundera, MD, PhD, FRCPC

Poster Presenter

Ms. Lisette Vernooij, Msc

D178. Gabapentinoids on the day of colorectal surgery are associated with adverse postoperative respiratory outcomes

Gabapentinoids (gabapentin and pregabalin) are recommended for acute postoperative pain management following colorectal surgery in Enhanced Recovery After Surgery (ERAS) protocols1. However, recent single-center studies2,3 have found associations between gabapentinoids and adverse postoperative events. The safety of gabapentinoids in the perioperative period has not yet been well-characterized. Our study aims to determine the association between gabapentinoids on the day of surgery and adverse postoperative respiratory outcomes in patients undergoing elective colorectal surgery in the United States. 

Submissions


CoAuthor(s)

Dr. Raquel Bartz, MD, MMCI
Dr. William Bryan, PharmD
Alan Ellis, Ph.D., MSW
Dr. John Hsia, MD
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Peter Lindenauer, MD, MSc
Dr. Tetsu Ohnuma, M.D., M.P.H.
Dr. Marc Pepin, PharmD
Dr. Srinivas Pyati, M.D., M.B.B.S.
Dr. Karthik Raghunathan, MD, MPH
Dr. Neil Ray, MD, MMCi
Dr. Mihaela Stefan, MD, PhD

Poster Presenter

Dr. Rosalie Yan, MD

D179. The transversus thoracic plane (TTP) block: A pooled review of 748 cases

The transversus thoracic plane (TTP) block is a regional anesthetic technique first described by Ueshima in 2015 that provides analgesia of the internal thoracic (mammary) nerve distribution. Given its relative novelty, most of the literature describing the TTP block is in the form of case reports. The primary objective of this review is to examine pooled clinical data from published literature to gain a better understanding of the characteristics of the TTP block. 

Submissions


CoAuthor(s)

Dr. Garrett Burnett, M.D.
Dr. Christina Jeng, MD
Dr. Ying Ye, MD, MPH

Poster Presenter

Dr. Kevin Chung, MD

D180. Continuous iliohypogastric nerve catheter infusions for postoperative analgesia following bladder augmentation in a child with Goldenhar syndrome.

Continuous peripheral nerve block catheters are most well-known for analgesia for procedures involving the extremities, however Transversus Abdominis Plane (TAP) catheters have gained popularity for adults undergoing abdominal procedures with contraindication for epidural placement. Their use in children has not frequently been reported. We describe the use of continuous iliohypogastic nerve block catheters for a postoperative analgesia in a child undergoing Mitrofanoff creation and open bladder augmentation. 

Submissions


CoAuthor

Dr. Sarah Hall, M.D., Ph.D.

Poster Presenter

Dr. Chris Denny, MD

D181. Comparison of the image quality of 8 different ultrasound machines for axillary and interscalene nerve blocks

Ultrasound machines are recommended to perform diagnostic or therapeutic procedures in ICU and anesthesia. Image quality is a cornerstone for accurate and safe procedures. There is no data to compare image quality among the available ultrasound machines. This study compared the image quality of 8 ultrasound machines in the field of axillary and interscalene nerves blocks. 

Submissions


CoAuthor(s)

Quentin Belot, MD
brice fermier, MD
marc laffon, MD PhD

Poster Presenter

Dr. francis remerand, MD PhD

D182. Title TBA. IARS General Abstract Submission - 1933

The first description of extraction of renal stones through a percutaneous tract was reported by Fernstron and Johanson in 1976. Percutneous nephrolithotomy (PCNL) is one of the main stay of treatment available for renal stones. It is the treatment of choice for large renal calculi (> 2-3cms), staghorn calculi, multiple calculi and calculi resistant to extracorporeal shock wave lithotripsy such as calcium oxalate monohydrate and cystine stones. Several modifications have been made in PCNL in the last few years in an attempt to refine the procedure and to lower the morbidity, analgesic requirement and duration of hospitalization. Use of regional anaesthesia like epidural anaesthesia, spinal anaesthesia, combined spinal epidural anaesthesia have further contributed to the recovery of patients undergoing PCNL. So we conducted a clinical study to compare the efficacy and safety of combined spinal epidural anaesthesia with general anaesthesia for percutaneous nephrolithotomy in terms of hemodynamic changes, patient and surgeon satisfaction and complications. 

Submissions


CoAuthor(s)

Dr. subhadarsini choudhury, MBBS, MD
Dr. kiran preet, MBBS, MD

Poster Presenter

Dr. suresh Singhal Professor, MBBS, MD

D183. Deliberate Intraneural Injection: Where Does It Spread and How

Our aim was to deliberately inject a marker1 intraneurally and then to study the pathways of possible spread. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Olga Nin, MD
Dr. Miguel Reina, Md, PhD
Dr. Xavier Sala-Blanch, MD
Dr. Richa Wardhan, MD

Poster Presenter

Dr. Cameron Smith, MD, PhD

D184. Discovery of a Antero-Laminar Fibrous Body That May Possibly Anchor Dura to the Lamina

Methods that enter and thus potentially disrupt the epidural space anatomy are traditionally used to describe the anatomy of the epidural space. We aimed to study the lumbar epidural space with three-dimensional (3D) reconstructions of human MRIs and to compare and validate the findings with actual targeted anatomic microdissections. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Barys Ihnatsenka, MD
Dr. Olga Nin, MD
Dr. Alberto Prats-Galino, MD, PhD
Dr. Miguel Reina, Md, PhD
Dr. Anna Server, MD

Poster Presenter

Dr. Cameron Smith, MD, PhD

D185. The Use of Pterygopalatine Ganglion Block for Positional Headache and Nausea Secondary to Iatrogenic CSF Leak

Case Report: A 64-year-old male presented at outside hospital for lumbar hemilaminectomy. Anesthesia was uneventful and he was discharged to the floor and home on postoperative day (POD) 2. On the third day, he presented with severe positional headache (PH) and nausea and vomiting (N&V). Computed tomography angiography of his head was normal. He was readmitted and received epidural blood patch (EBP) with immediate relief. His severe PH returned the next day with N&V. Surgical notes reported accidental intraoperative durotomy, and the next day, EBP was repeated without improvement. On POD9, he was discharged with persistent severe PH and N&V. Three months later, he presented to our institution with persistent severe PH and N&V. MRI revealed chronic intracranial hypotension and EBP was considered but pterygopalatine ganglion (PPG) block was offered instead, resulting in immediate and complete symptom resolution. He was discharged the following day without return of PH, but required monthly PPG block for N&V, which also completely relieved the symptoms for 3 to 4 weeks. PPG neuromodulation or transcutaneous vagal nerve stimulation was considered as a potential permanent solution, but the symptoms completely disappeared after 12 monthly PPG blocks. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Erik Helander, MBBS

Poster Presenter

Dr. Cameron Smith, MD, PhD

D186. Risk of Major Cardiovascular Complications after Elective Surgery in Patients with Sleep Disordered Breathing

Sleep-disordered breathing (SDB) is a common comorbidity in the surgical population and has important perioperative implications. SDB disorders such as obstructive sleep apnea (OSA) are associated with increased incidence of cardiovascular diseases such as coronary artery disease, heart failure, hypertension, atrial fibrillation, pulmonary hypertension, cerebrovascular accidents and sudden death. Current literature suggests that SDB is associated with cardiovascular and respiratory postoperative complications. However, there is limited and conflicting data on mortality with studies reporting an increased[sup]1[/sup] or decreased[sup]2[/sup] in-hospital mortality among SDB patients undergoing surgery. The objective of this study was to determine whether SDB is associated with increased risk of post-operative major cardiovascular events, mortality and length of hospital stay using a large patient database. 

Submissions


CoAuthor(s)

Dr. Frances Chung, MBBS, LMCC, FRCPC
Dr. Talha Mubashir, MD
Dr. Clodagh Ryan, MD, MB, FRCPC
Dr. Colin Suen, MD, PhD
Dr. Jean Wong, MD

Poster Presenter

Dr. Rabail Chaudhry, MD

D187. Sleep Disordered Breathing as an Independent Risk Factor for Post-operative Delirium in Elective Surgical Procedures

Post-operative delirium (POD) is a common complication in older adults that is associated with increased morbidity, mortality and hospital stay.[sup]1[/sup] Recently sleep disordered breathing (SDB) has been linked to POD in a few small studies.[sup]2,3[/sup] As SDB is often underdiagnosed it is important to establish its relationship with POD. Our objective was to analyze the relationship between SDB and POD in a large population cohort using data collected for the National Inpatient Sample (NIS) in patients undergoing elective surgical procedures. 

Submissions


CoAuthor(s)

Dr. Frances Chung, MBBS, LMCC, FRCPC
Enoch Lam, student
Dr. Talha Mubashir, MD
Dr. Greesha Padnekar, MD
Dr. Jean Wong, MD

Poster Presenter

Dr. Rabail Chaudhry, MD

D188. The SANDMAN Study: Sleep Apnea, Neuroinflammation, and Cognitive Dysfunction Manifesting After Non-cardiac surgery

Up to 40% of older patients will develop postoperative cognitive dysfunction (POCD), a syndrome of thinking/memory deficits that occurs 1-12 months after surgery and is associated with decreased quality of life, further long-term cognitive decline, and increased mortality. One possible risk factor for POCD is obstructive sleep apnea (OSA), a frequently undiagnosed disorder characterized by repetitive interruptions in breathing (apneas and hypopneas) during sleep. OSA is prevalent in elderly patients undergoing surgery and can be diagnosed with home sleep apnea tests (HSAT), which estimate the apnea-hypopnea index (AHI). Increased AHI (an indicator of OSA severity) has been associated with long-term cognitive decline outside of the perioperative setting and postoperative delirium. Yet, no study has examined the possible role of OSA in POCD. Neuroinflammation, which has been hypothesized to play a role in POCD, might be increased in patients with OSA, since OSA is associated with increased peripheral inflammation and magnetic resonance spectroscopy (MRS) markers of neural damage. In the SANDMAN study, we will determine the extent to which OSA severity is associated with POCD, neuroinflammation and MRS markers of neural damage. 

Submissions


CoAuthor(s)

Dr. Miles Berger, MD, PhD
Dr. Jeffrey Browndyke, PhD
Mr. Thomas Bunning, BS
Ms. Mary Cooter, MS
Dr. Jennifer Dominguez, MD, MHS
Dr. Joseph Mathew, MD
Dr. Patrick Smith, PhD
Dr. Andrew Spector, MD

Poster Presenter

Dr. Michael Devinney, MD, PhD

D189. Obstructive sleep apnea does not predispose to postoperative delirium: a retrospective EHR based analysis.

Obstructive sleep apnea (OSA) has been associated with postoperative morbidity including delirium (POD) in several studies. Our center screens for OSA preoperatively by questionnaire, and regularly administers the CAM-ICU. We hypothesized that pre-operative OSA would associate with POD in the ICU, and that positive airway pressure (PAP) adherence would reduce the impact. 

Submissions


CoAuthor(s)

Dr. Michael Avidan, MBBCh
Dr. Krisztina Escallier, MD
Dr. Bradley Fritz, MD

Poster Presenter

Dr. Christopher King, MD, PhD

D190. Prevalence of sleep disordered breathing in chronic non-cancer pain patients on opioid therapy: A systematic review and network meta-analysis

Background: Sleep disordered breathing (SDB) is characterized by abnormal or insufficient breathing during sleep causing sleep fragmentation and reduced blood oxygen level. Several observational studies have reported opioids increase the risk for sleep disordered breathing (SDB) in chronic non-cancer pain patients on long term opioids therapy;(1-4) however, these studies failed to quantitate the strength of evidence for this relationship. The objective of this study was to use network meta-analysis (NMA) to investigate the strength of evidence between opioid therapy and the prevalence of SDB in chronic non-cancer pain patients. 

Submissions


CoAuthor(s)

Mr. Joseph M Botros, MD
Dr. Frances Chung, MBBS, LMCC, FRCPC
Dr. NILUFAR ESFAHANIAN, MD
Dr. Talha Mubashir, MD
Dr. Clodagh Ryan, MD, MB, FRCPC
Dr. Jean Wong, MD

Poster Presenter

Dr. Mahesh Nagappa, MD

D191. Response to inhaled anesthetics measured by the Triple Variable Index reveals population-specific patterns of intraoperative hypotension exposure

Intraoperative hypotension (IOH) is a common, potentially modifiable risk factor for severe, costly postoperative complications and death (1). IOH is difficult to anticipate and prevent, in part, because it remains unknown how IOH exposure varies between patients. IOH events that occur in individual patients may vary according to frequency, relative location within surgery, and depth below threshold. Identifying patterns of IOH exposure that are characteristic of specific patient populations would provide key information towards improving a clinician's ability to better anticipate IOH. The objective of this study was to evaluate and compare IOH exposure as a function of event frequency, location, and depth and time below threshold between three patient populations each with a unique risk of experiencing IOH. 

Submissions


CoAuthor(s)

Dr. David Danks, PhD
Dr. Pritika Dasgupta, MPH, MS
Dr. Harry Hochheiser, PhD
Dr. James Ibinson, MD, PhD
Dr. Ata Kaynar, MD, MPH
Dr. Douglas Landsittel, PhD
Dr. Aman Mahajan, MD, PhD, MBA
Dr. Keith Vogt, MD, PhD
Dr. Steven Whitehurst, MD

Poster Presenter

Dr. Michael Schnetz, MD, PhD

D192. The effect of low dose intra-operative ketamine on closed-loop controlled general anesthesia; a randomized controlled equivalence trial

Closed-loop control of propofol-remifentanil anesthesia using the WAV[sub]CNS[/sub] depth-of-hypnosis index (NeuroSENSE NS-701, v2.0.0.3, NeuroWave Systems Inc, Cleveland, OH) is clinically feasible in adult patients undergoing general anesthesia for elective surgery [1]. Ketamine, frequently used as a component of a multimodal intraoperative regime to reduce postoperative pain [2], affects high-frequency EEG power [3], but lower doses have minimal effect on the WAV[sub]CNS[/sub] [4]. The purpose of this study was to evaluate the performance of closed-loop administration of propofol-remifentanil anesthesia during induction and maintenance of anesthesia in the presence or absence of a low (analgesic) dose of ketamine. Clinical equivalence in controller performance was the percentage time within ±10 units of the WAV[sub]CNS[/sub] setpoint [5]. We assumed an equivalence range of ±8.99 units for controller performance based on data from [1] with a controller performance score of 89.9%. 

Submissions


CoAuthor(s)

Dr. J Mark Ansermino, MBBCH, MMed, MSc, FFA, FRCPC
Ms. Erin Cooke, BSc
Dr. Guy Dumont, PhD, P.Eng
Richard Merchant, MD, FRCPC
Ms. Gabrielle Napoleone, BSc
Dr. Klaske van Heusden, PhD
Mr. Nicholas West, MSc

Poster Presenter

Dr. Matthias Görges, PhD

D193. Poiseuille's Law Demonstration to Compare Flow Rates with Commonly Used Vascular Catheters and IV Tubing Accessories

In an effort to demonstrate physics principles for resident education in an approachable way, we designed a hand's on "science fair" style project to study practical applications of Poiseuille's Law. We developed an interactive experience that allowed residents to manipulate four variables that impact laminar flow: pressure, catheter length and radius, and fluid viscosity, as well as the introduction of turbulence in a simulated operating room environment. We evaluated 12 different central and peripheral catheters (Table 1) of varying length and radius in common use at our institution and measured the flow rate of normal saline with various IV tubing and injection port adjuncts. 

Submissions


CoAuthor(s)

Dr. David Berman, MD
Dr. Shirley Duarte, MD
Dr. Steven Frank, MD
Dr. Adam Schiavi, PhD, MD

Poster Presenter

Dr. Christina Miller, MD

D194. Implementation of a Distributed Research Network Virtual Data Warehouse for a Multi-Center Observational Study

Both the National Institutes of Health and Food and Drug Administration have suggested that distributed research networks (DRN) are essential tools for extracting and pooling large volumes of data for multi-center observational studies or pragmatic trials.1 DRNs take advantage of the fact that while electronic medical records are increasingly being adopted by health care systems, data holders need to maintain physical and logical control over their data. A key component of a DRN therefore is the development of a virtual data warehouse (VDW) that fits local data elements to a common data model. Little information is available on the implementation of a DRN within Veterans Health Affairs (VHA) facilities. As part of a multi-year, multi-healthcare system, post-marketing study for the Food and Drug Administration on the outcomes of chronic opioid use, we describe the implementation and evaluation of the Health Care Systems Research Network (HCSRN) VDW within the Veterans Health Affairs System.2 

Submissions


CoAuthor(s)

Mr. Justin Chambers, MS
Dr. David Clark, MD, PhD
Ms. Aditi Kapoor, MS
Dr. Jennifer Lee, MD, PhD
Dr. Edward Mariano, MD, MAS
Dr. Randall Stafford, MD, PhD
Dr. Fan Wu, PhD

Poster Presenter

Dr. Seshadri Mudumbai, MD

D195. A Novel Learning Management System to Revolutionize Generation, Administration, and Assessment of Simulation-Based Medical Education

Simulation-Based Medical Education (SBME) has become routine in the training of healthcare professionals with skills and competencies required for their discipline and maintenance of licensure (1,2). There is currently no standardized mechanism for creation, delivery, and assessment of medical simulation. Currently performance during SBME is evaluated using pass/fail metrics coupled with debriefing following simulation scenarios (3). The lack of granularity in evaluation and assessment of learners makes it difficult to characterize effectiveness of SBME curricula and to determine whether skills acquired during simulation transfer to real world clinical operations (2). 

Submissions


CoAuthor(s)

Ms. Cristina Alvarado, M.B.A., R.N.
Mr. Douglas Brunner, MS
Dr. Andrew Casabianca, M.D.
Dr. James Hofmann, M.D.
Mr. Mohammad Owais, MS
Dr. Thomas Papadimos, MD
Mr. Jeffrey Schneiderman, NREMTP, EMSI

Poster Presenter

Dr. Scott Pappada, Ph.D.

D196. Cardiac index measurement by pulmonary artery catheter, arterial waveform analysis and impedance cardiography during liver transplantation

Monitoring the cardiac output (CO) is useful during major operations. The most commonly used method is using thermodilution detected by a pulmonary artery catheter (PAC). However, pulmonary artery catheterization is invasive and associated with increased mortality and morbidity. Arterial pressure waveform analysis is minimally invasive and a useful and reliable method. Impedance cardiography (ICG) is noninvasive, easy to apply and does not require special training. In this study, correlation between thermodilution, arterial waveform analysis and impedance cardiography was evaluated simultaneously in patients undergoing liver transplantation. 

Submissions


CoAuthor

Dr. Bon-Nyeo Koo, MD

Poster Presenter

Dr. MinGi Ban, MD

D197. An Intraoperative Clinical Decision Support Tool Optimizes Post-Operative Glucose Levels in Diabetic Patients

The goal of this study was to assess the impact of an intraoperative glucose alert designed using Epic's Best Practice Advisory (BPA) clinical decision support tool. This BPA acts as an intraoperative glucose alert and is designed to facilitate the maintenance of normoglycemia in the diabetic anesthesia patient. A similar alert had been implemented in a prior AIMS (GasChart). We hypothesize that diabetic patients undergoing anesthesia would experience lower rates of PACU hyper and hypoglycemia after implementation of the BPA. 

Submissions


CoAuthor(s)

Dr. Robert Freundlich, M.D., M.S.
Mr. Gen Li, M.Chem, M.Stat
Dr. Jonathan Wanderer, MD

Poster Presenter

Ms. Chelsie Dietz, B.A.

D198. Different Responses of Healthy Humans Subjected to Lower Body Negative Pressure Induced Hypovolemia Using Continuous Noninvasive Arterial Pressure Cycle Duration and Heart Rate

Lower Body Negative Pressure (LBNP) is an experimental model that mimics hypovolemia by pooling blood in the lower extremities. Continuous Noninvasive Arterial Pressure (CNAP, CNSystems, Austria) is currently being used as a blood pressure monitor. The duration of ejection time (EJ), an estimate of systolic length, and non-ejection time (NEJ), an estimate of diastole, were measured. These values along with their respective ratios to the total cycle duration (TCD = EJ + NEJ) and the corresponding heart rate (HR) values were compared. This study aims to highlight variations in cardiac cycle length and HR as a tool for early prediction of hypovolemia. 

Submissions


CoAuthor(s)

Aymen Alian, MD
Dr. Mohamed Eid, MD
Mohamed Elgamal, MD
Dr. Kirk Shelley, M.D. PhD

Poster Presenter

Dr. Anna-Maria Eid, Doctor of Medicine

D199. The analysis of pediatric EEG using Poincaré plot after a fast Fourier transformation under sevoflurane anesthesia.

The Bispectral Index (BISTM) is commonly used as an indicator of anesthetic depth during general anesthesia. In this study, using a combination of Fourier transformation and Poincare plot analysis, we did a frequency analysis of electroencephalogram in pediatric cases. 

Submissions


CoAuthor

Dr. Teiji Sawa, M.D., Ph.D.

Poster Presenter

Mr. Kazuma Hayase, MD

D200. Hemodynamic Compensation during Selective Fetoscopic Laser Photocoagulation Using the Compensatory Reserve Index

Selective Fetoscopic Laser Photocoagulation (SFLP) is a minimally invasive fetal procedure to treat twin to twin transfusion syndrome and other abnormalities of higher order monochorionic gestations. To accomplish this procedure parturients require local or neuraxial anesthesia, intravenous analgesia, and often hemodynamic support in the form of a phenylephrine infusion. Terbutaline is occasionally given for procedural tocolysis.[1] Temporary tachycardia is common after terbutaline administration, however hypotension secondary to vasodilation is difficult to predict. The Compensatory Reserve Index (CRI) is a FDA cleared "adjunctive cardiovascular status indicator" that represents a new, individual-specific vital sign in patient monitoring. CRI trends changes in intravascular volume from normovolemia to decompensation (SBP < 80 mmHg) relative to the individual's response to hypovolemia. We hypothesized that parturients receiving terbutaline during cessation of phenylephrine infusions would have lower mean arterial blood pressure (MAP) and CRI values than parturients that did not receive terbutaline. 

Submissions


CoAuthor(s)

Nicholas Behrendt, MD
Dr. Henry Galan, MD
Steven Moulton, MD
Dr. Ryan Phillips, MD
Dr. Cristina Wood, MD
Dr. Michael Zaretsky, MD

Poster Presenter

Dr. David Leopold, MD

D201. Accuracy of spectrophotometric hemoglobin monitoring with digital nerve block

Due to potential complications, and also given the cost of providing blood products, transfusion should be done carefully and cautiously (1,2,3). Measuring Hemoglobin level during the surgery plays a vital role in making this decision.The accuracy of spectrophotometric hemoglobin (SpHb) depends on the finger perfusion. Hypothesizing that digital nerve blocks would improve accuracy of hemoglobin estimates by enhancing blood circulation (4,5) we investigated the effects of block on the accuracy of SpHb. 

Submissions


CoAuthor(s)

Dr. Farhad Etezadi, M.D.
Dr. Mohammad Reza Khajavi, M.D.
Dr. Atabak Najafi, M.D.
Dr. Pejman Pourfakhr, M.D.
Dr. Reza Shariat Moharari, M.D.

Poster Presenter

Dr. Babak Mostafazadeh Davani, M.D.

D202. Predicting ASA scores using Machine Learning

American Society of Anesthesiologists (ASA) scoring (1-6), a subjective assessment of health status, was developed as a universal standard to risk-stratify patients' anesthetic morbidity and mortality. ASA scores are used for resource allocation, improving workflow, and reimbursement. ASA misclassification can affect observed versus expected mortality ratios of surgical patients within an institution[sup]1[/sup] or also affect billing. Recent ASA classifiers using machine learning (ML) methods are limited by small sample sizes and unbalanced data, inability to classify a variety of ASA scores, and/or limited to binary classification (ASA 1-2 vs 3-5)[sup]2-4[/sup]. Our aim was to develop more robust models to address these limitations. 

Submissions


CoAuthor(s)

Dr. Matthias Eikermann, MD PhD
Dr. Priya Ramaswamy, MD, MEng
Ms. Dana Raub, MD candidate
Dr. Peter Santer, MD

Poster Presenter

Dr. John Pearson, MD

D203. Prediction of intraoperative hypotension: logistic regression vs deep learning methods

Early detection of hypotension during surgery is essential to reduce the risk of ischemia in major organs and improve postoperative outcome. Analysis of real-time arterial pressure waveforms can be used as an indicator of hypotension, because it provides vast amounts of information about ongoing changes in cardiovascular status. A previous study using machine learning method predicted hypotension 10 min before the event with a sensitivity of 0.842, a specificity of 0.843, and the area under the ROC curve (95% CI) of 0.920 (0.896-0.943). In the current study, we developed and compared models for predicting intraoperative hypotension from changes in arterial pressure using logistic regression and deep learning methods. 

Submissions


CoAuthor(s)

Dr. Min Hur, MD
Chul-Woo Jung, MD, PhD
Dr. Hyung-Chul Lee, MD
Dr. Hyung-Been Yhim, MD

Poster Presenter

Dr. Soo Bin Yoon, M.D.

D204. Regulation of microtubule dynamics in the HKSA-induced endothelial barrier dysfunction.

Staphylococcus aureus is one of major causes of sepsis and acute lung injury associated with severe endothelial cell (EC) barrier dysfunction and inflammation. However, the molecular mechanisms of bacterial pathogen–induced EC barrier disruption are not fully understood. Our group have previously demonstrated that enhancement of EC barrier by hepatocyte growth factor (HGF) involved Rac1 GTPase-mediated remodeling of peripheral actin cytoskeleton, increase in the pool of stable (acetylated) microtubules and stimulation of microtubule peripheral growth (2). Here, we investigated the role of microtubule dynamics in the mechanisms of EC barrier compromise caused by heat-killed gram-positive Staphylococcus aureus (HKSA) bacteria. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Boyoung Cha, Ph.D.

D205. Airway Management by Anesthesiologists at Level-1 Trauma Center in the Era of Video Laryngoscopy.

Rapid sequence induction and intubation is the preferred method to secure the airway in trauma patients recommended by ATLS guidelines. Previously, a trauma airway management algorithm mainly relying on DL was demonstrated to have a success rate of 99.7% [1]. In settings where anesthesiologists are not the primary providers involved in emergency airway management, failed laryngoscopy requiring airway rescue has a higher prevalence of 2.7% [2]. Over the past decade, the use of VL both in and out of the operating room has increased, particularly in emergency and trauma settings [3-5]. In this retrospective study, we examined if the immediate availability of VL changed either the approach to airway management or the prevalence of failed intubations requiring a surgical airway in a practice supervised by trauma anesthesiologists. Our first hypothesis was that the use of VL in the trauma bays would be less than 10%. Our second hypothesis was that there would be no trend for increased use of VL over time. 

Submissions


CoAuthor(s)

Dr. Richard Dutton, MD, MBA
Dr. Richard Epstein, MD
Dr. Jack Louro, MD
Yvette Rodriguez, MD

Poster Presenter

Dr. Roman Dudaryk, MD

D206. Efficacy of tranexamic acid infusion in experimental trauma/hemorrhagic shock is dependent on blood

We compared the ability of tranexamic acid (TXA) to restore hemodynamic stability after experimental trauma/hemorrhagic shock (T/HS) with intravenous or enteral TXA in rats reperfused with blood or lactated Ringer's solution (LR). Enteral TXA delivery has previously been shown to improve outcomes in blood-resuscitated models of T/HS. 

Submissions


CoAuthor(s)

Dr. Federico Aletti, PhD
Dr. Fernando Dos Santos, PhD
Joyce Li, BS

Poster Presenter

Dr. Erik Kistler, MD, PhD

D207. Etomidate is less frequently used for Rapid Sequence Intubation in pediatric trauma patients

In emergency settings, rapid sequence intubation (RSI) including the use of an anesthetic induction agent is commonly used for airway management. In the emergency department (ED), etomidate is the most commonly used induction agent for adults, being used in over 90% of intubations[sup]1[/sup]. In pediatric ED and critical care intubations, other intravenous induction agents such as midazolam and ketamine have been reported as more prevalent[sup]2,3[/sup], many times due to concern for adrenal suppression. We reviewed intubation records of our trauma population to determine if there was decreased use of etomidate in the pediatric patients compared to the adult population. 

Submissions


CoAuthor(s)

Dr. Roman Dudaryk, MD
Paul Elias, B.S.
Neil Masters, MD

Poster Presenter

Dr. Jack Louro, MD

D208. A Retrospective Review of Electrolyte Repletion During Massive Transfusion Protocol at a Level One Trauma Center

Establishing the appropriate ratio of packed red blood cells, plasma, and platelets during Massive Transfusion Protocols (MTPs) has been aimed at decreasing risk of further bleeding and improving overall survival.[1, 2] MTPs guide the clinician on many aspects of resuscitation, including initiation, termination, and blood product ratio. [3] Regarding repletion of electrolytes, MTPs often recommend frequent monitoring of electrolyte levels but provide no guideline for repleting electrolytes.[4] Citrate toxicity is a well described adverse effect associated with high volume transfusion. It leads to a predictable decrease in calcium and magnesium levels. Calcium, in particular, is an integral part of many systems crucial for survival during massive hemorrhage and is essential to myocardial contractility, coagulation, and autonomic function. Decraesed ionized calicum levels have been associated with an increased risk of hospital mortality.[5] This dose dependent correlation with mortality suggests that hypocalcemia is an easily reversible factor that may contribute to overall outcome in patients receiving massive transfusion. We hypothesized that the majority patients who receive transfusion via massive transfusion protocol will have documented hypocalcemia. We also hypothesized that lower ionized calcium level was associated with increased risk of mortality. We sought to establish a recommended dose of calcium and magnesium during MTP based on serum calcium levels, number of units of blood products administered, timing of massive transfusion, and calcium administered. 

Submissions


CoAuthor(s)

Mr. Nadder Azzam, B.S.
Dr. Talia Ben-Jacob, MD
Dr. Akhil Patel, MD
Ms. Xiaolu Xu, M.D.

Poster Presenter

Dr. Christopher Potestio 9688516, MD

D209. Decreased thrombin inhibition with hypothermia as measured by calibrated automated thrombography (CAT)

Hypothermia contributes to the development of trauma-induced coagulopathy by reducing platelet aggregation and impairing coagulation-enzyme activity.1 While it is well-documented that pro-coagulant enzymes have reduced activity, particularly at temperatures of 33ºC and lower,2,3 the effect of hypothermia on anticoagulant proteins is often overlooked. Inability to regulate thrombin could lead to thrombotic complications during resuscitation efforts. Calibrated automated thrombography (CAT) allows quantification of thrombin generation during the initiation, propagation, and termination phases of coagulation.4 In this in-vitro experiment, we investigated the effect of hypothermia on the thrombin generation curve, dividing the endogenous thrombin potential (ETP) into 2 halves, representing the propagation and termination phases. Our null hypothesis was that the ratio of the 2 phases would remain constant as the temperature decreased. 

Submissions


CoAuthor(s)

Dr. Alexander Mitrophanov, PhD
Dr. Jaques Reifman, PhD
Fania Szlam, MMSc

Poster Presenter

Dr. Roman Sniecinski, MD

D210. Inability to Measure Activated Clotting Time During Atrial Flutter Ablation

Heparin anticoagulation (AC) is used while performing ablation on the left side of the heart. The goal is to prevent formation of thrombi on catheters, which could potentially embolize to coronary, cerebral or peripheral arteries. AC is monitored with the Activated Clotting Time (ACT). Cardiologists prefer ACT maintained between 350 - 400 sec. We report a case of Atrial Flutter Ablation during which ACT could not be measured. 

Submissions


CoAuthor(s)

Jinu Abraham, RN
Dr. Michael Grushko, MD
Ms. Jazmin Juarez, BS
Dr. Jorge Romero, MD
Dr. Agathe Streiff 3202743, MD

Poster Presenter

Dr. Sheldon Goldstein, MD