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Tucker-Bartley A, Medeiros H, Sabouri AS. Chest Wall Hematoma after Continuous Serratus Anterior Plane Block. Anesthesiology 2024; 140:1018-1019. [PMID: 38372354 DOI: 10.1097/aln.0000000000004890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Anthony Tucker-Bartley
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Heitor Medeiros
- Department of Anesthesiology, Hospital Universitario Onofre Lopes, Natal, Brazil
| | - A Sassan Sabouri
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Missett RM, Beig Zali S, Winograd J, Scemama de Gialluly P, Sabouri AS. Intraoperative Ultrasound-Guided Transversus Abdominis Plane Catheters Placed for Post-operative Analgesia Following Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction: A Case Report. Cureus 2023; 15:e39045. [PMID: 37323334 PMCID: PMC10266741 DOI: 10.7759/cureus.39045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Transverse rectus abdominis (TRAM) flap reconstruction of the breast is a procedure in which a flap of skin, fat, and underlying rectus abdominis muscle is used to reconstruct the breast. This procedure is commonly performed after mastectomy and results in significant pain at the donor abdominal site. We present this case of a 50-year-old female undergoing pedicled TRAM flap surgery in which ultrasound-guided transversus abdominis plane (TAP) catheters were placed intraoperatively, in a novel fashion: under ultrasound guidance, directly on the abdominal musculature, without overlying fat, subcutaneous tissue, or dressing. Our case-reported numeric pain scores ranged from 0-5/10 during postoperative days one to two. The patient's IV morphine requirement on postoperative days zero to two ranged between 1.34 mg to 2.6 mg per day, representing a significant decrease compared to literature-reported opioid consumption after such surgery. Her pain and opioid consumption increased significantly after catheter removal, suggesting the efficacy of our intraoperative TAP catheters.
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Affiliation(s)
- Richard M Missett
- Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Jonathan Winograd
- Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
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Jung KT, Kelly L, Kuznetsov A, Sabouri AS, Lee K. Determination of optimal tip position of peripherally inserted central catheters using electrocardiography - a retrospective study. Korean J Anesthesiol 2022:kja.22639. [PMID: 36550778 DOI: 10.4097/kja.22639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Accurate tip positioning of a peripherally inserted central catheter (PICC) is crucial to ensuring optimal drug delivery and avoiding potential complications. The main objective of this study was to evaluate the amplitude ratios of intravascular ECG (ivECG) and body surface ECG (exECG) when the correct tip position was confirmed by chest X-ray (CXR). Methods This retrospective study analyzed ivECG, exECG, and CXR of 278 patients who underwent a PICC placement procedure. The tip-to-carina distance (TCD) was measured using vertebral body units (VBU) on CXR, and tip locations were categorized as follows: Zone 1, malposition as TCD <0.8 VBU; Zone 2, suboptimal as 0.8 VBU ≤ TCD < 1.5 VBU; Zone 3, optimal as 1.5 VBU ≤ TCD ≤2.4 VBU; Zone 4, deep as TCD > 2.4 VBU. The amplitude ratios between ivECG and exECG and within ivECG of the corresponding waves were calculated and compared in each Zone. Results The ivECG/exECG amplitude ratios of P-wave (Piv/Pex) and QRS-complex (QRiv/QRex and RSiv/RSex) in Zone 3 were significantly higher than in Zones 1 and 2 (adjusted P<0.05). The amplitude ratios of the P-wave and QRS-complex of the ivECG (Piv/QRiv and Piv/RSiv) were significantly lower in Zone 3 than in Zones 1 and 2 (adjusted P<0.001). The calculated TCD using stepwise multiple regression analysis was estimated to be 1.121 + 0.078 × Piv/Pex - 0.172 × Piv/QRiv. Conclusions The amplitude ratios between ivECG and exECG and within ivECG (Piv/Pex and Piv/QRiv) can help determine catheter tip positioning during the PICC catheterization procedure. However, caution is required for accurate positioning of the PICC tip.
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Affiliation(s)
- Ki Tae Jung
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114 USA.,Harvard Medical School, Boston, MA 02115 USA.,Department of Anesthesiology and Pain Medicine, College of Medicine and Medical School, Chosun University, Gwangju, Korea 61453
| | - Linda Kelly
- Clinical Nursing Services, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Alexandra Kuznetsov
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114 USA
| | - A Sassan Sabouri
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114 USA.,Harvard Medical School, Boston, MA 02115 USA
| | - Kichang Lee
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114 USA.,Cardiovascular Research Center, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114 USA.,Harvard Medical School, Boston, MA 02115 USA
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Rahimzadeh P, Faiz SHR, Salehi S, Imani F, Mueller AL, Sabouri AS. Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial. Anesth Pain Med 2022; 12:e132152. [PMID: 36938107 PMCID: PMC10016115 DOI: 10.5812/aapm-132152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. Objectives We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. Methods This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Results Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). Conclusions A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajede Salehi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ariel L. Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - A. Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
- Corresponding Author: Department of Anesthesia, Critical Care and Pain Medicine, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA.
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Oaklander AL, Van Houten T, Sabouri AS. Characterization of mononeuropathy of the lateral cutaneous nerve of the calf. Muscle Nerve 2021; 64:494-499. [PMID: 34197644 PMCID: PMC10066601 DOI: 10.1002/mus.27367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION/AIMS Isolated injuries to the lateral cutaneous nerve of the calf (LCNC) branch of the common peroneal nerve can cause obscure chronic posterolateral knee and upper calf pain and sensory symptoms. Routine examination and electrodiagnostic testing do not detect them because the LCNC has no motor distribution and it is not interrogated by the typical peroneal nerve conduction study. There are only about 10 prior cases, thus scant physician awareness, so most LCNC injuries remain misdiagnosed or undiagnosed, hindering care. METHODS We extracted pertinent records from seven patients with unexplained posterolateral knee/calf pain, six labeled as complex regional pain syndrome, to investigate for mononeuropathies. Patients were asked to outline their skin area with abnormal responses to pin self-examination independently. Three underwent an LCNC-specific electrodiagnostic study, and two had skin-biopsy epidermal innervation measured. Cadaver dissection of the posterior knee nerves helped identify potential entrapment sites. RESULTS Initiating events included knee surgery (three), bracing (one), extensive kneeling (one), and other knee trauma. All pin-outlines included the published LCNC neurotome. One oftwo LCNC-specific electrodiagnostic studies revealed unilaterally absent potentials. Longitudinal, controlled skin biopsies documented profound LCNC-neurotome denervation then re-innervation contemporaneous with symptom recovery. Cadaver dissection identified the LCNC traversing through the dense fascia of the proximolateral gastrocnemius muscle insertion. DISCUSSION Isolated LCNC mononeuropathy can cause unexplained posterolateral knee/calf pain syndromes. This series characterizes presentations and supports patient pin-mappings as a sensitive, globally available, low-cost diagnostic aid. Improved recognition may facilitate more rapid, accurate diagnosis and, thus, optimize management and improve outcomes.
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Affiliation(s)
- Anne Louise Oaklander
- Nerve Unit, Departments of Neurology and Pathology (Neuropathology), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Trudy Van Houten
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - A Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The emergence of the coronavirus disease 2019 (COVID-19) virus has increased in patients with acute respiratory distress syndrome (ARDS). The use of prone positioning during COVID-19-associated ARDS has led to improved oxygenation and decreased mortality. Extended hours of proning may delay or prevent traditional approaches to central vascular access, such as jugular, subclavian, or femoral cannulation. A peripherally inserted central catheter (PICC) is a viable option for prone patients. This article presents a PICC placement in a 56-year-old man with COVID-19 ARDS who required 20- to 24-hour prone positioning during his care in the intensive care unit. Insertion of a PICC while the patient is prone expedites lifesaving medications and infusions without waiting for the patient to be stable enough to be turned to the supine position.
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Affiliation(s)
- Linda Kelly
- Corresponding Author: Linda Kelly, DNP, CNP, NCMP, Massachusetts General Hospital, 55 Fruit St, MGH Bigelow 1034, Boston, MA 02114 ()
| | - Denise Dreher
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - Georgia Kim
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - Timothy Hughes
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
| | - A. Sassan Sabouri
- Massachusetts General Hospital, Boston, Massachusetts (Drs Kelly and Sabouri, Mss Dreher and Kim, and Mr Hughes)
- Linda Kelly, DNP, CNP, NCMP, is a doctoral-prepared nurse. She has worked at Massachusetts General Hospital for 38 years and is currently the nursing director for the vascular access nursing team. In her role she promotes patient-centered care and advancing vascular access. Dr Kelly also practices as a certified nurse practitioner
- Denise Dreher, RN, CRNI®, VA-BC, has worked at Massachusetts General Hospital for 46 years, 39 of those on the vascular access nursing team. Ms Dreher is a clinical scholar and a subject matter expert in vascular access nursing
- Georgia Kim, RN, CRNI®, has worked on the vascular access nursing team at Massachusetts General Hospital for 15 years. In her role, she has championed the use of ultrasound guidance in peripheral intravenous catheter placements
- Timothy Hughes, BSN, RN, has worked at Massachusetts General Hospital for 15 years and on the vascular access nursing team for the past 6 years. In his role, Mr Hughes is one of the primary resource nurses for the vascular access nursing team
- A. Sassan Sabouri, MD, holds a dual appointment at Massachusetts General Hospital, as the medical director of the vascular access nursing team for 5 years and as an anesthesiologist for the Department of Anesthesia, Critical Care, and Pain Medicine for 10 years. He is an assistant professor of anesthesia at Harvard Medical School and has 29 years of experience in anesthesia and critical care medicine
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Dabbagh A, Sezari P, Tabashi S, Tajbakhsh A, Massoudi N, Vosoghian M, Moshari M, Jaffari A, Nooraei N, Sabouri AS, Shojaei S, Salarian S. Attitudes of Anesthesiology Residents Toward a Small Group Blended Learning Class. Anesth Pain Med 2020; 10:e103148. [PMID: 32944563 PMCID: PMC7472787 DOI: 10.5812/aapm.103148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accreditation Council for Graduate Medical Education (ACGME) has been used to evaluate the residents' competency; however, the thriving of residents needs especial training methods and techniques. Small group learning has been used for this propose. OBJECTIVES This study assessed the attitudes of CA-1 to CA-3 anesthesiology residents toward level-specific small-group blended learning. METHODS Anesthesiology residents from Department of Anesthesiology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran participated in this cross-sectional attitude assessment descriptive-analytical study throughout the 2nd academic semester (May-October 2019). They took part in a level-specific small-group blended learning program and filled out an attitude assessment questionnaire. The questionnaire included eight closed questions and was filled out anonymously. RESULTS The residents believed that this program made important contributions to their theory training and clinical skills of anesthesia; while created a greater sense of solidarity. In addition, nearly the majority of the respondents did not believe that participating in the classes made interference in their clinical duties or was a difficult task. Instead, the majority of residents believed that these classes were in favor of reducing their burnout. The reliability of the questionnaire based on Cronbach's Alpha was 0.885. CONCLUSIONS Anesthesiology residents are in favor of small-group learning, especially when considering their clinical setting and the degree of burnout they tolerate.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parissa Sezari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Tabashi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nilofar Massoudi
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoghian
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Moshari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jaffari
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Nooraei
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A. Sassan Sabouri
- Anesthesiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Seyedpouzhia Shojaei
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Salarian
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yamak Altinpulluk E, Galluccio F, Sabouri AS, Arnay EG, Salazar C, Perez MF. Redefining clavipectoral fascial block for clavicular surgery: Response to Dr. Ince et al. J Clin Anesth 2020; 61:109645. [PMID: 31668475 DOI: 10.1016/j.jclinane.2019.109645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/11/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Ece Yamak Altinpulluk
- Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic, OH, USA; Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpaşa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Felice Galluccio
- Department of Clinical and Experimental Medicine, University Hospital AOU Careggi, Florence, Italy
| | - A Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Emilio Gonzalez Arnay
- Department of Anatomy, Histology and Neuroscience, Universidad Autonoma de Madrid, Spain
| | - Carlos Salazar
- Department of Anesthesia, Hospital Infanta Leonor, Madrid, Spain
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Dabbagh A, Elyassi H, Sabouri AS, Vahidshahi K, Ziaee SAM. The Role of Integrative Educational Intervention Package (Monthly ITE, Mentoring, Mocked OSCE) in Improving Successfulness for Anesthesiology Residents in the National Board Exam. Anesth Pain Med 2020; 10:e98566. [PMID: 32547933 PMCID: PMC7260396 DOI: 10.5812/aapm.98566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND National Board of Anesthesiology (NBA) pass rate is an important and critical step in clinical residency programs. OBJECTIVES This study was designed to assess the relationship between an integrative educational intervention (IEI) and the relative annual pass rate (RAPR). RAPR is defined as ratio of NBA pass rate of Shahid Beheshti University of Medical Sciences (SBMU) to the NBA pass rate of all the anesthesiology residency programs across Iran. METHODS In a descriptive-analytic retrospective study from 2012 to 2019, RAPR was calculated. IEI was implanted in the latter 4years period of this time interval includes: (1) individualized mentorship for residents by faculty members; (2) monthly in-training examination (ITE) in written; and (3) periodical mocked OSCE exam. Spearman's correlation coefficient was used to assess correlation between integrative educational intervention and RAPR results. P value less than 0.05 was considered statistically significant. RESULTS There was a statistically significant relationship between "integrative educational intervention program" and the RAPR results: Spearman's correlation coefficient = 0.655 (P value = 0.039). CONCLUSIONS The IEI package of Anesthesiology Department, SBMU showed a significant relationship with improvements in successfulness for anesthesiology residents in the National Board Exam (RAPR trend). More prolonged studies could prevail further aspects of these interventions.
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Affiliation(s)
- Ali Dabbagh
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedayatollah Elyassi
- Anesthesiology Department, Anesthesiology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A. Sassan Sabouri
- Anesthesiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Anesthesiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kourosh Vahidshahi
- Pediatric Cardiology Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Anderson TA, Segaran JR, Toda C, Sabouri AS, De Jonckheere J. High-Frequency Heart Rate Variability Index: A Prospective, Observational Trial Assessing Utility as a Marker for the Balance Between Analgesia and Nociception Under General Anesthesia. Anesth Analg 2020; 130:1045-1053. [PMID: 31008745 DOI: 10.1213/ane.0000000000004180] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Maintaining a balance between nociception and analgesia perioperatively reduces morbidity and improves outcomes. Current intraoperative analgesic strategies are based on subjective and nonspecific parameters. The high-frequency heart rate (HR) variability index is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This prospective observational study investigated whether intraoperative changes in the high-frequency HR variability index correlate with clinically relevant nociceptive stimulation and the addition of analgesics. METHODS Instantaneous and mean high-frequency HR variability indexes were measured continuously in 79 adult subjects undergoing general anesthesia for laparoscopic cholecystectomy. The indexes were compared just before and 2 minutes after direct laryngoscopy, orogastric tube placement, first skin incision, and abdominal insufflation and just before and 6 minutes after the administration of IV hydromorphone. RESULTS Data from 65 subjects were included in the final analysis. The instantaneous index decreased after skin incision ([SEM], 58.7 [2.0] vs 47.5 [2.0]; P < .001) and abdominal insufflation (54.0 [2.0] vs 46.3 [2.0]; P = .002). There was no change in the instantaneous index after laryngoscopy (47.2 [2.2] vs 40.3 [2.3]; P = .026) and orogastric tube placement (49.8 [2.3] vs 45.4 [2.0]; P = .109). The instantaneous index increased after hydromorphone administration (58.2 [1.9] vs 64.8 [1.8]; P = .003). CONCLUSIONS In adult subjects under general anesthesia for laparoscopic cholecystectomy, changes in the high-frequency HR variability index reflect alterations in the balance between nociception and analgesia. This index might be used intraoperatively to titrate analgesia for individual patients. Further testing is necessary to determine whether the intraoperative use of the index affects patient outcomes.
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Affiliation(s)
- T Anthony Anderson
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Joshua R Segaran
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Chihiro Toda
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - A Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Julien De Jonckheere
- Perinatal Environment and Health, Faculté of Médicine, University of Lille, Centre Hospitalier Universitaire, Lille, France
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Chen KY, Abhold E, Shin JH, Sabouri AS. Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case Report. A A Pract 2019; 13:369-372. [PMID: 31361660 DOI: 10.1213/xaa.0000000000001070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7-L1 fusion and T10 corpectomy. Before fascial closure, catheters were advanced into the T10 paravertebral space under direct visualization by the surgeon bilaterally. Postoperatively, his pain was well controlled, and narcotic requirements were decreased. Our case report demonstrates that for patients undergoing posterior spine surgery, intraoperative placement of bilateral paravertebral catheters can be used to help manage postoperative pain.
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Affiliation(s)
- Kelly Y Chen
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | - Eric Abhold
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
| | - John H Shin
- Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - A Sassan Sabouri
- From the Departments of Anesthesia, Critical Care, and Pain Medicine
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Sabouri AS, Crawford L, Bick SK, Nozari A, Anderson TA. Is a Retrolaminar Approach to the Thoracic Paravertebral Space Possible?: A Human Cadaveric Study. Reg Anesth Pain Med 2018; 43:864-868. [PMID: 29923954 DOI: 10.1097/aap.0000000000000828] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The retrolaminar block (RB) is used for truncal analgesia, but its mechanism of neural blockade remains obscure. We sought to learn the pattern of local anesthetic spread after thoracic RB using cadaveric models. METHODS In 8 fresh cadavers, an ultrasound-guided T4 RB was performed with 20 mL of methylene blue 1% and bupivacaine 0.5%. For comparison, an RB at T9 in 1 cadaver and a T4 thoracic paravertebral block in another cadaver were performed. Subsequently, posterior and anterior thoracic dissections were performed to examination where the dye spread. RESULTS After T4 RB, dye was noted to spread in the ipsilateral retrolaminar plane (all 8 cadavers, median cephalad spread 3.5 cm, caudad spread 10.7 cm, lateral spread 2.5 cm), the contralateral retrolaminar plane (6 cadavers), the paravertebral space (5 cadavers, median of 3 segments, T3-T5), the intercostal space (5 cadavers, median of 3.5 cm laterally), the T4 epidural space (6 cadavers), and the intervertebral foramina (4 cadavers, median of 2 segments, T4-T5). After T9 retrolaminar injection, dye was noted in the ipsilateral retrolaminar plane (5.5 cm cephalad, 13.5 cm caudad, and 2.5 cm lateral), the contralateral retrolaminar plane, and the epidural space. Dye after T4 traditional paravertebral block spread to T1-T6 paravertebral space with 15-cm lateral spread. CONCLUSIONS Injectate spread to the paravertebral space, epidural space, intercostal space, and intervertebral foramina is possible in the RB but is quite variable. In comparison to the thoracic paravertebral block, injectate spread within the paravertebral space is more limited.
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Affiliation(s)
| | - Lane Crawford
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Sarah K Bick
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Thomas A Anderson
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA
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Sabouri AS, Jafari A, Creighton P, Shepherd A, Votta TJ, Deng H, Heard C. Association between Bispectral Index System and airway obstruction: an observational prospective cohort analysis during third molar extractions. Minerva Anestesiol 2018; 84:703-711. [PMID: 29338145 DOI: 10.23736/s0375-9393.18.12147-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sedation regimes during oral procedures frequently associated with airway obstruction. The aim of this study was to define the association of Bispectral Index (BIS) to the depth of sedation and airway obstruction events. METHODS Forty-seven patients between 14-21 years old, who were candidates for 3rd molar teeth extraction, were enrolled in this study. Patients received a total of 4 mg midazolam, 100 microgram fentanyl followed by titrated incremental propofol in 10 mg. The Richmond Agitation Sedation Score (RASS) was used to assess the depth of sedation. Each patient was attached to BIS monitor, while clinicians were not involved in the data collection process. Apnea, airway obstruction, O2 saturation, timing and interventions for controlling the situation were recorded. All data was synchronized with BIS data monitoring. RESULTS The results show that 97.5% of cases were ASA 1 and 2, with average age of 17.3 years (±1.4) and a median BMI of 26.1. By using linear regression, for every unit decrease of median RASS (less than zero), there was 1.78 decrease in mean BIS Score (P=0.045, 95% CI: 0.08-3.47). The mean BIS Index (over 1 minute) with airway obstruction was 64 (±10.2), which was significantly lower than the BIS during non-airway obstruction (77±11.6), (P<0.001). By using logistic regression analysis, for every on unit increase in BIS Index, there is 24% decrease in odds in having airway obstruction (P=0.0009, 95% CI: 0.65-8.94). CONCLUSIONS This study demonstrates that the BIS could potentially be a valid continuous monitoring method to avoid airway obstruction during sedation for patients undergoing dental surgery.
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Affiliation(s)
- A Sassan Sabouri
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA -
- Department of Anesthesiology, Critical Care and Pain Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran -
| | - Alireza Jafari
- Department of Anesthesiology, Critical Care and Pain Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul Creighton
- Department of Pediatric and Community Dentistry, University at Buffalo, Buffalo, NY, USA
| | - Adam Shepherd
- Pediatric Dentistry, University at Buffalo, Buffalo, NY, USA
| | - Timothy J Votta
- Department of Oral and Maxillofacial Surgery, Women and Children's Hospital at Buffalo, University of Buffalo, Buffalo, NY, USA
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Heard
- Department of Pediatric and Community Dentistry, University at Buffalo, Buffalo, NY, USA
- Department of Oral and Maxillofacial Surgery, Women and Children's Hospital at Buffalo, University of Buffalo, Buffalo, NY, USA
- Department of Anesthesia, University of Buffalo, Buffalo, NY, USA
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Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, Maktabi M, Lee J, Kwo J, Pino R, Sabouri AS, McGovern F, Staehr-Rye AK, Eikermann M. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth 2015; 115:743-51. [PMID: 25935840 DOI: 10.1093/bja/aev104] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. METHODS Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance. RESULTS Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02). CONCLUSIONS After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov:NCT01479764.
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Affiliation(s)
- B Brueckmann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - N Sasaki
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - P Grobara
- Biostatistics and Research Decision Sciences, MSD, Oss, The Netherlands
| | - M K Li
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - T Woo
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - J de Bie
- Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA
| | - M Maktabi
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Lee
- Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Kwo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - R Pino
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA
| | - A S Sabouri
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
| | - F McGovern
- Harvard Medical School, Boston, MA, USA Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - A K Staehr-Rye
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - M Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA Essen-Duisburg University, Essen, Germany
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Sabouri AS, Firoozabadi F, Carlin D, Creighton P, Raczka M, Joshi P, Heard C. Noise level measurement, a new method to evaluate effectiveness of sedation in pediatric dentistry. Acta Anaesthesiol Taiwan 2014; 52:169-75. [PMID: 25577448 DOI: 10.1016/j.aat.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/03/2014] [Accepted: 11/06/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Pediatric dentists perform moderate sedation frequently to facilitate dental treatment in uncooperative children. Assessing the depth and quality of sedation is an important factor in the clinical utilization of moderate sedation. We aimed to determine if the level of noise, created by the children who are undergoing moderate sedation during dental procedures, could be used as a nonsubjective measurement of the depth of sedation and compare it to the Ohio State Behavior Rating Score (OSBRS). METHODS Following Institutional Review Board approval and after receiving informed consent, we studied 51 children with a mean age of 4.2 years and average weight of 18.5 kg, who were undergoing restorative or extractive dental procedures, requiring moderate sedation. Sedation efficacy was assessed using OSBRS at several stages of the procedure. The noise level was measured by using a NoisePRO logging device to record the noise level at a rate of every second throughout the procedure. RESULTS The depth of sedation assessed by OSBRS during the operative procedure was significantly correlated with noise level. The act of administering the local anesthesia and the operative procedure itself were two phases of the encounter that were significantly associated with higher OSBRS as well as noise levels. CONCLUSION Measurement of noise level can be used as an effective guide to quantify the depth of sedation at different stages of the dental procedure. It is a nonsubjective and continuous measurement, which could be useful in clinical practice for the administration of moderate sedation during dental procedures. By using noise level analysis we are able to determine successful, poor, and failed sedation outcome.
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Affiliation(s)
- A Sassan Sabouri
- Department of Anesthesiology, Women and Children's Hospital of Buffalo, SUNY School of Medicine, Buffalo, NY, USA.
| | - Farshid Firoozabadi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Drew Carlin
- Department of Pediatric and Community Dentistry, SUNY School of Dentistry, Buffalo, NY, USA
| | - Paul Creighton
- Department of Pediatric and Community Dentistry, SUNY School of Dentistry, Buffalo, NY, USA
| | - Michelle Raczka
- Department of Anesthesiology, Women and Children's Hospital of Buffalo, SUNY School of Medicine, Buffalo, NY, USA
| | - Prashant Joshi
- Division of Pediatric Critical Care, Women and Children's Hospital of Buffalo, SUNY School of Medicine, Buffalo, NY, USA
| | - Christopher Heard
- Department of Anesthesiology, Women and Children's Hospital of Buffalo, SUNY School of Medicine, Buffalo, NY, USA; Department of Pediatric and Community Dentistry, SUNY School of Dentistry, Buffalo, NY, USA; Division of Pediatric Critical Care, Women and Children's Hospital of Buffalo, SUNY School of Medicine, Buffalo, NY, USA
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Sabouri AS, Lerman J, Heard C. Effects of fresh gas flow, tidal volume, and charcoal filters on the washout of sevoflurane from the Datex Ohmeda (GE) Aisys, Aestiva/5, and Excel 210 SE Anesthesia Workstations. Can J Anaesth 2014; 61:935-42. [PMID: 25069780 DOI: 10.1007/s12630-014-0200-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/18/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We investigated the effects of tidal volume (VT), fresh gas flow (FGF), and a charcoal filter in the inspiratory limb on the washout of sevoflurane from the following Datex Ohmeda (GE) Anesthesia Workstations (AWSs): Aisys, Aestiva/5, and Excel 210SE. METHODS After equilibrating the AWSs with 2% sevoflurane, the anesthetic was discontinued, and the absorbent anesthesia breathing circuit (ABC), reservoir bag, and test lung were changed. The lung was ventilated with 350 or 200 mL·breath(-1), 15 breaths·min(-1), and a FGF of 10 L·min(-1) while the washout of sevoflurane was performed in triplicate using a calibrated Datex Ohmeda Capnomac Ultima™ and a calibrated MIRAN SapphIRe XL ambient air analyzer until the concentration was ≤ 10 parts per million (ppm). The effects of decreasing the FGF to 5 and 2 L·min(-1) after the initial washout and of a charcoal filter in the ABC were recorded separately. RESULTS The median washout times with the Aisys AWS (14 min, P < 0.01) and the Aestiva/5 (17 min, P < 0.001) with VT 350 mL·breath(-1) were significantly less than that with the Excel 210SE (32 min). The mean (95% confidence interval) washout time with the Aisys increased to 23.5 (21.5 to 25.5) min with VT 200 mL·breath(-1) (P < 0.01). Decreasing the FGF from 10 to 5 and 2 L·min(-1) with the Aisys caused a rebound in sevoflurane concentration to ≥ 50 ppm. Placement of a charcoal filter in the inspiratory limb reduced the sevoflurane concentration to < 2 ppm in the Aisys and Aestiva/5 AWSs within two minutes. CONCLUSION The GE AWSs should be purged with large FGFs and VTs ~350 mL·breath(-1) for ~25 min to achieve 10 ppm sevoflurane. The FGF should be maintained to avoid a rebound in anesthetic concentration. Charcoal filters rapidly decrease the anesthetic concentration to < 2 ppm.
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Affiliation(s)
- A Sassan Sabouri
- Department of Anesthesia, Women and Children's Hospital of Buffalo, SUNY at Buffalo, 219 Bryant ST, Buffalo, NY, 14222, USA
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