• Absolute cerebral oximeters for cardiovascular surgical cases

      Arthur, Mary E.; Department of Anesthesiology and Perioperative Medicine (Georgia Regents University, 2013-02)
      In 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.
    • Anterior Mediastinal Mass in a Patient Requiring Lung Isolation

      Janardhanam, Ram; Patel, Vijay; Arthur, Mary E.; Department of Anesthesiology and Perioperative Medicine; Department of Cardiothoracic Surgery (American Society of Anesthesiologists, 2010-10)
      A 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.
    • Does CVP Correlate with Transesophageal Echocardiographic Evaluation of Right Heart Function?

      Arthur, Mary E.; Reddy, Satish V.; Mehta, Anand R.; Castresana, Manuel R.; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      Important goals in the management of cardiac patients under general anesthesia include accurate evaluation of right heart function, preload status, and assessment of fluid responsiveness. Central venous pressure (CVP) recorded from the right atrium or superior vena cava is said to reflect intravascular volume. The ability of the CVP to predict fluid responsiveness, i.e., an increase in stroke index/cardiac index following a fluid challenge, has indirectly advanced the idea that CVP is a measure of right heart function and that patients with right ventricular failure may exhibit elevated CVP. Several echocardiographic parameters including right ventricular ejection fraction, amplitude of the tricuspid annular plane systolic excursion (TAPSE) assessed by M-mode, and tricuspid annular systolic velocity recorded by Doppler tissue imaging have been used to evaluate right ventricular function.
    • Improving cultural competency among anesthesiology residents via virtual interactions with Hispanic standardized patients

      Arthur, Mary E.; Albritton, Josephine; Florentino-Pineda, Ivan; Odo, Nadine; Head, C. Alvin; Palladino, Christie; Department of Anesthesiology and Perioperative Medicine (Association of American Medical Colleges, 2010-11)
      Hispanics/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.
    • TEE to facilitate anesthetic management during thoracotamy in a patient with severe pulmonary hypertension and pulmonary venous obstruction

      Aryal, Anuj; Mehta, Anand; Arthur, Mary E.; Castresana, Manuel R.; Medical College of Georgia; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      The lateral decubitus position, use of one-lung ventilation, and the prevention and treatment of hypoxemia continue to present challenges to the anesthesiologist, particularly in the patient with pulmonary hypertension. We describe the utility of intraoperative transesophageal echocardiography in the management of a patient with severe pulmonary hypertension and pulmonary vein stenosis undergoing thoracotomy for tissue diagnosis.