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1. Incidence and prevalence of hypertension in 18–40‐year‐old patients referred for palpitations with normal cardiac monitor findings

Author

Christopher Wasco, Zeryab Khan, Aimee Willett, Andrew Volio, Cody Carter, Aditya Kesari, Shaili Kothari, Andrew Scheidemantel, Katelyn Bennett, Jessalyn Schafer, Marie Lockhart, and Nagesh Chopra

Subjects
community‐based studies, hypertension—general, left ventricular hypertrophy (LVH) hypertension/arrhythmias, primary care issues, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Sixteen percent of patients referred for cardiology evaluation are found to have no cause for palpitations. Studies show that hypertension intricately influences “heart rate” and “contractility,?” the key components of “palpitation.” While the prevalence of hypertension is 22.4% in 18–39‐year‐olds, the relationship between palpitations and hypertension remains unknown in this age group. In our study, we assessed the incidence and prevalence of hypertension over 5 years in 18–40‐year‐olds referred for palpitations who had no known arrhythmic cause for palpitations between January 1, 206 and December 31, 2017. We found that over a period of 2.2 (0.7–4.1) years, an additional 56% patients were diagnosed with stage 1 (65/130) and stage 2 (28/130) hypertension, increasing the prevalence from 16% at the start of the study period to 72% at the end of the study period (p

Published
2024
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2. Reducing inpatient opioid consumption after caesarean delivery: effects of an opioid stewardship programme and racial impact in a community hospital

Author

Eric Chiang, Daniel Dongiu Kim, Andrew Volio, Alexis Skolaris, Aratara Nutcharoen, Eric Vogan, Kevin Krivanek, and Sabry Salama Ayad

Subjects
Medicine (General), R5-920
Abstract

Caesarean section is the most common inpatient surgery in the USA, with more than 1.1 million procedures in 2020. Similar to other surgical procedures, healthcare providers rely on opioids for postoperative pain management. However, current evidence shows that postpartum patients usually experience less pain due to pregnancy-related physiological changes. Owing to the current opioid crisis, public health agencies urge providers to provide rational opioid prescriptions. In addition, a personalised postoperative opioid prescription may benefit racial minorities since research shows that this population receives fewer opioids despite greater pain levels. Our project aimed to reduce inpatient opioid consumption after caesarean delivery within 6 months of the implementation of an opioid stewardship programme.A retrospective analysis of inpatient opioid consumption after caesarean delivery was conducted to determine the baseline, design the opioid stewardship programme and set goals. The plan-do-study-act method was used to implement the programme, and the results were analysed using a controlled interrupted time-series method.After implementing the opioid stewardship programme, we observed an average of 80% reduction (ratio of geometric means 0.2; 95% CI 0.2 to 0.3; p

Published
2024
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3. Pain and Opioid Consumption and Mobilization after Surgery: Post Hoc Analysis of Two Randomized Trials

Author

Wael Saasouh, Lauretta Mosteller, Andrew Volio, Paul Minko, Daniel I. Sessler, Eva Rivas, Li Xiang, Xuan Pu, Alparslan Turan, Kamal Maheshwari, Barak Cohen, and Guangmei Mao

Subjects
Adult, Male, medicine.medical_specialty, Sitting, law.invention, Randomized controlled trial, Interquartile range, law, Post-hoc analysis, Humans, Medicine, Mobility Limitation, Aged, Pain Measurement, Randomized Controlled Trials as Topic, Retrospective Studies, Postoperative Care, Pain, Postoperative, Mobilization, business.industry, Incidence (epidemiology), Recovery of Function, Middle Aged, Surgery, Analgesics, Opioid, Anesthesiology and Pain Medicine, Quartile, Female, business, Abdominal surgery
Abstract

Background Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications. Methods The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing. Results A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009). Conclusions Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Published
2021

4. Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial

Author

Mark D, Neuman, Rui, Feng, Susan S, Ellenberg, Frederick, Sieber, Daniel I, Sessler, Jay, Magaziner, Nabil, Elkassabany, Eric S, Schwenk, Derek, Dillane, Edward R, Marcantonio, Diane, Menio, Sabry, Ayad, Manal, Hassan, Trevor, Stone, Steven, Papp, Derek, Donegan, Mitchell, Marshall, J Douglas, Jaffe, Charles, Luke, Balram, Sharma, Syed, Azim, Robert, Hymes, Ki-Jinn, Chin, Richard, Sheppard, Barry, Perlman, Joshua, Sappenfield, Ellen, Hauck, Mark A, Hoeft, Ann, Tierney, Lakisha J, Gaskins, Annamarie D, Horan, Trina, Brown, James, Dattilo, Jeffrey L, Carson, Thomas, Looke, Sandra, Bent, Ariana, Franco-Mora, Pamela, Hedrick, Matthew, Newbern, Rafik, Tadros, Karen, Pealer, Kamen, Vlassakov, Carolyn, Buckley, Lauren, Gavin, Svetlana, Gorbatov, James, Gosnell, Talora, Steen, Avery, Vafai, Jose, Zeballos, Jennifer, Hruslinski, Louis, Cardenas, Ashley, Berry, John, Getchell, Nicholas, Quercetti, Gauasan, Bajracharya, Damien, Billow, Michael, Bloomfield, Evis, Cuko, Mehrun K, Elyaderani, Robert, Hampton, Hooman, Honar, Dilara, Khoshknabi, Daniel, Kim, David, Krahe, Michael M, Lew, Conjeevram B, Maheshwer, Azfar, Niazi, Partha, Saha, Ahmed, Salih, Robert J, de Swart, Andrew, Volio, Kelly, Bolkus, Matthew, DeAngelis, Gregory, Dodson, Jeffrey, Gerritsen, Brian, McEniry, Ludmil, Mitrev, M Kwesi, Kwofie, Anne, Belliveau, Flynn, Bonazza, Vera, Lloyd, Izabela, Panek, Jared, Dabiri, Chris, Chavez, Jason, Craig, Todd, Davidson, Chad, Dietrichs, Cheryl, Fleetwood, Mike, Foley, Chris, Getto, Susie, Hailes, Sarah, Hermes, Andy, Hooper, Greg, Koener, Kate, Kohls, Leslie, Law, Adam, Lipp, Allison, Losey, William, Nelson, Mario, Nieto, Pam, Rogers, Steve, Rutman, Garrett, Scales, Barbara, Sebastian, Tom, Stanciu, Gregg, Lobel, Michelle, Giampiccolo, Dara, Herman, Margit, Kaufman, Bryan, Murphy, Clara, Pau, Thomas, Puzio, Marlene, Veselsky, Kelly, Apostle, Dory, Boyer, Brenda Chen, Fan, Susan, Lee, Mike, Lemke, Richard, Merchant, Farhad, Moola, Kyrsten, Payne, Bertrand, Perey, Darius, Viskontas, Mark, Poler, Patricia, D'Antonio, Greg, O'Neill, Amer, Abdullah, Jamie, Fish-Fuhrmann, Mark, Giska, Christina, Fidkowski, Stuart Trent, Guthrie, William, Hakeos, Lillian, Hayes, Joseph, Hoegler, Katherine, Nowak, Jeffery, Beck, Jaslynn, Cuff, Greg, Gaski, Sharon, Haaser, Michael, Holzman, A Stephen, Malekzadeh, Lolita, Ramsey, Jeff, Schulman, Cary, Schwartzbach, Tangwan, Azefor, Arman, Davani, Mahmood, Jaberi, Courtney, Masear, Syed Basit, Haider, Carolyn, Chungu, Ali, Ebrahimi, Karim, Fikry, Andrew, Marcantonio, Anitha, Shelvan, David, Sanders, Collin, Clarke, Abdel, Lawendy, Gary, Schwartz, Mohit, Garg, Joseph, Kim, Juan, Caruci, Ekow, Commeh, Randy, Cuevas, Germaine, Cuff, Lola, Franco, David, Furgiuele, Matthew, Giuca, Melissa, Allman, Omid, Barzideh, James, Cossaro, Armando, D'Arduini, Anita, Farhi, Jason, Gould, John, Kafel, Anuj, Patel, Abraham, Peller, Hadas, Reshef, Mohammed, Safur, Fiore, Toscano, Tiffany, Tedore, Michael, Akerman, Eric, Brumberger, Sunday, Clark, Rachel, Friedlander, Anita, Jegarl, Joseph, Lane, John P, Lyden, Nili, Mehta, Matthew T, Murrell, Nathan, Painter, William, Ricci, Kaitlyn, Sbrollini, Rahul, Sharma, Peter A D, Steel, Michele, Steinkamp, Roniel, Weinberg, David Stephenson, Wellman, Antoun, Nader, Paul, Fitzgerald, Michaela, Ritz, Greg, Bryson, Alexandra, Craig, Cassandra, Farhat, Braden, Gammon, Wade, Gofton, Nicole, Harris, Karl, Lalonde, Allan, Liew, Bradley, Meulenkamp, Kendra, Sonnenburg, Eugene, Wai, Geoffrey, Wilkin, Karen, Troxell, Mary Ellen, Alderfer, Jason, Brannen, Christopher, Cupitt, Stacy, Gerhart, Renee, McLin, Julie, Sheidy, Katherine, Yurick, Fei, Chen, Karen, Dragert, Geza, Kiss, Halina, Malveaux, Deborah, McCloskey, Scott, Mellender, Sagar S, Mungekar, Helaine, Noveck, Carlos, Sagebien, Luat, Biby, Gail, McKelvy, Anna, Richards, Ramon, Abola, Brittney, Ayala, Darcy, Halper, Ana, Mavarez, Sabeen, Rizwan, Stephen, Choi, Imad, Awad, Brendan, Flynn, Patrick, Henry, Richard, Jenkinson, Lilia, Kaustov, Elizabeth, Lappin, Paul, McHardy, Amara, Singh, Joanne, Donnelly, Meera, Gonzalez, Christopher, Haydel, Jon, Livelsberger, Theresa, Pazionis, Bridget, Slattery, Maritza, Vazquez-Trejo, Jaime, Baratta, Michael, Cirullo, Brittany, Deiling, Laura, Deschamps, Michael, Glick, Daniel, Katz, James, Krieg, Jennifer, Lessin, Jeffrey, Mojica, Marc, Torjman, Rongyu, Jin, Mary Jane, Salpeter, Mark, Powell, Jeffrey, Simmons, Prentiss, Lawson, Promil, Kukreja, Shanna, Graves, Adam, Sturdivant, Ayesha, Bryant, Sandra Joyce, Crump, Michelle, Verrier, James, Green, Matthew, Menon, Richard, Applegate, Ana, Arias, Natasha, Pineiro, Jeffrey, Uppington, Phillip, Wolinsky, Amy, Gunnett, Jennifer, Hagen, Sara, Harris, Kevin, Hollen, Brian, Holloway, Mary Beth, Horodyski, Trevor, Pogue, Ramachandran, Ramani, Cameron, Smith, Anna, Woods, Matthew, Warrick, Kelly, Flynn, Paul, Mongan, Yatish, Ranganath, Sean, Fernholz, Esperanza, Ingersoll-Weng, Anil, Marian, Melinda, Seering, Zita, Sibenaller, Lori, Stout, Allison, Wagner, Alicia, Walter, Cynthia, Wong, Denise, Orwig, Maithri, Goud, Chris, Helker, Lydia, Mezenghie, Brittany, Montgomery, Peter, Preston, J Sanford, Schwartz, Ramona, Weber, Lee A, Fleisher, Samir, Mehta, Alisa J, Stephens-Shields, Cassandra, Dinh, Jacques E, Chelly, Shiv, Goel, Wende, Goncz, Touichi, Kawabe, Sharad, Khetarpal, Amy, Monroe, Vladislav, Shick, Max, Breidenstein, Timothy, Dominick, Alexander, Friend, Donald, Mathews, Richard, Lennertz, Robert, Sanders, Helen, Akere, Tyler, Balweg, Amber, Bo, Christopher, Doro, David, Goodspeed, Gerald, Lang, Maggie, Parker, Amy, Rettammel, Mary, Roth, Marissa, White, Paul, Whiting, Brian F S, Allen, Tracie, Baker, Debra, Craven, Matt, McEvoy, Teresa, Turnbo, Stephen, Kates, Melanie, Morgan, Teresa, Willoughby, Wade, Weigel, David, Auyong, Ellie, Fox, Tina, Welsh, Bruce, Cusson, Sean, Dobson, Christopher, Edwards, Lynette, Harris, Daryl, Henshaw, Kathleen, Johnson, Glen, McKinney, Scott, Miller, Jon, Reynolds, B Scott, Segal, Jimmy, Turner, David, VanEenenaam, Robert, Weller, Jineli, Lei, Miriam, Treggiari, Shamsuddin, Akhtar, Marcelle, Blessing, Chanel, Johnson, Michael, Kampp, Kimberly, Kunze, Mary, O'Connor, Jinlei, Li, Duminda N, Wijeysundera, Sachin, Kheterpal, Reneé H, Moore, Alexander K, Smith, Laura L, Tosi, Lee, Fleisher, Christine, Langlois, Samuel, Oduwole, and Thomas, Rose

Subjects
Male, Analgesics, Canada, Pain, Postoperative, Hip Fractures, Pain, General Medicine, Anesthesia, General, Anesthesia, Spinal, Patient Satisfaction, Internal Medicine, Humans, Female, Aged
Abstract

The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported.To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).46 U.S. and Canadian hospitals.Patients aged 50 years or older undergoing hip fracture surgery.Spinal or general anesthesia.Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups.Missing outcome data and multiple outcomes assessed.Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.Patient-Centered Outcomes Research Institute

Published
2022

7. Trends in personal protective equipment use by clinicians performing airway procedures for patients with coronavirus disease 2019 in the USA from the intubateCOVID registry

Author

Sabry Ayad, May Hua, Michael F. Aziz, Guy Shochat, Cynthia A. Lien, Timothy G. Gaulton, Frederick G. Mihm, Laura Fonseca, Marian Sherman, Ahmed Salih, Danny J.N. Wong, Jill M. Mhyre, Julie K. Freed, Elizabeth Abramowicz, Richard P. Dutton, Miriam M. Treggiari, Mark Giska, Catherine Chen, Lynnette Harris, Aratara Nutcharoen, Timothy T. Houle, Matthew T. Murrell, James Dattilo, Robert B. Schonberger, Kay B. Leissner, Amy Gunnett, Kathleen N. Johnson, Michael A. Gropper, Karen B. Domino, Jochen D. Muehlschlegel, Jessica L Shanahan, Michael R. Mathis, Steven I. Bott, Laurie K. Davies, Dhanesh K. Gupta, Katherine Nowak, Jacob G. Fowler, P. M. Desai, Yatish S. Ranganath, Anoop Chhina, Yinhui Low, Benjamin H. Cloyd, Alyssa Brzenski, Meir Dashevksy, Ludmil Mitrev, Andrea J. Strathman, Mark D. Neuman, Mark I. Neuman, Aaron M. Joffe, Andrew Volio, Max W. Breidenstein, Donald H. Penning, Kariem El-Boghdadly, Richard Lee Applegate, Imran Ahmad, Timothy Gaulton, Michael B Majewski, Meghan B. Lane-Fall, J. Matthew Fisher, Lyle Gerety, Samuel A. Schechtman, Lakisha J. Gaskins, Ashish Khanna, Peter Panzica, Craig Johnstone, Matthew Wecksell, Kelsey Adair, Alexander Nagrebetsky, Jayakar Guruswamy, Andrea Olmos, Shannon Michel, Daniel Kim, Zita Sibenellar, Shanna S. Hill, Vanessa Cervantes, B. Scott Segal, J. Doug Jaffe, Alexander F. Friend, Nadir Sharawi, Howard B. Gutstein, Alexander Mittnacht, Joy Steadman, Ami R. Stuart, Steven Berstein, Jinlei Li, Michael Y. Lin, David W. Healy, Amie Hoefnagel, Alexis Skolaris, Brenda G. Fahy, and Douglas A. Colquhoun

Subjects
Adult, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Physicians, Correspondence, medicine, Intubation, Intratracheal, Humans, tracheal intubation, Personal protective equipment, business.industry, Tracheal intubation, respiratory failure, aerosol-generating procedures, COVID-19, Middle Aged, United States, Anesthesiology and Pain Medicine, Respiratory failure, Emergency medicine, personal protective equipment, Female, business, Airway
Published
2021
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8. Intermittent Bolus Versus Continuous Paravertebral Infusion on Postoperative Pain after Unilateral Mastectomy: A Retrospective Cohort Study

Author

Aratara Nutcharoen, Daniel Kim, Sabry Ayad, Alexis Skolaris, and Andrew Volio

Subjects
medicine.medical_specialty, business.industry, Postoperative pain, Intermittent bolus, Medicine, Retrospective cohort study, business, Surgery, Unilateral mastectomy
Abstract

Background: Persistent pain is a common complication after mastectomy for breast cancer, and postoperative analgesia through paravertebral infusion is a promising technique for pain control after mastectomy. Although paravertebral local anesthetic infusion can be performed using continuous or intermittent bolus modes, there is no evidence of superiority of either infusion mode.Methods: We retrospectively studied patients who had undergone unilateral mastectomy with paravertebral catheter placed for postoperative analgesia between October 2017 and September 2018. Logistic regression was created to estimate the relative risk for moderate to severe pain defined by average pain scores greater than 4 using a 0 to 10 Numeric Rating Scale (NRS) within first 24 hours after surgery. Opioid consumption was compared using a Student T-test for difference in means using the log-transformed cumulative opioid consumption converted to milligrams of oral morphine equivalents (OME) within the first 48 hours after surgery.Results: 49 patients were included (continuous infusion group: 14; bolus infusion group: 35). Bolus paravertebral infusion was associated with reduction of relative risk of moderate to intense pain (adjusted relative risk: -0.96; 95%CI: -1.81, -0.1; p = 0.029) but there was no association with reduction in opioid consumption (difference of means: -1.4mg of OME; 95%CI: -2.78, 1.42; p = 0.33).Conclusion: Intermittent bolus infusion was associated with reduction of relative risk for moderate to severe postoperative pain for unilateral mastectomies. Therefore, paravertebral catheter infusion modality may influence postoperative pain experience after unilateral mastectomies.

Published
2021

9. Diurnal blood pressure variation in adults after abdominal surgery–An observational cohort study

Author

Barak Cohen, Eva Rivas, Xuan Pu, Kamal Maheshwari, Jorge A. Araujo-Duran, Oguz Turan, Andrew Volio, Esra Kutlu Yalcin, and Alparslan Turan

Subjects
Adult, Cohort Studies, Male, Anesthesiology and Pain Medicine, Humans, Arterial Pressure, Blood Pressure, Female, Hypotension, Middle Aged, Circadian Rhythm
Abstract

To describe the prevalence of various circadian blood pressure patterns in adults recovering from abdominal surgery, and to evaluate the association between loss of normal circadian variation in blood pressure and hypotension during the initial 2 postoperative days.A post-hoc analysis of data obtained from two randomized trials.Operating rooms of the Cleveland Clinic.Adults having abdominal surgery from 2015 to 2019 with at least one overnight stay. Participants were continuously monitored by wearable vital signs monitors starting in the post-anesthesia care unit and for the first 48 postoperative hours.None. The exposure of interest was the degree of nocturnal decrease in blood pressure - normal nocturnal decrease in blood pressure ("normal dipping", more than 10% decrease compared to day-time), no nocturnal decrease ("non-dipping", less than 10% nocturnal decrease), or nocturnal increase in blood pressure ("rising").Postoperative hypotension, defined by the time weighted average (TWA) area under a mean arterial pressure (MAP) threshold of 70 mmHg.In total, 590 patients were eligible for analysis (mean(SD) age 50(15) years, 56% females, median [IQR] surgery duration 4.0 [2.7, 5.8] hours). Median TWA area under a MAP threshold of 70 mmHg was 0.96 (95%CI 0.59, 1.33) mmHg*minute per monitoring hour lower in patients with either no nocturnal blood pressure decrease (N = 317, 54%), or an increase in nocturnal blood pressure (N = 211, 36%), than in the reference group of patients with normal nocturnal decrease (N = 62, 11%), P 0.001 for both.Abnormal diurnal blood pressure patterns are common in adults during the initial 2 days after abdominal surgery. Lack of normal night-time decrease in blood pressure is associated with less postoperative hypotension. Future studies should evaluate whether abnormal postoperative diurnal blood pressure patterns are associated with worse outcomes.

Published
2022

10. Large branchial arch cyst excision using superficial and deep cervical plexus blocks in a patient with severe comorbidities

Author

Aratara Nutcharoen, Alexis Skolaris, Andrew Volio, Sabry Ayad, N. Bhatnagar, and D. D. Kim

Subjects
medicine.medical_specialty, Unusual case, Second branchial arch, business.industry, Energy Engineering and Power Technology, Branchial arch, Regional anaesthesia, Case Report, medicine.disease, Malignancy, Surgery, Fuel Technology, medicine, General anaesthesia, Cyst, Deep cervical plexus, business
Abstract

Branchial arches are embryologic structures that develop between the fourth and seventh gestational week. Anomalies may form if these structures fail to develop. The majority of cases are diagnosed during childhood, with surgical excision recommended to prevent risk of infection, growth or malignancy. We report an unusual case of a 72-year-old man with severe cardiac comorbidities who presented with a large second branchial arch cyst extending into the oropharynx. General anaesthesia to facilitate surgical excision was deemed too risky. Therefore, we performed successful ultrasound-guided superficial and deep cervical plexus blocks as a sole mode of anaesthesia. This case highlights how regional anaesthesia can be utilised to facilitate surgery in high-risk patients, as well as presenting an alternative for general anaesthesia.

Published
2020

11. Massive Hemoperitoneum Secondary to Splenic Laceration After Extracorporeal Shockwave Lithotripsy

Author

Oguz Turan, Omer Bakal, Sabry Ayad, Andrew Volio, and Ahmed Salih

Subjects
medicine.medical_specialty, Abdominal pain, Resuscitation, Pleural effusion, medicine.medical_treatment, Urology, Splenectomy, 030204 cardiovascular system & hematology, Splenic artery, splenectomy, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, medicine.artery, medicine, Embolization, Hemoperitoneum, splenic rupture, hemoperitoneum, business.industry, General Engineering, medicine.disease, kidney stone, Extracorporeal shock wave lithotripsy, Surgery, General Surgery, splenic injury, shockwave lithotripsy, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Extracorporeal shock wave lithotripsy (ESWL) is considered a safe technique, but not without complications, though the vast majority are minor complications. We describe a rare case of splenic injury after ESWL. A 33-year-old male presented to the emergency department (ED) after three weeks experiencing severe intermittent left-sided flank pain that he contributed to a previous motor vehicle accident. Then computerized tomography (CT) revealed a left renal stone. ESWL was performed after three weeks. After being discharged home, he returned the same day to the ED with persistent, worsening abdominal pain, hypotension, and multiple syncopes. CT demonstrated the presence of active contrast extravasation from the spleen likely due to active bleeding. Initial resuscitation was with intravenous fluids and blood products. The following day, the embolization of the splenic artery was done. The patient was discharged home after nine days of conservative management. After one month, he had shortness of breath due to a large left-sided pleural effusion and lung collapse managed with thoracocentesis and thoracoscopic surgery. Subsequent follow-up reveals much improvement and successful conservative management. Splenic injury is a rare complication of ESWL, and all of the 11 reported cases in the literature were managed with splenectomy. Our case is unique in being successfully managed conservatively.

Published
2020

12. Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Author

Jennifer Hruslinski, Diane A. Menio, Robert A. Hymes, J. Douglas Jaffe, Christine Langlois, Lolita Ramsey, Lakisha J. Gaskins, Mark D. Neuman, Thomas Looke, Sandra Bent, Ariana Franco-Mora, Pamela Hedrick, Matthew Newbern, Rafik Tadros, Karen Pealer, Edward Marcantonio, Kamen Vlassakov, Carolyn Buckley, Svetlana Gorbatov, James Gosnell, Talora Steen, Avery Vafai, Jose Zeballos, Louis Cardenas, Ashley Berry, John Getchell, Nicholas Quercetti, Daniel I. Sessler, Sabry Ayad, Manal Hassan, Assad Ali, Gauasan Bajracharya, Damien Billow, Michael Bloomfield, Kavita Elliott, Robert Hampton, Linda He, Hooman Honar, Dilara Khoshknabi, Daniel Kim, Paul Minko, Adam Morris, Azfar Niazi, Tara Nutcharoen, Jeffrey Roberts, Partha Saha, Ahmed Salih, Alexis Skolaris, Taylor Stang, Victor Strimbu, Jesse Templeton, Andrew Volio, Jiayi Wang, Kelly Bolkus, Matthew DeAngelis, Gregory Dodson, Jeffrey Gerritsen, Brian McEniry, Ludmil Mitrev, Kwesi Kwofie, Flynn Bonazza, Vera Lloyd, Izabela Panek, Jared Dabiri, Chris Chavez, Jason Craig, Todd Davidson, Chad Dietrichs, Cheryl Fleetwood, Mike Foley, Chris Getto, Susie Hailes, Sarah Hermes, Andy Hooper, Greg Koener, Kate Kohls, Leslie Law, Adam Lipp, Allison Losey, William Nelson, Mario Nieto, Pam Rogers, Steve Rutman, Garrett Scales, Barbara Sebastian, Tom Stanciu, Gregg Lobel, Michelle Giampiccolo, Dara Herman, Margit Kaufman, Bryan Murphy, Clara Pau, Thomas Puzio, Marlene Veselsky, Trevor Stone, Kelly Apostle, Dory Boyer, Brenda Chen Fan, Susan Lee, Mike Lemke, Richard Merchant, Farhad Moola, Kyrsten Payne, Bertrand Perey, Darius Viskontas, Mark Poler, Patricia D'Antonio, Richard Sheppard, Amer Abdullah, Jamie Fish-Fuhrmann, Mark Giska, Christina Fidkowski, Trent Guthrie, William Hakeos, Lillian Hayes, Joseph Hoegler, Katherine Nowak, Robert Hymes, Jeffery Beck, Jaslynn Cuff, Greg Gaski, Sharon Haaser, Michael Holzman, A. Stephen Malekzadeh, Jeff Schulman, Cary Schwartzbach, Frederick Sieber, Tangwan Azefor, Charles Brown, Arman Davani, Mahmood Jaberi, Courtney Masear, Balram Sharma, Syed Basit Haider, Carolyn Chungu, Ali Ebrahimi, Karim Fikry, Kerri Gannon, Andrew Marcantonio, Meredith Pace, David Sanders, Collin Clarke, Abdel Lawendy, Gary Schwartz, Mohit Garg, Joseph Kim, Mitchell Marshall, Juan Caurci, Ekow Commeh, Randy Cuevas, Germaine Cuff, Lola Franco, David Furguiele, Matthew Giuca, Melissa Allman, Omid Barzideh, James Cossaro, Armando D'Arduini, Anita Farhi, Jason Gould, John Kafel, Anuj Patel, Abraham Peller, Hadas Reshef, Mohammed Safur, Fiore Toscano, Tiffany Tedore, Michael Akerman, Eric Brumberger, Sunday Clark, Rachel Friedlander, Anita Jegarl, Joseph Lane, John P. Lyden, Nili Mehta, Matthew T. Murrell, Nathan Painter, William Ricci, Kaitlyn Sbrollini, Rahul Sharma, Peter A.D. Steel, Michele Steinkamp, Roniel Weinberg, David Stephenson Wellman, Antoun Nader, Paul Fitzgerald, Michaela Ritz, Steven Papp, Greg Bryson, Alexandra Craig, Cassandra Farhat, Braden Gammon, Wade Gofton, Nicole Harris, Karl Lalonde, Allan Liew, Bradley Meulenkamp, Kendra Sonnenburg, Eugene Wai, Geoffrey Wilkin, Derek Donegan, Cassandra Dinh, Nabil Elkassabany, Annamarie Horan, Samir Mehta, Karen Troxell, Mary Ellen Alderfer, Jason Brannen, Christopher Cupitt, Stacy Gerhart, Renee McLin, Julie Sheidy, Katherine Yurick, Jeffrey Carson, Fei Chen, Karen Dragert, Geza Kiss, Halina Malveaux, Deborah McCloskey, Scott Mellender, Sagar S. Mungekar, Helaine Noveck, Carlos Sagebien, Barry Perlman, Luat Biby, Gail McKelvy, Anna Richards, Syed Azim, Ramon Abola, Brittney Ayala, Darcy Halper, Ana Mavarez, Stephen Choi, Imad Awad, Brendan Flynn, Patrick Henry, Richard Jenkinson, Lilia Kaustov, Elizabeth Lappin, Paul McHardy, Amara Singh, Ellen Hauck, Joanne Donnelly, Meera Gonzalez, Christopher Haydel, Jon Livelsberger, Theresa Pazionis, Bridget Slattery, Maritza Vazquez-Trejo, Eric Schwenk, Jaime Baratta, Brittany Deiling, Laura Deschamps, Michael Glick, Daniel Katz, James Krieg, Jennifer Lessin, Marc Torjman, Ki Jinn Chin, Rongyu Jin, Mary Jane Salpeter, Mark Powell, Jeffrey Simmons, Prentiss Lawson, Promil Kukreja, Shanna Graves, Adam Sturdivant, Ayesha Bryant, Sandra Joyce Crump, Derek Dillane, Michael Taylor, Michelle Verrier, Richard Applegate, Ana Arias, Natasha Pineiro, Jeffrey Uppington, Phillip Wolinsky, Joshua Sappenfield, Amy Gunnett, Jennifer Hagen, Sara Harris, Kevin Hollen, Brian Holloway, Mary Beth Horodyski, Trevor Pogue, Ramachandran Ramani, Cameron Smith, Anna Woods, Matthew Warrick, Kelly Flynn, Paul Mongan, Yatish Ranganath, Sean Fernholz, Esperanza Ingersoll-Weng, Anil Marian, Melinda Seering, Zita Sibenaller, Lori Stout, Allison Wagner, Alicia Walter, Cynthia Wong, Jay Magaziner, Denise Orwig, Trina Brown, Jim Dattilo, Susan Ellenberg, Rui Feng, Lee Fleisher, Lakisha Gaskins, Maithri Goud, Chris Helker, Lydia Mezenghie, Brittany Montgomery, Peter Preston, Alisa Stephens, J. Sanford Schwartz, Ann Tierney, Ramona Weber, Jacques Chelly, Shiv Goel, Wende Goncz, Touichi Kawabe, Sharad Khetarpal, Kevin King, Frank Kunkel, Charles Luke, Amy Monroe, Vladislav Shick, Anthony Silipo, Caroline Stehle, Katherine Szabo, Sudhakar Yennam, Mark Hoeft, Max Breidenstein, Timothy Dominick, Alexander Friend, Donald Mathews, Richard Lennertz, Helen Akere, Tyler Balweg, Amber Bo, Christopher Doro, David Goodspeed, Gerald Lang, Maggie Parker, Amy Rettammel, Mary Roth, Robert Sanders, Marissa White, Paul Whiting, Brian Allen, Tracie Baker, Debra Craven, Matt McEvoy, Teresa Turnbo, Stephen Kates, Melanie Morgan, Teresa Willoughby, Wade Weigel, David Auyong, Ellie Fox, Tina Welsh, Bruce Cusson, Sean Dobson, Christopher Edwards, Lynette Harris, Daryl Henshaw, Kathleen Johnson, Glen McKinney, Scott Miller, Jon Reynolds, Jimmy Turner, David VanEenenaam, Robert Weller, Shamsuddin Akhtar, Marcelle Blessing, Chanel Johnson, Michael Kampp, Kimberly Kunze, Jinlei Li, Mary O'Connor, and Miriam Treggiari

Subjects
medicine.medical_specialty, Canada, Research Subjects, Patient engagement, Hip fracture surgery, Patient Advocacy, Anesthesia, General, Patient advocacy, Anesthesia, Spinal, 03 medical and health sciences, 0302 clinical medicine, Nursing, 030202 anesthesiology, Fracture Fixation, Medicine, Humans, General anaesthesia, Cooperative Behavior, Geriatrics, Hip fracture, business.industry, Hip Fractures, Lived experience, Age Factors, Research process, medicine.disease, United States, Anesthesiology and Pain Medicine, Research Design, Patient Participation, business, Decision Making, Shared
Abstract

Summary Engaging patients—defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them—as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.

Published
2020

13. Suspected Septic Sacroiliitis Following Recent Cesarean Section Under Spinal Anesthesia

Author

Andrew Volio, Alexis Skolaris, Sabry Ayad, Aratara Nutcharoen, and Ahmed Salih

Subjects
septic sacroiliitis, musculoskeletal diseases, medicine.medical_specialty, Coccyx, Septic Sacroiliitis, Infectious Disease, 030204 cardiovascular system & hematology, sacroiliitis, mobility limitation, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, sacroiliac joint, Back pain, medicine, Buttocks, spinal anesthesia, pyogenic sacroiliitis, Sacroiliac joint, cesarean section, business.industry, General Engineering, Sacroiliitis, Spinal anesthesia, medicine.disease, Surgery, medicine.anatomical_structure, Obstetrics/Gynecology, medicine.symptom, business, 030217 neurology & neurosurgery, Right buttock
Abstract

Septic sacroiliitis is sacroiliac (SI) joint inflammation secondary to microbial invasion of the synovial space characterized by tenderness over the sacroiliac joint, difficulty walking, and lower back pain that can radiate to the buttocks. Clinicians can easily overlook septic sacroiliitis as a potential diagnosis due to its rare occurrence and non-specific symptoms. A 30-year-old female (G2P2A0) who presented acutely to the ED nine days after an uncomplicated Cesarean section performed under spinal anesthesia. The patient experienced progressive lancinating, electric-shock pain originating from the coccyx radiating to the right buttock and lower back with the inability to bear weight. MRI pelvis demonstrated edematous changes of the right SI joint, indicative of septic sacroiliitis. Patient’s condition improved after empiric intravenous antibiotics and was discharged home on the continued intravenous course. Rapid empiric administration of intravenous antibiotics may have prevented the onset of severe complications of an infective SI joint.

Published
2020

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