Browsing Department of Anesthesiology and Perioperative Medicine by Issue Date
Now showing items 1-20 of 34
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Absolute cerebral oximeters for cardiovascular surgical casesIn the US, about 465,000 cardiopulmonary bypass grafting (CABG) procedures are performed every year. Decreases in oxygen levels occur in about 17-23% of CABG procedures which cause brain injury even in uncomplicated surgeries, and may lead to stroke, cognitive dysfunction, longer ventilation times; longer ICU and hospital stays, and higher health care costs. Because of the brain’s high metabolic rate with limited oxygen reserves, only about 10 seconds at normal body temperature makes the brain is susceptible to oxygen deprivation. A study on patients who underwent CABG surgery found that incidence of cognitive decline was 53% at discharge and 42% at 5 years (Newman, 2001). Furthermore, elderly patients are more likely to develop cerebral desaturation because of age-related reductions in physiologic reserve (Casati, 2005), and the number of surgeries involving older patients is on the rise.
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Vigilance at GRUTable of Contents: 3 Faculty and Staff News; 4 Wu: Physician, Investigator, Resident, Graduation and Awards Banquet, "Small" News; 5 Recognition, FCCS Workshop to Offer Training for Noncritical Care Specialists; 6-9 A Celebration of 75 Years of Anesthetic Excellence, Saluting Our Veteran Anesthesiologists and Nurse Anesthetists; 10-11 Publications, Presentations and Research.
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Vigilance at Georgia Health Sciences UniversityTable of Contents: 3 Faculty and Staff News; 4 Chief Resident Anderson: A passion for medicine; 6 Angie Skinner: Blissit award finalist 'always several steps ahead,' Classroom gets an IT makeover; 7 Orthopedic surgeon 'walks a mile' in anesthesiologist's shoes, Publications, Presentations and Research.
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Vigilance at Georgia Health Sciences UniversityTable of Contents: 3 Respiratory Therapy Receives EPA Award of Excellence, Accomplished researched named Professor, other faculty and staff news; 4 Gale looking forward to retirement, Gregoretti bids department 'arrivederci,' GHSU holds rainly inaugural Earth Day; 5 Alumna of notes: DeCore reminisces about days as a resident; 6 Emergence delirium discussed at Latin American symposium, Thalidomide analog holds hope as sickle cell treatment, What's That? Masks; 7 Publications, Presentations, and Abstracts, and Research.
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Vigilance at Georgia Health Sciences UniversityTable of Contents: 3-4 Faculty and Staff News; 5 Our First Reception at ASA, In Memoriam: Dr. Jack K Pruett; 6 Zack Gramling: Creating a Legacy; 7 New Name, New Web site, New Email, 'Healthy Perspectives to Improve Cultural Competency at GHSU; 8 Nitric Oxide, Aptamers Could Treat Sickle Cell Disease; 9 Dr. Berger Plans to Combat Pain, Rapid Response Team Take Quick Action; 10 Publications, Presentations and Abstracts, and Research.
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Hydroxyurea induces fetal hemoglobin expression by activating cAMP signaling pathways in a cAMP- and cGMP-dependent mannerHere we show that hydroxyurea (HU) induces fetal hemoglobin (HbF) expression by activating the cAMP pathway through two independent mechanisms. Although HU increased both cAMP and cGMP levels in CD34+-derived erythroblasts, only the cAMP pathway was found to be activated. However, HU-induced HbF expression was affected by the activities of both adenylate cyclase (AC) and soluble guanylate cyclase (sGC). HU decreased the expression of cGMP-inhibitable phosphodiesterase (PDE) 3B in a sGC-dependent manner, resulting in activation of the cAMP pathway. Second, HU induced the expression of cyclooxygenase-1 (COX-1) and increased the production of prostaglandin E2 (PGE2), which resulted in activation of the cAMP signaling pathway through AC. HU therapy elevated plasma PGE2 levels in sickle cell patients. These results demonstrate that HU induces HbF expression by activating the cAMP pathway via dual signaling mechanisms.
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Transcranial Doppler measures in patients with sickle cell disease at high risk for stroke and receiving hydroxyurea: the HyRetro ancillary studyChildren with sickle cell disease (SCD) and increased transcranial Doppler sonography velocity measures are at increased risk for stroke. Although chronic transfusion decreases risk tenfold, this form of therapy is burdensome and includes risk of iron overload. Hydroxyurea therapy is effective in preventing SCD complications, although its effect in preventing SCD central nervous system complications is less clear and a matter of current investigation.
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Synergistic Enhancement of Sickle Red Blood Cell Adhesion to Endothelium by Hypoxia and Low Nitric Oxide BioavailabilityThe mechanisms underlying sickle red blood cell (RBC) adhesion to the endothelium, which constitutes a major pathologic event in sickle cell disease (SCD), are not fully understood. Adhesion of sickle RBCs to endothelial cells is believed to be regulated by multiple hematologic and physiologic factors including fetal hemoglobin levels, leukocyte count, oxygen tension, inflammatory cytokines, and nitric oxide (NO) bioavailability, but the extent to which each parameter contributes to sickle RBC adhesion remains unclear. Our objective was to examine how the adhesion of sickle RBCs to endothelium is affected by hypoxia and NO bioavailability using an in vivo system.
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Granulomatous Conduit for Intrathecal Infusion of Morphine and BupivacaineIntrathecal Drug Delivery Systems (IT-DDS) have gained widespread acceptance as a therapeutic alternative to high dose parenteral opioids for unremitting chronic pain. Granuloma formation has been reported as a side effect in association with the greater use of IT-DDS. Etiological factors include infection, reaction to catheter material, and trauma at the site of implantation. The most widely accepted etiology is the use of intrathecal morphine, with granuloma formation dependent on morphine dosage. We present the case of a woman with unremitting GI pain and IT-DDS placement who developed a granuloma at the hub of the catheter which formed a sealed conduit that re-established drug flow between the pump and catheter.
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Improving cultural competency among anesthesiology residents via virtual interactions with Hispanic standardized patientsHispanics/Latinos comprise about 15% of the US population and are the fastest growing minority in America. In Georgia, however, Hispanics represent only about 3% of the population, and health professionals training in the state may have few opportunities to interact with Hispanic patients. Language and cultural barriers, lack of health insurance, and so on, can lead to health disparities. Improved cultural competence among health care professionals can help to reverse such disparities. As such, the Medical College of Georgia at Georgia Health Sciences University (MCG) has made it a priority to improve the cultural competency of its allied health, dental, medical and nursing students through its Quality Enhancement Plan. Similarly, the anesthesiology department is planning a project in which residents will interview the standardized patient remotely via Skype and webcams, in a manner similar to the telemedicine model, then receive immediate feedback from the SP and faculty member.
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Strategies for a Successful Anesthesiology Clerkship and Rewarding Experience for Medical StudentsThe anesthesiology clerkship is a senior year selective in our institution which fulfills the critical care rotation requirement. Our clerkship has been such a popular rotation that enrollment can be quite competitive. Thanks to the dedication of our faculty and residents, students consistently report positive experiences about this rotation. Many of the medical students are not aware of the anesthesiologist’s multi- faceted role as a perioperative physician until their clerkship rotation in anesthesiology. Choosing a specialty is a difficult and stressful process. Anesthesiology continues to be a highly desirable specialty among U.S. medical students.
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General Anesthesia in an Ex-Utero Intrapartum Treatment (EXIT) Procedure for a Neonate with NAGER SyndromeIn the ex-utero intrapartum treatment (EXIT) procedure, an incision is made similar to that for a cesarean section. Following uterine incision, the baby is partially delivered by the obstetrician but remains attached to the maternal-fetal unit, allowing the pediatric surgeon to establish or secure an airway while the baby maintains oxygen saturation on utero-placental support. Once the airway has been secured, the obstetric team resumes control of the procedure, the umbilical cord is cut and clamped, and the delivery of the baby is completed. We report on an EXIT procedure performed for fetal craniofacial abnormalities secondary to Nager Syndrome.
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Thrombolytic Therapy in a Patient with an Epidural CatheterThe ability to provide comfort and relieve pain during the postoperative period is a priority in the care of the surgical patient. Epidural anesthesia is widely used to manage postoperative pain. The epidural infusion of local anesthetics combined with opioids provides excellent pain relief. It also reduces intra- and postoperative narcotic requirements, leading to earlier mobilization and faster discharge. However, epidural analgesia carries risks for the patient. This presentation reports on the risk of treating a patient with thrombolytics while receiving epidural analgesia.
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Prevention of Progressive Deterioration of Motor Evoked Potentials During General AnesthesiaThe increasing frequency and complexity of spinal column corrective procedures have aided the advancement of evoked potential monitoring. The effectiveness of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to detect iatrogenic cord ischemia during surgical manipulation has been well established. Detection followed by corrective measures can limit and/or prevent iatrogenic injuries associated with instrumentation during these corrective surgical procedures.
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Anterior Mediastinal Mass in a Patient Requiring Lung IsolationA patient with an anterior mediastinal mass poses numerous challenges to an anesthesiologist, the major concerns being pulmonary or cardiac collapse on induction of anesthesia. Preoperative evaluation of the chest x-ray as well as the CT scan is valuable in assessing potential problems regarding management of this type of airway. An awake fiberoptic intubation is the preferred method of securing the airway.
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Unanticipated Acute Adrenal Insufficiency During Emergency Thoracotomy Re-ExplorationFor the last 50 years there has been a debate over the management of corticosteroid supplementation in the context of surgical or critically ill patients. At a minimum, clinicians agree that chronic corticosteroids should be continued in the perioperative or ICU setting, however in patients without a history of steroid use, acute adrenal insufficiency as the cause of hemodynamic compromise can be an elusive diagnosis. We present a case report.
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Challenge of a Difficult Airway and Anesthetic Management in a Patient with Still's DiseaseAdult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology with articular and extra-articular (systemic) manifestations. The disorder owes its name to Sir George Frederick Still, who in 1897 described 22 children with symptoms consistent with what is currently known as systemic onset juvenile idiopathic arthritis. AOSD was established almost a century later in 1971, when Eric Bywaters encountered and described adult patients presenting with pediatric Still’s disease symptoms. Compared to rheumatoid arthritis in adults, AOSD runs a much more acute course, quite often affecting many parts of the body before settling in the various joints. Diagnosis of AOSD is difficult to establish due to the nonspecific clinical and laboratory findings. Tracheal intubation may become difficult due to impairment of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). Patients with chronic articular disease have more disability and worse prognosis than patients with only systemic symptoms.
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Use of the Video RIFL (Rigid Flexible Laryngoscope) as an Adjunct to Direct LaryngoscopyThe ASA difficult airway algorithm incorporates different modalities in its progression. It is not uncommon for the user to fail at direct laryngoscopy, thus requiring an alternate method for securing an airway. Frequently, the alternate modalities include supraglottic airways, rigid videolaryngoscopes, or flexible fiberoptic bronchoscopes. We retrospectively reviewed charts from February 2009 to February 2010 on patients intubated in the operating room using the Video RIFL.
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Vigilance at MCGTable of Contents: 3 Faculty and Staff news; 4 Who are the Aqualumni?, Rawlings believes in caring for people; 5 Medical students scope out anesthesiology, Antibiotic sponge ineffective on sternal wound infections, Critical care workshop slated for January, Study notes risks of desflurane during pediatric surgery; 6 Publications, Presentations and Abstracts, and Research.
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Neurologic Deficit Following Ultrasound Guided Femoral Nerve BlockUltrasound provides real time visualization of peripheral nerves while performing a peripheral nerve block. We present a case of post operative neural dysfunction following ultrasound guided femoral nerve block on a patient undergoing left knee arthroscopy.