ANES2013 Abstract Guide FINAL

Transcription

Covidien puts the power of Capnography and
Pulse Oximetry with Respiration Rate into your hands.
Monitoring a wide range of critical respiratory parameters, the Sensing Systems of
Covidien help caregivers provide faster, more informed interventions for their patients.
Microstream® Capnography delivers:
• New technology...introducing Capnostream®
20p bedside monitor with Apnea-Sat Alert.
• The earliest non-invasive indication of
evolving respiratory compromise for
intubated and non-intubated patients
from neonate to adult.
Nellcor™ Pulse Oximetry with OxiMax™
Technology provides:
• Digital signal processing technology
with beat-to-beat variations, for constant,
accurate reading of physiological status.
• SpO2, Pulse Rate and Respiration Rate
in a single sensor design.
To get a better sense of our Respiratory Function capabilities,
visit us at Booth #1727, Hall B or go to covidien.com/RMS
THE SENSING SYSTEMS OF COVIDIEN
Microstream® Capnography | Nellcor™ Pulse Oximetry with OxiMax™ Technology
BIS™ Brain Monitoring | INVOS™ Cerebral/Somatic Oximetry
COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and internationally registered
trademarks of Covidien AG. Other brands are trademarks of a Covidien company. ©2012,2013 Covidien. 12-PM-0227
2013 SCIENTIFIC ABSTRACT GUIDE
Revealing a more
complete picture.
EZ-Blocker
®
Endobronchial Blocker
The next generation
in one-lung ventilation.
Innovative, intuitive
and secure.
PharMEDium O.R. anesthesia
services offer a comprehensive
perioperative medication solution.
Look for our free offer in your registration bag to
sign up for an Anesthesia Medication Use Analysis.
We can help you:
• Reduce the potential for medication errors
• Standardize your OR medications
• Reduce waste and improve efficiency
•C
omply with Joint Commission
labeling requirements (NPSG 03.04.01)
Please visit us at Booth #2215
Or Call 1.800.523.7749
See it
h
at boot
1804
The home of ARROW®,
Hudson RCI®, LMA® and
Rusch®. Four distinct brands
united by a common sense
of purpose.
www.pharmedium.com
@pharmedium
©PharMEDium Services, LLC. All rights reserved. P10348 REV1
American Society of Anesthesiologists is a registered trademark of American Society of
Anesthesiologists (ASA). Teleflex, ARROW, EZ-Blocker, Hudson RCI, LMA and Rusch
are trademarks or registered trademarks of Teleflex Incorporated or its affiliates.
© 2013 Teleflex Incorporated. All rights reserved. 2013-2107
table of contents
2013 SCIENTIFIC ABSTRACT GUIDE
INTRODUCTION ……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..…… 2
2013 COMMITTEE ON SCIENTIFIC ADVISORY……..……..……..……..……..……..……..……..……..……..……..……. 3
PLANNER DISCLOSURES ……..……..……..……..……..……..……..……..……..……..……..……..……..……..……. 4
BEST OF ABSTRACTS: Basic Science ……..……..……..……..……..……..……..……..……..……..……..……..……. 6
JOURNAL SYMPOSIUM: Cardiac Arrest and Resuscitation ……..……..……..……..……..……..……..……..……..……. 7
BEST OF ABSTRACTS: Clinical Science ……..……..……..……..……..……..……..……..……..……..……..……..……. 8
ABSTRACTS……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..… 10
SATURDAY, OCTOBER 12
Oral Presentations ……..……..……..……..……..……..……..……..……..……..……..……..……..……..…… 10
Poster Discussions ……..……..……..……..……..……..……..……..……..……..……..……..……..……..…… 11
Poster Presentations……..……..……..……..……..……..……..……..……..……..……..……..……..……..… 18
SUNDAY, OCTOBER 13
MONDAY, OCTOBER 14
TUESDAY, OCTOBER 15
Oral Presentations ……..……..……..……..……..……..……..……..……..……..……..……..……..…….. 104
Poster Discussions ……..……..……..……..……..……..……..……..……..……..……..……..……..…….. 108
Poster Presentations……..……..……..……..……..……..……..……..……..……..……..……..……..……. 112
WEDNESDAY, OCTOBER 16
Oral Presentations ……..……..……..……..……..……..……..……..……..……..……..……..……..…….. 138
Poster Discussions ……..……..……..……..……..……..……..……..……..……..……..……..……..…….. 139
DISCLOSURES……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..… 142
SPEAKER INDEX ……..……..……..……..……..……..……..……..……..……..……..……..……..……..……..…….. 156
1
INTRODUCTION
LEARNING TRACK CODES
Sessions and scientific abstracts are designated by the following learning track codes:
AM Ambulatory Anesthesia
CA Cardiac Anesthesia
CC Critical Care Medicine
FA Fund. of Anesthesiology
NA Neuroanesthesia
OB Obstetric Anesthesia
PN Pain Medicine
PD Pediatric Anesthesia
PI Professional Issues
RA Regional Anesthesia and Acute Pain
ELECTRONIC POSTERS (E-POSTERS)
ASA will be expanding the number of e-posters this year. All abstracts will be presented in an electronic format (e-posters) on large, highdefinition monitors. These posters will also be available for viewing at your leisure on HD monitors located throughout the convention center.
SCIENTIFIC ABSTRACT SESSIONS
Scientific Abstract sessions consist of Oral Presentations, Poster Discussions and Poster Sessions. During Oral Presentations and Poster
Discussions, the author presents a summary of the study, including hypothesis, methods, data and conclusions. Questions and comments
from the audience are welcome and encouraged at the conclusion of the presentation. Poster Sessions represent in-depth and informative
discussions among authors and attendees. Poster authors will be available for discussion during designated times during the meeting.
Full text for all scientific abstracts are available to view online at www.ANESTHESIOLOGY2013.org.
LATE-BREAKING ABSTRACTS
Late-Breaking Abstracts focus on significant and timely findings while showcasing late-breaking data and results that affect the field of
anesthesiology. These abstracts will be presented during designated periods during the ANESTHESIOLOGY™ 2013 annual meeting.
TARGET AUDIENCE
The ANESTHESIOLOGY™ 2013 annual meeting is intended for anesthesiologists, residents and other health care professionals
interested in expanding their knowledge and enhancing their skills to improve competency and professional practice in anesthesiology.
OVERALL LEARNING OBJECTIVES
At the conclusion of this activity, participants should be able to:
• Assess the potential applications of emerging issues and advances that affect the practice of anesthesia.
• Integrate technical knowledge about state-of-the-art procedures, advanced therapeutic agents and medical device uses into practice.
• Apply contemporary practice management skills and knowledge of regulatory issues to the efficient and safe delivery of patient care.
• Translate expanded knowledge into improvements in practice, patient outcomes and patient satisfaction.
ACCREDITATION AND CREDIT DESIGNATION STATEMENTS
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to
provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this live activity for a maximum of 42 AMA PRA Category 1 Credits™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
DISCLOSURE
The American Society of Anesthesiologists adheres to ACCME Essential Areas, Standards, and Policies regarding industry support of
continuing medical education. Disclosure of the planning committee and faculty’s commercial relationships will be made known at
the activity. Speakers are required to openly disclose any limitations of data and/or any discussion of any off-label, experimental, or
investigational uses of drugs or devices in their presentations.
All abstract author disclosure information can be found at the end of this book. All planners’ disclosure information can be found on the next
page.
For a full listing of all presenters and their sessions, please go to www.ANESTHESIOLOGY2013.org.
DISCLAIMER
The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent
medical judgment of a health care provider relative to diagnostic and treatment options of a specific patient’s medical condition.
PHOTOGRAPHY/VIDEOTAPING POLICIES
No photography, videotaping or audio taping is permitted in the scientific abstract sessions, instructional courses, exhibit hall or committee
meetings.
2
2013 COMMITTEE ON SCIENTIFIC ADVISORY
ASA would like to express appreciation to the chairs of the Committee on Scientific Advisory.
Joy L. Hawkins, M.D., Chair
Andrea M. Kurz, M.D.
William R. Furman, M.D., Vice Chair
Jacqueline Leung, M.D.
Douglas Bacon, M.D., M.A.
Martin London, M.D.
Ansgar Brambrink, M.D., Ph.D.
Vinod Malhotra, M.D.
Daniel R. Brown, M.D., Ph.D.
Stephen T. Robinson, M.D.
Asokumar Buvanendran, M.D.
Brett A. Simon, M.D., Ph.D.
Dhanesh K. Gupta, M.D.
Ken Solt, M.D.
W. Michael Hooten, M.D.
Susan T. Verghese, M.D.
Judy R. Kersten, M.D.
Cynthia A. Wong, M.D.
3
PLANNER DISCLOSURES
The American Society of Anesthesiologists adheres to the ACCME Accreditation Criteria, Standards for Commercial Support™ and Policies
regarding continuing medical education. In accordance with the ACCME Standards for Commercial Support™, the ASA implemented
mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all persons in a
position to control content of this CME activity.
The following planners have disclosed that they have financial relationships with commercial interests:
Gregory K. Applegate, D.O.: University of Buffalo Dept of Anesthesia-Honoraria
Lauren C. Berkow, M.D.: Masimo-Consulting Fees, Honoraria;
Teleflex-Consulting Fees, Honoraria; Medtronic-Consulting
Fees; Ambu-Consulting Fees
Asokumar Buvanendran, M.D.: Pfizer-Funded Research;
NIH-Funded Research
Sorin J. Brull, M.D.: Merck Inc-Consulting Fees
Maxime Cannesson, M.D., Ph.D.: Edwards
Lifesciences-Funded Research, Consulting Fees,
Honoraria; Masimo Corp.-Funded Research, Honoraria;
Sironis-Ownership, Equity Position
Matthias Eikermann, M.D.: Merck-Funded Research; Resmed
Foundation-Funded Research; Masimo-Funded Research
Gyorgy Frendl, M.D., Ph.D.: EarlySense-Funded Research;
AlloCure-Funded Research, Consulting Fees
Jeffrey L. Galinkin, M.D.: Purdue-Consulting Fees
Ralf E. Gebhard, M.D.: Purdue-Funded Research;
Merck-Funded Research; Baxter-Consulting Fees; Kimberly Clark-Consulting Fees
Jeffrey Green, M.D.: Covidien-Funded Research,
Consulting Fees, Honoraria
Brian M. Ilfeld, M.D., M.S.: Baxter Healthcare-Funded
Research; Summit Medical-Funded Research;
AcelRx-Funded Research; Pacira Pharmaceuticals-Funded
Research
Michael L. James, M.D.: Baxter-Funded Research;
Cephalogics-Funded Research; National Institutes of
Health-Funded Research
Alan D. Kaye, M.D., Ph.D.: Depomed-Funded Research,
Honoraria
Bhavani Shankar Kodali, M.D.: Covidien-Other Material
Support; Philips-Other Material Support
Jens W. Krombach, M.D.: Vidacare-Honoraria
Robert Loeb, M.D.: Picis-Honoraria
Keira P. Mason, M.D.: Hospira-Funded Research
C. David Mazer, M.D.: AstraZeneca-Honoraria; Cubist-Funded
Research, Honoraria; Medicines Company-Honoraria;
NovoNordisk-Funded Research; Hospira-Funded Research;
Quark-Consulting Fees
Peter Nagele, M.D., M.Sc.: Roche Diagnostics-Funded Research
Satya-Krishna Ramachandran, M.D.: Galleon
Pharmaceuticals-Consulting Fees
Keith J. Ruskin, M.D.: Masimo Corp.-Consulting Fees
Mark E. Schroeder, M.D.: REMOT Medical Innovation
LLC-Ownership
Daniel Sessler, M.D.: Merck-Funded Research; 3M
(All fees to charity)-Funded Research, Consulting Fees;
Molnlycke (All fees to charity)-Consulting Fees;
37 (All fees to charity)-Consulting Fees; Hospira-Funded
Research; AcelRx-Funded Research
Eugene R. Viscusi, M.D.: Cubist-Consulting Fees;
Salix-Consulting Fees; Cadence-Consulting Fees;
AcelRx-Consulting Fees; Pacira-Consulting Fees
The following planners have disclosed that they have no financial relationships with commercial interests:
Meredith Adams, M.D.
Jane Ahn, M.D.
Theodore A. Alston, M.D.
Magdalena Anitescu, M.D.
Katherine W. Arendt, M.D.
Michael Avram, Ph.D.
Douglas Bacon, M.D., M.A.
Sheila R. Barnett, M.B.,B.S., B.Sc.
Brian T. Bateman, M.D.
Yaakov Beilin, M.D.
Honorio T. Benzon, M.D.
Luca Bigatello, M.D.
Wendy B. Binstock, M.D.
Timothy M. Bittenbinder, M.D.
Ansgar Brambrink, M.D., Ph.D.
Daniel R. Brown, M.D., Ph.D.
John Butterworth, IV, M.D.
Kenneth D. Candido, M.D.
Davide Cattano, M.D., Ph.D.
Mark A. Chaney, M.D.
Wei Chao, M.D., Ph.D.
4
Daniel P. Corsino, M.D.
Saundra E. Curry, M.D.
Laurie Davies, M.D.
Amy B. DeRoche, M.D.
Richa Dhawan, M.D.
Melanie J. Donnelly, M.D., M.P.H.
Jesse M. Ehrenfeld, M.D.
Nabil Elkassabany, M.D.
Ehab S. Farag, M.D.
Randy J. Fayne, D.O.
Matt J. Fiegel, M.D.
Lee A. Fleisher, M.D.
Stuart Forman, M.D., Ph.D.
Thomas M. Fuhrman, M.D.
William R. Furman, M.D.
Kishor Gandhi, M.D., M.P.H.
Paul S. Garcia, M.D., Ph.D.
Leslie M. Garson, M.D.
Halena M. Gazelka, M.D.
Julian M. Goldman, M.D.
Peter Goldstein, M.D.
** PRESENTER DISCLOSURES BEGIN ON PAGE 142
Heather C. Nixon, M.D.
Christina M. Pabelick, M.D.
Sheela S. Pai, M.D.
Arvind Palanisamy, M.D., FRCA
Brian M. Parker, M.D.
Feyce M. Peralta, M.D.
Anahi Perlas, M.D.
Misha Perouansky, M.D.
Phillippe G.M. Richebe, M.D., Ph.D.
Matthias Riess, M.D., Ph.D.
Stephen T. Robinson, M.D.
Barbara Rogers, M.D.
Raymond S. Roginski, M.D., Ph.D.
John Rogoski, D.O.
Deborah A. Rusy, M.D.
Leif Saager, M.D.
Nicholas Sadovnikoff, M.D.
Scott A. Schartel, D.O.
Kathy D. Schlecht, D.O.
Roman Schumann, M.D.
Hariharan Shankar, M.B.,B.S.
Deepak Sharma, M.B.,B.S., M.D.
Brett A. Simon, M.D., Ph.D.
Mark A. Singleton, M.D.
Doreen E. Soliman, M.D.
Ken Solt, M.D.
Ramprasad Sripada, M.D.
Astrid G. Stucke, M.D.
Balachundhar Subramaniam, M.B.,B.S.
Christer H. Svensen, M.D., Ph.D.
Tiffany R. Tedore, M.D.
John E. Tetzlaff, M.D.
Laurence Torsher, M.D.
Steven R. Tosone, M.D.
Ravi Tripathi, M.D.
Richard D. Urman, M.D., M.B.A.
Susan A. Vassallo, M.D.
Susan T. Verghese, M.D.
Marcos F. Vidal-Melo, M.D., Ph.D.
Anupama Wadhwa, M.B.,B.S.
David B. Waisel, M.D.
Christian M. Welch, M.D.
David J. Wlody, M.D.
Cynthia A. Wong, M.D.
Zheng Xie, M.D.
Zhongcong Xie, M.D., Ph.D.
Christopher J. Young, M.D.
Zdravka Zafirova, M.D.
Steven E. Zgleszewski, M.D.
Jie Zhou, M.D., M.S., M.B.A.
PLANNER DISCLOSURES
Cheryl K. Gooden, M.D.
Nikolaus Gravenstein, M.D.
Loreta Grecu, M.D.
Jay S. Grider, D.O., Ph.D.
Dhanesh K. Gupta, M.D.
Ashraf S. Habib, M.B.,B.Ch., M.Sc., FRCA
Anthony Han, M.D.
Raafat S. Hannallah, M.D.
Joy L. Hawkins, M.D.
David Healy, M.D.
Hugh C. Hemmings, M.D., Ph.D.
Jan Hirsch, M.D.
Robert S. Holzman, M.D.
W. Michael Hooten, M.D.
Harriet W. Hopf, M.D.
Steve K. Howard, M.D.
Fumito Ichinose, M.D.
Uday Jain, M.D., Ph.D.
Andrew Jenkins, Ph.D.
William Johnston, M.D.
Suzanne B. Karan, M.D.
Shubjeet Kaur, M.D.
Judy R. Kersten, M.D.
Evan D. Kharasch, M.D., Ph.D.
Hiroyuki Kinoshita, M.D.
Daryl J. Kor, M.D.
Deven S. Kothari, M.D.
Tom Krejcie, M.D.
Andrea M. Kurz, M.D.
Michael R. Lasky, M.D.
Jae W. Lee, M.D.
Jacqueline Leung, M.D.
Roy C. Levitt, M.D.
Henry Liu, M.D.
Loreto Lollo, M.D.
Martin London, M.D.
Bruce M. MacIver, M.Sc., Ph.D.
Vinod Malhotra, M.D.
Ricardo Martinez-Ruiz, M.D.
George Mashour, M.D., Ph.D.
Keira P. Mason, M.D.
Mary Ellen McCann, M.D., M.P.H.
William L. McNiece, M.D.
Stavros G. Memtsoudis, M.D., Ph.D.
Jill Mhyre, M.D.
John D. Mitchell, M.D.
Richard E. Moon, M.D.
Philip G. Morgan, M.D.
Debra E. Morrison, M.D.
Gundappa Neelakanta, M.D.
5
SPE09 BEST OF ABSTRACTS: BASIC SCIENCE
MONDAY, OCTOBER 14 | 8:00-10:00 A.M.
ROOM 2020-WEST BUILDING
NA BOS01
Optogenetic Stimulation of Dopamine Neurons in the Ventral
Tegmental Area Induces Reanimation From General Anesthesia
Specific activation of dopamine neurons in the Ventral Tegmental Area by
pulses of light using optogentic tools produced reanimation from general
anesthesia induced by isoflurane while activation of dopamine neurons in
the Substantia Nigra did not. Norman E. Taylor, M.D., Ph.D., Christa Van
Dort, Ph.D., Jonathan Kenny B.S., Emery N. Brown, M.D., Ph.D., Ken
Solt, M.D., Anesthesia Critical Care and Pain Medicine, Massachusetts
General Hospital, Boston, Department of Brain and Cognitive Sciences,
Massachusetts Institute of Technology, Cambridge.
NA BOS02
Dextroamphetamine Restores Conscious Behaviors Including the
Righting Reflex during Sevoflurane General Anesthesia
Dextroamphetamine restores conscious behaviors including the righting
reflex during continuous sevoflurane anesthesia. The primary mechanism
of action is likely D1 dopamine receptor activation. These findings suggest
that dextroamphetamine may be clinically useful to restore consciousness in
anesthetized patients. Jonathan Kenny, Emery N. Brown, M.D., Ph.D., Ken
Solt, M.D., Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston.
NA BOS03
fMRI Correlates of Auditory Regularities Processing in Awake and
Anaesthetized Monkeys
Modern neuroimaging methods allow to explore the brain under general
anesthesia and show that anesthetics (propofol ketamine) transform the
brain activity from the awake state to a new cognitive state. Lynn Uhrig,
M.D., David Janssen, M.Sc., Olivier Joly, Ph.D., Naoki Tani, M.D., Ph.D.,
Tristan Bekinschtein, Ph.D., Lionel Naccache, M.D., Ph.D., Stanislas
Dehaene, Ph.D., Bechir Jarraya, M.D., Ph.D., CEA Neurospin Saclay
Inserm Avenir Bettencourt-Schueller, Saclay, France, Cognition and Brain
Sci. Unit Med. Res. Council, Cambridge, United Kingdom, AP-HP Groupe
Hospitalier Pitie Salpetrie ICM Res. Ctr., Paris, France, CEA Neurospin
Saclay INSERM Unicog College de France Saclay, Paris, CEA Neurospin
Saclay Inserm Avenir Bettencourt-Schueller Neuromodulation Unit,
Department of Neurosurgery, Foch Hospital, Univ. of Versailles SaintQuentin Saclay, Suresnes, France.
FA BOS04
GNAS Gene Variants Affect Beta-Blocker-Related Survival After
Coronary Artery Bypass Grafting
Cardiac overexpression of the β-adrenoceptor (βAR)-coupled stimulatory
G-protein subunit Gαs enhances inotropic responses improves survival.
Genetic variation within Gαs results in increased protein expression which
is associated with better survival following CABG operation in 1627 CAD
patients. Ulrich H. Frey, M.D., Jochen Muehlschlegel, M.D., Christoph
Ochterbeck, Ph.D., Amanda Fox, M.D., Stanton Shernan, M.D., Charles
Collard, M.D., Peter Lichtner, M.D., Jurgen Peters, M.D., Simon Body,
M.D., Anesthesiology, University Hospital, Essen, Germany, Brigham and
Women’s Hospital, Boston, MA, Division of Cardiovascular Anesthesiology,
Texas Heart Institute, Houston, Helmholtz Zentrum Munchen, Deutsches
Forschungszentrum fur Gesundheit und Umwelt, Munchen, Germany.
CA BOS05
Extracellular RNA Contributes to Myocardial Ischemia/Reperfusion
Injury
We show that RNA is released from hypoxic cardiomyocytes in vitro and
from ischemic myocardium in vivo. We demonstrate that extracellular RNA
mediates necrosis-induced cytokine response in cardiomyocytes and may
contribute to myocardial ischemia-reperfusion injury. Chan Chen, M.D., Yan
Feng, M.D., Ph.D., Lin Zou, M.D., Ph.D., Jia-Yan Cai, B.S., Jun-Mei Xu,
M.D., Ph.D., Wei Chao, M.D., Ph.D., Department of Anesthesia, Critical
Care and Pain Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, Department of Anesthesiology, The Second
Xiangya Hospital, Central South University, Changsha, China.
6
CC BOS06
Microvesicles Derived From Human Bone Marrow Mesenchymal Stem
Cells Restored Lung Protein Permeability and Reduced Inflammation in
E.coli Endotoxin-Induced Acute Lung Injury in Mice
In acute lung injury most of the therapeutic benefit of mesenchymal stem
cell-based therapy appears to derive from the release of paracrine soluble
factors which stabilize the injured alveolar epithelium and lung endothelium
reduce inflammation increase the absorption of pulmonary edema fluid and
have anti-microbial activity. Recently mesenchymal stem cells have also
been found to release circular membrane fragments called microvesicles
which contain numerous proteins mRNAs microRNAs organelles and lipids
and which may have therapeutic properties as well. Jae W. Lee, M.D., Yinggang Zhu, M.D., Xiao-mei Feng, M.D., Ph.D., Jason Abbott, B.S., Xiao-hui
Fang, M.D., Antoine Monsel, M.D., Jie-ming Qu, M.D., Michael Matthay,
M.D., Anesthesiology, UCSF Medical Center, San Francisco, CA.
CC BOS07
Diaphragm is the Preferential Target During Sepsis in the Critically Ill:
A Tridimensional Pilot CT Study
The present study reports for the first time in Human critically ill a preferential
diaphragmatic atrophy compared to limb muscles in severe sepsis. Boris
Jung M.D., Stephanie Nougaret M.D., Gerald Chanques M.D., Coisel
Yannael M.D., Fouad Belafia M.D., Noemie Clavieras M.D., Daniel
Verzilli M.D., Samir Jaber, M.D., ICU and Anesthesiology Department,
Radiology Department, Montpellier University Hospital, France.
PN BOS08
Whole Exome Sequencing Identifies Novel Genetic Variants in
Amputees With Persistent Residual Limb Pain
We sequenced the exomes of soldiers with persistent post amputation pain
and identified hundreds of novel DNA sequence variants associated with
this specific nerve injury pain syndrome. Andrew D. Shaw M.B., Thomas
Vandeven M.D., Alex Kieber B.S., John Hsia M.D., Nick Grissom B.S.,
Thomas Buchheit M.D., David Macleod M.B., Mary McDuffie R.N.,
Chester Buckenmaier M.D., Duke University Medical Center, Durham,
NC, Walter Reed National Military Medical Center, Washington, DC.
PN BOS09
Genetic Variants Affecting CRH-Binding Protein Predict Pain
Persistence After Trauma Exposure
Genetic variants in the hypothalamic-pituitary-adrenal axis genes predict
persistent pain development after two types of stressful trauma (motor
vehicle collision and sexual assault). Andrey Bortsov, M.D., Ph.D., Sarah
D. Linnstaedt, Ph.D., Robert A. Swor, M.D., David A. Peak, M.D., Niels
K. Rathlev, M.D., David C. Lee, M.D., Robert M. Domeier, M.D., Phyllis
L. Hendry, M.D., Jeffrey S. Jones, M.D., Samuel A. McLean, M.D.,
Anesthesiology, University of North Carolina, Chapel Hill, NC, William
Beaumont Hospital, Royal Oak, MI, Massachusetts General Hospital,
Boston, MA, Baystate Medical Center, Springfield, MA, North Shore
University Hospital, Manhasset, NY, Saint Joseph Mercy Health System,
Ypsilanti, MI, University of Florida, Jacksonville, FL, Spectrum Health
System, Grand Rapids, MI.
FA BOS10
Palonosetron With Hydroxyzine Reduces Symptoms of Narcotic Drug
Withdrawal in Humans
Pre-treatment with a 5 HT-3 receptor antagonist significantly reduced a
wide-range of objective but not subjective symptoms associated with opioid
narcotic withdrawal in humans. Larry F. Chu, M.D., M.S., Natacha Telusca
M.D., Matthew Erlendson, B.S., Nicole D’Arcy, B.S., Gary Peltz, M.D.,
David Clark, M.D., Department of Anesthesia, Stanford University School
of Medicine, Stanford, CA, Department of Anesthesia, Palo Alto VA
Hospital, Palo Alto, CA.
NA BOS11
Amantadine Alleviates Postoperative Cognitive Dysfunction by
Reducing Microglia-Associated Neuroinflammation and Stimulating
GDNF Release in Rats
These findings suggest that amantadine can reduce POCD. Together with
existing evidence in the literature our results indicate that the protective
effects of amantadine may be mediated by a dual action: reducing microgliaassociated inflammation and increasing GDNF expression. Junfeng Zhang,
M.D., Zhiyi Zuo, M.D., Ph.D., Department of Anesthesiology, University of
Virginia, Charlottesville, VA.
NA Neuroanesthesia
PN Pain Medicine
Inflammatory Pain Induces Cognitive Impairment Through an IL-6Dependent and PSD95-Associated Mechanism
Inflammatory pain is a major health problem for patients and is associated
with increased disability and reduced quality of life. PSD95 is involved in the
synaptic plasticity and formation of learning and memory. We therefore set
out to determine the effects of inflammatory pain on learning and memory
function and brain levels of PSD95 in mice. We found that inflammatory
pain may contribute to cognitive impairment by decreasing PSD95 levels
in the cortex of the mice through an IL-6 dependent mechanism. These
findings will likely promote more studies to determine the role of pain in
cognitive function. Longqiu Yang Sr., Ph.D., Lei Zhang, Ph.D., Guorong Tao,
Ph.D., Yuanlin D+ong, M.D., Yiying Zhang, M.D., Zhongcong Xie, Ph.D.,
Anesthesia, Massachusetts General Hospital, Boston, MA
SPE19 JOURNAL SYMPOSIUM:
CARDIAC ARREST AND RESUSCITATION
TUESDAY, OCTOBER 15 | 8:00-11:00 A.M.
FA JS01
Care-Related in Hospital Cardiac Arrest (CR-IHCA): Incidence and
Outcome - A Single Center Report
Authors present a retrospective single-center database analysis aiming to
establish the incidence and outcome of care-related In Hospital Cardiac
Arrest (CR-IHCA). 15.3% of IHCA were found to Care-related. CR-IHCA
is a subgroup of patients with considerably better outcome than control
cases. Authors present a short review and discuss the importance of their
findings and the possible modifications of care process in their institution.
Philippe Burtin, M.D., Charlotte Vannucci, M.D., Anais Marie, M.D.,
Jean Yves Bigeon, M.D., Anne Granier, M.D., Constantin Halchini, M.D.,
Patrick Courant, M.D., Anesthesie Reanimation, Clinique du Millenaire,
Montpellier, France.
CA JS02
Improved Mitochondrial Function Myocardial Injury and
Hemodynamics by Anesthetic Postconditioning in a Pig Model of
Prolonged Ventricular Fibrillation
Postconditioning with inhaled sevoflurane at the initiation of CPR leads
to preserved cardiac mitochondrial function and dramatically improves
myocardial function and hemodynamics post-CPR in a pig model of
prolonged ventricular fibrillation. This may have profound future implications
for CPR in humans. Matthias Riess, M.D., Ph.D., Timothy Matsuura, B.Sc.,
Martin Bienengraeber, Ph.D., Mohammed Aldakkak, M.D., Jason Bartos,
M.D., Ph.D., Demetris Yannopoulos, M.D., Anesthesiology and Physiology,
Clement J. Zablocki VA Medical Center and Medical College of Wisconsin,
Milwaukee, WI Cardiology, University of Minnesota, Minneapolis, MN.
CC JS04
Handheld Doppler to Improve Pulse Checks During Resuscitation of
Putative PEA Arrest: A Case Series
With IRB approval investigators applied a portable Doppler to an available
femoral artery during resuscitation attempts for putative PEA arrest (N=8).
The incidence of Doppler-positive-palpation-negative pulse checks was
62.5% (95% CI 29-96%). Systolic blood pressures in the discordant group
ranged from 58-160mmHg with a mean of 106.4mmHg. Diastolic blood
pressures ranged from 30-100mmHg with a mean of 56.2mmHg. 3 of 5
discordant cases were immediately found to have a palpable pulse on repeat
manual pulse check suggesting that the addition of portable Doppler to
resuscitation algorithms may enhance the accuracy of manual pulse checks.
Further study is needed to determine if this relatively inexpensive intervention
will improve outcomes of resuscitation attempts for PEA Arrest. Robert B.
Schonberger, M.D., Jessica Feinleib, M.D., Ph.D., Anesthesiology, Yale
University, New Haven, CT.
CA JS05
Predictors for Successful Weaning and Survival in Patients Undergoing
ECMO Therapy
APACHE at ICU-Admission SOFA at ICU-Admission and ROD at Day of Death
seem to be good prognostic scores for surviving ECMO therapy. Henryk
Welp, M.D., Christian Lanckohr, M.D., Thomas Volkert, M.D., Mirela
Scherer, M.D. Ph.D., Sven Martens, M.D., Ph.D., Bjorn Ellger, M.D., Ph.D.,
Antje Gottschalk, M.D., Department of Cardiac Surgery, Department of
Anesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Muenster, Germany.
CA JS06
Comparison of Standard BLS Training to BLS Training Enhanced With
Action Linked Phrases
Performance of cardio-pulmonary resuscitation (CPR) during cardiac arrest
is highly variable denoting poor compliance with American Heart Association
(AHA) guidelines. Reducing the intervals where no compressions are given
is a critical determinant of patient outcome in cardiac arrest. In this study
simulation was used to practice and assess key CPR skills. Use of simulation
methods with focused debriefing after resuscitation can improve CPR quality
and increase initial resuscitation success. Hillenn Cruz Eng, M.D., Elizabeth
H. Sinz, M.D., Melanie Hodge, B.S., Tammi Bortner, R.N., Christie Mulvey,
Milton Hershey Medical Center, Anesthesiology, Penn State Hershey
Medical Center, PA.
SPE09 BEST OF ABSTRACTS | SPE19 JOURNAL SYMPOSIUM
PN BOS12
CA JS03
Hibernation Specific Changes in Myocardial Protein Abundance
in Response to Surgical Ischemia-Reperfusion: A Two-Species
Comparison Using Label Free Proteomic Profiling
Hibernation is protective against ischemia-reperfusion injury in a deep
hypothermic cardiac arrest model. To further elucidate the regulation of the
protective hibernator phenotype we employed a label-free proteomic profiling
approach to interrogate the myocardium of rats and arctic ground squirrels
after injury. We have observed differential responses in protein expression
across the two species as well as seasonal differences that should inform
on the hibernator phenotype. Quintin J. Quinones, M.D., Ph.D., Qing
Ma, M.D., Ph.D., Joseph Lucas, Ph.D., Matthias Riess, M.D., Ph.D.,
Brian Barnes, Ph.D., Mihai Victor Podgoreanu, M.D., Anesthesiology,
Institute for Genome Sciences and Policy Duke University, Durham, NC,
Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, Institute of
Arctic Biology, University of Alaska, Fairbanks, AK.
NA Neuroanesthesia
PN Pain Medicine
7
FA BOC05
SPE22 BEST OF ABSTRACTS:
CLINICAL SCIENCE
TUESDAY, OCTOBER 15 | 1:00-3:00 P.M.
FA BOC01
Incidence Predictors and Outcome of Difficult Mask Ventilation
Combined With Difficult Laryngoscopy: A Report From the Multicenter
Perioperative Outcomes Group
Difficult mask ventilation combined with difficult laryngoscopy is a
challenging airway event. 176 679 cases included a documented face mask
ventilation and laryngoscopy attempt were reviewed across 4 centers. 698
patients experienced the primary outcome an overall incidence of 0.40%.
Management across providers demonstrates diverse approaches. Sachin
Kheterpal, M.D., M.B.A., David Healy, M.D., F.R.C.A., Michael Aziz, M.D.,
Amy M. Shanks, M.S., Robert E. Freundlich, M.D., Fiona Linton, M.B.,
Ch.B., Jerry L. Epps, M.D., Ana Fernandez-Bustamante, M.D., Leslie C.
Jameson, M.D., Kevin K. Tremper, M.D., Ph.D., Anesthesiology, University
of Michigan, Ann Arbor, MI Anesthesiology, Oregon Health and Sciences
University, Portland, OR, Anesthesiology, University of Tennessee,
Knoxville, TN, Anesthesiology, University of Colorado, Aurora, CO.
NA BOC02
Heterogeneous Spatiotemporal Cortical Dynamics During PropofolInduced Burst Suppression
Burst suppression is classically thought to be a global phenomenon in which
all of cortex undergoes simultaneous bursts and suppressions but this view
is based on scalp EEG recordings which are spatially blurred. We recorded
from intracranial electrodes during propofol general anesthesia and found
that burst suppression can occur in local cortical regions while other areas
show no sign of suppression. In addition the spectral content of bursts was
consistent with the hypothesis that burst suppression results from decreased
cerebral metabolism. Laura Lewis, B.Sc., ShiNung Ching, Ph.D., Veronica
Weiner, Ph.D., Robert A. Peterfreund, M.D., Ph.D., Emad N. Eskandar,
M.D., Sydney S. Cash, M.D., Ph.D., Emery N. Brown, M.D., Ph.D., Patrick
L. Purdon, Ph.D., MIT, Harvard-MIT, Cambridge, MA, Massachusetts
General Hospital, Harvard Medical School, Boston, MA.
PI BOC03
An Electronic Checklist Improves Patient Information Transfer and
Retention at Intraoperative Handoff of Care
Communication of critical patient information during intraoperative handoff
of care is crucial for patient safety since poor handoffs are associated with
adverse events. Utilization of a checklist can help to overcome barriers
to effective handovers by providing a template for organized consistent
and accurate information discussion. We demonstrate that use of an
intraoperative electronic handoff checklist improves transfer and retention
of patient information among anesthetists at handover of care. Lisa Warren
M.D., Aalok Agarwala, M.D., M.B.A., Meredith A. Albrecht, M.D., Ph.D.,
Paul Firth, M.B., Ch.B., Guido Musch, M.D., Anesthesia, Critical Care and
Pain Management, Massachusetts General Hospital, Boston, MA.
PI BOC04
Simulation-Based Structured Interviews Stratify Residency Candidates
in Phase One
Supported by FAER Research in Education Grant this research explores a
simulation-based interview format to evaluate residency candidate noncognitive attributes. The endpoint of this prospective longitudinal study is
academic clinical & professional performance in residency as defined
by ACGME core competencies. Initial data vs. standard format shows greater
candidate stratification in the experimental arm with limited correlation.
This suggests that the experimental format may provide orthogonal insight
into non-cognitive attributes. Darren R. Raphael, M.D., M.B.A., Rob Boud,
Student, Khanhvan Le, B.A., Christine Lee, B.S., Allison Nguyen, B.A.,
Ceci Canales, M.P.H., Joseph Rinehart, M.D., Suzanne Strom, M.D., Zeev
Kain, M.D., M.B.A., Department of Anesthesiology and Perioperative
Care, University of California, Irvine, Irvine, CA.
8
The Impact of Metabolic Syndrome on Postoperative Pulmonary
Complications: A Large Bariatric Surgical Database Analysis
We analyzed the Bariatric Outcomes Longitudinal Database (BOLD) for the
prevalence of metabolic syndrome in this vulnerable population and its
possible impact on adverse pulmonary events. We correlated the presence
of metabolic syndrome with composite outcomes of pneumonia atelectasis
pleural effusion pneumothorax respiratory failure and ARDS following weight
loss surgery. Except for pneumothorax MetS was significantly associated
with all investigated adverse pulmonary outcomes. Roman Schumann,
M.D., Jeffrey Sigl, Ph.D., Omar Al Yamani, M.D., Scott A. Shikora, M.D.,
Scott D. Kelley, M.D., Anesthesiology, Tufts Medical Center, Boston, MA,
Respiratory & Monitoring Solutions, Covidien, Boulder, CO, Center for
Metabolic Health and Bariatric Surgery, Brigham & Womens’s Hospital,
Boston, MA.
PD BOC06
Multimodal Assessment of Cognitive Outcomes Associated With
Exposure to Anesthesia in Early Childhood
The safety of anesthetic agents in children has been questioned after the
discovery that immature animals exposed to anesthesia display apoptotic
neurodegeneration and long-term cognitive deficiencies. This study examines
the association between exposure to anesthesia in children under age 3 and
cognitive outcomes at age 10 using neuropsychological tests ICD9 coded
developmental and behavioral disorders and standardized test scores. Caleb
H. Ing, M.D., Charles DiMaggio, Ph.D., Eva Malacova, Ph.D., Andrew
Whitehouse, Ph.D., Mary K. Hegarty, M.B., B.S., Britta S. von UngernSternberg, M.D., Andrew Davidson, M.D., Guohua Li, M.D., Lena S. Sun
M.D., Columbia University, New York, NY, University of Western Australia,
Princess Margaret Hospital for Children, Perth, Australia, Murdoch
Children’s Research Institute & Royal Children’s Hospital’ Melbourne’
Australia.
AM BOC07
Optimal PONV Management - SCOR Database
The SCOR database was explored to determine the optimal number of antiemetics required to prevent PONV for increasing number of Apfel risk factors.
Peter Glass, M.B., B.Ch., Lucy Everett, M.D., Martin Redmond, M.D.,
Douglas Merrill, M.D., Jamie Romeiser, B.A., Anesthesia, Stony Brook
Medicine, Stony Brook, NY, Anesthesia, Massachusetts General Hospital,
Boston, MA, Anesthesia, Dartmouth College, Hanover, NH.
PI BOC08
An Improved Statistical Method for Comparing Anesthesiologists’
Performance on Mandated Metrics
Joint Commission requires periodic evaluations of the clinical performance
of anesthesiologists. We have developed a Bayesian statistical approach for
such evaluations that accounts for wide variations in case numbers and case
types and which may be a preferrable method for comparing providers.
Emine O. Bayman, Ph.D., Michael M. Todd, M.D., Department of
Anesthesia, University of Iowa College of Medicine, Iowa City, IA.
PI BOC09
Predicting Surgical Volume
We undertook a study to find out working from the elective schedule asit
develops over time whether: (1) surgical case volume can be predicted (2)
if so with what confidence and (3) how many days in advance. Development
of the validated model showed that predicting surgicalvolume is possible
with fairly high confidence. The models predictions are most accurate 4 to 6
days prior to the day of surgery. This gives sufficient time to adjust staffing.
Vikram Tiwari, Ph.D., William R. Furman, M.D., Warren S. Sandberg, M.D.,
Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
NA Neuroanesthesia
PN Pain Medicine
SPE22 BEST OF ABSTRACTS: CLINICAL SCIENCE
RA BOC10
Dexmedetomidine Added to Ropivacaine Extends the Duration of
Interscalene Brachial Plexus Blocks for Elective Shoulder Surgery
When Compared to Ropivacaine Alone: A Prospective Randomized
Triple-Blind Controlled Trial
Dexmedetomidine (150 mcg) added to 0.5% ropivacaine for interscalene
blocks for shoulder surgery increased the duration of of block and
significantly improved postoperative pain when compared to ropivacaine.
There were no significant acute postoperative side effects including vital sign
changes or opioid-related symptoms. There were also no signs of acute or
delayed neurotoxicity. Thomas Danninger, M.D., Gerhard Fritsch, M.D.,
Karl Allerberger, M.D., Alexander Tsodikov, Ph.D., Thomas Felder, Ph.D.,
Monika Kapeller, M.D., Beatrice Steitz, M.D., Peter Gerner, M.D., Chad M.
Brummett, M.D., Anesthesiology, Hospital for Special Surgery, New York,
NY, Anesthesiology, Paracelsus Medical University, Salzburg, Austria,
University of Michigan, Ann Arbor, MI.
RA BOC11
Inpatient Falls After Total Knee Arthroplasty - The Role of Anesthesia
Type and Peripheral Nerve Blocks
In this study based on national population based data of total knee
arthroplasty patients we found that neuraxial anesthesia was associated
with decreased odds for the outcome of inpatient falls compared to general
anesthesia. The use of a a peripheral nerve block did not alter this risk.
Stavros G. Memtsoudis, M.D., Ph.D., Thomas Danninger, M.D., Ottokar
Stundner, M.D., Rehana Rasul, Ph.D., Suzuko Suzuki, M.D., Jashvant
Poeran, M.D., Ph.D., Edward Mariano, M.D., Madhu Mazumdar, Ph.D.,
Hospital for Special Surgery, Cornell Medical College, New York, NY,
Stanford University, Palo Alto, CA.
FA BOC12
Duration and Incidence of Postoperative Hypoxemia
The potential impact of perioperative hypoxemia on mortality and
cardiovascular events after noncardiac surgery appears to be substantial
and monitoring and intervention may improve patient outcome. We used
continuous pulse oximetry to quantify desaturation in a cross-section of
patients having non-cardiac surgery. Hypoxia was common and prolonged in
a surprising fraction of elective general surgical patients. Aram Shahinyan,
M.D., Zhuo Sun, M.D., Patrick S. Finnegan, B.A., Cameron Egan, B.Sc.,
Alex Fu, M.D., Philip J. Devereaux, M.D., Jarrod Dalton, Ph.D., Daniel I.
Sessler, M.D., Andrea Kurz, M.D., Outcomes Research, Department of
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, McMaster
University, Hamilton ON, Canada.
NA Neuroanesthesia
PN Pain Medicine
9
RA A1005
ORAL PRESENTATIONS
OR16-2 REGIONAL ANESTHESIA AND ACUTE PAIN:
ACUTE POSTOPERATIVE PAIN
SATURDAY, OCTOBER 12 | 8:00-9:30 A.M.
ROOM 123
RA A1000
Early Perioperative Immunological Effects of Anesthesia and Analgesia
in Patients Undergoing Prostate Cancer Surgery
In this prospective randomized pilot study we assessed the NK cell
cytotoxicity and the adaptive cell-mediated immune response in patients
undergoing open radical retropubic prostatectomy and randomized to
receive either thoracic epidural analgesia or patient controlled analgesia with
morphine. Federica Fant, M.D., Ph.D., Andrea Perniola, M.D., Anil Gupta,
M.D., Ph.D., Anaesthesia and Intensive Care University Hospital, Orebro,
Orebro, Sweden.
RA A1001
Provider Board Certification Status and Practice Patterns in Total Knee
Arthroplasty
Recent studies of large population-based patient samples have pointed
towards wide disparities in the use of various anesthesia techniques for
total knee arthroplasties. As reasons for this disparity remain unknown we
identified significant differences in practice patterns of non-board certified
anesthesiologists versus board certified anesthesiologists caring for patients
undergoing total knee arthroplasty. Peter M. Fleischut, M.D., Licia GaberBaylis B.A., Sn L. Faggiani, R.N., Madhu Mazumdar, Ph.D., Stavros G.
Memtsoudis, M.D., Ph.D., New York Presbyterian Hospital - Cornell New
York, NY, Anesthesiology, Public Health/Biostatistics and Epidemiology
Weill Cornell Medical College, New York, NY, Anesthesiology, Hospital
for Special Surgery, New York, NY. Hannah F. Lewis Jr. M.B. Ch.B., Mark
Edwards, M.B. B.S., Pervez Sultan M.B. Ch.B., Gareth Ackland F.R.C.A.,
Ph.D, Ramani Moonesinghe M.D. F.R.C.A. Anaesthetics University
College Hospital London, London, United Kingdom.
RA A1002
Preoperative Lymphopenia and Prolonged Postoperative Pain
Laboratory studies show that primed murine T cells produce endogenous
opioids that act peripherally to reduce inflammatory pain. There is no
patient data to support this concept. This prospective orthopedic cohort
demonstrates that preoperative lymphopenia is associated with prolonged
postoperative pain which is related to an increased length of hospital stay
and other postoperative morbidities. Hannah F. Lewis Jr., M.B. Ch.B., Mark
Edwards, M.B. B.S., Pervez Sultan, M.B. Ch.B., Gareth Ackland, F.R.C.A.,
Ph.D, Ramani Moonesinghe, M.D. F.R.C.A. Anaesthetics, University
College Hospital London, London, United Kingdom.
RA A1003
Prediction of Acute Postoperative Pain Following Breast Cancer
Surgery Using the Pain Sensitivity Questionnaire
Moderate to severe acute pain following breast cancer surgery can be
predicted by the pain sensitivity questionnaire. It can also be predicted with
similar accuracy by the simple question how intense do you imagine the
pain after your surgery but not by objective measures of pain sensitivity
such as pain elicited by electrical or hot water stimulation or the withdrawal
reflex threshold. Benno Rehberg M.D., Stan Mathivon, R.N., Georges
Savoldelli, M.D., Anesthesiology, Hospital Universitys de Geneve,
Geneve, Switzerland.
OR14-1 PATIENT SAFETY PRACTICE MANAGEMENT
SATURDAY, OCTOBER 12 | 1:00-2:30 P.M.
ROOM 123
PI A1006
Lack of Utility of a Decision Support System to Mitigate Delays in
Admission From the Operating Room to the Post Anesthesia Care Unit
Under biased conditions favoring useful performance of a decision support
system designed to reduce PACU delays through notifications when the
PACU census was at or near capacity we were unable to demonstrate
sufficient utility to warrant implementation. Rather the evidence-based
approach of matching PACU staffing to historical workload is recommended.
Richard H. Epstein M.D., Jesse M. Ehrenfeld M.D. M.P.H., Brian S.
Rothman M.D., Warren S. Sandberg M.D., Ph.D., Franklin Dexter M.D.,
Ph.D., Anesthesiology, Thomas Jefferson Hospital, Philadelphia, PA,
Anesthesiology, Vanderbilt University Nashville, TN, Anesthesiology,
University of Iowa, Iowa City, IA.
PI A1007
Can Telemedicine be Used for Preanesthesia Evaluations: A Survey of
Pre-Surgical Patients
Increasing demands placed on the health care industry as well
as advancement in technology have led to the implementation of
telecommunication in many medical subspecialties. A study was performed
to investigate patient preferences regarding the use of mainstream video
calling for the preoperative anesthesia testing (PAT) assessment and to
evaluate whether it offers time and cost-savings for the patient. The results
suggest that patients are amenable to the idea of telemedicine for PAT.
Time and cost data from this pilot should be compared to PAT evaluations
done using telecommunication- likely resulting in a significant difference and
therefore a potentially substantial reduction in the cost to society. Brian A.
Mirante M.D., Michael A. Fishman M.D. M.B.A. Feng Dai Ph.D., Audrey
Senior R.N. Viji J. Kurup M.D., Anesthesiology, Yale University School of
Medicine, New Haven, CT.
PI A1008
Medication Safety in the Operating Room: An Evaluation of APSF
Guidelines in Children’s Hospitals
The primary aim of this study was to benchmark the current state of the
Anesthesia Patient Safety Foundation (APSF) safety recommendations in
various children’s hospitals across the United States. Medication errors can
be decreased if more hospitals and their pharmacies continued to follow the
APSF recommendations and shifted medication preparation to outside the
operating room environment. Robert Shaw B.S., Ronald S. Litman, D.O.,
The Children’s Hospital of Philadelphia, PA.
PI A1009
RA A1004
Effect of Spinal Anesthesia on Intrinsic Functional Brain Connectivity
Measured by Resting-State fMRI in Healthy Volunteers
Spinal anesthesia induces connectivity changes in supraspinal regions
visualized by resting-state fMRI. Elske Sitsen M.D., Marieke Niesters,
M.D., M.S., Jaap Vuyk, M.D., Ph.D., Albert Dahan, M.D., Ph.D.,
Anesthesiology, Leiden University Medical Center, Leiden, Netherlands.
10
Effects of Stellate Ganglion Blockade on Vasomotor Symptoms:
Findings From a Randomized Clinical Trial of Postmenopausal
Women
Several uncontrolled studies have shown that stellate ganglion blockade
(SGB) may reduce vasomotor symptoms or hot flashes in women. In a
prospective randomized controlled pilot study of SGB with bupivacaine
versus sham saline injection in women with natural and surgical menopause
a significant decline in frequency of moderate-severe hot flashes (34%)
was seen and provides new evidence that stellate ganglion blockade may
modulate thermoregulation. David R. Walega M.D., Pauline M. Maki
Ph.D., Leah Rubin Ph.D., Suzanne Banuvar B.S., Lee Shulman M.D.,
Anesthesiology, Obstetrics and Gynecology Northwestern University
Feinberg School of Medicine, Psychiatry, University of Illinois at Chicago,
Chicago, IL.
Development and Implementation of a Faculty Peer Eval System as
Part of On-Going Professional Practice Evaluation
We have used our Perioperative Information Management System to
implement a multi-source peer evaluation system for clinical faculty
members. Results are provided to our Departmental Peer Review
Committee Chair by means of a secure web-based reporting tool to facilitate
performance improvement initiatives. Dylan T. Snyder B.A., Jesse M.
Ehrenfeld M.D. M.P.H., William R. Furman M.D., Vanderbilt University,
Nashville, TN.
NA Neuroanesthesia
PN Pain Medicine
Automated Identification of Drug Allergies Entered in Anesthesia
Information Management Systems Using Non-Standard Terminology
Allergies are often transmitted to anesthesia information management
systems in non-standard formats that are not interpretable for decision
support purposes. We describe the development of a high performing natural
language processing algorithm to identify allergies by matching to the
RxNorm database. Richard H. Epstein M.D., Michael Stockin M.D., Paul
St. Jacques M.D., Jesse M. Ehrenfeld M.D. M.B.A., Brian S. Rothman
M.D., Joshua C. Denny, M.D., M.S., Anesthesiology, Thomas Jefferson
Hospital, Philadelphia, PA, Anesthesiology, Vanderbilt University
Nashville, TN.
PI A1011
Using Quality Control Charts to Evaluate Anesthesia Department
Metrics and Measure Performance
Using quality control charts to evaluate anesthesia departments metrics
and measure performance. Uduak U. Williams, M.D., Joe Ensor, Ph.D.,
Elizabeth Rebello, M.D., Antoinette Van Meter, M.D., Joseph R. Ruiz,
M.D., Anesthesiology and Perioperative Medicine, Biostatistics, MD,
Anderson Cancer Center, Houston, TX.
OR11-1 HISTORY AND EDUCATION
ROOM 125
PI A1015
N.I. Pirogov: Author of the Earliest Monograph on Ether Anesthesia
and a Father of a Field Anesthesiology
N. Pirogov was a scientist doctor teacher public servant. There is no
much awareness about his contribution into the field of anesthesiology.
Search of literature about his legacy was done. In 1847 Pirogov developed
a theory of the action and use of anesthetic. Pirogov first performed 45
experimental etherizations on animals applying ether to nerves brain and
spine introducing it into the veins stomach trachea rectum. Pirogov used
ether in 1847 for breast cancer excision. In 1847 he published the first in
the world monograph on anesthesia Practical and Physiological Studies of
Ether. He was the first to use anesthetic through the rectum. Pirogov was
the first surgeon to use anesthesia in a field operation during war. In 1864
he published Principles of War Surgery which were widely used during WWII.
Sergey Pisklakov, M.D., Anesthesiology, New Jersey School of Medicine,
Newark, NJ.
PI A1010
PI A1016
Hannah Greener and Chloroform: A Better Explained Death
New laboratory information and autopsies of recent deaths from chloroform
inhalation suggest that Hannah Greener died from the effects of chloroform
on her heart and not from aspiration or respiratory obstruction. Raymond
C. Roy M.D., Ph.D., Anesthesiology, Wake Forest School of Medicine,
Winston-Salem, NC.
PI A1017
PI A1012
The McKesson Vocaphone
Credited as an inventive genius by members of his peer group and historians
of anaesthesia the American anaesthetist Elmer Isaac McKesson (18811935) designed and patented a wide range of medical devices during the
course of his twenty-eight years in clinical practice. Whist the majority of
these were intended for use in the field of anaesthesia some addressed
more peripheral problems. This paper concerns one such invention - the
McKesson Vocaphone. Peter J. Featherstone, M.B., B.Ch., C. Neil Adams
M.B. B.S., Douglas R. Bacon, M.D., Department of Anaesthetics Ipswich
Hospital, Ipswich, United Kingdom, Department of Anaesthetics, West
Suffolk Hospital, Bury St. Edmunds, United Kingdom, Department of
Anesthesiology, Wayne State University, Detroit, MI.
PI A1013
Georg Hirschel - An Exceptionally Gifted Surgeon With an Anaesthetic
Faible
Hirschel - the father of the first percutaneous performed plexus block pointed the way for the popularization of local anaesthesia techniques by
the edition of his textbook Local Anaesthesie published in 1913. It was
translated in several other languages. Even an edition in Russian and
Spanish appeared. Moreover he was an outstanding surgeon and one of
the originators of the well known Whipple-procedure. His contributions
are still an integral part of our daily anaesthetic armamentarium and
should not be forgotten. Benjamin Loeser, M.D., Michael Goerig Ph.D.,
Center of Anaesthesiology and Intensive Care, Medicine, Department
of Anaesthesiology, Hamburg Eppendorf University Medical Center,
Germany.
How Did J. Julian Chisolm Administer Chloroform Before He Invented
His Inhaler?
The precursor to the Chisolm nasal chloroform inhaler was a funnel that
covered the nose and mouth at its most open end and held a small
sponge containing chloroform suspended near the narrow end. The funnel
is described in the 1st edition of his Manual of Military Surgery for the
Use of Surgeons in the Confederate Army 1861. Raymond C. Roy M.D.,
Ph.D., Mark Erickson M.D., Debra Chisolm Ruehlman, Annie Jenkins,
Anesthesiology, Wake Forest School of Medicine, Winston-Salem
NC, Wake Forest School of Medicine, Winston-Salem, NC, Great
Great Granddaughter of J. Julian Chisolm Winston-Salem, NC, Great
Granddaughter of William Edward Aiken, Chisolm Colleague, WinstonSalem, NC.
POSTER DISCUSSIONS
PD03-1 CHRONIC AND CANCER PAIN: BASIC SCIENCE
ROOM 124
PN A1018
AAV2-Agrin Peripheral Nerve Delivery Suppresses Neuropathic Pain
Induced by Spinal Cord Injury
We found that 50 kDaagrin by intraneural AAV2 vector delivery can be
expressed in the DRG and DH andsuppress SCINP in the rat SCI model
consequently becoming a very promisingapproach for neuropathic pain
treatment. Diana M. Erasso, Ph.D., Gabriel Tender, M.D., Roy C. Levitt,
M.D., Jian-Guo Cui, M.D., Ph.D., Anesthesiology, University of Miami,
Miami, FL, Neurosurgery, Louisiana State University, New Orleans, LA.
PN A1019
PI A1014
Popularization of Anesthesia Apparatus in Japan From 1868 to 1914 A Study of Old Japanese Medical Equipment Sales Catalogs
The years in which important anesthetic techniques or apparatus were
developed are often widely known. However it is not known how long it
takes for such improvements to become popular among Japanese doctors.
In this study we investigated old Japanese medical equipment sale catalogs
published from 1868 to 1914 and concluded that the time span was
about ten years. Hiroshi Makino, M.D., Ph.D., Takasumi Katoh, M.D.,
Ph.D., Shigehito Sato, M.D., Ph.D., Anesthesiology and Intensive Care,
Hamamatsu University School of Medicine, Hamamatsu, Japan.
Enantioselective Effect Of Ketamine Metabolites On Serine Racemase
Expression and Function In 1321N1 And PC-12 Cells
We report the effect of (R S)-Ketamine metabolites on intracellular D-Ser
concentrations and the expression of monomeric- and dimeric-Serine
Racemase (m-SR d-SR). All test compounds decreased intracellular D-ser
and increased the expression of monomeric-SR with no effect on d-SR.
(2S 6S;2R 6R)-hydroxynorketamine metabolite was approximately 200
times more potent than (R S)-norketamine and (R S)-dehydronorketamine
indicating that the presence of a hydroxyl moiety at carbon6 in
cyclohexanone ring increases potency. Michael Goldberg, M.D., Rajib K.
Paul Ph.D., Nagendra S. Singh Ph.D., Marc C. Torjman Ph.D., Irving
W. Wainer Ph.D., Anesthesiology, Cooper University Hospital, Cooper
Medical School of Rowan University, Camden, NJ, The Laboratory of
Clinical Investigation, National Institute on Aging, Intramural Research
Program, National Institute of Health, Baltimore, MD.
NA Neuroanesthesia
PN Pain Medicine
11
PN A1020
PN A1025
PN A1021
PD04-1 CLINICAL CIRCULATION
ROOM 125
Gabapentin And (S)-Pregabalin Attenuate Basal Serine Racemase
Activity In PC-12 Cells
This study reports on the effect of Gabapentin (GBP) and (S)-pregabalin
(PGB) on intracellular D-serine concentrations in the PC-12 cell line. GBP
and PGB reduced the basal activity of serine racemase, most likely a result
of the decreased Ca+2 flux produced via interaction of the drugs with the
2- subunit of voltage-gated calcium channels. Thus, GBP and PGB may act
as indirect antagonists of NMDAR, a mechanism that may contribute to the
clinical effects of the drugs in neuropathic pain. Michael Goldberg, M.D.,
Nagendra S. Singh, Ph.D., Rajib K. Paul, Ph.D., Marc C. Torjman Ph.D.,
Irving W. Wainer Ph.D., Anesthesiology, Cooper University Hospital,
Cooper Medical School of Rowan University, Camden, NJ, The Laboratory
of Clinical Investigation, National Institute on Aging Intramural Research
Program, National Institute of Health, Baltimore, MD.
Deletion of Type II TGF-946; Receptor Gene in Articular Chondrocytes
Leads to Progressive OA in Mice
Inhibition of TGF-signaling in articular chondrocytes leads to progressive
osteoarthritis-like phenotype in mice with development of pain-related
behavior. Future studies will examine the critical downstream target genes
involved in TGF- signaling pathway during the development of osteoarthritis.
Jeffrey S. Kroin Ph.D., Jia Li Ph.D., Hee-Jeong Im, Ph.D., Di Chen, Ph.D.,
Anesthesiology, Biochemistry, Rush Medical College, Chicago, IL.
PN A1022
Temporal Differences in NR2B Expression in Various DRG Cells
Following Spared Nerve Injury in Rats The time course of increase in NR2B expression was different in the
various DRG cells and it was dependent on the type of SNI. Microglia
displayed a transient increase in NR2B expression that was similar in both
SNI variants; this pattern correlated with the presence of acute allodynia.
However the transient increase in NR2B in microglia did not correlate with
the development of chronic mechanical or cold allodynia. In contrast the
increase in NR2B expression in neurons and SGCs was only observed in
Tibial-SN; suggesting that it may play a role in the chronic state of allodynia;
however additional functional studies are required to discern their role.
Monica Norcini, Ph.D., Lourdes A. Martin, M.S., Alexandra Sideris Ph.D.,
Jin Zhang M.D., Thomas JJ Blanck M.D., Ph.D., Esperanza Recio-Pinto,
Ph.D., Anesthesiology, NYU, New York, NY.
PN A1023
Bone Marrow-Derived Microglia That Express IL-1 Might Cause
Negative Emotions Induced by Neuropathic Pain
We investigated the involvement of bone marrow-derived microglia (BMDM)
in negative emotions in a model mouse of neuropathic pain following partial
sciatic nerve ligation. Neuropathic pain induced anxiety-like behavior in model
mice at 4 weeks after surgery. At the same time BMDM which expressed
higher levels of IL-1 had migrated into the central nucleus of the amygdala
(CeA) in model mice but not in sham or control mice. These results indicate
that migration of BMDM into the CeA might cause negative emotions induced
by neuropathic pain. Atsushi Sawada, M.D., Yukitoshi Niiyama, M.D.,
Ph.D., Michiaki Yamakage, M.D., Ph.D., Anesthesiology, Sapporo Medical
University School of Medicine, Sapporo, Japan.
PN A1024
New Alpha-2 Adrenergic Agonist Was Effective to Reduce Hyperalgesia
and Allodynia Induced by SNL Model in Rats
Treatment of neuropathic pain is an unsolved problem in medicine. Here
we investigated the effect of a new alpha-2 adrenergic receptor agonist
3-(2-chlore-6-fluorobenzil)-imidazolinide-2 4-dione (PT-31) (US 8 217
068 B2) to reduce hyperalgesia and allodynia signals in rats prepared
to reproduce neuropathic pain. PT-31 was effective in reducing thermal
hyperalgesia and mechanical allodynia induced by SNL in rats. Rachel D.
Vieiralves, M.D., Carlos Eduardo Monteiro, Ph.D., Gisele Zapata Sudo
Ph.D., Maria do Carmo Alves Lima, Ph.D., Ivan Rocha Pitta, Ph.D.,
Roberto Takashi Sudo, Ph.D., Pharmacology, UFRJ, Rio de Janeiro, Brazil,
NUPIT UFPE, Recife.
12
A Quantum Mechanical Approach to Medication Toxicity: A Case Study
With Acetaminophen
This abstract illustrates the use of Quantum mechanical parameters such as
softness and electrophilicity calculated based on the Hard and Soft Acids
and Bases (HSAB) theory of Pearson to predict drug metabolite toxicity
and identify putative cytoprotectants. Amaresh Vydyanathan, M.B., B.S.,
Boleslav Kosharskyy, M.D., Naum Shaparin, M.D., Richard LoPachin
Ph.D., Terrence Gavin Ph.D., Anesthesiology and Pain Medicine, Albert
Einstein College of Medicine/Montefiore Medical Center, New York, NY,
Montefiore Medical Center, New York, NY, Chemistry, Iona University, New
Rochelle, NY.
CA A1026
Intra-Aortic Protamine Administration After Cardiopulmonary Bypass
Results In Decreased Pulmonary Artery Pressures and Improved
Alveolar-Arterial Gradient
Intraaortic protamine administration after cardiopulmonary bypass resulted in
decreased mean pulmonary artery pressures and improved alveolar-arterial
gradient without hemodynamic compromise. Mark A. Chaney, M.D., Richa
Dhawan, M.D., Edris Negron, M.D., Joseph D. Roberts, M.D., Anesthesia
and Critical Care, University of Chicago Medical Center, Chicago, IL.
CA A1027
Predictive Accuracy of FIBTEM Assay for Clauss Fibrinogen Varies With
Fibrinogen Substitution Thresholds
Predictive accuracy of FIBTEM assay for Clauss fibrinogen varies for
fibrinogen substitution thresholds recommended by current guidelines.
For a most accurate discrimination of fibrinogen status and an adequate
rapid substitution based on point-of-care testing FIBTEM-A10 appears
superior to FIBTEM-MCF. Gabor Erdoes M.D., Giuseppe Colucci, M.D.,
Germaine Gerster Student, Reto Basciani, M.D., Lorenzo Alberio, M.D.,
Balthasar Eberle, M.D., Department of Anesthesiology and Pain Therapy,
Department of Hematology, University Hospital Bern, Bern, Switzerland.
CA A1028
A Novel Method of Data Analysis for Utilization of Red Cell Transfusion
We describe novel methods for analyzing RBC transfusion data. By including
data for the hemoglobin trigger and target along with a comparison of
the restrictive trigger to target range from the large clinical trials we can
show the percentage of patients who may have been overtransfused. This
approach may improve blood utilization which may reduce costs improve
patient safety and improve outcomes. Steven M. Frank, M.D., Linda MS
Resar M.D., James A. Rothschild, M.D., Elizabeth A. Dackiw, R.N., Will
J. Savage, M.D., Ph.D., Paul M. Ness, M.D., Anesthesiology/Critical
Care Medicine, Medicine, Oncology, Pediatrics, Pathology (Transfusion
Medicine), The Johns Hopkins Medical Institutions, Baltimore, MD,
Pathology (Transfusion Medicine) Brigham and Women’s, Boston, MA.
CA A1029
Evaluation of Hypercoagulability Via ROTEM Thromboelastography
After Ventricular Assist Device Implantation
In this prospective observational study ROTEM thromboelastography was
performed on eighteen patients before and up to six days after implantation
of ventricular assist device. Small non-significant changes in ROTEM
profile indicating hypercoagulability were noted on postoperative days 1
and 2. However the changes did not reach statistical significance and did
not persist after postoperative day 2. Clinical relevance of these change
in ROTEM profile requires further study. Maung Hlaing, M.D., Alexander
Hincker, B.S., Justin Feit, Robert Sladen, M.B. Ch.B., Gebhard Wagener
M.D., Anesthesiology, Biological Sciences Columbia College, New York,
NY.
NA Neuroanesthesia
PN Pain Medicine
The Independent Effects of Anemia and Transfusion on Mortality After
Coronary Artery Surgery
The main findings of our study are that (1) anemia in the absence of RBC
transfusion is not associated with late mortality (2) that RBC transfusion
is associated with increased late mortality in both anemic and non-anemic
patients and (3) the mortality risk associated with RBC transfusion is
increased in anemic patients compared to non-anemic patients. The
combined risk of death from anemia and RBC transfusion is double that
of the non-anemic non-transfused patient. Sean Neill, M.B. Ch.B., Milo
Engoren M.D., Thomas A. Schwann M.D., Robert H. Habib M.D.,
Jennifer Vance M.D., Donald S. Likosky Ph.D., Anesthesiology,
Cardiac Surgery, University of Michigan, Health System Ann Arbor,
MI, Cardiothoracic Surgery University of Toledo, Toledo, OH, Internal
Medicine, American University of Beirut, Beirut, Lebanon.
CA A1031
Red Blood Cell Deformability and Aggregation in Patients Undergoing
Cardiac Surgery
The findings suggest that the combination of cardiopulmonary bypass and
allogeneic blood transfusion has a synergistic effect resulting in decreased
red blood cell deformability in the early postoperative period. Red blood cell
aggregation was decreased during bypass and increased postoperatively.
Osman N. Salaria, M.B. B.S., Steven M. Frank, M.D., Dan E. Berkowitz,
M.D., Daniel Nyhan, M.D., Ashish S. Shah, M.D., Viachaslau M. Barodka,
M.D., Anesthesiology/Critical Care Medicine, Cardiac Surgery, The Johns
Hopkins Medical Institutions, Baltimore, MD.
CA A1032
Bleeding in Patients Undergoing Noncardiac Surgery During
Antiplatelet Therapy: The BIANCA Trial
In patients under dual antiplatelet therapy preoperative LTA-assessed
platelet inhibition indicates increased bleeding in non-cardiac surgery. This
ongoing study may help to define a bleeding cut-off and thereby allow a more
targeted and individualized timing of surgery. Wolfgang Toller, M.D., Helmar
Bornemann M.D., Florian Pruller, M.D., Peter Rehak, Ph.D., Reinhard
Raggam M.D., Ruediger Musil, M.D., Anneliese Baumann M.D.,
Christian Gorog M.D., Elisabeth Mahla M.D., Helfried Metzler M.D.,
Department of Anesthesiology and Intensive Care, Medicine, Clinical
Institute of Medical and Chemical Laboratory Diagnostics, Department of
Surgery Unit of Medical Engineering & Computing, Graz, Austria.
CA A1033
The Influence of Hemodilution on Outcome After Cardiopulmonary
Bypass: Results of a Randomized Trial
To explore that a lower hematocrit during CPB is as safe as a higher
hematocrit in patients undergoing elective open heart cardiac surgery and
to determine whether the influence of erythrocyte transfusion on AKI (acute
kidney injury) differs in anemic and nonanemic patients. Qinjuan Wu M.B.,
Liu Bin M.D., Laboratory of Anesthesia and Critical Care, Medicine, West
China Hospital Sichuan University, Chengdu, China.
PD06-1 CRITICAL CARE: INFLAMMATION AND CELL INJURY
ROOM 124
CC A1034
Effect of Mechanical Ventilation and Endotoxemia on Neutrophilic
Inflammation and Ultrastructural Lung Injury
Neutrophilic inflammation is a fundamental early process occurring
during lung injury. We compared FDG PET measurements of neutrophilic
inflammation resulting from a predominantly mechanical lung injury with
those resulting predominantly from moderate systemic endotoxemia. In
addition we studied the relationship between PET assessments and electron
microscopic. Luiz Fernando Reis Falcao M.D., Ph.D., Tyler J. Wellman
Ph.D., Vera L. Capelozzi M.D., Ph.D., Guido Musch M.D., Ph.D., Tilo
Winkler Ph.D., Nicolas de Prost M.D., Ph.D., Mauro R. Tucci M.D.,
Ph.D., Robert S. Harris M.D., Jose Venegas Ph.D., Marcos F. Vidal Melo
M.D., Ph.D., Department of Anesthesia Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, Pathology Sao Paulo
University, Sao Paulo, Brazil.
CC A1035
Non-Dependent Regions Show Relative Upregulation of VILI Genes and
Late Increases in FDG Uptake in a Sheep Model of ALI
It is not clear which lung regions in a heterogeneously inflated lung would
show changes in expression of genes previously associated with VILI. To
address this question we combined PET FDG imaging with microarray
analysis to study regional lung injury patterns over long-term mechanical
ventilation with systemic endotoxemia. Tyler Wellman Ph.D., Nicolas de
Prost M.D., Ph.D., Tilo Winkler Ph.D., Guido Musch M.D., Ph.D., Mauro
Tucci M.D., Ph.D., Luiz Fernando Reis Falcao M.D., Ph.D., Jen-Hwa
Chu M.D., Ph.D., Benjamin A. Raby M.D., Ph.D., Rebecca M. Baron
M.D., Ph.D., Marcos F. Vidal Melo M.D., Ph.D., Massachusetts General
Hospital, Boston, MA, Channing Laboratory, Division of Pulmonary and
Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA.
CA A1030
CC A1036
Role of Cardiac Versus Myeloid Myd88 in Endotoxin Shock - A Study
With Tissue-Specific Deletion Models
Cardiac- or myeloid-MyD88 deletion mice were generated using Cre-loxP
system and subjected to endotoxin shock model together with their control
littermates. This pilot study demonstrates that 1) myeloid MyD88 plays
an important role in cardiac dysfunction during endotoxin shock and 2)
both cardiac- and myeloid-MyD88 contribute to the mortality. Yan Feng
M.D., Ph.D., Lin Zou M.D., Ph.D., Chan Chen M.D., Yuntai Yao M.D.,
Ph.D., Jiayan Cai B.S. Wei Chao M.D., Ph.D., Massachusetts General
Hospital, Boston, MA.
CC A1037
Caveolin-1 Phosphorylation Triggers Sepsis-Induced Lung Inflammation
Caveolin-1 Y14 phosphorylation was required for the interaction with
TLR4 and activation of TLR4-MyD88 signaling and sepsis-induced lung
inflammation. Inhibiting caveolin-1 Tyr14 phosphorylation and resultant
inactivation of TLR4 signaling in pulmonary vascular endothelial cells
represents a novel target for preventing sepsis-induced lung inflammation
and injury. Hao Jiao M.D., Zhen-Guo Wang Ph.D., Zhibo Yan M.D.,
Gongjian Liu M.D., Ph.D., Richard D. Minshall Ph.D., David Schwartz
M.D., Guochang Hu M.D., Ph.D., Anesthesiology and Pharmacology,
University of IL at Chicago, Chicago, IL, Anesthesiology, Xuzhou Medical
College, Xuzhou, China.
CC A1038
Critical Role of Interleukin-11 in Isoflurane-Mediated Protection
Against Ischemic Acute Kidney Injury
Isoflurane induces renal tubular IL-11 to protect against ischemic AKI.
Exogenous administration of IL-11 may reduce the morbidity and mortality
arising from AKI without the systemic effects of volatile anesthetics. HT Lee,
M.D., Ph.D., Ahrom Ham, Ph.D., Joo Y. Kim, Ph.D., Mihwa Kim, Pharm.D.,
Anesthesiology, Columbia University, New York, NY.
CC A1039
Local Anesthetics and Mechanotransduction: Ropivacaine Blocks
Pressure-Induced Pulmonary Capillary Leakage Via Inhibition of eNOS
and Src
Ropivacaine at a clinically relevant concentration completely blocked
pressure-induced increase in pulmonary capillary leakage which we
hypothesize is dependent on the inhibition of eNOS-mediated Src activation
and caveolin-1 phosphorylation. This novel property of ropivacaine may have
significant therapeutic potential in patients with acutely elevated pulmonary
pressures. Tobias Piegeler M.D., Nikhil Bommakanti, Ayman Isbatan,
Richard D. Minshall Ph.D., Randal O. Dull M.D., Ph.D., Department
of Anesthesiology Departments of Anesthesiology and Bioengineering,
Departments of Anesthesiology and Pharmacology, University of Illinois
Hospital and Health Sciences Center, Chicago, IL.
NA Neuroanesthesia
PN Pain Medicine
13
CC A1040
Effects of Intravenous Versus Inhaled Aerosolized Insulin on
Inflammatory Responses in Acute Lung Injury
In our experimental model of acute lung injury induced by lung lavage using
rabbit hyperglycemia exacerbated inflammatory responses in the lungs.
Treatment with both aerosolized insulin and intravenous insulin attenuated
TLR-4 and IL-8 mRNA expressions in the bronchoalveolar lavage fluid cells.
However its efficacy may be better when administered by aerosol. Mariko
Senda, M.D., Wei Fan M.D., Koichi Nakazawa M.D., Ph.D., Shinya Abe
Ph.D., Miori Inoue, Masanobu Kitagawa M.D., Ph.D., Koshi Makita M.D.,
Ph.D., Department of Anesthesiology and Critical Care Medicine, Tokyo
Medical & Dental University, Department of Comprehensive Pathology
Ageing and Developmental Sciences Tokyo Medical & Dental University,
Tokyo, Japan.
CC A1041
Role of Increased Protein Farnesylation in Burn-Induced Muscle
Metabolic Derangements and Increased Circulating Alarmins
Burn increased farnesyltransferase (FTase) expression and protein
farnesylation in mouse muscle which paralleled insulin resistance metabolic
derangements and increased circulating alarmins. FTase inhibitor reversed
or ameliorated these alterations in burned mice. Our study identifies FTase
as a novel potential target to improve the clinical outcome of burn patients.
Marina Yamada Ph.D., Masao Kaneki M.D., Ph.D., Anesthesia, Critical
Care and Pain Medicine, Massachusetts General Hospital, Shriners
Hospitals for Children Harvard Medical School, Boston, MA.
PD10-1 EXPERIMENTAL NEUROSCIENCES: CNS ISCHEMIA
NEUROTOXICITY AND NEUROPROTECTION
ROOM 125
NA A1042
Interaction of Isoflurane TNF-Alpha and Beta-Amyloid on Long-Term
Potentiation in Rat Hippocampal Synapses
We studied whether transient exposure to ~0.8 MAC isoflurane worsens
impairment of long-term potentiation caused by A or TNF- peptides in young
rat hippocampal slices. Although both peptides impair LTP isoflurane did not
enhance this effect; instead isoflurane prevented the suppression of LPT by
A whereas TNF- suppression of LTP was unaltered by isoflurane. Whether this
occurs in aging hippocampus requires further study. Philip E. Bickler M.D.,
Ph.D., Ran Zhou M.D., John P. Clark Ph.D., Yun Yue, M.D., Anesthesia
and Perioperative Care, University of California - San Francisco, San
Francisco, CA, Anesthesia, Capital Medical University, Beijing, China.
NA A1043
The Anti-Inflammatory Effects of Agmatine on Focal Cerebral Ischemia
in Diabetic Rats
AGM post-treatment reduced cerebral infarct size and neurological deficit
expression in diabetic rats subjected to MCAO. This neuroprotective effect of
AGM may be associated with a decrease in innate inflammation. Hae Sun
Cho M.D., Seokyung Shin M.D., Bon-Nyeo Koo M.D., Anesthesiology
and Pain Medicine, Yonsei University College of Medicine, Seoul,
Republic of Korea.
NA A1044
Early Post-Natal Exposure to Anesthetics and Surgery Does Not
Prevent Fear Associative Memory Formation in Adult Mice
Exposure to isoflurane with or without surgery during the neonatal period
did not affect adult associative learning processes measured by the fear
conditioning test. Kiri Mackersey, M.D., Michael Haile, M.D., Yan Lin,
M.D., David Quartermain Ph.D., Guang Yang, Ph.D., Richard Kline, Ph.D.,
Alex Bekker M.D., Ph.D., Anesthesiology, Neurology, NYU Langone
Medical Center, New York, NY, Anesthesiology, University of Medicine and
Dentistry of New Jersey, Newark, NJ.
14
NA A1045
Association of Leptin and Insulin With Cortical Atrophy in the ADNI
Database
Complex relationships between circulating blood factors such as Leptin
and anatomical regions of interest may be analyzed to identify and confirm
possible therapeutic approaches for potential postoperative cognitive
changes. Richard P. Kline, Ph.D., Michael Haile, M.D., Anesthesiology,
NYU Langone Medical Center, New York, NY.
NA A1046
Marker For Neurons in the Thalamus Shows Slowed Growth After
Anesthesia Exposure in Neonatal Rats
The findings of anesthesia induced neurotoxicity in the neonatal brain has
caused much concern over the past few years. We sought to compare
spectra acquired from animals exposed to anesthesia at 24 and 48
hours after the exposure to those acquired from animals who were not
exposed. These spectra were acquired from the thalamic region of the brain
using proton Magnetic Resonance Spectroscopy (1HMRS). Our results
demonstrate major metabolic changes occurring in the thalamus that may
likely be related to anesthesia induced neuroapoptosis. Specifically the
decrease in the rate of increase of [NAA] a neuronal marker may be
indicative of a slowed neuronal growth and/or apoptosis in those exposed to
anesthesia. Rany Makaryus, M.D., Tian Feng, B.S., Hedok Lee, Ph.D., Mei
Yu B.S., Anesthesiology, Stony Brook Medicine, Statistics and Applied
Mathematics, Stony Brook University, NY.
NA A1047
Decreased Surgical Bleeding in Sprague Dawley Rats Pretreated With
Crotalus Atrox Venom
We have noticed that preconditioning prior to surgery with sub-lethal doses
of C. atrox venom reduces intraoperative bleeding in the rat model of surgical
brain injury. This study tried to elucidate a mechanism that might account
for this finding. Our results suggest that venom causes increased fibrinogen
production in reaction to disrupted fibrinogen structure and fibrin split
products which could account for improved surgical hemostasis. Ronak N.
Raval, M.D., Cherine Kim B.S., Karen Hay M.S., John Zhang M.D.,
Ph.D., Richard Applegate II M.D., Brian Bull M.D., Anesthesiology, Loma
Linda University, School of Medicine, CA.
NA A1048
Specific Inhibition of TRPM2 Channels Provides Protection Against
Ischemic Stroke in Male mMce
Inhibition of TRPM2 channels by blocking the ADPr binding domain using
newly designed peptide provides protection from ischemic stroke in male
mice while having no effect in female mice. The peptide may be a unique
new tool to study the role of TRPM2 channels. Takeru Shimizu M.D.,
Ph.D., Richard J. Traystman Ph.D., Paco S. Heerson Ph.D., Department
of Anesthesiology, University of Colorado, Anschutz Medical Campus,
Denver, CO, University of Colorado, Anschutz Medical Campus Aurora,
CO.
NA A1049
Annexin-A1 Tripeptide Modulates Activation of BV2 Microglia After
Simulated Ischemia-Reperfusion
Our current research provides preliminary evidence that a novel Annexin-A1
tripeptide an anti-inflammatory agent modulates activation of BV2 microglia
by suppressing inflammatory responses after simulated ischemia-reperfusion.
This is associated with inhibited NF-kB activity and suppressed expression
of downstream target pro-inflammatory genes. Zhiquan Zhang Ph.D., Qing
Ma M.D., Mihai V. Podgoreanu M.D., Duke University Medical Center,
Durham, NC.
NA Neuroanesthesia
PN Pain Medicine
ROOM 123
FA A1050
Distribution of Neuromuscular Blocking Agent Utilization
Administration Times Within the National Anesthesia Clinical Outcomes
Registry
We conducted a retrospective analysis of neuromuscular blocking agent use
within the National Anesthesia Clinical Outcomes Registry to explore the
timing of last doses of neuromuscular blockade (NMB). Patients received
the last dose of NMB 56 65 and 63 minutes prior to reversal agent
administration surgical site closure and emergence respectively. We also
estimate based upon the timing of NMB administration that 75.9% 85.5%
and 91.3% of patients had achieved a train of four state of T2 or greater at
the same time points respectively. The last administration of NMB agents is
often at a time point that may result in low levels of NMB towards the end of
surgical procedures. Scott Devine Ph.D., Steven Ladas, Richard Dutton
M.D., Lance Mueller, Jonathan Yong M.D., Merck Sharp & Dohme
Corp., Whitehouse Station, NJ, Anesthesia Quality Institute, Chicago, IL.
FA A1051
Timing of Neuromuscular Blockade Reversal Agents Within the
National Anesthesia Clinical Outcomes Registry
We conducted a retrospective analysis of reversal agent utilization
within the National Anesthesia Clinical Outcomes Registry to explore the
administration timing relative to other points. The mean administration time
of a reversal agent was 56 (SD 30.02) minutes after the last dose of a
neuromuscular blocking agent and 7 minutes (SD 6.98) minutes prior to
surgical site closure. The range of reversal agent administration relative to
neuromuscular blockade and surgical site closures were wide. The reasons
for the large inconsistency and variability in practice may be multi-factorial
and determinants should be explored in future studies. Scott Devine, Ph.D.,
Steven Ladas, B.S., Richard Dutton, M.D., Lance Mueller, Jonathan Yong,
M.D., Merck Sharp & Dohme, Corp, Whitehouse, Station, NJ, Anesthesia
Quality Institute, Chicago, IL.
FA A1052
Frequency of Inadequate Neuromuscular Blockade During General
Anesthesia
Prevalence of inadequate intraoperative neuromuscularblockade (IINMB)
was identified using a hybrid of automated search criteria andmanual review
of electronic health record data of 129 209 patients undergoing general
anesthesia between 1/1/2005 to 3/1/2013. We observed that nearly 1% of
all general anesthetics involving non-depolarizing neuromuscular blockade
agents (NMBA)exhibit IINMB and 39% demonstrate IINMB via subjective
train-of-four monitoring requiring additional NMBA. Timur Dubovoy, M.D.,
Amy Shanks, M.S., Scott Devine, Ph.D., Sachin Kheterpal, M.D., M.B.A.,
Anesthesiology, University of Michigan, Health System, Ann Arbor, MI,
Outcomes Research Scientist, US Outcomes Research, Merck, Sharp and
Dohme Corp., St. Louis, MO.
FA A1053
Impact of Severity of Residual Neuromuscular Blockade on
Perioperative Complications and Health Care Resource Utilization
The RECITE study is a prospective multicenter study investigating the
incidence and impact of rNMB in Canadian clinical practice. The aim of this
analysis was to assess the impact of the severity of rNMB on the incidence
of peri-operative complications and the associated healthcare resource
utilization. Andre Galarneau Ph.D., Dolores McKeen M.D., Kim Turner
M.D., Louis-Philippe Fortier M.D., Etienne DeMedicis M.D., Brian
Warriner M.D., Philip M. Jones M.D., Alan Chaput M.D., Jean-Francois
Pouliot Ph.D., Merck Canada, Kirkland QC Canada, IWK Health Centre,
Halifax NS, Canada, Queen’s University Kingston, ON Canada, Hopital
Maisonneuve Rosemont, Montreal QC, Canada, Centre Hospitalier
University de Sherbrooke, Sherbrooke QC, Canada, Vancouver General
Hospital, Vancouver BC, Canada, London Health Sciences Center,
London ON, Canada, The Ottawa Hospital, Ottawa ON, Canada.
FA A1054
Insufficient Neuromuscular Block-Temporal Description and Treatment:
A Registry Analysis
The incidence timing and treatment of insufficient intraoperative
neuromuscular block remain unclear. Electronic search strategy coupled
with individual chart review identified 129 documented cases of insufficient
neuromuscular block of which 23 (18%) were within 30 minutes of
emergence. Neuromuscular blocking agents were used to treat less than
half (48%) of these episodes; propofol (56%) and increasing volatile
anesthetic partial pressure (52%) was used in preference. Brian D. Hesler
M.D., Zohaib Akhtar M.D., Scott Devine Ph.D., Dongsheng Yang
M.S., Andrea Kurz M.D., Daniel Sessler M.D., Alparslam Turan M.D.,
Leif Saager M.D., Outcomes Research, Cleveland Clinic Foundation,
Cleveland, OH, Outcomes Research Merck & Co. Whitehouse Station,
NJ.
PD13-3 OUTCOMES AND DATABASE RESEARCH: RELAXATION
FA A1055
The Incidence of Insufficient Neuromuscular Block: A Registry
Analysis
We determined the incidence of insufficient neuromuscular block in a
select surgical population where adequate muscle relaxation is generally
considered necessary. Retrospective analysis of 48 315 anesthesia records
by various electronic search strategies yielded 13 573 cases of insufficient
neuromuscular block or an overall incidence of 28.09%. Brian D. Hesler,
M.D., Cameron Egan B.S., Scott Devine Ph.D., Dongsheng Yang
M.S., Andrea Kurz M.D., Daniel Sessler M.D., Alparslam Turan M.D.,
Leif Saager M.D., Outcomes Research Cleveland Clinic Foundation,
Cleveland, OH, Outcomes Research Merck and Co. Whitehouse Station,
NJ.
FA A1056
Residual Neuromuscular Blockade at Tracheal Extubation in the United
States (RECITE-U.S.): Interim Analysis
This is interim analysis of a prospective study to assess the incidence of
residual neuromuscular blockade (rNMB) at tracheal extubation among US
adult abdominal surgery patients. Among 168 patients 63% had rNMB
despite use of neostigmine and peripheral nerve stimulator. Beverly K. Philip,
M.D., Scott Groudine, M.D., Leif Saager, M.D., Pedro Tanaka, M.D., Roy
Soto, M.D., Harold Minkowitz, M.D., Tong Joo Gan, M.D., Tricia Meyer,
Pharm.D., Yiliam Rodriguez-Blanco, M.D., Eric Maiese, Ph.D., Brigham
& Women’s Hospital, Boston, MA, Albany Medical Center, Albany, NY,
Cleveland Clinic, Cleveland, OH, Stanford University, Stanford, CA,
William Beaumont Hospital, Royal Oak, MI, Memorial Hermann Memorial
City Medical Center, Houston, TX, Duke University, Durham, NC, Scott &
White HealthCare, Temple, TX, University of Miami, Miami, FL, Merck &
Co. Inc., West Point, PA.
PD08-2 EQUIPMENT MONITORING AND ENGINEERING TECHNOLOGY:
UTILIZING ADVANCES IN TECHNOLOGY
ROOM 124
FA A1058
Keyboard Stowaways: UV Rx-Pilot Study Improving Healthcare EMR
Hygiene
At care provider workstations the EMR keyboard is an important potential
pathogen vector. We evaluated bacterial burden from OR and medical ICU
EMR keyboards before and after short wave UV to assess effectiveness
of decontamination. Devon C. Cole, M.D., Sadiq Shaik, M.D., Nik
Gravenstein, M.D., Anesthesiology, University of Florida, Gainesville, FL.
FA A1059
How Closed is Automated Closed-Circuit Anesthesia?
The latest software version SW 4.03 MK 04672-00 has succeeded in
making the Zeus work in CCA mode such that under the conditions specified
in this study it is unlikely that any further meaningful reduction in agent
waste can be made. Sofie D. De Cooman M.D., Rik Carette M.D., Jan
FA Hendrickx M.D., Ph.D., Andre De Wolf M.D., Anesthesiology/CCM
Sint Jan Hospital, Brussel, Belgium, Anesthesiology/CCM OLV Hospital,
Aals,t Belgium, Anesthesiology, Northwestern University, Chicago, IL.
NA Neuroanesthesia
PN Pain Medicine
15
FA A1060
Desflurane Usage With Two Different Automated Target Controlled Low
Flow Anesthesia Machines
Desflurane usage was 52% higher with the Aisys than with the Zeus (or
vice versa the Zeus used only 66% the amount the Aiysys used). Two
factors that contribute to higher desflurane usage by the Aisys are (1) the
higher initial FGF required to more aggressively attain the target FIO2 after
induction of anesthesia and (2) the higher maintenance FGF. Robrecht De
Medts M.D., Andy De Baerdemaeker M.D., Rik Carette M.D., Sofie
De Cooman M.D., Jan Hendrickx M.D., Ph.D., Andre De Wolf M.D., OLV
Aalst Mechelen Belgium, OLV Hospital Aalst Belgium, Sint Jan Hospital,
Brussel, Belgium, Northwestern University, Chicago, IL.
FA A1061
The Impact of Real-Time Automated Error Detection and Notification
on Anesthesia Record Documentation of Relief Time
National and regional regulations dictate attending anesthesiologists
oversight of residents and nurse anesthetists (CRNA) with stipulations on
the allowed number of concurrent cases and associated reimbursement
amounts. The implementation of a real-time automated error detection
and notification system can significantly decrease the number of missed
opportunities or failures to document resident and CRNA relief times. Peter
M. Fleischut, M.D., Ansara M. Vaz B.A., Sn L. Faggiani, R.N., Christian
P. Tope B.S., Mahdu Mazumdar, Ph.D., Stavros G. Memtsoudis M.D.,
Ph.D., Anesthesiology, Public Health/Biostatistics and Epidemiology Weill
Cornell Medical College, Anesthesiology, Hospital for Special Surgery,
New York, NY.
FA A1062
Intraoperative Application of the Artificial Endocrine Pancreas
We used continuous blood glucose monitoring to identify the typical blood
glucose level changes associated with various operative methods and
ascertained the intraoperative application of the artificial endocrine pancreas.
Naoji Mita M.D., Shinji Kawahito, M.D., Ph.D., Nami Kakuta M.D.,
Katsuyoshi Kume M.D., Kazumi Takaishi M.D., Ph.D., Hiroshi Kitahata
M.D., Ph.D., Tokushima University, Tokushima, Japan.
FA A1063
Systematic Evaluation of Mobile Phone Pulse Oximetry Performance
An automated system for verifying the performance of mobile phone
oximeters is presented and applied to three different models of phone
oximeters. The results are visualized graphically showing good overall
performance of the devices in the limits of low peripheral perfusion and
optical transmission and offering a new way to systematically evaluate
and compare emerging low cost mobile oximeter technology. Christian
L. Petersen Ph.D., Matthias Gorges Ph.D., Heng Gan M.B. B.Ch.,
Mark Ansermino M.B. B.Ch., Guy Dumont Ph.D., University of British
Columbia ,Vancouver BC, Canada.
FA A1064
TMAC of Desflurane Isoflurane and Sevoflurane
For the first time we described the temperature-vapor pressure relationship
at clinical concentrations for desflurane isoflurane and sevoflurane. Using
this data we established the TMAC for each of the three agents. Further
we found that it is possible to exploit the temperature-vapor pressure
relationship in order to deliver volatile anesthetics using technology that is
distinct from currently available devices. Katie J. Schenning, M.D. M.P.H.,
Henry Casson, M.D., Nabil J. Alkayed, M.D., Ph.D., Michael P. Hutchens,
M.D., Anesthesiology and Perioperative Medicine, Oregon Health &
Science University, Portland, OR.
16
FA A1065
Using Open Source Web Framework for Remote Anesthesiology Data
Visualization
A system that allows for local or remote viewing of patient data and exploring
new ways to present this data can enhanced patient care. To effectively
do this we have developed a data abstraction layer and coupled this to a
data presentation layer to allow for web-based anesthesiology data. This
framework has been developed to explore novel ways of data presentation
for anesthesiology and explore platform independent remote aggregation and
viewing of patient data. The use of such a system allows for standardization
in data display not constrained by a given manufacture of monitor or AIMS
and allows for the development of remote web-based monitoring of patients
under anesthesia irrespective of the monitoring type. Donald M. Voltz,
M.D., Alfred Pinchak, M.D., Matthew Joy, M.D., Anesthesiology, Aultman
Hospital, Canton, OH, Anesthesiology, MetroHealth Medical Center,
Cleveland, OH.
PD12-1 OBSTETRIC ANESTHESIA: LABOR ANALGESIA
ROOM 125
OB A1066
Maternal Outcomes in Parturients Supplemented With a High Protein
Drink in Labor
This study evaluates if in parturients receiving labor epidural analgesia highprotein drink supplementation compared to ice chips/water PRN decreases
nausea and emesis and increases patient satisfaction. It also compares
gastric emptying (t1/2) between high-protein drink and ice chips/water using
cross-sectional measurements of the antrum. Benjamin Cobb M.D., Talora
Steen B.S., Sukhdip Singh M.D., Amy Phelps Ph.D., Manuel C. Vallejo
M.D., Anesthesiology, University of Pittsburgh Medical Center, Medicine
University of Pittsburgh School of Medicine, Duquesne University,
Pittsburgh, PA.
OB A1067
Effects on Anxiety of a Video Presentation in Addition to Traditional
Epidural Analgesia Information in Obstetrics
Can a video-assisted obstetrical pre-anesthetic consultation diminish anxiety
in nulliparous women? Isabelle Federspiel M.D., Stefanie Koessler M.D.,
Simone Mangeant, M.D., Maria Tucella, M.D., Boris Aleil, M.D., Michael
Federspiel, M.A., Nicolas Meyer M.D., Ph.D., Veronique Legendre
M.D., Pierre Diemunsch M.D., Ph.D., Anesthesiology-Intensive Care,
Statisticse University Hospital of Strasbourg, English University of
Strasbourg, Psychiatrie, University Hospital of Strasbourg, Strasbourg,
France.
OB A1068
Socioeconomic and Obstetric Predictors of Labor Epidural Analgesia
Utilization at Two California Medical Centers
In this study of perinatal databases at an academic hospital and a nearby
community hospital in California labor epidural use was greater with varying
ethnicity and intrapartum events. More epidural use was seen with higher
income older age more education and lower BMI at the community
center; and with the presence of medical problems at the academic center
suggesting that hospital-specific factors influence a woman’s choice of labor
epidural. Josemine M. Miranda B.A., John Feiner M.D., Jennifer M.
Lucero M.D., Yvonne Cheng M.D. M.P.H., Malini A. Nijagal M.D., Mark
D. Rollins M.D., Ph.D., Anesthesia and Perioperative Care, Obstetrics
Gynecology and Reproductive Sciences, University of California San
Francisco, San Francisco, CA, Obstetrics and Gynecology, Marin
Community Clinics, Prima Medical Foundation, Greenbrae, CA.
NA Neuroanesthesia
PN Pain Medicine
Does Combined Spinal Epidural Technique Delay the Recognition
of Failed Epidural Catheters as Compared to Traditional Epidural
Technique for Labor Analgesia?
Time (time course) to recognition and replacement of failed labor epidural
catheter was not different or delayed with CSE vs with EPID technique but
the odds of epidural catheter failure was 1.7 times higher with EPID than
with CSE technique during the course of labor analgesia or when needed
for Cesarean delivery. These findings provided new evidences that epidural
catheters placed with CSE technique are more reliable and recognition of
catheter failure is not delayed when compared with catheters placed with
traditional epidural technique. Joshua C. Pan B.S., Jay Mortonhoward,
M.D., Lynne C. Harris, B.S.N., Vernon H. Ross, M.D., Wake Forest
University, Winston-Salem, NC.
OB A1070
Initiation of a Nitrous Oxide Service: Implications for Patient Access to
Obstetric Anesthesia Services
We offer Inhaled Nitrous oxide (IN2O) for labor. We set out to understand
how IN2O impacts access to anesthesia services epidural rates & maternal
satisfaction. IN2O offered a viable option for a small fraction of the women
presenting in labor. Satisfaction with the overall experience was maintained
but satisfaction with pain control during labor and delivery was diminished in
patients opting for IN2O. IN2O appeared to reduce epidural use somewhat.
Sarah A. Starr M.D., Jesse M. Ehrenfeld M.D. M.P.H., Curtis L.
Baysinger, M.D., Khensani Marolen, M.S., Warren Sandberg, M.D.,
Anesthesia Vanderbilt OB Anesthesiology, Nashville, TN.
OB A1071
A Qualitative Analysis of Analgesic Disparities in Hispanic Parturients
Racial and ethnic disparities in neuraxial labor analgesia use exist. This
qualitative study evaluated analgesic decision-making in Hispanic parturients.
Despite having spoken to their obstetric providers and anesthesiologists
misconceptions were prevalent among the Hispanic women interviewed.
Paloma Toledo, M.D. M.P.H., Feyce Peralta, M.D., Javiera Pumarino,
B.A., William A. Grobman, M.D., MBA, Cynthia A. Wong, M.D., Romana
Hasnain-Wynia, Ph.D., Anesthesiology, Center for HealthCare Studies,
Obstetrics and Gynecology Northwestern University, Chicago, IL, Patient
Centered Outcomes Research Institute, Washington, DC.
OB A1072
Genetic Variants of Oxytocin Receptor Gene (OXTR) Morphine Use
Acute and Persistent Pain After Cesarean Delivery
Our findings suggest that rs237902 genotype of OXTR influences morphine
use pain scores and nausea after cesarean delivery. We could not
demonstrate an effect of any haplotype or single SNP on the incidence of
chronic pain. Pascal H. Vuilleumier, M.D., Clemens M. Ortner, M.D., Alex T.
Sia, M.D., Jean-Louis Blouin, Ph.D., Ruth Landau, M.D., Anesthesiology
and Pain Medicine, University of Washington, Seattle, Women’s
Anesthesia, KK Women’s and Children’s Hospital, Singapore, Medical
Genetics, University of Geneva, Switzerland.
OB A1073
Assessment of Labour Pain Using Hand Grip Force
To treat labor pain in cases of contraindication to neuraxial block
remifentanil bolus application can be used. Bolus application may be
optimized by generating a time series of pain during contractions using hand
grip force measurement and prediction of the next contraction allowing for
bolus application before the contraction actually begins. Nadine Wickboldt,
M.D., Georges Savoldelli, M.D., Benno Rehberg-Klug, M.D., Department
of Anesthesiology and Intensive Care, Medicine, University Hospital of
Geneva, Switzerland.
PD05-1 CLINICAL NEUROSCIENCES - CONTROVERSIES IN
NEUROANESTHESIA
ROOM 123
NA A1074
Laryngoscope Force and Cervical Spine Motion During Endotracheal
Intubation
The relationship between laryngoscope force application and resulting cervical
spine motion (Airtraq® Macintosh) during endotracheal intubation was found
to be nonlinear and to differ between laryngoscopes. Bradley J. Hindman
M.D., Brandon G. Santoni Ph.D., Robert P. From D.O., Michael M. Todd
M.D., Christian M. Puttlitz Ph.D., Anesthesia University of Iowa, Iowa
City, IA, Foundation for Orthopaedic Research and Education Tampa, FL,
Mechanical Engineering Colorado State University, Fort Collins, CO.
OB A1069
NA A1075
Effect of Chronic Antiplatelet and Anticoagulation Therapy on
Emergency Neurosurgery Outcomes: Preliminary Data
This retrospective pilot study on 129 adult patients who had undergone
emergency neurosurgery in a Level 1 Trauma center over a one year period
compared outcomes after surgery in patients receiving chronic antiplatelet or
anticoagulation therapy versus patients not on these medications. Chronic
aspirin therapy was not found to be associated with any increased in-hospital
mortality ICU or hospital stay nor with any increased incidence of bleeding
and thrombotic events. Alex T. Lee, M.D., Arni Gagnidze, B.A., Ahmed
Zaky M.D., M.P.H., Bala Nair, Ph.D., Irene Rozet, M.D., Anesthesiology,
University of Washington, Seattle, WA.
NA A1076
Impact of Anesthesia Type on Mortality in Acute Ischemic Stroke
Patients Undergoing Endovascular Intervention Therapy
One hundred nine patients with acute ischemic stroke (AIS) who underwent
endovascular clot retrieval under general anesthesia (GA) or conscious
sedation (CS) were retrospectively studied. Patients received GA had higher
mortality at discharge compared to CS patients. our results also suggest that
GA and elevated post-procedural glucose level were risk factors of mortality
for AIS receiving endovascular intervention therapy. Fenghua Li M.D., Eric
Deshaies M.D., Amit Singla M.D., Mark Villwock M.S., Reza Gorji
M.D., Zhong-jin Yang M.D., Department of Anesthesiology, Department
of Neurosurgery , SUNY Upstate Medical University, Syracuse, NY.
NA A1077
The Seattle Spine Team Approach to Adult Deformity Surgery: A
Systems Based Approach to Perioperative Care and Subsequent
Reduction in Perioperative Complication Rate
Major deformity spinal surgery is accompanied by a very high complication
rate. Using a three-pronged approach: multi-disciplinary preoperative
screening dual-attending surgeon and complex spine anesthesiologists
and a standard protocolized approach to intraoperative care-with a focus
on coagulation we were able to demonstrate a reduction in perioperative
complication rate. Ryan Pong M.D., Rajiv K. Sethi, M.D., Jean-Christopher
Leveque, M.D., Vishal Gala M.D., Thomas C. Dean M.D., Stephen J.
Olivar M.D., Stephen M. Rupp M.D., Virginia Mason Medical Center,
Group Health Cooperative, Seattle, WA.
NA A1078
Comparison of Dexmedetomidine and Lidocaine on Attenuation of
Airway and Pressor Responses During Tracheal Extubation
Without interfering in emergence and extubation times, attenuation of
pressor response is comparable between dexmedetomidine 0.5µg/kg and
lidocaine 1.5 mg/kg, in patients undergoind spinal surgeries. However,
airway response was better controlled with use of dexmedetomidine allowing
a smooth easy tracheal extubation, thereby providing a more comfortable
recovery and early neurological examination. Hemanshu Prabhakar, M.D.,
Vivek B. Sharma, M.D., Girija P. Rath, M.D., Neuroanaesthesiology, All
India Institute of Medical Sciences, New Delhi, India.
NA Neuroanesthesia
PN Pain Medicine
17
NA A1079
A Study Comparing Effects of 20% Mannitol and 3% Hypertonic Saline
on Intracranial Pressure and Systemic Hemodynamics
A comparison of the effects of equiosmolar solutions of mannitol and
hypertonic saline in patients undergoing craniotomy for supratentorial
tumors showed a comparable effect on intracranial pressure. However the
hypertonic saline was considered as a better agent than mannitol in terms
of maintaining acceptable systemic hemodynamics causing less increase in
blood lactate levels and preventing unnecessary increase in urine output.
Girija P. Rath M.D., Navdeep Sokhal M.D., Arvind Chaturvedi M.D.,
Manmohan Singh M.S., Hari H. Dash M.D., NeuroAnaesthesiology, All
India Institute of Medical Sciences New Delhi, India.
NA A1080
Intraoperative Ketamine Does Not Reverse Remifentanil-Induced
Postoperative Hyperalgesia in Major Spine Surgery
In this retrospective cohort study of 588 patients undergoing major spine
surgery we found evidence for a delayed emergence of remifentanilinduced hyperalgesia leading to significantly increased postoperative opiate
requirements maximal on postoperative day 3. We found no evidence that
the intraoperative use of low-dose ketamine was protective or had any other
significant effect on postoperative opiate requirements during the initial 72
hours. Nikhil Shankar B.A., Carl Wang M.D., Peter Fleischut M.D., Kane
Pryor M.D., Weill Cornell Medical College, New York, NY.
NA A1081
Do Motor or Somatosensory Evoked Potentials During Aneurysm
Surgery Predict Postoperative Deficits?
The sensitivity of persistent neuromonitoring changes especially SSEP
changes for predicting postoperative limb paresis was low while the
specificity was high. MEPs and SSEPs did not predict deficits other than limb
paresis. Francis A. Wolf M.D., Adrian W. Gelb M.D., Wilson Cui M.D.,
Ph.D., Michael Mensah B.A., Erik Kofler B.A., Michael T. Lawton M.D.,
John Feiner M.D., Lanjun Guo, M.D., M.S., Anesthesia and Perioperative
Care, School of Medicine, Neurological Surgery, Neuromonitoring,
University of California, San Francisco, San Francisco, CA, Touro College
of Osteopathic Medicine, Vallejo, CA.
Regional Anesthesia and Postoperative Pain Outcomes in the SAMBA
Clinical Outcomes Registry
This abstract summarizes information about postoperative and post-discharge
pain in the first 46 242 cases submitted to the SAMBA Clinical Outcomes
Registry (SCOR). Regional anesthesia improved immediate post-operative
pain control in some subsets of patients. Post-discharge pain was significant
in some groups suggesting that attention to the transition pain regimen
could be helpful. Outcomes differed significantly by center suggesting
that identification of best practices could allow providers to optimize care.
Lucinda L. Everett, M.D., Douglas Merrill M.D., Peter Glass, M.D.,
Massachusetts General Hospital, Boston, MA, Dartmouth-Hitchcock
Medical Center, Lebanon, NH, Stony Brook Medical Center, Stony Brook,
NY.
AM A1084
National Anesthesia Practice Patterns for Ambulatory Meniscectomies:
An Analysis of Data From the Anesthesia Quality Institute
Ambulatory meniscectomies represent one of the most commonly performed
orthopedic operations in the United States. While this surgical intervention
can be performed under various types of anesthesia data collected from
the Anesthesia Quality Institute (AQI) showed that the vast majority of
meniscectomies are being performed under general anesthesia. Peter M.
Fleischut, M.D., Licia Gaber-Baylis B.A., Sn L. Faggiani R.N., Madhu
Mazumdar Ph.D., Stavros G. Memtsoudis M.D., Ph.D., Anesthesiology,
Public Health/Biostatistics and Epidemiology, New York Presbyterian
Hospital/Weill Cornell Medical College New York, NY, Anesthesiology,
Hospital for Special Surgery, New York, NY.
AM A1086
POSTER PRESENTATIONS
Perioperative Glucose Control After Implementation of a New
Perioperative Diabetes Protocol
A study was conducted comparing perioperative glucose management before
and after implementation of a new protocol for diabetes management. There
was no significant differences found between the two groups although there
were some categories suggesting improvement after implementation of the
new protocol. Melissa R. House, M.D., Kip Robinson, M.D., Carolyn Snider,
B.S., Eric Heidel, Ph.D., Anesthesiology, The University of Tennessee,
Knoxville, TN.
PO01-1A AMBULATORY ANESTHESIA
AM A1087
ROOM 104-AREA A
AM A1082
Effect of a Small Dose of Fentanyl on Intraoperative Conditions
Recovery Times and Postoperative Side Effects in the Ambulatory
Setting
The adjunctive administration of a small-dose of fentanyl improved
intraoperative conditions by preventing purposeful movements during
surgery. However, fentanyl failed to influence the incidence of coughing
during ambulatory procedures under propofol-desflurane anesthesia when
an LMA device was used for airway management in spontaneously breathing
patients. The fentanyl group also had lower HR and MAP values during the
maintenance period. Intraoperative administration of a small dose of fentanyl
failed to improve pain management during the postoperative recovery period.
Ofelia L. Elvir-Lazo, M.D., Ronald H. Wender, M.D., Roya Yumul, M.D.,
Ph.D., Robert K. Kariger, M.D., Alan S. Zaentz, M.D., Matthew Eng, M.D.,
Monique Vuong, B.A., Alan Stern, B.A., Tridu Huynh, B.S., Paul F. White,
M.D., Ph.D., Anesthesiology, Cedars Sinai Medical Center, Los Angeles, CA.
18
AM A1083
Premedication With Oral Alprazolam and Melatonin Combination a
Comparison With Wither Alone: A Randomized Double Blind Placebo
Controlled Study
Addition of melatonin to alprazolam had superior premedication effects in
terms of anxiolysis and patients preference compared with either drugs alone
or placebo. The adding on melatonin neither worsened sedation score nor
the amnesic effect of alprazolam alone. Krishna Pokharel, M.D., Mukesh
Tripathi, M.D., Anesthesiology and Critical Care, B.P. Koirala Institute of
Health Sciences, Dharan Nepal, Anesthesiology, SGPGIMS, Lucknow,
India.
AM A1088
Perioperative Analgesic and Anxiolytic Effect of Melatonin in Patients
Undergoing Third Molar Teeth Extraction - A Randomized Controlled
Pilot Study
This blinded randomized controlled pilot study investigated the use of
preoperative Melatonin versus placebo for pain and anxiety amelioration in
wisdom teeth extraction under general anesthesia in 48 patients. Multimodal
analgesia technique resulted in mild pain for all patients. Addition of
Melatonin premedication in this surgical population does not contribute
significantly to anxiety and pain reduction. More studies with larger sample
size may be required to determine procedure-specific efficacy of Melatonin
for perioperative pain and anxiety management. Edwin Seet, M.B., B.S.,
Sylvia Tay, M.D., Teoh Pei Fen, M.B. ,B.S., Anaesthesia Khoo Teck Puat
Hospital, Singapore, Singapore, Dental Surgery Khoo Teck Puat Hospital,
Singapore, Singapore.
NA Neuroanesthesia
PN Pain Medicine
A Prospective Randomized Double-Blind Multicenter Phase III Trial
to Evaluate the Therapeutic Efficacy and Safety of Palonosetron in the
Treament of Postoperative Nausea and Vomiting
In this multicenter randmized placebo-controlled trial assessed the efficacy
and safety of a single intravenous dose of palonosetron 0.075 mg in
the treatment of postoperative nausea and vomiting (PONV) in high-risk
patients group over a 72 hour period. 43.8% of patients developed PONV
and randomzed. Complete response rate was significantly higher and
incidence of emesis was significantly lower in the palonosetron group than
the placebo group. Won Ho Kim, M.D., Young Gon Son, M.D., Tae Soo
Hahm, M.D., Ph.D., Anesthesiology and Pain Medicine, Samsung Medical
Center, Anesthesiology and Pain Medicine, Samsung Medical Center,
Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
PO03-2A CHRONIC AND CANCER PAIN: BASIC SCIENCE
ROOM 104-AREA B
PN A1090
Duloxetine Inhibits Menthol-Activated Currents of TRPM8 Channels
Expressed in Xenopus Oocytes
Cold allodynia is common symptom in neuropathic pain patients, but the
underlying mechanisms are not clear. Recently, TRPM8 channel has been
suggested to play an important role in cold allodynia and antidepressants
duloxetine has been shown to improve cold allodynia. We assessed the
effects of duloxetine on TRPM8 channel function using two-electrode
voltage-clamp techniques in Xenopous oocytes to clarify the mechanisms of
this effect by duloxetine. Duloxetine inhibited menthol (100µmo/L) activatedcurrents in clinically relevant concentrations, suggesting the inhibition of
TRPM8 channel function by duloxetine may be one of the mechanisms of
reducing cold allodynia. Takafumi Horishita M.D., Ph.D., Nobuyuki Kishi,
M.D., Dan Ookura, M.D., Takeyoshi Sata, M.D., Ph.D., Anesthesiology,
School of Medicine University of Occupational and Environmental Health,
Kitakyushu, Japan.
PN A1094
Antinociceptive Effects of Vitamin C and Vitamin E in Chronic PostIschemia Pain (CPIP) Rat Model
The anti-allodynic effects of vitamins C and E and the reduced levels of
pNR1 and pERK indicate that vitamins C and E inhibit the modulation of
neuropathic pain processing in the spinal cord. Kyung-Hwa Kwak, M.D.,
Dong Gun Lim, M.D., Jun Mo Park, M.D., Sung Hye Byun, M.D., Hoon
Jung, M.D., Kwangook Choi, M.D., JeongEun Lee, M.D., Jin Seok Yeo,
M.D., Department of Anesthesiology and Pain Medicine, Kyungpook
National University Hospital, Daegu, Korea, Republic of Korea.
PN A1095
Phosphorylation of GluR1 in Spinal Dorsal Horn Neurons Accompanies
Chronic Constriction Injury of the Rat Sciatic Nerve
Neuropathic pain due to chronic constriction injury of the rat sciatic nerve
was associated with increased phosphorylation of the GluR1 subunit of
glutamatergic AMPA receptors in the membrane of dorsal hornneurons.
Intrathecal injection of calcineurin provided pain relief and decreased GluR1
phosphorylation in the membrane of the dorsal horn neurons. Clinical therapy
with calcineurin may prove to be a novel effective and safe approach in
the management of well-established neuropathic pain. Brenton M. Meier
M.D., Gordana Miletic Ph.D., Vjekoslav Miletic Ph.D., Anesthesiology,
University of Wisconsin, Madison, WI.
AM A1089
PN A1096
Anti-Hyperalgesic Effects of Intervention With Multisensory
Rehabilitation in a Rat Model of Neuropathic Pain
In the present study we investigated the effects of the multisensory
rehabilitation on the development of neuropathic pain after nerve injury. Our
results indicated that could alleviate the depression-like behaviors but not
affect directly the sensory hyperexcitability resulting in the anti hyperalgesic
effects after painful nerve injury. Yositaka Ogino, M.D., Takashi Kawano
M.D., Haidong Chi Ph.D., Satoru Eguchi D.D.S., Takahiko Tamura M.D.,
Yasuhiro Takahashi, Hideki Iwata, Ryu Nakamura M.D., Masataka
Yokoyama M.D., Kochi Medical School , Nankoku Japan, Tokushima
University Hospital, Tokushima, Japan.
PN A1097
PN A1091
STAT3 Contributed to Mechanical Allodynia by Regulating Chemokine
Expression in Astrocytes
Stat3 was activated and contributed to inflammatory pain by regulation of
chemokines especially CX3CL1. Tony Gin, M.D., Xiaodong Liu Ph.D., Na
Lu M.Sc., Yuanyuan Tian, M.Sc., Christopher HK Cheng Ph.D., Matthew
TV Chan FANZCA, Anaesthesia and Intensive Care, School of BioMedical
Sciences, Chinese University of Hong Kong, Shatin, NT, Hong Kong.
PN A1092
Not Only Intraperitoneal But Also Oral Administration of L-serine
Improved Paclitaxel-Induced Mechanical Allodynia/Hyperalgesia in a
Preclinical Rat Model
Oral administration of L-serine could improve paclitaxel-induced mechanical
allodynia/hyperalgesia to the same extent as intraperitoneal administration.
Soshi Iwasaki M.D., Ph.D., Fumiyuki Sugime, M.D., Michiaki Yamakage
M.D., Ph.D., Anesthesiology, Sapporo Medical University School of
Medicine, Sapporo, Japan.
PN A1093
Spinal Cord Stimulation Decreased Serotonin Synthetic Enzyme in the
Spinal Cord of Neuropathic Pain Model Rats
The aim of this study was to investigate the expression changes of synthetic
enzymes of serotonin and noradrenaline in the spinal cord with or without
spinal cord stimulation (SCS) and compared the central changes of
descending antinociceptive system (DAS). In SNL rats, SCS decreased the
expression levels of synthetic enzymes of serotonin and noradrenaline in
the spinal cord whereas number of the serotonergic neuron in dorsal raphe
was increased. These results suggested that SCS might increase serotonin
release from terminal of DAS, but not increase synthesis serotonin in the
spinal dorsal horn. Yoshinori Kamiya, M.D., Ph.D., Kensuke Saeki B.Sc.,
Masato Takiguchi, B.Sc., Yusuke Nakahashi, M.D., Hironobu Shinbori,
M.D., Ph.D., Anesthesiology, Niigata University Hospital, Niigata Japan,
Neuroanatomy, Anesthesiology, Yokohama City University, Yokohama,
Japan.
Baicalin Ameliorates Neuropathic Pain by Suppressing of HDAC1
Expression in the Spinal Cord of Spinal Nerve Ligation Rats
Histone-H3 acetylation may play a role in neuropathic pain formation.
Inhibition of HDACs with drugs such as baicalin might be a new therapeutic
approach for neuropathic pain management and provide some hints for
further studies on the role of histone modification in neuropathic pain. Ru-Yin
Tsai, Ph.D., Chen Hwan Cherng, Ph.D., Kuang Yi Chou, Ph.D., Chih Shung
Wong, Ph.D., Anesthesiology, Cathay General Hospital, Taipei, Taiwan,
Anesthesiology, Tri-Service General Hospital and National Defense
Medical Center, General Education Center National Taipei University of
Nursing and Health Sciences, Taipei, Taiwan.
PO10-1A EXPERIMENTAL NEUROSCIENCES: MECHANISMS I
ROOM 104-AREA C
NA A1098
Effects of Bupropion and Imipramine on Isoflurane’s Inhibitory Action
on the Neurotransmitter Release Machinery Isoflurane inhibits the neurotransmitter release machinery in neuroscretory
cells. Bupropion completely reversed the inhibition produced by isoflurane
while imipramine did not. Both drugs are effective inhibitors of the dopamine
transporter. Using these drugs it may be possible to determine whether
inhibition of neurotransmitter release plays a role in the active arousal from
anesthesia observed by Solt et al. (2011). Robert Fong II, M.D., Ph.D.,
Qiang Wang Ph.D., Kyle McMillan B.S., Aaron P. Fox Ph.D., Zheng Xie
M.D., Ph.D., Department of Anesthesia and Critical Care, Department of
Neurobiology Pharmacology and Physiology, Department of Neurobiology,
Pharmacology & Physiology, University of Chicago, Chicago, IL.
NA Neuroanesthesia
PN Pain Medicine
19
NA A1099
Propofol Differentially Alters Neuronal Dynamics in Somatosensory
Versus Higher Order Cortices in Primates
Propofol-induced loss of consciousness is associated with an abrupt change
in multiple neural modalities including a decrease in single neuron firing rate
an increase in delta LFP power and an increase in delta phase-locking of
spikes in a primate sensory cortex. These neural changes are all significantly
delayed in the higher-order cortex compared to the primary sensory cortex
suggesting that higher-order neurons are more resilient to the effect of
propofol. Yumiko Ishizawa M.D., Ph.D., Omar J. Ahmed Ph.D., Demetrio
Sierra Ph.D., Shaun Patel B.S., Kaushik Ghose Ph.D., Emery N. Brown
M.D., Ph.D., Emad N. Eskandar M.D., Anesthesia Critical Care & Pain
Medicine, Neurology, Neurosurgery, Massachusetts General Hospital,
Boston, MA.
NA A1100
Sevoflurane But Not Propofol Reduces Thalamocortical Activity
Propagation: Results From Voltage-Sensitive Dye Imaging
In thalamocortical slices of mice sevoflurane but not propofol at clinically
relevant concentrations reduced thalamocortical activity propagation.
Stephan Kratzer M.D., Corinna Mattusch Ph.D., Rainer Haseneder
M.D., Eberhard F. Kochs M.D., Gerhard Rammes Ph.D., Department
of Anesthesiology, Klinikum rechts der Isar der TU Muenchen, Munich,
Germany.
NA A1101
Xenon Dose-Dependently Reduces Neuronal Activity Propagation in the
Thalamocortical Network
Xenon dose-dependently reduced thalamocortical activity propagation in
acute murine brain slices. Corinna Mattusch Ph.D., Stephan Kratzer M.D.,
Rainer Haseneder M.D., Eberhard F. Kochs M.D., Gerhard Rammes
Ph.D., Department of Anesthesiology, Klinikum rechts der Isar der TU
Muenchen, Munich, Germany.
NA A1102
Excitatory Synaptic Transmission is Depressed in a Mutant Mouse With
Anesthetic Hypersensitivity
The basic mechanisms by which volatile anesthetics exert their effects are
unknown. However mitochondrial mutations alter anesthetic sensitivity in
multiple organisms. We determined that defects in mitochondrial complex I
leads to a depression in excitatory synaptic transmission in the hippocampus
and central medial thalamus. Philip G. Morgan, M.D., Christian Woods,
B.A., Margaret M. Sedensky, M.D., Anesthesiology and Pain Medicine,
NA A1103
Glutamatergic Cell-Specific Mutations in Complex I Control Volatile
Anesthetic Sensitivity
The basic mechanisms by which volatile anesthetics exert their effects
are unknown. We have discovered a link between mitochondrial complex I
and sensitivity to volatile anesthetics that holds true for multiple species.
Restricting complex I mutations to specific neuronal cell types indicates
that complex I effects in glutamatergic neurons are crucial in determining
anesthetic sensitivity. These results are consistent with mitochondrial
complex I being an important target for volatile anesthetics. Philip G. Morgan
M.D., Margaret M. Sedensky M.D., Albert Quintana Ph.D., Richard
D. Palmiter Ph.D., Anesthesiology and Pain Medicine, University of
Washington, Biochemstry. HHMI and University of Washington, Seattle,
WA.
NA A1104
NA A1105
Sevoflurane Anesthesia Results in Increased Protein Kinase;
Expression in the Adult Mouse Hippocampus: Implications for PostOperative Cognitive Dysfunction
Protein kinase M is critical for long-term memory maintenance. Active place
avoidance training of mice persistently increases PKMζ protein in specific
layers of the hippocampus. These increases may represent a spatial memory
(engram). Sevoflurane anesthesia also results in widespread increased PKMζ
expression in the mouse hippocampus. This effect occurs in an anatomically
non-specific manner, and may cause post-operative cognitive dysfunction, by
introducing noise into the engram. Panayiotis Tsokas, Ph.D., Fei Liu, B.A.,
Benjamin R. Hartley B.A., Changchi Hsieh Ph.D., Ira S. Kass Ph.D.,
Todd C. Sacktor, M.D., James E. Cottrell, M.D., Anesthesiology, Physiology
& Pharmacology; Robert F Furchgott Center for Neural & Behavioral
Science, SUNY Downstate Medical Center, Polytechnic Institute of New
York University Brooklyn, NY. PO14-1A PATIENT SAFETY PRACTICE MANAGEMENT
ROOM 104-AREA D
PI A1106
Clinical Evaluation of a Novel System for Monitoring Surgical
Hemoglobin Loss
Evaluation of a novel device for measuring hemoglobin on surgical sponges
and comparison with the current standard of weighing sponges. Allen
Holmes, M.D., M.S., Gerhardt Konig, M.D., Vicki Ting, M.D., Bridget
Philip, M.D., Thomas Puzio M.D., Gregory Botz M.D., Jonathan H.
Waters, M.D., Anesthesiology and Perioperative Medicine, Critical Care,
MD Anderson Cancer Center, Houston, TX, Anesthesiology, University of
Pittsburgh Medical Center, Pittsburgh, PA, Anesthesiology, Santa Clara
Valley Medical Center, Santa Clara Valley Medical Center, San Jose, CA,
Anesthesiology and Critical Care, Englewood Hospital and Medical Center,
Englewood, NJ.
PI A1107
The Effects of Sufentanil on Intraocular Pressure to Intubation Without
Muscle Relaxant
This study evaluate the effect of sufentanil (0.8 μg/kg) on intraocular
pressure (IOP) when used for anesthesia induction and intubation
without muscle relaxants. Inci Kara M.D., Gamze Sarkilar M.D., Seza
Apiliogullari M.D., Ergun Gunduz M.D., Berker Bakbak M.D., Jale
Bengi Celik M.D., Sansal Gedik M.D., Department of Anesthesiology
and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey,
Department of Anesthesia and Intensive Care Necmettin Erbakan
University Meram Medical Faculty, Konya, Turkey, Department of
Ophtalmology, Selcuk University Medical Faculty, Konya, Turkey.
PI A1108
Movements of Double-Lumen Endotracheal Tube as a Result of
Head Rotation Tube Fixation and Lateral Position: A Thiel-Embalmed
Cadaver Study
We investigated the effects of head movement different position of fixation
and lateral position on depth of the DLT at the lip using Thiel-embalmed
cadavers. The DLT moves with lateral positioning and midline of mouth
fixing and the movements are predominantly in the upward direction.
Daisuke Maruyama M.D., Tomohiro Chaki M.D., Naoyuki Hirata M.D.,
Ph.D., Masanori Yamauchi M.D., Ph.D., Michiaki Yamakage M.D.,
Ph.D., Anesthesiology, Sapporo Medical University School of Medicine
Sapporo, Japan.
Strain Differences in Anesthetic Effects on Consciousness and
Sensory Processing
Numerous cortical and sub cortical sites have been identified as targets
for anesthetic action that result in transitions between the conscious and
unconscious states. There is considerable individual variation in anesthetic
sensitivity with regard to transitions in consciousness. Strain differences
in response to sevoflurane suggest genetically identifiable mechanisms for
electroencephalographic correlates of transitions in consciousness. Thomas
A. Stekiel, M.D., J. Bruce McCallum, Ph.D., Anesthesiology, The Medical
College of Wisconsin, Milwaukee, WI.
20
NA Neuroanesthesia
PN Pain Medicine
PO17-2A RESPIRATION II
Effect of the Outdoor Air Temperature on the Occurrence of Shivering
After Abdominal Surgery: Patients Are More Prone to Shivering in the
Summer
Postoperative shivering occurs more readily in the summer when the outdoor
air temperature is higher because the body’s shivering threshold shifts to
a higher temperature when the outdoor air temperature increases. Yoshimi
Nakamura M.D., Mutsuko Matsumoto M.D., Ph.D., Sayaka Azumi M.D.,
Mayuko Inai M.D., Tomoko Nishiumi M.D., Hiroshi Morimatsu M.D.,
Ph.D., Kiyoshi Morita M.D., Ph.D., Japanese Red Cross Society Himeji
Hospital, Himeji Japan, Department of Anesthesiology and Resuscitology
Okayama University Medical School, Okayama, Japan.
PI A1110
The Role of Perioperative Hematocrit Variability in Surgical Site
Infection: A prospective Observational Study
A Cohort prospective observational study was conducted with the purpose of
evaluating the prevalence of perioperative hematocrit variability (HtcCV) and
their effects on one-month postoperative incidence of Surgical Site Infection
(SSI) in patients undergoing orthopedic surgery.We found no statistically
significant correlation between increased periopera HtcCV and SSI(p =
0.561). Although not the primary outcome post-hoc analysis showed
that patients receiving intraoperative transfusion were more likely to have
increased risk of SSI (p = 0.025). Ricardo M. Pereira Sr. Ph.D., Diana
Henriques Ph.D., Amelia Almeida Ph.D., Ines Tellechea Ph.D., Celine
Marques Ph.D., Emanuel Joao Ph.D., Joana Alves Ph.D., Rita Santa
Barbara Ph.D., Alexandra Resende Ph.D., Anesthesiology, Hospital
Santa Maria, Lisboa Portugal.
PI A1111
The Use of Conventional Laryngoscopy for Rescuing Failed Glidescope®
Videolaryngoscopy
The Glidescope® failed as the intended intubation device and required
rescuing by direct laryngoscopy and specialized airway devices. When direct
laryngoscopy (DL) was success in rescuing failed Glidescope® DL may have
permitted better manipulation of the ETT with stylets of different angles.
Molly B. Perini B.A., Randy W. Calicott M.D., Deborah Whelan M.D.,
Yvon F. Bryan M.D., Anesthesiology, Wake Forest University, School of
Medicine Winston-Salem, NC.
PI A1112
Teaching Intraoperative Handoffs Using Simulation-Based Education
With Deliberate Practice: Evidence of Skills Retention at One-Year
Intraoperative handoffs are common poorly characterized events that are
a potential source of medical error. SBE with deliberate practice (DP) is an
educational strategy demonstrated to successfully teach technical skills to
physician trainees. We describe the effects of simulation-based education
with deliberate practice on anesthesiology residents’ intraoperative handoff
communication skills one year after integration into the curriculum. Erin W.
Pukenas, M.D., Amanda Burden, M.D., Edward Deal, D.O., Keyur Trivedi,
M.D., Gregory Dodson, M.D., Irwin Gratz, D.O., Anesthesiology, Cooper
Medical School of Rowan University, Camden, NJ.
PI A1113
Endotracheal Tube Cuff Pressures and Postoperative Complications in
an Adult Population-An Observational Study
This is an observational study to evaluate the accuracy of anesthesia
providers in estimating endotracheal tube cuff pressures in adults in addition
to the incidence of post-operative complications in relation to increased cuff
pressures. Howard C. Teng M.D., Justin Hamrick M.D., Janine WhitsonWest D.O. Rebecca Grutsch M.D., Megan Kostibas M.D., Myron Yaster
M.D., Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital,
Baltimore, MD.
ROOM 104-AREA E
FA A1114
Effect of Rocuronium-Sugammadex Clathrate on Rat Airway Smooth
Muscle Contraction
Rocuronium-sugammadex clathrate had no constrictive effects in rat
airway smooth muscle. Motohiko Hanazaki M.D., Ph.D., Naoki Yoshioka
M.D., Yoshihisa Fujita M.D., Ph.D., Hideki Nakatsuka M.D., Ph.D.,
Hiroshi Katayama M.D., Ph.D., Yoshihiko Chiba Ph.D., Department of
Anesthesiology and Intensive Care Medicine, Kawasaki Medical School,
Okayama, Japan.
PI A1109
FA A1115
Mechanical Ventilation Induces Lung Inflammation Via Autophagy
Pathway
Autophagy activation mediates early lung inflammation during ventilatorinduced lung injury via reactive oxygen species-dependent signaling.
Inhibition of autophagy activation may therefore provide a novel and
promising strategy for the prevention and treatment of ventilator-induced lung
injury. Yang Zhang, M.D., Gongjian Liu M.D., Ph.D., David Schwartz M.D.,
Guochang Hu M.D., Ph.D., Anesthesiology, University of IL at Chicago
Chicago, IL, Anesthesiology, Xuzhou Medical College Xuzhou China.
FA A1116
The Free Fatty Acid Receptor 1 is Expressed and Potentiates
Contraction in Airway Smooth Muscle
Functional free fatty acid receptor 1 is expressed in both human and
guinea pig airway smooth muscle. Activation of the free fatty acid receptor
1 potentiated airway smooth muscle contraction and produced transient
intracellularCa2+ increase through IP3 synthesis. Kentaro Mizuta D.D.S.,
Yi Zhang M.D., Dingbang Xu Ph.D., Fumiko Mizuta D.D.S., Eiji Masaki
M.D., Ph.D., Charles W. Emala M.D., Dento-oral Anesthesiology, Tohoku
University Graduate School of Dentistry, Sendai, Japan, Anesthesiology,
Columbia University, College of Physicians & surgeons New York, NY.
FA A1117
Targeted Delivery of Inhaled Anesthetics for Treatment of
Bronchospasm
Jarred Mondonedo, B.S., John McNeil, M.D., Brett A. Simon, M.D., Ph.D.,
David W. Kaczka, M.D., Ph.D., Department of BioMedical Engineering,
Boston University, Boston, MA, Beth Israel Deaconess Medical Center,
Boston, MA. Although volatile anesthetics are often used as rescue therapy
during acute refractory bronchospasm their exact bronchodilator mechanism
of action is not well understood. This project aims to elucidate the direct vs.
systemic effects of these inhaled anesthetic agents and thereby determine
whether sufficient bronchodilation can be achieved via direct luminal diffusion
to airway smooth muscle.
FA A1118
GABAA-Receptor Antagonists Bicuculline and Picrotoxin Show the
Differential Effects on the Diazepam-Induced Hypoglossal and Phrenic
Nerve Inhibition in Anesthetized Rabbits
We examined the effects of bicuculline and picrotoxin on the diazepaminduced hypoglossal and phrenic nerve inhibition (Dz-I) using vagotomized
paralyzed and artificially ventilated-anesthetized rabbits. Picrotoxin reversed
hypoglossal Dz-I but bicuculline did not reverse it. Shinichi Nakamura
M.D., Ph.D., Hisakazu Terao M.D., Masahiko Suzuki Pharm.D, Masaaki
Nishida M.D., Ph.D., Kimie Terayama M.D., Tsutomu Mieda M.D.,
Takero Arai M.D., Ph.D., Hiroshi Nagasaka M.D., Ph.D., Nobuyuki
Matsumoto M.D., Ph.D., Akira Kitamura M.D., Ph.D., JA Kumagaya
General Hospital, Kumagaya, Japan, Saitama Medical University
International Medical Center, Hidaka Japan, Hanyu General Hospital,
Hanyu Japan, Dokkyo Medical University Koshigaya Hospital, Koshigaya,
Japan.
NA Neuroanesthesia
PN Pain Medicine
21
FA A1119
Propofol Modulates Mucin Production in H292 Airway Epithelial Cells
After Exposure to Cigarette Smoke Extract
Propofol enhanced MUC5AC production induced by cigarette smoke extract
in cultured human airway epithelial cells. ERK activation was involved in this
effect of propofol. Yoko Sugiyama, M.D., Kumiko Tanabe, M.D., Hiroki Iida,
M.D., Anesthesiology and Pain Medicine, Gifu University Graduate School
of Medicine, Gifu, Japan.
FA A1120
Effects of the Transient Receptor Potential (TRP) V1 Antagonist
Capsazepine on Airway Smooth Muscle Function
Expression of multiple transient receptor potential (TRP) channel subtypes
have been shown in airway smooth muscle. We show that the TRPV1
antagonist capsazepine relaxes contracted airway smooth muscle
potentially by off-target effects. This effect cannot be explained by
inhibition of store-operated calcium entry (SOCE). Gene T. Yocum M.D.,
Elizabeth A. Townsend Ph.D., Yi Zhang M.D., Charles W. Emala M.D.,
Anesthesiology, New York Presbyterian Hospital, Columbia University,
New York, NY.
FA A1121
Phosphodiesterase 4 Inhibitor Roflumilast Improves the
Bronchodilative Effect of Sevoflurane in Sensitized Airway
Phosphdiesterase 4 inhibitor roflumilast with sevoflurane had an additive
bronchodilator effect and the contemporary increase of cAMP level in
sensitized airway smooth muscle might be one of the mechanisms of this
combined relaxation effect. Jing Zhou M.D., Sohshi Iwasaki, M.D., Ph.D.,
Michiaki Yamakage, M.D., Ph.D., Sapporo Medical University, Sapporo,
Japan.
PO01-1BAMBULATORY ANESTHESIA
ROOM 104-AREA A
AM A1122
The Use of a Respiratory Volume Monitor to Assess Ventilation Before
and After Airway Maneuvers During Upper Endoscopy
Anesthesiologists often rely on common airway maneuvers such as chin
lifts and jaw thrusts to relieve airway obstructions and ensure adequate
breathing. Unfortunately, little is known about the effectiveness of these
maneuvers on ventilation. A non-invasive Respiratory Volume Monitor
(RVM) was used to measure minute ventilation (MV) tidal volume (TV)
and respiratory rate (RR) during upper endoscopy. Airway maneuversled
to a significant improvement in MV (50% increase p<0.05) and TV (43%
increase p<0.05). RVM can provide non-invasive quantification of the
effectiveness of various airway maneuvers in restoring upper airway patency
during endoscopic procedures. Katherine Holley, D.O., Donald Mathews,
M.D., Jenny Freeman, M.D., Jordan Brayanov, Ph.D., Howard Schapiro,
M.D., Anesthesiology, University of Vermont College of Medicine,
Burlington, VT, Respiratory Motion, Inc., Waltham, MA.
AM A1123
Monitored Anesthesia Care for Vitreoretinal Surgeries: Which
Technique is Safest?
In our institution, it was noted that a number of patients receiving anesthetics
prior to retrobulbar blocks required some type of airway intervention. The
purpose of our study was to investigate which if any combination of
anesthetics provides adequate analgesia while minimizing the need for
airway intervention. Jody C. Leng, M.D., Ruwan A. Silva, M.D., John BrockUtne, M.D., David Drover, M.D., Theodore Leng, M.D., Anesthesiology,
Ophthalmology, Stanford University, Stanford, CA.
AM A1124
The Impact of a Potential Malignant Disease on Cognitive Performance
There is a considerable normal variation in the cognitive performance using
the questionnaires Postoperative Quality of Recovery Scale and Cognitive
Failure Questionnaire. In a group of middle-aged women with suspected
breast cancer the impact of information of a potential malignant disease
on cognitive performance might be of similar importance as the impact of
surgery and anaesthesia. Marja Lindqvist M.D., Anna Schening R.N.
Anna Granstrom R.N. Hakan Bjorne M.D., Ph.D., Jan Jakobsson P.A.,
Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
22
AM A1125
Correlation of Patient Airway Self-Exam With Airway Exam Performed
by a Trained Anesthesia Provider
PAT clinics can identify patients with potentially difficult airways. These visits
can be inconvenient and costly. It may be possible to assess a patient’s
airway over the phone. Adult patients presenting through SDS were screened
and administered a guided airway exam looking at Mallampati score
thyromental distance and mouth opening. This was compared to an exam
administered by a blinded anesthesiologist on the DOS. Results indicated
the patient self-exam had poor positive predictive valve but good negative
predictive value. This was likely due to the low sensitivity of each individual
question as well as the low prevalence of truly difficult airways. Christopher
S. Manfred, M.D., Anna K. Kowalczyk, M.D., Douglas Merrill M.D.,
Michael L. Beach, M.D., Dartmouth Hitchcock Medical Center, Lebanon,
NH, UC Davis Medical Center, Sacramento, CA.
AM A1126
Outpatient Laparoscopic Cholecystectomy Performed in an Ambulatory
Setting Versus a Hospital Setting: How to Narrow the Difference
We can effectively reduce the LOS for LC in a hospital setting by reducing
PWT and PRT though simple goal-oriented education of perioperative
team members but no obvious cost reduction. Chunyuan Qiu, M.D., Vu
T. Nguyen, M.D., Narendra S. Trivedi, M.D., Jessica Y. Qiu, Student,
Celin H. Jo., Student, Mijin Lee-Brown, M.D., Renato V. Etrata, M.D.,
Preeti P. Shah, M.D., Diana C. LaPlace, M.D., Maria T. Enciso, B.S.N.,
Anesthesiology, Kaiser Permanente, Baldwin Park, CA.
AM A1127
Evaluation and Efficacy of a Preoperative Computer-Based Educational
Module of Smoking Cessation in Surgical Patients - A Pilot Study
Preoperative smoking cessation intervention increases abstinence and
reduces the risks of surgical complications. However it is not routinely
provided due to lack of time training and other barriers. Evidence regarding
Computer based education for preoperative smoking cessation is very limited.
We did a pilot study in 20 smokers scheduled for elective surgery to assess
the usability and acceptability of a computer based interactive education
module. The patient feedback evaluation showed that it is highly acceptable
and useful. And a follow up telephonic interview showed a quit rate of 30% at
the time of surgery. Raviraj Raveendran M.D., Shadman Islam Student,
Frances Chung, M.D., Jean Wong, M.D., Anesthesia Toronto Western
Hospital University Health Network University of Toronto, ON, Canada.
AM A1128
Screening for Obstructive Sleep Apnea: Use of the Validated STOPBang Screening Tool in the Preadmission Clinic
Through a retrospective chart review the current study sought to determine
if any relationship existed between the STOP-Bang screening tool for OSA
and the occurrence of any perioperative adverse events in adult patients
presenting for elective non-cardiac surgery at the Foothills Medical Centre
(Calgary, Alberta). Tiffany Rice, M.D., Ph.D., Brendan Miles, M.D., Julia
Saar B.Sc., Melinda Davis, FANZCA, Rosaleen Chun, M.D., Department
of Anesthesia, University of Calgary, AB, Canada.
AM A1129
Entropy Versus Standard Clinical Monitoring Using Total Intravenous
Anesthesia for Transvaginal Oocyte Retrieval
We studied the role of Entropy monitor in 120 ASA I/II Indian female
patients undergoing Transvaginal Oocyte Retrieval (TVOR). Total Intravenous
Anaesthesia(TIVA) using Propofol and Fentanyl was administered. Studies
suggest that there is a dose and time dependent undesirable effect of
propofol on fertilization of oocytes. Also fears have been expressed that
TIVA with these drugs could be associated with awareness. In this study the
Entropy Monitor provided significant benefit over Standard Clinical Monitoring
in reducing propofol consumption and accelerating on-table recovery of
patients. Intraoperatively better differentiation between the hypnotic and
analgesic components was possible and lack of awareness was ensured.
Saipriya Tewari Jr., M.B., B.S., Poonam Bhadoria, M.D., Sonia Wadhawan,
M.D., Sudha Prasad, M.S., Amit Kohli, M.D., MAMC, Delhi University,
India.
NA Neuroanesthesia
PN Pain Medicine
ROOM 104-AREA B
PN A1130
Analgesic Action of Intrathecally Administered Gamma-Aminobutyric
Acid Transporter-3 Inhibitor in Rat Pain Models
The GAT-3 inhibitor may prove useful in treatment of various painful
conditions. Kazunori Kataoka, M.D., Koji Hara, M.D., Ph.D., Yasunori
Haranishi, M.D., Ph.D., Tadanori Terada, M.D., Takeyoshi Sata, M.D.,
Ph.D., Anesthesiology, University of Occupational and Environmental
Health School of Medicine, Kitakyushu, Japan.
PN A1131
Role of Spinal MicroRNA-146a and -183 Cluster in Knee Joint
Osteoarthritic Pain
Downregulation of spinal microRNA-146a and microRNA-183 cluster is
correlated with increased allodynia in a rat traumatic osteoarthritis model.
Therefore microRNA-146a and microRNA-183 cluster could serve as
powerful therapeutic targets with their dual function for alleviation of joint
pain and concomitant regeneration of peripheral knee joint cartilage.
Jeffrey S. Kroin, Ph.D., Jinyuan Li, M.D., Ph.D., Xin Li, Ph.D., Di Chen
Ph.D., Guozhi Xiao, Ph.D., K C. Ranjan, Ph.D., Hee-Jeong Im, Ph.D.,
Anesthesiology, Biochemistry, Rush Medical College, Chicago, IL.
PN A1132
C-C Chemokine Receptor Type 5 is an Important Regulator in the
Development and Maintenance of Neuropathic Pain
In the model of neuropathic pain the level of CCL3 and CCR5 mRNA was
significantly increased in ipsilateral spinal cord. Intrathecal injection of CCR5
antagonist and CCL3 neutralizing antibody suppressed the development and
maintenance of nerve injury-induced tactile allodynia. These results suggest
that CCL3 and CCR5 upregulated in the spinal cord after nerve injury play an
important role in neuropathic pain and that one of the chemokine signaling
triggered by CCL3 has a crucial role in the mechanism of neuropathic pain.
Thus CCL3-CCR5 signaling pathway might be a new therapeutic target for
neuropathic pain. Katsuyuki Matsushita, M.D., Hidetoshi Tozaki-Saitoh,
Ph.D., Makoto Tsuda, Ph.D., Kazuhide Inoue, Ph.D., Sumio Hoka, M.D.,
Ph.D., Department of Anesthesiology and Critical Care Medicine,
Department of Molecular and System Pharmacology, Kyushu University,
Fukuoka, Japan.
PN A1133
AZD Administration in Mice May Contribute to Pain Relief in
Neuropathetic Pain Model
Neuropathic pain still remains one of the most challenging diseases.
Development of specific inhibitors for MAPK pathways may lead to new
therapies for neuropathic pain. AZD is a specific inhibitor of MEK and blocks
MAPK pathways.Spinal nerve ligation (SNL) model of rat was selected. Four
weaks after SNL AZD or saline was administrated through the intrathecal
catheter. Pain behavior was inhibited in AZD group after drug administration.
AZD might reduce SNL-induced neuropathic pain. And western blot analysis
revealed that pERK was sifnificantly decreased in the ipsilateral L5 spinal
cord in the AZD group. Hiroki Omiya, M.D., Yoshikazu Matsuoka, M.D.,
Ph.D., Noriko Ishii, M.D., Arata Taniguchi, M.D., Masako Kinoshita, M.D.,
Norihiko Obata, M.D., Ph.D., Ryuji Kaku, M.D., Ph.D., Satoshi Mizobuchi,
M.D., Ph.D., Hiroshi Morimatsu, M.D., Ph.D., Anesthesiology, Okayama
University Hospital, Japan.
PN A1134
Novel Nicotinic Agonist Reduces Hyperalgesia and Allodinia in
Neuropathic Pain in Rats
Novel agonist of nicotinic receptor a pyrazole derivative abolish the
development of allodynia and heat hyperalgesia in animal model of
neuropathic pain. Roberto T. Sudo, M.D., Ph.D., Margarete M. Trachez,
M.D., Ph.D., Roberto C. Debom, Pharm.D, Kesley Oliveira, Ph.D., Ariel L.
Garcia, Ph.D., Lidiane M. Godoy, Ph.D., Ogari C. Pacheco, M.D., Ph.D.,
Gisele Zapata-Sudo, M.D., Ph.D., Pharmacology, Universityersidade
Federal Do Rio De Janeiro, Brazil, Cristalia Produtos Quimicos e
Farmaceuticos Ltda, Sao Paulo, Brazil.
Genome-Wide DNA Methylation Analysis in Amputees With Chronic
Residual Limb Pain Reveals Significant Epigenetic Regulation of the
MAPK Pathway
Genome-wide DNA methylation analysis of soldiers with and without chronic
residual limb pain after amputation reveals significant epigenetic regulation of
the MAPK pathway. Thomas J. Van de Ven, M.D., Ph.D., Nicholas Grissom,
B.S., Alex Kieber, B.S., Thomas Buchheit, M.D., David Macleod, M.B.,
Simon Gregory, Ph.D., Mary McDuffie, R.N., Chester Buckenmaier, M.D.,
Andrew Shaw, M.B., Duke University Medical Center, Durham, NC, Walter
Reed National Military Medical Center, Washington, DC.
PN A1136
PN A1135
PO03-2BCHRONIC AND CANCER PAIN: BASIC SCIENCE
Spinal Menin Regulates Glutamatergic Transmission After Peripheral
Nerve Injury
Spinal menin has a dual functionality of enhancing synaptic excitability
through forming a reinforcing loop by elevating synaptic ratio of glutamate/
GABA via decreasing the level of GAD65 and simultaneously increasing
synaptic activity via upregulating the expression of both NR1 and GluR1.
Fuzhou Wang, M.D., Ph.D., Shiqin Xu, M.D., M.P.H., Xiaofeng Shen, M.D.,
M.P.H., Department of Anesthesiology, Nanjing Maternity and Child Health
Care Hospital, Nanjing Medical University, China.
PN A1137
Improvement of Diabetic Neuropathy in Rats After Treatment With a
Novel Sulfonylhydrazone Derivative
Novel sulfonylhydrazone derivative (LASSBio-1473) effectively reduced
neuropathic pain assessed by mechanical allodynia and thermal hyperalgesia
in rats with streptozotocin-induced diabetes. Gisele Zapata-Sudo, M.D.,
Ph.D., Lidia M. Lima, Ph.D., Sharlene L. Pereira, Ph.D., Margarete
M. Trachez, M.D., Ph.D., Beatriz J. Souza, Carlos E. Monteiro, Eliezer
J. Barreiro, Ph.D., Roberto T. Sudo, M.D., Ph.D., Pharmacology,
Universityersidade Federal Do Rio De Janeiro, Brazil.
PO10-1BEXPERIMENTAL NEUROSCIENCES: MECHANISMS I
SATURDAY, OCTOBER 12| 9:00-10:00 A.M.
ROOM 104-AREA C
NA A1138
Not Only Histamine H1 Blocker But Also H2 Blocker Famotidine
Decreased the Hypnotic Dose of Propofol in DDY Mice
Histaminergic system would be involved in the mechanism of general
anesthesia. One of major complications of antihistaminic drugs is drowsiness.
Presynaptic H3 receptor agonist may potentially decrease the effective
dose of propofol. In the current investigation hydroxyzine enhanced the
hypnotic activity of propofol however chlorpheniramine did not. Famotidine
reduced the hypnotic dose whereas H3 agonists showed no effect. The
inconsistent results indicate that the histaminergic activity of tuberomamillary
histaminergic system would be complex. Yushi Adachi M.D., Ph.D., Junpei
Tochikubo M.D., Toshiyuki Hatano M.D., Shinsuke Hashimoto M.D.,
Tadashi Ejima M.D., Naoyuki Matsuda, M.D., Ph.D., Department of
Emergency Medicine, Department of Emergency & Critical Care Medicine,
Nagoya University Hospital, Japan.
NA A1139
Emotional Memory and Emotional Responsiveness With the NMDA
Antagonists Ketamine or Nitrous Oxide: An fMRI Study
Using event-related fMRI it was found that neither low-dose ketamine nor
30% nitrous oxide modulated long-term emotional memory of emotionally
arousing or neutral pictures in human volunteers despite a slight amnesic
effect on overall memory. However nitrous oxide did reduce the number of
items selected as emotionally arousing and suppressed amygdala activation
to the emotional material. This suggests nitrous oxide may have further
clinical utility for helping to attenuate emotional processing in anxiety-related
disorders such as post-traumatic stress disorder. Michael T. Alkire M.D.,
Hiroki Hayama Ph.D., Chris Reist M.D., Larry Cahill Ph.D., VA Long
Beach Healthcare System & University CA, Irvine, CA.
NA Neuroanesthesia
PN Pain Medicine
23
NA A1140
PO14-1BPATIENT SAFETY PRACTICE MANAGEMENT
In Utero Exposure to Isoflurane Decreases Reelin Level: Regulatory
Protein in Developing Rat Cortex
In utero exposure to isfluorane causes apoptosis of Cajal Retzius cells
decreases Reelin levels and subsequently results in abnormal pattern of
neuronal migration in developing cerebral cortex of rats. Vicko Gluncic
M.D., Ph.D., Jeffrey S. Kroin, Ph.D., Mario Moric, M.S., Seby L. Edassery,
Ph.D., Yaping Chu, M.D., Ph.D., Leo Kelly, B.A., Kenneth J. Tuman, M.D.,
Anesthesiology, Pharmacology, Neurology, Rush University Medical
Center, Chicago, IL.
NA A1141
Longer In Utero Anesthetic Exposure Increases Neurons in
Inappropriate Cortical Layers in Rats
Histological quantification showed lower numbers of newly generated cells in
upper layers and larger numbers in deeper layers and subjacent white matter
in rat pups prenatally exposed to anesthetics (p<0.05) in 50 and 120 min
groups that systematically increased with duration of exposure. There was no
significant difference among the animals in the 20 min group. Vicko Gluncic
M.D., Ph.D., Yaping Chu M.D., Ph.D., Jeffrey S. Kroin Ph.D., Jinyuan Li
M.D., Ph.D., Mario Moric M.S., Kenneth J. Tuman M.D., Anesthesiology,
Neurology, Rush University Medical Center, Chicago, IL.
NA A1142
Longer In Utero Anesthetic Exposure at Peak Cortical Neurogenesis
Impairs Behavior in Rats
Motor skills and coordination tests revealed no differences among the 20 50
and 120 min groups and among isoflurane propofol and oxygen exposed
rats within these groups. However in terms of sensorimotor function and
learning and memory statistically significant deficits were observed between
the anesthetic-exposed vs. the oxygen-exposed animals (p<0.05) in the 50
and 120 min groups. Vicko Gluncic M.D., Ph.D., Jeffrey S. Kroin Ph.D.,
Mario Moric M.S., Amanda L. Persons Ph.D., Leo Kelly B.A., Kenneth
J. Tuman M.D., Anesthesiology, Pharmacology, Rush University Medical
Center, Chicago, IL.
NA A1143
Epigenetic Regulation of Period Expression in the Mouse
Suprachiasmatic Nucleus by Sevoflurane
We revealed the epigenetic regulation of clock gene expression under
anesthetic treatment. Sevoflurane inhibits the binding of CLOCK to the E-box
sequence and represses the acetylation of histones which leads to the
suppression of Per2 mRNA expression. Keisuke Mori, M.D., Izumi Matsuo,
M.D., Shimpei Higo, Ph.D., Satoko Aikawa, Ph.D., Megumi Anzai, M.D.,
Norio Iijima, Ph.D., Hitoshi Ozawa, M.D., Ph.D., Atsuhiro Sakamoto, M.D.,
Ph.D., Department of Anesthesiology and Pain Medicine, Department of
Anatomy and Neurobiology, Graduate School of Medicine Nippon Medical
School, Tokyo, Japan.
NA A1144
NMDA Receptor Interacts With GCOM1 and Internexin-Alpha
We present data showing that GCOM1 proteins interact with a subunit of
the NMDAreceptor and with internexin a known interactor of the NMDAR
suggesting a novel pathway ortrimeric complex that may initiate changes
in neuronal gene expression. Raymond S. Roginski M.D., Ph.D., Sara
J. Weaver, B.S., Phillip P. Santoiemma, B.S., Jay Yang, M.D., Ph.D.,
Anesthesiology and Critical Care, University of Pennsylvania, and PVAMC
Philadelphia, Anesthesiology, University of Wisconsin, Madison, WI.
PI A1146
Triple Therapy With Scopolamine Ondansetron and Dexamethasone
for Prevention of Post Operative Nausea and Vomiting in Patients
Undergoing Neurological Surgery and General Anesthesia
The evaluated triple-therapy with scopolamine patch dexamethesone and
ondansetron showed to be an effective regimen for prophylaxis of vomiting
and/or nausea for up to 120 hours especially during the first 24 hours
in patients undergoing neurological surgery under general anesthesia.
Sergio D. Bergese, M.D., Joseph Werner, M.D., Erika G. Puente, M.D.,
Alberto A. Uribe, M.D., Priscilla Agbenyefia B.S., Maria A. Antor, M.D.,
Anesthesiology, The Ohio State University Wexner Medical Center
Columbus, Anesthesiology, Jackson Memorial Hospital, Miami, FL.
PI A1147
What is the Appropriate Concentration of Desflurane for Prevention
of Awareness During Anesthesia and for Reliable Recovery From
Anesthesia in Clinical Practice?
We investigated the effects of low concentrations of desflurane on safety
and clinical significance in clinical practice. Desflurane at an end-tidal
concentration of 3.5% slightly shortened the time of recovery from
anesthesia compared to 5.5% desflurane. However duration of BIS >60
in 3.5% desflurane was longer than that with 4.5% or 5.5% desflurane.
Our results suggested that 4-5% desflurane is appropriate for completely
preventing awareness during anesthesia. Naoyuki Hirata, M.D., Daisuke
Maruyama, M.D., Tomohiro Chaki, M.D., Michiaki Yamakage, M.D., Ph.D.,
Anesthesiology, Sapporo Medical University, Japan.
PI A1148
Injured Patients: The Impact on Anesthesia Residents When They Have
Caused Injury
During anesthesiology training the attainment of anything less than
perfection may result in an injury to the patient. We hypothesized that any
injury caused by a resident could affect their mental health and/or their
perspective of the field. The findings from a survey of NYU anesthesia
residents and fellows indicate that some may be considered second victims
as they showed symptoms of PTSD depression and anxiety. As these
trainees are often on there own this and other studies suggest that there
is a need for structured approaches to second victim recovery in anesthesia
training programs. Kimberley Howell, M.D., Odinakachukwu Ehie, M.D.,
Vito Infante M.D., Corey Scher, M.D., Anesthesiology, NYU Langone
Medical Center, New York, Psychiatry, Catholic University of Leuven,
Brussels, Belgium.
PI A1149
Effect of Incorrectly Applied Cricoid Pressure During Rapid Sequence
Induction - Evaluation With High-Resolution Manometry
Correctly and incorrectly applied cricoid pressures following a rapid sequence
induction in patients scheduled for elective surgery were evaluated using
high-resolution manometry (HRM). Incorrectly applied cricoid pressure
against the thyroid cartilage or trachea generates a significant rise of
pressure in the region of the upper esophagus comparable to pressures
generated by a cricoid pressure against the cricoid cartilage. In order to
prevent passive regurgitation the exact position of the application of cricoid
pressure seems to be of less importance. Richard Pellrud M.D., Rebecca
Ahlstrand M.D., Ph.D., Anesthesiology and Intensive Care and Center for
Health Care Sciences, Orebro University Hospital, Sweden.
PI A1150
NA A1145
Effects of Etomidate on Excitatory Postsynaptic Currents of S1 and
VPM Neurons in Rats
The sEPSC and mEPSC of neurons of S1 and VPM were recorded before
and after infusing the different concentrations of etomidate in artificial
cerebrospinal fluid together with bicuculline. The results suggest that The
reduction of excitatory neurotransmission of the neurons of S1 except VPM
may be a sensitive way of nerve centre and a mechanism for etomidate to
induce unconsciousness by inhibiting the sensory information transmission
under the clinically physiological conditions. Yuan Wang M.Sc., Tian Yu
M.D., Bao Fu M.Sc., Hao Yang M.Sc., Maosheng Xu M.Sc., Zunyi
Medical College, Affilicated Hospital of Zunyi Medical College, China.
24
ROOM 104-AREA D
Use of Ferric Carboxymaltose With Epoitin Reduces Transfusion in
Major Orthopedic Surgery: A 2-Phases Prospective Observational
Study
A protocol combining ferric carboxymaltose (FCM) and epoietin the month
before a major orthopedic surgery is feasible and effective in reducing
perioperative transfusions. The use of FCM compared with oral iron increases
perioperative hemoglobin levels and decreases preoperative iron deficiency.
Emmanuel Rineau M.D., Aurelie Chaudet M.D., Thomas Gaillard M.D.,
Laurence Carlier M.D., Jean-Claude Granry M.D., Sigismond Lasocki
M.D., Ph.D., Pole d’Anesthesie-Reanimation, LUNAM Universityersite
d’Angers, CHU Angers, France.
NA Neuroanesthesia
PN Pain Medicine
The Effect of Fatigue on the Clinical Performance of Experienced
Anesthesiologists: A Simulation Study
The primary aim of this randomized controlled trial was to examine the
effect of fatigue on clinical performance of attending anesthesiologists in a
simulated obstetric emergency. Attending anesthesiologists from a single
practice center were recruited to perform a simulated general anesthetic for
emergency cesarean delivery on two separate days once while rested and
once while fatigued. Performance scores were not different between the
FATIGUED and RESTED groups (137.6 vs 127 P = 0.145).A trend towards
decreased performance was seen in the fatigued arm although this was
not statistically significant. Torin D. Shear M.D., Arthur Tokarczyk, M.D.,
Steven Greenberg M.D., Melissa Pant, M.D., Shivani Patel, B.A., Max
Kroloff, B.S., Barbara Scavone, M.D., Peggy Ochoa, R.N., Valen Anderson
B.S., NorthShore University HealthSystem, Evanston, IL, University of
Chicago, IL.
PI A1152
Effects of Neostigmine Reversal on Postoperative Complications
Neostigmine is administered to reverse non-depolarizing neuromuscular
blocking agents in order to prevent postoperative residual paralysis. Highdose neostigmine reversal is an independent predictor of prolonged PACU
length of stay and associated with increased occurrence of postoperative
atelectasis. Kimberly N. Taylor, B.S., Nobuo Sasaki, M.D., Matthew J.
Meyer, M.D., Anne B. Stanislaus, M.S., Sanjana A. Malviya, B.S., Jeroen
C.P. Simons, Student, Andrea L. Tsai, M.D., Teresa O. MacDonald, R.N.,
Mary E. Doran, M.S.N., Matthias Eikermann, M.D., Ph.D., Emergency
and Critical Care Medicine, Showa General Hospital, Tokyo, Japan,
Anesthesia, Critical Care and Pain Medicine, PostAnesthesia Care Unit,
Massachusetts General Hospital, Boston, MA.
PI A1153
Identification of Factors Influencing Anesthetic Drug Cost Variation
Using AIMS records from Vanderbilt University and Massachusetts General
Hospital volatile and intravenous drug costs were calculated for 5 504
anesthetics performed for 10 types of surgical procedures over a period
of 18 months. Median cost was $38.25 and the factors responsible
for the majority of the observed variation in anesthetic drug costs were
predominately case duration and procedure type. The variation seen between
attending anesthesiologists was smaller than the variation seen within
their cases after controlling for patient and surgical factors. Jonathan
P. Wanderer, M.D., Douglas L. Hester, M.D., Warren S. Sandberg
M.D., Ph.D., John Anderson-Dam M.D., Jesse M. Ehrenfeld M.D.,
Ph.D., Department of Anesthesiology, Vanderbilt University, Nashville,
TN, Department of Anesthesia, Critical Care and Pain Medicine
PO17-2BRESPIRATION II
ROOM 104-AREA E
FA A1154
Postoperative Acute Lung Injury in Patients With Previous Exposure to
Bleomycin
We found post-operative acute lung injury (PO-ALI) in 7 out of 541 major
invasive surgical procedures in bleomycin exposed patients. All cases of
PO-ALI involved Caucasian males 6 were current or former smokers. POALI cases trended toward a longer surgical duration and use of red blood
cell transfusion consistent with significantly greater crystalloid and colloid
administration. Benjamin M. Aakre, M.D., Richard Efem, M.S., Greg
Wilson, R.R.T., Daryl Kor, M.D., John Eisenach, M.D., Anesthesiology,
Mayo Clinic, Rochester, MN, Stony Brook University School of Medicine,
NY, Mayo Clinic, Rochester, MN.
FA A1155
Predictive Value of Matrix Metalloproteinase 2 in Bronchoalveolar
Lavage on Outcome After Lung Resection Surgery
The elevation of matrix metalloproteinase 2 (MMP-2) in bronchoalveolar
lavage fluid has been suggested to play a role in alveolar epithelium
disruption and therefore it could affect the outcome of lung resection
surgery. The present study evaluates the predictive value of MMP-2 on
outcome in patients undergoing lung resection surgery. Francisco A.
de la Gala Sr. M.D., Ph.D., Ignacio Garutti, M.D., Ph.D., Patricia Pineiro,
M.D., Almudena Reyes, M.D., Elena Vara, M.D., Ph.D., Lisa Rancan,
V.M.D., Carlos Simon, M.D., Ph.D., Javier Casanova, M.D., Ph.D., Mª
Jose Garcia, M.D., Pilar Benito, M.D., Anesthesiology, Hospital General
Universityersitario Gregorio Maranon, Madrid, Spain, Biochemistry and
Molecular Biology III Universityersidad Complutense, Madrid, Spain.
PI A1151
FA A1156
Sevoflurane Post-Treatment Inhibits Inflammatory Response in Dog
Lungs With Oleic Acid-Induced Injury
Sevoflurane post-treatment reduced inflammatory infiltration in OA-injured
canine lungs compared with pentobarbital or propofol possibly via inhibition
of TNF. Guizhi Du, M.D., Zhiyi Zuo, M.D., Jin Liu, M.D., Anesthesiology,
West China Hospital of Sichuan University, Chengdu, Anesthesiology,
University of Virginia Health System, Charlottesville, VA, West China
Hospital of Sichuan University Chengdu.
FA A1157
Experimental Study on the Pulmonary and Systemic Anti-Inflammatory
Effects Associated With Systemic Lidocaine During Lung Resection
Surgery
In this experimental study we’ve showed that administration of intravenous
lidocaine during lung resection surgery with one-lung ventilation decreases
intra and postoperative systemic and lung inflammation. Ignacio Garutti Sr.
M.D., Ph.D., Gabriel Cti, Ph.D., Carlos Simon, M.D., Ph.D., Guillermo
Sanchez-Pedrosa, Ph.D., Francisco Moraga, Ph.D., Luis Olmedilla, M.D.,
Ph.D., Lisa Rancan, Ph.D., Elena Vara, M.D., Ph.D., Maria Arellano,
Ph.D., Anesthesia Department, Hospital Gregorio Maranon Madrid,
Universityersidad Complutense Medicine, Spain.
FA A1158
The Influence on Kidney Function of A New Type of Lung Preservation
Solution Containing Na/H(+) Exchanger 1 Blocker: Experimental
Research
This is a experimental research from the anesthesiology department of
Western China Hospital. They found that a new type of lung Preservation
Solution Containing cariporide a Na/H(+) Exchanger 1 Blocker could
protect the function of the donor lung. At the same time it had no
influence on the receptor’s kidney function. In addition lung transplant
surgery didn’t cause significant acute kidney injury but will cause more
inflammatory factors infiltration in kidney tissue which highly related with the
inflammatory response in transplanted lung. Gu Juan, M.D., Liu Bin, Ph.D.,
Anesthesiology, Western China Hospital, Chengdu.
FA A1159
PaO2 Oscillations During Cyclic Recruitment and Derecruitment are
Transmitted into Porcine Renal Cortex Microcirculation
The present proof of concept study investigates if paO2 oscillations are
transmitted and can be detected in renal microcirculation in a porcine
surfactant-washout ARDS-model. Rainer Thomas, M.D., Alexander
Ziebart, M.D., Erik Hartmann, M.D., Tanghua Liu, M.D., Matthias David,
M.D., Department of Anesthesiology, Medical Center of the JohannesGutenberg University, Mainz, Germany.
NA Neuroanesthesia
PN Pain Medicine
25
FA A1160
Serum Angiopoietin-2 as a Biomarker for Postoperative Respiratory
Failure After Cardiac Surgery
We measured the serum levels of angiopoietin-2 (ANG-2) in patients
undergoing cardiac surgeries and studied its ability to detect postoperative
respiratory failure. Serum levels of ANG-2 elevated postoperatively and
ANG-2 on POD 1 showed good predictive performance for respiratory failure
after cardiac surgery. Postoperative ANG-2 levels might reflect the severity
of postoperative lung dysfunction and cardiopulmonary bypass might be
one of major factors related with its elevation. Hiroto Yamamoto M.D.,
Tokujiro Uchida M.D., Ph.D., Hiroyuki Ito M.D., Nagara Ohno M.D.,
Miho Asahara M.D., Yoshitsugu Yamada M.D., Ph.D., Osamu Yamaguchi
M.D., Ph.D., Koshi Makita M.D., Ph.D., Tokyo Medical and Dental
University Graduate School of Medicine, Japan, The University of Tokyo
Graduate School of Medicine, Japan, Yokohama City University Medical
Center, Japan.
FA A1161
Addition of Cariporide to Low-Potassium Dextran (LPD) Solution
Promotes Protection on the Graft Lung Against Warm Ischemia From
the Isolated Lung Transplantation Model in Rabbits
In this study we found that Cariporide modified LPD solution attenuates
ischemia/reperfusion injury after warm ischemia and improve the lung graft
viability compared with the LPD solution. Jianqiao Zheng, M.D., Fuyun Man,
M.D., Bin Liu, M.D., Ph.D., West China Hospital of Sichuan University,
Chengdu.
PO04-4A CLINICAL CIRCULATION
ROOM 104-AREA A
CA A1162
Anesthetic Management of Emergent Endovascular Aneurysm Repair
(EVAR): Case Series and Review
Anesthetic management of emergent endovascular repair for abdominal
aortic aneurysm (EVAR) has not been reported. We present the anesthetic
management of 23 consecutive emergent EVAR cases. Both general and
spinal anesthesia were used successfully. Local infiltration alone PAC or
CSFD were not used. Due to the heterogeneity of cases it is difficult to
draw further conclusions. With continued advances in endovascular stenting
patients deemed high-risk for traditional open repair will present increasingly
for emergent EVAR. Further research is needed to develop best practice
guidelines. David M. Carroll, M.D., Elizabeth Ling, M.D., John Harlock
M.D., David Szalay, M.D., Anesthesia, Vascular Surgery, McMaster
University, Hamilton, ON, Canada.
CA A1163
Effect of Sensor Location on Regional Cerebral Oxygen Saturation
Measured by INVOS 5100 in Cardiac Surgery With Cardiopulmonary
Bypass
It is often unfeasible to attach NIRS sensors to the location commercially
recommended as combined use of neurological monitoring systems is
common. The primary purpose of this study was to compare the values of
regional cerebral oxygen saturation (rSO2) measured by NIRS between upper
and lower sides of the forehead during cardiac surgery. The left upper and left
lower rSO2 and other clinical measurements were monitored intraoperatively.
rSO2 was significantly lower in the LU forehead than in the LL forehead
during pre- and intra-CPB peroids. Ah Reum Cho, M.D., Jae-Young Kwon,
M.D., Ph.D., Hae-Kyu Kim, M.D., Ph.D., Anesthesia and Pain Medicine,
Pn National University Hospital, Bn, Republic of Korea.
CA A1164
Low Levels of High-Density Lipoproteins are Associated With Acute
Kidney Injury After Chronic Limb Ischemia Revascularization
Acute kidney injury following revascularization is not uncommon (12.0%)
found to be similar after endovascular or open procedures and the majority
were mild injuries. Lower HDL along with lower preoperative albumin levels
and presence of CKD are associated with increased odds of postoperative
AKI. If these observations can be verified in a prospective fashion strategies
for increasing HDL level in patients with high risk of postoperative AKI should
be investigated. Sina Davari Farid, M.D., Pradeep Arora, M.D., Matthew
P. Gannon, M.D., James W. Lohr, M.D., Hasan H. Dosluoglu, M.D., Nader
D. Nader, M.D., Anesthesiology, Medicine Nephrology, Surgery Vascular
Surgery, University at Buffalo, NY.
CA A1165
Lower Limb Peripheral Near-Infrared Spectroscopy Parameters
During an Aascular Occlusion Test: An Experimental Study in Healthy
Volunteers
Physiological values of rSO2 at the lower limb vary according to the
anatomical site of measurement whereas a vascular occlusion test induces
major changes that differed between male and female. Diagnostic and
prognostic studies using NIRS parameters at the lower limb should consider
variations induced by anatomical site and gender. Jean-luc Fellahi, M.D.,
Marc-Olivier Fischer, M.D., Georges Daccache, M.D., Jean-Luc Hanouz
M.D., Pole Reanimations Anesthesie, CHU de Caen, France.
CA A1166
Preoperative Anxiety in Patients Undergoing Cardiac Surgery
Anxiety is a leading cardiovascular risk factor in cardiac surgery. Diverse
tools such as VAS and APAIS have been poorly reported to assess anxiety
in these patients. Our results suggest that preoperative length of stay >2
days and lack of information especially related to surgery are crucial
factors. Diego Fuentes-Garcia, M.D., Luis Falcon-Arana, M.D., Ph.D.,
Joaquin F. Hernandez-Palazon, M.D., Ph.D., Antonio Rodriguez-Ribo, M.D.,
Carlos Garcia-Palenciano, M.D., Ph.D., Maria Jose Roca-Calvo, M.D.,
Anesthesia Hospital Virgen de la Arrixaca, Thoracic Surgery, Hospital
Virgen de la Arrixaca El Palmar, Murcia, Spain.
CA A1167
Predictors of Intraoperative and 24-hours Postoperative Cardiac Arrest
in Elective Surgery: Ten Years Review of 101 015 Anesthetics
Preoperative hyperkalemia and postoperative PTT prolonged should be
corrected to reduce the risk of perioperative cardiac arrest. Cardiovascular
disease intermediate risk surgery intraoperative massive hemorrhage
intraoperative bradycardia and desaturation increase the risk of perioperative
cardiac arrest in elective surgery. Panthila Rujirojindakul, M.D., Edward
McNeil, M.Sc., Alan Geater, Ph.D., Anesthesiology, Epidemiology Unit,
Prince of Songkla University, Hat Yai, Thailand.
CA A1168
Response of Nexfin Pulse Pressure and Stroke Volume Variation on a
Provoked Fluid Shift in Mechanically Ventilated Patients
Study showing that Nexfin PPV and SVV adequately detect a provoked fluid
shift, comprised of 15o Trendelenburg positioning in mechanically ventilated
patients while parameters like mean arterial pressure (MAP) and cardiac
index (CI) are not sensitive enough to reflect this fluid challenge. Wide levels
of agreement between Nexfin PPV and SVV suggest that the calculated
SVV values using the CO-trek algorithm are strongly affected by patient
demographics. Jurre Stens, M.D., Jeroen Oeben, Student, Christa Boer
Ph.D., Anesthesiology, VU Medical Centre, Amsterdam, Netherlands.
CA A1169
Incidence of Bezold-Jarisch During Arthroscopic Shoulder Surgery
The incidence of bradycardia during arthroscopic surgery is high-even in the
absence of interscalene nerve block. It is higher in male than female patients
and higher in shoulder stabilisations than subacromial decompressions.
Andrew Tait, M.B. Ch.B., Khaled Ismail M.D., Balachandran
Venkateswaran M.D., Anaesthetics, Mid Yorkshire Hospitals,
Orthopaedics, Mid Yorkshire Hospitals, Dewsbury, United Kingdom.
26
NA Neuroanesthesia
PN Pain Medicine
NA A1175
Somatosensory Evoked Potentials Under Xenon Anesthesia
Neuromonitoring of somatosensory evoked potential (SSEP) amplitude is
feasible under xenon/remifentanil anesthesia although SSEP amplitudes
decrease to 43 percent of baseline whereas SSEP latencies remain
unchanged. Martin Neukirchen, M.D., Maximilian S. Schafer, M.D., Legler
Annette, M.D., Peter Kienbaum, M.D., Department of Anesthesiology,
University Hospital, Dusseldorf, Germany.
Quantitative Analysis of the Auditory Evoked Potentials Under
Desflurane Anesthesia
“The purpose of this study was to clarify whether the auditory evoked
potential (AEP) index changes in a dose dependent manner under desflurane
anesthesia. Seventeen patients were enrolled. The AEP index was recorded
at desflurane concentrations of 0.5, 1.0, 1.5 and 2.0 MAC. The AEP index
at each desflurane concentration was 35±5 (0.5MAC), 33±6 (1.0MAC),
33±4 (1.5MAC) and 32±5 (2.0MAC), respectively. No significant difference
was observed between these AEP index. The AEP index has no linear function
during desflurane anesthesia. Masaki A. Ohno Sr. M.D., Naoko Sato, M.D.,
Yasuhiro Watanabe, M.D., Takeshi Ouchi, Ph.D., Ryohei Serita, Ph.D.,
Toshiya Koitabashi, Ph.D., Anesthesiology, Ichikawa General Hospital,
Tokyo Dental College, Japan.
NA A1171
NA A1176
ROOM 104-AREA B
NA A1170
Does Tegaderm Placed on Eyes to Prevent Lagopthalmos Affects
Visual Evoked Potentials Monitoring Data Accuracy: A Pilot Study
During surgical removal of a pituitary adenoma conduction in the anterior
visual pathways is monitored by continuous recording of visual evoked
responses (VER). The method employes special goggles application. Goggles
may lead to corneal abrasions. In order to prevent that eyes can be covered
with tegaderm. There is a question if tegaderm affects reliability of VER
in terms of latency and amplitude. VER data latency and amplitude were
compared before and after tegaderm placement. No change in VER data
was noted in all 10 cases. Our preliminary pilot conclusion is that tegaderm
application probably does not affect VER data latency and amplitude.
Patrick J. Descepola, M.D., Sergey Pisklakov, M.D., Jyotsna Rimal, M.D.,
Ali Hashemi, B.A., Anesthesiology, UMDNJ-New Jersey Medical School
Newark, NJ.
NA A1172
Monitoring Upper and Lower Limb Motor Evoked Potentials is No Better
than Upper Limb Alone to Predict Outcome During Cerebral Aneurysm
Surgery
MEP monitoring is used as an adjunct method to SEPs during cerebral
aneurysm surgery to predict postoperative pure motor deficit caused by
subcortical ischemia. Using lower stimulating voltage by recording MEPs from
hand muscles along may avoid the disadvantages such as patient movement
induced by excessive muscle contractions and stimulation on deeper
subcortical structures compared to recording from hand and foot muscles.
This study demonstrates that hemiplegia is the most common type of
postoperative motor deficit; monoplegia of the upper limb is second common
pattern. Weakness or paralysis of the lower limb along was not observed.
Therefore the strategy of using lower stimulation and recording MEPs from
hand muscles only is a reasonable approach. LanJun Guo, M.D., Wilson Cui,
M.D., Francis Wolf, M.D., Michael T. Lawton, M.D., Adrian W. Gelb, M.B.,
Ch.B., University of California, San Francisco, CA.
NA A1173
Poincare Analysis of the Electroencephalogram During Sevoflurane
Anesthesia
The Poincar33; plot pattern of the frontal electroencephalogram(EEG) is
correlated to the anesthesia depth and is useful in detecting the EEG
changes in the different sevoflurane concentrations. Kazuko Hayashi, M.D.,
Anesthesiology, Nantan General Hospital, Kyoto, Japan.
NA A1174
A Multimodal Indicator of Depth of Anesthesia: Comparison to EEG and
Standard Monitoring Parameters
Based on patient data of a study in 6 European centers a multimodal
integration of both standard monitoring and EEG parameters may more
precisely reflect the level of anesthesia than monitoring based on one of
these aspects alone. Denis Jordan, Ph.D., Gerhard Schneider, M.D.,
Adem Omerovic, M.Sc., Matthias Kreuzer, M.Sc., Sebastian Berger,
M.Sc., Eberhard F. Kochs, M.D., Anesthesiology, Klinikum rechts der Isar
Technische Universityersitat Munchen, Germany, Anesthesiology, Witten/
Herdecke University, Helios Clinic Wuppertal, Germany.
PO05-2A CLINICAL NEUROSCIENCES - MONITORING THE CENTRAL
NERVOUS SYSTEM
Bilateral Bispectral Index Monitoring in Comparison Between
Electroconvulsive and Magnetic Seizure Therapy
Twenty patients suffering from treatment-resistant depression were treated
with either electroconvulsive (ECT) or magnetic seizure therapy (MST) and
monitored with bilateral BIS electrodes. MST-patients recovered faster and
showed higher BIS-values postictally. Differences between the left and right
BIS were observed neither in the ECT nor in the MST group. Martin Soehle,
M.D. M.B.A., Sarah Kayser, M.D., M.S., Richard K. Ellerkmann, M.D.,
Thomas E. Schlaepfer, M.D., Department of Anesthesiology and Intensive
Care, Medicine, Department of Psychiatry and Psychotherapy, University
of Bonn, Germany.
NA A1177
Comparison of Bispectral Index and End Tidal Anesthetic
Concentration Monitoring on Recovery Profile of Desflurane
Several studies have been conducted to determine whether use of BIS
guided or ETAC guided anesthesia was effective in preventing awareness in
patients undergoing surgery with inhalational anesthesia. This randomized
double blinded study was conducted to compare the effect of BIS or
ETAC monitoring on clinical signs that can be correlated with depth of
anesthesia like awakening recovery and discharge from PACU in patients
undergoing desflurane - nitrous oxide anesthesia. Jyotsna Wig, M.D., R.
Sudhakaran, M.B. B.S., Jeetinder Kaur Makkar, M.D., Rajesh Chhabra,
M.S., Anaesthesia and Intensive Care, Postgraduate Institute of Medical
Education and Research, Chandigarh, India, Department of Anaesthesia
& Intensive Care, Department of Neurosurgery, Post Graduate Institute of
Medical Education & Research, Chandigarh, India.
PO08-4A EQUIPMENT MONITORING AND ENGINEERING TECHNOLOGY:
AIRWAYS AND VENTILATION
ROOM 104-AREA E
FA A1178
Robust Respiratory Rate Detection Using Alar Photoplethysmography
and a Thermistor
The nasal alar allows the monitoring of two physiological signals (aPPG and
flow) with a single integrated sensor that provides robust RR determination.
Sean Cohen, B.S., Richard J. Melker, M.D., Ph.D., Michael W. Stahl,
M.S., Donn M. Dennis, M.D., Assurance Biosense, Gainesville, FL, Xhale,
Gainesville, FL.
FA A1179
Evaluation in Humans of the Influence of O2 Flow Rates on the
Performance of Different Nasal Cannulas to Detect ETCO2
This study in awake healthy volunteers evaluated four NCs (Salter Labs
#4707 Oridion Microstream O2/CO2 #006912 Hudson Softec Bi-Flo
#1845 and Medline Mac-Safe #369-E) to determine their variability for
detecting ETCO2 when altering the FGF rate of O2. Hudson had significantly
greater variability during all conditions and Medline was significantly greater
at 4 LPM FGF. Salter and Oridion NCs had the least variability and were
not influenced by FGF and thus may be the most reliable for detecting
RR and estimating ETCO2. Thomas J. Ebert, M.D., Ph.D., Jutta Novalija,
M.D., Ph.D., Toni D. Uhrich, M.S., Jill A. Barney, M.S., Anesthesiology,
VA Medical Center and Medical College of Wisconsin, Milwaukee, Research
Service VA Medical Center and Medical College of Wisconsin, Milwaukee, WI.
NA Neuroanesthesia
PN Pain Medicine
27
FA A1180
PO11-1A HISTORY AND EDUCATION
Clinical Evaluation on Acoustic Respiration Rate (RRa™) in PACU
Compared With the Conventional Monitoring System
RRa™ is the most effective method for monitoring respiration rate of
patients in PACU. Tomoko Fukada, M.D., Yuko Uenaka, R.N., Yuri Tsuchiya,
M.D., Hiroko Iwakiri, M.D., Minoru Nomura, M.D., Makoto Ozaki, M.D.,
Department of Anesthesiology, Tokyo Women’s Medical University School
of Medicine, Japan.
FA A1181
End-Tidal Control Anesthesia-Adopted Minimum Fresh Gas Flow
is Superior to Manual cCntrol 2 Liter Low-Flow Sevoflurane and
Desflurane Anesthesia in Clinical Practice
End-tidal control anesthesia-adopted minimum fresh gas flow is equivalent
to manual control 1.1 liter low-flow sevoflurane anesthesia and 0.8 liter
low-flow desflurane anesthesia in clinical practice. Soshi Iwasaki, M.D.,
Ph.D., Chaki Tomohiro, M.D., Fumiyuki Sugime, M.D., Zhou Jing, M.D.,
Ph.D., Michiaki Yamakage, M.D., Ph.D., Anesthesiology, Sapporo Medical
University School of Medicine, Japan.
FA A1182
Calculated Values of Respiratory Variations in the
Photoplethysmographic Amplitude Depends on the Pulse Oximetry
Device
Respiratory variations in the pulse oximetry waveform (POP) is suggested as a
non-invasive method to detect fluid responsiveness, but results from clinical
studies are conflicting. This abstract shows that the calculations of POP
depend on the pulse oximeter used. Svein A. Landsverk, M.D., Ph.D., Lars
Oivind Hoiseth, M.D., Inger Elise Hoff, M.D., Ove Andreas Hagen, M.D.,
Knut Arvid Kirkeboen, M.D., Ph.D., Department of Anesthesiology, Oslo
University Hospital, Norway, Medical Faculty University of Oslo, Norway,
Norwegian Air Ambulance Foundation, Drobak, Norway.
FA A1183
A Study in Adults Undergoing Propofol Sedation During Spinal
Anesthesia to Assess the Effectiveness and Safety of Continuous
Negative External Pressure (cNEP) in Maintaining Upper Airway
Patency
A new sleep apnea device cNEP which works by application of negative
pressure over the neck was tested on patients under spinal anesthesia
receiving propofol sedation during knee arthroplasty. This randomized
double-blinded evaluation of 30 patients did not reveal any advantage to
using cNEP to decrease episodes of obstruction during propofol sedation.
Andrew S. Manolides, M.D., Wade Weigel, M.D., Graduate Medical
Education, Virginia Mason Medical Center, Seattle, WA.
FA A1184
Detection of Airway Obstruction Using Alar Photoplethysmography Indices derived from the aPPG signal appear to have practical application.
While presently no single method is sufficiently reliable for accurate detection
of impending respiratory failure in non-intubated spontaneously breathing
patients aPPG derived parameters plus airflow deserve further evaluation.
Richard J. Melker, M.D., Ph.D., Michael W. Stahl, M.S., Donn M.
Dennis, M.D., Anesthesiology, University of Florida, College of Medicine,
Gainesville, Assurance Biosense, Glastonbury, CT.
ROOM 104-AREA C
PI A1186
How Does Simulation-Assisted Curriculum Affect Anesthesia Medical
Students Exposure to Real Patients
Fifth year Medical students in a single academic center were surveyed about
their perception of the exposure to real surgical patients after implementing
an innovative high fidelity simulation-assisted undergraduate Anesthesia
2-weeks Curriculum. Abeer A. Arab Jr., M.D., Abdullah M. Kaki M.D.,
Anesthesia & Critical Care, King Abdulaziz University, Jeddah, Saudi
Arabia.
PI A1187
The Learning is in the Struggle: Medical Student Perceptions on the
Anesthesia Simulator
Clinical medical students at UCSF all participate in a simulation course
during their required anesthesia clerkship. In order to maximize participation
and interactivity students are allowed to work as a peer level team with
well-defined roles during multiple clinical scenarios. Instructor intervention
was intentionally minimized to require problem solving on an individual and
team basis. Student perceptions of this activity were analyzed qualitatively
and demonstrated that they benefited from a limited amount of struggling
with peer assistance and occasional instructor intervention and that the
challenge was perceived as safe. Adam B. Collins, M.D., Roger Lee, B.S.,
University of California, San Francisco, CA.
PI A1188
Patient Simulation Improves Residents’ Ability to Manage Local
Anesthetic Systemic Toxicity as Measured by Written and Objective
Clinical Assessment
A knowledge deficit was identified in the learners’ ability to recognize
symptoms and initiate proper therapy of local anesthetic toxicity. We
demonstrate better understanding and retention of key concepts when using
simulation compared to video didactic lecture only. Jeremy S. Dority M.D.,
Brooke Ginter M.D., John Michael McGaugh M.D., Brett Elmore M.D.,
University of Kentucky, Lexington, KY.
PI A1189
The Growth of Fellowship Programs in Medical Simulation
The use of simulation-based medical education has become widespread
in anesthesiology and is now a compulsory element for both graduate
medical education and for maintenance of certification. The goal of this
research is to identify catalog and describe available medical simulation
fellowship programs in the United States and Canada. Paul S. Jansson
M.S., Yuemi An-Grogan, M.D., David H. Salzman, M.D., John A. Vozenilek,
M.D., Christine S. Park, M.D., Augusta Webster, M.D., Office of Medical
Education, Anesthesiology, Emergency Medicine, Northwestern University
Feinberg School of Medicine, Chicago, IL, Emergency Medicine University
of Illinois at Peoria, IL.
PI A1190
FA A1185
Audible Capnometric Cues Facilitate Targeted Control of End-Tidal
Cdioxide During Manual Ventilation
Capnometry is an essential monitor of adequacy of ventilation. We designed
audible cues for hypercapnia, normocapnia (35-40mmHg), and hypocapnia
and investigated whether they enhanced control of end-tidal carbon dioxide
(ETCO2) during manual ventilation. Ten providers ventilated a simulator for
5 minutes using a bag-valve resuscitator. Without monitoring, providers
hyperventilated (22.6±6.4mmHg). Use of capnography tended towards
hyperventilation (30.9±5.6mmHg). Addition of audible cues resulted in
tighter control (36.4±4.5mmHg). Such cues should be featured in the next
generation of mainstream capnometry products. Kiyoyuki W. Miyasaka,
M.D., Toshiki Aoki, Masayuki Inoue, Shinji Yamamori, Ph.D., Katsuyuki
Miyasaka, M.D., Ph.D., Department of Anesthesia and Critical Care, St.
Luke’s International Hospital, Tokyo, Japan, Nihon Kohden Corporation,
Tokyo, Japan.
28
Simulation Training During the Anesthesiology Rotation Understanding the Medical Students’ Learning Needs and Perspectives
on its Utility
The role of simulation for 3 year medical students rotating in anesthesia
has not been clearly defined. Little guidance exists in the literature as
to what should be taught. The goal of this study is to better understand
students’ learning needs and perspectives on the utility of simulation. Alina
Lazar, M.D., Igor Tkachenko, M.D., Ph.D., Catherine Bachman, M.D.,
Anesthesia and Critical Care, University of Chicago, IL.
NA Neuroanesthesia
PN Pain Medicine
Evaluation of Anesthesiology Resident Stress Response to Simulation
Training
Simulation training in critical events is an effective learning modality for
Anesthesiology residents. This pilot study evaluates the stress level using
Visual Analog Scale and Salivary Alpha Amylase during the simulation
session. Results showed that residents’ stress level begins to increase prior
the reading of the simulation stem throughout the scenario and decreased
during debriefing. This pilot study could help to establish a baseline for
future research on the impact critical event simulation on resident stress
level. Marc Lilot, M.D., Cameron Ricks, M.D., Sabrina Segal, Ph.D.,
Cecilia Canales, M.P.H., Christine Lee, B.S., Michele Fortier, Ph.D., Zeev
Kain, M.D., MBA, Hospitalices civiles de Lyon, France, Department of
Anesthesiology and Perioperative Care, UCI, Orange, CA.
PI A1192
Simulation-Based Education for Training Pain Interventionalists in the
Management of Emergency Events
We describe a simulation platform for learning and testing critical skill sets
during emergency situations for pain medicine interventionalists. Naileshni S.
Singh, M.D., David J. Copenhaver, M.D., Samir J. Sheth, M.D., Scott M.
Fishman, M.D., Division of Pain Medicine, Department of Anesthesiology
and Pain Medicine, University of California Davis Medical Center,
Sacramento, CA.
PI A1193
Patient Safety Exercise Increases Residents Awareness of Their
Accountability to Patient Safety
The next accreditation system includes resident evaluations of teamwork
transitions of care and fatigue awareness. Resident patient safety exercises
documents these evaluations and increases residents awareness of their
own accountability to patient safety. Michael C. Wajda, M.D., Kimberly
Dugan, M.D., Mitchell Lee, M.D., David Furgiuele, M.D., Daniel O’Neill,
M.D., Anesthesiology, New York University, NY.
PO15-1A PEDIATRIC ANESTHESIA: GENERAL PEDIATRICS
ROOM 104-AREA D
PD A1196
Endotracheal Tube Cuff Pressures and Postoperative Complications in
Pediatrics - An Observational Study
This is an observational multi-institutional study to evaluate the accuracy of
advanced practioners in estimation of ETT cuff pressures along with incidence
of increased ETT cuff pressures and post-operative complications. Justin T.
Hamrick, M.D., Allison Fernandez, M.D., Deepa Katail, M.D., Stephanie
Khantroff, M.D., Michael Shane, M.D., Myron Yaster, M.D., Pediatric
Anesthesiology and Critical Care Medicine, Johns Hopkins University,
Baltimore, MD, Department of Pediatric Anesthesiology, All Children’s
Hospital, St. Petersburg, FL.
PD A1197
PI A1191
Prophylactic Midazolam 0.03 mg/kg May at the End of Surgery Reduce
the Emergence Agitation
Intravenous administration of midazolam 0.03 mg kg-1 just before the end of
surgery may reduce EA without delaying recovery time in children undergoing
strabismus surgery under sevoflurane anaesthesia. Hyub Huh, M.D., Hyea
Hyoung Cho, M.D., Jang Eun Cho, M.D., Ph.D., Hye Won Shin, M.D.,
Ph.D., Sung Uk Choi, M.D., Ph.D., Seong Ho Chang, M.D., Ph.D., Hae Ja
Lim, M.D., Ph.D., Suk Min Yoon, M.D., Ph.D., Hye Won Lee, M.D., Ph.D.,
Seung Zhoo Yoon, M.D., Ph.D., Department of Anaesthesiology and Pain
Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
PD A1198
Does Combining Sevoflurane and Ondansetron in Children Prolong the
QT Interval?
Sevoflurane prolongs the QTc interval and its combination with ondansetron
further increased this effect in paediatric patients. Although there were no
adverse events such as ventricular arrhythmia in this study the anaesthetist
should still be aware of the possibility of encountering paediatric patients
with undiagnosed long QT syndrome. Careful EGC monitoring is advisable
when ondansetron is administered during sevoflurane inhalation especially
in children. Ji-Hyun Lee, M.D., Yong-Hee Park, M.D., Jin-Tae Kim, Ph.D.,
Chong-Sung Kim, Ph.D., Hee-Soo Kim, Ph.D., Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, Republic of Korea,
Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul,
Republic of Korea.
PD A1199
PD A1194
Audit of Intraoperative Blood Glucose in Neonates and Infants
Audit of intraoperative glucose levels to determine the appropriate monitoring
and management of intraoperative administration of dextrose containing
fluids in neonates and infants. Tiffany L. Bartsch, M.D., Uma Parekh, M.B.,
B.S., Priti Dalal, M.D. F.R.C.A, Patrick M. McQuillan, M.D., Anesthesiology,
Penn State Milton S. Hershey Medical Center, PA.
PD A1195
NPO Guidelines for Pediatric Sedation
We reviewed 226,475 sedation procedures from the Pediatric Sedation
Research Consortium during 2004 to 2010 to estimate the frequency of
aspiration and major complications related to NPO status. In this cohort there
were no deaths 14 aspirations and 132 major complications (defined as
death aspiration or unplanned hospital admission). NPO status for clear
liquids was not associated with either aspiration or major complication.
There was a non-statistically significant increase related to NPO status for
solids and non-clear liquids for aspiration (OR 1.85 p=0.34) and major
complication (OR 1.35 p=0.12). Michael L. Beach, M.D., Joseph P.
Cravero, M.D., Anesthesiology, Dartmouth-Hitchock Medical Center,
Lebanon, NH, Boston Children’s Hospital, Harvard Medical School,
Boston, MA.
Incidence of Stridor in a Neonatal Intensive Care Unit (NICU) After
the Use of Uncuffed and MicroCuff® Tracheal Tubes: A Retrospective
Review
In our institution neonatologists use only uncuffed tracheal tubes to
intubate the tracheas whereas anesthesiologists have recently begun to use
MicroCuff® tracheal tubes (TT). Neonates who developed post-extubation
stridor were more premature and had reduced birth weight their tracheas
were intubated for longer and they required multiple tracheal intubations
compared with neonates who did not develop stridor. The incidence of
stridor in neonates who had uncuffed TT 7.7% was 2.5 fold less than that in
neonates who had MicroCuff® TT (17.8%). Madhankumar Sathyamoorthy
M.B. B.S., Jerrold Lerman, M.D., Rajeshri Asariparampil, M.B. B.S.,
Satyan Lakshminrusimha, M.D., University of Mississippi Medical Center,
Jackson, MS, Neonatology, Women and Children’s Hospital of Buffalo,
SUNY at Buffalo, NY.
PD A1200
Upper Airway Morphology in Children with Down Syndrome Versus
Children With Normal Airway Under Dexmedetomidine
Increasing doses of Dexmedetomidine showed significant upper airway
dimensions reduction using Magnetic Resonance Cine Imaging in children
with Down’s syndrome and a history of obstructive sleep apnea compared
to children with normal upper airway. These changes are significant at the
narrowest points in the nasopharyngeal and retroglossal airways. Rajeev
Subramanyam, M.D., Robert Fleck, M.D., John McAuliffe, M.D., M.B.A.,
Mario Patino, M.D., Megan Schmitt, M.D., Mohamed Mahmoud, M.D.,
Anesthesia, Radiology Cincinnati Children’s Hospital, OH.
NA Neuroanesthesia
PN Pain Medicine
29
PD A1201
An Examination of Child Temperament as a Predictor of Parental
Postoperative Analgesic Administration
Studies have identified misconceptions regarding analgesic use as a predictor
of analgesic administration and have shown an association between child
temperament and self-reported pain after surgery. To date no study has
included all these variables in one model. Accordingly the purpose of this
study was to examine children’s temperament as a predictor of analgesics
administered by parents following outpatient surgery after controlling for
parental misconceptions regarding pain medication for children. Sheeva
Zolghadr, B.S., Michelle A. Fortier, Ph.D., Zeev N. Kain, M.D., M.B.A.,
Department of Anesthesiology and Perioperative Care, University of
California Irvine, Orange, CA.
PO04-4BCLINICAL CIRCULATION
SATURDAY, OCTOBER 12| 11:00 A.M.-12:00 P.M.
ROOM 104-AREA A
CA A1202
Optimization of Cardiovascular Function and Volume Therapy in
Complete Cytoreductive Surgery (CRS) Combined With Intra Peritoneal
Chemohyperthermiia (HIPEC)
This is a prospective and observational study concerning 8 successive
patients undergoing CRS +/- HIPEC irrespective of the indications. The aim of
this study is the determination of reliable markers for vascular filling. Rachid
Attof, M.D., Hospitalices Civils de Lyon, France.
Preoperative Estimated Glomerular Filtration Ratio (eGFR) Predicts
Hemodynamic Responses to Anesthesia Induction in Middle-Aged to
Elderly Patients
Patients with decreased eGFR are susceptible to high blood pressure in
response to direct laryngoscopy and tracheal intubation. Atsushi Kohjitani,
D.D.S., Masaaki Miyata, M.D., Ph.D., Keiko Yanagibashi, D.D.S., Sachi
Ohno, D.D.S., Akina Tohya, D.D.S., Kazuna Sugiyama, D.D.S., Dental
Anesthesiology, Respiratory and Metabolic Medicine, Cardiovascular,
Kagoshima University Graduate School of Medical and Dental Sciences,
Japan.
CA A1207
Effects of Isoflurane on Tissue Doppler Profiles of Lateral Mitral
Annular Velocity in Cardiac Surgery Patients
Isoflurane below 1.6 inspired vol% reduces LV systolic function in a dosedependent manner during remifentanil-based anaesthesia for cardiac
surgery. Effort for reducing isoflurane dosage may be indicated in patients
with reduced myocardial functional reserve. Jungho Seok, Esq., M.D., TaeYop Kim, M.D., Chungsik Oh, M.D., Chung-Hee Joo, M.D., Hyunju Jung,
M.D., Seong-Hyop Kim, M.D., Woon-Seok Kang, M.D., Department of
Anesthesiology, Konkuk University Medical Center, Seoul, Republic of
Korea, The Catholic St. Mary’s Hospital, Seoul, Republic of Korea.
CA A1208
Analysis of Hemodynamic Changes Using LiDCOrapid™ in Patients
Undergoing Giant Ovarian Tumor Resection
We investigated hemodynamic changes using LiDCOrapidTM (LiDCO Sales
Office Cambridge, United Kingdom) in patients who underwent giant
ovarian tumor resection. Our results indicated that LiDCOrapidTM is useful
for management of patients in whom the hemodynamic state may change
dramatically. Tomohiro Chaki, M.D., Naoyuki Hirata, M.D., Ph.D., Daisuke
Maruyama, M.D., Michiaki Yamakage, M.D., Ph.D., Department of
Anesthesiology, Sapporo Medical University School of Medicine, Japan.
Changes in Blood Volume and Colloid Osmotic Pressure During Fluid
Absorption in Patients Undergoing Endoscopic Urosurgery
Recognizing the exact change in circulating blood volume (BV) is important
perioperative concerns but there is no standard method of evaluating BV.
We assessed whether measurement of the dilution of naturally occurring
intravascular components such as plasmacolloid osmotic pressure
(COP) total protein (TP) albumin (Alb) andhematocrit (Hct) could be
used as measures of changes in BV. Changes in BV calculated using the
four hemodynamic markers and their correlation with waterbalance were
compared using Pearson’s correlation coefficient and Bland-Altmananalysis.
COP was the most useful marker as measures of change in BV. Hct was not
estimate minute changes in BV exactly. Kaori Yagi, M.D., Chihiro Kamagata,
Ph.D., Atsuhiro Sakamoto, Ph.D., Anesthesiology and Pain Medicine,
Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
CA A1204
CA A1209
CA A1203
The Association of Intraoperative Blood Lactate Concentrations With
Outcomes in Adult Cardiac Surgery Patients Required Cardiopulmonary
Bypass
This is retrospective study to study the association of intraoperative lactate
levels and patients’ outcome in adult cardiac surgery patients. Maximum
lactate levels during surgery was significantly associated with ICU free days
at postoperative day (POD) 28 (r=-0.30 p=0.01). Such an association was
dominantly seen in maximum lactate level after CPB (r=-0.31 p=0.01)
but not in before and during CPB (p=0.13 p=0.14) Even after adjusted
relevant confounders including euro score maximum lactate after CPB was
independently associated with decreased ICU free days at POD 28. Nana
Furushima, M.D., Junichi Araki, M.D., Daisuke Ono, M.D., Yuriko Nakada,
M.D., Moritoki Egi M.D., Kiyoshi Morita, M.D., Anesthesiology, Kobe Red
Cross Hospital, Kobe-City, Japan, Anesthesiology, Okayama University
Hospital, Japan.
CA A1205
Catecholamine Concentrations During and After Retroperitoneoscopic
Adrenalectomies
During surgery for pheochromocytoma the release of catecholamines can
lead to excessive blood pressure increases. To compare this pathological
stress response to physiological stress plasma metanephrine concentrations
were measured together with hemodynamic variables in patients with
pheochromocytoma incidentaloma and physicians perioperatively. There
were significant catecholamine concentration increases in all groups but
the increase in pheochromocytoma patients was 30 times higher and
normalized at the time in the recovery room. Harold T. Groeben, M.D., Laura
Schulze, Violeta Brunkhorst, Piero Alesina, M.D., Martin K. Walz, M.D.,
Anesthesiology, Surgery, Kliniken Essen-Mitte, Germany.
30
CA A1206
Is Inotropic Drugs Associated With Perioperative Atrial Fibrillation?
Perioperative atrial fibrillation (PAF) is the most frequent complication that
occurs after cardiovascular surgery. The incidence of cardiovascular events
such as cerebral infarction and heart failure increases by twofold in the
presence of chronic atrial fibrillation (AF). We evaluated perioperative risk
factors in 221 patients who underwent elective coronary artery bypass graft
or valvular surgery and are in sinus rhythm. Olprinone is an independent
risk factor for postoperative AF after cardiac surgery. Atsushi Yoshikawa,
M.D., Takeshi Omae, M.D., Yuichi Kanmura, M.D., Sakiko Kawabata
M.D., Kumiko Yoshikawa M.D., Toshiro Fujimoto, M.D., Anesthesiology,
Fujimoto General Hospital, Miyakonojo, Japan, Anesthesiology,
Kagoshima University, Japan.
PO05-2BCLINICAL NEUROSCIENCES - MONITORING THE CENTRAL
NERVOUS SYSTEM
SATURDAY, OCTOBER 12 | 11:00 A.M.-12:00 P.M.
ROOM 104-AREA B
NA A1210
SEEG-fMRI A Novel Promising Method for Identifying Seizure Focus in
Medically Retractable Epilepsy
SEEG-fMRI is a novel method for identifying seizure foci. Anesthetic
considerations including best method of anesthesia SEEG monitoring
and functional MRI has to be determined. Rafi Avitsian, M.D., Stephen
E. Jones, M.D., Ph.D., Myron Zhang, B.A., Juan Bulacio, M.D., Pallab
Bhattacharyya, Ph.D., Rei Enatsu, M.D., Ph.D., Imad Najm, M.D., Dileep
Nair, M.D., Michael Phillips, M.D., Gonzalez-Martinez Jorge, M.D., Ph.D.,
Anesthesiology and Neurological Institutes, Imaging Institute, Epilepsy
Center, Cleveland Clinic Foundation, OH.
NA Neuroanesthesia
PN Pain Medicine
NA A1216
NA A1212
NA A1217
Temperature of Dominant Versus Nondominant Cerebral Hemispheres:
Can a Difference be Detected via the Brain Temp Tunnel?
Monitoring brain temperature with a Brain Temperature Tunnel sensor in the
superomedial orbit identified higher temperature emanating for the dominant
hemisphere of 45 right-handed and 10 left-handed subjects. Trevor M.
Banack, M.D., I-Hsun Liang, M.D., Valeria Gianaroli, M.D., Siqin Nie
M.D., Diana Nordquist, M.D., David G. Silverman, M.D., Anesthesiology,
Yale University School of Medicine, New Haven, CT.
The Effect of Sitting Position on Regional Cerebral Oxygen Saturation
and Cardiac Output in Neurosurgical Patients
“The effect of sitting position on regional cerebral oxygen saturation
(rSO2/StO2) and the relationship of global hemodynamics and regional
hemodynamicis not yet clear. Therefore, rSO2/StO2 and cardiac output were
assessed in patients undergoing hemodynamic challenge consisting in sitting
position.” Dorothea Closhen, M.D., Frank Hagen, M.D., Tilman Gooeck,
Student, Patrick Schramm, M.D., Kristin Engelhard, Ph.D., Irene Tzanova,
M.D., Department of Anesthesiology, Johannes Gutenberg University
Medical Center, Mainz, Germany.
NA A1213
Effect of Application of an Impedance Threshold Device on Low
Frequency Oscillations in Cerebral Near Infrared Spectroscopy
Waveforms in Spontaneously Ventilating Volunteers
The NIRS waveform appears to demonstrate respiratory variation similar to
that noted in the traditional photoplethsmography this work demonstrates
that respiratory variation in cerebral NIRS and PPG waveforms do not appear
to be related. However after the application of an impedance threshold
device changes in the magnitude of respiratory variation in cerebral NIRS
waveforms are related to changes in the magnitude of respiratory variation
in PPG waveforms. Low frequency oscillations in NIRS waveforms may be
related to fluid responsiveness after volume administration and deserve
further investigation. Douglas Colquhoun, M.B., Ch.B., Kimberly B. Naden,
B.A., Robert H. Thiele, M.D., Department of Anesthesiology, School of
Medicine, University of Virginia, Charlottesville, VA.
NA A1214
Influence of Circulating Asymmetric Dimethylarginine and Arginine
Concentrations on Cerebrovascular CO2 Reactivity During General
Anesthesia in Patients With Chronic Renal Failure We investigated the effect of blood urea nitrogen (BUN) and circulating
endogenous nitric oxide synthase inhibitor, asymmetric dimethylarginine
(ADMA) and arginine (Arg) concentrations on cerebrovascular CO2 reactivity
(CO2R) in patients with chronic renal failure (CRF) during isoflurane-nitrous
oxide anesthesia. A positive correlation between BUN and baseline cerebral
blood flow velocity was observed. CO2R correlated negatively with BUN and
Arg. No relationship was evident between CO2R and ADMA. Not ADMA but
some cerebrovascular dilation factors including Arg may contribute to the
impairment of CO2R. Kazuyoshi Ishida, M.D., Yasuhiko Iida, M.D., Koji
Utada, M.D., Atsuo Yamashita, M.D., Masato Uchida, M.D., Satoshi
Yamashita, M.D., Kiyotaka Shiramoto, M.D., Mishiya Matsumoto, M.D.,
Anesthesiology, Yamaguchi University Graduate School of Medicine Ube,
Japan.
NA A1215
Cerebral Blood Flow Measurement Using Near Infrared Spectroscopy
in Cerebral Endarterectomy
Recently, near-infrared spectroscopy (NIRS) with high accuracy has
developed, which enables to measure regional cerebral blood flow by
injection of indocyanine green. We conducted to measure the regional
cerebral blood flow derived from NIRS during carotid endarterectomy. Blood
flow index (BFI) of diseased side significantly decreased during carotid cross
clumping compared to the level of pre carotid cross clamping. (from0.15±
0.047 μmol/l/s to 0.096± 0.042 μmol/l/s) (p<0.01) BFI as regional cerebral
blood flow of the diseased side significantly decreased during clamping the
common carotid artery. Shinya Kato, M.D., Kenji Yoshitani, M.D., Yoshihiko
Ohnishi, M.D., Anesthesiology, National Cerebral and Cardiovascular
Center, Suita, Japan.
Are Vagal Stimuli Detected by the Analgesia Nociception Index Monitor
During Surgery of Cerebello-Pontine Angle Tumor? The analgesia and nociception index (ANI) monitor is based on
parasympathetic tone monitoring. This device can also detect direct
indvertent vagal stimulation during surgery of cerebello-pontine angle tumors.
Florian Robin, M.D., M. Sesay, M.D., Barbara Kolanek, M.D., Delphine
Pena, M.D., Mahira Penna, M.D., Karine Nouette-Gaulain, M.D., Ph.D.,
SAR III - Neurosurgery A Pellegrin University Hospital, Bordeaux, France.
Cerebral O2 Saturation During Trendelenburg Positioned Robotic
Surgery in a Diverse Surgical Sample
Cerebral tissue oxygen saturation (SctO2) was measured in 42 patients
undergoing Trendelenburg positioning for robotic surgery with insufflation and
eleven robotic surgical controls in the supine position without insufflation.
Cerebral desaturation occurred in 15 of 42 patients in the study group
and zero in the control group. Additionally the relationship between MAP
and SctO2 was inconsistent FiO2 and EtCO2 were generally strong direct
modifiers of SctO2 and SctO2 consistently declined with phenylephrine and
an increased with ephedrine. Despite cerebral desaturation episodes there
were no major adverse cerebral events at discharge. Laura A. Lahaye, M.D.,
Mario Grasso, C.R.N.A., Jeffrey Green M.D., Chuck Biddle, C.R.N.A.,
Anesthesiology, Virginia Commonwealth University, Richmond, VA.
NA A1211
PO08-4BEQUIPMENT MONITORING AND ENGINEERING TECHNOLOGY:
ROOM 104-AREA E
FA A1218
Effects of New Developed Mask for Novel Mask Holding on the Quality
of Mask Ventilation and the Pressure Between Face and Mask
We developed the new mask changing the shape into easier to hold with
novel mask ventilation technique; Grip and Lift (GL). Our results show that
MV holding the new mask with GL technique improves by inexperienced
residents as compared to MV holding the traditional mask with GL technique
or MV with EC technique. Our results further indicate that MV holding the
new mask with GL technique provides superior distribution of pressure on
the face. Mai Morimoto, M.S., Katsuya Tanaka, M.D., Michikko Kinoshita,
M.D., Noriko Kanbe, M.D., Ryosuke Kawanishi, M.D., Katsuyoshi Kume,
M.D., Naohiro Oshita, D.D.S., Yasuo M. Tsutsumi, M.D., Shuzo Oshita,
M.D., Faculty of Medicine, The University of Tokushima, Anesthesiology,
Institute of Health Biosciences, The University of Tokushima Graduate
School, Tokushima Prefectural Central Hospital, Japan.
FA A1219
Inhaled Anesthetic Agent-Vaporizer Mismatch: Management in Settings
With Limited Resources
We provide a safe and simply way to predict vaporizer output during vaporizeragent mismatch. Potential to improve safe practice in areas with limited
resources. Adam C. Adler, M.D., M.S., Neil R. Connelly, M.D., Abistanand
Ankam, M.D., Karthik Raghunathan, M.D. M.P.H., Anesthesiology,
Baystate Medical Center, Springfield, CT, Anesthesiology, Duke University,
Medical Center, Durham, NC.
FA A1220
A Power Failure of the Desflurane Vaporizer: Discontinuation of
Desflurane Delivery Could Be Unrecognizable With a Vaporizer Alarm
Battery Failure
A power failure of the desflurane vaporizer can occur during sharing of
electrical power via a multi-outlet strip for the AIMS equipment. If the
vaporizer itself cannot alert the failure due to the depleted alarm battery in
the vaporizer the complications of intraoperative awareness and inadequate
anesthesia can result. Preventive measures include an assignment of an
exclusive power outlet for the desflurane vaporizer periodic replacement and
testing of the alarm battery and vigilant monitoring of the desflurane levels on
the anesthesia monitor. Won K. Chee, M.D., Department of Anesthesiology,
The Montefiore Medical Center, Albert Einstein College of Medicine of
Yeshiva University, Bronx, NY.
NA Neuroanesthesia
PN Pain Medicine
31
FA A1221
PO11-1BHISTORY AND EDUCATION
Where is the Correct Position to Measure Inspiratory Humidity and
Temperature? Y-Piece Versus Inspiratory Limb
We aimed to assess the compatibility of the conventional location for
measuring the temperature and absolute humidiry of inspiratory gas between
the endotracheal tube and the Y-piece by comparing the temperature
and absolute humidiry at both limbs of the breathing circuit in the low
flow anesthesia. We recommend that the proper location to assess the
temperature and absolute humidiry of inspired gas during mechanical
ventilation is the inspiratory limb of breathing circuit. Jang-Eun Cho, M.D.,
Hye-Won Shin, M.D., Hye-Ja Lim, M.D., Seung-Zhoo Yoon, M.D., Korea
University, Anam Hospital, Seoul.
FA A1222
In Vitro Performance of 4 Different Brands of Prefilled CO2 Absorbent
Canisters With the Aisys®
Canisters differ in both the time until first appearance of FICO2 and the rate
of rise of FICO2 once breakthrough starts and both properties determine
clinical efficiency. With FICO2 = 0.5% the 2 NaOH free canister brands
are 30% less efficient (but they have the advantage of producing neither
compound A nor CO). Our analysis ignores the efficiency per amount of
fresh granule which may be relevant when discussing the cost-efficiency of
refillable canisters. Andy De Baerdemaeker, M.D., Sofie De Cooman, M.D.,
Jan Poelaert, M.D., Ph.D., Rik Carette, M.D., Tom Van Zundert, M.D., Jan
FA Hendrickx, M.D., Ph.D., Andre M. De Wolf, M.D., Anesthesiology, CCM
OLV Hospital, Aalst, Belgium, St. Jan Hospital, Brussels, Anesthesiology,
CCM, Free University Brussels/VUB, Belgium, Northwestern University
Chicago, IL.
FA A1223
Continuous Measurement of the Intracuff Pressure of Cuffed
Endotracheal Tubes in Spinal Surgery Patients
This prospective study was conducted to evaluate the intracuff pressure of
cuffed endotracheal tubes continuously over time in patients undergoing
posterior spinal fusion using an invasive pressure monitoring setup. We
observed that the intracuff pressure fluctuated over a wide range and was
more than 30 cmH2O in several patients. Hiromi Kako, M.D., Senthil G.
Krishna, M.D., Joseph D. Tobias, M.D., Department of Anesthesiology and
Pain Medicine, Nationwide Children’s Hospital, Columbus, OH.
PI A1226
Laryngeal Versus Endotracheal Tube for Airway Management Training
of Intensive Care Trainees
We evaluated in intensive care trainees (all non-anesthesiologists) the
success rate and time for intubation of patients with an endotracheal versus
laryngeal tubes. The success rate with laryngeal tubes was significantly
higher and the time for intubation faster compared to intubations with
an endotracheal tube. We recommend to include the use of supraglottic
devices in the airway management training of intensive care trainees. Harold
T. Groeben, M.D., Anna Grzesik, Dirk Muller, M.D., Fuat Saner, M.D.,
Anesthesiology, Kliniken Essen-Mitte, Surgery, Universityersitat Duisburg,
Essen, Germany.
PI A1227
Will Residents Use Tablet Computers to Enhance the Educational
Experience?
Tablet computers may enhance residency educational experiences.
Residency education curriculum must change to maximize the benefits of
this new technology. Marcia B. Henry, Ph.D., Julia Barnhill, Ph.D., Michael
Yarborough, M.D., Jonathan Weed, M.D., Frank Rosinia, M.D., Sabrina
Bent, M.D., M.S., Anesthesiology, Tulane University, New Orleans, LA.
PI A1228
The Evolution of Informed Consent: What It Means for
Anesthesiologists Today
A historical overview of the origination of informed consent in medicine and
its implications in the field of anesthesiology today is presented. Focus is
placed on current requirements based on The Joint Commission and the
Centers for Medicare & Medicaid Services. Legality of informed consent for
anesthesia is also discussed. Sarah K. Herbst, M.D., Robert Lagasse, M.D.,
Anesthesiology, Yale-New Haven Hospital, CT.
PI A1229
Face-Mask General Anesthesia Using Jaw Elevating Device (JED®)
We evaluated the validity and the safety of facemask general anesthesia
using jaw elevating device (JED® HYPNOZ Therapeutic Devices Inc.). We
recruited 59-adult patients with normal upper airway anatomy planned for
elective surgery. The anesthesia was standardized by TIVA. The facemask
was fixed by the harness and airway management was performed by JED.
Sufficient ventilation was able to be obtained except four patients. There
were no serious complications. Facemask general anesthesia using JED can
be performed safely. We can realize hands-free facemask general anesthesia
management using JED. Daisuke Ono, M.D., Yuki Watanabe, M.D., Yuriko
Nakada, M.D., Yasuo Hori, M.D., Ryo Kanzaki, M.D., Nana Furushima,
M.D., Ryu Nakamura, M.D., Takashi Tsukiji, M.D., Junichi Araki, M.D.,
Department of Anesthesiology, Kobe Red Cross Hospital, Japan.
Creating a Global Health Corps: What do U.S. Resident
Anesthesiologists and Surgeons Offer Abroad?
Our study presents a first-time national sample of US residents across
surgery-related specialties and geographic regions with a high level of interest
in international service. Positive findings of resident workforce assets and
academic exchange potential support the prospect of a global health corps.
The next step is to increase partnering between LMIC programs and a
willing workforce of resident teachers. Aruna M. Kamath, M.D., Nicholas J.
Kassebaum, M.D., Peter J. Dunbar, M.B., Ch.B., Ramana K. Naidu, M.D.,
Ryan J. Jense, M.D., Anesthesiology, Yale University School of Medicine,
New Haven, CT, Pediatric Anesthesiology and Pain Medicine, Institute
for Health Metrics & Evaluation, Seattle Children’s Hospital; University
of Washington, Health Services University of Washington School of
Medicine & School of Public Health, Anesthesiology and Pain Medicine,
Global Health, University of Washington, Seattle, WA, Anesthesiology and
Perioperative Care, University of California San Francisco, CA.
FA A1225
PI A1230
FA A1224
Effect of Increasing Airway Pressures on the Pressure of the
Endotracheal Cuff
The aim of the study was to test the hypothesis that high airway pressures
(AWp) are transmitted to the cuff of the endotracheal tube (ETT) and that
this effect is modified by the size of the ETT. Our simulation data reveal that
increasing the pressure in the airway during mechanical ventilation results in
a significant increase in the pressure of the ETT cuff. This effect is modified
by the relationship between the diameters of the trachea and the ETT.
Despite a baseline ETT cuff inflation pressure aimed to protect the tracheal
mucosa (<30 mm Hg) large increases in the AWp during certain anesthesia
conditions may pose the trachea at risk of ischemic complications. Eric B.
Rosero, M.D., M.S., Miguel A. Prada, M.D., Tri Phung, M.D., N. Martin
Giesecke, M.D., Anesthesiology and Pain Management, UT Southwestern
Medical Center, Dallas, TX.
32
ROOM 104-AREA C
Responding to Student-Identified Learning Needs During the
Anesthesia Clerkship Using a Simulation Curriculum
The students surveyed in this study reported a decreased confidence in their
ability to perform basic tasks required in the management of acutely unstable
patients. A short simulation course significantly improved the students’
perceived competence in the management of emergencies. Alina Lazar,
M.D., Igor Tkachenko, M.D., Ph.D., Catherine Bachman, M.D., University
of Chicago, IL.
NA Neuroanesthesia
PN Pain Medicine
A Systematic Approach to Curriculum Development for Training on an
Anesthesia System in an Austere Setting
We used a systematic approach for curriculum development with the use
of the Universal Anaesthesia Machine an anesthesia machine designed for
austere settings in 2 hospitals in Sierra Leone. We used this approach to
gauge the effectiveness of our curriculum. Benjamin H. Lee, M.D., M.P.H.,
E. V. Jackson Jr., M.D., MBA, R. Koka, M.D. M.P.H., H.G. Taylor, M.D.,
M.P.H., M. Koroma, M.B., B.S., A.M. Chima, M.D., M.P.H., M.A. Rosen,
Ph.D., O.U. Ogbuagu, M.D., M.P.H., M.K. Marx, M.S.N., J.B. Sampson,
M.D., Anesthesia and Critical Care Medicine, Faculty Centers and
Academic Programs, Armstrong Institute of Patient Safety and Qualit,
Johns Hopkins School of Medicine (JHUSOM) Baltimore, MD, Value
Institute Christiana Care Health System, Newark, DE, Anesthesia Princess
Christian Maternity Hospital, Freetown, Sierra Leone.
PI A1232
Errors Simulation Versus Pre-Training Evaluation and Feedback: The
Effect on Skill Acquisition of Basic Life Support in Medical Students
Pre-training assessment is a good tool to identify trainees’ weakness before
basic life support (BLS) training. Trainees’ errors observed in pre-training
assessment could be delivered as feedback to facilitate followed training.
However pre-training assessment was time-consuming. And to show trainees’
errors as feedbacks in a group might face the conflict of confidentiality. In
this study we demonstrated that showing simulated errors (performed by
an actor) to trainees as feedbacks before training instead of trainees’ own
errors observed in pre-training assessment had the same beneficial effect as
pre-training assessment and feedback on skill acquisition of BLS. Qi Li, M.D.,
Rong-hua Zhou, M.D., Hong Xiao, M.D., Anesthesiology, West China
Hospital of Sichuan University, Chengdu.
PI A1233
Simulation Based Training Improves Students’ Performance in
Anesthesiology
This study reveals that students trained by Simulation Based Training before
clinical apprenticeship in the OR gain a better assessment by the mentoring
attending anesthesiologists than those not being trained. Thomas Ott, M.D.,
Tobias Limbach, M.D., Philip Gottschling, M.D., Tobias Gehrig, M.D.,
Alexander Bentley, M.D., Sandra Kurz, M.D., Irene Schmidtmann, Ph.D.,
Hendrik Gervais, Ph.D., Gunther Pestel, Ph.D., Anesthesiology, Institute
of Medical Statistics and Documentation, Johannes Gutenberg-University
Medical Center Mainz, Germany.
PO15-1BPEDIATRIC ANESTHESIA: GENERAL PEDIATRICS
ROOM 104-AREA D
PD A1234
Cephalosporin Cross-Reactivity With Penicillin Allergy What is the Risk
in Pediatrics?
Perioperative administration of antibiotics is important to limit the risk of
surgical site infections. We hypothesize that the risk of cross-sensitivity
of administering cephalosporins for presurgical prophylaxis in registered
penicillin-allergic pediatric patients is lower than the literature reported 10%.
Ralph J. Beltran, M.D., Marla Freeman, M.D., Hiromi Kako, M.D., Joseph
Tobias, M.D., Anesthesiology, Nationwide Children’s Hospital/Department
of Anesthesiololgy, New Albany, OH, Anesthesiology, Nationwide
Children’s Hospital, Columbus, OH.
PD A1236
Validation of the ASA OSA Prediction Tool in Children
In 2006 the ASA developed a tool to predict obstructive sleep apnea (OSA)
in adults and children. It consisted of 16 pedictor variables related to
physical stature nocturnal airway obstruction and unusual daytime behavior.
We compared tool performance and validity/reliability of predictor variables to
the gold standard of a sleep study administered to 329 children. We found
the tool had limited usefulness to screen for moderate-severe OSA (MSOSA).
Only loud snoring (heard through a door) and observed pauses were found to
be both reliable and predictive of MSOSA in children. Kimmo Murto, M.D.,
Sherri Katz, M.D., Carol Bradbury, M.D., Kelly-Ann Ramakko, B.Sc., Nick
Barrowman, Ph.D., Gregory L. Bryson, M.D., Children’s Hospital of Eastern
Ontario Research Institute, Children’s Hospital of Eastern Ontario, The
Ottawa Hospital Research Institute, ON, Canada.
PI A1231
PD A1237
A Novel Method for Ultrasound Guided Radial Arterial Catheterization
in Pediatric Patients
A radial artery depth of 2-4 mm provided optimal visualization for ultrasoundguided catheterization in pediatric patients; increasing the depth to 2-4
mm by subcutaneous saline injection improved the catheterization time
and success rate. Yoshinobu Nakayama, M.D., Yasufumi Nakajima, M.D.,
Ph.D., Daniel I. Sessler, M.D., Jun Takeshita, M.D., Satoru Ogawa,
M.D., Masayuki Shibasaki, M.D., Ph.D., Toshiki Mizobe, M.D., Ph.D.,
Anesthesiology and Intensive Care, Kyoto Prefectural University of
Medicine, Japan, Department of Outcomes Research, Cleveland Clinic,
OH.
PD A1238
Is Ultrasound-Guided Nerve Block Really Useful in Day-Case Pediatric
Hernia Repair Surgery?
We performed a prospective randomized double-blind study to evaluate the
utility of ultrasound-guided ilioinguinal/iliohypogastric nerve (IHN) block for
perioperative analgesia in pediatric day-case open inguinal hernia repair
and compared IHN block and non-IHN block group. Both groups were
administered rectal acetaminophen and none received intraoperative opioids.
IHN block permitted use of a significantly lower amount of sevoflurane and
provided more effective analgesia during the operation. However non-IHN
group provided postoperative pain relief and comfort at same level to that
provided by IHN block. Nobuko Ohashi, M.D., Sadahei Denda, M.D., Ph.D.,
Department of Anesthesiology, Niigata University Graduate School of
Medical and Dental Sciences, Niigata City General Hospital, Japan.
PD A1239
The Quality of Tracheal Intubation and Incidence of Complications in
Pediatric Patients Receiving Sevoflurane Anesthetic Regimens Without
Muscle Relaxants: A Meta-Analysis of Randomly Controlled Trials
Based on continued physician equipoise the objective of this study is to:
1. Review the current literature regarding Sevoflurane anesthetic regimens
without muscle relaxants in the pediatric population. 2. Compare the quality
of tracheal intubations and adverse event rates in these patients. 3. Use
sensitivity analysis to determine which factors may improve the quality of
tracheal intubation with Sevoflurane in pediatric patients and reduce the
incidence of anesthesia related complications. The incidence good airway
visualization with the use of Sevoflurane appears highly dependent on
regimen and is improved with pre-medication and remifentanyl. Christian G.
Samuelson, M.D., R. Seth Baker, M.D., Brian J. Gelpi, M.D., Hoa N. Luu,
M.D., Anesthesiology, LSU Health Sciences Center Shreveport, LA.
PD A1240
PD A1235
Peripheral Blood Cells After Nitrous Oxide Anesthesia in Adolescents
Nitrous oxide exposure for up to eight hours does not appear to be
associated with clinically significant megaloblastic anemia in adolescents
undergoing major spine surgery. However the postoperative increase in
anisocytosis-index in two patients may have been related to their nitrous
oxide exposure and subsequent vitamin B12 inactivation. Andreas Duma,
M.D., Christopher Cartmill, Student, Jane Blood, B.S.N., Anshuman
Sharma, M.D., Evan Kharasch, M.D., Ph.D., Peter Nagele, M.D., M.S.,
Department of Anesthesiology, Washington University, St. Louis, MO.
Making Decisions About Intravenous Acetaminophen in Tonsillectomy:
Cost-Effectiveness Issues
The combination of intravenous acetaminophen and opioids is more
effective and less costly than opioids alone in Tonsillectomy with or without
adenoidectomy. With this pilot data and the model assumptions we
recommend use of intravenous acetaminophen for tonsillectomy. Rajeev
Subramanyam, M.D., Anna Varughese, M.D., M.P.H., C. Dean Kurth,
M.D., Jessica Prim, B.S., Tara Buesking, B.S., Mark Eckman, M.D.,
M.S., Anesthesia, Cincinnati Children’s Hospital, OH, Internal Medicine,
University of Cincinnati, OH.
NA Neuroanesthesia
PN Pain Medicine
33
PD A1241
Pediatric Airway: Does the Internal Shape Match the External
Appearance of the Airway?
Pediatric airway has been in much debate in recent years. Studies have
challenged the cone-shape of airway. The present study demonstrates
that the external shape of the airway is conical. However the internal
physical characteristics of the airway shows a more transitional change in
internal size than a conical shape. This observation might help clinicians
understand better the relationship between anatomical shape of the airway
in regards to anesthesia management of children. Tariq Wani, M.D.,
Mahmood Rafiq Malik, M.D., Joseph D. Tobias, M.D., Bruno Bissonette,
M.D., Anesthesiology, Nationwide Children’s Hospital, Columbus, OH,
Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
CA A1242
Connection From Left Main Coronary Artery to Left Sinus of Valsalva by
Transesophageal Echocardiography in Adult-Type Bland-White-Garland
Syndrome
Origination of the left main coronary artery (LMCA) from the pulmonary
artery (PA) known as Bland-White-Garland syndrome (BWGS). A 43-yearold female patient with an asymptomatic heart murmur was diagnosed
with mitral regurgitation and BWGS. Preoperative cardiac catheterization
did not reveal flow of the LMCA into the left sinus of Valsalva. The patient
underwent uncomplicated reimplantation of the LMCA using an artificial graft
into the aortic root and mitral valve (MV) repair. Postoperative TEE showed
reimplantation of the LMCA orifice and the color flow of the LMCA from the
left sinus of Valsalva owing to the improvement in cardiac function by the
artificial graft and MV repair. Kazuyoshi Ando, M.D., Mitsuharu Kodaka,
M.D., Keiko Kurokawa, M.D., Keiko Okamura, M.D., Junko Ichikawa, M.D.,
Makiko Komori, M.D., Anesthesiology, Tokyo Women’s Medical University
Medical Center, East Tokyo, Japan.
CA A1243
Alterations in Myocardial Strain and Strain Rate During Aortic Valve
Replacement
The immediate effect of removal of a stenotic aortic valve on myocardial
function is unclear. Our goal was to assess the effect of aortic valve
replacement on intraoperative left ventricular function using myocardial strain
and strain rate measured with speckle-tracking echocardiography. Patients
following aortic valve replacement demonstrated improved intraoperative left
ventricular function. Andra I. Duncan, M.D., Babak Kashy, M.D., Andrej
Alfirevic, M.D., Daniel I. Sessler, M.D., James Thomas, M.D., Department
of Cardiothoracic Anesthesia, Department of Outcomes Research,
Department of Cardiovascular Medicine, Cleveland Clinic, OH.
Modified Live xPlane Imaging Allows Cross Sectional Evaluation of
Pulmonary Valve by Transesophageal Echocardiography
Perioperative assessment of pulmonic valve (PV) by transesophageal
echocardiography can be challenging due to its anterior location in the chest.
Guidelines focusing on PV assessment is limited with no description for
short-axis evaluation. Matrix array probes allow use of Xplane imaging with
vertical tilt which helps to evaluate PV in its short axis. Use of Color Doppler
to assess flow character and planimetry to calculate valve area in the Xplane
mode can potentially provide further beneficial information regarding valve
assessment. We describe a simple protocol to achieve this although further
validation is required. Sanjay Dwarakanath, M.B., B.S., Mary E. Arthur,
M.D., Anesthesiology and Perioperative Medicine, Georgia Regents
University, Augusta, GA.
34
Effect of General Anesthesia and Positive Pressure Ventilation on
Echocardiographic Markers of Diastolic Function
Echocardiographic measures of diastolic function showed a decrease after
general anesthesia and positive pressure ventilation in cardiac surgery
patients with varying degrees of diastolic dysfunction. Both flow and tissue
Doppler measurements as well as left atrial volume decreased with the
expected decrease in preload associated with anesthesia with PPV. Left atrial
strain also decreased with maintenance doses of inhaled anesthetic. TTE
and TEE derived measurements obtained under the same hemodynamic
conditions showed varying degrees of correlation with the greatest variability
seen in tissue Doppler. Kimberly J. Howard-Quijano, M.D., Michael Hall,
M.D., Melissa McCabe, M.D., David Liu, B.S., Aman Mahajan, M.D.,
Ph.D., Anesthesiology, UCLA, Los Angeles, CA.
CA A1246
ROOM 104-AREA E
CA A1244
CA A1245
Preoperative Three-Dimensional Strain Imaging is an Independent Risk
Factor for Worsening Outcomes After Coronary Artery Bypass Surgery
This prospective study shows that transthoracic 3D strain is an accurate and
reliable measure of cardiac function in cardiac surgical patients. 3D strain
measurements of left ventricular function correlated better with volumetric
ejection fractions as compared to 2D strain and were better determinants
of LV dysfunction. Global area strain was the most accurate of all the strain
indices. Preoperative strain is an independent risk factor for worsening
postoperative outcomes in CABG patients and may be useful as a future
risk stratification tool. Kimberly J. Howard-Quijano, M.D., Einat Mazor, Ali
Salem, M.D., Charles Barkulis, M.D., Jennifer Scovotti, M.A., Jonathan
Ho, M.D., Aman Mahajan, M.D., Ph.D., Anesthesiology, UCLA, Los
Angeles, CA.
CA A1247
Trendelenburg Position Does Not affect Left Ventricular Volumes or
Mechanics
Trendelenburg position is often used to treat intraoperative hypotension.
We evaluated whether hemodynamics left ventricular volumes and left
ventricular mechanics were improved with Trendelenburg position in patients
having aortic valve replacement for aortic stenosis. Trendelenburg position
did not result in a clinically significant difference in left ventricular volumes
or mechanics. Babak Kateby Kashy, M.D., Andra E. Duncan, M.D., Shiva
Sale, M.D., Daniel I. Sessler, M.D., James Thomas, M.D., Outcomes
Research, Anesthesiology Institute, Cleveland Clinic, OH.
CA A1248
Focused Transthoracic Echocardiography (TTE) Aids in Hemodynamic
Management of Patients in the Post-Anesthesia Care Unit
Focused transthoracic echocardiography (TTE) performed by anesthesiologists
aids in the diagnosis and managment of hypotension hypoxia and
myocardial ischemia in the post-anesthesia care unit (PACU). Jacques
Neelankavil, M.D., Kimberly Howard-Quijano, M.D., Stacy Krueth,
M.D., Mark Goldman, B.S., Aman Mahajan, M.D., UCLA, Department
of Anesthesiology, Los Angeles, CA, David Geffen School of Medicine at
UCLA, Los Angeles, CA.
CA A1249
Echocardiographic Evaluation of Mitral Inflow Hemodynamics After
Double Orifice Repair
Our study demonstrates that while the differences between orifice areas and
the maximum velocities across the asymmetric orifices after a double-orifice
MVP are statistically significant the corresponding difference in trans-orifice
pressure gradients is unimportant in regards to clinical assessment. Thus
for practical purposes either orifice can be interrogated for the Doppler
echocardiographic determination of maximum velocity and calculated
pressure gradient following double-orifice MVP. Agnieszka Trzcinka, M.D.,
John A. Fox, M.D., Douglas C. Shook, M.D., Andrea H. Worthington, B.A.,
Stanton Shernan, M.D., Department of Anesthesiology, Perioperative and
Pain Medicine, Brigham & Women’s Hospital, Boston, MA.
NA Neuroanesthesia
PN Pain Medicine
Prognostic Profile of Intra-Abdominal Pressure in SICU Patients
Prognostic impact of intra-abdominal pressure and its derivative variables on
outcome of SICU patients was investigated in a prospective observational
study. The optimal cut-off values for IAP and APP were 12 and 60 mmHg
respectively. We drew a conclusion that IAP and its derivatives are useful
prognostic tests with APP having the maximum prognostic potential. Remi
V. Akopyan, M.D., Ph.D., Aram Shahinyan, M.D., Aren Panoyan, M.D.,
Department of Anesthesiology and Intensive Care, Anesthesiology and
Intensive Care, Ophthalmology Center After S. Malayan, Yerevan State
Medical University, Armenia.
Is the WHO Recommended Dose of Pralidoxime Effective in the
Treatment of Organophosphorus Poisoning - A Randomized DoubleBlinded and Placebo-Controlled Trial
The study suggests that add-on WHO-recommended Pralidoxime therapy
does not provide any benefit over atropine monotherapy. Adding Pralidoxime
does not seem to be beneficial as shown by Pawar et al 2006 and at the
same time does not result in increased mortality rates as shown by Eddleston
et al 2009. Our practice changed after completion of this study and it has
proven to be of significant benefit to patients who had to bear the expense
of the treatment. Showkat A. Gurcoo, M.D., Sumaya Syed, M.D., Waqar-Ul
Nisa, M.D., Ayaz Farooqi, M.D., Joseph D. Tobias, M.D., Tariq M. Wani,
M.D., Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical
Sciences, India, Anesthesiology and Critical Care, Sheri Kashmir Institute
of Medical Sciences, Srinagar, India, Anesthesiology, Nationwide
CC A1251
CC A1255
ROOM 104-AREA A
CC A1250
Gene Variants Influencing the Stress Response Not Head Injury
Predict Post-Concussive Symptom Severity After MVC
Post-concussive symptoms (PCS) traditionally attributed to minor traumatic
brain injury may be influenced by the function of stress response systems.
Among 830 individuals experiencing motor vehicle collision genetic variants
influencing stress system function but not head injury were associated
with vulnerability to PCS. Lauriane Auvergne B.S., Jacob C. Ulirsch, B.S.,
Andrey Bortsov, M.D., Ph.D., David A. Peak, M.D., Jeffrey S. Jones, M.D.,
Robert A. Swor, M.D., Robert M. Domeier, M.D., David C. Lee, M.D., Niels
K. Rathlev, M.D., Samuel A. McLean, M.D., University of North Carolina,
Chapel Hill, NC, Massachusetts General Hospital, Boston, Spectrum
Health Systems Butterworth, Grand Rapids, MI, William Beaumont
Hospital, Royal Oak, MI, St. Joseph Mercy Hospital, Ann Arbor, MI, North
Shore University, Manhasset, NY, Baystate Medical Center, Springfield,
MA.
CC A1252
Delirium in Intensive Care Unit: Abysmal Gap Between Actual
Prevalence and Psychiatric Referral for the Same
There is a huge mismatch between the incidence and prevalence of
delirium in ICU patients prospectively diagnosed with structured validated
instruments and the diagnosis of delirium in cases referred to psychiatry
mostly for abnormal behaviour. This gap needs to be narrowed down in order
to improve patient outcome. Debasish Basu, M.D., Sandeep Grover, M.D.,
Narayana Yaddanapudi, M.D., Siddharth Sarkar, M.D., Abhishek Ghosh,
M.D., Psychiatry, Anaesthesia & Intensive Care, Postgraduate Institute of
Medical Education & Research, Chandigarh, India.
CC A1254
PO06-1A CRITICAL CARE: OUTCOMES
Oral Intake and Mixed Venous Desaturation in Patients Undergoing
Fast-Track Cardiac Surgery
This prospective observational study found that transient and reversible
decrease of mixed venous oxygen saturation was found in 59% of the
subjects who resumed oral intake on the morning of 1st postoperative day
while none of the subjects who did not resume early oral intake. Yoshifumi
Kotake, M.D., Ph.D., Daisuke Toyoda, M.D., Keiko Tomichi, M.D., Shigeo
Shinoda, M.D., Ph.D., Anesthesiology, Toho University Ohashi Medical
Center, Tokyo, Japan.
CC A1256
Low Dose Atrial Natriuretic Peptide Provides Effective Renal Protection
From Acute Kidney Injury After Aortic Arch Surgery: A Randomised
Controlled Trial
The objective of this study was to evaluate whether a low dose intravenous
atrial natriuretic peptide (ANP) infusion prevents acute kidney injury (AKI) in
patients with normal preoperative renal function undergoing elective aortic
arch surgery requiring hypothermic circulatory arrest. Patients were randomly
assigned to receive either a continuous intravenous infusion of ANP at a fixed
dose of 0·0125 μg/kg/min or placebo. AKI developed in 30·0% of patients
who received ANP compared with 72·7% of patients who received placebo.
This study demonstrated that an intravenous infusion of low dose ANP is an
effective intervention for reducing the incidence of postoperative AKI and
appears to afford a degree of renal protection. Yosuke Mori, M.D., Ryoichi
Ochiai, M.D., Anesthesia Kawasaki Saiwai Hospital, Kawasaki, Japan,
Anesthesiology, School of Medicine, Toho University, Tokyo, Japan.
CC A1257
CC A1253
Characteristics Short and Long-Term Outcome of Patients Who Stayed
More Than 90 Days in the ICU: An Observational Study of 50 Cases
Characteristics short and long-term outcome of patients who stayed more
than 90 days in the ICU: an observational study of 50 cases Mortality at 6,
9, and 12 months after ICU admission was respectively 60%, 64% and 66%.
Only 40% of patients were discharged alive from the hospital COPD and heart
disease were significantly associated with a shorter survival time unlike age
or SAPSII score. Fouad Belafia, M.D., Charlotte Vannucci, M.D., Audrey
De Jong, M.D., Gerald Chanques, M.D., Ph.D., Boris Jung M.D., Ph.D.,
Samir Jaber, M.D., Ph.D., Saint Eloi University Hospital, Montpellier,
France.
Electroconvulsive Therapy as a Treatment of Protracted Refractory
Delirium in the Intensive Care Unit
Five cases of severe protracted refractory delirium in the intensive care unit
treated successfully with ECT. Rikke M. Nielsen, M.D., Karsten Olsen,
M.D., Anne Lauritsen, M.D., Anaesthesiology and Critical Care, Glostrup
Hospital, University of Copenhagen, Glostrup, Denmark.
PO07-2A DRUG DISPOSITION
ROOM 104-AREA B
FA A1258
Performance of NSRI or Pupillary Dilatation Reflex to Predict
Responses to Skin Incision
Pupillary Dilatation Reflex (after a calibrated tetanos) can predict motor or
laryngeal response to incision whereas Noxious Stimulation Response Index
(calculated from opioid and hypnotic concentrations) can predict motor or
hemodynamic response. Valerie Billard, M.D., Gaelle Bouroche, M.D.,
Anesthesia, Institut Gustave Roussy, Villejuif, France.
NA Neuroanesthesia
PN Pain Medicine
35
FA A1259
Early Reversal of Rocuronium-Induced Profound Neuromuscular Block
by Sugammadex in Pediatric Patients
This study clarified the reversibility and dose-dependency of sugammadex
administered 5 minutes after an intubating dose of 0.6 mg kg-1 rocuronium
in pediatric patients. The time to recover to a TOF ratio of 0.9 measured
at the adductor pollicis muscle was 160.5 (80.6) s 74.9 (37.4) s and
44.2 (26.3) respectively in the patients received 4, 8 and 16 mg kg-1
sugammadex. Even in padiatric patients sugammadex ensures to promptly
antagonize profound neuromuscular block. In emergency situations
sugammadex 16 mg kg-1 is recommended to rapidly restore neuromuscular
function. Atsuko Hirano, M.D., Tomomi Nishio, M.D., Saki Ishikawa, M.D.,
Chihiro Igarashi, M.D., Noriko Miyazawa, M.D., Ph.D., Shinichi Yamamoto,
M.D., Ph.D., Takahiro Suzuki, M.D., Ph.D., Tokyo Metropolitan Children’s
Medical Center, Department of Anesthesiology, Nihon University School of
Medicine, Tokyo, Japan.
FA A1260
A Solvent-free Lidocaine-Loaded Biodegradable Pellet -In Vitro and In
Vivo Studies
We developed a novel solvent-free method of manufacturing biodegradable
lidocaine-PLGA pellets to extend the duration of lidocaine and reduced
hypersensitivity for at least 24 hours in postoperative pain model without
any significant local or systemic toxicity. Yi-Chuan Kau, M.D., Shih-Jung Liu,
Ph.D., Department of Anesthesiology, Chang Gung Memorial Hospital,
Linkou, Taoyuan, Taiwan, Department of Mechanical Engineering, Chang
Gung University, Taoyuan, Taiwan.
Effect of Hematocrit Variation on Brain-Blood Partition Coefficient of
Xenon Measured by Computed Tomography
The brain-blood partition of Xenon (Xe) is inversely correlated with Hematocrit
(HCT) variations. This study offers the perspective of predicting Xe from
the HCT value. M. Sesay, M.D., Denis Gense De Beaufort, M.D., Amer
Chehab, M.D., Delphine Pena, M.D., Barbara Kolanek, M.D., Mahira
Penna, M.D., Patrick Tauzin-Fin, M.D., Vincent Dousset, Ph.D., Karine
Nouette-Gaulain, Ph.D., Anesthesiology, Radiology, Pellegrin University
Hospital, Bordeaux, France.
FA A1265
Pharmacokinetics and Pharmacodynamics of Rocuronium Delivered by
Target-Controlled Infusion in Patients With Obstructive Jaundice
To investigate the pharmacokinetic and pharmacodynamic profiles and
security of rocuronium TCI in patients with obstructive jaundice 60 patients
were assigned to group A (with severe obstructive jaundice n=20) group
B(with mild obstructive jaundice n=20) or group C (with normal liver
function). A twitch in TOF (T1) as a neuromuscular monitoring indicators.
As shown by our study rocuronium TCI is safe for patients with obstructive
jaundice while obstructive jaundice could produce a significant effect on
its pharmacokinetic and pharmacodynamic. Hui Xu M.D., Hui Shi M.D.,
Department of Anesthesiology, Tongji Medical College Huazhong
University of Science and Technology, Wuhan, China.
PO13-1A OUTCOMES AND DATABASE RESEARCH: RISK AND
PREDICTIMAL
ROOM 104-AREA C
FA A1266
FA A1261
Reversal of Neuromuscular Blockade With Sugammadex Based on the
Residual of Rocuronium in the Body
We evaluated the reversal of neuromuscular blockade (NMB) with
sugammadex which dose was calculated from the residual amount of
rocuronium. The residual of rocuronium was estimated using pharmacokinetic
simulation. Though residual-based reversal with sugammadex (4 times
the residual rocuronium) resulted in longer recovery time to train-of-four
of 0.9 than reversal with 2mg/kg of sugammadex recovery profile was
excellent. Smaller-than-recommended dose of sugammadex might be
sufficient to reverse NMB if the residual of rocuronium is provided. Tomotaka
Morita, M.D., Osamu Uchida, M.D., Satoshi Hagihira, M.D., Ph.D.,
Hiroyasu Terashima, M.D., Yuuji Fujino, M.D., Ph.D., Department of
Anesthesiology and Intensive Care, Osaka University Graduate School of
Medicine, Suita, Japan.
FA A1262
Pharmacodynamics of Propofol in Pigs: Determination of ke0
Following the previous development of a pharmacokinetic model for propofol
in pigs we now determined the constant of drug elimination (ke0) to be
able to predict the propofol concentration at the effect-site using the Total
Power of the EEG as measure of effect. Catarina S. Nunes, Ph.D., Aura
Silva, Ph.D., Pedro Amorim, M.D., Paula Guedes de Pinho, Ph.D., David
A. Ferreira, Ph.D., Anesthesiology, Service Centro Hospitalar do Porto,
Toxicology, REQUIMTE Faculdade de Farmacia da Universityersidade
do Porto, Porto, Portugal, CICV-Veterinary Sciences Research Center
Faculdade de Medicina Veterinaria, Universityersidade Lusofona de
Humanidades e Tecnologia, Lisboa, Portugal.
FA A1263
Development of an Interactive Mobile Application Based Simulator for
Total Intravenous Anesthesia
An application for Android OS was developed using an algorithm to calculate
manual infusion schemes suitable for volumetric infusion pumps based on
pharmacokinetic models. This application calculate infusion schemes for
remifentanil and propofol which provide an adequate correlation in relation
to the desired effect site concentrations with bias less than 5%. David
E. Ramirez Sr., M.D., Jose A. Calvache, M.D., M.S., Anesthesiology,
Universityersidad del Valle, Cali, Colombia, Cauca Universityersidad del
Cauca Popayan, Colombia.
36
FA A1264
The Comparison of Eagle Criteria Revised Cardiac Risk Index and
Portsmuth POSSUM Cardiac Risk Scoring Systems In Patients
Undergoing Cardiac Surgery
This study presents the retrospective evaluation of three cardiac risk scoring
systems in terms of predicting major cardiac complications after cardiac
surgery. Cigdem Cicekdag, M.D., Fatma Askar, M.D., Fusun Demir, M.D.,
Seden Kocabas, M.D., Anesthesiology and Reanimation, Ege University
Faculty of Medicine, Izmir, Turkey.
FA A1267
Incidence and Severity of Hypothermia in Patients Warmed With
Forced-Air During Non-Cardiac Surgery
Perioperative hypothermia is associated with morbid outcomes. Despite
active intraoperative warming redistribution hypothermia occurs which
makes patients at least transiently hypothermic. However, the magnitude and
duration of hypothermia in actively warmed general surgical patients remains
poorly characterized. In this retrospective study we showed that in 58 814
patients having non-cardiac surgery at Cleveland Clinic between April 2005
and February 2013, even with forced-air warming hypothermia was common
and often prolonged. We concluded it is likely that hypothermia-related
complications depend more on time-weighted core temperature than final
intraoperative temperature. Hooman Honar, M.D., Jarrod E. Dalton, Ph.D.,
Leif Saager, M.D., Daniel I. Sessler, M.D., Andrea Kurz, M.D., Outcomes
Research, Cleveland Clinic, OH.
FA A1268
Total Bilirubin as a Predictor of Mortality After Cardiac Surgery
Little is known about the role of hepatic dysfunction and failure after cardiac
surgery. This single-institution retrospective data analysis demonstrates
that postoperative total bilirubin levels can be a good predictor of short and
intermediate term mortality after cardiac surgery. Meghan A. Kirksey, M.D.,
Ph.D., Gebhard Wagener, M.D., New York Presbyterian, Columbia.
FA A1269
Lowest Hematocrit During Cardiopulmonary Bypass is a Better
Predictor of Adverse Outcomes Following Cardiac Surgery Than Lowest
Oxygen Delivery
We retrospectively investigated the suitability of lowest oxygen delivery or
hematocrit during cardiopulmonary bypass as the better predictor of Major
Organ Morbidity and Mortality (MOMM) following cardiac surgery. A forward
stepwise multivariate logistic regression chose lowest hematocrit as the
better predictor of MOMM; the risk of MOMM increased 11% with each
percent decrease in hematocrit. Prospective randomized trials are needed to
identify acceptable thresholds for lowest hematocrit and strategies to reduce
hemodilution during cardiopulmonary bypass. Chang Park, B.A., Hung-Mo
Lin, Ph.D., Richard Booth, B.S., Haesun Han, B.A., Gregory W. Fischer,
M.D., Anesthesiology, Icahn School of Medicine at Mount Sinai, New York,
NY, New York Medical College, Valhalla, St. Louis University, MO.
NA Neuroanesthesia
PN Pain Medicine
Single Nucleotide Polymorphisms of the Glucocorticoid - Receptor
Gene Influence the Outcome of Cardiac Surgery
Single nucleotide polymorphisms (SNPs) of the glucocorticoid receptor
(GR) gene which influence the sensitivity of the GR to cortisol affect
the early outcome of cardiac surgery. In particular an SNP resulting in
cortisol resistance of the GR is associated with increased hydrocortisone
and vasopressor dosage requirements to achieve hemodynamic stability
and a prolonged length of stay in the ICU and in the hospital. Martina
Pfob Jr., M.D., Daniela Hauer, M.D., Toth Roland, M.D., Markus Giel,
M.D., Christian Kowalski, M.D., Erich Kilger, M.D., Gustav Schelling,
M.D., Department of Human Genetics, Department of Anaesthesiology,
Munich, Germany, Gottsegen Gyorgy Hungarian Institut of Cardiology,
Budapest, Hungary.
FA A1271
Is the Euroscore II Reliable to Estimate Operative Mortality of Valvular
Surgery?
The original Euroscore I has been recently updated as Euroscore II. The aim
of this work was to evaluate its performance for predicting operative mortality
in valvular surgery. Sophie Provenchere, M.D., Bernard Iung, M.D., Ph.D.,
Claire Bouleti, M.D., Marie Pierre Dilly, M.D., Soleiman Alkhoder, M.D.,
Rachid Ait-Namane, Philipe Charles Montravers, M.D., Ph.D., Alec
Vahanian, M.D., Ph.D., Department of Anesthesiology, Departments of
Cardiology and Cardiac Surgery, Bichat University Hospital, Paris, France.
FA A1272
Intraoperative Hypothermia and Duration of Hospitalization in
Non-Cardiac Surgical Patients
Anesthetic-induced intraoperative hypothermia provokes a variety of severe
complications despite essentially universal forced-air warming. This study
first evaluated the relationship between hypothermia and duration of
hospitalization for general surgical populations over a range of temperatures.
Zhuo Sun, M.D., Daniel Sessler, M.D., Jarrod Dalton, D. Phil, Leif Saager,
M.D., Andrea Kurz, M.D., Outcomes Research, Cleveland Clinic, OH.
FA A1273
Intraoperative Hyperthermia May Associate With the High Incidence of
Postoperative Pancreatic Fistula
Intraoperative hyperthermia during colorectal surgery has been known to
associate with the high incidence of postoperative anastomotic leakage.
The relationship between intraoperative hyperthermia and postoperative
pancreatic fistula in pancreaticoduodenectomy has not been clarified. This
study was aimed to examine the relationship between body temperature
measured at the end of surgery and the incidence of postoperative
pancreatic fistula. Tadashi Tanioku, M.D., Keisuke Fujii, M.D., Akari
Yoshida, M.D., Kazuhiro Mizumoto, M.D., Ph.D., Wakayama Medical
University, Japanese Red Cross Wakayama Medical Center, Japan.
PO16-1A REGIONAL ANESTHESIA AND ACUTE PAIN: BASIC SCIENCE
ROOM 104-AREA D
RA A1274
Epidural Anesthesia Reduces the Risk of Surgical Site Infection
Through the Augmentation of Lipocalin-2 Expression
In a LPS-treated rat model we showed that continuous epidural anesthesia
for 72 hrs augmented lipocalin-2 expression in both plasma and tissue and
attenuated the overgrowth of bacteria at surgical site. Toru Igarashi, M.D.,
Katsuya Mori, M.D., Kei Inoue, M.D., Takeshi Suzuki, M.D., Nobuyuki
Katori, M.D., Hiroshi Morisaki, M.D., Keio University, Tokyo, Japan.
RA A1275
Can Epigenetic Inhibition at the Spinal Level Reduce Pain in
Neuropathic Rats?
Although intrathecal HDAC inhibitors reduce inflammatory hyperalgesia
in mice that class of drugs does not reduce mechanical allodynia in
a neuropathic pain model in rats. Jeffrey S. Kroin, Ph.D., Asokumar
Buvanendran, M.D., Jinyuan Li, M.D., Ph.D., Kenneth J. Tuman, M.D.,
Anesthesiology, Rush Medical College, Chicago, IL.
RA A1276
Does Methylglyoxal Mediate Sciatic Nerve Block Duration in Diabetic
Rats?
At present the mechanism for the increased duration of local anesthetic
nerve block in diabetic rats is unknown. Results show that the glucose
metabolite methylglyoxal could only account for part of this increase in nerve
block duration. Jeffrey S. Kroin, Ph.D., Asokumar Buvanendran, M.D.,
Kenneth J. Tuman, M.D., Anesthesiology, Rush Medical College,
Chicago, IL.
RA A1277
Intrathecal TRPA1 Antagonist in a Mouse Neuropathic Pain Model
Although intrathecal TRPA1 antagonists reduce mechanical hypersensitivity
in rat neuropathic pain models we could not demonstrate any potency in a
mouse neuropathic pain model. The robustness of spinal TRPA1 antagonists
in reducing pain needs further investigation. Jeffrey S. Kroin, Ph.D.,
Asokumar Buvanendran, M.D., Kenneth J. Tuman, M.D., Anesthesiology,
Rush Medical College, Chicago, IL.
FA A1270
RA A1278
Local Anesthetics May Exacerbate Sciatic Nerve Demyelination in a
Murine Model of Pre-Diabetes
In our ex-vivo model of injury-induced demyelination local anesthetics do not
appear to exacerbate demyelination in the isolated murine sciatic nerve. This
remains also true when nerves are incubated under high glucose conditions.
However in a murine model of prediabetes insulin resistance may increase
susceptibility to myelin damage from local anesthetics. Emily A. Olsen, M.D.,
Jeffrey R. Kirsch, M.D., Nabil J. Alkayed, M.D., Ph.D., Catherine M. Davis,
Ph.D., Anesthesiology and Perioperative Medicine, Oregon Health &
Science University, Portland, OR.
RA A1279
Evaluation of the Neurotoxicity of Intrathecal Dexmedetomidine on Rat
Spinal Cord (Electronmicroscopic Observations)
Spinal administration of dexmedetomidine has been proposed as an
adjuvant in spinal anaesthesia. However, there is limited information about
its possible neurotoxic effect after neuroaxial administration. This study was
performed two groups. The dexmedetomidine (D) group (n=10) received
10 µg (0.5 ml) whereas the control (C) group (n=10) received 0.5 ml 0.9%
sodium chloride via indwelling intrathecal catheter. 7 days after injection the
medulla spinalis was extracted. Samples were withdrawn from both groups
for histologic electron microscopic examination. A single dose of intrathecal
dexmedetomidine did not produce histologic evidence of neurotoxicity.
Dilek Ozdamar, M.D., Huban Dayioglu, M.D., Ihsan Anik, M.D., Seyhun
Solakoglu, M.D., Mine Solak, M.D., Kamil Toker, M.D., Kocaeli University,
Turkey, Istanbul University, Turkey.
RA A1280
Intrathecal Cannabinoid-1 Receptor Agonist Prevents Hyperalgesia in
an Acute Rat Model of Acrolein-Induced Cystitis
An acute rat model of acrolein-induced cystitis was used to evaluate
the efficacy of intrathecal arachidonyl-2’-chloroethylamide (ACEA) a
cannabinoid-1 receptor (CB1R) agonist to attenuate the associated
hyperalgesia and hyperreflexia. Cystometry demonstrated that intrathecal
administration of ACEA prior to intravesical acrolein infusion did not change
bladder function compared to controls. However, ACEA decreased the
associated hyperalgesia apparently at the spinal level. Marsha E. RitterJones, M.D., Ph.D., Zun-Yi Wang, Ph.D., Dale Bjorling, D.V.M., Department
of Anesthesiology, University of Wisconsin, WI, School of Veterinary
Medicine, University of Wisconsin, Madison.
RA A1281
Peroxisome Proliferator-Activated Receptor-Gamma Agonist
Rosiglitazone Attenuates Postincisional Pain by Regulating
Macrophage Polarization
PPAR agonist rosiglitazone ameliorates postoperative pain in mice.
Rosiglitazone suppressed polarization of local macrophages towards
proinflammatory M1 phenotype and promoted differentiation to antiinflammatory M2 phenotype. Takayuki Saito, M.D., Maiko HasegawaMoriyama, M.D., Ph.D., Kohei Godai, M.D., Tetsuya Ohnou, M.D., Ph.D.,
Tomotsugu Yamada, M.D., Yuichi Kanmura, M.D., Ph.D., Anesthesiology,
Kagoshima University School of Medicine, Japan.
NA Neuroanesthesia
PN Pain Medicine
37
CA A1287
ROOM 104-AREA E
CA A1282
New Presentation of Hemodynamic Changes Following Reperfusion of
the Graft in Liver Transplantation
In this study we demonstrated that in addition to traditional PRS a
new type of hemodynamic changes, PPRH occurred in 16.1% of adult
patients undergoing LT. Similar to PRS PPRH was associated with poor
postoperative outcomes. Worapot Apinyachon, M.D., Inthuon Sangasilpa,
M.D., Randolph H. Steadman, M.D., Victor W. Xia, M.D., Anesthesiology,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand, Anesthesiology, David Geffen School of Medicine, University of
California, Los Angeles, CA.
CA A1283
Incidence of SAM and SAM Predictive Echocardiographic Criteria
in Patients Considered Low Risk for Developing SAM After Mitral
Valvuloplasty
The incidence of SAM in a population considered low risk is still relatively
high. Only about 50% of these patients have no predictive parameters for
SAM by previously described criteria. Our study shows that after mitral valve
repair SAM is still a significant clinical problem that cannot be accurately
predicted by current echocardiographic criteria. Anna Kowalczyk, M.D.,
Jeffrey Swanson, M.D., Luigino Nascimben, M.D., Ph.D., Anesthesiology
and Pain Medicine, University of California Davis, Sacramento,
Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA.
CA A1284
Determination of Mitral Valve Area With Echocardiography: Using
Intraoperative 3-Dimensional Versus Intra and Postoperative Pressure
Half-Time Technique in Mitral Valve Repair Surgery
MVA measured by 3D planimetry technique with TEE at the intra-operative
post-MVR period was seemed to be larger than that measured by the PHT
technique with TTE at the post-operative period. However it did not mean
that the 3D planimetry technique was inaccurate but needs cautions at
determination of MVA using different techniques. Chung-Sik Oh, M.D.,
Jae Won Choi, M.D., Woon-Seok Kang M.D., Seong-Hyop Kim, Ph.D.,
Department of Anaesthesiology and Pain Medicine, Konkuk University
Hospital, Seoul, Korea
CA A1285
LiDCOrapid™ Hemodynamics From Continuous Non-Invasive (CNAP®)
Versus Invasive Arterial BP During Induction
To compare absolute values and trends of MAP and SV derived from
LiDCOrapid™ via CNAP® and ABP during induction. A radial arterial line (i) was
inserted pre-induction and the CNAP® noninvasive cuff (c) was applied on
the same arm. MAP and SV were recorded pre-induction post-induction nadir
ABP and at knife to skin. 28 patients vascular surgery patients were enrolled.
Bland-Altman and Sensitivity-Specificity analysis were performed. LiDCOrapid
tracks changes in MAP and SV equally well with invasive and non-invasive
BP waveforms. Kiran Salaunkey, M.B., B.S., Eric Mills, M.Sc., Audrey
Tan, M.B., Ch.B., Heena Bidd, M.B. Ch.B., David Green, M.B. Ch.B.,
Anaesthesia and Intensive Care, King’s College Hospital, London, United
Kingdom, LiDCO Plc, London, United Kingdom.
CA A1286
Impact of Propofol Anesthesia Induction on Cardiac Function in LowRisk Patients as Measured by Intraoperative Tissue Doppler Imaging
Propofol’s direct impact on myocardial function during anesthesia induction
has not been well investigated and focused in healthy patients. TDI of
mitral annular velocity seems to be an appropriate non-invasive modality
to evaluate the real-time changes of both systolic and diastolic myocardial
function:It assesses LV function by quantifying higher-amplitude and
lower-velocity signals of tissue motion. Jungho Seok, Esq., M.D., Tae-Yop
Kim, M.D., Ga-Yon Yu, M.D., Jun Heum Yon, M.D., Chungsik Oh, M.D.,
Department of Anesthesiology, Konkuk University Medical Center, Seoul,
Korea.
38
Comparison of the Hemodynamic Parameters Difference in Pulse
Pressure (dPP) and Pleth Variability Index (PVI) in Patients Undergoing
Elective Abdominal Surgery
This study has demonstrated that there is no fixed bias between dPP and PVI
and the limits of agreement are rather large. Therefore both methods are
considered not to be interchangeable. The plots around the regression line
appear V-shaped which indicates that at least one of the methods strongly
depends on the magnitude of measurements. Lydia T. Strys, M.D., Bjoern
Latz, M.D., Kimiko Fukui, M.D., Ph.D., Dorothea Closhen, M.D., Florian
Heid, M.D., Ph.D., Ruediger Noppens, M.D., Irene Schmidtmann, Ph.D.,
Gunther Pestel, M.D., Ph.D., Anesthesiology, University Medical Center of
the Johannes Gutenberg-University Mainz, Germany, Institute of Medical
Biostatistics, Epidemiology and Informatics, Leipzig, Germany.
CA A1288
Prediction of Left Ventricular Dysfunction Using Early Diastolic Mitral
Annular Velocity After MVR for Severe MR
The preoperative early diastolic mitral annular velocity (E) value was found
to be an independent risk factor for postoperative left ventricular dysfunction
(LVD) after mitral valve repair in patients with severe MR. The preoperative
E value appeared to be useful in predicting the incidence of postoperative
LVD more reliably than the other echocardiographic variables. Koichi
Suehiro, M.D., Katsuaki Tanaka, M.D., Ph.D., Tadashi Matsuura, M.D.,
Ph.D., Tomoharu Funao, M.D., Ph.D., Tokuhiro Yamada, M.D., Ph.D.,
Takashi Mori, M.D., Ph.D., Kiyonobu Nishikawa, M.D., Ph.D., Department
of Anesthesiology, Osaka City University Graduate School of Medicine,
Japan.
CA A1289
Role of Intraoperative TEE for Early Diagnosis of TAVI Complications
A case was presented where the role of TEE for early diagnosis of TAVI
procedure-related complications was pivotal leading to early lifesaving
measures and therefore potentially improving outcomes. Marc Vives, M.D.,
Ph.D., Simone Schulein, M.D., Annette Vegas, M.D., Toronto General
Hospital, Canada.
PO06-1BCRITICAL CARE: OUTCOMES
ROOM 104-AREA A
CC A1290
Awareness and Explicit Recall After Surgical Procedures in Intensive
Care: Incidence and Risk Factors - CABIS Trial
This work describes the incidence and risk factors for Intra-operative Explicit
Recall in severely ill patients during surgery with TIVA at a tertiary care
surgical unit and its relation with BIS monitoring data. Jorge H. MeijaMantilla, M.D., Monica P. Vargas, M.D., Juan F. Sanjuan, M.D., Fredy
Ariza, M.D., Anesthesiology, Intensive Care Research Unit, Fundacion
Valle del Lili, Cali, Colombia.
CC A1291
The Elevation of Blood Glutamate Concentration During the Course of
Blood Bank Storage
The results of this study suggest that concentrations of glutamate increase
significantly in blood during its storage. Benjamin F. Gruenbaum M.D.,
Yoram Shapira, M.D., Ph.D., Matthew Boyko, Ph.D., Ruslan Kuts, M.D.,
Alexander Zlotnik, M.D., Ph.D., Department of Anesthesiology and Critical
Care, Soroka Medical Center and Ben-Gurion University of the Negev,
Beer Sheva, Israel.
CC A1292
Vital Signs Predict Physiologic Derangement in Combat
RelatedThoracic Trauma
In patients with combat related thoracic trauma a systolicblood pressure <90
or a pulse pressure <30 can be used to rule inphysiological derangement.
This relationship can be used for triage of trauma patients in mass casualties
or when laboratory testing is not readily available. Ryan J. Keneally, M.D.,
Dale Szpisjak, M.D., Andrew Parsons, M.D., Anesthesiology, Uniformed
Services University of the Health Sciences, Potomac, MD, Anesthesiology,
Walter Reed National Military Medical Center, Bethesda, MD.
NA Neuroanesthesia
PN Pain Medicine
PO07-2BDRUG DISPOSITION
Perioperative Risk Factors for Postoperative Acute Kidney Injury After
Off-Pump Coronary Artery Bypass Grafting
To identify risk factors for acute kidney injury (AKI) after off-pump coronary
artery bypass grafting (off-pump CABG) we reviewed 302 medical records
of patients who underwent isolated off-pump CABG at our institution.
Multivariate logistic regression analysis demonstrated that history of atrial
fibrillation perioperative intra-aortic balloon pumping and intraoperative use
of frosemide had a significant association with AKI after off-pump CABG.
Yuta Kumada, M.D., Kenji Yoshitani, M.D., Yoshihiko Ohnishi, M.D.,
Department of Anesthesiology, National Cerebral and Cardiovascular
Center, Suita Osaka, Japan.
CC A1294
SCCM Versus SCA Blood Transfusion Guidelines: A Tale of Two
Societies
We compared two blood transfusion guidelines published by the Society
of Critical Care Medicine (SCCM) and the Society of Cardiovascular
Anesthesiologists (SCA). SCCM had a total of 27 recommendations and
did not explicitly state the level of evidence (LOE) whereas the SCA had 35
recommendations of which 13 were based on a strong LOE. Both papers
referenced a similar proportion of primary studies but the SCCM guidelines
used a significantly higher proportion of processed data (reviews metaanalyses guidelines). Given the trend towards using more processed data we
recommend practitioners to consider the quality of evidence before applying
guidelines in a clinical setting. Alice Li, B.S., Shamsuddin Akhtar, M.B.
B.S., Department of Anesthesiology, Yale University, New Haven, CT.
CC A1295
Use of Severe Restrictive Fluid Therapy and Acute Kidney Injury in the
Three First Postoperative Days of Lung Resection Surgery
The perioperative intravenous fluid overload has been linked to acute lung
injury development in lung resection surgery. Thus restrictive fluid infusion
has been adopted in the perioperative period of this surgery. However an
increased postoperative acute kidney injury (AKI) has been pointed as a
drawback. This study retrospectively evaluates the AKI incidence in the
postoperative using a severe restriction of fluid infusion and compare it with
recently published data. Patricia Pineiro, M.D., Francisco A. de La Gala,
M.D., Ph.D., Ignacio Garutti, M.D., Ph.D., Almudena Reyes, M.D., Luis
Olmedilla, M.D., Ph.D., Patricia Cruz, M.D., Ph.D., Carlos Simon, M.D.,
Ph.D., Patricia Duque, M.D., Ph.D., Fidel E. Reyes, M.D., Ana Mesa, M.D.,
Anesthesiology, Hospital General Universityersitario Gregorio Maranon,
Thoracic Surgery, Hospital General Universityersitario Gregorio Maranon,
Madrid, Spain.
CC A1296
Association of Glycemic Variabillity and Acute Kidney Injury in Cardiac
Surgery Patients
In patients undergoing CABG and/or valve surgery this study found that an
elevated variability of perioperative glycemia as defined by the difference
of pre- and post-operative glucose levels was significantly correlated with
increased incidence of postoperative AKI suggesting that glycemic variability
may contribute to AKI in patients undergoing cardiac surgery. Jian-Zhong
Sun, M.D., Linong Yao, M.D., Jianbin He, M.D., Will Sun, M.S., Jordan
Goldhammer, M.D., James Diehl, M.D., Anesthesiology, Thomas Jefferson
University Philadelphia, PA, The Fourth Military Medical University, Xian,
China.
CC A1297
Early Complications Outcome and Long-Term Survival After ECMO
Implantation
We completed a five year review of all extracorporeal membrane oxygenation
(ECMO) patients from our institution to evaluate complications and long-term
survival. Survival is 17%; ECMO has value for critically ill patients expected to
die. Enrico M. Camporesi, M.D., Devanand Mangar, M.D., Jordan Miller,
B.S., Collin Sprenker, M.D., Rachel Karlnoski, Ph.D., Cedric Sheffield,
M.D., Christiano Caldiera, M.D., Cristiano Faber, M.D., Philippe E.
Spiess, M.D., Hesham Omar, M.D., Surgery, University of South Florida,
Florida Gulf-to-Bay Anesthesiology, Associates LLC, College of Medicine,
University of South Florida, Tranplant Tampa General Hospital, Urology,
Moffitt Cancer Center, FL, Internal Medicine, Mercy Hospital, Chicago, IL.
ROOM 104-AREA B
FA A1298
Optimizing a Drug for PCA Delivery: The Clinical Importance of CST½
and take
The context sensitive half-time (CST½ or the time required from Cmax to
50% of Cmax) and effect-site equilibration time (t½ke0) are properties
that better describe the choice of opioids for PCA than the traditional
venous PK parameters. The Sufentanil NanoTab PCA System, a novel
preprogrammed hand-held device which delivers sublingual sufentanil 15
mcg with a 20 min lockout, was designed using these principles and may
provide a viable alternative to traditional IV PCA analgesia. It is currently
in Phase 3 development. Tong-Joo Gan, M.D., Pamela P. Palmer, M.D.,
Ph.D., Mike Royal, M.D., Anesthesiology, Duke University Medical Center,
Durham, NC, Medical, AcelRx Pharmaceuticals, Inc., Clinical AcelRx
Pharmaceuticals, Inc., Redwood City, CA.
CC A1293
FA A1299
Pharmacokinetics of Free Hydromorphone Concentrations in Patients
After Cardiac Surgery
Pharmacokinetics of free hydromorphone were studied in patients
after cardiac surgery. A three-compartment model was developed by
population analysis. Age and body weight showed significant influence
on hydromorphone pharmacokinetics. Harald Ihmsen, Ph.D., Jan Mell,
M.D., Katharina Frohlich M.D., Teijo I. Saari M.D., Ph.D., Jorg Fechner
M.D., Jurgen Schuttler, M.D., Christian Jeleazcov, M.D., Department of
Anesthesiology, University Hospital Erlangen, Germany.
FA A1300
Safer Tranexamic Acid Dosing for Patients With Renal Dysfunction
We use a simulated model to demonstrate the high plasma tranexamic
acid concentrations achieved among chronic renal dysfunction patients
undergoing cardiac surgery with cardiopulmonary bypass and recommend
a safer dosing regime for this high-risk patient population. Angela Jerath,
M.B., B.S., Marcin Wasowicz, Ph.D., Qi Yang, B.Sc., K. Sandy Pang,
Ph.D., Anesthesia and Pain Medicine, Leslie Dan Faculty of Pharmacy,
Department of Pharmacology, University of Toronto, ON, Canada.
FA A1301
Is Xenon Anesthesia Useful in Low Risk Thoracic Surgery Patients? Xenon is an expensive volatile anesthetic gas. We used it in the specific
setting of ASA 1 patients undergoing surgical repair of pectus excavatum:
In comparison with Sevoflurane 60-70% inhaled Xenon anesthesia
exposes to per-operative risks of insufficient anesthesia awareness and
hypertensive events. Emergence of anesthesia is faster with Xenon. Our
study brings interrogation regarding use of Xenon anesthesia for patients
without cardiovascular comorbidity. Olivier Joulin, M.D., Ph.D., Enguerrand
Desanlis, M.D., Bogdan Dobrin, M.D., Gabor Kiss, M.D., Robin Emmanuel,
M.D., Ph.D., Chirurgie Thoracique, University Hospital of Lille, France.
FA A1302
Effects of Single-Dose Emulsified Isoflurane on QTc Interval in Healthy
Volunteers
Emulsified isoflurane is a new intravenous anesthetic that has been
investigated in Phase Ι clinical studies. Drug-induced QT interval
prolongation has been one of the most common reasons for the withdrawal
of the drugs from the market. The objective of this material was to assess the
effects of emulsified isoflurane on the QTc interval. Rong Liu, M.D., Xiaoqian
Yi, M.S., Wengsheng Zhang, M.D., Jin Liu, M.D., Yan Li, M.S., Jing Xu,
M.S., Department of Anesthesiology, West China Hospital, Sichuan
University, Affiliated Hospital of Shandong University of Traditional
Chinese Medicine, Laboratory of Anesthesia and Critical Care, Medicine
Translational Neuroscience Center, West China Hospital, Sichuan
University, Chengdu, China.
NA Neuroanesthesia
PN Pain Medicine
39
FA A1303
Oprm1 Gene Polymorphism Reduces DNA Methylation at the Upstream
CpG Island in Male Patients
The results of this study indicated that DNA methylation in males was
different among genotypes of near SNP. Oprm1 promoter methylation might
be related to genetic variations of A118G-SNP in the gene. Shigekazu
Sugino, M.D., Ph.D., Tomo Hayase, M.D., Misako Higuchi, M.D., Yuko
Nawa, M.D., Ph.D., Yukihiro Kumeta, M.D., Ph.D., Michiaki Yamakage,
M.D., Ph.D., Department of Anesthesiology, Sapporo Medical University
School of Medicine, Japan.
FA A1304
The Effects of Bolus Doses of Remifentanil in Rapid Induction With
Midazolam-Ketamine Combination
In rapid induction with midazolam (0.1 mg/kg)-ketamine (0.5 mg/kg)
combination and rocuronium (50mg) a bolus of 5 μg/kg remifentanil can
attenuate mean arterial blood pressure and heart rate increases due to
sympathetic nerve activation by intubating stimuli. Sympathetic nerve
activation with intubating stimuli ends within 5 min because LF/HF (low
frequency component / high frequency component in heart rate variability
analysis) did not show any significant change between values measured
before induction agents were given and 5 min after intubation. Masashi
Uchida, M.D., Anesthesiology, Shonan Kmakura General Hospital, Japan.
FA A1305
Can Neuromuscular Monitoring at the Adductor Pollicis Detect Timing
for Safe Tracheal Intubation in the Elderly?
In elderly patients the onset time of rocuronium is significantly slower than in
younger adult patients and varies widely among the individuals. However 1.0
mg/kg rocuronium provided excellent intubating conditions even in the elderly.
Intubating dose of rocuronium should be decided based on the effective
doses at the laryngeal muscles and diaphragm not on that at the APM. The
response of the APM to a simple TOF ulnar nerve stimulation is adequate to
detect a timing of tracheal intubation when a sufficient paralyzing dose of
rocuronium is administered. Satomi Yamamoto, M.D., Yusuke Yamamoto,
M.D., Junpei Konishi, M.D., Fumihiko Yoshida, M.D., Akihiro Kashiwai,
M.D., Naoko Fukano, M.D., Takahiro Suzuki, M.D., Ph.D., Department of
Anesthesiology, Nihon University School of Medicine, Tokyo, Japan.
PO13-1BOUTCOMES AND DATABASE RESEARCH: RISK AND
PREDICITION 1
ROOM 104-AREA C
FA A1306
Utilization of the Surgical Apgar Score as a Continuous Measure of
Intraoperative Risk
The continuous assessment of the surgical Apgar score is predictive for major
postoperative complications. This tool monitors real-time changes in patients’
risk throughout the surgery and may support clinical decision-making in the
operating room. Jesse M. Ehrenfeld, M.D., M.B.A., Khensani N. Marolen,
M.S., Matthew Shotwell, Ph.D., Jason Denton, B.S., Warren S. Sandberg,
M.D., Ph.D., Monika Jering, B.S., Vanderbilt University, Nashville, TN,
Ludwig Maximilian University of Munich, Germany.
FA A1307
Prognostic Value of Brain Natriuretic Peptide in Aged Patients
Undergoing Hip Fracture Surgery
Elderly patients often have multiple comorbidities and are at increased
risk of perioperative major adverse cardiac events (MACE). Preoperative
value of brain natriuretic peptide (BNP) is noticed as a predictor of MACE
and mortality in patients with cardiovascular disease. We investigated the
relationship between perioperative value of BNP and MACE or mortality
in aged patients undergoing hip fracture surgery. In multivariate logistic
regression analysis BNP was an independent predictor of MACE. On the
other hand perioperative value of BNP would not seem to associate with the
mortality in aged patients undergoing hip fracture surgery. Sojiro Matsumoto,
M.D., Yoshiaki Terao, M.D., Ph.D., Akiko Sakai, M.D., Hiroko Araki, M.D.,
Mai Okada, M.D., Makoto Fukki, M.D., Ph.D., Koji Sumikawa, M.D., Ph.D.,
Nagasaki Rosai Hospital, Sasebo, Japan, Nagasaki University Hospital,
Japan.
40
FA A1308
The Predictor of Postreperfusion Syndrome During Living Donor Liver
Transplantation
Incidence and predictors of postreperfusion syndrome (PRS) were
retrospectively investigated in living donor liver transplantation (LDLT). The
incidence of PRS in LDLT was 20% at our institution. Recipient’s age has
proved to be the only predictive factor of PRS. Yoshimitsu Miyai, M.D.,
Takehiro Shoda, Ph.D., Toshiyuki Mizota, M.D., Yasuhiro Fujimoto, Ph.D.,
Hajime Segawa, Ph.D., Shinji Uemoto, Ph.D., Kazuhiko Fukuda, Ph.D.,
Anesthesia, Hepatobiliary Pancreatic Surgery and Transplantation,
Intensive Care Unit, Kyoto University Hospital, Japan.
FA A1309
Simple Preoperative Risk Stratification Systems Are at Least as Good
as Complex Systems Requiring Operative Data
This study demonstrated that simple preoperative risk stratification systems
such as Charlson score and POSSUM physiological score are at least as good
at discriminating short term postoperative outcomes after elective general
surgery as detailed systems which include intra-operative variables. Charles
M. Oliver, M.B. Ch.B., S.R. Moonesinghe, M.B., B.S., University College
London Hospital, United Kingdom.
FA A1310
Predicting Cancellation on the Day of Scheduled Surgery at a
Children’s Hospital
To aid a quality improvement project reducing cancellations on the day of
scheduled surgery at a children’s hospital we have developed a statistical
model to predict patients at high risk of cancellation. We present data
supporting the model’s validity. A map is presented to illustrate that zip code
of residence is an important predictor. Jayant N. Pratap, M.B. B.Ch., Anna
M. Varughese, M.D., F.R.C.A, Clare R. Herlihy, M.D., William R. Stone,
M.S., Monir Hossain, Ph.D., Anesthesia, Medical Operations, Center
for Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical
Center, OH.
FA A1311
What Are the Predictive Performance and Limitations of the Euroscore II?
The logistic European System for Cardiac Operative Risk Evaluation
(Euroscore I) is commonly used to identify high-risk patients. Un updated
version of the Euroscore I was recently validated in a contemporary cardiac
surgical population (Euroscore II) but external validations are scarce. The
aim of this study was to compare the performance of Euroscore I and II in
our institution. Sophie Provenchere, M.D., Bernard Iung M.D., Ph.D.,
Marie Pierre Dilly, M.D., Claire Bouleti, M.D., Soleiman Alkhoder, M.D.,
Philipe Charles Montravers, M.D., Ph.D., Alec Vahanian, M.D., Ph.D.,
Department of Anesthesiology, Departments of Cardiology and Cardiac
Surgery, Bichat University Hospital, Paris, France.
FA A1312
Demographic Predictors of Rural Versus Urban Practice Location of
the Physician Anesthesiology Workforce of Texas
This study aimed to evaluate the demographic characteristics of physician
anesthesiologists practicing in rural and urban areas of Texas and to assess
provider-related factors associated with these practice locations. A publically
available database of licensed physicians practicing in the State of Texas
was used for this purpose. Our data revealed that the population living in
rural areas is seriously deprived of healthcare services provided by physician
anesthesiologists and that the rural anesthesiologist workforce is not being
renovated. This disparities were not explained by demographic factors of the
practitioners. Eric B. Rosero, M.D., M.S., N. Martin Giesecke, M.D., Daniel
Condie, B.S., Girish P. Joshi, M.D., Anesthesiology and Pain Management,
UT Southwestern Medical Center, Dallas, TX.
NA Neuroanesthesia
PN Pain Medicine
Dynamic Markers of Intraoperative Instability - A Feasibility Study
Lower Blood pressure complexity in cases was clearly seen by multiscale
entropy analysis in this feasibility study. This approach offers promise
compared to the linear models that are unable to capture the complex
time-varying features of physiological signals such as blood pressure that
determines organ perfusion and subsequent outcomes. Balachundhar
Subramaniam, M.D., M.P.H., Madalena Costa, Ph.D., Adam Lerner, M.D.,
Kamal Khabbaz, M.D., Murray Mittleman, M.D., Priyam Mathur, B.S.,
Roger Davis, ScD, Ary Goldberger, M.D., Anesthesiology, Interdisciplinary
Medicine and Biotechnology, Cardiac Surgery, Beth Israel Deaconess
Medical Center, Boston, MA.
PO16-1BREGIONAL ANESTHESIA AND ACUTE PAIN: BASIC SCIENCE
ROOM 104-AREA D
RA A1314
The Pattern of Altered Pain Response in Sickle Cell Mice Suggests the
Presence of a Neuropathic Component
During acute crisis in sickle cell disease (SCD) pain results from organ
ischemia and inflammation associated with microvascular entrapment of
erythrocytes. Here we tested the hypothesis that there is a neuropathic
component of SCD pain. We found that SCD mice have altered nociception
in a pattern that vary according to genotype mouse strain and age.
Interestingly these changes were associated with decreases in A fibers
threshold which in turns suggests that in mice there might be a neuropathic
component contributing to altered pain sensitivity in SCD. Zena N. Quezado,
M.D., Nicholas Kenyon, B.S., Alfia Khaibullina, Ph.D., Luis Almeida, M.D.,
Ph.D., LaShon Middleton, Julia Finkel, M.D., Virginia Guptill, Ph.D., The
Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC.
RA A1315
The Success and Duration of Sciatic Nerve Block Success and
Duration of Sciatic Nerve Block Using 0.5% Bupivacaine or Ropivacaine
at Different Volumes: A Double Blind Randomized Clinical Trial
Injecting 10 ml of 0.5% bupivacaine or 0.5% ropivacaine below common
investing extraneural layer of the sciatic nerve produces duration of sensory
and motor blockade as volumes as large as 30 ml. Jessica J. Buren,
M.D., Mark C. Kendall, M.D., Antoun Nader, M.D., Anesthesiology,
Northwestern University, Feinberg School of Medicine, Chicago, IL.
RA A1316
RA A1318
Effects of Intrathecal Injection of CaMKII Inhibitor KN93 on
Remifentanil-Induced Hyperalgesia in Rats
This study investigated the effects of intrathecal injection of CaMKII inhibitor
KN93 on the hyperalgesia induced by remifentanil in a rat model of incisional
pain. The results indicated that intrathecal injection of KN93 could relieve
the postoperative hyperalgesia induced by remifentanil in rats. Xiaoping
Gu, Ph.D., Zhengliang Ma, Ph.D., Chongxue Cheng, M.D., Yue Liu, M.D.,
Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical
School of Nanjing University, China.
RA A1319
Is There Post-Surgery Pain Sensitization in a Rat Knee Surgery Model?
Prior surgery on the ipsilateral knee did not produce enhanced hyperalgesia
after a second surgery on the contralateral knee in rats. This suggests that
the postoperative pain after the second total knee replacement (TKR) will
not be worse than after the first TKR. Jeffrey S. Kroin, Ph.D., Asokumar
Buvanendran, M.D., Kenneth J. Tuman, M.D., Anesthesiology, Rush
Medical College, Chicago, IL.
FA A1313
RA A1320
Deafferentation Augments Pain Sensitivity Associated With Enhanced
Thalamo-Cortical Connectivity
In this study the contribution of afferent signaling pathways on pain
modulation was investigated and correlated to intrinsic brain connectivity
measured by resting-state magnetic resonance imaging. Twelve healthy
male volunteers were studied in a randomized crossover design using spinal
anesthesia as model for deafferentiation. Spinal anesthesia significantly
increased pain sensitivity and was correlated to an increase in functional
connectivity in the thalamus anterior cingulate cortex and insula all regions
involved in the endogenous modulation of pain. Marieke Niesters, M.D.,
M.S., Elske Sitsen, M.D., Jaap Vuyk, M.D., Ph.D., Leon Aarts, M.D.,
Ph.D., Albert Dahan, M.D., Ph.D., Anesthesiology, Leiden University
Medical Center, Netherlands.
RA A1321
Inhibition of Fatty Acid Oxidation By CVt-4325 Has No Effect on
Intralipid Rescue of Bupivacaine-Induced Neurotoxicity
Unlike the heart the protective action of intralipid in the brain can not
be explained by a metabolic effect. Siamak Rahman, M.D., Parisa
Partownavid, M.D., Salil Sharma, Ph.D., Mansoureh Eghbali, Ph.D.,
Nicholas Amelin, B.S., Anesthesiology, Ronald Reagan UCLA Medical
Center, Los Angeles, CA.
Pre-Administration of NMDA Antagonists Decrease GabapentinPotentiated Antinociception of Tramadol in Mice
The present study demonstrated that NMDA receptor is implicated in the
potentiation of tramadol antinociception by gabapentin. The influence of
NMDA antagonists on this potentiation appears to be dose dependent. This
result provides useful information for clinic translation into pain therapy
as well as practical suggestion for pain management. Further studies are
needed to better understand how the NMDA receptor system modulates
gabapentin potentiation of antinociception by tramadol. Xiaoli Dai, M.D.,
Tangeng Ma, Ph.D., Ike Eriator, M.D., Claude Brunson, M.D., Joana Panni,
Ph.D., Anesthesiology, UMMC, Jackson, MS, Cancer Institute, UMMC,
Jackson, MS.
RA A1317
Lidocaine Open Channel Block of Na+ Channels: A Priming Mechanism
for Long-Lived Inactivated Block
Local anesthetics (LA) block voltage-gated Na+ channels with clinical
utility as cardiac antiarrythmics and in nerve conduction blockade. A key
feature of LA action is use-dependent block (UDB) in which repetitive
activation produces progressive channel block. LAs block the open state of
Na+channels but the role of this effect in UDB remains unclear. The results
suggest that open channel block contributes to UDB by priming the channel
for the development of long-lived inactivation block known to contribute to
UDB. Kevin J. Gingrich, M.D., Larry Wagner II, M.S., Anesthesiology, UT
Southwestern Medical Center, Dallas, TX, Physiology and Pharmacology
University of Rochester School of Medicine, NY.
NA Neuroanesthesia
PN Pain Medicine
41
ORAL PRESENTATIONS
OR08-1 EQUIPMENT MONITORING AND ENGINEERING TECHNOLOGY:
CNS: DEPTH OF ANESTHESIA NOCICEPTION AND OXYGENATION
SUNDAY, OCTOBER 13 | 8:00-9:30 A.M.
ROOM 123
FA A2000
Prediction of Immediate Postoperative Pain Using Analgesia/
Nociception Index (ANI): An Observational Study
The Analgesia/Nociception Index (ANI) is a 0-100 index reflecting the
parasympathetic component of heart rate variability. An ANI value of <50
measured immediately before extubation at arousal from general anesthesia
using halogenated agents and remifentanil predicts immediate postoperative
pain with good performance (ROC curve AUC = 0.89). Emmanuel
Boselli, M.D., Ph.D., Gerard Begou, M.D., Lionel Bouvet, M.D., Rabia
Dabouz, M.D., Julien Davidson, M.D., Jean-Yves Delostem, M.D., Najia
Rahali, M.D., Abbes Zadam, M.D., Bernard Allaouchiche, M.D., Ph.D.,
Anesthesiology and Intensive Care, Edouard Herriot Hospital, HCL, Lyon,
France.
FA A2001
Timing and Slope of Cerebral Desaturation Depend on the Cerebral
Oximetry Device During an Acute Decrease of Pump Flow During
Bypass Cardiac Surgery
The INVOS cerebral oxymeter detects a quicker and steeper decrease
in cerebral oxygenation after an acute decrease of pump flow than the
Fore-Sight oximeter. This device seems to be superior in clinical practice
to assess the impact of flow on cerebral hemodynamics despite a less
sophisticated technology. Olivier Desebbe, Sr., M.D., Roland Henaine,
M.D., Jean-Francois Obadia, M.D., Ph.D., Catherine Binet, Jr., Laurent
Chardonnal Jr., Olivier Bastien, M.D., Ph.D., Anesthesiology and Intensive
Care Hospitalices Civils de Lyon, Surgery, Hospitalices Civils de Lyon,
Lyon Bron, France.
FA A2002
Prediction of Remifentanil Effect Site Concentrations by EEG
Frequency Bands During Sedation-Analgesia With Propofol and
Remifentanil for Upper Gastrointestinal Endoscopy
A combination of EEG frequencies extracted using an ANFIS approach
optimally predicts individual remifentanil effect-site concentrations. Pedro
L. Gambus, M.D., Jose F. Valencia, D.Eng., Xavier Borrat, M.D., Erik W.
Jensen, D.Eng., Anesthesiology, Hospital CLINIC de Barcelona, Centre
Recerca Enginyeria Biomedica (CREB), Universityersitat Politecnica de
Catalunya (UPC), Spain.
FA A2003
Effects of Patent Blue a Blue Dye on Cerebral Regional Oxygen
Saturation Readings
In this study, we evaluated the effect of patent blue on cerebral regional
tissue oxygen saturation values (SrO2) readings and peripheral arterial oxygen
saturation (SpO2) readings. We also assessed the influence of sevoflurane
and propofol on the change of SrO2 after patent blue injection. Women
having breast cancer, who were supposed to use patent blue during the
operation, were included. After patent blue injection, both SrO2 and SpO2
decreased significantly, though decrease in SpO2 was small. Anesthetic
methods may not affect the change in SrO2 after patent blue injection.
Tadahiko Ishiyama, Ph.D., Masakazu Kotoda, M.D., Nobumasa Asano,
M.D., Kodai Ikemoto, M.D., Takashi Matsukawa, Ph.D., Surgical Center,
University of Yamanashi, University of Yamanashi Hospital, Chuo, Japan.
FA A2004
Validation of the qNOX Pain/Nociception Index for Monitoring Loss of
Response to Tetanic Stimulation During General Anaesthesia
The objective of this study was the validation of a new EEG derived pain and
nociception index termed qNOX. The qNOX and a previously published drug
interaction model performed equally well in this dataset (pK=0.87) whereas
the combination of the qNOX and the remifentanil effect site concentration
had a significantly higher (pk =0.92). Erik W. Jensen, Ph.D., Pedro L.
Gambus, M.D., Jose F. Valencia, Ph.D., Mathieu Jospin, M.Eng., Xavier
Borrat, Ph.D., Michel Struys, M.D., F.R.C.A, Hugo P. Vereecke, Ph.D.,
Patricia P. Pineda, Student, Technical University of Barcelona, Hospital
Clinic, Universityesidad Politecnica de Cataluna, Quantium Medical
Barcelona, Spain, Universityersidad del Valle, Cali, Colombia, Department
of Anesthesiology, University Medical Center Groningen, Netherlands.
FA A2005
The Brain Anaesthesia Response Monitor During Cardiac Surgery: A
Double-Blind RCT With Fentanyl
The Brain Anaesthesia Response Monitor (BAR Monitor) non-invasively
monitors cerebral function in response to anesthetic and sedative agents.
Using a double blind randomized controlled trial design the BAR monitor
was shown to differentiate two different fentanyl level treatment groups
indicating that the BAR Monitor may be useful in the titration of fentanyl
as an antinociceptive agent during cardiac surgery. David T. Liley, M.D.,
Ph.D., Mehrnaz Shoustarian, Ph.D., Louis Delacretaz, M.B.A., Desmond
McGlade, M.B., B.S., Brain and Psychological Sciences Research Centre
Swinburne University of Technology, Cortical Dynamics Ltd, Hawthorn,
Australia, Department of Anaesthesia, St Vincent’s Hospital, Fitzroy,
Australia.
FA A2006
Alerting Thresholds for the Prevention of Intraoperative Awareness
With Explicit Recall
There are no systematic analyses of appropriate thresholds to develop
alerting algorithms in the prevention of intraoperative awareness. Our
data could not derive a single population-based alerting threshold for the
prevention of intraoperative awareness using either anesthetic concentration
of Bispectral Index® values. These data indicate a need to move towards an
individualized based alerting algorithm in the prevention of intraoperative
awareness. Amy Shanks, Ph.D., Michael Avidan, M.B., B.Ch., Sachin
Kheterpal, M.D., M.B.A., Kevin Tremper, M.D., Ph.D., George Mashour,
M.D., Ph.D., Anesthesiology, University of Michigan, Health System, Ann
Arbor, Anesthesiology, Washington University School of Medicine,
St. Louis, MO.
OR07-1 DRUG DISPOSITION
ROOM 123
FA A2007
Drug Interactions: Beyond the Hypnotic/Opioid Balance?
Opioid and hypnotic concentrations as well as Noxious Stimulation Response
Index (index build from both concentrations and age predicting the response
to laryngoscopy) are influenced by coanalgesic drugs but unsensitive to
the type of surgical stimulation during optimized anesthetic conditions.
Large therapeutic window and drug titration on adverse effects may explain
these results. Marie Binczak, M.D., Frederique Servin, M.D., Ph.D.,
Gaelle Bouroche, M.D., Brice Lortat-Jacob, M.D., Valerie Billard, M.D.,
Anesthesia, Institut Gustave Roussy, Villejuif, France, Anesthesia, Bichat Claude Bernard University Hospitalita, Paris, France, Critical Care Hospital
Europeen Georges Pompidou, Paris, France.
NA Neuroanesthesia
42
PN Pain Medicine
OR03-1 CHRONIC AND CANCER PAIN: CLINICAL SCIENCE
Pharmacometabolomic Patterns In Bipolar Depression Patients
Receiving (R S)-Ketamine: Novel Approach To Chronic Pain
Therapies?
The study identified patient biomarkers associated with response to
ketamine. Michael Goldberg, M.D., Alma Villasenor, Ph.D., Anuradha
Ramamoorthy, Ph.D., Gonzalo Laje, M.D., Mariana Silva dos Santos
Pharm.D, Carlos Zarate, Jr., M.D., Coral Barbas, Ph.D., Marc C. Torjman,
Ph.D., Irving W. Wainer, Ph.D., Anesthesiology, Cooper University Hospital,
Cooper Medical School of Rowan University, Camden, NJ, Center for
Metabolomics and Bioanalysis, Facultad de Farmacia, Universityersidad
CEU San Pablo Campus Monteprincipe, Madrid, Spain, The Laboratory
of Clinical Investigation, National Institute on Aging Intramural Research
Program, National Institute of Health, Maryland Institute for Neuroscience
and Development (MIND), Baltimore, Experimental Therapeutics &
Pathophysiology Branch, IRP, NIH National Institute of Mental Health
(NIMH), Bethesda, MD.
SUNDAY, OCTOBER 13 | 3:00-4:30 P.M.
ROOM 125
PN A2013
Are Baseline Pain Sensitivity and Genetic Factors Associated With
Acute and Chronic Post-Thoracotomy Pain?
This study examines the association of pre-operative Quantitative Sensory
Testing and genetic factors with acute postoperative pain and the
development of chronic post-thoracotomy pain. Andre P. Boezaart, M.D.,
Charles T. Klodell, Jr., M.D., Margaret R. Wallace, Ph.D., Reginald F.
Frye, Pharm.D, Barbara A. Hastie, Ph.D., Department of Anesthesiology,
Division of Acute and Peri-operative Pain Medicine, Division of Thoracic
and Cardiovascular Surgery, Molecular Genetics and Microbiology
Pharmacotherapy and Translational Research, Community Dentistry &
Behavioral Science, University of Florida, Gainesville, FL.
SUNDAY, OCTOBER 13
FA A2008
PN A2014
FA A2009
Predictive Performance of Propofol Pharmacokinetic Models in
Children for Long-Time Infusion
We evaluated predictive performance of propofol pharmacokinetic models in
children for long-time anesthesia. Measured propofol plasma concentrations
were compared with predicted concentration using eleven pharmacokinetic
models. Prediction error (PE) was calculated, and MDPE, MDAPE, and
divergence PE were derived for the assessment. Three models (Short,
Rigby-Jones, and Schüttler) were finally selected to have better performance
than the others. Mariko Hara, M.D., Kenichi Masui, M.D., Osamu Uchida,
M.D., Department of Anesthesiology, Chiba Children’s Hospital, Japan,
Department of Anesthesiology, National Defense Medical College,
Tokorozawa, Japan, Department of Anesthesiology and Intensive Care,
Osaka University Graduate School of Medicine, Suita, Japan.
FA A2010
Blood Gas Partition Coefficient of Propofol in Humans
We calculated the blood gas partition coefficient for propofol in humans from
healthy volunteers undergoing propofol anesthesia. Cyrill Hornuss, M.D.,
Gustav Schelling, M.D., Christian C. Apfel, M.D., Ph.D., Department
of Anaesthesiology, Ludwig-Maximilians-University Munich, Germany,
Department of Anesthesia and Perioperative Care, University of California,
San Francisco, CA.
FA A2011
Influence of Age and Gender on Propofol and Remifentanil
Consumption Evaluated by a Closed-Loop Controller During Elective
Surgery
We evaluated the influence of age and gender on propofol and remifentanil
consumptions using a closed-loop controller allowing the automated titration
of propofol and remifentanil guided by the Bispectral index in 4711 patients.
Propofol and remifentanil consumptions were age and gender-dependent
during induction. The controller correctly decreases the amount of propofol
and remifentanil related to the patient age during maintenance. Ngai Liu,
M.D., Ph.D., Morgan Le Guen, M.D., Thierry Chazot, M.D., Marc Fischler,
M.D., Anesthesia Hospital Foch, Suresnes, France.
FA A2012
The Effect of Propofol on Intrathecal Morphine-Induced Pruritus and
Its Mechanism
Morphine elicited dose-independent scratching responses followed
intrathecal injection in rats. Morphine 40 µg/kg intrathecal injection-induced
scratching responses could be reversed by propofol via increasing the
expression of CB(1) receptor in ACC. Wangning Shangguan, M.D., Ph.D.,
Xiulan Liu, M.D., Hongyan Zhao, M.D., Hongxia Mei, M.D., Qingquan Lian,
M.D., Ph.D., The Second Affiliated Hospital at Yuying Children’s Hospital
of Wenzhou Medical University, China, The Second Hospital of Wenzhou
Medical University, China.
The Impact of Centralized Pain on Long-term Analgesic Response
to Lower Extremity Joint Arthroplasty: A Prospective Observational
Cohort Study
In addition to previously described outcome predictors the American College
of Rheumatology survey criteria for fibromyalgia independently predicted
poorer pain outcomes following total knee and hip arthroplasty. This simple
validated self-report measure used as a surrogate of pain that is more
centralized in nature may assist in patient selection for arthroplasty. Chad
M. Brummett, M.D., Brian Hallstrom, M.D., Andrew Urquhart, M.D.,
Alex Tsodikov, Ph.D., David A. Williams, Ph.D., Daniel J. Clauw, M.D.,
Anesthesiology, Orthopaedic Surgery, Biostatistics, University of Michigan,
Ann Arbor, MI.
PN A2015
Heat Pain Sensitivity Predicts Persistent Postoperative Pain (PPP)
After Total Knee Replacement
Preoperative heat pain sensitivity was correlated with persistent postoperative
pain at 3 months after total knee replacement surgery. Asokumar
Buvanendran, M.D., Mario Moric, M.S., Mahendra Shah, M.D., Jeffrey S.
Kroin, Ph.D., Kenneth J. Tuman, M.D., Anesthesiology, Rush University
Medical Center, Chicago, IL.
PN A2016
Hyperalgesia Around Surgical Wound is Associated With Persistent
Pain After Total Knee Replacement
After total knee replacement there was a positive correlation between
increased area of mechanical hyperalgesia around the surgical wound and
pain at 3 months. Asokumar Buvanendran, M.D., Mario Moric, M.S.,
Mahendra Shah, M.D., Jeffrey S. Kroin, Ph.D., Kenneth J. Tuman, M.D.,
Anesthesiology, Rush University Medical Center, Chicago, IL.
PN A2017
CRPS Following Arthroscopic Shoulder is Associated With IL1-ra
Genotype
CRPS can develop following extremity surgery even when the acute pain is
well controlled using regional anesthesia in the perioperative period. Being
homozygous for the A2 allele of IL-1ra significantly increased the likelihood
of developing this condition after arthroscopic rotator cuff repair. Craig T.
Hartrick, M.D., Doug Wendell, Ph.D., Cecile Pestano, B.S.N., Sn Hartrick,
B.S.N., Guangzhi Qu, Ph.D., BioMedical Sciences and Anesthesiology,
Oakland University William Beaumont School of Medicine, Engineering
and Computer Science, Oakland University, Biology (Genetics), Oakland
University, Rochester, MI, Anesthesiology, Research, Beaumont Health
System Research Institute, Troy, MI.
NA Neuroanesthesia
PN Pain Medicine
43
PN A2018
POSTER DISCUSSIONS
Regional Anesthesia Catheters Reduce the Incidence of Chronic
Neuropathic Pain After Traumatic Amputation: Initial Results From the
VIPER-80 Discovery Cohort of Injured Military Personnel
In this VIPER-80 cohort the incidence of chronic post-amputation pain was
greater than 50% and there is significant overlap between phantom and
residual limb pain. Both adversely interfere with patients’ daily activities.
Analysis of this cohort has demonstrated significant differences between
S-LANSS pain and PTSD scores between groups receiving regional catheters
for pain control versus those that did not. There is also a trend towards a
decreased overall incidence of pain in patients receiving regional catheters
a finding that warrants further study. Hung-Lun J. Hsia, M.D., Thomas
Buchheit, M.D., Thomas Van de Ven, M.D., Ph.D., David MacLeod,
M.D. F.R.C.A, Mary McDuffie, R.N., Chester Buckenmaier, M.D., William
White, M.S., Andrew Shaw, M.D. F.R.C.A, Anesthesiology, Duke University
Medical Center, Durham, NC, Walter Reed National Military Medical
Center, Bethesda, MD.
OR17-1 RESPIRATION: CONTROL OF BREATHING
ROOM 124
KEYNOTE SPEAKER: DENHAM S. WARD, M.D., Ph.D.
FA A2019
Neurally Adjusted Ventilatory Assist in Obese and Non-Obese Intensive
Care Patients: A Prospective Crossover Study
The objectives were to compare the effectiveness of NAVA compared to PSV
in obese patients and to compare NAVA in obese and non-obese patients.
Ten obese patients and 11 non-obese patients were ventilated for 30 min in
NAVA and 30 min in PSV according a randomized order. In obese and nonobese patients NAVA was associated with a reduction of ineffective efforts
but the asynchrony index remained similar in the 2 modes. Compared to PSV
ventilatory variability and PaO2/FiO2 ratio increased in NAVA in both group.
In obese and non-obese patients NAVA improves oxygenation and decreases
ineffective efforts compared to PSV. Matthieu Conseil, M.D., Yannael
Coisel, M.D., Noemie Clavieras, M.D., Boris Jung, M.D., Samir Jaber,
M.D., Ph.D., Department of Critical Care Medicine and Anesthesiology,
Saint Eloi University Hospital and Montpellier School of Medicine, France.
FA A2020
GAL-021: A New Intravenous Selective Potassium-Channel Blocker is
Well Tolerated and Stimulates Ventilation in Healthy Volunteers
GAL-021 a novel BK potassium channel blocker and carotid body stimulant
increases minute volume in healthy human subjects without increasing
blood pressure. Francis J. Golder, D.V.M., Ph.D., Sean Peng Ph.D., Lance
Meyers, Ph.D., Paul A. Hoskins, M.S., James F. McLeod, M.D., Galleon
Pharmaceuticals, Horsham, PA, Vivonoetics, San Diego, CA.
FA A2021
Moxduo (Morphine: Oxycodone Combination) Reduces the Incidence
of Oxygen Desaturation Events Compared to Equianalgesic Doses of
Either Morphine or Oxycodone Alone in Subjects With Postoperative
Pain Following Bunionectomy
Moxduo® is a combination of morphine and oxycodone that was developed
to reduce opioid induced adverse events. In a study of 375 postoperative
patients continuous pulse oximetry was recorded every 2 seconds for 48
hours while patients were on room air. Patients receiving Moxduo had
decreased desaturations particularly in higher risk ranges below 80%
compared to equianalgesic doses of morphine and oxycodone. Patricia T.
Richards, M.D., Ph.D., Warren Stern, Ph.D., Bruce Stouch, Ph.D., John O.
Holaday, Ph.D., QRx Pharma, Inc., Bedminister, NJ.
®
FA A2022
Characterization of Respiratory Depression During Procedural
Sedation During procedural sedation for gastrointestinal endoscopy procedures
periods of hypoxemia may be observed. The objective of this study was to
learn whether decreased respiratory rate or tidal volume or both typically
characterizes a decrease in minute ventilation associated with reduced
SpO2. Lara Brewer, Ph.D., Simon Rodriguez, Student, John Fang, M.D.,
Joe Orr, Ph.D., University of Utah, Salt Lake City, University of Utah Health
Sciences Center, Salt Lake City, UT.
44
PD05-2 CLINICAL NEUROSCIENCES - POSTOPERATIVE COGNITIVE
DEFICIT
ROOM 124
NA A2023
The Effect of General Anesthesia on Young and Middle-Age Patients’
Memory
We enrolled subjects undergoing gastroscopic inspection a minimally invasive
procedure which can help us to evaluate the effect of general anesthesia
on young and middle-aged patients’ memory. Tao Zhu, M.D., Fangfang
Fu, B.M., Department of Anaesthesia, West China Hospital Chengdu,
Sichuan, China.
NA A2024
Apolipoprotein E4 Genotyope is Associated With Long-Term Cognitive
Decline Following Cardiac Surgery
In a cohort of 233 Caucasian cardiac surgery patients previously enrolled in
prospective cognitive trials APOE genotype was evaluated using multivariable
linear regression with an additive genetic model toward the E4 allele. Here
we report an association between APOE4 and long-term neurocognitive
function five years following cardiac surgery. Pre-operative identification of
patients with APOE4 genotype might allow improved risk stratification for
patients at risk for cognitive decline. Karsten Bartels, M.D., Yi-Ju Li, Ph.D.,
Yen-Wei Li, Ph.D., William D. White, M.P.H., Miklos Kertai, M.D., Mark
Stafford-Smith, M.D., Mihai V. Podgoreanu, M.D., Mark F. Newman, M.D.,
Joseph P. Mathew, M.D., Anesthesiology, Duke University Medical Center,
Durham, NC.
NA A2025
Neurocognitive Performances in Patients Undergoing Vascular Surgery:
General Versus Blended Anesthesia
The study deals with the neurocognitive outcomes in patients undergoing
major vascular surgery. We compared two choices of anesthesia general
and blended associated with a rational use of Bispectral Index Monitoring.
Despite the small number of patients we managed to confirme how
a deep anesthetic plan could worsen the short middle and long term
outcomes even associated with Postoperative Cognitive Dysfunctions.
Silvia Buonocore, M.D., Domitilla Brancadoro, M.D., Cristiano Barbaglia,
M.D., Michela Sparano, M.D., Laura P. Bucci, M.D., Silvia Di Prospero,
M.D., Dario Marino Taussig De Bodonia, M.D., Giovanni Pinto, M.D.,
Anesthesiology and Critical Care, Sant’Andrea Hospital, La Sapienza
University, Rome, Italy.
NA A2026
Effect of Intraoperative Brain Protection With Propofol on
Postoperative Cognition in Patients Undergoing Temporary Clipping
During Intracranial Aneurysm Surgery
Pharmacologic neuroprotection with propofol during temporary clipping
in patients with aneurysmal subarachnoid hemorrhage did not offer any
advantage as far as preservation of cognition is concerned. Surya K.
Dube, M.D., Charu Mahajan, M.D., Rajendra S. Chouhan, M.D., Hari H.
Dash, M.D., Girija P. Rath, M.D., Ashish Suri, M.S., P. Sarat Chandra,
M.S., Aman Mahajan, M.D., NeuroAnesthesiology, Neurosurgery, All
India Institute of Medical Sciences, New Delhi, Department of Psychiatry,
South Illinois University School of Medicine, Springfield, IL.
NA A2027
Recovery of Postoperative Cognitive Function in Elderly Patients After
a Long Duration of Desflurane Anesthesia
We examined the quality of emergence and postoperative cognitive
dysfunction in elderly patients after long exposure to inhalation anesthetics.
Desflurane may provide a higher quality of emergence and the greater
retention of cognitive function in elderly patients undergoing anesthesia.
Satoshi Kazuma, M.D., Tomo Hayase, M.D., Michiko Osuda, M.D.,
Shigekazu Sugino, M.D., Ph.D., Michiaki Yamakage, M.D., Ph.D.,
Department of Anesthesiology, Sapporo Medical University School of
Medicine, Japan, Sapporo Medical University School of Medicine, Japan.
NA Neuroanesthesia
PN Pain Medicine
Effect of Preconditioning on Postoperative Cognitive Function in
Patient With Intracranial Aneurysm Surgery
The aim of this study was to investigate the security and feasibility of hypoxia
preconditioning (HPC) and the mechanisms of HPC involved besides the
protective of HPC on cognitive function in patient with intracranial aneurysm
surgery would be investigated. HPC could stimulate NGB upregulation
and increase tolerance to hypoxia. Though HPC cannot reverse cognitive
dysfunction in patients it could prevent patients’ cognitive dysfunction go
worse to some extent. Yu Li, M.D., Shiqi Li, M.B., West China Hospital,
Sichuan University, Chengdu.
NA A2029
Bilateral BIS-Monitoring for Early Detection of Delirium After Cardiac
Surgery
Twenty six out of 81 patients (32.1%) developed postoperative delirium
following cardiac surgery. Patients with delirium showed a significantly higher
burst suppression ratio and a significantly longer burst suppression period
than patients without delirium. Martin Soehle, M.D., M.B.A., Alexander
Dittmann, M.D., Richard K. Ellerkmann, M.D., Christian Putensen, M.D.,
Ulf Guenther, M.D., Department of Anesthesiology and Intensive Care,
Medicine, University of Bonn, Department of Neurology and Psychiatry
LVR-Clinic, Germany.
NA A2030
Cerebral Oximetry and Recovery in Thoracic Surgery
Analysis from an initial thirty subjects in a prospective observational study
found evidence that patients that experience cerebral oxygen desaturations
during thoracic surgeries requiring one lung ventilation demonstrate slower
physiologic emotional physical and cognitive recovery. Further desaturation
is predictive of post-operative delirium. Monique L. Roberts, B.A., Elizabeth
Tinuoye, B.A., Edmond Cohen, M.D., Andrew Kaufman, M.D., Raja Flores
M.D., David Reich, M.D., Gregory Fischer, M.D., Jeffrey Silverstein, M.D.,
Anesthesia, Thoracic Surgery, Icahn School of Medicine at Mount Sinai,
New York, NY.
CIRCULATION AND FLUID MANAGEMENT
ROOM 124
FA A2033
Pulse Pressure Variation by a New Noninvasive Brachial Double-Cuff
System for Pulse Wave Analysis
The feasibility of a new noninvasive double-cuff brachial pulse wave analysis
system (prototype FC-2; UP-MED GmbH Munich Germany) based on
hydraulic coupling with the upper arm to determine pulse pressure variation
(PPV) was compared with PPV recorded by the invasive femoral arterial
line. The new non-invasive brachial pulse wave analysis system shows
a good to very good agreement with the invasively recorded PPV over a
wide range. Ines Kaufmann, M.D., Manuel Goettler, Student, Julia Jell,
Student, Vincent Schmidt, Student, Josef Briegel, M.D., Department of
Anesthesiology, Ludwig-Maximilians-University, Munich, Germany.
FA A2034
First Automated Fluid Management in Abdominal Surgery - Feasibility
Study Analyzing Cardiac Output Optimization
Hemodynamic optimization based on fluid management and stroke volume
optimization have been shown to improve patient outcomes especially
for moderate and high risk abdominal surgical patients. We have recently
described a novel closed-loop fluid administration system called Learning
Intravenous Resuscitator (LIR®) based on multi-parameter hemodynamic
monitoring. We describe the first clinical use of this system in a series
of patients undergoing abdominal surgery. Marc Lilot, M.D., Christine
Lee, B.S., Davinder Ramsingh, M.D., Cameron Ricks, M.D., Maxime
Cannesson, M.D., Ph.D., Joseph Rinehart, M.D., Hospitalices Civiles de
Lyon, France, Department of Anesthesiology and Perioperative Care, UCI,
Orange, CA.
FA A2035
Automated Photo-Pethysmographic (PPG) Waveform Analysis Predicts
Early Transfusion in Trauma Patients
Theaddition of automated PPG waveform analysis to standard VS improved
the predictive power for transfusion. Collection of PPG feature data for longer
than 15 minutes provided no further improvement in the predictive power for
transfusion. Colin F. MacKenzie, M.B., B.Ch., Yulei Wang, M.S., Fu-Ming
Hu, M.S., Shih-Yu Chen, M.S., Hegang Chen, Ph.D., George Hagegeorge,
B.S., Lynn Stansbury, M.D., Stacy Shackelford, M.D., Shock Trauma
Anesthesia Research Organized Research Center, Computer Science and
Electrical Engineering, C-STARS Baltimore and Shock Trauma Center,
University of Maryland, Baltimore.
FA A2036
FA A2031
A Robust Method for Calculation of Pulse Pressure Variation (PPV)
Pulse pressure variation (PPV) is a good predictor for fluid responsiveness
during controlled mechanical ventilation. So far PPV as calculated
conventionally (convPPV) is a two-point calculation which is incorrect during
transient periods of artifacts in the pressure wave form and arrhythmia like
extra-systoles. In this study a new method for modelling of PPV (mPPV UPMED GmbH Munich Germany) was evaluated during periods of arrhythmic
events and compared to convPPV. The data demonstrate that mPPV is
a robust new method for calculation of PPV even during short periods of
arrhythmia. Ines Kaufmann, M.D., Manuel Goettler, Student, Julia Jell,
Student, Vincent Schmidt, Student, Josef M. Briegel, M.D., Ph.D.,
Department of Anesthesiology, Ludwig-Maximilians-University, Munich,
Germany.
FA A2032
Noninvasive Brachial Pulse Wave Analysis by Hydraulic Coupling
Three versions of a new non-invasive brachial pulse wave analysis system
(prototypes FC-3a-c UP-MED GmbH Munich Germany) based on hydraulic
coupling with the upper arm were compared in healthy volunteers to identify
the best performing prototype. The tripartite shell integrated double-cuff
system with a pneumatic actor recorded the best tissue pressure curves and
was found most comfortable. Hence, it was the best performing version of
a new non-invasive brachial pulse wave analysis system. Ines Kaufmann,
M.D., Julia Jell, Student, Vincent Schmidt, Student, Manuel Goettler,
Student, Josef Briegel, M.D., Department of Anesthesiology, LudwigMaximilians-University, Munich, Germany.
Evaluation of Hemodynamic Changes and Fluid Responsiveness in
Lithotomy and Prone Position by Stroke Volume Variation During
Volume Controlled Ventilation in Patients Undergoing Percutaneous
Nephrolithotomy
Hemodynamic changes in three different positions: supine lithotomy and
prone were studied by measuring cardiac output and stroke volume variation
using FloTrac-Vigileo™ system during volume controlled ventilation in patients
undergoing percutaneousnephrolithotomy. Cardiac output and stroke volume
variation showed significant changes in response to fluidloading in all three
positions: supine lithotomy and prone. Significant reduction in cardiac
outputand increase in SVV was observed while changing patient position
from supineto prone. SVV is a goodpredictor of fluid responsiveness in the
supine position less in lithotomyposition and the least in the prone position.
Virender K. Mohan, M.D., Suhas P. Nair, M.B., B.S., Lokesh Kashyap,
M.D., Dilip Shende, M.D., Anaesthesia, All India Institute of Medical
Sciences, New Delhi.
SUNDAY, OCTOBER 13
NA A2028
PN Pain Medicine
NA Neuroanesthesia
45
FA A2037
Stroke Volume Variation As A Predictor Of Fluid Responsiveness In
Mechanically Ventilated Patients: A Comparison With Central Venous
Pressure And Systolic Pressure Variation
Our study on mechanically ventilated poatients under general anaesthesia
showed that stroke volume variation obtained by pulse contour analysis
using Flotrac/Vigileo system can predict fluid responsiveness in mechanically
ventilated patients(Area under ROC curve 0.694).Stroke volume variation
and Systolic pressure variation both have good predictive value (Area
under ROC curve >0.5) as compared to CVP (Area under ROC <0.5)
for fluid responsiveness. Vimi Rewari, M.D., Ravi Raj, M.D., Rashmi
Ramachandran, M.D., Anjan Trikha, M.D., Chandra Lekha, M.D.,
Anaesthesiology, All India Institute of Medical Sciences, New Delhi,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India.
FA A2038
The Integrated Axial Flow and Balloon Pump (IAFBP) A Novel Acute
Cardiac Assist Device Analytical Design Model for Heart Failure
Safe and effective therapies for acute heart failure are lacking. There
remains a need for improved acute cardiac assist devices. We designed
the Integrated Axial Flow and Balloon Pump (IAFBP) a novel acute cardiac
assist device and an improved design over existing percutaneous cardiac
assist devices featuring a combination of the IABP and the Impella LVAD.
For its development a novel way to design and test the device prototype was
implemented. An analytical model of the circulatory system was designed
in Simulink and a physical experimental setup was engineered and built
to validate acute cardiac assist device designs avoiding unncessary cost
and saving development time. Brian J. Lee, M.D., Thomas A. Anderson,
M.D., Ph.D., Anesthesia, Critical Care and Pain Medicine, Massachusetts
General Hospital, Boston, MA.
PD15-2 PEDIATRIC ANESTHESIA: CARDIAC
ROOM 125
Assessment of the Withdrawal Assessment Tool (WAT-1) in Children
With Congenital Heart Disease: A Retrospective Pilot Study
The WAT-1 is the withdrawal assessment tool utilized to wean iatrogenic
opioid dependent congenital cardiac patients. This withdrawal assessment
tool is not validated for this patient population. Many of the physiologic
parameters measured by the WAT-1 assessment tool are also present in
congestive heart failure elevated WAT-1 scores may be reflective of other
physiologic stressors in these patients. The WAT-1 may be of limited value in
diagnosing opioid withdrawal or guiding weaning in patients with CHD. Allison
M. Fernandez, M.D., Constance L. Monitto, M.D., Anesthesia & Critical
Care, All Children’s Hospital, Saint Petersburg, FL, Anesthesia and Critical
Care, Medicine, Johns Hopkins University, Baltimore, MD.
PD A2042
Effect of Dexamethasone or Clonidine When Given as an Adjunct to
Ropivacaine for Caudal Analgesia on Duration of Analgesia Compared
to Placebo in Children
This was a prospective randomized double-blinded placebo controlled study
in healthy outpatient children to evaluate effects of adding preservative free
dexamethasone to ropivacine 0.2% on caudal analgesia duration compared
to clonidine and placebo. Preliminary results suggest adding dexamethasone
to ropivacaine may prolong caudal analgesia. Samia N. Khalil, M.D., Happy
Eskander, M.D., Mohammed Ali, M.D., Sudah Balan, M.D., Tamara N.
Norwood, M.D., Alice Z. Chuang, Ph.D., Anesthesiology, Opthalmology
and Visual Sciences, The University of Texas Medical School at Houston,
Houston, TX.
PD A2043
The Role of Epidural Analgesia in the Perioperative Pain Management
of Pediatric Patients With Median Arcuate Ligament Syndrome
The pain management of patients with MALS is challenging. Epidural
analgesia is associated with better pain control compared to PCA in patients
previously taking pain medications. Alina Lazar, M.D., Sophy Zheng, A.A.,
Magdalena Anitescu, M.D., Ph.D., University of Chicago, IL.
PD A2044
PD A2039
TAOK3: A Novel GWAS Locus Associated With Morphine Requirement
and Postoperative Pain in Pediatric Day Surgery
Genome-wide association study identifies SNPs in TAOK3 encoding the
serine/threonine-protein kinase TAO3 to be associated with increased
morphine requirement in children of European Caucasian ancestry
undergoing day surgery tonsillectomy and adenoidectomy. Scott D. CookSather, M.D., Jin Li, Ph.D., Theodora K. Goebel, R.N., Emily M. Sussman,
B.A., Mohamed A. Rehman, M.D., Hakon Hakonarson, M.D., Ph.D.,
Anesthesiology and Critical Care Medicine, Center for Applied Genomics
Children’s Hospital of Philadelphia, Children’s Hospital of Philadelphia
and the Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA.
PD A2040
Is Post-Thoracotomy Pain Being Managed Well in our Tertiary Referral
Paediatric Hospital?
This is an audit conducted in a paediatric hopital looking at peri-operative
analgesia for thoracic surgery. This audit shows that although we have
good pain control post operatively with regional anaesthesia we still have
a high useage of morphine. We could improve our regional anaesthesia
by increasing our infusion or by increasing knowledge regarding local
anaesthesia boli via the catheter. This audit displays that we need to conduct
a prospective randomized trial comparing regional anaesthesia and opiate
analgesia post operatively for thoracic surgery. Fiona Desmond, M.B., B.Ch.,
Sinead Harte, M.B., B.Ch., Gill O’Callaghan, R.N., William Casey, M.B.
B.Ch., Department of Anaesthesia and Critical Care Medicine, Our Ladys
Hospital for Sick Children, Dublin, Ireland.
46
PD A2041
Pharmacogenetics of Celecoxib in Children Post Adenotonsillectomy
Human studies report decreased celecoxib clearance in carriers of the P450
liver enzyme CYP2C9 variant *3. We performed a sub-group analysis of
282 children 2-18 years scheduled for elective adenotonsillectomy. They
were randomized in a double blinded fashion to be treated with either six
scheduled doses of celecoxib or placebo in addition to other analgesics
as required to manage post-operative pain. We found that heterozygous
carriers of the *3 allele who received celecoxib experienced neither less pain
nor increased adverse events compared to placebo. Kimmo Murto, M.D.,
Christine Lamontagne, M.D., Johnna MacCormick, M.D., Colleen Daly,
M.D., Kelly-Ann Ramakko, B.Sc., Mary Aglipay, B.Sc., Regis Vaillancourt,
Pharm.D., Children’s Hospital of Eastern Ontario Research Institute
Ottawa, Canada
PD A2045
Low Dose Ketamine Infusion Does Not Change Opioid Requirement
After Pediatric Scoliosis Surgery
Low-dose ketamine has shown to be useful in reducing postoperative
pain and opioid use in a variety of surgical procedures. This prospective
randomized controlled study aimed to measure the analgesic efficacy and
opioid-sparing effect of perioperative low-dose ketamine infusion in pediatric
patients undergoing posterior spinal fusion. Administration of a continuous
infusion of ketamine failed to reduce opioid consumption after pediatric
scoliosis surgery. Sophie R. Pestieau, M.D., Mariana M. Junqueira, M.D.,
Julia C. Finkel, M.D., Zena Quezado, M.D., Division of Anesthesiology
and Pain Medicine, Children’s National Medical Center, Washington, DC,
Division of Anesthesiology and Pain Medicine, The Sheikh Zayed Institute
for Surgical Innovation, Children’s National Medical Center, Washington,
DC.
NA Neuroanesthesia
PN Pain Medicine
Single-Shot Caudal Block Versus Ultrasound-Guided Ilioinguinal/
Iliohypogastric Nerve Block for Pediatric Orchidopexy
This study was to clarify postoperative analgesia between caudal block
and ultrasound-guided ilioinguinal/iliohypogastric nerve block in pediatric
orchidopexy surgery. Caudal block was performed by classical landmark
method with 1mg/kg of 0.2% ropivacaine. (Caudal group) Ultrasound-guided
ilioinguinal/iliohypogastiric nerve block were performed that needle inserted
by in-plane or out of plane method with 0.3ml/kg of 0.2% ropivavaine. (II/
IL group) Patients were assessed 24hr for pain scores using FLACC scale.
This study resulted that there weren’t remarkable differences between caudal
block and ilioinguinal/iliohypogastric nerve block for postoperative analgesia
in pediatric orchidopexy surgery therefore we conclude that peripheral nerve
blocks were desirable than caudal block. Yasuo Suzuki, M.D., Sakurako
Miwa, M.D., Chihiro Igarashi, M.D., Mamiko Sato, M.D., Noriko Miyazawa,
M.D., Ph.D., Shinichi Yamamoto, M.D., Ph.D., Koichi Hiroki, M.D., Ph.D.,
Tokyo Metropolitan Children’s Medical Center, Japan.
PD02-1 ANESTHETIC ACTION AND BIOCHEMISTRY: RISKS AND
BENEFITS OF ANESTHETIC AGENTS
ROOM 125
FA A2047
Effect of Anaesthetic Technique on Immune Cell Infiltration in Breast
Cancer: A Follow-Up Pilot Analysis of a Prospective Randomized
Investigator-Masked Study
Paravertebral-propofol anaesthesia induced increased levels of NK and
T helper immune cell infiltration into breast cancer tissue compared with
GA. This is consistent with the hypothesis that anaesthetic technique
may affect perioperative immune function conducive to resisting breast
cancer recurrence and metastasis. Fiona A. Desmond, M.B., B.Ch., Janet
McCormack, B.Sc., Niall Mulligan, M.B., B.Ch., Maurice Stokes, M.B.,
B.Ch., Donal J. Buggy, M.B., B.Ch., Department of Anaesthesia and
Critical Care Medicine, Department of Core Pathology, Department of
Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
FA A2054
Phosphatidylinositide 3-Kinases Pathway is Involved in Mediating the
Anti-Inflammation Effects of Naloxone
This results demonstrate that the anti-inflammation effects of naloxone
could be offset by the PI3K inhibitors. Therefore, PI3K pathway is involved in
mediating the anti-inflammation effects of naloxone. Ping-Cheng Shih, M.D.,
Chun-Jen Huang, M.D., Ph.D., Anesthesiology, Buddhist Tzu-Chi General
Hospital, New Taipei City, Taiwan.
FA A2048
Neither Droperidol Nor Ondansetron Produce Dispersion of Ventricular
Repolarization in Anesthetized Adult Patients
This is a randomized double-blinded trial designed to assess the effects
of droperidol (1.25 mg) and ondansetron (4 mg) on the dispersion of
repolarization measured through the Tp-e interval in adult non cardiac
surgical patients anesthetized with TCI of propofol. Both drugs prolonged
the QT interval but only droperidol increased the QTc interval. Neither drug
changed the Tp-e interval. Juan I. Gomez-Arnau, Sr., Ph.D., Antonio
Gonzalez, M.D., Gabriela L. Agamez, M.D., Santiago Garcia del Valle
M.D., Amador Rubio, M.D., Elena Esteban, M.D., Elia Perez, Ph.D.,
Anesthesia & Critical Care, Hospital Universityersitario Fundacion
Alcorcon, Cardiology Unit, Hospital Universityersitario Fundacion Alcorcon,
Research Institute, Hospital Universityersitario Fundacion Alcorcon,
Madrid, Spain.
FA A2049
The In Vivo Identification Of (2S 6R) Hydroxynorketamine Metabolic
Pathway
The data support that downstream metabolites may be responsible for
ketamine’s therapeutic response for the treatment of chronic pain. Michael
Goldberg, M.D., Ruin Moaddel, Ph.D., Zeruesenay Desta, Ph.D., Mitesh
Sanghvi, Ph.D., Kathleen O’Loughlin, Ph.D., Carol Green, Ph.D., Marc
Torjman, Ph.D., Irving W. Wainer, Ph.D., Anesthesiology, Cooper University
Hospital, Cooper Medical School of Rowan University, Camden, NJ,
The Laboratory of Clinical Investigation National Institute on Aging
Intramural Research Program, National Institute of Health, Baltimore,
MD, Department of Medicine, Division of Clinical Pharmacology, Indiana
University School of Medicine, Indianapolis, SRI International, Menlo
Park, CA, The Laboratory of Clinical Investigation, National Institute
on Aging Intramural Research Program, National Institute of Health,
Baltimore, MD.
SUNDAY, OCTOBER 13
PD A2046
FA A2050
Effects of Isoflurane on Intracellular Calcium in Boutons of
Hippocampal Neurons
Laser- scanning fluorescence image measurements of intracellularCa2+
in transfected neonatal rat hippocampal neurons were made using the
genetically encodedCa2+-indicator GCaMP3 and action potential-evoked
exocytosis was measured with synaptophysin- pHluorin. Our data suggest the
primary anesthetic targets in the inhibition of neurotransmitter release from
small synaptic vesicles are situated upstream ofCa2+ entry and not within
the synaptic vesicle fusion machinery. Masato Hara, M.D., Ph.D., Joel P.
Baumgart, Ph.D., Zhenyu Zhou, M.D., Ph.D., Michael B. Hoppa, Ph.D.,
Hugh C. Hemmings, Jr., M.D., Ph.D., Anesthesiology, Pharmacology,
Biochemistry, Weill Cornell Medical College, New York, NY.
FA A2051
Anesthetic Conditioning in Liver Transplantation. A Multicenter
Randomized Controlled Trial
This first multicenter RCT evaluating protective effects of sevoflurane in liver
transplantation failed to show significant benefits compared to propofol.
Marie-Elisabeth Kajdi, M.D., John Michael Bonvini, M.D., Erik Schadde,
M.D., Milo Puhan, Ph.D., Estela RR Figueira, M.D., Joel A. Rocha Filho,
M.D., Koen Reyntjens, M.D., Pierre-Alain Clavien, M.D., Ph.D., Stefan
Breitenstein, M.D., Beatrice Beck-Schimmer, M.D., Anesthesiology,
Swiss HPB and Transplant Center, University Hospital Zurich, Horten
Centre University of Zurich, Liver and Gastrointestinal Transplant Division,
Anesthesiology, Hospital das Clinicas, University of Sao Paulo, Brazil,
Anesthesiology, Ghent University Hospital, Belgium.
FA A2052
Failure to Rescue From Fulminant Malignant Hyperthermia: Deaths and
Their Genetic Variants, 2007-2012
Analysis of cardiac arrest/death reports to The North American Malignant
Hyperthermia (MH) Registry of MHAUS from 2007-2012 demonstrates
failure to rescue 8 U.S. MH patients. 7 had low-intermediate risk surgery 6
were healthy. MH family history was unknown preoperatively in 3. MHAUS
recommendations for temperature monitoring and dantrolene dosage were
not followed for 7. In 2 misdiagnosis contributed to death. 3 MH causative
mutations & 3 VUS were identified. To help guide future anesthetics for
surviving relatives postmortem genetics should be performed on all patients
dying from a perioperative event suspect for MH. Marilyn G. Larach, M.D.,
Barbara W. Brandom, M.D., Gregory C. Allen, M.D., Gerald A. Gronert,
M.D., North American MH Registry of MHAUS, Anesthesiology, UPMC/
NAMHR, Pittsburgh, PA, NAMHR/Olympia Anesthesia, WA, Anesthesiology,
UC-Davis, CA.
NA Neuroanesthesia
PN Pain Medicine
47
FA A2053
FA A2058
PD13-4 OUTCOMES AND DATABASE RESEARCH: HEALTH CARE
ECONOMY
FA A2059
Morphine Inhibition of Isocitrate Dehydrogenase: Implications for
Metabolic and Epigenetic Cellular Alterations
Isocitrate Dehydrogenase (IDH) a rate limiting enzyme that plays a prominent
role in tricarboxylic acid cycle is implicated is some human cancers. The role
of IDH modulation in cancer is likely related to the loss of normally protective
alpha-ketoglutarate or production of the tumorigenic 2-hydroxyglutarate
both IDH metabolic by-products. We found that morphine inhibits IDH at
normal serum concentrations. This implies that morphine could potentially
have a role in cellular metabolic derangements and epigenetic modulations
in cancer progression. Diana Raj, M.B., Ch.B., Lawrence Wengle,
Student, Ramesh Vanama, M.Sc., Jason Thomas Maynes, M.D., Ph.D.,
Department of Anesthesia and Pain Medicine, Hospital for Sick Children,
Toronto, ON, Canada.
ROOM 124
FA A2055
Retrospective Analysis of Direct Drug Costs and Associated Time
Costs Comparing Sevoflurane and Isoflurane Anesthetics in an
Academic Setting
A retrospective review of 7,993 cases in an academic setting comparing the
acquisition and time costs associated with the choice of sevoflurane versus
isoflurane anesthesia. John L. Anderson-Dam, M.D., Jonathan P. Wanderer,
M.D., Department of Anesthesiology, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, Department of Anesthesiology,
Vanderbilt University Medical Center, Nashville, TN.
FA A2056
The Burden of Obesity on Perioperative Resource Utilization
24.3% to 29.5% of US adults are obese with medical spending estimated
at 42% higher for an obese person vs. one of normal weight. This study
examined traits associated with obesity in a perioperative setting. We found
that obese patients presented with higher comorbidity burden higher rates
of abnormal hemodynamic parameters and were more time intensive in
their anesthetic care. We conclude that obesity may impact significantly
on the perioperative utilization of resources. Peter M. Fleischut, M.D.,
Ansara M. Vaz, B.A., Jonathan M. Eskreis-Winkler, B.S., Andrew N. Lazar,
B.S., Madhu Mazumdar, Ph.D., Stavros G. Memtsoudis, M.D., Ph.D.,
Department of Anesthesiology, Department of Public Health/Biostatistics
and Epidemiology, Weill Cornell Medical College, Department of
Anesthesiology, Hospital for Special Surgery, New York, NY.
FA A2057
Hospital Costs Associated with Complication Following Open
Colectomy
A chart review of open colectomies was performed to determine the
incidence and hospital costs associated with perioperative complications.
Minor complications were associated with a small but significant increase
in costs while major complications were associated with dramatically
increased costs. Quality improvement leading to complication prevention
could improve value by generating better outcomes at decreased cost. David
N. Flynn, M.D., M.B.A., Rebecca M. Speck, Ph.D., Guy David, Ph.D.,
Lee A. Fleisher, M.D., Department of Anesthesiology and Critical Care,
Perelman School of Medicine, Department of Health Care Management,
The Wharton School, University of Pennsylvania, Philadelphia, PA.
Trends in Injuries To The Visual Pathways and Medicolegal Payments
From the Closed Claims Project Database
Though modern anesthesia is considered very safe changes in surgical
practice give rise to new perioperative complications and anesthetic
challenges that may increase liability risks. Malpractice claims associated
with injuries to the visual pathways had a significant increase in permanent
injuries over time primarily related to injuries to the optic nerve and central
retinal artery or vein occlusion in association with spine surgery. The higher
severity of injuries over time correlated with a more than 3-fold increase in
the median payments made. These changes in medicolegal claims against
anesthesiologists occurred during the same time period that spinal fusion
procedures more than doubled. Lorri Lee, M.D., Karen L. Posner, Ph.D.,
Karen B. Domino, M.D., M.P.H.. Anesthesiology and Pain Medicine,
Costs of Invasive Mechanical Ventilation Among Different Age Strata
Patients who receive invasive mechanical ventilation (IMV) consume a
disproportionate share of resources. The objective of this study was to
examine recent patterns of IMV costs among different age strata within
California. While the overall cost of a hospitalization with an IMV episode in
California has increased substantially our data indicated highest total hospital
costs for cohorts 50-69 years. Seshadri Mudumbai, M.D., Juli Barr, M.D.,
Jennifer Scott, M.S., Edward J. Bertaccini, M.D., Hieu T. Nguyen, B.A.,
Ciaran Phibbs, Ph.D., Edward R. Mariano, M.D., Brian Cason, M.D., Todd
Wagner, Ph.D., Anesthesia and Perioperative Care, Center for Health Care
Evaluation, VA Palo Alto, CA, St. Bonaventure University, NY.
FA A2060
Lack of Significant Influence of Anesthesia Group Consolidation on
Private-Payer Payment in the USA
Markets for anesthesia services are becoming increasingly consolidated
with medical groups growing larger in size and fewer in number. Whether
this increased consolidation allows anesthesia groups to leverage their
market power for higher payments from private payers is unknown. This
study used administrative claims data to examine the association between
market consolidation and private insurer payments. No association between
anesthesia group consolidation and private insurer reimbursement was
found. Eric Sun, M.D., Ph.D., Alex Macario, M.D., Franklin Dexter,
M.D., Ph.D., Thomas Miller, Ph.D., Laurence Baker, Ph.D., Department
of Anesthesia, Stanford University, CA, Department of Anesthesia,
University of Iowa, Iowa City, American Society of Anesthesiologists,
Washington, D.C., Department of Health Research and Policy, Stanford
University, CA.
FA A2061
The 2 Year Cost-Effectiveness of the MILD Procedure in Patients with
Symptomatic Lumbar Spinal Stenosis
Three main treatment options exist for the treatment of lumbar spinal
stenosis; epidural spinal stenosis minimally invasive lumbar decompression
(MILD) and surgical decompression. This study analyzes the 2 year costeffectiveness of these interventions for a patient who has failed conservative
therapy. Belinda Udeh, Ph.D., Nagy Mekhail, M.D., Raktim Ghosh, M.D.,
Hani Yousef, M.D., Jarrod Dalton, Ph.D., Outcomes Research, EvidenceBased Pain Research, Quanitative Health Sciences, Cleveland Clinic, OH.
FA A2062
Design and Implementation of a Custom Anesthesia Outcomes
Database as a Component of the Perioperative Surgical Home
We developed and implemented a custom-built secure searchable database
to document anesthetic and surgical specifics patient demographics and
inpatient outcomes at postoperative day 1-2. This MS Access information
platform added value to our Perioperative Surgical Home model of veteran
care. Our HIPPA-compliant database summarizes our inpatient caseload
and anesthetic delivery methods as well as offering a simple and rapid
mechanism for evaluating and improving our outcomes. Tessa L. Walters,
M.D., Alexander Kou, B.A., Steven K. Howard, M.D., Carlos Brun, M.D.,
T. Kyle Harrison, M.D., Lawrence C. Siegel, M.D., Edward Bertaccini, M.D.,
Natasha Funck, M.D., Audrey Shafer, M.D., Edward R. Mariano, M.D.,
Anesthesiology, Palo Alto Veterans Affairs Medical Center (PAVAMC), CA.
48
NA Neuroanesthesia
PN Pain Medicine
ROOM 123
RA A2063
Review of Optimal Epidural Opioid Use in Postoperative Analgesia: A
Meta-Analysis
We conducted a meta-analysis of RCTs that compared at least two
continuous epidural infusions for acute postoperative analgesia over at least
24h in abdominal thoracic orthopedic and obstetrical surgeries. A higher
incidence of PONV was noted through our analysis in patients receiving
morphine versus fentanyl. Further we note that the compared opioids in
our study showed similar abilities to provide analgesia in the post-operative
setting. Tristan M. Alie, M.D., M.S., Nayer Youssef, M.D., David Orlov,
M.D., Matthew Chong, B.Sc., Toni Tidy, B.Sc., Ji Cheng, B.Sc., Lehana
Thabane, Ph.D., James Paul, M.D., Anesthesia, McMaster University,
Hamilton, ON, Canada, Anesthesia, University of Toronto, Canada.
RA A2064
Local Anesthetics Inhibit Proliferation and Migration of Hepatoma
Cells in-vitro by Blocking the Cell Cycle in G2 Phase
We observed that amide-linked LA (ropivacaine and lidocaine) inhibited in
vitro hepatoma cells proliferation and migration by blocking the cell cycle in
G2 phase. Morphine at very high doses stimulated proliferation and migration
of hepatoma cells. Fentanyl had no effect on cells. Further experiments
are actually developed in order to investigate the molecular mechanisms
involved in these effects. Genome-wide expression profiling using micro-array
and integrative genomics are scheduled next. Helene Beloeil, M.D., Ph.D.,
Cedric Coulouarn, Ph.D., Yannick Malledant, M.D., Bruno Clement, Ph.D.,
Service Anesthesie-Reanimation, Inserm UMR 991 University Rennes 1
and CHU Rennes, France.
RA A2068
Transversus Abdominis Plane (TAP) Block Efficacy in Gynecologic
Surgery a Prospective Study
A prospective randomized double-blinded placebo control clinical trial
assessing preoperative bilateral TAP block efficacy in perioperative analgesia.
There is statistically significant reduction in the use of intraoperative fentanyl
in the drug group versus placebo. No significant reduction is observed in
postoperative analgesia. Siddharth Sata, D.O., Junping Chen, M.D., Ph.D.,
Jonathan B. Lesser, M.D., Franco Resta-Flarer, M.D., Henry Bennett,
Ph.D., Peter Byrnes, B.S., Anesthesiology, St Lukes-Roosevelt Hospital
Center, New York, NY.
RA A2069
Comparison of Bilateral Thoracic Paravertebral Block to Thoracic
Epidural Analgesia for Postoperative Analgesia in Patients Undergoing
Abdominal Surgery - A Randomized Open Label Study
This is an open label randomized study to document the proof of principle
that bilateral paravertebral blocks can be as effective as thoracic epidural
anaglesia with better safety and lesser side effect profile. The study
compares the efficacy and safety of continuous bilateral thoracic PVB to
TEA with respect to postoperative pain score in patients undergoing open
abdominal surgery. Rakesh V. Sondekoppam, M.D., Magdalena Terlecki,
M.D., Jonathan Brookes, M.D., F.R.C.A, Shalini Dhir, M.D., Vishal Uppal,
M.D., F.R.C.A, Sugantha Ganapathy, M.D., Department of Anesthesia
and Perioperative Medicine, Department of Anesthesia and Perioperative
Medicine, Western University, London, ON, Canada.
RA A2070
RA A2065
Postoperative Epidural Analgesia With Administration of Subcutaneous
Heparin Three Times Daily in Cancer Patients: A Review of 3705 Cases
Conflicting guidelines exist from American Society of Regional Anesthesia
(ASRA) and American College of Chest Physicians (ACCP) in regards to
subcutaneous (SC) administration of unfractionated heparin (UFH) three
times daily (TID) and epidural analgesia. In cancer patients we allow
maintenance with UFH SC TID holding one dose of UFH during catheter
removal and avoiding neuraxial manipulation for at least 4 hours after UFH
dose and 2 hours prior to next UFH dose. No epidural hematomas in 3,705
cases that received concurrent UFH TID SC with epidural analgesia were
found. Jackson Su, M.D., Jose M. Soliz, M.D., Keyuri U. Popat, M.D.,
Rodolfo Gebhardt, M.D., Anesthesiology and Perioperative Medicine, MD
Anderson Cancer Center, Houston, TX.
RA A2066
PD01-1 AMBULATORY ANESTHESIA - OUTCOMES AND
COMPLICATIONS
Review of Case Reports of Spinal Hematomas
Complete paralysis at presentation is the only factor associated with poor
functional recovery following spinal hematoma. Prompt surgical intervention
does not appear to improved functional recovery. Honorio T. Benzon,
M.D., Ariana Nelson, M.D., Silas Hoxie, M.D., Robert McCarthy, Ph.D.,
Anesthesiology, Northwestern University Feinberg School of Medicine,
Chicago, IL.
Peripheral Nerve Catheters in Patients Receiving Anticoagulation
Therapy
In this retrospective review of 234 continuous peripheral nerve catheters
placed over 2 years 32 catheters were placed in patient who received
anticoagulation therapy while the catheter was in place and no hemorrhagic
complications were noted in any of these patients. Christine L. Carqueville,
M.D., Dalia H. Elmoft, M.D., Tariq M. Malik, M.D., Department of
Anesthesia & Critical Care, University of Chicago Medical Center, IL.
RA A2067
Effect of Polyamine-Deficient Diet on Perioperative Pain for Spine
Surgery: A Prospective (IIb/III) Study
It was a prospective multicenter randomized and blinded study with
patients randomized into two groups: complete (Gr1) or partial polyaminedeficient diet (Gr2). In Gr1 observance was excellent (100%). The trend
of decrease of pain at rest before surgery became significant after and the
same tendency was reported at motion. This difference was more significant
in patients with worst pain. Quality-of-life was improved before surgery and
the tendency was prolonged after. Jean-Pierre C. Estebe, M.D., Ph.D.,
C. Degryse, M.D., G. Rezzadori, M.D., F. Dimache, M.D., D. Daccache,
M.D., A. Le Naoures, M.D., A. Belbachir, M.D., P. Schoeffer, M.D.,
University Hospital, Rennes, France, University Hospital, Bordeaux,
France, University Hospital, Nice, France, University Hospital, Strasbourg,
France, Private Hospital, Caen, France, University Hospital, Paris, France,
University Hospital, Clermont-Ferrand, France.
SUNDAY, OCTOBER 13
PD16-1 REGIONAL ANESTHESIA AND ACUTE PAIN: REGIONAL
ANESTHESIA AND ANALGESIA
ROOM 123
AM A2071
A Randomized Trial of Pre-Warming on Intraoperative Core
Temperature in Outpatient Surgery
This randomized prospective study tested the hypothesis that forced-air
pre-warming improves core temperature in patients having brief outpatient
operations. In this interim description, we observed 0.9°C separation of
core temperatures between warming and no pre warming groups at 90
minutes. Our results confirm that pre-warming, even for a relatively brief
period, reduces redistribution hypothermia and helps maintain a normal
intraoperative core temperature. Zohaib Akhtar, M.D., Brian D. Hesler,
M.D., Muhammad Mohsin Buttar, M.D., Daniel Sessler, M.D., Andrea
Kurz, M.D., Sabry Ayad, M.D., Leif Saager, M.D., Outcomes Research,
Anesthesiology and Pain Management, Cleveland Clinic Foundation, OH.
NA Neuroanesthesia
PN Pain Medicine
49
AM A2072
Post-Operative Alertness and Recovery. Sugammadex Versus
Neostigmine/Glycopyrrolate and Placebo
Clinically patients presume to be more alert in early recovery after NMB
reversal with sugammadex compared to cholinesterase inhibitor or
spontaneous recovery. We aimed to assess if sugammadex had a positive
effect on postoperative alertness. 33 patients were included at the end of
surgery when TOFratio was 0 9 patients received sugammadex neostigmine/
glycopyrrolate or placebo. Recovery cognitive en psychomotor tests were
performed 30 60 and120 minutes postoperative. NMB reversal resulted in
a faster return to preoperative status in Maddox wing test and suggamadex
patients reported a higher alertness VAS compared with the others. Diana
M. Gomez Valdez, Sr., M.D., Gert J. Scheffer, Ph.D., Anesthesiology,
Pijn and Palliative Care, Radboud University Nijmegen Medical Centre,
Netherlands.
AM A2073
Comparison of Two Techniques of Regional Anesthesia for Outpatient
Surgery: Unilateral Spinal Anesthesia and Sciatic Nerve Block
This is a comparison of two techniques of regional anesthesia for outpatient
surgery: unilateral spinal anesthesia and sciatic nerve block. Caroline Garcia,
Ph.D., Christelle Fescau, Ph.D., Cecile Degryse, Ph.D., Francis Gadrat,
Ph.D., Nadia Hoarau, Ph.D., Gil Mourembles, Ph.D., Francois Sztark,
Ph.D., CHU Pellegrin, Bordeaux, France.
AM A2074
Factors Impacting PONV and PDNV in the Ambulatory Setting
The SAMBA SCOR data base (which contains over 40,000 patients) was
explored to provide the demographics and factors that are associated
with PONV and PDNV. Peter Glass, M.B., B.Ch., Lucy Everett, M.D.,
Douglas Merrill, M.D., Martin Redmond, M.D., Stony Brook Medicine,
NY, Anesthesia, Massachusetts General Hospital, Boston, Anesthesia,
Dartmouth-Hitchcock, Hanover, NH.
AM A2075
Risk Factors for Complications Following Surgery for Obstructive Sleep
Apnea
The objective of the study was to assess risk factors for postoperative
complications after obstructive sleep apnea surgery. Out of 2642 patients
OSA 67 adult patients underwent surgery and only 46 charts were available.
Severe OSA and history of smoking was associated with a higher rate
of complications. Mary M. Joseph, M.D., Jane Moon, B.A., Hilario M.
Ramirez, B.S., Ryan Reddick, B.S., Zaruhi Meliksetyan, M.D., Kashif
Mazhar, M.D., Anesthesiology, Otolaryngology, Keck School of Medicine,
University of Southern California, Los Angeles, CA.
AM A2076
The Effect of Sevoflurane Versus Desflurane on the Incidence of Upper
Respiratory Morbidity in Patients Undergoing General Anesthesia Using
a Laryngeal Mask Airway: A Meta-Analysis of Randomized Controlled
Trials There is currently no evidence to suggest that Desflurane when used with
laryngeal mask airway causes more upper airway morbidity than sevoflurane.
R-Jay L. Marcus, M.D., Gildasio DeOliveira, M.D., Anesthesiology,
Northwestern University, Feinberg School of Medicine, Chicago, IL.
AM A2077
Preoperative Intravenous Parecoxib Reduces Length of Stay on
Ambulatory Laparoscopic Cholecystectomy
Preoperative administration of parecoxib for postoperative analgesia provided
significant effect on reducing PACU length of stay (LOS) and discharge time
reduced pain intensity and additional analgesic improved patient outcome
after ambulatory LC. Li Shuying, Student, Wang Xiao, M.D., Liang Peng,
M.D., Department of Anesthesiology, West China Hospital, Sichuan
University, Chengduo.
50
AM A2078
Liability in Office-Based Anesthesia: Closed Claims Analysis
Office-based anesthesia (OBA) malpractice claims had similar severity of
injury but more commonly failed to meet appropriate standards of anesthesia
care compared to other outpatient claims. OBA claims were more likely to
result in payment than other outpatient claims but payment amounts were
similar. Continuing focus on improvements in office-based procedure safety
and regulatory oversight for office-based surgery has potential to improve
anesthesia patient safety and liability in office-based practice settings.
Rebecca Twersky, M.D., M.P.H., Karen L. Posner, Ph.D., Karen B. Domino,
M.D., M.P.H., Anesthesiology, SUNY Downstate Medical Center, Brooklyn,
NY, Anesthesiology and Pain Medicine, University of Washington,
Seattle. POSTER PRESENTATIONS
PO06-2A CRITICAL CARE: SEPSIS AND INFLAMMATION
ROOM 104-AREA A
CC A2079
Hyperbaric Oxygen Preconditioning (HBO) Before Whipple Surgery:
A Randomized Trial
HBO therapy administered 24 hours before pancreatoduodenectomy
(Whipple)was compared to sham treated controls. Pre-oxygenation with
HBO significantly reduced postoperative pneumonias biliary fistulae
and pro-inflammatory cytokines. Enrico M. Camporesi, M.D., Gerardo
Bosco, M.D., Andrea Casarotto, M.D., Claudio Bassi, M.D., Manuel
Nasole, M.D., Giulo Di Tano, M.D., Zhong-Jin Yang, M.D., Devanand
Mangar, M.D., Surgery, University of South Florida, Florida, Gulf-to-Bay
Anesthesiology, Associates, LLC, Tampa, FL, Department of BioMedical
Science, University of Padua, Italy, Laboratory of Translational Surgery,
University of Verona, Italy, Istituto Iperbarico SpA Via Francia, Verona,
Italy, Department of Imaging, Physiology Lab, G d’Annunzio University,
Chieti, Pescara, Italy, Anesthesiology, SUNY Upstate Medical University,
Syracuse, NY.
CC A2080
Hypoxic Pulmonary Vasoconstriction (HPV) in Isolated Rat Lungs in a
Septic Rodent Model
Hypoxic pulmonary vasoconstriction (HPV) was observed in an isolated
rat lung preparation and was correlated to endogenous nitric oxide (NO)
production. We compared normal or artificially elevated NO levels after
E Coli lipopolysaccharides (LPS) induced sepsis. Our results suggest that
hypoxia may reduce NO production however NO levels seem to play a limited
role on vascular tone and on HPV. Enrico M. Camporesi, M.D., Alessia
Pedoto, M.D., Collin Sprenker, B.S., Devanand Mangar, M.D., Sal Tawfic
Hakim, M.D., Surgery, University of South Florida, Florida, Gulf to Bay
Anesthesiology, Associates, LLC, Tampa, FL, Memorial Sloan-Kettering
Cancer Center, New York City, NY, Physiology, Pulmonary, Anesthesiology,
Surgery, SUNY Upstate Medical University, Syracuse, NY.
CC A2081
Simvastatin Mitigates Blood-Brain Barrier Integrity Disruption in a
Rodent Model of Polymicrobial Sepsis
Simvastatin mitigates blood-brain barrier integrity disruption in a rodent
model of polymicrobial sepsis. Chun-Jen Huang, M.D., Ph.D., Kuang-Yao
Li, M.D., Ping-Cheng Shih, M.D., Ming-Chan Kao, M.D., Cay-Huyen Chen,
M.D., Department of Anesthesiology, Buddhist Tzu Chi General Hospital,
Taipei Branch, New Taipei City, Taiwan.
CC A2082
Clinical Doses of Propofol Reduce Sepsis-Induced Hepatocyte
Apoptosis Via Regulation of TNF Expression in the Rats
Activated Kupffer cells caused hepatocyte apoptosis concurrently with liver
dysfunction via release of TNF in the rat sepsis. Clinically relevant doses
of propofol reduced the derangement via regulation of TNF expression.
Hiroyuki Kinoshita, M.D., Ph.D., Kazuo Ando, M.D., Guo-Gang Feng,
M.D., Ph.D., Jiazheng Li, M.D., Jiazhen Jiang, M.D., Takahiko Akahori,
M.D., Eri Matsunaga, M.D., Emi Nakamura, M.D., Yoshihiro Fujiwara,
M.D., Ph.D., Anesthesiology, Aichi Medical University School of Medicine,
Pharmacology, Aichi Medical University School of Medicine, Nagakute,
Japan.
NA Neuroanesthesia
PN Pain Medicine
Effects of Recombinant Human Soluble Thrombomodulin in Patients
With Disseminated Intravascular Coagulation
Thrombomodulim (TM) the thrombin receptor on the endothelial cell surface
plays an important role in coagulation and inflammation. Previous studies
reported that administration of recombinant human TM (rTM) improved
organ dysfunction in patients with sepsis-induced disseminated intravascular
coagulation (DIC). We investigated the therapeutic effect of rTM in patients
with sepsis who had DIC managed in our intensive care unit. The platelet
count C reactive protein levels DIC scores and sequential organ failure
assessment scores of patients with DIC were improved by treatment with
rTM. Makiko Komori, M.D., Yoriko Sone, M.D., Kazuyoshi Ando, M.D.,
Goro Kaneko, M.D., Keiko Nishiyama, M.D., Yasuko Tomizawa, M.D.,
Mitsuharu Kodaka, M.D., Anesthesiology, Medical Center, East Tokyo,
Women’s Medical University, Japan.
CC A2084
Effects of Early Goal-Directed Fluid Therapy on Endothelial Function in
Severe Acute Pancreatitis
Mortality in SAP remains high. We could show that keeping the SVI in
individual constant levels ensured an adequate macrocirculation during
systemic inflammatory response and avoided endothelial damage by fluid
overloading as well as organ-dysfunction. Karin H. Wodack, M.D., Annika
M. Poppe, M.D., Lena Tomkotter, M.D., Constantin J.C. Trepte, M.D., Kai
A. Bachmann, M.D., Ph.D., Kai Heckel, M.D., Cilly M. Strobel, Student,
Daniel A. Reuter, M.D., Ph.D., Department of Anesthesiology, Center of
Anesthesiology and Intensive Care Medicine, Department of GeneralVisceral- and Thoracic Surgery Center of Surgical Sciences, University
Medical Center Hamburg-Eppendorf, Germany.
CC A2085
LipoxinA4 Promotes Epithelial Wound Repair Whilst Reducing
Fibroproliferation
Our data provides evidence for a new mechanism of action of LXA4 by which
this compound contributes to inflammation resolution promoting alveolar
epithelial repair and prevent FasL induced apoptotic cell death in AT2 cells
whilst inhibiting fibroproliferation. Shengxing Zheng, M.D., Ph.D., Shengwei
Jin, M.D., Ph.D., Qingquan Lian, M.D., Ph.D., Qingquan Lian, M.D., Ph.D.,
The Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou
CC A2086
Complement Factor B is a Downstream Effector of Toll-Like Receptors
and Plays a Critical Role in Polymicrobial Sepsis
Toll-like receptors (TLRs) and the complements are critical parts of the
innate immunity. We show that: 1) Activation of distinct TLRs markedly upregulates complement factor B (cfB) production in macrophages and cardiac
cells 2) Polymicrobial sepsis augmented cfB level in the serum peritoneal
cavity and multiple organs 3) Absence of cfB conferred a protective
effect with improved survival improved cardiac function and attenuated
kidney injury during sepsis. Lin Zou, M.D., Ph.D., Yan Feng, M.D., Ph.D.,
Chan Chen, M.D., Jiayan Cai, B.S., Yu Gong, Ph.D., Wei Chao, M.D.,
Ph.D., Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA.
PO07-1A DRUG DISPOSITION
ROOM 104-AREA B
FA A2087
FA A2088
Effects of Digoxin on Gene Expressions Related to Angiogenesis in
Cultured Rat Cardiomyocytes
Digoxin exposure altered the gene expressions in cultured cardiomyocytes.
Those gene expression alterations may attenuate myocardial angiogenesis
thus negatively affecting myocardial collateral circulation and
revascularization. Mingbing Chen, M.D., Juan Tan, M.D., Yuke Tian, M.D.,
Seth Christian, M.D., Lyndia Jones, M.D., Robert Hansen, M.D., Nakeisha
L. Pierre, M.D., Santiago Gomez, M.D., Henry Liu, M.D., Anesthesiology,
Tongji Hospital, Tongji Medical College of Huazhong University of Science
and Technology, Wuhan, China, Anesthesiology, Tulane University Medical
Center, New Orleans, LA.
FA A2089
Effect of Magnesium on the Recovery Time of Neuromuscular
Blockade With Sugammadex: Randomized Controlled Trial
This prospective randomized double-blind study concluded that the use
of magnesium sulfate did not significantly alter the recovery time after
sugammadex on moderate neuromuscular blockade. Paulo A. Filho,
M.D., Ismar L. Cavalcanti, M.D., Ph.D., Louis Barrucand, M.D., Ph.D.,
Raphael C. Rodrigues, M.D., Luana Rodrigues, M.D., Vitor N. Andrade,
M.D., Ludmila B. Henrique, M.D., Nubia V. Figueiredo, M.D., Ph.D.,
Anesthesiology, Pathology, Hospital Federal de Bonsucesso, Rio de
Janeiro, Brazil, Anesthesiology, Universityersidade Federal Fluminense,
Niteroi, Brazil, Anesthesiology, Universityersidade Federal Do Rio De
Janeiro, Brazil.
FA A2090
Tranexamic Acid Pharmacokinetics in Normal Renal Function Patients
Tranexamic acid pharmacokinetics in normal renal function patients
undergoing cardiac surgerySummaryThis study confirms that our previously
developed 2-compartmental model and pharmacokinetic parameters
within patients with normal renal function undergoing cardiac surgery with
cardiopulmonary bypass remain identical regardless on the duration of
infusion and sampling times. Angela Jerath, M.B. B.S., Marcin Wasowicz,
Ph.D., Qi Yang, B.Sc., K. Sandy Pang, Ph.D., Anesthesia and Pain
Medicine, Toronto General Hospital, ON, Canada, Leslie Dan Faculty
of Pharmacy, Department of Pharmacology, University of Toronto, ON,
Canada.
FA A2091
Novel Application Solid Phase Microextraction (SPME) to the Study
Metabolomics in Liver Transplantation
Metabolomics describes the quantitaive changes of metabolites in biofluids due to disease and treatment. It can identify biomarkers that can
guide individualized patient treatment and may help guide management of
early graft dysfunction following liver transplantation. Solid Phase Microextraction (SPME) can simultaneously measure multiple metabolites and
drugs in a simple and cost-effective manner. We describe the first application
of SPME to metabolomics in cadaveric liver transplantation. Michael
Kluger, FANZCA, Angela Jerath, FANZCA, Barbara Bojko, Ph.D., Stuart
McCluskey, M.D., Ph.D., Janusz Pawliszyn, Ph.D., Marcin Wasowicz, M.D.,
Ph.D., Anesthesia and Pain Management, Toronto General Hospital, UHN
University of Toronto, ON, Canada, Chemistry, University of Waterloo, ON,
Canada.
FA A2092
Quantitative Assessment of Neuromuscular Block in the Morbidly
Obese
Despite great advances in anesthesia technology quantitative assessment
of neuromuscular block is rarely available. This study describes it’s use in
an understudied and airway vulnerable patient. Lawrence P. Frank, M.D.,
Carlos H. Cajina, M.D., Ira Abels, M.D., Yaniv Cozacov, M.D., Wagih
Gobrial, M.D., Anesthesiology, MIS/Bariatrics, Cleveland Clinic, Weston, FL.
Evaluation of the Effectiveness of Sugammadex for Verapamil
Intoxication
The hypothesis of our study is that sugammadex similar to beta cyclodextrin
will have a delaying effect in a cardiotoxicity model induced by verapamil.
To test this hypothesis rats given verapamil infusion were administered
sugammadex in doses of 16 mg/kg 100 mg/kg and 1000 mg/kg and
the effects on verapamil cardiotoxicity were investigated. We found 16
mg/kg sugammadex delayed verapamil cardiotoxicity in a rat model
of verapamil toxicity. However, 1000 mg/kg sugammadex accelerated
verapamil cardiotoxicity in a rat model of verapamil toxicity. Further studies
must be conducted to investigate the interaction between verapamil and
sugammadex. Sule Ozbilgin, M.D., Anesthesiology and Reanimation,
Dokuz Eylul University Hospital, Izmir, Turkey.
PN Pain Medicine
SUNDAY, OCTOBER 13
CC A2083
NA Neuroanesthesia
51
FA A2093
Performance of Compartmental Pharmacokinetic Model for
Rocuronium: Comparison of Five Parameter Sets
When comparing the published five PK models for rocuronium the
Szenohradszky model is relatively acceptable to predict rocuronium plasma
concentration during continuous infusion although the Szenohradszky model
overpredicted plasma concentrations. Tomoki Sasakawa, M.D., Kenichi
Masui, M.D., Ph.D., Tomiei Kazama, M.D., Ph.D., Hiroshi Iwasaki, M.D.,
Ph.D., Asahikawa Medical University, Japan, National Defense Medical
College, Tokorozawa, Japan.
FA A2094
Infusion Requirement and Reversibility of Rocuronium at the
Corrugator Supercilii Muscle During Anesthesia With Sevoflurane and
Propofol
The aim of this study is to compare the infusion rates required to maintain a
constant moderate neuromuscular block and the reversibility of rocuronium
at the CSM during anesthesia using sevoflurane and propofol. The
recommended infusion rates required to maintain a constant moderate
neuromuscular block at the CSM were approximately 7µg/kg/min during
sevoflurane anesthesia and 10µg/kg/min during propofol anesthesia.
Neostigmine-mediated reversal was slower during sevoflurane anesthesia.
Yusuke Yamamoto, M.D., Takahiro Suzuki, M.D., Satomi Yamamoto, M.D.,
Miki Kasai, M.D., Hitoshi Mizutani, M.D., Jitsu Kato, M.D., Shigeru Saeki,
M.D., Anesthesiology, Nihon University School of Medicine, Tokyo, Japan.
PO09-1A EXPERIMENTAL CIRCULATION: ISCHEMIA AND REPERFUSION
INJURY
ROOM 104-AREA C
CA A2095
Pretreatment of Volatile Anesthetics Differentially Modulates
Endothelial Barrier Function During Inflammation
In response to inflammatory stimuli sevoflurane has protective effect on
monolayer integrity and endothelial barrier function while isoflurane has
destructive effect on endothelial permeability. Our findings suggest that
volatile anesthetics differentially regulate paracellular vascular permeability
and could play an important role in the development of postoperative
inflammatory edema. Nosheen Muzaffar, M.D., Zhibo Yan, M.D., David
Schwartz, M.D., Guochang Hu, M.D., Ph.D., Anesthesiology and
Pharmacology, University of IL at Chicago.
CA A2096
Role of Endogenous Opioid System in Ischemic-Induced Late
Preconditioning
Cardioprotection by ischemic late preconditioning involves activation of
opioid receptors and upregulation of opioid receptors within eight hours after
ischemic late preconditioning is associated with an increase in endogenous
opioid peptides. Ragnar Huhn, M.D., Ph.D., Jan Fraessdorf, M.D., Ph.D.,
Andre Heinen, M.D., Ph.D., Nina C. Weber, Ph.D., Bendikt Preckel,
M.D., Markus W. Hollmann, M.D., Ph.D., Department of Anesthesiology,
Academic Medical Center (AMC) University of Amsterdam, Amsterdam,
Netherlands, Department of Anesthesiology, University Hospital
Duesseldorf, Germany.
CA A2097
Short-Term Simvastatin Administration in Hyperglycemia Rabbits
Facilitate Anesthetic Postconditioning
We studied the effects of short-term administration of simvastatin on
isoflurane-induced postconditioning during hyperglycemia in vivo rabbits. Our
results indicate that simvastatin restores isoflurane-induced postconditioning
in the presence of hyperglycemia. Noriko Kanbe, M.D., Katsuya Tanaka,
M.D., Nami Kakuta, M.D., Yasuo M. Tsutsumi, M.D., Shuzo Oshita,
M.D., Anesthesiology, Institute of Health Biosciences, The University of
Tokushima Graduate School, Japan.
CA A2098
The Role of Fatty Acids in Anesthetic Preconditioning
Anesthetic cardioprotection (APC) is attenuated in diabetes when cellular
metabolism is altered. The role of the energy source on APC has not been
studied. We observed excessive oxidative stress in the presence of palmitate
causing higher vulnerability in mouse cardiomyocytes. Palmitate induced
mitochondrial uncoupling and attenuated isoflurane inhibition on respiration.
The combination of excessive oxidative stress and attenuated triggering
action of isoflurane may prevent APC in diabetes. Chika Kikuchi, M.D.,
Curtis Bradford, B.A., Xiaowen Bai, M.D., Ph.D., Zeljko J. Bosnjak, Ph.D.,
Martin Bienengraeber, Ph.D., Anesthesiology, Physiology, Pharmacology
and Toxicology, Medical College of Wisconsin, Milwaukee.
CA A2099
Synergistic Effects of Nand Apoptosis Inhibition Against Myocardial
Ischemia-Reperfusion Injury The programmed necrosis necroptosis is involved in acute myocardial
ischemia-reperfusion injury and simultaneous inhibition of necroptosis
and apoptosis confers a synergistic effect in isolated guinea pig hearts.
Shizuka Koshinuma, D.D.S., Masami Miyamae, M.D., Ph.D., Kazuhiro
Kaneda, D.D.S., Vincent M. Figueredo, M.D., Junichiro Kotani, D.D.S.,
Department of Anesthesiology, Department of Internal Medicine, Osaka
Dental University, Japan, Institute for Heart and Vascular Health, Einstein
Medical Center and Jefferson Medical College, Philadelphia, PA.
CA A2100
Tempol Restores Anesthetic Preconditioning in the Aging Heart:
Effects on Mitochondrial Autophagic Pathways
We and others have reported that older animals fail to benefit from
anesthetic preconditioning (APC) ischemic preconditioning. Recently our
study has shown that chronic Tempol treatment restores pharmacological
preconditioning in the senescent rat heart. To address a possible mechanism
underlying age-related differences this study was designed to explore
changes in the autophagic pathway and to investigate the effects of oxidative
stress on autophagy in the aging heart by treating senescent animals with
the oxygen free radical scavenger TEMPOL. Our results point to a specific
mechanism for boosting autophagy and restoring anesthetic preconditioning
in the aging heart after Tempol pretreatment. Lixin Liu, M.D., Ph.D., Jiang
Zhu, M.D., Mario J. Rebecchi, Ph.D., Qun Gao, M.D., Ph.D., Peter S.A.
Glass, M.B. Ch.B., Anesthesiology, Stony Brook University School of
Medicine, NY.
CA A2101
Intravenous Ascorbic Acid Protects Forearm Vascular Endothelium
From Ischemia Reperfusion Injury in Humans
Vitamin C (Vit C ascorbic acid) is a non-enzymatic antioxidant that can
neutralize the action of ROS through direct and indirect mechanisms.
Systemic Vit C administration reduced I/R injury (forearm blood flow) of the
vascular endothelium in the human forearm during regional hyperglycemia.
Jutta Novalija, M.D., Ph.D., Thomas J. Ebert, M.D., Ph.D., Toni D. Uhrich,
M.S., Jill A. Barney, M.S., Anesthesiology, VA Medical Center and Medical
College of Wisconsin, Milwaukee.
PO12-1A OBSTETRIC ANESTHESIA: CESAREAN DELIVERY
HEMORRHAGE
ROOM 104-AREA D
OB A2102
Enhanced Recovery in Obstetric Surgery (EROS) - The First UK
Established Programme
We at King’s College Hospital, London have set up the first enhanced
recovery program in obsetetric surgery in the UK (Kings-EROS) for patients
undergoing an elective caesarean section. We present our first two months
data and compare it with data collated prior to the initiation of this program.
The results show a significant reduction in time to first mobilisation time
to catheter removal length of hospital stay and a very positive patient
satisfaction rate. There is also no increase in day seven readmission rates.
Daniel Abell, M.B., Ch.B., Oliver Long, M.B., Ch.B., Ilias Giarenis, M.D.,
Shereen Cameron, Claire Davidson, Leonie Penna, M.B., B.S., Vanessa
Skelton, M.B., B.S., Jay Dasan, M.B., B.S., Saju Sharafudeen, M.D.,
Anaesthesia, King’s College Hospital, London, United Kingdom.
52
NA Neuroanesthesia
PN Pain Medicine
Retrospective Assessment of the Effect of Anesthetic Type for
Cesarean Delivery on Neonatal Acid-Base Status
Previous meta-analysis has reported neonatal cord pH to be significantly
lower when spinal anesthesia is used compared to general or epidural
anesthesia for cesarean delivery. This study re-evaluated the effects of
anesthesic technique on cord pH now that phenylephrine has largely replaced
ephedrine use in our practice. Claire G. Dakik, M.D., William D. White,
M.P.H., Ashraf S. Habib, M.B., B.Ch., Department of Anesthesiology,
Duke University, Durham, NC.
OB A2104
Why Did It Take That Long? A Study of Factors Influencing Cesarean
Delivery Times
We examined possible factors that could affect surgical time during
cesarean sections including patient factors (e.g. BMI) and surgical factors
(e.g. primary secondary tertiary or quaternary or more cesarean) at our
institution. This information can help tailor the anesthetic plan especillay
whether or not an epidural catheter may be needed. Antonio Gonzalez-Fiol,
M.D., Marie-Louise Meng, M.D., Minjae Kim, M.D., Richard Smiley, M.D.,
Ph.D., Anesthesiology, Columbia University, New York, NY.
OB A2105
Effects of Left Uterine Displacement Depend on Fetal Position in
Patients Receiving CSEA - A Pilot Study We examined the relationship between effectiveness of left uterine
displacement (LUD) and the intrauterine position of the fetus in parturients
undergoing elective cesarean section. Effectiveness of LUD in maintaining
maternal blood pressure depends on the fetal position in parturients
undergoing cesarean section. LUD is more effective in parturients in whom
the fetus is lying to the left rather than the right of the maternal spine.
Shunsuke Hyuga, M.D., Tomoyuki Kawamata, M.D., Mikito Kawamata,
M.D., Department of Anesthesiology and Resuscitology, Shinshu
University School of Medicine, Matsumoto, Nagano, Japan.
OB A2106
Effect of Intrathecal Versus Epidural Opioid Administration on
Postoperative Pain Following Caesarean Section The aim of this prospective randomized trial was to investigate if single
bolus intrathecal opioid administration (SPA) was superior to epidural opioid
(CSE)or continuous epidural patient controlled anesthesia (CSEPCEA)
administration for pain relief after caesarean section. SPA was shown to
have lower pain scores compared to CSE (p=0 03) and CSEPCEA (p< 0
01). Lutz Kaufner, Sr., M.D., Silke Heimann, M.D., Desiree Zander, M.D.,
Michael Sander, M.D., Spies Claudia Doris, M.D., Martin Schuster, M.D.,
Katharina von Weizsacker, M.D., Klaus-D Wernecke, Ph.D., Christian
von Heymann, M.D., Anaesthesiology, Obstetrics, Charite University
Medicine, Berlin, Germany, Anesthesiology, Furst Stirum Clinic, Bruchsal,
Germany, Statistics, SOSTANA Statistical Analysis, Berlin, Germany.
OB A2107
Satisfaction Mobilization and Side-Effects According to the Mode of
Regional Anesthesia for Cesarean Section
The aim of this prospective randomized trial was to investigate the influence
of 3 different regional anesthetic techniques on satisfaction mobility nausea
and pruritus 24h and 48h after caesarean section. Continuous patient
controlled epidural analgesia is associated with reduced mobility as indicated
by a higher Bromage score over 24h and has no benefit compared to spinal
anesthesia and combined spinal-epidural anesthesia with regard to overall
satisfaction. Lutz Kaufner, Sr. M.D., D. Zander, M.D., S. Heimann, M.D.,
M. Schuster, M.D., M. Sander, M.D., C.D. Spies, M.D., K. von Weizsacker,
M.D., K.D. Wernecke, Ph.D., C. von Heymann, M.D., Anesthesiology,
Obstetrics, Charite University Medicine, Berlin, Germany, Anesthesiology,
Furst Stirum Clinic, Bruchsal, Germany, Statistics SOSTANA Statistical
Analysis, Berlin, Germany.
OB A2108
Bolus Colloid Coload Prevents Spinal-induced Hypotension in
Parturient Undergoing Elective Caesarean
An effective method for preventing hypotension during spinal anaesthesia
associated with caesarean delivery has to be found. For this purpose a
prospective randomized double blind study comparing colloid coload versus
crystalloid coload is conducted. We found that a bolus of 15ml/kg of 6%HES
130/0.4 is reliable to reduce maternal hypotension ephedrine consumption
and maternal discomfort than 20ml/kg of Ringer Lactate solution when
elective caesarean delivery is conducted under spinal anaesthesia. Hosni Kouadja, Ed.D., Anis Gaddab, Ed.D., Fehmi Farhi, Ed.D., Khalil
Tarmiz, Ed.D., Amor Slama, M.D., Afif Chehata, M.D., Amine Bouslama,
Ed.D., Nabiha Bouafia, Ed.D., Khaled Ben Jazia, Ph.D., Anesthesia and
Intensive Care, Community Medicine, Farhat HACHED Teaching Hospital,
Sousse, Tunisi.
SUNDAY, OCTOBER 13
OB A2103
OB A2109
National Anesthesia Practice Patterns for Cesarean Sections: An
Analysis of Data From the Anesthesia Quality Institute
Cesarean Sections (CS) are increasingly common obstetrical procedures
yet little is known about the types and characteristics of anesthesia that
are most frequently used. Though the majority of CS at Anesthesia Quality
Institute (AQI) participating institutions are performed under neuraxial
anesthesia general anesthesia is utilized among sicker patients and at
University Hospitals. James E. Littlejohn, M.D., Ph.D., Licia Gaber-Baylis,
B.A., Madhu Mazumdar, Ph.D., Stavros G. Memtsoudis, M.D., Ph.D.,
Peter M. Fleischut, M.D., Department of Anesthesiology, New York
Presbyterian Hospital - Weill Cornell Medical College, New York, NY,
Department of Public Health/Biostatistics and Epidemiology, Weill Cornell
Medical College, New York, NY, Department of Anesthesiology, Hospital
for Special Surgery, New York, NY.
PO16-2A REGIONAL ANESTHESIA AND ACUTE PAIN: ACUTE
POSTOPERATIVE PAIN
ROOM 104-AREA E
RA A2110
Ultrasound Guidance Decreases Procedural Time Compared to Nerve
Stimulation for Lateral Popliteal-Sciatic Nerve Block in Obese Patients
A Randomized Controlled Trial demonstrating that the ultrasound is superior
to the nerve stimulation technique in the lateral popliteal approach to the
sciatic nerve in the obese population. Nicholas C. Lam, M.D., Edward R.
Mariano, M.D., Timothy R. Petersen, Ph.D., Christopher Arndt, M.D.,
Brian J. Starr, M.D., Neal Gerstein, M.D., Department of Anesthesiology,
University of New Mexico, Albuquerque, Department of Anesthesiology,
Stanford University School of Medicine, Palo Alto, CA.
RA A2111
A Genetic Variant in ADRA2A Predicts Extent of Acute Pain After Motor
Vehicle Collision
Using genetic association studies we show that SNP rs3750625 in
ADRA2A is associated with acute pain after stress. Sarah Linnstaedt,
Ph.D., Andrey Bortsov, M.D., Ph.D., Margaret Walker, Robert Swor, D.O.,
Jeffrey Jones, M.D., David C. Lee, M.D., David A. Peak, M.D., Robert
Domeier, M.D., Niels Rathlev, M.D., Samuel McLean, M.D., Department
of Anesthesiology, University of North Carolina, Chapel Hill, Department
of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, Department
of Emergency Medicine, Spectrum-Health, Grand Rapids, MI, Department
of Emergency Medicine, North Shore University Hospital, Manhasset NY,
Department of Emergency Medicine, Massachusetts General Hospital,
Boston, Department of Emergency Medicine, St. Joseph Mercy Hospital,
Ann Arbor, MI, Department of Emergency Medicine, Baystate Medical
Center, Springfield, MA.
NA Neuroanesthesia
PN Pain Medicine
53
RA A2112
Morphine-Sparing Effect of Ketamine After Scoliosis Surgery Depends
on the Dose of Intraoperative Remifentanil
The objective of this study was to examine whether the dose of intraoperative
remifentanil would affect morphine sparing effect of ketamine after
remifentanil-based anesthesia in scoliosis surgery. Seventy-four patients
aged 7-19 yr were retrospectively studied. Our result showed ketamine
reduced postoperative morphine requirement after low-dose remifentanilbased anesthesia in scoliosis surgery whereas morphine-sparing effect of
ketamine was not significant after high-dose remifentanil-based anesthesia.
High dose remifentanil could attenuate clinical efficacy of ketamine after
scoliosis surgery. Rie Minoshima, M.D., Naho Araki, M.D., Reiko Hoshino,
M.D., Reiko Murase, M.D., Shizuko Kosugi, M.D., Hiroshi Morisaki M.D.,
Department of Anesthesiology, KEIO University School of Medicine,
Tokyo, Japan.
RA A2113
Continuous Versus Single-Shot Sciatic Nerve Block Added to
Continuous Femoral Nerve Block for Analgesia After Total Knee
Arthroplasty
This study is a prospective double-blind randomized controlled trail comparing
the efficacy of continuous sciatic nerve block with single-shot sciatic nerve
block for analgesia of total knee arthroplasty when added to continuous
femoral nerve block. The combination of continuous femoral and sciatic nerve
block provides the superior opioid sparing effect and improves analgesia after
total knee arthroplasty. Keita Sato, M.D., Seiju Sai, M.D., Naoto Shirai,
M.D., Noriko Naoi, M.D., Takehiko Adachi, M.D., Ph.D., Anesthesiology,
Kitano Hospital, Osaka, Japan.
RA A2114
Neuraxial Anesthesia in Patients Undergoing Total Knee Arthroplasty:
Comparison of Upper and Lower Extremity Tissue Perfusion
In our study we compare tissue perfusion above and below the level of
neuraxial blockade. Ottokar Stundner, M.D., Thomas Danninger, M.D.,
Yan Ma, Ph.D., James Bae, B.A., Daniel Yoo, M.S., Daniel Maalouf, M.D.,
Alejandro Gonzalez Della Valle, M.D., Thomas P. Sculco, M.D.,
J. Matthias Walz, M.D., Stavros G. Memtsoudis, M.D., Ph.D., Department
of Anesthesiology, Paracelsus Medical University, Salzburg, Austria,
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical
College of Cornell University, New York, NY, Department of Anesthesiology,
University of Massachusetts Medical School, Worcester.
RA A2115
Minimum Levobupivacaine Concentration Required to Block Axillary
Nerves While Preserving Motor Function
According to Dixon’s up-and-down method ultrasound-guided precise axillary
BPB with 16 mL of 0.089% levobupivacaine could prevent postoperative
pain with preserved motor function in 90% of patients for soft tissue surgery
of the forearm. We previously reported that 0.114% ropivacaine could
prevent postoperative pain with preserved motor function in 62% of patients.
Levobupivacaine facilitated a differential nerve block more surely than
did ropivacaine. Kazunobu Takahashi, M.D., Masanori Yamauchi, M.D.,
Ph.D., Tomohisa Niiya, M.D., Ph.D., Michiaki Yamakage, M.D., Ph.D.,
RA A2116
A Randomized Trial Evaluating the Effects of 35% and 50% N2O on
Remifentanil Induced Hyperalgesia in Human Volunteers
N2O 35% and 50% significantly reduced the hyperalgesia developed
after reminfentanil administration. Andreas P. Wehrfritz, M.D., M.B.A.,
Jens Henning, M.D., Baptiste Bessiere, Ph.D., Jean Hazebroucq,
M.D., Sandrine Khairallah, M.Sc., Nathalie Noel, M.Sc., Department
of Anaesthesiology, Erlangen University Hospital, Germany, CRCD, Air
Liquide Sante International, Jouy-en-Josas, France.
54
RA A2117
Effects of Ropivacaine Concentration on the Spread of Sensory Block
Produced by Continuous Paravertebral Block
We designed this prospective randomized double-blind controlled study
to test the hypothesis that continuous thoracic paravertebral block using a
higher ropivacaine concentration would enable a wider segmental spread
of sensory block. Our results indicate that ropivacaine concentration does
not affect the segmental spread of sensory block produced by continuous
thoracic paravertebral block. Takayuki Yoshida, M.D., Takashi Fujiwara,
M.D., Kenta Furutani, M.D., Ph.D., Nobuko Ohashi, M.D., Hiroshi
Baba, M.D., Ph.D., Division of Anesthesiology, Niigata University
Graduate School of Medical and Dental Sciences, Japan, Department of
Anesthesiology, Saiseikai Niigata Daini Hospital, Japan.
PO06-2BCRITICAL CARE: SEPSIS AND INFLAMMATION
ROOM 104-AREA A
CC A2118
Systemic Endotoxinaemia-Induced Alternation of Interleukin-1 in
Different Organs of TAC1-/- NK1-/- TRPV1-/- AND TRPA1-/- Knockout
Mice
Interleukin-1 is a cytokine of the acute inflammatory responses
Lipopolysaccharide was injected to TAC1-/- NK1-/- TRPV1-/- TRPA1-/- mice
and their wild-type counterparts. IL-1 level of heart lung liver and kidney was
measured with ELISA. Four hours following LPS treatment the elevation of
IL-1 was inhibited in all organ in each knockout mice compared to wild-type
mice. TAC1 gene NK1 TRPV1 and TRPA1 receptor have an important role
in LPS induced endotoxaemia. Orsolya Lengl, M.D., Erika Pinter, Ph.D.,
John P. Quinn, Ph.D., Janos Szolcsanyi, Ph.D., Zsuzsanna Helyes, Ph.D.,
Department of Anaesthesiology and Intensive Therapy, Department of
Pharmacology and Pharmacotherapy, Faculty of Medicine University
of Pecs, Hungary, School of BioMedical Sciences, Liverpool University,
United Kingdom.
CC A2119
SIRS and Compromised Perfusion Status Related to CPB: Why
Early Goal-Directed Therapy Based on NIRS will HelpLowering the
Perioperative Shock
Microcirculation dysfunction induced by cardiopulmonary bypass (CPB) lead
to a complex shock starting six hours postoperatively. Clinical signs or lab
test are trustworthy but delayed. Catheterization and echocardiography may
not be usable. The aim of this study was to investigate whether or not a new
insight provided by the NIRS (Near Infra Red Spectroscopy a non invasive
bedside tool) would help the clinician to optimize the perfusion status. We
developed a dynamic (10 sec.) test which can predict postoperative blood
lacate level. Thus it can help physicians improving the outcome after CPB
and shocks. Xavier Alacoque, M.D., Anesthesia & Perioperative Care,
Children Faculty Hospital, Toulouse, France.
CC A2120
Plasma Neutrophil Gelatinase - Associated Lipocalin (NGAL) as an
Early Biomarker of Acute Kidney Injury After Aortic Surgery
Acute kidney injury (AKI) occurs in up to 40% of adult patients after aortic
surgery and is associated with increased morbidity and mortality. Neutrophil
Gelatinase-Associated Lipocalin (NGAL) was identified as a promising
biomarker of AKI. In this 10-month prospective study including 50 patients
who underwent aortic surgery plasma NGAL concentration was strongly
correlated with the severity of AKI and predicted renal replacement therapy
requirement. Jean-Louis Claudot, Jr., M.D., Jean-Marc Lalot, M.D., Denis
Schmartz, M.D., Serguei Malikov, M.D., Ph.D., Marie-Reine Losser, M.D.,
Ph.D., Claude Meistelman, M.D., Ph.D., Anesthesiology and Critical Care,
Vascular Surgery, University of Lorraine, CHU Brabois, Vandoeuvre-lesNancy, France.
CC A2121
Chronic Kidney Disease and Sepsis: Analyze of Hemodynamic and
Inflammation in a Murine Model
Preexisting chronic kidney disease involves a higher mortality in septic shock:
analyze of hemodynamic and inflammation in a murine model. Benedicte
Dehedin, M.D., Julien Maizel, M.D., INSERM U-1088, University of
Picardie, Amiens, France.
NA Neuroanesthesia
PN Pain Medicine
IL-19 Promotes Surgical Wound Healing in Diabetic Mice
IL-19 promotes surgical would healing in diabetic mice through increasing
KGF collagen 1 TGFb fibronectin VEGF MMP-2 and MMP-9 expression.
Chung-Hsi Hsing, M.D., Ph.D., LY Wang, M.S., MC Lin, M.D., TS Wei, M.S.,
CH Yeh, Ph.D., Chi-Mei Medical Center, Graduate Institute of Medical
Sciences, Chang Jung Christian University, Tainan, Taiwan.
CC A2123
A Novel Role of Recombinant Human Thrombomodulin in the Formation
of Neutrophil Extracellular Traps
We showed that rhTM regulated the lethality and production of cytokines in
the LPS-induced septic shock model in mice and also played a novelrole in
the formation of neutrophil extracellular traps (NETs) in human neutrophils
which was induced by in vitro LPS stimulation. Yasuyo Shimomura,
Ph.D., Mika Suga, M.D., Osamu Nishida, M.D., Tomoyuki Nakamura,
M.D., Naohide Kuriyama, M.D., Yoshitaka Hara, M.D., Yu Kato, Hiroshi
Nagasaki, M.D., Naoki Yamamoto, M.D., Shingo Yamada, Department of
Anesthesiology and Critical Care Medicine, Department of Physiology,
Laboratory of Molecular Biology and Histochemistry, Fujita Health
University School of Medicine, Tokyo, Japan.
CC A2124
Reduction in Gut Flora Attenuates Lung Ischemia-Reperfusion Injury
Through Decreased Inflammatory Mediators
Antibiotic treatment reduces gut flora and systemic pro-inflammatory
mediators leading to reduced lung injury following ischemia-reperfusion.
Alveolar macrophages and other cell types appear to be involved in this
process. Shirin Sundar, Ph.D., Arun Prakash, M.D., Ph.D., Judith Hellman,
M.D., Anesthesia and Perioperative Care, University of California San
Francisco, CA.
CC A2125
Coenzyme Q10 Supplementation Improves Sepsis Survival Along With
Reversal of Increased Circulating Alarimins and Organ Neutrophil
Infiltration
Coenzyme Q10 (CoQ10) insufficiency has been recently proposed as a
potential contributor to mortality of septic patients. Our study showed that
CoQ10 supplementation improved survival and bacterial clearance in septic
mice. The pro-survival effects of CoQ10 were associated with reversal of
elevated circulating alarmins and hyperlactatemia and paralleled inhibition of
neutrophil infiltration into multiple organs in septic mice. Our study provides
scientific rationale to develop a clinical study to evaluate the safety and
efficacy of CoQ10 supplementation in septic patients. Marina Yamada,
Ph.D., Masao Kaneki, M.D., Ph.D., Anesthesia, Critical Care and Pain
Medicine, Massachusetts General Hospital, Shriners Hospital for Children
Harvard Medical School, Boston, MA.
PO07-1BDRUG DISPOSITION
SUNDAY, OCTOBER 13| 9:00-10:00 A.M.
ROOM 104-AREA B
FA A2126
Quality of Recovery Assessed by the PQRS After Elective Surgery
Using Neostigmine or Sugammadex as Reversal Agents
Multicenter observational study to compare the effect of neostigmine and
sugammadex as NMB reversal agents on postoperative recovery after
elective surgery using the PQRS Portuguese version. Filipa Lagarto, M.D.,
Blandina Gomes, M.D., Simao Esteves, M.D., Antonio Bismarck, M.D.,
Nuno Rodrigues, M.D., Mafalda Nogueira, M.D., Pedro Amorim, M.D.,
Ph.D., Anesthesiology, Hospital de Santo Antonio, CHP, Porto, Portugal,
Anesthesiology, Hospital da Luz, Lisboa, Portugal, Merck Sharpe & Dohme
Lda, Paco de Arcos, Portugal.
FA A2127
Remifentanil Target Controlled Infusion (TCI) for Conscious Sedation in
Spontaneous Ventilation
Remifentanil target controlled infusion allows conscious sedation for
interventional radiology or endoscopy in fragile patients but respiratory
depression episode should be expected and treated by decreasing the target.
Valerie Billard, M.D., Geraldine Roche, R.N., Frederic Deschamps, M.D.,
Pascal Burtin, M.D., Frederique Servin, M.D., Ph.D., Cyrus Motamed,
M.D., Anesthesia & Intensive Care, Interventional Radiology, Gastro
Enterology & Endoscopy, Institut Gustave Roussy, Villejuif, France,
Anesthesia, Bichat-Claude Bernard University Hospital, Paris, France.
SUNDAY, OCTOBER 13
CC A2122
FA A2128
Pharmacokinetics of Prophylactic Cefazolin in Parturients Undergoing
Cesarean Section
We developed a population pharmacokinetic model for cefazolin disposition
in pregnant women undergoing elective cesarean section and their neonates
and evaluated cefazolin placental transfer. Cefazolin clearance increases
by 74% during pregnancy elimination half-life in newborns is 3 times
longer than that in adults and placental transfer is high (49%). Based on
simulations using our model we recommend that 2g is administered 1
hour before surgery and re-dosed every 2 hours until delivery to maximize
prophylaxis. External antibiotic therapy should not be initiated in infected
neonates until 6 hours after birth. Mohammed Elkomy, Ph.D., Pervez
Sultan, M.B., Ch.B., David Drover, M.D., Brendan Carvalho, M.B., B.Ch.,
Anaesthesia, Stanford University, CA, Anaesthesia, University College
London Hospital, United Kingdom.
FA A2129
Cucurbiturils Increases Intralipid Binding Affinity for Bupivacaine
Intralipid has a high capacity but low affinity for bupivacaine. The macrocycle
cucurbiturils when dissolved in Intralipid has an affinity constant for
bupivacaine that is 100-fold greater than Intralipid alone. Raymond
Glassenberg, M.D., Anesthesiology, Northwestern University, Feinberg
School of Medicine, Chicago, IL.
FA A2130
Staircase Phenomenon Observed in Pediatric Neuromuscular
Monitoring
This study was designed to clarify the characteristics of the staircase
phenomenon in pediatric patients. After induction of anesthesia contraction
of the adductor pollicis muscle in response to the ulnar nerve train-of-four
(TOF) stimulation was measured every 15 sec using a TOF-Watch SXTM.
Twitch potentiation (%T1 of control) and the TOF ratio were observed and
recorded throughout 30 min. When compared with the control %T1 of
control measured at 5 min, 10 min, 15 min, 20 min, 25 min and 30 min
were significantly potentiated to 113.7 (16.2)% 117.3 (17.5)% 118.9
(19.4)% 116.7 (19.1)% 117.4 (19.8)% and 116.3 (21.0)% respectively.
Potentiation of the T1 value was stabilized in the first 5 min after the TOF
stimulation. In conclusion control TOF stimulation for 5 min may improve the
data integrity in pediatric neuromuscular monitoring. Saki Ishikawa, M.D.,
Miki Kasai, M.D., Chihiro Igarashi, M.D., Noriko Miyazawa, M.D., Ph.D.,
Shinichi Yamamoto, M.D., Ph.D., Takahiro Suzuki, M.D., Ph.D., Tokyo
Metropolitan Children’s Medical Center, Department of Anesthesiology,
Nihon University School of Medicine, Tokyo, Japan.
FA A2131
Monitoring of Neuromuscular Block in One Muscle Group Alone May
Not Reflect Recovery of Total Muscle Function in Patients With Ocular
Type Myasthenia Gravis
Neuromuscular (NM) monitoring at the adductor pollicis muscle (APM) and
the corrugator supercilii muscle (CSM) were performed simultaneously in four
ocular type myasthenia gravis (OMG) patients during their surgery. All the
patients showed deeper NM block at the CSM compared to the APM. The
APM recovered faster than the CSM even the NM reversal with Sugammadex.
These responses are completely opposite to that seen in healthy patients.
In OMG the NM monitoring of the APM alone may not be suggested.
Assessment of recovery of the CSM may better reflect the quality of the
NM reversal. Hajime Iwasaki, M.D., Kenichi Takahoko, M.D., Shigeaki
Otomo, M.D., Tomoki Sasakawa, M.D., Takayuki Kunisawa, M.D., Ph.D.,
Hiroshi Iwasaki, M.D., Ph.D., Anesthesiology and Critical Care Medicine,
Asahikawa Medical University, Japan.
NA Neuroanesthesia
PN Pain Medicine
55
FA A2132
Type2 Diabetes Mellitus Affects the Evaluation of Neuromuscular
Block Using TOF-Watch®SX
13 diabetic patients (DM group) and 21 non-diabetic patients (nonDM group) were intended for retrospective analysis. Every patients were
monitored with TOF-Watch® SX during the surgery. It is demonstrated that
the values of the SENS (sensitivity of the transducer after the calibration
with TOF-Watch® SX) and the recovery speed of neuromuscular block were
significantly higher in DM patients compared to non-DM patients. High value
of the SENS after CAL2 calibration may be a predictor of the NM recovery
delay especially when desflurane was selected to maintain the anesthesia.
Hajime Iwasaki, M.D., Kenichi Takahoko, M.D., Shigeaki Otomo, M.D.,
Tomoki Sasakawa, M.D., Takayuki Kunisawa, M.D., Ph.D., Hiroshi Iwasaki,
M.D., Ph.D., Asahikawa Medical University, Japan.
FA A2133
Evaluation of Bias for Blood Concentrations of Propofol During TCI in
Japanese Obese Patients
We used a new device to rapidly measure whole blood propofol
concentrations. Measured propofol concentrations tend to be greater than
calculated concentrations as body mass index became higher when using
TCI of propofol and there is a possibility of overdosage of propofol for obese
patients when using a commercially available TCI pump that contains a
Marsh’s pharmacokinetic model in Japanese patients. Nobuko Tachibana,
M.D., Yukitoshi Niiyama, M.D., Ph.D., Michiaki Yamakage, M.D., Ph.D.,
Department of Anesthesiology, Sapporo Medical University School of
Medicine, Japan.
PO09-1BEXPERIMENTAL CIRCULATION: ISCHEMIA AND REPERFUSION
INJURY
ROOM 104-AREA C
CA A2138
Inhibition of STAT3 Signaling Pathway Abolishes the IntralipidInduced Cardioprotection Against Ischemia/Reperfusion Injury in Late
Pregnancy
STAT3 signaling pathway plays a role in the intralipid-induced cardioprotection
against ischemia/reperfusion injury in late pregnancy. Jingyuan Li, Ph.D.,
Areian Eghbali, B.S., Denise Mai, B.S., Mansoureh Eghbali, Ph.D., UCLA,
Los Angeles, CA.
CA A2139
Nitrite Attenuates Ischemia-Induced Ventricular Arrhythmias by
Reduction to Nitric Oxide in Rats
We investigated the effects of nitrite on ischemia-induced ventricular
arrhythmias and we found that 0.15 mg/kg nitrite attenuates ischemiainduced ventricular arrhythmias via reduction to nitric oxide in rats.
Daisuke Maruyama, M.D., Naoyuki Hirata, M.D., Ph.D., Ryo Miyashita,
M.D., Ryoichi Kawaguchi, M.D., Michiaki Yamakage, M.D., Ph.D.,
CA A2140
Effect of Endogenous PGI2 on mRNA Expression of MMPs and Their
Inhibitors After Vascular Ligation
The ratio of MMP-9 and TIMP-1 in ligated arteries in IP-/- mice was higher
than that in WT mice, indicating that VSMCs have greater migration and
proliferation properties after carotid artery ligation in IP-/- mice. Osamu
Takahata, M.D., Ph.D., Koh-ichi Yuki, Ph.D., Fumitaka Ushikubi, M.D.,
Ph.D., Hiroshi Iwasaki, M.D., Ph.D., Anesthesiology, Pharmacology,
Asahikawa Medical University, Japan.
PO12-1BOBSTETRIC ANESTHESIA: CESAREAN DELIVERY
HEMORRHAGE
ROOM 104-AREA D
CA A2134
Protecting the Aged Heart by NS1619 Induced Postconditioning In
Vivo
Activation of mBKCa channels induces postconditioning not only in young but
also aged rat hearts in vivo. Therefore pharmacological targeting of mBKCa
channels might be a therapeutic strategy for the protection of aged hearts.
Marianne de Schmidt, M.D., Friederike Behmenburg, M.D., Markus W.
Hollmann, M.D., Ph.D., Ragnar Huhn, M.D., Ph.D., Andre Heinen, M.D.,
Ph.D., Department of Anesthesiology, University Hospital Duesseldorf,
Germany, Department of Anesthesiology, Academic Medical Center (AMC)
University of Amsterdam, Netherlands.
CA A2135
Isoflurane Pretreatment Before Ischemia Attenuates Left Ventricular
Dysfunction Following Global Ischemia in Dogs
Isoflurane pretreatment prior to global ischemia attenuates left ventricular
dysfunction in dogs after an initial period of dysfunction. Michael Haile,
M.D., Richard Kline, Ph.D., Paul Heerdt, M.D., Ph.D., Thomas Blanck,
M.D., Ph.D., Anesthesiology, NYU Langone Medical Center, New York, NY,
Anesthesiology, New York Presbyterian Weill Cornell Medical Center, NY.
CA A2136
Impact of Connexin43 in Protein Kinase: An Induced Cardioprotection
Pharmacological inhibition of connexin43 prevents cardioprotection by
forskolin induced protein kinase A activation. Andre Heinen, M.D., Ph.D.,
Anika Schmidt, Student, Nadine Stracke, M.D., Markus W. Hollmann,
M.D., Ph.D., Ragnar Huhn, M.D., Ph.D., Department of Anesthesiology,
University Hospital Duesseldorf, Germany, Department of Anesthesiology,
Academic Medical Center (AMC) University of Amsterdam, Netherlands.
OB A2141
Thromboelastographic Study to Assess Age-Related Coagulation
Profile Differences in Parturients Undergoing Elective Cesarean
Delivery
The risk of postpartum venous thromboembolism is increased in women
of advanced maternal age (AMA) however it is uncertain if age-dependent
differences exist in the peripartum coagulation profile. This prospective study
compared the peripartum coagulation profiles of women of AMA [age >35y]
vs. non-AMA women [age 8804;35 y] undergoing elective cesarean delivery
(CD).Based on TEG and laboratory coagulation data healthy AMA women
had similar peripartum coagulation profiles as healthy non-AMA women
undergoing elective CD. Alexander Butwick, M.B., B.S., Gillian Hilton, M.B.,
B.S., Anesthesia, Stanford University School of Medicine, CA.
OB A2142
Effects of Exogenous Pre-Delivery Oxytocin Dosing on Post-Partum
Uterotonic Use
A retrospective medical chart review was conducted on primigravid patients
with >36 weeks gestational age admitted for spontaneous labor analyzing
pre-delivery oxytocin exposure using Area Under the Curve (AUC) and its
association with postpartum uterotonic use. Our results show an association
between higher pre-delivery oxytocin AUC exposure and increased need for
uterotonic administration which may reflect greater acute down-regulation of
oxytocin receptors. Catherine Cha, M.D., Andrew Geller, M.D., Audrey Yen,
M.D., Eddie Teng, M.D., Kimberly Gregory, M.D., Mark Zakowski, M.D.,
Department of Anesthesiology, Obstetric Anesthesiology, Maternal Fetal
Medicine, Cedars Sinai Medical Center, Los Angeles, CA.
CA A2137
Myocardial Ischemia/Reperfusion Injury in Late Pregnancy Regulates
Several MicroRNAs Involved in Inflammation and Apoptosis
MicroRNA regulation in late pregnancy may underlie at least in part the
higher vulnerability to ischemia/reperfusion injury. Andrea Iorga, B.Sc.,
Jingyuan Li, Ph.D., Salil Sharma, Ph.D., Marjan Amjedi, M.D., Mansoureh
Eghbali, Ph.D., University of California, Los Angeles, CA.
56
NA Neuroanesthesia
PN Pain Medicine
Implementation of a Massive Transfusion Protocol Improves Blood
Product Delivery Practices in Patients With Severe Postpartum
Hemorrhage
Recent studies suggest that a transfusion ratio of platelets to fresh frozen
plasma (FFP) to red blood cells (RBC) of 1:1:1 may be beneficial in cases
of massive postpartum hemorrhage as has been shown in patients with
other forms of massive bleeding. At our institution we initiated a Massive
Transfusion Protocol along with a multidisciplinary educational program
regarding the benefits of appropriate transfusion ratios for massive
hemorrhage. Blood bank data was analyzed for cases of massive transfusion
in postpartum hemorrhage and showed that implementation of an
educational program and Massive Transfusion Protocol led to a significantly
greater FFP to RBC ratio. Maggie R. Lesley, M.D., James A. Rothschild,
M.D., Andrew J. Satin, M.D., Jamie D. Murphy, M.D., Steven M. Frank,
M.D., The Johns Hopkins Medical Institutions, Baltimore, MD.
OB A2144
Bedside Assessment of Coagulation Disorders in Post-Partum
Hemorrhage by Thrombelastography: A Pilot Study
Point of care coagulation monitors have already been evaluated in traumatic
and obstetric hemorrhages: they provide an early detection of coagulation
disorders allowing adapted treatment. The aim of this study was to compare
the Thrombelastography (TEG® Haemonetics) parameters to standard
coagulation tests during post-partum hemorrhage. Thrombelastography
derived parameters (MRTGG-K and MRTGG-FF) provide an early and
reliable detection of coagulation disorders: hypofibrinogenemia <2g/L
and/or thrombocytopenia <80.000/mm3. Nicolas Louvet, M.D., Agnes
Rigouzzo, M.D., Laure Girault, M.D., Federica Piana, M.D., Remi Favier,
M.D., Isabelle Constant, Ph.D., Anesthesie Reanimation, Laboratoire
d’hemostase, Hopital A. Trousseau, Paris, France.
OB A2145
Maternal Intravenous Nitroglycerin Administration to Facilitate Delivery
of Preterm Fetus at Cesarean Delivery: Analysis of Gestational Age
Less Than 26 Weeks
Maternal intravenous nitroglycerin administration at cesarean section
for fetuses less than 26 weeks gestational age were associated with
longer uterine incision to delivery interval and larger initial catecholamine
requirement in the neonates without decreasing the incidence of IVH in
this retrospective analysis. Sayuri Nagashima, M.D., Motoshi Tanaka
M.D., Kazumi Tamura M.D., Yusuke Mazda M.D., Katsuo Terui, M.D.,
Department of Obstetric Anesthesiology, Saitama Medical Center,
Kawagoe, Japan, Anesthesiology, National Defense Medical School,
Tokorozawa, Japan, Saitama Medical Center, Obstetric Anesthesiology,
Saitama Medical Center, Kawagoe, Japan.
OB A2146
Postpartum Hemorrhage and Blood Product Utilization: Comparison by
Mode of Delivery for Childbirth
We conducted a retrospective chart review at a major academic center
in order to analyze the differences in the incidence of transfusion and
postpartum hemorrhage in parturient patients (n=7 330). We looked at
the transfusion rates of RBC’s FFP and platelets across various modes of
delivery including vaginal primary cesarean and repeat cesarean. Results
are reported both in percentage of patients transfused as well as units
per patient. James A. Rothschild, M.D., Maggie R. Lesley, M.D., Jamie
D. Murphy, M.D., Meredith L. Birsner, M.D., Steven M. Frank, M.D.,
Anesthesiology and Critical Care Medicine, Obstetrics and Gynecology,
Johns Hopkins School of Medicine, Baltimore, MD.
OB A2147
Postpartum Hemorrhage Rate - Definition Versus Reality
We conducted a retrospective medical chart review on primigravid patients
with a gestational age >36 weeks to identify with greater accuracy our
institution’s incidence of PPH according to ACOG’s criteria and compare it
to the literature. PPH is often quoted as 2.9% while our study found 42%
a significantly higher rate. Also noted was that the EBL was an exceedingly
poor screening tool for PPH. Eddie Teng, M.D., Andrew Geller, M.D.,
Catherine Cha, M.D., Audrey Yen, M.D., Kimberly Gregory, M.D., Mark
Zakowski, M.D., Department of Anesthesiology, Obstetric Anesthesiology,
Department of Obstetrics and Gynecology, Maternal Fetal Medicine,
Cedars Sinai Medical Center, Los Angeles, CA.
OB A2148
Estimated Blood Loss During Cesarean Section - A Simulation
Scenario
This study used a simulated frozen scene Cesarean delivery scenario to
assess the accuracy of visual estimated blood loss. We calculated the
percentage error rate for over or underestimation after visualization of a
pictorial guide. Most clinicians inaccurately estimated blood loss by 20%.
Sonia Vaida, M.D., Michael Goldenberg, Elbert Mets, Elizabeth Sinz, M.D.,
Priti Dalal, M.D., Anesthesiology, Penn State Milton S. Hershey Medical
Center, PA.
PO16-2BREGIONAL ANESTHESIA AND ACUTE PAIN: ACUTE
POSTOPERATIVE PAIN
SUNDAY, OCTOBER 13
OB A2143
ROOM 104-AREA E
RA A2149
Review of Case Reports of Spinal Hematomas Related to Pain
Management
Spinal hematoma can present as back pain alone. Leg paralysis is the
only predictive factor in lack of recovery after decompressive laminectomy.
Honorio T. Benzon, M.D., Samer Narouze, M.D., David Provenzano, M.D.,
Anesthesiology, Northwestern University Feinberg School of Medicine,
Chicago, IL, Anesthesiology, Pain Medicine Summa Western Reserve
Hospital, Cuyahoga Falls, OH, Anesthesiology, Ohio Valley General
Hospital, Pittsburgh, PA.
RA A2150
Correlation of Patient Satisfaction in Patients Receiving Thoracic
Epidural Analgesia
A retrospective correlation analysis was conducted on a random sample
of patients who received thoracic epidural analgesia for postoperative pain
management. Data regarding patient satisfaction pain score at rest and
movement ambulation and PO status was assessed. Based on the limited
sample size no correlation was found between patient satisfaction and pain
score at rest pain score with movement ambulation or PO status. However
an observation that is worth noting was that patients that were walking on
POD #1 scored 3 on satisfaction. These preliminary observations warrant
further investigation. Dalia H. Elmofty, M.D., Magdelena Anitescu, M.D.,
Anesthesia, University of Chicago, IL.
RA A2151
Five Year Comparative Evaluation of Patient Satisfaction of Pain Care
in United States Hospitals
With the intention of improving the quality of patient care the Centers
for Medicare & Medicaid Services (CMS) created the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Implemented in October 2006 this survey consists of a battery of questions
that is designed to assess patients’ perception of their medical care in areas
such as pain management and overall quality of care. In this study we
assessed the quality of pain management that was reported in March 2008
and compared it to the newest dataset that was released in the December
2012 HCAHPS Report. Anita Gupta, D.O., Anesthesiology and Pain
Medicine, Drexel University College of Medicine, Philadelphia, PA.
RA A2152
The Comparison of the Intensity of Postoperative Pain Between OnPump and Off-Pump Coronary Artery Bypass Graft
Chronic pain is a major complication aftercardiac surgery. We carried
out questionnaire survey of the intensity of postoperative pain on
postoperativeday 1 (POD1) postoperative day 7 (POD7) and 1 month
after the operation (1M) with visual analog scale (VAS). The results of VAS
score were compared between on-pump CABG group (ON) and off-pump
CABGgroup (OFF) using unpaired t-test. VASof chest pain was significantly
higher in the ON at POD7 and 1M and VAS of forearm pain was significantly
higher in the ON at 1M. Kimito Minami, M.D., Kenji Yoshitani, M.D., Ph.D.,
Hiroki Iida, M.D., Ph.D., Yoshihiko Ohnishi, M.D., National Cerebral and
Cardiovascular Center, Osaka, Japan, Department of Anesthesiology, Gifu
Graduate School of Medicine, Japan.
NA Neuroanesthesia
PN Pain Medicine
57
RA A2153
The Effect of Opioid Receptor Gene Polymorphism (A118g) on
Tramadol Consumption in Gynecologic Surgery Performed With
Pfannenstiel Incision
In our study we investigated the relation and effects of opioid receptor gene
polymorphism on postoperative tramadol consumption analgesic quality
and side effect incidence following gynecologic surgery performed with
pfannenstiel incision. Huseyin Sen, M.D., Bulent B. Guven, M.D., Kadir H.
Cansiz, M.D., Sezai Ozkan, M.D., Guner Dagli, M.D., Anesthesiology and
Reanimation, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
RA A2154
Arterial Plasma Concentration After Ultrasound-Guided Subcostal
Transversus Abdominis Plane Block in Adults
Arterial plasma concentration (Cp) is reliable for assessing the toxic threshold
of local anesthetic. This is the first report about arterial Cp time course
following ultrasound-guided subcostal transversus abdominis plane block
(TAPB). Ropivacaine at 3 mg/kg for ultrasound-guided subcostal TAPB leads
to rapid increases and slow decreases in arterial Cp of the anesthetic during
the first 2 hours. The highest Cmax nearly reached the toxic threshold
for systemic toxicity. We have to recognize that 3 mg/kg ropivacaine for
ultrasound-guided subcostal TAPB is potentially toxic. Kazuya Toju, M.D.,
Katsunori Shiraishi, M.D., Rieko Oishi, M.D., Tsuyoshi Isosu, M.D.,
Masahiro Murakawa, Ph.D., Fukushima Medical University, Japan.
RA A2155
Does Pregabalin Improve Pain Management After Posterior Spinal
Fusions?
In a blinded placebo controlled study the addition of pregabalin to a narcotic
pain regimen was assessed for a reduction in narcotic requirements and
improved outcome after posterior spinal fusion surgery. Pregabalin (150mg/
day) did not reduce IV narcotic usage improve physical therapy milestones
or reduce length of hospital stay. During the first 24 hours after surgery
Numeric Rating Scale scores oral opioid usage and nausea/vomiting were
reduced in the pregabalin patients. Michael K. Urban, M.D., Kristy M.
Labib, M.D., Shane C. Reid, M.S., Valeria L. Buschiazzo, Amanda K.
Goon, B.A., Anesthesiology, Hospital for Special Surgery, New York, NY,
Anesthesiology, Yale University, New Haven, CT.
RA A2156
Adverse Events With Ketamine for Opioid Tolerant Postoperative Pain
Management: A Retrospective Review
Opioid tolerant patients are likely to have uncontrolled postoperative pain.
Ketamine has demonstrated utility in managing these patients but there
has been reluctance to use this drug because of historic side effects. This
retrospective review supports that low dose ketamine infusions are safe
and well tolerated. Jon Y. Zhou, M.D., Eugene R. Viscusi, M.D., Ronak
Patel, M.D., Sean M. Philippo, B.S., Jonathan A. Rost, B.S., Janelle M.
Tryjankowski, M.S., Anesthesiology, Thomas Jefferson University Hospital,
Philadelphia, PA.
PO02-1A ANESTHETIC ACTION AND BIOCHEMISTRY:
PHARMACOKINETICS PHARMACODYNAMICS AND SIDE EFFECTS OF
ANESTHETICS
ROOM 104-AREA C
FA A2157
Morphine Metabolism in Diet-Induced Obese Mice Compared to LeptinDeficient Obese Mice
Morphine metabolism is evaluated in diet-induced obese (DIO) mice
compared to leptin-deficient (OB) obese mice as determined by highperformance liquid chromatography- tandem mass spectrometry in whole
blood samples. Accumulation of morphine and morphine-3 glucuronide are
statistically higher in OB mice when compared to DIO mice. Further studies
to explain these findings are necessary. Nicholas M. Dalesio, M.D., D.
Hale McMichael, B.S., Rachael Rzasa Lynn, M.D., Huy Pho, B.S., Rafael
Arias, B.S., Jeffrey L. Galinkin, M.D., Alan R. Schwartz, M.D., Myron
Yaster, M.D., Anesthesiology and CCM, Pulmonary Critical Care Medicine,
Johns Hopkins University, Baltimore, MD, University of Colorado Anschutz
Medical Campus, Aurora, CO.
58
FA A2158
Determination Of Ketamine And Its Major Metabolites In Plasma And
Brain Of Wistar Rats
(R S)-Ketamine (Ket)is effective in the treatment of depression and chronic
pain. Ket isextensively metabolized to norketamine (NK) dehydronorketamine
(DHNK) hydroxynorketamines (HNK) and hydroxyketamines (HK). In this
study we demonstrate that significant concentrations of the downstream
metabolites of Ket are present in plasma and brain tissue after a single dose
of the parent drug. Michael Goldberg, M.D., Mitesh Sanghvi, Ph.D., Carol
Green, Ph.D., Kathleen O’Loughlin, Ph.D., Marc C. Torjman, Ph.D., Irving
W. Wainer, Ph.D., Ruin Moaddel, Ph.D., Anesthesiology, Cooper University
Hospital, Cooper Medical School of Rowan University, Camden, NJ, The
Laboratory of Clinical Investigation, National Institute on Aging Intramural
Research Program, National Institute of Health, Baltimore, MD, SRI
International, Menlo Park, CA.
FA A2159
Sevoflurane Suppresses Excitatory Synaptic Transmission in
Hippocampal CA1 Region
We examined the effect of sevoflurane on excitatory synaptic transmission
in hippocampal CA1 region. Application of 5% sevoflurane reduced field
EPSPs, and this effect was accompanied with concurrent enhancement
of paired-pulse facilitation, suggesting possible presynaptic site of action
of sevoflurane. Presynaptic fiber volley a compound action potential of
axons was not significantly affected by application of sevoflurane. These
results suggest that 5% sevoflurane potently suppresses excitatory synaptic
transmission as well possibly by presynaptic mechanisms independent
of modulation of action potential waveforms. Kan Hasegawa, M.D.,
Haruyuki Kamiya, M.D., Ph.D., Yuji Morimoto, M.D., Ph.D., Department
of Anesthesiology, Departments of Neurobiology, Hokkaido University,
Sapporo, Japan.
FA A2160
Airway Constriction Delays Uptake and Elimination of Desflurane
and Isoflurane. An Experimental Study in Metacholine Induced
Bronchoconstricted Piglets
The pharmacokinetics of desflurane and isoflurane follow a bimodal
exponential function. Metacholine inhalation-induced bronchoconstriction
increases ventilation-/perfusion-mismatch and pulmonary shunt and
decreases arterial pO2. As a consequence the uptake and elimination of
the volatile anesthetics are significantly impaired. Moritz Kretzschmar,
M.D., Thomas Schilling, M.D., Ph.D., Alf Kozian, M.D., Ph.D., Dina
von Rohrscheidt, M.D., James E. Baumgardner, M.D., Ph.D., Anders
Larsson, M.D., Ph.D., Goran Hedenstierna, M.D., Ph.D., Thomas
Hachenberg, M.D., Ph.D., Department of Anesthesiology and Intensive
Care, Otto-von-Guericke-University Magdeburg, Germany, Oscillogy LLC,
Folsom, PA, Department of Surgical Sciences, Anesthesia and Intensive
Care, Department of Medical Sciences, Clinical Physiology, Uppsala
University, Sweden.
FA A2161
Metacholine Inhalation But Not Infusion Results in Ventilation-/
Perfusion-Mismatch Related Delay of Desflurane Uptake and
Elimination
The pharmacokinetic of the volatile agent desflurane follows a bimodal
exponential function that represents slow and fast pulmonary compartments.
Metacholine inhalation induces bronchoconstriction and low VA/Q regions
more than MCH infusion with subsequently delayed uptake and elimination
of the inhalational anesthetic. Thomas Schilling, M.D., Ph.D., Moritz
Kretzschmar, M.D., Sarah Hoffmann, Student, Alf Kozian, M.D., Ph.D.,
James E. Baumgardner, M.D., Ph.D., Anders Larsson, M.D., Ph.D.,
Goran Hedenstierna, M.D., Ph.D., Thomas Hachenberg, M.D., Ph.D.,
Department of Anesthesiology and Intensive Care, Otto-von-GuerickeUniversity Magdeburg, Germany, Oscillogy LLC, Folsom, PA, Department
of Surgical Sciences, Anesthesia and Intensive Care, Department of
Medical Sciences, Clinical Physiology, Uppsala University, Sweden.
NA Neuroanesthesia
PN Pain Medicine
Hepatic Microsomal Midazolam 1’-Hydroxylation is Related to CYP3A5
But Not CYP3A4 Content in Taiwanese Patients
The report shows the correlation between hepatic microsomal CYP3A5
content and midazolam hydroxylation in Taiwanese patients. Chan Wei-Hung,
M.D., Anesthesiology, National Taiwan University Hospital, Taipei.
FA A2163
Minimum Alveolar Concentration(MAC) of Sevoflurane in Patients With
Liver Dysfunction
MACtetanus of sevoflurane was determined by up-and-down method using
a 50Hz 80mA electrical stimulation in patients with liver dysfunction and it
decreased significantly compared that of patients with normal liver function.
Yan Yin, M.D., Tao Zhu, M.D., Jirimutuya Han, M.D., Anesthesiology, West
China Hospital, Sichuan University, Chengdu.
PO03-3A CHRONIC AND CANCER PAIN: CLINICAL SCIENCE II
ROOM 104-AREA A
PN A2164
Predicting and Preventing Central Nervous System Changes Leading to
Chronic Pain After Cardiac Surgery
We present a randomized controlled trial of analgesia to prevent the
development of chronic pain after cardiac surgery in 150 patients. In addition
we also demonstrate the prediction of peripheral and central nervous system
changes which lead to this phenomenon by the use of quantitative sensory
testing (QST) paradigms. Sibtain Anwar, M.B. B.S., Junia Rahman, M.B.
B.S., Chhaya Sharma, M.B. B.S., Anne Hemming, M.B., B.S., Richard
Langford, M.B., B.S., Pain and Anaesthesia Research Centre, Barts
Health NHS Trust, London, United Kingdom.
PN A2165
Assessing the Longevity and Complications of Implantable Intrathecal
Drug Delivery Systems for Chronic Pain Management: A Seventeen
Year Retrospective Analysis of 365 Patients
We provide a 17-year retrospective analysis of the cost to maintain 365
intrathecal pump (ITP) patients. The observed lifespan of the ITP until revision
for battery depletion was 4.7 years resulting in a cost of $2 920 per year
based on current reimbursement rates. There was a 30.5% likelihood that
a patient in the cohort would require removal or revision of the system prior
to depletion of the ITP battery for infection therapeutic failure mechanical
pump failure or catheter related complications increasing the maintenance
cost to $3 285 per year in this subset. Our report provides an assessment of
the longevity complication rate and cost of maintaining an ITP in a real-world
cohort. Robert B. Bolash, M.D., Belinda Udeh, Ph.D., Maged Guirguis,
M.D., Jarrod Dalton, Ph.D., Nagy Mekhail, M.D., Ph.D., Pain Management,
Department of Outcomes Research, Evidence Based Pain Medicine
Research, Cleveland Clinic Foundation, OH.
PN A2166
Pediatric Complex Regional Pain Syndrome: Short and Long-Term
Results of an In-Patient Rehabilitation Program
The use of regional anesthesia techniques can accelerate the return to full
functions in children with CRPS when admitted in an inpatient-rehabilitation
program. A close follow-up after discharge in cooperation with a psychologist
and psychiatrist is needed to control mood disorders which are common in
this population. Giovanni Cucchiaro, M.D., Kevan Craig, M.D., Kerri Marks,
B.A., Kristin Cooley, B.A., Talitha Kay Black Cox, B.A., Anesthesiology
Department, Children’s Hospital of Los Angeles, CA, Rehabilitation,
Children’s Hospital of Los Angeles, CA.
PN A2167
The Incidence of Chronic Post-Surgical Pain After Inguinal Hernia
Surgery
More than 30% of patients reported chronic post-surgical pain up to 4
months after open inguinal hernia surgery. Risk factors analysis highlighted
the severity of acute post-surgical pain and younger age. Katsushi Doi,
M.D., Yasue Kashiwagi, M.D., Noritaka Imamachi, M.D., Yoji Saito, M.D.,
Anesthesiology, Hamada Medical Center, Japan, Anesthesiology, Shimane
University Faculty of Medicine, Japan.
PN A2168
Nerve Block Inhibits Brain Activities by Acupuncture
The present study tested the hypothesis that acupuncture modulates brain
activities instead of through meridians through nerve network. We founded
that brain areas showing changes in BOLD signal increases and decreases
were identified in participants received acupuncture. There were no activation
and deactivation of brain areas in participants received acupuncture after
brachial plexus block. Therefore nerve block inhibits brain activities by
acupuncture which suggested that acupuncture modulates brain activities
through nerve network. Weidong Gu, M.D., Ph.D., Wei Jiang, M.D.,
Songbin Liu, M.D., Jiasheng Chen, M.D., Jingwei He, M.D., Zhaoxin Wang,
Ph.D., Department of Anesthesiology, Shanghai Minhang Central Hospital,
Shanghai Xinzhuang Hospital, East China Normal University, Shanghai,
China.
SUNDAY, OCTOBER 13
FA A2162
PN A2169
The Analgesic Effect of Lidocaine Infusion in a Fibromyalgia Patient
Population Is Significantly Better in Non-Smokers
IV lidocaine infusion provides significant pain relief. This study was able
to elucidate that both smoking status and race played a significant role in
baseline pain scores and also the degree of pain relief in post-infusion pain
scores. Smokers had a worse outcome when compared to non-smokers.
Also, caucasians received a greater amount of pain relief from IV lidocaine
infusion when compared to African Americans when assessed by BPI and
PI pain scores. Hung-Lun J. Hsia, M.D., Yang Hyung Kim, M.D., Christian
Horazeck, Student, Billy K. Huh, M.D., Ph.D., Anesthesiology, Duke
University Medical Center, Durham, NC, Department of Anesthesiology,
National Cancer Institute, Seoul, Korea.
PN A2170
Peripheral Nerve Stimulation in the Treatment of Chronic Intractable
Headaches: A Long-Term Follow-Up of Efficacy and Safety
Peripheral nerve stimulation (PNS) is an effective modality in the long-term
management of intractable chronic headaches. Despite a long history of
chronic headache the majority of our patients showed a significant reduction
in both numeric rating scale (NRS) and number of headache days per
month. Very good efficacy was reported even after >16 months of PNS
treatment and up to 96 months of therapy. This outcome seems unaffected
by prior extent of intractable pain. Rate of complications was relatively high
and better implant techniques may be required. Billy K. Huh, M.D., Ph.D.,
Pyung B. Lee, M.D., Ph.D., Christian Horazeck, Student, Francis Sangun
Nahm, M.D., Anesthesiology, Duke University Medical Center, Durham,
NC, Department of Anesthesiology and Pain Medicine, Seoul National
University Bundang Hospital, Seongnam, Korea.
PN A2171
Preoperative Inflammatory Bowel Diseases But Not Diverticulitis
Increase the Risk of Chronicisation of Postoperative Pain After
Laparoscopic Colorectal Surgery
After laparoscopic colorectal surgery patients with IBD complained of more
intense postoperative pain and had a greater risk of developing CPSP than
patients who had bowel surgery for neoplasm or diverticulitis. This confirms
preoperative inflammatory stress affects acute and chronic postoperative
pain. However the type of inflammatory profile (IBD vs. diverticulitis) seems
to be determinant. Jean L. Joris, M.D., Didier Ledoux, M.D., Mathieu
Georges, M.D., Caroline Ramquet, M.D., Kamel Medjahed, M.D., Gaelle
Damilot M.D., Jean Francois Brichant, M.D., Anesthesiology and
Intensive Care Medicine, CHU Liege, Belgium.
NA Neuroanesthesia
PN Pain Medicine
59
CIRCULATION
ROOM 104-AREA B
FA A2172
Reliability of LiDCOrapid™; and FloTrac/Vigileo™; Cardiac Output
Measurements
We evaluate LiDCOrapid™ and FloTrac/Vigileo™ cardiac output
measurements in CABG and LDLT surgery. LiDCOrapid™ seems to be more
reliable than FloTrac/Vigileo™ for cardiac output measurements but they
still have systemic biases. Masaaki Asamoto, M.D., Ryo Orii, M.D., Ph.D.,
Masahiko Bougaki, M.D., Ph.D., Yosuke Imai, M.D., Nobuhide Kin, M.D.,
Yoshitsugu Yamada, M.D., Ph.D., Department of Anesthesiology, The
University of Tokyo Hospital, Japan.
FA A2173
Ability of esCCO and ECOM to Track Changes in Cardiac Output During
an Alveolar Recruitment Maneuver After Cardiac Surgery
esCCO and ECOM cardiac output monitors were compared to the Swan-Ganz
catheter during an alveolar recruitment maneuver after cardiac surgery. Both
devices had a low accuracy for absolute values. However, ECOM was better
to track changes in cardiac output than esCCO. Olivier Desebbe, Sr., M.D.,
Roland Henaine, M.D., Magalie Thonnerieux, Jr., Jean-Francois Obadia,
M.D., Olivier Bastien, M.D., Ph.D., Anesthesiology and Intensive Care
Hospitalices, Surgery, Civils de Lyon, Lyon Bron, France.
FA A2174
Correlation of Arterial Blood Pressure With Pulse Transit Time
Measured Using ECG and Carotid Doppler Signals
We developed a system to easily measure pulse transit time using the
ECG R-wave and a Doppler ultrasound detector on the anterior neck and
examined the correlation of systolic arterial pressure with it. There was a
moderate correlation between them suggesting feasibility of noninvasive
continuous blood pressure monitoring with these signals during anesthesia
or in the ICU. Yoshihisa Fujita, M.D., Ph.D., Motohiko Hanazaki, M.D.,
Ph.D., Keita Hazama, M.D., Nami Yoshitake, M.D., Etsuko Sugimoto,
M.D., Department of Anesthesiology and ICM, Kawasaki Medical School,
Kurashiki, Japan.
FA A2175
Difference of Plethysmographic Waveform Characteristics Between
Finger and Forehead Sensor of Pulse Oximeter
This prospective, observational study demonstrated that SpO2 data obtained
by finger sensor was more accurate and better correlated with SVV than that
obtained by forehead sensor during major gastrointestinal surgery. Mitsue
Fukuda, M.D., Ririko Iwasaki, M.D., Daisuke Toyoda, M.D., Ryoichi
Ochiai, M.D., Ph.D., Yoshifumi Kotake, M.D., Ph.D., Toho University Omori
Medical Center, Toho University Ohashi Medical Center, Tokyo, Japan.
FA A2176
Comparison Between Continuous Arterial Pressure Measured by NonInvasive Finger Cuff CareTaker® to Invasive Intra-Arterial Pressure in
Patients Undergoing Major Intra-Abdominal Surgery
Measurement of mean arterial pressure from the non-invasive finger cuff
system using Pulse-Decomposition Analysis technology showed good
accuracy with the radial artery. The device weighs 4 oz and runs for about
12 hours on a single battery charge and communication is wireless by
bluetooth. The small and portable nature of the device makes it ideal for
blood pressure monitoring in the field and during combat conditions. Irwin
Gratz, D.O., Edward Deal, D.O., Francis Spitz, M.D., Smith Jean, Ph.D.,
Elaine Allen, Ph.D., Anesthesiology, Surgery, Cooper Medical School at
Rowan University/Cooper University Hospital, Camden, NJ, Epidemiology &
Biostatistics, University of California, San Francisco, CA.
60
FA A2177
Continuous Noninvasive Arterial Pressure Monitoring Compared to
Invasive Arterial Pressure Monitoring: Systematic Review and MetaAnalysis
The current meta-analysis of 28 published studies for the comparison of
continuous noninvasive arterial pressure and invasive arterial pressure
revealed that continuous noninvasive arterial pressure monitoring
technologies provide acceptable measurements compared to invasive arterial
pressure monitoring based on their overall small biases and SD for mean
arterial pressure. Sang-Hyun Kim, M.D., Ph.D., Marc Lilot, M.D., Bobby
Sidhu, M.D., Maxime Cannesson, M.D., Ph.D., Soonchunhyang University
Bucheon Hospital, Korea, UCI Medical Center, Irvine, CA.
FA A2178
Measurement of the Cardiac Output With the esCCO®Monitor: A
Comparaison Study With the Thermodilution Reference Method in the
ICU Patient
This study evaluate a new non invasive cardiac output device (esCCO) in ICU
patients comparing with thermodilution. A Bland-Altman plots was performed
and showed a poor precision of this method based on the Pulse Wave
Transit Time (PWTT) measurement. Benjamin Lebas, M.D., Brice Samyn,
M.D., Julien Pottecher, M.D., Ph.D., Francis Schneider, M.D., Ph.D.,
Pierre Diemunsch, M.D., Ph.D., Anesthesia and Surgical ICU, Hospital
Universitys, Strasbourg, France.
FA A2179
Validation of Electrical Velocimetry Versus Fick Method and
Thermodilution to Determine Cardiac Output in Patients Undergoing
Cardiopulmonary Exercise Testing
Cardiac output measured with electrical velocimetry is comparable to that
with the Fick method and thermodilution at rest and during cardiopulmonary
exercise testing. Yan Hong Liu, M.D., Ph.D., Anesthesia, Chinese PLA
General Hospital, Beijing, China.
PO10-2A EXPERIMENTAL NEUROSCIENCES: CNS ISCHEMIA AND
INJURY
ROOM 104-AREA E
NA A2180
Effects of Inhibition of Thioredoxin-1 on BBB Permeability in Focal
Cerebral Ischemia in Rats
PX-12 attenuated BBB disruption in the early stage of focal cerebral ischemia
suggesting the involvement of thioredoxin-1 (Trx-1) system. VEGF may not
play a major role in the Trx-1 pathway inducing BBB disruption during the
early stage of focal cerebral ischemia. Oak Z. Chi, M.D., Sylviana Barsoum,
M.D., Jeremy Grayson, M.D., Xia Liu, M.D., Harvey R. Weiss, Ph.D.,
Department of Anesthesia, University of Medicine and Dentistry of New
Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ.
NA A2181
Sexually Dimorphic Impairment of Brain Mitochondrial Respiration
Following Neonatal Hypoxia-Ischemia
A rat pup model of neonatal hypoxic/ischemic encephalopathy was used
to test the hypothesis that there are sexually dimorphic mitochondrial
responses to injury. The results demonstrate that respiration by mitochondria
from the brains of females is not inhibited to the same extent as that of
mitochondria from males. Gary M. Fiskum, Ph.D., Tyler Demarest, B.S.,
Rosemary Schuh, Ph.D., Jaylyn Waddell, Ph.D., Mary McKenna, Ph.D.,
Anesthesiology, University of Maryland School of Medicine, Baltimore,
MD.
NA A2182
Anti-Neutrophil Antibody Enhances the Neuroprotective Effects of
Granulocyte-Colony Stimulating Factor by Decreasing Neutrophil
Mobilization in Hypoxic Ischemic Neonatal Rat Model
The combination of granulocyte-colony stimulating factor and anti-neutrophil
antibody was associated with decreased brain infarction and improved
neurobehavioral outcomes in a neonatal rat hypoxia ischemia model. Tiffany C. Hadley, M.D., Desislava Doycheva, B.S., Li Li, Jiping Tang, M.D.,
Richard Applegate, II, M.D., John H. Zhang, M.D., Ph.D., Department of
Anesthesiology, Loma Linda University School of Medicine, CA.
NA Neuroanesthesia
PN Pain Medicine
Propofol Prevents Cerebral Ischemia-Triggered Autophagy Activation
and Cell Death in the Rat Hippocampus Through the NF-B/p53
Signaling Pathway
Propofol reduces autophagy activation induced by cerebral ischemia. Propofol
reduces pyramidal neurons death induced by cerebral ischemia. Propofol
decreased the upregulation of p53 induced by cerebral ischemia insult.
Propofol inhibits autophagy and apoptosis through NF-B/p53 signaling
pathway. Wei Jiang, M.D., Ph.D., Derong Cui, M.D., Ph.D., Li Wang, M.D.,
Ph.D., Department of Anesthesiology, Shanghai Sixth People’s Hospital
Affiliated with Shanghai Jiaotong University, China.
NA A2184
Cerebral Blood Flow Remains Reduced With Return of Spontaneous
Circulation After Cardiac Arrest Without Evidence of Ischemia: A
Rodent fMRI Study
After resuscitation from asphyxia-induced cardiac arrest in rats magnetic
resonance imaging of brain reveals significantly reduced cerebral perfusion
with normal diffusion weighted imaging indicating no ongoing cerebral
ischemia. This may reflect reduced metabolic activity in the post-arrest brain.
John J. Marota, M.D., Joseph B. Mandeville, Ph.D., Ona Wo, Ph.D.,
Department of Anesthesia, Critical Care and Pain Medicine,
NA A2185
The Effects of Synaptic Cell Adhesion Molecule 1 (SynCAM 1) on
Neuronal Morphology and Behavior After Severe Traumatic Brain Injury
We examine whether Synaptic Cell Adhesion Molecules (SynCAMs)alter
outcomes in traumatic brain injury (TBI). SynCAMs are neuronal adhesion
proteins which direct synapse formation and integrate central nervous system
function. We use controlled cortical impact to create severe TBI in control
SynCAM overexpressing and SynCAM knockout mice. We then perform
histological assays of hippocampal neurons or perform behavioral tests of
learning and memory. Based on our preliminary data it is likely that SynCAM
1 contributes to changes in synapse number after TBI and may impact
cognitive outcomes after TBI. SynCAM 1 may be a potential therapeutic
target after TBI. Kellie A. Park, M.D., Ph.D., Fabian Laage Gaupp, Student,
Thomas Biederer, Ph.D., Anesthesiology, Yale University, School of
NA A2186
Acute Activation of GPER1/GPR30 Reduces Neuronal Injury Following
Global Cerebral Ischemia in Mice
Single dose of the GPR30 agonist G1 administered at a clinically relevant
timepoint following global cerebral ischemia induced by cardiac arrest
reduces neuronal injury in mice. Kaori Shimizu, M.D., Richard J. Traystman,
Ph.D., Paco S. Herson, Ph.D., Department of Anesthesiology, University of
Colorado Denver, Anschutz Medical Campus, Aurora, CO.
NA A2187
Auricular Acupuncture for Neurological Recovery Following IntraOperative Ischemic Injury
We examined auricular acupuncture a cost-effective and easy to use
modality for anti-inflammatory properties and treatment of ischemic stroke
injury in adult rats. Adult male Wistar rats were anesthetized with isoflurane
anesthesia and underwent right middle cerebral artery occlusion for one
hour then treated immediately post-operatively with auricular acupuncture.
Auricular acupuncture has the potential to accelerate post-operative recovery
improve return of neurological function following ischemic cerebrovascular
accidents and decrease healthcare costs if correctly applied in a clinical
setting. Anna Woodbury, M.D., Shan Ping Yu, M.D., Ph.D., Ling Wei,
M.D., Anesthesiology, Emory University, Atlanta, GA, Neurology, Emory
University, Atlanta, GA.
PO13-3A OUTCOMES AND DATABASE RESEARCH: COAGULATION
BLEEDING
ROOM 104-AREA D
FA A2188
Blood Transfusion Increases the Risk for Prosthetic Joint Infection
After Prmary Knee Arthroplasty
Deep wound infection was diagnosed in 2.4% of 1331 patients after knee
arthroplasty. Only packed RBC stored longer than 14 days were associated
with a higher risk of infection. Misericordia Basora, Ph.D., Sandra GomezLesmes, M.D., Juan C. Martinez-Pastor, M.D., Sebastian Garcia-Ramiro,
Ph.D., Arturo Pereira, Ph.D., Miguel Marcos, M.D., Eduard Tornero,
M.D., Laura Morata, M.D., Josep Mensa, Ph.D., Alex Soriano, Ph.D.,
Anesthesiology, Hospital Clinic, Barcelona, Spain, Hospital of SalamancaIBSAL, Spain.
SUNDAY, OCTOBER 13
NA A2183
FA A2189
Characterizing the Epidemiology of Transfusion Associated Circulatory
Overload in Surgical Transfused Patients
In this cohort study, Clifford et al. describe the incidence and characteristics
of patients developing transfusion associated circulatory overload (TACO)
following intraoperative blood product transfusion. Rates of TACO are
described before and after the introduction of various blood product
management strategies aimed at reducing transfusion complications.
Leanne Clifford, B.M., Qing Jia, M.D., Arun Subramanian, M.B., B.S.,
Hemang Yadav, M.B., B.S., Gregory A. Wilson, R.R.T., Sean P. Murphy,
B.S., Jyotishman Pathak, Ph.D., Darrell R. Schroeder, M.S., Daryl Jon
Kor, M.D., Department of Anesthesiology, Internal Medicine, Anesthesia
Clinical Research Unit, Clinical Informatics Systems, BioMedical Statistics
and Informatics, Mayo Clinic, Rochester, MN.
FA A2190
Risk-adjusted Clinical Outcomes are Equivalent or Better in Patients
who Refuse Compared to Those Who Accept Allogeneic Blood
Transfusion
Patients who requested bloodless medical care had equivalent or better
outcomes as compared to those who accepted allogeneic blood transfusion
and this finding was valid even after risk adjustment for factors predicting
morbidity. Steven M. Frank, M.D., James A. Rothschild, M.D., Linda
Resar, M.S., M.D., Andrew C. Pippa, B.A., Elizabeth A. Dackiw, R.N.,
Paul M. Ness, M.D., Jerry L. Stonemetz, M.D., Anesthesiology/Critical
Care Medicine, Bloodless Medicine and Surgery, Medicine Oncology
Pediatrics, Pathology (Transfusion Medicine) The Johns Hopkins Medical
Institutions, Baltimore, MD.
FA A2191
Standard of Care in Transfusion Management: The Same if Patients
Participate in a Clinical Trial or Not?
We compared outcome parameters of patients with major intraoperative
bleeding randomized to standard of care in an RCT to a retrospective control
cohort. Data showed no difference indicating that being part of a study
per se does not influence transfusion management and outcome. Evelyn
Luggauer, M.D., Maren Kleine-Brueggeney, M.D., Lorenz Theiler, M.D.,
Robert Greif, M.D., Natalie Urwyler, M.D., Department of Anesthesiology
and Pain Therapy, University Hospital of Bern, Switzerland.
FA A2192
The Effect of Acute Bleeding and Fresh RBC Transfusion on the
Progress of Liver Regeneration Following Hepatectomy
In animals undergoing PHx bleeding delays the liver regeneration process
while enhancing early liver injury. Transfusion of fresh RBC partially restores
liver regeneration capacity. Idit Matot, M.D., Lior Felman, M.D., Rinat
Abramovitch, Ph.D., Anesthesiology and Intensive Care & Pain, Tel Aviv
Sourasky Medical Center, Israel, Hadassah Hebrew University Medical
Center, Jerusalem, Israel.
NA Neuroanesthesia
PN Pain Medicine
61
FA A2193
Thrombotic and Bleeding Risks of Patients on Antiplatelet Therapy
Undergoing Major Abdominal Malignancy Surgery
Thrombotic and bleeding risks were investigated in patients who were
on antiplatelet therapy preoperatively and underwent major abdominal
malignancy surgery. The incidence of thromboembolic events increased
more than 6 folds when all the preoperatively administered antiplatelet
drugs were withdrawn while the exogenous transfusion rate did not change
even if aspirin was continued in the perioperative period. Above results
may suggest that aspirin continuation is likely to decrease the perioperative
thromboembolic risks on one hand unlikely to increase the risk of bleeding
on the other. Kazumi Ono, M.D., Hidekuni Hidaka, M.D., Yusuke Koyama,
M.D., Chiharu Tanaka, M.D., Shinya Taguchi, M.D., Mako Kosaka, M.D.,
Momoho Kimura, M.D., Anesthesiology, Fukuyama City Hospital, Japan.
FA A2194
Multimodal Blood Conservation Reduces Intraoperative Transfusion in
a Community-Based Cardiac Surgery Practice
Transfusion in cardiac surgical patients is associated with increased
hospital morbidity and mortality. We hypothesized that a multimodal blood
conservation strategy (MBCS) based upon the recommendations of the
Society of Cardiovascular Anesthesiologists and Society of Thoracic Surgeons
in a community-based cardiac surgical program would reduced transfusions.
Douglas Ririe, M.D., Ph.D., Robert Brooker, M.D., Anesthesiology, Wake
Forest School of Medicine, Winston-Salem, NC, Memorial Regional
Hospital, Hollywood, FL.
FA A2195
Massive Blood Transfusion and Hyperkalemia During Pediatric Liver
Transplantation
Several preoperative and donor factors have been identified as risk factors of
massive blood transfusion and patients in different age groups have different
risk factors. In addition, red blood cell transfusion is also associated with
intraoperative hyperkalemia. Such information may be used as a guide for
preoperative and intraoperative management to improve outcome in pediatric
OLT patients. Inthuon Sangasilpa, M.D., Worapot Apinyachon, M.D., Victor
W. Xia, M.D., Anesthesiology, Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand, Anesthesiology, Ronald Reagan UCLA, Medical Center,
Los Angeles, CA.
PO02-1BANESTHETIC ACTION AND BIOCHEMISTRY:
PHARMACOKINETICS PHARMACODYNAMICS AND SIDE EFFECTS OF
ANESTHETICS
SUNDAY, OCTOBER 13 | 11:00 A.M.-12:00 P.M.
ROOM 104-AREA C
GABA-A Receptors the Molecular Targets of General Anesthetics
General anesthetics can modulate function of GABA-A receptors by binding to
appropriate domains on the protein. Further analysis of these domains could
lead to development of more potent and specific drugs. Guodong Li, M.D.,
Ph.D., Richard W. Olsen, Ph.D., Anesthesiology, Pharmacology, UCLA,
Los Angeles, CA.
FA A2199
Does Pre-Operative Muscle Weakness in Type 2 Diabetes Promote
Residual Paralysis During Emergence From General Anesthesia?
Preliminary Report
Type 2 diabetics may suffer from skeletal muscle weakness due to
mitochondrial dysfunction. We are investigating the possible association
of this condition with residual paralysis during emergence from general
anesthesia. At this point Type 2 diabetics seem to be at no disadvantage
in strength compared to controls when extubated at a TOF ratio ≥ 0.9.
Christiane C. Vogt-Harenkamp, M.D., Cecilia Pena, M.D., Bettina U.
Schmitz, M.D., Anesthesiology, TTUHSC Lubbock, TX.
FA A2200
The Role of PKC-Mediated Calcium Sensitization in Propofol-Induced
Vasodilation
Propofol can decrease phosphorylation of PKC at Thr-505 and CPI-17 activity
resulting in depressed calcium-sensitization of vascular smooth muscle cells
Which may at least partly contributes to propofol-induced endotheliumindependent vasodilation. Li Wang, M.D., Huixuan Zhou, B.S., Yan Wang,
B.S., Derong Cui, M.D., Wei Jiang, M.D., Anesthesiology, Shanghai Sixth
Municipal Hospital, School of Medicine, Shanghai Jiaotong University,
China.
FA A2201
Crossover Studies in Monkeys Show that a New Ultra-Short Acting
Nondepolarizer CW 1759-50, in Contrast With Gantacurium, Elicits No
Cutaneous or Circulatory Histaminoid Phenomena
In the monkey, studies evaluating tachyphylaxis and antihistamine prophylaxis
show that CW 1759-50 at 80 x ED95 does not cause circulatory or
cutaneous histaminoid phenomena which are easily elicited by gantacurium
at 30 x ED95. John J. Savarese, M.D., Matthew R. Belmont, M.D., Hiroshi
Sunaga, M.D., Matthew T. Murrell, M.D., Ph.D., Jeff McGilvra, Ph.D., Paul
M. Heerdt, M.D., Ph.D., Jaideep Malhotra, M.D., Erin Jeannotte, V.M.D.,
Jingwei Zhang, B.S., Bryce J. Petty, B.A., Anesthesiology, Weill Cornell
Medical College, New York, NY, Cedarburg Hauser Pharmaceuticals, Inc.,
Grafton, WI, Albany Medical College, NY.
PO03-3BCHRONIC AND CANCER PAIN: CLINICAL SCIENCE II
FA A2196
Cysteine Substitutions Define State-Dependent Accessibility and
Etomidate Binding in the M1 Domain of GABAA Receptors
In GABAA receptors many cysteine substituted residues in the outer 1-M1
domain (from Q229 to Q242) react with pCMBS and modification rates
increase with channel activation. Etomidate protects cysteines substitutions
at L232, M236, and T237 from modification, suggesting these residues
contribute to drug binding. Stuart Forman, M.D., Ph.D., Deirdre S. Stewart,
Ph.D., Mayo Hotta, B.A., Rooma Desai, Ph.D., Anesthesia Critical Care &
Pain Medicine, Massachusetts General Hospital, Neurobiology, Harvard
Medical School, Boston, MA.
FA A2197
Global Kinetic Modeling of GABA-A Receptor Macrocurrents Based on
Allosteric Principles
We developed a 10-state, highly constrained kinetic model for GABAA
receptor activation desensitization deactivation and resensitization based
on allosteric principles. The model has 10 free parameters which were
fit by least squares using a simplex algorithm and variable decimation to
eight input patch-clamp macrocurrent recordings from 122L receptors.
The optimized model closely simulates most features of the data set. This
model is expected to also simulate the effects of anesthetic modulation and
receptor mutations. Stuart Forman, M.D., Ph.D., Alex T. Stern, B.S., Tilo
Winkler, Ph.D., Massachusetts General Hospital, Boston, MA.
62
FA A2198
ROOM 104-AREA A
PN A2202
Increasing Vertebral Height With Percutaneous Vertebral Augmentation
Decreases Both Pain Score and Opiate Requirements While Improving
Functional Status: A Long-Term Retrospective Analysis
Retrospective analysis of 68 patients with vertebral compression fractures
who underwent kyphoplasty were reviewed. Median pain score decreased
from 7.5 to 3.9 at one-month follow-up and a decrease in opiate
consumption of 10 morphine equivalents was noted within 24 hours.
Kyphoplasty restored an average of 45% of the lost vertebral height and
activity level was increased in 82% of patients. We demonstrate the utility
of kyphoplasty in the treatment of vertebral fractures with radiographically
significant restoration of vertebral height and clinically significant
improvements in pain scores opiate analgesic intake and functional status. Robert B. Bolash, M.D., Reda Tolba, M.D., Joshua Shroll, M.D., Jarrod
Dalton, Ph.D., Chirag Sanghavi, M.D., Nagy Mekhail, M.D., Ph.D., Pain
Management, Department of Outcomes Reseach, Evidence Based Pain
Medicine Research, Cleveland Clinic, OH.
NA Neuroanesthesia
PN Pain Medicine
Patient Registry of Intrathecal Ziconotide Management (PRIZM) in
Patients With Severe Chronic Pain
PRIZM is an open-label long-term multicenter observational study to
evaluate intrathecal ziconotide infusion in patients with severe chronic pain.
The study will evaluate effectiveness safety tolerability health-related quality
of life concomitant pain medication use ziconotide administration modalities
patient impression of improvement patient characteristics and treatment
satisfaction. David Caraway, M.D., Eric J. Grigsby, M.D., Michael S. Leong,
M.D., Richard L. Rauck, M.D., Michael F. Saulino, M.D., Chinglin Lai,
Ph.D., Sonja Hokett, Pharm.D, Sn. M. Shelby, Ph.D., Geertrui F. Vanhove,
M.D., St. Mary’s Pain Relief Center, Huntington, WV, Neurovations Clinical
Research, Napa, CA, Stanford University, Palo Alto, CA, Center for Clinical
Research, Winston-Salem, NC, Moss Rehabilitation, Elkins Park, PA, Jazz
Pharmaceuticals, Palo Alto, CA.
PN A2204
Analysis of Inadvertent Intradiscal and Intravascular Injection During
Transforaminal Epidural Steroid Injection: A Prospective Study
The overall incidence of intradiscal and intravascularinjection was 3.1%
and 15.5%. Aspiration test and static radiography frequently missed the
intravascular injection. Most of intravascular injections showed simultaneous
epiduraland vascular injection. Real time fluoroscopy should be the
gold standard to confirm the intravascular injection. Ji H. Hong, Ph.D.,
Anesthesiology and Pain Medicine, Keimyung University, Daegu, Korea.
PN A2205
A Retrospective Comparison of VAS Scores in Chronic Pain Patients
on Methadone vs Oxycodone, Oxycontin, Oxymorphone, Hydrocodone,
Hydromorphone, Morphine, and Transdermal Fentanyl
Despite recent advances in interventional pain management strategies
opioids remain the mainstay for treatment of chronic noncancer pain.
Methadone has surfaced as an alternative opioid for management of chronic
non-cancer pain. The purpose of this retrospective review was to determine if
methadone is a viable alternative opioid analgesic for the treatment of noncancer pain as measured by VAS scores during outpatient pain clinic visits.
Preliminary data form this review suggests that low-dose methadone may be
more efficacious than other opioids when treatment success is measured
in such terms. A follow up study may illustrate that low-dose methadone
therapy is not associated with the tolerance typically seen with other opioids.
Thomas J. Hopkins, M.D., Jennifer Parsons, M.S.N., Lance Roy, M.D.,
Yen-Wei Li, Ph.D., Yi-Ju Li, Ph.D., Billy Huh, M.D., Ph.D., Anesthesiology,
Duke University Medical Center, Durham, NC.
PN A2206
Pain Disability and Exacerbation Factor in Patients With Chronic Pain
It is well known that high intensity of pain often exacerbates quality of life
(QOL). Chronic pain also leads to pain disability in daily life. In this study
we investigated characteristics and factors that affect QOL in patients with
intractable chronic pain. Anxiety depression pain catastrophyzing thinking
and wide painful areas are exacerbation factors in patients with chronic
pain. Evaluation and treatment for mental status are essential in treatment
of chronic pain patients. Shinichi Ishikawa, M.D., Ph.D., Daniel Obata,
M.D., Hiroyuki Nishie, M.D., Makako Kinoshita, M.D., Norihiko Obata,
M.D., Ph.D., Ryuji Kaku, M.D., Ph.D., Kenji Sato, M.D., Ph.D., Satoshi
Mizobuchi, M.D., Ph.D., Hiroshi Morimatsu, M.D., Ph.D., Okayama
PN A2207
Long-Term Outcomes of Percutaneous Radiofrequency
Thermocoagulation of Gasserian Ganglion for 2nd- and MultipleDivision Trigeminal Neuralgia
Although several studies have shown the efficacy of PRT for Gasserian
ganglion against trigeminal neuralgia(TN) the outcome particularly of 2nd
and multiple division TN has not been well evaluated compared to isolated
3rd division TN. We retrospectively examined the long-term outcome of PRT
for the Gaseerian ganglion against the 2nd division and multiple divisions TN
compared to the isolated 3rd division TN. Shizuku Kosugi, M.D., Masahiro
Shiotani, M.D., Yasuhisa Otsuka, M.D., Yasushi Innami, M.D., Saori
Hashiguchi, M.D., Hiroshi Morisaki, M.D., Department of Anesthesiology,
Keio University, School of Medicine, Shiotani Pain Clinic, Tokyo, Japan.
PN A2208
Adjuvant Hyaluronidase to Epidural Steroid Injection Improves the
Quality of Analgesia in Patients With Failed Back Surgery Syndrome
Adding hyaluronidase to transforaminal lumbar epidural steroid injectate is
effective in the management of chronic low back pain in patients with failed
back surgery syndrome. Vandana Sharma, M.B. B.S., Poupak Rahimzadeh,
M.D., Farnad Imani, M.D., Hamid Reza Faiz, M.D., Mohammad Reza
Ghodraty, M.D., Alireza Nikzad-Jamnani, M.D., Nader D. Nader, M.D.,
Ph.D., Anesthesiology, University at Buffalo, NY, Rasoul-e-Akram Hospital,
Tehran University of Medical Sciences, Firouzgar Hospital, Tehran
University of Medical Sciences, Islamic Republic of Iran.
SUNDAY, OCTOBER 13
PN A2203
PN A2209
The Effect of Nitrous Oxide on Functional Outcomes After Epidural
Blocks for Neuropathic Back Pain
Nitrous oxide (N2O) is an NMDA receptor antagonist. Even a single exposure
to N2O reportedly facilitates rehabilitation. We therefore thus tested the
hypothesis that nitrous oxide improves functional capacity in patients
with neuropathic chronic low back pain. The study showed that nitrous
oxide administration did not significantly improve psychological or physical
aspects of health related quality of life. Nitrous oxide does not appear to be
an effective treatment for chronic neuropathic back pain. Hani F. Yousef,
M.D., Ph.D., Sheryar Sarwar, M.D., Sumit Katyal, M.D., Abdulkadir
Atim, M.D., Daniel J. Leizman, M.D., Nagy Mekhail, M.D., Ph.D., Manu
Mattews, M.D., Jing You, M.S., Daniel I. Sessler, M.D., Alparslan Turan,
M.D., Departments of Outcomes Research and Pain Management, Case
Western University Hospital, Pain Management Department, Cleveland
Clinic Foundation, OH.
CIRCULATION
ROOM 104-AREA B
FA A2210
Hemodynamic Parameters in the Extremely Obese: Indexed Values
May be Misleading
Morbid obesity is an ever present issue in todays patient population. The
use of non-invasive monitors in the operating room and intensive care unit
utilizes the BSA of the patients to obtain hemodynamic parameters. In large
patients the BSA may lead to distorted indexed parameters. In this abstract
we contrast BSA and BMI in this population demonstrating a discordance in
these values in larger individuals. We conclude that the use of non-indexed
values is superior in these patients. Adam C. Adler, M.D., M.S., Brian H.
Nathanson, Ph.D., Karthik Raghunathan, M.D., M.P.H., Anesthesiology,
Baystate Medical Center, Springfield, MA, OptiStatim, LLC, Longmeadow,
MA, Anesthesiology, Duke University Medical Center, Durham, NC.
FA A2211
Feasibility of Goal-Directed Fluid Management Based on Monitoring of
Pleth Variability Index (PVI)
Respiratory variation in the pulse oximeter waveform is a reliable predictor
of fluid responsiveness. Using goal directed fluid optimization based on the
respiratory variation in the pulse oximeter waveform is feasible may help
to standardize intraoperative fluid management and may result in reduced
post-operative morbidity. Cecilia Canales, M.P.H., Christine Lee, B.S.
Khanh-Van Le, B.A., Cris Ramos Hanacek, Student, Natalia Newcomb,
B.A., Catherine Nguyen, Student, Amy Le, Student, Robert S. Boud,
Student, Joseph Rinehart, M.D., Maxime Cannesson, M.D., Ph.D., UC
Irvine, CA.
FA A2212
Rapid Assessment of Hemoglobin Loss in Surgical Suction Canisters
Evaluation of a novel device for rapidly assessing hemoglobin mass in
surgical suction canisters. Allen Holmes, M.D., M.S., Rosario Garcia, M.D.,
Gregory Botz, M.D., Anesthesiology and Perioperative Medicine, Critical
Care, MD Anderson Cancer Center, Houston, TX, Anesthesia, Stanford
University School of Medicine, CA.
NA Neuroanesthesia
PN Pain Medicine
63
FA A2213
Intraoperative Pleth Variability Index Predicts Delayed Graft Function
The aim was to determine if intraoperative PVI or CVP could predict DGF.
CVP and PVI values at each time point were compared by regression analysis
and for the ability of changes in CVP or PVI to predict DGF. In patients with
DGF PVI values were significantly higher. PVI>8.3% before declamping of
the renal artery was related to the occurrence of DGF.PVI>8% may predict
DGF. Lina Jazaerli, Jr., Nassim Heshmati, Jr., Olivier Collange, M.D.,
Celine Biermann, M.D., Anne Lejay, M.D., Clotilde Muller, M.D., ErikAndre Sauleau, M.D., Paul-Michel Mertes, M.D., Ph.D., Annick Steib,
M.D., Ph.D., Surgical Anesthesia and Intensive Care, Vascular Surgery,
Nephrology-Transplantation, Public Health, Strasbourg University Hospital,
France.
FA A2214
Can We Estimate Blood Volume With a Plethysmograph? Eliminating
Background, Reducing Impact of Attenuation
We herein introduce and test a two-step process to reduce PPG variability
among subjects by minimizing the impact of background and normalizing
for varying degrees of signal attenuation. I-Hsun Liang, M.D., Siqin Nie,
M.D., Samrawit Goshu, M.D., Aymen Alian, M.D., Kirk Shelley, M.D.,
Ph.D., David G. Silverman, M.D., Anesthesiology, Yale University School of
FA A2215
Instantaneous Monitoring of Heart Rate Variability and Respiratory
Sinus Arrhythmia during Dexmedetomidine Anesthesia
In this work we aim to characterize dexmedetomidine anesthesia using point
process models for heartbeat dynamics. Our results show that these real
time monitoring approaches previously applied to propofol anesthesia are
successfully able to illustrate autonomic states such as vagal activity and
respiratory sinus arrhythmia during dexmedetomidine anesthesia. Kara
Pavone, B.S., Oluwaseun Johnson-Akeju, M.D., Jieun Kim, Ph.D., Aaron
Sampson, B.S., Emery N. Brown, M.D., Ph.D., Riccardo Barbieri, Ph.D.,
FA A2216
Comparison of Invasive and Non-Invasive Pulse Pressure Variation in
Morbidly Obese Patients
We compared the non-invasive ccNexfin Pulse Pressure Variation (PPV)
with A-line derived PPV in morbidly obese patients. Bland-Altman and
correlation analyses suggest an acceptable correlation between both
techniques. ccNexfin is a reasonable alternative for the assessment of fluid
responsiveness in this challending population when invasive hemodynamic
monitoring is not otherwise indicated. Roman Schumann, M.D., Wilbert A.
Wesselink, Ph.D., Iwona Bonney, Ph.D., Tufts Medical Center, Boston, MA,
Edwards Lifesciences Bmeye, Amsterdam, Netherlands.
FA A2217
Pneumoperitoneum Increases Invasive and Non-invasive Pulse
Pressure Variation in Morbidly Obese Patients
Pnemoperitoneum at a target pressure of 15 mmHg in morbidly obese
patients significantly increases Pulse Pressure Variation as measured noninvasively (ccNexfin) or by A-line. Both methods of assessment correlate
reflecting PP induced PPV changes and have a >90% concordance. Roman
Schumann, M.D., Wilbert A. Wesselink, Ph.D., Iwona Bonney, Ph.D., Tufts
Medical Center, Boston, MA, Edwards Lifesciences BMEYE, Amsterdam,
Netherlands.
64
PO10-2BEXPERIMENTAL NEUROSCIENCES: CNS ISCHEMIA AND
INJURY
ROOM 104-AREA E
NA A2218
Effects of Deep Hypothermic Circulatory Arrest on the Blood Brain
Barrier in a Rodent Cardiopulmonary Bypass Model
In this pilot study of experimental cardiopulmonary bypass in a rat
model MRI was utilized to detect increased brain capillary permeability
to commercially available low molecular weight contrast agent after deep
hyopthermic circulatory arrest. No quantitative changes in expression of
select proteins relevant for BBB structure and function (P-glycoprotein
Occludin Claudin-5) were detected in a brain capillary preparation on
post-operative day one. Our novel approach of molecular blood brain barrier
analyses combined with advanced MRI technology in a rodent bypass model
is highly translatable and can improve our understanding of the impact of
deep hyopthermic circulatory arrest on blood brain barrier function. Karsten
Bartels, M.D., Ma Qing, M.D., Talaignair N. Venkatraman, Ph.D., Mihai
V. Podgoreanu, M.D., Christopher D. Lascola, M.D., Joseph P. Mathew,
M.D., Duke University, Medical Center, Durham, NC.
NA A2219
A New Model of Global Cerebral Ischemia in Mice
We have made a new model of Global Cerebral Ischemia-reperfusion in mice
with simple procedure. This model can be used for screening the potential
pharmacological agents and analysis molecular of pathogenesis of ischemiareperfusion injury. Takasuke Fukuda, D.D.S., Satoshi Iseki, M.D., Manabu
Kakinohana, M.D., Ph.D., Chitoshi Takayama, M.D., Ph.D., Masayuki
Matsushita, M.D., Ph.D., Kazuhiro Sugahara, M.D., Ph.D., University of
the Ryukyus, Okinawa, Japan.
NA A2220
Treatment of Combined Traumatic Brain Injury and Hemorrhagic Shock
With Fractionated Blood Products Versus Fresh Whole Blood
This study explores the optimal treatment goals for combined traumatic brain
injury and hemorrhagic shock in a rat model. We find that best survival and
optimal physiological and neurological outcomes are achieved with mild
resuscitation to an arterial blood pressure below baseline while using fresh
whole blood. Resuscitation with fresh whole blood may be advantageous
compared to platelet free fractionated blood products. Akiva Leibowitz,
M.D., Evgeni Brotfain, M.D., Benjamin E. Gruenbaum, M.D., Yoram
Shapira, M.D., Ph.D., Alexander Zlotnik, M.D., Ph.D., Anesthesiology and
Critical Care, Soroka University Medical Center, Ben-Gurion University of
the Negev, Beer-Sheva, Israel.
NA A2221
Axonal Injury in a Rodent Model of Perioperative Ischemic Optic
Neuropathy
Evidence of axonal damage was found in a rodent model of perioperative
ischemic optic neuropathy. Steven Roth, M.D., John C. Dreixler, Ph.D.,
Afzhal R. Shaikh, M.S., Sineadh Conway, B.S., Anesthesia and Critical
Care, University of Chicago, IL.
NA A2222
Contrasting Brain Injury and Behavioral Patterns in Two Subarachnoid
Hemorrhage Models in the Rat
The etiology of cognitive dysfunction associated with aneurysmal
subarachnoid hemorrhage remains unknown. This rat study shows that both
anterior and posterior hemorrhages may result in cognitive dysfunction.
However hemorrhage distribution usually determined by aneurysm location
in patients determines both brain injury and behavioral patterns observed
in experimental subarachnoid hemorrhage. Toshihiro Sasaki, M.D., Huaxin
Sheng, M.D., David S. Warner, M.D., Federick W. Lombard, M.B., B.Ch.,
Duke University, Medical Center, Durham, NC.
NA Neuroanesthesia
PN Pain Medicine
PAI-2 Has No Influence on Cerebral Inflammation and Brain Water
Content After Traumatic Brain Injury in Mice
PAI-2 deficiency has no influence on inflammatory marker expression or
brain water content in traumatized brain tissue. Eva-Verena Schaible,
M.D., Tobias Hirnet, Kristin Engelhard, M.D., Ph.D., Serge Thal, M.D.,
Anesthesiology, Medical Center of the Johannes Gutenberg-University,
Mainz, Germany.
NA A2224
The Effects of Various Aspirin Regimens on Neurological Outcome
After Brain Ischemia in Rats
Aspirin is neuroprotective against perioperative transient cerebral ischemia
in rats. This effect may be mediated through suppressing IL-6 and IL-1
expressions via inhibition of notch activation. Zhongxing Wang, M.D., Zhiyi
Zuo, M.D., Ph.D., Anesthesiology, University of Virginia, Charlottesville,
VA.
NA A2225
Cdh1 Inhibits Reactive Astrocyte Proliferation After Oxygen-Glucose
Deprivation and Reperfusion
In conclusion, APC-Cdh1 was down-regulated during reactive astrocyte
proliferation. Lentivirus-mediated over-expression of Cdh1 inhibited reactive
astrocyte proliferation after OGD/R. It indicated the role of APC-Cdh1 in
regulation of astrocyte activation during nervous system injury and APCCdh1 could be an important target for neuroprotection. Wenlong Yao,
Ph.D., Jin Qiu, Ph.D., Chuanhan Zhang, M.D., Youyou Lv, Student, Yue
Zhang, Student, Chang Zhu, Ph.D., Xueren Wang, Ph.D., Department
of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China.
FA A2229
Blood Transfusions in Total Hip and Knee Arthroplasty
We were able to show that patients receiving blood transfusions surrounding
THA and TKA were older and had higher comorbidity burden. These factors
and potentially others may be responsible for worse outcomes and may
not be attributable to blood transfusions themselves. Thomas Danninger,
M.D., Ottokar Stundner, M.D., Rehana Rasul, M.A., Jashvant Poeran,
M.D., Ph.D., Madhu Mazumdar, Ph.D., Peter Fleischut, M.D., Stavros
G. Memtsoudis, M.D., Ph.D., Anesthesiology, Hospital for Special
Surgery, New York, NY, Paracelsus Medical University, Salzburg, Austria,
Department of Public Health, Division of Biostatistics and Epidemiology,
Weill Cornell Medical College, New York, NY.
FA A2230
Intraoperative Hypothermia and Requirement of Red Blood Cell
Transfusion in Non-Cardiac Surgical Patients
Hypothermia was common despite essentially universal forced-air
warming. Hypothermia impairs platelet function and coagulation. Even
very mildhypothermia for short periods of time significantly increased the
requirement of red blood cell transfusion innon-cardiac surgical patients.
Maintaining strict core normothermia throughout surgery is likely to reduce
transfusion requirements. Krit Panjasawatwong, M.D., Daniel I. Sessler,
M.D., Zhuo Sun, M.D., Jarrod E. Dalton, Ph.D., Leif Saager, M.D., Andrea
Kurz, M.D., Outcomes Research, Cleveland Clinic, OH.
FA A2231
FA A2226
Assessment of Fibrinolysis With Thromboelastometry (ROTEM) in
Orthotopic Liver Transplantation
Orthotopic liver transplantation recipients developed severe fibrinolysis
measured by thromboelastometory during ahepatic phase. However the
recovery from the severe fibrinolysis was fast after reperfusion of liver graft
except of early graft dysfunction. Therefore an antifibrinolytic therapy during
the ahepatic state may not be recommended. Tsukasa Shimauchi, M.D.,
Ken Yamaura, M.D., Kiyokazu Abe, M.D., Midoriko Higashi, M.D., Sumio
Hoka, M.D., Department of Anesthesiology and Critical Care, Operating
Rooms, Kyushu University Hospital, Fukuoka, Japan.
FA A2227
Antifibrinolytics in Adult Spinal Deformity Surgery: A Prospective
Randomized Controlled Comparison
A randomized double-blinded placebo controlled comparison of tranexamic
acid (TXA) and aminocaproic acid (EACA) in reducing blood loss in spine
surgery. TXA and EACA were found to reduce blood loss relative to placebo
with no difference between the medications. Kseniya Slobodyanyuk, B.A.,
Thomas Cheriyan, M.B., B.S., Frank J. Schwab, M.D., Baron Lonner, M.D.,
Thomas J. Errico, M.D., New York University Hospital for Joint Diseases,
NY.
PO13-3B OUTCOMES AND DATABASE RESEARCH: COAGULATION
BLEEDING
ROOM 104-AREA D
Perioperative Transfusion-Related Acute Lung Injury: The Canadian
Blood Services Experience
There is a paucity of data on the incidence and characteristics of Transfusionrelated acute lung injury (TRALI) cases that occur perioperatively. We report
the national characteristics of perioperative TRALI cases reported to Canadian
Blood Services over a 12 year period and compare them to non-perioperative
cases. Asim Q. Alam, M.D., Mary Huang, R.N., Qi-Long Yi, Ph.D., Barbara
Hannach, M.D., Department of Anesthesia and Pain Medicine, University
of Toronto, The Hospital for Sick Children, Canadian Blood Services,
Toronto, ON, Canada, Canadian Blood Services, Ottawa, ON, Canada.
FA A2232
Perioperative Blood Transfusions and Survival in Patients With NonSmall Cell Lung Cancer
This restrospective study showed that perioperative blood transfusions
were associated with shorter overall survival but not poorer recurrence free
survival. Juan P. Cata, M.D., Varun Chukka, M.D., Hao Wang, Student,
Lei Feng, M.S., Fernando Martinez, M.D., Vijaya Gottumukkala, M.D.,
Ara Vaporiciyan, M.D., Anesthesiology and Perioperative Medicine,
Biostatistics, Laboratory Medicine, Thoracic Surgery, The University of
Texas - MD Anderson Cancer Center, Houston.
FA A2233
FA A2228
SUNDAY, OCTOBER 13
NA A2223
Safety and Efficacy of Antifibrinolytics on Surgical Bleeding:
A Meta-Analysis
A meta-analysis was performed to evaluate efficacies of tranexamic acid
(TXA) and aminocaproic acid (EACA) in reducing blood loss (BL) in orthopedic
surgery. TXA and EACA were found to be effective in reducing BL and
transfusion rates with no evidence of increased complications. Kseniya
Slobodyanyuk, B.A., Thomas Cheriyan, M.B., B.S., Kristina Bianco, B.A.,
Stephen Maier, B.A., Thomas Errico, M.D., New York University Hospital
for Joint Diseases, NY.
Characterizing the Epidemiology of Transfusion-Related Acute Lung
Injury in Surgical Patients
In this retrospective cohort study Clifford et al. describe the incidence and
characteristics of patients developing transfusion related acute lung injury
(TRALI) following intra-operative blood product transfusion. Data are displayed
from 2004 and 2011 before &; after the introduction of various blood
product management strategies aiming to mitigate TRALI. Leanne Clifford,
B.M., Qing Jia, M.D., Hemang Yadav, M.B., B.S., Arun Subramanian,
M.B., B.S., Gregory A. Wilson, R.R.T., Sean P. Murphy, B.S., Jyotishman
Pathak, Ph.D., Darrell R. Schroeder, M.S., Daryl J. Kor, M.D., Department
of Anesthesiology, Internal Medicine, Anesthesia Clinical Research Unit,
Clinical Informatics Systems, BioMedical Statistics and Informatics,
Mayo Clinic, Rochester, MN.
NA Neuroanesthesia
PN Pain Medicine
65
CA A2239
ROOM 104-AREA A
CA A2234
Dose Dependent Analysis of Thrombotic Events Following the
Administration of Recombinant Activated Factor VII in Cardiac Surgery
Patients
Recombinant activated Factor VII (rFVIIa) has been used in cardiac surgery
to decrease blood loss and subsequent transfusion requirement but has
previously been associated with thrombotic complications. We have found
that high dose rFVIIa has no statistically significant increased rate of postoperative thrombosis as compared to low dose rFVIIa. Allison K. Dalton,
M.D., Jennifer Hofer, M.D., Michael O’Conner, M.D., Ishaq Lat, Pharm.D,
Katie Mieure, Pharm.D, Department of Anesthesia & Critical Care
University of Chicago, IL.
CA A2235
The Effect of Aspirin on Bleeding and Transfusion in Contemporary
Cardiac Surgery
In patients undergoing CABG and/or valve surgery this study found that
preoperative aspirin use is not associated with an increase in bleeding
complications or transfusion of FFP and PLTs but is associated with an
increased probability of receiving RBC transfusion although no difference in
the number of units transfused. Jordan Goldhammer, M.D., Mark Berguson,
B.S., John Bowen, M.S., Gregary Marhefka, M.D., Constantine Daskalakis,
M.S., James Diehl, M.D., Jian-Zhong Sun, M.D., Anesthesiology,
Cardiology, Pharmacology & Experimental Therapeutics, Cardiothoracic
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
CA A2236
Off-Label Use of Recombinant Activated Factor VII Decreases
Transfusion Rates in Cardiac Surgery Patients
Off-label administration of recombinant activated factor VII in cardiac surgery
patients is associated with a statistically significant decrease in blood
product transfusion rates. Jennifer E. Hofer, M.D., Allison Dalton, M.D.,
Michael O’Connor, M.D., Ishaq Lat, Pharm.D, Katherine Mieure, Pharm.D,
Anesthesia and Critical Care, Pharmacy, The University of Chicago, IL.
CA A2237
CA A2241
Epigallocatechin Gallate (EGCG) Selectively Inhibits ADP-Stimulated
Platelet Activation: Suppression of p38 MAP Kinase
Epigallocatechin gallate (EGCG) a major component of green tea have
various beneficial properties such as anti-oxidative anti-bacterial and
anti-carcinogenic effects. In the present study we examined the effects of
EGCG on human platelet activation. We clarified that EGCG selectively inhibits
ADP-stimulated human platelet activation and EGCG reduces the release of
PDGF-AB and sCD40L due to suppressing p38 MAP kinase. Yuko Iida, M.D.,
Osamu Kozawa, M.D., Ph.D., Hiroki Iida, M.D., Ph.D., Anesthesiology and
Pain Medicine, Gifu University Graduate School of Medicine, Japan.
MONITORING AND COAGULATION
Red Blood Cell Transfusions in Cardiac Surgery: Don’t Disregard the
Exclusion Criteria
Clinical practice guidelines are based on primary studies that may have
specific exclusion criteria that may not be explicit in the guidelines. We
conducted a search of primary studies on red blood cell transfusions in
cardiac surgery populations and examined the exclusion criteria. The five
most common exclusion criteria were renal insufficiency (51%) bleeding/
coagulation disorder (36%) reoperation (33%) liver disease (31%) and
emergency surgery (23%). We suggest highlighting the exclusion criteria
in practice guidelines and creating a new category of clinical discretion
along with class of recommendation and level of evidence. Alice Li, B.S.,
Shamsuddin Akhtar, M.B., B.S., Department of Anesthesiology, Yale
ROOM 104-AREA D
Time-Dependent Changes in Intraplatelet Bax Relevant to Platelet
Dysfunction After Cardiac Surgery With Cardiopulmonary Bypass
Increases in intraplatelet Bax might contribute to platelet dysfunction in the
perioperative period of cardiac surgery with cardiopulmonary bypass. Yasfumi
Nakajima, M.D., Ph.D., Momoko Murase, M.D., Yoshinobu Nakayama,
M.D., Daniel I. Sessler, M.D., Masayuki Shibasaki, M.D., Ph.D., Toshiki
Mizobe, M.D., Ph.D., Anesthesiology and Intensive Care, Kyoto
Prefectural University of Medicine, Kyoto, Japan, Cleveland Clinic, OH.
FA A2243
CA A2238
66
Risk Factors of Symptomatic Proximal Deep Vein Thrombosis
Early diagnosis of deep vein thrombosis (DVT) is clinically essential for
avoiding development of pulmonary thromboembolism (PTE). Especially
proximal DVT is crucial risk factor in the development of acute PTE. We
focused on the possibility of more effective diagnosis of proximal DVT by
combining plasma D-dimer levels with lower limb symptoms and examined
the risk factors associated with symptomatic proximal DVT development.
Toshiyuki Sawai, M.D., Ph.D., Tomohiro Tanaka, M.D., Shinichi Tatsumi
M.D., Ph.D., Junko Nakahira M.D., Ph.D., Toshiakai Minami M.D., Ph.D.,
Anesthesiology, Osaka Medical College, Takatsuki, Japan.
CA A2240
Protamine Requirements in Cardiac Surgery - Effect of Changes in the
Heparin Reference Standard
The recent change in UFH standard by the FDA and USP has not affected its
susceptibility to protamine neutralization. Circulating UFH (as quantified by
anti-IIa and anti-Xa assays) is commonly present following exposure to CPB.
Ravi Taneja, M.D., F.R.C.A, Leslie Berry, Ph.D., Unnikrishnan Pappu,
M.B., B.S., Larry Stitt, Ph.D., Puneet Sayal, M.D., Peter Allen, Hugh
Hoogendoorn, Anthony Chan, M.D., Anesthesia and Perioperative
Medicine, Biostatistics and Epidemiology, Clinical Perfusion, University of
Western Ontario, London ON, Canada, Pediatrics, McMaster University,
Hemostasis Reference Laboratory Inc., Hamilton, ON, Canada, George
Washington University, Washington, DC.
FA A2242
Atrial Component Extraction From Clinical Monitor Electrocardiograms
Postoperative atrial fibrillation (PAF) occurs in 10% to 65% of the patients
undergoing cardiac surgery. In order to develop novel ECG-based risk markers
for PAF one must first classify the variation seen in atrial activity. Hence one
must extract the atrial component of the ECG waveform. This can be seen as
a blind source separation problem which can be analyzed using independent
component analysis (ICA) as well as a newly proposed method. This report
describes the implementation and evaluation of these methods on data from
multiple environments. James M. Blum, M.D., Satinder Baveja, Ph.D.,
Chih-Chun Chia, B.S., Zahi Karam, Ph.D., Anesthesiology, Computer
Science and Engineering, University of Michigan, Ann Arbor, MI.
Effect of Application of an Impedance Threshold Device on StO2
Measured by Cerebral Near Infrared Spectroscopy in Spontaneously
Ventilating Volunteers
This work tests the hypothesis that the pulsatile and non-pulsatile
components of a NIRS waveform are attributable to arterial and venous
blood. To make these phenomena more prominent an respiratory impedance
threshold device was used. No low frequency algorithms to assess StO2 were
consistently different from non-pulsatile estimates of StO2. Respiratory and
cardiac frequency-based estimates of StO2 are often both larger or both
smaller than non-pulsatile StO2 suggesting that they may be interrogating
the same vascular bed. Measurement of O2 saturation in arterial and venous
blood using NIRS may require a novel means of discriminating between
these signals. Douglas Colquhoun, M.B., Ch.B., Kimberly B. Naden, B.A.,
Robert H. Thiele, M.D., Department of Anesthesiology, School of Medicine
University of Virginia, Charlottesville.
NA Neuroanesthesia
PN Pain Medicine
A New Device for Continuous Assessment of Gut Microcirculation.
Proof of Concept on a Porcine Model of Septic Shock
Microcirculatory impairment of the gut is correlated to death during sepsis.
We have tested herein a probe that provides a plethysmographic signal of
the gut called the PAC in a model of porcine septic shock. Ten piglets were
tested the PAC was strongly correlated with the lactate. At the beginning of
sepsis the PAC was able to detect circulatory failure while macrocirculatory
parameters did not. Matthias Jacquet-Lagreze, Jr., M.S., Bernard
Allaouchiche, M.D., Ph.D., Olivia Vassal, Jr., M.S., Jeanne-Marie BonnetGarin, Ph.D., Jean-Yves Ayoub, Christian Paquet, Stephane Junots,
V.M.D., Service d’anesthesie-reanimation, Hospitalices Civils de Lyon,
France, Service d’anesthesie-reanimation Hospital Edouard-Herriot, Lyon,
France, EA 4174 Sepsis Inflammation Hemostase, Vetagro Sup Lyon
Marcy-l’Etoile, France.
FA A2245
Measurement of Esophageal Temperature at Two Separate Sites
During Pulmonary Vein Ablation
We studied 25 patients during pulmonary vein ablation monitoring the
luminal esophageal temperature. We suggest that measurement of
temperature at two separate esophageal locations is more sensitive and
accurate that one location in detecting temperature increases. Mohamed
Koronfel, M.B., B.Ch., Paul Loubser, M.B., B.Ch., Mohamed Elhakim,
M.B., B.Ch., Bharat Kantharia, M.D., Nada B. Memon, M.D.,
Anesthesiology, Cadriovascular Medicine, University of Texas, Medical
School at Houston, TX.
FA A2246
Comparison of Automated Versus Manual Determination of the
Respiratory Variations in the EKG Waveform Recordings
Respiratory variation in the EKG lead II R-wave amplitude (EKGv) has been
shown to correlate with pulse pressure variation in patients under general
anesthesia and to predict volume status. However the only current method
for EKGv calculation is manual-measuring. The goal of this study was to
assess the accuracy of a computer-automated algorithm compared to
manual measurement as an accurate and dynamic calculation of EKGv in
the clinical environment. Christine K. Lee, B.S., Cris Hanacek, Natalia
Newcomb, B.S., Maxime Cannesson, M.D., Ph.D., Joseph Rinehart, M.D.,
Department of Anesthesiology and Perioperative Care, University of
California Irvine, Orange County, CA.
FA A2247
Continuous Blood Glucose Monitoring During Cardiopulmonary Bypass
for Children
Use of continuous blood glucose monitoring system during CPB for pediatric
cardiovascular surgery proved to be remarkably reliable. Naoji Mita, M.D.,
Shinji Kawahito, M.D., Ph.D., Nami Kakuta, M.D., Katsuyoshi Kume, M.D.,
Kazumi Takaishi, M.D., Ph.D., Hiroshi Kitahata, M.D., Ph.D., Tokushima
University, Japan.
FA A2248
Accuracy of Pulse CO-Oximeter in Children and Infants
The accuracy of total hemoglobin measured with Pulse CO-Oximeter even
when body weight <10 kg is acceptable but might not be accurate with lower
perfusion index in children and infants. Rieko Oishi, M.D., Kazuya Toju,
M.D., Shinju Obara, M.D., Tsuyoshi Isosu, M.D., Masahiro Murakawa,
Ph.D., Fukushima Medical University, Japan.
FA A2249
Influence of Anesthesia Induction and Vasopressors on Noninvasive
SpHb Measurements
Monitoring of intraoperative changes in Hb concentration by the noninvasive
Radical 7 monitor (SpHb®) is considered acceptably valid especially after
calibration by an invasive assessment. Furthermore the influence of
vasopressors on SpHb readings is unknown as of yet. We assessed the
influence of anesthesia induction and vasopressors on SpHb. The mean
SpHb value changed significantly in the first 15 minutes after induction of
anesthesia with even longer times for individual changes. Administration of
vasopressors had no effect on SpHb. Calibration of the SpHb with an invasive
Hb measurement should therefore be performed after a stabilization period
of at least 15 minutes after induction of anesthesia. Marieke Poterman,
M.D., Thomas W.L. Scheeren, M.D., Ph.D., Alain F. Kalmar, M.D., Ph.D.,
Department of Anesthesiology, University Medical Center Groningen,
University of Groningen, Netherlands.
SUNDAY, OCTOBER 13
FA A2244
PO10-4A EXPERIMENTAL NEUROSCIENCES: CEREBRAL BLOOD FLOW
AND NEUROPROTECTION
ROOM 104-AREA B
NA A2250
The Effects of Vasopressin on Pial Microvessels During Global Brain
Iscemia-Reperfusion Period in Rabbits
The aims of the present study were to evaluate the direct effects of
vasopressin on cerebral pial arterial diameter changes in the normal
state and during ischemia-reperfusion period using cranial window.
Conclusions:Vasopressin constricted cerebral pial arterioles in the normal
state. Vasopressin also constricted cerebral pial arterioles during ischemiareperfusion period. Vasopressin is a potent cerebral vasoconstrictor.
Vasopressin may enhance the cerebral vasoconstriction during global brain
ischemia-reperfusion period. Nobumasa Asano, M.D., Tadahiko Ishiyama,
M.D., Ph.D., Masakazu Kotoda, M.D., Noriyuki Shintani, M.D., Taishi
Masamune, M.D., Ph.D., Kodai Ikemoto, M.D., Takashi Matsukawa, M.D.,
Ph.D., Surgical Center, University of Yamanashi, Chuo, Japan.
NA A2251
Xenon at Subanesthetic Concentrations Partially Reverses
Synaptotoxic Effects of Amyloid Beta 1-42In Vitro
In this study we investigated interactions between soluble Amyloid
beta oligomers (A1-42) as an important factor in Alzheimer’s disease
pathogenesis and the gaseous anaesthetic Xenon (Xe) on hippocampal long
term potentiation (LTP) in vitro. Subanesthetic concentrations of Xe (18%
and 30%) did not significantly alter LTP. A1-42 induced a LTP deficit which
was partially restored in the presence of 30% Xe. These results point to an
additional neuroprotective property of Xe.e. Martina Buerge, M.D., Stephan
Kratzer, M.D., Corinna Mattusch, Ph.D., Eberhard Kochs, M.D., Gerhard
Rammes, Ph.D., Klinik fuer Anaesthesiologie, Klinikum rechts der Isar,
Muenchen, Germany.
NA A2252
Sevoflurane Preconditioning Affects Protein Kinase M and AntiApoptotic mRNA Expression After Hypoxia
The mRNA expression of PKMzeta and the antiapoptotic bcl-xl were
profoundly reduced by hypoxia; sevoflurane-induced preconditioning
significantly attenuated these changes leading to better maintained levels
of bcl-xl and pkmZzeta mRNA one hour after hypoxia; this correlates with
improved recovery and may contribute to prolonged protection after hypoxia.
Joan Y. Hou, M.D., Alejandro I. Hernandez, Ph.D., James E. Cottrell, M.D.,
Ira S. Kass, Ph.D., Anesthesiology, Pathology, SUNY Downstate, Brooklyn,
NY.
NA Neuroanesthesia
PN Pain Medicine
67
NA A2253
PO13-7A OUTCOMES AND DATABASE RESEARCH
Development of a Mouse Model of Intracranial Aneurysm in Mice
We have developed a mouse model for intracranial aneurysms. Aneurysms
were induced by a combination of hypertension and single injection of
elastase into the cerebrospinal fluid. In this model elastase in the range
between 10 and 35 milli-units had dose-dependent effects on the rupture
rate but not the formation rate of aneurysms. This mouse model of
intracranial aneurysm provides us with a unique opportunity to study the
mechanisms of aneurysmal rupture as well as pharmacological prevention.
Mari Kudo, M.D., Kosuke Wada, M.D., Shoko Murakami, M.D., Ph.D.,
Yoshiteru Tada, M.D., Ph.D., Tomoki Hashimoto, M.D., Department
of Anesthesia and Perioperative Care, University of California, San
Francisco, San Francisco, CA.
NA A2254
Early Multisensory Rehabilitation Prevents Spatial Memory Impairment
After Isoflurane Anesthesia and Surgery in Aged Rats
In the present study we investigated the effects of early multisensory
rehabilitation after surgery on postoperative spatial memory impairment
in aged rats. Our finding implies that postoperative early rehabilitation can
be used as a non-medication approach for the prevention of postoperative
cognitive dysfunction in elderly patients. Akihiro Morikawa, Takashi
Kawano, M.D., Haidong Chi, Ph.D., Satoko Imori, Sayaka Waki, Takahiro
Aoki, Yusuke Tanigawa, Anna Ito, Fumimoto Yamazaki, M.D., Masataka
Yokoyama, M.D., Kochi Medical School, Nankoku, Japan.
NA A2255
Suppression of Central CX3CR1 Signaling Alleviates Amyloid-Induced
Memory Deficiency
Introducing exogenous amyloid fibrils induced significant upregulation of
CX3CR1 signaling via an epigenetic mechanism in the hippocampal CA1
area. Suppression of CX3CR1 signaling attenuated amyloid fibril-induced
microglia activation Il-1 protein expression and ameliorated the impaired
glutamatergic transmission and memory deficiency in the rodent model of
Alzheimer’s disease. The findings suggest that blocking CX3CR1 signaling
appears to have neuroprotective effects in the settings of Alzheimer’s
disease. Mohamed Naguib, M.D., F.R.C.A, Bihua Bie, M.D., Ph.D., Jijun
J. Xu, M.D., Ph.D., Jiang Wu, M.D., David L. Brown, M.D., General
Anesthesia, Cleveland Clinic, OH.
NA A2256
Lithium Improves Cognitive Function After Aged Rats Having
Splenectomy by Inhibiting TLR4/NF-B Pathway
Neuroinflammation in aged rats induced by splenectomy, is possibly
mediated by microgliosis and related to a selective activation in TLR4/ NF-B
pathway. Lithium could improve cognitive function in aged rats after surgery
by inhibiting TLR4/ NF-B cascades. Yanning Qian, Ph.D., Bo Gui, Ph.D.,
Shunmei Lu, M.D., Anesthesiology, First Affiliated Hospital with Nanjing
NA A2257
Targeting Damage-Associated Molecular Patterns to Prevent
Postoperative Cognitive Decline
The study of damaged associated molecular patterns can be used to both
diagnose and possibly treat exaggeration and persistence of surgery-induced
cognitive decline. Sna Vacas, M.D., Vincent Degos, M.D., Ph.D., Mitchell
Marubayashi, M.Sc., Stuart Dilg, B.A., Huan Yang, Ph.D., Kevin Tracey,
M.D., Mervyn Maze, M.B., B.Ch., Anesthesia and Perioperative Care,
University California San Francisco, San Francisco, CA, Feinstein Institute
for Medical Research, Manhasset, NY.
68
ROOM 104-AREA E
FA A2258
Postoperative Shivering in the Patients Who Undergoes TRAM Flap op
for Breast Cancer Related to Anesthetic Technique
The occurrence of postoperative shivering after TIVA or balanced technique
using remifentanil is related to the infusion rate of remifentanil. The aim of
this study was to elucidate the influence of propofol and volatile anesthetics
on the development of remifentanil induced postoperative shivering. In
conclusion propofol and sevoflurane exerts protective effect against
remifentanil induced postoperative shivering. Yangin Yoon, M.D., Ji-Yeon
Bang, M.D., Byung-moon Choi, M.D., Ph.D., Gyu-jeong Noh, M.D., Ph.D.,
Department of Anesthesiology and Pain Medicine, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea.
FA A2259
Factors Associated With the Development of Chronic Pain After
Mastectomy: A Propensity Matched Analysis
Age and Lymph node dissection but not radiation are risk factors for chronic
pain after mastectomy. Gildasio S. De Oliveira, Jr., M.D., M.S., R-Jay
Marcus, M.D., Robert McCarthy, Pharm.D, Anesthesiology, Northwestern
University, Chicago, IL.
FA A2260
Postoperative Emergency Department Utilization Following Elective
Spine Surgery: A Pilot Study Aimed to Assess Perioperative Value
Delivery for Chronic Pain Patients Under the Affordable Care Act (ACA)
With the passage of the Affordable Care Act (ACA) healthcare reform
in the U.S. has transitioned from distant possibility to imminent reality.
In the immediate future perioperative value delivery and consequently
reimbursement models will be measured in terms of exceptional clinical
outcomes superior patient satisfaction and cost effectiveness. A clear
and reproducible perioperative management strategy for chronic back
pain patients presenting for elective spine surgery offers an opportunity to
maximize perioperative value delivery for the anesthesiologist in the ACA
Era. With these concepts in mind this retrospective study was designed to
investigate measurable health service outcomes in chronic back pain patients
presenting for elective spine surgery. Thomas J. Hopkins, M.D., Jason
Guercio, M.D., Tanya Saloom, M.P.H., Andrew Shaw, M.B., B.S., Solomon
Aronson, M.D., Anesthesiology, Duke University, Medical Center, Durham,
NC.
FA A2261
Preadmission Opioid Use is Associated With Increased Hospital Length
of Stay in Total Knee Arthroplasy Patients
Retrospective review of 1600 total knee arthroplasty patients shows that
patients with preadmission opioid use have a longer hospital length of
stay when compared to opioid naive patients. Bassam Kadry, M.D., Sean
Mackey, M.D., Ph.D., Natacha Telusca, M.D., Ken Lau, M.D., Hassan
Alosh, M.D., M.S., Alex Macario, M.D., M.B.A., Anesthesiology, Standford
University Medical Center, CA, Orthopaedics, University of Pennsylvania,
Philadelphia, PA.
FA A2262
Change in Postoperative Blood Glucose After 4mg Versus 8-10mg
Dexamethasone for PONV Prophylaxis in Patients With Type II Diabetes
Mellitus
A retrospective analysis in diabetic patients who received 4mg or 8-10mg
Dexamethasone for PONV prophylaxis performed to assess the impact
of anti-emetic dexamethasone dose on postoperative glycemic control in
type II DM. Results show that using an 8-10mg dose results in significantly
increased hyperglycemia and insulin requirement compared to a 4mg dose
and suggest this may be a safer dose for diabetic patients. Yinghui Low,
M.D., William D. White, M.P.H., Ashraf Habib, M.D., Anesthesiology, Duke
University, Hospital, Durham, NC.
NA Neuroanesthesia
PN Pain Medicine
Intraoperative Acetaminophen Use in Lower Extremity Orthopedic
Surgery Does Not Decrease Postoperative Pain or Opioid Use
I.V. Acetaminophen has been reported as useful adjunct for postoperative
analgesia. This study was performed to assess the impact of I.V.
Acetaminophen on postoperative pain control opioid use and nausea in
orthopedic surgeries and unexpectedly found higher opioid requirements in
patients who had received intraoperative I.V. Acetaminophen. These results
suggest the need for more selective use of prophylactic I.V. Acetaminophen
and further studies to determine which group of patients will benefit most
from prophylactic administration of the drug. Yinghui Low, M.D., William
D. White, M.P.H., Tong Joo Gan, M.P.H., Anesthesiology, Duke University,
Durham, NC.
FA A2264
Incidence of Intraoperative Hypothermia in Japan
Incidence of hypothermia was 17% in all measured cases under general
anesthesia in Japan. Head and Neck surgery and pediatric surgery had low
incidence of hypothermia. Nobutada Morioka, M.D., Ph.D., Rie Kanamori,
M.D., MIrei Nagai, M.D., Keisuke Shimizu, M.D., Maho Kinoshita,
M.D., Yusuke Kasuya, M.D., Makoto Ozaki, M.D., Anesthesiology, Tokyo
Women’s Medical University, Japan.
FA A2265
Effect of Preoperative Intravenous Glucose Loading on Metabolic
Response of Patients Undergoing Elective Laparoscopic Colorectal
Surgery
Preoperative glucose loading with glucose-containing intravenous solution
suppressed lipid metabolism in patients who underwent laparoscopic
colorectal surgery. Keisuke Yamaguchi, M.D., Yusuke Sugasawa, M.D.,
Ph.D., Yuka Kitajima, M.D., Saiko Wakabayashi, M.D., Kazuyo Takaeuchi,
M.D., Eiichi Inada, M.D., Anesthesiology and Pain Medicine, Juntendo
University School of Medicine, Bunkyo-Ku, Japan.
PO14-4A PATIENT SAFETY PRACTICE MANAGEMENT
ROOM 104-AREA C
PI A2266
Audit and Analysis of Early Warning Scoring Systems and Rapid
Response Teams in Obstetrics: Maternal Safety Improvement Initiative
We developed Obstetrics early warning score (OB-EWS)that can assist health
care workers to identify the need for obtaining timely help and trigger a rapid
response process. We modified MEWS (medical early warning score) tool
parameters to reflect physiological changes of parturient. Parameters that are
specific to pregnancy are also added. We added the OBEWS to the automatic
task functioning of electronic medical record so that it is hard wired into
documentation work flow. The RRT calls in 2011 and 2012 were analyzed
as continuing quality improvement initiative. OBMEWS helped in summoning
timely help and improved patient safety. Rishimani S. Adsumelli, M.B.,
B.S., Antonietta A. Lynch, R.N., Valeri Wong, B.S., Beata Evans, M.D.,
Anesthesiology, Division of Nursing, Stony Brook University Hospital,
School of Medicine, SUNY Stony Brook, NY.
PI A2267
Time to Intubation in Obese Patients. A Comparison Between Stortz
Video Laryngoscopy and Macintosh Direct Laryngoscopy
Obese patients are at higher risk of aspiration of gastric contents and
desaturation during anesthesia induction compared to lean patients. In this
stydy we compared the use of Stortz video laryngoscopy to Macintosh direct
laryngoscopy in order to evaluate if the use of video laryngoscopy might
reduce the time to intubation. There were no difference in time to intubation
between the groups. Fredrik Ander, M.D., Alex de Leon, M.D., Ph.D.,
Anesthesia and Intensive Care, Orebro University Hospital, Sweden.
PI A2268
Blood Transfusion Increases the Risk for Prosthetic Joint Infection
After Primary Knee Arthroplasty
Wound infection was diagnosed in 2.4% of 1331 patients after knee
arthroplasty. Only packed RBC were associated with a high risk of infection.
Misericordia Basora, Ph.D., Sandra P Gomez-Lesmes M.D., Juan C
Martinez-Pastor M.D., Sebastian Garcia-Ramiro Ph.D., Arturo Pereira
Ph.D., Miguel Marcos M.D., Eduard Tornero M.D., Laura Morata M.D.,
Josep Mensa Ph.D., Alex Soriano Ph.D., Anesthesiology, Orthopedic
Surgery, Hemotherapy and Hemostasis, Infectious Diseases, Hospital
Clinic, Barcelona, Spain, Internal Medicine University Hospital of
Salamanca-IBSAL, Salamanca, Spain.
SUNDAY, OCTOBER 13
FA A2263
PI A2269
Comparison of the Sniffing With Ramped Position for Laryngeal
Views and Intubation Attempts According to Anesthetic Experience in
Patients With Expected Difficult Intubation
The aim of this study was to compare the sniffing position with ramped
position for laryngeal views and intubation attempts according to anesthetic
experience in patients with expected difficult intubation. Ramped position
both in less skilled resident and Fully trained and experienced attending
anesthesiologist provides better laryngeal view than sniffing position and
increases successful intubation in Fully trained and experienced attending
anesthesiologist. Ju Hwan Lee, M.D., Cheol Lee, M.D., Department of
Anesthesiology and Pain Medicine, Wonkwang University, Iksan, Korea.
PI A2270
Morbidly Obese Patients Undergoing Primary Hip Arthroplasty Require
Forty-Four More Minutes of Operating Room Time
Morbidly obese (MO) patients undergoing primary hip arthroplasty require
30% more OR time including 50% more Anesthesia time prior to incision. In
the future we must find ways to narrow the gap to improve efficiency in the
operating room and reduce loss of revenue. Christopher D. Press, M.D.,
Bassam Kadry, M.D., Hassan Alosh, M.D., Isaac Mueller Oper, B.S., Igor
Andrei Popov, B.S., Joe Orsini, B.S., Alex Macario, M.D., MBA, Jay B.
Brodsky, M.D., Department of Anesthesia, Economics, Stanford University
Medical Center, CA, Anesthesia, University of Pennsylvania, Philadephia,
PA.
PI A2271
Educational Intervention to Decrease Volatile Agent Waste Via
Changes in Fresh Gas Flow Management
This is a quality improvement project designed to decrease environmental
waste by influencing the fresh gas flow (FGF) management practices of
anesthesia providers in a large academic anesthesia department. A simple
concise email-based educational intervention was used to decrease FGF
volatile agent waste environmental greenhouse gas production and OR
costs. Benjamin F. Redmon, M.D., Gabriel M. Rice, M.D., Kasey K. Fiorini,
M.D., Anthony N. Passannante, M.D., Anesthesiology, University of North
Carolina, Chapel Hill, NC.
PI A2272
Smoking History: An Important Risk Factor for Difficult Intubation
We analyzed the medical records of 51 difficult intubation patients and
817 non-difficult intubation patients to determine the risk factors of difficult
intubation. Univariate analysis showed that male gender surgeries for
otolaryngology hypertension age >55 years BMI > 25 and smoking
history were significant risk factors of difficult intubation. Multivariate
analyses of these factors demonstrated that smoking history was the only
statistically significant risk factor influencing difficult intubation. Kazutaka
Tanaka, M.D., Masayuki Kuroiwa, M.D., Masayasu Arai, M.D., Hirotsugu
Okamoto, M.D., Anesthesiology, Kitasato University School of Medicine,
Sagamihara-shi, Kanagwa, Japan.
NA Neuroanesthesia
PN Pain Medicine
69
PI A2273
BMI as a Predictor Factor of Potential Difficult Intubation Airway
In conclusion our results are highly significant (p<0.001) and supported
that BMI is an efficient predictor for difficult intubation in men and confirmed
that Mallampati score is also a good predictor for both genders. This study
emphasis and support the use of BMI preoperatively to potentially predict
difficult intubation in men. Thus a preoperative evaluation is important
for screening for patients at risk of unanticipated difficult intubation and it
should include BMI assessment and Mallampati score in special in obese
population. It would contribute to maintain and improve patient safety and
increase awareness of this condition. Alberto A. Uribe, M.D., Erika G.
Puente, M.D., Andrew J. Otey, B.S., Duane Allen, M.D., Nicole Dubosh,
M.D., Sergio D. Bergese, M.D., Anesthesiology, The Ohio State University
Wexner Medical Center, Columbus, OH.
PO04-2B CLINICAL CIRCULATION
CA A2274
Recombinant Activated Factor VII Tranexamic Acid and Desmopressin
Fail to Reduce Bleeding in Rabbits Treated With Prasugrel
The efficacy and safety of recombinant activated factor VII, tranexamic acid
and desmopressin were assessed in animals treated with prasugrel using a
model of bleeding and thrombosis. These non specific agents failed to reduce
prasugrel induced bleeding. Fanny Bonhomme, M.D., Anne Godier, M.D.,
Ph.D., Charles Marc Samama, M.D., Ph.D., Pierre Fontana, M.D., Ph.D.,
Anesthesiology, Geneva University Hospital, Switzerland, Department of
Anesthesiology and Critical Care, Cochin Hospital, Assistance PubliqueHospital de Paris, France.
CA A2275
Multimodal Blood Conservation Reduces Intraoperative Transfusion in
a Community-Based Cardiac Surgery Practice
Transfusion in cardiac surgical patients is associated with increased hospital
morbidity and mortality. Institution of a multimodal blood conservation
strategy based on the Society of Thoracic Surgeons/Society of Cardiovascular
Anesthesiologists transfusion and blood conservation guidelines reduces
the rate of intraoperative blood product transfusion in a community-based
cardiac surgical program. Robert Brooker, M.D., Douglas G. Ririe, M.D.,
Ph.D., Memorial HealthCare System, Hollywood, FL, Anesthesiology,
Wake Forest School of Medicine, Winston-Salem, NC.
CA A2276
Effect of Fibrinogen Substitution on Clot Firmness and Clot Stability
Under Thrombocytopenia as Evaluated Using Thromboelastometry
(ROTEM)
Whole blood laboratory model of thrombocytopenia demonstrated a liner
relationship between maximum clot firmness (MCF) on ROTEM and the
platelet count after a semilogarithimictransformation. Clot amplitude at 10
min and MCF on ROTEM were never normalized even when fibrinogen is
supplemented in thrombocytopenia to reach final fibrinogen concentration
of 600 mg dl-1 although fibrin clot resist to fibrinolysis induced by tissuetype plasminogen activator. Junko Ichikawa, M.D., Yuriko Samejima, M.D.,
Keiko Okamura, M.D., Goro Kaneko, M.D., Mitsuharu Kodaka, M.D.,
Makiko Komori, M.D., Tokyo Women’s Medical University Medical Center
East, Japan.
The Effects of Intraoperative Administration of Flurbiprofen on the
Platelet Functions in Patients Undergoing General Anesthesia
Our findings show that administration of flurbiprofen with recommended doses
can inhibit platelet agguration induced by collagen in patients undergoing
general anesthesia. Nonsteroidal anti-inflammatory drugs may include the
possibility of temporary replacement of aspirin. Asuka Ito, M.D., Ph.D., Seiji
Watanabe, M.D., Ph.D., Yasunori Mishima, M.D., Ph.D., Shuhei Niiyama,
M.D., Ph.D., Kazuo Ushijima, M.D., Ph.D., Anesthesiology, Kurume
University School of Medicine, Japan, Dental Anesthesiology, Kyusyu
Dental University, Kokura, Japan.
70
Use of ROTEM and Multiple Electrode Aggregometry (Multiplate) to
Monitor Hemostasis in a Cardiac Surgical Patient With ITP
We present a patient with idiopathic thrombocytopenic purpura
who underwent aortic valve replacement monitored using rotation
thromboelastometry (ROTEM®) and multiple electrode aggregometry
(Multiplate®). During CPB the maximum clot firmness (MCF) in EXTEM
MCF in FIBTEM of ROTEM® were decreased. Moreover, all Multiplate®
measurements during CPB were decreased. After transfusion ROTEM®
measurements increased to the normal range, but low Multiplate®
measurements were still obtained. However, the abnormal Multiplate®
measurements did not affect perioperative bleeding. Goro Kaneko, M.D.,
Mitsuharu Kodaka, M.D., Junko Ichikawa, M.D., Keiko Kurokawa, M.D.,
Keiko Nishiyama, M.D., Makiko Komori, M.D., Anesthesiology, Tokyo
Women’s Medical University Medical Center East, Japan.
CA A2279
ROOM 104-AREA A
CA A2277
CA A2278
The Effects of a 30-Degree Head-Up Position on Intraoperative
Bleeding During Functional Endoscopic Sinus Surgery
Maintaining patients at a 30-degree head-up position was associated
with less intraoperative blood loss and improved surgical field during FESS
compared to a 15-degree head-up position. Vsevolod Rozentsveig, M.D.,
Andrew Schwartz, M.D., Ruslan Kuts, M.D., Matthew Boyko, Ph.D.,
Alexander Zlotnik, M.D., Ph.D., Department of Anesthesiology and Critical
Care, Soroka Medical Center and Ben-Gurion University of the Negev,
Beer Sheva, Israel.
CA A2280
Elevated Internationalized Normalized Ratio (I.N.R.) And Surgical
Bleeding In Patients Undergoing Limb Salvage
Clinicians’ preferred normal target is an INR of about less than 1.3 before
surgery. A retrospective study of patients undergoing limb preservation
procedures indicated that patients undergoing limb preservation procedures
with a a high INR greater than 1.4 did not show significant increase in
bleeding intraoperatively or postoperatively. Large number of patients have
to be studied to definitely conclude that there is no increase in hemorrhage
in performing limb preservation procedures in patients with an INR of greater
than 1.4. Nalini Vadivelu, M.D., Vijay Kodumudi, Feng Dai, Ph.D.,
Sn Dabu-Bondoc, M.D., Peter Blume, Department of Anesthesiology, Yale
University, New Haven, CT, School of Liberal Arts and Science, University
of Connecticut, Storrs, CT.
CA A2281
Propofol Has Suppressing Effects on Human Platelet Functions in Vitro
The present study shows that propofol has suppressive effects on various
platelet functions. Propofol suppressed U46619- thromboxane analog
ADP- and epinephrine-induced platelet aggregation. Furthermore propofol
suppressed U46619 induced platelet granule secretion integrin activation
and intracellular Ca2+ release. Akiko Koyasu, M.D., Naoko Sugita, M.D.,
Hideo Hirakata, M.D., Ph.D., Anesthesia, Psychiatry, National Hospital
Organization Kyoto Medical Center, Japan.
PO08-1B EQUIPMENT MONITORING AND ENGINEERING TECHNOLOGY:
MONITORING AND COAGULATION
ROOM 104-AREA D
FA A2282
Continued Improvement in Absolute and Trend Accuracy of
Non-Invasive and Continuous Hemoglobin Monitoring
Hemoglobin measurement is essential to red blood cell transfusion
management. Noninvasive measurement needs to have acceptable absolute
and trend accuracy to reliably guide clinical decisions. Compared to results
from an earlier version of a Pulse CO-Oximetry continuous noninvasive
hemoglobin device we found improved absolute and trend accuracy.
Noninvasive hemoglobin measurement could add to patient safety if it is
found to be reliable in patients with low hemoglobin who are at higher risk for
transfusion during major surgery. Richard Applegate, II, M.D., Carl Collier,
D.O., Mark Macknet, M.D., Mohammad Hassanian, M.D., Gerald Andrews,
M.B., B.S., Michael Um, B.S., Anesthesiology, Loma Linda University
School of Medicine, CA.
NA Neuroanesthesia
PN Pain Medicine
Prospective Investigation of Preoperative Thrombelastography®
Platelet Mapping™
Thrombelastograph® Platelet Mapping™ detects platelet inhibition of
arachadonic acid (AA) and/or ADP-induced platelet aggregation. Our aim
was to assess the ability of the TEG-PM™ to detect platelet inhibition
secondary to clopidogrel and/or aspirin therapy in patients in the preoperative
anesthesia clinic or day surgery unit. Davide Cattano, M.D., Ph.D., Alfonso
Altamirano, M.D., Rashida Callender, B.S., Carin Hagberg, M.D., Evan
Pivalizza, M.D., Anesthesiology, University of Texas Health Science Center
at Houston, Houston.
FA A2284
Prospective Perioperative of Preoperative Thrombelastography®
Platelet Mapping™
Thrombelastograph® Platelet Mapping™ detects platelet inhibition of
arachidonic acid (AA) and/or of ADP-induced aggregation. Our aim was
to detect preoperative platelet inhibition secondary to clopidogrel and/or
aspirin and observe the effect of surgery on platelet inhibition by comparing
preoperative to postoperative samples. Davide Cattano, M.D., Ph.D.,
Rashida Callender, B.S., Alfonso Altamirano, M.D., Carin Hagberg, M.D.,
Evan Pivalizza, M.D., Anesthesiology, University of Texas Health Science
Center at Houston, Houston, TX.
FA A2285
Rotational Thromboelastometry (ROTEM) Predicts Thromboembolic
Complications After Major Surgery
Thromboembolic complications contribute significantly to postoperative
morbidity and mortality but routine laboratory tests are poor predictors
of such complications. Rotational thromboelastometry (ROTEM) is a
modification of conventional thromboelastography that may detect not only
coagulopathy but also hypercoagulability. The present study shows that
preoperative ROTEM can detect patients at increased risk for postoperative
thromboembolic complications. Alexander M. Hincker, B.A., Justin Feit,
Robert N. Sladen, M.B., Ch.B., Gebhard Wagener, M.D., Anesthesiology,
Columbia University, New York, NY.
FA A2286
Evaluation of a Non-Invasive Hemoglobin Pulse CO-Oximeter in
Surgical Patients
Non-invasive determinations of blood hemoglobin as made with the Masimo
Rainbow SET Pronto-7 Pulse CO-Oximeter were compared with laboratory
measurements in anesthetized surgical patients. Analysis suggests that
the device has limitations with respect to detecting anemia and hence has
limited usefulness as a transfusion decision support tool. Eli D. Musselman,
M.S., Sundara Reddy, M.B., B.S., Michael M. Todd, M.D., Carver College
of Medicine, Department of Anesthesia, The University of Iowa, Iowa City,
IA.
FA A2287
Quantitative Review and Comparison of Noninvasive Hemoglobin
Accuracy and Trend Ability
A review of published data on Radical-7® Pulse CO-Oximeter’s accuracy
and trend ability measuring arterial blood hemoglobin noninvasively. We
concluded that combined use of laboratory tHb value and SpHb trends
may provide the needed accuracy and timeliness to optimize transfusion
decisions. Nicole Ribeiro Marques, M.D., George Kramer, Ph.D., Marc
Moisi, M.D., Irene Pedraza, M.A., Muzna Khan, B.S., Michael Kinsky,
M.D., Anesthesiology, University of Texas Medical Branch, Galveston, TX.
FA A2288
Reversal of Warfarin Anticoagulation With 3-Factor Prothrombin
Complex Concentrate or Plasma - AnIn Vitro Thromboelastometry
Study
The in vitro addition of 3-factor PCC or plasma similarly improved clotting
time in plasma samples from patients on warfarin although 20% volume
replacement (60 µL) was much higher than added PCC (<10 µL). Clot
stability and lysis profile were unaffected. Emily L. Sturgill, M.D., Kenichi
Tanaka, M.D., M.S., Steve Bader, M.D., University of Pittsburgh Medical
Center (UPMC), PA.
FA A2289
Point of Care Screening for Patients With Low Hemoglobin in the
Surgeons Office. Choosing the Device and Cut-Off Value
This retrospective study tested how a point of care (POC) device could be
used during an initial orthopedic consultation to screen patients for low
hemoglobin (Hb). Knowing the POC sensitivity specificity and positive
predictive value (PPV) compared to a reference device is important to
establish a threshold to defer anemic patients. In our study a POC Hb
threshold of >= 12.5 g/dl had a PPV of 89.4%. It increased to 91.5% using
13.1 g/dl Hb but would falsely defer 10% more patients. Klaus Torp, M.D.,
Stefanie M. Smith, Student, Marsha F. Bertholf, M.D., Mary I. O’Connor,
M.D., Abba C. Zubair, M.D., Ph.D., Anesthesiology, Clinical Research
Internship Study Program, The Blood Alliance, Orthopedics, Transfusion
Medicine, Mayo Clinic Florida, Jacksonville, FL.
SUNDAY, OCTOBER 13
FA A2283
PO10-4BEXPERIMENTAL NEUROSCIENCES: CEREBRAL BLOOD FLOW
AND NEUROPROTECTION
ROOM 104-AREA B
NA A2291
Inhalation of Nitric Oxide Improves the Deterioration of Tissue Oxygen
Partial Pressure and Blood Flow of Spinal Cord During Aortic CrossClamping
In the present study we aimed to evaluate the change in tissue oxygen
partial pressure (PsptO2) and blood flow of spinal cord (SCBF) following aortic
clamp and unclamp and to assess the effects of inhalation of nitric oxide in
preventing spinal cord ischemic injury in an experimental model. Inhalation of
nitric oxide improves the deterioration of PsptO2 and SCBF after aortic crossclamping for 20 minutes. Kazuhiro Kito, M.D., Motoyasu Takenaka, M.D.,
Ph.D., Kenji Iwata, M.D., Mami Iida, M.D., Ph.D., Hiroki Iida, M.D., Ph.D.,
Anesthesiology and Pain Medicine, Gifu University Graduate School of
Medicine, Japan.
NA A2292
Activation of Mast Cells Lead to the Rupture of Intracranial Aneurysms
We investigated the role of mast cells in the formation and rupture of
intracranial aneurysms in a mouse model. Activation of mast cells during
the formation of aneurysms did not significantly affect the incidence of
aneurysmal formation and rupture. Contrary activation of mast cells after
aneurysm formation significantly increased the rupture rate without affecting
the overall incidence of aneurysms. These findings suggest mast cells play
key roles in aneurysmal rupture. Pharmacological stabilization of mast cells
may be an effective treatment for the prevention of aneurysmal rupture.
Atsushi Kuwabara, M.D., Kousuke Wada, M.D., Fumiaki Shikata, M.D.,
Ph.D., Kenji Shimada, M.D., Ph.D., Makoto Ozaki, M.D., Ph.D., Tomoki
Hashimoto, M.D., Anesthesia and Perioperative Care, University of
California, San Francisco, San Francisco, CA, Anesthesia, Tokyo Women’s
Medical University, Tokyo, Japan.
NA A2293
Minocycline Improves the Postoperative Cognitive Impairment by
Inhibiting the Activation of Astrocyte in Aged Mice
Hippocampus astrocytic activation contributes to the long-time POCD
in aged mice. Minocycline alleviates the long-time POCD inhibits
hippocampal astrocytic activation after surgery and reduces postoperative
hippocampal inflammatory cytokines in aged mice. Yanning Qian, Ph.D.,
Wenjie Jin, Ph.D., Zhou Feng, M.D., Shunmei Lu, M.D., Department of
Anesthesiology, 1st Affiliated Hospital, Nanjing Medical University, China.
NA A2294
Dexmedetomidine Postconditioning Induces Neuroprotection Against
Brain Hypoxia-Ischemia in Neonatal Rats
Our results indicate that dexmedetomidine postconditioning dosedependently attenuates brain HI-induced injury in the developing brain.
Administration of dexmedetomidine may be an important adjunct to pr event
brain injury due to birth asphyxia in clinics. Xiaoyan Ren, M.D., Zhiyi Zuo,
M.D., Ph.D., Anesthesiology, University of Virginia, Charlottesville.
NA Neuroanesthesia
PN Pain Medicine
71
NA A2295
Dexmedetomidine Increases Neuronal Glutamate Transporter EAAT3
Expressed in Xenopus Oocyte: Evidence for the Involvement of Protein
Kinase C (PKC)
Dexmedetomidine increases the activity of EAAT3 expressed in Xenopus
oocyte and PKC likely contributes to this effect. This result may be related
with neuroprotective effect of dexmedetomidine. Hye-min Sohn, M.D.,
M.S., Sang-Hwan Do, M.D., Ph.D., Jin-Hee Kim, M.D., Ph.D., Jung-Won
Hwang, M.D., Ph.D., Junghee Ryu, M.D., Ph.D., Seoul National University
Bundang Hospital, Seongnam-si, Republic of Korea.
NA A2296
The Effects of Inhaled Nitric Oxide on Pial Microvessels in Rabbits
We evaluated the effects of inhaled nitric oxide(NO) in low dose (20
ppm) and high dose (80 ppm) on cerebral pial microvessels in rabbits in
vivo using cranial window technique. Inhaled high dose NO did not dilate
cerebral pial microvessles in normal situation. Masakazu Kotoda, M.D.,
Tadahiko Ishiyama, M.D., Ph.D., Kazuha Mitsui, M.D., Nobumasa Asano,
M.D., Takashi Matsukawa, M.D., Ph.D., Surgical Center, Department
of Anesthesiology, University of Yamanashi Hospital, University of
Yamanashi, Chuo, Japan, Department of Anesthesia, Yamanashi
Prefectural Central Hospital, Kohu, Japan.
NA A2297
Effect of Quinone Reductase 2 Inhibition on Surgical Myocardial
Ischemia-Reperfusion Injury in Rats
Chloroquine and a selective Quinone Reductase 2 inhibitor exert
cardioprotective effects following surgical ischemia-reperfusion.
Qing Ma, M.D., Talaignair N. Venkatraman, Ph.D., Zhiquan Zhang, Ph.D.,
Jesse Fitzpatrick, M.D., Christopher Lascola, M.D., Ph.D., Joseph P.
Mathew, M.D., Mihai V. Podgoreanu, M.D., Anesthesiology, Radiology and
Neurobiology, Duke University Medical Center, Durham, NC.
PO13-7BOUTCOMES AND DATABASE RESEARCH
ROOM 104-AREA E
FA A2298
The Impact of Right Ventricle Upon Early Cardiac Mortality of Patients
With Ischemic Mitral Regurgitation Undergoing Mitral Valve Surgery
This study has confirmed the importance of the right ventricular function
as predictor of mortality in patients affected by ischemic mitral valve
regurgitation undergoing cardiovascular procedure. Carlo Di Lorenzo, M.D.,
Assunta Fabozzo, M.D., Mohammed Amjad Khan, M.D., Paolo Pelaia,
M.D., Paolo Cerchiara, M.D., Antonio Maria Calafiore, M.D., Anesthesia,
Dr. Sulaiman Al Habib Al Takhassusi Hospital, Riyhad, Saudi Arabia,
Cardiac Surgery, University of Padova, Italy, AOU Riuniti, Ancona, Italy,
Cardiac Surgery, Prince Sultan Cardiac Center, Riyhad, Saudi Arabia.
FA A2299
The Role of Transoesophageal Echocardiography in High Risk Patients
Undergoing Cardiovascular Surgery
The aim of this study was to analyze how the use of transoesophageal
echocardiography in operating room is associated to a better postoperative
outcome in terms of reduction of complications and short term survival.
Carlo Di Lorenzo, M.D., Assunta Fabozzo, M.D., Mohammed Amjad Khan,
M.D., Paolo Pelaia, M.D., Paolo Cerchiara, M.D., Antonio Maria Calafiore,
M.D., Anesthesia, Dr. Sulaiman Al Habib Al Takhassusi Hospital, Riyhad,
Saudi Arabia, Cardiac Surgery, University of Padova, Italy, AOU Riuniti,
Ancona, Italy, Cardiac Surgery, Prince Sultan Cardiac Center, Riyhad,
Saudi Arabia.
72
FA A2300
Aprepitant In Combination With Ondansetron Reduces Postoperative
Vomiting In Bariatric Surgery Patients
Morbidly obese patients are often at an increased risk for developing post
operative nausea and vomiting in bariatric procedures. We attempted to
identify the efficacy of oral aprepitant in combination with ondansetron in
reducing the rate of PONV when compared to ondansetron alone. We found
that the combination therapy significantly reduced the occurrence of vomiting
but did not have a significant impact on the rate of nausea when compared
to ondansetron alone. Gregory K. Kim, M.D., Mansoor M. Aman, M.D.,
Dipty Mangla, M.D., Navneet Grewal, M.D., E. Andrew Ochroch, M.D.,
Ashish C. Sinha, M.D., Department of Anesthesiology, Drexel University
College of Medicine, Department of Anesthesiology, University of
Pennsylvania, Philadelphia, PA.
FA A2301
Type of Non-Cardiac Surgery and Ethnicity Effect Incidence and
Severity of Post-Operative Myocardial Infarction
We examined retrospectively through the Stanford STRIDE database the
surgery type and timing of post-operative myocardial infarction and further
if ethnic differences exist for post-operative MI. We found our incidence of
post-operative MI at 0.06% with 75% of the post-operative MI patients
occurring after orthopedic surgery. Although having a very small data set
to study post-operative peak troponin was higher for Asian patients when
compared to Caucasian patients. Further data analysis and studies are
needed to examine these initial findings. Andre J. Pinesettm, B.S., Bassam
Kadry, M.D., Daria Mochly-Rosen, Ph.D., Eric R. Gross, M.D., Ph.D.,
Anesthesiology, Stanford University, CA.
FA A2302
Pituitary Tumor Excision and Associated Perioperative Cardiovascular
Complications: A Study of the Nationwide Inpatient Sample
This is a retrospective study utilizing the HCUP NIS from 2008-2010.
Hospitalizations for pituitary tumor resections were identified by crossmatching International Classification of Diseases-9 codes for diagnoses
of pituitary tumor and perioperative complications of interest for pituitary
tumor resection. Analysis identified a total of 73 596 diagnoses of pituitary
tumor and 6 019 of pituitary resections. Of the 319 resections with one
or more complications cardiac arrest/cardiorespiratory failure during or
resulting from a procedure iatrogenic pulmonary embolism and infarction
venous air embolism or thrombosis of other specified veins and other
pulmonary embolism were the most frequent complications. Raymond
Malapero, M.P.H., Sergey Pisklakov, M.D., Shawn Puri, M.D., Chaiyapat
Charoonbara, M.D., Alex Bekker, M.D., Ph.D., Anesthesiology, New
Jersey School of Medicine, Department of Anesthesiology, Newark,
Anesthesiology, UMDNJ - New Jersey Medical School, Newark, NJ.
FA A2303
Intraoperative Use of Esmolol for Maintaining Hemodynamic Stability
During Lumbar Laminectomy Surgery in Opioid-Dependent Patients:
Effects on Perioperative Outcomes
This prospective, randomized, double-blinded and placebo-controlled
study was designed to evaluate the adjunctive effects esmolol on the
anesthetic and analgesic requirements hemodynamic stability during
surgery postoperative pain opioid requirements and postoperative recovery
outcomes in this chronic pain patient population. Roya Yumul, M.D.,
Ph.D., Ofelia L. Elvir Lazo, M.D., Robert T. Naruse, M.D., Alen Ternian,
M.D., Taizoon Yusufali, M.D., Hailu Ebba, M.D., Bradley Reid, M.D., Alan
Stern, B.A., Antonio Hernandez-Conte, M.D., Paul F. White, M.D., Ph.D.,
Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
NA Neuroanesthesia
PN Pain Medicine
Liver and Kidney Transplantation for Glycogen Storage Disease Type
1A - Perioperative Management and Follow-Up
Glycogen storage disease type 1A is a rare metabolic disorder characterized
by a deficient activity of glucose-6-phosphatase. This genetic defects leads to
hypoglycemic episodes and elevated lactate. Most patients achieve metabolic
control with dietetic measures. When it fails and/or hepatic adenomas
undergo malignant liver transplantation is the treatment of choice. There are
few reports on perioperative management in these patients. We describe 3
cases of GSD1A female adult patients requiring transplantation focusing on
management of perioperative metabolic disturbances. Blandina M. Gomes,
M.D., Filipa R. Lagarto, M.D., Paula S. Couto, M.D., Teresa Branco,
M.D., Isabel Aragao, M.D., Anesthesiology and Intensive Care, Centro
Hospitalar do Porto, Portugal.
ROOM 104-AREA C
PI A2305
Cost-Effectiveness Analysis of Stocking Dantrolene in Ambulatory
Surgery Centers
An analysis was performed to assess the cost-effectiveness of stocking
dantrolene in ambulatory surgery centers for the treatment of malignant
hyperthermia due to anesthesia. Comparing dantrolene administration to
a supportive-care only strategy the incremental cost effectiveness ratio
was $196 320 (in 2010 dollars) per life saved. Sensitivity analysis showed
that the results were robust for the plausible range of all variables and
assumptions tested. Taiwo Aderibigbe, B.S., Barbara H. Lang, B.S., Henry
Rosenberg, M.D., Guohua Li, M.D., Ph.D., Columbia University, New York,
NY, Saint Barnabas Medical Center, Livingston, NJ.
PI A2306
Are You Within the Legal Limit? The Anesthesia Consent Process
This study looked at differences in practices between resident and attending
anesthesiologists in the informed consent discussion prior to anesthesia. We
found that residents and attendings only differed significantly with respect
to total duration of the discussion (with attendings spending less time)
though relatively few anesthesiologists overall discussed with patients the
major risks of anesthesia and offered alternatives to the anesthetic plan.
Sharon F. Chang, M.D., Rebecca Speck, Ph.D., Michael PasCarella, D.O.,
Maureen McCunn, M.D., Department of Anesthesiology and Critical Care,
University of Pennsylvania, Philadelphia.
PI A2307
Another Anesthesia Workspace Infection Source to Stymie: The Hand
Sanitizer - A Pilot Study
At the anesthesia work station there are high-touch surfaces that become
potential pathogen vectors. We evaluated bacterial burden on hand sanitizer
dispenser surfaces and measured effectiveness of disposable wipes for
reduction. Devon C. Cole, M.D., Sadiq Shaik, M.D., Nik Gravenstein, M.D.,
Anesthesiology, University of Florida, Gainesville.
PI A2309
Personal Hand Gel for Improved Hand Hygiene Compliance on the
Block Team
This abstract describes a retrospective review of a quality improvement
database evaluating the affect of personal hand gel dispensers on hand
hygiene compliance in our institution. On the block team, compliance
improved significantly when providers were supplied with individual gel
dispensing devices. Colby L. Parks, M.D., Richard E. Galgon, M.D., M.S.,
Christopher A. Guite, M.D., Anesthesiology, University of Wisconsin,
School of Medicine and Public Health, Madison.
PI A2310
SUNDAY, OCTOBER 13
FA A2304
Optimizing Equipment In-Service Frequency for the Belmont Rapid
Infuser
The Belmont Rapid InfuserR was listed on a departmental survey as a device
with which more than 20% of the staff required periodic in-service. Pre and
post in-service surveys were conducted and the results placed on pie charts.
Future in-service will be conducted every 6 months per survey results.
Jon D. Samuels, M.D., Vinod Malhotra, M.D., Anesthesiology, New York
Presbyterian Hospital, NY, Anesthesiology, Weill Cornell Medical College,
New York, NY.
PI A2311
Medication Discrepancies by Anesthesiology Residents: A Program
Director and Resident Survey
Despite existing protocols in place to deter medication diversion the
potential for abuse among anesthesiologists remains alarmingly high. An
anonymous and voluntary survey was distributed to 50 anesthesiology
programs throughout the eastern United States. The results of this survey
show considerable homogeneity in program-director and resident views
regarding substance abuse and the continued presence of repeated
medication discrepancies amongst anesthesiology residents. In addition
most program directors and residents consider repeated medication
discrepancies by anesthesiology residents a measure of professionalism.
Kalpana Tyagaraj, M.D., Natalie Younger, M.D., Jason Yu, M.D.,
Anesthesiology, Maimonides Medical Center, Brooklyn, NY.
PI A2312
Leadership Emphasis Improves PONV Guideline Adherence But
Anesthesiologists Changed From a Risk Adjusted to a Fixed Guideline
Compliance for PONV Prophylaxis
Leadership emphasis resulted in improved PONV prophylaxis guideline
adherence. However anesthesiologists changed from a risk adjusted to a
fixed guideline compliance for PONV prophylaxis. Antoinette Van Meter,
M.D., Joe Ensor, Ph.D., Jeffrey Lim, M.D., Thomas Rahlfs, M.D., Joseph
Ruiz, M.D., Anesthesiology and Perioperative Medicine, Biostatistics,
University of Texas M.D. Anderson Cancer Center, Houston.
PI A2308
Does Physical Stress Affect Anesthesia Provider Performance?
Anesthesia providers are often required to run to the site of an emergency
where they need to rapidly assess the situation and to act immediately
and appropriately while still under physical stress from running to the
site. Therefore we tested the hypothesis that physical stress alters the
performance of providers in an emergency. Our results indicate that physical
stress affects in particular the ability of providers to memorize facts. Jan
Hirsch, M.D., Vivian K. Lee, M.D., Abigail Fitzgerald, R.N., John C. Uy,
R.N., Lily V. Ver, R.N., James A. Frank, M.D., Richard L. Fidler, C.R.N.A.,
Anesthesia and Perioperative Care, University of California, Anesthesia
Service, San Francisco VAMC, Simulation Center, Veterans Affairs
Medical Center, San Francisco, CA.
NA Neuroanesthesia
PN Pain Medicine
73
FA A3005
ORAL PRESENTATIONS
OR13-1 OUTCOMES AND DATABASE RESEARCH: ORAL INNOVATIVE
APPROACHES TO DATABASE AND OUTCOMES RESEARCH
MONDAY, OCTOBER 14 | 1:00-2:30 P.M.
ROOM 125
FA A3000
Pretransplant Chronic Narcotic Use Predicts Death and Graft Loss
After Kidney Transplantation
Chronic narcotic use is common among patients with end-stage renal failure
and may be associated with adverse clinical outcomes. This study reveals
pre-transplant narcotic use is a significant correlate of post-transplant death
and graft loss. The implications of this are significant ranging from a need
to optimize chronic pain management in patients with end-stage renal
disease to selecting and risk-stratifying potential kidney transplant recipients.
Christopher L. Beuer, M.D., Hui Yuan, M.D., Mark Schnitzler, Ph.D.,
Huiling Xiao, M.S., Janet Tuttle-Newhall, M.D., Krista Lentine, M.D., Saint
Louis University Hospital, St. Louis, MO.
FA A3001
A Comparison of Epidural Analgesia and Traditional Pain Management
Effects on Outcomes After Gastric Cancer Resection: A PopulationBased Study
In a population-based cohort study of 2745 patients undergoing gastrectomy
for carcinoma no difference in cancer recurrence or survival was found
between patients who had epidural analgesia and those who did not.
Kenneth C. Cummings, M.D., M.S., Meatal Patel, M.P.H., Phyo Than Htoo,
M.D., M.P.H., Paul Bakaki, M.D., Linda C. Cummings, M.D., M.S., Siran
Koroukian, Ph.D., Anesthesiology Institute, Cleveland Clinic, Case
Western Reserve University, Division of Gastroenterology and Liver
Disease, University Hospitals Case Medical Center, Cleveland, OH.
FA A3002
Massive Hemorrhage: A Report from the Closed Claims Project
Review of the ASA Closed Claims database revealed 76 cases from the past
decade in which hemorrhage contributed to high severity adverse outcomes.
The majority of these cases revealed preventable errors in identifying
hemorrhage and applying timely treatment. Lorri A. Lee, M.D., Richard P.
Dutton M.D. M.B.A., Karen L. Posner, Ph.D., Linda S. Stephens, Ph.D.,
Karen B. Domino, M.D. M.P.H., Anesthesiology and Pain Medicine,
University of Washington, Seattle, WA, Anesthesiology, Quality Institute
AQI, Park Ridge, IL.
FA A3003
Association of Positive Airway Pressure Device Treated Obstructive
Sleep Apnea and 30 Postoperative Mortality and Healthcare Resource
Use: A Population Based Study
A population-based cohort study of the positive airway pressure-treated
obstructive sleep apnea association with 30-day mortality and healthcare
resource use following non-cardiac surgery. We found no association with
mortality length of stay or readmission. ICU admissions were more common
among those with OSA. Daniel I. McIsaac M.D. M.P.H., Andrea Gershon
M.D., M.S., Gregory L. Bryson M.D., M.S., Duminda N. Wijeysundera
M.D., Ph.D., Neal Badner M.D., Carl van Walraven M.D., M.S.,
Anesthesiology, University of Ottawa, The Ottawa Hospital Institute for
Clinical Evaluative Sciences , Internal Medicine, Ottawa ON Canada,
Institute for Clinical Evaluative Sciences, Anesthesiology, Toronto ON,
Canada, Anesthesiology, University of British Columbia, Kelowna BC,
Canada.
FA A3004
Preoperative Predictors of Intraoperative Double Low and Triple Low
Advanced age, lower BMI and renal failure were independent preoperative
predictors of intraoperative triple low (low minimal alveolar concentration
requirement low mean arterial pressure and low bispectral index) in
this database review of 18 256 patients undergoing non-emergent noncardiac surgery under general anesthesia. Ron Benton Pitkanen M.D.,
Robert M. Craft M.D., Roger C. Carroll Ph.D., Justin M. Barnes M.S.,
Anesthesiology, University of Tennessee, Knoxville, TN.
74
Long-Term Mortality Results From 2 Prospective Randomized Trials
Comparing 30% to 80% Perioperative Inspired Oxygen
The effect of supplemental perioperative oxygen (30% vs. 80%) on surgical
wound infection remains controversial with randomized trials showing
conflicting results. Recently a follow-up analysis from the largest study
reported increased long-term mortality amongst patients assigned to the
80% supplemental oxygen group especially those having cancer surgery.
In our follow-up of 833 patients from 2 randomized trials and 3 centers
we found no such relationship suggesting that these patients are unlikely
to suffer increased mortality. Attila Podolyak, M.D., Christian Reiterer
Student, Edith Fleischmann, M.D., Ozan Akca, M.D., Edward Mascha
Ph.D., Daniel I. Sessler, M.D., Andrea Kurz M.D., Outcomes Research,
Cleveland Clinic, Cleveland, OH, University of Vienna, Vienna, Austria,
University of Louisville, Louisville, KY.
OR16-1 REGIONAL ANESTHESIA AND ACUTE PAIN: ULTRASOUND AND
REGIONAL ANESTHESIA
ROOM 123
RA A3006
Ultrasound Guidance Combined With Nerve Stimulation for Nerve
Blocks: Does the Minimal Stimulation Threshold Depend From
Anatomical Characteristics at the Puncture Site?
The minimum stimulation threshold (MST) doesn’t allow to predict ideally
the position of the needle tip in relation to the nerve. The main objective
of this study was to obtain MST values according to the US guided location
of the needle tip (extraneural paraneural intraneural) for superficial
nerve blocks. With one thousand patients included it is not possible to
determine a minimal threshold allowing to predict ideal positioning of the
needle tip before the injection. However our results claims for a MST value
excluding an intra-epineural injection at 0.1mA. As it was the MST value
determination seems useful. Bertrand Abbal M.D., Olivier Choquet, M.D.,
Sophie Bringuier, Pharm.D, Philippe Biboulet, M.D., Nathalie Bernard,
M.D., Denis Jochum, M.D., Xavier Capdevila, M.D., Ph.D., Anesthesiology
and Critical Care Medicine, Lapeyronie University Hospital, Montpellier,
France, Albert Schweitzer Hospital, Colmar, France.
RA A3007
Treatment of Post-Mastectomy Pain With Ambulatory Continuous
Paravertebral Nerve Blocks: A Randomized Triple-Masked PlaceboControlled Study
This randomized triple-masked placebo-controlled trial provides evidence
that following mastectomy adding a multiple-day ambulatory continuous
ropivacaine infusion to a single-injection ropivacaine paravertebral nerve
block results in improved analgesia with less functional deficit during the
infusion. In contrast following the end of the infusion there were no benefits
detected from the additional continuous paravertebral block. Brian M. Ilfeld,
M.D., Sarah J. Madison, M.D., Preetham J. Suresh, M.D., NavParkash S.
Sandhu M.D., Nicholas J. Kormylo, M.D., Nisha Malhotra, M.D., Vanessa
J. Loland, M.D., Mark S. Wallace, M.D., Cindy H. Wen, B.S., Anne M.
Wallace, M.D., Anesthesiology, Surgery, University of California - San
Diego, San Diego, CA
RA A3008
Comparison Among Three Femoral Nerve Catheter Insertion
Techniques During Ultrasound Guided Femoral Nerve Block
The use of stimulating needle with non-stimulating catheter during Femoral
Nerve Block was noninferior (i.e. no worse) to both stimulating needle/
stimulating catheter and ultrasound alone in regards to pain management.
Therefore the use of ultrasound alone will be sufficient for successful
femoral nerve block. Michael Nasr Boles Kot M.D., Raktim Ghosh, M.D.,
Jarrod Dalton, Ph.D., Edward Mascha Ph.D., Loran Mounir-Soliman
M.D., Wael Ali Sakr Esa, M.D., Ph.D., Sherif Zaky, M.D., Ph.D., Andrea
Kurz M.D., Daniel Sessler, M.D., Ehab Farag, M.D. F.R.C.A., Outcomes
Research Anesthesia Department, Quantitative Health Sciences, General
Anesthesiology, Cleveland Clinic, Cleveland, OH.
NA Neuroanesthesia
PN Pain Medicine
A Randomized Comparison of Long-Axis and Short-Axis Imaging for InPlane Ultrasound-Guided Popliteal-Sciatic Catheter Insertion
Preoperatively subjects receiving an ultrasound-guided non-stimulating
popliteal-sciatic perineural catheter for elective foot and ankle surgery
were randomly assigned to either the long-axis in-plane or short-axis inplane technique. The short-axis group (n=17) took a median (10th-90th
percentile) of 18.0 (8.4-30.0) minutes compared to 18.0 (11.4-27.6)
minutes for long-axis (n=17 p=0.208) to achieve complete sensory
anesthesia. Short-axis procedures took 6.5 (4.0-12.0) minutes to perform
compared to 9.5 (7.0-12.7) for long-axis (p<0.001) with no other
differences in secondary outcomes. Edward Mariano M.D., Steven K.
Howard M.D., Natasha Funck M.D., T. Kyle Harrison M.D., Tessa Walters
M.D., Michael Wagner M.D., Toni Ganaway B.A.T. Edward Kim M.D.,
Anesthesiology and Perioperative Care, VA Palo Alto Health Care System,
Stanford University School of Medicine, Palo Alto, CA.
RA A3010
A Randomized Comparison of Ultrasound Guided Interscalene Versus
Combined Suprascapular and Axillary Nerve Blocks for Postoperative
Pain Relief in Arthroscopic Shoulder Rotator Cuff Repair
Our study provides the comparison of analgesic efficacy of US guided
combined suprascapular and axillary nerve blocks to interscalene nerve block
for arthroscopic shoulder surgery. The results of the study provides evidence
to clinicians in choosing suitable regional analgesic technique for ambulatory
shoulder surgery. Rakesh V. Sondekoppam, M.D., Shalini Dhir, M.D.,
Ranjitha Sharma, FANZCA, Sugantha Ganapathy, M.D., Department of
Anesthesia and Perioperative Medicine, Western University, London, ON,
Canada.
RA A3011
Cutaneous Sensory Block Area After Ultrasound Guided Transversus
Abdominis Plane Block in Volunteers
In this randomized placebo-controlled blinded study we mapped and
determined inter- and intra-individual variability in the cutaneous sensory
block area (CSBA) after a repeated ultrasound-guided Transversus Abdominis
Plane (TAP) block in 16 healthy volunteers. CSBA was predominantly located
postero- infero-laterally in the flank and over the hip while medial distribution
was minor. Block area was subjected to a large inter- and intra-individual
variability. The location of the CSBA differs from previous clinical studies.
Kion B. Stoeving, M.D., Christian Rothe, M.D., Charlotte V. Rosenstock
M.D., Ph.D., Eske K. Aasvang, M.D., Ph.D., Lars H. Lundstroem M.D.,
Ph.D., Kai H. W. Lange, M.D., Ph.D., Department of Anesthesiology,
Nordsjaellands Hospital, Hilleroed, Denmark.
OR01-1 GERIATRIC ANESTHESIA - POSTOPERATIVE DELIRIUM AND
COGNITIVE DECLINE
ROOM 123
AM A3012
Impaired Olfaction and Risk for Delirium and Cognitive Decline After
Cardiac Surgery
Impaired olfaction is common in patients before and after cardiac surgery.
Impaired olfaction is association with postoperative delirium but not
postoperative cognitive score in adjusted models. Charles H. Brown, M.D.,
Candice Morrissey, M.D., M.P.H., Masahiro Ono, M.D., Ph.D., Gayane
Yenokyan, Ph.D., Charles Hogue, M.D., Department of Anesthesiology
and Critical Care Medicine, Division of Cardiac Surgery, Department of
Surgery, Johns Hopkins University, School of Medicine, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD.
AM A3013
Predicting Delirium; the Role of the Stress Response and Anesthetic
Technique
Postoperative delirium (PD) is a pervasive complication occurring in 20% of
elderly patients and 50% of high risk patients (ICU hip fracture). Previous
studies have shown that total intravenous anesthesia (TIVA) has been shown
to decrease the cortisol (C) epinephrine (E) and norepinephrine (N) response
to surgical stimulation. We hypothesized that elderly patients undergoing
TIVA 1) would have a lesser stress response and2) the stress response would
be associated with delirium. In specific we examined whether TIVA was a
predictor of PD in a model which controls for patient comorbidity and surgical
procedure variables. Stacie G. Deiner M.D., Hung-Mo Lin Ph.D., Mary
Sano Ph.D., Jeffrey H. Silverstein M.D., Anesthesiology Department and
Psychiatry Department, The Mount Sinai Icahn School of Medicine New
York, NY.
AM A3014
Effect of Intraoperative Blood Pressure on Postoperative Delirium
During hip fracture repair surgery under spinal anesthesia elderly patients
with at least one 5 minute epoch of intraoperative hypotension were at
greater odds of having postoperative delirium compared to patients without
any hypotension epoch. Ai Hirao M.D., Allan Gottschalk M.D., Ph.D.,
Frederick Sieber M.D., Nae Yuh Wang Ph.D., Anesthesiology, Johns
Hopkins Bayview Medical Center, General Internal Medicine, Johns
Hopkins Medical institution, Baltimore, MD.
AM A3015
Intraoperative Blood Pressure Variance Not Hypotension Impacts
Early Postoperative Delirium
There is conflicting data if intraoperative low blood pressure contributes to
delirium early after surgery. Our results add to the body of evidence against
such an association. However the data of this study in 594 patients after
non-cardiac surgery indicate that intraoperative blood pressure variance
may contribute to the pathogenesis of postoperative delirium. Jan Hirsch,
M.D., Glen DePalma, M.S., Tiffany L. Tsai, B.A., Laura P. Sands, Ph.D.,
Jacqueline M. Leung, M.D., Anesthesia and Perioperative Care, University
of California, San Francisco, CA, School of Nursing Department of
Statistics, Purdue University, West Lafayette, IN.
AM A3016
Incidence and Risk Factors of Postoperative Cognitive Dysfunction in
Older Adults after Major Non-Cardiac Surgery
Sixty-nine patients ≥65 years undergoing orthopedic or neurosurgery
and 54 nonsurgical controls were screened using the Mini-Mental State
Examinationand cognitive function determined. On the dayof surgery
C-reactive protein and apolipoprotein E4 (ApoeE4) were measured. Three
months later testing was repeated. Analysis showed significant association
between POCD as the primary outcome and the presence of ApoE4genotype;
POCD was strongly associated with the number of intraoperative hypothermic
events. Anticholinergic and/or sedative-hypnotic drug use was significantly
associated with POCD. After adjusting for learning effects 16% of patients
hadPOCD three months after surgery. Laura A. Lahaye, M.D., Osama
Shoair, Ph.D., Mario Grasso, C.R.N.A., Patricia Slattum Ph.D., Chuck
Biddle C.R.N.A., Ronsard Daniel, M.D., Jeffrey Green, M.D., Virginia
Commonwealth University, Richmond, VA.
AM A3017
Postoperative Subsyndromal Delirium Predicts Development of Full
Delirium and Increases Length of Hospital Stay
Subsyndromal delirium has been described as a predelirious state vs. distinct
clinical syndrome. The purpose of this study was to characterize features of
postoperative subsyndromaldelirium and evaluate outcomes such as length
of hospital stay and functional and cognitive performance after hospital
discharge. Results indicated that the number of features of subsyndromal
delirium predicted development to delirium and were significantly associated
with longer length of hospital stay. Subsyndromal delirium did not correlate
with performance on functional and cognitive assessments post discharge.
J. Jewel Shim M.D., Glen Depalma M.A., Laura Sands Ph.D.,
Jacqueline Leung M.D., Psychiatry, Anesthesiology and Perioperative
Care, University of California San Francisco, San Francisco, CA, Purdue
University, West Lafayette, IN.
PN Pain Medicine
MONDAY, OCTOBER 14
RA A3009
NA Neuroanesthesia
75
CC A3022
POSTER DISCUSSIONS
PD06-2 CRITICAL CARE: OUTCOMES
ROOM 123
CC A3018
One-Lung Ventilation and Risk Factors for Acute Lung Injury After
Thoracic Surgery: A Prospective Study
In 1123 patients undergoing lung resection those who had an anatomic lung
resection developed acute lung injury (ALI) more often than those who had a
non-anatomic wedge resection. Among patients who had an anatomic lung
resection male gender lower preoperative diffusion capacity lower static
compliance during one-lung ventilation and increased intraoperative fluid
administration were associated with ALI. Peak or plateau airway pressures
and tidal volume during one-lung ventilation did not differ between patients
who did or did not develop ALI. David Amar, M.D., Hao Zhang, M.D.,
Alessia Pedoto, M.D., Dawn P. Desiderio, M.D., Weiji Shi, M.S., Howard T.
Thaler, Ph.D., Anesthesiology and CCM, Epidemiology and Biostatistics,
Memorial Sloan-Kettering Cancer Center, New York, NY.
CC A3019
Early Severity Assessment and Mortality Prediction: A Nomogram to
Guide Accelerated Care in the Elderly
We are presenting a nomogram that has been validated to predict mortality
in the elderly neurologically compromised patients admitted in the ICU.
Alexander F. Bautista M.D., Rainer C. Lenhardt M.D., Changhong
Yu Ph.D., Edward Mascha, Ph.D., Ozan Akca, M.D., Department of
Anesthesiology and Perioperative Medicine, University of Louisville,
Louisville, KY, Department of Quantitative Health Sciences, Cleveland
Clinic, Cleveland, OH.
CC A3020
Association of Plasma Gamma-Aminobutyric Acid Concentrations With
Postoperative Delirium in Critically Ill Patients
In this single center prospective study we included 40 postoperative patients
required intensive care for more than 48 hours. Postoperative delirium
occurred in 13 (33%) of the patients. Although there was no difference in
plasma gamma-aminobutyric acid (GABA) concentration before the operation
between patients with and without delirium Plasma GABA concentration
on POD2 was significantly lower in patients with delirium than in those
without delirium. Even after adjustment of multiple variables plasma GABA
concentration on POD2 was independently associated with postoperative
delirium. Moritoki Egi M.D., Shiho Yoshitaka M.D., Hiroshi Morimatsu
M.D., Tomoyuki Kanazawa M.D., Yuichiro Toda M.D., Kiyoshi Morita
M.D., Okayama University Hospital, Okayama City, Japan.
CC A3021
Rescue Therapies for Refractory Hypoxemia: Preliminary Results for an
Exploratory Analysis of Patient Outcomes
Rescue therapies for the treatment of refractory hypoxemia in severe acute
respiratory distress syndrome (ARDS) are among the most costly and
resource intensive interventions used in the ICU. Furthermore aside from
the personal and institutional economic burden these therapies can add to
patient discomfort and cause harm. Our preliminary results do not suggest
that the use of rescue therapies is associated with a mortality benefit. Nita
Khandelwal M.D., Catherine Hough M.D., M.S. David Veenstra Ph.D.,
Miriam Treggiari M.D., Ph.D., University of Washington, Seattle, WA.
Comparative Evaluation of the Efficacy of Laryngeal Tube Combitube
and Endotracheal Tube for Emergency Airway Management and Their
Effect on No Flow Time’ in a Simulated Cardiac Arrest Scenario
The Laryngeal tube is superior to the Combitube which in turn is better than
the Endotracheal tube in terms of ease of insertion success rate of insertion
as well as time of insertion in a manikin in a simulted cardiac arrest situation.
The hands off time or no flow time is considerably reduced when chest
compressions are not interrupted. Therefore whenever possible emergency
airway management in a cardiac arrest situation should be attempted with
simultaneous chest compressions to minimize the no flow time and hence
increase the chances of successful resuscitation. Manasi Mittal Sr. M.D.,
Munisha Agarwal M.D., Rakesh Kumar M.D., Anesthesiology and
Intensive Care Maulana Azad Medical College and Lok Nayak Hospital
New Delhi, India.
CC A3023
Individualized Early Goal-directed Fluid Therapy is Superior to
Standardized Maximization of Stroke Volume
In our study we compared two different treatmentalgorithms for early goaldirected therapy in SAP. Compared to consequent maximization of SVI (stroke
volume index) we could show that a regimen oriented on individualized
goals for SVI was associated with less tissue edema and endorgan damage.
Annika Poppe M.D., Karin H. Wodack M.D., Lena Tomkoetter M.D.,
Constantin J. C. Trepte M.D., Kai A. Bachmann M.D., Ph.D., Kai
Heckel M.D., Cilly M. Strobel Student, Daniel A. Reuter M.D., Ph.D.,
Anaesthesiology, General, Visceral and Thoracic Surgery , University
Medical Center Hamburg- Eppendorf, Hamburg, Germany.
CC A3024
Volatile Anesthetics Improve Survival in 24-Hour Model of
Experimental Sepsis
In a long-term sepsis model we show for the first time that the 3 most
commonly used volatile anesthetics (sevoflurane desflurane and isoflurane)
produce favorable effects with respect to survival when compared to the
anesthetic drug propofol. Martin Schlapfer M.D., M.S., Randal O. Dull
M.D., Ph.D., David E. Schwartz M.D., Richard D. Minshall Ph.D.,
Beatrice Beck Schimmer M.D., Anesthesiology and Pharmacology
University of Illinois at Chicago Chicago, IL, Anesthesiology, Physiology
University Hospital Zurich, Zurich, Switzerland.
CC A3025
Efficacy of Midodrine in Liberating Low-Level Hypotensive Surgical ICU
Pfrom I.V. Vasopressors
A prospective observational study to examine if midodrine administration
to patients on low doses of I.V. vasopressors who otherwise meet ICU
discharge criteria will increase the rate of decline of I.V. vasopressors. The
results showed that midodrine use was associated with a four-fold increase
in phenylephrine equivalent decline. Anne B. Stanislaus, M.S., Matthew J.
Meyer, M.D., Alexander Levine, Pharm.D, Cheryl Ryan, R.N., Stephanie
A. Ball, R.N., Sheri M. Berg, M.D., Rebecca Kalman, M.D., Matthias
Eikermann, M.D., Ph.D., Anesthesia, Critical Care and Pain Medicine,
Pharmacy, Patient Care Units, Clinical Nursing Services, Massachusetts
PD10-2 EXPERIMENTAL NEUROSCIENCES: MECHANISMS
ROOM 125
NA A3026
Persistent Postoperative Cognitive Decline is Associated With
Dysregulation Macrophage Activation in the White Adipose Tissue in a
Rat Model of Metabolic Syndrome
Postoperative LCR (Metabolic syndrome) rats exhibited less anti-inflammatory
(M2) and more pro-inflammatory (M1) macrophages in white adipose tissue
vs HCR (control) rats as long as 5 month after surgery. The above-mentioned
findings may contribute to the impairment in the resolution of systemic and
neuroinflammation as well as cognitive decline during metabolic syndrome.
Xiaomei Feng M.D., Ph.D., Yinggang Zhu M.D., Suneil K. Koliwad M.D.,
Lauren G. Koch Ph.D., Steven L. Britton Ph.D., Mervyn Maze M.B.
Ch.B., Anesthesia and Perioperative Care, Diabetes Center University
of California San Francisco, San Francisco, CA, Department of
Anesthesiology, University of Michigan Medical School, Ann Arbor, MI.
76
PN Pain Medicine
NA Neuroanesthesia
Isoflurane Induces Dendritic Spine Loss in Rat Hippocampal Neurons
Dendritic spines form the postsynaptic site of excitatory synapses and
are crucial for memory and learning. We tested the effect of isoflurane
on dendritic spines in rat hippocampal neurons using confocal imaging
techniques. Isoflurane significantly reduced spine number and F-actin
amount. Karl Herold M.D., Ph.D., Jimcy Platholi Ph.D., Shelley Halpain
Ph.D., Hugh C. Hemmings Jr. M.D., Ph.D., Anesthesiology, Weill
Cornell Medical College, New York, NY, Division of Biology Section of
Neurobiology, University of California San Diego, San Diego, CA.
NA A3028
Immobilization-Induced Atrophy Induces Increased Peri-Junctional
Expression of Acetylcholine Receptors in Muscle - Morphological
Approach
In immobilized atrophy muscle the area of acetylcholine receptors which
can bind with alpha-bungarotoxin increase in the neuromuscular junction.
Yasuyoshi Inagaki, M.D., Tomoki Sasakawa, M.D., Hajime Iwasaki,
M.D., Sangseok Lee, M.D., Mohammed Kahn, Ph.D., Hiroshi Iwasak,
M.D., Ph.D., Jeevendra Martyn, M.D., Ph.D., Anesthesiology and Critical
Care Medicine, Asahikawa Medical University, Asahikawa, Japan,
Massachusetts General Hospital, Shriners Hospitals for Children Boston
and Harvard Medical School, Boston, MA.
NA A3029
Autistic Mice Have Altered Nociception
There is evidence suggesting that autistic children have alteration in sensory
processing based on parent reporting and observations of self-injurious
behavior. Here we show that in two strains of autistic mice nociception
is altered and pain sensitivity is different than control animals. Zena N.
Quezado M.D., Li Wang M.D., Ph.D., Luis Almeida M.D., Ph.D.,
Nicholas Kenyon B.S., Brandon S. Martin Ph.D., Joshua Corbin Ph.D.,
Julia Finkel M.D., The Sheikh Zayed Institute for Pediatric Surgical
Innovation, Children’s National Medical Center, Washington, DC.
NA A3030
Propofol 2 μg/mL Affects Higher Mental Function Networks in the Brain
Propofol 0.5 MAC equivalent primarily affects higher mental function
networks in the brain (fMRI study). In addition regions connected to
higher mental function network and visual/auditory network are affected.
Ramachandran Ramani M.B. B.S., Maolin Qiu Ph.D., Saeeda Qadri
M.D., Francisco Gomez Ph.D., Steven Laureys M.D., Ph.D., Robert Todd
Constable Ph.D., Anesthesia, Magnetic Resonance Research Center
Yale University School of Medicine, New Haven, CT, Coma Science Center
University of Liege, Liege, Belgium.
NA A3031
Midazolam and High Fat Diet Exposure in Middle-Aged Rodents Lead
to Significant Neuronal Tissue Alterations in MR Diffusional Kurtosis
Imaging and to Poor Performance in Spatial Working and Reference
Memory Testing
Middle-aged rodents exposed to midazolam and high fat diet showed
significant neuronal alterations in MR diffusional kurtosis imaging and
significant impaired memory function compared to animals on conventional
rodent chew and midazolam. Data of this animal study supports a dual
hit mechanism underlying cognitive impairment in middle-aged rodents.
Dorothea S. Rosenberger M.D., Ph.D., David Wynn B.S., Heather
Boger Ph.D., Claudia Umphlet B.S., Xingju Nie M.D., Ann-Charlotte
Granholm Ph.D., Department of Anesthesia and Perioperative Medicine,
Department of Neurosciences, Department of Radiology, Medical
University of South Carolina, Charleston, SC.
NA A3032
NA A3033
Isoflurane’s Inhibitory Action on the Neurotransmitter Release
Machinery is Reversed by Methylphenidate
Isoflurane inhibits the neurotransmitter release machinery in neuroscretory
PC12 cells. Methylphenidate was able to reverse the inhibition produced by
isoflurane thereby restoring neurotransmitter release. This process may play
a role in the active arousal from anesthesia observed by Solt et al. (2011).
Zheng Xie, M.D., Ph.D., Robert Fong, M.D., Ph.D., Qiang Wang, Ph.D.,
Kyle McMillan, B.S., Aaron P. Fox, Ph.D., Department of Anesthesia and
Critical Care, Department of Neurobiology, Pharmacology & Physiology,
University of Chicago, Chicago, IL.
PD14-1 PATIENT SAFETY PRACTICE MANAGEMENT
MONDAY, OCTOBER 14
NA A3027
ROOM 124
PI A3034
Cardiovascular Events: Still a Major Proportion of Complications in the
Postanesthesia Care Unit
Despite a decreasing overall rate of complications in a university teaching
hospital setting over the last 2 decades cardiovascular events continue to
constitute a major proportion of all complications in the postanesthesia care
unit (PACU). Risk factors were identified as predictors of such perioperative
cardiovascular complications. Anesthetic type ASA class gender and
admission temperature were found to influence the likelihood of developing
cardiovascular complications in the PACU. Sn M. Dabu-Bondoc, M.D.,
Feng Dai Ph.D., Gail Watrous R.N., Li Qin, Ph.D., Xiangyu Cong Ph.D.,
Tianzhou Ma M.S., Kirk Shelley M.D., Ph.D., Roberta Hines, M.D.,
Anesthesiology, Yale University School of Medicine, Biostatistics Yale
School of Public Health, Yale School of Public Health, New Haven, CT.
PI A3035
Shared Decision-Making (SDM) in a Surgical Clinic Setting: Adoption
Through Implementation
Shared decision-making (SDM) is a collaborative decision-making process
between patient and provider for preference-sensitive treatment decisions.
Providers do not routinely include all elements of SDM during clinical
encounters. We implemented SDM in two spine surgery clinics. A toolkit
was part of the implementation to engage stakeholders identify barriers
and develop interventions to overcome barriers. Shawn L. Mincer, B.A.,
Michael J. Lee, M.D., Richard J. Bransford, M.D., Saint Adeogba, M.D.,
Karen L. Posner, Ph.D., Pornsak Chandanabhumma, M.P.H., Lynne S.
Robins, Ph.D., Michelle S. Lam, B.S., Karen B. Domino, M.D. M.P.H.,
Anesthesiology and Pain Medicine, Orthopaedics & Sports Medicine ,
BioMedical Informatics & Medical Education, University of Washington,
Seattle, WA.
PI A3036
The Incidence of Mallampati Class Zero Airway and the Relation
Between Mallampati Score and Difficult Intubation
We investigated the incidence of Mallampati class zero airway and the
relationship of Mallampati score with difficult intubation. A total of 1200
adult patients were enrolled. Although Mallampati class zero airway had an
incidence of 0.67% and was not associated with difficult mask ventilation or
difficult intubation it may be related to a difficult airway when other airway
characteristics are present. Mallampati classification was shown to be related
to the incidence of difficult intubation in our investigation. Hirotsugu Miyoshi
M.D., Shinji Kusunoki M.D., Ph.D., Takahiro Kato M.D., Masashi
Kawamoto M.D., Ph.D., Department of Anesthesiology, Hiroshima
University Hospital, Critical Care Medical Center Hiroshima Prefectural
Hospital, Hiroshima, Japan.
LOC-Associated Breakdown of Feedback Connectivity Depends on Time
for Cortico-Cortical Communication
The transfer time for cortico-cortical communication plays an important role
for STEn-based analyses of effective connectivity. Gisela Untergehrer, M.D.,
Denis Jordan Ph.D., Eberhard F. Kochs, M.D., Gerhard Schneider M.D.,
Department of Anesthesiology, Helios Clinic Wuppertal Wuppertal,
Germany, Department of Anesthesiology, Klinikum rechts der Isar,
Munchen, Germany.
PN Pain Medicine
NA Neuroanesthesia
77
PI A3037
Automated Assessment of Difficult Ventilation With Facial Recognition
Techniques
Difficulty in mask ventilation may have dramatical consequence on patients’
safety and outcome. No recognized scale to grade mask ventilation difficulty
is available today. Computerized morphological features recognition are used
daily for security reason for example. We propose a method using computer
vision and machinge learing to automatically grade and predict difficult
ventilation on patients undergoing general anesthesia. Patrick Schoettker
M.D., Gabriel Cuendet M.Eng., Jean-Philippe Thiran M.Eng., Matteo
Sorci Ph.D., Christophe Perruchoud M.D., Anesthesiology, CHUV,
Signal Processing Lab Ecole Polytrechnique Federale, nViso Sarl, Lanne
Switzerland, Anesthesiology, Ensemble Hospitalier Morges, Morges,
Switzerland.
PI A3038
Analysis of Anesthesiology Services After Five PM: Strategizing a
Staffing Model to Meet Demand
At our institution the operating rooms (ORs) have been busier after five pm
this year in comparison to prior years. Using OR Manager (©PICIS Inc.) our
operating room electronic record keeping system we quantified this change.
We identified that the need for anesthesia personnel after five pm exceeded
scheduled staff. Further staffing demand varied with days of the week and
months of the year. Using this data strategic adjustment in staffing was
recommended to efficiently staff ORs according to demand using residents
CRNAs and faculty while reducing overtime. Further investigation of late work
for non-call residents demand for staffing for non-OR anesthesia (NORA)
overtime hours and daytime workflow contributing to evening demand is in
progress. Angela Selzer M.D., Eric Brumberger M.D., Arden Ward B.A.
Peter Fleischut M.D., Vinod Malhotra M.D., NYP-WCMC, New York, NY.
PI A3039
The Effect of Anesthesia Charting Modalities on the Rate of Charting
Deficiencies: A Comparison of Paper and Electronic Anesthesia
Records
We tested the hypothesis that installation of an AIMS would decrease
anesthesia chart completeness. 200 paper records (Paper group) and 200
electronic records (AIMS group) two months after installation of the AIMS
were systematically reviewed.7 deficiency end-points were significantly
(p<0.05) worse in the AIMS group including documentation of equipment
check EKG rhythm respiratory rate blood pressure antibiotic administration
anesthesia-type and oxygen administration. Installation of AIMS may increase
charting deficiencies. Practitioners should be cautious when using AIMS that
lack or have under-powered real-time alert capabilities as this may worsen
chart completion. Torin D. Shear, M.D., Jason Mitchell, M.D., Mark Deshur,
M.D., Shivani Patel B.A., Vicki Silk, M.D., Anesthesia, NorthShore
University HealthSystem, Evanston, IL.
PI A3040
Excellence and Meritocracy in an Anesthesia Practice Group: Report of
the First Year Following Implementation of a Competency Matrix
Differences in work-life balance personal motivation and productivity
incentives have imposed a formidable challenge to anesthesia practice
groups over the last decade. In addition meritocracy and excellence has
been addressed more recently in medical practice including the practice of
anesthesia. Associating these concepts to our anesthesia group that applied
seniority as the sole criterion to differentiate financial compensation was
one of our main objectives in the last 3 years. The objective of this report is
to describe the rationale and the main lessons obtained at the end of the
first year of implementation of a competency matrix. Flavio Takaoka, M.D.,
Ph.D., Raffael Pereira Cezar Zamper, M.D., Fabio Augusto Schiavuzzo
M.D., Alex Goncalves Belote, M.D., Celso Augusto Parra, M.D., CATA,
Clinica de Anestesia, Sao Paulo, Brazil.
78
PI A3041
Opioid-Induced Respiratory Depression - Evaluation of a New Protocol
to Identify Patients at Risk
Opioid-induced respiratory depression impacts patient safety length of stay
&; cost of care. A non-invasive Respiratory Volume Monitor was used to
measure Minute Ventilation in PACU patients. Individual Predicted values
for adequate MV were calculated. Patients with MV <80% Predicted were
classified At-risk. 7/11 patients classified At-risk had an Unsafe drop in MV
(defined as <40% Predicted. 1/22 patients classified Not-at-risk had an
Unsafe drop in MV. Importantly this protocol focused more on sensitivity than
specificity and reported an NPV of 95.5%. Only one patient with potential
respiratory compromise was misclassified. Christopher Voscopoulos M.D.,
C. Marshall MacNabb, M.S., Jordan Brayanov Ph.D., Jenny Freeman
M.D., Edward George M.D., Ph.D., Brigham and Women’s Hospital,
Massachusetts General Hospital, Boston, MA, Respiratory Motion, Inc.
Waltham, MA.
PD15-1 PEDIATRIC ANESTHESIA: PAIN
ROOM 124
PD A3042
Intraoperative RBC Transfusion in Infant Heart Transplant Patients Is
Not Associated with Worsened Outcomes
Children under 1 year of age frequently require red blood cell transfusion
during cardiac transplant surgery. Concern has been raised regarding
resultant increased morbidity and HLA allosensitization. This retrospective
analysis of transplant recipients under 1 year of age showed no increase in
post-transplant length of stay related to either donor exposures or the volume
of red blood cell transfusion. Harmony F. Carter M.D., Carol Lau M.D.,
Richard Applegate II M.D., Lindsey Van Drunen B.S., Ken Ochiai B.S.,
Michael Um B.S., Anesthesiology, Loma Linda University School of
Medicine, Loma Linda, CA.
PD A3043
Perioperative Global and Regional Hemodynamic Assessment With
NIRS Predicts Outcome After Neonatal Arterial Switch Operation
Measured and derived parameters from somatic and cerebral NIRS
monitoring can identify conditions that are related to organ-specific and
global outcomes following the arterial switch operation and may provide
appropriate targets for intervention. George M. Hoffman M.D., Nancy S.
Ghanayem M.D., Kathleen A. Mussatto Ph.D., Luke J. Lamers M.D.,
James S. Tweddell M.D., Anesthesiology and Pediatrics, Children’s
Hospital and Medical College of Wisconsin, Cardiothoracic Surgery
Children’s Hospital and Medical College of Wisconsin, Herma Heart
Center Children’s Hospital of Wisconsin Milwaukee, WI, Pediatric
Cardiology, American Family Children’s Hospital, Madison, WI.
PD A3044
Predictive Value of Postoperative Cardiac Troponin-I Concentrations in
Short and Long-Term Outcome of Congenital Cardiac Surgery
This prospective ongoing study evaluates the value of postoperative cardiac
troponin-I measurements in the prediction of short- and long-term outcome
of newborns and children of less than 10 years old undergoing congenital
cardiac surgery with or without cardiopulmonary bypass. Mona Momeni
M.D., Ph.D., Thierry Detaille M.D., Amine Matta M.D., Marie-Therese
Rennotte M.D., Laurent Houtekie M.D., Emilien Derycke M.D., Astrid
Haenecour M.D., Stephan Clement de Clety M.D., Francis Veyckemans
M.D., Anesthesiology, Cliniques Universitys Saint Luc, Brussels Belgium.
PD A3045
Neurodevelopmental Outcomes After Pediatric Cardiac Surgery: A
Follow-Up of a Prospective Randomized and Blinded Study
With the advancement in the surgical outcomes after pediatric cardiac surgery
the focus has shifted from the mere survival of patients after the surgical
procedure toward improvement in the neurodevelopmental outcomes following
these complex procedures. In this pilot study we tried to evaluate the possible
correlation between blunting of the stress response and the possible improved
neurodevelopmental outcome in the setting of fast tracking after pediatric
cardiac surgery. Aymen N. Naguib M.D., Joseph Tobias M.D., Keith Yeates
M.D., Bruno Bissonnette M.D., Yongjie Miao M.S., Mark Galantowicz
M.D., Timothy Hoffman M.D., Department of Pediatric Anesthesia and
Pain Medicine, Nationwide Children’s Hospital Columbus, OH.
NA Neuroanesthesia
PN Pain Medicine
Cardiac Dysfunction Following Brain Death After Severe Pediatric
Traumatic Brain Injury
In summary, our study is the document to effect of severe TBI on cardiac
function by echocardiogram early after injury in children. Brain death
representing the most severe form of TBI demonstrated the highest rate
of cardiac dysfunction. Hopefully our data can open the door for further
studies inquiring into possibility of evaluation of all brain dead organ donors
with echocardiography and further investigation into myocardial protective
medications and techniques that may allow a larger amount of patients
with TBI-induced brain death to be potential cardiac donors. Sumidtra
Prathep M.D., Vijay Krishnamoorthy M.D., Deepak Sharma M.D.,
Yasuki Fujita M.D., William Armstead Ph.D., Monica Vavilala M.D.,
Anesthesiology and Pain Medicine, University of Washington, Seattle,
WA, Anesthesiology and Critical Care, Pharmacology, University of
Pennsylvania, Philadelphia.
PD A3047
Comparative Effects of Aminocaproic Acid Versus Aprotinin in Pediatric
Cardiac Surgical Patients - A Single Center Experience
Intraoperative RBC transfusion is increased in neonates receiving Aminocaproic acid compared to aprotonin during open heart surgery. Lena S.
Sun M.D., Tara Quinn B.A., Kevin Charette B.A., Terry Ann Chambers
M.D., Joanna Koenigsberg M.D., Shuang Wang Ph.D., Columbia
University, School of Medicine, New York, NY, Columbia University, New
York, NY, New York Presbyterian New York, NY, Albert Einstein Medical
College, New York, NY, New York University, New York, NY.
PD A3048
The Effects of Tracheal Extubation on Urine Output After Cardiac
Surgery - Fontan Procedure and Biventricular Repair
Positive-pressure ventilation (PPV) has deleterious effects on hemodynamics
by reducing venous return and cardiac output. We examine whether urinary
output one of the clues to estimate organ perfusion; increase after tracheal
extubation following Fontan procedure and biventricular repair. The urinary
output increased after extubation in patients underwent univentricular
Fontan procedure but not in whom underwent biventricular repair. Fontan
patients might be vulnerable to negative effects of PPV on hemodynamics
because of its poor circulatory performance. Therefore early extubation may
be beneficial especially in these patients group. Kana To M.D., Kaoru
Izumi M.D., Ph.D., Mariko Tanaka M.D., Manabu Tanaka M.D., Nobuo
Jimi M.D., Rieko Sumiyoshi M.D., Ph.D., Keiichirou Mizuno M.D., Ph.D.,
Department of Anesthesia, Fukuoka Children’s Hospital, Fukuoka,
Japan.
PD A3049
Impact of Anesthetic Dosage on the Duration of Postoperative
Mechanical Ventilation After Pediatric Congenital Heart Disease
Surgery
We examined the impact of anesthetic dose on the duration of postoperative
mechanical ventilation in pediatric congenital heart disease surgeries
scheduled for fast-tracking. Even a low to mild dose of fentanyl which is
generally considered suitable for fast-tracking had a positive correlation
with duration of postoperative mechanical ventilation for single ventricle
surgery in which fast-tracking is often performed as soon as possible
for hemodynamic stability. Yusuke Yoshikawa M.D., Yuko Nawa M.D.,
Ph.D., Naoyuki Hirata M.D., Ph.D., Michiaki Yamakage M.D., Ph.D.,
Anesthesiology, Hokkaido Medical Center for Child Health and
Rehabilitation, Anesthesiology, Sapporo Medical University School of
Medicine, Sapporo, Japan.
PO01-2A GERIATRIC ANESTHESIA - OUTCOMES RESEARCH
ROOM 104-AREA B
AM A3050
Sex Differences in Preoperative Mobility Nutrition and Frailty Status
Predict Hospital Length of Stay in Older Patients for Noncardiac
Surgery
Women account for the majority of the aging Western population and older
women are more likely than men to live alone or be engaged in spousal care
and can neglect their own nutritional and functional health. We identified
geriatric-specific measures of general health and physical state for men and
women and determined whether these non-traditional preoperative (preop)
measures predict length of hospital stay (LOS) after low and intermediate-risk
surgery. Geriatric-specific measures of general health and functional status
along with procedural risk predict LOS differently between sexes. Leanne
Groban M.D., Sunghye Kim M.D., Angela Edwards M.D., Lauren
Rustowicz B.S., Catherine Roach B.S., Anthony Marsh Ph.D., Jack
Rejeski Ph.D., Stephen Kritchevsky Ph.D., Anesthesiology, Wake Forest
School of Medicine, Winston-Salem, NC.
MONDAY, OCTOBER 14
PD A3046
AM A3051
The Association Between Heart Rate Variability and Postoperative
Memory Impairment in Elderly Patients
The objective of this study was to delineate the association between
preoperative heart rate variability (HRV) and postoperative memory
impairment in elderly patients. Memory function and HRV were assessed
before and after surgery in 37 patients over 70 yr of age undergoing
orthopedic surgery under general anesthesia. The postoperative memory
impairment was greater in elderly patients with low L/H of HRV than those
with high L/H. Makoto Kobayashi M.D., Toru Komatsu M.D., Hiroyuki
Kinoshita M.D., Ph.D., Yoshihiro Fujiwara M.D. M.B.A., Department of
Anesthesiology, National Center for Geriatrics and Gerontology, Obu
Japan, Department of Anesthesiology, Aichi Medical University School of
Medicine, Nagakute, Japan.
AM A3052
Surgical Outcomes in Advanced Aged Patients
The surgical outcomes of patients >95 years of age were studied to examine
the association of patient’s preoperative health and the occurrence of lifethreatening complications and 30-day mortality. Patients of advanced age
have high rates of mortality and morbidity following surgical procedures. We
found the rate of these adverse events is associated with the extensiveness
of surgery and is independent of preexisting comorbidities. Kelly J. Larson,
M.D., Toby N. Weingarten, M.D., Juraj Sprung, M.D., Ph.D., Ryan J.
Hamlin, M.D., Darrell R. Schroeder, M.S., Anesthesiology, Mayo Clinic,
Rochester, MN.
AM A3053
Spinal Anesthesia for Lower Extremity Surgery in Geriatric Patients:
Minimum Dose Requirement of 0.2% Hypobaric or Hyperbaric
Bupivacaine
The minimum effective dose of intrathecal hypobaric and hyperbaric 0.2%
bupivacaine for lower extremity surgery was determined by administering
incremental doses to elderly patients. A total dose of 4 mg or less of
hypobaric and hyperbaric 0.2% bupivacaine was sufficient to produce
satisfactory lower extremity surgical anesthesia in over 80% of geriatric
patients. Limiting the spread of spinal anesthesia may reduce the
hemodynamic effects and improve speed of recovery. Yoshimichi Namba,
M.D., Ph.D., Michiaki Yamakage, M.D., Ph.D., Sapporo Medical University,
Sapporo, Japan.
NA Neuroanesthesia
PN Pain Medicine
79
AM A3054
MRI Reveals Brain Structural And Functional Changes In Elderly
Patients With And Without POCD
This study use MRI to detect the differences of brain structure and function
among elderly patients with POCD and without POCD and healthy geriatrics.
We find that the POCD group showed significantly lower gray matter volume
in the anterior cingulate and the parahippocampal gyrus decreased ALFF
in left thalamus bilateral precuneus and right posterior cingulate in relative
to controls while the non-POCD group showed reduced ALFF in bilateral
thalamus. Patients with POCD showed more widespread changes of gray
matter volume and cerebral regional function especially in cortical-thalamus
circuit which is important for cognitive function. Lu Peilin M.D., Zuo Yunxia
M.D., Anesthesiology, West China Hospital Sichuan University, Chengdu,
China.
AM A3055
Reducing Preoperative Waiting Time for Hip Fracture: An Urgent Call
for Anesthesiologist’ Leadership
Anesthesiologists as specialists in perioperative care can and should take
a leading role in reducing both the PWT and LOS in the optimization of
care for hip fracture patients. Chunyuan Qiu M.D., Vu T. Nguyen M.D.,
Renato V. Etrata M.D., Diana C. LaPlace M.D., Celin H. Jo Student,
Jessica Y. Qiu Student, Preeti P. Shah M.D., Chandra D. Heyman M.D.,
Narendra S. Trivedi M.D., Maria T. Enciso B.S.N., Anesthesiology, Kaiser
Permanente, Baldwin Park, CA.
AM A3056
Age is Positively Associated With Increased Dose of Inhaled Volatile
Anesthetics
MAC decreases with age but it is not known how well anesthesia providers
adhere to guidelines for age-adjusted MAC. This study examined 8500
single volatile agent anesthetics from a single hospital in 2012. Patient
age was found to be associated with an ever-increasing predicted ageadjusted MAC although the rate of that increase became less severe after
age 65. Alec Rooke M.D., William Van Cleve M.D., Bala G. Nair Ph.D.,
Anesthesiology and Pain Medicine, University of Washington, Seattle,
WA.
AM A3057
Aged Rats Exhibit Prolonged Emergence from General Anesthesia
In adult rats aging prolongs emergence from general anesthesia with
isoflurane and propofol and decreases the dose requirement for isofluraneinduced loss of righting. Neurophysiological data reveals that the same
dose of isoflurane induces a greater depth of general anesthesia in older
rats suggesting that the aged brain is more sensitive to anesthetic-induced
unconsciousness. These findings encourage further work to elucidate the
neural mechanisms underlying aging-related changes in sensitivity to general
anesthesia. Ken Solt M.D., Jessica J. Chemali B.S. Olatoye Olutola
B.S. Jonathan D. Kenny Emery N. Brown M.D., Ph.D., Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital,
Boston, MA.
ROOM 104-AREA A
CA A3058
Critical Causes for Retained Guidewires After Central Venous
Catheterization
We critically analyzed eight instances of retained guidewire after central
venous catheterization (CVC) from a database of 15 930 CVC during a 26
month period at our institution. We describe how procedural inattention
and other clinical factors may have contributed to this event. We propose
the creation and implementation of a pre and post-CVC checklist to prevent
this complication. Enrico M. Camporesi M.D., Devanand Mangar M.D.,
Jordan Miller B.S., Collin Sprenker B.S., Rachel Karlnoski Ph.D.,
Hesham Omar M.D., Surgery University of South Florida, Florida Gulfto-Bay Anesthesiology, Associates LLC, College of Medicine University of
South Florida Tampa, FL, Internal Medicine Mercy Hospital, Chicago, IL
80
CA A3059
Can Arterial Stiffness Measured by Pulse Wave Velocity Preoperatively
Predict Hypotension During Induction of Anesthesia?
We investigated whether brachial-ankle pulse wave velocity (baPWV) an
indicator of aortic stiffness is correlated with incident hypotension during
the induction of anesthesia. baPWV was measured before operation in 105
patients undergoing non-cardiovascular surgery. These results suggest that
increased aortic stiffness measured by baPWV is associated with hypotension
during the induction of anesthesia. Preoperative measurement baPWV which
is non-invasive could be a useful method in anesthetic evaluation. Miyazaki
Shinichiro M.D., Kido Haruki M.D., Ryosuke Mihara M.D., Tanaka
Motoshige M.D., Ph.D., Minami Toshiaki M.D., Ph.D., Anesthesiology,
Osaka Medical College, Takatsuki City, Osaka, Japan
CA A3060
Impact of Heart Rate to Respiratory Rate Ratio on the Predictive Value
of Pulse Pressure Variation in the Intraoperative Setting
Unusually high respiratory rates (RR) or low heart rates (HR) may affect
the fluid responsiveness threshold value of pulse pressure variation. We
determined that the HR/RR ratio does affect intraoperative PPV threshold
(and gray zone) values at low HR/RR ratios. Brenton S. Alexander B.S.,
Yannick Le Manach M.D., Ph.D., Christoph K. Hofer M.D., Benoit
Tavernier M.D., Maxime Cannesson M.D., Ph.D., Department of
Anesthesiology and Perioperative Care, University of California Irvine,
Irvine, CA, Departments of Anesthesia & Clinical Epidemiology and
Biostatistics Michael DeGroote School of Medicine Faculty of Health
Sciences, McMaster University Ontario ON, Canada, Institute of
Anesthesiology and Intensive Care Medicine, Triemli City Hospital,
Zurich, Switzerland, Department of Anesthesiology and Critical Care
Medicine, Centre Hospitalier University de Lille, France.
CA A3061
Does Stroke Volume Variation Predict Intraoperative Fluid
Responsiveness in Kidney Transplant Recipients?
Intraoperative fluid assessment can be challenging in renal failure patients.
In patients with normal renal function stroke volume variation can predict
positive response to fluid challenges. We did not find a relationship between
stroke volume variation prior to fluid challenges and stroke volume index
increase ≥5% after fluid challenges in patients undergoing kidney transplant.
Richard Applegate II M.D., Ryan Lauer M.D., Jason Gatling M.D.,
Michael Chen M.D., Mohammad Hassanian M.D., Michael Um B.S.,
Anesthesiology, Loma Linda University School of Medicine, Loma Linda,
CA.
CA A3062
Evaluation of Risk Factors for Paraplegia After Endovascular Aortic
Repair for Descending Thoracic and Thoracoabdominal Aortic Aneurism
Paraplegia is still one of the most devastating complications after thoracic
endovascular aortic repair (TEVAR). The present study was conducted
to investigate the risk factors for paraplegia after TEVAR. One-hundred
and seventy-one patients undergoing TEVAR were enrolled in this study.
Permanent paraplegia developed in 6 patients (3.5%). Duration of procedure
were significantly higher in patients with permanent paraplegia. Multivariate
logistic regression analysis revealed that lowest hemoglobin during the
procedure had a significant association with permanent paraplegia.
Kyoko Hasuwa M.D., Kenji Yoshitani M.D., Yoshihiko Ohnishi M.D.,
Department of Anesthesiology, National Cerebral and Cardiovascular
Center, Osaka, Japan.
CA A3063
Acute Kidney Injury Rates Following Ex-Vivo Lung Perfusion (EVLP)
Versus Standard Orthotopic Lung Transplant
Ex-vivo lung perfusion (EVLP) identifies transplant viability for otherwise
marginal organs. Evidence supports equivalency for EVLP vs. non EVLP lung
transplants regarding graft dysfunction length of stay and mortality. However
comparisons of other organ dysfunction have not been reported. To assess
for renal insult we tested the hypothesis that EVLP-transplants are associated
with different AKI rates than standard (non-EVLP) lung transplant procedures.
Jennifer Hauck M.D., Asishana Osho B.A., Anthony Castleberry
M.D., Matthew Hartwig M.D., Barbara Phillips-Bute Ph.D., Madhav
Swaminathan M.D., Joseph Mathew M.D., Mark Stafford-Smith M.D.,
Anesthesiology, General Surgery, Cardiothoracic Surgery, Duke University,
Durham, NC.
NA Neuroanesthesia
PN Pain Medicine
Use of the Vigileo-FloTrac Monitor With a Protocol for Intra-Operative
Hypotension Management in Craniotomies
We prospectively studied whether hypotension during craniotomy surgery
treated using an algorithm for fluid and pressor administration based on
CI and SVV derived with the FloTrac/Vigileo monitor compared to standard
anesthesia care alone reduced intraoperative fluid and pressor requirements.
Ludmil V. Mitrev M.D., Elird Bojaxhi M.D., Marc Torjman Ph.D., Michael
Misbin M.D., Keyur Trivedi M.D., Muhammad Muntazar M.D., Alan
Turtz M.D., Steven Brecher B.A., Anesthesiology, Cooper University
Hospital, Camden, NJ.
CA A3065
The Effect of General Anesthesia on the QT Interval - A Preliminary
Data Analysis
A prospective study to investigate incidence and time course of perioperative
QT interval prolongations measured by continuous EKG holter Monitoring.
Maximilian S. Schafer M.D., Silke Schillinger M.D., Thomas J.
Osterberg-Deiss B.A., Serpil Cakmakkaya M.D., Kerstin Kolodzie M.D.,
Ph.D., Klinik fur Anaesthesiologie, Universityersitatsklinikum Dusseldorf,
Dusseldorf, Germany, Department of Anesthesia & Perioperative Care,
University of California San Francisco, San Francisco, CA, Department of
Medical Education, Cerrahpasa Medical School University of Istanbul,
Istanbul, Turkey.
PO13-6A OUTCOMES AND DATABASE RESEARCH: MISCELLANEOUS
ROOM 104-AREA C
FA A3066
Comparison of Intraoperative Penile Erection During General
Anesthesia With Isoflurane Sevoflurane and Propofol for Endourology:
An Exploratory Randomized Controlled Clinical Trial
This is a first study to demonstrate that anesthesia with isoflurane may
significantly reduce the incidence of intraoperative penile erection in
comparison with anesthesia with propofol and deepening anesthesia with
isoflurane may promptly produce detumescence. Li Yuan M.D., Luo Zhen
M.D., Wei Xinchuan M.D., Department of Anesthesiology, West China
Hospital Sichuan University, Chengdu, Sichuan People’s Republic of
China, Chengdu, China.
FA A3067
Is Leukocytosis a Common Finding in the Postoperative Period?
This study demonstrates the elevation in leukocyte and neutrophil counts
after different surgical procedures as well as its fast resolution during the
early post-operative period. The study also demonstrates that these findings
of leukocytosis and neutrophilia are consistent for different patient groups
surgeries and anesthetic approaches and is not the result of infection
invasiveness of surgery or anesthesia. Barak Cohen M.D., Elia Dery M.Sc.
Anat Cattan M.Sc. Idit Matot M.D., Anesthesiology and ICM Tel-Aviv
Sourasky Medical Center, Tel-Aviv, Israel.
FA A3068
Incidence of Postoperative Deterioration in a Cohort of 35,090
Surgical Patients
An automated algorithm was used to locate potential cases of post-operative
deterioration (POD). A total of 790 cases were identified. The primary
precipitating causes were identified by manual chart review. 33% were from a
respiratory event 36% were from a cardiovascular event and 9% were from
narcotics. Prospective identification of patients at risk for POD may allow for
meaningful intervention. Derick N. Jenkins M.D., Rachel M. Hayes Ph.D.,
Jonathan P. Wanderer M.D., Roger R. Dmochowski M.D., Jesse M.
Ehrenfeld M.D. M.P.H., Anesthesiology, Department of Surgical Services,
BioMedical Informatics, Vanderbilt University Medical Center, Nashville,
TN.
FA A3069
Survival and Quality of Life Associated With ICU Residence in a United
States Veteran Population
The duration of an appropriate trial of therapy in the Intensive Care Unit us
deserved little attention however is of great importance to family members
of ICU patients. We therefore conducted an observational study of over 1000
ICU admissions and their 1 year status. Patients >70 years of age or who
resided in the ICU greater than 14 days are at very high risk for one year
mortality and high dependence on health care. Geoffrey K. Lighthall M.D.,
Ph.D., Luis Verduzco M.D., Anesthesiology, Stanford University School
of Medicine, Mountain View, CA, Anesthesiology, Stanford University
School of Medicine, Palo Alto, CA.
MONDAY, OCTOBER 14
CA A3064
FA A3070
Minimum Alveolar Concentration of Sevoflurane Inducing Isoelectric
EEG in Middle-Aged Adults With Nitrous Oxide
We determined the minimal alveolar concentration of sevoflurane with
60% nitrous oxide inducing isoelectric electroencephalogram in 50% of
the subjects (MACie) in middle-aged subjects was 3.3 ±0.1%. Ben Niu
M.D., Wei Mei M.D., Ph.D., Yuke Tian M.D., Ph.D., Department of
Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical
College Huazhong University of Science and Technology, Wuhan, China.
FA A3071
Assessing Patients Opinion About Preoperative Anaesthesia
Consultation
Though Preoperative Anaesthesia Consultation (PAC) has now been
implemented in the organizational structure of most hospitals patients’
experiences and satisfaction with the PAC have been little studied. The aims
of our study were to audit PAC in our hospital and to assess patient’s opinion
about it. The majority of our patients didn’t present a major concern about
anaesthesia. Globally the satisfaction and importance attributed to PAC were
very high. Luis G. Pereira M.D., Adriano Moreira M.D., Cristiana Pinho
M.D., Madalena Passos M.D., Centro Hospitalar de Sao Joao E.P.E.,
Porto, Portugal.
FA A3072
Comparable Graft and Patient Survival in Lean and Morbidly Obese
Liver Transplant Recipients
Obesity increases risk for perioperative complications but how affects
liver transplantion outcomes remains unclear. We compared graft/patient
survival after liver transplant in 2 groups: obese patients (BMI >38 kg/
m2) vs. lean patients (BMI 20-26 kg/m2). No significant difference was
observed in graft/patient survival between groups. Silvia E. Perez-Protto
M.D., Cristiano Quintini M.D., Luke F. Reynolds M.S., Jing You M.Sc.,
Jacek B. Cywinski M.D., Daniel I. Sessler M.D., Charles Miller M.D.,
Anesthesiology Institute, Department of General Surgery, Liver Transplant
Center, Departments of Quantitative Health Sciences, Department
of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH,
Division of Urology, The Ottawa Hospital, Ottawa ON, Canada.
FA A3073
Is the Quality of Dreams During General Anesthesia Associated With
Anesthetic Agents?
The aim of this study was to examine the relationship between the quality
of dreams and general anesthetics. Before leaving from the operating room
1235 patients could answer the interview. 314 [25.4%] patients reported
that they had a dream. The incidence of dreams was similar between the
propofol group [30.5%] and the desflurane group [29.8%] and that was
significantly lower in the sevoflurane group [21.5%]. Among the patients who
had a dream the incidence of pleasant dreams was inclined to be higher in
both the propofol group [54.8%] and the desflurane group [54.8%] than the
sevoflurane group [43.9%] despite a lack of statistical significance. Akari
Yoshida M.D., Keisuke Fujii Ph.D., Takaaki Negoro Ph.D., Kazuhiro
Mizumoto Ph.D., Anesthesiology, Wakayama Medical University,
Anesthesiology, Japanese Red Cross Society Wakayama Medical Center,
Wakayama Japan.
NA Neuroanesthesia
PN Pain Medicine
81
PD A3078
ROOM 104-AREA E
PD A3074
Do Small Doses of Atropine Cause Bradycardia in Young Children?
Intravenous atropine is administered to infants and children to counteract
bradycardia during induction of anesthesia. A minimum dose of 0.1 mg is
recommended irrespective of the child’s weight because smaller doses are
thought to paradoxically cause bradycardia. The aim of this study is to record
the heart rate response to 5 mcg/kg atropine in 60 neonates and children
less than 2 yrs of age. To date 31 infants have completed the study without
an episode of bradycardia although the blinded review of the EKG recordings
will occur only after enrollment is complete. The final results of the study will
be presented at the ASA meeting. Lara Eisa M.D., Yuvesh Passi M.D.,
Jerrold Lerman M.D., Christopher Heard M.D., Anesthesia, Women and
Children’s Hospital of Buffalo, Buffalo, NY.
PD A3075
Development of 12 Teaching Modules to Aid in Securing the Difficult
Airway Through Evaluation of Over 300 Videolaryngoscopy Recordings
in Congenital Vascular and Lymphatic Anomalies of the Head and Neck
In this large case study of over 300 pediatric patients with congenital
vascular and lymphatic malformations of the head and neck the authors
recorded the laryngoscopies using the Glidescope and complied a large
video database. The patients were stratified by patient age and lesion type.
The authors’ utilized this database to formulate twelve teaching modules
aimed at securing the difficult airway. The teaching modules demonstrate:
1) specific teaching techniques for use of video laryngoscopy 2) using
video laryngoscopy for diagnostic purposes including monitoring disease
progression and guiding therapeutic interventions 3) advanced airway
techniques and overcoming specific anatomic challenges. Keith D. Haller
D.O., Franco Resta Flarer M.D., Jonathan Lesser M.D., Robert Bolash
M.D., Junping Chen M.D., Ph.D., Anesthesiology, St. Lukes Roosevelt
Hopsital System, New York, NY.
PD A3076
Clinical Effective Dose of Preoperative Intravenous Dexmedetomidine
to Attenuate the Emergence Agitation of Children
The clinical effective dose of dexmedetomidine to attenuate the emergence
agitation of 50 and 95% of children was 1.0 and 1.44 μg/kg respectively.
In children single dose intravenous infusion before anesthetic induction
reduced emergence agitation effectively after general anesthesia. Haemi
Lee Ph.D., Department of Anesthesiology and Pain Medicine, School of
Medicine, Yeungnam University, Daegu, Korea.
PD A3077
Intrathecal Morphine Reduces Blood Loss During Idiopathic Scoliosis
Surgery: Retrospective Study of 256 Pediatric Cases
This retrospective cohort study was designed to assess the impact of
intrathecal morphine compared with no intrathecal morphine on blood loss
and on hemodynamic stability during surgery for pediatric idiopathic scoliosis
correction. Our data demonstrates that intrathecal morphine inpediatric
surgical scoliosis correction significantly decreases intra-operative blood loss
and transfusions and enhances blood pressure stability. Aleksandra Lesniak
M.D., Pierre Tremblay M.D., Bernard J. Dalens M.D., Maryse Aucoin
M.D., Pierre Mercier M.D., Anesthesiology, Laval University, Quebec,
Canada, Centre Hospitalier University de Quebec (CHUQ), Quebec,
Canada.
82
Improving Non-Compliance With Home Anticonvulsant Medication
Regimens Prior to Surgery From June 2012 to January 2013; an
Ongoing Quality Improvement Project at a Tertiary Care Children’s
Hospital
Children with seizure disorders face unique challenges during the
perioerative period which makes getting their anticonvulsant medication
prior to their procedure important. We have utilized the Institute for Health
Care Improvement (IHI) method to achieve this. Through application of
the IHI model we have seen improvement with our compliance from 60%
to 80%. We are currently transitioning team leadership from neurology to
anesthesiology and hope to achieve and sustain 100% compliance. Vidya T.
Raman M.D., Charlotte Jones M.D., Ph.D., Thomas Taghon M.D., Julie
Rice R.N., Joseph D. Tobias M.D., Anesthesiology and Pain Medicine,
Nationwide Children’s Hospital, Columbus, OH, Neurology, Nationwide
PD A3079
Laryngeal Mask Airway Placement in Children Prior to an Intravenous
Line Utilizing Heart Rate as an Indicator of Anesthetic Depth
In inhalation inductions in children inserting the LMA before placing the IV is
a safe alternative to placing the IV first. Our ease of placement data compare
favorably with studies using the more common IV-then-LMA technique. A
10% decline in HR or waiting 3 minutes while administering 8% sevoflurane
in 70% nitrous oxide is a reliable method of assuring acceptable anesthetic
depth when placing an LMA in children under 7 years of age. Placing an LMA
first has several potential advantages including allowing for better pediatric
IV supervision and teaching and in situations where the anesthesia provider
does not have experienced IV assistance. Donald A. Schwartz, M.D.,
Annemarie Begley, R.N., Charles Gibson R.N., Paul Visintainer, Ph.D.,
Neil R. Connelly, M.D., Department of Anesthesiology, Baystate Medical
Center, Springfield, MA.
PD A3080
New Trends in Pediatric Regional Anesthesia: Our Experience
We describe our clinical practice in 15 years of experience in pediatric
regional anesthesia, before and after ultrasound introduction (17698 total
blocks). Besides an increasing in total block number peripheral and central
single shot and continuous infusions, ultrasound technique has made the
anesthesiological practice easier reducing failure rate. Noemi Vicchio,
M.D., Valeria Mossetti M.D., Lucia Caccavale, M.D., Marco Leopardi,
M.D., Ferdinando Gagliardi, M.D., Antonello Di Filippo, M.D., Giorgio Ivani,
M.D., Pediatric Anesthesiology and Intensive Care, Regina Margherita
Children’s Hospital, Turin, Italy.
PD A3081
Length and Diameter of Mainstem Bronchi in Pediatric Population
Specific airway dimensions in the pediatric population is not clearly defined.
The present study shows that right and left bronchi have different diameters
as well as configurations. The length of the left bronchus shows why the
age of the patient makes it difficult to isolate the lung efficiently. Our study
provides indirect CT based measurements of left and right mainstem bronchi
which may prove useful for the use for the lung isolation equipment.
Tariq Wani M.D., Joseph D. Tobias M.D., Mahmood Rafiq Malik, M.D.,
Ghulam M. Mir, M.D., Bruno Bissonette, M.D., Nationwide Childrens
Hospital, Columbus, OH, Anesthesiology, King Fahad Medical City,
Riyadh, Saudi Arabia.
NA Neuroanesthesia
PN Pain Medicine
ROOM 104-AREA D
RA A3082
Application of the Pythagorean Theorem to Train Novice Learners in
the Use of Ultrasound Guided Out-Of-Plane Peripheral Nerve Blocks
Teaching the out-of-plane (OOP) technique for peripheral nerve blocks is
challenging. Using models this study measures the effectiveness of applied
trigonometry and the Pythagorean Theorem in teaching novice trainees OOP
peripheral nerve blocks. Our findings may suggest that without a mathematic
approach novice trainees may misdirect the needle deeper than the target.
David H. Beang M.D., Jaime L. Baratta M.D., Kishor Gandhi M.D.
M.P.H., Elird Bojaxhi M.D., Belen De Jose Maria M.D., Anesthesiology,
Thomas Jefferson University Philadelphia, PA, Anesthesiology, Shirner’s
Childrens Hospital Philadelphia, PA.
RA A3083
A Survey of Complications Associated With 27 031 Ultrasound-Guided
Axillary Blocks
This work is the largest series of ultrasound guided axillary blocks in a
wide multicentric study. Local anesthetic systemic toxicty was rare and
postoperative neurologic symptoms were extremely rare. Helene Beloeil
M.D., Ph.D., Emmanuel Oger M.D., Claude Ecoffey M.D., Service
Anesthesie-Reanimation Inserm UMR 991 University Rennes 1 and CHU
Rennes Rennes France, Pharmacologie CHU Rennes Rennes France,
Service Anesthesie-Reanimation.
RA A3084
Multicenter Open-label Surveillance Trials to Evaluate the Safety and
Efficacy of a Shortened Infusion Time of Intravenous Ibuprofen
Phase I.V. study safety and efficacy results of I.V. Ibuprofen administered
over a shorten infusion time. Sergio D. Bergese, M.D., Keith A. Candiotti,
M.D., Sabry S. Ayad, M.D., Beverly K. Philip, M.D., Alparslan Turan, M.D.,
Asokumar Buvanendran, M.D., Eugene R. Viscusi, M.D., Stacy Witham,
Pharm.D, Tong J. Gan, M.D. F.R.C.A, Anesthesiology, The Ohio State
University, Columbus, OH, Anesthesiology, University of Miami, Miami, FL,
Fairview Anesthesiology, Cleveland Clinic, Cleveland, OH, Anesthesiology,
Perioperative and Pain Medicine, Brigham & Women’s Hospital, Boston,
MA, Outcomes Research Cleveland Clinic, Cleveland, OH, Anesthesiology,
Rush University Medical Center, Chicago, IL, Anesthesiology, Thomas
Jefferson University, Philadelphia, PA, Cumberland Pharmaceuticals,
Nashville, TN, Anesthesiology, Duke University, Medical Center, Durham,
NC.
RA A3085
Sufentanil NanoTab® PCA System Versus IV PCA Morphine for
Postoperative Pain: A Randomized Open-Label Active-Comparator
Trial
The Sufentanil NanoTab PCA System is a novel preprogrammed noninvasive
product in Phase 3 development designed to deliver sublingual sufentanil
15 mcg microtablets with a 20-minute lockout period. The current study
demonstrated the ability of the System to produce comparable patient
satisfaction with post-operative pain control faster onset and reduced
incidence of oxygen desaturation with post-operative pain control to IV PCA
with morphine 1 mg q6 min lockout. Timothy Melson M.D., David L.
Boyer M.D., Harold Minkowitz M.D., Pamela P. Palmer M.D., Ph.D.,
Mike Royal M.D., Anesthesiology, Helen Keller Hospital Sheffield AL,
Beer Simon and Associates Florence AL, Anesthesiology, Memorial
Hermann Memorial City Hospital Medical Center, Houston, TX, Medical
AcelRx Pharmaceuticals Inc., Redwood City CA, Clinical AcelRx
Pharmaceuticals Inc., Redwood City, CA.
MONDAY, OCTOBER 14
RA A3087
PO16-6A REGIONAL ANESTHESIA AND ACUTE PAIN
RA A3088
The Effect of Epinephrine Use on Ultrasound-Guided Upper Extremity
Blocks: A Meta-Analysis
The goal of this study was:1. To review the current literature on the use
of epinephrine in ultrasound-guided blocks of the upper extremity.2. To
use meta-analysis to compare the effectiveness and complication rate
of studies using epinephrine (EPI+) to those not (EPI-) No randomized
controlled studies exist that directly examine the role of epinephrine in
ultrasound guided blocks of the upper extremity. While there are theoretical
concerns and potential advantages there is not clear evidence that the
use of epinephrine improves the quality and duration of neural blockade or
increases adverse outcomes. As such further study is warranted.
Christian G. Samuelson M.D., Oga Willett M.D., Sai Arulkumar M.D.,
Veerandra Koyyalamudi, M.D., Anesthesiology, LSU Health Sciences
Center, Shreveport, LA.
RA A3089
A Retrospective Analysis of the Impact of Intraoperative I.V.
Acetaminophen on Post-Anesthesia Care Unit Opioid Use and Pain
Scores in Women Undergoing Gynecologic Surgery
In this retrospective study of women undergoing major gynecological surgery
under general anesthesia we assessed the impact of the administration
of intraoperative intravenous acetaminophen on total opioid use and pain
scores in the post-anesthesia care unit (PACU) and found that intravenous
acetaminophen did not confer any useful analgesic effect in PACU.
Bronwyn Southwell, M.D., Ashraf S. Habib, M.D. F.R.C.A., Anesthesiology,
Duke University, Medical Center, Durham, NC.
PO01-2BGERIATRIC ANESTHESIA-OUTCOMES RESEARCH
Would the Performance of an On-Q Ball Infusion Device Change if
External Pressure was Applied?
Disposable elastomeric pumps, such as the On-Q ball have gained great
popularity in providing post-op analgesia in both inpatient and outpatient
settings. Although elastomeric pumps seem to provide the same analgesic
efficacy as electronic pumps they are not as accurate. Our preliminary
investigation demonstrates a significant increase of the infusion rate of an
On-Q pain ball infusion device when external pressure is applied. Care must
be taken for the device not to be left on the patient’s bed while infusing or
the elastomeric infusion pump should be placed within a hard case.
Elird Bojaxhi M.D., Irwin Gratz D.O. Edward Deal D.O., Anesthesiology,
Cooper Medical School at Rowan University, Cooper University Hospital,
Camden, NJ.
RA A3086
Analgesic Effect of Multimodal Pain Management After Total Knee
Arthroplasty
Peri-articular infiltration of mixture of ropivacaine fentanyl and
methylprednisolone, added to continuous femoral nerve block can
improve early analgesia for patients after total keen arthroplasty and when
compared with sciatic nerve block, it causes no motor impairment and
arouses less anxiety. Lu Li, M.D., Jianming Gu, M.D., Qingguo Yang, M.D.,
Anesthesiology, Beijing Jishuitan Hospital, Bejing, China.
ROOM 104-AREA B
AM A3090
Pulmonary Hypertension and its Impact on Outcomes in Geriatric
Patients Undergoing Hip Fracture Repair
Pulmonary hypertension is a known independent risk factor for morbidity and
mortality for patients undergoing non-cardiac surgery. These patients present
a unique challenge to anesthesiologists due to the semi-urgent nature of
this moderate-risk surgery and the delicate physiology inherent within this
patient population. To date, no studies have specifically evaluated cardiorespiratory postoperative complications in elderly patients with pulmonary
hypertension undergoing hip fracture repair. We conducted a retrospective
analysis of charts to determine the impact of pulmonary hypertension on
outcomes. Piyush Gupta, M.D., Giselle Torres, M.D., Robert Lacivita, M.D.,
Mark Kronenfeld, M.D., Darlene Saberito, R.N., Peter Homel, Ph.D., Kack
Choueka, M.D., Vijay Shetty, M.D., Anesthesiology, Maimonides Medical
Center, Brooklyn, NY.
NA Neuroanesthesia
PN Pain Medicine
83
AM A3091
The Effect of Milrinone on the Induced Hypotensive Anesthesia in
Elderly Patients
This study aimed to evaluate the effect of with milrinone on hypotensive
anesthesia compare with other agents. ASA I-II 60-80yrs scheduled for
spine surgery patients were randomized: milrinone(M) group (n=20) sodium
nitroprusside(S) group(n=20) nitroglycerine(N) group(n=20) . After surgical
incision each study drug was infused to maintain mean blood pressure at
approximately 60 mmHg. On initiating surgical filed irrigation the infusion
of study drug was discontinued. Estimated blood loss (cc) was significantly
lower in M group with higher hourly urine output. CO CI rSVO2 MMSE
were significantly higher in M group. Milrinone maintain cardiac output and
cerebral /renal perfusion during effective induced hypotensive anesthesia
in elderly patients compared to other hypotensive angent. Wonjung Hwang
M.D., Eunsung Kim M.D., Seoul St. Mary’s Hospital, Seoul, Republic of
Korea.
AM A3092
Red Blood Cell Transfusion in Octogenarians: Extrapolation or Real
Data?
Many clinical guidelines are based on data that have typically excluded
or have minimal representation of octogenarians. The guidelines may be
extrapolated to elderly patients which may not be applicable. We examined
primary studies on red blood cell transfusion over the past five years and
analyzed the data on age. Of the 81 studies 48% were related to cardiac
surgery of which most had a mean age of 60-69 years. All of the trauma
studies (31%) had a mean age <50 years. This shows that the octogenarian
population is poorly represented in both trauma and cardiac studies. We
recommend that practitioners be aware of this under-representation when
applying RBC transfusion guidelines to octogenarians. Alice Li B.S.,
Shamsuddin Akhtar M.B. B.S., Department of Anesthesiology, Yale
AM A3093
Comparison of Perioperative Symptoms of Depression in Older
Patients
Subjectively reported high symptoms of depression are prevalent in older
patients awaiting surgery and independently predicted the occurrence
of postoperative delirium. Because of the prevalence and prognostic
significance of preoperative depression we aimed to determine if
preoperative depression symptoms persisted after surgery. Gabriela L.
Meckler B.S., Eunjung Lim Ph.D., Laura P. Sands Ph.D., Stacey R.
Newman B.A., Jacqueline M. Leung M.D., Department of Anesthesia and
Perioperative Care, UCSF Medical Center, San Francisco, CA, School of
Nursing and Department of Statistics, Purdue University, West Lafayette,
IN.
AM A3094
Care of Very Elderly Patients: Population Excluded in Studies But
Recommendations Extrapolated
The practice of medicine is now significantly influenced by clinical
guidelines. However many of the primary studies on which the guidelines
are based have excluded elderly and frail patients. We analyzed the
2009 AHA Perioperative Guidelines on beta-blocker therapy to examine
the representation of the elderly in these studies. Sara E. Neves, M.D.,
Kenneth Ike, Shamsuddin Akhtar, M.D., Yale University, New Haven, CT.
AM A3095
Evaluation of Postoperative Cognitive Changes in Older Patients - A
Comparison of Tests and Clinical Implications
Postoperative cognitive decline (POCD) in older patients after surgery is
well documented and has been shown to be associated with long-term
adverse events. Most previous studies did not evaluate the cognitive status
immediately after surgery. This study aims to determine which cognitive test
shows the largest decrement in the early postoperative period in a cohort
of older patients undergoing major noncardiac surgery and the clinical
significance of such decline. Stacey Newman B.A., Eunjung Lim Ph.D.,
Laura Sands Ph.D., Gabriela Meckler B.S., Jacqueline M. Leung M.D.,
Anesthesia & Perioperative Care, University of California, San Francisco,
San Francisco, CA, School of Nursing and Department of Statistics,
Purdue University West Lafayette, IN.
84
AM A3096
Age and Tramadol Administrated for Postoperative Analgesia
Contribute to Postoperative Delirium in Patients Aged Over 60 After
Major Surgery
A total of 732 consented elderly patients aged over 60 scheduled for
selective major surgery were enrolled and evaluated for postoperative delirium
till 7 days post-surgery. PD was observed in 47 (6.5%) of 719 patients
who completed the trial. Age and Tramadol administration were the 2 risk
factors for PD (P<0.05). Xue Tian M.D., Haiyan An M.D., Yi Feng M.D.,
Anesthesiology Department, Peking University People’s Hospital, Peking
University People’s Hospital, Beijing, China.
AM A3097
Global Perfusion Parameters and Postoperative Delirium in Older
Patients Undergoing to Open Colon Surgery
Postoperative delirium (POD) is relevant in older patients. We explored
association between perioperative hemodynamics brain oxigenation and
global perfusion parameters (ScvO2 and Lactate) with POD. Methods:
We enrolled older with elective indication of colon surgery. To traditional
monitoring we added rSO2% ScvO2 and lactate. Delirium was evaluated
with CAM for five days. Results: In 22 patients enrolled only 2 developed
DPO (9.1%). A low postoperative ScvO2 was associated with the presence of
DPO. Eduardo A. Tobar, M.D., Jaime Godoy, M.D., Mario Abedrapo, M.D.,
Jose Luis Llanos, M.D., Critical Care Unit, Medicine Department, Hospital
Clinico Universityersidad de Chile, Santiago de Chile, Chile.
ROOM 104-AREA A
CA A3098
Anesthetic Course of Patients Requiring Mechanical Circulatory
Support for Ventricular Tachycardia Ablation
Ventricular tachycardia (VT) ablation is the only alternative treatment in
advanced heart failure patients resistant to medical therapy or repetitive
defibrillator shocks. Mechanical circulatory support using different devices
has been suggested for providing hemodynamic stability during the VT
ablation procedure. In this case series we report the anesthetic course
of advanced heart failure patients who underwent ventricular tachycardia
ablation with the aid of mechanical circulatory support using three different
devices. Ioanna Apostolidou M.D., Kamini Sundarbose M.D., Mojca R.
Konia M.D., Kenneth K. Liao M.D., Ranjit John M.D., Fei Lu M.D.,
Department of Anesthesiology Department of Surgery, Department of
Cardiology, University of Minnesota Minneapolis MN.
CA A3099
A Retrospective and Preliminary Evaluation of Present Risk Scoring
Models for Acute Kidney Injury After Cardiac Surgery Using Gray Zone
Approach in a Single Center
The authors attempted to evaluate the accuracy of eight pre-existing
prediction models for predicting acute kidney injury after cardiac surgery
using the area under the receiver operating characteristic (ROC) curve and
a gray zone approach in patient who underwent aortic surgery. Of 375
adult aortic surgery patients operated with cardiopulmonary bypass risk
scores of AKCIS Mehta Thakar Brown Aronson Fortescue Rhamanian
and Wijeysundera were calculated respectively. We found that in at least
more than half of patients pre-existing scoring models for postoperative
AKI prediction would be inconclusive. Won Ho Kim, M.D., Jong Hwan Lee,
M.D., Ph.D., Eun Hee Kim, M.D., Gahyun Kim, M.D., Anesthesiology
and Pain Medicine, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Republic of Korea.
CA A3100
Effects of Trendelenburg Position and Intraperitoneal Insufflation on
Hemodynamics
Pneumoperitoneum combined with Trendelenburg position reduces cardiac
output by about 9% due to a reduction of SV with unchanged heart rate
during robotic gynecological surgery. These hemodynamic changes may
become important in patients with borderline cardiac functions. Rainer
Lenhardt, M.D., Sahil Chhabra, M.D., Gary Loyd, M.D., Ozan Akca, M.D.,
Anesthesiology, University of Louisville, Louisville, KY.
NA Neuroanesthesia
PN Pain Medicine
PO13-6B OUTCOMES AND DATABASE RESEARCH: MISCELLANEOUS
Can Photoplethysmography Approximate Simulated Blood Loss During
Lower Body Negative Pressure?
Normalization of the baseline(venous) volume of photoplethysmographto the
AC component (which is proportional to stoke volume) enables assessment
of volume loss. I-Hsun Liang, M.D., Siqin Nie, M.D., Nina Stachenfeld,
Ph.D., Kirk Shelley, M.D., Ph.D., Aymen Alian, M.D., David G. Silverman,
M.D., Anesthesiology, Yale University School of Medicine, New Haven, CT,
Physiology, John B. Pierce Laboratory, Yale University School of Medicine,
New Haven, CT.
CA A3102
Haptoglobin Polymorphism and Postoperative Serum Creatinine Levels
After Coronary Artery Bypass Grafting in Patients with Diabetes
In this prospective observational analysis of diabetic patients who required
coronary bypass surgery the haptoglobin 2-2 phenotype is a predictor of
increased postoperative serum creatinine levels. Thus diabetic patients with
the haptoglobin 2-2 phenotype are at increased risk for post-CABG AKI and
possibly other morbidities. Jacob Raphael M.D., Swapna Thammishetti
M.D., Chenzhuo Feng M.D., Danja Groves M.D., Zhiyi Zuo M.D.,
Anesthesiology, University of Virginia, Charlottesville, VA.
CA A3103
Discrepancy Between ScvO2 and SvO2 is a Reliable Index to Predict
Postoperative Complications in Cardiac Surgery
The discrepancy between ScvO2 and SvO2 (SO2) during cardiac surgery is
an independent risk factor of postoperative complications such as prolonged
ICU stay and ventilation time. We can predict the severity and incidence of
postoperative complications by measuring the value of SO2 during cardiac
surgery. The reliability of SO2 to predict postoperative complications may
be better than that of ScvO2 and SvO2. Koichi Suehiro M.D., Katsuaki
Tanaka M.D., Ph.D., Tadashi Matsuura M.D., Ph.D., Tomoharu Funao
M.D., Ph.D., Tokuhiro Yamada M.D., Ph.D., Takashi Mori M.D., Ph.D.,
Kiyonobu Nishikawa M.D., Ph.D., Department of Anesthesiology, Osaka
City University Graduate School of Medicine, Osaka City, Japan.
CA A3104
Intraoperative Crystalloid Adminstration in Adults: Actual Versus Ideal
Body Weight
Over 25,000 anesthesia records were analysed to see whether crystalloid
fluids were given according to actual or ideal weight. Some groups of patients
were systematically given either too much or too little fluid. BMI and ideal
weight should probably be considered for crystalloid dosing and extremes of
size should prompt care with intravenous fluid administration. Jack O. Wasey
B.M. B.Ch., Richard J. Rivers M.D., Sharon L. Paul M.S. Steven M.
Frank M.D., Department of Anesthesiology and Critical Care Medicine,
The Johns Hopkins Medical Institutions, Baltimore, MD.
CA A3105
Hemodynamic Indexes Related With Intraoperative Onset of Atrial
Fibrillation Under Thoracoscopic Esophagectomy
We investigated whether hemodynamic changes including Pulse
pressure (PP) were related with intraoperative onset of atrial fibrillation in
thoracoscopic esophagectomy. 27 cases were identified between October
2007 and September 2012. 81 patients were selected as control group
matched with age and sex. Preoperative patient characteristics did not
show significant difference between groups other than CRP. On multivariate
logistic analysis mean blood pressure after induction PP at intubation and
heart rate after start of procedure were independent risk factors associated
with the occurrence of AF. Tokuhiro Yamada M.D., Koichi Suehiro M.D.,
Kiyonobu Nishikawa M.D., Anesthesiology, Osaka City University
Graduate School of Medicine, Osaka, Japan
ROOM 104-AREA C
FA A3106
Impact of Advance Notification to Complete PACU Orders Prior to PACU
AdmissionPostoperative order availability prior to patient admission to the
PACU is ideal but can be inconsistent. We evaluated whether sending a
reminder notification to an attending anesthesiologists or in-room anesthesia
provider to write postoperative orders increased the number of orders
that were written prior to a patient’s arrival in the PACU. The notification
system improved the frequency of postoperative order creation before PACU
admission and may have led to the reduction in total time spent in the PACU.
Jesse M. Ehrenfeld M.D. M.P.H., Merrick Meese M.D., Brian Rothman
M.D., Shane C. Selig, Vanderbilt University, Nashville, TN, University of
Texas at Houston, Houston, TX
MONDAY, OCTOBER 14
CA A3101
FA A3107
Questionnaires Within Electronic Health Records: Goldmine or
Landmine of Data?
While of potential benefit because of the information that they provide
questionnaires can often lead to uncertainty as to the clinical relevance of
the responses. I-Hsun Liang, M.D., Shiveta Cherwoo, M.D., Audrey Senior,
A.P.R.N., Elizabeth Cozza, A.P.R.N., Siqin Nie, M.D., Saeeda Qadri, M.D.,
David G. Silverman, M.D., Anesthesiology, Yale University School of
FA A3108
The Evaluation of Postoperative Visual Dysfunction After Aortic Arch
Surgery With Selective Cerebral Perfusion
This prospective study was designed to investigate postoperative visual
dysfunction (POVD) after aortic arch surgery under selective cerebral
perfusion (SCP) using pre- and postoperative neuro-ophthalmic examination
including funduscopy visual field visual acuity intraocular pressure color
vision and eye movement. As a result the incidence of POVD after aortic
arch surgery under SCP was 27.8% (5 of 18 patients). The present
study verified the presence of the patients with asymptomatic as well as
symptomatic POVD after aortic arch surgery and indicated that its incidence
is relatively high. Hironobu Hayashi M.D., Masahiro Okamoto M.D.,
Toyoaki Matsuura M.D., Satoki Inoue M.D., Masahiko Kawaguchi M.D.,
Anesthesiology, Ophthalmology, Nara Medical University Kashihara,
Nara, Japan.
FA A3109
Sugammadex Has Changed the Amount of Rocuronium Used and
Criteria for Administration of Antagonists of Neuromuscular Blocking
Agents
We investigated whether sugammadex changed the amount of rocuronium
used during anesthesia and the criteria for administration of antagonists of
neuromuscular blocking agents (NMBAs). Our study revealed that the use
of sugammadex has resulted in an increase in the amount of rocuronium
used and in earlier timing of administration of the NMBA antagonist. Tomoya
Koizumi M.D., Naoyuki Hirata M.D., Daisuke Maruyama M.D., Michiaki
Yamakage M.D., Ph.D., Anesthesiology, Sapporo Medical University,
Sapporo, Japan.
FA A3110
Validation and Results of An Inpatient Survey of Patient Satisfaction
With the Day of Surgery Experience Administered During their
Hospital Stay
A patient questionnaire was created and validated for use for assessment
of the day of surgery patient experience in inpatients. It is administered
within 48 hours prior to discharge and is valid in both a written or verballydelivered format. Six months of quantitative data will be presented to
demonstrate the questionnaire’s value in focusing quality improvement
efforts. Douglas G. Merrill M.D., Jessica M. Seaver B.S., Cantwell
Clark M.D., Kristin E. Charette B.A., Andreas H. Taenzer M.D., Giridhar
Venkatraman M.D., Laurie B. Heels M.S.N., The Center for Perioperative
Services, Anesthesiology, Surgery, Darmouth-Hitchcock Medical Center,
Lebanon, NH
NA Neuroanesthesia
PN Pain Medicine
85
FA A3111
Prevalence and Prognostic Value of Early Repolarization in Patients
Undergoing Anesthetic Management
Early repolarization is not rare in patients undergoing a non-cardiac operation
and this pattern was more prevalent in male population. Patients with this
pattern in preoperative ECG have a higher risk of newly observed cardiac
events including arrhythmias and structural heart and coronary disease within
one year although this condition was not associated with an increased risk
of death from any cause or from cardiac causes. Chiho Ota M.D., Yukio
Hayashi M.D., Shinnosuke Shiono M.D., Osamu Uchida M.D., Satoko
Kinouchi M.D., Yuji Fujino M.D., Osaka University Graduate School of
Medicine, Suita, Japan.
FA A3112
Functional Decline in Elderly Patients After Orthopedic Surgery: A
Prospective Observational Study
Hospitalization and perioperative period in the elderly are associated with
functional losses. We intended to assess functional outcome of elderly
patients submitted to orthopedic surgery and find risk factors associated with
functional decline. Previous dependence non-elective surgery and length of
hospitalization were independent significant risk factors for functional decline
in elderly. A decrease in functional status was frequent in elderly after surgery
at discharge but most patients had recovered 3 months after discharge.
Care planning should be carefully done to prevent functional decline after
orthopedic surgery. Ines Tellechea M.D., Ricardo Pereira M.D., Diana
Henriques M.D., Rita Santa-Barbara M.D., Celine Marques M.D., Joana
Alves M.D., Emanuel Almeida M.D., Marlene Monteiro M.D., Alexandra
Resende M.D., Anesthesiology, Santa Maria University Hospital, Lisbon,
Portugal.
FA A3113
A Comparison of Observational Scales to Assess Pain and Emergence
Delirium in Children in Recovery
Eye contact and Awareness common criteria in observational scales
assessing pain or Emergence delirium are relevant for ED.
Pablo M. Ingelmo M.D., Marta Somaini M.D., Chiara Marzorati
M.D., Rosa Lucia Pinciroli M.D., Emre Sahillioglu M.D., Marinella
Astuto M.D., Thomas Engelhardt M.D., Ph.D., McGill University Health
Centre, Montreal Children Hospital, Montreal, Canada, Department of
Experimental Medicine Milan Bicocca University San Gerardo Hospital
Monza, Monz,a Italy, Department of Anesthesia Ospedale Civile di
Legnano Italy, Legnano, Italy, Department of Anesthesia and Intensive
Care, Kozyatagi Acibadem Hospital, Istanbul, Turkey, Department of
Anesthesia, Policlinico Universityersitario, Catania, Italy, Department
of Anaesthesiology, Royal Aberdeen Children’s Hospital Aberdeen,
Aberdeen, United Kingdom.
PD A3116
Comparison of the Laryngoscopy View Using Miller and Macintosh
Laryngoscopy Blades in Children Under 2-Years of Age
Although Miller blades are the standard for laryngoscopy in neonates and
infants their use is not evidence-based. We sought to compare the glottic
view using a Miller blade to lift the epiglottis with the view using a Macintosh
blade not lifting the epiglottis in children under 2 years of age. The results
of this registered on-going study will be presented at the ASA as an interim
analysis was not planned for this study. Yuvesh Passi M.D., Madhankumar
Sathyamoorthy M.D., Jerrold Lerman M.D., Christopher Heard M.D.,
Michael Marino M.D., Anesthesia Women and Children’s Hospital of
Buffalo, Buffalo, NY, Pediatric Anesthesia, University of Mississippi
Medical Center, Jackson, MS.
Difficult Intubation and Related Complications in Obese Patients in
Perioperative Medicine
In obese patients, severe life-threatening complications related to intubation
where increased in intensive care unit (ICU) in comparison to operative room
(OR). Moreover these complications were more frequent in case of difficult
intubation in ICU but not in OR and incidence of difficult intubation was twice
higher in ICU. Besides in obese patients difficult intubation devices were
more used in case of difficult intubation in OR than in ICU. Further studies
are required to determine if a better management of intubation in ICU could
reduce life-threatening complications related to intubation in obese patients.
Daniel Verzilli Sr. M.D., Audrey De Jong Jr. Nicolas Molinari Ph.D.,
Boris Jung M.D., Ph.D., Gerald Chanques M.D., Yvan Pouzeratte M.D.,
Samir Jaber M.D., Ph.D., Saint Eloi University Hospital, Montpellier,
France.
PD A3117
PO15-2BPEDIATRIC ANESTHESIA: GENERAL PEDIATRICS
PD A3118
ROOM 104-AREA E
PD A3114
Efficacy of Single-Shot Dexmedetomidine Versus Placebo in Preventing
Pediatric Emergence Delirium in Strabismus Surgery
The goal of this study is to determine whether a small dose of
dexmedetomidine given after induction will attenuate the rate of emergence
delerium after strabismus surgery in healthy pediatric patients aged one
through seven years-old. The presence of ED is determined by use of the
post-anesthetic emergence delerium scale. Secondary outcome measures
such as total narcotic use presence of airway events postoperative nausea
and vomiting and time to discharge from the PACU are also evaluated.
Jason Brown M.D., Cynthia Feng M.D., Annelise Von Bergen Granell
B.S., Mark Steele M.D., Gordana Stjepanovic M.D., Jung Kim M.D.,
Anesthesiology, New York University, New York, NY.
86
PD A3115
Heart Rate Changes In Children During a Sevoflurane Induction are
Age Dependent
In children <7 years undergoing an inhalation induction with 8% sevoflurane
in 70% nitrous oxide HR rises peaks and then declines toward baseline by
3 minutes. When analyzed by age younger children (<24 months) peak and
experience a 10% decline earlier than older children while older children
(>48 months) had the greatest percent increase in HR. Understanding
and recognizing HR changes during sevoflurane induction are important if
HR is used as an indicator of anesthetic depth. This might occur during I.V.
placement airway manipulation with an oral or nasal airway, or if an LMA is
placed prior to I.V. insertion. Donald A. Schwartz, M.D., Annemarie Begley,
R.N., Charles Gibson, R.N., Paul Visintainer, Ph.D., Neil R. Connelly, M.D.,
Department of Anesthesiology, Baystate Medical Center, Springfield MA.
Effects of Dexmedetomidine Hydrochloride on Crying and Pain Relief in
Postoperative Pediatric Moyamoya Disease
We investigated the effectiveness of DEX in postoperative care of patients
with pediatric moyamoya disease. Significantly lower in the DEX group were
the number of uses of analgesic drugs occurrences of crying and vomiting.
Use of DEX to avoid excitement and nausea associated with arousal from
anesthesia crying due to mental stress and rapid collapse of cerebral
circulation due to postoperative pain suggests that safe sedation and
analgesia management. Yoshinori Tanigawa M.D., Akira Nakagawachi
M.D., Tomoko Yamada M.D., Kouichi Matumoto M.D., Yoshiro
Sakaguchi Ph.D., Department of Anesthesiology and Critical Care
Medicine, Faculty of Medicine, Saga University Hospital, Saga City,
Japan.
PD A3119
Reviewing Demographics of Unplanned Admissions of the Pediatric
Surgical Outpatient From 2011-2012 at Children’s Hospital
Cost containment is an important driving force in increasing number if
ambulatory surgeries performed in children. It is important to analyze the
incidence and demographics of unanticipated admissions. We found that ENT
surgeries (37.5%) and respiratory post-operative concerns were the largest
percent of unanticipated admissions. Arlyne Thung M.D., Vidya T. Raman
M.D., Thomas Taghon M.D., Veronica Miler M.D., Joseph D. Tobias
M.D., Department of Anesthesiology and Pain Medicine, Nationwide
Children’s Hospital Columbus, OH.
NA Neuroanesthesia
PN Pain Medicine
Shape of Pediatric Airway - Cone or Cylinder What is the Reality?
The shape of the airway in young children is more suggestive of a transitional
change between the vocal cords and trachea. Our observations demonstrate
that the antero-posterior dimensions change from an oval to a round rather
than conical shape. This more rounded shape is confirmed by the presence
of constant cross sectional area at the two levels. Tariq Wani M.D.,
Mahmood Rafiq Malik M.D., Joseph D. Tobias M.D., Bruno Bissonette
M.D., Nationwide Childrens Hospital Columbus, OH, Anesthesiology,
King Fahad Medical City, Riyadh, Saudi Arabia.
PD A3121
Optimal Insertion Depth of Central Venous Catheter in Pediatric
Patients
We examined the distance from puncture site to inferior border of clavicle as
anatomic landmarks for determining the optimal depth of CVC in pediatric
population. The optimal insertion depth of CVC showed more correlation
with distance from skin puncture site to the inferior border of clavicle (r =
0.89). The insertion depth could be predicted as the formula: the insertion
depth (cm) = 0.76603 + 1.177 × (the distance from puncture site to
inferior border clavicle)( r2 = 0.79 P < 0.0001). Jun Yoshino M.D., Ph.D.,
Mariko Tanaka M.D., Naomitsu Murayama M.D., Sho Kawasaki M.D.,
Chiaki Kato M.D., Reiko Makizono M.D., Department of Anesthesia, St.
Mary’s Hospital, Fukuoka, Japan.
PO16-6BREGIONAL ANESTHESIA AND ACUTE PAIN
ROOM 104-AREA D
RA A3125
Prospective Randomized Evaluation of the Changes in Regional
Hemodynamic Parameters in the Ipsilateral Brachial Artery After a
Supraclavicular Versus an Axillary Brachial Plexus Block
Supraclavicular brachial plexus block induces greater changes in regional
hemodynamic parameters in the ipsilateral brachial artery than an axillary
brachial plexus block. Jiawei LI Ph.D., Manoj Kumar Karmakar M.D.,
Winnie Samy M.Sc., Wing Hong Kwok FANZCA, Pawinee Pangthipampai
M.D., Department of Anesthesia and Intensive Care, The Chinese
University of Hong Kong, Hong Kong, Department of Anaesthesia and
Intensive Care.
MONDAY, OCTOBER 14
PD A3120
RA A3126
Accuracy In Identifying The Spinous Interspace Level During Lumbar
Puncture: An Assessment Of Correlated Factors
This study evaluated the accuracy of anesthesiologists’ spinous process
interspace identification and assessed some correlated factors contributing
to the inaccuracy. The overall accuracy of determining the actual
intervertebral level among all anesthesiologists was 55.8%. Patients with
larger abdominal circumference higher body mass index and older age were
more likely to have their lumbar vertebral level be identified lower than the
actual level. Accuracy in identifying the proper intervertebral level was not
related to anesthesiologists’ years of experience. Nan Lin M.D., John F.
Bebawy M.D., Jia Dong M.D., Lin Hua Ph.D., Anesthesiology, Beijing
Tiantan Hospital, Beijing, China, Northwestern University Feinberg School
of Medicine, Chicago, IL, BioMedical Engineering Institute of Capital
Medical University, Beijing, China.
RA A3127
RA A3122
Coagulopathy and Epidural Analgesia for Major Hepatic Resection
Epidural catheter placement is a well-known analgesic adjunct for patients
undergoing abdominal surgical procedures. We examined the frequency of
epidural catheter placement in patients undergoing laparotomy for major
hepatic resection the patterns of postoperative coagulopathic changes and
the incidence of neurologic injury associated with epidural use in these
patients. Kelly G. Elterman M.D., Zhiling Xiong M.D., Ph.D., Department
of Anesthesiology, Perioperative and Pain Medicine Brigham and
Women’s Hospital Boston, MA.
RA A3123
Super-Selective Scalp Block During Prolonged Awake Craniotomies:
Effective Duration Patient Comfort and Clinical Value
Scalp block using the infiltration technique has been used for years in
awake brain surgeries. The limitation of this technique is a short 4-6
hours duration. We have developed a new technique of the super-selective
scalp block and evaluated its effectiveness in patients undergoing awake
craniotomies lasting more than ten hours. The super-selective scalp block
offers significantly more extended duration of scalp analgesia. David Z.
Ferson M.D., Elbert Chang B.A., Andrew Dinh B.A., Linh Nguyen
M.D., Anh-Thuy Nguyen M.D., Radha Arunukumar M.D., Frederick Lang
M.D., Linda Chi M.D., MD Anderson Cancer Center, Houston, TX.
RA A3124
Ultrasound Guided Regional Anesthesia Technique for Pain
Management in Transcatheter Aortic Valve Implantation: A Preliminary
Report
This retrospective case series illustrates that both TAP blocks for transfemoral
and paravertebral blocks for transapical are viable methods for pain control
after TAVI. Patients that underwent transapical approaches seemed to
have increased pain with movement when compared to the transfemoral
approach.Jacob L. Hutchins M.D., Tenzin Desa M.D., Suriyamurthy
Pillai M.D., Katherine Vo R.N., Mojca Remskar Konia M.D., Ioanna
Apostolidou M.D., Anesthesia University of Minnesota, Minneapolis
MN.
Postoperative Recovery Following Total Knee Arthroplasty: Effects of
Combined Analgesia
We retrospectively investigated sciatic nerve block (Group S) and intravenous
patient-controlled analgesia (Group P) in order to determine the effects of
combined analgesic methods on recovery following total knee arthroplasty.
Breakfast consumption was significantly higher in Group S compared to
Group P while the day walking was resumed was significantly earlier in
Group S compared to Group P.FNB+SNB was considered an effective
postoperative analgesic method for TKA because it promotes early recovery.
Yoshiko Onodera M.D., Megumi Matsumoto M.D., Takafumi Iida M.D.,
Keiya Takahashi M.D., Shigeaki Otomo M.D., Tomoki Sasakawa M.D.,
Takayuki Kunisawa M.D., Ph.D., Keiko Mamiya M.D., Ph.D., Osamu
Takahata M.D., Ph.D., Hiroshi Iwasaki M.D., Ph.D., Anesthesiology,
Asahikawa City Hospital, Asahikawa, Japan.
RA A3128
Retrospective Review of Duration of Single Shot Popliteal Sciatic
Nerve Blocks for Foot and Ankle Surgery
Real time ultrasound guidance for popliteal sciatic block is considered to be
a successful technique for providing anesthesia/analgesia for foot and ankle
surgery. Ultrasound guided single shot popliteal sciatic blocks are routinely
performed on patients undergoing ankle and foot surgery. The purpose of
this study was to retrospectively determine whether a higher volume or
concentration of local anesthetic affected duration of single shot popliteal
sciatic nerve block performed by regional anesthesiologists. Joanna D.
Thomas M.D., Jinlei Li M.D., Feng Dai Ph.D., Richa Wardhan M.D.,
Elissa Mastrangelo R.N., Anesthesiology, Yale University, School of
RA A3129
Thoracic Epidural Analgesia for Pectus Excavatum Repair Procedures:
Outcomes Review
Thoracic epidural analgesia (EPI) is one of the most helpful technique
to control pain after minimally invasive pectus excavatum repair (Nuss
procedure). A recent study shows more advantages with PCA than EPI. We
have reviewed the records of 122 patients and our results show that EPI is
effective and safe. Luigi Viola M.D., Jagroop Mavi M.D., Andrew
Costandi M.D., Michael Baker M.D., Senthilkumar Sadhasivam M.D.,
Anesthesia, Cincinnati Children’s Hospital Medical Center, Cincinnati,
OH
NA Neuroanesthesia
PN Pain Medicine
87
PO09-3A EXPERIMENTAL CIRCULATION: CARDIOVASCULAR
PATHOPHYSIOLOGY
ROOM 104-AREA A
CA A3130
Induction of MicroRNA 193-3p by 4F Rescues Pre-existing Pulmonary
Hypertension in Hypoxic Mice by Suppressing ALOX5 Lipoxygenase
By inducing microRNA miR-193 4F therapy rescues pre-existing PH in
hypoxic mice possibly by reducing HETEs and HODEs through suppression
of lipoxygenase ALOX5. Salil Sharma Ph.D., Gabe Wong B.S., Mohamad
Navab Ph.D., Srinivasa Reddy Ph.D., Mansoureh Eghbali Ph.D.,
Anesthesiology, University of California Los Angeles, Los Angeles, CA
CA A3131
Evaluation of Proarrhythmic Changes in Experimental Pulmonary
Hypertension
In this study we use telemetered rats to assess ECG and hemodynamic
changes in the monocrotaline (MCT) model of PH. A beat-to-beat approach
is utilized to evaluate ventricular dispersion as that may be indicative of the
underlying electrophysiological mechanisms that may render the myocardium
to reentrant circuits a factor in arrhythmogenesis. Ray Chui, M.S., Gabriel
Wong, B.S., Hrayr S. Karagueuzian, Ph.D., Mansoureh Eghbali, Ph.D.,
CA A3132
The Lipoxygenase Inhibitor Nordihydroguaiaretic Acid Prevents
Human Pulmonary Artery Smooth Muscle Cell Proliferation Induced by
Oxidized Fatty Acids
Oxidized fatty acids stimulate smooth muscle cell proliferation and their
accumulation might play a role in the development of PH. The oxidized fatty
acid inhibitor NDGA fully prevents cell proliferation. Andrea Iorga, B.Sc.,
Gabriel Wong, B.A., Salil Sharma, Ph.D., Harnek Singh, B.Sc., Mansoureh
Eghbali, Ph.D., University of California Los Angeles, Los Angeles, CA.
CA A3133
Nitrite Attenuates Sepsis-Induced Cardiac Dysfunction in Acute Severe
Septic Rats
We investigated the effects of nitrite on sepsis-induced cardiac dysfunction.
In an isolated heart experiment LVDP was decreased in septic rats compared
to that in control rats. Administration of 1 mg/kg of nitrite improved LVDP
in septic rats. Our results suggest that 1 mg/kg nitrite can preserve cardiac
function in acute severe septic rats. Ryouichi Kawaguchi M.D., Naoyuki
Hirata M.D., Ryo Miyashita M.D., Daisuke Maruyama M.D., Michiaki
Yamakage M.D., Ph.D., Department of Anesthesiology, Sapporo Medical
University School of Medicine, Sapporo, Japan.
CA A3134
Thromboxane A2 Receptor Forms Complexes With Endoplasmic
Reticulum Membrane Proteins
LC/MS/MS analysis identified endoplasmic reticulum membrane-spanning
proteins (a phosphatidylinositide phosphatase, glycosyltransferases and
the calcium ATPase) that form macromolecular complexes with TP. Their
association with TP was confirmed by co-immunoprecipitation experiments.
These proteins may be involved in the regulation of TP cotranslational
modification and trafficking. Min Li, Ph.D., Enrico Stefani, M.D., Ph.D., Ligia
Toro, Ph.D., UCLA, Los Angeles, CA.
CA A3135
Involvement of Phosphatidylinositol 3-Kinase and Akt Signaling in
Myocardial Dysfunction Following Brain Death in Rats
Wortmainnin a potent inhibitor of Phosphatidylinositol 3-kinase
significantly improves myocardial function following brain death in rats.
Thus Phosphatidylinositol 3-kinase and Akt signaling may be involved in the
myocardial dysfunction following brain death. Masanori Sato M.D., Yukio
Hayashi, M.D., Hiroo Yamanaka M.D., Yuka Miyata M.D., Takahiko
Kamibayashi M.D., Yuji Fujino M.D., Department of Anesthesiology and
Intensive Care, Osaka University Graduate School of Medicine, Osaka,
Japan.
88
CA A3136
Serial Changes of the Angiotensin-Converting Enzyme-2 Expression on
the Diabetic Rat Hearts: An Initial Report
ACE2 expression and heart function would have a periodic variation following
the clinical flow of diabetes mellitus in a rat model. Our initial data may be
helpful for developing the research model to evaluate the pathophysiology of
diabetic cardiomyopathy in the future. Younghee SHIN M.D., Jong-Hwan
Lee, M.D., Ph.D., Sangmin M. Lee, M.D., Ph.D., Hyun-Sung Cho M.D.,
Ph.D., Chung Su Kim M.D., Ph.D., Won Ho Kim M.D., Seung Hyeon
Lee M.D., Department of Anesthesiology and Pain Medicine, Samsung
Medical Cente, Seoul, Republic of Korea.
PO12-2A OBSTETRIC ANESTHESIA: GLOBAL HEALTH COMORBIDITIES
MISCELLANEOUS
ROOM 104-AREA B
OB A3137
An Impact Study of No Pain Labor and Delivery on Labor Analgesia
Rate and Obstetric Outcomes in a Chinese Academic Center
Our findings suggest that No Pain Labor N’ Delivery - Global Health Initiative
has changed obstetric practice with improvements in labor and delivery
outcomes. The outcomes were sustained for at least one year. Ling Qun
Hu M.D., Mingpin Hu M.D., Qingquan Lian M.D., Ph.D., Cynthia A.
Wong M.D., Yuhuan Wang M.D., Wenguang Huang M.D., Robert
McCarthy Pharm.D, Jeffry Chen M.D., Yimei Li B.S., Anesthesiology,
Northwestern University Feinberg School of Medicine, Chicago, IL,
Anesthesiology, The Second Hospital of Wenzhou Medical College
Wenzhou, China, Obstetrics and Gynecology The Second Hospital of
Wenzhou Medical College Wenzhou, China, Labor and Delivery Suite The
Second Hospital of Wenzhou Medical College Wenzhou, China.
OB A3138
A Modified Delphi Method to Create a Scoring System for Performance
in Maternal Cardiac Arrest Studies have found clinicians to be poor at resuscitating pregnant patients.
Beyond the American Heart Association guidelines no accepted tool exists to
assess the performance of practitioners managing these patients. Therefore
the authors used a modified Delphi method to capture expert judgment to
create a checklist of tasks practitioners should perform during the first five
minutes of a maternal cardiac arrest. This new weighted scoring system
may have applications for education and research of the management of a
maternal cardiac arrest. Jennifer Banayan M.D., Barbara Scavone M.D.,
Angela Blood M.P.H., Yoon Soo Park Ph.D., Department of Anesthesia
and Critical Care, University of Chicago, Chicago, IL, Simulation Center
University of Chicago, Chicago, IL, University of Illinois Chicago, Chicago,
IL.
OB A3139
Epidural-PCA Ropivacaine 0.1% for Labor Pain: Does the Addition of
Epidural Fentanyl and/or Epinephrine Improve Analgesia?
We determined whether adding of fentanyl (F) 4 mcg/ml &; epinephrine (E)
2 mcg/ml to epid ropivacaine (R) 0.1% can improve analgesia with minimal
side effects. The addition of F and E to epidural R for labor pain provided
adequate analgesia with minimal motor block and minimal need for boluses
of the study solution of R 0.25%. The addition of F to epidural R for labor
pain is preferred over the addition of E. Shaul Cohen, M.D., Dora Zuker,
M.D., Shruti Shah, M.D., Adil Mohiuddin, M.D., Renu Chhokra, M.D.,
Scott Mellender, M.D., Pavel Shapiro, B.S., Safa Shaikh, B.A., Achillina
Rianto, B.S., Christine W. Hunter, M.D., Anesthesiology, UMDNJ-Robert
Wood Johnson University Hospital, Rutgers University, New Brunswick NJ.
OB A3140
Is the Dose of Oxytocin Pre-Delivery Associated With More Epidural
Drug Consumption?
Is the use of pre-delivery oxytocin for labor augmentation associated with a
higher analgesic requirements. Calculation of the area under the curve for
pre-delivery oxytocin usage for labor augmentation was compared to epidural
drug consumption. Andrew W. Geller M.D., Audrey Yen M.D., Eddie Teng
M.D., Cathy Cha M.D., Kimberly Gregory M.D., Mark Zakowski M.D.,
Anesthesiology, OB/GYN, Cedars Sinai Medical Center, Los Angeles, CA.
NA Neuroanesthesia
PN Pain Medicine
Impact of Neuraxial Labor Analgesia on Newborn Safety Markers:
A Report From No Pain Labor in Delivery in China
Our data suggests that the implementation of neuraxial analgesia in the
first stage of labor in this Chinese academic medical center is safe to
newborns based on 15 415 deliveries in the study period. Ling Qun Hu
M.D., Qingquan Lian M.D., Ph.D., Mingpin Hu M.D., M.S., Weike
Tao M.D., Yuhuan Wang M.D., Yimei Li B.Sc., Tony Chang M.D.,
Wenguang Huang M.D., Pamela D. Flood M.D. M.P.H., Department
of Anesthesiology, Chicago, IL, Anesthesiology, The Second Hospital
of Wenzhou Medical College, Wenzhou, China, Anesthesiology and
Pain Management, University of Texas Southwestern Medical Center,
Dallas TX, Obstetrics and Gynecology The Second Hospital of Wenzhou
Medical College, Wenzhou, China, Labor and Delivery Suit, The Second
Hospital of Wenzhou Medical College, Wenzhou, China, Anesthesia
and Perioperative Care, University of California at San Francisco, San
Francisco, CA.
OB A3142
Postoperative Atrial Fibrillation After Cesarean Delivery
Atrial fibrillation is one of the most common arrhythmias and a serious
problem postoperatively causing increased length of hospitalization cost
and increased morbidity. Postoperative atrial fibrillation exists as a rare
complication in cesarean patients with an incidence of 0.04%. Occurrence
of atrial fibrillation after cesarean delivery increased length of hospital stay
and utilization of resources. Arun Kalava M.D., Kate Mignosi Student,
Joel M. Yarmush M.D., Joseph SchianodiCola M.D., Jonathan Wienberg
M.D., Anesthesiology, New York Methodist Hospital ,Brooklyn, NY, St
George’s University School of Medicine, NY.
OB A3143
Obstetrical Anesthesia in French Guyana: Current situation and Future
in oversea french territory obstetrical anesthesia is quite the same than in
french territory except for epidural analgesia that is quite lower (15 vs 86%).
Ethnic characteristic of the population seems to be the main factor to be
considered. Bruno Marciniak M.D., Anne-Christele Dzierzek M.D., CHRU,
Lille, France, CHRU, Cayenne, French Guiana.
OB A3144
Value of Ultrasound Assessment of Epidural Space in Obstetric
Patients
This study prospective and randomized showed that preview US before
epidural anesthesia is associated with a decrease in anesthetic complications
in 706 pregnant women. Anne-Laure Saint-Pol M.D., Brice Richez
M.D., Benjamin Julliac M.D., Alexis Soulard M.D., Laurence Saltel
M.D., Francois Sztark M.D., Ph.D., Department of Anesthesiology and
Intensive Care, University Hospital, Bordeaux, France.
ROOM 104-AREA D
PI A3145
Pilot Study Measuring Patient Satisfaction With Anaesthesia in a U.K.
University Hospital: Feasibility and Initial Results
Assessing patient satisfaction with anaesthesia using psychometrically
developed & validated questionnaires can help to ensure high quality care
and benchmarking of standards. Sarah Barnett M.B. B.S., Alexander
Crean M.B. B.Ch., Duncan Wagstaff M.B. B.Ch., Muhammad Awal M.B.
B.S., Mark Lambert M.B. B.S., Jamie Smart M.B. Ch.B., Suneetha R.
Moonesinghe M.B. B.S., UCL/UCLH Surgical Outcome Research Centre
(SOuRCe) Department of Applied Health Research, University College
London Hospitals, NHS Foundation Trust, London, United Kingdom
PI A3146
Assessing the Communication Interruptions and Distractions
Experienced by an Anesthesia Clinical Director
In determining whether or not an Anesthesia Clinical Director has distractionfree time to provide primary patient care as well as provide operating
room supervision we sought out to assess the amount of mobile phone
interruptions experienced by a Clinical Director and to compare the results to
the amount of mobile phone interruptions experienced by another anesthesia
management position such as the PACU resident. Our results indicated the
Clinical Director experiences far more and longer phone calls as well as far
more texts each day throughout a five-month period than the PACU resident.
The incessant amount of mobile phone interruptions seen here is an evident
impediment to a Clinical Director’s ability to provide direct patient care.
Thomas E. Schulte M.D., Benjamen M. Jones B.A., Ellen K. Roberts,
M.D., Kristina S. Birch, M.D., Anesthesiology Department, University of
Nebraska Medical Center, Omaha, NE.
MONDAY, OCTOBER 14
OB A3141
PI A3147
The Impact of Electronic Distraction in the Operating Room: A Survey
of Members of the American Association of Clinical Directors
Distractions are ominous in the operating room (OR) where clinical vigilance
is paramount to patient safety and care. They affect the entire team and may
have catastrophic consequences during the critical phases of anesthesia
and surgery. Research has demonstrated that electronic devices have
increased road accidents and caused near-misses in the aviation industry.
The full impact of electronic devices on patient safety and quality of care in
the OR is as yet unknown. The purpose of this survey was threefold: (1) To
determine the extent of distractions in the OR environment; (2) To determine
the existence of policies relating to electronic devices; and (3) To identify
the likelihood of adverse outcomes related to electronic devices.
Marcin K. Karcz M.D., M.S., Shane K. Lee M.D., Ashwani K. Chhibber
M.D., Michael P. Eaton M.D., Peter J. Papadakos M.D., Department of
Anesthesiology, University of Rochester, Rochester, NY.
PI A3148
Variability Analysis of Surgical Case Length to Guide Perioperative
Patient Flow Quality Improvement Initiatives
Lack of predictability in the Elective Operating Room Schedule is a source
of patient and provider dissatisfaction and increased cost. We performed
a variability analysis of surgical case length to guide Perioperative patient
flow quality improvement initiatives. We focused on patients scheduled for a
Carotid End Arterectomy and looked at the variance in surgical case duration
(booked vs. actual) by surgeon and by campus and the time interval between
start of anesthesia and start of surgery. There is significant inter-campus and
inter- provider variability of practice. There is an opportunity to standardize
processes to improve the predictability of the elective OR Schedule.
Shubjeet Kaur, M.D., Matthias Walz M.D., Makism Zayaruzny, M.D.,
Christain Mueller, M.D., Anesthesiology, UMass Memorial Medical Center,
Worcester, MA.
PI A3149
A Survey OF 5 000 Active ASA Members On The Subject Of Bullying
And Aggressive Behavior: Anesthesiologists Working In Places With an
Anti-Bullying Policy In Place Are Less Likely To have Been Bullied In
This is an ongoing multiphase study to make anesthesia community aware
of a bullying and aggressive behavior problem and to develop measures and
comprehensive policies to prevent bullying. There is a statistically significant
association between being bullied by an anesthesia provider and having a
bullying policy in the workplace (p=.04). Those working in environments
with an anti-bullying policy in place are less likely to have been bullied by an
anesthesia provider in the last 2 years (odds ratio=0.67; 95% confidence
interval=0.45 0.98). Sergey Pisklakov M.D., Cathy Schoenberg B.S.,
Andrea Marcus M.P.H., Melissa L. Davidson M.D., Anesthesiology,
New Jersey School of Medicine Department of Anesthesai, Newark
NJ, Anesthesiology, UMDNJ - New Jersey Medical School Newark NJ,
Epidemiology UMDNJ - New Jersey Medical School Newark, NJ.
NA Neuroanesthesia
PN Pain Medicine
89
PI A3150
The Lap-Chole Dance: A System-Wide Campaign to Decrease LOS for
Laparoscopic Cholecystectomy in a Large HMO
Goal directed behavior change can be achieved through increased education
and collaboration among the team players which is applicable to all hospitals
and surgical centers. Chunyuan Qiu M.D., Vu T. Nguyen M.D., Narendra
S. Trivedi M.D., Renato V. Etrata M.D., Preeti P. Shah M.D., Diana C.
LaPlace M.D., Jessica Y. Qiu Student, Celin H. Jo Student, Chandra
D. Heyman M.B.A., Maria T. Enciso B.S.N., Anesthesiology, Kaiser
Permanente, Baldwin Park, CA.
PI A3151
Contextual Inquiry to Support the Design of Electronic Health Records
The goal of our research is to develop principles for the design of electronic
health records that will better support clinicians in their work through the
application of contextual design methods. We recorded providers’ information
use activities during actual patient care followed by retrospective verbal
protocol interviews. Transcripts were coded and analyzed to identify emerging
themes that may be useful for generating design principles. Noa Segall
Ph.D., Sherry Dunbar M.S., Eugene W. Moretti M.D., Rebecca A.
Schroeder M.D., Jeffrey M. Taekman M.D., Melanie C. Wright Ph.D.,
Duke University, Medical Center, Durham, NC, Saint Alphonsus Health
System and Trinity Health, Boise ID, Durham VA Medical Center,
Durham, NC.
PI A3152
Current Adoption of Anesthesia Information Management Systems by
Academic Anesthesia Departments in the United States
In this study we surveyed all hospitals with an anesthesia residency program
to examine the current and historical trends of AIMS deployment in US
academic practices. Surveys were completed by 92% of the residency
programs and results were compared with trends identified in a 2007 survey
of AIMS use in academic hospitals. Our findings indicate that following a
prolonged period of stagnancy acceleration in deployment of AIMS began
in 2003 and has risen nearly exponentially since that time; results further
suggest that nearly 70% of academic hospitals will have an AIMS in place by
the end of 2014. Ilana S. Stol B.A., Richard H. Epstein M.D., Jesse M.
Ehrenfeld M.D. M.P.H., Department of Anesthesia, Vanderbilt University
School of Medicine, Nashville, TN, Department of Anesthesia, Jefferson
Medical College, Philadelphia, PA
ROOM 104-AREA E
RA A3153
The Effect of Nitrous Oxide Anesthesia on Early Postsurgical Opioid
Consumption and Pain
This retrospective study of a non-cardiac mixed surgical population showed
no difference in early postoperative opioid consumption and pain between
patients who received intraoperative nitrous oxide anesthesia (n=353) and
patients who did not (n=89). Andreas Duma M.D., Daniel Helsten M.D.,
Frank Brown B.S. Michael Bottros M.D., Peter Nagele M.D., M.S.,
Department of Anesthesiology, Washington University, St. Louis, MO.
RA A3154
TAP Block in Pediatric Surgery Ultrasound Guidance Versus Anatomic
Technique: Is it All About Precise Localization?
Prospective randomized study. Ultrasound guidance seems to improve
regional anesthesia efficacy. We looked at blind vs. ultrasound guided TAP
block in pediatric surgery under GA. We confirm that ultrasound improves
localization. But does it improve the TAP block efficacy? Marie-Laurence
guye Jr., Jeanne Pinoteau Jr. Nada Sabourdin M.D., Isabelle Murat
M.D., Ph.D., Isabelle Constant M.D., Ph.D., Anesthesiology and
Intensive Care/Burn Unit, University Hospital Armand Trousseau, Paris,
France.
90
RA A3155
Regional Anesthesiology Injection Pressures comparing Skilled
Assistants With SAFIRA in a Simulated Ultrasound Guided Technique
A two phase study in Regional Anesthesiology comparing operating
department practitioners during a simulated ultrasound guided regional
technique recording the pressure of injection and a new prototype injection
pump called the Safe Injection in Regional Anesthesiology pump (SAFIRA)
that limits the pressure of injection to improve safety. Robin Heij M.B.
B.Ch., Emad Eldin M.B. Ch.B., Peter Young M.B. Ch.B., Joseph Carter
M.B. Ch.B., John Gibson M.B. Ch.B., Amr Ali M.B. Ch.B., Monica
Liu M.B. Ch.B., Anaesthesia, Queen Elizabeth Hospital Kings Lynn,
Kings Lynn, United Kingdom, Anaesthesia, Peterborough City Hospital,
Peterborough, United Kingdom
RA A3156
Effect of Intravenous Dexmedetomidine as an Adjuvant to Epidural
Morphine on the Perioperative Analgesic Requirement in Patients
Undergoing Thoracotomy - A Randomized Clinical Trial
The use of dexmedetomidine IV in the intraoperative period with an initial
bolus dose of 0.5 µg/ kg followed by an infusion of 0.4 µg/ kg/hour as an
adjuvant to Epidural morphine was found to decrease the perioperative
morphine requirement in patients undergoing thoracotomy. Dexmedetomidine
also resulted in reducing the isoflurane requirement in the intraoperative
period. At this dexmedetomidine dose the haemodynamic parameters were
maintained in a safe range. Dexmedetomidine can be used as an adjuvant to
opioids in patients undergoing thoracotomy as part of a multimodal analgesic
regimen. Lokesh Kashyap M.D., Ravindran Chandran M.B. B.S., Arvind
Kumar M.S., Ravinder Kumar Batra M.D., Virender Kumar Mohan
M.D., Dilip Shende M.D., Anaesthesia, All India Institute of Medical
Sciences, New Delhi, India.
RA A3157
ADYX-001: A Phase 1 Safety Study of AYX1 an Intrathecally
Administered Transcription Factor Decoy Against EGR1 Intended to
Reduce Acute And Prevent Persistent Postoperative Pain
ADYX-001 was a single center randomized double-blind placebo-controlled
P1 study to evaluate the safety and tolerability of ascending dose levels of a
single intrathecal (IT) injection of AYX1 vs. placebo in 30 healthy adults. AYX1
is a transcription factor decoy drug candidate that mimics the genomic target
binding sequence for EGR1 a key trigger for post-traumatic central neuronal
sensitization. AYX1 demonstrated marked reduction in post-operative
mechanical hypersensitivity in preclinical models with a single preoperative
IT injection. All 30 subjects completed the study without clinically significant
AYX1-related adverse events. Donald C. Manning M.D., Ph.D., Kimberly
Hebert A.A., Scott Harris M.S., William K. Schmidt Ph.D., Julien
Mamet Ph.D., Adynxx Inc., San Francisco, CA, NorthStar Consulting,
Davis, CA.
RA A3158
A Prospective Randomized Controlled Study Comparing 0.5%
Ropivacaine Versus 0.5% Levobupivacaine for UltrasoundGuided Peripheral Nerve Blocks for Anterior Cruciate Ligament
Reconstruction
Ropivacaine and levobupivacaine are two long-acting local anesthetics
available for peripheral nerve blocks but had not yet been compared
regarding the effects on blockade and on postoperative pain after knee
surgery. In this prospective randomized controlled study we compared the
effects of a combination of ultrasound-guided peripheral nerve blocks using
0.5% ropivacaine and 0.5% levobupivacaine in patients undergoing anterior
cruciate ligament reconstruction. We found that levobupivacaine provided
longer sensory blockade of the sciatic nerve and analgesia and lower
postoperative pain scores than ropivacaine. Shinichi Sakura M.D., Akemi
Shido M.D., Minori Wada M.D., Arisa Tomozawa M.D., Yoji Saito M.D.,
Department of Anesthesiology, Shimane University School of Medicine,
Izumo City, Japan.
NA Neuroanesthesia
PN Pain Medicine
Efficacy and Safety of Three Different Approaches for Ultrasound
Guided Femoral Nerve Block for Patients Undergoing Total Knee
Arthroplasty
There have been studies showing the benefit of single-shot femoral nerve
block (SFNB) and continuous femoral nerve block (CFNB) individually
comparing SFNB and CFNB as well as comparing stimulating and nonstimulating catheters in CFNB. However this is the first study comparing all
three techniques in relation to postoperative pain control and rehabilitation.
Preliminary results of this prospective randomized single-blind study on 67
patients showed generally less pain relief in the group with stimulating CFNB.
However this difference was statistically significant only on postoperative
day 3 as compared with SFNB. Antony R. Tharian M.D., Sergio Gonzalez
M.D., Nicholas Niemiec D.O. Siavosh Saatee M.D., Raja Omar M.D.,
Ruben Sauer M.D., Lalida Chupatanakul M.D., Kenneth D. Candido
M.D., Nebojsa N. Knezevic M.D., Ph.D., Anesthesiology, Advocate
Illinois Masonic Medical Center, Chicago, IL.
RA A3160
A Pilot Study to Determine the Efficacy of Intravenous Ibuprofen for
Pain Control Following Arthroscopic Knee Surgery
Currently there are two NSAIDS approved for intravenous use in the
US ibuprofen and ketorolac. Both are used and labeled in part for the
management of moderate to severe pain as adjuncts to opioid analgesics.
The results from this study show that patients that received ibuprofen
compared to those that received ketorolac reported significantly less pain and
required less narcotic prior to discharge and in the 24 hours following surgery
when dosed according to their respective labels. Additionally patients treated
with ibuprofen were less likely to need any narcotic prior to discharge.
Alberto A. Uribe M.D., Fernando Arbona M.D., Eric Lopez B.S. Andrew
Otey B.S. Charles Hamilton M.D., Andrew Roth M.D., John Norton
M.D., Peter DeSocio M.D., Babak Khabiri M.D., Sergio Bergese M.D.,
Anesthesiology, The Ohio State University Wexner Medical Center,
Columbus, OH.
PO17-1A RESPIRATION I
ROOM 104-AREA C
FA A3161
Patient-Ventilator Asynchrony in Pressure Support Ventilation (PSV)
and in a Fully Closed Loop Control Solution (Intellivent) During
Weaning From Mechanical Ventilation
No study has been performed to evaluate patient-ventilator interaction in
Intellivent an automated-mode which adjusts automatically both ventilation1
and oxygenation parameters. We compared the incidence of patientventilator asynchrony in critically ill patients during PSV and Intellivent. There
was no significant difference of total asynchrony index between PSV and
Intellivent. The use of automated mode is probably safe regarding the low
incidence of asynchronies during weaning of mechanical ventilation with
intellivent. Noemie Clavieras M.D., Fabrice Galia Ph.D., Matthieu Conseil
M.D., Yannael Coisel M.D., Samir Jaaber Ph.D., Department of Critical
Care and Anesthesiology, (DAR B) Saint Eloi University Hospital and
Montpellier School of Medicine, Montpellier, France.
FA A3162
The Accuracy of Cricothyroid Membrane Identification by Palpation
We sought to determine the success rate of the ability to correctly palpate
the cricothyroid membrane (CTM) as performed by anesthesia resident and
staff participants. There were an equal number of male/female and nonobese/obese (BMI ≥ 30) supine volunteer subjects with their necks placed
in the neutral position. Ultrasound was used to determine success or failure
of palpation. Twelve subjects were palpated by 61 participants giving a total
of 186 palpations. Success rate (42.5%) of correct identification of the CTM
was slightly higher than reported in the literature (30% or less) but palpation
success rate remains poor at our institution. Factors that contributed to
difficulty included the female population and those with higher BMIs. Austin
Lamb M.D., Jinbin Zhang M.D., Orlando Hung M.D., Bruce Flemming
M.D., Tim Mullen M.D., Mary-Beth Bissell M.Sc. Iain Arseneau B.Sc..
Dalhousie Halifax NS, Canada.
FA A3163
Postoperative Opioids Requirement and Sleep Disordered Breathing
In adult OSA patients 1st 24h opioid requirement was associated with
AHI obstructive apnea index central apnea index mixed apnea index and
respiratory arousal index on postoperative night 1. In non-OSA patient only
central apnea index and mixed apnea index were associated with opioids
requirement. Pu Liao M.D., Sazzadul Islam M.Sc., Frances Chung
M.B. B.S., Anesthesia, Toronto University Health Network, Toronto ON,
Canada.
FA A3164
Disordered Breathing Detected During Ambulatory Surgery Using an
Alar Senor
We hypothesized that nasal pulse oximetry could help discern respiratory
patterns during MAC in spontaneously breathing patients undergoing
ambulatory upper extremity surgery. In these subjects (n=19) we used
the alar pulse oximetry sensor to identify mini-desaturations (n=12 >3%
decrease from baseline) desaturations (n=6 SpO2≤90%) apnea
(n=6) hypopnea (n=11) ataxic breathing (n=7) and airway obstruction
(n=9). The nasal alar sensor may not only be useful to monitor SpO2 and
heart rate but also to provide insight into the presence of apnea and other
abnormal breathing patterns in spontaneously breath patients undergoing
MAC. Timothy Morey M.D., Sean F. Cohen, Mark J. Rice M.D., Donn M.
Dennis M.D., Richard J. Melker M.D., Ph.D., Anesthesiology, University
of Florida, College of Medicine Gainesville, FL, Assurance Biosense Inc.,
Glastonbury, CT.
MONDAY, OCTOBER 14
RA A3159
FA A3165
Doxapram Reduces Alfentanil Plasma Concentrations Associated With
an Increase in Cardiac Output
Doxapram reduces alfentanil plasma concentrations associated with an
increase in cardiac outputDoxapram is known for his positive effect on
respiration but may also have a positive effect on cardiac output. The
influence of doxapram on alfentanil-induced respiratory depression cardiac
output alfentanil pharmacokinetics and alfentanil-induced analgesia were
evaluated in a randomized two-part cross-over placebo-controlled study.
We conclude that doxapram elevates the cardiac output causing the
enhanced hepatic clearance which could explain the decline in alfentanil
concentration and pain control. No effect on respiration was observed.
Margot Roozekrans, M.D., Rutger van der Schrier M.D., Paul
Hoskins B.S., James Mc Cleod M.D., Albert Dahan M.D., Ph.D.,
Anesthesiology, Leiden University Medical Center, Leiden, Netherlands,
Galleon Pharmaceuticals Horsham, PA.
FA A3166
Supraglottic Airway Devices Narrow the Laryngeal Airway
Supraglottic airway devices decrease the glottic aperture angle and the
ProSeal laryngeal mask airway tended to larger decreasing than the i-gel. It is
recommended to consider the possibility of the contribution of these devices
to anatomical change and the increment of laryngeal resistance.
Hisanori Yogo M.D., Shiroh Isono M.D., Ph.D., Anesthesiology,
Tomishiro Central Hospital, Tomigusuku, Japan, Anesthesiology,
Graduate School of Medicine Chiba University, Chiba, Japan.
FA A3167
Comparison of Partial Pressure of End Tidal Carbon Dioxide
during Ventilation With Bag-Mask I-Gel and Endotracheal Tube in
Anesthetized Paralyzed Patients
This randomized cross-over study compared PETCO2 during ventilation
for 3 minutes each with a bag-mask I-gel and endotracheal tube in 200
anesthetized paralyzed ASA grade 1/2 patients using uniform ventilatory
settings. PETCO2 values with ETT and I-gel did not significantly differ but
PETCO2 values with bag-mask were significantly lower than those with
ETT (12.9% lower) and I-gel (11.6% lower). When extrapolated to the
resuscitation scenario the PETCO2 cut-off for effective CPR should thus
be the same with I-gel as advised with ETT (>10 mmHg) but probably >9
mmHg when using bag-mask. Chaitra Kalakrishnan M.B. B.S., Rakesh
Kumar M.D., Munisha Agarwal M.D., Manoj Bhardwaj M.D., Sunil Kumar
M.B. B.S., Neera R. Gupta M.D., Anaesthesiology and Intensive Care,
Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
NA Neuroanesthesia
PN Pain Medicine
91
FA A3168
The Evaluation of the Incidence and Risk Factors of Respiratory
Depression After General Anesthesia
We evaluate the incidence and risk factors of respiratory depression after
general anesthesia. Respiratory depression and desaturation occurred 14%
and 28% respectively after general anesthesia. Univariate logistic regression
indicated that epidual anesthesia intravenous patient-controlled analgesia
and intraoperative amount of fentanyl were significant determinants
associated with respirator depression. Further subgroup analysis would be
required to identify the risk factors of respirator depression. Junji Egawa
M.D., Masahiko Kawaguchi M.D., Hideaki Kawanishi M.Eng. Takashi
Shiota M.Eng. Yuu Tanaka M.D., Satoki Inoue M.D., Hitoshi Furuya
M.D., Nara Medical University, Kashihara, Japan.
PO09-3BEXPERIMENTAL CIRCULATION; CARDIOVASCULAR
PATHOPHYSIOLOGY
MONDAY, OCTOBER 14 | 11:00 A.M.-12:00 P.M.
ROOM 104-AREA A
CA A3169
Antioxidant Effects of Muscle Relaxants (Vecuronium Rocuronium) on
the Rabbit Abdominal Aortic Endothelial Damage Induced by Reactive
Oxygen Species
The degree of smooth muscle relaxation of the Muscle relaxant investigated
using rabbit abdominal aorta ring segment. Muscle relaxants protect against
free radical injury in isolated rabbit abdominal aorta as dose dependent
manner. This protective effect of muscle relaxants is related to superoxide
anion scavenging. Jiseon Jeong M.D., Jungkook Suh M.D., Ph.D.,
Kyunam Kim M.D., Miae Jeong M.D., Ph.D., Dongwon Kim M.D., Ph.D.,
Heejong Lee M.D., Ph.D., Anesthesia and Pain Medicine, Hanyang
University Hospital, Seoul, Republic of Korea.
CA A3170
MiR-98 Plays a Regulatory Role in the Cardiac Vulnerability of
Pregnancy to Ischemia Reperfusion Injury
Pregnancy induced upregulation of miR-98 which plays a role in apoptosis
and possibly cell proliferation may lead to greater cardiac damage to
ischemia reperfusion injury. Jingyuan Li Ph.D., Salil Sharma Ph.D., Andrea
Iorga Ph.D., Mansour Eghbali M.D., Mansoureh Eghbali Ph.D., UCLA,
Los Angeles, CA.
CA A3171
Effects of Milrinone on Gene Expressions Related to Endothelial Cell
Adhesion in Cultured Cardiomyocytes
Milrinone is widely used in managing patients with heart failure. But milrinone
is associated with unfavorable clinical outcome. Our findings indicated
some gene expression changes related to endothelial adhesion induced
by milrinone may be related to this adversaries. Henry Liu M.D., Jiao Liu
M.D., Marilyn M. Li M.D., Mingbing Chen M.D., Juan Tan M.D., Ph.D.,
Santiago Gomez M.D., Michael Yarborough M.D., Sabrina Bent M.D.,
Alan Kaye M.D., Ph.D., Francis A. Rosinia M.D., Anesthesiology, Tulane
University Medical Center New Orleans, LA, Tongji Hospital of Tongji
Medical College, Wuhan, China, LSUHSC-New Orleans, New Orleans,
LA.
CA A3172
Endothelial Function Assessed by Reactive Hyperemia Peripheral
Arterial Tonometry (RH-PAT) During the Perioperative Period of
Propofol-Remifentanil Anesthesia
Vasodilator responses to reactive hyperemia-stimulated NO were impaired
during propofol-remifentanil anesthesia in moderate surgery which were
not recovered to the control level until POD4. Sachi Ohno D.D.S., Atsushi
Kohjitani D.D.S., Teruto Hashiguchi M.D., Ph.D., Masaaki Miyata M.D.,
Ph.D., Hiroshi Hijioka D.D.S., Kazuhide Matsunaga D.D.S., Norifumi
Nakamura D.D.S., Kazuna Sugiyama D.D.S., Dental Anesthesiology,
Laboratory and Vascular Medicine, Cardiovascular Respiratory and
Metabolic Medicine, Oral and Maxillofacial Surgery, Kagoshima University
Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
92
CA A3173
Hepato-Protection by 1 3 Dicarbonyl Compounds: A Study in a Rat
Model of Hepatic Ischemia-Reperfusion Injury
Cellular injury after ischemia re-perfusion is mediated by many reactive
species that are electron acceptors. This study studies the efficacy of 1 3
dicarbonyl enols that are soft nucleophiles in ameliorating the cellular injury
in a rat model of hepatic ischemia-reperfusion. Amaresh Vydyanathan
M.B. B.S., Boleslav Kosharskyy M.D., Richard M. LoPachin Ph.D.,
Anesthesiology and Pain Medicine, Montefiore Medical Center, Bronx,
NY.
CA A3174
Differential Effects of Sevoflurane and Propofol on Electrophysiological
Cardiac System - Study in an Experimental Porcine Model
Sevoflurane vs. propofol depressed sinus and AV node. This effect suggests
that sevoflurane may be more appropriate that propofol in patients with
SVTs. Sevoflurane prolonged the ventricular refractoriness and will most likely
prevent initiation of ventricular tachydysrhythmias than propofol.
Matilde Zaballos Sr. Ph.D., Raul Sevilla M.D., Brezo Del Blanco Ph.D.,
Jorge Gonzalez M.D., Carlos De Diego M.D., Mª Jose Anadon Ph.D.,
Concepcion Jimeno Ph.D., Jesus Almendral Ph.D., Anaesthesia
Hospital Universityersitario Gregorio Maranon, Hospital Infanta Leonor,
Hospital Universityersitario de Getafe, Hospital Torrejon, Complutense
University, Grupo Hospital de Madrid, Madrid, Spain.
PO12-2BOBSTETRIC ANESTHESIA: GLOBAL HEALTH COMORBIDITIES
MISCELLANEOUS
ROOM 104-AREA B
OB A3175
Anesthetic Considerations for Intrapartum Management of Women
With Hypertrophic Cardiomyopathy
A retrospective analysis of medical records of women with HCM who
delivered at Brigham and Women’s Hospital from 1994 through 2013
focused on anesthetic management and complications during labor delivery
and the early postpartum period revealed favorable obstetric and anesthetic
outcomes; there were no maternal or neonatal deaths although the overall
morbidity was close to 30% and the incidence of CHF in the peripartum
period was 15%. Neuraxial anesthesia was safe and well tolerated in
parturients with HCM with no hemodynamic instability related to intrathecal
or epidural administration of local anesthetics. Elena Ashikhmina M.D.,
Ph.D., Michaela K. Farber M.D., M.S., Anesthesiology, Brigham &
Womens Hospital, Boston, MA.
OB A3176
Epidural Blood Patches Do Not Affect the Efficacy of Subsequent
Epidurals
Studies of epidurals after epidural blood patches have showned mixed results
regarding the efficacy of these subsequent epidurals. This study examines
women who have had labor epidurals after previous epidural blood patches
to determine the efficacy of these epidurals. Results indicate that a history
of epidural blood patches does not influence the efficacy of subsequent
epidurals.Beverly P. Chang M.D., Jie Zhou M.D., Anesthesiology,
Brigham and Women’s Hospital, Boston, MA.
OB A3177
Photoplethysmography and Heart Rate Variability for the Prediction of
Preeclampsia
The vascular reactivity changes that pre-date the onset of preeclampsia
can be detected non-invasively with photoplethysmography and heart
rate variability analysis. This may allow prediction of preeclampsia and
enhance prenatal management and preventative therapy research. Tammy
Y. Euliano M.D., Shalom Darmanjian Ph.D., Lauren Silva Student,
Robert Egerman M.D., Anthony R. Gregg M.D., Convergent Engineering,
Obstetrics & Gynecology, University of Florida, Gainesville, FL.
NA Neuroanesthesia
PN Pain Medicine
Anesthetic and Obstetric Outcomes Among the Super Obese
Parturients: A Retrospective Review
Limited data exist regarding the super obese (BMI>50) obstetric population.
We compared super obese (BMI >50) to obese and non obese parturients
in terms of obstetric anesthetic and neonatal outcomes from 20092011. The super obese and obese patients were more likely to undergo
induction of labor less likely to deliver spontaneously and more likely to
undergo a cesarean delivery compared to the non-obese group. Anesthetic
complications were few. Care for these patients although difficult is fraught
with fewer anesthetic complications than would be anticipated. Farhan
Farooqui M.D., Barbara Scavone M.D., Anesthesia and Critical Care,
University of Chicago, Chicago, IL.
OB A3179
Extracellular Fluid Volume Changes With During Cesarean Section
Measured by Segmental Bioelectrical Impedance Can Relate to the
Body Weight Gain During Pregnancy in Pre-Eclampsia
A prospective cohort study using the segmental bioelectrical impedance
method suggested that extracellular fluid volume can relate the body weight
gain during pregnancy in late onset pre-eclampsia. Takahiko Kaneko M.D.,
Nobutaka Kariya M.D., Ayaka Matsuo M.D., Tsuneo Tatara M.D.,
Chikara Tashiro M.D., Munetaka Hirose M.D., Anesthesiology, Hyogo
College of Medicine, Nishinomiya, Japan, Anesthesiology, Sanda City
Hospital, Sanda, Japan.
OB A3180
Spinal Catheters Versus Epidural Catheters for Labor Analgesia
Following Inadvertent Dural Puncture
The prolonged presence of a spinal catheter after inadvertent dural
puncture has been reported to reduce the incidence of postdural puncture
headache (PDPH) and the need for epidural blood patch (EBP). We report
a retrospective series of parturients (n=74) managed with spinal catheters
(n=55) compared with re-sited epidural catheters (n=19) after inadvertent
DP. Failure rate of spinal catheters was higher in our series (14.5%) than
reported in the literature for non-obstetric patients; however failure rates
between spinal catheters and epidural catheters placed after inadvertent
dural puncture were not different in our series. The prolonged presence
of a spinal catheter did not significantly reduce the incidence of PDPH or
EBP placement. Dionne F. Peacher, M.D., Mercy A. Udoji, M.D., Ashraf
S. Habib, M.B., B.Ch.. Anesthesiology, Duke University Medical Center,
Durham, NC.
OB A3181
Patients’ Perspectives on Obstetric Anesthesiology Consultations: A
Preliminary Qualitative Analysis
In this qualitative study we explored patients’ preferences for mode of
obstetrical anesthesia consultation. We compared conventional mode (inperson) to telemedicine (telephone-based or videoconference) consultations.
Patients preferred telemedicine to conventional consultation. Feyce M.
Peralta M.D., Cynthia A. Wong M.D., Enid Montague Ph.D., Thomas
Klumpner M.D., Paloma Toledo M.D. M.P.H., Anesthesiology, General
Internal Medicine and Geriatrics, Northwestern University Feinberg School
of Medicine, Chicago, IL.
OB A3182
Obstetric Admissions to Major Urban Academic Medical Center
Intensive Care Units: A 6-Year Review
Postpartum hemorrhage and cardiac disease were the most common
causes of admission to our institution ICU’s. However in both developed and
developing countries the second most common cause of admission to ICU
was hypertensive disorders of pregnancy. It is possible that in our hospital
the antihypertensive infusions arterial line and central venous monitoring
are done in high risk labor and delivery suite and only women that require
ventilator support or pulmonary artery catheter monitoring are transferred
to the ICU hence we do not see as many ICU admissions with hypertensive
disorders of pregnancy. The admission rate to intensive care may be
reduced by improving medical therapy of cardiac disease and educating
the patients about the risks of pregnancy with congenital heart disease or
cardiomyopathy. Elena Reitman-Ivashkov M.D., Richard Smiley M.D.,
Ph.D., Anesthesiology, Columbia University, New York, NY.
ROOM 104-AREA D
PI A3183
Improving Efficiency in Preoperative Assessment: A Pilot Study on Visit
Times for Preoperative Evaluation
Preoperative clinics are an increasingly common mechanism for optimization
of patients prior to procedures. Efficient visit scheduling avoids extended
waiting times. Predictors of prolonged visit length for preoperative evaluation
are poorly understood. Multivariate logistic regression was used to identify
predictive factors for prolonged visit length. Scheduling models that integrate
such predictors into workflow processes can improve patient care and allow
for more efficient use of resources for the preoperative assessment.
Angela M. Bader M.D., Beverly Chang M.D., Sheila Hassan M.S.N.,
Patricia Kidik M.S.N., Alexander Arriaga M.D., David Hepner M.D.,
Stuart Lipsitz Ph.D., Brian Thomas B.S.N., Brigham and Women’s
Hospital, Boston, MA, Northeastern University, Boston, MA.
MONDAY, OCTOBER 14
OB A3178
PI A3184
Organization and Execution of a Multi-Disciplinary Operating Room Fire
Simulation: Lessons Learned
We report our experience in the organization and execution of a multidisciplinary operating room (OR) fire simulation. Ten simultaneous fire
simulations were conducted in the OR suite followed by a mass evacuation.
The fire simulation was well received by all OR personnel and resulted in
several system changes including addition of carbon dioxide extinguishers
to the OR suite and advocating for a modification of the surgical time out
to assess the risk of fire. Debnath Chatterjee M.D., Karin Underberg
R.N., Gee Mei Tan M.D., Anesthesiology, Children’s Hospital Colorado,
Aurora, CO, Perioperative Nursing Children’s Hospital Colorado, Aurora,
CO.
PI A3185
Compliance With Priority Leveling System: Economic Feasibility
There appears to be wide variation in when patients arrive in the operating
theatre after being leveled. Cases rarely achieve their ideal goals for various
reasons not always apparent in the timing. Irwin Gratz D.O., Edward Deal
D.O., Erin Pukenas M.D., Amanda Burden M.D., Fatimah Habib M.D.,
Joseph Drucker, Cooper Medical School at Rowan University, Cooper
University Hospital Camden, NJ.
PI A3186
The Association Between Anesthesia Operating Room Personnel
and the Amount of Communication Interruptions Experienced: A
Retrospective Study
Patient care and the quality of clinical performance are delayed by assorted
means of interruptions in the hospital setting. We performed a retrospective
study comparing the amount of mobile phone interruptions and distractions
experienced by specific anesthesia personnel in the operating room
setting. By doing so we showed an Anesthesia Clinical Director receives
a significantly more amount of mobile phone interruptions consistently
throughout the day and month when compared to other operating room
management positions. Thomas E. Schulte M.D., Benjamen M. Jones
B.A., Ellen K. Roberts, M.D., Kristina S. Birch, M.D., Anesthesiology
Department, University of Nebraska Medical Center, Omaha, NE.
PI A3187
Simulation-Based Self-Evaluation of the Technical Conditions for
the Management of a Vital Emergency in an Intermediate Care Unit
Recently Opened Adjustement and 6-Months Assessment
This study presents a safe way of preventing dysfunction in a recently opened
intermediate care unit (IMCU) by using simulation-based self-evaluation of
the technical conditions (TC) for the management of vital emergency initially
and at 6 months after TC modifications. The whole team participates and
confronts realistically the TC. Among the 27 items assessed one third were
first judged insufficient and were secondly improved just as the IMCU TC
global score. Vincent Lassalle Jr. M.D., Olivier Manessiez M.D., Ouarda
Krid M.D., Antoine Edelson B.S.N., Christophe Huet B.S.N., Sandrine
Mons M.D., Serge Cabaret M.D., Reanimation Centre Hospitalier
territorial Papeete French Polynesia, CESU Centre Hospitalier territorial
Papeete French Polynesia.
NA Neuroanesthesia
PN Pain Medicine
93
PI A3188
Installation of an Anesthetic Information Management System
Increases the Number of Arterial Line Supply Charges Per Day by 35%
Prior to anesthesia information management systems (AIMS) services
and supplies may have been undercounted and underbilled because the
documentation burden was high and there were stiff penalties for fraudulent
billing and/or incomplete documentation. We tracked the number of
arterial line supply charges prior to AIMS implementation and post-AIMS.
By integrating required documentation for billing into the AIMS workflow a
35% increase in arterial line supply charge capture was realized. Kenneth
K. Lau M.D., Bassam Kadry M.D., Natacha Telusca M.D. M.P.H., Cliff
Schmiesing M.D., Alex Macario M.D., MBA, Anesthesiology, Stanford
Hospital & Clinics Stanford, CA.
PI A3189
Assessing Systems of Value-Based Allocation of Scarce Resources as
Models for Allocating OR Block Time
Historic utilization alone is not sufficient to allocate OR block time. Many
industries and non-perioperative healthcare systems have developed scarce
resource allocation methods based upon value estimated by management
and customers. We examined these and developed a value-based allocation
system for O.R. block time allowing identification and weighting of the
many factors that should be considered in such allocation decisions.
Douglas G. Merrill M.D., Rex Atwood B.S., Irina Kalaida, John H.
Higgins B.S., Elizabeth A. Stedina B.A., Ellyn M. Ercolano B.A., Center
for Perioperative Services, Surgery, Finance, Dartmouth-Hitchcock,
Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH.
PI A3190
Optimal Block Scheduling for the Operating Room Suite: From Tactical
to Strategic Planning
Creating a block schedule when OR capacity is an issue is often a very
complex task. The model presented in this abstract utilizes prior OR
utilization to create a block schedule that considers additional factors
such as profitability the hospital’s academic mission and the needs of
the community in determining appropriate block assignments. Kenneth
Rosenfeld M.D., Thomas R. Sexton Ph.D., Herbert F. Lewis Ph.D.,
Melissa A. Dolan M.S., Anesthesiology, Stony Brook University School of
Medicine, College of Business Stony Brook University, Stony Brook, NY.
RA A3191
Lidocaine Does Not Reverse Seizure Activity in Bupivicaine-Induced
Neurotoxicity
Lidocaine has been shown to reverse seizure activity of several etiologies.
This study shows that seizure activity is not reversed by lidocaine however in
the setting of bupivacaine-induced neurotoxicity. Nicholas S. Ameln, B.S.,
Salil Sharma, Ph.D., Parisa Partownavid, M.D., Mansoureh Eghbali, Ph.D.,
Siamak Rahman, M.D., Anesthesiology, David Geffen School of Medicine
at UCLA, Los Angeles, CA.
Optimal Dose of Dexmedetomidine for Sedation During Spinal
Anesthesia
This study was designed to investigate the optimal dose of intravenous
dexmedetomidine for proper sedation with minimal recovery time in spinal
anesthesia. The loading dose (1 μg/kg/10 min) of dexmedetomidine was
sufficient for surgery of less than 60 min. Dexmedetomidine infusion followed
by maintenance dose (0.2 μg/kg/hr) was sufficient for surgery within 90 min.
Seung-Hoon Baek M.D., Ph.D., Hwoe Gyeong Ok M.D., Seung Wan Baik
M.D., Ph.D., Hee Young Kim M.D., Hyae-Jin Kim M.D., Eun Jung Kim
M.D., Sang Wook Shin M.D., Ph.D., Anesthesia and Pain Medicine, Bn
National University, Yangsan Hospital, Yangsan Kyoungnam, Korea.
94
The Analgesic Effect of the Ultrasound-Guided Transversus Abdominis
Plane Block After Laparoscopic Gynecologic Surgery
This study was carried out to analyze the effects of transversus abdominis
plane (TAP) block through postoperative analgesia its complications according
to time. VAS in patients who received TAP block was significantly decreased
up postoperative 12 hours (P < 0.05). Intraoperative remifentanil use was
significantly lower in patients who received TAP block (p < 0.05).
Chaeseong Lim, M.D., Wang Yong Lee M.D., Seok-hwa Yoon, M.D., Ph.D.,
Eun-ha Lee, M.D., Woo-Suk Chung, M.D., Ph.D., Anesthesia and Pain
Medicine, Chungnam National University Hospital, Daejeon, Republic of
Korea.
RA A3194
Lidocaine 5% Patch For Treatment of Acute Pain After Robotic Cardiac
Surgery and Prevention of Persistent Incisional Pain: A Randomized
Placebo-Controlled Double-blind Trial
This randomized placebo-controlled double-blind trial shows that lidocaine
5% patches did not reduce acute or persistent pain in patients having
robotic thoracic surgery. Clinicians should thus choose alternative analgesic
approaches in these patients. Shahbaz Qavi, M.D., Bruce Vrooman, M.D.,
Leonardo Kapural, M.D., Sheryar Sarwar, M.D., Edward J. Mascha, M.D.,
Tomislav Mihaljevic, M.D., Mark Gillinov, M.D., Daniel I. Sessler, M.D.,
Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH.
RA A3195
Impact of Anesthetic Technique on Perioperative Outcomes Following
Lumbar Spine Surgery. A Meta-Analysis
Neuraxial anesthesia (NA) offers a number of potential benefits for patients
presenting for lumbar spine surgery. Recently published data suggests that
NA may not be as beneficial as previously reported. A meta-analysis review
of manuscripts published during or after 1988 that compared NA to general
anesthesia (GA) demonstrated decreases in urinary retention blood loss
and nausea when NA is used as the primary anesthetic for lumbar spine
surgery. Randomized trials that evaluate NA techniques versus GA provided
by intravenous agents are required to ascertain if previously reported benefits
are related to NA or simply avoidance of inhalational agents. Kristopher M.
Schroeder M.D., Melanie J. Donnelly M.D., Richard E. Galgon M.D.,
M.S., Anesthesiology, University of Wisconsin School of Medicine and
Public Health, Madison, WI.
RA A3196
ROOM 104-AREA E
RA A3192
RA A3193
The Effect of Addition Clonidine 15,25,35 µg to Spinal Heavy
Bupivacaine 10mg on Sub Arachnoid Block Characteristics
Spinal Clonidine prolongs the duration of intrathecally administered local
anaesthetics. After Ethics Committee approval and informed consent
80 patients randomly assigned to 4 groups to receive 2ml of hyperbaric
bupivacaine intrathecally with 3 different doses of clonidine (15µg 25µg
35 µg)Time to first request of analgesia & 2 segment regressions was
significantly higher in BC35 gp. Other subarachnoid block characteristics
were comparable. Conclusion: 35 micrograms of clonidine can be used
safely with 10 mg 0.5% Bupivacaine providing optimal intraoperative
anaesthesia and contributing to immediate postoperative analgesia for
patients undergoing TURP/TURBT. Dilip R. Shende, M.D., S. Sivaneasn,
M.D., L. Kashyap, M.D., V. Mohan, M.D., R. Batra, M.D., Anaesthesia
Dr.R.P.C. A.I.I.M.S., New Delhi, India.
RA A3197
Comparison of Postoperative Pain Scores Post-Subacromial
Decompression: Interscalene Block Versus Routine Analgesia
Interscalene nerve blocks carry life threatening complications. Our study
revealed that patients were more comfortable on discharge when they
received standard analgesia compared to ones that had a nerve block.
Andrew Tait, M.B., Ch.B., Khaled Ismail, M.D., Anaesthesia, Mid Yorkshire
Hospitals, Dewsbury, United Kingdom.
NA Neuroanesthesia
PN Pain Medicine
Effect of Intraoperative Ketamine on Postoperative Pain in Patients
Undergoing Median Arcuate Ligament Release
Median Arcuate Ligament Syndrome (MALS) classically presents with chronic
difficult to control abdominal pain requiring hospitalization and exposure to
high doses of narcotics with minimal relief. Ketamine has been successfully
used in other chronic pain conditions and offer potential effective alternative.
Sophy Zheng M.D., Alina Lazar M.D., Magdalena Anitescu M.D., Ph.D.,
Department of Anesthesia and Critical Care, University of Chicago,
Chicago, IL.
PO17-1BRESPIRATION I
Analysis of the Factors of Successful Result of Helmet Noninvasive
Positive Pressure Ventilation
Helmet NPPV improved oxygenation in ARF patients immediately after
induction of NPPV. Although there were no significant predictable parameters
of unsuccessful NPPV before induction of NPPV a lot of excretion of sputum
might be suggested as a risk factor. Hironori Ishiaki M.D., Yoshiaki Terao
M.D., Sojiro Matsumoto M.D., Akiko Sakai M.D., Satoshi Egashira
M.D., Makoto Fukki M.D., Koji Sumikawa M.D., Anesthesiology,
Nagasaki Rosai Hospital, Sasebo, Japan, Anesthesiology, Nagasaki
University Hospital, Nagasaki, Japan.
FA A3204
ROOM 104-AREA C
FA A3199
Functional Residual Capacity Changed During Robot-Assisted
Laparoscopic Radical Prostatectomy
We studied relation between body position and FRC during robot-assisted
laparoscopic radical prostatectomy. FRC decreased from the horizontal
position to the Trendelenburg position but PaO2/FIO2 did not significantly
change. PEEP increased FRC and PaO2/FIO2 in the Trendelenburg position.
Nozomu Abe M.D., Daizoh Satoh M.D., Ph.D., Hiroyuki Anzai M.D.,
Akihiro Kanaya M.D., Shin Kurosawa M.D., Ph.D., Masanori Yamauchi
M.D., Ph.D., Department of Anesthesiology and Perioperative Medicine,
Tohoku University Postgraduate Medical School, Sendai, Japan.
FA A3200
Real Time Determinations of Total Resistance Endotracheal Tube
Resistance and Airways Resistance
Measurement of total resistance (RTOT) of imposed endotracheal tube
resistance (RETT) and physiologic airways resistance (RAW)has been
performed by real time measurements in vitro on a series of resistors in
line by inserting a catheter through the ETT passed to its distal end to
measure Ptrach via a transducer. RTOT, RETT, and RAW could be accurately
determined at preset inspiratory flow rates allowing RTOT and its component
parts of RETT and RAW to be determined. When applied in vivo, this will
enable clinicians to diagnose specific resistance abnormalities and choose
appropriate interventions. Nawar N. Al-Rawas M.D., Michael J. Banner
Ph.D., Neil Euliano Ph.D., A Daniel Martin Ph.D., Carl G. Tams Ph.D.,
Babette A. Brumback Ph.D., Andrea Gabrielli M.D., University of Florida,
Convergent Engineering, Gainesville, FL.
FA A3201
Postoperative Pharyngolaryngeal Adverse Events With Laryngeal Mask
Airway: High Versus Low Cuff Pressure
The cuff pressure below 25 cmH2O using aneroid manometer showed
effective safety of airway security and lower incidence of postoperative
pharyngolaryngeal adverse events compared with conventional pressure with
60 cmH2O. Jae Won Choi M.D., Chung-Sik Oh M.D., Woon-Seok Kang
M.D., Seong-Hyop Kim M.D., Ph.D., Department of Anesthesiology and
Pain Medicine, Konkuk University Medical Center, Seoul, Republic of
Korea.
FA A3202
FA A3203
MONDAY, OCTOBER 14
RA A3198
Effects Of Acute Hypoxia On Hemoglobin Concentration In Healthy
Humans
The effect of acute hypoxia on hemoglobin concentration was studied
in a population of 98 healthy human volunteers. Inspired oxygen was
changed to produce 25 oxygen saturation levels between 100% and 70%
with arterial samples taken at each steady state over the course of about
1 hr. Hypoxia caused a significant (P < 0.0001) increase in the blood
hemoglobin concentration of about 2.5% in both men and women and may
represent release from the spleen. John R. Feiner M.D., Calvin Gruss
M.S., Philip E. Bickler M.D., Ph.D., Anesthesia and Perioperative Care,
Otolaryngology - Head and Neck Surgery, University of California, San
Electrical Impedance Tomographic Differences Between HighFrequency Jet Ventilation and One-Lung Ventilation
This study compared by means of electrical impedance tomography
(EIT) atelectasis during one-lung ventilation (OLV) and high-frequency jet
ventilation (HFJV). The main finding was a surprisingly diminished global
ventilation during HFJV as compared to OLV. Saskia A. Vanden Eynde M.D.,
Laszlo L. Szegedi M.D., Ph.D., Jan Poelaert M.D., Ph.D., Anesthesiology
and Perioperative Medicine, Anesthesiology and Perioperative Medicine,
Universityersitair Ziekenhuis Brussel, Jette, Belgium.
FA A3205
High-Frequency Ultrasound in Ex-Vivo Animal Lungs in Pulmonary
Edema
In this study a novel technique of high-frequency three-dimensional
ultrasound is used to study sonopathology and generation mechanism of
sonographic B-lines. B-lines tightly correlate with extravascular lung water
accumulation. Jacek A. Wojtczak M.D., Ph.D., Ronald W. Wood Ph.D.,
Department of Anesthesiology, Department of Obstetrics/Gynecology,
Urology, Neurobiology and Anatomy, University of Rochester Medical
Center, Rochester, NY.
FA A3206
Risk of Barotrauma When Using Non Reinhalation Water Valves:
A Comparative Study on Bench Test
When using manual ventilation use of new generation Waters valve should be
different from historic Waters valve. Indeed barotrauma could be occurred by
inadapted valve expiratory opening pressure settings. Coisel Yannael M.D.,
Fabrice Galia Ph.D., Matthieu Conseil M.D., Julie Carr M.D., Gerald
Chanques M.D., Ph.D., Boris Jung M.D., Ph.D., Samir Jaber M.D.,
Ph.D., Noemie Clavieras M.D., CHU Saint Eloi Montpellier Hospital,
Montpellier, France
PO03-1A CHRONIC AND CANCER PAIN: CLINICAL SCIENCE I
ROOM 104-AREA B
PN A3207
Preoperative Pain Catastrophizing Predicts Incidence of Chronic Pain
After Total Knee Replacement
Catastrophic thinking significantly predicted incidence of continued
postoperative pain at 6 months after total knee replacement. Asokumar
Buvanendran M.D., Mario Moric, M.S., Jeffrey S. Kroin, Ph.D., Kenneth
J. Tuman, M.D., Anesthesiology, Rush University Medical Center, Chicago,
IL.
PN A3208
Pain in an Underserved Population: An Observational Study in Webuye,
Kenya
he results of this study indicate that pain in this population in Kenya is
currently not being well-controlled. Shaun E. Gruenbaum M.D., Jonas
B. Aharoni M.D., Benjamin F. Gruenbaum M.D., Viji J. Kurup M.D.,
Alexander Zlotnik M.D., Ph.D., Department of Anesthesia, Yale University
School of Medicine, New Haven, CT, Department of Internal Medicine,
Banner Good Samaritan Medical Center, Phoenix, AZ, Department of
Anesthesiology and Critical Care, Soroka Medical Center and Ben-Gurion
University of the Negev, Beer Sheva, Israel.
NA Neuroanesthesia
PN Pain Medicine
95
PN A3209
Effects of Two Different Doses of Epidural Steroid on Blood Glucose
Levels and Pain Control in Patients With Diabetes Mellitus
We compared the effects of two common doses of triamcinolone (40 mg
20 mg) administered via epidural injections on blood glucose levels and
pain control in patients with diabetes mellitus to determine the adequate
epidural steroid dose in patients with DM. The higher dose of triamcinolone
increased FBG and PBG greater than lower dose did without an advantage
of pain control. Thus with respect to glucose and pain control 20 mg
of triamcinolone appears to be recommendable than 40 mg in diabetic
patients. Won Ho Kim, M.D., Woo Seog Sim M.D., Ph.D., Ryunga Kang
M.D., Song-I Yang M.D., Anesthesiology and Pain Medicine, Samsung
Medical Center, Seoul, Republic of Korea, Anesthesiology and Pain
Medicine, Samsung Medical Center Sungkyunkwan University, School
of Medicine, Seoul, Republic of Korea.
PN A3210
Concordant Pressure Paresthesia During Interlaminar Lumbar Epidural
Steroid Injections Correlates With Pain Relief in Patients With Low
Back Pain and Unilateral Radicular Pain
This prospective blinded randomized study showed that the lateral
parasagittal interlaminar approach was more effective than the midline
interlaminar approach in targeting low back pain with unilateral radicular
pain secondary to degenerative lumbar disc disease. It also showed that
pressure paresthesias occurring ipsilaterally during an LESI correlates with
pain relief and may therefore be used as a prognostic factor. Nebojsa Nick
Knezevic M.D., Ph.D., Kenneth D. Candido M.D., Maunak V. Rana
M.D., Antony Tharian M.D., Ruben I. Sauer M.D., Lalida Chupatanakul
M.D., Vladimir Vasic Ph.D., Anesthesiology, Advocate Illinois Masonic
Medical Center, Chicago, IL, Faculty of Economics University of Belgrade,
Belgrade, Serbia.
PN A3211
Lesion Dimensions Altered in Radiofrequency Ablation Near the
Bone-Muscle Interface
Radiofrequency (RF) ablation near bone is an established treatment of spine
pain. Current literature describes RF lesioning in homogenous media such
as bulk muscle and does not take into account the effect of the bonemuscle interface on the dimension of the lesion. This is a novel bone-muscle
interface model to investigate RF lesion size either against bone or in muscle.
Effects of bone may cause increased projection of the lesion compared with
previous estimates. Steven Lee Lindauer, M.D., Maxim S. Eckmann, M.D.,
Somayaji Ramamurthy, M.D., Department of Anesthesiology and Pain
Medicine, University of Texas Health Sciences Center, San Antonio, TX.
PN A3212
Puncture Distance and Distribution of the Vertebral Artery in
Echography-Guided Stellate Ganglion Block
For ultrasound-guided stellate ganglion block (SGB) the position of the
vertebral artery should be identified using Doppler echography in cases in
which this artery is present on the anterior surface of the transverse process
at the C6 and C5 levels. There is a large variation in the puncture distance
for SGB but the distance can be shortened to about 20 mm with pressing
at a painless level allowing the block to be applied using a short puncture
needle. Kaori Mizuno, M.D., Takasumi Kato, M.D., Ph.D., Shigehito Sato,
M.D., Ph.D., Anesthesiology, Hamamatsu University School of Medicine,
Hamamatsu, Japan.
PN A3213
Relationship Between Serum Carbamazepine Concentration and
Degree of Satisfaction in Patients With Neuropathic Pain
The purpose of this study was to evaluate the efficacy of therapeutic drug
monitoring (TDM) on relationship between measured serum carbamazepine
(CBZ) concentration and satisfaction in patients with neuropathic pain.
Significant correlations were found between dose of CBZ and serum CBZ
concentration and between serum CBZ concentration and satisfaction
regarding the treatment. TDM is useful for CBZ when the dose of CBZ
is increased or when CBZ is switched to another antiepileptic drug in
patients with neuropathic pain. Nobuko Tachibana M.D., Masanori
Yamauchi M.D., Ph.D., Michiaki Yamakage M.D., Ph.D., Department
of Anesthesiology, Sapporo Medical University School of Medecine
Sapporo, Japan, Department of Anesthesiology, Tohoku University
Senndai, Japan.
96
PN A3214
Efficacy of Facet Rhizotomy for Patients With Chronic Refractory Back
Pain Resulting From Osteoporotic Vertebral Compression Fracture
In 28 patients with persistent back pain resulting from osteoporotic vertebral
compression fracture (OVCF) we assessed the efficacy and safety of facet
rhizotomy (FR). FR appeared to be a safe and usefulprocedure for the
treatment of focal back pain secondary to OVCF when conservative treatment
has failed. Noritaka Yoshimura, M.D., Motoyasu Takenaka, M.D., Ph.D.,
Shinobu Yamaguchi, M.D., Shigemi Matsumoto, M.D., Hiroki Iida, M.D.,
Ph.D., Anesthesiology and Pain Medicine, Gifu University Graduate School
of Medicine, Gifu, Japan.
IMAGING AND AIRWAY ACCESS
ROOM 104-AREA A
FA A3215
Minimizing Impact of Spatial Heterogeneity on Laser Doppler
Assessment of Fatty Meal Impact
Laser Doppler flowmetry identified compromised arterial compliance after a
fatty meal in healthy volunteers. This was most evident with respect to the
width of the pulsatile Laser Doppler tracing since it was less disturbed by
spatial heterogeneity than height or peak area. Siqin Nie, M.D., Daniel Tran,
B.S., I-Hsun Liang, M.D., Nina Stachenfeld, Ph.D., Tyler J. Silverman,
D.P.M., David G. Silverman, M.D., Anesthesiology, Physiology, John B.
Pierce Laboratory, Yale University School of Medicine, New Haven, CT,
Podiatry, Cambridge Health Alliance, Boston, MA.
FA A3216
Evaluation of the Ultrasound Guided Subclavian Vein Cannulation With
the Use of Linear Hockey Stick Probe
In the research described here a linear hockey stick probe and a linear probe
were used to examine the possibility of subclavian vein cannulation from
the central side. The incidence of complications with this approach was
also examined. The distance from the mid-clavicular line was significantly
shorter for a linear hockey stick probe using. No complications were observed
in any of the subjects. Shuto Harada, M.D., Takayuki Kunisawa, M.D.,
Ph.D., Atushi Kurosawa, M.D., Ph.D., Takafumi Iida, M.D., Yasuyoshi
Inagaki, M.D., Hirothugu Kanda, M.D., Tomoki Sasakawa, M.D., Hiroshi
Iwasaki, M.D., Ph.D., Anesthesiology and Critical Care, Asahikawa
Medical University, Asahikawa, Japan, Department of Anesthesiology,
Perioperative Medicine and Pain Management, University of Miami, Miller
School of Medicine, Miami, FL.
FA A3217
A Prospective and Randomised Study to Evaluate and Compare
C-Trach and C-Mac as Intubating Devices in Adult Patients
C-Trach and C-Mac provide indirect laryngeal visualization and intubation
under vision. When evaluated and compared C-Mac appears better than
C-Trach in term of ease of insertion complication time required for intubation
with styletted tube. Pratibha Kujur, M.D., Rakesh Kumar, M.D., Munisha
Agarwal, M.D., Manoj Bhardwaj, M.D., Sunil Kumar, M.B., B.S., Neera
Gupta, M.D., Anesthesiology and Intensive Care Unit, Maulana Azad
Medical College and Associated Lok Nayak Hospital, New Delhi, India.
FA A3218
A Comparison of the Airtraq® With a Fiberoptic Bronchoscope and the
Airtraq® Alone for Tracheal Intubation in Surgical Patients
We evaluated the efficacy of the combined use of the Airtraq® laryngoscope
(AL) and a fiberoptic bronchoscope (FOB) compared with that of the AL alone
for tracheal intubation in surgical patients and compared the results with
those in our previous manikin study. Tracheal intubation was significantly
faster with the combined use than with the use of the AL alone in patients
with difficult airways as was found in the manikin study. The times to
intubation in patients with normal airways in contrast to the results in the
manikin study were not significantly different between the two intubation
techniques. Kohki Nishikawa, M.D., Tatsuya Kunigoh, M.D., Takuya
Tonozaki, M.D., Shigeo Tsuchiya, M.D., Yuki Shimodate, M.D., Michiaki
Yamakage, M.D., Anesthesia, Muroran City General Hospital, Muroran,
Japan, Anesthesiology, Sapporo Medical University School of Medicine,
Sapporo, Japan.
NA Neuroanesthesia
PN Pain Medicine
Biomechanical Analysis of the Conventional Macintosh Type
Laryngoscope and Two Different Video Laryngoscopes
Surface EMG and Inertial Measurement Unit were recorded to elucidate
differences of biomechanics of endotracheal intubation with three different
intubation devices; Macintosh type McGRATH Video Laryngoscope and
AWS-S100. Video laryngoscope required smaller muscle activation during
the intubation procedure. Mirei Nagai M.D., Yusuke Kasuya M.D., Ph.D.,
Yohan Noh Ph.D., Luca Bartolomeo Ph.D., Massimiliano Zecca Ph.D.,
Hiroyuki Ishii Ph.D., Atsuo Takanishi Ph.D., Makoto Ozaki M.D., Ph.D.,
Anesthesiology, Tokyo Women’s Medical University, Faculty of Science
and Engineering , Graduate School of Advanced Science and Engineering,
Department of Modern Mechanical Engineering Waseda University,
Tokyo, Japan.
FA A3220
A Comparison of Intubation Time Using the Glidescope Cobalt Video
Laryngoscope Versus the Direct Intubation Trainer
This is a prospective randomized study investigating intubation time of
Meditronic NIM EMG and Mallinckrodt LASER-Flex endotracheal tubes using
the Glidescope Direct Intubation Trainer vs. the Glidescope Cobalt Video
Laryngoscope. Janice Riso M.D., Franco Resta-Flarer M.D., Jonathan
Lesser M.D., Thomas Maliakal M.D., Junping Chen M.D., Ph.D., Henry
Bennett Ph.D., Peter Byrnes B.S., Anesthesiology, St. Luke’s Roosevelt
Hospital Center, Columbia University, College of Physicians and
Surgeons, New York, NY.
FA A3221
Usability of the TruFlex Articulating Stylet for Videolaryngoscopy
The Glidescope videolaryngoscope provides reliable imaging of the glottis
but does not guarantee successful intubation particularly when the vocal
cords are anterior to the endotracheal tube. The goal of this study was to
evaluate the usability of a new articulating stylet intended improve video
intubation success. Our initial evaluation suggests that the articulating
mechanism reliably moves the endotracheal tube tip anteriorly which may
be an advantage in patients with unfavorable anatomy for conventional rigid
stylets. Kenneth P. Rothfield, M.D., Kevin Lopez, C.R.N.A., Scott Langlois,
C.R.N.A, Vania Milnes, R.N., Anesthesiology, St. Agnes Hospital,
Baltimore, MD.
FA A3222
Effect of Electronic Beam Steering on Visibility of Echogenic and NonEchogenic Needles During Ultrasound-Guided Regional Anesthesia
Our study evaluates the effect of electronic beam steering technology on
the visibility of echogenicn and non-echogenic needles at various angles of
needle insertion. The information from the study can be used for obtaining
best results during ultrasound-guided nerve blocks in a most cost effective
manner. Vishal Uppal, M.D., F.R.C.A, Rakesh Sondekoppam, M.D.,
Sugantha Ganapathy, M.D., Anesthesia, University of Western Ontario,
London ON, Canada.
ROOM 104-AREA C
PI A3223
Do We Know What Residents Know and Think About Clinical Quality
Improvement Initiatives? A Survey of Anesthesia Residents on Their
Perceptions and Attitudes Regarding Clinical Quality Improvement
Processes
Results of a survey of anesthesiology trainees at a large tertiary academic
center on their knowledge and perceptions of clinical quality improvement
processes are presented. Although trainees felt that they could identify areas
for quality improvement they did not necessarily feel empowered to affect
change and a significant proportion felt quality improvement is a euphemism
for someone making a mistake. We conclude that educational programs
designed to actively engage residents in clinical quality improvement are
needed to allow trainees to effectively contribute to improving patient care
during residency and beyond. Michael R. Hernandez, M.D., Avery Tung,
M.D., Anesthesia and Critical Care, University of Chicago, Chicago, IL.
PI A3224
The Portrayal of Anesthesiologists in Fiction: False Impressions
Causing Misrepresentations
Anesthesiologists, unlike surgeons have been portrayed negatively in fiction.
The negative character traits given to anesthesiologists include timid lazy
and servile. Molly B. Perini B.A., Yvon F. Yvon M.D., Anesthesiology,
Wake Forest University, School of Medicine, Winston-Salem, NC.
PI A3225
Cost of Resident Scholarly Activity and its Effect on Resident Clinical
Experience
This study was to analyze the impact of residents’ scholarly activity on
anesthesiology department finances and on anesthesiology residents’ clinical
experience. Scholarly activity is an important part of Anesthesiology residency
training yet incurs a significant cost to the supporting department. Residents
who elect to spend months conducting research rotations completed
significantly more scholarly projects but experienced less clinical cases.
Nicholas J. Schott M.D., Trent D. Emerick, M.D., David G. Metro, M.D.,
Tetsuro Sakai, M.D., Ph.D., Department of Anesthesiology, University of
Pittsburgh Medical Center, Pittsburgh, PA.
MONDAY, OCTOBER 14
FA A3219
PI A3226
Simulation-Based Evaluation for Cognitive Performance Deficiencies in
an Anesthesiology Residency Training Program
The primary aim of this investigation was to evaluate anesthesiology resident
trainees for deficiencies in cognitive performance within and across three
clinical domains. We conclude that simulation-based assessment can
separate between higher-order (cognitive) and lower-order (basic & technical)
skills expected of a relatively experienced (PGY3 and 4) anesthesiology
resident. In addition, simulation-based assessments can also highlight areas
of relative strength and weakness in a residency curriculum. Avner Sidi,
M.D., T. Ozrazgat Baslanti, Ph.D., N. Gravenstein, M.D., S. Lampotang,
Ph.D., University of Florida, Gainesville, FL.
PI A3227
Current Status of Resident-As-Teacher Training Activities in Canadian
and U.S. Anesthesia Residency Programs
Through a survey completed by program directors this study evaluates the
status of resident-as-teacher training activities at accredited Anesthesia
residency programs in Canada and the U.S. In addition, this study attempts
to capture the perceptions of residents-as-teachers and current barriers to
instituting a training program for anesthesia residents-as-teacher training.
Zoe Unger, M.D., Megan Hayter, M.D., University of Toronto, Toronto, ON,
Canada.
PO13-2A OUTCOMES AND DATABASE RESEARCH: RISK AND
PREDICTION II
ROOM 104-AREA E
FA A3228
Gender Controlled Variability of External Neck Landmarks in Adult
Patients
We present the results of an observational prospective study at Memorial
Hermann Hospital Texas Medical Center - Houston Texas. The dimensions
of external airway landmarks were recorded for 200 patients and stratified
according to gender and height. The primary aim of this study is to evaluate
measurements of external neck landmarks as an estimation of internal airway
size and to correlate the size of these landmarks to gender and height.
Davide Cattano M.D., Ph.D., Jacek Wojtczak M.D., Ph.D., Rashida
Callender B.S., Carin Hagberg M.D., Anesthesiology, University of
Texas Health Science Center at Houston, Houston, TX, Anesthesiology,
University of Rochester Rochester, NY.
FA A3229
Acute Kidney Injury After Pediatric Liver Transplantation
Acute kidney injury is a frequent complication after adult liver transplant
however little is known about acute kidney injury after pediatric liver
transplant. Incidence of acute kidney injury and effect of on mortality
is analyzed in this retrospective chart review of pediatric liver transplant
patients. Vanessa Cowan M.D., Gebhard Wagener M.D., New York
Presbyterian-Columbia University, New York, NY.
NA Neuroanesthesia
PN Pain Medicine
97
FA A3230
Intraoperative Anaphylaxis: A Registry Analysis
We evaluated the incidence of intraoperative allergic reactions and
anaphylaxis in a United States surgical population. A retrospective analysis
of 178 746 anesthesia records by electronic search strategy followed by
manual adjudication yielded 264 cases of allergic reactions. The overall
incidence of allergic reactions was 1:677 whereas grade 3+ reactions
anaphylaxis occurred in 1:4583 patients. Brian D. Hesler M.D., Cameron
Egan B.S., Herve Besson Ph.D., Maria Bauer M.D., Edward Mascha
Ph.D., Andrea Kurz M.D., Daniel Sessler M.D., Alparslam Turan M.D.,
Leif Saager M.D., Outcomes Research, Cleveland Clinic Foundation,
Cleveland, OH, Epidemiology Merck & Co, Oss, Netherlands,
Anesthesiology, Weill Cornell New York, NY.
FA A3231
Objective Assignment of ASA Physical Status Class by Organ System
Severity Scoring
Organ-specific severity scoring can be implemented as part of EHR to guide
assignment of ASA physical status score with increased objectivity and
could be easily automated. George M. Hoffman M.D., Sn P. Taylor M.D.,
Richard J. Berens M.D., Anesthesiology and Pediatrics Children’s
Hospital of Wisconsin Milwaukee, WI, Anesthesiology, Anesthesiology
and Pediatrics Children’s Hospital and Medical College of Wisconsin,
Milwaukee, WI.
FA A3232
Patients With a Bedside or an Formal Diagnosis of Sleep Apnea Have
Comparable Characteristics and Outcomes
Patients with a bedside or an formal diagnosis of sleep apnea have
comparable characteristics and outcomes. Leslie C. Jameson M.D.,
Kenneth Bullard B.S., Chirag Shah M.D., Ana Fernandez-Bustamante
M.D., University of Colorado Health Sciences Center Aurora, CO
Perioperative Risk Factors of Acute Kidney Injury After Liver Resection
Surgery Under Sevoflurane Anesthesia
Among 642 patients who underwent liver resection surgery under sevoflurane
anesthesia acute kidney injury (AKI) was diagnosed in 78 patients (12.1%)
based on Acute Kidney Injury Network criteria within 72 hours after surgery.
Multivariate analysis demonstrated an independent association between
postoperative AKI and baseline low estimated glomerular filtration rate
preoperative hypertension and intraoperative red blood cell transfusion.
Development of AKI within 72 hours after liver resection surgery was
associated with increased hospital mortality increased rates of reintubation
and renal replacement therapy and prolonged hospital length of stay.
Nobuhiro Shiota M.D., Seiji Ishikawa M.D., Ph.D., Arisa Tomozawa M.D.,
Phantila Cholvisudhi M.D. F.R.C.A, Koshi Makita M.D., Ph.D., Tokyo
Medical and Dental University, Tokyo, Japan, Chulalongkorn University,
Chulalongkorn, Thailand.
ROOM 104-AREA D
RA A3236
Ultrasound-Guided Maxillary Nerve Block by Intraorbital Approach on
Cadavers
The maxillary block is a deep block. Ultrasound with the suprazygomatic
needle-way permit only to visualise the local anesthetic diffusion if it is in
the maxillary fossea. With an intraorbital approach the block should be
ultrasound guided during all the performance needle guidance and real time
injection. We tested this hypothesis on 7 cadavers. Lucie Beylacq Sr. M.D.,
Yann Hamonic Jr., Mathieu Laurentjoye M.D., Karine Nouette-Gaulain
M.D., Ph.D., Anesthesiology, University Hospital Bordeaux France.
RA A3237
FA A3233
Prediction of Difficult Airway Management - A Cohort Study of 188 052
Patients Registered in the Danish Anaesthesia Database
Preoperative airway assessment and its registration in the Danish Anesthesia
Database (DAD) is based on a non-specified clinical assessment. The purpose
of this study is to analyse the diagnostic value of a clinical assessment for
prediction of difficult airway and to determine the prevalence of unanticipated
difficult airway management i DenmarkA cohort of 188 052 intubated
patients was extracted from the DADThe prevalence of difficult intubation by
direct laryngoscopy was 1.85% [1.79 - 1.92 95% CI]. The prevalence of
difficult mask ventilation was 0.72% [0.68 - 0.76 95% CI]. For both difficult
intubation and difficult mask ventilation 93% were not foreseen as difficult.
Anders K. Norskov M.D., Charlotte V. Rosenstock M.D., Ph.D., Jorn
Wetterslev M.D., Ph.D., Lars H. Lundstrom M.D., Ph.D., Department of
Anesthesia, Hillerod Hospital, Hillerod Denmark, Copenhagen Trial Unit
RigsHospitalet, Copenhagen, Denmark.
FA A3234
Antidepressiva in Patients With a Positive Screen for Depression
Predict Postoperative Delirium in the Elderly: Observational
Investigation in the Perioperative Setting
This observational study in ~ 800 elderly undergoing elective surgery showed
that antidepressant medication in patients with suspected depression seems
to be an independent risk factor for post-operative delirium. Bruno Neuner
M.D., Finn Radtke M.D., Edith Weiss-Gerlach Ph.D., Henning Krampe
Ph.D., Claudia Spies M.D., Department of Anesthesiology and Intensive
Care Medicine, Charite - Universityersitaetsmedizin Berlin, Berlin,
Germany.
98
FA A3235
Persistent Pain After Arthroscopic Shoulder Surgery is Associated With
Preoperative Anxiety and Somatization
Preoperative somatization and anxiety levels were predictive of persistent
pain at 3 months following arthroscopic rotator cuff repair; COMTand
IL-1ra polymorphisms were not predictive. Craig T. Hartrick, M.D., Doug
Wendell, Ph.D., Cecile Pestano, B.S.N., Sn Hartrick, B.S.N., Guangzhi
Qu, Ph.D., BioMedical Sciences and Anesthesiology, Oakland University
William Beaumont School of Medicine Rochester, MI, Biology (Genetics)
Oakland University, Rochester, MI, Anesthesiology, Research Beaumont
Health System Research Institute, Troy, MI, Anesthesiology, Research
Beaumont Health System Research Institute, Troy, MI, Engineering and
Computer Science Oakland University, Rochester, MI.
RA A3238
A Multicenter Randomized Double-Blind Placebo-Controlled Trial
to Evaluate the Efficacy and Safety of the Sufentanil NanoTab® PCA
System/15 mcg for the Treatment of Post-Operative Pain in Patients
After Knee or Hip Replacement Surgery
The Sufentanil NanoTab PCA System a preprogrammed noninvasive
product in development delivers SL sufentanil 15 mcg tablets with a 20min lockout. After major orthopedic surgery patients were enrolled in this
placebo-controlled postop pain trial. At the time of submission it was nearly
complete. Full results will be presented in the poster. Harold Minkowitz
M.D., Maurice Jove M.D., David W. Griffin M.D., Timothy Melson M.D.,
Pamela P. Palmer M.D., Ph.D., Mike Royal M.D., Anesthesiology,
Memorial Hermann Memorial City Hospital Medical Center, Houston, TX,
Southeastern Center for Clinical Trials, Decatur, GA, Orthopedic Center
of Vero Beach, Vero Beach, FL, Anesthesiology, Helen Keller Hospital,
Sheffield, AL, Medical AcelRx Pharmaceuticals Inc., Redwood City,
CA, Clinical AcelRx Pharmaceuticals, Inc., Redwood City, CA.
NA Neuroanesthesia
PN Pain Medicine
PO03-1BCHRONIC AND CANCER PAIN: CLINICAL SCIENCE I
Postoperative Management of Patients Following the Nuss Procedure:
A Survey of Practice
We present the results of a web based survey designed to assess current
practices for perioperative pain management of patients undergoing repair
of pectus excavatum with the minimally invasive Nuss procedure and identify
areas for future research. Wallis T. Muhly M.D., Lynne G. Maxwell M.D.,
Joseph P. Cravero M.D., Anesthesiology and Critical Care Medicine
The Children’s Hospital of Philadelphia; Perlman School of Medicine
at the University of Pennsylvania, Philadelphia, PA, Anesthesiology,
Perioperative and Pain Medicine Children’s Hospital, Boston, Harvard
RA A3240
Body Mass Index is Not Associated With Postoperative Pain and Opioid
Consumption After Bariatric Surgery
We did a retrospective cohort study of 476 adult patients who had
laparoscopic bariatric surgery at the Cleveland Clinic Main Campus between
2004 and 2010. This study shows that after adjusting for confounders BMI
was not significantly associated with increased postoperative pain or total
opioid consumption. Shahbaz Qavi M.D., Cameron Egan, Raktim Ghosh
M.D., Sherry Yu, Lovkesh Arora M.D., Somnath Bose M.D., Jing You,
Ashish Khanna M.D., Anthony Doufas M.D., Alparslan Turan M.D.,
Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, Stanford
University Stanford, CA.
RA A3241
The Effects of Dexamethasone in Patients Receiving a Sciatic Block
Although the motor block duration was longer for the groups that received
dexamethasone compared to normal saline group the quality of recovery was
the same among groups. Both intravenous and perineural dexamethasone
enhances and prolongs the analgesic effects of bupivacaine when used for
sciatic nerve block for foot and ankle surgery. Rohit Y. Rahangdale M.D.,
Mark C. Kendall M.D., Anesthesiology, Northwestern University Feinberg
RA A3242
Does the Side for Paramedian Technique In Thoracic Epidural
Placement Improve the Distribution of Sensory Blockade on the
Ipsilateral Side?
The ipsilateral approach to paramedian epidural placement may result in
better sensory blockade on the ipsilateral side. Siamak Rahman M.D.,
John Shin M.D., Sachin Gupta M.D., Dena Yassin B.S. Sarah Zacharia
MBS, Anesthesiology, Ronald Reagan UCLA, Medical Center, Los
Angeles, CA.
RA A3243
Assessment of a Checklist-Based Educational Tool for UltrasoundGuided Interscalene Peripheral Nerve Blockade
We evaluated the adherence of residents to a previously validated block
checklist in clinical care during a regional anesthesia/ambulatory anesthesia
rotation. This checklist adapted from other sources and previously validated
was tailored for single-shot interscalene peripheral nerve block. Residents
exposed to a partial-task trainer to practice ultrasound-guided block while
enacting a checklist displayed high fidelity to the checklist during actual
block conduct later in the rotation. Joseph P. Resti M.D., Steven L.
Orebaugh M.D., Anesthesiology, University of Pittsburgh Medical Center
Pittsburgh, PA.
ROOM 104-AREA B
PN A3244
Chronicisation of Post-Surgical Pain After Laparoscopic Colorectal
Surgery: Characteristics and Risk Factors
This study reports a 17% incidence of CPSP after laparoscopic colorectal
surgery. Risk factors were: age preoperative pain severe postoperative
pain and redo surgery for postoperative peritonitis. Mathieu Georges M.D.,
Didier Ledoux M.D., Kamel Medjahed M.D., Gaelle Damilot M.D.,
Caroline Ramquet M.D., Jean Francois Brichant M.D., Jean L. Joris
M.D., Anesthesiology and Intensive Care Medicine, CHU Liege, Liege,
Belgium.
MONDAY, OCTOBER 14
RA A3239
PN A3245
Comparison of Numerical Rating Scale Between Red and Green
Questionnaires in Patients With Chronic Pain
Our findings suggest that the red questionnaire but not the green
questionnaire augments the scores of Numerical Rating Scale in patients
with chronic pain on antidepressant therapy. Akifumi Kanai Sr., M.D.,
Ph.D., Shigehiro Matsumoto M.D., Hirotsugu Okamoto, M.D., Ph.D.,
Anesthesiology, Kitasato University School of Medicine Sagamihara
Japan, Kitasato University School of Medicine, Sagamihara, Japan.
PN A3246
Incidence of Intravascular Injection in Cervical Medial Branch Blocks
by Using Digital Subtraction Angiography
Intravascular injection during CMBB procedure by DSA was found in 10.2%
which was higher than reported 3.9%. As a higher incidence of intravascular
injection was found in DSA mode checking DSA image in CMBB procedure
can help lower false-negative in diagnosing cervical facet joint syndrome
and also decrease the incidence of complication. Saeyoung Kim M.D.,
Hyungdong Kim M.D., Younghoon Jeon M.D., Ph.D., Anesthesiology and
Pain Medicine, Keimyung University Dongsan Medical Center, Keimyung
University Dongsan Medical Center, Kyungbook University Hospital,
Daegu, Republic of Korea.
PN A3247
Effect of Diabetes on Pain Reduction After Epidural Steroid Injections
for Radiculopathy
The proposed study investigates if diabetic patients experience worse
analgesic outcomes after epidural steroid injections for radicular back pain
compared to the non-diabetic patients. The primary aim was to evaluate
whether or not there is a difference in pain reduction between diabetic versus
non-diabetic patients (two groups). A secondary aim was to evaluate if the
level of Hemoglobin A1c is independently associated with pain reduction
among diabetic patients. We did not find a significant difference in pain
reduction after epidural steroid injections between diabetic and non-diabetic
patients. Pain reduction may generally decrease with increasing of HbA1c
level and become stable and negative for patients with high HbA1c values.
However further investigation is necessary in order to confirm our results.
Bahram Namdari D.O., Francis Wong D.O., Cleveland Clinic, Cleveland,
OH.
PN A3248
The Impact of Decision-Making for End Of Life Care on the Preferred
Place of Care and Death in Japan: A Population Based Survey
Compared with western countries the number of home death is low in
Japan. We hypothesized that considering end-of-life issues influences their
preference of place of care and death and explored the correlation between
having a living will and the preferred place of care and death. We sent a
mail to 1000 general Japanese population. We asked whether they had an
interest in creating a living will and their preferred place of care and death.
740 mails were returned to the authors. Participants who were interested
in Living Will preferred hospice as the place of care and death with an OR
of 4.37 (95%CI 1.74-11.4) 2.59 (1.61-4.19) respectively. But there
was no significant difference between having an interest in a living will and
preference of home or hospital. Hiroyuki Nishie M.D., Daniel Obata M.D.,
Kenji Sato M.D., Satoshi Mizobuchi M.D., Yuichiro Toda M.D., Hiroshi
Morimatsu M.D., Okayama University Hospital, Okayama, Japan.
NA Neuroanesthesia
PN Pain Medicine
99
PN A3249
FA A3253
PN A3250
FA A3254
Clinical Improvement Through Nonoperative Treatment of Adult Spinal
Deformity: Who Is Likely to Benefit?
Adult spinal deformity (ASD) patients treated non-operatively were evaluated
for clinical improvement at 1-year using the SRS-22 outcomes scale.
Baseline and 1-year minimum clinically important differences (MCIDs) from
normative data were calculated. 24% of the patients treated non-operatively
improved by more than 1MCID for the SRS Pain domain with non-operative
scores. Improvement and final outcomes were significantly impacted by the
level of baseline disability but not by the radiographic profile. Kseniya
Slobodyanyuk B.A., Carrie Poorman B.S. Frank J. Schwab M.D.,
Virginie Lafage Ph.D., New York University Hospital for Joint Diseases,
New York, NY.
A Comparison of Ketamine Infusion Efficacy in Type 1 Versus Type 2
Complex Regional Pain Syndrome
The proposed study retrospectively investigated whether or not patients with
Type 1 complex regional pain syndrome (CRPS) experience worse analgesic
outcomes after ketamine infusion compared to the Type 2. We hypothesized
that analgesic outcomes after ketamine would be better in type 2 CRPS.
After applying exclusion criteria 42 patients remained in the study including
31 (74%) and 11 (26%) patients with Type 1 and Type 2 complex regional
pain syndrome respectively. In conclusion we did not find a significant
difference in pain reduction after ketamine infusion between Type 1 and
Type 2 CRPS patients. However further investigation is necessary in order to
confirm our results. Francis D. Wong D.O., Jijun Xu M.D., Anesthesiology,
Cleveland Clinic, Cleveland, OH.
PN A3251
Effect of Nitrous Oxide on Pain and Opioid Requirement in Patients
With Neuropathic Low-Back Pain
An estimated 2 million patients suffer from chronic neuropathic low back pain
refractory to pharmacological treatment causing high demand on health care
cost. In this study we looked to the effect of nirtours oxide in pain and opioed
usages in patients with neuropathic pain. Although nitrous oxide does not
reduce pain level however it somewhat reduces opioid use in those patients.
Yosaf Zeyed M.D., Katyal Sumit M.D., Sheryar Sarwar M.D., Abdulkadir
Attim M.D., Daniel Leizman M.D., Nagy Mekhail M.D., Manu
Matthews M.D., Jing You M.S., Daniel Sessler M.D., Alparslan Turan
M.D., Outcomes Research Cleveland Clinic, Case Western University
Hospital, Cleveland, OH.
IMAGING AND AIRWAY ACCESS
ROOM 104-AREA A
FA A3252
Flexible Optical Intubation Via the Ambu Aura-I Versus Blind Intubation
Via the Single Use Intubating LMA - A Prospective Randomized Clinical
Trial
A supraglottic airway device can be used either as a ventilator device or
as a condiut for intubation making them an integral part of the difficult
airway algorithm in securing the airway. As the focus on improving airway
management techniques grows new intubation devices are introduced
into clinical practice. The purpose of this study was to compare the
Ambu®Aura-I™ and Ambu® aScope™ to the ILMA™ in patients undergoing
general anesthesia. Alfonso Altamirano M.D., Carlos Artime M.D.,
Katherine Normand M.D., Lara Ferrario M.D., Praveen Maheshwari
M.D., Hassan Aijazi M.B. B.S., Carin Hagberg M.D., Anesthesiology,
University of Texas at Houston Medical School, Houston, TX.
100
Evaluating Intubation Condition Using Clarus Video System in Patients
With Restricted Neck Mobility
Intubating conditions of Clarus video system was evaluated in 74 patients
with simulated difficult airway using a cervical collar. Clarus video system
is an effective and safe device for orotracheal intubation in patients with
simulated difficult airway regardless of Cormack &; Lehane score. However
visualization of vocal cord and advancement into the glottis aperture are less
feasible in high grade difficult airway than those in low grade patients.
Hyun-Seok Cho M.D., Sung-Hoon Kim M.D., Hyun Kang M.D., Eun-Ha
Suk M.D., Jai-Hyun Hwang M.D., Department of Anesthesiology and
Pain Medicine, University of Ulsan College of Medicine Asan Medical
Center, Seoul, Republic of Korea.
Blind Tracheal Intubation Through the Supraglottic Airway Devices
AirQ™; and Ambu Aura-i™; in Children
This randomized controlled trial compares the blind intubation through
the pediatric AirQ and the Ambu Aura-i in anesthetized children. We found
that both supraglottic airway devices are reliable for ventilation and that
blind intubation is more successful with the AirQ. However blind intubation
cannot be recommended through either device since success rates for blind
intubation are overall very low. Maren Kleine-Brueggeney M.D., Lorenz
Theiler M.D., Stefan Seiler M.D., Yves Charriere M.D., Franziska Stucki
M.D., Christine Riggenbach, Anna Nicolet M.D., Natalie Urwyler M.D.,
Robert Greif M.D., Anesthesiology and Pain Therapy, University Hospital
Inselspital and University of Bern, Bern, Switzerland.
FA A3255
Performance of the Pediatric Laryngeal Mask Airway Supreme™;
Compared With the Pediatric Ambu Aura Once™
This study in anesthetized children shows that with high overall success rates
of >95% and comparable airway leak pressures both the pediatric LMA
Supreme and the Ambu Aura Once are suitable for ventilation of anesthetized
children. The LMA-S shows a higher first attempt success rate and the
Aura Once a more favorable alignment with the laryngeal structures. Maren
Kleine-Brueggeney M.D., Lorenz Theiler M.D., Franziska Stucki M.D.,
Christine Riggenbach, Stefan Seiler M.D., Yves Charriere M.D., Natalie
Urwyler M.D., Robert Greif M.D., Anesthesiology and Pain Therapy,
University Hospital Bern, Bern, Switzerland.
FA A3256
A Pilot Study of a Novel Modification of an Existing Oral Airway to
Decrease Limitations and Improve on Fiberoptic Intubation
The Ovassapian airway is made of flexible plastic bent on the distal end to
comply with the curvature of the oropharynx. Posterior phalanges forming
the canal are narrow to allow the endotracheal tube and fiber optic scope to
glide through smoothly. We present an efficient method to improve on this
design and a pilot study on the dummy to assess effectiveness of a modified
airway. Almost all providers required less time to achieve fiberoptic intubation
on a dummy with airway modified by cutting phalanges to eliminate the
restriction of the posterior boundary while maintaining the anterior segment.
This modification increases the allowable area for the endotracheal tube
and fiberoptic scope to facilitate passage. Shawn K. Puri M.D., Sergey
V. Pisklakov M.D., Van Le M.D., Anesthesiology, UMDNJ-New Jersey
Medical School, Newark, NJ.
FA A3257
McGrath® MAC Facilitates Transesophageal Echocardiography Probe
Insertion
This study evaluated the effectiveness of McGrath® MAC as an aid to TEE
probe placement and compared it with that of the classical Macintosh
laryngoscope. The results of the present study show that the McGrath®
MAC provides a better view of the esophageal inlet shortens the duration
of TEE probe insertion attempts and decreases the complication rate in
anesthetized patients. Chiaki Takahashi M.D., Takashi Ishida M.D., Mikito
Kawamata M.D., Anesthesiology and Resuscitology, Shinshu University
of Medicine, Matumoto, Japan.
NA Neuroanesthesia
PN Pain Medicine
McGRATH™; MAC Video Laryngoscope Facilitate Easier Nasogastric
Tube Insertion in Intubated Patients
A nasogastric tube (NGT) is often inserted during perioperative periods.
However it can sometimes be difficult to insert an NGT in intubated patients.
Various techniques one of which involves the Macintosh laryngoscope
have been reported to facilitate NGT insertion. The new video laryngoscope
McGRATH™ MAC has been shown to be more useful to observe the larynx
than the Macintosh laryngoscope. In this study we investigated whether
the McGrath™ MAC facilitates easier NGT insertion compared to the
laryngoscope in intubated patients. The results of this study show that
McGrath™ MAC facilitates easier NGT insertion and reduces the duration
of the procedure compared to using the Macintosh laryngoscope.
Yuki Yoshiyama M.D., Tomoyuki Kawamata M.D., Takatoshi Tsujimoto
M.D., Masatoshi Urasawa M.D., Mikito Kawamata M.D., Anesthesiolosy
and Resuscitology, Shinshu University School of Medicine, Matsumoto,
Japan.
FA A3259
A Randomized Prospective Study Comparing the Video Miller Device
to a Standard Pediatric Miller Blade for Direct Laryngoscopy and
Tracheal Intubation of Young Children
This is a prospective and randomized. We compared the use of the new
Video Miller device to a commonly used Miller blade for performing direct
laryngoscopy and tracheal intubation in young children (< 3 yr.) after
a standardized inhalation induction of general anesthesia. Roya Yumul
M.D., Ph.D., Ofelia L. Elvir Lazo M.D., Tan Glenn M.D., Anita Mathoni
M.D., Daren B. Filsinger M.D., Emad G. Hemaya M.D., Joshua
Scherling M.D., Alan Stern B.A., Firuz Yumul B.A., Paul F. White M.D.,
Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
ROOM 104-AREA C
PI A3260
Trends in Anesthesiology Residency Program Sizes between 2008 and
2012
Recently, there have been changes in the anesthesia education
environment. The way in which these changes have affected sizes of
individual residency training programs has not been studied. NRMP data
regarding number of residents matched annually to each US residency
program from 2008-2012 were analyzed for trends in program size and
compared based on number of residents in each program. These results
imply that recent changes in the residency training environment have resulted
in both increases and decreases in the size of residency programs with
more decreases seen in larger programs. G. Kenton Allen M.D., Robert
W. Lekowski M.D., Angela M Bader M.D., Brigham & Women’s Hospital,
Boston, MA.
PI A3261
The Use of DOPS as a Self-Assessment Instrument in the Chilean
Anesthetic Context
The intubations performed during four months by anesthesia residents at
Pontificia Universidad Catolica were assessed using DOPS. The anesthesia
staff in charge of the theatre room carried out the resident’s assessment
and each student performed a self-assessment of the procedure using
the same instrument. The level of agreement between staffs and students
was established using ICC. 585 intubations were assessed. The general
performance of second and third year students was better than first year
students. The ICC was 0.423. The agreement between staffs’ assessments
and students’ self-assessment was poor. The use of DOPS as a selfassessment instrument requires important work in students’ training.
Alejandro E. Delfino M.D., Fernando Altermatt, M.D., Ghislaine
Echevarria, M.D., Anesthesiology, Pontificia Universityersidad Catolica de
Chile, Santiago, Chile.
PI A3262
Laryngeal Mask Versus Laryngeal Tube in the Training of Intensive
Care Trainees
Non-anesthesiologist intensive care trainees were trained in the use of
supraglottic airway devices in the OR. We compared the laryngeal mask
versus laryngeal tube and found a 98% success rate. Laryngeal tubes
were placed faster but the resulting tidal volumes were lower compared to
laryngeal masks. Harold T. Groeben M.D., Anna Grzesik, Dirk Muller
M.D., Fuat Saner M.D., Anesthesiology, Kliniken Essen-Mitte Essen
Germany, Surgery Universityersitat Duisburg Essen, Essen, Germany.
PI A3263
MONDAY, OCTOBER 14
FA A3258
Simulation as a Set-Up for Technical Mastery: Can a High-Fidelity
Virtual Warm-Up Improve Resident Performance of Fiberoptic
Intubation?
High-fidelity virtual warm-up has been utilized in surgical subspecialties to
enhance trainee performance of complex procedures. We examine the ability
of a brief warm-up using virtual bronchoscopy to enhance anesthesiology
resident performance of live fiberoptic intubation. Stefan T. Samuelson
M.D., Alan J. Sim M.D., Lydia Miller B.A., Tony Chang B.S., Samuel
DeMaria Jr. M.D., Anesthesiology, Icahn School of Medicine at Mount
Sinai, New York, NY.
PI A3264
A Flipped Classroom Curriculum to Increase Medical Knowledge During
the CB-1 Year
ImPRINT is a blended-learning online and simulation-based course for
interns. We use a flipped classroom structure (e.g. have interns do online
homework before attending class) and combine online lectures group
discussion and simulation to educate students on common clinical
situations encountered during the CB-1 year. By unloading the traditional
didactic lecture as homework prior to each in-person session we are able
to emphasize group discussions and simulation exercises. Ankeet D. Udani
M.D., Anna M. Clemenson B.A., Thomas K. Harrison M.D., Monica C.
Garbin M.S., Lawrence F. Chu M.D., M.S., Anesthesiology, Perioperative
& Pain Medicine, Anesthesia Informatics and Media Lab, Stanford
University Stanford, CA, Anesthesiology and Perioperative Care Service,
VA Palo Alto, Palo Alto, CA, Education, UNICAMP Campinas, Sao Paulo,
Brazil.
PO13-2BOUTCOMES AND DATABASE RESEARCH: RISK AND
PREDICTION II
ROOM 104-AREA E
FA A3265
Electronic Anesthesia Records: Quality Improvement of Errors in
Databases
With increases in electronic anesthesia records large amounts of data are
being stored. This also has improved data analysis and research. However
there are errors in the database that must be monitored and cleaned to
improve quality. In our AIMS database it was found that there were over 10
cases that erroneously inputted multiple entries of the same drug at the
same time throwing off pharmacies totals patient charges as well as data
analysis. These type of errors ranged from 2 to 49 entries. No pattern was
determined. Due to the small number of cases we were able to clean the
database. More data is being currently analyzed to look for other types of
errors but such practices should become standard thereby improving the
quality of patient care and research. Vimal N. Desai M.D., Alfred Pinchak
M.D., Ph.D., Tejbir S. Sidhu M.D., Anesthesiology, Case Western
University School of Medicine, MetroHealth Medical Center, Cleveland,
OH.
NA Neuroanesthesia
PN Pain Medicine
101
FA A3266
FA A3272
FA A3267
Intraoperative Urine Output and Postoperative Acute Kidney Injury in
Pancreatic Surgery - Preliminary Results
Intraoperative urine output is considered a reflection of the patient’s
intravascular volume and renal function. In our study we hypothesized that
there is no correlation between intraoperative urine output and postoperative
acute kidney injury. We have found that acute kidney injury is not rare among
patients undergoing elective pancreatic surgery. We have also found that the
development of acute kidney injury does not correlate with low intraoperative
urine output. Or Goren M.D., Idit Matot M.D., Ph.D., Department of
Anesthesiology and ICM, Tel Aviv Medical Center, Tel Aviv, Israel.
Acute Kidney Injury and 30-Day Mortality in Patients Undergoing
General Surgery
General surgery is comprised of a heterogeneous group of procedures
with varying degrees of perioperative acute kidney injury (AKI) risk. AKI
was significantly associated with 30-day mortality across all types of
procedures with the strongest association in procedures with a low risk of
AKI. It is imperative to closely monitor patients who develop perioperative
AKI as they have an increased risk of short-term mortality. Minjae Kim
M.D., Joanne E. Brady M.S., Guohua Li M.D., Ph.D., Anesthesiology,
Columbia University Medical Center New York, NY, Anesthesiology and
Epidemiology, Mailman School of Public Health, New York, NY.
FA A3268
Noradrenaline Does Not Impair Postoperative Renal Function in
Endovascular Stent Graft Repair
Continuous infusion of noradrenaline to keep spinal cord perfusion pressure
equal or more than normal value for maintaining spinal cord circulation
during endovascular stent graft repair of aortic aneurysm does not impair
postoperative renal function. Takehiro Kinjo M.D., Yuiko Madanbashi
M.D., Shunsuke Izumi M.D., Masakatsu Oshiro M.D., Ph.D., Kazuhiro
Sugahara M.D., Ph.D., University of the Ryukyus, Okinawa, Japan
FA A3269
Effect of Hypothyroidism on In-Hospital Mortality and Length of
Hospital Stay After Non-Cardiac Surgery
Mild-to-moderate hypothyroidism with elevated TSH concentrations slightly
prolonged hospitalization but did not increase in-hospital mortality.
Postponing surgery to initiate thyroid replacement therapy in patients with
mild or moderate hypothyroidism appears unnecessary. Ryu Komatsu
M.D., Jing You M.S., Edward J. Mascha Ph.D., Daniel I. Sessler M.D.,
Alparslan Turan M.D., Anesthesiology Institute Cleveland Clinic,
Cleveland, OH.
FA A3270
Acute Renal Failure and Bleeding With Postoperative Ketorolac:
Analysis of a US Electronic Health Record Database
The safety of repeated dose ketorolac with a focus on renal events and
bleeding was examined using US Electronic Health Record data. The data
included >7400 postsurgical patient encounters involving use of ≥8 doses
of ketorolac. Acute renal failure and anemia rates were 6.2% and 38%
respectively. Dialysis was needed in 2% of acute renal failure patients. Blood
transfusion was performed in 28% of anemic patients. Use of repeated dose
ketorolac may be associated with renal and bleeding risks in postsurgical
patients. Peter Lacouture Ph.D., Randall Ostroff M.D., Victor Khangulov
Ph.D., Fred Peyerl Ph.D., Scott Paluszkiewicz Ph.D., Funmi Taiwo
Pharm.D, Debra Tennant Pharm.D, Lauren Min Pharm.D, Hospitalira
Inc., Lake Forest IL, Ambulatory Anesthesiologists of Chicago Chicago,
IL, Boston Strategic Partners, Boston, MA.
FA A3271
Association Between Vitamin D and Wound Infection After Colorectal
Surgery
The authors found no association between the incidence of surgical site
infection and Vitamin D concentrations in the peri-operative period of
colorectal surgeries. Further prospective study is warranted to analyze the
same as the immunomodulatory effects of Vitamin D and better ulcer
healing after its reposition are shown in other studies. Thilak Sreenivasalu
M.D., Jing You M.S., Alparslan Turan M.D., Anesthesiology, Cleveland
Clinic Foundation, Cleveland, OH, Quantitative Health Sciences,
Outcomes Research.
ROOM 104-AREA D
RA A3273
Our Experience With Ambulatory Peripheral Nerve Catheters: A Three
Year Retrospective Analysis
This was a retrospective study that included 1059 patients with ambulatory
catheters (769 supraclavicular 290 popliteal) in three years period. Our
primary outcome was to measure the complications of ambulatory catheters.
We found that prolonged use of ambulatory catheters for a median period of
5 days did not lead to an increased incidence of complications. In our study
the main complications were minor infections and pharmacologic symptoms
which resolved with catheter removal. Alaa A. Abd-Elsayed M.D., Ramez
Gharabawy M.D., Hesham Elsharkawy M.D., Ehab farag M.D., Kenneth
Cummings M.D., Gamal Eid M.D., Maria Mendoza M.D., Loran
Mounir Soliman M.D., Richard Rosenquist M.D., Wael Sakr Esa M.D.,
Anesthesiology, University of Cincinnati Cincinnati, OH, Cleveland Clinic,
Cleveland, OH.
RA A3274
Contrast-Enhanced Ultrasound with Perflubutane Microbubbles for
Femoral Nerve Block - A Human Cadaver Study
Using human cadavers embalmed by Thiel’s method we used a solution of
perflubutane including indigo carmine for ultrasound-guided femoral nerve
block and assessed the distribution of microbubbles around the nerve.
The distribution of microbubbles detected by ultrasound and the dyed area
measured after dissection were very similar. Contrast-enhanced ultrasound
with perflubutane microbubbles is a reliable method to evaluate local
anesthetic spread when performing ultrasound-guided femoral nerve block.
Eri(Huiling) Gi(Wei) M.D., Hideaki Sasaki M.D., Tomohisa Niiya M.D.,
Ph.D., Masanori Yamauchi M.D., Ph.D., Michiaki Yamakage M.D., Ph.D.,
Department of Anesthesiology, Sapporo Medical University, Sapporo,
Japan.
RA A3275
Should We Still Worry About Anatomical Variations of Sciatic Nerve?
We examined with ultrasound the anatomical variations of sciatic nerve(SN)
in popliteal fossa. We found and kept in mind that some variations of SN
division exist. However the use of ultrasonography shows that SN division in
popliteal fossa accurs lower than expected from traditional surface landmarks
for neurostimulation. Alexandre Gnaho M.D., Sylvain Vico M.D., Laeticia
Franck M.D., Philippe Laitselart M.D., Alexandre Salvadori M.D.,
Stephane Merat M.D., Marc Emmanuel Gentili M.D., Ph.D., Department
of Anesthesia and Intensive Care, Hospitald’Instruction des Armees
Begin Saint-Mande, France, Centre Hospitalier Prive Saint Gregoire,
Saint Gregoire, France.
Is eGFR a Better Predictor of 30-day Mortality After Non-Cardiac
Surgery Than Serum Creatinine?
An Analysis of 92 888 Patients Renal dysfunction is a strong predictor of
postoperative complications and mortallity. We tested the hypothesis that
preoperative eGFR is a better predictor of 30-day mortality after non-cardiac
surgery than preoperative creatinine. In our retrospective analysis of 92
888 patients eGFR calculated using CKD- EPI better discriminated 30-day
mortality than serum creatinine. Abraham Sonny M.D., Edward Mascha
Ph.D., Daniel Sessler M.D., Jacek Cywinski M.D., Anesthesiology,
102
NA Neuroanesthesia
PN Pain Medicine
Effect of Adding Intraarticular Analgesics and Sciatic Block to
Continuous Femoral Block for Total Knee Arthoplasty
Patients receiving continuous femoral nerve block and intra-articular (IA)
analgesic s with and without single-shot sciatic block were compared.
Incremental improvement over IA injection alone was not seen with singleshot sciatic block; both have short-term effects that once resolved are
associated with a worsening of pain and increased ketorolac use compared
to patients who only received continuous femoral block. Craig T. Hartrick
M.D., Mark H. Mounayer M.D., Cecile Pestano B.S.N., Sn Hartrick
B.S.N., Guangzhi Qu Ph.D., Donald Knapke M.D., Anesthesiology,
Oakland University William Beaumont School of Medicine, Troy
MI, Wayne State University/Detroit Medical Center Detroit, MI,
Anesthesiology, Research Beaumont Health System, Troy, MI,
Computer Science and Engineering Oakland University Rochester, MI,
Orthopaedics Beaumont Health System, Troy, MI.
RA A3277
The Effect of the Administration of Different Single Doses of
Intraarticular Levobupivacaine on the Cartilage in the Rabbit Shoulder
Joint Model
We aimed to investigate the effects of intraarticular administration of
levobupivacaine (into the shoulder joint) with this study. Bulent Karslioglu
M.D., Mustafa Soner Ozcan M.D., Menekse Ozcelik M.D., Ozlem
Selvi Can M.D., Mahmut Kalem M.D., Nazli Hayirli M.Sc., Oya Evirgen
M.D., Ph.D., Feyhan Okten M.D., Ph.D., GMMA Orthopeadics and
Traumatology Clinics, Ankara Turkey, Ankara Occupational Diseases
Hospital, Anesthesiology and Reanimation Clinics, Ankara Turkey,
Ankara University Anesthesiology and Reanimation Clinics Ankara,
Turkey, Polatl, Duatepe State Hospital Orthopeadics And Traumatology
Clinics, Ankara, Turkey, Ankara University Medical School Histology and
Embryology Clinic, Ankara, Turkey.
RA A3279
Postoperative Epidural Analgesia After Hepatic Resections in Cancer
Patients: A Review of 1644 Cases
Controversy exists regarding use of epidural analgesia with hepatic
resections. Despite significant incidence of postoperative coagulopathy after
hepatic resections no epidural hematomas in 1 644 cases utilizing epidural
analgesia after hepatic resections were found. Jackson Su M.D., Jose Soliz
M.D., Keyuri Popat M.D., Rodolfo Gebhardt M.D., Anesthesiology and
Perioperative Medicine, MD Anderson Cancer Center, Houston, TX.
RA A3280
The Respiratory and Hemodynamic Effects of Opiorphin a Human
Physiological Inhibitor of Enkephalin Breakdown - A Dose-Effect Study
Human opiorphin is a natural dual enkephalinase inhibitor that produces
a potent analgesia in animal pain models. Here we demonstrated that
the Opiorphin does not elicit respiratory depression and/or hemodynamic
disturbances. Alain C. Van Elstraete Sr. M.D., Philippe Sitbon M.D.,
Leila Hamdi Student, Jean-Xavier Mazoit M.D., Ph.D., Dan Benhamou
M.D., Catherine Rougeot Ph.D., Anesthesiology, Centre MedicoChirurgical Saint Paul Fort de France France, Anesthesiology, Institut
de Cancerologie Gustave Roussy Villejuif France, Laboratory of
Anesthesiology, INSERM U788 Universityersite Paris-Sud Le KremlinBicetre France, Anesthesiology, HospitalBicetre AP-HP Le Kremlin
Bicetre France, Anesthesiology, HospitalBicetre AP-HP Le KremlinBicetre France, Laboratoire de Pharmacologie de la Douleur Institut
Pasteur Paris, France.
MONDAY, OCTOBER 14
RA A3276
RA A3278
Treatment of Headaches Associated With Spinal Drain Placement
A retrospective chart review of 135 patients who received spinal drains while
undergoing thoracoabdominal aortic aneurysm repairs revealed a post-dural
puncture headache (PDPH) frequency of approximately 24.4%. Of these
33 patients Epidural Blood Patching (EBP) was found to treat PDPH far
better than conservative therapy alone (100% vs. 44%). Furthermore 90%
of patients receiving EBP after failing conservative therapy experienced
headache resolution. It appears reasonable to offer EBP to patients who
develop a moderate-severe PDPH following spinal drain placement even
without a prior trial of conservative therapy. Diana Khatib M.D., Melanie
J. Donnelly M.D., Kristopher M. Schroeder M.D., Anesthesiology,
University of Wisconsin School of Medicine and Public Health Madison,
WI.
NA Neuroanesthesia
PN Pain Medicine
103
ORAL PRESENTATIONS
OR11-2 HISTORY AND EDUCATION
OR09-1 EXPERIMENTAL CIRCULATION: ISCHEMIA AND REPERFUSION
INJURY
ROOM 123
ROOM 125
PI A4005
CA A4000
Downregulated MicroRNA-21 in Type-2 Diabetic Patient Stem CellDerived Cardiomyocytes May Contribute to Attenuated Anesthetic
Cardioprotection
In this study, we examine the role of miR-21 in anesthetic cardioprotection.
Our data indicate an important role of miR-21 a microRNA whose expression
is suppressed under diabetic conditions possibly as a new therapeutic
target for reducing perioperative cardiovascular morbidity and mortality in
diabetic patients. Jessica Olson, M.S., Yasheng Yan M.S., Scott Canfield,
B.S., Danielle Twaroski, B.S., Chika Kikuchi, M.D., Alison Kriegel, Ph.D.,
Xiaowen Bai, M.D., Ph.D., Mingyu Liang, Ph.D., Zeljko J. Bosnjak, Ph.D.,
Physiology, Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
CA A4001
Protection of Glycocalyx Decreases Platelet Adhesion After Ischemia/
Reperfusion
Adhesion of platelets to coronary endothelium is a key event for cardiac
ischemia/reperfusion-injury. The endothelial glycocalyx clothes every
healthy vascular endothelium but is deteriorated by ischemia/reperfusion.
Preservation of the glycocalyx via antithrombin mitigated postischemic
platelet adhesion and should alleviate vascular leakage tissue edema and
inflammation. Daniel Chappell M.D., Ph.D., Florian Brettner M.D., Nina
Dorfler M.D., Matthias Jacob M.D., Ph.D., Markus Rehm M.D., Ph.D.,
Bernhard F. Becker M.D., Ph.D., Peter Conzen M.D., Ph.D., University
Hospital Munich, Walter-Brendel-Centre of Experimental Medicine,
Munich, Germany.
CA A4002
Postconditioning Effect of CpG-ODN Is Preserved Following 7 days Of
Reperfusion After Myocardial Ischemia
Postcondtioning with CpG oligodesoxynucleotide preserves myocardial
mass for up to 7 days following myocardial ischemia and reperfusion in
mice. Furthermore myocardial macrophage infiltration is significantly lower
compared to ischemic postconditioning. The significance of inflammatory
infiltration has to be further explored. Se-Chan Kim M.D., Max Schneider
Student, Shuijing Wu M.D., Jens Neumann Student, Daniel Durr
M.D., Pascal Knufermann M.D., Andreas Hoeft M.D., Ph.D., Georg
Baumgarten M.D., Ph.D., Anesthesiology, University Hospital Bonn,
Cardiovascular Surgery, University Hospital Bonn, Germany.
CA A4003
Mice With One X Chromosome are More Protected Against Myocardial
Ischemia/Reperfusion Injury Than Mice With Two X Chromosomes
The expression of X or Y chromosome contributes to sex differences in
cardiac ischemia/reperfusion injury. Jingyuan Li Ph.D., Rebecca McClusky
B.S. Xuqi Chen Ph.D., Arthur P. Arnold Ph.D., Mansoureh Eghbali Ph.D.,
CA A4004
Isoflurane-Induced Trafficking of Caveolin to Mitochondria Results in
Cardiac Protection and is Dependent on Inhibitory G-Protein Signaling
Our data suggest that activation of Gi proteins is a necessary step in the
trafficking of caveolin to mitochondria to ultimately induce cardiac protection
via preservation of mitochondrial function and structure. Thus Gi activation
may be a generalized pathway used by multiple cell systems as a means
to adapt to stress via a caveolin-mitochondrial dependent pathway. Jia
Wan Wang M.D., Ingrid Niesman M.S., Jan Schilling M.D., David M.
Roth M.D., Yun Yue M.D., Hemal H. Patel Ph.D., Anesthesiology,
Beijing Chaoyang Hospital Capital Medical University, Beijing, China,
Anesthesiology, University of California, San Diego and VAMC San Diego,
San Diego, CA.
104
Teaching Final Year Medical Students Portable Transthoraic
Echocardiography
During the Anesthesia Rotation Teaching final year medical students bedside
transthoracic echocardiography during a 2-week anesthesia rotation was a
positive experience for the students. In spite of the brief duration students
successfully acquired most of the basic TTE windows in cardiac surgery
patients and was able to identify most of the valvulopathy presented.
Anthony M. Ho M.D., Lester AH Critchley M.D., Joseph Leung M.Phil.,
Siu K. Ng M.B. B.S., Simon KC Chan M.B. B.S., Patricia KY Kan M.B.
B.S., Sylvia Au M.B. B.S., Anaesthesia and Intensive Care, The Chinese
University of Hong Kong, Anaesthesia and Intensive Care Prince of
Wales Hospital Shatin Hong Kong.
PI A4006
Drug Calculation Errors in Anesthesia Residents and Faculty
In a drug calculation test error rates were greatest in the CA-1 year
and increased post-residency in faculty. Jerrold Lerman M.D., Shira
Black D.O., Luciana Curia M.D., Shawn Banks M.D., Deborah
Schwengel M.D., Corey Nelson M.D., James M. Foster M.B.
B.S., Stephen Breneman Ph.D., Dana P. Turner M.P.H., Tim Houle
Ph.D., Anesthesiology, Children’s Hospital of Buffalo, Buffalo, NY,
Anesthesiology, University of Rochester Rochester, NY, Anesthesiology,
University of Miami, Miller School of Medicine, Miami, FL,
Anesthesiology, Critical Care Medicine and Pediatrics Johns Hopkins
University, School of Medicine, Baltimore, MD, Anesthesiology and
Perioperative Care School of Medicine, University of California Irvine
Irvine, CA, Anesthesiology, SUNY Upstate Medical University, Syracuse,
NY, Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC.
PI A4007
Milestone-Specific Observed Data Points for Evaluating Levels of
Performance (MODEL) Assessment Blueprint
Anesthesiology residency programs will be expected to have Milestonesbased evaluation systems in place by July 2014 as part of the Next
Accreditation System (NAS). The Anesthesiology residency programs in
San Antonio, Texas - San Antonio Uniformed Services Health Education
Consortium (SAUSHEC), and University of Texas Health Sciences Center at
San Antonio (UTHSCSA)-have jointly developed an NAS-compliant evaluation
system (MODEL) a year ahead of schedule. Our aim in this presentation is
to help other programs adapt their own evaluation systems prior to ACGMErequired implementation. Christopher J. Nagy, M.D., Travis D. Wilson, M.D.,
Department of Anesthesia and Operative Services (DOAOS) San Antonio
Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam
Houston, TX, Department of Anesthesiology, University of Texas Health
Sciences Center at San Antonio, San Antonio, TX.
PI A4008
Validation Strategy for Developing a Critical Care Medicine Clerkship
Examination for Medical Students
Few medical schools require a critical care medicine clerkship and no
validated examination has been created for medical students. In order to
incorporate knowledge assessment into clerkship evaluations we sought
to develop and validate a clerkship examination. Questions encompassing
relevant subject areas were selected from published sources and
administered to 20 medical students. Item analysis was performed to
evaluate individual questions and descriptive statistics were employed to
determine overall examination quality. Analysis of this examination suggests
that it has utility as an objective knowledge assessment for the critical care
clerkship. Vidya Rao M.D., MBA, Erin Hennessey M.D., Irina Russell
Ph.D., Jennifer Deitz M.A., Juliana Barr M.D., Anesthesiology, Stanford
University, Division of Medical Evaluation, Stanford University School of
Medicine, CA.
NA Neuroanesthesia
PN Pain Medicine
ASA Committee on Professional Diversity Mentoring Award: An
Innovative Approach to Facilitate Mentoring Relationships and Foster
Leadership
Mentoring has been established as a critical component of career
development and advancement in medicine. The American Society of
Anesthesiologists (ASA) has responded to this need by creating a mentoring
award which provides funding to mentor-mentee pairs to develop a project
in a mutually agreed area of interest. The objective of this study is to
measure the effectiveness of the ASA Committee on Professional Diversity
Mentoring Award in enhancing career development leadership potential
and active involvement within the ASA. Elizabeth Rebello M.D., Gregory
Kerr M.D., Jerome Adams M.D., Anesthesiology and Perioperative
Medicine, University of Texas MD Anderson Cancer Center, Houston,
TX, Department of Anesthesiology, New York Presbyterian Hospital Weill
Cornell Medical Center, New York, NY, Department of Anesthesiology,
Indiana University School of Medicine, Indianapolis, IN.
PI A4010
Teaching Point-Of-Care Ultrasound of the Chest-Animal Models and
Phantoms
In this study we have assessed the feasibility of using low cost animal
models (porcine lungs and rib cages) and phantoms (polyurethane foam)
to simulate lung sonopathology and allow controlled supervised teaching
of lung ultrasound. Jacek A. Wojtczak, M.D., Ph.D., Gino Soldati M.D.,
Department of Anesthesiology, University of Rochester Medical Center
Rochester, NY, Department of Emergency Medicine Valle del Serchio
General Hospital, Lucca, Italy.
OR07-2 DRUG DISPOSITION
ROOM 125
CC A4011
Use of Propofol for Premedication - A Placebo-Controlled Randomized
Double-Blinded Comparison With Midazolam
Propofol 20 mg I.V., appears to be an excellent alternative to midazolam, 2
mg I.V. for premedication prior to entering the operating room. Although both
propofol and midazolam produced an increased level of sedation, propofol
was more effective in reducing the patient’s level of anxiety prior to induction
of anesthesia. Even midazolam produced more amnesia than propofol
none of the study patients had recalls. Jun Tang M.D., Ronald H. Wender
M.D., Roya Yumul M.D., Ph.D., Ofelia L. Elvir-Lazo M.D., Jonathan
Hausman M.D., Antonio H. Conte M.D., Emad Hemaya M.D., Monique
Vuong B.A. Firuz Yumul B.A. Paul F. White M.D., Ph.D., Department of
Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA
CC A4012
Impact of Sugammadex Versus Usual Care on Residual Blockade and
Perioperative Surgical Timepoints
Adult patients (n=154) were randomized to receive sugammadex (2 or 4
mg/kg) or usual care (neostigmine/glycopyrrolate) to reverse rocuroniuminduced blockade. Sugammadex significantly reduced the incidence of
residual blockade in the post-anesthesia care unit (0% in sugammadex
group vs 43% in usual care group; p<0.0001). On top of that, the time from
study drug administration to patient being considered ready for operating
room discharge (14.7 vs 18.6 min, p=0.021) was also reduced in the
sugammadex group versus the usual care group. Matthias Eikermann M.D.,
Britta Brueckmann M.D., Nobuo Sasaki M.D., Peter Grobara M.Sc.,
Michael K. Li B.S., Tiffany Woo M.S., Massachusetts General Hospital,
Boston, MA, MSD Oss Netherlands, Merck Sharp & Dohme Corp.
Whitehouse Station, NJ.
CC
PN Pain Medicine
CC A4013
Sugammadex for Rocuronium- or Vecuronium-Induced Blockade
Reversal: A Pooled Analysis of 26 Controlled Studies
Sugammadex at recommended doses provides rapid and predictable reversal
of rocuronium and vecuronium-induced moderate and deep blockade as
well as immediate blockade reversal 3 min after rocuronium. Sugammadex
results in statistically and clinically significantly more rapid reversal of
moderate and deep blockade versus neostigmine or spontaneous recovery.
Hein Fennema, Ph.D., Tiffany Woo, M.S., R. Kevin Jones, M.D., Hendrikus
Lemmens, M.D., Manfred Blobner, M.D., Karin Khuenl-Brady, M.D., Armin
Szegedi M.D., Biostatistics and Research Decision Sciences MSD
Os, Netherlands, Merck Sharp & Dohme Corp. Whitehouse Station,
NJ, Saddleback Memorial Medical Center, Laguna Hills, CA, Stanford
University School of Medicine, Stanford, CA, Klinik fur Anaesthesiologie
der Technischen, Munich, Germany, Medical University Innsbruck,
Innsbruck, Austria.
TUESDAY, OCTOBER 15
PI A4009
CC A4014
Microfluidic Synthesis of Nano-Liposomal Anesthetics
The microfluidic technique can produce a narrow range of liposome
sizes. In this study we could show that small liposomes may be passively
incorporated into dermal tissue due to their diameters being within the
size range of the pores of the skin. The microfluidic technique enables the
production of novel formulations which will quickly penetrate through the skin
layers promoting fast onset anesthesia while also providing long duration and
improved safety profiles. Extrapolating these findings clinically we postulated
that this technique can be applied for many drugs in clinical anesthesia and
pain medicine and controlling the size and liposomes features we will be
able to allow transdermal uptake for topical application and for systemic drug
delivery. Mariana M. Junqueira M.D., Zena Quezado M.D., Don DeVoe
Ph.D., Renee Hood Ph.D., Eric Kendall Ph.D., Julia Finkel M.D., Sheikh
Zayed Institute for Surgical Innovation, Children’s National Medical Center
Washington, DC, Clark School of Engineering, University of Maryland,
College Park, MD.
CC A4015
Qualitative Neuromuscular Transmission and Neostigmine Reversal
Monitoring Fail to Improve Postoperative Respiratory Safety
Qualitative neuromuscular transmission monitoring and neostigmine
administration are two strategies employed to monitor and reverse the
effects of residual neuromuscular blockade after surgery. Using propensity
matched cohorts our data analysis finds neither qualitative neuromuscular
transmission monitoring nor neostigmine administration is associated with
a reduction in the occurrence of postoperative respiratory events including
oxygen desaturations and reintubation. Matthew J. Meyer M.D., Brian
T. Bateman M.D., Tobias Kurth M.D., Nobuo Sasaki M.D., Matthias
Eikermann M.D., Ph.D., Anesthesia, Critical Care and Pain Medicine,
Anaesthesia, Critical Care and Pain Medicine, Boston, MA, University
of Bordeaux, Bordeaux, France, Emergency and Critical Care Medicine,
Showa General Hospital, Tokyo, Japan.
CC A4016
Pharmacokinetics of A Novel Propofol Prodrug HX0969w in Rabbits
The research investigated the pharmacokinetics of HX0969w in rabbits.
HX0969w showed a quick onset and short duration of anesthesia and a fast
elimination. Wang Yin M.S., Yu Wang M.S., Jun Yang Ph.D., Yi Kang
B.S., Jin Liu M.D., Ph.D., Wen-Sheng Zhang M.D., Ph.D., State Key
Laboratory of Biotherapy, Sichuan University, Laboratory of Anesthesia
and Critical Care, Medicine and Translational Neuroscience Center, West
China Hospital, Sichuan University, Chengdu, China.
Critical Care Medicine
NA Neuroanesthesia
105
PN A4022
OR03-2 CHRONIC AND CANCER PAIN: BASIC SCIENCE
ROOM 124
PN A4017
Capsazepine Alleviates Trigeminal Neuralgia that Manifested With Cold
Allodynia and Hyperalgesia in a Rat Model
We performed our experience on 2 groups of rats (sham and ION-CCI). We
used Ugo Basile Orofacial Stimulation Test System® (ComerioVA, Italy) for
testing with 3 sets of temperature (24◦C, 17 ◦C, and 12◦C). After training
the rats and obtaining base line data which included the total contact time
against the different mentioned degrees of temperature; ION-CCI group was
treated with Capsazepine and our results suggest that at cold temperature of
17◦C and 12◦C, capsazepine could alleviate cold allodynia and hyperalgesia.
Thus, TRPM8 is potentially a therapeutic target in treating trigeminal
neuralgia manifested with cold allodynia and hyperalgesia. Alaa A. AbdElsayed M.D., Zuo Xiaozhuo M.D., Jianguo Gu Ph.D., Anesthesiology,
University of Cincinnati Cincinnati, OH.
PN A4018
Characteristics of Pain Related Behavior in Chronic Inflammatory
Model and Cancer Pain Model in Mice
Spontaneous pain related behavior in addition to evoked pain behavior
by von Frey was evaluated in detail in chronic inflammation and cancer
pain model in mice. Weight-bearing distribution tests lower-limb flinching
counts and open field tests were conducted to assess spontaneous and
emotional pain behavior. In chronic inflammation pain model we observed
similar impairment patterns for the von Frey and weight-bearing distribution
tests but there were no changes in flinching counts and open field tests.
In bone cancer model there were greater changes in the both evoked and
spontaneous pain behavior. Mice tended to be less active and more anxiolytic
in the open field tests. Pain behavior patterns after morphine administration
also varied between these animal pain models. Yukiko Katsube Student,
Tetsuro Nikai M.D., Ph.D., Junichi Ota M.D., Yoji Saito M.D., Ph.D.,
Anesthesiology, Shimane University, Izumo, Japan.
PN A4019
Can Continuous Low-Dose Ketamine Infusion Attenuate Neuropathic
Pain After Infusion Is Discontinued?
Long-term infusion of ketamine at a dose that produced behavioral
changes (e.g. decreased rearing), but was not sedating did not ameliorate
mechanical allodynia in neuropathic rats in the post-ketamine period.
Jeffrey S. Kroin Ph.D., Asokumar Buvanendran M.D., Jinyuan Li M.D.,
Ph.D., Kenneth J. Tuman M.D., Anesthesiology, Rush Medical College,
Chicago, IL
PN A4020
Opioid Receptor Antagonists at Therapeutic Concentrations Block EMT
in Human Lung Cancer Cells
This study examined the concentration response relationship of mu opioid
receptor (MOR) antagonists on epithelial-mesenchymal transition (EMT) a
crucial process for cancer progression in human NSCLC cells. We provide
evidence that MOR antagonism by methylnaltrexone and naltrexone inhibits
opioid and growth factor-induced EMT in NSCLC at clinically relevant
concentrations. Jonathan Moss M.D., Ph.D., Frances Lennon Ph.D.,
Tamara Mirzapoiazova M.D., Ph.D., Bolot Mambetsariev Ph.D., Ravi
Salgia M.D., Ph.D., Patrick Singleton Ph.D., University of Chicago, IL.
PN A4021
Identification of mRNA Changes at the DRG That Correlate With
Development of Chronic Allodynia
The mRNA pattern in DRG of adult rats was compared following Sural-SNI
and Tibial-SNI. It was found that on Day 23 following SNI the expression of
many of the mRNAs (100s) was commonly affected in Sural- and Tibial-SNI
mostly displaying an increase. In contrast the number of mRNAs that were
distinctly altered between Sural- and Tibial-SNI was smaller (~30); indicating
that the development of sustained chronic allodynia following a peripheral
nerve injury involves a selective change in protein expression rather than a
generalized increase in protein synthesis. Esperanza Recio-Pinto Ph.D.,
Monica Norcini Ph.D., Alexandra Sideris, Ph.D., Lourdes A. Martin
Hernandez, M.S., Thomas JJ. Blanck, M.D., Ph.D., Anesthesiology, NYU,
New York, NY.
106
The Therapy of Pulsed Electrical Magnetic Field Over Neuropathic Pain
Induced by Chronic Constriction of Sciatic Nerve
Pulsed electromagnetic field has therapeutic effects on neuropathic pain
induced by CCI and PEMF can reverse the decline of Nissl body in DRG
neurons after CCI. Yunxia Zuo, M.D., Hui Liu, M.D., Department of
Anaesthesiology, West China Hospital, Sichuan University, Chengdu,
China, Jiangsu Cancer Hospital, Nanjing, China
OR06-1 CRITICAL CARE: OUTCOMES
ROOM 125
CC A4023
Investigation of Predictive Variables of Unexpected Admission to the
ICU Due to Respiratory Failure
The incidence of unexpected ICU admission from general wards due to
respiratory failure was 40%. Most of the patients required respiratory support.
It is important to detect early changes in vital signs of patients in general
wards. A simple physiological scoring system such as MEWS or establishment
of a rapid response system might be useful for detecting abnormalities.
Masayuki Akatsuka, M.D., Jyunichi Sato M.D., Ph.D., Joji Arakawa M.D.,
Ph.D., Anesthesiology, Japanese Red Cross Kitami Hospital, Kitami,
Japan
CC A4024
Glucocorticoid and Endocannabinoid Receptor SNPs Increase the Risk
for PTSD - Stress Symptoms After ICU Therapy
Single nucleotide polymorphisms (SNPs) of the glucocorticoid receptor (GR)
gene affecting the sensitivity of the GR to cortisol and a functional SNP of the
endocannabinoid type 2 receptor are significant predictors of PTSD-related
stress symptoms in patients after ICU therapy. Our study confirms previous
experimental findings and allows their translation to a highly stressed
patient population. Gustav Schelling M.D., Martina Pfob M.D., Claudia
Marceca Student, Patrizia Campolongo Ph.D., Marion Weis M.D.,
Dominique de Quervain M.D., Daniela Hauer M.D., Anaesthesiology,
Medical Genetics University of Munich, Munich, Germany, Physiology and
Pharmacology Sapienza University of Rome, Rome, Italy, Division of
Cognitive Neuroscience, University of Basel, Switzerland.
CC A4025
A New Score at Admission to Predict Prolonged Length of Stay in ICU
for Patients With Subarachnoid Hemorrhage
We developed compared and validated a new score to predict at admission
a prolonged length of stay in ICU for patients followed for aneurysmal SAH.
Vincent Degos M.D., Ph.D., Frederic Clarencon M.D., Chiheb Zeghal
M.D., Walid Koubaa M.D., Vincent Reina M.D., Louis Puybasset M.D.,
Ph.D., Anesthesia and Perioperative Care, Hopital Pitie Salpetriere,
Paris, France.
CC A4026
Intraoperative Blood Glucose Levels During Liver Transplantation and
Impact on Outcomes
In this retrospective analysis of 175 patients undergoing liver transplantation
intraoperative blood glucose increased significantly from the preoperative
baseline. High peak blood glucose levels were significantly associated
with worse postoperative outcomes in univariate analyses. In the adjusted
multivariate analysis this significance persisted only for the 90-days
readmission rate. Blood glucose control during LT is challenging but when
improved it may contribute to better outcomes. Jana Hudcova M.D.,
Robin Ruthazer M.P.H., Iwona Bonney Ph.D., Roman Schumann
M.D., Department of Surgical Critical Care, Lahey Hospital & Medical
Center Burlington, MA, Bisotatistics Research Center, Department of
Anesthesia, Tufts Medical Center, Boston, MA.
NA Neuroanesthesia
PN Pain Medicine
A Novel Study Evaluating Efficacy and Utility of the Current Dysphagia
Protocol in the Postoperative Cardiac Patient
Post-operative dysphagia incidence in cardiothoracic surgery patients
at LUMC is 10%. Patients with intubation time >72h have a four-fold
increase in dysphagia incidence. Patients with dysphagia who go on to
recover completely do so early in the recovery period usually after 1 to
3 days. Michael Majewski M.D., Jayanta Mukherji M.D., Kathryn
O’Sullivan M.A., Noelle M. Fabian B.S., W. Scott Jellish M.D., Ph.D.,
Anesthesiology, Inpatient Rehabilitation Services, Loyola University
Medical Center, Maywood, IL.
CC A4028
Risk of Re-Intubation Following the Implementation of an Extubation
Safety Algorithm: Findings From the Extubation Safety and Quality
Improvement Project (ESQIP)
As a quality improvement (QI) initiative we implemented a planned
extubation safety algorithm to help reduce the occurrence of re-intubation
in a cohort of mechanically ventilated patients admitted to the ICU.
Implementation of the QI-intervention was associated with a trend toward
reduced re-intubation. Jacob E. Sunshine M.D., M.S., Aaron Joffe D.O.,
N.D. Yanez Ph.D., Steven Deem M.D., Nita Khandelwal M.D., A Dagal
M.D., Miriam Treggiari M.D., Ph.D., Anesthesiology and Pain Medicine,,
University of Washington, Biostatistics University of Washington, Seattle,
WA.
OR02-1 ANESTHETIC ACTION AND BIOCHEMISTRY: MECHANISM OF
ACTION OF CURRENT AND NEW ANESTHETIC AGENTS
ROOM 124
FA A4032
Deciphering How Inhaled Anesthetic Agents Work: The Role of Ion
Channels
Drosophila in which the expression of genes for specific ion channels had
been reduced demonstrated resistance to the effects of IAAs. However
we rejected the null hypothesis because ion channels that when silenced
conferred resistance to anesthesia depended upon whether the fly was
exposed to isoflurane or halothane. Candidates for further study to determine
their role in producing anesthesia through a common mechanism include
the 10 ion channels that had reduced expression on the cell membrane and
were associated with marked resistance to both halothane and isoflurane.
Michael Murray M.D., Ph.D., Trevor Batty B.S., Winnie Cheung B.S.,
J. Ryan Jackson B.S., Joel P. Goodman B.S., Gerald B. Call Ph.D.,
Anesthesiology, Mayo Clinic Hospital, Phoenix AZ, Arizona College of
Osteopathic Medicine/ Midwestern University, Glendale, AZ.
TUESDAY, OCTOBER 15
CC A4027
FA A4033
CW 1759-50: An Ultra-Short Acting Cysteine-Reversible NMBA Lacking
Histaminoid Side-Effects: Safety Versus Gantacurium in Rhesus
Monkeys
The ultra short acting ND NMB CW 1759-50 shows greater circulatory
safety than gantacurium in the rhesus monkey model. John J. Savarese
M.D., Matthew R. Belmont M.D., Hiroshi Sunaga M.D., Matthew
T. Murrell M.D., Ph.D., Jeff McGilvra Ph.D., Paul M. Heerdt M.D.,
Ph.D., Jaideep Malhotra M.D., Erin Jeannotte V.M.D., Jingwei Zhang
B.S., Karen Krause D.V.M., Anesthesiology, New York Presbyterian
Hospital-Weill Cornell Medical College New York, NY, Cedarburgh Hauser
Pharmaceuticals, Grafton WI, Albany Medical College, NY.
FA A4034
FA A4029
A GABA Receptor Model Predicts the Presence of Anesthetic Activity in
Newer Propofol Analogues
Homology modeling produces a model of the GABAaR showing an
intersubunit anesthetic binding cavity within the transmembrane domain
of LGIC’s that has characteristics which allow reasonable prediction of
anesthetic potencies in compounds previously unknown to possess such
activity. Edward J. Bertaccini M.D., Robert Brosnan D.V.M. Ph.D.,
Department of Anesthesia 112A Stanford University - Palo Alto San
Jose, CA, Department of Surgical and Radiological Sciences, University
of California at Davis School of Veterinary Medicine, CA.
FA A4030
CW1759-50: A New Ultra-Short Acting Non-depolarizer: Spontaneous
Recovery Versus Antagonism by L-Cysteine
Two examples of antagonism of CW1759-50 blockade by L-cysteine have
been studied. L-cysteine significantly accelerated 5-95% recovery intervals
after both boluses and infusions. Hiroshi Sunaga M.D., Jeff McGilvra
Ph.D., Matthew R. Belmont M.D., Matthew T. Murrell M.D., Ph.D.,
Paul M. Heerdt M.D., Ph.D., John J. Savarese M.D., Anesthesiology,
Weill Cornell Medical College New York, NY, Cedarburgh Hauser
Pharmaceuticals, Grafton, WI.
OR10-1 EXPERIMENTAL NEUROSCIENCES
ROOM 125
A Tandem Pore Potassium Channel Model Demonstrates a Possible
Anesthetic Binding Site
Homology modeling produced a model of the K2P that revealed a potentially
relevant anesthetic binding cavity identified by the convergence of amino
acid residues known to modulate anesthetic activity. Edward J. Bertaccini
M.D., James R. Trudell Ph.D., Nicholas P. Franks Ph.D., Department
of Anesthesia 112A Stanford University - Palo Alto, San Jose, CA,
Department of Anesthesia, Stanford University School of Medicine,
Stanford, CA, Department of Life Sciences, Imperial College London,
United Kingdom.
NA A4035
FA A4031
NA A4036
GABA-A Receptor on M2 is an Etomidate Binding Determinant
GABA-A receptor mutations to Met (M) or Cys (C) at βN265 in the M2
domain eliminate etomidate sensitivity, and may form part of the etomidate
binding site. We a introduced βN265C into α1β2γ2L receptors. The β2N265C
sulfhydryl was modified by pCMBS, but not protected by 300 μM etomidate.
In contrast, α1M236C is modified and protected by 30 μM etomidate.
We created α1M236Cβ2N265Mγ2L receptors and determined that the
substituted C is modified by pCMBS and weakly protected by 300 μM
etomidate. We conclude that βN265C/M mutations profoundly weaken
etomidate binding and that βN265 is a likely contact point. Stuart Forman
M.D., Ph.D., Mayo Hotta B.A., Deirdre S. Stewart Ph.D., David Pierce
B.A., Youssef Jounaidi Ph.D., Massachusetts General Hospital, Harvard
Can a Recent Ischemic Stroke Affect Post-Operative Cognitive
Dysfunction?
History of stroke is associated with an increasing risk of post-operative
cognitive dysfunction (POCD). In this experimental study we did not observe
any significant effect of bone fracture on the memory dysfunction induced
by acute stroke lesions. Vincent Degos M.D., Ph.D., Sna Vacas M.D.,
Zhenying Han M.D., Hua Su M.D., William L. Young M.D., Mervyn Maze
M.D., Anesthesia and Perioperative Care, University of California, San
NMDA Receptor Signaling: An Essential Cell Patterning Role in Early
Embryological Development
Generation of polarity within an embryo is fundamental to early development.
The ability to access and manipulate populations representing early
developmental stages in the stem cell differentiation cultures provides a
new model of early mammalian development that enables manipulations
comparable to those carried out in other organisms such zebrafish. Properly
applied this model has widespread implications in the areas of drug
discovery and development. Oluwaseun Johnson-Akeju M.D., Kevin Eggan
Ph.D., Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, Department of Stem Cell
and Regenerative Biology, Harvard Stem Cell Institute, Cambridge, MA.
NA Neuroanesthesia
PN Pain Medicine
107
NA A4037
POSTER DISCUSSIONS
Inhibition of Temporal-Frontal Auditory Feed Forward Processing During
Propofol Induced Unconsciousness
During auditory stimulation propofol induced unconsciousness affects frontal
to temporal and temporal to frontal information transfer in EEG. This suggests
effects of hypnotic drugs on the projection of primary auditory pathways to
high-order processing networks as well as on feedback projections.
Denis Jordan Ph.D., Rudiger Ilg M.D., Gisela Untergehrer M.D., Gerhard
Schneider M.D., Eberhard F. Kochs M.D., Anesthesiology, Neurology
Klinikum rechts der Isar Technische Universityersiat Munchen, Munich,
Germany, Anesthesiology, Helios Clinic Wuppertal, Witten/Herdecke
University, Wuppertal, Germany.
NA A4038
Sevoflurane Does Not Alter Long-Term Potentiation When Present
Before But Not During the High Frequency Stimulation
Even though sevoflurane (4%) reduces the slope of the epsp and the epsp
has not fully recovered after 10 min of washout at the start of high frequency
LTP inducing stimulation their is no attenuation of the LTP compared to
untreated tissue. We conclude that by 10 min after its washout sevoflurane
does not reduce LTP which is a correlate of learning and memory. This
rapid recovery of LTP may help explain why patients who wake up during
anesthesia with volatile agents remember intraoperative events after surgery.
Ira S. Kass Ph.D., Jinyang Liu M.S., Lie Yang Ph.D., James E. Cottrell
M.D., Anesthesiology, SUNY Downstate Medical Center, Physiology and
Pharmacology SUNY Downstate Medical Center, Brooklyn, NY.
NA A4039
Isoflurane Prolongs the Time Lag of Analytic LFP Amplitudes Between
Hippocampus and Basolateral Amygdala - Results From Pilot
Experiments
Hypnotic concentrations of isoflurane increase the time lag of the analytic
amplitude’s cross correlation between local field potentials recorded in
hippocampus and basolateral amygdala in mice. Matthias Kreuzer M.Sc.,
Stephanie Polta M.Sc., Stephan Kratzer M.D., Eberhard F. Kochs
M.D., Thomas Fenzl Ph.D., Anesthesiology, Technische Universityersitat
Munchen, Max Planck Institute of Psychiatry Munich, Germany,
Pharmacology and Toxicology University of Innsbruck, Austria.
NA A4040
Localizing EEG Oscillatory Dynamics of Unconsciousness and Return of
Consciousness
We investigated changes in the organization of cortical electrical activity
accompanying loss of consciousness during propofol general anesthesia.
We found two brain states with distinct cross-frequency phase-amplitude
coupling. Eran A. Mukamel Ph.D., Elvira Pirondini Ph.D., Behtash Babadi
Ph.D., Eric T. Pierce M.D., Priscilla G. Harrell M.D., John L. Walsh M.D.,
Sydney S. Cash M.D., Ph.D., Emad N. Eskandar M.D., Emery N. Brown
M.D., Ph.D., Patrick L. Purdon Ph.D., Computational Neurobiology
Laboratory, Salk Institute for Biological Studies, La Jolla, CA, Anesthesia
Critical Care and Pain Medicine, Neurology, Neurosurgery, Massachusetts
PD17-2 RESPIRATION: OBSTRUCTIVE SLEEP APNEA
ROOM 124
FA A4041
Identification of Factors Associated With Postoperative Increase of
Apnea and Hypopnea in Patients With No Obstructive Sleep Apnea
120 non-OSA patients completed preoperative and postoperative N1 and/or
N3 sleep studies. Only 31 patients had postoperative AHI ≥15. Preoperative
polysomnographic parameters such as lower sleep efficiency and higher
sleep fragmentation higher AHI and higher respiratory arousal index are
helpful for identifying non-OSA patients who may develop a significant
postoperative increase in AHI. Maged S. Andrawes M.D., Yiliang Yang
Ph.D., Weimin Kang M.D., Pu Liao M.D., Colin Shapiro M.B. B.S.,
Babak Babak Mokhlesi M.D., Frances Chung M.B. B.S., Anethesia
Department, Psychiatry and Sleep Research Unit, University Health
Network, Toronto ON, Canada, Sleep Disorders Center, University of
Chicago Medical Center, IL.
FA A4042
The Correlation Between Right Heart Dysfunction and the STOP Bang
Questionnaire in the Preoperative Population
The aim of this study was to assess the relationship between right heart
dysfunction (RHD) diagnosed via transthoracic echocardiography and
the number of positive responses to the STOP Bang questionnaire in
patients presenting to the Preoperative Clinic at the University of Utah. We
hypothesized that there would be a positive correlation between RHD and the
number of positive responses to the STOP Bang questionnaire. No correlation
between the number of positive responses to the STOP Bang questionnaire
and right heart dysfunction were observed in our preliminary study.
Rebecca E. Evans M.D., Joshua Zimmerman M.D., Kenneth Johnson
M.D., Sonia Shishido D.O., Elise Heath, M.D., Amber Bledsoe M.D.,
Anesthesiology, University of Utah, Salt Lake City, UT
FA A4043
No Association Between Preoperative Sleep Parameters and
Postoperative Opioids Requirement in Adult Patients With Obstructive
Sleep Apnea
In adult patients, no significant difference in postoperative opioids
requirements was found between OSA and non-OSA patients. Preoperative
sleep parameters measuring sleep disordered breathing were not correlated
with the 72h postoperative opioids requirement in OSA patients. Pu Liao,
M.D., Sazzadul Islam, M.Sc., Frances Chung, M.B., B.S., Anesthesia,
Toronto University Health Network, ON, Canada.
FA A4044
One Hour Oxygen Desaturation Index Does Not Predict Severity of
Sleep Disordered Breathing
Monitoring of oxygenation for one hour fails to predict sleep disordered
breathing (p=0.72) but monitoring of oxygenation for six hours has
prediction sensitivity of sleep disordered breathing 85% and prediction
specificity 80% (p<0.0001). Isaac Lowenwirt, M.D., Osvaldas
Pranevicius, M.D., Mindaugas Pranevicius, M.D., Peter Silverberg, M.D.,
Anesthesiology, New York Hospital Queens, Flushing NY, Jacobi Hospital,
Bronx, NY.
FA A4045
CPAP Treatment Ameliorates the Respiratory Depressant Effects of
Opioids and Sleep Following Weight-Loss Surgery
We assess whether continuous positive airway pressure (CPAP) improves
respiratory function in obese patients after weight-loss surgery. CPAP
decreased the apnea hypopnea index improved respiratory function and
reduced the effects of opioid-induced respiratory depression in these
patients. Sanjana A. Malviya B.S., Sebastian Zaremba M.D., Britta
Brueckmann M.D., Martina Grosse-Sundrup M.D., Kimberly N.
Taylor B.S., Matthew Hutter M.D., Denise W. Gee M.D., Teresa O.
Macdonald R.N., Matthew J. Meyer M.D., Matthias Eikermann M.D.,
Ph.D., Anesthesia Critical Care and Pain Medicine, Surgery, Patient
Care Units, Massachusetts General Hospital, Boston, MA.
108
NA Neuroanesthesia
PN Pain Medicine
The Effect of Nasal High Flow for Acute Hypoxemia on Oxygenation and
Respiratory Rate
We studied NHF for acute hypoxemia and/or respiratory support after
extubation in our general surgical ICU. PaO2 values after NHF were
significantly higher than that before NHF. Similarly the respiratory rate after
6 h was significantly lower than that at baseline. In 27 (90%) patients their
respiratory status has been improved with NHF. The respiratory rate of the
failure cases was improved temporarily after NHF but worsened in 6 h
after NHF. Our study showed that NHF improves oxygenation and reduces
respiratory rate in patients with acute hypoxemia even in the general
surgical ICU. Transit improvement of respiratory rate would be observed
even in the failed cases after NHF. Shuji Okahara M.D., Masao Hayashi
M.D., Takashi Matski M.D., Ph.D., Hiroshi Morimatsu M.D., Ph.D.,
Anesthesiology and Resuscitology, Okayama University Graduated School
of Medicine, Japan.
FA A4047
Effects of Carbon Dioxide Insufflation on Propofol and Sevoflurane
Induced Partial Upper Airway Collapse
We hypothesize that propofol and sevoflurane decrease the slope of the
hypercarbic normoxic ventilator response and that CO2 administration during
steady state propofol and sevoflurane anesthesia restores airway patency
expressed as a decrease in upper airway resistance and an increase in duty
cycle (Ti/Ttot). Our preliminary data suggest that carbon dioxide insufflation
ameliorates the effects of anesthetics on upper airway patency. Eric T.
Pierce M.D., Ph.D., Jeroen C.P. Simons Student, Matthew J. Meyer
M.D., Sanjana A. Malviya B.S., Sebastian Zarembra M.D., Daniel
Diaz-Gil Student, William J. Sauer M.D., Karen Y.G. Kan M.Eng., Carl
E. Rosow M.D., Ph.D., Matthias Eikermann M.D., Ph.D., Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard
FA A4048
Forty-Five Degrees Elevated Body Position Early After Delivery
Improves Sleep Apnea and Does Not Impair Sleep Architecture
Elevated body position increases airway size during wakefulness which
translates to a reduced incidence and severity of OSA during sleep. OSA is
common during the early post-partum period and associated with increased
rates of adverse pregnancy outcomes and post-delivery hospital length
of stay. Sebastian Zaremba M.D., Stefanie Jung M.D., Anne Heisig
Student, Lisa Leffert M.D., Kimberley Nicole Taylor, Yasuko Nagasaka
M.D., Brian Bateman M.D., Jeffrey Ecker M.D., Matthias Eikermann
M.D., Ph.D., Anesthesia Critical Care and Pain Medicine, Massachusetts
PD12-2 OBSTETRIC ANESTHESIA: HEMORRHAGE COMORBIDITIES
ROOM 124
OB A4049
Retrospective Assessment of the Incidence of Respiratory Depression
Following Neuraxial Morphine Administration for Post-Cesarean
Delivery Analgesia
Neuraxial morphine administration is an important form of analgesia
for women undergoing cesarean delivery under neuraxial anesthesia;
however both early-onset (30 to 90 minutes) and delayed-onset (6 to
18 hours) respiratory depression are complications of neuraxial morphine
administration. Data on respiratory depression are sparse in the obstetric
population (reported incidence 0-0.9%). In this single-center retrospective
study we did not identify any instances of respiratory depression requiring
naloxone administration or RRT involvement in 5036 obstetric patients
undergoing cesarean delivery and receiving neuraxial morphine despite a
mean BMI of 34. Theresa Crowgey Student, Jennifer Dominguez M.D.,
Cathleen Peterson-Layne M.D., Ph.D., Terrence K. Allen M.B. B.S., Holly
Muir M.D., Ashraf Habib M.D., Duke University, Durham, NC
OB A4050
Impact of an Obstetric Bleeding Protocol on Transfusion Practices and
Coagulopathy in a Tertiary Care Medical Center
Strategies for improving obstetric patients’ outcomes include obstetric
hemorrhage protocols (OHP). However the impact of OHP on intraoperative
resuscitation has not been well described. We conducted a retrospective
review of obstetric patients examining the impact of our institution’s
OHP on intraoperative transfusion practices laboratory monitoring and
perioperative markers of coagulation and perfusion. Our findings suggest
that intraoperative OHP use may reduce the incidence and severity of
perioperative coagulopathy during management of obstetric hemorrhage.
Jennifer E. Dominguez M.D., Amy A. Mauritz M.D., Evelyn Lockhart
M.D., Chad Grotegut M.D., Maria J. Small M.D. M.P.H., Terrence Allen
M.B. B.S., Anesthesiology, Pathology, Obstetrics and Gynecology, Duke
University, Durham, NC.
TUESDAY, OCTOBER 15
FA A4046
OB A4051
Simulation Study Assessing Knowledge of Preeclampsia/Eclampsia
Management in a Tertiary Referral Center
Simulation-based study to assess the knowledge of labor and delivery staff
at a tertiary referral center in the management of preelcampsia/eclampsia.
Our results suggest excellent magnesium utilization however the use of
antihypertensive medication is not universally appreciated or compliant with
current guidelines. This study also suggests that for cognitive aids to be
utilized and effective it is essential that physicians and nurses are familiar
with them prior to an event. Gillian Hilton M.B. Ch.B., Kay Daniels M.D.,
Brendan Carvalho M.B. B.Ch., Anesthesia, Obstetrics and Gynecology,
Stanford University School of Medicine, CA.
OB A4052
The Use of Postpartum Hemorrhage Protocols in United States
Obstetric Anesthesia Units
Protocol-driven care is associated with improved outcomes in many settings
and many advocate for protocol-driven management of PPH. US academic
obstetric anesthesia units were surveyed to identify the current level of
PPH protocol availability and key components. While PPH protocols were
not universal MTP protocols were present in nearly all of the responding
units. Considerable variability exists in components of PPH protocols
specifically related to mobilization and utilization of blood/component therapy
and the use of a team to respond to PPH. Rachel M. Kacmar M.D.,
Barbara M. Scavone M.D., Jill M. Mhyre M.D., Paloma Toledo M.D.,
Anesthesiology, Anesthesia and Critical Care,, Northwestern University
Chicago, IL, Department of Anesthesiology, University of Michigan,
Health System, Ann Arbor, MI.
OB A4053
Magnetic Resonance Image Grading of Suspected Placenta Accreta
and Correlation With Operative Hemorrhagic Morbidity
Antepartum diagnosis of placenta accreta has been shown to decrease
maternal hemorrhagic morbidity. However the relationship between magnetic
resonance image (MRI) grading of suspected accreta with estimated blood
loss (EBL) and blood product transfusion has not been established. We
seek to identify if MRI grades correlate with hemorrhagic outcomes which
could help in the preoperative stratification of patients at risk for severe
hemorrhage. Katherine G. Lim M.D., Bradley Hewlett M.D., Jeanne
Horowitz M.D., Senta Bergrruen M.D., Rebecca Linn M.D., Linda Ernst
M.D., Robert McCarthy Pharm.D, Laurie Chalifoux M.D., Anesthesiology,
Radiology, Pathology, Northwestern University Feinberg School of
Medicine, Chicago, IL.
OB A4054
Simulation Training-Enhanced Competence for Performing Safe
General Anesthesia for Emergency Cesarean Delivery: Long Term
Retention and Frequent Management Mistakes
Following an 8 week OB-anesthesia clinical rotation and simulation enhanced
training anesthesia residents achieved and retained for 8 months a
competency level to performanesthesia for emergency cesarean delivery
comparable to that of specialized obstetricanesthesia attendings.
Clemens M. Ortner M.D., Laurent A. Bollag M.D., Pascal Vuilleumier
M.D., Brian K. Ross M.D., Ruth Landau M.D., Anesthesiology and Pain
Medicine, University of Washington, Seattle, WA.
NA Neuroanesthesia
PN Pain Medicine
109
OB A4055
Obstructive Sleep Apnea in First-Day Postpartum Women
We performed a prospective observational study among 51 women to identify
obstructive sleep apnea prevalence and respiratory complications among
women with body mass index of 18 or greater during the first 24 hours
after giving birth. Obstructive sleep apnea is present in 21.6% of first day
postpartum women and is associated with significant hypoxemia during sleep
in the first night postpartum. Christopher J. Parr B.Sc., Fahd AlGurashi
M.B. B.S., Bill Y. Ong M.D., Eleni Giannouli M.D., XiaoQing Liu M.D.,
Anesthesia and Perioperative Medicine, Internal Medicine, Obstetrics
Gynecology and Reproductive Sciences, University of Manitoba,
Winnipeg, MB, Canada.
OB A4056
Impact of Neuraxial Labor Analgesia on Oxytocin Augmentation and
Postpartum Hemorrhage: A Report From No Pain Labor and Delivery in
China
This study suggests that the increase in low dose intrapartum oxytocin
augmentation observed after a marked increase in the rate of neuraxial
labor analgesia during the first stage of labor had no negative impact on
postpartum hemorrhage. Yun Xia M.D., Ph.D., Mingpin Hu M.D., Ling
Qun Hu M.D., Cynthia A. Wong M.D., Francis S. Stellaccio M.D.,
Yuhuan Wang M.D., Wenguang Huang M.D., Yunping Li M.D., Tianna
J. Xia B.A., Roger R. Dzwonczyk M.S., The Ohio State University Wexner
Medical Center Columbus, OH, The Second Hospital of Wenzhou Medical
College, Wenzhou, China, Northwestern University Feinberg School of
Medicine, Chicago, IL, Stony Brook University School of Medicine, Stony
Brook, NY, Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, MA, Case Western Reserve University, Cleveland, OH.
PD13-1 OUTCOMES AND DATABASE RESEARCH: CARDIAC OUTCOMES
FOR NON CARDIAC SURGERY
ROOM 123
FA A4057
Anesthesia-Related Cardiac Arrests in 169,390 Anesthetics at an
Academic Medical Center
160 cardiac arrests in 169 390 cases occurred at a rate of 1 per 1058
cases most related to surgery or patient condition. 12 cases were
anesthesia-attributable for a cardiac arrest rate of 1 per 14 116 anesthetics.
41 cases were anesthesia-contributory 1 per 4 131 anesthetics.
Anesthesia-related cardiac arrest contributes to perioperative mortality.
Sheila J. Ellis M.D., Myrna Newland M.D., Jean Simonson M.D.,
Kenneth R. Peters M.D., Debra Romberger M.D., David W. Mercer
M.D., John Tinker M.D., Ronald Harter M.D., James Kindscher M.D.,
Steven Lisco M.D., Anesthesiology, Surgery, University of Nebraska
Medical Center, Medicine, VA Nebraska Western Iowa HealthCare
System, Omaha, NE, Anesthesiology, The Ohio State University,
Columbus, OH, Anesthesiology, University of Kansas Medical Center
Kansas City, KS.
FA A4058
Effect of Hypothyroidism on Cardiovascular and Wound Complications
After Non-Cardiac Surgery
Mild-to-moderate hypothyroidism with elevated TSH concentrations was
not associated with increased risk of composite cardiovasular or infectious
complications. Postponing surgery to initiate thyroid replacement therapy in
patients with mild or moderate hypothyroidism appears unnecessary.
Ryu Komatsu, M.D., Jing You M.S., Edward J. Mascha Ph.D., Daniel I.
Sessler M.D., Alparslan Turan M.D., Anesthesiology Institute, Outcomes
Research, Cleveland Clinic, OH.
FA A4059
Global Impact of Continuous Monitoring at Various Times of Day on InHospital Cardiac Arrest Mortality
The impact of continuous monitoring and the time of day of cardiac arrests
was studied by retrospective reviews of 124 consecutive arrests. Survival
is best during daytime hours with a higher incidence of shockable and
respiratory arrests. The data suggests that improved patient monitoring
practices may improve the detection and survival of night time arrests.
Geoffrey K. Lighthall M.D., Anesthesiology, Stanford University School of
Medicine, Palo Alto, CA.
FA A4060
Retrospective Cohort Study to Assess the Impact of New or Worsening
Heart Failure on Outcomes After Non-Cardiac Surgery
Congestive heart failure is known to increase perioperative risk for
postoperative cardiac adverse events but the impact on noncardiac
complications is less well described. This retrospective cohort study examined
the incidence of cardiac and noncardiac complications in patients with
and without worsening preoperative congestive heart failure undergoing
noncardiac surgery. We found these patients to be at increased risk for
pulmonary renal and infectious complications with a similar incidence of
myocardial infarction between the two cohorts. Michael Maile M.D., Milo
Engoren M.D., Kevin Tremper M.D., Ph.D., Elizabeth Jewell M.S.,
Sachin Kheterpal M.D. M.B.A., Anesthesiology, University of Michigan,
Ann Arbor.
FA A4061
Is Diastolic Dysfunction a Risk Factor for Adverse Cardiovascular
Outcomes After Liver Transplantation?
Though systolic dysfunction is considered a contraindication to liver
transplantation more subtle and latent abnormalities are less well studied.
We tested the hypothesis that identification of pretransplant diastolic
dysfunction on echocardiography is associated with Major Adverse
Cardiovascular Events (MACE) after transplantation. From among 219
transplant recipients 48 MACEs were identified. Left ventricular mass
index was significantly associated with increased incidence of postransplant
MACEs. Abraham Sonny M.D., Andres Schuster M.D., Jacek Cywinski
M.D., Anesthesiology, Cardiovascular Medicine Cleveland Clinic, OH.
FA A4062
Lack of Association Between Carotid Stenosis and Stroke or
Myocardial Injury After Non-Cardiac Surgery
Whether carotid stenosis predicts stroke after non-cardiac surgery remains
unknown. We therefore tested the primary hypothesis that the degree of
carotid stenosis is associated with the composite outcome of in-hospital
stroke or 30-day all-cause mortality. We analyzed a cohort of 2 110 patients
who had carotid Doppler exams between 6 months before and 1 month after
non-cardiac surgery. The degree of carotid stenosis was not associated with
perioperative stroke and/or 30-day mortality (adjusted P = 0.84).
Abraham Sonny M.D., Heather Gornik M.D., Edward Mascha Ph.D.,
Daniel Sessler M.D., Anesthesiology, Cardiovascular Medicine,
Cleveland Clinic, OH.
FA A4063
Post PCI Patients Undergoing Non Cardiac Surgery - Measurements of
Platelet Inhibition of Patients Having Major Adverse Cardiac Events
Patients with previous stent placement and non-cardiac surgery still have
a high incidence of MACE in spite of the continuation of their anti platelet
therapy. The study looks at the incidence of MACE in non-cardiac surgery
and the sufficiency of perioperative antiplatelet therapy. Lukasz Starzyk
M.D., Summer Syed M.D., Duminda Wijeysundera M.D., Praphiba
Harsha M.D., Ronit Lavi M.D., Scott W. Beattie M.D., Marcin Wasowicz
M.D., Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, Toronto ON, Canada, Department
of Anesthesia Hamilton Health Science Centre, McMaster University,
Hamilton ON, Canada, Department of Anesthesia and Perioperative
Medicine, London Health Science Centre, University of Western Ontario,
London ON, Canada.
CC
110
PN Pain Medicine
Critical Care Medicine
NA Neuroanesthesia
The One Year Incidence of Postoperative Myocardial Ischemia in
Patients Undergoing Major Orthopedic Surgery
We assessed the incidence of Troponin I elevations in patients undergoing
major orthopedic surgery to determine the incidence of myocardial injury
(PMI) in patients at risk for cardiac ischemia. During a one year period 1%
of all patients undergoing major orthopedic surgery demonstrated evidence
of PMI. In patients at risk for ischemic heart disease the incidence of PMI
was 12.9%. Michael K. Urban M.D., Ph.D., Steffan W. Wolfe B.A., Neil
M. Sanghavi B.S., Steven K. Magid M.D., Anesthesiology, Hospital for
Special Surgery, Rheumatology Hospital for Special Surgery, New York,
NY.
PD04-2 CLINICAL CIRCULATION
CA A4068
The Change in Stroke Volume Variation May Not Correlate With
the Change in Left Ventricular End-Diastolic Volume; A Prospective
Randomized Study
We assessed changes in left ventricular volumeand SVV following fluid
loading. Both SVV and LVEDV showed significant changes after HES
infusion whereas LVEDV did not change despite significant decrease in
SVV after infusion of normal saline. The LVEDV may be a less sensitive
indicator in the assessment of fluid status. Hirotsugu Kanda M.D.,
Yuki Toyama M.D., Yuji Hirasaki M.D., Takafumi Iida M.D., Atsushi
Kurosawa M.D., Takayuki Kunisawa M.D., Ph.D., Hiroshi Iwasaki M.D.,
Ph.D., Anesthsesiology and Critical Care Medicine Asahikawa Medical
University, Asahikawa, Japan, Tokyo Women’s University Tokyo, Japan.
TUESDAY, OCTOBER 15
FA A4064
CA A4069
ROOM 123
CA A4065
Cyclosporine-Induced Protection Against Myocardial Reperfusion Injury
During Aortic Valve Surgery
Administration of cyclosporine just before the aortic cross unclamping
reduces myocardial injury in patients undergoing aortic valve surgery. This
postconditioning affords a 35% reduction of area under the curve of cardiac
troponin. Pascal Chiari M.D., Ph.D., Denis Angoulvant M.D., Ph.D.,
Nathan Mewton M.D., Ph.D., Olivier Desebbe M.D., Jean-Francois
Obadia M.D., Ph.D., Jacques Robin M.D., Ph.D., Fadi Farhat M.D.,
Ph.D., Olivier Bastien M.D., Ph.D., Jean-Jacques Lehot M.D., Ph.D.,
Michel Ovize M.D., Ph.D., Anesthesiology, Cardiology, Cardiac Surgery,
Hopital Louis Pradel, CHU de Lyon, France.
CA A4066
Effect of Pre-Emptive Analgesia in Form of Parasternal Block With
Ropivacaine for Postoperative Pain Relief in Patients Undergoing
Coronary Artery Bypass Grafting: A Randomized Double Blind
Controlled Study
The efficacy of preemptive parasternal intercostals block with ropivacaine
for postoperative analgesia was studied in patients undergoing CABG.
Conclusion Preemptive parasternal intercostals block for postoperative pain
relief in adult cardiac surgical patients is easy, quick to perform and appears
to be useful adjunct to postoperative pain relief in first 24-48 hours.
Minati Choudhury Jr. M.D., Milind Hote M.S., Sarvesh Pal Singh,
M.D., Usha Kiran, M.D., M. Kalaivani, M.Sc., Cardiac Anaesthesia,
Cardiothoracic and Vascular Surgery, Biostastistics, All India Institute of
Medical Sciences New Delhi, India.
CA A4067
Phenylephrine Administration Increases Cardiac Output in
Parasympathically Blocked Patients
Phenylephrine is conventionally considered to increase the arterial blood
pressure by isolated arterial vasoconstriction thereby increasing ventricular
afterload and thus decreasing cardiac output. We demonstrate that venous
vasoconstriction by Phenylephrine significantly increases cardiac preload reflected in decreased stroke volume variation - and eventually can increase
cardiac output in parasympathically blocked patients. In light of the complex
cardiovascular interactions induced by phenylephrine we advise using
advanced (noninvasive) hemodynamic monitoring during its administration.
Alain F. Kalmar M.D., Ph.D., Marieke Poterman M.D., Thomas WL
Scheeren M.D., Ph.D., Department of Anesthesiology, University
Medical Centre Groningen, Groningen, Netherlands.
NT-proBNP Improves the Ability of High-Sensitivity Cardiac Troponin
T to Predict Myocardial Injury and Infarction and Long-Term Mortality
After Non-Cardiac Surgery
This study shows that the addition of NT-proBNP to preoperative highsensitivity troponin T concentrations identified a group of patients at
significantly increased risk for postoperative myocardial injury and infarction
and long-term mortality after major non-cardiac surgery. Michael Kopec
M.D., Peter Nagele M.D., M.S., Frank Brown B.S., Mitchell Scott
Ph.D., Anesthesiology, Washington University School of Medicine, St.
Louis, MO, Pathology and Genomic Medicine, Washington University
School of Medicine, St. Louis, MO.
CA A4070
Immersion Pulmonary Edema Susceptibility: Hemodynamics and Effect
of Sildenafil
Immersion pulmonary edema (IPE) is a condition in which cough hemoptysis
dyspnea hypoxemia develop after surface swimming/diving. Ten healthy
individuals with history of IPE and 20 controls were studied during immersed
prone exercise in 20°C water. IPE subjects were studied before and
after administration of sildenafil 50 mg orally. IPE subjects had significantly
higher PAP and PAWP despite lower CO which were significantly reduced
after sildenafil-- suggesting that it may be an effective preventive drug for
those at high risk for IPE. Dionne F. Peacher M.D., John J. Freiberger
M.D., Stefanie D. Martina B.S. Anne D. Cherry M.D., Tracy E. Wester
M.D., Michael J. Natoli B.S. Eric A. Schinazi B.S. Dawn Kernagis
Ph.D., Richard E. Moon M.D., Center for Hyperbaric Medicine and
Environmental Physiology and Department of Anesthesiology, Duke
University Medical Center, Durham, NC.
CA A4071
Transcatheter Aortic Valve Implantation Versus Surgical Aortic
Valve Replacement in Octogenarians: Clinical Outcomes in Low or
Intermediate Surgical Risk Patients
This study compare the clinical outcome of patients older than 80 years with
intermediate or low risk treated either by TAVI or by SAVR under general
anesthesia. Principal aim is 1-year mortality. Secondary criteria are defined
according to the Valve Academic Research Consortium. Pascal Petit M.D.,
Mathieu Pascual M.D., Romain Chopard M.D., Guillaume Besch M.D.,
Sebastien Pili-Floury M.D., Ph.D., Sidney Chocron M.D., Ph.D., Benoit
Barrucand M.D., Guillaume Flicoteaux M.D., Nicolas Meneveau M.D.,
Ph.D., Emmanuel Samain M.D., Ph.D., Department of Anesthesiology
and Intensive Care, Cardiology, Cardiovascular and Thoracic Surgery
University Hospital of Besancon, France.
CA A4072
Intraoperative Hypotension as a Risk Factor for Occurrence of Delirium
After Cardiac Surgery
Occurrence of postoperative delirium might be sign of cerebral hypoperfusion.
The association between intraoperative hypotension (IOH) and occurrence
of postoperative delirium after cardiac surgery is not clear. Therefore we
performed an observational cohort study (n=646) nested in the DECS-trial
to study this associaton. This study showed that independent of its definition
IOH was not associated with occurrence of delirium after cardiac surgery (OR
1.00; 95% CI: 1.00-1.00) in adjusted logistic regression analysis.
Esther M. Wesselink M.D., Teus H. Kappen M.D., Diederik van Dijk
M.D., Ph.D., Wilton A. van Klei M.D., Ph.D., Arjen JC Slooter M.D.,
Ph.D., University Medical Center, Utrecht, Netherlands.
NA Neuroanesthesia
PN Pain Medicine
111
CA A4077
ROOM 104-AREA A
CA A4073
Renal Protection Effect of the Nicardipine on Deliberated Hypotension
During Spine Surgery
Nicardipine may prevent kidney injury during deliberated hypotension in
posterior lumbar interbody fusion patients. Patients with nicardipine infusion
showed less RIFLE criteria than control group. Chul Ho Chang M.D.,
Ph.D., Jong Seok Lee M.D., Anesthesiology and Pain Medicine, Yonsei
University College of Medicine, Seoul Korea Republic of.
CA A4074
General Anesthesia and Inducibility/Stability of Ventricular Tachycardia
During Radiofrequency Ablation
The use of GA in the EP Lab for radiofrequency ablation (RFA) of Ventricular
Tachycardia (VT) is controversial. Review of 40 procedures showed that GA
did not significantly alter inducibility. Hemodynamic stability was adequately
controlled by phenylephrine infusion. Non-inducibility of VT during NIPS
may predict non-inducibility during GA. Further study is needed to delineate
specific electrophysiological effects of GA on VT. Wendy L. Gross M.D.,
Douglas C. Shook M.D., Eyal Nof M.D., Kelly Price M.D., Wiliam
Gregory Stevenson M.D., Department of Anesthesiology, Perioperative
and Pain Medicine, Department of Cardiology, Brigham and Women’s
CA A4075
Respiratory Variation of Stroke Volume During Liver Surgery
The aim of our study was to investigate whether respiratory variation of
stroke volume (RVSV) measured by Esophageal Doppler (ED) can predict
preload dependency before portal triad clamping (PTC) and volume expansion
(VE) in liver resection. 23 patients were classified as responders (R) or non
responders (NR). For VE the RVSV value ≥ 12 % allowed discrimination
between R and NR with an area under the ROC curve of 0.989. For PTC the
RVSV value ≥ 13 % allowed discrimination between R and NR with an area
under the ROC curve of 0.69. RVSV was a better predictor than RVAPP and
CVP. RVSV is an accurate predictor of preload dependency in liver resection.
Nassim Heshmati Jr., Lina Jazaerli Jr. Vincent Garcia M.D., Clement
Bongarzone Jr. Brice Samyn M.D., Bruno Saumande M.D., Gilles
Mahoudeau M.D., Thierry Pottecher M.D., Ph.D., Pierre Diemunsch
M.D., Ph.D., Anesthesie-Reanimation Hospital University de Strasbourg,
France.
CA A4076
Stroke Volume Variation Measured by Impedance Cardiography During
Passive Leg Raising to Assess Fluid Responsiveness After Cardiac
Surgery
The aim of our study was to investigate whether stroke volume variations
(∆SSV) by impedance cardiography during passive leg raising (PLR) can
predict preload dependency after cardiac surgery compared to velocity time
integral variation (∆SVTI) by transthoracic echocardiography. 50 patients
were classified as responders (R) or non responders (NR) after PLR based on
∆SVTI. A ∆SSV ≥ 20.7 % allowed discrimination between R and NR with an
area under the ROC curve of 0.818. ∆SSV by impedance cardiography during
PLR is a reliable predictor for preload dependency. Nassim Heshmati Jr.,
Sandrine Marguerite M.D., Lina Jazaerli Jr., Clement Bongarzone Jr.,
Jean-Claude Thiranos M.D., Nicolas Meyer M.D., Ph.D., Jean-Philippe
Mazzucotelli M.D., Ph.D., Annick Steib M.D., Ph.D., Paul-Michel Mertes
M.D., Ph.D., Anesthesie-Reanimation Hospital University de Strasbourg,
Sante Publique Hospital Universitys de Strasbourg, Chirurgie CardioVasculaire Hospital Universitys de Strasbourg, France.
112
The Suppressive Effects of Landiolol Administration on the Plasma
IL-6 Elevations and Occurrences of Arrhythmias in Patients Undergoing
Esophageal Surgery
Landiolol a short-acting selective beta1 antagonist administration
suppressed the plasma IL-6 elevations and occurrences of arrhythmias in
patients undergoing esophageal surgery. Yuta Horikoshi M.D., Toru Goyagi
M.D., Takashi Horiguchi M.D., Toshiaki Nishikawa M.D., Anesthesia and
Intensive Care Medicine, Akita University Graduate School of Medicine,
Akita-city, Japan.
CA A4078
Risk Factors for Post-Dural Puncture Headache After Spinal Drain
Placement
A retrospective chart review of 135 patients who received spinal drains
while undergoing thoracoabdominal aortic aneurysm repairs revealed a
post-dural puncture headache (PDPH) frequency of approximately 24.4%.
A younger age (p<0.01) and history of preoperative headaches (p<0.01)
were identified as risk factors for developing PDPH. Interestingly a longer
duration of hospitalization (p=0.04) was found in those patients that did
not have a PDPH. The following were not found to be risk factors (p>0.05):
gender BMI ASA score smoking status presence of diabetes pain score
preoperative opioid consumption needle size number of dural holes first
recorded CSF pressure intraoperative CSF drained or total CSF drained.
Diana Khatib M.D., Melanie J. Donnelly M.D., Kristopher M. Schroeder
M.D., Anesthesiology, University of Wisconsin School of Medicine and
Public Health, Madison, WI.
CA A4079
Can Dexamethasone for the Prophylaxis of PONV Prevent the
Mesenteric Traction Syndrome?
We tried validating whether dexamethasone for the prophylaxis of PONV
could prevent the mesenteric traction syndrome (MTS). To achieve this
purpose we measured the systemic vascular resistance index continuously
using a FloTracTM sensor. As a result we found that dexamethasone for the
prophylaxis of PONV could NOT prevent MTS however it might modify the
hemodynamic instability induced with MTS. Motoshi Takada M.D., Ph.D.,
Tomohiro Ohsaki M.D., Yuki Uematsu M.D., Chieko Taruishi M.D.,
Tomoko Sudani M.D., Akira Suzuki M.D., Ph.D., Hiroki Iida M.D., Ph.D.,
Daiyukai Gen Hospital, Anesthesiology Department, Ichinomiya, Japan,
Gifu Graduate School of Medicine, Department of Anesthesiology and
Pain Medicine, Gifu, Japan.
CA A4080
Incidence and Management of Acute Coronary Syndrome Associated
With Pheochromocytoma
P can mimick an ACS. Coronarography differentiates an catecholaminemediated cardiomyopathy from an coronary syndrome. Medical preoperative
preparation by IV administration of α1 blockade controls HTA crisis and
improves cardiac function. Side-effect of urapidil due to its central action on
serotonine receptors associated with transient autonomic dysregulation may
require temporary pace-maker. Patrick Tauzin-Fin M.D., M Sesay M.D.,
Reshma Kureemun-Mowlah M.D., Alice Quinart M.D., Philippe Gosse
M.D., Francois Sztark Ph.D., Hospital Pellegrin University, Bordeaux
Cedex, France, SAR 1, Cardiologie Hopital University Pellegrin-Tripode
Bordeaux, France.
NA Neuroanesthesia
PN Pain Medicine
ROOM 104-AREA B
NA A4081
The Influence of Fibrinogen Coagulation Factor XIII and Platelet Count
on Postoperative Hemorrhage After Craniotomy
The aim of this study was to correlate perioperative coagulation parameters
with the incidence of postoperative intracranial hematoma after craniotomy.
Postoperative fibrinogen levels but not coagulation Factor XIII levels
or platelet count were significantly lower in patients with postoperative
bleeding complications after craniotomy. Dieter Adelmann M.D., Daniel
Klaus Student, Udo Illievich M.D., Eva Schaden A.A., Department of
Anaesthesia, General Intensive Care and Pain Control, Medical University
of Vienna, Vienna, Austria, Landes-Nervenklinik Wagner-Jauregg, Linz,
Austria.
NA A4082
Incidence and Time of Onset of Early Postoperative Complications in
Neurosurgery
Overall incidence of postoperative complications was 16% (7% of them
were neurological).Early detection of the complications requiring urgent care
justifies the need for monitoring these patients in ICU during the first 24
postoperative hours. Amandine Albert M.D., Tarik Riahi M.D., M Sesay
M.D., Siyana Dimitrova M.D., Chantavy Philakham M.D., Hugues
Loiseau M.D., Ph.D., Karine Nouette-Gaulain M.D., Ph.D., Neurosurgery,
Pellegrin University Hospital, Bordeaux, France.
NA A4083
NA A4086
Post-Craniotomy Acute Kidney Injury is Associated With Heightened
Mortality
Multiple studies have shown that acute kidney injury (AKI) in cardiothoracic
patients is associated with higher mortality and morbidity however little
is known about the significance of AKI postcraniotomy. In our retrospective
cohort study development of AKI in neurosurgical patients is associated with
higher 30 day mortality (OR= 4.25 95%CI 1.52-11.87 p=0.006). This
relationship remained strongly significant even after adjusting for age gender
race and comorbidities using multivariable logistic regression model. Further
studies should focus on designing effective prophylactic and treatment
options for AKI in neurosurgical patients. Vesela Kovacheva M.D., Ph.D.,
Linda Aglio M.D., M.S., Kenneth Christopher M.D., Department of
Anesthesiology, Perioperative and Pain Medicine, Renal Division, Brigham
and Women’s Hospital, Boston, MA.
NA A4087
Anaesthesia Mangement for Microsurgery (Keyhole Surgery) Based
on Hemifascial Spasme and Trigeminal Neuralgia Cases in Developing
Country
Anaesthesia management has an important role in keyhole surgery especially
for microvascular decompression operation in hemifascial spasm and
trigeminal neuralgia cases. The potent anaesthesia drugs tight observation
intraoperative and post operative regulation of the cerebral perfusion
pressure have a big influence for the final results. Anna S. Veterini Jr.
M.D., Anestesiology and Reanimation, Airlangga University, Surabaya,
Indonesia.
NEUROMUSCULAR BLOCKADE SAFETY AND DELIVERY SYSTEMS
Effects of Assisted Acupuncture in Neuroanesthesia
In conclusion, a combination of acupuncture and general anesthesia may
be safe beneficial and even of economical benefit. The analysis suggests
that the complimentary use of acupuncture for craniotomy has significant
additional analgesic/sedative effects. Our findings may stimulate future
randomized controlled trials to provide definitive recommendations.
Sven Asmussen M.D., Dirk M. Maybauer M.D., Ph.D., Jiande D. Chen
Ph.D., John F. Fraser M.D., Ph.D., Kristofer Jennings Ph.D., Marc O.
Maybauer M.D., Ph.D., Anesthesiology, Internal Medicine, Biostatistics,
University of Texas Medical Branch, Galveston, TX, Critical Care Research
Group The University of Queensland and Prince Charles Hospital,
Brisbane, Australia.
ROOM 104-AREA C
Elevated Troponin Indicates Worsened Outcome in Cerebral Risk
Patients
Data analysis indicates that troponin is significantly elevated in patients with
cerebral bleeding processes (Babuin 2006). These path mechanism seemed
to be unaffected by brain surgery (4. TU controls). The highest variability in
troponin responses was particularly observed in the 1. SAB group correlating
with worsened outcome (Miketic JK 2010). So far there are no guidelines to
treat patients with elevated troponin and no coronary disease (Agewall 2011)
although derivative myocardial injury may result from bleeding mediated
stress response. Petra Bischoff Bischoff M.D., Bastian Wasgien M.D.,
Michael Michels M.D., Anesthesiology, Ruhr Universityerstat Bochum
Knappschaftkrankenhaus, Germany.
FA A4089
NA A4084
NA A4085
Effect of Equiosmolar Solutions of Mannitol Versus Hypertonic Saline
on Blood Coagulation Assessed by Thromboelastometry During
Elective Craniotomy
Our goal was to compare the effect of mannitol and hypertonic saline
on blood coagulation assessed by thromboelastometry (TEM) along
with brain relaxation electrolyte and hemodynamic changes during
craniotomy for neurosurgical procedures. Neither significant alterations
in TEM nor differences in brain relaxation were observed appearing an
acute consumptive coagulopathy and an increase in blood osmolality.
Daciano Gaona-Atienza M.D., Joaquin Hernandez-Palazon M.D., Ph.D.,
Luis Falcon-Arana M.D., Ph.D., Diego Fuentes-Garcia M.D., Claudio
Piqueras-Perez M.D., Paloma Domenech-Asensi M.D., Anesthesia,
Neurosurgery, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
TUESDAY, OCTOBER 15
PO05-1A CLINICAL NEUROSCIENCES - INTRAOPERATIVE MANAGEMENT
OUTCOMES NEUROCRITICAL CARE NEUROMUSCULAR BLOCKADE
FA A4088
Computer Vision Assisted Identification of Implanted Medical Devices
in X-Ray Images
The software prototype we have developed provides highly accurate
and instantaneous identification of Implanted Medical Devices (IMD)
s in X-ray Images. Mario Moric M.S., Vicko Gluncic M.D., Ph.D., Greg
Shakhnarovich Ph.D., Srdan Kobsa Ph.D., Sameer Ansari M.D., Ph.D.,
Leo Kelly M.S., Rush University Medical Center, Toyota Technological
Institute at Chicago, Northwestern Memorial Hospital, Chicago, IL, Yale
University School of Medicine, New Haven, CT.
Epidural and General Anesthesia in Thoracic Surgery - A Pathway to
Hypothermia?
Patients undergoing thoracic surgery suffer from perioperative hypothermia.
The use of an additional epidural catheter does not significantly decrease
body core temperature. Patients might benefit from prewarming to reduce
the incidence of perioperative hypothermia. Ivo F. Brandes M.D., Gereon
Gries M.D., Marc Hinterthaner M.D., Martin Bauer M.D., Anselm
Brauer M.D., Department of Anesthesiology, Emergency and Intensive
Care Medicine, Department of Thoracic and Cardiovascular Surgery
Universityersitaetsmedizin Goettingen, Germany.
FA A4090
Computer Vision Assisted Analysis of X-Ray for Rapid Detection of
Retained Surgical Foreign Objects
We have developed a software prototype based on pattern recognition
algorithms to identify Retained Surgical Foreign Objects on X-ray images.
Vicko Gluncic M.D., Ph.D., Serge Kobsa Ph.D., Mario Moric M.S.,
Greg Shakhnarovich Ph.D., Sameer Ansari M.D., Ph.D., Leo Kelly
M.S., Anesthesiology, Rush, Toyota Technological Institute at Chicago,
Northwestern Memorial Hospital, Chicago, IL, Yale University School of
NA Neuroanesthesia
PN Pain Medicine
113
FA A4091
Influence of Neuromuscular Blockade on Surgical Conditions During
Laparotomy: A Pig Model
In a pig model we investigated if intense neuromuscular blockade (NMB)
improved surgical conditions by reducing the force needed to adapt the
fascia while closing an ileus-laparotomy. No difference between the force
needed to adapt the fascia were found when comparing no NMB with
intense NMB. Matias Vested Madsen Sr. M.D., Anders Donatsky M.D.,
Bente Rona Jensen Ph.D., Jacob Rosenberg M.D., Ph.D., Mona Ring
Gatke M.D., Ph.D., Department of Anesthesiology, Department of
Surgery, Herlev Hospital University of Copenhagen, Herlev Denmark,
Department of Nutrition Exercise and Sports, University of Copenhagen,
Denmark.
FA A4092
Monitoring Intense Neuromuscular Blockade in a Pig Model
A pig model for monitoring intense neuromuscular blockade was established.
We verified total relaxation of the diaphragm and the abdominal muscles.
The pig model is suitable for studies where monitoring of intense NMB
is deemed and where relaxation of the diaphragm and the abdominal
muscles are required. Matias Vested Madsen Sr. M.D., Anders Donatsky
M.D., Bente Rona Jensen Ph.D., Jacob Rosenberg M.D., Ph.D., Mona
Ring Gatke M.D., Ph.D., Department of Anesthesia, Department of
Surgery, Herlev Hospital University of Copenhagen, Herlev, Denmark,
University of Copenhagen, Department of Nutrition, Exercise and Sports,
Copenhagen, Denmark.
PI A4096
Residents as Teachers: Identification of Barriers to Teaching in the
Perioperative Setting
Anesthesiology residents have unique challenges to teaching medical
students in the perioperative setting. A needs assessment through surveyed
self-reflection and observed simulation evaluation could provide information
to develop a resident-as-teacher curriculum tailored to anesthesiology
residents. Benjamin P. Carroll M.D., Yue Ming Huang Ed.D., Tatum Korin
Ed.D., Sebastian H.J. Uijtdehaage Ph.D., Judi A. Turner M.D., Ph.D.,
Anesthesiology, UCLA, Los Angeles, CA, Keck School of Medicine,
University of Southern California, Los Angeles, CA.
PI A4097
Gas Injuries at Base Hospital #28 from Kansas City in World War I
BH #28 in Limoges France had doctors and nurses from the University
of Kansas and Kansas City area. From July 1918 to May 1919 BH #28
treated 8724 soldiers including hundreds of gas victims. Ten percent of
patients admitted to BH #28 had gas-related injuries with injuries to skin
eyes and lungs as well as psychological effects. Gas injuries generally had
high morbidity, low mortality and low long-term sequelae. Anthony L. Kovac
M.D., Anesthesiology, University. of Kansas Medical Center, Kansas City,
KS.
FA A4093
PI A4098
FA A4094
PI A4099
Skeletal Muscle Mass Serves as an Index of a Neuromuscular Junction
Blocking Agent Dose
A neuromuscular blocking agent dose is usually calculated by considering
an individual’s weight. The present study clarified the relationship between
skeletal muscle mass and onset and duration of rocuronium-induced
neuromuscular blockade. The study results suggested the duration of
rocuronium action was dependent on an individual’s % skeletal muscle mass.
Hiroyuki Nishi M.D., Kumiko Kitano M.D., Sumire Taira M.D., Manabu
Kakinohana M.D., Ph.D., Kazuhiro Sugahara M.D., Ph.D., Faculty of
Medicine University of Ryukyus, Nishihara Japan.
12 Hour Evaluation of Filters to Prepare an Anesthesia Machine for
Malignant Hyperthermia Susceptible Patients
Activated charcoal filters are used to prevent residual anesthetic vapors
from reaching patients susceptible malignant hyperthermia. We evaluated
these filters to determine if they are effective for long cases. We found
the commercially available activated charcoal filters maintain anesthetic
concentration below the five parts per mission safety threshold for 12
hours when tested in a Draeger Apollo anesthesia machine using isoflurane
sevoflurane and desflurane. Robert Stoker, M.D., Mathew Romankowski,
M.D., Kyle M. Burk, Joseph A. Orr, Ph.D., Anesthesiology, University of
Utah, Salt Lake City, UT.
FA A4095
Effectiveness of Point-of-Care Pharmacokinetic Simulation on
Anesthetic Practice
Introduction of pharmacokinetic simulation incorporated in the anesthesia
information management system has brought about the effect of increased
use of fentanyl on anesthetic management for open abdominal gynecologic
surgery. This increase resulted in higher effect-site concentration of fentanyl
during post-operative period and less need of additional analgesics. Point-ofcare pharmacokinetic simulation would improve anesthetic care. Shunsuke
Yamamoto M.D., Kosaka Iwayama M.D., Tomotaka Morita M.D., Osamu
Uchida M.D., Satoshi Hagihira M.D., Ph.D., Yuji Fujino M.D., Ph.D.,
Department of Anesthesiology and Intensive Care, Osaka University
Graduate School of Medicine, Suita Osaka, Japan.
114
ROOM 104-AREA D
Horace Wells’ Death Mask: From Connecticut to Kansas
Preserved death masks from the mid-19th century are relatively common.
Death masks of anesthesia pioneers are rare. It is also rare to have one
of the Horace Wells’ plaster copies. W. Harry Archer (1805-1980) was a
significant oral surgeon anesthesia historian and expert on Wells in the
mid-20th century who was instrumental in having copies made of Wells’
death mask. The Clendening Library &; Museum at the University of Kansas
Medical Center is fortunate to have one of the copies of the Horace Wells’
death masks in its collection. Anthony L. Kovac M.D., Dawn McInnis B.S.,
Anesthesiology, History and Philosophy of Medicine, University of Kansas
Medical Center, Kansas City, KS.
Orval Cunningham: The Man, His Machine, His Tank in Kansas City and
Cleveland
Although controversial at the time, the early work of Orval Cunningham had
an important place in history because his original ideas set the precedent for
the development of the iron lung U.S. Navy diving advances and submarine
rescue work. He is considered to be one of the first practitioners in the
U.S. to make use of hyperbaric oxygenation. As such, his experimentation
with hyperbaric therapy can be considered to be truly pioneering. Anthony
L. Kovac M.D., George S. Bause M.D., University of Kansas Medical
Center, Kansas City KS, Anesthesiology, Case Western Reserve
University, Cleveland, OH.
PI A4100
When and Where Did J. Julian Chisolm Inventor of the Nasal
Chloroform Inhaler Witness His First Chloroform Anesthetic?
J. Julian Chisolm, MD, who invented his nasal chloroform inhaler in 1864
witnessed his first chloroform anesthetic in 1851 either in Paris or in Berlin
at the surgery clinic of Bernhard Langenbeck. Raymond C. Roy M.D.,
Ph.D., Mark Erickson M.D., Annie Jenkins, Debra Chisolm Ruehlman,
Anesthesiology, Wake Forest School of Medicine, Winston-Salem NC,
Great Granddaughter of William Edward Aiken, Great Great Granddaughter
of J. Julian Chisolm Winston-Salem, NC.
PI A4101
Developing Ultrasound Curriculum for Preclinical Medical Students
We believe ultrasound skills are of vital importance in the practice of
medicine today especially in the context of procedures. This study aims
to develop a time and cost-effective curriculum to train preclinical medical
students basic ultrasound techniques. Robert Shaw B.S., Valerie Wong
B.S. Christopher R. Page M.D., Matthew F. Tito M.D., Peggy A. Seidman
M.D., Stony Brook University, Stony Brook, NY.
NA Neuroanesthesia
PN Pain Medicine
Tracheobronchial Angles in Infants and Children: Historical Perspective
and Clinical Implications
A review of the literature revealed wide disparities in measurements of
the tracheobronchial angles in infants and children. Currently there is a
consensus that these measurements are similar to those in adults. This has
important clinical implications. Carmen Simion M.D., M. Ramez Salem
M.D., George J. Crystal Ph.D., Anesthesiology, Ann and Robert Lurie
Chicago Children’s Hospital, Chicago, IL, Anesthesiology, Advocate
Illinois Masonic Medical Center, Chicago, IL.
PI A4103
Evaluation of the Foundation for Anesthesia Education and Research
Resident Scholar Program on Career Paths
Prior Foundation for Anesthesia Education and Research (FAER) Resident
Scholar Program (RSP) participants were surveyed on their program
experience career progress and academic productivity. Results showed that
a majority of prior RSP participants had practiced academic anesthesiology
at some point in their career and most felt the program was helpful in
shaping their career. Based on our survey data it appears that FAER has
been successful in achieving the goal of increasing important scholarship
in our specialty. Eleanor A. Vega M.D., Dawn Dillman M.D., Jeffrey
Kirsch M.D., Paloma Toledo M.D., Department of Anesthesiology and
Perioperative Medicine, Oregon Health and Science University, Portland
OR, Department of Anesthesiology, Northwestern University Feinberg
ROOM 104-AREA E
PI A4104
Failures and Complications of Flexible Fiberoptic Bronchoscopy Under
Awake/Sedation Versus General Anesthesia
Our study found greater failures and desaturations when using flexible
fiberoptic bronchoscopy (FFB) under general anesthesia than awake/sedation
in patients with difficult airways. In cooperative patients with difficult airways
awake/sedation may be a safer option. Kevin Keys B.S., Joseph May B.S.,
Deborah Whelan M.D., Randy W. Calicott M.D., Yvon Bryan M.D., Wake
Forest University, School of Medicine, Winston Salem, NC.
PI A4105
Adverse Hemodynamic Effects of Periarticular Local Anesthetic
Cocktail - A Retrospective Review
Anesthetic records of patients who received Periarticular Local Anesthetic
Cocktail (PLAC) during total hip arthroplasty were reviewed. We conclude
that the speed of absorption of PLAC in patients with medical co-morbidities
may predispose them to adverse cardiac events. Ann-Marie Manley M.D.,
Harvey J. Woehlck M.D., Matthias L. Riess M.D., Ph.D., Department
of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI,
Departments of Anesthesiology and Physiology VAMC and Medical
PI A4106
Perioperative Dental and Oral Injuries: A Retrospective Analysis of
Documented Injuries at Penn State Hershey Medical Center
In order to analyze the incidence risk factors and consequences of dental
and oral injury directly attributed to anesthesia at our institution data was
retrospectively obtained and analyzed from EMR and paper records incident
reports and filed dental claims from January 2008 to July 2012.
Sarah H. Nie M.D., Jansie Prozesky M.B. Ch.B., Sonia Vaida M.D.,
Anesthesiology, Penn State Milton S. Hershey Medical Center, PA.
PI A4107
Brigham & Women’s Hospital (BWH) Perioperative Ocular Injury
Protocol: A Quality Improvement Project
Ocular injury is a rare complication after anesthesia that can delay discharge
and have a significant impact on patient satisfaction. A cross-sectional
analysis was performed at Brigham and Women’s Hospital to characterize
the local epidemiology of perioperative ocular injury. A protocol was then
designed to improve the diagnosis and management of patients presenting
with ocular pain. Marc T. Pimentel M.D., Luigino Nascimben M.D., Ph.D.,
Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s
PI A4108
TUESDAY, OCTOBER 15
PI A4102
The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is
There a Gender Difference?
The current study was designed to test the hypothesis that women
require less cricoid force than men. The results indicate that a CF of 30
N was necessary to occlude the esophageal entrance in men but that
women required a CF of only 20 N. This difference may be related to
the smaller cross sectional area of the cricoid cartilage in women.
M. Ramez Salem M.D., Ahed Zeidan M.D., George J. Crystal Ph.D.,
Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL,
ProCare Riaya Hospital, Al Khobar, Saudi Arabia.
PI A4109
Face Transplantation:Specificities of the Anesthetic and Intensive Care
Management
The face-grafting techniques are innovative and highly complex. Anesthesia
for this long procedure involves advanced planning for airway management
vascular access technique of anesthesia and fluid management.
Amir Sedaghati-nia Sr. M.D., Alain Gilton M.D., Catherine Liger M.D.,
Fabrice Cook M.D., Michele Binhas M.D., Bouziane Ait-mamar M.D.,
Emmanuelle Scherrer M.D., Gilles D’honneur M.D., Ph.D., Benoit Plaud
M.D., Ph.D., Jean Marty M.D., Ph.D., Anesthesia & Surgical Intensive
Care Units, Henri-Mondor Hospital, Creteil, France.
PI A4110
Evaluation of Six Video Laryngoscopes in a Difficult Airway Scenario. A
Multicenter Trial in 720 Anesthetized Patients
Not all VLS evaluated reached the desirable intubation success rate of
>90%. Most devices required two attempts to reach this success rate. The
integrated tracheal tube guidance does not seem to offer any advantages
over unguided laryngoscopes in the hands of experienced anesthesiologists.
Lorenz G. Theiler M.D., Maren Kleine-Brueggeney M.D., Manuel
Kotarlic Student, Patrick Schoettker M.D., Georges Savoldelli M.D.,
Natalie Urwyler M.D., Florence Joray M.D., Stanislas Mathivon
R.N., Christine Riggenbach R.N., Robert Greif M.D., Department of
Anaesthesiology, and Pain Therapy University Hospital Inselspital and
University of Bern, Bern, Switzerland, Department of Anesthesiology,
University Hospital Center and University of Lanne, Lanne Switzerland,
Division of Anesthesiology, University Hospitals of Geneva and Faculty of
Medicine, University of Geneva, Switzerland.
PI A4111
Deep Venous Thrombosis Calculator is Reliable for Perioperative
Prevention
We tried to find the relationship between the risk score calculated using
University of Michigan’s DVT calculator and the incidence of DVT in surgical
patients. Five patients in high or exra-high risk group developed DVT
postoperatively. DVT risk calculator was reliable and practical tool.
Hiroshi Yamaguchi M.D. M.B.A., Hazuki Watanabe C.R.N.A., Masafumi
Uesugi M.D., Hiroko Ishihara C.R.N.A., Anesthesia, Tsukuba Medical
Center Hospital, Tsukuba, Japan.
NA Neuroanesthesia
PN Pain Medicine
115
CA A4117
PO04-5B CLINICAL CIRCULATION
ROOM 104-AREA A
CA A4112
Intravenous Acetaminophen Can Facilitate Extubation in Thoracic
Surgery Patients
This single-center retrospective study aimed to provide preliminary
information on its use in managing pain related to thoracic surgery. The
findings of this study suggest that intraoperative IV acetaminophen can
improve the likelihood of earlier extubation in these patient populations
regardless of procedure complexity. Mark A. Banks M.D., Nadine Odo
B.A. Manuel R. Castresana M.D., Mary Arthur M.D., Department of
Anesthesiology and Perioperative Medicine, Georgia Regents University
and Georgia Regents Medical Center, Augusta.
CA A4113
The Effect of Postoperative Blood Transfusions on Muscle Tissue
Oxygenation After Total Knee Arthroplasty
In this study we showed a trend toward increased muscle tissue oxygenation
in response to blood transfusion after a blood transfusion. If this finding is
related to an increase in oxygen carrying capacity and/or the expansion of
intravascular volume remains unclear however in the absence of a positive
passive leg raise test the latter contributor may be less likely a factor.
Thomas Danninger M.D., Ottokar Stundner M.D., Daniel Yoo, Isabelle
Kao, Suzuko Suzuki M.D., Matthias Walz M.D., Stavros G. Memtsoudis
M.D., Ph.D., Department of Anesthesiology, Hospital for Special Surgery,
New York, NY, Department of Anesthesiology, Perioperative Medicine
and Critical Care Medicine Paracelsus Medical University, Salzburg,
Austria, Department of Anesthesiology, UMass Memorial Medical Center,
Worcester, MA.
CA A4114
Agreement and Trending of Stroke Volume Changes of the
Oesophageal Doppler and Pulse-Contour-Analysis Within a GoalDirected Haemodynamic Algorithm
This study compares the oesophageal doppler monitor against a pulsecontour analysis during the entire course of surgery in regard to agreement
and trending of stroke volume changes within a goal-directed hemodynamic
algorithm. Aarne Feldheiser M.D., Oliver Hunsicker M.D., Holger
Krebbel M.D., Karin Weimann M.D., Klaus-Dieter Wernecke Ph.D.,
Claudia Spies M.D., Department of Anesthesiology and Intensive Care,
Medicine, Charite Universityersitaetsmedizin Berlin, Sostana GmbH
Berlin, Germany.
CA A4115
Increased Oxygen Consumption After Reperfusion During Liver
Transplantation
Intra-operative oxygen consumption during liver transplantation increased
after reperfusion irrespective of mean artery pressure cardiac index or SvO2.
The mechanism of increased oxygen consumption after reperfusion was
unknown however this increased oxygen consumption might be reflected
with liver-enzymes. Takashi Matski M.D., Mari Shibata M.D., Norihiko
Obata M.D., Ryuji Kaku M.D., Hiroshi Morimatsu M.D., Okayama
CA A4116
Changes of Urinary Liver-type Fatty Acid-Binding Protein in Open
Abdominal Aortic Surgery Versus Endovascular Repair
We evaluated the perioperative changes of urinary liver type fatty acidbinding protein (LFABP) during aortic abdominal replacement procedure
(open surgery [OS] n=11) and endovascular aortic repair (EVAR n=30).
In the OS group urinary LFABP increased to a maximum at 2 h after aortic
cross clamping. On the other hands urinary LFABP in the EVAR group
increased to its maximum at 4 h after surgery. The peak level of urinary
LFABP during the study was significantly higher in the OS group than in the
EVAR group. We conclude that urinary LFABP is a sensitive biomarker of AKI
in patients undergoing abdominal aortic surgery. Yumi Obata M.D., Takeshi
Tateda M.D., Ph.D., Miki Sakamoto M.D., Chisaka Nakayama M.D.,
Anesthesiology, St. Marianna University School of Medicine Kawasaki,
Japan.
116
Effectiveness of Dexmedetomidine in Sttabilization of Hemodynamics
in Patients Undergoing Carotid Endarterectomy
In this study Dexmedetomidine (DEX) significantly decreased the maximum
doses of nicardipine plasma Noradrenaline levels and sedation scores in
patients undergoing carotid endarterectomy after extubation. Low-dose Dex
enhanced perioperative hemodynamic stability. Shogo Tsujikawa M.D.,
Sumiko Toriyama M.D., Wataru Shirasaka M.D., Yoshiyuki Tani M.D.,
Tomoyuki Yamashita M.D., Kazutoshi Ikeshita Ph.D., Yao Tokushukai
General Hospital, Yao City, Japan.
CA A4118
Lumbar Epidural Anesthesia Does Not Affect the Suppressive Effect of
Landiolol on Endotracheal Intubation-Induced Tachycardia
We examined the effects of landiolol on heart rate changes during intubation
in patients under lumbar epidural anesthesia. Our study showed that lumbar
epidural anesthesia does not affect the suppressive effect of landiolol on
endotracheal intubation-induced tachycardia. Masatoshi Urasawa M.D.,
Tomoyuki Kawamata M.D., Fumiko Shimizu M.D., Naomi Ando M.D.,
Takeshi Kitoh M.D., Hiroaki Ina M.D., Junichi Sasao M.D., Mikito
Kawamata M.D., The Department of Anesthesiology and Resuscitology,
Shinshu University School of Medicine, Department of Anesthesiology,
Marunouchi Hospital, Matsumoto, Japan, Department of Anesthesiology,
Nagano Matsushiro General Hospital, Nagano, Japan, Department
of Anesthesiology, Suwa Red Cross Hospital, Japan, Department of
Anesthesiology, Ina Central Hospital, Japan.
CA A4119
Assessment of Pericardium Volume by the Stroke Volume Variation in
Patients With Off-Pump Cardiac Surgery
During open chest surgery SVV in the basic state can assess the fluid
responsiveness of general anesthesia patients with OPCABG although the
diagnostic threshold of SVV during open chest surgery is lower than that
in traditional non-open chest surgery in predicting fluid responsiveness
(8.8%).2. During open chest surgery the accuracy of fluid responsiveness
in mechanically ventilated in patients undergoing general anesthesia as
measured by the FloTracTM/VigileoTM system is relatively low. Yuelan Wang
Ph.D., Chenyang Dai Student, Guofeng Dai Ph.D., Qianfoshan Hospital,
Clinical Medicine of Shandong University, Qilu Hospital of Shandong
University, Jinan, China.
PO05-1B CLINICAL NEUROSCIENCES - INTRAOPERATIVE MANAGEMENT
OUTCOMES NEUROCRITICAL CARE NEUROMUSCULAR BLOCKADE
ROOM 104-AREA B
NA A4120
Can HMGB1 Blood Level at Admission Improve the Prediction of 1 Year
Outcome for Subarachnoid Hemorrhage Patients?
A recent study proposes high-mobility group box 1 (HMGB1) blood level as
a new predictor for patient with SAH. In our cohort HMGB1 blood level at
admission and at Day-6 did not improve outcome prediction compared to
other predictors such as ABC score. Vincent Degos M.D., Ph.D., Leire
Azurmendi Gil B.Sc., Paola Sanchez M.D., Ph.D., Natalia Tiberti Ph.D.,
Natacha Turk Ph.D., Louis Puybasset M.D., Ph.D., Jean-Charles Sanchez
Ph.D., Anesthesia and Perioperative Care, Hopital Pitie Salpetriere
Paris, France, Centre Medical University, Geneva, Switzerland.
NA A4121
Factors Associated With ICU Admission After Elective Endovascular
Treatment of Unruptured Intracranial Aneurysms
A retrospective record review of patients undergoing endovascular treatment
of unruptured intracranial aneurysm (n=170) identified univariate and
multivariate factors associated with the need for immediate postoperative
intensive care. Patient factors and comorbidities were not associated with the
need for intensive care. Rather aneurysm characteritics and intraoperative
events were the primary determinants. Sarah H. Eisen M.D., David M.
Hasan M.D., Emine O. Bayman Ph.D., Bradley J. Hindman M.D.,
Anesthesia, Neurosurgery, University of Iowa, Iowa City, IA.
NA Neuroanesthesia
PN Pain Medicine
Effect of Pre-Administered Sugammadex on the Neuromuscular Block
of Rocuronium in Ten Re-Surgical Patients
After antagonizing with recommended dose of Sug (sugammadex)
(2.0~4.3mg•kg-1) at the end of first surgery, 10 patients were required
re-surgery within a short time (12min ~6hrs). Under general anesthesia,
required doses ofrocuronium( Roc) for 95% depression in the twitch heights
were evaluated. Required Roc doses and onset time in re-surgery were
0.6~1.4mg•kg-1 and 44~300 seconds, respectively. It is demonstrated
that re-establishment of NMB by Roc can be achieved by using clinically
recommended dosage of Roc over one hours after the administration of Sug.
Hiroshi Iwasaki M.D., Ph.D., Hajime Iwasaki M.D., Tomoki Sasakawa
M.D., Shigeaki Otomo M.D., Takahiro Suzuki M.D., Hideki Nakatsuka
M.D., Anesthesiology, Asahikawa Medical University, Asahikawa, Japan,
Anesthesiology, Nihon Universityerity School of Medicine Tokyo, Japan,
Anesthesiology, Kawasaki Medical University, Kurashiki, Japan.
NA A4123
Propofol Requirements in Obese Patients During Bariatric Surgery
Obese patients (body weight: 102 - 241 kg) undergoing bariatric surgery
received anesthesia with propofol and remifentanil (0.5 or 0.8 µg/kg/min).
During the steady state an EEG stage with dominating delta waves was
maintained. The propofol dosage during the steady state (in mg / kg body
weight / h) decreased significantly with increasing weight (p < 0.0001)
and age (p = 0.005) and was higher with 0.5 compared to 0.8 µg/kg/
min remifentanil (p = 0.02).On average the propofol maintenance dosage
(mg / kg body weight / h) has to be reduced in obese compared to normalweight patients. As there are several factors which influence the propofol
requirements especially in obese patients EEG monitoring is useful for dosing
propofol. Gabriele Kraus M.D., Michael Schulmann M.D., Arthur Schultz
M.D., Barbara Schultz M.D., Klinikum Region Hannover, Medizinische
Hochschule Hannover, Germany.
NA A4124
The Effect of Intraoperative Esmolol and Metoprolol on Anesthesia
Requirement
Esmolol a short-acting 1-receptor antagonist has been shown to decrease
anesthesia requirement measured by bispectral index (BIS). However
the effect of longer-acting 1-receptor antagonists such as metoprolol
on anesthesia requirement has not been prospectively studied. In this
randomized placebo-controlled double-blind study we confirmed the
anesthesia-sparing effect of esmolol by showing decreased concentrations
of sevoflurane required to achieve a target BIS level. However we did not
find a similar effect with metoprolol administered intraoperatively in clinically
relevant doses. Mehmet S. Ozcan M.D., Qaiser S. Khan M.D., Tilak
Raj M.D., Abhinava Madamangalam M.D., Amir L. Butt M.D., Praveen
Kalra M.D., Ian Bond M.D., Pramod Chetty M.D., Department of
Anesthesiology, The University of Oklahoma, Oklahoma City, OK.
NA A4125
Prospective Analysis of Sugammadex in 9 Patients With Myasthenia
Gravis
We prospectively studied outcomes for more than one year in 9 patients
with MG in whom sugammadex was used to reverse rocuronium-induced
neuromuscular blockade. Symptoms due to muscle weakness occurred in
4 of the 9 patients. These symptoms were not be improved by additional
administration of sugammadex and seemed to be caused by exhaustion
of the muscles not to recurarization after sugammadex reversal. Without
serious difficulties or problems sugammadex could probably be used for
reversal of rocuronium-induced neuromuscular blockade in patients with MG.
Kazunobu Takahashi M.D., Tomohisa Niiya M.D., Ph.D., Eichi Narimatsu
M.D., Ph.D., Michiaki Yamakage M.D., Ph.D., Anesthesiology, Emergency
Medicine Sapporo Medical University School of Medicine, Japan.
NEUROMUSCULAR BLOCKADE SAFETY AND DELIVERY SYSTEMS
ROOM 104-AREA C
FA A4126
Impact of Infusion Set Design on the Accuracy of Morphine PatientControlled Administration: An In Vitro Study
Our study shows that the dead space volume and architecture of the
infusionset used have an serious impact on the accuracy of the morphine
dose delivered to the patient during a bolus and also limit the adverse effects
associated with the patient-controlled administration of morphine.
Aurelie Foinard M.Sc., Bertrand Decaudin Ph.D., Christine Barthelemy
Ph.D., Gilles Lebuffe Ph.D., Bertrand Debaene Ph.D., Pascal Odou
Ph.D., Department of Biopharmacy, Galenic and Hospital Pharmacy,
Faculty of Pharmacy, Department of Anesthesia and Intensive Care
Lille University Hospital, Lille, France, Department of Anesthesia and
Intensive Care, Poitiers University Hospital, France.
TUESDAY, OCTOBER 15
NA A4122
FA A4127
Efficacy of a New Diposable IV-PCA Pump With Fentanyl for
Management After Laparoscopic Colectomy
We investigated the efficacy of a new disposable PCA device with changeable
background flow rate in fentanyl IV-PCA for postoperative management after
laparoscopic colectomy compared with a PCA device with the fixed flow
rate. The total dose of fentanyl could be decreased without increasing pain
by changing background flow rate. Patients who used the new device had
comparable side effects and had a high level of satisfaction. The results
suggest that the new disposable PCA device with changeable background
flow rate can play an important role in postoperative analgesia using IV-PCA
with fentanyl. Yukitoshi Niiyama M.D., Ph.D., Michiaki Yamakage M.D.,
Ph.D., Department of Anesthesiology, Sapporo Medical University
School of Medicine, Japan.
FA A4128
Automated Anesthesia in Burn Surgery: Feasibility and Performance of
a Closed-Loop Coadministration of Propofol and Remifentanil Guided
by the Bispectral Index
We evaluated the feasibility and performance of an automated anesthesia
controller in burned patients. Controller was able to perform the
coadministration of propofol and remifentanil and maintained BIS values
in predetermined boundaries despite the well-known pharmacological
modifications in burned patients. Nicolas Donat M.D., Thomas
Leclerc M.D., Ngai Liu M.D., Ph.D., Thierry Chazot M.D., Clement
Hoffmann M.D., Arthur Davy M.D., Audrey Cirodde M.D., Patrick
Jault M.D., Laurent Bargues M.D., Marc Fischler M.D., Burn
Center, Hospitald’Instruction des Armees PERCY, Clamart, France,
Anesthesiology, Hospital Foch, Suresnes, France.
FA A4129
A Central Venous Catheterization Needle With Lower Penetration Force
Facilitates Prevention of Posterior Venous Wall Puncture
Various central venous catheter (CVC) kits have recently been developed
to reduce mechanical complications but criteria for CVC kit selection are
unclear. We compared the penetration forces of CVC needles and examined
the clinical significance. Penetration forces of CVC needles were different
even though needle sizes were the same and lower penetration force of a
CVC needle could decrease the incidence of posterior venous wall puncture.
Hideaki Sasaki M.D., Masanori Yamauchi M.D., Ph.D., Fumiyuki
Sugime M.D., Aki Mizuguchi M.D., Soushi Iwasaki M.D., Rika Sekine
M.D., Michiaki Yamakage M.D., Ph.D., Department of Anesthesiology,
Sapporo Medical University School of Medicine, Japan.
NA Neuroanesthesia
PN Pain Medicine
117
FA A4130
Influence of the Plasma-Effect Site Equilibration Rate Constant of
Propofol on Loss of Consciousness During Target-Controlled Infusions
With Diprifusor®or Orchestra Base Primea®
The calculated effect-site concentration of propofol at loss of
consciousness is different according to the Ke0 value even though the
same pharmacokinetic model is applied to the TCI devices (Diprifusor® vs.
Orchestra Base Primea®). Jeong-Hwa Seo M.D., Ph.D., Hyun Joo Kim
M.D., Jung-Won Hwang M.D., Ph.D., Anesthesiology and Pain Medicine,
Seoul National Universityersal Hospital, Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seoul Korea, Republic
of, Seoul National University, Bundang Hospital, Seongnam, Republic of
Korea.
FA A4131
Maximum Fluid Flow Rate of Needleless-Connector Valves: Not All
Valves are the Same
This study documents the flow through needless connector valves utilizing
the Belmont rapid infuser. Megan J. Sharpe, M.D., Tara L. Kennedy, M.D.,
Anna Rabinowitz, M.D., Richard H. Epstein, M.D., Richard E. Sharpe Jr.,
M.D., David Maguire, M.D., Anesthesiology, Radiology, Thomas Jefferson
University Hospital, Philadelphia, PA.
FA A4132
Clinical Assessment of Control Performance in Closed-Loop
Anesthesia
Recently, several control systems for closed-loop anesthesia have been
demonstrated both in simulation and clinical studies. A set of performance
measures proposed by Varvel et al. have constituted the standard
means of comparing systems. This paper debates the adequacy of the
Varvel measures as applied to closed-loop anesthesia and proposes an
alternative set of measures. Kousha Talebian, B.Sc., Kristian Soltesz,
M.Sc., Guy A. Dumont, Ph.D., J. Mark Ansermino, M.D., Electrical and
Computer Engineering in Medicine, Anesthesiology, Pharmacology and
Therapeutics, The University of British Columbia, Vancouver, BC, Canada,
LCCC Automatic Control LTH Lund University, Lund, Sweden.
FA A4133
The Effects of Surgical Masks on Speech Perception
A concern about the acoustics and noise levels in induction rooms where
parental presence was welcomed led to a survey of operating room staff
about their ability to hear clearly in their daily communication. The survey
revealed that personnel often had difficulty hearing what was being
communicated especially in the operating room environment. As a result of
a simulated experiment we conclude that communication was suboptimal
especially when talkers were wearing surgical masks and blood shields.
Statistical analyses using a 3-way repeated measures indicated that:
speaking condition talker gender and sentence context were significant
at the 0.01 level. Peter D. Winch M.D., MBA, Kelsi Wittum Student,
Lawrence Feth Ph.D., Evelyn Hoglund Ph.D., Nationwide Children’s
Hospital Anesthesiology, Columbus, OH, Speech and Hearing Science,
The Ohio State University, Columbus, OH.
ROOM 104-AREA D
The Acadia Project: Anesthesia Education by Synchronous Internet
Videoconference Between the United States and Uganda
Transfer of anesthetic knowledge occurs via small group lectures delivered
both in person and remotely via simultaneous Internet videoconferencing.
This technique may be useful to expand anesthetic educational capacity
and international cooperation between academic institutions a particular
priority in the growing field of Global Health. Paul G. Firth M.B. Ch.B.,
Joseph K. Kiwanuka M.B. Ch.B., Ersne Eromo M.D., Sharma E. Joseph
M.D., Melissa E. Duan M.D., Adeniran A. Haastrup M.D., Keith H.
Baker M.D., Ph.D., Stephen S. Ttendo M.B. B.Ch., Anesthesia Critical
Care & Pain Medicine, Massachusetts General Hospital, Boston, MA,
Anesthesia & Critical Care, Mbarara Regional Referral Hospitalita,
Uganda.
PI A4136
Challenges in Trauma Anesthesia Education at a Level 1 Trauma
Center
Trauma anesthesiology is growing subspecialty with minimal didactic
and clinical curricula. Of note the ABA in service training exam does not
include keywords evaluating resident’s knowledge of trauma anesthesia so
standardized knowledge assessment is difficult. Despite dedicated focus on
trauma anesthesia education in our institution junior residents in particular
report the need for greater exposure to trauma cases. Most residents felt
month-long trauma anesthesia rotation would be beneficial and preferred
night float template as half of all admissions present at night. Olga Y. Kaslow
M.D., Ph.D., Eva Hanko M.D., Chris Fox M.S., Karen Brasel M.D.
M.P.H., Elena Holak M.D., Anesthesiology, Surgery, Medical College of
Wisconsin, Milwaukee, WI.
PI A4137
The T.A.S.K of Maintaining Patient Safety While Delivering Thoracic
Anesthesia Training: Results of a Multi-Level Teaching Evaluation
A multi-level evaluation of a new educational course in thoracic anaesthesia
for non-specialists in the field comprising results of written and practical
skills tests undertaken by candidates before and after the course. Significant
improvement in knowledge and skill was demonstrated following participation
in this simulation-based educational intervention. While logistical issues and
cost can deter educators from using high fidelity simulation we highlight
the patient safety benefits for this type of training in thoracic anesthesia.
Linda-Jayne Mottram M.B. B.Ch., Killian C. McCourt M.D., Sheena MC
Gormley M.D., Aoibhin B. Hutchinson M.B. B.Ch., Jonathan Adams
M.B. B.Ch., Martin O. Shields M.D., Anaesthetics Department, Royal
Hospitals, Belfast, United Kingdom.
PI A4138
Development and Assessment of A Novel Perioperative Ultrasound
Curriculum for Anesthesiology Residents: A FAER Sponsored Study
This study introduced the concept of a comprehensive POC perioperative
ultrasound examination for resident anesthesiologists. The results suggest
improved resident learning and a promising beginning to a curriculum that
may play an instrumental role in the advancement of anesthesiology resident
education. Davinder S. Ramsingh, M.D., Wendell Williams, M.D., Adriana
Capatina, Brenton Alexander, B.S., Khanhvan Le, B.A., Ceci Canales,
M.P.H., Maxime Cannesson, M.D., Ph.D., Department of Anesthesiology,
University of California Irvine, Orange County, CA.
PI A4139
PI A4134
War Stories: Feasability of Using Video to Capture ACGME Core
Competency Teaching Points in the Operating Room
Video technology can capture intraoperative teaching prompted by
spotaneous events. This innovative method can broaden the scope and
reach of anesthesia education. Angela M. Bader M.D., Alex Arriaga
M.D., Yue-Yung Hu M.D., Sarah Peyre Ed.D., Emilie Roth Ph.D.,
Katherine Corso M.P.H., Olivia Nelson M.D., Robert Lekowski M.D.,
Stuart Lipsitz Ph.D., Caprice Greenberg M.D., Brigham and Women’s
Hospital, Boston, MA, Beth Israel Hospital Boston, MA, U of Rochester,
Rochester, NY, Roth Cognitive Engineering, Menlo Park, CA, U of
Wisconsin, Madison, WI.
118
PI A4135
Evaluation of an Online Training Module for Goal Directed Fluid
Therapy at a Major Academic Center
As GDT fluid therapy becomes more accepted as the appropriate method
of managing fluids intraoperatively the ability to educate anesthesiologists
on this topic is becoming increasingly important. This research shows an
effective method of achieving this via an online tutorial system. Davinder
S. Ramsingh M.D., Joseph Rinehart M.D., Khanhvan Le, B.A., Maxime
Cannesson, M.D., Ph.D., Department of Anesthesiology, University of
California Irvine, Orange County, CA.
NA Neuroanesthesia
PN Pain Medicine
USMLE-1 Score as a Predictor of Success on the Certification
Examinations of the American Board of Anesthesiology
USMLE 1 scores are significantly associated with success in first pass
completion of the ABA exam. It appears to validate the selection of residents
into anesthesia residency programs who are likely to be successful at the
boards. However this will not be an accurate indicator of the quality of
the program per se. Assessment of program quality should adjust for the
USMLE1 scores of the matriculating residents. Kokila N. Thenuwara, M.D.,
Clarence Kreiter, Ph.D., Michael Todd, M.D., Department of Anesthesia,
University of Iowa, Carver College of Medicine, University of Iowa, Roy J.
and Lucille A. Carver of Medicine, Iowa City, IA.
PI A4141
The Influence of an International Teaching Program on the Use of
Regional Anesthesia for Cesarean Section in a Serbian Obstetric
Hospital
Kybele is a non-profit humanitarian organization dedicated to improving
childbirth safety in developing countries. A four-member team sponsored by
Kybele visited Novi Sad University hospital in September 2012 to provide
education and training in regional anesthesia. The collaborative program
increased the use of regional anesthesia for Cesarean Section. We believe
this was due to enhanced staff awareness of regional anesthesia and better
patient education. Ivan A. Velickovic M.D., Borislava Pujic M.D., Ph.D.,
Curtis Baysinger M.D., Medge Owen M.D., Anesthesiology, SUNY
Downstate Medical Center, Brooklyn, NY, Klinicki Centar Vojvodine
Klinika za Ginekologiju i Akuserstvo, Novi Sad, Serbia, Vanderbilt
University Hospital, Vanderbilt University Medical Center, Nashville, TN,
Wake Forest Medical Center, Wake Forest University, Winston-Salem,
NC.
ROOM 104-AREA E
PI A4142
Models for Determining External Neck Landmark Dimensions and
Predicting Internal Airway Size
We present the results of an observational prospective study at Memorial
Hermann Hospital Texas Medical Center - Houston Texas. The dimensions of
external airway landmarks were recorded for 200 patients. The primary aim
of this study is to evaluate measurements of external neck landmarks as an
estimation of internal airway size and to create prediction models for these
landmarks on the basis of easily accessible variables - age gender height
and weight. Davide Cattano M.D., Ph.D., Jacek Wojtczak M.D., Ph.D.,
Rashida Callender B.S., Carin Hagberg M.D., Anesthesiology, University
of Texas Health Science Center at Houston, Houston, TX, Anesthesiology,
University of Rochester, Rochester, NY.
PI A4143
Airtraq and Pentax Airway Scope Versus Macintosh Laryngoscope for
Tracheal Intubation in Adults: A Systematic Review and Meta-Analysis
of Randomized Controlled Trials
We performed a systematic review and meta-analysis of randomized control
trials to compare the tracheal intubation conditions of the Airtraq and Pentax
Airway Scope are rigid indirect video laryngoscopes (RILs) with those of the
Macintosh laryngoscope. Hiroshi Hoshijima D.M.D., Norifumi Kuratani
M.D., Ph.D., Yoshihiro Hirabayashi M.D., Ph.D., Risa Takeuchi D.M.D.,
Eiji Masaki M.D., Ph.D., Norimasa Ohtani M.D., Yutaka Yasui M.D.,
Ph.D., Dental-Oro Anesthesiology, Tohoku University Graduate School
of Dentistry Miyagi Japan, Anesthesiology, Saitama Children’s Medical
Center, Saitama Japan, International University of Health and Welfare,
Tochigi , Japan, Tohoku University Graduate School of Dentistry, Miyagi,
Japan, Atsugi Hospital, Kanagawa, Japan.
PI A4144
Improving Glottic Visualization in EMS: Comparing Direct Laryngoscopy
and C-MAC PM® Videolaryngoscopy
Out-of-hospital emergency patients are generally at higher risk of difficult
tracheal intubation (TI). This study shows improvement of glottic visualization
in this setting associated with a high overall success rate and a high firstattempt success rate by using C-MAC PM® videolaryngoscope. Bjoern
Hossfeld, M.D., Kristina Frey, Student, Lorenz Lampl, M.D., Ph.D., Volker
Doerges, M.D., Ph.D., Matthias Helm, M.D., Ph.D., Anaesthesiology,
and Intensive Care Medicine, Armed Forces Hospital, Ulm, Germany,
University Hospital Schleswig-Holstein UKSH, Campus, Kiel, Germany.
PI A4145
TUESDAY, OCTOBER 15
PI A4140
Measurement of 8-Hydroxy-2’-Deoxyguanosine (8-OHdG) to Assess
Oxidative Stress During Operation Using a Novel Point-of-Care Testing
Device
We tried to examine the changes of urinary 8-OHdG value in prospectively
between two different RF dose groups in patients who were scheduled to
undergo elective gynecological open abdominal surgery. As a result the
possibility that oxidative stress caused by intraoperative surgical stress was
controlled by high dose RF was shown. It might become able to evaluate the
degree of intraoperative oxidative stress by measuring 8-OHdG as point-ofcare testing and the possibility that it might be the new parameter that could
evaluate the degree of analgesic effect quantitatively was found.
Toru Kaneda M.D., Ph.D., Genya Urimoto M.D., Kai Yamazaki M.D.,
Maki Takahashi M.D., Toshiyasu Suzuki M.D., Ph.D., Department of
Anesthesiology, Tokai University School of Medicine, Isehara, Japan.
PI A4146
Truflex™; Articulating Stylet Reduces Tracheal Intubation Attempts and
Time During Storz D-Blade™; Videolaryngoscopy
Truflex™ articulating stylet (TAS) assisted tracheal intubation with Storz
D-Blade™ abolishes the need for multiple intubation attempts as ocassionally
needed while using conventional stylets. Intubation Difficulty Score are
also lowered when using TAS indicating an overall easier TAS assisted
intubation. Naresh Kaul Sr. M.D., Aida Al Qasmi Jr. M.B. B.S., Waffa
Al Alawi M.B. B.S., Azharuddin M. Malik Jr. M.D., Rashid M. Khan Sr.
M.D., Anaesthesia, Khoula Hospital, Al Harthy Complex, Oman,
Anaesthesiology, National Trauma Center, Khoula Hospital, Muscat,
Oman, Medicine JN Medical College, Aligarh, India.
PI A4147
Airway and Anesthetic Management of Patients With Parotid Lesions
Undergoing Surgical Resection: A Pilot Study
The use of general anesthesia and videolaryngoscopy for intubation is a safe
alternative to awake/sedation in patients with significant parotid lesions. Our
findings suggest several different devices may be used for intubation.
Amelia Morgan B.S., Joseph May B.S. Randy W. Calicott M.D.,
Deborah Whelan M.D., Yvon F. Bryan M.D., Anesthesiology, Wake Forest
University, School of Medicine, Winston-Salem, NC.
PI A4148
Improving Team Performance and Patient Outcomes During
Transcatheter Aortic Valve Replacement (TAVR) Through Simulation
The requirement for unique multidisciplinary teamwork combined with
the multiple comorbidities of TAVI candidates and the complexity of this
intervention make the TAVI learning curve a very high-risk period. Cadaver
training provides an initial opportunity for team training and has been
suggested to improve OR performance specifically in minimally invasive
surgery. Samata Paidy M.D., Ntesi Asimi M.D., Sugam Bhatnagar M.D.
M.P.H. Robert Poston M.D., University of Arizona, Tucson, AZ.
PI A4149
Ultrasound Assessment of Tracheal Intubation
We investigated the ultrasonographic findings of the airway during intubation.
We categorize sonographycal findings in 3 grades. Number of patients in
grade A B C were 22(88%) 1(4%) 2(8%) respectively. At suprasternal
notch tracheal tube was identified in majority of the cases. Hiroshi Tanaka
M.D., Akihiro Suzuki M.D., Tomoki Sasakawa M.D., Megumi Matumoto
M.D., Akihito Tampo M.D., Atsushi Kurosawa M.D., Takayuki Kunisawa
M.D., Osamu Takahata M.D., Hiroshi Iwasaki M.D., Asahikawa Medical
College, Asahikawa, Japan.
NA Neuroanesthesia
PN Pain Medicine
119
PO09-2A EXPERIMENTAL CIRCULATION: VASCULAR BIOLOGY
ROOM 104-AREA C
CA A4150
Superoxide Production Via NADPH Oxidase Reduces Vasodilator Effect
of L-Cysteine in the Rat Mesenteric Artery
In the rat visceral artery with endothelium thromboxane receptor activation
mediates vasoconstrictor responses induced by pathological concentrations
of L-cystein. In these arteries superoxide production via NADPH oxidase
activation impairs vasodilation related to ATP-sensitive K+ channels.
Hiroyuki Kinoshita M.D., Ph.D., Yoshitaka Yasuda M.D., Yukiko Mori
M.D., Kazuo Ando M.D., Kensuke Sakakibara M.D., Noboru Hatakeyama
M.D., Ph.D., Yoshihiro Fujiwara M.D., Ph.D., Anesthesiology, Aichi
Medical University School of Medicine, Nagakute, Japan.
CA A4151
The Relation Between F-Actin Constitution and NADPH Oxidase
Activation in the Human Artery Exposed to High Glucose
In the human artery treated with high glucose a cytoskeletal disruption agent
decreased levels of superoxide produced by NADPH oxidase. Rac-1 probably
supports both the F-actin constitution and NADPH oxidase activation.
Hiroyuki Kinoshita M.D., Ph.D., Yukiko Mori M.D., Guo-Gang Feng M.D.,
Ph.D., Toshiharu Azma M.D., Ph.D., Jiazheng Li M.D., Jiazhen Jiang
M.D., Yoshihiro Fujiwara M.D., Ph.D., Anesthesiology, Pharmacology,
Aichi Medical University School of Medicine, Nagakute, Japan,
Anesthesiology, Kohnodai Hospital National Center for Global Health and
Medicine, Ichikawa, Japan.
CA A4152
Dexmedetomidine-Induced Contraction Involves PKC-δ-Mediated JNK
Phosphorylation in Isolated Rat Aorta
Taken together these results suggest that dexmedetomidine-induced
contraction involves PKC-δ dependent pathway-mediated JNK phosphorylation
in rat aortic vascular smooth muscle. Ju-Tae Sohn M.D., Seong-Ho
Ok M.D., Jeong Yeol Han M.D., Department of Anesthesiology,
Gyeongsang Nat’l University Hospital and Gyeongsang National University
School of Medicine, Jinju, Korea Republic of.
CA A4153
Carbon Monoxide Sensing Properties of the Human BK Channel Gating
Ring
The results from this study demonstrate that human BK channel gating
ring in complex with reduced heme (Fe2+-heme) binds CO and undergoes
conformational changes under physiologically-relevant conditions. Thus the
gating ring acts as a functional CO-sensing superstructure, mediating COdependent activation of human BK channels. Taleh Yusifov Ph.D., Nicoletta
Savalli Ph.D., Riccardo Olcese Ph.D., Anesthesiology, UCLA, Los
Angeles, CA.
CA A4154
A Novel BKCa Subunit LRRC18 From Human Coronary Arterial Smooth
Muscle Regulates BKCa Channels
We report a new leucine-rich repeat regulatory subunit of BKCachannel
LRRC18 that forms a complex with the channel in human coronary arterial
smooth muscle. LRRC18 lacks a predicted transmembrane domain and
thus it likely regulates BKCa channels via distinct mechanisms from the
transmembrane LRRC26 subunit. Zhu Zhang Ph.D., Christina Lee, Min Li
Ph.D., Jure Marijic M.D., Enrico Stefani M.D., Ph.D., Ligia Toro Ph.D.,
Anesthesiology, Division of Molecular Medicine UCLA, Los Angeles, CA.
CA A4155
BKCa Channel Gene Ablation Enhances Acute Renal Vascular
Response to Angiotensin II
Using the BKCa channel knockout animal we show that the BKCa channel
plays a critical role in the regulation of renal arterial tone in response to
Angiotensin II. Zhu Zhang Ph.D., Harpreet Singh Ph.D., Enrico Stefani
M.D., Ph.D., Ligia Toro Ph.D., Anesthesiology, Division of Molecular
Medicine, UCLA, Los Angeles, CA.
CA A4156
RCK Domains of BKCa Channel are Dispensable for its Close
Association With Angiotensin II Type 1 Receptor
We investigated the molecular mechanisms of AT1R and BKCa channel
interaction. The results support a physical protein-protein interaction between
AT1R and BKCa channels that does not require the RCK domains of BKCa
channels localized in the channel C-terminus. Zhu Zhang Ph.D., Enrico
Stefani M.D., Ph.D., Ligia Toro Ph.D., Anesthesiology, Division of
Molecular Medicine UCLA, Los Angeles, CA.
PO10-3A EXPERIMENTAL NEUROSCIENCES: NEUROTOXICITY
ROOM 104-AREA D
NA A4157
Xenon Neurotoxicity in Rat Hippocampal Slice Cultures is Similar to
Isoflurane and Sevoflurane
Using postnatal rat hippocampal slice cultures the authors demonstrated
that xenon used at 1 minimum alveolar concentration-equivalent
concentration increased apoptosis similarly to sevoflurane and isoflurane
at equipotent concentrations and that this effect was abolished by
preconditioning the tissue with a subtoxic concentration of isoflurane.
Philip E. Bickler M.D., Ph.D., Heather Brosnan B.S., Anesthesia
and Perioperative Care, University of California - San Francisco San
Francisco, CA.
NA A4158
Brain Serotonin Content Regulates Manifestation of Tramadol-Induced
Seizure in Rats
Mechanism of tramadol-induced seizure was investigated with in-vivo
microdialysis study in rats. We have demonstrated that modulation of
brain serotonin concentration altered threshold for the expression of
tramadol-induced seizure. Yohei Fujimoto M.D., Tomoharu Funao M.D.,
Ph.D., Koichi Suehiro M.D., Ryota Takahashi M.D., Ph.D., Katsuaki
Tanaka M.D., Ph.D., Kiyonobu Nishikawa M.D., Ph.D., Department
of Anesthesiology, Osaka City University Graduate School of Medicine,
Osaka, Japan.
NA A4159
Repeated Exposure To Ketamine Anesthesia During Early
Synaptogenesis Impairs Learning-Dependent Synaptic Plasticity in
Adulthood
Using in vivo two-photon imaging technique we examined learningdependent synaptic structural plasticity in adult mice with or without early
exposure to ketamine anesthesia. Our studies indicate that repeated
exposure to anesthesia during early but not late stages of synaptogenesis
impairs motor learning-induced dendritic spine formation and behavioral
improvement after motor training. Lianyan Huang Ph.D., Michael Haile
M.D., Thomas JJ Blanck M.D., Ph.D., Guang Yang Ph.D., Anesthesiology,
New York University School of Medicine, New York, NY.
NA A4160
Repeated Neonatal Intrathecal Lidocaine Injection Attenuate the
Object Recognition in Adult Age in Rats
Repeated intrathecal lidocaine-injection to neonatal rats resulted in
decreased object recognition in the adult age. Boris Piskoun, B.S., Lisa
Doan, M.D., Olga Eydlin, M.D., Michael Haile, M.D., Thomas JJ. Blanck,
M.D., Ph.D., Fang Xu, Ph.D., Anesthesiology, NYU Medical Center, New
York, NY.
NA A4161
Influence of Oxygen Tension on Inflammatory Microglia-Induced
Mitochondrial Respiratory Inhibition
Activated inflammatory microglial cells cause mitochondrial respiratory
inhibition in microglia and co-cultured neurons. Respiratory inhibition is
mediated by nitric oxide at physiological 3% oxygen but not at atmospheric
21% oxygen. Our study demonstrates the critical importance of considering
oxygen tension as a variable when studying microglial activation and
associated mitochondrial dysfunction. Brian M. Polster, Ph.D., Evan A.
Bordt, B.S., Shealinna X. Ge, B.S., Anesthesiology, University of Maryland
School of Medicine, Baltimore, MD.
120
NA Neuroanesthesia
PN Pain Medicine
Propofol Did Not Affect Contextual Learning After Intraperitoneal
Administration in Adult Rats
We investigated whether propofol impairs contextual learning in postanesthetic period. Young adult rats that received 150 mg/kg of propofol
showed no significant change of IA learning at 1 and 7 days after i.p.
administration. Rats that received 150 mg/kg followed by 75 mg/kg 30 and
60 min later (total 300mg/kg) showed no significant change but tendency
to impair IA learning at 1 day after administration. These results suggest
that clinically relevant concentration of propofol may not affect hippocampal
learning. Kazuhiro Uchimoto M.D., Yosuke Tominaga M.D., Youko
Matuda M.D., Tomoyuki Miyazaki M.D., Ph.D., Takahisa Goto M.D.,
Department of Anesthesiology and Critical Care Medicine, Yokohama City
University Graduate School of Medicine, Yokohama, Japan.
NA A4163
Dexmedetomidine Induces Remote Tau Phosphorylation in the Mouse
Hippocampus
Prolonged (24h) administration of dexmedetomidine in mice increased
hippocampal tau phosphorylation immediately at the end of the infusion.
Interestingly hippocampal tau hyperphosphorylation was still present
1 week later. This suggests that the capacity to induce remote tau
hyperphosphorylation is not solely a property of volatile anesthetics.
Robert A. Whittington M.D., Laszlo Virag M.S., Department of
Anesthesiology, Columbia University, College of Physicians & Surgeons,
New York, NY.
NA A4164
Prenatal Exposure to Propofol Induces Synaptic Loss and Long-Term
Behavioral Deficits in the Offspring Rats
A number of studies have documented that propofol (2 6-diisopropylphenol)
may produce neurotoxic effects to immature neurons. We hypothesized that
propofol may interfere with synaptogenesis and cause behavioral abnormality
in the offsprings if administered during pregnancy. In this study we gave
propofol to rats on gestational day18 and studied the brain and learning
behavioral changes in their offspring. Our results indicate that propofol
administration during pregnancy may interfere with synaptogenesis in the
offspring rats. These neurotoxic effects may cause the impairment in learning
performance measured by the radial arm maze task and the open field task.
Ming Xiong M.D., Ph.D., Jing Li M.D., Ph.D., H. M. Alhashem M.D.,
Sergey Pisklakov M.D., Steve Shulman M.D., Jiang H. Ye M.D., M.S.
Alex Bekker M.D., Ph.D., Anesthesiology, UMDNJ, Newark, NJ.
PO13-5A OUTCOMES AND DATABASE RESEARCH: INTERVENTIONS AND
OUTCOMES II
TUESDAY, OCTOBER 15 |10:00-11:00 A.M.
ROOM 104-AREA E
FA A4165
Perioperative Starch-Based Colloids and Acute Kidney Injury Following
Liver Transplantation
Orthotopic liver transplantation is associated with one of the highest rates
of postoperative acute kidney injury (AKI) leading to significant morbidity
and mortality. We retrospectively examined the association between starchbased colloid (HES) fluid resuscitation and AKI following all liver transplants
at Duke University Medical Center from June 2000 to December 2012. No
statistically significant association was found between the perioperative use
of HES and AKI. However our sample size was too small to separately assess
subsets of high risk patients such as those developing postoperative sepsis.
The definitive answer will be found in multi-center trials. Nasrin Aldawoodi
M.D., Eugene Moretti M.D., Tong J. Gan M.D., William White M.P.H.
Mark Stafford-Smith M.D., Kerri Wahl M.D., Duke University, Medical
Center, Durham, NC.
FA A4166
Association of Hydroxyethl Starch-Based Intravascular Plasma Volume
Expanders With an Increase in Indices of Renal Dysfunction in the
Perioperative Setting
The use of hydroxyethyl starch (HES) based plasma volume expanders in
septic patients is associated with increased risk of developing acute kidney
injury. Whether HES is associated with renal dysfunction in the perioperative
setting is unknown. We completed a retrospective secondary analysis of a
cohort of patients undergoing surgery. After adjusting for several risk factors
HES was associated with a small but statistically significant association with
developing renal dysfunction. Raquel R. Bartz M.D., Jennifer Hauck M.D.,
William White Ph.D., Tong J. Gan M.D., Duke University, Medical Center,
Durham, NC.
TUESDAY, OCTOBER 15
NA A4162
FA A4167
The Effect Of Hydroxyethylstarch (HES) on Postoperative Kidney
Function In Patients Undergoing Non-Cardiac Surgery
The potential harmful effects of hydroxyethylstarch (HES) on kidney function
have been widely studied. Most of the studies however investigated critically
ill patients. Our retrospective study investigates the effect of the HES solution
Hextend on acute kidney injury (AKI) in non-cardiac surgical patients. Our
results from 36 50 patients indicate a significant association between
HES and AKI. In our secondary analyses we found a significant association
between total volume of colloid and risk of developing AKI but we did not
find an association between baseline risk and AKI. Babak Kateby Kashy
M.D., Atilla Podolyak M.D., Natalya Makarova M.S. Andrea Kurz M.D.,
Outcomes Research Anesthesiology Institute The Cleveland Clinic,
Cleveland, OH.
FA A4168
The Effects of Glucose Control Steroids and Depth of Anesthesia
on Postoperative Quality of Life in Patients Having Major Noncardiac
Surgery
Perioperative interventions such as tight glucose control, steroid
administration and light anesthesia do not improve quality of life 30-days
after surgery. Michael Nasr Boles Kot M.D., Andrea Kurz M.D., Daniel
Sessler M.D., Jing You M.S., Basem Abdelmalak M.D., Outcomes
Research Anesthesia Department, Cleveland Clinic, OH.
FA A4169
Exploration of Variability in Crystalloid Administration During
Abdominal Surgery in Two Academic Medical Centers
Restrictive crystalloid infusion associated with colloid goal directed therapy
has been reported to be an effective balanced fluid strategy during
abdominal surgery. Standardization of fluid therapy has the proven ability to
decrease morbidity and mortality and decrease hospital length of stay. Using
automatically captured data we explored how much variability in crystalloid
infusion delivery existed during abdominal surgery in two large U.S. academic
medical centers before standardization of therapy. Marc Lilot M.D., Jesse
M. Ehrenfeld M.D. M.P.H., Christine Lee B.S., Maxime Cannesson M.D.,
Ph.D., Joseph Rinehart M.D., Hospitalices Civiles de Lyon Lyon, France,
Department of Anesthesiology and BioMedical Informatics, Vanderbilt
University Medical Center, Nashville, TN, Department of Anesthesiology
and Perioperative Care, UCI, Orange County, CA.
FA A4170
A Prospective Randomized Controlled Trial of 0.9% Saline Versus a
Balanced Cristalloid in Renal Transplantation
In this prospective open-label randomized controlled trial we compared the
effects of NaCl 0.9% and Elomel isoton (R) on the incidence of perioperative
hyperkalemia as well as on acid-base and eletrolyte stability during and
after renal transplantation. Although patients in the Elomel isoton (R) group
had less metabolic acidosis there was no difference in the incidence of
hyperkalemia or postoperative need for renal replacement therapy.
Gregor Lindner M.D., Eva Meitner M.D., Peter Biesenbach M.D.,
Christian Reiterer M.D., Edith Fleischmann M.D., Emergency Medicine
Inselspital University Hospital Bern, Bern, Switzerland, Department of
Anesthesiology, General Intensive Care Medicine and Pain Management
Medical University of Vienna, Vienna, Austria.
NA Neuroanesthesia
PN Pain Medicine
121
FA A4171
Incidence of Extrapyramidal Symptoms Following Administration of
Oral Perphenazine 8 mg: A Retrospective Analysis
An 11-year retrospective analysis was performed to examine the incidence
outcome and risk factors of Extrapyramidal System (EPS) dysfunction among
patients who received single oral dose of perphenazine 4 or 8 mg for PONV
prophylaxis. Out of 45 766 patients who received perphenazine there were
four very likely cases of EPS dysfunction and two possible cases identified.
Expressed in events per 10 000 patients there were 1.3 events 95% CI
[0.4 3.0]. Katherin Anne Peperzak M.D., John P. Henao M.D., Alicia B.
Lichvar Pharm.D, Sn J. Skledar RPh MPH FASHP, Steven L. Orebaugh
M.D., Brian A. Williams M.D., MBA, Department of Anesthesiology,
University of Pittsburgh Medical Center, Pittsburgh, PA, School of
Pharmacy Veterans Affairs, Pittsburgh HealthCare System, PA.
FA A4172
Perioperative Hyperglycemia and Glucose Variability During Major
Abdominal Surgery (PAVAS study)
In this prospective cohort study 166 female patients were included
to investigate whether hyperglycemia and blood glucose variability
independently predict postoperative complications in patients undergoing
major abdominal surgery. Data of 131 female patients was analyzed. Glucose
values increased significantly in response to major gynaecologic surgery.
Increased postoperative glucose variability was associated with postoperative
complications within 3 months. Jorinde Polderman, M.D., J Hans deVries
M.D., Ph.D., Markus W. Hollmann M.D., Ph.D., Benedikt Preckel M.D.,
Ph.D., Jeroen Hermanides M.D., Ph.D., Academic Medical Centre,
Amsterdam Netherlands.
TUESDAY, OCTOBER 15 |10:00-11:00 A.M.
ROOM 104-AREA B
PI A4173
Innovative Surgical Suite Design Improves OR Efficiency
Operating room design can have significant effects on patient throughput.
We evaluated the performance of an innovative new surgical suite designed
to foster parallel processing in an academic medical center by analyzing OR
efficiency metrics before and after opening of the unit. Our results suggest
that OR design can improve efficiency and increase the number of cases
performed per day. Aalok Agarwala M.D. M.B.A., Wilton C. Levine M.D.,
Brianna Germain M.P.H., Mazen A. Maktabi M.D., David W. Rattner
M.D., Dawn L. Tenney R.N., Peter F. Dunn M.D., David L. Berger M.D.,
Anesthesia Critical Care and Pain Medicine, Perioperative Services,
Surgery, Massachusetts General Hospital, Boston, MA.
PI A4174
Pre-Procedural Evaluation and Redesign
In an effort to streamline processes reduce appointment wait-time and
improve patient satisfaction we redesigned the pre-procedural testing clinic’s
processes. A clinic was opened to pilot the practices. After 7 weeks patients
clinic staff and leadership expressed tremendous satisfaction with the clinic
practices. Appointment time has been reduced by 89 minutes on average
and wait-time has been virtually eliminated. Eden Brand M.P.H., Kelsey
McCarty M.B.A., Adam J. Carinci M.D., Mary Elizabeth Ellbeg R.N.,
James P. Rathmell M.D., Department of Anesthesia, Critical Care and
Pain Medicine, Massachusetts General Hospital, Boston, MA.
PI A4175
Development and Implementation of a Faculty Peer Eval System as
Part of Ongoing Professional Practice Evaluation
We have used our Perioperative Information Management System to
implement a multi-source peer evaluation system for clinical faculty
members. Results are provided to our Departmental Peer Review
Committee Chair by means of a secure web-based reporting tool tofacilitate
performance improvement initiatives. Jesse M. Ehrenfeld M.D. M.P.H.,
William R. Furman M.D., Dylan Snyder B.S., Vanderbilt University,
Nashville, TN.
122
PI A4176
Apps for Everyone! A Clinician-Controlled Mobile App for Pediatric
Anesthesia
We present a framework for developing a mobile app for Pediatric Anesthesia
using widely available open-source technologies. Our approach focuses on
placing clinical users of the app with little development experience in control
of the content delivered. Our primary goal is to provide a framework for
development that can be targeted to a specific clinical context while limiting
the need for technical support. Peter V. Killoran M.D., Amy GrahamCarlson M.D., Davide Cattano M.D., Ph.D., Maria Matuszczak M.D.,
Anesthesiology and BioMedical Informatics, University of Texas Health
Science Center, Houston, TX.
PI A4177
Do Preoperative Records Enable Anesthesiologists to Triage and Plan
Effectively?
This study shows that anesthesiologists often encounter charts that lack
vital information most notably regarding comorbidities upon review of
available electronic medical records prior to surgery. Increased attention
should therefore be paid to providing accurate morbidity information in
order to improve the efficiency and effectiveness of the anesthesiologist’s
preoperative assessment and planning. Michael C. Lubrano B.A., I-Hsun
Liang M.D., David G. Silverman M.D., Anesthesiology, Yale University
School of Medicine, New Haven, CT.
PI A4178
Evaluating Improvements in First-Case-On-Time-Starts Using Process
Control Methodologies
After an initiative tied to financial incentives FCOTS improved fromless than
50% to greater than 70% and this improved performance was sustained
beyond incentive expiry. Here we seek to determine whether people achieved
the goal simply by starting earlier - suggested if distribution of start times
retains its shape but shifts earlier or whether the process itself was improved
as would be suggested if the distribution of start times compacts. Our results
indicate that the improvement occurred both as a result of better process
control as well as due to getting patients into the room earlier. Vikram
Tiwari Ph.D., Jesse M. Ehrenfeld M.D., Warren S. Sandberg M.D.,
Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
PI A4179
Resident Led Quality Improvement Initiative to Identify the Barriers of
Effective Perioperative Time Outs
Direct observation gives insight into the quality of a given task. Simply
checking a box to indicate that a task was completed is insufficient evidence
of optimal performance. Although no adverse events have been recorded
inquiry into effective time-outs show the importance of periodically reviewing
protocols and systems that are in place rather than relying on retrospective
chart reviews. Defining barriers to effective time outs in the peri-operative
setting can improve patient outcomes and safety interdisciplinary team
communication and situation awareness. Padmaja K. Upadya M.D.,
Silvester Kagunye M.D., Siddharth Shah M.D., St. Joseph’s Regional
Medical Center, Paterson, NJ.
PI A4180
Substantial Improvement in First Case On-Time Starts Using the RPIW
Methodology
The Center for Perioperative Services and the Departments of Surgery and
Anesthesia at Dartmouth Hitchcock Medical Center (DHMC) created a
multidisciplinary Rapid Process Improvement Workshop that improved on
time starts from 53% to over 80% in a sustained fashion for first cases of the
day. This is credited with upwards of $2M a year in combined cost savings
of overtime pay and - for some services - additional cases and increased
revenue. Sophia van Hoff M.D., Douglas Merrill M.D. M.B.A. Thomas
Dodds M.D., Sara Graves M.D., Daniel Herrick, Dartmouth Hitchcock
Medical Center, Lebanon, NH.
NA Neuroanesthesia
PN Pain Medicine
ROOM 104-AREA A
PD A4181
Effect of Propofol Versus Desflurane on Cardiac Electrophysiology
in Children Undergoing Radiofrequency Catheter Ablation for
Tachyarrhythmias
The effects of desflurane and propofol on the electrophysiologic parameters
in children undergoing radiofrequency catheter ablation for tachyarrhythmias
were evaluated in a randomized crossover manner. Sinus node recovery
time and sinoatrial conduction time were significantly shorter during
anesthesia with desflurane than with propofol (P = 0.02 and P < 0.01
respectively). Accessory pathway effective refractory period was significantly
longer during anesthesia with desflurane than with propofol (P = 0.01).
These results suggest that desflurane and propofol have different effect on
electrophysiology in children. Hideki Hino, M.D., Yutaka Oda M.D., Ryu
Okutani, M.D., Anesthesiology, Osaka City General Hospital, Osaka,
Japan.
PD A4182
A Prospective Randomized Study Comparing Neurophysiologic
Monitoring With Total Intravenous Anesthesia Versus Inhalational
Anesthesia During Posterior Spinal Fusion in Adolescents With
iIiopathic Scoliosis
Total intravenous anesthesia (TIVA) is the most common anesthetic
technique for scoliosis patients undergoing corrective spinal surgery. This
study compared efficacy of neurophysiologic monitoring with either TIVA
or a volatile agent. The primary advantage of the volatile-based technique
includes a more rapid awakening and a greater degree of titratability.
Anita S. Joselyn M.D., David P. Martin M.D., Tarun Bhalla M.D., Arlyne
Thung M.D., Walter Samora M.D., Allan Beebe M.D., Jan Klamar
M.D., Joseph D. Tobias M.D., Anesthesiology and Pain Medicine,
Orthopedics, Nationwide Children’s Hospital Columbus, OH.
PD A4183
Right and Left Ventricular Mitochondrial Supercomplexs Differ in Rat
Heart Myocardium
In this study we evaluated the supercomplexs of the mitochondrial inner
membrane respirasomes of the electron transport chain in isolated
mitochondria from rat ventricular cardiomyocytes and how they are
effected by maternal gestaional diet as well as ex vivo hypoxia. Michael
A. Keenaghan M.D., Aili Wang M.D., Lena S. Sun M.D., Pediatrics
Columbia University, New York, NY, Anesthesiology, Columbia University,
New York, NY.
PD A4184
Comparison of Neurodegeneration and Cognitive Impairment in
Neonatal Mice Exposed to Propofol or Isoflurane
Animal studies have demonstrated neuronal apoptosis and associated
cognitive impairment after isoflurane or propofol exposure in neonatal rodents
but have not compared the degree to which each effect the neurocognition.
Eight day old mice were exposed to isoflurane or propofol at an equipotent
concentration for two general anesthetics. Each group were sacrificed and
examined for evidence of neurodegeneration as well as neuronal apoptosis
and inflammation. To compare the possible detrimental effects of isoflurane
or propofol on cognitive function we measure their memory and learning
ability using Morris Water Maze at forty days after the anesthesia exposure.
Soorena Khojasteh M.D., Grace Liang M.D., Zhen Wu Ph.D., Huafeng
Wei M.D., Ph.D., Anesthesiology and Critical Care, University of
Pennsylvania, Philadelphia, PA.
PD A4185
Isoflurane Exposure in Neonatal Rats Is Not Associated With Social
Avoidance in Early Adulthood
The relationship between isoflurane exposure in neonatal rats and preference
for novel social interactions was studied using the Three Compartment
Sociability Assay. Neither isoflurane-exposed nor control rats displayed social
avoidance a behavior associated with autism spectrum disorders.
Jacqueline S. Lagoy M.D., Meredith M. Pace M.D., Michael G. Holmes
M.D., Jennifer M. O’Donnell Student, Christine D. Bub Student, Kyle
Jenks B.S., Michael L. Beach M.D., Gregory L. Holmes M.D., Rod
Scott M.D., Ph.D., Simon C. Hillier M.D., Anesthesiology, Neurology,
Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of
Medicine at Dartmouth College, Hanover, NH.
TUESDAY, OCTOBER 15
PD A4186
Cuirass Negative Pressure Ventilation Decreases Morbidity of Pleural
Effusion After the Fontan Procedure
Pleural effusion after the Fontan procedure is one of the major morbidities
which prolongs ICU stay. As negative pressure ventilation with external
cuirass increases cardiac output even in patients receiving positive pressure
ventilation we examined if continuous negative pressure ventilation (CNPV)
after extubation would decrease pleural effusion and the necessity of
chest tube in patients undergoing Fontan operation. CNPV reduced pleural
effusions and need of chest tube postoperatively. It also shortened ICU stay.
Nobuyuki Katori M.D., Tomoko Oyaizu M.D., Norihito Nakamura M.D.,
Hiroshi Morisaki M.D., Ph.D., Anesthesiology, Keio University Tokyo,
Japan.
PD A4187
Change in Regional Liver Oxygen Saturation May Reflect Adequacy of
Pulmonary Artery Banding
The effectiveness of pulmonary artery banding (PAB) was evaluated by
regional oxygen saturation in liver (rSO2L). The change in rSO2L reflected
the effectiveness of PAB. Monitoring of rSO2L may be a good indicator
to decide the tightness of the band. Tomoko Oyaizu M.D., Eiki Hatori
M.D., Nobuyuki Katori M.D., Ph.D., Hiroshi Morisaki M.D., Ph.D.,
Anesthesiology, Keio University Tokyo, Japan.
PD A4188
Comparison of Intraoperative Cerebral Oxygen Saturation and
Postoperative Neurological Complications in Pediatric Cardiac Surgery
With Selective Cerebral Perfusion
Antegrade selective cerebral perfusion (SCP) is used to protect the brain
from ischemic injury during pediatric aortic arch repair such as Norwood
procedure. We retrospectively collected the data including cerebral rSO2
hemodynamic parameters during surgery and postoperative neurological
complications in fourteen pediatric patients undergoing SCP. As a result
bilateral cerebral rSO2 showed a discrepancy during SCP even in the setting
of deep hypothermia. Three of 14 patients had postoperative neurological
complications and presented lower values in right and left cerebral rSO2
mainly during SCP. Ken Kuwajima M.D., Kenji Yoshitani M.D., Yoshihiko
Ohnishi M.D., Anesthesiology, National Cerebral and Cardiovascular
Center, Suita Osaka, Japan.
NA Neuroanesthesia
PN Pain Medicine
123
PO09-2B EXPERIMENTAL CIRCULATION: VASCULAR BIOLOGY
TUESDAY, OCTOBER 15 | 11:00 A.M.-12:00 P.M.
ROOM 104-AREA C
CA A4189
The New Findings of the Enhancing and Suppressing Effects of
Dexmedetomidine on Human Platelet Functions
We previously reported that dexmedetomidine (DEX) has suppressing
and enhancing effects on human platelet aggregation possibly via α 2
-adrenoceptor (α 2-R) and imidazoline 1-receptor (I 1-R) respectively. Here we
show DEX enhanced P-selectin (PS) expression of platelets with or without
ADP stimulation via α 2-R and phosphorylation of ERK 1/2 which was involved
in I 1-R pathway. Phosphorylation of ERK 1/2 was abolished in the presence
of imidazoline 1-antagonist. We conclude that DEX has enhancing and
suppressing effects on platelet functions other than aggregation via α 2-R and
I 1-R respectively. Shuji Kawamoto M.D., Hideo Hirakata M.D., Ph.D.,
Naoko Sugita M.D., Kazuhiko Fukuda M.D., Ph.D., Anesthesiology,
Psychiatry, Kyoto University, Anesthesiology, National Hospital
Organization Kyoto Medical Center, Kyoto, Japan.
CA A4190
L-Kynurenine Causes Hypotension Via Vasodilation Mediated by KCNQ
Voltage Sensitive K+ Channels in Rats
L-kynurenine producesvasodilation via activation of Kv7 channels in
the vascular smooth musclecells. In rats this tryptophan metabolite
causes hypotension which is partlyrestored by administration of a Kv7
channel inhibitor. Kensuke Sakakibara M.D., Hiroyuki Kinoshita M.D.,
Ph.D., Yukiko Mori M.D., Kazuo Ando M.D., Yoshitaka Yasuda M.D.,
Noboru Hatakeyama M.D., Ph.D., Yoshihiro Fujiwara M.D., Ph.D.,
Anesthesiology, Aichi Medical University School of Medicine, Nagakute,
Japan.
CA A4191
Mepivacaine-Induced Vasoconstriction is Mediated Mainly by Calcium
Influx From Extracellular Space
Taken together these results suggest that mepivacaine-induced contraction
of isolated rat endothelium-denuded aortas is mediated primarily by calcium
influx from the extracellular space via VOCCs and in part by 1 4 5-inositol
trisphosphate receptor-mediated calcium release from the sarcoplasmic
reticulum. Ju-Tae Sohn M.D., Seong-Ho Ok M.D., Jeong Yeol Han M.D.,
Department of Anesthesiology, Gyeongsang National University Hospital
and Gyeongsang National University School of Medicine, Jinju, Korea
Republic of.
CA A4192
Ropivacaine-Induced Contraction is Attenuated by Voltage-Dependent
Potassium Channels in Isolated Rat Aorta Taken together these results suggest that ropivacaine-induced contraction
is attenuated by both endothelial NO and voltage-dependent potassium
channels. In addition endothelial nitric oxide release induced by ropivacaine
appears to be unassociated with the activation of the pathway involving PI3KAkt-eNOS. Ju-Tae Sohn M.D., Seong-Ho Ok M.D., Jeong Yeol Han M.D.,
Department of Anesthesiology, Gyeongsang National University Hospital
and Gyeongsang National University School of Medicine, Jinju, Korea
Republic of.
CA A4193
Exercise Modulates Vascular Properties by a No-Regulated
Transglutaminase-Dependent Pathway
This study underscores the dynamic nature of NO mediated S-nitrosylation
and the ability to modulate S-nitrosylation levels by a physiological
intervention. Exercise however did not prevent age-dependent increase
in PWV. This supports the idea that age alone is a risk factor for increased
vascular stiffness independent of lifestyle or genetic factors. Jochen Steppan
M.D., Gautam Sikka M.D., Viachaslau M. Barodka M.D., Maggie Kuo,
Alexey M. Belkin Ph.D., Daniel Nyhan M.D., Alberto Avolio Ph.D., Dan
E. Berkowitz M.D., Lakshmi Santhanam Ph.D., Anesthesiology and
Critical Care Medicine, Johns Hopkins University, Baltimore, MD, The
Australian School of Advanced Medicine, Macquire University, Sydney,
Australia.
124
CA A4194
Mechanism of the Inhibitory Effect of Desflurane on Angiotensin IIInduced Vasoconstriction
To investigate the mechanism of inhibitory effect of desflurane on angiotensin
II-induced vasoconstriction phosphorylation of myosin light chain was
measured in the presence or absence of desflurane or Rho kinase inhibitor.
The inhibition of Ang II-induced MLC phosphorylation by desflurane as well
as Y27632 suggests that the mechanism of DES on inhibitory effect of Ang
II-induced vasoconstriction is involved in the Rho kinase pathway.
Yasuyuki Tokinaga M.D., Ph.D., Yukimasa Takada M.D., Shunsuke
Hayashi, Masayuki Akatsuka M.D., Michiaki Yamakage M.D., Ph.D.,
Anesthesiology, Sapporo Medical University School of Medicine,
Sapporo, Japan.
PO10-3BEXPERIMENTAL NEUROSCIENCES: NEUROTOXICITY
ROOM 104-AREA D
NA A4195
Sevoflurane Exposure-Induced Neural Apoptosis and Impairment of
Long-Term Spatial Cognitive Function in Neonatal Rats
We investigated whether long hours of sevoflurane anesthesia induce
neural apoptosis and cognitive impairment in neonatal rats. Long hours
of sevoflurane exposure with low oxygen to neonatal rats induced neural
apoptosis and long-term cognitive impairment. Toru Goyagi M.D., Yoko
Masaki Ph.D., Takashi Horiguchi M.D., Toshiaki Nishikawa M.D.,
Anesthesia and Intensive Care Medicine, Akita University Graduate
School of Medicine, Akita-City, Japan.
NA A4196
Neonatal Sevoflurane Exposure Disturbs Granule Cell Migration in the
Rat Dentate Gyrus
Neonatal sevoflurane exposure may disturb the migration of generated
granule cells (GC) in the dentate hilus to the granule cell layer. We examined
the influence of sevoflurane exposure by histological method. At postnatal
day 7 (P7) Wistar/ST rats were exposed either to 3% sevoflurane or to
air (control) for 2 h and immunohistochemical staining was conducted
to detect the GCs at P7 P21 and P35. In the sevoflurane exposed group
significantly higher ratios of ectopic hilar GCs were observed at P21 and P35
compared. Our data demonstrated that P7 sevoflurane exposure derange the
migration of GCs in the rat. Rui Kato M.D., Ph.D., Toshikazu Hashimoto
M.D., Ph.D., Hitoshi Saito M.D., Yosuke Uchida M.D., Tetsutaro Hase
M.D., Kenkichi Tsuruga M.D., Koichi Takita M.D., Ph.D., Yuji Morimoto
M.D., Ph.D., Department of Anesthesiology and Critical Care Medicine,
Hokkaido University Graduate School of Medicine, Sapporo, Japan.
NA A4197
Increasing Anesthetic Duration in Association With Lower Arterial
Blood Pressure Following Embolic Stroke Increases Blood-Brain Barrier
Disruption in Rats
In the setting of hyperacute embolic middle cerebral artery ischemia
extending time under Isoflurane anesthesia coupled with a stable controlled
arterial blood pressure (relative hypotension) increases the risk of bloodbrain barrier permeability. Thomas Tung M.D., Xiaoguang Liu M.D., Ph.D.,
Alexander Papangelou M.D., Raymond Koehler Ph.D., Anesthesiology
and Critical Care Medicine, The Johns Hopkins University, School of
Medicine Baltimore, MD.
NA A4198
Prenatal Propofol Exposure Delays Postnatal Development in the Rat
Propofol (2 6-diisopropylphenol) is an agent commonly used for the induction
and maintenance of anesthesia. Despite its widespread use the effects of
propofol administration to the parturients on the neurodevelopment of the
offspring have not been well explored. In the present study we administered
propofol to pregnant rats and assessed the development of the offspring.
Our study indicates that prenatal exposure to propofol was deleterious to
the normal development of the offspring rats. The delay in physical and
neurological development might be interpreted as an alteration in maturation
of some neuronal circuitry induced by the prenatal propofol exposure.
Ming Xiong, M.D., Jing Li, Ph.D., Hussain M. Alhashem, M.D., Yong Zhang,
B.Sc., Vasanti Tilak, M.D., Allan Siegel, Ph.D., Jiang Hong Ye, M.D., Alex
Bekker, M.D., Anesthesiology, Neuroscience, UMDNJ, Newark, NJ.
NA Neuroanesthesia
PN Pain Medicine
Single Exposure to Propofol in Utero Induces Neuron Loss in the
Hippocampus of Developing Offspring Rats
Anesthetic drugs administered to immature animals may cause
neurohistopathological changes and alterations in hippocampal-dependent
learning and memory. This study tested the hypothesis that fetal rats exposed
to propofol during maternal anesthesia on gestational day18-19 which
corresponds to the second trimester in humans would lead to pathological
changes in the hippocampus after birth. Our results show that propofol
administration to the pregnant rats during a gestational period resulted in a
decreased neuronal density in the CA1 and CA3 regions of the hippocampus
in the offspring rats. The difference in the neuronal density persisted into
early adolescence. Ming Xiong M.D., Ph.D., Jing Li M.D., Ph.D., Hussain
M. Alhashem M.D., Rao Fu M.D., Anuradha Patel M.D., Jiang H. Ye
M.D., M.S., Alex Bekker M.D., Ph.D., Anesthesiology, UMDNJ, Newark,
NJ.
NA A4200
Effects of Nicotine on the Activity of Glutamate Transporter Type 3 and
the Modulation Mechanism
This is about the mechanism of nicotine which is related to the
glutmataetransporter. Heajo Yoon M.D., Sang-Hwan Do M.D., HyeMin Sohn M.D., Young-Jin Lim M.D., Anesthesiology, Cheil General
Hospital, Seoul, Korea Republic of, Seoul National University Bundang
Hospital, Seong-nam Si Gyeonggi-do, Korea Republic of.
NA A4201
Anesthetic Agents Induce Protein Misfolding and Affect Carbon Dioxide
Response in the Brainstem
The Phox2B transcription factor is responsible for sensing rising blood carbon
dioxide levels and triggering breathing. Mutations in the Phox2B gene cause
Congenital Central Hypoventilation Syndrome (CCHS). We created five
mutants of the Phox2B gene with increasing sizes of poly-alanine expansion
that were tagged with a fluorescent protein. Each of these constructs were
transfected into mammalian cells. After imaging each of the transfections
were exposed to anesthetic agents. Our results show that propofol and
isoflurane can induce Phox2B protein misfolding and precipitate the CCHS
disease phenotype. Our model will lead to further investigation of anesthetic
effects on the cellular Unfolded Protein Response. Matthew Coghlan M.B.
B.Ch., Jason T. Maynes, M.D., Ph.D., Sadiq Shaik, M.D., The Hospital for
Sick Children, Toronto, ON, Canada.
NA A4202
Ketamine Exposure and microRNA Expression in Developing Human
Neurons
In this study, we evaluated microRNA expression in hESC-derived neurons
following ketamine exposure in an attempt to assess the role of microRNAs
in anesthetic-induced neurotoxicity of developing human neurons. Our
preliminary findings indicate that ketamine administration induces changes
in the expression of several microRNAs implicating a potential role of
microRNAs in anesthetic-induced neurotoxicity. Danielle Twaroski, B.S.,
Xiaowen Bai, M.D., Ph.D., Yasheng Yang, B.S., Jessica Olson, M.S.,
Yanan Liu, Ph.D., Zeljko J. Bosnjak, Ph.D., Anesthesiology, Medical
PO13-5B OUTCOMES AND DATABASE RESEARCH: INTERVENTIONS AND
OUTCOMES II
ROOM 104-AREA E
FA A4203
Hyperoxia and Surgical Site Infection in Orthopedic Surgery: A
Prospective Observational Study
Surgical site infection is a public health issue of great importance. In
recent years efforts have been made in order to identify factors to prevent
it. Hyperoxia has been postulated has having the potential to decrease
the incidence of surgical site infection. Mixed results have been published
so far. The purpose of this study is to access these effects on a Surgical
Orthopedic Population. No statiscally relevant relation was found between
the development of SSI and perioperative hyperoxia. Further studies should
be made in order to study the influence of other factors in cell oxygenation.
Joana Alves M.D., Rita Santa Barbara M.D., Ricardo Mota Pereira
M.D., Celine Rodrigues Marques M.D., Diana Henriques M.D., Ines
Tellechea M.D., Emanuel Almeida M.D., Alexandra Resende M.D.,
Anesthesiology, Santa Maria Hospital University, Lisbon, Portugal.
TUESDAY, OCTOBER 15
NA A4199
FA A4204
Prevention of Postoperative Nausea and Vomiting With Triple Therapy
With Palonosetron Dexamethasone and Promethazine in Patients
Undergoing Craniotomy and General Anesthesia
The evaluated triple-therapy with palonosetron dexamethesone and
promethazine showed to be an effective regimen for prophylaxis of vomiting
and/or nausea for up to 120 hours especially during the first 24 hours in
patients undergoing neurological surgery under general anesthesia.
Sergio D. Bergese M.D., Erika G. Puente M.D., Gilat Zisman M.D.,
Alberto A. Uribe M.D., Natali F. Erminy M.D., Ohio State University,
Columbus, OH, Anesthesiology, The Ohio State University Wexner Medical
Center, Internal Medicine Riverside Methodist Hospital, Columbus, OH.
FA A4205
Effect of Statin Use on Insulin Requirements in Non Cardiac Surgical
Patients
Statins causes insulin resistance and promote new-onset diabetes. We did
this study to find out the effects of statin on glucose concentrations and
insulin requirements during intraoperative period which are still unclear.
While insulin use was not significantly greater among statin users there
was nonetheless a clinically important trend towards increased requirement
which is consistent with our hypothesis. Our results provide a basis for further
investigation regarding the insulin requirement for statin users in the surgical
population. Muhammad M. Buttar, M.D., Cameron Egan, M.S., Zohaib
Akhtar, M.D., Jing You M.S., Daniel Sessler, M.D., Alparslan Turan, M.D.,
Basem Abdelmalak, M.D., Outcomes Research, Anesthesiology Institute,
Cleveland Clinic Foundation, Cleveland, OH.
FA A4206
Complications in the Postanesthesia Care Unit: Then and Beyond
A review of over a hundred thousand cases in a university teaching
hospital anesthesia database indicates a reducing complication rate in
the postanesthesia care unit (PACU) over time and a continuing longer
stay in those who had complications. Patient anesthetic as well as other
perioperative factors continue to impact complication rates in the PACU.
Sn M. Dabu-Bondoc M.D., Roberta Hines M.D., Kirk Shelley M.D.,
Ph.D., Gail Watrous R.N., Xiangyu Cong Ph.D., Tianzhou Ma M.S., Li
Qin Ph.D., Feng Dai Ph.D., Anesthesiology, Yale University, School of
Medicine, New Haven, CT, Biostatistics Yale School of Public Health,
New Haven, CT.
NA Neuroanesthesia
PN Pain Medicine
125
FA A4207
PI A4211
FA A4208
PI A4212
Use of Labetalol as an Alternative to Esmolol and Fentanyl for
Maintaining Hemodynamic Stability During Laparoscopic Surgery:
Comparative Effects on Postoperative Recovery
This is a randomized double-blinded and active-controlled study designed
to compare the adjunctive effects of labetalol and esmolol (vs. fentanyl)
on the hemodynamic stability during surgery and postoperative recovery
outcomes (e.g. pain PONV return of bowel function). The primary objective
was to determine if the intraoperative use of labetalol reduces recovery times
and side effects (vs. fentanyl) following laparoscopic surgery. Ofelia L. Elvir
Lazo M.D., Ronald H. Wender M.D., Antonio Hernandez-Conte M.D.,
Alejandro Sloninsky M.D., Marshal B. Kaplan M.D., Alan S. Zaentz M.D.,
Shahriar Pirouz M.D., Roya Yumul M.D., Ph.D., Robert K. Kariger M.D.,
Paul F. White M.D., Ph.D., Anesthesiology, Cedars Sinai Medical Center
Los Angeles, CA.
Impact of Hyperglicemia on Surgical Site Infection (SSI) in Orthopaedic
Surgery
Surgical site infections (SSI) are the most common nosocomial infections in
surgical patients. Although diabetics have higher incidence of complications
development of perioperative hyperglycemia in non-diabetic is also a
predictor of adverse outcomes. This work evaluated the prevalence of
perioperative hyperglicemia and its effects on incidence of SSI in orthopaedic
patients. We found that preoperative value of glycemia had statistically
significant difference in SSI suggesting that better control of this parameter
may have positive impact on incidence of SSI. Diana Henriques M.D.,
Ricardo Mota Pereira M.D., Celine Marques M.D., Ines Tellechea
M.D., Joana Alves M.D., Rita Santa Barbara M.D., Emanuel Almeida
M.D., Maria Manso M.D., Alexandra Resende M.D., Department of
Anesthesiology, Santa Maria University Hospital, Lisbon, Portugal.
FA A4209
Relation Between Serum Glycated Albumin Levels and Complications
in Patients Undergoing Surgery
Glycated albumin (GA) levels which reflect shorter-term glycemic control
status than widely-used glycated hemoglobin can also be used to monitor
blood glucose control recently. To examine if serum GA levels are a useful
preoperative risk factor we measured them in surgical patients and analyzed
the relations of the levels to complications. Patients with high GA levels had
significantly increased incidences of cardiovascular and cerebrovascular
disease. The measurement of GA levels can facilitate the early detection and
early treatment of diabetes mellitus in surgical patients. It can also contribute
to the prevention of the exacerbation of diabetes and the management of
perioperative complications. Makiko Komori M.D., Goro Kaneko M.D.,
Kazuyoshi Ando M.D., Mitsuharu Kodaka M.D., Yoriko Sone M.D.,
Yasuko Tomizawa M.D., Anesthesiology, Medical Center East, Tokyo
Women’s Medical University, Tokyo, Japan.
ROOM 104-AREA B
PI A4210
Intraoperative Hand-Over of Patient Information Between Anesthesia
Providers. Are We As Good As We Think We Are?
An anonymous questionnaire sent to anesthesia providers at different
residency programs in the United States showed that current intra-op
handover practice among anesthesia providers is imperfect and can lead to
patient mismanagement or complications. Dominik W. Choromanski M.D.,
Joel Frederick M.D., Patrick Fattouch M.D., George McKelvey Ph.D.,
Hong Wang M.D., Ph.D., Department of Anesthesiology, Wayne State
University/Detroit Medical Center, Detroit, MI.
126
3DiTeams Handover Initiative: Improving Handovers In Critical Care
Using Human-Centered Design
The Duke Human Simulation and Patient Safety Center received an external
educational grant that aims to improve communication and decrease
preventable adverse events in critical care handovers using an immersive
educational environment. Human-centered design was used to intimately
involve educational program participants in designing tools to help improve
handovers within their own units. Multiple focus groups separated by role
were conducted to gather unit- and role-specific information about postoperative handovers with key members of the neuro OR and ICU. Feedback
will be used to form content for an immersive educational intervention aimed
at improving handovers in critical care. Genevieve C. DeMaria B.S., Noa
Segall Ph.D., Alberto S. Bonifacio B.S.N. Jeffrey M. Taekman M.D.,
Anesthesiology, Duke University Medical Center, Durham, NC.
Utilization of the Preanesthesia Clinic in an Academic Medical Center:
Opportunity for Improvement
Preanesthesia clinics (PAC) have been shown to increase perioperative
efficiency. A review of the patient characteristics and encounter times at a
PAC was performed at a major academic institution. Patients with higher
ASA physical status scores require longer visits. The results suggest that PAC
referral patterns must be reexamined and other modes of evaluating patients
with mild systemic disease should be explored. This has the potential to
confer time and cost savings to patients and providers. Michael A. Fishman
M.D. M.B.A., Brian A. Mirante M.D., Craig Odermatt B.S., Viji Kurup
M.D., Department of Anesthesiology, Yale University School of Medicine,
New Haven, CT, Perioperative Services Business Manager, Yale-New
Haven Hospital, New Haven, CT.
PI A4213
Peer Review Online: Using Web-Based Tools to Facilitate Quality
Improvement
We evaluated three widely available web-based platforms for conducting
asynchronous peer review discussions at a large academic tertiary care
medical center. Each of the platforms deployed provided a simple means
of organizing cases under review and a consistent means of following the
discussion thread. While existing web platforms can be adapted for secure
peer review discussions they do require some technical expertise to deploy
and maintain. Peter V. Killoran M.D., M.S., Sam D. Gumbert M.D.,
Davide Cattano M.D., Ph.D., Maria Matuszczak M.D., Evan G. Pivalizza
M.B. Ch.B., Anesthesiology and BioMedical Informatics, University of
Texas Health Science Center - Houston Houston, TX.
PI A4214
Improving Effectiveness of a Preoperative Assessment Phone
Screening Program
Improving the effectiveness of our pre-operative Phone Program required two
critical elements: 1) Adequate and timely data to measure clinic and clinician
efficiency and 2) Effective patient communication to ensure availability and
required preparation for appointments. Kelsey McCarty M.B.A., Adam J.
Carinci M.D., Eden Brand M.P.H. Mary Elizabeth Ellbeg R.N. Karen L.
Parmenter R.N. James P. Rathmell M.D., Department of Anesthesia,
Critical Care and Pain Medicine, Massachusetts General Hospital,
Boston, MA.
PI A4215
Communication in the Pre-Anesthetic Interview
This study looked communication practices of anesthesiologists in the
pre-anesthetic interview. We found lapses in communication on the part
of physicians during pre-anesthetic interviews especially in the aspects of
greeting patients fully introducing themselves acknowledging others present
and body language. Michael R. PasCarella, D.O., Sharon Chang M.D.,
Rebecca Speck Ph.D., Maureen McCunn M.D., Anesthesiology and
Critical Care, University of Pennsylvania, Philadelphia, PA.
NA Neuroanesthesia
PN Pain Medicine
Post-Hurricane Sandy Disruption in a Department of Anesthesiology: A
Cloud Based Information System Comes to the Rescue
In the aftermath of Hurricane Sandy, the New York VA Hospital closed due to
flooding and its Department of Anesthesiology transferred to the Brooklyn VA.
Distribution and access to administrative information was problematic due
to the limitations of the infrastructure. We determined that a cloud based
administrative management system with appropriate software could serve
as the basis for a new information management system if it was accessible
on multiple operating systems and different types of devices. The Evernote
system was adopted. When existing infrastructure is interrupted other
technology-based information management solutions may be needed. Such
a system may have broader application within anesthesiology departments.
Jan R. Purgess M.D., Esther Solomon Ph.D., NYU Department of
Anesthesiology and the NY VA, New York, NY, Fordham University
Graduate School of Business, New York, NY.
PI A4304
The Effect of Implementing a Standardized Anesthesiology Handoff in
the Operating Room Setting
A standardized handoff was designed and implemented to improve
communication between anesthesia providers in the operating room
at a single institution. Surveys were administered prior to and after
implementation of the standardized handoff. We evaluated respondents
compliance and perceptions of the nonstandardized and standardized
handoffs, including questions about thoroughness, missing information,
misinformation, timeliness, and patient outcomes. Statistically significant
improvements were noted in communication; no changes were observed
in timeliness; and modest levels of compliance were achieved. Scott D.
McLaren, M.D., James L. Walker, M.D., Beryl Silkey, M.Sc., Christine
Yates, M.A, Anesthesiology, University of Kansas School of Medicine,
Research, Via Christi Hospitals Wichita, Wichita, KS.
PO15-3B PEDIATRIC ANESTHESIA: GENERAL PEDIATRICS
ROOM 104-AREA A
PD A4217
The Effect of Spectral Entropy Monitoring on Propofol Use and
Recovery in Children
Entropy guided anesthetic administration is associated with reduced propofol
use and faster recovery in children. Soron Choi M.D., Ph.D., Jiyeon Lee
M.D., Chanjong Chung M.D., Ph.D., Seungcheol Lee M.D., Ph.D.,
Jihyeon Lee M.D., Ph.D., Jonghwan Lee M.D., Ph.D., Department of
Anesthesiology, Dong-A University. Hospital, Bn Korea Republic of.
PD A4218
Effects of Ultrasound Guided Bilateral Thoracic Paravertebral Block on
Analgesia and Postoperative Negative Behavior of Children Undergoing
Nuss Procedure
Ultrasound guided bilateral thoracic paravertebral block is a safe and
effective complement to general anesthesia for children undergoing Nuss
procedure with better postoperative analgesia and less postoperative
behavior disturbance. Bin DU M.D., Yunxia Zuo Ph.D., Anesthesiology,
West China Hospital, Chengdu, China.
PD A4219
A Prospective Open-Label Trial of Clevidipine for Controlled
Hypotension During Posterior Spinal Fusion
This study was conducted to prospectively evaluate the dosing requirements
efficacy and safety of clevidipine for controlled hypotension (CH) during
spinal surgery in the pediatric population. Clevidipine maintained the MAP at
55-65 mmHg and provided effective CH during a desflurane and remifentanil
based anesthetic. Its rapid onset and offset allows easy titration during
cases where blood pressure instability may occur. Hiromi Kako M.D.,
David Martin M.D., Tarun Bhalla M.D., Allan Beebe M.D., Walter
Samora M.D., Jan Klamar M.D., Joseph D. Tobias M.D., Department of
Anesthesiology and Pain Medicine, Department of Orthopedic Surgery,
Nationwide Children’s Hospital, Columbus, OH.
PD A4220
Determination of Minimum Alveolar Isoflurane Concentration in a
Neonatal Rat Model of Cortical Dysplasia
We hypothesize that pre-existing cognitive impairment may place an
individual at increased risk of adverse cognitive outcome following
anesthesia. Neonatal MAM-E17 rat pups a model for cortical dysplasia
and cognitive impairment were exposed to a four-hour, one-MAC isoflurane
anesthetic and found to have similar isoflurane requirements to controls.
Jacqueline S. Lagoy M.D., Meredith M. Pace M.D., Michael G. Holmes
M.D., Christine D. Bub Student, Jennifer M. O’Donnell Student, Kyle
Jenks M.S., Lisa M. Carson Student, Michael L. Beach M.D., Rod
Scott M.D., Ph.D., Simon C. Hillier M.D., Anesthesiology, Neurology,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, Geisel School of
Medicine at Dartmouth College, Hanover, NH.
TUESDAY, OCTOBER 15
PI A4216
PD A4221
The GAS Study: Perioperative Outcomes in an RCT Comparing Spinal
and General Anesthesia for Infant Hernia Repair
The GAS study is an RCT comparing awake regional (RA) and general
anesthesia (GA) for effects on neurodevelopmental outcome and apnea in
infants. 15% of patients received GA for failed spinal or protocol violation.
There were not statistically significant differences in apnea between the
two groups. Mary Ellen McCann M.D., David Bellinger D.Phil., Sarah
Arnup B.S., Jurgen C. De Graaff M.D., Nicola Disma M.D., Davinia E.
Withington M.D., Neil Morton M.B. Ch.B., Andrew J. Davidson M.B.
B.S., Harvard, Boston, MA, RCH Melbourne, Australia, UMC, Utrecht,
Netherlands, Gaslini CH, Genoa, Italy, MCH, Montreal QC, Canada,
RHSG, Glasgow, United Kingdom.
PD A4222
Transthoracic Echocardiography for Obtaining an Optimal Insertion
Depth of Internal Jugular Venous Catheters in Infants
The purpose of this study is to evaluate the efficacy of transthoracic
echocardiography (TTE) for correct positioning of CVC in infants. The right
atrium and SVC junction or great vessls in pulmonary artery bifurcation level
was showed by TTE. Adequate positioning of CVC was possible in 96.23%
of patients. The mean distance of CVC tip from the carina level was -3.82
±8.15 mm. There was no significant complication associated with CVC and
TTE. Therefore TTE is practically useful tool for determining the optimal depth
of CVC in infants undergoing surgery of congenital heart disease.
Yonghee Park M.D., Eunjin Ahn M.D., Jihyun Lee M.D., Jin-Tae Kim
Ph.D., Heesoo Kim Ph.D., Department of Anesthesiology and Pain
Medicine, Chung-Ang University Hospital, Seoul Korea Republic of.
PD A4223
Spinal Anesthesia in Neonates: What is the Impact on Cerebral Oxygen
Saturation?
In neonates under 60 weeks post conceptional age general anesthesia (GA)
was associated with an increased incidence of postoperative adverse events.
Spinal anesthesia (SA) seems to be an alternative to GA in this high-risk
population. However significant decrease in cerebral blood flow associated
with decrease in the arterial blood pressure has been reported after SA in
former preterm infants. This study aimed to assess the impact of SA on
cerebral oxygen saturation of infants using Near-infrared spectroscopy (NIRS)
as a noninvasive and continuous monitor of the quality of cerebral perfusion.
Chrystelle Sola M.D., Sophie Julie-Bibi M.D., Olivier Raux M.D., M.S.
Christine Macq M.D., Sophie Bringuier Pharm.D Xavier Capdevila M.D.,
Ph.D., Christophe Dadure M.D., Ph.D., Department of Anesthesia and
Critical Care, Medicine, Pediatric Anesthesia Unit, Lapeyronie University
Hospital, Montpellier, France.
NA Neuroanesthesia
PN Pain Medicine
127
PD A4224
FA A4229
PO02-2A ANESTHETIC ACTION AND BIOCHEMISTRY: NON-NEURONAL
EFFECTS OF ANESTHETICS-IMMUNOMODULATION ORGAN PROTECTION
AND MALIGNANT HYPERTHERMIA
FA A4230
Intraoperative Use of High Frequency Oscillatory Ventilation in
Thoracoscopic Neonatal Surgery
The intraoperative application of HFOV guided by TCC02 monitoring provides
adequate oxygenation ventilation surgical visualization and effective C02
elimination in neonates undergoing thoracoscopic CDH and TEF/EA repair.
TCC02 shows good correlation to PaC02 following proper calibration.
Postoperative recovery characteristics are noted for early extubation time
minimal use of opioids and quick transition to oral feeds. Arlyne K. Thung
M.D., Karen Diefenbach M.D., Christopher McKee D.O., David P.
Martin M.D., Joseph D. Tobias M.D., Anesthesiology, Pediatric Surgery
Nationwide Children’s Hospital and the Wexner Medical Center at the
Ohio State University, Columbus, OH.
ROOM 104-AREA C
FA A4225
Mu Opioid Receptor Expression in Various Tumor Types: Creating a Mu
Scoring System
Creation of a standardized Mu receptor grading system for tumors may
be beneficial if opioids promote tumor growth or metastasis. Evaluation of
one commercially available Mu opioid receptor antibody for the purpose of
developing a standardized grading system was completed. Assessment of
other available antibodies is currently underway. Tyler R. Call M.D., Jolanta
Jedrzkiewicz M.D., Sheryl R. Tripp B.S., Andrew J. Wilson B.A., Ben
Chortkoff M.D., Ben L. Witt M.D., Anesthesiology, Pathology, University
of Utah, ARUP Laboratories, Salt Lake City, UT.
FA A4226
The Influence of Glucose Load During the Operation on the Metabolism
We investigated the influence that glucose load during anesthesia using
remifentanil gives for metabolism. Nonesterified fatty acid and ketone bodies
levels were higher in no glucose group than those in a low dose of glucose
group during operation. There were no significant difference between the
groups in energy expenditure respiratory quotient creatinine and 3-methylhistidine. The glucose load during anesthesia may attenuate catabolism of fat
and not influence the metabolism of protein without hyperglycemia.
Noriko Kambe M.D., Katsuya Tanaka M.D., Rie Oi M.D., Asuka Kasai
M.D., Yasuo M. Tsutsumi M.D., Shuzo Oshita M.D., The University
of Tokushima Graduate School, Tokushima, Japan, JA Kochi Hospital,
Kochi, Japan, Takamatsu Red Cross Hospital, Kagawa, Japan.
FA A4227
Propofol Inhibits Lipopolysaccharide-Stimulated NADPH O(NOX2)Mediated TNF- and IL-6 Production in Macrophages
The current study was designed to examine the mechanisms of propofol in
LPS-induced NADPH oxidase (NOX2)-mediated TNF- and IL-6 production in
macrophages through examing NOXs activity and NADPH expression. Tao
Meng M.D., Jingui Yu male M.D., Department of Anesthesiology, Qilu
Hospital of Shandong University, Jinan, China.
FA A4228
The Protective Effect of Propofol® But Not Propofol
(2 6-Diisopropylphenol) on Anandamide-Induced Cell Injury in
Human Umbilical Vein Endothelial Cells
The protective effect of Propofol® against AEA-induced cell injury may be due
to the Lipofundin® the solvent of propofol rather than propofol itself.
Yasunori Mishima M.D., Ph.D., Asuka Ito M.D., Ph.D., Kazuo Ushijima
M.D., Ph.D., Anesthesiology, Kurume University School of Medicine,
Kurume Shi, Japan.
128
Sevoflurane Ameliorates Lipopolysaccharide-Induced Acute Lung Injury
and Changes Micro RNA Expression
Recent studies show that microRNA (miRNA) regulate gene expressions
and play important role in inflammatory lung diseases. Volatile anesthetics
sevoflurane has lung protective effects on Acute Lung Injury (ALI) by inhibiting
inflammatory mediators. However its effects on miRNA remain unknown.
We hypothesized sevoflurane influences miRNA expressions and performed
comprehensive miRNA screening tests. The results indicate miRNAs play a
key role in the lung protective effects of sevoflurane anesthesia.
Tatsuro Otsuki M.D., Masahi Ishikawa Ph.D., Shunsuke Tanaka Ph.D.,
Yoko Hori M.D., Gentaro Goto M.D., Atsuhiro Sakamoto Ph.D.,
Anesthesiology and Pain Medicine, Nippon Medical School, Tokyo,
Japan.
Immunomodulatory Effects of Volatile Anesthetics
General regional inhaled and intravenous anesthetics have all been found
to exert effects on components of innate and adaptive immunity. We believe
that isoflurane exposure may modulate the immune system specifically
suppressing the function of bone marrow dendritic cells (BMDC) a critical
component of innate and adaptive immunity. Lindsay M. Stollings M.D.,
Binfeng Lu Ph.D., Yan Xu Ph.D., Anesthesiology, Immunology, University
of Pittsburgh, PA.
FA A4231
Sevoflurane Anesthesia Downregulates Circulating Muscle-Derived
miRNA
We investigated miRNA expression change in rat plasma cardiac muscle
and skeletalmuscle. General anesthesia by sevoflurane decreased variable
miR expression in rat peripheralblood. In particular muscle specific
miRs decreased dramatically. Conversely muscle specific miRs tended to
increase in cardiac muscle and skeletal muscle. Jumpei Takeuchi M.D.,
Toshihiro Takizawa Ph.D., Atsuhiro Sakamoto Ph.D., Department of
Anesthesiology and Pain Medicine, Graduate School of Medicine Nippon
Medical School, Department of Molecular Medicine and Anatomy
Nippon Medical School, Tokyo, Japan.
FA A4232
Effects of Propofol on Secretion and Insulinotropic Efficiency of
Glucagon-Like Peptide-1: AnIn Vitro Study
In the present study we investigated that the effects of propofol on GLP-1
secretion and the interaction of GLP-1 with propofol on insulin secretion from
isolated islets. Our results indicate that propofol has no effect on the GLP-1
release from intestinal L cells as well as the insulinotropic efficiency of GLP1. Daiki Yamanaka M.D., Takashi Kawano M.D., Haidong Chi M.D.,
Kentaro Yamamoto M.D., Yori Inoue, Tomoka Eri, Mitsuki Fukuta, Rie
Ihara, Masataka Yokoyama M.D., Satoru Eguchi D.D.S., Kochi Medical
School, Nankoku, Japan, Tokushima University Hospital, Tokushima,
Japan.
PO06-3A CRITICAL CARE: LUNG INJURY TRANSPLANT LIFE SUPPORT
AND TECHNOLOGY
ROOM 104-AREA D
CC A4233
Single Preoperative Exhaustive Exercise Increases Proangiogenic
Hematopoietic Cells and Poor Cellular Response Correlates With
Postoperative Complications
Poor response of proangiogenic hematopoietic cells to preoperative exercise
associates with increased postoperative complications. Robert Schier M.D.,
Ph.D., Volker Schick M.D., Hanke Marcus M.D., Marnie Collins B.Sc.,
Randa El-Zein M.D., Ph.D., John V. Heymach M.D., Ph.D., Reza Mehran
M.D., Bernhard Riedel M.D., Ph.D., Department of Anaesthesiology
and Intensive Care, Medicine University Hospital of Cologne, Cologne,
Germany, Department of Anaesthesia & Pain Medicine, Peter MacCallum
Cancer Centre, Melbourne, Australia, Department of Epidemiology,
Department of Thoracic/Head and Neck Oncology, The University of Texas
M.D. Anderson Cancer Center, Houston, TX.
NA Neuroanesthesia
PN Pain Medicine
Training for Focused Transthoracic Echocardiography: Simulator
Training is Not Inferior to Training Using Live Volunteers
TTE training using a simulator is not inferior to training using live volunteers.
Thomas Edrich M.D., Ph.D., Raghu Seethala M.D., Benjamin Olenchock
M.D., Annette Mizuguchi M.D., Ph.D., Jose Rivero M.D., Sascha Beutler
M.D., Ph.D., Stephanie Y. Kang B.S., Xiaoxia Liu M.S., John Fox M.D.,
Gyorgy Frendl M.D., Ph.D., Department of Anesthesia Perioperative
and Pain Medicine, Department of Emergency Medicine, Department of
Medicine, Division of Cardiology, Department of Surgery, Brigham and
Women’s Hospital, Boston, MA.
CC A4235
Systems Immunology Reveals Massive Expansion of Myeloid Derived
Suppressor Cells in Patients Undergoing Surgery
Recovery from surgery requires a coordinated inflammatory response.
Using mass cytometry a novel multi-parameter flow cytometry platform
we describe the system-wide analysis of cellular and intracellular signaling
networks that govern the immune response to surgical trauma. Surgery
induces a profound reorganization of the cellular and functional architecture
of the human immune system and the 3-9 fold expansion of myeloid
derived suppressor cells whose immunosuppressive effects on T-cells have
been described in the context of sepsis and human malignancies. Brice
Gaudilliere M.D., Ph.D., Gabriella Fragiadakis B.S., Martha Tingle
R.N., Julian Silva B.S., Christine Yeh B.Sc., Garry Nolan Ph.D., Martin
Angst M.D., Anesthesiology, Immunology, Microbiology and Immunology,
Stanford University, Stanford, CA.
CC A4236
A New Cytokine Release Assay as a Monitoring Tool for Immune
Answer in Patients With Septic Shock
This small pilot study presents a new ex vivo cytokine release assay derived
from the skin delayed type hypersensitivity (DTH) test which monitors T cell
mediated immune reactions in septic shock patients in a highly standardized
fashion using a three step process: I) blood collection II) whole blood ex
vivo incubation and III) cytokine determination from the assay supernatant.
Patients with septic shock show a decreased cytokine release in this assay
suggesting a diminished T cell competence. Ines Kaufmann M.D., Lars
Sudhoff Student, Markus Feyahn Student, Julia Goeschl Student,
Christian Hoppstock Student, Martin Koehler Student, Clarence
Sams Ph.D., Matthias Feuerecker M.D., Josef Briegel M.D., Alexander
Chouker M.D., Department of Anesthesiology, University of Munich,
Munich, Germany, Johnson Space Center NASA, Houston, TX.
CC A4237
Progressive Evaluation of Integrated Pulmonary Index (IPI) During
Spontaneous Breathing Trials in Medical and Surgical Patients
IPI values are higher in successful SBTs than in failing SBTs in patients
undergoing evaluation for weaning. Further studies and larger sample size
are needed to more clearly define the value of IPI during weaning from
mechanical ventilation. Vikas Kumar M.D., Arthur Taft R.R.T., Sn
Johnson R.R.T., Ramona Herrington R.T., Manuel Castresana M.D.,
Anesthesiology, Respiratory Therapy, Georgia Regents University,
Augusta, GA.
CC A4238
Cell Free DNA as a Potential Marker to Predict Carbon TetrachlorideInduced Acute Liver Failure in Rats
This study describes the pattern of Cell-free DNA (CFD) elevation in acute HF
in rats. Furthermore a positive correlation between CFD levels and blood GOT
GPT and total bilirubin was demonstrated. Ruslan Kuts M.D., Alexander
Zlotnik M.D., Ph.D., Akiva Leibowitz M.D., Evgeny Brotfain M.D.,
Matthew Boyko Ph.D., Department of Anesthesiology and Critical Care,
Soroka Medical Center and Ben-Gurion University of the Negev, Beer
Sheva, Israel.
CC A4239
Diagnostic Performance of High-Sensitive Troponin in Patients With
Renal Insufficiency: A Cross Sectional Analysis
High-sensitive troponin levels are often elevated in patients with renal
insufficiency. In the present study we investigated whether high-sensitive
troponin correlates with the grade of renal insufficiency and evaluated
the diagnostic accuracy of high-sensitive troponin for acute coronary
syndrome diagnosis in patients with renal insufficiency. High-sensitive
troponin correlates with the grade of renal insufficiency. Its diagnostic
accuracy for acute coronary syndrome in renal insufficiency patients is
very low and resembles tossing a coin. Gregor Lindner M.D., Carmen
Andrea Pfortmueller M.D., Alexander B. Leichtle M.D., Aristomenis K.
Exadaktylos M.D., Emergency Medicine, Center for Laboratory Medicine,
Inselspital University Hospital, Bern, Bern, Switzerland.
TUESDAY, OCTOBER 15
CC A4234
CC A4240
Respirophasic Carotid Artery Peak Velocity Variation as a Predictor of
Fluid Responsiveness in Mechanically Ventilated Patients
Respirophasic variation in carotid artery peak flow velocity measured by
Doppler ultrasound could be a useful tool for the noninvasive assessment of
fluid responsiveness in patients receiving mechanical ventilation.
Young Song M.D., Younglan Kwak Ph.D., Jaekwang Shim Ph.D., Yonsei
University Health System, Seoul, Korea Republic of.
PO10-5A EXPERIMENTAL NEUROSCIENCES: MECHANISMS II
ROOM 104-AREA E
NA A4241
Volatile Anesthetic Isoflurane Induces c-Fos Expression in the Rat Area
Postrema
Postoperative nausea and vomiting (PONV) continues to be a common
complication of anesthesia. In this study we assessedc-Fos expression in
the rat AP to investigate the emetic mechanism ofisoflurane. Adultmale
Wistar ST rats were exposed to isoflurane under some conditions and their
AP sections were immunostained with c-Fos antibody. Isoflurane induced
c-Fos expression in the rat AP. These results suggest that isoflurane activates
AP neurons and it may be involved in the emetic mechanism of isoflurane.
Tetsutarou Hase M.D., Toshikazu Hashimoto M.D., Ph.D., Koichi Takita
M.D., Ph.D., Hitoshi Saito M.D., Yosuke Uchida M.D., Rui Kato M.D.,
Ph.D., Kenkichi Tsuruga M.D., Yuji Morimoto M.D., Ph.D., Department
of Anesthesiology and Perioperative Medicine, Hokkaido University
Graduate School of Medicine, Sapporo Hokkaido, Japan.
NA A4242
In the Mouse Hippocampus Tranexamic Acid Dose-Dependently
Reduces GABA(A) Receptor Mediated Synaptic Transmission
This study demonstrates that tranexamic acid reduces GABA(A) receptor
mediated inhibitory synaptic transmission in the murine hippocampus. This
action might explain how this drug promotes epileptiform activity in the
CNS. Rainer Haseneder M.D., Hedwig Irl Student Stephan Kratzer
M.D., Eberhard Kochs M.D., Gerhard Rammes Ph.D., Department of
Anesthesiology, Klinikum rechts der Isar der TU Munchen, Munich,
Germany.
NA A4243
The Human Carotid Body Function-Neurotransmitter Release in
Response to Hypoxia
The carotid body (CB) governs the ventilatory response to hypoxia through
oxygen sensing and signaling in the type 1 cell. This mechanism is not yet
described in the human CB and we here demonstrate release of ACh and
ATP from human CBs exposed to hypoxia. Gene expression in the human
CB after a hypoxia challenge is also studied and this is consequently the
first study establishing human CB functionality. Jessica A. KÃhlin M.D.,
Souren Mkrtchian M.D., Ph.D., Anette Ebberyd B.Sc. Malin Jonsson
Fagerlund M.D., Ph.D., Lars I. Eriksson M.D., Ph.D., Department of
Anesthesiology and Intensive Care Medicine, Department of Physiology
and Pharmacology, Karolinska Institute, Karolinska University Hospital,
Stockholm, Sweden.
NA Neuroanesthesia
PN Pain Medicine
129
NA A4244
Cognitive Function and Behavior in a Mouse Model of Alzheimer’s
Disease are Defined by Gender
Awareness of gender-specific differences in Alzheimer’s disease is growing.
Our study investigated male vs. female Tg2576 from 6 - 16 months
showing gender- and age dependent differences in cognition and behavior
thus representing the first gender specific characterization of theTg2576
model providing the background for future gender-specific preclinical
research strategies. Kristine Kellermann D.V.M., M. Lucia Gordan M.D.,
Diana Fendl, Manfred Blobner M.D., Ph.D., Eberhard F. Kochs M.D.,
Ph.D., Gerhard Rammes Ph.D., Bettina Jungwirth M.D., Klinik fur
Anaesthesiologie Klinikum rechts der Isar, Munich, Germany.
NA A4245
Dexmedetomidine Inhibits Epileptiform Activity Mainly Via Alpha2Adrenoreceptors in Rat Hippocampus
Dexmedetomidine depressed excitatory synaptic transmission but did
not affect inhibitory synaptic transmission mediated via GABAA-receptor
in rat hippocampal slices. Furthermore the anticonvulsant action of
dexmedetomidine could be involved mainly via alpha 2 -adrenoceptors not
via imidazoline receptors. Atsushi Kurosawa M.D., Yasumitsu Sato M.D.,
Ph.D., Tomoki Sasakawa M.D., Takayuki Kunisawa M.D., Ph.D., Hiroshi
Iwasaki M.D., Ph.D., Anesthesiology & Critical Care, Asahikawa Medical
University, Asahikawa, Japan, Anesthesiology, Tokuhiro Orthopaedic
Clinic, Asahikawa, Japan.
NA A4246
Forebrain HCN1 Channels Contribute to Hypnotic Actions But Not
Immobility of Volatile Anesthetics
Deletion of HCN1 channels from forebrain increased LORR Ec50 of volatile
anesthetics which indicated forebrain HCN1 channels contribute to hypnotic
actions of volatile anesthetics. Meanwhile conventional deletion of HCN1
channels did not change MAC of tail-clamping of volatile anesthetics which
indicated that mechanisms other than HCN1 channels critically affect
immobility of isoflurane and sevoflurane. Peng Liang M.D., Cheng Zhou
Ph.D., Dong xiang Chen M.D., Yi Zhao M.B., Jin Liu M.D., Department
of Anesthesiology, West China Hospital Sichuan University, Chengdu,
China.
NA A4247
Comparison of the Sural-Spared Nerve Injury Model in Mice and Rats:
Implications for Preclinical Allodynia Modeling
We compared the development of allodynia in adult mice and rats for 5
weeks following sural-Spared Nerve Injury. The electronic von Frey and
acetone tests were used to measure mechanical and cold allodynia
respectively. Mice developed mechanical but not cold allodynia. Rats
however developed robust mechanical and cold allodynia immediately after
injury that was maintained for 5 weeks. Alexandra Sideris, Ph.D., Monica
Norcini Ph.D., Thomas JJ. Blanck, M.D., Ph.D., Esperanza Recio-Pinto
Ph.D., Anesthesiology, New York University Langone Medical Center, New
York, NY.
NA A4248
Noradrenaline Excites Neurons Through Beta Adrenoceptor Activation
in the Central Nucleus of the Amygdala
To elucidate the role of NA in the aversive memory formation by nociception
we analyzed the effects of NA on spontaneous inhibitory postsynaptic
currents (sIPSCs) in the neurons in the medial division of the central
amygdala (CeA) in mouse brain slices. NA dramatically and reversibly
increased sIPSC frequency and amplitude in a manner sensitive to
tetrodotoxin and propranolol. NA depolarized a subset of CeA neurons and
increased intracellular Ca2 + concentration. NA directly excites GABAergic
neurons in the CeA and modulates outputs from the amygdala network
to other brain nuclei. Sumii Yamamoto, M.D., Yukari Takahashi, Ayako
Watabe, Ph.D., Makoto Tanaka, M.D., Fo Kato, M.D., Ph.D., Department
Anesthesiology, Fac Med, University Tsukuba, Tsukuba, Japan,
Department Neuroscirnce, Jikei University School of Medicine, Tokyo,
Japan.
130
PO13-4A OUTCOMES AND DATABASE RESEARCH: INTERVENTIONS AND
OUTCOMES I
ROOM 104-AREA A
FA A4249
Effect of Nocturnal Hypoxemia on Postoperative Pain and Opioid
Consumption Studied the correlation between nocturnal hypoxemia with or without the
presence of sleep fragmentation and postoperative pain as well as opioid use
for post operative analgesia in adult bariatric patient population.
Lovkesh Arora M.D., Cameron Egan B.S., Alex Fu Student, Raktim
Ghosh M.D., Somnath Bose M.D., Shahbaz Qavi M.D., Ashish
Khanna M.D., Anthony Doufas M.D., Ph.D., Alparslan Turan M.D.,
Anesthesiology, Outcome Research, Cleveland Clinic Foundation,
Cleveland, OH, Anesthesiology, Stanford University, Stanford, CA.
FA A4250
Patient Perception of Regional Anesthesia: Lessons from Social
Network Analysis
Using a graph analytic approach we analyzed modularity communities
degree centrality and degree frequency of component terms (unigrams)
and four-word phrases (quadgrams) of the public’s perception of regional
anesthesia. We found that the public is largely familiar with occipital and
alveolar nerve blocks and that the prevailing sentiment focuses on the block
wearing off or producing a disconcerting feeling of numbness. Utilizing such
social network analysis may help Anesthesiologists tailor their informed
consent process and patient education to manage patient expectations and
improve patient satisfaction. Natalia Klosak M.D., Catherine Dietrich B.S.
Patrick J. Tighe M.D., University of Florida, Gainesville, FL.
FA A4251
Impact of Different Anesthetic Modes on Surgical Outcomes and
Complications in Lower Limb Fracture Patients: A Population-Based
Study
Patients receiving neuraxial anesthesia had better surgical outcomes in lower
limb fracture surgeries compared to those receiving general anesthesia.
Kuan-Yao Li M.D., Ping-Cheng Shih, M.D., Pei-Shan Tsai, Ph.D., Yen-Chun
Fan M.S., Chun-Jen Huang, M.D., Ph.D., Department of Anesthesiology,
Buddhist Tzu Chi General Hospital, College of Nursing, Taipei Medical
University, Taipei, Taiwan.
FA A4252
A Comparison of Regional Anesthesia and General Anesthesia
Effects on 5-Year Survival and Cancer Recurrence After Transurethral
Resection of Bladder Tumor
We compared the effects of regional anesthesia and general anesthesia on
5-yr survival and recurrence after transurethral resection of bladder tumor.
Patients with follow-up until 5 years after the surgery and showed pathologic
finding of Urothelial carcinoma grade I-II/III were enrolled finally (general
anesthesia n=19 vs. regional anesthesia n=32). 5-yr survival was 74%
in the general group and 97% in the regional group (P=0.022). Regional
anesthesia seems to be associated with improved 5-yr survival in patients
with non-metastatic bladder cancer undergoing TUR-B. Chaeseong Lim,
M.D., Wang Yong Lee, M.D., Dale Jang, M.D., Yohan Kim, M.D., Woo-Suk
Chung, M.D., Ph.D., Anesthesia and Pain Medicine, Chungnam National
University Hospital, Daejeon, Republic of Korea.
FA A4253
The Effect of Paravertebral Block During Surgery on the Recurrence of
Breast Cancer
In a prospective randomized placebo-controlled and double-blinded trial in
eighty-eight breast cancer patients scheduled to undergo elective tumour
resection or mastectomy we found that paravertebral block in combination
with general anaesthesia significantly reduced the mortality and recurrence
rate compared to general anaesthesia alone. Asser M. Oppfeldt, M.D.,
Palle S. Carlsson, M.D., Ph.D., Department of Anaesthesiology, Aarhus
University Hospital, Aarhus, Denmark.
NA Neuroanesthesia
PN Pain Medicine
Chronic Pain Patients are Associated With a Higher Risk of Coronary
Heart Disease: A Population-Based Study
Chronic pain patients are associated with a higher risk of coronary heart
disease. Pei-Shan Tsai Ph.D., Yen-Chun Fan M.S., Chun-Jen Huang
M.D., Ph.D., College of Nursing Taipei Medical University, Taipei,
Taiwan, Department of Anesthesiology, Buddhist Tzu Chi General Hospital
Taipei Branch, New Taipei City, Taiwan.
FA A4255
A Retrospective Chart Review of High Spinal Anesthesia in Cardiac
Surgery
We present a retrospective review of the use of high spinal anesthesia
combined with general anesthesia in elective cardiac surgery. The use of high
spinal anesthesia facilitated extubation in the operating room shortened total
ventilation time and may be a valuable fast-tracking technique. Theodore W.
VanDerHorst D.O., Benjamin R. Randall M.D., M.S. Kenichi Ueda M.D.,
Department of Anesthesia University of Iowa, Iowa City, IA.
FA A4256
Intraoperative Acetaminophen Use in Laparoscopic Cholecystectomy
Does Not Decrease Postoperative Pain or Opioid Use
IV acetaminophen has been widely adapted as a useful opioid-sparing
adjunct for postoperative analgesia. We performed a retrospective database
review of laparoscopic cholecystectomy and found that intraoperative IV
acetaminophen was not associated with improved postoperative pain or
lower opioid requirements and was unexpectedly associated with increased
postoperative nausea and vomiting. These results suggest that routine
intraoperative use of IV acetaminophen may not be beneficial for patients
undergoing laparoscopic cholecystectomy. Nathan H. Waldron M.D., Ying
Hui Low M.D., William White M.P.H. Tong Joo Gan M.D., Department of
Anesthesiology, Duke University, Durham, NC.
ROOM 104-AREA B
RA A4257
Near Infra Red Spectroscopy as an Objective Monitor for Axillary Block
Efficiency
This study aims to evaluate ability of Near Infra red spectroscopy to monitor
the Sympathetic block induced by an axillary block. It should be an objective
tool to evaluate axillary block when sensory-motor testing is impossible
or when a continuous evaluation is necessary for hand or finger flap
replantation. Lucie Beylacq Sr. M.D., Gregory Miquel M.D., Francois
Hein M.D., Karine Nouette-Gaulain M.D., Ph.D., University Hospital,
Bordeaux, France, Public Hospital, Pau, France.
RA A4258
A Retrospective Analysis of the Effect of Vitamin D Level on
Postoperative Pain
Vitamin D deficiency has been associated with nonspecific chronic pain
syndromes however its relationship with postoperative pain had not been
studied. In this retrospective cohort study of 232 patients we examined
the relationship of preoperative Vit D levels and postoperative pain in
morbidly obese patients presenting for bariatric surgery. We did not find
any significant correlation between preoperative Vit D level and TWA of pain
scores or median opioid consumption in these patients. Somnath Bose,
M.D., C. Egan, B.S., R. Ghosh, M.D., S. Yu, Student, L. Arora, M.D., S.
Qavi, M.D., J. You, M.S., A. Khanna, M.D., A. Doufas, M.D., A. Turan,
M.D., Anesthesiology Institute, Outcomes Research, Cleveland Clinic
Foundation, Case Western Reserve University School of Medicine,
Cleveland, OH, Stanford University School of Medicine, CA.
RA A4259
The Effect of the TRPV1 Antagonist JTS-653 in a Rat Model of
Postoperative Pain
We evaluated an analgesic effect of TRPV1 antagonist JTS-653 in a rat
model of postoperative pain. In the behavioral study administration of
either IV or IT JTS-653 increased the withdrawal threshold and latency in a
dose-dependent manner. In the electrophysiological study administrations
of IV and spinal administration of JTS-653 reduced spontaneous activity
and evoked response to mechanical stimuli in WDR neurons after surgery.
Administration of JTS-653 reduce mechanical and thermal hyperalgesia
after plantar incision in the rat suggesting that JTS-653 is a new agent
for relieving postoperative pain in a clinical setting. Takashi Ishida M.D.,
Masahiro Sakata Ph.D., Yuji Hamada Ph.D., Akira Matsuo Ph.D., Mikito
Kawamata M.D., Anesthesiology and Resuscitology, Shinshu University
of Medicine, Matumoto, Japan, Central Pharmaceutical Research
Institute, Japan Tobacco Inc., Takatuki.
TUESDAY, OCTOBER 15
FA A4254
RA A4260
A Double Blind Randomized Control Trial on the Use of the STAR
Maneuver in Needle Visualization
A double blind randomized controlled trial demonstrating that the use of four
sequential moves created by the principle investigator known as the STAR
maneuver (See Tilt Align Rotate) improves needle visualization in novices
performing simulated ultrasound guided regional anesthesia. Nicholas C.
Lam M.D., Edward R. Mariano M.D., Steven Fishburn B.Sc., Angie
Renee Hammer Student, Timothy Petersen Ph.D., Department of
Anesthesiology, University of New Mexico, Albuquerque NM, Stanford
University, Palo Alto, CA.
RA A4261
The Optimum Patient Position for Thoracic Epidural Insertion
The purpose of this study was to determine the optimum patient position
for insertion of a right paramedian thoracic (T9/T10) epidural. Using
ultrasonography to measure the maximal length of the visualised posterior
longitudinal ligament (PLL) we looked at 5 different positions in 30 healthy
volunteers. Positioning the patient flexed with 10,176; of dorsal table
tilt (p=0.007) or flexed with a maximum rotation to the right (p=0.001)
significantly increased the visualised length of the PLL compared to the
traditional sitting flexed position. Using either of these two positions
may improve the ease of paramedian thoracic epidural insertion.
Neil G. Ramsay M.B. Ch.B., Joanna L. Walker M.B. Ch.B., Department
of Anesthesiology, Pharmacology and Therapeutics, Vancouver General
Hospital, Vancouver BC, Canada.
RA A4262
Activation of Transient Receptor Potential M8 by Cooling and
Application of Menthol Can Reduce Propofol Injection-Induced Pain
Injection of propofol has high potential to induce intense burning pain
probably due to the activation of transient receptor potentials V1 and A1. It
is well known that cooling an aching area can reduce pain. We hypothesized
that 1) cooling of the skin can prevent propofol injection-induced pain and 2)
the possible analgesic effect of the cooling is caused due to the activation of
TRPM8 in the skin. The results of the present study have shown that cooling
and application of menthol are effective in reducing the pain experienced
during IV injection of propofol. This fact suggests the analgesic effect on
propofol injection-induced pain is caused by the activation of TRPM8 in
the periphery. Natsuko Watanabe, M.D., Takashi Ishida M.D., Mikito
Kawamata M.D., Department of Anesthesiology and Resuscitology,
Shinshu University of Medicine, Matsumoto, Japan.
RA A4263
QX-314 Induced Long-Term Analgesia Via Thermal Activation of TRPV1
Enhanced by Emulsified Isoflurane
Previous studies found that activation of TRPV1 channel could mediate entry
of QX-314 into sensory neurons. The present study demonstrated that heat
could also open TRPV1 channel that induced long-term analgesic effect and
the effect was longer than the analgesia evoked by capsaicin. With addition
of emulsified isoflurane thermal activation threshold of TRPV1 channel
could decrease to safe range. This result provides an available long-term
analgesic method induced by heat and enhanced by emulsified isoflurane.
Cheng Zhou, Ph.D., Peng Liang M.D., Jin Liu M.D., Xiangdong Chen,
M.D., Laboratory of Anesthesia & Critical Care Medicine and Department
of Anesthesiology, West China Hospital of Sichuan University, Chengdu,
China.
NA Neuroanesthesia
PN Pain Medicine
131
RA A4264
Effects of Opiorphin a Human Dual Enkephalinase Inhibitor in a Model
of Postoperative Pain in Rats
Intravenous infusion of human Opiorphin induces potent analgesia in a
rat model of post-operative pain. Philippe Sitbon Sr. M.D., Leila Hamdi
Student, Alain C. Van Elstraete M.D., Jean-Xavier Mazoit M.D., Ph.D.,
Dan Benhamou M.D., Catherine Rougeot Ph.D., Anesthesiology,
Institut Gustave Roussy Villejuif, France, Laboratory of Anesthesiology,
INSERM U788 Universityersite Paris-Sud, Le Kremlin-Bicetre, France,
Anesthesiology, Centre Medico-Chirurgical Saint Paul, Fort de France,
France, Laboratoire de Pharmacologie de la Douleur Institut Pasteur,
Paris, France.
PO02-2BANESTHETIC ACTION AND BIOCHEMISTRY: NON-NEURONAL
EFFECTS OF ANESTHETICS-IMMUNOMODULATION ORGAN PROTECTION
AND MALIGNANT HYPERTHERMIA
FA A4265
Releasing Rate From the Sarcoplasmic Reticulum by One Point
Mutation in CACNA1S
The genotype of a novel mutation in CACNA1S (p.I639V) with no mutation
in the RYR1 segregated well with an enhanced CICR phenotype in our case
study. Our findings suggest that a mutant α1 subunit of the dihydropyridine
receptor may also induce a malfunctioning of the skeletal muscle’s ryanodine
receptor as expressed by the observed enhancement in the CICR rates.
Yasuko Ichihara M.D., Ph.D., Hirosato Kikuchi M.D., Ph.D., Carlos A.
Ibarra M.D., Ph.D., Koji Fujio M.D., Ph.D., Anesthesiology, Kikkoman
Hospital Noda-shi Chiba, Japan, Abiko Toho Hospital, Abiko City, Chiba
Pref. Japan, Anesthesiology, Hadassah Ein Kerem Medical Center,
Jerlem, Israel.
FA A4266
Clinical MH and Ca2+ Release From Sarcoplasmic Reticulum
Phenotype in the Presence of Homozygous Pro2366Arg RYR1 Mutation
The clinical features of the proband during the MH crisis were not particularly
severe despite bearing a homozygous Pro2366Arg RYR1 mutation. In
addition Ca2+ release pattern from the SR was similar to that of her
daughters who bear the same mutation but in heterozygous state. Our
results suggests that there might be no relationship between the normalto-mutant units expressed in a given RYR1 tetramer and the severity of the
MH phenotype. Hirosato Kikuchi M.D., Ph.D., Yasuko Ichihara M.D.,
Ph.D., Carlos A. Ibarra M.D., Ph.D., Kouji Fujio M.D., Ph.D., Anesthesia,
Urology, Abikotoho Hospital, Anesthesia, Kikkoman Hospital, Noda City,
Chiba, Japan, Anesthesiology and Critical Care Medicine, Hadassah Ein
Kerem Medical Center, Jerlem, Israel.
FA A4267
New Blood Bimarkers in Cancer Diagnosis and Prognosis
Serum free fatty acids and their metabolites have the potential to be
biomarkers for screening and evaluating prognosis and cancer recurrence
after potentially curative surgery. Jinbo Liu M.D., Peter Mazzone M.D.,
Juan Cata M.D., Andrea Kurz M.D., Maria Bauer M.D., Edward
Mascha M.D., Robert H. Silverman Ph.D., Eric Klein M.D., Daniel I.
Sessler M.D., The Cleveland Clinic, Cleveland, OH, University of Texas
MD Anderson Cancer Center, Houston, TX.
Intravenous Fatty Emulsion: Rats Survive Clonidine and Propranolol
Overdose, Our data demonstrates IFE is effective for resuscitation from
a sympathoplegic state in rats following overdose of propranolol alone or
combined with clonidine. We also demonstrated IFE is more effective than
conventional epinephrine treatment. Kimberly Macala M.D., Reza Tabrizchi
Ph.D., Anesthesia, Memorial University of Newfoundland, St. John’s
NL, Canada, Memorial University of Newfoundland, St. John’s NL,
Canada.
132
Dantrolene for the Treatment of Malignant Hyperthermia and Other
Malignant Hyperthermia-Like Syndromes: A Multicenter 5 Year Cohort
Study
Dantrolene is well known to be effective in the treatment of malignant
hyperthermia. This epidemiologic study shows that dantrolene is also
efficacious in the treatment of neuroleptic malignant syndrome and a
variety of malignant hyperthermia-like syndromes. In conjunction with
standard treatment the drug effectively resolved rigidity hyperthermia
and rhabdomyolysis in 93% of study patients with a variety of malignant
hyperthermia-like syndromes. Shonali C. Pawar M.D. M.P.H., Henry
Rosenberg M.D., Robert Adamson Pharm.D, Ronald Chamberlain
M.D., Surgery, Medical Education and Clinical Research, Saint Barnabas
Medical Center, Saint George’s University School of Medicine, Livingston,
NJ.
FA A4270
ROOM 104-AREA C
FA A4268
FA A4269
Epinephrine Slows Down the Lidocaine-inhibition of Human Oral
Squammous Cancer HSC-3 Cell Proliferation
Lidocaine dose-dependently inhibits proliferation of the human oral cancer
HSC-3 cells in vitro. Epinephrine slows down this cytotoxic process but not
makes difference in caspase activation. Therefore lidocaine alone or with
epinephrine may play a beneficial role in peri-operative cancer treatment
and in minimizing proliferating growth and metastases especially in oral and
maxillofacial surgery. Boris Piskoun B.S., Olga Eydlin M.D., Lisa V. Doan
M.D., Thomas J.J. Blanck M.D., Ph.D., Brian Schmidt D.D.S., Fang Xu
Ph.D., Anesthesiology, NYU Langone Medical Center, New York, NY, Oral
and Maxillofacial Surgery, NYU College of Dentistry, New York, NY.
FA A4271
Sargramostim Improves HLA-DR Response and Cumulative Infection
Rate After Surgical Immunosuppression
The aim of the study was to investigate whether sargramostim or vaccination
can increase HLA-DR in patients after major surgery. Claudia Spies M.D.,
Alawi Luetz M.D., Markus Renius M.D., Gunnar Lachmann, Clarissa
von Haefen, Wernecke Klaus-Dieter Ph.D., Marcus Bahra M.D.,
Alexander Schiemann M.D., Marco Paupers M.D., Christian Meisel
M.D., Charite - Universityersitaetsmedizin Berlin, Berlin, Germany.
PO06-3B CRITICAL CARE: LUNG INJURY TRANSPLANT LIFE SUPPORT
AND TECHNOLOGY
ROOM 104-AREA D
CC A4272
Protective Effect of Hypothermia on Lung Injury During Sepsis is
Related to Attenuation of No Production
Mild hypothermia in a rat model of sepsis contributed to reduced lung
injury improved survival and decreased Nitric Oxide (NO) synthesis as
measured from expired NO. Hypothermia was found an effective intervention
in preventing NO upregulation and increasing survival during. Enrico M.
Camporesi M.D., Alessia Pedoto M.D., Nandi Jyotirmoy Ph.D.,
Devanand Mangar M.D., Collin Sprenker B.S., Sal Tawfic Hakim Ph.D.,
Surgery Florida Gulf-to-Bay Anesthesiology, Associates LLC Tampa, FL,
Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering
Cancer Center, New York City, NY, Research,Physiology, Pulmonary
Anesthesiology, Surgery, SUNY Upstate Medical University, Syracuse,
NY.
CC A4273
Acute Respiratory Distress Syndrome (ARDS) as Primary Manifestation
in ANCA-Associated Vasculitis
Outcome of patients with AAV and ARDS is favourable. Early mortality was
not related to pulmonary involvement. Among patients with ARDS routine
screening for ANCA can rapidly establish the diagnosis of AAV. Michael E.
Dolch M.D., Michael Irlbeck M.D., Matthias Wessely M.D., Simon
Rau M.D., Lorenz Frey M.D., Ulf Schonermarck M.D., Anesthesiology,
Division of Nephrology, Internal Medicine IV Ludwig-Maximilians
University of Munich, Munich, Germany.
NA Neuroanesthesia
PN Pain Medicine
Out-of-Hospital Cardiac Arrest Prior Admission in Trauma Center is
Associated With High Survival Rate in Severe Trauma Patients
The objective was to evaluate the outcome of patients that presented with
cardiac arrest prior their admission to the trauma center based on the
analysis of a multicentre prospective trauma registry. Among 88 included
patients 10 patients survived (11%): 9 patients with GCS 15 and CPC
1-2. This unexpectedly high survival rate encourages the continuation of
ACLS measures for this subpopulation. Francois-Xavier Duchateau, M.D.,
Tobias Gauss, M.D., Sophie Hamada, M.D., Mathieu Raux, M.D., Anatole
Harrois, M.D., Jean Mantz, M.D., Ph.D., Catherine Paugam-Burtz, M.D.,
Ph.D., EMS, Anesthesiology and Intensive Care, Beaujon University
Hospital, Clichy, France, Anesthesiology and Intensive Care, Kremlin
Bicetre University Hospital, Le Kremlin Bicetre, France, Anesthesiology
and Intensive Care, Pitie Salpetriere University Hospital, Paris, France.
CC A4275
Novel Application of Sugammadex to Reverse Non-Depolarizing Muscle
Relaxants in a Perfusion Model of Human Cadaver Larynx: A Pathway
to Laryngeal Transplants: A Pilot Study
Sugammadex is approved in the EU for reversal of moderate and deep block
with 2 mg/kg and 4 mg/kg dosages respectively. It is also used for reversal of
steroidal non-depolarizing muscle relaxants in an emergency cannot intubatecannot intubate situation at the 16 mg/kg dose. It has been resubmitted
to the FDA in the US and possibly may be approved. This pilot study in an
experimental circulation model suggests that sugammadex may also be
successful in reversal in situations where there are no biologic mechanisms
to either metabolize or excrete muscle relaxants. Jonathan S. Jahr M.D.,
Abie H. Mendelsohn M.D., Christopher Kk Jamora M.D., Jonathan
Salinas M.D., Gerald S. Berke M.D., Anesthesiology, Head and Neck
Surgery University of California, Los Angeles, Los Angeles, CA
CC A4276
Effect of Donor Quality on Transfusion Requirements During Liver
Transplantation
Due to the scarcity of liver donors and high recipient demand centers
have adopted the practice of transplanting marginal allografts. While this
practice has not been associated with increased post-operative mortality
little is known about its effect on intra-operative case complexity. This
study examines whether donor variables affect intra-operative transfusion
requirements during liver transplantation. Teresa A. Mulaikal M.D.,
Nanshi Sha Ph.D., Gebhard Wagener M.D., Anesthesiology, Columbia
University, New York, NY.
CC A4277
Glibenclamide an ATP Potassium Channel Blocker Abolishes Lipid
Rescue of Bupivacaine-Induced Cardiotoxicity
Glibenclamide abolishes lipid rescue of bupivacaine-induced cardiotoxicity.
Parisa Partownavid M.D., Salil Sharma Ph.D., Siamak Rahman M.D.,
Mansoureh Eghbali Ph.D., UCLA, Los Angeles, CA.
CC A4278
Pulmonary Effects of Spontaneous Ventilation Versus Controlled
Ventilation in Experimental Early Sepsis in Pigs
The present study compares a spontaneous mode of ventilation (pressure
support ventilation; PSV) versus a controlled ventilation mode (volume
controlled ventilation; VCV) targeted to a tidal volume of 6 ml/kg in a
prospective-randomized porcine model of early sepsis. Parameter of gas
exchange inflammatory response edema formation and histopathologic lung
damage yielded no intergroup differences three and six hours after induction
of lipopolysaccarid (LPS) sepsis. Alexander Ziebart M.D., Rainer Thomas
M.D., Erik Hartmann M.D., Tanghua Liu M.D., Bastian Duenges
Ph.D., Arno Schad M.D., Matthias David M.D., Ph.D., Department of
Anaesthesiology, Institute of Pathology, Medical Center of the Johannes
Gutenberg-University Mainz, Germany.
CC A4279
Two Hit Model of Lung Injury Following Ventilated Ischemia
Reperfusion
Models of ventilated lung ischemia reperfusion (IR) are not consistently
used to dissect the cellular and molecular pathways that regulate this innate
immune process. Using a mouse model of ventilated lung IR injury we
demonstrate that pure IR does not result in lasting lung injury whereas longterm lung dysfunction morbidity and mortality occurs when lung infection is
superimposed on IR. Arun Prakash M.D., Ph.D., Shirin V. Sundar Ph.D.,
Judith Hellman M.D., Anesthesia and Perioperative Care, University of
California San Francisco, San Francisco, CA.
PO10-5B EXPERIMENTAL NEUROSCIENCES: MECHANISMS II
TUESDAY, OCTOBER 15
CC A4274
ROOM 104-AREA E
NA A4280
Effects of Dexmedetomidine on Microregional O2 Supply and
Consumption Balance During Reperfusion After Focal Cerebral
Ischemia
Dexmedetomidine infusion during reperfusion reduced the heterogeneity of
microregional O2 supply/consumption balance and decreased the number
of microregions with low O2 supply/consumption balance in the ischemicreperfused cerebral cortex. Aliraza Dinani, M.D., Jeremy Grayson, M.D.,
Sylviana Barsoum, M.D., Xia Liu, M.D., Harvey R. Weiss Ph.D., Oak Z. Chi
M.D., Department of Anesthesia, University of Medicine and Dentistry of
New Jersey - Robert Wood Johnson Medical School, New Brunswick, NJ.
NA A4281
Effects of Propofol on Phasic and Tonic GABA(A) Receptor-Mediated
Inhibition in the Spinal Ventral Horn
Propofol produces neuronal inhibition of the spinal ventral horn rather by
modulation of phasic than by tonic GABA(A) receptor mediated currents.
It seems therefore unlikely that the immobilizing properties of propofol are
mediated by a modulation of tonic GABA(A) receptor-mediated currents.
Christian Grasshoff M.D., Veit-Simon Eckle M.D., Bernd Antkowiak
Ph.D., Anesthesiology and Intensive Care, Eberhard-Karls-University,
Tuebingen Germany.
NA A4282
Effect of L-type Calcium Channel Antagonist on Propofol SelfAdministration and Relapse Behavior in Rats
Propofol relapse model could be induced by drug-related cues. Moreover
The present results indicate that the L-type calcium channel may play an
important role in the incubation of propofol dependent and craving behavior.
Qingquan Lian M.D., Ph.D., Ling Tang M.D., Benfu Wang M.D., The
Second Hospital & Yuying Children’s Hospital of Wenzhou Medical
University, Wenzhou, China.
NA A4283
Hyperglycemia Increases the Shivering Threshold in Rabbits
We evaluated the effect of blood glucose concentration on the shivering
threshold in rabbits. The shivering threshold was linearly related to blood
glucose concentration in lightly anesthetized rabbits. Taishi Masamune
M.D., Ph.D., Hirofumi Ino M.D., Keiichi Wada M.D., Hiroaki Sato M.D.,
Ph.D., Masakazu Kotoda M.D., Nobumasa Asano M.D., Takeshi Oguchi
M.D., Ph.D., Tadahiko Ishiyama M.D., Ph.D., Daniel I. Sessler M.D.,
Takashi Matsukawa M.D., Ph.D., Surgical Center Yamanashi University
Hospital, Chuo, Japan, Fujiyoshida Municipal Hospital, Fujiyoshida
Japan, Department of Outcomes Research The Cleveland Clinic, OH.
NA Neuroanesthesia
PN Pain Medicine
133
NA A4284
FA A4289
NA A4285
FA A4290
Roles of Mast Cells in the Rupture of Intracranial Aneurysms
Mast cells are emerging as a key regulator of inflammation in the
vasculature. We investigated if mast cells play critical roles in the
development of the rupture of intracranial aneurysms. KitWsh mice had a
significantly lower incidence of aneurysmal rupture than the wild-type mice.
The aneurysmal wall of KitWsh mice showed little MMP activity comparing
to wild type mice. Activation of MMPs by mast cell derived-chymase may
play a significant role in promoting aneurysmal rupture. Mast cell or mast
cell-derived cytokines may be a therapeutic target for the prevention of
aneurysmal rupture. Kosuke Wada M.D., Yoshiteru Tada M.D., Ph.D.,
Hiroshi Makino M.D., Ph.D., Mari Kudo M.D., Shoko Murakami M.D.,
Ph.D., Kenji Shimada M.D., Ph.D., Atsushi Kuwabara M.D., Makoto Ozaki
M.D., Ph.D., Tomoki Hashimoto M.D., Anesthesia and Perioperative Care,
University of California San Francisco, San Francisco, CA.
Different Neuroprotective Effects of Sevoflurane Postconditioning in
the Normal and Hyperlipidemic Mice
Hyperlipidemia attenuates the neuroprotective effect of sevoflurane
postconditioning. Sevoflurane postconditioning has different effects on the
LKB1-AMPK signaling pathway in the normal and hyperlipidemic mice. Hai
Yu, M.D., Zhiyi Zuo, M.D., Ph.D., Department of Anesthesiology, West
China Hospital of Sichuan University, Chengdu, China, Department of
Anesthesiology, University of Virginia, Charlottesville, VA.
NA A4286
Immobilization With Atrophy Induces Increased Expression of
Neuronal 7 Acetylcholine Receptors in Muscle Contributing to
Neurotransmission
In normal, innervated adult muscle only one isoform of AChRs is expressed
and is involved with neurotransmission. During immobilization immature
and α7AChR isoforms are expressed. This study using specific blockers to
each AChRs subunit shows their contribution to neurotransmission during
immobilization. Sangseok Lee, M.D., Hong-seuk Yang, M.D., Tomoki
Sasakawa, M.D., Michio Nagashima, M.D., Mohammed A.S. Khan, Ph.D.,
Ashok Khatri, Ph.D., Jeevendra J.A. Martyn, M.D., Ph.D., Department
of Anesthesia and Pain Medicine, Sanggye Paik Hospital Inje University,
Seoul, Korea Republic of, Department of Anesthesiology and Pain
Medicine, Asan Medical Center, College of Medicine, University of Ulsan,
Seoul, Korea Republic of, Department of Anesthesiology, Critical Care and
Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for
Children in Boston and Harvard Medical School, Boston, MA.
NA A4287
Mechanism of Increased Blood Flow in Brain and Spinal Cord During
Isovolemic Hemodilution
The vasodilating effect of hypercapnia was used in a canine model to clarify
the mechanism(s) responsible for the increases in blood flow in the brain and
spinal cord during hemodilution. The findings suggested that these blood flow
increases were solely due to a reduction in vasomotor tone; a decrease in
blood viscosity played no role. George J. Crystal Ph.D., Edward A.. Czinn
M.D., M. Ramez Salem M.D., Anesthesiology, Advocate Illinois Masonic
Medical Center, Chicago, IL, Anesthesiology, Broward Health Medical
Center, Fort Lauderdale, FL.
PO13-4BOUTCOMES AND DATABASE RESEARCH: INTERVENTIONS
AND OUTCOMES I
ROOM 104-AREA A
Growth Differentiation Factor 15 is Superior to N-Terminal Pro B-Type
Natriuretic Peptide and Logistic Euroscore for Predicting Severe Acute
Kidney Injury in Cardiac Surgery Patients
Growth-differentiation-factor 15 (GDF-15) is an emerging humoral marker
for risk stratification in cardiovascular disease and an independent predictor
of longterm mortality and morbidity in cardiac surgical patients. The present
retrospective analysis shows that the preoperative plasma level of GDF-15
levels is also an independent predictor of severe (grade 3) postoperative
acute kidney injury (AKI) in elective cardiac surgical patients and in this
regard superior to the additive Euroscore N-terminal pro B-type natriuretic
peptide or estimated glomerular filtration rate. Matthias Heringlake M.D.,
Nicola Gatz Jan-Hendrik Kabler Anna Beilharz Julika Schon M.D.,
Hauke Paarmann M.D., Department of Anesthesiology, University of
Lubeck, Lubeck, Germany.
Etomidate and the Occurrence of Postoperative Atrial Arrhythmia in
Cardiac Surgery
Despite unopposed inflammatory response thought to be resulted from
etomidate-induced adrenal insufficiency anesthetic induction with
etomidate for cardiac surgery requiring CPB is not associated with increased
incidence postoperative atrial arrhythmias or prolonged ICU and hospital
length of stay. Ryu Komatsu M.D., Natalya Makarova M.S., Jing You
M.S., David G. Anthony M.D., Daniel I. Sessler M.D., Alparslan Turan
M.D., Anesthesiology Institute, Cardiothoracic Anesthesia, Outcomes
Research, Cleveland Clinic, Cleveland, OH.
FA A4291
Perioperative Dexmedetomidine Use and Postoperative Acute Kidney
Injury in Patients Undergoing Cardiac Surgery
Acute kidney injury (AKI) is a common complication after cardiac surgery
and associates with adverse outcomes and high healthcare costs. This study
is the first to demonstrate that perioperative dexmedetomidine infusion
is associated with a significant decrease in the incidence of mild acute
kidney injury in these cardiac surgical patients with preoperative normal
renal function and mild chronic kidney disease. The perioperative use of
dexmedetomidine is also associated with a significant decrease in in-hospital
30-day mortality and the incidence of postoperative overall complications.
Hong Liu M.D., Fuhai Ji M.D., Anesthesiology and Pain Medicine,
University of California Davis Health System, Sacramento, CA, The First
Affiliated Hospital of Soochow University, Suzhou, China.
FA A4292
Do Medical Personnel Dynamics in the Operating Room Affect Surgical
Site Infections in Orthopedic Surgery? Surgical Site Infections (SSIs) may be caused or aggravated by airborne
contaminants the level of which can be proportional to the number of the
people present in the operating room. The purpose of the study is to assess
both the impact of the number of people in the operating room and shift
changes on the development of SSIs. No statistically relevant relation was
found between the development of SSIs and shift changes. Moreover no
statistically relevant relation was found between the number of elements in
the operating table and the development of SSIs. Celine R. Marques Sr.
M.D., Ricardo Mota Pereira M.D., Diana Henriques M.D., Rita Santa
Barbara M.D., Ines Tellechea M.D., Emanuel Almeida M.D., Joana
Alves M.D., Alexandra Resende M.D., Anesthesiology, Santa Maria
University Hospital, Lisbon, Portugal.
FA A4288
The Effect of Antiemetic Doses of Dexamethasone on Blood Sugar in
the Perioperative Period in Diabetic and Non-Diabetic Patients
Postoperative nausea and vomiting prophylaxis with dexamethasone 8
mg given at induction of anesthesia significantly increases postoperative
blood glucose. This effect is consistent among diabetics and non-diabetics
regardless of baseline blood glucose. Ashraf S. Habib M.B. Ch.B., William
D. White M.P.H. Adeyemi J. Olufolabi M.B. B.S., Ryan Fink M.D., Tong
J. Gan M.D., Anesthesiology, Duke University Medical Center, Durham,
NC.
134
NA Neuroanesthesia
PN Pain Medicine
Postoperative Outcomes Associated With Enhanced Recovery After
Surgery (ERAS) Protocol Compliance
Substantial evidence suggests that following an enhanced recovery after
surgery (ERAS) program which includes esophageal doppler monitoring
to optimize perioperative fluid use is effective in improving post-surgical
outcomes. We examined the potential associations between compliance with
ERAS protocol elements and post-operative fluid use hospital length of stay
(LOS) and readmissions using prospectively and retrospectively collected
data. Use of an ERAS protocol was associated with reduced utilization of
post-operative intravenous fluids and opioids hospital length of stay and
30-day readmissions. Timothy Miller, M.B., Ch.B., Frank R. Ernst, Pharm.D,
Michelle R. Krukas, M.A., Tong S. Gan, M.B., Duke University Medical
Center, Durham, NC, Premier Research Services, Premier HealthCare
Alliance, Charlotte, NC.
FA A4294
Enhanced Recovery in England: A Descriptive Analysis of Procedure
Compliance and Associated Hospital Length of Stay
This study of nearly 25,000 cases is substantially the largest ever
assessment of the relationship between ER protocol compliance and
outcome. It found a significant association between better ER protocol
compliance and shorter hospital lengths of stay. Joanna Simpson, M.B.
B.S., S. Ramani Moonesinghe, M.B. B.S., Michael Grocott, M.D.,
Mike Galsworthy, Andy McMeeking, Michael Mythen M.D., University
College London Hospital, London, United Kingdom, University Hospitals
Southampton NHS Trust, Southampton, United Kingdom, National Cancer
Action Team, London, United Kingdom.
FA A4295
Procedural Sedation Outcomes in a Tertiary Care Academic Institution
Our data indicates that patients with high ASA status are at risk for incidents
with high severity scores while undergoing procedural sedation. It is critical to
establish a robust quality reporting system and continuously evaluate patient
outcomes. Richard D. Urman M.D. M.B.A., Rebecca Grammer D.M.D.,
Wendy Gross M.D., Brigham and Women’s Hospital, Boston, MA,
Harvard Medical School, Boston, MA.
PO16-5B REGIONAL ANESTHESIA AND ACUTE PAIN
ROOM 104-AREA B
RA A4296
Interest of High-Frequency Volume Probes for Peripheral Nerve Blocks:
A New Paradigme in the Fourth Dimension
There is no clinical trial highlighting the interest of real time 4D US guidance
during PNB in terms of LA spread and block quality. This study showed that
the three-plan mode permitted to display the real time LA spread along
the nerve in 3 different space plans (longitudinal transversal and coronal)
without moving the probe. Fourth-dimension algorithms could allow to
calculate the clinical efficacious volume after injection that can provide an
optimal anesthetic block. Bertrand ABBAL M.D., Olivier Choquet M.D.,
Jibril Nouri M.D., Xavier Capdevila M.D., Ph.D., Anesthesiology and
Critical Care Medicine, Lapeyronie University Hospital, Montpellier,
France.
RA A4297
Sub Anesthetic Doses of Ketamine Do Not Influence the Analgesia
Nociception Index (ANI) Measured With the PhysioDoloris DeviceTM
This pilot study evaluated the clinical utility of the Analgesia Nociception
Index (ANI) measured with the PhysioDoloris® Device after 0.5 mg/kg of
the commonly used analgesic drug ketamine was given five minutes after
intubation. Laurent A. Bollag M.D., Clemens Ortner M.D., Srdjan Jelacic
M.D., Cyril Rivat Ph.D., Philippe Richebe M.D., Ph.D., UWMC, Seattle,
WA.
RA A4298
Can Opioid-Induced Hyperalgesia be Prevented by Gradual Dose
Reduction Versus Abrupt Cessation of Remifentanil?
Remifentanil may reduce the pain threshold, resulting in enhanced pain
as the opioid effect diminishes after the end of administration. This
phenomenon is known as opioid-induced hyperalgesia (OIH). The aim of
our study was to investigate whether gradual dose reduction of remifentanil
infusion vs. abrupt cessation could prevent OIH in humans using the cold
pressor test (CPT). 16 subjects went through CPT before during and two
times after remifentanil infusion. Gradual dose reduction of remifentanil
infusion does not significantly reduce OIH compared to abrupt cessation of
infusion. OIH does not persist long as we found return to baseline numerical
rating scale for pain 110 min after end of infusion in both sessions.
Marlin Comelon M.D., Johan C. Raeder Ph.D., Audun Stubhaug Ph.D.,
Tomas Draegni C.R.N.A., Harald Lenz Ph.D., Anesthesiology, Oslo
University Hospital, Oslo, Norway.
TUESDAY, OCTOBER 15
FA A4293
RA A4299
Efficacy of Dexmedetomidine as an Adjuvant With Bupivacaine in
Paravertebral Block in Surgery for Breast Cancer
The study was conducted to evaluate the analgesic efficacy of
dexmedetomidine added to bupivacaine in paravertebral block in patients
undergoing major surgical procedures for management of breast cancer. It
was concluded that dexmedetomidine 1 µg/kg when added to bupivacaine
for paravertebral block provides better and longer analgesia without any
increase in side-effects than paravertebral block with bupivacaine alone or
no paravertebral block in patients undergoing breast cancer surgery under
general anesthesia. Bhumika Kalra Jr. M.B. B.S., Medha Mohta M.D.,
A. K. Sethi M.D., Navneet Kaur M.S., Anesthesiology and Critical Care,
University College of Medical Sciences and Guru Teg Bahadur Hospital
Delhi Delhi India, General Surgery University College of Medical
Sciences and Guru Teg Bahadur Hospital Delhi Delhi India.
RA A4300
Apnea Hypopnea Index is Not Associated With Increased Postoperative
Pain and Opioid Consumption in Bariatric Surgery Patients
Retrospective review of data examining the relationship of apnea hypopnea
index (AHI) with pain scores and opioid requirements in the immediate postoperative period in patients with obstructive sleep apnea (OSA) undergoing
bariatric surgery. Ashish K. Khanna M.D., Cameron R. Egan Student,
Raktim Ghosh M.D., Sherry Yu Student, Somnath Bose M.D., Shahbaz
Qavi M.D., Jing You M.D., Lovkesh Arora M.D., Anthony Doufas
M.D., Alparslan Turan M.D., Anesthesiology Institute, Department of
Outcomes Research Cleveland Clinic Foundation, School of Medicine,
Case Western Reserve University, Cleveland, OH, School of Medicine,
Stanford University, Stanford, CA.
RA A4301
Intra or Extraneural: How Accurate is the Assessment by Ultrasound?
Although US can be used to detect intraneural injection of small volumes
at present its sensitivity specificity and intra- and inter-rater reliability
are unknown. In this cadaver study these data were obtained after USguided injections within and around the sciatic nerve using sections
obtained by cryomicrotomy as gold standard. The observations were done
by anesthesiologists with different levels of experience in ultrasoundguided regional anesthesia.
Annelot C. Krediet M.D., Nizar Moayeri
M.D., Ph.D., Ronald L.A.W. Bleys M.D., Ph.D., Gerbrand J. Groen
M.D., Ph.D., Anesthesiology, Neurosurgery, University Medical Center
Utrecht, Utrecht, Netherlands, Anatomy, Pain Center, Department
of Anesthesiology, University Medical Center Groninge Groningen,
Netherlands.
NA Neuroanesthesia
PN Pain Medicine
135
RA A4302
Does the Application of Tourniquet at the I.V. Site Followed by I.V.
Lidocaine Further Reduce Burning Sensation From I.V. Propofol When
Compared With Administration of Their Mixture During I.V. Induction for
Endoscopy?
Application of tourniquet at the injection site before administration of
I.V. lidocaine followed by propofol for induction of deep I.V. sedation for
endoscopy did not further reduce sensation of burning when compared with
administration of lidocaine mixed with propofol. Sagar S. Mungekar, M.D.,
Adil Mohiuddin, M.D., Shaul Cohen, M.D., Shubhankar Chhokra, Oren Y.
Ambalu, B.A., Arpan Patel, B.S., Achillina Rianto, B.A., Sal Zisa, M.D.,
Renu Chhokra, M.D., Christine W. Hunter, M.D., Anesthesia, UMDNJRobert Wood Johnson Medical School, Fort Lee, NJ.
RA A4303
A Randomized Double-Blind Trial to Evaluate the Efficacy and Safety
of the Sufentanil NanoTab® PCA System/15mcg Plus Rescue Morphine
Versus Placebo Plus Rescue Morphine in Patients With Moderate-toSevere Pain After Open Abdominal Surgery
The Sufentanil NanoTab PCA System is a preprogrammed noninvasive
product in development which delivers sublingual sufentanil 15 mcg tablets
with a 20-min lockout. This novel system produced superior post-operative
pain control compared to placebo. The only statistically significant difference
in adverse events was pruritus in the sufentanil group. Forrest G. Ringold
M.D., Harold Minkowitz M.D., Tong-Joo Gan M.D., Keith Aqua M.D.,
Pamela P. Palmer M.D., Ph.D., Mike Royal M.D., Surgery, Surgical
Associates of Mobile, Mobile, AL, Anesthesiology, Memorial Hermann
Memorial City Hospital Medical Center, Houston, TX, Anesthesiology,
Duke University Medical Center, Durham, NC, Atlantic Clinical Research
Collaborative, Boynton Beach, FL, Medical AcelRx Pharmaceuticals
Inc., Clinical AcelRx Pharmaceuticals, Inc., Redwood City, CA.
136
NA Neuroanesthesia
PN Pain Medicine
TUESDAY, OCTOBER 15
NOTES
137
CA A5004
ORAL PRESENTATIONS
OR09-2 EXPERIMENTAL CIRCULATION: PHARMACOLOGICAL
CARDIOPROTECTION
WEDNESDAY, OCTOBER 16 | 8:00-9:30 A.M.
ROOM 124
CA A5000
Estrogen Rescues Advance Heart Failure Via miR129 Induction and
Suppression of Cardiac Fibrosis Associated Genes
Estrogen therapy can rescue heart failure by regulating fibrosis-associated
genes via microRNA miR129 induction through ER beta receptor as a novel
mechanism. Salil Sharma Ph.D., Andrea Iorga B.S., Harnek Singh B.S.,
Jingyaun Li Ph.D., Mansoureh Eghbali Ph.D., Anesthesiology, University of
California, Los Angeles, Los Angeles, CA.
CA A5001
Intralipid Enhances Endogenous Cardioprotection in Normothermic
Isolated Hearts From Summer-Active Arctic Ground Squirrels Hibernating mammals and their unique seasonal changes in metabolism
offer an intriguing insight into cardioprotective mechanisms necessary
under extreme physiological conditions. A genetically triggered switch to
FA metabolism challenges the current paradigm that increased glucose
utilization and inhibition of FA metabolism are favorable during myocardial IR.
Richard J. Deklotz M.D., Mihai V. Podgoreanu M.D., Brian M. Barnes
Ph.D., Matthias L. Riess M.D., Ph.D., Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, Anesthesiology, Duke University, Durham, NC,
Institute of Arctic Biology University of Alaska Fairbanks, Fairbanks, AK,
Anesthesiology and Physiology, Clement J Zablocki VA Medical Center and
Medical College of Wisconsin, Milwaukee, WI.
CA A5002
Estrogen Replacement Downregulates Cardiac Angiotensin II in an
ACE-Independent Manner in Oophorectomized mRen2.Lewis Rats
The cardioprotective effects of estrogen are well recognized but the
mechanisms remain poorly understood. We hypothesized that estrogen
replacement limits the development of the LVDD phenotype after ovarian
hormone loss by shifting the RAS from the pro-fibrotic angiotensin II (Ang
II)/ Ang II type 1 receptor (AT1R)/converting enzyme (ACE) and aldosterone
pathway to the anti-fibrotic Ang-(1-7)/Mas/ACE2 pathway. E2 treatment
inhibits upsurges in cardiac Ang II expression in the OVX-mRen2 rat possibly
in a non-ACE-dependent manner. Leanne Groban M.D., Hao Wang M.D.,
Ph.D., Zhuo Zhao M.D., Ph.D., Jewell Jessup Ph.D., Marina Lin M.S.,
Lindsay MacNamara B.S., Carlos M. Ferrario M.D., Anesthesiology, Wake
Forest School of Medicine, Winston-Salem, NC.
CA A5003
Effects of Quinone Reductase 2 Inhibition on Cerebral Outcomes
Following Experimental Deep Hypothermic Circulatory Arrest in Rats
This study provides preliminary preclinical evidence that preoperative
systemic administration of chloroquine or a novel selective QR2 inhibitor
attenuates cerebral injury following CPB/DHCA by improving blood brain
barrier stability and decreasing neuronal death. This selective QR2 inhibitor
provides perioperative neuroprotective efficacy non-inferior to chroloquine but
devoid of potential side effects. Qing Ma M.D., Talaignair N. Venkatraman
Ph.D., Zhiquan Zhang Ph.D., Jess Fitzpatrick M.D., Joseph P. Mathew
M.D., Mihai V. Podgoreanu M.D., Christopher Lascola M.D., Ph.D.,
Anesthesiology, Radiology and Neurobiology, Duke University Medical
Center, Durham, NC.
138
Critical Role of MicroRNA-21 in Isoflurane-Induced Cardioprotection
Against Ischemia/Reperfusion Injury
The aim of this study was to investigate the role of microRNA-21 in IsoPCelicited cardioprotection. The expression of myocardial microRNA-21 and
infarct area were measured. microRNA-21 was significantly increased by
194±64%, 39±8%, and 87±28% 30 min, 3 h, and 6 h after isoflurane
treatment, respectively. IR resulted in an infarct size of 54±3% of area at risk
in C57BL/6 mice, which was significantly decreased to 36±4% by IsoPC, but
not in microRNA-21 gene mice (62±4%) compared with C57BL/6 mice. The
expression of microRNA-21 in mouse myocardium is up-regulated following
isoflurane treatment. Isoflurane protects mouse hearts from I/R injury by a
microRNA-21-dependent mechanism. Shigang Qiao M.D., Jessica Olson
M.S. Yasheng Yan M.S. Xiaowen Bai M.D., Ph.D., David C. Warltier M.D.,
Ph.D., Zhidong Ge M.D., Ph.D., Zeljko J. Bosnjak Ph.D., Anesthesiology,
Medical College of Wisconsin, Milwaukee, WI.
OR14-2 PATIENT SAFETY PRACTICE MANAGEMENT
ROOM 124
PI A5005
Would Education in Cognitive Aid Use Improve Local Anesthetic
Systemic Toxicity Management Among Senior Residents?
We studied senior anesthesiology residents as they managed a simulated
local anesthetic systemic toxicity event. We focused on critical actions
and cognitive aid (CA) use. None of the residents completed all critical
actions and 31% used the CA. Reasons for failing to use the CA included
embarrassment and difficulty managing the event while reading the CA.
Specific education in CA use may be necessary. Amanda R. Burden M.D.,
Marc Torjman Ph.D., Erin W. Pukenas M.D., Fatimah Habib M.D., Karen
Fleming M.D., Keyur Trivedi M.D., Irwin Gratz D.O., Edward Deal D.O.,
Anesthesiology, Cooper Medical School of Anesthesiology, Cooper
Medical School of Rowan University, Camden, NJ.
PI A5006
Blood Ordering Practices for Elective Cesarean Deliveries: Cost
Analysis and Practice Improvement
Curtailing unnecessary pre-operative blood orders for elective surgical
procedures may result in cost savings to the hospital. We conducted a
cost analysis for elective cesarean sections by calculating a crossmatch to
transfusion ratio. We distributed anonymous surveys to physicians to assess
their individualized rationale regarding blood ordering practices. Data revealed
that most crossmatch orders were unnecessary and most physicians based
their blood ordering decisions on personal experience alone. We believe
scarce resources could be better allocated in order to mitigate blood bank
costs decrease inappropriate requests improve blood resource management
and thus positively impact patient care at our trauma hospital. Shobana
Chandrasekhar M.D., Brittany Serratos M.D., Maya Suresh M.D.,
Anesthesiology, Baylor College of Medicine, Houston, TX.
PI A5007
Intraocular Pressure (IOP) More Reduced When Using TIVA
With Propofol During Robot-Assisted Laparoscopic Radical
Prostatectomy
In this randomized controlled trial addressing the effect of anesthesia using
TIVA with propofol on attenuating IOP increase in patients undergoing
RLRP we observed a statistically significant reduction in IOP during
pneumoperitoneum and steep Trendelenburg position as well as faster
recovery of IOP after surgery in the TIVA group. Our study has a clinical
significance in that the study was aimed at patients who were vulnerable
to the ocular complications. Maintaining low IOP under the anesthesia
using TIVA with propofol may be beneficial especially in patients who are
vulnerable to ocular complication due to IOP increase. Eunkyeong A. Choi
M.D., Nayoung Kim M.D., Sunjoon Bai M.D., Ph.D., Department of
Anesthesiology and Pain Medicine, Yonsei University College of Medicine,
Seoul Korea Republic of.
NA Neuroanesthesia
PN Pain Medicine
Intravenous Lipid Emulsion Improves Recovery Time and Quality From
Isoflurane Anesthesia: A Double-Blind Clinical Trial
Intravenous lipid emulsion improves recovery time and quality from
isoflurane anesthesia. The mechanism underline might be related to the
lipid sink phenomenon. Qian Li M.D., Jin Liu, M.D., Di Yang, M.D., Jingyu
Zhang, M.D., Anesthesia, West China Hospital of Sichuan University,
Anesthesiology and Translational Neuroscience Center, West China
Hospital of Sichuan University, Chengdu, China.
PI A5009
Use of Standardized Handoffs Improves Communication and Patient
Safety in Obstetric Anesthesia
Effective communication and teamwork are key to patient safety especially in
the dynamicobstetric suite. ACGME mandates to improve resident duty hours
and patient safety have been associated with the following: an unanticipated
increase in self-reported medical errors and an increased need in the number
of handoffs. This study demonstrates that use of a standardized handoff tool
improves communication during transitions in patient care when compared
to the use of a non-standardized method. Effective communication and
teamwork contribute to patient safety and optimize maternal-fetal outcomes.
Chawla LaToya Mason M.D., Quisqueya T. Palacios M.D., Charles G.
Minard Ph.D., Maya S. Suresh M.D., Anesthesiology, Dan L. Duncan
Institute for Clinical and Translational Research Baylor College of
Medicine, Houston, TX.
PI A5010
Successful Implementation of Quantitative Neuromuscular Blockade
Monitoring in an Academic Department
Although experts recommend quantitative neuromuscular blockade
monitoring to minimize the likelihood of residual postoperative paralysis such
monitoring is not widely used. We describe a 2 year program to implement
universal quantitative monitoring in an academic anesthesia department
along with evidence of its success. Michael M. Todd, M.D., Bradley J.
Hindman, M.D., Brian J. King B.A., Anesthesia, University of Iowa,College
of Medicine, Iowa City, IA.
POSTER DISCUSSIONS
PD13-2 OUTCOMES AND DATABASE RESEARCH: RISK AND
PREDICTION
ROOM 123
Predicting Post-Operative Mortality with Comorbidity Scales:
Establishment and Validation of a Modified Charlson Comorbidity
Score for Operative Patients
Aim of this study was to compare the ASA PS and the Charlson Comorbidity
Score (CCS) in regard to their predictability of post-operative mortality. The
CCS was marginally superior in predicting postoperative mortality than the
ASA PS. A modified CCS for operative patients was constructed from the
predictive potential of the particular CCS items to predict post-operative
mortality as modelled in binary logistic regression. This CCS for operative
patieents was superior to both ASA and conventional CCS. Felix Kork, M.D.,
Felix Balzer, M.D., Claudia Spies, M.D., Anesthesiology and Intensive Care
Medicine, Charite - University Medicine Berlin, Berlin, Germany.
FA A5014
Age as a Predictor of Opioid Administration Immediately After the
Emergence of Anesthesia
Analgesic requirements in the immediate post-emergence period may provide
an indication of the adequacy of patients’ overall pain management and is
not well understood. The purpose of this study is to examine the relationship
between age opiate administration and pain early after emergence from
anesthesia for patients undergoing hip and knee arthroplasty. Karim
Ladha M.D., Jon Wanderer, M.D., Karen Nanji M.D. M.P.H., Department
of Anesthesiology, Critical Care and Pain Medicine, Massachusetts
General Hospital, Boston, MA, Department of Anesthesiology, Vanderbilt
University, Nashville, TN.
FA A5015
Predictors of Respiratory Adverse Events in Ambulatory Patients: A
Database of 45,703 Anesthetics Over a 4 Year Period
Data describing practices and adverse events during anesthesia and in
the PACU were collected prospectively on 45,703 consecutive ambulatory
surgical patients from 10/1/2009 to 1/21/2013 as part of the SCOR SAMBA
Clinical Outcome Registry project. After analyzing this database we found
that there is a relative higher rate of respiratory adverse events in children
compared with adults in an ambulatory population. Other risk factors that
predict respiratory adverse events include intraoperative opioid administration
and endotracheal intubation. David T. Maduram, M.D., Ph.D., Peter S. A.
Glass M.D., Douglas G. Merrill M.D., Lucinda Everett M.D., Department
of Anesthesia Critical Care and Pain Medicine, Massachusetts General
Hospital, Boston, MA, Stony Brook University, Stony Brook, NY,
Dartmouth-Hitchcock Medical Center, Lebanon, NH.
FA A5016
FA A5011
Variation in Pediatric Traumatic Brain Injury Outcomes in the United
States
This was a retrospective cohort study of 51,697 pediatric patients admitted
to the hospital with traumatic brain injury. Our hypothesis was that there
was significant state-to-state variation in clinically relevant outcomes. We
specifically looked at discharge to rehabilitation after hospitalization and
inpatient mortality. We found significant variation between states which
may be responsible for as many as 2,539 patients not getting appropriate
rehabilitation care and the death of 607 patients annually. Nathaniel H.
Greene, M.D., Mary A. Kernic Ph.D., Monica S. Vavilala, M.D., Frederick
P. Rivara, M.D. M.P.H., Anesthesiology and Pain Medicine, Epidemiology,
Pediatrics, University of Washington, Seattle, WA.
FA A5012
FA A5013
PI A5008
Intraoperative and Demographic Factors More Strongly Predict Patient
Wake-Up Time Than Duration of Clinical Anesthesia Training
We quantified the relative effect of patient demographic anesthesia staffing
and intraoperative variables on patient WUT using multiple regression. The
strongest predictors of prolonged WUT were use of paralytics, ASA physical
status and emergency case status. Underlying case differences among
CA residents have a greater impact on patient WUT than resident training
duration. Lawrence M. House II, B.A., Department of Anesthesiology,
Vanderbilt University Medical Center, Nashville, TN.
Predictors of Poor Outcome Among Elderly Liver Transplant Recipients
With the increasing age of liver transplant recipients there is a need for
tools for better risk stratification in this age group. Our study aims to identify
predictors of post transplant mortality and graft failure among liver transplant
recipients >60 years of age. Cox regression analysis showed that history
of pretransplant CAD arrhythmias and valvular heart disease are significant
predictors of post transplant outcomes in this age group. Abraham Sonny
M.D., Dympna Kelly M.D., Jacek Cywinski M.D., Anesthesiology, General
Surgery Cleveland Clinic, Cleveland, OH.
FA A5017
A Novel Risk Index for Adverse Postoperative Outcome: Validation
and Dependence Upon High-Fidelity Intraoperative Blood Pressure
Information
An association is confirmed at two different medical centers between a
novel set of indices of hypotensive exposure (periods of time exceeding
certain exposure limits for cumulative time spent at a mean arterial pressure
below certain thresholds) derived from monitor-acquired high-fidelity blood
pressure recordings and adverse patient outcome thus lending support to
their proposed role as a tool for prioritizing postoperative care and potentially
a basis for intraoperative clinical decision support (DSS alert) functionality in
real time aimed at preempting worsened outcome by minimizing unwarranted
hypotensive exposures. Wolf H. Stapelfeldt M.D., Jesse M. Ehrenfeld
M.D., Pamela Bromley M.B.A., Jarrod Dalton Ph.D., Marc Reynolds
M.S., Bhaswati Ghosh M.S., General Anesthesiology, Cleveland Clinic,
Cleveland, OH, Department of Anesthesiology, Vanderbilt University
Nashville, TN.
NA Neuroanesthesia
PN Pain Medicine
139
FA A5018
A Novel Risk Index Portending Adverse Postoperative Outcome
Based on the Number of Intraoperative Hypotensive Exposure Limits
Exceeded
An association exists between the indices of hypotensive exposures (number
of exposure limits exceeded for cumulative time spent below certain mean
arterial pressure thresholds) and adverse patient outcome. These indices
may thus serve as a novel readily available risk stratification tool for
identifying patients at increased risk for adverse outcome thereby allowing
their postoperative care to be prioritized. Furthermore through decision
support notification in real time worse outcome may be preempted by
minimizing unwarranted hypotensive exposures. Wolf H. Stapelfeldt, M.D.,
Jarrod Dalton, Ph.D., Eric Hixson, Ph.D., Pamela Bromley, M.B.A., Jacek
Cywinski, M.D., Marc Reynolds, M.S., Bhaswati Ghosh, M.S., General
Anesthesiology, Quantitative Health Sciences, Quality & Safety Institute,
PD17-1 RESPIRATION: VENTILATION LUNG MECHANICS AND GAS
EXCHANGE
ROOM 125
FA A5019
Risk Factors For Postoperative Pneumonia: A Retrospective Analysis
We sought to identify risk factors for postoperative pneumonia by evaluating
a variety of preoperative and intraoperative variables. We found that receiving
a long-acting neuromuscular blockade longer length of time in the operating
room and not receiving neostigmine during surgery were associated with an
increased risk for developing post operative pneumonia. Jesse M. Ehrenfeld,
M.D., M.P.H., Shane Selig, Barbara J. Martin, R.N., Roger Dmochowski,
M.D., Catherine M. Bulka, M.S., Anesthesiology, Vanderbilt University,
Nashville, TN.
FA A5020
Tidal Volume in the Operating Room for Patients Without Lung Injury
It is unknown whether a lung protective low tidal volume ventilation strategy
as defined by the ARDSNet Trial is used in the operating room for patients
without acute lung injury. Our observational study showed that in our
institution compared to an ideal tidal volume of 6 ml/kg predicted body
weight patients are ventilated with higher tidal volumes. Women and those
with a higher BMI were found to receive higher tidal volumes than men
and those with a lower BMI. Anesthesia providers may have a difficult time
estimating predicted body weight when setting intraoperative tidal volumes.
Kayla G. Bryan M.D., Barbara Phillips Bute Ph.D., Thomas Hopkins
M.D., Ryan J. Fink M.D., Anesthesiology, Duke University Medical
Center, Durham, NC
FA A5021
Preoxygenation in the Head-up Position Increases Non-Hypoxic Apnea
Duration in the Elderly - A Randomized Controlled Trial
Preoxygenation is a widely practiced strategy to increase the duration
of non-hypoxic apnea of paralyzed patients. No studies however have
evaluated this strategy in elderly patients. Our results indicate that providing
preoxygenation to elderly patients in the 2186; head-up position increases
the duration of non-hypoxic apnea after the induction of anesthesia.
The benefit was offset by a greater decrease of blood pressure levels of
patients positioned head-up when compared to patients preoxygenated
supine. Mauricio Daher M.D., Ph.D., Edno Magalhaes M.D., Ph.D.,
Catia S. Goveia, M.D., M.S. Luis Claudio A. Ladeira M.D., Juliana A.
Souza, M.D., Andre M. O. Melo, M.D., Department of Anesthesiology,
Universityersidade de Brasilia, Brasilia, Brazil.
140
FA A5022
Comparison of Mechanical Ventilation With Constant and Decelerating
Inspiratory Flows by Assessing Lung Functional and Structural Changes
in a Rabbit Model of Acute Lung Injury
No difference in respiratory mechanics and regional ventilation could be
detected between constant flow volume controlled and pressure regulated
volume control mode with decelerating flow in healthy and surfactant
depleted rat lung. Walid Habre M.D., Ph.D., Ferenc Petak Ph.D.,
Iliona Malaspinas Student, Gergely Albu M.D., Ph.D., Camille Doras
Ph.D., Liisa Porra Ph.D., Sam Bayat M.D., Ph.D., Anesthesiology,
Pharmacology and Intensive Care University Hospitals of Geneva,
Geneva, Switzerland, Department of Medical Physics and Informatics
University of Szeged, Szeged, Hungary, Department of Physics,
University of Helsinki, Helsinki, Finland, Pediatric Lung Function
Laboratory University of Picardie Jules Verne, Amiens, France.
FA A5023
Low-Level Pressure Support Ventilation With CPAP Prevents
Desaturation With Induction in Morbidly Obese Patients
44 morbidly obese patients received 2 min of preoxygenation either by
neutral pressure or by 5 cm H2O CPAP / 5 cm H2O pressure support prior
to a rapid-sequence induction. The latter group had significantly higher postinduction pO2 and no desaturation episodes compared to controls.
J. F. Hesselvik, M.D., Ph.D., Waldemar Gozdzik, M.D., Ph.D., Piotr
Harbut, M.D., Ph.D., Richard Marsk, M.D., Ph.D., Elsa Stjernfalt, M.D.,
Department of Anesthesia and Intensive Care, Department of Surgery,
Danderyd Hospital, Stockholm, Sweden, Department of Anesthesiology,
Wroclaw University Hospital, Wroclaw, Poland.
FA A5024
Feasibility of Electric Impedance Tomography Based PEEP-Titration in
Morbidly Obese Patients During Anesthesia
Electric Impedance Tomography based PEEP-titration in morbidly obese
during anesthesia is feasible resulting PEEP values are higher than
commonly used and in the same range as obtained by dynamic compliance.
Christian Nestler, M.D., Philipp Simon, M.D., Soren Hammermuller, R.N.,
Daniela Kamrath, Student, Luciana M. Camilo, M. Eng., Alessandro
Beda, Ph.D., Arne Dietrich, Ph.D., Andreas W. Reske, Ph.D., Udo X.
Kaisers, Ph.D., Hermann Wrigge, Ph.D., Department of Anesthesiology
and Intensive Care, Medicine, Integrated Research and Treatment Center
(IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany,
Inst. of Biophysics Carlos Chagas Filho, Federal University of Rio de
Janeiro, Rio de Janeiro, Brazil, Department of Electronic Engineering
Federal University of Minas Gerais, Belo Horizonte, Brazil.
FA A5025
Effects of Individualized PEEP-Adjustment in Obese Patients
Undergoing Bariatric Surgery
In obese patients undergoing bariatric surgery, inhomogeneity of lung
inflation can be minimized by lung recruitment and PEEP-titration guided
by Electric Impedance Tomography resulting in higher PEEP than commonly
recommended. Philipp Simon, M.D., Christian Nestler, M.D., Soren
Hammermuller, R.N., Maria Thiele, Student, Luciana M. Camilo,
M. Eng., Alessandro Beda, Ph.D., Arne Dietrich, Ph.D., Andreas W. Reske,
Ph.D., Udo X. Kaisers, Ph.D., Hermann Wrigge, Ph.D., Department of
Anesthesiology and Intensive Care, Medicine, Department of Surgery,
Integrated Research and Treatment Center (IFB) Adiposity Diseases
University Hospital, Leipzig, Germany, Inst. of Biophysics Carlos Chagas
Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,
Engineering School, Federal University of Minas Gerais, Belo Horizonte,
Brazil.
NA Neuroanesthesia
PN Pain Medicine
Minimal Impairment in Pulmonary Gas Exchange Following
Laparoscopic Surgery
In this observational study of 60 women undergoing laparoscopiccholecystectomy or - hysterectomy pulmonary gas exchange was only
minimally impaired 2 and 24 h after surgery compared to preoperative
values. Anne K. Staehr-Rye M.D., Lars S. Rasmussen M.D., Ph.D., Jacob
Rosenberg M.D., Ph.D., Christian S. Hansen M.D., Therese F. Nielsen
M.D., Helle V. Clausen M.D., Ph.D., Charlotte V. Rosenstock M.D., Ph.D.,
Jakob von H. Regeur M.D., Mona R. Gatke M.D., Ph.D., Department
of Anesthesiology, University of Copenhagen, Herlev Hospital, Herlev,
Denmark, RigsHospitalet, Copenhagen, Denmark, Hillerod Hospital,
Hillerod, Denmark.
ROOM 123
2-Methacryloyloxyethl Phosphoryl Choline Covering the Endotracheal
Tube Cuff May Prevent Respiratory Tract Mucosa Damage
2-methacryloyloxyethl phosphoryl choline (MPC) is similar in structure to
molecules constituting the cell membrane and suppresses inflammatory
reactions decreases the frictional coefficient. We hypothesized that if the
cuff of the endotracheal tube is coated with MPC the tube might have less
impact on the respiratory tract mucosa. Sixty patients scheduled to undergo
surgery were enrolled. In 30 patients the cuff of the endotracheal tube
was coated with MPC. It was expected that if the respiratory tract mucosa
is damaged mucosal epithelia might attach to the cuff of the endotracheal
tube. The cell attachment rate was calculated. The mean rates of cell
attachment to the cuff in the control and MPC groups differed significantly
at 15.4% and 1.2% respectively. Tadashi Okayasu M.D., Ph.D., Kazumasa
Yasumoto M.D., Ph.D., Department of Anesthesiology, Showa University
School of Medicine Tokyo, Japan.
FA A5031
FA A5027
Respiratory Pause Detection and False Alarms from Capnography and
Acoustic Monitoring in Procedure Related Sedation
Drugs administered for procedure related sedation can cause respiratory
depression. Analysis of closed claims identified detection of these events as
a method to prevent complications. Compared to nasal cannula capnometry
acoustic respiratory monitoring had better positive predictive value for
detection of respiratory pauses ≥15 sec in adults undergoing procedure
related sedation. Richard Applegate II M.D., John Lenart M.D., Mathew
Malkin M.D., Mark Macknet M.D., Anesthesiology, Loma Linda
University School of Medicine, Loma Linda, CA.
FA A5028
Emergency Cricothyroidotomy by Inexperienced Clinicians - Surgical
Versus Indicator-Guided Technique
In this human cadaver study on emergency cricothyroidotomy the indicatorguided puncture technique produced more complications and more failures
than the standard surgical technique. In the hand of the inexperienced
the standard surgical approach seems to be a safe procedure which can
successfully be performed within an adequate time. The indicator-guided
technique cannot be recommended for inexperienced operators. Matthias
Helm M.D., Bjorn Hossfeld, M.D., Christian Jost, M.D., Lorenz Lampl
M.D., Department of Anaesthesiology and Intensive Care Medicine,
Armed Forces Medical Centre, Ulm, Germany.
FA A5029
FA A5030
FA A5026
Use of Non-Invasive Respiratory Volume Monitoring in Postoperative
Cardiac Surgery Patients Following Extubation
Early detection of respiratory compromise following extubation could improve
outcomes. Non-invasive respiratory volume monitor (RVM) traces during the
first 60 min post-extubation showed (in real time) that MV & TV decreased
in the first 30 minutes post-extubation compared to pre-extubation values
(p<0.05), while RR and O2 saturation remained practically unchanged. In
the next 30 minutes, MV & TV improved, returning to pre-extubation baseline
in those who were successfully extubated. It is hypothesized that those who
fail to return to baseline within 60 minutes may need further intervention.
Ongoing work will continue to evaluate the capability of RVM to provide
early warning of respiratory compromise, and improve patient safety. Stefan
Ianchulev, M.D., C. Marshall MacNabb, M.S., Jordan Brayanov, Ph.D.,
Jenny Freeman, M.D., Tufts Medical Center, Boston, MA, Respiratory
Motion, Inc., Waltham, MA.
Clinical Evaluation of End Tidal CO2 Measurement During Noninvasive
Ventilation
We evaluated a method of calculating end-tidal CO2 during noninvasive
ventilation. Our method uses the CO2 and flow signals as measured between
the mask and the exhalation port. We compared our results against PaCO2
measured by arterial blood gas in seven patients. The average difference in
the measurements was -5.6 mm Hg. Joseph Orr Ph.D., Branden Rosenhan
M.D., Lara M. Brewer Ph.D., Boaz Markewitz M.D., Anesthesiology,
Medicine Pulmonary Division, University of Utah Health Sciences Center,
Salt Lake City, UT.
FA A5032
LINSHOM: A New Respiratory Monitor
LINSHOM is a non-invasive portable device that measures respiratory rate
and estimates tidal volume in humans by measuring the temperature in
the exhaled breath. We found that Linshom detected apnea measured the
respiratory rate and estimated tidal volume between 50 and 1000 mL
(r2 = 0.79). Madhankumar Sathyamoorthy M.B. B.S., Jerrold Lerman,
M.D., Doron Feldman, M.D., Ronen Feldman, B.S., John Moser, B.S., Uri
Feldman, Ph.D., University of Mississippi Medical Center, Jackson, MS,
Women and Children’s Hospital of Buffalo, SUNY at Buffalo, Buffalo, NY.
FA A5033
Detection of Respiratory Pauses by Clinical Observation: Capnography
and Acoustic Monitoring
When compared to clinical observation or capnography rainbow acoustic
monitoring may provide the best method for detection of respiratory pause
during procedures requiring sedation because it has acceptable accuracy
for detection of respiratory pause with a low rate of false alarms. Pedro
P. Tanaka, M.D., David Drover, M.D., Maria Tanaka M.D., Anesthesia,
Stanford University School of Medicine, Stanford, CA.
FA A5034
The Changing Scope of Difficult Airway Management
The introduction of video-laryngoscopes has resulted in dramatic changes
to how we secure difficult airways over the past decade. We analyzed 524,
668 AIMS records to identify institutional airway management trends. Usage
of videolaryngoscopes rose, FOI decreased and bougie use increased.
Interesting while usage of SGAs rose, the overall rate of subjectively difficult
intubations declined. Our data suggest that technology-driven change
sparked by guidelines promulgated by the ASA has led to shifts in how we
manage the airway. Jonathan P. Wanderer, M.D., Jesse M. Ehrenfeld,
M.D. M.P.H., Warren S. Sandberg, M.D., Ph.D., Richard H. Epstein, M.D.,
Departments of Anesthesiology and BioMedical Informatics, Vanderbilt
University, Nashville, TN, Department of Anesthesiology, Jefferson Medical
College, Philadelphia, PA.
NA Neuroanesthesia
PN Pain Medicine
141
The following contributors for ANESTHESIOLOGY™ 2013 have reported financial relationships with commercial interests:
Basem Abdelmalak
Aspect medical acquired by Cavidian, Funded Research
Gareth Ackland
AMS/HealthFoundation; NIHR UK,
Funded Research
Takehiko Adachi
Hospira Japan Inc., Funded Research; Maruishi Pharmaceubcal Co. Ltd.,
Consulting Fees
Zohaib Akhtar
Merck, TSI, Funded Research
Bernard Allaouchiche
Advanced Perfusion Diagnostics, Funded Research
Nawar Al-Rawas
Convergent Engineering, Funded Research
Pedro Amorim
Merck Sharpe & Dohme, LDA,
Consulting Fees
J. Ansermino
GE Healthcare, Consulting Fees;
Draeger, Funded Research
Mark Ansermino
LionsGate Technologies, Ownership
Toshiki Aoki Nihon Kohden Corporation,
Salary
Richard Applegate
Baxter, Masimo, Funded Research
Keith Aqua
AcelRx Pharmaceuticals, Funded
Research
Fernando Arbona
Cumberland Pharmaceuticals, Funded
Research
Carlos Artime
Cadence Pharmaceuticals; Funded
Research, Honoraria; Mylan
Pharmaceuticals, Honoraria
Sabry Ayad
Cumberland Pharmaceuticals, TSCI,
Funded Research
Jean-Yves Ayoub
Advanced Perfusion Diagnostics,
Funded Research
Michael Aziz
Karl Storz Endoskope, Funded Research,
Consulting Fees
Steve Bader
Grifols Biotherapeutics USA, Covidien,
Inc., Consulting Fees, Honoraria
James Baumgardner
Oscillogy LLC, Ownership
Joel Baumgart
National Institutes of Health Grant,
Funded Research
Sergio Bergese
Cumberland Pharmaceuticals, Eisai
Pharmaceuticals, Funded Research
Baptiste Bessière
Air Liquide Santé International, France,
Salary
Hervé Besson
Merck, Salary
142
Philip Bickler
Masimo Inc., Honoraria, Other
Material Support; Various Pulse Oximeter
Manufacturers, Other Material Support
Antonio Bismarck
Merck Sharpe & Dohme, LDA,Consulting
Fees, Other Material Support
Manfred Blobner
MSD, Funded Research, Consulting Fees
James Blum
Retia Medical, Funded Research,
Consulting Fees
Andre Boezaart
Teleflex Medical, Royalties, Consulting
Fees; Elsevier, Royalties
Fanny Bonhomme
Astra Zeneca, Honoraria
Alberto Bonifacio
Pfizer, Abbott, Honoraria
Jeanne-Marie Bonnet-Garin
Advanced Perfusion Diagnostics, Funded
Research
David Boyer
Research
Barbara Brandom
The Malignant Hyperthermia Association
of the United States (MHAUS), Funded
Research
Jordan Brayanov
Respiratory Motion, Inc., Salary, Stock
Options
Lara Brewer
Philips Medical, Funded Research,
Consulting Fees, Other Material Support
Britta Brueckmann
Merck, Funded Research
Chad Brummett
Purdue Pharma, The University of
Michigan has filed for a patent
application covering the subject matter
of this publication. Brummett, CM,
Inventor; The Regents of the University of Michigan, Assignee; Anesthetic,
Consulting Fees
Kyle Burk
Axon Medical Inc., Salary
Alexander Butwick
Haemonetics, Other Material Support
Asokumar Buvanendran
Pfizer, NIH, Cumberland
Pharmaceuticals, Funded Research
Keith Candiotti
Research
Maxime Cannesson
Edwards LifeSciences, Covidien, Masimo
Corp., Philips Medical Systems,
Fresenius Kabi, Consulting Fees; Sironis,
Equity Position
Xavier Capdevila
General Electric Healthcare, Philips
Healthcare, Other Material Support
David Caraway
Jazz Pharmaceuticals, Consulting Fees,
Honoraria
Juan Cata
Hospira, Funded Research
Davide Cattano
Haemonetics Corporation, Other Material
Support
Alan Chaput
Merck Canada, Honoraria
Hegang Chen
US Air Force, Funded Research
A Chima Gradian Health Systems LLC.,
Funded Research
Olivier Choquet
General Electric Healthcare, Philips
Healthcare, Other Material Support
Daniel Clauw
Purdue Pharma, Pfizer, Johnson and
Johnson, Forest Pharmaceuticals, Nuvo,
Eli Lilly, Grunenthal Pharma, Ltd., Jazz
Pharma, Consulting Fees; Merck,
Funded Research, Consulting Fees
Edmond Cohen
Cook Critical Care, Honoraria
Sean Cohen
Assurance Biosense, Salary, Stock
Options
Carl Collier
Masimo, Funded Research
Albert Dahan
Galleon Pharmaceuticals, Salary, Stock
Options, Funded Research
Jarrod Dalton
Covidien, Funded Research
Shalom Darmanjian
Convergent Engineering, Salary
Louis Delacretaz
Cortical Dynamics Ltd, Stock Options,
Consulting Fees
Genevieve DeMaria
Pfizer, Abbott, Funded Research
Etienne DeMedicis
Donn Dennis
Xhale, Inc. (Assurance Biosense wholly-owned subsidiary), Salary,
Ownership, Royalties, Equity Position,
Stock Options, Funded Research;
NanoMedex Therapeutics, Inc., Equity
Position; University of Florida, Salary,
Royalties
Gildasio DeOliveira
Baxter HealthCare Corporation, Other
Material Support
Fiona Desmond
Eccles Unit for Breast Cancer Research,
Sisk Foundation, Funded Research
Peter DeSocio
Research
Philip Devereaux
Louis-Philippe Fortier
John Fox
Philips Healthcare, Other Material
Support
Jenny Freeman
Respiratory Motion, Inc., Salary, Equity
Position
Alex Fu
Andrea Gabrielli
Convergent Engineering, Funded
Research
Andre Galarneau
Merck Canada, Salary
Tong Gan
Cumberland Pharmaceuticals, Cara
Therapeutics,Premier, Inc., AcelRx,
Cheetah Medical, Acacia, Merck,
Pacira, Funded Research; Fresnius,
Funded Research, Honoraria; Hospira,
Consulting Fees, Honoraria, Baxter,
Cadence, Honoraria
Kishor Gandhi
B-Braun Inc.,Consulting Fees
Mona Gätke
Merck & Co., Consulting Fees, Honoraria
Mona Ring Gätke
Merck, Consulting Fees, Honoraria
Bhaswati Ghosh
Talis Clinical, LLC., Salary, Ownership,
Royalties, Equity Position
Anne Godier
CSL Behring, Octapharma, LFB, Bayer,
Boehringer-Ingelheim, BMS-Pfizer,
Sanofi, Honoraria
Francis Golder
Options
Blandina Gomes
Merck Sharpe & Dohme, LDA, Other
Material Support
Juan Gómez-Arnau
ProStrakan, Consulting Fees, Honoraria;
Glaxo Smith Kline, Abbott, Honoraria
Toru Goyagi
ONO PHARMACEUTICAL CO., LTD.,
Funded Research
Jeffrey Green
Covidien, Consulting Fees, Honoraria
David Griffin
Research
Eric Grigsby
Jazz Pharmaceuticals, Flowonix, Funded
Research, Consulting Fees; Medtronic,
Funded Research, Consulting Fees,
Honoraria; Palyon, Consulting Fees
Leanne Groban
National Institutes of Health, Anesthesia
Patient Safety Foundation, Funded
Research
Peter Grobara
MSD, Salary
Scott Groudine
Merck & Co. Inc., Funded Research,
Ashraf Habib
Merck, Honoraria, Other Material
Support
Walid Habre
Maquet Critical Care AB, Solna, Sweden,
Funded Research
Carin Hagberg
Ambu A/S, Funded Research, Honoraria;
Aircraft Medical, Karl Storz Endoscopy,
King Systems, Clarus, Cook Medical,
Mercury, Olympus, Verathon, Other
Material Support; LMA, Honoraria, Other
Material Support
Tae Soo Hahm
CJ Pharmaceutical, Funded Research
Charles Hamilton
Research
Scott Harris
Adynxx Inc, Salary, Equity Position
Craig Hartrick
Pacira, Funded Research; Incline,
Consulting Fees; Wiley, Royalties
Jean Hazebroucq
Salary
Kimberly Hebert
Adynxx Inc., Salary, Equity Position
Matthias Helm
Karl Storz, Tuttlingen, Germany, Other
Material Support
Hugh Hemmings
Anesthesiology, British Journal of
Anaesthesia, Honoraria; National
Institutes of Health, Consulting Fees
Jan Hendrickx
Draeger, GE, Maquet, Heine and
Lowenstein, AbbVie, Consulting Fees,
Honoraria
Jens Henning
Funded Research
Matthias Heringlake
Roche Diagnostics, Mannheim,
Germany, Other Material Support;
Covidien, Orion Pharma, Carinopharm,
Honoraria; Edwards Lifesciences,
Consulting Fees, Honoraria; Gambro
Hospal, Funded Research, Honoraria; Air
Liquide, Funded Research
Brian Hesler
Merck, TSCI, Funded Research
Christoph Hofer
Pulsion Medical Systems, CSL Behring,
Consulting Fees; Edwards Lifesciences,
Salary, Consulting Fees
Sonja Hokett
Jazz Pharmaceuticals, Salary, Stock
Options
John Holaday
QRx Pharma Inc., Salary, Equity Position,
Stock Options
Takashi Horiguchi
ONO Pharmaceutical CO., LTD, Funded
Research
DISCLOSURES
Scott Devine
Merck, Sharp & Dohme, Corp., Salary,
Equity Position
Franklin Dexter
University of Iowa, Salary
Volker Doerges
Karl Storz, Tuttlingen, Germany,
Consulting Fees
Timur Dubovoy
Merck, Sharp and Dohme Corp., Funded
Research
Guy Dumont
NeuroWave Systems Inc., Royalties;
GE Healthcare, Consulting Fees;
Draeger, Funded Research; Lionsgate
Technologies, Ownership
Mark Eckman
Foundation for Informed Medical
Decision Making. Role: PI, NIH/NCRR
(1U54 RR 025216). Role: Informatics
Co-Director, Office of the National
Coordinator for Health Information
Technology (90BC0016/01), Pfizer
Medical Education Group, National Heart
Lung & Blood Institute, HCA International
Perioperative Fellowship, Funded
Research
Matthias Eikermann
Merck, Pfizer, ResMed Foundation,
Funded Research; Hill-Rom, Honoraria
Richard Epstein
MDA Ltd., Ownership
Natali Erminy
Eisai Pharmaceuticals, Funded Research
Frank Ernst
Premier, which contracted with Deltex
Medical to conduct the study, Salary
Thomas Errico
AOSpine, Paradigm Spine, OREF,
Omega, Fridolin, Other Material
Support; K2M, Fastenetix, Royalties
Jean-Pierre Estebe
Nutrialys SA, Funded Research
Simao Esteves
Merck Sharpe & Dohme, LDA,
Consulting Fees, Other Material Support
Neil Euliano
Convergent Engineering, Ownership
Tammy Euliano
Convergent Engineering, Ownership
John Feiner
Masimo Inc., Oximeter Manufacturers,
Other Material Support
Doron Feldman
LINSHOM LLC, Equity Position
Ronen Feldman
Uri Feldman
Hein Fennema
MSD, Salary
Patrick Finnegan
Pierre Fontana
Evolva, AstraZeneca, Funded Research;
CSL Behringer, Bayer, Honoraria
143
Yuta Horikoshi
ONO Pharmaceutical CO., LTD, Funded
Research
Paul Hoskins
Options
Björn Hossfeld
Material Support
Fu-Ming Hu
US Air Force, Funded Research
Billy Huh
St. Jude Medical, Consulting Fees,
Boston Scientific, Honoraria
Jacob Hutchins
Pacira, I-Flow, Honoraria
Brian Ilfeld
Baxter Healthcare, Funded Research
Masayuki Inoue
Nihon Kohden Corporation, Salary
Takashi Ishida
Japan Tobacco, Inc., Other Material
Support
Bernard Iung
Servier, Boerhinger Ingelheim, Bayer,
Valtech, Abbott, Consulting Fees;
Edwards Lifesciences, Saint Jude
Medical, Sanofi-Aventis, Honoraria
Giorgio Ivani
GE, Consulting Fees
Samir Jaber
Maquet, Draeger, Hamilton Medical,
Fisher Paykel, Abbott, Funded Research,
E Jackson
Gradian Health Systems LLC., Funded
Research
Matthias Jacquet-Lagreze
Research
Jonathan Jahr
Organon/Schering-Plough, Merck,
Funded Research, Honoraria
Leslie Jameson
GE Healthcare - International Advisory
Board: Travel Expenses, Masimo Advisory Board: Travel Expenses, Other
Material Support
Erik Jensen
Aircraft Medical, Equity Position
R Jones
Merck, Funded Research, Honoraria
Girish Joshi
Pfizer, Baxter, Cadence, Pacira, Edwards
Life Sciences, Mallinkrodt, Honoraria
Mathieu Jospin
Quantium Medical SL, Salary
Maurice Jove
Research
Boris Jung
Merck, Honoraria
Stéphane Junots
Research
144
Arun Kalava
New York Methodist Hospital, Funded
Research
Mikito Kawamata
Japan Tobacco Inc., Other Material
Support
Babak Khabiri
Cumberland Pharmeceuticals, Funded
Research
Sandrine Khairallah
Consulting Fees
Victor Khangulov
Hospira, Inc., Consulting Fees
Sachin Kheterpal
Merck, Sharp and Dohme Corp., Funded
Research
Karin Khuenl-Brady
MSD, Funded Research
Peter Kienbaum
Air Liquide Santé Internationale, Funded
Research, Consulting Fees; Mölnlycke,
Baxter, Consulting Fees
Se-Chan Kim
Society of Cardiovascular
Anesthesiologists, Funded Research
Won Ho Kim
CJ Pharmaceutical, Funded Research
Raymond Koehler
NIH R01,Funded Research
R Koka
Research
Nicholas Kormylo
M Koroma
Gradian Health Systems LLC., Other
Material Support
Yoshifumi Kotake
Edwards Lifesciences, Consulting Fees;
Nohon Koden Corp., MSD, Funded
Research
George Kramer
Arcos, Resuscitation Solutions,
Ownership
Michelle Krukas
Premier, which contracted with Deltex
Medical to conduct the study, Salary
Tobias Kurth
Allergan, Merck, MAP Pharmaceutical,
Honoraria
Andrea Kurz
Aspect Medical, Merck, TSCI, Covidien,
Funded Research
Peter Lacouture
Hospira, Inc., Salary
Virginie Lafage
International Spine Study Group,MSD,
K2M, DePuy Spine, Other Material
Support; Nemaris, LLC, Stock Options,
Other Material Support; Medtronic,
Consulting Fees;
Filipa Lagarto
Merck Sharpe & Dohme, LDA, Other
Material Support
Chinglin Lai
Jazz Pharmaceuticals, Salary, Stock
Options
Christine Lamontagne
Janssen Pharmaceuticals Inc., Honoraria
Lorenz Lampl
Material Support
Ruth Landau
Millennium Research Institute, Funded
Research
Sigismond Lasocki
ViforPharma, Consulting Fees
Yannick Le Manach
Air Liquide Sante, Consulting Fees;
Masimo Corp., Fresenius Kabi, Other
Material Support
Benjamin Lee
Research
Haemi Lee
Yeungnam University, Funded Research
Hendrikus Lemmens
Merck, Funded Research
John Lenart
Masimo, Funded Research
Michael Leong
Jazz Pharmaceuticals, Consulting Fees,
Honoraria
Jerrold Lerman
LINSHOM LLC, Ownership, Equity
Position; Abbott Canada, Honoraria;
Piramal, Other Material Support; Elsevier
Publisher, Royalties
Michael Li
Merck, Salary
Yan Li
Yichang Humanwell Pharmaceutical
Co., Ltd., Funded Research, Other
Material Support
David Liley
Cortical Dynamics Ltd., Salary, Stock
Options
Marina Lin
National Institutes of Health, Funded
Research
Steven Lisco
EndoEthicon Surgery, Consulting Fees
Hong Liu
Edwards Lifescience, LLC, Funded
Research
Jin Liu
Material Support
Rong Liu
Material Support
Vanessa Loland
Tricia Meyer
Merck & Co., Inc., Funded Research,
Honoraria
Lance Meyers
Galleon Pharmaceuticals, Consulting
Fees
Thomas Miller
American Society of Anesthesiologists,
Salary
Timothy Miller
Covidien. Edwards, Consulting Fees
Eric Mills
LiDCO PLC, Salary, Royalties, Equity
Position, Stock Options, Honoraria,
Other Material Support
Lauren Min
Hospira, Inc., Salary
Harold Minkowitz
Merck & Co., Inc., Funded Research,
Consulting Fees, Honoraria; Incline
Therapeutics, Funded Research;
Cadence Pharmaceuticals, Pacira,
AcelRx, Funded Research, Honoraria
Michael Misbin
Edwards Lifesciences, Funded Research
Ludmil Mitrev
Edwards Lifesciences, Funded Research
Katsuyuki Miyasaka
Nihon Kohden Corporation, Other
Material Support
Kiyoyuki Miyasaka
Nihon Kohden Corporation, Other
Material Support
Kentaro Mizuta
Takeda Science Foundation, Funded
Research
Daria Mochly-Rosen
ALDEA, Ownership
Philipe Montravers
Astellas, Astra Zeneca, Eli Lilly,
Fresnius,Pfizer, Consulting Fees; Gilead,
Honoraria;Merck Sharp and Dohme Chibret, Consulting Fees, Honoraria
Ramani Moonesinghe
University College London Hospital/
University College London Biomedical
Research Centre, National Institute
of Health Research (NIHR) Biomedical
Research Centre funding scheme,
London, United Kingdom, Surgical
Outcomes Research Centre, NIAA/
UCL;UCLH/UCL Joint Comprehensive
Biomedical Research Centre which
receives funding from the UK
Department of Health’s National
Institute for Health Research Centres’
funding scheme, Funded Research
Timothy Morey
Xhale, Inc., Equity Position, Stock
Options, Funded Research, Consulting
Fees; NanoMedex Therapeutics, Inc.,
Equity Position
John Moser
Jonathan Moss
Salix Pharmaceuticals, Consulting Fees
Kimmo Murto
Janssen Pharmaceutical Inc., Funded
Research
Michael Mythen
UCLH/UCL Joint Comprehensive
Biomedical Research Centre which
receives funding from the UK
Department of Health’s National
Institute for Health Research Centres’
funding scheme; National Clinical Lead,
Enhance Recovery Programme, England,
Consulting Fees
Antoun Nader
Pfizer, Inc., Funded Research
Peter Nagele
Roche Diagnostics, Express Scripts,
Funded Research
Martin Neukirchen
Air Liquide Santé Internationale, Funded
Research
Jens Neumann
Society of Cardiovascular
Anesthesiologists, Salary, Funded
Research
Hiroyuki Nishie
Takeda Pharmaceutical Company,
Stock Options; Sasagawa Memorial
Health Foundation, Funded Research
Toshiaki Nishikawa
ONO PHARMACEUTICAL CO., LTD.,
Funded Research
Nathalie Noel
Salary
Mafalda Nogueira
Merck Sharpe & Dohme, LDA, Salary,
Ownership, Consulting Fees, Oth

ANES2013 Abstract Guide FINAL

Transcription

Similar documents

Program - NYSORA.com

Anestesi vid kejsarsnitt

The ASA-GHO Resident International Anesthesia Scholarship in

sleepy times - Clinical Departments

Anesthesia Residency Brochure - Loma Linda Department of

Vigilance - Augusta University

Post Anesthesia Care

Penn State Anesthesiology News

brochure - Ghaly Neurosurgical Associates

Subcutaneous Port Catheter (Port, porta