IARS: Poster Session F

Mon, 5/20: 12:30 PM  - 2:00 PM 
IARS Poster Session 
1.5 
The Fairmont Queen Elizabeth 
Room: Place du Canada / Square Dorchester  

Presentations

F001. Changes in Applied Laryngoscope Force Affect Peak Spinal Cord Strain

Direct laryngoscopy and endotracheal intubation is a common contemporary healthcare procedure. Certain patient characteristics are associated with difficult intubation [1] in which laryngoscope forces are applied in an atypical manner. The aim of this study was to investigate the role of intubation force location, magnitude, and direction on resultant cervical spinal cord strains in a stable cervical spine using computational models. 

Submissions


CoAuthor(s)

Dr. Brad Hindman, M.D.
Mr. Mitchell Page, B.S.
Dr. Christian Puttlitz, Ph.D.
Dr. Michael Todd, MD
Dr. Vincent Traynelis, M.D.

Poster Presenter

Dr. Benjamin Gadomski, Ph.D.

F002. A randomized comparison of I-gel and Ambu AuraGain TM laryngeal mask airway in patients with simulated cervical immobilization

The I-gel and the Ambu AuraGain[sup]TM[/sup] are recently developed second-generation supraglottic airway devices that have specific features to improve positive-pressure ventilation and reduce the risk of aspiration. They have the same clinical indications and are recommended for difficult airway management, but there have been no studies comparing the two devices in simulated difficult airway. Therefore, we aimed to evaluate the clinical performance of these two devices in adults with simulated difficult airway. 

Submissions


CoAuthor(s)

Dr. Tae Kyong Kim, MD, PhD
Dr. Hyung-Chul Lee, MD

Poster Presenter

Dr. Min Hur, MD

F003. Effect of Cervical Collar on Oropharyngeal Sealing Pressure and Fiberoptic View of the Glottis with Ambu Aura GainTM Laryngeal Airway: A Randomized Cross Over Trial

Ambu® AuraGain™ laryngeal airway is one of the newer supraglottic airway devices introduced in 2014.[1] Cervical spine stabilization with hard cervical collar is a routine practice in patients with cervical spine instability, which makes insertion of supra-glottic airways and tracheal intubation difficult.[2] This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure(OSP) and fiberoptic view of the glottis in airways secured with the AmbuAuraGain LMA. 

Submissions


CoAuthor(s)

Dr. Sandeep Mishra, M.B.B.S., M.D.
Dr. DURAIYARASSU UTHAMAN, M.B.B.S., M.D.

Poster Presenter

Dr. Suman Lata, MBBS DCH MD

F004. Vallecular cyst in a patient undergoing emergency embolization of ruptured cerebellar aneurysm - an unanticipated difficult airway.

Vallecular cysts are mostly asymptomatic, supralaryngeal masses also called epiglottic cysts. While some cysts may result in dysphagia, voice changes, or worsening symptoms of obstructive sleep apnea (OSA), most vallecular cysts are incidentally discovered during laryngoscopy. Serious complications related to vallecular cysts include "can't ventilate, can't intubate" scenarios or cyst rupture, however, there are no established anesthetic guidelines describing assessment or management perioperatively. We present a case of difficult airway management due to an unexpected, large vallecular cyst. 

Submissions


CoAuthor

Dr. Eric Kamenetsky, MD

Poster Presenter

Dr. Yamin Noor, MD

F005. Experimental study on temperature change in circuit during low flow anesthesia due to difference in anesthesia circuit.

Carbon dioxide produce heat with thermal reaction with CO2 absorbent. This reaction may keep body temperature of patient during general anesthesia. In this study, we experimentally compare the temperature change in different anesthetic circuit. 

Submissions


CoAuthor

Hiroko Baba, MD

Poster Presenter

Dr. Nobukazu Sato, MD, PhD

F006. A pilot study to determine the accuracy of ultrasound in measurement of the dimensions of the pediatric cricothyroid membrane.

Emergency front of neck access (eFONA) through the cricothyroid membrane (CTM) is recommended as an airway rescue technique in children over 1 year of age (1). Recently it has been shown that clinical identification of the CTM is frequently inaccurate in older children (2). Similar and sometimes greater inaccuracy has been demonstrated in the adult population (3,4) and has prompted researchers to investigate bedside ultrasound (US) as a potential clinical tool for eFONA (5). In paediatrics, knowledge of the vertical height of the CTM may assist clinicians in determining the feasibility of eFONA, choice of technique and equipment selection. The ability of US to assist clinicians in CTM identification in children has not previously been explored. The aim of our study was to assess the accuracy of US assisted pediatric CTM localization and dimension measurement using magnetic resonance imaging (MRI) as a reference standard. 

Submissions


CoAuthor(s)

Dr. Paul Fennessy, MB, BCh, BAO.
Dr. Kevin McCarthy, MB, BCh, BAO, PhD
Dr. Conan McCaul, MB, BCh, BAO, MD.
Dr. Roisin Ni Mhuircheartaigh, MB, BCh, BAO, PhD
Dr. Aisling Snow, MB, BCh, BAO, MD.

Poster Presenter

Dr. Bill Walsh, MB, BCh, BAO.

F007. Adductor Canal Nerve Block vs Intra-articular Anesthetic in Knee Arthroscopy: A prospective randomized Trial

INTRODUCTION: Post operative pain is commonly associated with knee arthroscopy. Treatment includes an oral or intravenous opioid regimen which often leads to side effects like nausea, vomiting and constipation. These contribute to overall patient discomfort in the post operative period. Intraoperative injection of local anesthetic into the knee and regional nerve blocks have become common adjuncts to reduce post operative pain and reduce the use of opioids. Current literature on the efficacy of intra-articular injection for analgesia, and the use of adductor canal blocks for reduction of acute perioperative pain vs placebo for day case knee arthroscopy is inconclusive. There is no literature comparing intra-articular local anesthetic injection and adductor canal nerve blockade for knee arthroscopy. 

Submissions


Poster Presenter

Dr. Audrice Francois, MD

F008. Use of a modified infant face mask and a Mapleson C circuit to maintain spontaneous nasal ventilation and oxygenation in obese patients during outpatient EGD and colonoscopy

Patients routinely receive IV sedation and O2 via nasal cannula (NC) or a simple face tent (1-2) during ambulatory GI endoscopy. Over-sedation and/or airway obstruction may cause severe O2 desaturation, especially in obese patients with obstructive sleep apnea (OSA). These patients may require frequent chin-lift, jaw-thrust or nasal airways to maintain patent airway. In case of severe O2 saturation, the procedure has to be interrupted in order to resuscitate the patient. A simple nasal mask circuit assembly has been shown to provide CPAP to maintain spontaneous nasal breathing and improve oxygenation in sedated obese patients using existing anesthesia equipment and machine (2-5). However, many endoscopy centers do not always have an anesthesia machine. A pediatric face mask connected to a self-inflating bag has been used to improve oxygenation during TEE (Fig. 1) or emergency intubation in remote anesthesia locations without anesthesia machine (6-7). We used a modified pediatric face mask and a Mapleson C circuit to maintain spontaneous ventilation and oxygenation in two patients during GI endoscopy (Fig. 2). 

Submissions


CoAuthor(s)

Dr. Sylviana Barsoum, MS, MD
Dr. Kang Rah, MD

Poster Presenter

Dr. James Tse, PhD, MD

F009. Propofol Toxicity in Cardiomyocyte Mitochondria of Developing Mice: The Role of the Mitochondrial Transition Pore.

Propofol infusion syndrome (PRIS) is a life-threatening condition characterized by bradycardia, arrhythmia, lactic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, and cardiac and renal failure. 1 Risk factors include young age, long durations of exposure, and high cumulative doses. 1 Prior studies suggest that propofol inhibits the mitochondrial electron transport chain (ETC) and may interfere with coenzyme Q (CoQ). 2 However, the exact mechanism of toxicity remains unknown. Furthermore, there is no data regarding age-dependent vulnerability and few studies have assessed appropriate tissues of interest. Thus, we aimed to identify the mechanism of propofol toxicity within cardiomyocyte mitochondria obtained from developing mice. We hypothesized that propofol would induce discrete defects in immature mitochondria. 

Submissions


CoAuthor(s)

Sarah Brunner, MD
Dr. Richard Levy, MD, FAAP
Lifei Wang, BS
Ms. Aili Wang, MD

Poster Presenter

Dr. Matthew Barajas, MD

F010. S-ketamine enhances thalamocortical as well as intracortical synaptic transmission in mouse brain slices

The neuronal mechanisms of the anesthetic-induced loss of consciousness (LOC) are still under debate. In contrast to other anesthetics, s-ketamine increases thalamic and cortical neuronal activity¹. Virtually all sensory information from the periphery is relayed in thalamic nuclei before its transmission to the cortex. Therefore, both the thalamus and the cortex are essential to conscious perception and thus the thalamocortical network is an interesting target for anesthetics to induce LOC. Here we aim to elucidate the influence of s-ketamine on the thalamocortical network. 

Submissions


CoAuthor(s)

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

Poster Presenter

Mr. Matthias Bieber, M.S.

F011. Sevoflurane enhances iNOS Expression and Bactericidal Effects of Macrophages in vitro and in vivo in a murine model

In animal models of sepsis, sevoflurane anesthesia has been shown to decrease mortality1,2. During the early stage of sepsis, macrophages play a pivotal role as they kill invading pathogens by increasing oxidative stress through the release of free radicals such as NO and finally removing the microbes through phagocytosis. We were thus interested in evaluating whether sevoflurane has an effect on the anti-microbial function of macrophages in an endotoxin-induced injury model by assessing the expression and activity of inducible NO synthase (iNOS) and phagocytosis of E. coli in vitro as well as in vivo. 

Submissions


CoAuthor(s)

Dr. Beatrice Beck-Schimmer, MD
Dr. Marcelo Bonini, PhD
Dr. Randal Dull, MD PhD
Ms. Valerie Fehr, MMed
Dr. Guochang Hu, MD, PhD
Dr. Richard Minshall, PhD
Dr. Suellen Oliveira, PhD

Poster Presenter

Dr. Thomas Gerber, MD

F012. Pharmacodynamics of Handgrip Strength During Induction of Propofol Anesthesia

Response to verbal commands (RVC) is commonly used to assess level of consciousness (LoC). The effect site concentration (ESC) of propofol sufficient to induce loss of RVC exhibits high variance, in part due to non-standardized acoustic stimuli and the intermittent nature of assessments. Reported median effective concentrations (EC50) for loss of RVC range from 1.8 to 2.9 mcg/ml.[sup]1[/sup] Alternatively, LoC can be continuously assessed during induction of anesthesia using handgrip dynamometry.[sup]2[/sup] Although handgrip strength has previously been shown to decrease linearly during a constant propofol infusion, the dose-response relationship and EC50 for this novel behavioral paradigm have not been described. 

Submissions


CoAuthor

Dr. Gilles Plourde, MD, MSc

Poster Presenter

Dr. Christian Guay, MD

F013. Effect of Sevoflurane and Propofol on a human breast cancer cell line with tropism to brain in vitro

Breast cancer is the most frequently diagnosed cancer in women, and 15-30% of patients with metastatic breast cancer will develop brain metastases (BM), which is associated with extremely poor prognosis (1). A number of studies have reported that anesthetic agents may affect the biology of breast cancer cells (2-4). In this study, we investigated the effect of propofol and sevoflurane on the cell viability and migration of a highly brain metastatic breast cancer cell line. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Zhaosheng Jin, MBBS

F014. Intravenous vs volatile anesthesia and breast cancer surgery outcome- a systematic review and meta-analysis

Mastectomy or lumpectomy remain the primary treatment option for breast cancer. Several in vitro studies in recent years have suggested that anesthetic agent can alter the cancer cell phenotype or the immune system handling of cancer cells(1-5). In this systematic review we will investigate if the choice of intravenous anesthesia (TIVA) or volatile anesthesia (VA) during surgery affects the outcome after breast cancer surgery. 

Submissions


CoAuthor(s)

Dr. Ru Li, PhD
Dr. Jun Lin, MD, PhD
Dr. Jiaxin Liu, MD

Poster Presenter

Dr. Zhaosheng Jin, MBBS

F015. At Supra-Clinical Doses ABP-700 Produces Involuntary Muscle Movements Distinct From Seizure Activity In Beagle Dogs

BACKGROUND: ABP-700 is a "soft" etomidate analogue in development for induction of general anesthesia. At hypnotic doses, ABP-700 provides excellent hemodynamic stability but without adrenal suppression. As with etomidate, involuntary muscle movements (IMM) occur with administration to humans, rodents and dogs. Although we have demonstrated previously in rats that ABP-700 is an anticonvulsant, the question remains if this motor activity is due to convulsive seizure activity. 

Submissions


CoAuthor(s)

Simon Authier, DVM, MBA, PhD, DSP
Dr. Dario Lehoux, PhD
Dr. Mylene Pouliot, Ph.D., DSP
Brad Zerler, PhD

Poster Presenter

Dr. John Marota, MD, PhD

F016. Differential Inhibition of Steroidogenesis by Etomidate and Etomidate Analogs in Adult Male Rats

Cushing's syndrome is a rare endocrine disorder characterized by the overproduction of adrenocortical steroids, and steroidogenesis enzyme inhibitors are the mainstays of pharmacological management.[sup]1-3[/sup] Although there are currently no FDA-approved steroidogenesis enzyme inhibitors, etomidate (which is an extremely potent inhibitor) is sometimes used off-label to treat Cushing's syndrome.[sup]4[/sup] However, its use is complicated by its sedative-hypnotic activity, requiring administration within an ICU environment. We have recently shown that etomidate's sedative-hypnotic actions can be "designed out" by modifying its molecular structure, potentially without eliminating its steroidogenesis inhibitory activities.[sup]5[/sup] In the current studies, we describe the in vivo steroidogenesis inhibitory activities of four novel etomidate analogs (Fig. 2) that lack GABA[sub]A[/sub] receptor positive modulatory action (and thus sedative-hypnotic activities) and represent potential drug leads to treat Cushing's syndrome. 

Submissions


CoAuthor(s)

Alissa Hofmann, HS
Dr. Douglas Raines 7240343, MD

Poster Presenter

Ms. Megan McGrath, BS

F017. A semimechanistic model to characterize the pharmacokinetics and -dynamics of subcutaneous dexmedetomidine in in healthy adult volunteers

Patients receiving palliative sedation often need sedation to alleviate anxiety, intractable stress and pain. Dexmedetomidine has been demonstrated to induce dose­ dependent sedation without any risk of ventilatory depression and subcutaneous administration route could be favorable in palliative care. The objective of this study was to develop a semi-mechanistic model to characterize the pharmacokinetics and -dynamics (PK and PD) of subcutaneous dexmedetomidine to guide subcutaneous dexmedetomidine administration in palliative sedation. 

Submissions


CoAuthor(s)

Mr. Muhammad Ashraf, MSc
Dr. Mika Scheinin, Medical Doctor, PhD
Dr. Panu Uusalo, Medical Doctor, PhD Student

Poster Presenter

Dr. Teijo Saari, MD, PhD

F018. Studies of the New Neuromuscular Blocking Agent CW 1759-50 in the Cat, as in Monkeys, Predict Short- to Ultra-short Duration in Humans, Reflecting Rapid Degradation by L-Cysteine Adduction in Vitro

CW 1759-50 is an ultra-short acting nondepolarizing neuromuscular blocking agent (NMBA) in the monkey, most likely due primarily to its rapid degradation by L-cysteine adduction (1). Dose-duration comparisons in the monkey show a pharmacodynamic half-time of 2.7 min over a wide dose range consonant with its degradation half-time in vitro of 2.3 min (1). In this presentation we report the results of similar work done in the cat. 

Submissions


CoAuthor(s)

Ms. Farrell Cooke, B.S.
Dr. Paul Heerdt, MD, PhD
Ms. Anita Jegarl, BS
Mr. Randy Mack, MS
Dr. Stewart McCallum, MD
Jeff McGilvra, Ph.D.
Hiroshi Sunaga, MD

Poster Presenter

Dr. John Savarese, MD

F019. Prevalence of Bradycardia Associated with Sugammadex Administration in a Single-Center Retrospective Analysis of Electronic Medical Record Data

Sugammadex, capable of directly reversing the effects of the neuromuscular-blocking agents rocuronium and vecuronium, was approved for use in the United States in 2015 and has been used elsewhere since 2008. Rare but potentially life-threatening adverse reactions, such as anaphylaxis and bradycardia, have been described. As highlighted in a recent review [1], the prevalence of bradycardia remains uncharacterized. We therefore set out to retrospectively characterize the prevalence of bradycardia in this single-center observational study. 

Submissions


CoAuthor(s)

Dr. Courtney Elder, MD
Dr. Craig Jabaley, MD
Dr. Arjun Meka, MD
Dr. Lauren Meyer, MD
Dr. Vikas O'Reilly-Shah, MD, PhD
Dr. Milad Sharifpour, MD, MS

Poster Presenter

Dr. Matthew Weis, MD

F020. Restrictive versus liberal transfusion strategies in cardiac surgery: a systematic review and meta-analysis with trial sequential analysis

Blood transfusions are often necessary in cardiac surgery, with up to 90% of requiring transfusion of allogenic red blood cells (RBCs). On the one hand, there is a sound physiologic basis for the use of RBCs to improve oxygen delivery to tissues in situations of hemorrhage and anemia. However, there is a range of risks associated with blood transfusions, including infection, transfusion-related lung injury, and allergic reactions. Several studies have compared a "restrictive" strategy [i.e., RBC transfusion at a lower hemoglobin (Hb) or hematocrit (Hct)], with a "liberal" strategy (i.e., RBC transfusion at a higher Hb or Hct). Despite the large number of published studies, no clear consensus has emerged to guide blood transfusion practice in cardiac surgery patients. We conducted a systematic review (SR) and meta-analysis with trial sequential analysis (TSA) to critically appraise and summarize the evidence on the overall effect of restrictive transfusion on mortality and other clinical outcomes compared with liberal transfusion in adult patients undergoing cardiac surgery. 

Submissions


CoAuthor(s)

Dr. Ahmed Abou-Setta, MD, PhD
Dr. Hilary Grocott, MD, FRCPC
Dr. Morvarid Kavosh, MD, M.Sc
Carly Lodewyks, MD
Christine Neilson, BSc, MLIS
Rasheda Rabbani, PhD

Poster Presenter

Dr. Hessam Kashani, MD, MSc

F021. The Effect of Topical and Intravenous Tranexamic Acid on TXA levels, Thrombogenic, and Inflammatory Markers in Patients Undergoing Total Knee Replacement: A Randomized Double-Blind Controlled Study

Tranexamic acid (TXA) is used to decrease blood loss associated with total knee arthroplasty (TKA) [1]. While there are several meta-analyses on the safety and efficacy of TXA, there are none looking at TXA's mechanism and distribution both systemically and locally [2, 3]. Therefore, additional studies have been recommended. We sought to measure local and systemic levels of thrombogenic markers, IL-6 and TXA when the drug is given IV or topically. 

Submissions


CoAuthor(s)

Lila Baaklini, MD
Justin Cross, PhD
Kara Fields, MS
Dr. Kethy Jules-Elysee, MD
David Mayman, MD
Alexander McLawhorn, MD MBA
Amanda Pickard, PhD
Weige Qin, MS
Thomas Sculco, MD
Edwin Su, MD

Poster Presenter

Ms. Audrey Tseng, BA

F022. Greater Anemia Tolerance in Females Compared to Males for Inpatient Mortality

Although women have a lower baseline hemoglobin (Hb) compared to men, it is unknown whether women have a greater tolerance for anemia when hospitalized. As a result, we tested the hypothesis that women can tolerate a lower absolute Hb than men without an increase in inpatient mortality. 

Submissions


CoAuthor(s)

Dr. Steven Frank, MD
Dr. Eric Gehrie, MD
Ms. Kathryn Pearson, BA
Mrs. Taylor Purvis, BS

Poster Presenter

Ms. Mereze Visagie, BA

F023. Mitral Valve Repair complicated by Left circumflex coronary artery occlusion: the vital role of the Anesthesiologist

Mitral valve (MV) repair or replacement is the treatment of choice for severe mitral regurgitation (MR)1. Because of the vicinity of the left circumflex coronary artery (LCx) to the mitral annulus (as close as 1 mm)1, this artery is at risk of being injured during MV surgery. We present the case of 47-year-old man who underwent a minimally invasive MV repair for severe MR complicated by LCx occlusion by retraction of the vessel wall. The complication was diagnosed intraoperatively by the anesthesiologist and prompted an immediate cardiac catheterization which was both diagnostic and therapeutic. 

Submissions


CoAuthor

Dr. Jayanand D'Mello, M.D.

Poster Presenter

Dr. Andres Bacigalupo Landa, M.D.

F024. Guidance of Avalon Elite® ECMO Cannula Placement and Diagnosis of a Catastrophic Complex Occlusive Thrombus: Case Report and Literature Review

Transthoracic (TTE) and transesophageal (TEE) echocardiography can be used to monitor extracorporeal membrane oxygenation (ECMO) cannula position and blood flow directionality. Benefits of echocardiography include rapidity of diagnosis with the ability to make real-time modifications, ease of use, and portability. Useful views to visualize the ECMO cannula tip and reinjection orifice include: in TTE, subcostal and parasternal right ventricular inflow and right ventricular inflow-outflow views; and in TEE, mid-esophageal bicaval and modified bicaval views. In this patient, TEE and color flow Doppler were used to diagnose occlusive ECMO thrombus despite verification of correct single-catheter dual-lumen cannula position. 

Submissions


CoAuthor

Dr. Amanda Kleiman, MD

Poster Presenter

Dr. Sunny Chiao, MD

F025. Metabolomic Profiling Reveals Sex Differences and a Reduction in Metabolism after Remote Ischemic Preconditioning

Remote ischemic preconditioning (RIPC) is a low-cost low-risk intervention in which repeated cycles of upper extremity ischemia induce organ protection by an unknown mechanism. A recent meta-analysis of randomized controlled trials demonstrated that RIPC improves patient outcomes, but only in the absence of propofol (1). In addition to medications, patient factors such as diabetes reduce the efficacy of RIPC (2). There is a critical need to better understand the mechanism of RIPC to optimize organ protection prior to surgical procedures. Towards this end, we used mass spectrometry based metabolomic profiling to determine the metabolic response to RIPC in healthy volunteers. 

Submissions


CoAuthor(s)

Dr. Trevor Banack, MD
Dr. Nathan Clendenen, MD
Dr. Anushri Desai, MD
Dr. Joel Zylberberg, PhD

Poster Presenter

Mr. Elijah Christensen, BS

F026. Can the regional saturation of oxygen value predict complications associated with access-related vascular injury during transfemoral transcatheter aortic valve implantation?

Transfemoral transcatheter aortic valve implantation (TF-TAVI) has become a well-established alternative therapy to open surgery treat aortic stenosis in frail old patients. However, lower limb ischemia and vascular injury associated with vascular access and closure remain troublesome in TF-TAVI.[sup]1[/sup] We evaluated the lower limb ischemia by monitoring regional saturation of oxygen (rSO2) using near-infrared spectroscopy (NIRS) during TF-TAVI. This study aimed to analyze the decline of rSO2 from baseline (delta-rSO2) as lower limb ischemia induced by transfemoral approach, and the association between delta-rSO2 and access-related vascular injury. 

Submissions


CoAuthor(s)

Dr. Keisuke Nakazawa, M.D., Ph.D.
Dr. Makoto Ozaki 33538111, MD, PhD
Dr. Mihoshi Sato, MD
Dr. Sumire Yokokawa, M.D.

Poster Presenter

Dr. Shihoko Iwata, M.D.

F027. A retrospective review of complications and outcomes in patients undergoing extracoporeal membrane oxygenation (ECMO): a single center study

Improvements of extracorporeal life support technology has made it possible for critically ill patients with cardiorespiratory failure who fail conventional treatment to be considered for supportive care with extracorporeal membrane oxygenation (ECMO). ECMO options include venovenous (VV) ECMO to provide complete respiratory support in respiratory failure, and venoarterial (VA) ECMO to stabilize patients with decompensated heart failure. As is common with many emerging therapies, their optimal use currently lacks quality evidence. The objective of our retrospective study was to review the indications, mortality, outcomes and complications of patients at a single institution who received ECMO support. 

Submissions


CoAuthor(s)

Mr. Tewodrose Aseffa, BA
Dr. Kimberly Burcar, MD
Ms. Amanda Garza, BA
Dr. Jayanta Mukherji, MD

Poster Presenter

Dr. Kenneth Joseph, MD

F028. Effect of L-glutamine on O-Linked β-N-acetylglucosamine and heat shock protein 70 in the isolated ischemic rat heart model

Glutamine(Gln), a non-essential amino acid, has been demonstrated to protect against organ dysfunction in animal experiments(1-3). Previous studies in our lab also have shown cardioprotective effects of Gln in the isolated rat heart model. Gln administration was associated with increased levels of protein O-Linked β- N-acetylglucosamine(O-GlcNAc), a single sugar modification for Serin and Threonin residues of nuclear and cytoplasmic protein(4). Several pivotal proteins in the cell are modified by O-GlcNAc including cytoskeletal and nuclear pore proteins(5). Under septic conditions Gln was shown to induce the production of heat shock protein 70 (HSP70) via O-GlcNAc modification, thereby attenuating cardiomyocyte damage(6). Heat shock proteins appear in response to various forms of stress(6) and are important regulators of protein assembly, folding, and transport(7). While the increase of HSP70 via O-GlcNAc modification have been studied during sepsis, its role in the ischemic heart model is unclear. The current study was designed to assess the effect of Gln administration on myocardial HSP70 and O-GlcNAc levels in an isolated ischemic rat heart model. 

Submissions


CoAuthor(s)

Dr. Arkady Khoutorsky, PhD
Dr. YOSUKE NAKADATE, MD, PhD
Dr. Patricia Roque, MD, PhD C
Dr. Tamaki Sato, MD
Dr. Hiroaki Sato, M.D., Ph.D.

Poster Presenter

Ms. Akiko Kawakami, MD

F029. Oxidative damage, delirium, and neuronal injury in cardiac surgery

Twenty five to 52% of patients undergoing cardiac surgery develop postoperative delirium, and delirium is associated with increased mortality and long-term cognitive decline. The pathophysiologic mechanisms underlying delirium are unclear. We tested the hypothesis that intraoperative oxidative damage is associated with postoperative delirium and neuronal injury and that disruption of the blood-brain barrier modifies these associations. 

Submissions


CoAuthor(s)

Frederic (Josh) Billings, MD, MSCI
Dr. Christopher Hughes, MD
Dr. Matthew Shotwell, Ph.D

Poster Presenter

Dr. Marcos Lopez, MD, MS

F030. Effect of intranasal insulin administration on glycemia and plasma insulin in cardiac surgery patients

Intranasal insulin administration has been shown to improve both memory performance and metabolic integrity of the brain in patients suffering from Alzheimer's disease (AD) or cognitive impairment (1-3). Cognitive dysfunction (POCD) detected in up to 50% of elderly patients after cardiac surgery (4,5) has been associated with poor long-term outcome(5-7). We have previously demonstrated that intravenous administration of insulin preserves short and long-term memory function after open heart surgery (8). Although the mechanism underlying POCD are not clear, POCD and AD share a similar pathophysiology, including neuroinflammation and brain cell apoptosis. Hence, intranasal insulin, which has shown cognitive benefits in patients with AD, may represent a novel therapeutic option for the prevention of POCD. Insulin applied as spray via the nasal route bypasses the blood-brain-barrier and causes a sustained elevation of insulin concentrations in the cerebrospinal fluid (9). While intranasal insulin does not alter peripheral insulin levels in non-surgical subjects (9), its influence on glycemia and plasma insulin levels during major surgical tissue trauma remains to be investigated. 

Submissions


CoAuthor(s)

Renzo Cecere, MD, FRCSC
Ms. Akiko Kawakami, MD
Dr. Patricia Roque, MD, PhD C
Dr. Hiroaki Sato, M.D., Ph.D.
Dr. Tamaki Sato, MD
Dominique Shum-Tim, MD, MSc, FRCSC
Linda Wykes, PhD

Poster Presenter

Dr. YOSUKE NAKADATE, MD, PhD

F031. Prevention of Early Postoperative Decline (PEaPoD): A randomized controlled trial investigating the feasibility of a perioperative cognitive training program

Older cardiac surgery patients are at the highest risk of postoperative delirium and postoperative cognitive decline (POCD), leading to an increased risk of in-hospital mortality and long term cognitive deficits [1,2, 3]. Training software may increase cognitive reserve in areas that are affected in delirium and POCD [4, 5]. The feasibility of this novel, patient-led approach to prevent these conditions in the cardiac surgery population is currently unknown. 

Submissions


CoAuthor(s)

Doris Vanessa Gasangwa, BS
Dr. Alvaro Leone, MD PhD
Dr. Edward Marcantonio, MD SM
Ariel Mueller, MA
Dr. Balachundhar Subramaniam, MD MPH

Poster Presenter

Dr. Brian O'Gara, MD

F032. Protamine-heparin neutralization ratio in cardiac surgery

For the majority of operations using cardiopulmonary bypass, heparin (UFH) and protamine are used for anticoagulation and reversal, respectively. Controversy exists over the ideal method to dose protamine for heparin reversal. Methods include protamine dose based on total amount of heparin administered or titration of protamine to neutralize heparin in blood samples. Excess protamine is known to cause platelet inhibition, prolong the ACT, and increase the risk of bleeding. The Society of Thoracic Surgery recommends neutralization of unfractionated UFH with protamine using either titration method or empiric low-dose regimens, e.g. 50% the total amount of UFH administered intraoperatively. This low-dose regimen has not been substantiated by quantifying factor anti-IIa and Xa activity, the gold standard for measuring UFH activity. Hence, we sought to identify the minimum amount of protamine needed to neutralize the activated clotting time (ACT), anti-IIa and anti-Xa activity for patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). 

Submissions


CoAuthor(s)

Dr. Zach Hynes, MD
Dr. Ravi Taneja, MD

Poster Presenter

Dr. Daniel Szoke, MD

F033. Preliminary Results of A Study on The Use of A Wireless Holter-like Device to Detect Patients with Silent Atrial Fibrillation Leading to New Onset Atrial Fibrillation after CABG

New Onset Atrial Fibrillation (NOAF) is defined as atrial fibrillation (AF) in the first week postoperatively in patients without prior history of AF (AF-naïve). NOAF is associated with increased hospital length of stay, mortality and stroke, and prophylactic treatment of NOAF is recommended improve outcomes in high risk patients. The use of an implantable arrhythmia device in the REVEAL AF study showed that 40% of high-risk patients without a history of AF have silent AF. (1) Patients undergoing cardiac surgery have many of these high-risk traits, including advanced age, coronary artery disease, renal impairment and a greater CHADS2 score. We hypothesized that patients who develop NOAF after cardiac surgery may have silent AF prior to surgery, which is unmasked by continuous telemetry monitoring postoperatively. However, the use of implantable devices is costly and invasive, and hence this study aimed to evaluate if the use of continuous ECG monitoring in the preoperative period could identify patients with silent AF, whom we hypothesized are at risk for developing NOAF after coronary artery bypass surgery (CABG). 

Submissions


Poster Presenter

Dr. Lian Kah Ti, MBBS

F034. Turbulent pulmonary vein flow in adult patient after CABG

Acquired pulmonary vein stenosis (PVS) is a rare and serious complication after adult cardiac surgery. It can lead to dyspnea, hemoptysis, pulmonary edema, and hypoxemia. At present, radiofrequency ablation (RFA) for atrial fibrillation is the principal cause of adult PVS due to thermal injury during the procedure (1, 2). Other causes of non-iatrogenic adult PVS result from extrinsic compression secondary to sarcoidosis, lymphadenopathy, fibrosing mediastinitis, or tumors (3). Given its infrequency, there is little information about the incidence and management of PVS after adult open-heart surgery. Here we present a case of right superior pulmonary vein (RSPV) stenosis after on-pump beating coronary artery bypass graft (CABG). 

Submissions


CoAuthor

Dr. Aaron Mittel, MD

Poster Presenter

Dr. Emily Wang, MD

F035. Glycemic Stress Index: it is useful in every clinical scenario?

We read with great interest the article by Pilastra et al. [1] proposing the Glycemic Stress Index (GSI) as a new tool capable of accounting for the intraoperative glycemic stress in children. Hyperglycemia affects up to 90% of patients admitted to the pediatric intensive care unit (PICU) and is an independent predictor for prolonged length of stay and postoperative complications [2]. It is also negatively associated with the rise of creatinine in adult cardiac surgery patients [3]. Given the problematic nature of applying adult means of measurement, the GSI would be of particular importance in measuring metabolic derangement in pediatrics [3, 4]. Pilastra concluded that GSI significantly predicted a prolonged length of stay (LOS) in PICU after major pediatric neurosurgery. 

Submissions


CoAuthor(s)

Dr. Gianluca Bertolizio, MD
Mathieu Georges, MD

Poster Presenter

Dr. Swapnil Aswar 19996, MD

F036. Early Mobility in the Cardiothoracic Surgical Intensive Care Unit: A Quality Improvement Study

Intensive physical therapy for critically ill adults, including early mobility, has been associated with reduced length of stay and improvement in functional outcomes [1,2]. The use of a facilitator to coordinate early goal-directed mobilization has been an integral component of such programs. We undertook a quality improvement (QI) project in a university hospital cardiothoracic intensive care unit (ICU) to improve early mobility and evaluated the project's efficacy through a survey instrument. 

Submissions


CoAuthor(s)

Dr. Mark Caridi-Scheible, MD
Dr. Salila Hashmi, MD
Dr. Maxwell Hockstein, MD
Dr. Craig Jabaley, MD
Dr. Layne Madden, MD
Dr. Matthew Wiepking, MB BMedSc BAO BCh (Hons)

Poster Presenter

Dr. Michael Best, MD

F037. Carbon footprint of the critically ill: An economic input-output analysis of the ICU and the environmental impact of delayed patient discharge due to bottleneck in availability of lower acuity beds

We seek to evaluate the delay in ICU discharge at Yale-New Haven Hospital (YNHH) to both qualify the cause of delays as well as quantify the environmental costs of boarder bed-days. We will evaluate the environmental emissions of both intensive care unit (ICU) bed-days, as well as that of non-critically ill patients who remain in the ICU due to unavailability of beds in a less acute ward. We will review published literature on costs and modifiable areas of intervention, and then add motivation for improved patient bed flow to decrease the environmental footprint of a medically unnecessary ICU bed-day. 

Submissions


CoAuthor

Dr. Jodi Sherman, M.D.

Poster Presenter

Dr. Adjoa Boateng, MD

F038. Antipsychotic Medication Prescribing Patterns for Management of Intensive Care Unit (ICU) Delirium in 8872 Patients

Delirium in the intensive care unit (ICU) is a ubiquitous problem affecting a reported 20-87% of patients depending on study and population investigated.1 Non-pharmacologic prevention bundles can be implemented to decrease its occurrence,2 but once delirium develops, treatment options are limited. No medications have Food and Drug Administration approval for the treatment of delirium, but antipsychotic medications are often initiated for symptom management by critical care providers.3,4 As there is limited data supporting the efficacy of their use,5 there are currently no guidelines to direct antipsychotic prescribing practices for delirium with regard to: (1) timing of initiation of antipsychotic medication, (2) specific agent selection, (3) treatment duration, and (4) discontinuation regimens. This likely leads to significant variation in prescribing patterns, but limited data exist describing antipsychotic medication prescribing patterns in the management of ICU delirium. We aimed to describe the prescribing patterns of antipsychotic medications for the management of ICU delirium at a large academic medical center. 

Submissions


CoAuthor(s)

Xiaoke Feng, MS
Dr. Christopher Hughes, MD
Matt Marshall, PharmD
Dr. Matthew Shotwell, Ph.D
Joanna Stollings, PharmD

Poster Presenter

Dr. Christina Boncyk, MD

F039. Clevidipine use After First-line Treatment Failure for Perioperative Hypertension in Neurosurgical Patients: A Single-Center Experience

Perioperative hypertension occurs in 60% to 90% in neurosurgical population and requires acute blood pressure reduction therapy [1, 2]. The recommendation of targeted blood pressure is essential in the management of neurosurgical patients in order to avoid hemorrhagic conversion, hematoma extension, reperfusion injury, renal failure, encephalopathy and cardiac complications [1-3]. Due to the lack of established guidelines for acute hypertension management in the neurosurgical setting, different drugs have been proposed for hypertension management [4]. Despite the use of nicardipine as first-line agent for perioperative hypertension management in neurosurgical patients, evidences of the use of clevidipine in neurocritical population has been effective and showed an acceptable safety profile for rapid BP reduction, suggesting also a beneficial impact on hematoma expansion in patients with ICH [1, 3, 5, 6]. This study aims to compare the difference in proportion time in target systolic blood pressure (SBP) with the use of perioperative clevidipine after nicardipine treatment failure in neurosurgical patients. 

Submissions


CoAuthor(s)

Dr. Sergio Bergese, MD
Marilly Palettas, MS
Dr. Alberto Uribe, MD

Poster Presenter

Mr. Jaume Borrell-Vega, MD

F040. Successful Extracorporeal Membrane Oxygenation Utilization for Refractory Acute Respiratory Distress Syndrome Following Orthotopic Liver Transplantation Re-Exploration for Intra-Abdominal Hemorrhage

Postoperative respiratory failure carries a high rate of mortality in the adult orthotopic liver transplant (OLT) population. A recent retrospective study demonstrated that pulmonary complications in OLT patients were associated with a 2-fold increase in 1-year mortality, mechanical ventilation time, and hospital length of stay [1]. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy reserved for patients with refractory but potentially reversible respiratory failure after conventional treatment modalities have failed [2]. The application of ECMO in OLT patients during the perioperative period is poorly defined and largely limited to case reports [3-5]. In the absence of established indications for the use of ECMO in this population, it can be exceedingly difficult to identify which patients would benefit from this advanced medical therapy. Here we report the successful use of venovenous (VV)-ECMO in a postoperative OLT patient who suffered a hypoxic arrest and subsequent acute respiratory distress syndrome (ARDS) secondary to an intraoperative aspiration event. 

Submissions


CoAuthor

Dr. Suzanne Bennett, MD

Poster Presenter

Dr. Anna Ciullo, MD

F041. Association between preadmission chronic opioid usage and 90-day mortality in critically ill patients

Chronic opioid use suppresses immunity and increases the risk of infections. Although these adverse effects are crucial in critically ill patients, their association with chronic opioid use remains unknown. The aim of this study is to compare the 90-day mortality in the preadmission chronic opioid users and opioid naïve patients. 

Submissions


CoAuthor(s)

Dr. Sung-hee Han, MD PhD
Dr. Tak Kyu Oh, MD
Dr. Jung-hee Ryu, MD PhD
Dr. In-Ae Song, MD PhD

Poster Presenter

Dr. Ji-Yoon Han, MD

F042. Palliative Care Consultants in the Intensive Care Unit - A Systematic Review

We conducted a systematic review to investigate palliative care consultants in the intensive care unit (ICU). 

Submissions


CoAuthor

Dr. Rebecca Aslakson, MD, PhD, FAAHPM, FCCM

Poster Presenter

Dr. Diana Hylton, MD

F043. Racial and Ethnic Differences in Healthcare Utilization Following Severe Acute Brain Injury

Severe Acute Brain Injury (SABI) comprises a diverse group of diseases that render a patient acutely neurologically devastated, and often results in prognostic uncertainty and substantial healthcare utilization. While racial disparities in healthcare utilization have been recognized in the ambulatory setting, the relationship between race and healthcare utilization in critical illness is poorly understood. Knowledge of this relationship may help to provide improved patient and family-centered care to patients with SABI. Our study aimed to examine racial and ethnic differences in tracheostomy, percutaneous gastrostomy (PEG), and hospice utilization among patients with SABI in the United States. 

Submissions


CoAuthor(s)

Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Karthik Raghunathan, MD, MPH

Poster Presenter

Mrs. Rayleen Jones 2924640, MSN

F044. Outcomes in Patients with Post-Operative Vasoplegia Receiving Angiotensin II for Vasodilatory Shock

Vasoplegia is a common cause of distributive shock and may lead to catecholamine-resistant hypotension. Persistent hypotension due to vasoplegia can be a major risk factor for death among patients following cardiac surgery. In this study, we analyzed the effect of angiotensin II (Ang II) on mean arterial pressure (MAP) in patients with vasoplegia. 

Submissions


CoAuthor(s)

Laith Altaweel
Annette Chavez
Dr. Adam Evans, MD
Bruce Friedman, MD
Damian Handisides
Ara Klijian, MD
Dr. Caleb Mackey, MD
Rakshit Panwar

Poster Presenter

Dr. Ashish Khanna, MD, FCCP, FCCM

F045. Surrogate humane endpoints in small animal models of acute lung injury: A Modified Delphi Consensus Study of Researchers and Laboratory Animal Veterinarians

In many jurisdictions ethical concerns require surrogate humane endpoints to replace death in small animal models of acute lung injury (ALI). Heterogenous selection and reporting of surrogate endpoints renders interpretation and generalizability of findings between studies difficult. We aimed to establish consensus among preclinical scientists and laboratory animal veterinarians on selection and reporting of surrogate endpoints, monitoring of these models and the use of analgesia. 

Submissions


CoAuthor(s)

Dr. Carly Barron, MD, MSc
Dr. Dean Fergusson, PhD
Dr. Arnold Kristof, MD
Dr. Manoj Lalu, MD, PhD, FRCPC
Dr. Dawn Stacey, PhD

Poster Presenter

Dr. Ryan McGinn, MD, MSc

F046. Discordant anti-Xa and PTT levels during unfractionated heparin therapy and increased clinical risk for adverse events

Unfractionated heparin therapy (UFH) is commonly monitored by anti-Xa levels secondary to the more rapid ability to achieve therapeutic anticoagulation than activated partial thromboplastin times (PTT) monitoring, the ability maintain the therapeutic goal for longer, and the reduced frequency for lab monitoring (1). Prior to anti-Xa, PTT monitoring was common and found to be highly variable with poor correlation to exact heparin levels and clinical anti-coagulation (2). However, utilizing anti-Xa monitoring reflects only part of UFH's anticoagulation activity and does not account for levels of prothrombin, factor IX, factor VIII, and antithrombin which can affect an individual's response to UFH. (3) Prior studies have explored the correlation between PTT and anti-Xa monitoring during UFH and high rates of discordance between these values have been found within certain patient populations (3,4,5,6). High PTT values with sub-therapeutic anti-Xa have been associated with high factor VII levels, whereas high anti-Xa levels with sub-therapeutic PTT values have been associated with low factor II levels (3). Clinically, high PTT values with sub-therapeutic anti-Xa were associated with clinically relevant bleeding episodes in adult patients with cirrhosis (7) and post-op pediatric cardiothoracic surgery patients (8), suggesting the need to account for further anticoagulation data. At our institution, clinically relevant bleeding episodes were being noted in critically ill patients admitted on UFH with discordant lab values. We hypothesize that critically ill patients with specific clinical risk factors exhibit high levels of discordance between anti-Xa and PTT values and that the discordance confers an increased clinical risk of bleeding or adverse events suggesting the need for more complete measures of the coagulation process. 

Submissions


CoAuthor(s)

Dr. Andrew Barker, MD
Dr. Brant Wagener, MD PhD

Poster Presenter

Dr. Lauren Myers, MD

F047. Spatial and Temporal Identification of the IL-1β producing cell type in the lung through primary cell expression profiling in intact human and mouse lung tissue

Lung injury, from various etiologies including sterile and infectious injury, result in a coordinated immune and inflammatory response. Early on, this response involves lung resident cell types, including epithelial, endothelial, macrophage, and other cell types; and later, involves recruited cells, including neutrophils, inflammatory monocytes, infiltrating macrophages, T cells, etc. These different cell types produce a multitude of factors and activate numerous signaling pathways that currently are beyond our capabilities to spatially and temporally visualize or integrate. Often visualization and investigation of lung injury responses themselves perturb the system or are limited technologically. These strategies involve lung digestion, live imaging, and antibodies. We chose instead to interrogate lung cells in intact tissue with RNA based probes. Our prior work demonstrated that IL-1β regulates early lung inflammatory responses to sterile lung ischemia reperfusion (IR) injury (ref). Our primary goal in this study was to identify the cellular source(s) of IL-1β within the lung at baseline and after injury. 

Submissions


CoAuthor

Dr. xiaoli Tian, PhD

Poster Presenter

Dr. Arun Prakash, MD, PhD

F048. Inflammatory profile of murine septic AKI: role of CD11c+/CX3CR1+ antigen presenting cells

Acute kidney injury (AKI) is one of the most frequent forms of organ dysfunction and is seen in up to 70% of critically ill patients (1-3). AKI is associated with increased morbidity and mortality and longer ICU stays (4-6). The most common cause of AKI in critically ill patients is sepsis (7). Despite its high incidence and associated morbidity, there are currently no treatment options for septic AKI as the pathophysiology of septic AKI remains poorly understood. The objective of this study was to perform unbiased inflammatory profiling of murine kidneys following septic AKI to identify novel therapeutic immunomodulatory targets. 

Submissions


CoAuthor(s)

Dr. Steven Crowley, MD
Mr. Benjamin Morris, B.S.
Dr. Jiafa Ren, MD

Poster Presenter

Dr. Jamie Privratsky, MD, PhD

F049. Mushroom Poisoning from Amanita Phalloides Resulting in Orthotopic Liver Transplantation

Acute liver failure due to mushroom poisoning is rare but fatal condition especially if liver transplantation is not performed. We report a case of acute liver failure secondary to suspected Amanita phalloides poisoning and successful outcome post liver transplantation. 

Submissions


CoAuthor

Dr. Avneep Aggarwal, M.D.

Poster Presenter

Dr. Jeremy Rainey, D.O.

F050. Role of Innate Immune miRNA→TLR7 Signaling in Sepsis-induced Coagulopathy in Mice

Sepsis is life-threatening organ failure caused by a dysregulated host immune response to infection (1). It is often characterized by marked vascular inflammation and coagulation activation, the two key components inextricably linked in sepsis that lead to widespread microvascular thrombi deposition, impaired tissue perfusion, and clotting dysfunction, a condition termed sepsis-induced coagulopathy (SIC). We have reported that significant amount of host cellular RNAs including microRNA (miRNAs) are released into the blood circulation during sepsis, and that circulating host RNA levels are closely associated with sepsis severity in animals (2). These extracellular (ex) RNA/miRNAs work through innate immune Toll-like receptor 7 (TLR7), originally identified as a sensor for single-stranded RNA viruses (3, 4), and appear to be proinflammatory and uridine (U)-dependent (2, 5, 6). Moreover, our most recent studies have demonstrated that TLR7-deficient (TLR7-/-) and TLR2-/- mice are protected from SIC with lower mortality, improved global clotting function as measured by rotational thromboelastometry, normal platelet count, and normal plasma level of tissue factor (TF), a key clotting factor of the extrinsic coagulation cascade. To further investigate the role of TLR7 in SIC, we test the hypothesis that extracellular miRNAs and TLR7 activation is sufficient to induce TF expression in immune cells. 

Submissions


CoAuthor(s)

Dr. Wei Chao, MD, PhD
Ms. Jessica Neder, BA
Dr. Lin Zou, MD, Ph.D

Poster Presenter

Dr. Brittney Williams, MD

F051. Assessing Post-surgical Mortality Risk Through Nonlinear Coupling of Intraoperative Heart Rate and Blood Pressure Time Series

A number of studies have used diverse perioperative data to assess surgical mortality risk. Of particular interest in the present work are regularly-sampled hemodynamic data, which offer insight into patient stress and myocardial workload. Herein, the focus is on the coupling of mean arterial pressure (MAP) and heart rate (HR) as tools for assessing increased post-surgical mortality risk. In particular, we consider the mutual information (MI) between HR and MAP, a feature which captures more complex, nonlinear dependencies than standard summary statistics such as correlation. 

Submissions


CoAuthor(s)

Dr. David Dunson, PhD
Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Karthik Raghunathan, MD, MPH
Dr. Willem van den Boom, PhD
Dr. Hau-tieng Wu, MD, PhD

Poster Presenter

Dr. Alexander Young, PhD

F052. Efficient Trainee Allocation at an ACGME-accredited Regional Anesthesia and Acute Pain Medicine Fellowship program

The UPMC regional anesthesiology and acute pain medicine (RAAPM) fellowship is the largest ACGME accredited program of its kind today. Our program consists of 15 fellows and multiple rotation sites across the health system that offers both the depth and breadth of clinical experience necessary for the growth of our trainees. The Acute Interventional Perioperative Pain Service (AIPPS) at each site receives daily consults for nerve block procedures and acute pain management. However the case volume at each location on any given day can be very different. While we are fortunate to have the clinical staff and resources to sustain such a program, one of the challenges we face is efficiently allocating our fellows given the day to day variability of first start operating room cases and overall daily case volume at each site. Our purpose is to examine the aggregated daily case volume from each clinical site and describe a unique approach to allocating trainee resources within the healthcare system. 

Submissions


CoAuthor

Nicholas Schott, MD

Poster Presenter

Dr. Mushfique Ahmed, MD

F053. The Current State of Combined Pediatric Anesthesiology and Critical Care Medicine: A Survey of Dual-trained Practitioners in the United States

The original practitioners of pediatric critical care medicine (PCCM) were anesthesiologists who pioneered the field in collaboration with pediatricians. While combined specialty model is relatively common in adult practice, it is increasingly rare in pediatrics. The reasons for this temporal shift are unclear, but may relate to extended training, board certification requirements, and opportunity cost. To investigate this, we conducted a cross-sectional survey of dual-trained providers in the US. The specific aims were to 1) determine the basic demographics, training background, and career trajectories of dual-trained physicians in the US, 2) discover whether they continue to have a dual-specialty practice, and if not, the reasons why they have restricted practice, and 3) characterize the perceived barriers to both completing the requisite training and continued practice in both domains. 

Submissions


CoAuthor(s)

Arbi Ben Abdallah, PhD
Lindsay Juriga
Dr. Todd Kilbaugh, MD
John McCloskey
Timothy Welch

Poster Presenter

Dr. James Fehr, MD

F054. Insurance Payor Status not an independent risk factor for Post-operative complications of Anterior Lumber Interbody Fusion Surgeries

Bundled payment reimbursement models are becoming more common place for spine surgeries as hospitals receive payments per episode of care. As such, predictors for complications and prolonged hospital stay are important in minimizing expenses and maximizing revenue. Medicare and medicaid status is traditionally a socioeconomic predictor for post-operative complications and, therefore, financial risk. We investigated whether this held true for the Anterior Lumbar Interbody Fusion (ALIF) procedures since there has been a growing number of Medicare patients in recent years with healthcare plans that reimburse providers per encounter. But, given the safety profile and success of the ALIF procedure, it is unclear if insurance status is a risk-factor for increased complications resulting in increased costs, as is the case for most healthcare issues. In this study, we investigated the association of insurance status and complications. Furthermore, direct costs were analyzed across the different payor types. We hypothesize that no differences occur between the commercial, managed care, medicare and medicaid payor classes in regards to post-operative outcomes and expenses. 

Submissions


CoAuthor(s)

Dr. Jonathan Gal, MD
Sean Neifert, BA
Daniel Snyder, BA

Poster Presenter

Dr. John Foote Jr., MD

F055. Does a simulation course lead to improved management of an emergency situation? To determine the efficacy of a simulation course on clinical and non-clinical competency.

During personal reflection, many final year medical students reported inability to competently handle daily situations as well as inexperience with common emergency scenarios [1] [2]. A new course design was developed and implemented to address perceived inadequacies using daily ward situations and emergency scenarios with standardized patients/manikins followed by video-assisted personal feedback. The aim of our study was to investigate if participation in the course led to any changes in management of a standardized emergency scenario. 

Submissions


CoAuthor

Cynthia Szalai, Dr. med.

Poster Presenter

Dr. Stephanie Herbstreit MME, Dr. med.

F056. Point-of-Care Ultrasound Education in Anesthesiology: How can we use the PGY1 year?

Background: Point-of-care Ultrasound (POCUS) has become a valuable tool for the perioperative physician, allowing early identification of major abnormalities. In addition to ultrasound guidance for procedures, several publications have indicated the advantages of perioperative transthoracic echocardiography (TTE), abdominal ultrasound (FAST), and lung ultrasound for patient care.1 Anesthesiology residency programs are challenged to provide adequate learning opportunities for this novel technology. Ramsingh et al have outlined a very comprehensive training program.2 However, the implementation of this program requires a significant amount of faculty time and resources. We explored if a web-based POCUS training program is able to allow faculty-independent POCUS learning during the PGY-1 year. The aim of this study was to compare our standard POCUS training with the self-directed web-based POCUS training. 

Submissions


CoAuthor(s)

Ms. Amy DiLorenzo, MS
Dr. Jeremy Dority, MD
Dr. Annette Rebel, MD
Dr. Randall Schell, MD, MACM

Poster Presenter

Dr. Jon Holzberger, M.D.

F057. The Impact of Caffeine Ingestion on the Driving Performance of Anesthesiology Residents after Six Consecutive Overnight Work Shifts

Residency training involves care of hospitalized patients who require nearly continuous medical and surgical care. For resident physicians, this necessitates working extended shifts, including overnight shifts, resulting in altered sleep patterns and sleep deprivation.1 In addition to affecting patient care, sleep deprivation also has the potential to affect resident well-being by altering residents' ability to perform basic tasks including driving. Recently, we found that resident physicians have greater difficulty controlling speed and driving performance with increased reaction times and minor and major lapses in attention in the driving simulator following six consecutive night shifts.2 While the effect of night work on driving simulator performance has been studied, less is known about possible interventions, including caffeine consumption, and their effects on driving performance by residents after night shifts. 

Submissions


CoAuthor(s)

Daniel Cox, PhD, ABPP
Dr. Amanda Kleiman, MD
Mr. Matthew Moncrief, BS
Dr. Edward Nemergut, MD
David Scalzo, MD

Poster Presenter

Dr. Julie Huffmyer, MD

F058. [Withdrawn] Electronic Decision-Support Tools to Enhance Compliance with Performance Measures for Perioperative Temperature Management

Payers for anesthesia services have increasingly shifted in recent years from a fee-for-service model to a value-based model which ties payment to performance on quality and value metrics. The Centers for Medicare & Medicaid Service's Quality Pay for Performance program includes a quality measure focused on perioperative temperature management. Compliance with the quality measure requires refinement of data collection and reporting intraoperatively and postoperatively, as well as improvement in clinical practice. In addition to improving data capture, we implemented and evaluated an electronic decision-support tool in our anesthesia information management system to improve intraoperative adherence to this emerging standard. 

Submissions


CoAuthor(s)

Dr. Jonathan Gal, MD
Dr. Andrew Leibowitz, MD
Dr. Matthew Levin, MD
Dr. Hung-Mo Lin, ScD

Poster Presenter

Dr. Sameer Lakha, MD

F059. Trends in monthly frequency of common elective procedures based on insurance status- a National Inpatient Sample analysis

The volume of elective surgeries in the insured population reflects geographical and temporal differences in medical insurance policies (1, 2). It is likely that medical insurance status affects the frequency distribution of elective procedures over the course of the year. Financial factors such as annual co-pay limits may incentivize patients who have reached the limit to schedule additional elective procedures before the end of the coverage year. We hypothesized that insurance status would be associated with annual variability of the most common elective surgical procedures which would have significant implications for anesthesiology practices. 

Submissions


CoAuthor(s)

Dr. Richard Dutton, MD, MBA
Dr. Alexander Nagrebetsky, MD, MSc
Dr. Richard Urman, MD, MBA

Poster Presenter

Dr. Daewoong Lee, MD

F060. Women in Anesthesiology: Playing in the Sandbox is Not a One "Man" Show

Despite the increasing number of female anesthesiologists in Canada, women remain underrepresented in academic medicine and leadership.1 The reasons behind this are not fully understood but may include family responsibilities, inadequate mentorship, and lack of desire.2 Even when adjusted for part-time work, maternity leave and productivity, women are less likely to be promoted. A less frequently proposed issue is gender discrimination.3 The purpose of this study was to assess gender differences in career experiences, satisfaction, and advancement in academic anesthesiology. 

Submissions


CoAuthor(s)

Dr. Tulin Cil, MD, MEd, FRCSC
Dr. Alana Flexman, MD
Dr. Fiona Webster, PhD

Poster Presenter

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

F061. Women Program Directors in Anesthesiology: Closing the Gender Gap

Despite progress made over the past decades, women in academic medicine are less likely to reach leadership positions such as chair or dean. Women represent 46% of all US medical school graduates (1). However, fewer women are staying in academics and in anesthesiology, women represent 36.8% of residents, 35% of full-time faculty, 18% of professors, and 10% of chairs (2). Bissing et al. noted in their recent report that the gender gap was closing for program directors (PD) in anesthesiology, and that gender parity would soon be achieved for this academic leadership position (3). Our hypotheses were that across academic anesthesiology programs in the US: 1. Women are underrepresented in positions of PD 2. It takes longer for women to achieve PD position, compared to men. This study was designed with a primary aim to explore characteristics of academic anesthesiology PD along two aspects: 1) gender and 2) years in practice prior to becoming PD. The secondary aims of this study were to determine presence or absence of associations between PD gender and program characteristics, such as geographic region, NIH funding, and program size. 

Submissions


CoAuthor(s)

Dr. Maya Hastie, MD
Dr. Teresa Mulaikal, MD
Dr. Alexander Rusanov, MD

Poster Presenter

Dr. Andrea Miltiades, MD

F062. Use of 30-day versus 90-day Mortality Rates Following Cardiac Surgery to Compare Quality in New York State

Following cardiac surgery in New York State (NYS), a composite of 30-day and in-hospital mortality is a publically reported quality metric. 90-day mortality, however, may be a more meaningful outcome and may also be reflective of discharge practices which are not apparent at 30 days. (1-4) Hypothetically, post-discharge mortality may contribute substantially to post-surgical deaths, and the ability to capture these deaths may result in a more accurate measurement of a hospital's quality. We aimed to determine if use of 90-day mortality following cardiac surgery, as compared to 30-day mortality, would result in changes in the assessment of a hospital's quality. 

Submissions


CoAuthor(s)

Dr. Michael Argenziano, MD
Dr. Zara Cooper, MD
Dr. May Hua, MD, MSc
Dr. Dae Hyun Kim, MD

Poster Presenter

Dr. Aaron Mittel, MD

F063. Citation of retracted articles in anesthesiology- a systematic review

Recent studies have demonstrated a relative increase in the number of retracted articles. The increase in retracted articles is largely related to overall growth in the scientific publications.[1] Continuing to cite retracted articles during the post-retraction period challenges research integrity, especially when fraudulent studies are used to support the design of a new study. We are not aware of research exploring citation of anesthesiology retracted articles in the post retraction period and conducted a literature review, to evaluate the prevalence of continued citation of retracted articles in the specialty. 

Submissions


CoAuthor(s)

Dr. David Adams, M.D.
Dr. Ellise Delphin, MD, MPH
Jonathan Leff, M.D.
Mr. Benjamin Schwartz, BS

Poster Presenter

Dr. Singh Nair, PhD

F064. Reliability Analyses of the Objective structured clinical examination (OSCE) component of the Applied Certification Examination using Generalizability Theory.

Proper assessment of clinical ability among medical trainees is an ongoing challenge for educators. Knowledge-based written examinations are often utilized, and many tools that require the direct observation of a trainee's skills during patient care also exist. Increasingly, simulation-based assessment is being employed because of the opportunity for standardization, fidelity, and reproducibility. The Objective Structured Clinical Assessment Examination (OSCE), for example, is one such simulation-based assessment method that was introduced in the late 1970s. Estimating reliability, or the consistency of the assessment, is challenging because OSCEs are inherently multifaceted with variance in scores influenced by many sources. There are no studies in anesthesiology describing the utility and predictive value of OSCEs using generalizability theory. This study demonstrates the use of generalizability theory (G theory)10, which identifies factors influencing the variability of scores, calculates a refined measure of reliability, and makes post hoc projections of reliability when altering the structure of the OSCE. 

Submissions


CoAuthor(s)

Dr. Linda Liu, MD
Dr. Alex Macario, MD, MBA
Kate Tobin McCartney, MD
Yoon Soo Park, PhD
Dr. Charandip Sandhu, MD
Jared Spilka, MD
Dr. Ankeet Udani, MD, MSEd
Chelsia Varner, MD
Roya Yumul, MD, PhD

Poster Presenter

Dr. Pedro Tanaka, MD, PhD, MACM

F065. Comparing prefilled syringes of phenylephrine to standard practice in an operating room setting

While glass prefilled syringes are not new and have been stocked on cardiac arrest carts for years, newer plastic prefilled syringes are now manufactured and could become part of routine anesthetic care in the operating room. Prefilled syringes have been shown to enhance both speed and accuracy of drug delivery, especially in critical situations (Ref. 1, 2, 3). The Anesthesia Patient Safety Foundation has stated: "Routine provider-prepared medications should be discontinued whenever possible" and "Standardized pre-prepared medication kits by case type should be used whenever possible" (Ref 4). To investigate this issue an in situ simulation based study was performed randomizing participants to use either a prefilled syringe (PFS) or a self-filled syringe (SFS) to treat intraoperative hypotension. 

Submissions


CoAuthor

Dr. Stephen Choi, MD. FRCPC, MSc

Poster Presenter

Dr. Jordan Tarshis, MD, FRCPC

F066. Gender Differences among Adult Critical Care Program Directors

Recent studies have identified persistent gender differences in academic productivity, rank, and financial institutional support. These disparities are most evident in medicine, science, technology and engineering fields. This purpose of this study was to examine whether gender among program directors in adult critical care medical programs is associated with the production of scholarly works. 

Submissions


CoAuthor(s)

Mohammed Almualim, MBBS
Dr. Deborah Culley, MD
Dr. Brenda Fahy, MD, MCCM
Dr. Rogerio Santos, MD
Dr. Peggy White, MD

Poster Presenter

Dr. Terrie Vasilopoulos 2738910, PhD

F067. Accelerated Three Year MD Pathway For Future Anesthesia Residents

Our institution has an accelerated pathway that allows students to complete their curriculum and earn the medical degree in three years. Those students who have realized their career choice have the opportunity to apply to the three year program at the point of matriculation and two opt-in periods (winter of their first year and summer of their second year). Our Anesthesiology residency program reserves two spots a year for three year pathway students. The institution has accepted 86 students into the three year program from 2013 to 2017 with 3 of those students accepted into the Anesthesiology program. 

Submissions


CoAuthor(s)

Dr. Justin Feit, MD
Dr. David Furgiuele, MD
Mr. William Kim
Dr. Mitchell Lee, MD
Dr. Aaron Primm 8930902, MD
Dr. Ian Zolnowski, MD

Poster Presenter

Dr. Michael Wajda, MD

F068. Intraoperative Hypertension and Postoperative Intensive Care Unit (ICU) Admission Among Older Cancer Patients

Since older age has been previously shown to be the most significant factor for developing cancer, the number of older adults with cancer will almost surely continue to rise. Surgery is one of the primary treatment options for many cancers. Instead of age, frailty should be evaluated in the preoperative evaluation with the comprehensive geriatric assessment (CGA) as its gold standard. Intraoperative hemodynamic variables can correlate with negative outcomes especially in the older cancer patient. In our study, we aimed at assessing the relationship between intraoperative variables on the incidence of postoperative ICU admission among older adults with cancer who underwent surgery lasting at least 120 minutes following adjustment for patients' frailty status. 

Submissions


CoAuthor(s)

Dr. Gregory Fischer 9998601, MD
Mr. Dahniel Sastow, B.S
Dr. Armin Shahrokni, MD

Poster Presenter

Dr. Anoushka Afonso, MD, FASA

F069. Ease of Implementing Routine Preoperative Cognitive Screening to Identify Surgical Patients at Risk for Perioperative Neurocognitive Disorder

The most common perioperative complication to affect older adults is the development of a perioperative neurocognitive disorders (NCD) such as delirium or delayed neurocognitive recovery. The reported incidence ranges from 13 to 50% leading to increased length of stay and healthcare costs, with decreased patient satisfaction and potential decrease in postoperative global functioning [1,2]. The greatest risk factor for developing perioperative NCD is preoperative cognitive impairment [1,2] Despite this knowledge, and the recommendation by American College of Surgeons and American Geriatrics Society [3,4] for routine preoperative cognitive screening, a recent survey presented at ASA 2018 revealed that 90% of Anesthesiologists do not routinely screen older adults for pre-existing impairment. Our aim is to demonstrate the ease of implementing routine preoperative cognitive screening and how the results can be used to drive the development of a Brain Health improvement pathway. 

Submissions


CoAuthor(s)

Arash Motamed, M.D.
Dr. Carol Peden, MD MPH

Poster Presenter

Dr. Justyne Decker, M.D.

F070. [Withdrawn] Hemodynamic effects of dexmedetomidine on elderly patients with proximal femoral fractures under spinal anesthesia.

Proximal femoral fractures are related to high rates of morbidity and mortality in elderly patients. Spinal anesthesia is the common anesthetic method for elderly patients with proximal femur fractures. Dexmedetomidine (DEX) rarely affects the respiratory system, so it is useful for the sedation of elderly patients. This study investigated retrospectively the effect of dexmedetomidine on the hemodynamic values in elderly patients undergoing proximal femoral surgery under spinal anesthesia. 

Submissions


CoAuthor(s)

Dr. Jaehwan Kim, Medical Doctor
Dr. Jaehong Park, Medical Doctor
Dr. Dongju Shin Shin, Medical Doctor

Poster Presenter

Dr. Sangeun Lee, Medical Doctor

F071. A survey of older people after major surgery: Prioritization of routine and patient-reported postoperative outcome measures

Most major surgeries are performed for people >65 years, who experience a 2- to 4-fold increase in their risk of adverse outcomes compared to younger people. However, older people can and do benefit from surgery. To allow older people to make fully informed decisions about proceeding with surgery, research is needed to identify which outcomes matter most. The objective was to survey older people who have had major surgery to determine the importance of routinely collected, as well as patient-reported, outcomes. 

Submissions


CoAuthor(s)

E Beasley, BSc
Dr. Gregory Bryson, MD, FRCPC, MSc
E Hladkowicz, MA
Dr. Daniel McIsaac, MD, MPH, FRCPC

Poster Presenter

Ms. Julia Shaw, B.Sc. Kinesiology

F072. The impact of frailty on outcomes in adult trauma patients: a systematic review and meta-analysis

Many geriatric trauma patients have frailty, a multidimensional syndrome relate to accumulation of age- and disease-related deficits, which contributes to poor outcomes. Frailty tools have been systematically reviewed in trauma, however the association of frailty with outcomes after a traumatic injury has not been synthesized. The objective was to measure the association between frailty and outcomes after multisystem trauma. 

Submissions


CoAuthor(s)

Dr. Manoj Lalu, MD, PhD, FRCPC
J Lampron, MD
Dr. Daniel McIsaac, MD, MPH, FRCPC
F Nguyen, BSc
A Poulton, MD
A Tran, MD
C Wong, MD

Poster Presenter

Ms. Julia Shaw, B.Sc. Kinesiology

F073. Anaphylaxis associated with sugammadex: a case report

Anaphylaxis is a severe hypersensitivity reaction that can arise during any surgical or anesthetic procedure. It has a low incidence and is most commonly caused by neuromuscular blocking agents and antibiotics. Sugammadex is a reversal agent for rocuronium and vecuronium that offers a faster recovery from neuromuscular blockade. However, it has also been associated with serious hypersensitivity reactions. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Ioannis Angelidis, MD, MSPH

F074. Management of a Thrombus Overriding a Patent Foramen Ovale in a Patient with Concomitant Pulmonary Embolism

Patients with patent foramen ovale (PFO) are asymptomatic most of the time but are at risk of having a paradoxical embolism. The risks become even higher with concomitant deep venous thrombosis and a pulmonary embolism (PE). What would be the correct management when a thrombi is found transiting the PFO or a thrombus straddling the PFO (TO-PFO). That is what we try to answer in this case. 

Submissions


CoAuthor(s)

Dr. Oscar Aljure, MD
Dr. ROGER ALVAREZ, DO
Dr. RAFAEL ARCINIEGAS FLORES, MD
Dr. John Carey, MD
Dr. Srikar Jonna, MD
Dr. Ricardo Martinez Ruiz, MD
Dr. Anna Schuerner, MD
Dr. Arnaldo Vera-Arroyo, MD
Dr. Richard Zack-Guasp, MD

Poster Presenter

Dr. CHRISTIAN BALABANOFF ACOSTA, MD

F075. The Supertube: A Novel Lung Isolation Technique in Managing Bronchopleural Fistula

Bronchopleural fistula (BPF) is an abnormal communication between the bronchial tree and pleural space. The incidence of BPF after pneumonectomy is reported to be 4-20% [1], with a mortality rate of 25-71% [1, 2]. As such, BPF is one of the most serious and challenging post-operative complications of surgical lung resections. A case is presented in which the complex airway management of a patient with post-pneumonectomy right-sided BPF required the use of a novel lung isolation technique dubbed the Supertube. This is only the second documented instance of the Supertube's success at achieving lung isolation and the first documented instance of its use in the treatment of BPF. 

Submissions


CoAuthor(s)

Carlee Clark, MD
Dr. Stephanie Whitener, MD

Poster Presenter

Dr. Kacie Bhushan, DO, MPH

F076. Anesthetic Experience with MR-Guided Infusion of Adeno-Associated Virus Encoding Human Aromatic L-Amino Acid Decarboxylase (AADC) into the Midbrain of Pediatric Patients with AADC Deficiency

Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare, autosomal recessive disorder, with just over 100 cases diagnosed since its first description in 1990. This disorder is characterized by deficient synthesis of dopamine and serotonin, and, subsequently, epinephrine and norepinephrine. Patients present in infancy or early childhood with severe motor, cognitive, and behavioral impairments, such as hypokinesia, hypotonia, dysphagia, oculogyric crises, and autonomic disturbances. Treatment has included dopamine agonists, monoamine oxidase inhibitors, and pyridoxine (1, 2). A novel treatment which is being developed is infusion of a viral vector, adeno-associated virus type 2 (AAV2), which encodes the human AADC (hAADC) gene, into the human striatum or the midbrain (1, 3). We describe the anesthetic care of a cohort of subjects at our institution enrolled in a single-stage dose-escalation, open-label safety study of image-guided convection-enhanced AAV2-hAADC delivery into the midbrain (NCT02852213). 

Submissions


CoAuthor(s)

Dr. Nalin Gupta, MD, PhD
Dr. Gabriel Sarah, MD

Poster Presenter

Dr. Josemine Carey, MD

F077. Superior Vena Cava In The Operating Room

Superior Vena Cava syndrome involves an insidious compression of the superior vena cava (SVC), commonly characterized by upper chest and neck swelling, plethoric face, and edema. It is usually indicative of an intrathoracic neoplasm in proximity to the SVC and can present cardiopulmonary challenges to the anesthesia team. We describe the anesthetic management of a patient with a paratracheal mass complicated by Superior Vena Cava syndrome. 

Submissions


CoAuthor

Dr. Ahmed Khan, MD

Poster Presenter

Dr. Adaora Chima, MBBS, MPH

F078. Mediastinal mass necessitating awake cannulation for cardiopulmonary bypass

We present a 34-year-old woman who underwent surgical debulking of a large mediastinal mass through sternotomy. Her femoral vessels were cannulated for cardiopulmonary bypass (CPB) prior to induction of anesthesia under local analgesia given concern for cardiopulmonary collapse and loss of airway. While the patient did not require CPB support, this case highlights the interdisciplinary teamwork and anticipatory measures required for safe management of a complex patient. 

Submissions


CoAuthor

Dr. George Gilkey, MD

Poster Presenter

Dr. Grace Cunningham, MD

F079. A RECURRENT RARITY: our patient with HAE and acute laryngeal edema

Hereditary angioedema (HAE) is a rare yet serious condition caused by either C1-inhibitor (C1INH) deficiency or instead defective C1INH molecules with normal C1INH plasma concentrations. There are currently 4 known subtypes (see fig. 1), expressed through autosomal dominant inheritance.[1] Patients can rapidly develop life threatening or fatal upper airway edema. [2] HAE appears to be a bradykinin-mediated process, and is distinct from non-hereditary angioedema which is a Type 1 hypersensitivity reaction mediated by histamine. We present a case of acute HAE in the post-operative setting. 

Submissions


CoAuthor

Dr. Jeffrey White, MD

Poster Presenter

Dr. Warren Fowler, MD

F080. Cervical Spine Surgery with Neuromonitoring Under Total Intravenous Anesthesia in the Patient with a History of Stevens-Johnson Syndrome - How Did I Tailor My Anesthetic?

Stevens–Johnson syndrome (SJS) is a life-threatening hypersensitivity reaction. This syndrome is caused by an immune response to a wide range of drugs and infections. Though commonly implicated medications are sulfonamides, penicillins, barbiturates, and phenytoin, any substance is a potential threat. Patients with a history of SJS may present for spine surgery at any point during course of their disease. These cases are commonly considered a unique anesthetic challenge. Guidelines are still being elucidated. Here, we present an uncommon case of the patient with a history of SJS who presented for anterior cervical spine surgery under Total Intravenous Anesthesia (TIVA) with intraoperative neuromonitoring. 

Submissions


CoAuthor(s)

Dr. Marina Moguilevitch, MD
Dr. Sergey Pisklakov, MD

Poster Presenter

Dr. Daniel Garcia, MD, PhD

F081. Persistent Delirium from Recurrent Infective Parotitis Exacerbated by Dexmedetomidine in the Trauma Intensive Care Unit

Dexmedetomidine is a highly selective alpha2 adrenoreceptor agonist commonly used for its sedative properties in the intensive care unit (ICU). It also decreases salivary secretion through sympatholytic and vagomimetic effects, which is often beneficial for awake intubations. 

Submissions


CoAuthor(s)

Dr. Caleb Harrell 7674120, MD
Dr. Arturo Torres, MD

Poster Presenter

Dr. Steffin Golden, MD

F082. A Case of Acute Hypotensive Transfusion Reaction from Bradykinin Release Syndrome: A Possible Association with a Novel ACE Missense Mutation

Acute hypotensive transfusion reaction (AHTR) is a rare phenomenon characterized by sudden and often severe hypotension in response to exogenous blood product which typically responds to vasopressor administration and usually resolves with discontinuation of the transfusion.1 In patients taking ACE-inhibitors (ACE-I), AHTR appears to be more severe, due to inhibition of bradykinin metabolism, which is associated with nitric oxide mediated arterial vasodilation. 2 Further, bradykinin levels increase with blood filtration products and negatively charged membranes such as those found on extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB) circuits. 3 To date, there have been several case-reports,4-5 but no predisposing factors nor genetic association studies have been reported. 

Submissions


CoAuthor(s)

Dr. Tarif Chowdhury, MD
Joseph Hostyk, BA
Dr. Ruth Landau, MD
Dr. Peter Yim, MD

Poster Presenter

Dr. Andrew Greenwald, MD

F083. Anesthetic Management of Superimposed Pre-eclampsia with Severe Features Complicated by Severe Mitral Stenosis Secondary to Rheumatic Heart Disease

Rheumatic heart disease (RHD) is endemic in the developing world yet rarely presents in the United States thanks to the effectiveness of antibiotic treatment of streptococcal infections. While sequelae can be widespread, of the most concerning to the anesthesiologist is mitral valvular (MV) disease. While many patients with MV disease from RHD remain relatively asymptomatic for decades after disease development, certain insults can precipitate worsening of symptoms. Pre-eclampsia is the development of hypertension with proteinuria or hypertension with end-organ dysfunction in women after the 20th week of pregnancy. It occurs in roughly 3% of pregnancies in the US and a previous pregnancy with pre-eclampsia increases the risk 8 fold. The disease is characterized by widespread vascular dysfunction in the mother that can lead to symptoms ranging from headache to death. 

Submissions


CoAuthor

Dr. Gene Yocum, MD

Poster Presenter

Dr. Andrew Greenwald, MD

F084. Neuroleptic Malignant Syndrome in Patient with a Saddle Pulmonary Embolus

Neuroleptic Malignant Syndrome (NMS) is a life-threatening medical emergency associated with neuroleptic medication use and characterized by mental status changes, extrapyramidal symptoms, fever, and autonomic instability.[sup]1[/sup] This study describes a medically challenging case of a surgical patient with a complex hospital course who was found to have NMS in the setting of severe agitation, primary mood disorder, and bilateral pulmonary emboli. 

Submissions


CoAuthor(s)

Dr. Genevieve Manahan, MD
Dr. Albert Yen, MD

Poster Presenter

Dr. Jonathan Kim, MD

F085. [Withdrawn] Awake Deep Brain Stimulation for the Treatment of Childhood Secondary Dystonia

Primary (genetic) and secondary dystonia are conditions characterized by involuntary muscle contractions resulting in repetitive movements and contorted postures. Treatment for childhood secondary dystonia, most commonly associated with cerebral palsy, has historically focused on medications, but these are limited by side effects and waning efficacy over time¹. Deep brain stimulation (DBS) of the internal globus pallidus has emerged as a treatment for childhood dystonias². Most centers perform DBS under general anesthesia in children, as awake surgery is particularly difficult in this population. However, awake DBS provides the ability for intraoperative evaluation to ensure accurate lead placement³. We present a case of a 16 year-old male with history of generalized dystonia who successfully underwent awake DBS. 

Submissions


CoAuthor(s)

Dr. Christopher Fjotland, MD
Dr. Samuel Kiel, MD

Poster Presenter

Dr. Adeline Kim, MD

F086. Management of a patient with a large anterior mediastinal mass and syncope

Anterior mediastinal masses are uncommon in adults and present unique anesthetic challenges. Cardiovascular collapse and inability to intubate or ventilate are feared complications in the anesthetic management of these patients. Patients are often unable to lie flat due to compression of respiratory structures, and even with an endotracheal tube in place, mediastinal masses can compress smaller airways and impede ventilation. Neuromuscular blockade is dangerous due to the possibility of laryngomalacia and airway obstruction. Vascular compression is common. Superior vena cava syndrome may result from venous compression. This may potentiate an already difficult airway by contributing to laryngeal edema. Significant vascular compression may lead to cardiovascular collapse, elevated ICP, or TIA/CVA. 

Submissions


Poster Presenter

Dr. Kate Klatman, MD

F087. Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation Following Outpatient Cardioversion

In older patients, atrial fibrillation (AF) is the most common supraventricular arrhythmia encountered in practice (1). Elective cardioversion (ECV) for rhythm disturbances is commonly performed in the outpatient setting and is considered standard of care (1). Post-procedure bradyarrhythmia and sinus node arrest are known complications after cardioversion of atrial arrhythmias. Gronberg et. al reported a 0.9% rate of bradyarrhythmias and 0.7% rate of asystole > 5 seconds (3). Of those patients with bradycardic complications, 44% subsequently underwent permanent pacemaker placement (2). Other studies have shown similar rates of immediate bradyarrhythmic and cardiac arrest events, occurring in 0.4% and 0.1% of patients respectively (Steinberg) and 1.8% (Siaplaouras) (3, 4). Risk factors for post-ECV arrhythmias might include atrial flutter and previous cardiac surgery (1). 

Submissions


CoAuthor

Dr. Maurice Joyce III, MD, EdM

Poster Presenter

Dr. Danielle Lovett-Carter, MD

F088. The Other Negative Pressure Cavity: A Rare Case of an Epidural-Induced Pleural Effusion

Thoracic epidurals are a key component of multimodal analgesia in patients undergoing upper abdominal surgeries and have shown to provide excellent postoperative pain relief while reducing perioperative opioid consumption. Placing thoracic epidurals can be done via the midline or paramedian approach. Due to the overhanging vertebral spines, the midline approach can be very difficult and is often unsuccessful. As such the paramedian approach is more utilized instead. Although easier for most anesthesiologists, this technique is not without its risk. This study presents a rare complication of an epidural-induced pleural effusion due to misplacement of the catheter via the paramedian approach and the strategy used to recognize, treat, and manage this complication. 

Submissions


CoAuthor(s)

Dr. Christine Choi, MD
Dr. Kashif Khan, MD
Dr. Jonathan Kim, MD

Poster Presenter

Dr. Genevieve Manahan, MD

F089. Successful management of a pediatric acute aortic dissection: a case report

Acute aortic dissection usually occurs in adults with a history of hypertension or some connective tissue diseases and it rarely occurs in children or adolescences. We experienced a rare case of AAD in a child with no specific past medical history or family background. Herein, we report successful perioperative management of a pediatric AAD case. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Hiroki Matsushita, MD

F090. Irreversible anaphylaxis to thymoglobulin in living donor renal transplantation

Thymoglobulin is a rabbit-derived antibody commonly used in renal transplantation. Its administration can be associated with various transfusion reactions. Anaphylaxis is amongst the most catastrophic reactions to thymoglobulin, and presents a significant challenge to anesthesiologists. We present, as far as we know, the first case of irreversible anaphylaxis to thymoglobulin in renal transplantation leading to a fatal outcome. 

Submissions


CoAuthor

Dr. Mark Weller, MD

Poster Presenter

Dr. William Qiao, MD

F091. Angiotensin II For Treatment Of Severe Refractory Distributive Shock Post Cardiac Bypass.

The purpose for this report is to strengthen the evidence behind using Angiotensin II in the setting of distributive shock. 

Submissions


CoAuthor

Dr. Marcela Hanakova, M.D.

Poster Presenter

Dr. Patrick Savery, D.O.

F092. Pancreatic Artery Pseudoaneurysm After Right Nephrectomy, Retroperitoneal Lymph Node Dissection with IVC Reconstruction: a rare but important complication after idiopathic pancreatic injury

Pancreatic artery pseudoaneurysms, though uncommon, can lead to life threatening complications. It is necessary to have a high index of suspicion in those with a history of pancreatitis or pancreaticobiliary surgery given these are the most common settings in which pancreatic pseudoaneurysm develops. Proper diagnosis and timely intervention can greatly improve outcomes, with the mortality rate of 20-30%, varying based on location of pathology. 

Submissions


CoAuthor

Dr. Peiman Lahsaei, MD

Poster Presenter

Dr. Opetomi Seriki, DO, MPH

F093. Central Diabetes Insipidus Due to Ketamine Infusion in a Patient on Veno-Venous Extracorporeal Membrane Oxygenation

Ketamine, a chemical derivative of phencyclidine, has been used frequently in intensive care units via prolonged infusions for agitation and pain management1. Through N-methyl-d-aspartate (NMDA) receptor antagonism, ketamine provides rapid sedation and analgesia. Ketamine preserves gastrointestinal motility and respiratory function, and decreases vasopressor and opioid requirements, particularly in post-operative patients1. Here we describe a patient placed on a ketamine infusion for sedation while on veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) who subsequently developed central Diabetes Insipidus (DI). 

Submissions


CoAuthor

Dr. Christin Kim, MD

Poster Presenter

Dr. Juhee Sharma, MD

F094. The Case of The Traveling Tumor

CASE: A 43 year old gentleman with history of shortness of breath for 4 months, presented for surgical resection of left sided non-small cell carcinoma of the lung after bronchoscopy revealed a left main-stem tumor. Under sedation, a thoracic epidural and an arterial line were placed. Prior to induction and placement of double-lumen endotracheal tube for one lung ventilation, fiber optic bronchoscopy confirmed presence of a tumor in distal left mainstem bronchus at 3.5 cm from the carina. The case then proceeded with placement of double lumen tube. Following stapling of left main bronchus after removal of tumor, ETT was pulled back slightly for safety. Immediate increase in peak pressure noted with loss of end tidal CO2, inability to ventilate was noted. Patient was switched to 100% oxygen, circuit checked and ETT suctioned, slightly withdrawn, and hand ventilation attempted, all without success eventually resulting in hypoxia. The DLT was removed and a single lumen tube inserted via Glidescope guidance without success. Patient was then placed in supine position and was able to be ventilated, albeit with difficulty. Fiber optic bronchoscopy revealed a large piece of tumor in right mainstem causing a near total obstruction of the right main bronchus. Patient was hand ventilated and tumor removed via rigid bronchoscopy. Case proceeded uneventfully thereafter. 

Submissions


Poster Presenter

Dr. Jaspinder Sra, MD

F095. Prolonged unexpected hypotension after routine combined spinal epidural in an obese parturient

Hypotension after neuraxial anesthesia is common. Studies have shown that it occurs in about 50-60% of spinal anesthetics for caesarian section [1] and may even be as high as 80% [2]. A common mechanism proposed is decreased sympathetic vascular resistance leading to peripheral venodilation. This causes peripheral pooling of blood, resulting in decreased venous return and cardiac output [3]. Obesity is a risk factor for this phenomenon [4]. Severe hypotension requiring multiple vasopressors and long periods of resuscitation, however, seems to be uncommon especially without obvious additional cause. Antepartum hypotension is particularly concerning, as placental and maternal end-organ perfusion may be compromised. Importantly, hypotension has been associated with increased maternal and fetal morbidity [4]. We present a case of combined spinal epidural (CSE) for labor analgesia in which the patient developed prolonged symptomatic hypotension requiring multiple vasopressors and fluid resuscitation. 

Submissions


CoAuthor

Dr. Keith Vogt, MD, PhD

Poster Presenter

Dr. Aisha Ullah, MD

F096. Implementation of Extracorporeal Membrane Oxygenation For Severe Acute Respiratory Distress Syndrome in a Patient with Recent Subarachnoid Hemorrhage

Traditionally, extracorporeal membrane oxygenation (ECMO) has been contraindicated in patients with subarachnoid hemorrhage due to risk of bleeding and the need for systemic anticoagulation. We present a case of a patient admitted to the neurosurgery intensive care unit after a ruptured intracranial aneurysm coiling who developed severe acute respiratory distress syndrome unresponsive to conventional therapy and was successfully treated using veno-venous ECMO. 

Submissions


CoAuthor(s)

Dr. Maher Baz, MD
Dr. Stephen Grupke, MD
Dr. Bjorn Olsen, MD

Poster Presenter

Dr. Ekaterina Fain, MD

F096. [Withdrawn] An uncommon cause of lactic acidosis in a renal transplant recipient.

Most cases of intraoperative lactic acidosis are due to marked tissue hypoperfusion, resulting from hypovolemia, cardiac failure or sepsis, malignancy, alcoholism, and rarely in diabetic patients on Metformin. Here, we discuss a case of a 56-year-old female with worsening lactate despite remaining hemodynamically stable throughout the surgery, and after ruling out other causes of potential lactate elevation. 

Submissions


CoAuthor

Dr. Anoop Chhina, MD

Poster Presenter

Dr. Judah Weiss, M.D.

F097. Intra-operative electroencephalogram correlates of post-operative neurocognitive resilience in older adults

Each year over 16 million older Americans (i.e. age > 65 years) undergo general anesthesia and surgery. Of these older patients, 20-40% develop postoperative delirium, which is associated with long term cognitive decline and increased one year mortality risk. Although there are several known risk factors for postoperative delirium (i.e. increased age, frailty, increased surgery duration, etc.), many older patients with these risk factors do not develop delirium, suggesting that there are neurocognitive resilience factors that help reduce the risk of postoperative delirium in some patients. The entropy of various physiological variables has been shown to predict resilience to adverse outcomes in multiple clinical situations outside of perioperative care in older adults. Thus, here we examined whether increased intraoperative electroencephalogram (EEG) entropy would take predict postoperative neurocognitive resilience, i.e. a lack of delirium despite significant risk factors for it. 

Submissions


CoAuthor(s)

Dr. Miles Berger, MD, PhD
Lewis Lipsitz, MD
Dr. Heather Whitson, MD
Dr. Marty Woldorff, PhD
Junhong Zhou, PhD

Poster Presenter

Dr. Leah Acker, MD, PhD

F098. Decreased Frontal Interhemispheric Synchronization: A Novel Evoked EEG index that Correlates with Post-Operative Cognitive Dysfunction

Post-operative cognitive dysfunction (POCD) is a term used to describe changes in cognition, such as memory and executive function 1. The incidence of POCD is 20-40%, depending on the population, surgery type, diagnostic criteria, and timing 2-4. The mechanisms leading to POCD have not been fully elucidated 5-8. Currently, there is no gold standard monitoring available to predict the occurrence of POCD following anesthesia and surgery9. We have developed a novel algorithm analyzing evoked EEG 10-12 (from F3, F4, P3, P4 electrodes), generating an index of synchronization between left and right frontal hemispheres13. The interhemispheric synchronization (IS) index, is in the range of [0,1], where 1 indicates complete synchronization and 0 indicates complete desynchronization. We have recently demonstrated that ischemic lesion or brain hypo-perfusion are expressed by a decrease in the IS index. The primary outcome was a decrease in IS index is associated with POCD. 

Submissions


CoAuthor(s)

Dr. Judith Aharon-Peretz, MD
Dr. Yaron Berkovich, MD
Dr. Gil Bolotin, MD
Dr. Oved Cohen, MD
Dr. Tali Fisher, PhD
Gregory Hare, MD, PhD
Dr. Goded Shahaf, MD PhD
Dr. Keren Worms, PhD
Dr. Avishai Ziser, MD

Poster Presenter

Dr. Dana Baron Shahaf, MD PhD

F099. Differential Effects of Hypoxia on Cognitive Function Domains in Humans at Sea Level and High Altitude

Hypoxia-induced cognitive impairment is important both in acute illness and accidents (asphyxia, aviation decompression) and in chronic disease (COPD, sleep apnea, maladaptation to high altitude environments). Different durations and degrees of acute or chronic hypoxia produce divergent respiratory, cardiovascular, inflammatory and biochemical adaptations and responses. However, separating differences in cognitive effects between acute and chronic hypoxia has been difficult due to lack of reproducible cognitive tests and safe, well-characterized hypoxia models. This study tested the hypothesis that acute and chronic hypoxia impair different cognitive function domains in humans. 

Submissions


CoAuthor(s)

Dr. Philip Bickler, MD, PhD
Leah Campbell, High School Diploma
Ms. Frances Zorensky, High School Diploma

Poster Presenter

Dr. Odmara Barreto Chang, MD, PhD

F100. Effects of metabotropic glutamate receptor blockers on neonatal rat brain

Studying the central neurotoxic effects of anesthetic exposure in utero and repeatedly during infancy and subsequent functional outcomes in humans has remained a challenge. Neonatal animal models demonstrate accelerated neuronal cell death in certain brain areas accompanied by significant behavioral outcome differences between exposed and control animals (1). Anesthetic induced central nervous system maladaptive hyperexcitability may lead to neuronal apoptosis possibly mediated by the metabotropic glutamate receptor 5 (mGluR5). We previously reported that ketamine (Ket) induced neuronal apoptosis in neonatal rat brain was significantly reduced by the co-administration of the mGluR5 blocker 3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine (MTEP) (2) which also significantly preserved the functional outcomes of cognition and behavior (3). However, the potential effects of MTEP on healthy neonatal brain not subjected to injury is unclear. We hypothesized that MTEP administration has no neurotoxic effects on healthy neonatal brain or behavioral outcomes. 

Submissions


CoAuthor(s)

Jesus Azocar, BS
Dr. Ruben Azocar, MD, MHCM, FCCM, FASA
Dr. Roman Schumann, MD

Poster Presenter

Dr. Tinatin Chabrashvili, MD, PhD

F101. Influence of Perioperative Antibiotic Use on Postoperative Cognition

Recent data suggests that alteration of the gut microbiome may influence cognition and behavior.(1) Specifically, alteration of normal gut flora by antibiotic administration (e.g. antibiotic-induced dysbiosis) alters bidirectional communication via the "microbiota-gut-brain-axis".(2) There are no studies to date investigating the relationship between the use of perioperative antibiotics (and presumed antibiotic-induced dysbiosis) and cognitive outcomes in humans. We hypothesized that the use of antibiotics beyond the typical 24-hour postoperative period would be associated with lower cognitive scores over a 1-year period following surgery. 

Submissions


CoAuthor(s)

John Hunting, BS
Dr. Rebecca Klinger, MD, MS
Dr. Joseph Mathew, MD
Dr. Paul Wischmeyer, MD, EDIC

Poster Presenter

Dr. Sarah Cotter, M.D.

F102. Behavioral Sedation EEG Changes Induced by Dexmedetomidine Attenuated but not Eliminated in A Novel Adra2a Knockout Mouse

Dexmedetomidine (dex), a nonspecific α2-adrenoceptor (AR) agonist, has previously been shown to exert its sedative-hypnotic and antinociceptive effects through the A subtype (α2A-AR), which also mediates the drug's effects on vascular tone and hypothermia.(1-4) Genetic knockout of the α2A-AR ablates or significantly attenuates these behavioral and physiologic effects. Here, we describe a novel functional knockout of the α2A-AR protein in a mouse model, confirm previously described changes in behavioral, antinociceptive, and thermoregulatory response to dex in the mutant line, and examine electroencephalographic (EEG) correlates to the observed behavioral changes. 

Submissions


CoAuthor(s)

Ms. Bo Ku
Ms. Paula Kwasniewska
Dr. Andrew McKinstry-Wu, MD
Ms. Juliette Palermo
Dr. Steven Thomas, MD, PhD
Mr. Andrzej Wasilczuk, B.S.

Poster Presenter

Mr. Benjamin Harrison, High School (candidate for B.A.)

F103. Modeling the Risk of Ionizing Radiation Exposure after Aneurysmal Subarachnoid Hemorrhage

Patients with aneurysmal subarachnoid hemorrhage (aSAH) undergo frequent diagnostic tests and procedures that utilize ionizing radiation. Ionizing radiation from these sources may cause additional neurologic and non-neurologic injury. Early identification of aSAH patients at risk for this potentially harmful ionizing radiation exposure (PHIRE) may allow clinicians to modify care to reduce risk of additional injury. We, therefore, hypothesized that a model of PHIRE in aSAH patients could be developed and validated from a retrospective set of patient data. 

Submissions


CoAuthor(s)

Greeshma Allareddy
Andrew Clark
Ran Duan
Justin Fraser
Emily Slade

Poster Presenter

Dr. Kevin Hatton, MD

F104. Cell-type specific expression of anesthetic target proteins parallels cell-type selective effects of isoflurane in mouse frontal lobe in vivo

Anesthetic effects on neurons are often assumed to be homogeneous, despite often drastically different expression profiles between neuron populations. Two neuron populations in layers 2/3 of particular interest are the excitatory glutamatergic pyramidal neurons and inhibitory GABAergic parvalbumin (PV) expressing neurons. Pyramidal neurons provide direct corticocortical feedforward projections, and hence present a target for inhibition of corticocortical connectivity. PV neurons, by contrast, are inhibitory interneurons with high basal firing rates that contribute to the high frequency activity in cortex associated with arousal.[sup]1[/sup] The extent to which pyramidal and PV neurons differ in their expression of anesthetic target proteins is unknown. We hypothesize that pyramidal and PV neurons differ in their expression levels of anesthetic targets, and that these neuron populations will show differential sensitivity to isoflurane. 

Submissions


Poster Presenter

Dr. Andrew Hudson, MD, PhD

F105. Age and Comorbidity-dependent Changes in the Electroencephalogram during Isoflurane General Anesthesia

Depth of anaesthesia (DoA) monitors use surface electroencephalogram (EEG) derived parameters to calculate an arbitrary number depicting the level of hypnosis. Several of these parameters come from fast fourier transformed epochs of EEG, which provides detailed information of the amount (power) of predefined segments of EEG frequencies, e.g. alpha power.(1) Purdon et al reported a significant negative effect of age on frontal alpha power (R2 = -0.46) in a healthy population during sevoflurane anesthesia.(3) Furthermore, several comorbidities are known to influence cognitive function and the EEG of awake patients.(4) We wanted to investigate the relationship of age, comorbidities and frontal alpha power during isoflurane general anesthesia. 

Submissions


CoAuthor(s)

Dr. Balthasar Eberle, MD
Dr. Darren Hight, PhD
Dr. Trevor Hirschi, MD
Dr. David Reineke, MD
Dr. Christian Rummel, PhD

Poster Presenter

Dr. Heiko Kaiser, MD

F106. Intravenous D-amphetamine Reverses Dexmedetomidine-induced Unconsciousness in Rats

D-amphetamine (d-AMPH), which causes the direct release of dopamine and norepinephrine from synaptic terminals, produces emergence from propofol and isoflurane anesthesia in rats.[sup]1[/sup] Dexmedetomidine (DEX) targets pre-synaptic α[sub]2A[/sub]-adrenoreceptors on noradrenergic neurons projecting from the locus coeruleus and inhibits the release of norepinephrine.[sup]2,3[/sup] On the other hand, ketamine is an anesthetic that acts primarily by inhibiting N-methyl-D-aspartate (NMDA) type glutamate receptors.[sup]4[/sup] These drugs produce loss of consciousness (LOC) by different mechanisms from GABAergic agents such as propofol and volatile anesthetics. In this study, we tested the efficacy of d-AMPH for accelerating recovery from DEX- and ketamine-induced LOC in rats. 

Submissions


CoAuthor(s)

Dr. Oluwaseun Johnson-Akeju, MD
Ms. Olivia Mallari, AB
Mr. Eric Melonakos, Ph.D.
Mr. Morgan Siegmann 8310786, BS
Dr. Ken Solt, MD
Christa Van Dort, Ph.D.
Ms. Edlyn Zhang, BS

Poster Presenter

Ms. Risako Kato, Ph.D.

F107. Risk factors of repeat revascularization surgery for Moyamoya disease in pediatric cases; A Retrospective Study

Moyamoya disease (MMD) is a cerebrovascular occlusive disease first reported by Japanese surgeons' in 1957 as hypoplasia of the bilateral internal carotid arteries [1]. Although this entity is characterized by occlusive changes at the terminal portion of the bilateral internal carotid arteries which constitutes the circle of Willis [2], the etiology of MMD is still unknown, and thus its diagnosis is based on characteristic angiographic findings. In pediatric cases, the disease mainly manifests as ischemia. The effective treatment methods for MMD with symptoms of brain ischemia include indirect and direct revascularization, according to the Japanese Guidelines for the Management of Stroke 2015 (Recommendation grade B). However, cases of repeat revascularization have yet to be reported. Therefore, we decided to retrospectively investigate risk factors of re-operation for MMD in pediatric cases. 

Submissions


CoAuthor(s)

Dr. Takahiro Ando, M.D.
Dr. Kimitoshi Nishiwaki, Ph.D.

Poster Presenter

Dr. Tomomi Komaba, M.D.

F108. Age-Related EEG features of Bursting Activity During Anesthetic-Induced Burst Suppression

Electroencephalographic Burst Suppression (EEG-BS) occurs during an unconscious state of anesthesia with a distinct change from slow oscillatory activity to a pattern of isolectric EEG disrupted by strong bursts. Current research suggests an association between EEG-BS and the occurrence of post-operative delirium in the PACU and beyond [1, 2]. We investigated possible age-induced changes of the EEG-BS burst architecture to further understand how age influences brain electrical activity and add to the knowledge regarding EEG-BS that can help to optimize monitoring. 

Submissions


CoAuthor(s)

Dr. Paul Garcia, MD, PhD
Dr. Matthias Kreuzer, PhD
Dr. Gerhard Schneider, MD

Poster Presenter

Dr. Stephan Kratzer, MD

F109. Phenoxyalkoxypsoralen-1 (PAP-1), a highly-selective Kv1.3 channel blocker, Prevents Neuroinflammation and Postoperative Cognitive Decline in Vulnerable Mice

Inflammation is a pivotal step in the development of Postoperative Cognitive Decline (PCD) (1). The damage-associated molecular pattern (DAMP), known as high molecular group box 1 protein (HMGB1), is released from the cytosolic compartment of traumatized tissue and engages the innate immune system by binding to pattern recognition receptors on bone marrow-derived monocytes (BM-DMs) to induce translocation of the transcription factor NFκB into the nucleus where it enhances the transcription and translation of pro-inflammatory cytokines (2). The released cytokines are capable of disrupting the blood brain barrier, allowing the migration of both cells and potential neurotoxins, such as fibrinogen, into the CNS (3). Translocation of BM-DMs into the brain is orchestrated by an upregulation of the chemo-attractant MCP-1 from microglia. Within the CNS, the BM-DMs interact with, and activate, microglia to release proinflammatory cytokines, such as IL-1β and IL-6 within the parenchyma (4); these cytokines can disrupt synaptic plasticity thereby preventing long-term potentiation, the neurobiologic correlate of learning and memory. Strategies for preventing PCD that indiscriminately target inflammation, ubiquitously, may interfere with peripheral inflammation-mediated wound repair and healing. Therefore, discretely targeting neuroinflammation by preventing the activation of the microglia may be an appropriate alternative to avoid manipulating peripheral inflammation. The Kv1.3 channel is a unique microglial ion channel which is required for its activation; PAP-1 is a small molecule highly-selective inhibitor of Kv1.3 (5). We sought to determine the effect of PAP-1 on postoperative peripheral and hippocampal inflammation and cognitive decline. We also determined whether PAP-1 can be effective at preventing postoperative cognitive decline in diet-induced obese (DIO) mice that are especially vulnerable to a more exaggerated and longer-lasting form of PCD (4). 

Submissions


CoAuthor(s)

Mr. Kit Lai, BS
Dr. Rong Li, MD
Dr. Sarah Saxena, MD
Yosuke Uchida, MD
Dr. Heike Wulff, Ph.D.

Poster Presenter

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

F110. Extreme Sensitivity to Narcotics as an Indicator of Early Sepsis: A Case Series

Anesthesia providers regularly care for patients in both florid and early sepsis in our practice, yet many may not fully understand how inflammatory and/or uremic states affect the pharmacokinetics and pharmacodynamics of the drugs that we give. With the current push to extubate early to avoid complications of prolonged intubation, anesthesiologists frequently have to decide when and where to safely extubate. This case series presents a review of the etiology of opioid sensitivity and other causes of delayed awakening in critically ill patients. 

Submissions


Poster Presenter

Dr. Kevin Min, MD

F111. The operation of repeated ischemia and reperfusion of small intestine in mice impaired the series of behaviors, which mimicked the important features of postoperative delirium.

In the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V), postoperative delirium is defined as a syndrome characterized by the acute onset of fluctuating levels of attention, awareness, and cognition1. The incidence of delirium is reported up to 50% in patients undergoing major abdominal surgery2 3. There are sparse animal models for delirium research published4 5 6. Based on our previous study which investigated brain-injuries caused by the ischemia and reperfusion of small intestine7 and the theory and evidence that intermittent ischemia potentials reperfusion injuries8, our study aims to investigate the effects of repeated ischemia and reperfusion (IR) of small intestine, which mimicking the abdominal surgery, on the behavioral changes related to acute brain dysfunction postoperatively in mice. 

Submissions


CoAuthor(s)

Yehong Dong, MMED
Yingying FANG, Mphil
Dr. Xiaodong Liu, Ph.D
Kexuan Liu, M.D. Ph.D

Poster Presenter

Dr. JINGLAN MU, M.D. Ph.D

F112. The effects of dietary polyphenols on emergence and prompt recovery from anesthesia in a fruit fly model

While rapid and smooth recovery from general anesthesia is a goal for all patients, it becomes critical for patients during neurosurgery because failure to re-establish neurologic function quickly after the operation will prompt the medical team to consider emergency interventions to evaluate if the problem is surgical or related to anesthesia pharmacodynamics. Thus far, there has been no effective clinical strategy proven to improve recovery from surgical anesthesia, and options to prevent delayed arousal and hypoactivity in the perioperative setting remain limited. Therefore, it is necessary to find novel strategies that promote efficient emergence and favorable cognitive and physical recovery trajectories after surgical anesthesia. Polyphenols are plant metabolism products with anti-inflammatory, antioxidant, and other potentially beneficial bioactive properties. Polyphenolic compounds, including punicalagin and ellagic acid, are found in high concentrations in pomegranate juice [4]. Previous research from our laboratory has shown that administering pomegranate-derived polyphenols improved cognitive and physical performance in humans after heart surgery [5] and stroke [6]. Other experimental data from our lab demonstrates that pomegranate supplementation protected against depression-like behaviors (learned helplessness) induced by radiation exposure [7] and improved swim speed in transgenic mice [8]. Therefore, we hypothesized that polyphenol dietary supplementation would hasten emergence and improve motor recovery following anesthesia in Drosophila melanogaster. 

Submissions


CoAuthor(s)

Andrea Briseño, M.A.
Dr. Paul Garcia, MD, PhD
Richard Hartman, Ph.D.
Caleb Napan, M.A.
Lelah Villalpando, M.A.

Poster Presenter

Ms. Jaime Napan, B.S./B.A.

F113. Global anticorrelated resting-state brain activity differentiates awake, anesthetized, and early-recovery states

The ongoing NIH-funded Trajectory of Recovery in the Elderly (TORIE)1 project studies healthy human volunteers ages 40 to 80, awake and under general anesthesia in the absence of surgery, using neuroimaging and cognitive testing methods to ascertain whether recovery of cognitive function after general anesthesia differs based on age. Advanced functional MRI (fMRI) techniques are employed to follow the dynamics of resting-state neural activity during the peri-anesthetic period. 

Submissions


CoAuthor(s)

Dr. Mark Baxter, PhD
Jess Brallier, MD
Dr. Stacie Deiner, MD
Dr. Bradley Delman, MD
Dr. Yael Jacob, PhD
Dr. Prantik Kundu PhD, PhD
Dr. Patrick McCormick, MD MEng
Dr. Joshua Mincer, MD, PhD
Dr. Mary Sano, PhD
Dr. arthur schwartz, MD
Dr. Cheuk Tang, PhD

Poster Presenter

Dr. Tommer Nir, MD/PhD

F114. Electrophysiological Monitoring During Intracranial Aneurysm Surgery: Improving Test Validity by Accounting for the Treatment Paradox Affecting Signal Changes that Reverse with Intervention

Somatosensory- and motor evoked potentials (SSEP/MEP) are surrogate markers of the functional integrity of the brain and may help detect impending neurological injury during cerebral aneurysm (CA) clipping under anesthesia (1,2). (Fig 1.) However there is inconsistency in the reporting and interpretation of electrophysiological (EP) signal changes (3). Irreversible signal changes (ISC) are rare, may indicate severe injury and strongly predict new postoperative neurological deficits (PND). Reversible signal changes (RSC) may represent a transient loss of functional integrity, which reverses with an intervention. Whether an RSC would have caused PND cannot be established with absolute certainty because a neurological exam correlate cannot be obtained under anesthesia. Evidence of causation may be derived indirectly by linking an intervention with the reversal of an RSC based on biological plausibility, the strength of association and temporality between the two (e.g. recovery of the signal change immediately after adjusting the aneurysm clip) (4,5). (Fig 2.) We aimed to apply causality linking in a cohort undergoing CA clipping to more accurately classify those RSCs that were truly indicative of impending neurological injury as true positives, and thereby to strengthen the evidence that EP monitoring improves outcomes. 

Submissions


CoAuthor(s)

Dr. Christopher Fox, MD
Dr. Brian Hoh, MD
Dr. Adam Polifka, MD
Dr. Steven Robicsek, MD
Christoph Seubert, MD

Poster Presenter

Dr. Ferenc Rabai, md

F115. Case Report: The Anesthesia-induced EEG in a 30-Year Old Cancer Patient Resembles that of an "Old Brain"

Anesthetic drugs induce rhythmic EEG activity whose structure varies according to the drugs' underlying molecular and neural circuit mechanisms. Propofol and ether-based anesthetics such as sevoflurane induce simultaneous slow (<1 Hz) and frontal alpha oscillations (8–12 Hz). With increasing age, anesthesia-induced alpha band power and coherence decrease significantly. In elderly patients, anesthesia-induced EEG waveforms may be more than 4-fold smaller in amplitude compared to young patients. These small EEG waveforms are synonymous with an "old brain." In this report, we describe the case of a young woman receiving propofol during general anesthesia whose EEG resembles that of an "old brain." The etiology behind these changes is unknown. We will consider and review possible associations to this paradoxical observation 

Submissions


CoAuthor(s)

Dr. Emery Brown, MD, PhD
Gladia Hotan, Bachelor of Science
Dr. Hiroko Kunitake, M.D.
Dr. Patrick Purdon, PhD

Poster Presenter

Dr. Laura Santa Cruz Mercado, M.D.

F116. Lactic acidosis during glioblastoma resection: Evidence of the Warburg Effect during Intraoperative Tumor Manipulation

The Warburg effect, first described in the 1920's, refers to the observation that tumor cells generate more than 50% of cellular ATP from glycolysis even when in the presence of an aerobic environment. (1) The high glycolytic activity results in lactic acid production – the metabolic microenvironment created by this phenomenon is thought to promote tumor cell proliferation, angiogenesis, and metastasis. (2,3) There are a limited number of reports and studies related to lactic acidosis in the setting of high grade gliomas. (4,5) Awareness of the Warburg effect is valuable to specialists across a number of fields including intensive care medicine. 

Submissions


CoAuthor(s)

Dr. CHRISTIAN BALABANOFF ACOSTA, MD
Mr. Miguel Cobas, MD, FCCM
Dr. Alexander Fort, MD

Poster Presenter

Dr. Frank Vigil Gonzalez, MD

F117. MORPHINE AND FENTANYL DELIVERED TO PREFRONTAL CORTEX OF BEHAVING MICE DEPRESS BREATHING AND ALTER NEUROTRANSMITTER CONCENTRATIONS

The prefrontal cortex (PFC) contains opiate receptors[sup]1[/sup], modulates respiratory control[sup]2[/sup], and shares reciprocal connections with brain stem nuclei that generate breathing[sup]3[/sup]. This study tested the hypothesis that microdialysis delivery of morphine and fentanyl to the PFC of C57BL/6J mice (n = 27) alters breathing and concentrations of acetylcholine (ACh) and adenosine. 

Submissions


CoAuthor(s)

Mr. Aaron Baer, BA
Dr. Helen Baghdoyan, PhD
Ms. Kirsten Ferraro, BA
Ms. Bailey Hargrove, BA
Dr. Ralph Lydic, PhD
Dr. Weidong Mi, MD, PhD

Poster Presenter

Dr. Xiaoying Zhang, MD, PhD

F118. 3-4 years follow up of HbA1C after bariatric surgery- a single-center retrospective analysis

Bariatric surgery has demonstrated its success not only in weight reduction but also in addressing other comorbid conditions such as type-II diabetes and cardiovascular disease.1, 2 However, there is limited literature regarding the long-term benefits of bariatric surgery for glycemic control. In this retrospective study, we evaluated the pre and long-term (3-4 years) HbA1C values in patients who underwent bariatric surgery. 

Submissions


CoAuthor(s)

Dr. David Adams, M.D.
Dr. Ellise Delphin, MD, MPH

Poster Presenter

Dr. Singh Nair, PhD

F119. The impact of psychopathological conditions on in-hospital opioid consumption and pain scores following laparoscopic sleeve gastrectomy for obesity

In several studies the prevalence of psychopathological conditions (PsyPaC) among bariatric surgical candidates ranged between 36% and 69% (1). Few data are available regarding the association of such conditions with opioid utilization following bariatric surgery, and some information exists regarding the postoperative pain experience of this population. We hypothesized that patients affected by PsyPaC exhibit a higher total opioid consumption during their hospital stay and have higher pain scores compared to their unaffected peers. 

Submissions


CoAuthor(s)

Dr. Iwona Bonney, PhD
Mohammad Dahlawi, MD
Amr Jijakli, MS
Sara Morrison, MD
Dr. Roman Schumann, MD
Sajani Shah, MD

Poster Presenter

Dr. Joseph Cerasuolo, M.D.

F120. Obesity's Effect on Transpulmonary Pressure During Robotic Abdominal Laparoscopic Surgery

Obesity is a global epidemic that increases many perioperative risks, notably the development of postoperative pulmonary complications (PPC) (1). Lung protective ventilation strategies pioneered in the ICU have transitioned to the OR in an attempt to prevent ventilator induced lung injury from over distension or cyclic atelectasis. Laparoscopic abdominal surgery increases the risk of PPC and impairs pulmonary mechanisms through abdominal insufflation and bed positioning (2,3). Robotic abdominal laparoscopic surgery (RALS) is an extreme example of this unique physiological insult. We hypothesized that obese subjects undergoing RALS would have impaired pulmonary mechanics and evidence of cyclical atelectasis compared to nonobese subjects. In order to test this hypothesis, we conducted a cross sectional study of patients undergoing RALS and measured transpulmonary pressures (TPP) under specific surgical conditions using esophageal manometry. 

Submissions


CoAuthor(s)

Jason Bates, D.Sc., Ph.D.
Dr. S. Patrick Bender, MD
Mr. Max Breidenstein, BS
Alexander Friend, MS
Serena Murphy, MD
Melissa Rafferty, MD
Dr. William Tharp, MD

Poster Presenter

Mr. Collin Love, BS

F121. Prevalence and Trends of Obesity and Severe Obesity in a Multi-Institution Pediatric Surgical Population: A Report from the Multicenter Perioperative Outcomes Group (MPOG)

The prevalence of obesity in the general pediatric population is 18.5% and is highest among adolescents (20.6%, aged 12-19 years)(1). The high rates of obesity among US children is concerning because children with a high BMI show increased rates of acute perioperative complications(2). Although secular prevalence and trends of childhood obesity have been well documented, comparable data in children undergoing surgery are unavailable. An evaluation of obesity status among children undergoing surgical procedures would be advantageous for perioperative risk assessment. The present study aimed to estimate the prevalence and trends of obesity and severe obesity among children aged 2-17 years who underwent elective non-cardiac, non-bariatric surgery from 2008 to 2017 across many US hospitals. We hypothesize an increase in pediatric surgical obesity prevalence throughout the study period. 

Submissions


CoAuthor(s)

Dr. Olubukola Nafiu, MD, FRCA, MS
Ms. Jodi-Ann Oliver, MD

Poster Presenter

Mrs. Aleda Thompson, MS

F122. Opioid-Free Anesthesia in Bariatrics: Does it Make a Difference?

Morbidly obese patients undergoing bariatric surgery have a high prevalence of obstructive sleep apnea and are particularly susceptible to the respiratory depressant effects of opioids. Strategies to minimize the adverse effects of opioid use and eliminate postoperative nausea and vomiting (PONV) in this patient population have included multimodal pain management regimes and intraoperative use of intravenous anesthetic adjuvants in lieu of narcotics. Utilization of opioid-free anesthesia (OFA) for post-surgical pain is a growing trend to counter the risks of opioid abuse and opioid-related adverse drug events. The purpose of this study was to determine whether intraoperative OFA techniques minimized postoperative opioid requirements and enhanced patient recovery. 

Submissions


CoAuthor(s)

Dr. Judith Aronsohn, MD
Dr. Oonagh Dowling, PhD
Dr. Madina Gerasimov, M.D.
Dr. Greg Palleschi, M.D.

Poster Presenter

Dr. Masha Zeltsman, D.O.

F123. Intraoperative Ventilation Management and Postoperative Pulmonary Complications in Patients at High Risk for Obstructive Sleep Apnea Undergoing Laparoscopic Bariatric Surgery

Laparoscopic surgeries are gaining popularity because of beneficial outcomes such as lower pain levels, faster recovery, and shorter hospital stay (1). Obese patients may experience lung injury and greater risk of postoperative pulmonary complications (PPC) due to increased ventilation/perfusion mismatch and baseline intrabdominal pressure, pneumoperitoneum, and intraoperative reduced lung compliance (1,2). Obstructive Sleep Apnea (OSA) is prevalent among obese patients and associated with increased rates of perioperative desaturations, respiratory failure, and adverse cardiac events (3). STOP-BANG (Snoring, Tiredness, Observed apnea, high blood Pressure, BMI, Age, Neck circumference, and male Gender) is a tool used to assess OSA risk. Lung protective ventilation (LPV) including low tidal volume (Vt), moderate positive and-expiratory pressure (PEEP), and intraoperative lung recruitment maneuvers (RM) may reduce PPC rates and protect against ventilator induced lung injury (VILI) (4). Driving pressure (∆P) is defined as the difference between peek end-inspiratory pressure (PIP) and PEEP in patients under general anesthesia with Pressure Controlled Ventilation mode (PCV) (5). High driving pressure has been identified as a predictor of PPCs (6). 

Submissions


CoAuthor(s)

Mr. Mahmoud Abdel-Rasoul, MS, MPH
Dr. Sergio Bergese, MD
Mr. Alan Esparza Gutierrez, BS
Dr. Juan Fiorda-Diaz, MD
Dr. Samuel Lindsey, MD

Poster Presenter(s)

Ms. January Kim, BS
Dr. Alberto Uribe, MD

F124. What do the trends portend? A comparative analysis of 10 year data of obstetric admissions to critical care in a district general hospital in England.

Considerable improvements have been made to maternity services with major reductions in maternity related deaths as a result of audit findings published by the Intensive Care National Audit & Research Centre (ICNARC)[sup]1[/sup] and MBBRACE-UK[sup]2[/sup]. Whilst mortality figures have fallen, significant maternal morbidity is harder to quantify. Admission to critical care (ICU) can be a surrogate marker of severe maternal morbidity. In this service evaluation, we aimed to analyse the trends in obstetric admissions and morbidity over the last 10 years and compare these against national ICNARC data published in 2013. 

Submissions


CoAuthor(s)

Dr. Guanmei Luo, MBChB
Dr. Gowry Simon, FFARCS

Poster Presenter

Dr. Nisha Abraham-Thomas, MBBS BSc

F125. Prenatal, Labor, and Postpartum Pain Are Predictors for Postpartum Depression Symptoms: A Prospective Observational Study

Data linking labor pain and postpartum depression are emerging. Robust, prospective evaluations of this relationship while factoring psychological, psychosocial, and other important variables are lacking. We assessed psychological, psychosocial, pain, and perinatal factors predicting postpartum depression risk. 

Submissions


CoAuthor(s)

Francesca Facco, MD, MSc
Lia Farrell, B.S.
Kelsea LaSorda, MPH
Ann McCarthy, MSN, CNM

Poster Presenter

Dr. Grace Lim, MD, MSc

F126. Supplemental Intravenous Anesthesia with Remifentanil for Open Fetal Surgery for Myelomeningocele Repair

Myelomeningocele is a neural tube defect affecting approximately 5-10 per 10,000 pregnancies in the United States. The malformation can lead to significant deficits later in life, including hydrocephalus, motor impairment, and bowel and bladder dysfunction. Compared to postnatal repair, in utero repair reduces the need for ventriculoperitoneal shunting and improves motor outcomes.[sup]1[/sup] Open fetal surgery is typically performed at 19-26 weeks and requires specialized anesthetic techniques to maintain uterine relaxation, maternal-fetal perfusion, and fetal oxygen delivery.[sup]2[/sup] Until recently, high-dose inhaled anesthesia (>2 MAC) has been required to maintain uterine relaxation during open fetal surgery, but this technique is associated with abnormal umbilical arterial flow and direct fetal cardiovascular depression.[sup]3-4[/sup] A more recent anesthetic approach for open fetal surgery involves supplemental intravenous anesthesia with the use of propofol and remifentanil infusions to decrease volatile anesthetic requirements while maintaining adequate uterine relaxation.[sup]5[/sup] Because there is no human evidence to support the use of propofol for uterine relaxation, and propofol is a known myocardial depressant, we modified this anesthetic approach to rely on supplemental intravenous remifentanil alone to decrease the volatile anesthetic requirements for uterine relaxation in open fetal surgery. We propose that the newer technique with remifentanil may reduce the incidence of severe intraoperative umbilical artery flow abnormalities while maintaining adequate uterine relaxation. 

Submissions


CoAuthor(s)

Marla Ferschl, MD
Dr. Mark Rollins, MD, PhD
Dr. Jina Sinskey, MD

Poster Presenter

Dr. Benjamin Marsh, MD

F127. [Withdrawn] Intra-abdominal Pressure in Non-labouring Preeclamptic vs. Normotensive Patients Undergoing Caesarean Section: A Prospective Observational Study

Intra-abdominal pressure (IAP) is the steady state pressure concealed within the abdominal cavity [1, 2]. An increase to ≥ 12 mmHg is defined as intra-abdominal hypertension (IAH) while levels greater than 20 mmHg along with new onset multiorgan dysfunction constitute abdominal compartment syndrome (ACS) [2]. The detrimental effects of raised IAP including increased mortality and morbidity are well known. Increase in IAP is implicated as a cause of preeclampsia. The suggestion of raised IAP causing preeclampsia originates from the similarity in progressive multisystem dysfunction seen with preeclampsia and ACS [3]. It is hypothesized that an increase in IAP triggers placental or renal ischemia thus inciting organ dysfunction typical of preeclampsia. Another mechanism for increased IAP leading to preeclampsia is the direct compression and compromise of perfusion of organs such as kidney and liver. Raised IAP in preeclamptics may also be a result of the disease itself besides being a suggested cause, due to the increased capillary permeability seen with preeclampsia [15]. An increased IAP in preeclamptic patients if proven, could then be evaluated as a prognostic marker or a therapeutic goal. We could locate however only one clinical study comparing the IAP in preeclamptic and normotensive pregnant patients. Herein higher IAPs were seen in preeclamptic patients as compared to normotensive pregnancies prior to delivery as well as 24 hours later [4]. Also, knowledge of normative IAP values in pregnancy itself is scanty. The few published studies evaluating IAP in obstetric patients have shown raised IAPs in the range of conventionally defined IAH [5-7]. The consequences however of IAH documented in obstetric patients are not well understood. It remains to be seen whether the raised IAP during pregnancy affects organ functions adversely or is merely a physiological elevation. It is recommended that further work is still required in the area of IAP for pregnant patients. Against this background, the present study aimed to evaluate and compare the IAP and also its effect on organ functions, in normotensive and preeclamptic patients scheduled for caesarean section. 

Submissions


CoAuthor(s)

VANDNA ARORA, MD
ANKIT LUTHRA, MD
MUKUNDAN RAMANUJAN, MD

Poster Presenter

Dr. ASHA TYAGI, MD

F128. Impact of an Interactive Music App On Pain Threshold, Temporal Summation, and Conditioned Pain Modulation In Healthy Volunteers

Music has been shown to decrease pain and modulate affect, but the mechanism by which music conveys analgesia in relatively unexplored. Using quantitative sensory testing (QST), we assessed the impact of a novel app-based music intervention on the nociceptive processing of pain. 

Submissions


CoAuthor(s)

Dr. Richard Boyer, MD, PhD
Dr. Peter Chai, MD
Robert Edwards, PhD
Ms. Jasmine Gale, BS

Poster Presenter

Dr. Kristin Schreiber, MD, PhD

F129. Incidence of and Risk Factors for Stiffness After Total Knee Arthroplasty: An Exploratory Analysis of a Prospective Cohort Study

More than 700,000 total knee arthroplasties (TKAs) are performed in the United States each year[sup]1[/sup] and stiffness is the most common early post-operative complication with a reported rate of occurrence between 1.3-12%[sup]2-4[/sup] . Stiffness after TKA can lead to reduced patient satisfaction and impaired function and may require further interventions such as manipulation under anesthesia (MUA), arthroscopy, or component revision. The purpose of this prospective study was to objectively determine the incidence of early stiffness in a consecutive cohort of patients undergoing unilateral TKA and to determine associated factors that may allow for perioperative risk stratification. 

Submissions


CoAuthor(s)

Michael Cross, MD
Kara Fields, MS
Alejandro Gonzalez Della Valle, MD
Ugonna Ihekweazu, MD
Dr. Kethy Jules-Elysee, MD
Dr. Meghan Kirksey, MD
Michael Parks, MD
Peter Sculco, MD

Poster Presenter

Mr. George Birch, BS

F130. REMIFENTANIL-INDUCED HYPERALGESIA IS NOT PREVENTED BY ACETAZOLAMIDE IN PATIENTS UNDERGOING TOTAL THYROIDECTOMY

Acute administration of remifentanil may activate N-methyl-D-aspartate (NMDA)-dependent pronociceptive systems (1), reducing the nociceptive thresholds and leading to the opioid-induced hyperalgesia (OIH). However, studies in animal models suggest that OIH might also be mediated by impaired anionic homeostasis in spinal lamina I neurons due to a down-regulation of the K-Cl co-transporter KCC2 (2). Restoring the anionic homeostasis with the administration of acetazolamide, a carbonic anhydrase inhibitor, reversed the OIH in mice (2). The aim of this clinical trial was to test whether preoperative administration of 250 mg of acetazolamide during sevoflurane-remifentanil anesthesia diminishes the postoperative OIH in patients undergoing total thyroidectomy. 

Submissions


CoAuthor(s)

Dr. Alonso Blanch, MD
Dr. Daniela Bravo, MD
Dr. Patricio Cabané, MD, PhD
Dr. Felipe Contreras, MD
Dr. Jose Ignacio Egaña, MD, PhD
Dr. Patricio Gac, MD
Dr. Antonello Penna, MD, PhD
Dr. Daniel Rappoport, MD
Dr. Francisco Rodriguez, MD

Poster Presenter

Dr. Rodrigo Gutiérrez, MD

F131. A Prospective Appraisal of Opioid Consumption in Patients Undergoing Total Knee Arthroplasty

Total knee arthroplasty (TKA) is the procedure of choice to treat refractory knee pain and improve patient's quality of life. Postoperative pain management after TKA frequently includes intravenous (IV) opioids, oral analgesics, peripheral nerve blocks, and/or spinal analgesia. Patients who are admitted for at least 2 days in the hospital receive a significant amount of opioid medications to manage post-surgical pain. We aimed to assess post-operative in-hospital and post-discharge opioid consumption (OC) in patients undergoing TKA. 

Submissions


CoAuthor(s)

Mr. Mahmoud Abdel-Rasoul, MS, MPH
Dr. Sergio Bergese, MD
Alicia Gonzalez-Zacarias, MD
Dr. Nicoleta Stoicea, MD, PhD
Dr. Alberto Uribe, MD

Poster Presenter

Dr. Ana Mavarez-Martinez, MD

F132. Effects of Corticosteroid Injections on HbA1c Values in the Diabetic Population

Diabetes mellitus is one of the most common chronic medical conditions in the world, affecting nearly 350 million people worldwide in 2008[1]. Patients with poorly controlled diabetes are at increased risk for multiple co-morbidities including but not limited to diabetic foot infections, poor wound healing, chronic kidney disease, hypertension, heart disease, peripheral neuropathy, and stroke[2]. Thus, tight long term glycemic control, as measured by glycated hemoglobin or HbA1c testing, provides better outcomes with respect to morbidity and mortality[3]. In our study population, individuals receiving single or multiple corticosteroid pain injections could be adversely affected by increased HbA1c levels. These individuals could also benefit from pre-injection optimization of their glycemic control to prevent irreversible diabetic complications. 
 To our knowledge, there is little to no data observing the effects of corticosteroid pain injections on HbA1c values, and by extension, glycemic control. In this retrospective chart review, we evaluated the pre- and post-procedure A1c values of subjects who underwent single or multiple intraarticular corticosteroid injections. 

Submissions


CoAuthor(s)

Mr. Andrew Duarte, B.S.
Dr. Singh Nair, PhD
Dr. Naum Shaparin, MD, MBA

Poster Presenter

Dr. Moez Mithani, MD

F133. [Withdrawn] Persistent postoperative opioid use among US Veterans

Opioids are still the mainstay for postoperative pain management, and many patients are exposed to opioids for the first time after surgery. A subset of surgical patients continues to use long-term opioids. Unfortunately, the criteria for persistent postoperative opioid use is not well established and the remediable predictors are also largely understudied. Objective: To calculate the incidence of persistent postoperative opioid use at different time points (90, 180, 270, and 365 days) after surgery and identify the predictors. 

Submissions


Poster Presenter

Dr. Khodadad Namiranian, MD/PhD

F134. Evaluation of NOL index variations after a painful stimulus before and after a stellate ganglion block in patients with upper extremity complex regional pain syndrome: a pilot study

The nociception level index (NOL) is a multi-parameter index (0-100) that incorporates changes in autonomic parameters to evaluate physical pain, with more painful stimuli causing more pronounced index variations. However, chronic pain patients may respond differently to acute pain due to alterations in central pain processing, dysregulation in descending pain modulation and chronic pain therapy.The goal of this pilot study was to evaluate the NOL index variations after a painful physiotherapy exercise in patients with upper limb complex regional pain syndrome (CRPS), before and after a stellate ganglion block. 

Submissions


CoAuthor(s)

Dr. Véronique Brulotte, MD, MSc
Nadia Godin, RN
Dr. Philippe Richebé, MD, PhD

Poster Presenter

Dr. Tanya Santella, MD

F135. Enol Compounds Are Protective In Cell Models Of Cisplatinum Neurotoxicity

Platinum (Pt)-based antineoplastic drugs such as cisplatin (CisPt) are a highly effective treatment of solid tumors in children and adult patients. However, this chemotherapy is frequently (~60%) associated with treatment-limiting neurotoxicity (sensory neuropathy, ototoxicity) in patients1,2. Such side-effects can complicate tumor management and can lead to a poor clinical prognosis2,3. The development of an efficacious neuroprotectant is therefore an obvious unmet clinical need. However, although pre-clinical research showed that thiol nucleophiles (e.g., N-acetyl cysteine; NAC) could prevent CisPt neurotoxicity without disrupting antineoplastic efficacy, corresponding human trials failed to identify viable neuroprotectants3,4. This is likely to be due to the fact that sulfur is a reactive element that can participate in non-selective toxic side reactions; e.g., formation of toxic thiyl radicals. Thiol-based compounds can therefore act as pro-oxidants. Conversely, we have found evidence that a carbon-based series of nucleophilic enol compounds (e.g., N-(4-acetyl-3,5-dihydroxyphenyl)-2-oxocyclopentane-1-carboxamide; gavinol) might be useful in treating/preventing CisPt neurotoxicity. This is a completely unprecedented possibility with significant clinical relevance 6,7. 

Submissions


CoAuthor(s)

Brian Geohagen, BS
Dr. Richard LoPachin, Ph.D.

Poster Presenter

Dr. Naum Shaparin, MD, MBA

F136. Cannabinoid Modulation of the Analgesic Effects of Opioids on Acute Pain in Human Volunteers

Opioid analgesics are widely prescribed for acute and chronic pain, but are limited by adverse effects including addiction and abuse. Is there an ideal opioid adjuvant that would reduce the required opioid dose while improving analgesia? Does marijuana fulfill these criteria? Cannabinoid and opioid receptors are expressed in brain regions involving anti-nociception. Numerous rodent and primate studies demonstrate cannabinoids enhance the analgesic effects of opioids.The opioid-sparing effects of cannabinoids in clinical trials are inconsistent. Thus the aim of this study was to 1) examine the analgesic effects of dronabinol alone, and in combination with oxycodone, among healthy volunteers using acute pain models; and 2) to assess the safety of these drug combinations. 

Submissions


CoAuthor(s)

Dr. Shanna Babalonis, PhD
Dr. Laura Fanucchi, MD
Dr. Michelle Lofwall, MD
Mr. Paul Nuzzo, MA
Dr. Sharon Walsh, PhD

Poster Presenter

Dr. Paul Sloan 5524403, MD

F137. Sex Differences in Cannabis-Induced Modulation of Nociceptive Fiber Sensitivity

Despite a limited amount of research on cannabis and pain, the medical utilization of cannabis as an analgesic has been growing in the United States in recent years, particularly among the female population.(1-3) Previous studies in humans have demonstrated that males exhibit greater cannabis-induced analgesia than females and that females develop tolerance more readily than males to the antinociceptive effects of THC. However, these findings are different from preclinical reports which showed that female laboratory animals are more sensitive to antinociceptive effects of cannabinoids relative to males.(4-6) Therefore, a greater understanding of the sex-dependent effect of cannabis on nociception will better inform the clinical use of cannabis for pain. 

Submissions


CoAuthor(s)

Emily Blum, MD
Dr. Julia Finkel, M.D.
Mr. Kevin Jackson, BA
Brent Yeung, MD

Poster Presenter

Mr. Luka Vujaskovic, BSPH

F138. Individualized Anesthesia and Surgical Risk Assessment: A Multi-Center Study

The ASA, [1,2] ACS [3], CMS[4], the Joint Commission [5], and both the European and English Societies of Anaesthesia [6,7] require that surgical patients have a documented history, physical, and individualized risk assessment (RA) prior to surgery. It is known that individualized RA catalyzes pre-surgical shared-decision making, informed consent, informs pre-optimization, intra-operative management, and post operative disposition.[8] Most important, individualized RA has been shown to reduce surgical mortality by a factor of 3. The ASA score is a population based RA tool and thus does not provide individual RA.[9] While several individual surgical RA tool exist, the only tool validated for use in the U.S. is the ACS Risk Calculator, which provides organ specific risk of morbidity and mortality. The primary endpoint of this study was to assess the degree and rate of compliance with documented preoperative individualized RA in 756 high-risk patients who were cared for in 22 different medical centers. Secondary endpoints included the effects of assess age, sex, race & ethnicity, time of surgery, type of surgery, intraoperative and postoperative death, and the author of the note: Anesthesiologist or Surgeon. 

Submissions


CoAuthor(s)

Mrs. Jessica Curran, MSc
Mrs. Kelli Duarte, BSN
Ms. Deb Farley, RN
Dr. Tania Haddad, DMD, MD
Dr. John Jordan, MD
Ms. Kellie Kieffer, RN, MSN-L, CNML
Dr. Rafael Noriega, MD, MPH
Jennifer Pedersen, CRNA
Dr. David Sheinbein, MD, MBA
Dr. James Steinshouer, Ed.D., FACHE, LSSMBB

Poster Presenter

Dr. Joshua Bloomstone, MD, MSc, FASA

F139. Sedation Complications by non-Anesthesia Providers May be Related to Standards of Training

In order to accommodate the increasing volume of minimally invasive procedures which in turn increased the need for providers of sedation and anesthetics, the ASA made the decision to grant various specialties beside anesthesiology the ability to administer sedation to their patients. Specialties such as Emergency Medicine and Dentistry include sedation administration as a core part of their specialty training. The American Academy of Pediatrics, The American College of Emergency Physicians, and the American Academy of Pediatric Dentistry all have guidelines for sedation administration, which its members are encouraged to follow [1]. However, other specialties such as Internal Medicine do not teach sedation strategies to their residents, with some sub-specialties, such as Gastroenterology and Cardiology having no standard method for teaching the art of sedation administration to their patients, although some published advice exist [2]. The Joint Commission (JAHCO) recognizes the risks involved with sedation and analgesia for procedures and mandates that sedation practices throughout an institution be monitored and evaluated by a Director of Anesthesia who is a board-certified anesthesiologist whose duty it is to ensure the safe delivery of anesthesia services by all who practice it. The Director of Anesthesia at our institution wanted to determine whether there was a statistically significant difference in the use of sedation reversal agents and complication rates amongst various non-anesthesia specialties who administer sedation so that it could be appropriately addressed. 

Submissions


CoAuthor

Dr. Vilma Joseph, MD, MPH

Poster Presenter

Dr. Jacquelyn Francis 6679055, MD

F140. Safety and Efficacy of Interscalene Blocks Performed by General Anesthesiologists for Total Shoulder Arthroplasty in a Rural Community Hospital

Lower extremity regional anesthetic blocks have been performed safely by general anesthesiologists for total joint surgeries in rural community hospitals (1). Upper extremity blocks may be riskier due to their proximity to major vascular structures and the pleura (2). In addition, the interscalene block (ISB) may have negative respiratory effects in patients with restricted pulmonary function. We sought to determine the safety and efficacy of ISB performed by general anesthesiologists for patients undergoing total surgery arthroplasty (TSA) in a rural community hospital. 

Submissions


CoAuthor(s)

Dr. Yvon Bryan, MD
Dr. Daniel Forest, M.D.
Ms. Hannah Harris, B.S.
Ms. Abigail Muscoreil, Undergraduate
Mr. David VanEenenaam, Undergraduate

Poster Presenter

Ms. Kathleen Johnson, B.S.

F141. Carotid artery corrected flow time & respiratory variations of peak blood flow velocity for prediction of hypotension after induction of anesthesia in adult patients undergoing elective surgery

Hypotension is common after induction of general anaesthesia1 and intraoperative hypotension is associated with postoperative end organ injury such as acute kidney injury & myocardial ischemia1. Patients with low plasma volume was identified as a risk factor of intraoperative hypotension.2 This study has been designed to know the utility of carotid artery corrected flow time (cFT) and respirophasic variation in carotid artery blood flow peak velocity in prediction of hypotension after induction of general anaesthesia. 

Submissions


CoAuthor(s)

Dr. Rahul Anand, MD, EDIC
Dr. Dalim Baidya, MD, EDIC
Dr. Sulagna Bhattacharjee, MD, DNB, DM
Dr. Rajeshwari Subramanium, MD

Poster Presenter

Dr. Souvik Maitra, MD, DNB, EDIC

F142. Simulated Handoffs In Anesthesia Using An Automatically Generated Handoff Tool from the Electronic Medical Record: A Randomized Controlled Study

The majority of serious adverse events in healthcare occur during handoffs, the point at which "safety fails first" (1). Jones reported that "complete handovers" of intraoperative anesthesia care were associated with an increased risk of all-cause death and major complication (2). The Joint Commission advocates implementing a standardized handoff system that is easily accessed in the workflow such as the Electronic Medical Record (EMR), to improve communication failures, the most common root cause in 80% of serious medical errors (3). Jensen analyzed information decay in a simulation of sequential patient handoffs by medical students; descriptive analysis demonstrated a regression in handoff accuracy with 45% of the information passed on successfully by the third handoff (4). 

Submissions


CoAuthor(s)

Dr. Allan Gottschalk, MD, Phd
Dr. Bommy Mershon, MD
Dr. Adam Schiavi, PhD, MD

Poster Presenter

Dr. Christina Miller, MD

F143. VALUE OF PROGNOSTIC NUTRITIONAL INDEX, EARLY ENTERAL JEJUNOSTOMY TUBE FEEDING, AND PERIOPERATIVE EPIDURAL ANALGESIA IN IMPROVING PATIENTS SHORT- AND LONG-TERM SURVIVAL AFTER GASTRO-ESOPHAGEAL SURGERY

While current practice suggests decreased use of epidural analgesia in lower gastro-intestinal surgery at the expense of spinal/TAP blocks[1], the thoracic epidural analgesia still has room to improve tolerance to early enteral feeding in upper gastro-intestinal surgery[2]. In the context of enhanced recovery after surgery (ERAS) programs, nasogastric tubes are not recommended in colorectal surgery, but their use in patients undergoing gastrectomy and esophagectomy is still debatable [3], as well as the routine jejunostomy tube feeding following these procedures [4, 5]. The aim of our study was to provide data on clinical relevance of using epidural analgesia, early jejunostomy tube feeding, facilitated by Onodera's Prognostic Nutritional Index (PNI), in order to improve patients short- and long-term survival after open gastro-esophageal cancer surgery[6]. 

Submissions


CoAuthor(s)

Dr. Latchezar Djongov, MD, PhD
Mr. Todor Kundurzhiev, PhD
Dr. Alexander Shahov, MD

Poster Presenter

Dr. Dimitar Tonev, MD, PhD

F144. Real time ultrasound improves accuracy of caudal block in children

Caudal block is the most commonly performed regional anesthetic in children[1]. Caudal blocks are generally performed blindly relying on palpation and tactile feedback to assess if the local anesthetic is being administered correctly[1]. As a result, administration of local anesthetic totally or partially outside the caudal space may only become apparent after much or all of the dose has been injected, as is the case with subcutaneous bulging, or remain undetected until surgical incision. Real time ultrasound allows the provider to determine if the caudal space is correctly accessed prior to dose administration using minimal volume of local anesthetic or saline. While the technique of ultrasound guided caudal block for evaluation of placement has been well described, adoption by anesthesia providers has been relatively minimal, with the vast majority of providers still preferring placement by palpation alone [2-5]. Despite this, review of the 2015 Pediatric Regional Anesthesia Network data reports ultrasound utilization in less than 3% of caudal blocks[1]. As most caudal blocks in children are done by palpation, there has been no prospective study identifying the efficacy of this technique. We performed a prospective single blinded study to estimate the incidence of possible failed caudal block by providers performing caudal blocks by palpation. 

Submissions


CoAuthor(s)

Dr. Craig Belon, MD, PhD
Dr. Arvind Chandrakantan, MD, MBA, FAAP

Poster Presenter

Dr. Adam Adler, MD, MS, FAAP

F145. Anesthetic management of an infant with type IV laryngotracheo-esophageal cleft and Goldenhar syndrome

Laryngotracheo-esophageal cleft (LTEC) is a rare anomaly characterized by an abnormal communication between the trachea and esophagus. In severe cases, the prognosis is poor. We report a case of successful anesthetic management using Foley catheter in an infant with type Ⅳ LTEC and Goldenhar syndrome. 

Submissions


CoAuthor(s)

Dr. Tetsuro Kagawa, MD
Dr. Saeko Takatsuji, MD

Poster Presenter

Dr. HARUKI AKIIZUMI, MD

F146. Preoperative pulmonary function test results are not associated with postoperative intubation in children undergoing posterior spinal fusion for scoliosis: A retrospective observational study.

Scoliosis is the costliest pediatric inpatient surgical condition in the United States.(1) Evidence-based perioperative care and elimination of unnecessary preoperative testing is particularly important in this population. Preoperative pulmonary function tests (PFTs) are routinely obtained in children with scoliosis undergoing posterior spinal fusion (PSF), despite unclear benefits as a perioperative risk assessment tool and frequent inability of patients to provide acceptable results. The goal of this study was to determine whether preoperative PFT results are associated with the need for postoperative intubation or intensive care unit (ICU) admission following PSF. 

Submissions


CoAuthor(s)

Dr. Lauren Balmert, Ph.D.
Dr. Michael Evans, MD
Dr. Narasimhan Jagannathan
Dr. Kristen Rao, M.D.
Dr. Erin Toaz, M.D.
Mr. John Wieser, BA

Poster Presenter

Dr. Nicholas Burjek, MD

F147. Introduction of an enhanced recovery pathway results in decreased length of stay for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion

Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant postoperative pain and prolonged inpatient hospitalization. As a result, AIS is the pediatric surgical condition responsible for the greatest cumulative annual inpatient cost in the United States.(1) We hypothesized that a standardized enhanced recovery pathway that includes preoperative education, multimodal analgesia, nausea prophylaxis, rapid diet advancement, scheduled removal of drains and lines, and standardized daily physical therapy goals would result in decreased length of stay (LOS) without increased 30-day hospital readmissions among patients with AIS undergoing PSF. 

Submissions


CoAuthor(s)

Dr. Lauren Balmert, Ph.D.
Dr. Kristen Rao, M.D.

Poster Presenter

Dr. Nicholas Burjek, MD

F148. IANALYSIS OF PRE-PROCEDURAL PSYCHOSOCIAL AND ANESTHETIC DETERMINANTS IN ADOLESCENTS UNDERGOING PICC LINE PLACEMENT WITH ANESTHESIA

PICC lines in adolescents can be done both with and without anesthesia and there is no uniform process to determine which patients are best suited for anesthesia. There is a need to incorporate psychosocial factors of the patient into the workup to determine which patients require anesthesia. As a preliminary approach to this topic, we retrospectively analyzed pre-procedural anesthetic and psychosocial considerations in children undergoing PICC line procedures with anesthesia. 

Submissions


CoAuthor(s)

Dr. Adam Adler, MD, MS, FAAP
Mr. Andrew Jensen, Medical Student
Kamlesh Kukreja, MD
Mr. Michael Pratt, MS-IV

Poster Presenter

Dr. Arvind Chandrakantan, MD, MBA, FAAP

F149. General Anesthesia in a Boy with Autism, Mitochondrial and MTHFR Disorder, and a Family History of Malignant Hyperthermia

Our patient is a 6 year old, 20 kg boy diagnosed with Autism, Mitochondrial disorder, Metheleynetetrahydrofolate reductase (MTHFR) mutation, and a family history of Malignant Hyperthermia. He presented to the operating room for dental restoration. In light of the above history, Propofol, nitrous oxide and volatile anesthetics were contraindicated. Preoperative oral midazolam was administered. Intravenous access was secured and normal saline was utilized. Ketamine and fentanyl were used for induction. Spontaneous ventilation was maintained until the ability to mask ventilate was established. The patient was noted to be retrognathic and a Glidescope was used for successful oral intubation. Rocuronium was administered immediately prior to intubation. Dexmedetomidine and remifentanil infusions were used for maintenance. Blood pressure and heart rate remained within 20% of baseline throughout the case. At the end of the case the maintenanace infusions were stopped. The patient was reversed with neostigmine and glycopyrrolate and given ondansetron and Ofirmev. He was extubated and transferred to the PACU in stable condition. 

Submissions


CoAuthor

Carlyann Miller, MD

Poster Presenter

Dr. Mark Goldfinger, M.D.

F150. Non-Invasive Venous Waveform Analysis (NIVA) for Volume Assessment in Children Undergoing Craniosynostosis Repair

Hemorrhage during major surgery represents a major cause of perioperative pediatric morbidity. The Pediatric Perioperative Cardiac Arrest study (POCA) reports that under-resuscitation of hemorrhage is one of the principal causes of perioperative death in children.1-2 There remains a void for non-invasive monitoring for early, quantitative hemorrhage recognition, as well as predicting volume responsiveness in real time in pediatric patients. Craniosysostosis repair was used as a model procedure for blood loss. Non-Invasive Venous Analysis (NIVA) is a new non-invasive approach for measuring intravascular volume changes. NIVA uses the venous waveform for hemodynamic volume analysis by recording peripheral venous waveform signals from a device that fits on the wrist. The signal is then amplified, recorded and transmitted by a control panel to a dedicated tablet, which computes a fast Fourier transformation (fFT) of the signal followed by a summation algorithm of the frequency amplitudes to provide a NIVA value.  The NIVA value is an adjusted numerical value designed to correlate to the well understood clinical gold standard of volume status in adults, the pulmonary capillary wedge pressure (PCWP).3 Our hypothesis was that NIVA would correlate with changes in intravascular volume in pediatric patients undergoing craniosynostosis repair or revision cranioplasty. 

Submissions


CoAuthor(s)

Dr. Bret Alvis, MD
Colleen Brophy, MD
Kyle Hocking, PhD

Poster Presenter

Dr. Jenna Helmer Sobey, MD

F151. Exposure to Surgery and Anesthesia in Early Childhood and Subsequent Use of Stimulant Medication

Introduction: Recent clinical studies have found that anesthetic exposure in early childhood is not associated with lower scores in general intelligence and academic achievement. Some studies however have reported worse scores in behavioral function and an increased risk of attention deficit/hyperactivity disorder (ADHD).(1-3) This study evaluates the association between exposure to surgery and anesthesia, and the subsequent use of stimulant medications used to treat ADHD. Significant discrepancies between ADHD diagnoses and stimulant medication use have been reported.(4) The use of stimulant medication however is an important outcome because it is patient centered, requiring recognition of a need for pharmacological treatment and for parents to fill the prescriptions for their child, and may also be a marker of more severe disease. 

Submissions


CoAuthor(s)

Guohua Li, MD, DrPH
Ms. Xiaoyue Ma, BSc
Mark Olfson, MD, MPH
Ming Sun, MS
Melanie Wall, PhD

Poster Presenter

Dr. Caleb Ing, MD, MS

F152. Children and Adults with Congenital Heart Disease Show No Difference in Scores on Measures of Behavior as Compared to Their Healthy Peers: A Systematic Review and Meta-analysis

Children with congenital heart disease (CHD) are at higher risk for cognitive dysfunction compared to their healthy peers.1,2 Several reports have also indicated these children have an increased risk of behavioral problems,3,4 which may place them at higher risk for impaired educational attainment and a later diagnosis of mood disorders.5,6 To test the hypothesis that children with CHD have increased behavioral problems on validated parental and teacher reports of behavioral symptoms, we performed a meta-analysis of Total Problems scores on behavioral measures in children with CHD versus healthy children. 

Submissions


CoAuthor(s)

Dr. Mohammad Sadat, MD
Dr. Lena Sun, MD, MPH

Poster Presenter

Dr. William Jackson, MD

F153. Opioid-Sparing Analgesic Usage Among Pediatric Anesthesiologists: A Survey of Society for Pediatric Anesthesia Members

There is growing evidence to support the perioperative use of opioid-sparing analgesic medications in the pediatric population, but the use of, and attitudes toward, these agents among pediatric anesthesiologists is unknown. We designed a survey to characterize the utilization and views of opioid-sparing adjuncts among pediatric anesthesia practitioners. 

Submissions


CoAuthor(s)

Dr. Thomas Anderson, PhD, MD
Dr. Rebecca Wu, MD

Poster Presenter

Dr. Michael King, M.D.

F154. The Role of Preoperative Multi-Modal Analgesia following Pediatric ENT Surgery

Postoperative wound pain is commonly observed in the post-anesthesia care unit (PACU) following common pediatric ENT procedures. (1-3) Postoperative pain contributes to increased medical care costs and delayed patient discharge. (2-4) The purpose of this study is to review the benefits, if any, of preoperative administration of 0.2 mg/kg hydrocodone/acetaminophen elixir in this patient population. 

Submissions


CoAuthor(s)

Dr. Sarah Martin, MD
Dr. Bobby Nossaman, MD
Dr. Luis Salcedo, MD

Poster Presenter

Dr. Brooke LeBlanc, MD

F155. A RANDOMIZED BLINDED PROSPECTIVE TRIAL COMPARING SINGLE INTRAOPERATIVE DOSE OF METHADONE VERSUS PLACEBO IN PEDIATRIC PATIENTS UNDERGOING SPINE SURGERY

Scoliosis is a disease that involves lateral and/or rotational deformity of the spine and can affect up to 4% of the population. Patient undergoing this surgical correction experience severe pain in the postoperative period and the management includes the use of opioid-based patient-controlled analgesia (PCA). Methadone is an opioid with one of the longest elimination half-life and has been used as an effective analgesic for acute, chronic, neuropathic, and cancer pain in adults, children, and even neonates. A recent study by Gottschalk in adult patients demonstrated a 50% reduction of postoperative opioids at 48 hours and lower pain scores after a single bolus of methadone before surgical incision. Despite this potential benefit, methadone is seldom used in the perioperative setting. A more recent pharmacokinetic study of methadone in adolescents undergoing spine surgery failed to show a reduction in opioid consumption as it was powered to determine pharmacokinetics and not a secondary endpoint of postoperative opioid consumption. The aim of this study is to explore the efficacy of a single intra-operative dose of methadone in patients with idiopathic scoliosis undergoing multi-level posterior instrumentation and spinal fusion. The primary endpoints is the total opioid usage during POD (postoperative day) 0-4 and pain scores during rest and with activity (getting out bed and ambulation) on POD 0-5 and side effects. 

Submissions


CoAuthor(s)

Dr. Frank Gerow, MD
Dr. Chris Glover, MD, MBA
Dr. Darrell Hanson, Md
Mr. Eduardo Medellin, BS
Dr. Nihar Patel, MD

Poster Presenter

Dr. Kim Nguyen, MD

F156. Perioperative Morbidity and Mortality in a Cohort of Patients with Achondroplasia: the Commonest Form of Dwarfism

Achondroplastic skeletal dysplasia (ASD) is the most common form of short limb dwarfism and is caused by a point mutation in the gene for FGFR3 (1). Comorbid conditions requiring surgical intervention include central and obstructive apnea (OSA), difficult airway, otitis media, hydrocephalus, foramen magnum stenosis, cervicomedullary compression, lumbo-sacral stenosis, kyphoscoliosis, and varus deformities (Figure 1). Mortality and morbidity are higher than the general population, with highest mortality reported in the first four years of life(2). There are anecdotal reports of spinal cord injury and irreversible paralysis (unpublished due to litigation) even when the surgical procedure is unrelated to the spine. In this study we present 41 ASD patients (ASDP) and describe surgical interventions, anesthetics challenges, and perioperative complications including one case of perioperative death. 

Submissions


CoAuthor(s)

Mrs. Colleen Ditro, CPNP, DNP
Ms. Taylor Jones, B.S.
Mrs. Mary Little, RN
Dr. William Mackenzie, MD
Dr. Udayan Shah, M.D.
Dr. MARY THEROUX, MD

Poster Presenter

Dr. Abraham Oommen, M.D.

F157. Anesthetic Management of Vascular Ring Anomaly Repairs

Vascular rings (VR) comprise 1% of congenital cardiovascular anomalies.(1) These abnormalities of the aortic arch may result in compression of the trachea and esophagus resulting in dyspnea, dysphagia and respiratory symptoms which can have a profound impact on anesthetic management.(2) Surgical repair has been extensively described, however no study to date describes anesthetic management. We therefore conducted a retrospective review describing perioperative management and patient course of isolated VRs and at a high-volume center. 

Submissions


CoAuthor

Dr. Jue Hou, MD

Poster Presenter

Dr. Alison Robles, MD

F158. Tension Emphysema in Congenital Lober Emphysema - An exploration into Collateral Ventilation and Pulmonary Compliance

Congenital lobar emphysema (CLE) is a rare respiratory disorder characterized by hyperinflation of one or more of the pulmonary lobes. Due to its rare incidence, CLE is often misdiagnosed in children. The delay in diagnosis can result in mediastinal tension phenomena. Predominant lobes affected are the left upper lobe (40-50%) then the right middle lobe (25-35%) with a 3:1 male to female predominance. No cause is currently known, however, an association exists with airway obstruction, abnormal bronchial cartilage and bronchial atresia. 

Submissions


CoAuthor

Dr. Mark Teen, MD

Poster Presenter

Dr. Miguel Yaport, MD

F159. Characteristics and Contributing Factors of Case Cancellations at a Quaternary Care Children's Hospital

Case cancellations result in an inefficient utilization of resources, inconvenience to patients, families, and providers, and financial burden. Often preventable, case cancellations rates vary by institution(1,2) on the day of surgery and are due to factors such as incomplete medical/surgical evaluation, recent patient illness, lack of insurance authorization/financial, scheduling error, or patient or family declining surgery(3,4,5). To date, case cancellations have not been well characterized in the pediatric population. Our study aim was to investigate the amount and type of cancelled pediatric operating room and same day surgery cases at Texas Children's Hospital during a twelve-month period and reasons for cancellations. We examined factors including patient age, department, day of versus before day of surgery cancellation, utilization of our pre-operative clinic, and whether the cancelled case was elective. 

Submissions


CoAuthor(s)

Dr. Adam Adler, MD, MS, FAAP
Dr. Arvind Chandrakantan, MD, MBA, FAAP
Mr. Andrew Lee, MPH

Poster Presenter

Dr. Michael Yim, MD, MPH

F160. Rapid Cognitive Screening in the Preoperative Setting- Instrument Characteristics and Other Considerations

The preoperative workup involves an evaluation of risk across major organ systems (i.e., cardiac, respiratory, hematological, and gastrointestinal)1, 2 that does not systematically include assessment of central nervous system functioning3. Preoperative cognitive impairment is associated with increased utilization of available resources and poor postoperative outcomes4, 5. Thus, failure to identify cognitive vulnerabilities in older adults (those greater than age 65) presenting for surgery may misrepresent cost/benefit risk associated with the procedure6. Currently, we do not know which cognitive screeners are appropriate for fast-paced preoperative settings7. We therefore first compiled a comprehensive list of general cognitive screeners with used currently in community-based and primary care settings. We then characterized and described the brief instruments used within preoperative settings. 

Submissions


CoAuthor(s)

Ms. Rebecca Armstrong
Mr. Carlos Hernaiz, B.S.
Dr. Catherine Price, PhD, ABPP/CCN
Dr. Richard Urman, MD, MBA

Poster Presenter

Dr. Franchesca Arias, PhD

F161. Impact of inhaled agents on early clinical outcomes in pancreas transplantation

Due to the nature of solid organ transplantation, ischemia-reperfusion injury (IRI) is a not an uncommon cause of allograft dysfunction and patient morbidity. Previous studies have demonstrated the ability of inhaled anesthetics to protect against IRI.[1-4] Although inhaled anesthetics have been shown to protect against IRI in kidney, liver, neurological, and cardiothoracic procedures, little is known about this phenomenon when it comes to pancreas transplantation. This study compares the effect of different inhaled anesthetics on early IRI in a large cohort of pancreas allograft recipients. 

Submissions


CoAuthor(s)

Jonathan Fridell, M.D.
Mr. Ryan Graham, B.S.
Elizabeth Kroepfl, M.D.
Richard Mangus, M.D.
John Powelson, M.D.

Poster Presenter

Mr. Sam Atoa, B.S.

F162. Perioperative amino acid metabolism: possible contributor to postoperative cognitive dysfunction

Postoperative delirium and cognitive dysfunction (POCD) is multifaceted, difficult to predict, hard to study, and challenging to treat.[sup]1[/sup] Patients with POCD have worse outcomes and increased costs of hospitalization.[sup]2[/sup] While the neurobiology of POCD is unclear, some have hypothesized that changes in large neutral amino acids (LNAA) can induce disturbances in cognition and mood.[sup]3,4[/sup] LNAAs are precursors to many neurotransmitters (e.g. serotonin) and compete to cross the blood-brain barrier.[sup]5[/sup] Variations in plasma levels of LNAAs may affect central nervous system neurotransmitter concentrations leading to changes in cognitive function.[sup]6[/sup] Surgery is known to induce a catabolic state with increased amino acid metabolism.[sup]7[/sup] Using mass spectrophotometry based metabolomics and systems biology techniques, we asked whether LNAA metabolism was altered in the perioperative period. 

Submissions


CoAuthor(s)

Dr. S. Patrick Bender, MD
Alexander Friend, MS
Dr. Donald Mathews, MD
William Paganelli, M.D., Ph.D.
Dr. William Tharp, MD

Poster Presenter

Mr. Max Breidenstein, BS

F163. Peripheral nerve blocks, an approach towards opioid free laparoscopic living donor nephrectomy

Recovery after laparoscopic living donor nephrectomy (LLDN) is an important factor to be considered in the care of living donors. Our center, besides exclusively using a laparoscopic approach, we further enhance the post-operative experience for living donors by utilizing pre-operative peripheral nerve blocks (PNB) to reduce opioid use, minimizing the opioid crisis and its adverse effects. 

Submissions


CoAuthor(s)

Dr. Ramesh Batra, MD, FRCS
Ms. Elizabeth Cohen, PharmD, BCPS
Dr. Ranjit Deshpande, MBBS
Mr. Vincent Do, PharmD, BCPS
Dr. Claudia Fernandez-Robles, M.D.

Poster Presenter

Dr. Nikhil Chawla, M.D.

F164. A Novel Method of Crosslinking Mass Spectrometry Identifies Distinct Alpha 2 Macroglobulin Crosslinks in Pathological Coagulation

Pathological coagulation results in significant morbidity and mortality after surgery and venous thromboembolism (VTE) remains a significant risk despite prophylactic anti-thrombotic strategies. Approximately 1 million patients undergo total joint surgery in the United States each year with 0.5% experiencing VTE (1–3). Aging associated hypercoaguability is a significant risk factor for VTE, but the mechanism of increased risk is unknown. We hypothesized that the increased risk is due to production of lysis resistant clots which have a higher likelihood of embolizing. 

Submissions


CoAuthor(s)

Dr. Angelo D'Alessandro, PhD
Dr. Kirk Hansen, PhD
Rachel Henderson, BA
Dr. Nathaen Weitzel, MD

Poster Presenter

Dr. Nathan Clendenen, MD

F165. A Retrospective Quality Improvement Analysis of Post-Operative Complications requiring Medical Emergency Team Activation in Complex Surgical Patients

Surgical complexity coupled with high patient morbidity is associated with an increased incidence of adverse outcomes, and, not infrequently, unplanned Intensive Care Unit (ICU) admission. ICU based medical emergency teams (MET) have been shown to decrease long-term mortality following major surgery (1). Pre-operative morbidity, intra-operative and early post-operative complications contribute to post-operative adverse outcome. Pre-operative factors associated with unplanned ICU admission after total hip arthroplasty include creatinine clearance < 60 ml/min, BMI > 35 kg / m2 and prior myocardial infarction (2). In a prospective cohort study of unplanned surgical ICU admissions, Haller et al found that 52.2% of patients had at least one intra-operative incident (3). Examples included uncontrolled hypotension, persistent oxygen desaturation, arrhythmia and oliguria. Post-operatively, suboptimal pain control is associated with multiple pulmonary complications. In a meta-analysis of randomized controlled trials comparing effective epidural analgesia versus systemic opioids, Ballantyne et al found a reduced odds ratio for the incidence of pulmonary infection and overall pulmonary complication rate (4). This study is a retrospective analysis of operating room and ICU databases from a 650 bed tertiary care centre over an 18 month period. Our objectives were 1) to describe the incidence of MET activation within 72 hours of elective surgery when ICU admission was not anticipated, 2) to determine the incidence of ICU admission and / or in hospital mortality in this patient population and 3) to investigate the medical reasons for postoperative deterioration requiring MET team activation. 

Submissions


CoAuthor

Dr. Cherese Lapere, MB ChB

Poster Presenter

Dr. Derek Dillane, MB BCh BAO FCARCSI

F166. Opioid Sparing Anesthesia in the Perioperative Setting â€" A Case Control Study

Anesthesiologists have long used multi-modal analgesia for effective pain control. Today, an opioid sparing anesthetic is gaining popularity among practitioners in light of increasing concerns for potential opioid misuse and abuse among susceptible patients. New evidence suggests that the perioperative period may be more critical than previously understood for establishing later opioid use practices among patients. Currently, there is a critical gap in knowledge regarding outcomes after an opioid sparing anesthetic during general anesthesia. We hypothesized that an opioid sparing general anesthetic will not be inferior to a traditional opioid anesthetic as measured by PACU LOS, post-operative SPID, and post-operative MED. 

Submissions


Poster Presenter

Dr. Angela Forbes, DO

F167. Impact on Length of Stay and Other Episode of Care-related Metrics for a Non-Narcotic Approach to Robot-Assisted Radical Cystectomy

Radical cystectomy (RC) is a highly complex urologic procedure for muscle invasive bladder cancer that carries significant risk for patient morbidity and complications. Robot-assisted radical cystectomy (RARC) is a highly popular, minimally-invasive surgical technique that aims to decrease recovery time and complication rates. Current literature shows no statistically significant difference in overall hospital length of stay (LOS) or complication rates between patients receiving open RC versus RARC. In RARC patients, gastrointestinal complications, such as postoperative ileus, are most commonly the reason for prolonged hospital LOS. Streamlined recovery protocols for RARC often involve the use of perioperative narcotics for pain control with alvimopan, a peripheral mu-opioid receptor antagonist. The objective of our current study is to evaluate the effect of a non-narcotic perioperative technique on hospital LOS and other care-related metrics associated with RARC patients. 

Submissions


CoAuthor(s)

Dr. Francois Audenet, MD
Dr. Daniel Gainsburg, MD
Dr. Jonathan Gal, MD
Ms. Jia Huang, MS
Dr. Daniel Katz, MD
Dr. John Sfakianos, MD
Dr. Alan Sim, MD

Poster Presenter

Dr. Morgane Giordano, MD

F168. Team Consistency and Patient Outcomes in the Operating Room: A Retrospective Analysis

Technical skills, surgical volume and case complexity often are cited as the most influential factors affecting surgical outcomes. However, recent studies suggest that effective collaboration and teamwork also play a large role in impacting outcomes.¹ Each member of a surgical team plays an important and expected role in the operating room (OR) based on their profession and expertise. Scheduling conflicts and other difficulties often serve as barriers to consistent teams in the OR, therefore these expectations often can bridge the lack of familiarity between team members. In this study, we sought to identify how often surgical teams were consistent, and to evaluate the impact of consistency on surgical characteristics and patient outcomes. 

Submissions


CoAuthor(s)

Ariel Mueller, MA
Dr. Jennifer Stevens, MD, MS

Poster Presenter

Dr. Cullen Jackson, PhD

F169. The effect of femoral nerve block and local infiltration analgesia on the postoperative pain after total knee arthroplasty

The postoperative pain after total knee arthroplasty (TKA) is severe and affects the postoperative functional recovery and patient satisfaction1). In our hospital patients underwent TKA under general anesthesia and received fentanil by patient controlled analgesia (PCA) for postoperative analgesia until recent years. We started using femoral nerve block (FNB) and local infiltration analgesia (LIA) for postoperative analgesia. We compared the effects on the postoperative pain between fentanil by PCA and the combination of FNB and LIA retrospectively. 

Submissions


CoAuthor(s)

Dr. Makoto Fukusaki, Doctor of Medicine
Dr. Tetsuya Hara, Doctor of Medicine
Makito Oji, MD
Dr. Natsuko Oji, Doctor of Medicine
Maki Ono, MD
Ayako Shimasaki, MD
Dr. Yoshiaki Terao, Doctor of Medicine

Poster Presenter

Mr. Yusuke Kasai, MD

F170. Use of BIS as a recall probability monitor

The Bispectral Index Monitor (BIS Medtronic-Covidien, Dublin, Ireland) was developed as a depth of anesthesia monitor to reduce the incidence of intraoperative awareness events. Despite its widespread use, its meaning and appropriate applications are incompletely understood due, in part, to the proprietary nature of its algorithm. This study focused on delineating what BIS readings can tell us regarding perioperative memory formation. 

Submissions


CoAuthor(s)

Mr. Christopher Awounou, BA
Dr. David Glick, MD, MBA
Dr. Michael O'Connor, MD
Dr. Katherine Palmer, MD

Poster Presenter

Mr. Yaman Kherallah, BS

F171. Enhanced Recovery After Cardiac Surgery in Minimally Invasive Mitral Valve Replacement: Evaluation of Postoperative Pain Management, Opioid Consumption and Length of Stay

Enhanced Recovery After Surgery (ERAS) protocols have shown promise in improving pain scores, decreasing opioid use and shortening length of stay, thereby decreasing hospital costs and improving patient outcomes overall.1-3 Limited outcomes data from Enhanced Recovery After Cardiac Surgery (ERACS) have been published to date. The aim of this study was to evaluate the efficacy of our ERACS protocol on decreasing opioid use and length of stay among patients receiving Minimally Invasive Mitral Valve Replacement (MIMVR) surgeries. 

Submissions


CoAuthor(s)

Dr. Steven Haddy, MD
Dr. Tara Humphrey, DO
Dr. Yaroslava Longhitano, MD PhD
Dr. Carol Peden, MD MPH
Dr. Zerlina Wong, MD
Dr. Christian Zanza, MD-PhD

Poster Presenter

Dr. Michael Kim, DO

F172. The Effect of Perioperative Use of Normal Saline Solution as Compared to Balanced Crystalloids on Graft Function in Patients Undergoing Living Donor Kidney Transplantation

During kidney transplantation (KT), high volume crystalloid solutions are the first line therapy for intraoperative fluid management to maintain intravascular volume and ensure graft perfusion. Normal Saline (NS), balanced crystalloids (BaC) (PlasmaLyte, Ringer's Lactate), or combinations are commonly used. Metabolic and physiologic effects of high volume NS resuscitation are well described: the high chloride content causes a hyperchloremic metabolic acidosis, reduces kidney perfusion, reduces glomerular filtration rate and prolongs time to micturition.[1-3] However, primary endpoints of studies in a living donor KT population were laboratory changes such as acidosis and potassium levels. Relevant clinical outcomes such as allograft function were not investigated. We hypothesized that the metabolic changes associated with high volume perioperative administration of NS might affect the incidence of delayed graft function (DGF) in patients undergoing living donor KT. 

Submissions


CoAuthor(s)

Eshandeep S. Boparai, MD
Dr. Ozlem S. Cakmakkaya, MD, Ph.D.
John Feiner, MD
Claus U. Niemann, MD
Mehdi Tavakol, MD

Poster Presenter

Dr. Kerstin Kolodzie, MD PhD

F173. Predictive Value of Non-Invasive Cardiac Testing for Preoperative Coronary Revascularization and Adverse Cardiac Events 30-days Post Kidney Transplant

Renal transplantation is associated with adverse perioperative cardiovascular outcomes and pretransplant cardiac evaluation is, therefore, indicated for high-risk candidates. The predictive value of non-invasive stress testing for preoperative coronary revascularization and adverse outcomes in this high risk group is not well established. 

Submissions


CoAuthor(s)

Dr. Ramona Nicolau-Raducu, MD, PhD
Dr. Yehuda Raveh, MD
Dr. Vadim Shatz, MD

Poster Presenter

Dr. Nicholas Mendez, MD

F174. MONITORED ANAESTHESIA CARE FOR RADIOFREQUENCY ABLATION : OUR EXPERIENCE

Radiofrequency tumor ablation (RFA) refers to the direct application of ionic currents produced by radiowaves generating high levels of energy to focal tumor tissue for tumor destruction. This technique is one of the many ablative techniques developed for treatment of tumors which are unsuited for surgical resection, either because of the size, number, or location of tumor or poor general condition of the patient. Radiofrequency ablation is the heating and destruction of tissues employing a high-frequency alternating current that increases the temperature of the tissues beyond 60°C, causing coagulation necrosis surrounding the electrode, which is a strong stimulus requiring deep sedation and anesthesia levels during the radiofrequency procedure. Purpose of this study was to analyse the different anaesthesia techniques and outcomes in patients who underwent Radiofrequency tumor ablation(RFA) at our tertiary level cancer centre and formulate appropriate protocol for RFA ,in a radiology suite beyond the safe environment of the operating room, which is a challenge to the anesthesiologist. 

Submissions


CoAuthor(s)

Dr. Itee Chowdhury, DA, DNB ANAESTHESIA
Dr. ASHITA MOWAR, MBBS, DA, MD ( ANAESTHESIOLOGY)

Poster Presenter

Dr. Akhilesh Pahade, MBBS, MD (Anaesthesiology), PDCC (Cardiac Anaesthesia)

F175. Anesthetic management of a patient with anaplastic thyroid carcinoma compressing the internal carotid artery accompanied by recurrent shock

Head and neck cancers can result in various consequences including compression of arteries, veins, nerves and related structures [1]. Carotid sinus baroreceptors are located cephalad to the bifurcation of the common carotid artery. Manipulation of carotid sinus activates the carotid sinus reflex, which give rise to impulse carried via glossopharyngeal nerve to the medulla oblongata and may lead to hemodynamic alterations such as bradycardia and hypotension. Cardiac arrest during surgery of the carotid artery and robotically assisted total thyroidectomy has also been reported [2.3]. Therefore, operations which may affect the carotid sinus needs to be carefully approached and vigilantly monitored by anesthesiologists. 

Submissions


CoAuthor(s)

Ms. Ju Yeon Park, M.D.
Dr. Hyun-su Ri, Master
Dr. Tae Kyun Kim, Ph.D.
Dr. Kim So Hyun, M.D.

Poster Presenter

Dr. Soon Ji Park, M.D.

F176. Outcome of Esophageal Doppler Monitoring (EDM) during perioperative management of patients undergoing Robot -assisted Laparoscopic Prostatectomy (RALP)

Robot-assisted Laparoscopic Prostatectomy (RALP) is a well accepted and commonly performed minimally invasive surgery for patient with prostate cancer . Patient undergoing RALP are exposed to multiple cardiovascular effects during laparoscopy associated pneumoperitoneum , which may be exacerbated during Trendelenburg position [1] . Esophageal Doppler Monitoring (EDM) has been suggested as preferred hemodynamic monitor in patient undergoing laparoscopic surgery . We studied effects of EDM monitoring on patients undergoing RALP at a Veteran Admin Hospital . 

Submissions


Poster Presenter

Dr. Pariza Rahman, M.D.

F177. Association between severity of perioperative acute kidney injury and progression of chronic kidney disease following non-cardiac surgery

The association between perioperative acute kidney injury (AKI) and progression of chronic kidney disease (CKD) has been described in cardiac and non-cardiac surgeries (1,2), however, a dose-response relationship with AKI severity has not been examined. In this study, we sought to test whether such a relationship exists in non-cardiac surgery. 

Submissions


CoAuthor(s)

Dr. Vijay Krishnamoorthy, MD, PhD
Dr. Thorir Long, MD
Dr. Karthik Raghunathan, MD, MPH
Dr. Gisli Sigurdsson, MD, PhD
Dr. Martin Sigurdsson, MD, PhD

Poster Presenter

Dr. Mohammad Rasouli, MD

F178. Effects of Anticholinesterase Reversal Under General Anesthesia on Postoperative Cardiovascular Complications: A Retrospective Cohort Study

The anticholinesterase neostigmine and the muscarinic inhibitor glycopyrrolate are frequently co-administered for the reversal of neuromuscular blockade¹. This practice can precipitate severe tachycardia or bradycardia², but whether it affects the incidence of cardiovascular complications remains unclear. We hypothesized that anticholinesterase reversal with neostigmine and glycopyrrolate vs. no anticholinesterase reversal increases the risk of postoperative cardiovascular complications among adult patients undergoing noncardiac surgery with general anesthesia. 

Submissions


CoAuthor(s)

Dr. Hao Deng, M.D.
Dr. Matthias Eikermann, MD PhD
Dr. Stuart Forman, MD-PhD
Dr. Timothy Houle, PhD
Barry Kelly, M.D., M.Sc.
Anne-Louise Lihn, BSc. Med.
Ms. Anahita Nourmahnad, B.S., Chemistry
Ms. Flora Scheffenbichler, cand. med.
Dr. Xinling Xu, Ph.D.

Poster Presenter

Mr. Denys Shaydenfish, cand. med.

F179. Whole system immune phenotyping of male and female mice reveals striking sex similarities and differences in the immune response to injury

Recent advances in Enhanced Recovery After Surgery (ERAS) pathways highlight the significance of protracted surgical recovery that affects up to 30% of patients. However the elements of these protocols that may improve recovery are uncertain. To identify patient-specific modifiers that may be targeted pre-operatively to improve surgical recovery a precise understanding of the underlying biological mechanisms, in particular the immune response to injury, is critically needed. Here, we perform a novel high dimensional mass cytometry assay in a murine model of orthopedic surgery to 1) Establish baseline differences between the male and female immune system, 2) Establish a pre-clinical paradigm that recapitulates important components of the human immune response to surgery, 3) Enable the systems-wide analysis of sex differences and similarities in the immune response after injury to better understand predictors of pain. 

Submissions


CoAuthor(s)

Mr. Nima Aghaeepour, Ph.D.
Dr. Quentin Baca, MD, PhD
Dr. David Clark, MD, PhD
Dr. Anthony Culos, PhD
Dr. Edward Ganio, PhD
Dr. Brice Gaudilliere, MD, PhD
Mr. Sajjad Ghaemi, Ph.D.
Ms. Elena Haight

Poster Presenter

Dr. Vivianne Tawfik, MD, PhD

F180. INCIDENCE AND RISK FACTORS OF PROLONGED TRACHEAL EXTUBATION AFTER GENERAL ANESTHESIA

Prolonged extubation has been defined as a time interval longer than 15 minutes from end of surgery (EOS) to airway extubation (AE) (1). Unplanned prolonged extubation affects OR workflow (2), and may compromise patient throughput and effective utilization of personnel (3). Literature provides differing information regarding risk factors for prolonged extubation. Bayman recently showed that prolonged extubation is very rarely dependent on the performance of individual anesthesiologists (4). Other studies have shown that extubation time is affected by the use of specific anesthetic agents (1, 5-7), as well as by surgery and anesthesia related variables. Among those: surgeon's specialty; case length; intraoperative prone-position; and, possibly, use of an extraglottic airway (EGA) vs a tracheal tube (2, 7). The role of underlying patient characteristics and of additional anesthesia-related factors such as the choice of specific neuromuscular blocking agents (NMBAs), their reversal, and the administration of potential traumatic ventilation is not well understood. The aim of this study was to identify incidence and risk factors for prolonged extubation of adult patients undergoing general anesthesia and mechanical ventilation for surgical procedures not involving the airway and/or the chest. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Andrea Vannucci, MD

F181. Clinical application of quadratus lumborum: a systematic review

Quadratus lumborum block was first described by Blanco et al as a modified TAP block used for postoperative analgesia in abdominoplasty(1). Since then various modifications to the technique have been described. In addition, its use has also expanded beyond abdominal surgery as initially described. In this systematic review we will investigate the clinical applications of quadrates lumborum block. 

Submissions


CoAuthor(s)

Dr. Ru Li, PhD
Dr. Jun Lin, MD, PhD
Dr. Jiaxin Liu, MD

Poster Presenter

Dr. Zhaosheng Jin, MBBS

F182. Change in Transcutaneous pO2 After Popliteal Catheter Placement

Evidence suggests that sympathectomy from central and peripheral nerve block can improve peripheral blood flow in a variety of settings. For example, regional anesthesia has been shown to improve patency rates for arteriovenous fistulas (AVFs). Similarly, a case report demonstrated treatment of Raynaud's syndrome by noting resolution of symptoms and increase in Doppler signals after axillary brachial plexus block. In addition, lumbar sympathetic blocks have been performed in patients with post-thrombotic syndrome after deep venous thrombosis. We postulate that this effect could be utilized to improve peripheral blood flow to the lower extremities in peripheral vascular disease as an additional benefit to popliteal nerve block beyond operative anesthesia and post-operative analgesia. We extrapolated this information to two cases in which we recorded changes in transcutaneous pO2 (tcpO2) in two patients receiving a peripheral nerve block. 

Submissions


CoAuthor(s)

Dr. Sophia Koessel, MD
Robert Maniker, MD
Dr. Carolyn Thai, DO

Poster Presenter

Dr. Sara Anwar, MD

F183. Feasibility and efficacy trial comparing 0.25% Bupivacaine versus a mixture of 0.25% Bupivacaine and 0.65% Liposomal Bupivacaine in preoperative four compartment periarticular infiltration block for patients undergoing TKA; A single-blinded randomized trial

More than 1.1 million total joint arthroplasties are performed annually in the United States,TKA being the most common, and the demand for surgery will continue to increase. Despite advances in surgical technique, anesthesia and analgesia modalities, a significant number of patients continue to experience moderate to severe acute postoperative as well as persistent postsurgical pain. Regional anesthesia has been an integral part of the effective postoperative pain management after TKA, and new techniques and modalities have evolved in order to achieve the most optimal postoperative analgesia. Femoral and sciatic nerve blocks have been gradually replaced with adductor canal and periarticular injections in order to avoid motor blocks postoperatively and facilitate more effective physical therapy and mobilization. The purpose of this investigation was to evaluate the efficacy of Liposomal Bupivacaine in an assessor-blinded randomized controlled trial comparing the 0.25%Bupivacaine alone versus a mixture of 0.25%Bupivacaine and 0.65%Liposomal Bupivacaine in preoperative US guided periarticular soft tissue infiltration, in addition to adductor canal block with Bupivacaine only, in patients undergoing primary TKA. 

Submissions


CoAuthor(s)

Dr. Anis Dizdarevic, MD
Dr. Singh Nair, PhD

Poster Presenter

Dr. Brian Aviles, MD

F184. A comparison of the analgesic and respiratory effects of supraclavicular and interscalene blocks for shoulder surgery: Systematic review and meta-analysis

Interscalene nerve block (ISB) is the analgesic technique of choice for shoulder surgery, but its undesirable respiratory side effects have prompted examination of alternatives. Supraclavicular block (SCB) has been proposed and used as an ISB alternative, but evidence of comparative analgesic and respiratory-sparing effects is conflicting. This meta-analysis compares the analgesic and respiratory effects of SCB and ISB for shoulder surgery. 

Submissions


CoAuthor(s)

Dr. Faraj Abdallah, MD, MSc
Dr. Michael Essandoh, MD, FASE
Dr. Colin McCartney, MBChB, PhD, FRCA, FRCPC
Dr. Peter Rose, MD, MSc, FRCPC
Dr. Tristan Weaver, MD

Poster Presenter

Dr. Nasir Hussain, MD, MSc

F185. Compartment Syndrome Pain Breaks Through Peripheral Nerve Block

Acute Compartment syndrome (ACS) is a true surgical emergency and, therefore, early diagnosis and prompt surgical decompression is vital. Pain is the cardinal sign of ACS, so the role of regional anesthesia (RA) in patients at high risk for ACS remains controversial. Surgeons fear that RA will mask the presenting symptom of pain and thus delay diagnosis. However, this has proven to be false in numerous anesthesia case reports, and our case is yet another example of this. 

Submissions


CoAuthor

Dr. Matthew Lyman, MD

Poster Presenter

Dr. Jacob Loyd, MD

F186. MERGING PHYSICS WITH ANESTHESIA – THE SOTA OMOIGUI SHORT NEEDLE TECHNIQUE FOR INTERVENTIONAL PROCEDURES

Current guidelines for procedural injections e.g. spinal nerve blocks, intercostal blocks, require the length of needle to ensure that the needle tip is inserted to the nerve that needs to be blocked. The use of long and larger gauage needles may be associated with complications from needle insertion including trauma to the structures traversed. Utilizing laws of physics, including the equation of continuity and the principle of conservation of mass, and incorporating these into the practice of regional anesthesia, we describe the Sota Omoigui Short Needle technique, for procedural injections and increased safety of such injections. We have employed this short needle technique in more than 500 procedural injections with good success and no complications. 

Submissions


Poster Presenter

Dr. Sota Omoigui, MD

F187. [Withdrawn] To evaluate the efficacy of USG guided transversus abdominus plane block analgesia with Ropivacaine or Levo-bupivacaine for postoperative pain management in Laparoscopic donor nephrectomy

The management of postoperative pain is a key to patient early recovery, in particular, where the surgery was performed to benefit another human being. In recent years it has been recognized that multimodal analgesic methods are superior for postoperative pain relief. Although the laparoscopic donor nephrectomy has reduced the disincentives associated with open surgery, still significant percentage of donors suffers from postoperative pain. Though opioids provide good analgesia, they are far from being an ideal analgesic due to their adverse effects. TAP blocking is that local anaesthetic is injected into the neurofascial plane where it may act on the afferent sensory nerves of the lower six thoracic and upper lumbar nerves as they course through the plane before they pierce the musculature to innervate the abdominal wall. 

Submissions


CoAuthor(s)

Dr. Sanjay Dhiraaj, MD
Dr. CM Pandey, PHD
Dr. Zakia Saeed, MD, PDCC
Dr. Gaurav Sindwani, MD, PDCC

Poster Presenter

Dr. SANDEEP SAHU, MD, FACEE, FICCM

F188. Ultrasound Guided Stellate Ganglion Block for the Treatment of Electrical Storm Refractory to Percutaneous Ablation: A Case Report

Electrical storm is defined as the occurrence of three or more episodes of sustained ventricular arrhythmia over 24 hours.1 Antiarrhythmic medications and percutaneous catheter ablation is most commonly used for the treatment of Ventricular Tachycardia (VT). Autonomic neural modulation is increasingly becoming a novel modality in the treatment recently. The techniques include thoracic epidural anesthesia (TEA), spinal cord stimulation (SCS), Stellate Ganglion Block (SGB) or even surgical resection of the lower half of the stellate (cervicothoracic) ganglion and T2–4 sympathetic ganglia.2-4 We report a case of VT treated with SGB, which was refractory to percutaneous ablation and anti- arrhythmic medications. 

Submissions


CoAuthor

Dr. Paramvir Singh, MBBS

Poster Presenter

Dr. Estuardo Saravia Fernandez, MD

F189. Ambulatory Continuous Femoral Nerve Block drastically Reduces Hospital Stay, SNF Admission, Readmissions for Pain and Opioid Prescriptions after TKA and THA

To improve care value, we established a collaborative partnership between the acute pain service (APS) and orthopaedic surgical teams. The main goals were to improve quality metrics, ultimately leading to lower episode cost without compromising patient satisfaction and pain management. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Justin Deen, MD
Dr. Chancellor Gray, MD
Dr. Barys Ihnatsenka, MD
Dr. Hari Parvataneni, M.D.

Poster Presenter

Dr. Cameron Smith, MD, PhD

F190. Perineural Membranes Revisited: A Thus Far Undescribed Internal Epineurium?

The membrane that surrounds the peripheral nerve branches consists of collagen fibers, and is the epineurium. It is often confused with tissue surrounding fascicles and nerve bundles. Our aim was to histologically analyze a nerve, focusing on epineural collagen tissue by using different tissue-specific stains. 

Submissions


CoAuthor(s)

Dr. Andre Boezaart, Md, PhD
Dr. Linda Le-Wendling, MD
Dr. Miguel Reina, Md, PhD
Dr. Anna Server, MD
Dr. Richa Wardhan, MD

Poster Presenter

Dr. Cameron Smith, MD, PhD

F191. Meta-Analysis and Review of Transversus Abdominis Plane Block with Liposomal Bupivacaine

Effective analgesia is critical for successful rehabilitation following abdominal surgeries1. Adequate analgesia improves mobility and decreases postoperative pulmonary complications and deep venous thrombosis. Epidural analgesia and opioids have been the mainstay of perioperative analgesic regimens, particularly in patients undergoing laparoscopic and open abdominal surgeries2. However, opioids are associated with numerous adverse effects. Transversus abdominis plane (TAP) blocks have been shown to provide some block of the somatic component of pain associated with surgeries on the abdomen3,4. TAP blocks are intended to block the sensory nerves located in the lateral and anterior walls between internal oblique and transversus abdominis muscles. They have shown some success in reducing pain scores and amount of opioids used. Liposomal bupivacaine was introduced in the past decade as long acting local anesthetic7. Liposomal bupivacaine (Exparel™, Pacira Pharmaceuticals, Parsippany, NJ, USA) contains multivesicular liposomes carrying bupivacaine in an aqueous solution. It slowly releases bupivacaine from its lipid carrier, producing nerve block for up to 72 hours. Liposomal bupivacaine is an attractive choice for TAP blocks as it is slowly released at a low (but effective) concentration at the site of injection. Although meta-analyses conducted on TAP blocks for laparascopic surgeries have shown them to be safe and effective, there are no analogous studies on the effect of liposomal bupivacaine on TAP blocks. There are very few side effects reported with administration of liposomal bupivacaine in TAP blocks. Hence, we decided to combine the available studies for meta-analysis. The hypothesis is that liposomal bupivacaine in TAP block reduces postoperative opioid requirements and subsequently reduces the hospital length of stay. 

Submissions


CoAuthor

Dr. Kenneth Cummings, MD FASA

Poster Presenter

Dr. Jagan Devarajan, MD, MBA, FASA

F192. Efficacy of the Erector Spinae Plane (ESP) Block for Lumbar Spinal Surgery: A Retrospective Study

Poor perioperative pain management during pneumothorax surgery leads to respiratory complications in the post-operative period. The erector spinae plane (ESP) block technique has been shown to be able to block the thoracic spinal nerves. Therefore, the ESP block may provide effective analgesic during thoracic surgery. We have retrospectively investigated the effectiveness of the ESP block for postoperative pain management in pneumothorax surgery. 

Submissions


CoAuthor(s)

Dr. Mayumi Inagaki, Dr.
Mr. FUMIHIRO NIIHARA, M.D.
Dr. Hiroshi Otake, MD, MBA

Poster Presenter

Dr. Hironobu Ueshima, Lecturer

F193. The History and Trend of the Bier Block

Invented in 1908, the Bier block has been widely utilized as a method of providing rapid-onset anesthesia for extremity surgeries. Most commonly, it is used for upper extremity surgeries lasting less than 60 minutes, with success rates of 96-100% (1). While Bier blocks are reliable, cost-effective, easy to administer without the use of expensive equipment, it is limited by its inability to provide complete muscle relaxation, immobility and postoperative pain relief, as well as a theoretically higher risk of local anesthetic systemic toxicity (2). Since the advent of nerve stimulators for peripheral nerve blocks in 1955 (3) and ultrasound-guided regional anesthesia in the mid-1990's (4), other types of peripheral nerve blocks have been increasingly used over the years (5), possibly replacing Bier blocks in clinical practice. We sought to determine the incidence of Bier blocks at our institution, and discuss the future of intravenous regional anesthesia. 

Submissions


CoAuthor(s)

Dr. Christina Jeng, MD
Dr. Chang Park, MD

Poster Presenter

Dr. Ying Ye, MD, MPH

F194. Impact of Narcotic Dosing on Pediatric Post Operative Cleft Palate Patients

Surgical pediatric patients with respiratory compromise receiving narcotic pain control are at an increased risk of hypercapnic respiratory failure. End-tidal CO2 (EtCO2) remains the gold-standard for intubated patients to approximate arterial CO2, despite the challenging and unreliable nature of these measurements in pediatric patients(1,2,3). This IRB-approved study explores the accuracy of a noninvasive Transcutaneous CO2 monitor (TCOM) in both intra-operative and post-operative settings for pediatric cleft palate +/- lip. We hypothesized that intraoperative TCOM readings already validated in the operating room would allow us to monitor respiratory depression in the post-operative period in an extubated patient receiving narcotics. The utility of reliable CO2 monitoring in non intubated patients allows improved ability to address post op pain while monitoring for respiratory depression and hypercapnia. 

Submissions


CoAuthor(s)

Brian Paoletti, BS
Samuel Boas, BS
Dr. Anand Kumar, MD FAAP
Carlyann Miller, MD
Ryan Nazemian, MD
Corinne Wee, MD

Poster Presenter

Dr. Peggy Seidman, MD

F195. Feasibility of a Novel Point of Care Ultrasound (PoCUS) Tool to Evaluate High Risk Ob-structive Sleep Apnea (OSA) Patients in the Perioperative Setting â€" A Prospective Cohort Study

Obstructive sleep apnea (OSA) is a common sleep disordered breathing condition leading to upper airway obstruction, oxygen desaturation and postoperative complications.1 A Point-of-Care Ultra-sound (PoCUS) screening tool can help mitigate the pitfalls of OSA screening questionnaires such as poor specificity. We present our preliminary experience and feasibility data with this novel Po-CUS-OSA screening tool in the perioperative setting. 

Submissions


CoAuthor(s)

Dr. Vincent Chan, MD
Stephen Haskins, MD
Stavros Memtsoudis, MD, PhD
Dr. Nayeemur Rahman, MBBS
Arvind Tuteja, MD

Poster Presenter

Dr. Mandeep Singh, MBBS, MD, MSc

F196. A novel risk index for predicting sleep apnea in chronic pain patients on opioids

The risk of death is elevated in patients taking opioids for chronic non-cancer pain. Respiratory depression is the main cause of death due to opioids and sleep apnea is an important associated risk factor. The synergism between opiates and sleep apnea, a common but often unrecognized sleep disorder, has only recently been recognized. Sleep apnea is more prevalent in opioid-using patients, yet, at present, patients on chronic opioid therapy are not routinely screened for sleep apnea. In this study, we sought to develop and evaluate a novel sleep apnea risk index for patients taking opioids for chronic non-cancer pain. 

Submissions


CoAuthor(s)

Dr. Geoff Bellingham, MD
Dr. Frances Chung, MBBS, LMCC, FRCPC
Dr. Gerald Lebovic, PhD
Dr. Clodagh Ryan, MD, MB, FRCPC
Dr. Mandeep Singh, MBBS, MD, MSc

Poster Presenter

Dr. Jean Wong, MD

F197. Survey of program directors on the use of simulation in training in regional anesthesiology fellowship training

Although simulation is utilized in anesthesiology residency training and continuing education, little data exists to describe its current use within regional anesthesiology fellowship training. The purpose of this study is to describe the modalities of simulation and its use within regional anesthesiology fellowship programs. 

Submissions


CoAuthor(s)

Dr. Christina Jeng, MD
Dr. Anjan Shah, M.D.

Poster Presenter

Dr. Garrett Burnett, M.D.

F198. Increased Peripheral Venous Pressures (PVP) are not the same? (Impact of different physiological challenges on PVP)

Accurate assessment of blood volume status and the response to fluid challenge remains an important clinical goal. Leg raise test (LRT) is associated with an increase in venous return (300 cc) to the heart, 1,2 while Valsalva maneuver is associated with increased intrathoracic pressures and a reduction in preload and stroke volume (SV). Peripheral venous catheter is the most commonly used method of vascular access and peripheral venous pressures (PVP) reflects 'downstream' pressure to the right atrium. The aim of this study is to evalute the impact of changes in central blood volume and stroke volume on PVP. 

Submissions


CoAuthor(s)

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

Poster Presenter

Dr. Anna-Maria Eid, Doctor of Medicine

F199. Description of a novel simulation scenario combining an OSCE-type comprehensive pain assessment and a crisis scenario

Simulation training has become a mainstay of many anesthesia residency programs, with the goal of exposing learners to crisis situations, communication challenges, new procedures, and team dynamics in a standardized environment. With the addition of the Objective Structured Clinical Examination (OSCE) to the APPLIED board certification exam, there is now interest in helping to prepare residents prepare for this exam format. Many residency programs reported that they have not yet been able to institute formalized OSCE preparation, in part due to lack of time and funding. We therefore designed an acute pain medicine simulation scenario that combines OSCE-type patient evaluation with a crisis scenario. Trainees are tasked with performing a comprehensive pain assessment, intervening appropriately with epidural dosing, and then responding to an ensuing hemodynamic emergency. We posit that this type of mixed-methods OSCE-simulation makes optimum use of training time and can be easily incorporated into residency curricula. 

Submissions


CoAuthor

Robert Maniker, MD

Poster Presenter

Dr. Sophia Koessel, MD

F200. Factors Influencing the Use of Social Media by Anesthesiologists

There has been much advocacy for the use of Twitter within the field of anesthesiology for its ability to quickly disseminate knowledge and research. Twitter has been used to enhance medical conference discussions4, and there has been an association between journals with highly-performing Twitter accounts and increased impact factor. Despite the enthusiasm for social media, there has been limited empiric research demonstrating objective academic benefit for users or the predictors of use by clinicians. We have chosen to use the Unified Theory of Acceptance and Use of Technology (UTAUT) model as a basis to investigate the factors that predict the use of social media within the field of anesthesiology. 

Submissions


CoAuthor(s)

Monica Caldeira
Dr. Nan Gai

Poster Presenter

Dr. Clyde Matava, MBChB, DA, MMed

F201. What Counts? Comparison of Manual Palpation, Mechanomyography, Acceleromyography and Electromyography for Twitch Assessment

Manual palpation of muscle response to train of four (TOF) electrical stimuli from a conventional peripheral nerve stimulator is a widely used method of dosing neuromuscular blocking and reversal drugs. Quantitative twitch monitors such as mechanomyography (MMG), acceleromyography (AMG), and electromyography (EMG) have been shown to be more accurate than palpation for measuring the TOF ratio (1) but the accuracy of quantitative monitors for counting twitches from 0-4 has not been well studied. Accurate twitch counting is important when choosing the appropriate reversal drug and dose. We compared manual palpation of twitch counts to the quantitative assessment of twitches with a commercially available AMG twitch monitor (StimPod), a prototype EMG twitch monitor and a previously validated laboratory MMG twitch monitor (2). 

Submissions


CoAuthor(s)

T. Andrew Bowdle, M.D., Ph. D.
Logan Bussey, B.A.
Justin Hulvershorn, M.D., Ph. D.
Srdjan Jelacic, M.D.
Bala Nair, PhD
Kei Togashi, M.D.

Poster Presenter

Dr. Kelly Michaelsen, M.D., Ph. D.

F202. Variability in Examining Residual Neuromuscular Blockade after the use of Neuromuscular Blocking Agents: A Systematic Review of Randomized Controlled Trials

Neuromuscular blockade (NMB) facilitates tracheal intubation and can improve surgical conditions; however, complete post-surgical recovery from NMB is critical. We conducted a systematic literature review of randomized controlled trials (RCTs) to summarize the evaluation of residual NMB (rNMB) following the use of NMB agents alone or along with NMB reversal agents. 

Submissions


CoAuthor(s)

Vamshi Ruthwik Anupindi, MS
Diana Arper, MSc
Dr. Lori Bash, PhD, MPH
Dr. Sorin Brull, MD, FCARCSI(Hon)
Cheryl P. Ferrufino, BA
Andreas Karabis, PhD
Jennifer Uyei, PhD

Poster Presenter

Dr. Amit Raval, PhD

F203. Variation of Perfusion index (Pi) in different fingers of two hands in healthy volunteers: An observational study.

The fingertip is the standard monitoring site for pulse oximetry. Perfusion index (Pi) is an indirect and noninvasive measure of peripheral perfusion. It is calculated by means of pulse oximetry by expressing the pulsatile signal (during arterial inflow) as a percentage of the non-pulsatile signal.[sup]1[/sup] Fingers are the most common site used for pulse oximetry and Pi has shown variation from site to site selected in patients, Aim of our study was to compare perfusion index (Pi) of different fingers of the two hands. 

Submissions


CoAuthor(s)

Dr. Vijay Adabala, MBBS
Dr. Nilay Tripathi, MBBS

Poster Presenter

Dr. Mukesh Tripathi, MD, FAMS

F204. Development of a Head-mounted Holographic Needle Guidance System for Enhanced Ultrasound Guided Regional Anesthesia

The use of emerging mixed reality technology for enhancing needle-based procedures is a novel development. Image guided therapies are often performed by simultaneously visualizing an anatomic target and needle using a modality such as ultrasound (US). However, procedures that may benefit from real time image guidance, such as challenging neuraxial procedures (spinal or lumbar/thoracic epidural), can be difficult to perform in this manner. US guidance, in the context of neuraxial procedures, typically involves pre-procedural US scanning to identify relevant anatomy, estimate the intended needle pathway, and create surface markers to help guide needle insertion points. The procedure is then carried out by the operator, recreating from memory, the location and angulation of the ultrasound as a path for the needle. Previous studies have shown that this method can reduce procedure time and needle passes, and therefore potentially reduce patient discomfort and morbidity (Chin et al., 2011). However, little is known about the accuracy with which operators replicate an ideal needle trajectory once identified by US. The Microsoft Hololens is the first self contained, head-mounted, holographic computing device. It allows users to experience mixed reality – the combination of spatially stable holograms with the real world. We hypothesized that the use of a hologram representing the ideal needle path, as identified by pre-procedural ultrasound, would aid in thoracic epidural placement. 

Submissions


CoAuthor(s)

Dr. Fahad Alam, MD, FRCPC
Dr. Stephen Choi, MD. FRCPC, MSc
Dr. Lilia Kaustov, Phd
Dr. Clyde Matava, MBChB, DA, MMed
Dr. Paul McHardy, MD
Dr. Oskar Singer, MD, FRCPC

Poster Presenter

Dr. Julian Wiegelmann, MD

F205. Effect of ventilatory parameters on the measurement of arterial pressure-derived stroke volume variation in mechanically ventilated surgical patients

Stroke volume variation (SVV), a useful guide of fluid administration, has become less valuable in recent surgery because lung protective ventilation and surgical positioning result in substantial changes in ventilatory parameters and misreading of SVV values. The aim of this study was to quantitatively assess the effect of dynamic ventilatory parameters during surgery on SVV. 

Submissions


CoAuthor(s)

Dr. Min Hur, MD
Chul-Woo Jung, MD, PhD
Dr. Hyung-Chul Lee, MD
Dr. Soo Bin Yoon, M.D.

Poster Presenter

Dr. Hyung-Been Yhim, MD

F206. WHO SURGICAL SAFETY CHECK LIST IS PATIENT SAFETY AT RISK OUTSIDE THE REGULAR WORKING HOURS? A GERMAN SURVEY

The every day use of the WHO surgical safety check list is recommended in every single surgical patient (1). This WHO recommendation has been adopted by the absolute majority of national surgical and anesthesiological societies all over the world, including Germany (2). While the WHO surgical safety check list is part of the every day routine during regular working hours, we studied the adherence to this guideline and check list during after hours, at night and over the weekend. 

Submissions


CoAuthor(s)

Mr. Hendrik Booke, Student
Ms. Theresa Kuhlmann, physician

Poster Presenter

Dr. Rolf Nordmeier, Senior Doctor

F207. INTRAOPERATIVE CPR IN PRONE POSITION. TO TURN OR NOT TO TURN THE PATIENT IN SUPINE POSITION?

CPR is generally performed in supine position. Patients suffering from asystoly are generally brought into supine position before CPR is initiated, the reason being the easy access to the patients' airway, allowing for intermittent ventilation. However, even in the OR, patients being operated in prone position are brought into the supine position, although the airway is equipped with an endotracheal tube and ventilation is not an issue. During some operations, however, turning the patient into supine is not feasable, see photo. 

Submissions


CoAuthor(s)

Mr. Hendrik Booke, Student
Dr. Oliver Danzeisen, Senior Doctor
Ms. Theresa Kuhlmann, physician

Poster Presenter

Dr. Rolf Nordmeier, Senior Doctor

F208. Impact of a delirium reduction PACU orderset on administration of Beers Criteria medications to older adults

Delirium is a common, important, and costly complication of surgery in older adults. Certain perioperative medications, including several antiemetics, contribute to delirium. These medications have been termed Potentially Inappropriate Medications (PIMs) by the American Geriatrics Society, as defined by the Beers Criteria [1]. As part of a medical system-wide delirium reduction effort, we sought to change medication administration practices in the Post-Anesthesia Care Unit (PACU) through creation of a PACU orderset and implementation of a department-wide quality improvement intervention. Here, we compare the frequency of administration of five medications affected by the orderset and/or the quality improvement intervention to older adults during three time epochs surrounding the intervention. 

Submissions


CoAuthor(s)

Matthias Braehler
Dr. Elizabeth Whitlock, MD, MSc

Poster Presenter

Dr. Anne Donovan, MD

F209. Impact of Pre-Existing Right Ventricular Dysfunction on Success of Resuscitation After In-Hospital Cardiac Arrest

Girotra et al. reported survival to discharge rate of 17% after in-hospital cardiac arrest (CA) in 2012.1 The American Heart Association reported survival rate after in-hospital CA in adults was 24.8% in 2016.2 Improvement in survival rates would be welcomed. Adult Advanced Cardiac Life Support (ACLS) calls for dosing of epinephrine every three to five minutes. While re-establishment of a stable heart rhythm sometimes results in physiologic BP in patients who receive multiple doses of epinephrine, this is not always the case. One possible explanation is that, in patients with pre-existing right ventricular dysfunction (RVD), there may be insufficient RV contractility to fill the left side of the heart, even if right sided filling pressures are elevated. If so, such patients may not manifest sufficient systolic BP to result in survival after CA, even in the presence of good LV function. Theoretically, patients with RV dysfunction might have improved outcome after CA if dobutamine was administered during resuscitation in addition to epinephrine. The primary goal of this study is to learn if pre-existing RVD is associated with a lower rate of successful resuscitation after in-hospital CA, as compared to patients who do not have pre-existing right ventricular dysfunction. 

Submissions


CoAuthor(s)

Dr. Mohammed Al-Samrrai, MD
Dr. Ellise Delphin, MD, MPH
Ms. Jazmin Juarez, BS
Dr. Kiri Mackersey, MBChB
Dr. Singh Nair, PhD
Dr. Daniel Spevack, MD
Dr. Agathe Streiff 3202743, MD
Dr. Ahmed Treki, MD

Poster Presenter

Dr. Sheldon Goldstein, MD

F210. The Impact of Early Exposure to High-Fidelity Simulation on the Developing Anesthesiologist: A Qualitative Pilot Study

High-fidelity simulation has been established as an effective teaching tool for both technical and non-technical skills in anesthesia residents. 1–3 However, exposure to high-fidelity simulation, let alone in anesthesia, as a medical student is highly variable, especially during pre-clinical years. Two studies demonstrated that high-fidelity simulation in anesthesia scenarios was well received by final-year medical students.4,5 Thus, high-fidelity simulation in anesthesia may have a place in early medical education, allowing for early exposure to stressful scenarios and task training to a budding anesthesiologist. However, barriers exist for early high-fidelity simulation implementation, including gaps in didactic teachings, lack of technical ability, and the potential for emotional distress.6 These barriers could be a point of frustration for students, potentially leading to disinterest and negative attitudes towards anesthesiology. This study set out to pilot a high-fidelity anesthesia crisis simulation program to first-year medical students to examine its potential value in early anesthesia education and its effects on attitudes towards anesthesiology. 

Submissions


CoAuthor(s)

Dr. Michael Esterlis, MBBS, BHSc
Dr. Elaine Kilmartin, MD
Gavyn Ooi, MBA
Dr. Neeru Rattan, M.D.

Poster Presenter

Mr. Dylan Bard, B.S.