• 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.
    • The Influence of Ethnicity on Visual Analog Scale Pain Ratings: Pre- and Post-Radiofrequency Application for Pain of Zygapophyseal Joint Origin

      Rogg, Schuyler A; Martinez-Lu, Kianfa; Martin, Dan C; Williams, Gwendolyn O; Hammonds, William D; Department of Anesthesiology and Perioperative Medicine (American Society of Interventional Pain Physicians, 2010-02)
      Increased scrutiny of the allocation of health care dollars makes the identification of factors influencing treatment outcomes important. Few studies have examined the relationship between ethnicity and the efficacy of chronic pain management interventions (as opposed to acute pain syndromes). Radiofrequency application (RFA) is a common treatment modality for pain due to zygapophyseal joint (z joint) disease. This survey reviewed the efficacy of RFA in African American (AA) and non-Hispanic Caucasian patients. This study is a retrospective chart review of patients who underwent RFA to the L3, L4 medial branch nerves, dorsal ramus of L4, and the accessory nerve from the S1 dorsal ramus to the L5-S1 z joint.
    • Intranasal Septal Perforation in a 4-Year-Old by an Impacted Button Battery: A Case Report and Review of the Literature

      Mattingly, Diana; Crews, Lindsay K; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      While intranasal foreign bodies account for less than 1% of pediatric emergency room visits, proper diagnosis and management is critical to minimize significant morbidity and mortality. Intranasal button batteries in particular pose a significant threat to the pediatric population as nasal mucosal necrosis, septal perforation, facial cellulitis, and lateral nasal wall necrosis can occur within hours of insertion. The incidence of impacted button batteries has risen with the increased prevalence in common electronics like hearing aids, watches, and musical greeting cards. One study estimated that button batteries comprised 7% of intranasal foreign bodies removed from pediatric patients in a 6-month period. We report a case of intranasal button battery impaction in a 4-year-old male that resulted in significant tissue injury and required general anesthesia for extraction.
    • Morbidly Obese Complex Obstetrical Patient with Undiagnosed Peripartum Cardiomyopathy and Development of Flash Pulmonary Edema in PACU

      Donald, Ranita R.; Crews, Lindsay K; Department of Anesthesiology and Perioperative Medicine (International Anesthesia Research Society, 2010-05)
      Peripartum cardiomyopathy (PPCM) is a rare disorder of uncertain etiology. Virchow and Porack first recognized the relationship between heart failure and pregnancy in the 1870s when they noted myocardial degeneration in patients who died in the postpartum period. PPCM was first described as a distinctive cardiomyopathy in 1937 by Gouley et al. Since then, much has been learned about this disease process, and better treatment options now exist. Incidence varies greatly worldwide. Reports suggest an incidence of 1 case per 299 live births in Haiti, 1 per 1000 in South Africa, and 1 per 3000-4000 in the United States. Reported mortality rates are between 18% and 56%. A latent form of PPCM has also been described. Here we describe a case of latent PPCM in a morbidly obese patient who developed dramatic flash pulmonary edema in the postanesthesia care unit.
    • Neurologic Deficit Following Ultrasound Guided Femoral Nerve Block

      Aryal, Anuj; Mayfield, James; Hammonds, William D; Department of Anesthesiology and Perioperative Medicine (Society for Ambulatory Anesthesia, 2010-05)
      Ultrasound 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.
    • Prevention of Progressive Deterioration of Motor Evoked Potentials During General Anesthesia

      O'Bannon, Robert Toney; Dubin, Stevin; Department of Anesthesiology and Perioperative Medicine (Society for Neuroscience in Anesthesiology and Critical Care, 2010-10)
      The 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.
    • Severe Compartment Syndrome Following Extravasation of Fluids in a Critically Ill Neonate

      Martinez-Lu, Kianfa; Weatherred, Ted; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Intravenous therapy is generally a safe and effective way to administer different therapies to patients of all ages. Despite its ubiquitous use in modern medicine, it is not devoid of complications. Hematoma formation, phlebitis, infection, and tissue infiltration are some common complications of the use of peripheral IV catheters. Here we report a case in which peripheral IV fluid extravasation caused severe compartment syndrome in a critically ill preterm neonate undergoing exploratory laparotomy in the NICU.
    • Single-Stranded Oligonucleotide Aptamer Binding to P-Selectin Inhibits Adhesion of Sickle Red Blood Cells and Leukocytes to Endothelial Cells in Sickle Cell Disease Model Mice: Novel Therapeutics for Vaso-occlusive Episodes

      Gutsaeva, Diana R.; Parkerson, James B.; Schaub, Robert G.; Kurz, Jeffrey C.; Head, C. Alvin; Medical College of Georgia; Department of Anesthesiology and Perioperative Medicine (American Society of Hematology, 2009-12)
      Adhesive interactions between circulating red blood cells (RBC), leukocytes, and endothelial cells in post capillary venules have been implicated as a contributing factor to the pathogenesis of vaso-occlusion, the major cause of morbidity and mortality associated with sickle cell disease (SCD). Endothelial cell P-selectin, a member of the selectin family of cell adhesion molecules, plays a key role in leukocyte recruitment as well as in the adhesion of sickle RBC (sRBC) to the endothelium. The expression of P-selectin is elevated in SCD and the interaction of P-selectin and its ligands is likely to contribute to impairment of the microvascular flow and thereby to the development of painful vaso-occlusive episodes. Aptamers, short single-stranded oligonucleotides that fold into complex 3-D structures and bind to ligands, have been developed for a wide range of therapeutic targets. Although anti-P-selectin aptamers have been shown to inhibit leukocyte rolling in vitro and to display efficacy in mouse models for inflammation, anti-adhesion activity of anti-P-selectin aptamers has never been evaluated in SCD.
    • Strategies for a Successful Anesthesiology Clerkship and Rewarding Experience for Medical Students

      Donald, Ranita R.; Odo, Nadine; Dawkins, Susan; Mason, Nikova; Gilbertson, Laura; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      The 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.
    • Synergistic Enhancement of Sickle Red Blood Cell Adhesion to Endothelium by Hypoxia and Low Nitric Oxide Bioavailability

      Gutsaeva, Diana R.; Parkerson, James B.; Yerigenahally, Shobha D; Ikuta, Tohru; Head, C. Alvin; Department of Anesthesiology and Perioperative Medicine (American Society of Hematology, 2010-12)
      The 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.
    • 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.
    • Thrombolytic Therapy in a Patient with an Epidural Catheter

      Janardhanam, Ram; Mellinger, John D.; Hammonds, William D; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      The 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.
    • Transcranial Doppler measures in patients with sickle cell disease at high risk for stroke and receiving hydroxyurea: the HyRetro ancillary study

      Adamkiewicz, Thomas; Odo, Nadine; Kutlar, Abdullah; Kwiatkowski, Janet L; Adams, Robert J; School of Medicine; Morehouse College; Department of Anesthesiology and Perioperative Medicine (American Society of Hematology, 2010-12)
      Children 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.
    • Unanticipated Acute Adrenal Insufficiency During Emergency Thoracotomy Re-Exploration

      Rawlings, J Lee; Spivey, Jerry A; Castresana, Manuel R.; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      For 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.
    • Use of Dexmedetomidine as Adjuvant for the Anesthetic Management of Obese Children with Obstructive Sleep Apnea Undergoing Tonsillectomy and Adenoidectomy

      Mendiola, Raul A.; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Obstructive sleep apnea (OSA) in children is most commonly associated with tonsillar and adenoid hypertrophy. Use of opioids and residual amounts of inhaled agents can cause severe respiratory depression and thus represent an added risk to patients with OSA in the immediate postoperative period. Dexmedetomidine, a specific alpha 2-adrenergic receptor agonist, is known for its hypnotic, sedative, analgesic and sympatholytic properties. It potentiates analgesia with the advantages of minimal respiratory compromise, rapid onset and clearance. Because dexmedetomidine has been shown to be effective as an analgesic and sedative agent while minimizing respiratory compromise, it offers a safer alternative as an adjuvant for the anesthetic management of obese pediatric patients with OSA undergoing tonsillectomy and adenoidectomy.
    • The Use of Dexmedetomidine During Nasotracheal Intubation in a Patient with CHARGE Syndrome

      Crews, Lindsay K; Mattingly, Diana; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      CHARGE Syndrome (CS), also known as Hall-Hittner syndrome, is a congenital disorder comprised of multiple anomalies (coloboma, heart defect, atresia choanal, retarded growth and development, genital hypoplasia, ear anomalies/deafness). First described in 1979 by Hall and Hittner, it is caused by a mutation in the gene CHD7 on chromosome 8.1 Facial and upper airway features of CS, including midface hypoplasia, micrognathia, cleft lip, and palate, anterior larynx, and subglottic stenosis, make the airway management of these patients a challenge for the anesthesiologist. Because difficult airway management is a concern, spontaneous ventilation is recommended until the airway is secured. We report the use of dexmedetomidine (DEX) for deep sedation in a CS patient who required nasotracheal intubation using a fiberoptic bronchoscope (FB) while breathing spontaneously.
    • Use of the Video RIFL (Rigid Flexible Laryngoscope) as an Adjunct to Direct Laryngoscopy

      Setty, Harsha; Gallen, Thomas; Dubin, Stevin; Department of Anesthesiology and Perioperative Medicine (Society for Airway Management, 2010-09)
      The 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.