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Morales JF, Gomez A, Carvalho J, Ye XY, Downey K, Siddiqui N. Quality of Recovery After Unplanned and Planned Cesarean Deliveries: A Prospective Observational Study Using the Obstetric Quality of Recovery-10 Tool. Anesth Analg 2024:00000539-990000000-00755. [PMID: 38381657 DOI: 10.1213/ane.0000000000006876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries. METHODS We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings. RESULTS We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients' perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries). CONCLUSIONS As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.
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Affiliation(s)
- Juan F Morales
- From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario Canada
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Roffi K, Siddiqui N, Portelli S, Sharma D, Juneau J, Kolhe P, Badkar A. Laser Measurement and Numerical Simulation of Elastomer Stopper Motion during High-Altitude Shipping of Pharmaceutical Syringes. PDA J Pharm Sci Technol 2023; 77:449-471. [PMID: 37451836 DOI: 10.5731/pdajpst.2022.012809] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
During high-altitude shipping of pre-filled syringes, pressure differentials can cause the elastomer stopper to move unintentionally. This motion represents a risk to container closure integrity and drug product sterility. To understand and quantitate this risk, we combined high-accuracy laser measurements and numerical simulations of stopper motion. We tested the effects of syringe barrel siliconization, stopper design, syringe orientation, and altitude rate on stopper displacement; only the siliconization factor had a significant effect. Our observations were compared with two mathematical models based on Boyle's Law and a force balance approach. For well-lubricated syringes, stopper motion was reasonably predicted by Boyle's Law (residual ≤ 10%). When the lubricant amount was reduced, Boyle's Law failed to accurately predict stopper motion (residual ≈ 40%). To simulate stopper motion more accurately, we developed a dynamic model in MATLAB-Simulink to incorporate the dry and viscous friction inherent to the lubricated interference fit. Using a Coulomb-viscous subroutine, deviations from Boyle's Law were successfully explained in terms of the displacement, but the system dynamics were not fully accurate. The combination of laser measurements and numerical simulation has yielded unique insight into stopper motion during high-altitude shipping. These tools can provide valuable input to a risk-based drug development strategy to enable global distribution of pre-filled syringes.
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Affiliation(s)
- Kirk Roffi
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Naveed Siddiqui
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Samantha Portelli
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Divya Sharma
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Jennifer Juneau
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Parag Kolhe
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
| | - Advait Badkar
- Pharmaceutical Research and Development, Pfizer, 1 Burtt Rd, Andover, MA 01810, USA
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Gleicher Y, Dos Santos Fernandes H, Peacock S, Alekberli T, Di Grazia V, Estrellas R, Wolfstadt J, Matelski J, Siddiqui N. Comparison of migration rates between traditional and tunneled adductor canal block catheters: a randomized controlled trial. Reg Anesth Pain Med 2023:rapm-2023-104654. [PMID: 37704437 DOI: 10.1136/rapm-2023-104654] [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: 05/09/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Total knee arthroplasty is associated with significant postoperative pain. Continuous adductor canal blocks via an inserted adductor canal catheter are effective analgesia interventions with the advantage of decreasing quadriceps weakness and the potential of extending the analgesic effect. The classical adductor canal catheter insertion technique may have a high likelihood of catheter dislodgement out of the canal. The interfascial plane between the sartorius muscle and femoral artery (ISAFE) approach has the potential of decreasing the adductor canal catheter migration. The purpose of this study was to evaluate the incidence of catheter dislodgment to outside the adductor canal, for ISAFE and classical approaches. We hypothesized that ISAFE approach would result in a lower dislodgment rate. METHODS Ninety-seven patients for unilateral total knee arthroplasty were included and randomized to either ISAFE intervention group or conventional group. The primary outcome was the incidence of adductor canal catheter dislodged to outside the adductor canal, on ultrasound evaluation, 24 hours after the surgery. Secondary outcomes were pain scores, opioid consumption and continuous adductor canal block related complications for the first 48 hours after surgery. RESULTS The catheters placed using ISAFE approach had a lower rate of dislodgement in comparison to the control group (18.6% vs 44.9%, respectively, p=0.01), at 24 hours after surgery; and lower pain scores for rest, on the first two postoperative days. CONCLUSIONS ISAFE group had a significantly lower rate of dislodgement at 24 hours. The continuous adductor canal block analgesic benefit for knee arthroplasty depends on the position of the tip of the catheter inside the adductor canal.
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Affiliation(s)
- Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Sharon Peacock
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tural Alekberli
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vitaliano Di Grazia
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Regine Estrellas
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University of Toronto, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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Tanwani J, Nabecker S, Hiansen JQ, Mashari A, Siddiqui N, Arzola C, Goffi A, Peacock S. Use of a Novel Three-Dimensional Model to Teach Ultrasound-guided Subclavian Vein Cannulation. ATS Sch 2023; 4:344-353. [PMID: 37795109 PMCID: PMC10547090 DOI: 10.34197/ats-scholar.2022-0104in] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/18/2023] [Indexed: 10/06/2023] Open
Abstract
Background Central venous cannulation is an essential skill in perioperative and critical care medicine. Ultrasound guidance is the standard of care for femoral and internal jugular vein access, with the subclavian vein being perceived to be less amenable to ultrasound-guided (UG) insertion, resulting in a lack of procedural competency and low cannulation rate. There is a paucity of resources and a lack of experience among staff physicians to effectively instruct trainees. Simulation-based medical education has the potential to help maintain high-stakes, infrequently performed skills and counteract possible unrecognized skill decline. We aimed to create a novel, low-cost, high-fidelity three-dimensional (3D) model for UG subclavian vein (UG-SCV) access with an accompanying curriculum to improve this important skill. Methods A curriculum was created consisting of preparatory material reviewing UG-SCV access, followed by an in-person didactic lecture focusing on ultrasound use and management of complications and a deliberate practice session scanning volunteers and practicing UG vascular puncture on a 3D model. A qualitative usability test design was used to assess the validity of the curriculum in trainees with advanced vascular access skills (anesthesiologists). Participants were second-year anesthesia residents, anesthesia fellows, and staff physicians. Focus groups conducted after each session explored the face validity of the model and curriculum. By applying a usability design, the curriculum was optimized and finalized. Results Between September 2020 and February 2021, 28 participants tested the curriculum. The focus groups ensured that the curriculum achieved its objective, with iterative changes made after each session in a quality improvement framework Plan-Do-Study-Act approach. After the third cycle, minimal changes were suggested, and the curriculum and 3D model were finalized. An additional group of participants was used to ensure that no new input would help improve the curriculum further. Conclusions A focused curriculum for enhancing skills in UG-SCV cannulation using a novel 3D model was successfully implemented and validated through a usability test design. This curriculum is better targeted for practitioners experienced in central venous access to master a subclavian approach and maintain their skill level.
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Affiliation(s)
- Jaya Tanwani
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Joshua Qua Hiansen
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Azad Mashari
- Department of Anesthesia and Pain
Management, and
- Advanced Perioperative Imaging Lab,
Toronto General Hospital, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Cristian Arzola
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Alberto Goffi
- Keenan Research Centre and Li Ka Shing
Knowledge Institute, Department of Critical Care Medicine, St. Michael’s
Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical
Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Peacock
- Department of Anesthesiology and Pain
Medicine, Sinai Health System, Toronto, Ontario, Canada
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Dos Santos Fernandes H, Siddiqui N, Peacock S, Vidal E, Matelski J, Entezari B, Khan M, Gleicher Y. Effectiveness of preoperative thoracic epidural testing strategies: a retrospective comparison of three commonly used testing methods. Can J Anaesth 2023:10.1007/s12630-023-02545-9. [PMID: 37505418 DOI: 10.1007/s12630-023-02545-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/14/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Thoracic epidural analgesia (TEA) is a well stablished technique for pain management in major thoracic and abdominal surgeries; however, it has considerable failure rates. Local anesthetic (LA) administration and subsequent assessment of sensory block through physical examination (e.g., decreased temperature perception determined via an LA temperature dissociation test [LATDT]) has been the historical standard for evaluation of thoracic epidural placement. Nevertheless, newer methods to objectively evaluate successful placement have recently been developed, e.g., the epidural electrical stimulation test (EEST) and epidural pressure waveform analysis (EWA). The purpose of this study was to evaluate the effectiveness of preoperative TEA catheter testing (LATDT, EEST, and EWA) on reducing TEA failure. METHODS After obtaining an institutional research ethics board approval for a retrospective study, we conducted a single-institution retrospective review on all TEAs performed between January 2016 and December 2021. Patients were assigned to one of four groups based on the performed test method to verify the placement of the TEA catheter: no test, LATDT, EEST, and EWA. A TEA was deemed successful if it provided bilateral dermatomal sensory block to ice test in the postoperative period, and was used for patient analgesia for at least 24 hr. RESULTS One thousand two hundred and forty-one patients submitted to preoperative TEA were included. Twenty-eight patients were excluded. Tested and untested epidurals had failure rates of 3.8% (95% confidence interval [CI], 1.8 to 6.2) and 11.5% (95% CI, 5.2 to 17.1), respectively (P < 0.001). CONCLUSION Objective preoperative testing after placement of thoracic epidurals was associated with a reduction in failure rates.
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Affiliation(s)
- Hermann Dos Santos Fernandes
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada.
- Mount Sinai Hospital, 600 University Ave., Room 7-405, Toronto, ON, M6G 1X5, Canada.
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
| | - Sharon Peacock
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
| | - Ezequiel Vidal
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
| | - John Matelski
- Biostatistics Research Unit, University of Toronto, Toronto, ON, Canada
| | - Bahar Entezari
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
| | - Muhammad Khan
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
| | - Yehoshua Gleicher
- Department of Anesthesia and Pain Management, Mount Sinai Hospital - Sinai Health, Toronto, ON, Canada
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Siddiqui N, Charoenpong P. Outcomes of Double Lung and Combined Double Lung-Liver Transplant in Cystic Fibrosis Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Gleicher Y, Fernandes HDS, Peacock S, Siddiqui N. Questions remain about efficacy of adductor canal blocks. Reg Anesth Pain Med 2023; 48:191. [PMID: 36596582 DOI: 10.1136/rapm-2022-104208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Sharon Peacock
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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Zasso FB, Liu L, Siddiqui N, Wild E, Massouh F, You-Ten KE. Impact of the COVID-19 pandemic on anesthesiology residents in Canada: a nationwide survey. Can J Anaesth 2023; 70:172-175. [PMID: 36447089 PMCID: PMC9708137 DOI: 10.1007/s12630-022-02366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fabricio Batistella Zasso
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Laura Liu
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON Canada
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON Canada
| | - Evan Wild
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON Canada
| | - Faraj Massouh
- Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
| | - Kong Eric You-Ten
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON Canada
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Khan MI, Khandadashpoor S, Rai Y, Vertolli G, Backstein D, Siddiqui N. Comparing Analgesia on an As-Needed Basis to Traditional Intravenous Patient-Controlled Analgesia Within Fast-Track Orthopedic Procedures: A Randomized Controlled Trial. Pain Manag Nurs 2022; 23:832-837. [PMID: 35599141 DOI: 10.1016/j.pmn.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim was to determine if the use of intravenous patient-controlled analgesia (IVPCA) in a fast-track joint replacement program is associated with increased use of perioperative opioid consumption and increased length of hospital stay. DESIGN A prospective, double-blind, randomized controlled trial. SETTINGS Academic hospital. PARTICIPANTS/SUBJECTS A total of 80 patients aged 18-85 years, with body mass index (BMI) 18-40, undergoing elective total knee arthroplasty were recruited. METHODS Pre-operatively, patients received gabapentin, celecoxib, and acetaminophen. Peri-operatively, patients received spinal anesthesia with morphine and fentanyl, and periarticular local anesthetic administration by the surgeon. Postoperatively, 80 patients were randomized by a computer-generated sequence into IVPCA group (group A, n = 40) and non-IVPCA group (group B, n = 40). RESULTS The primary outcome was 48-hour postoperative opioid consumption and length of hospital stay. Secondary outcomes included side effects of opioids, patient satisfaction, and pain scores. There was no significant difference within 48-hour postoperative opioid consumption (median 61.3 vs. 87.5, p = .181) and length of hospital stay (median 49.8 hours vs. 49.5 hours; p = .89) between the two groups. Also, there was no significant difference in patient satisfaction (median 5 in both groups), pain scores, and opioid-related side effects. CONCLUSIONS IVPCA was associated with nonsignificant reduction in opioid exposure in elective total knee arthroplasty surgery within 48 hours. Neither group was superior in terms of length of hospital stay, opioid related side-effects, pain scores, and patient satisfaction.
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Affiliation(s)
- Muhammad Imran Khan
- From the Department of Anesthesia, Mount Sinai Hospital, University Health Network, University of Toronto, Canada
| | - Shiva Khandadashpoor
- From the Department of Anesthesia, Mount Sinai Hospital, University Health Network, University of Toronto, Canada
| | - Yeshith Rai
- From the Department of Anesthesia, Mount Sinai Hospital, University Health Network, University of Toronto, Canada
| | - Giuliana Vertolli
- From the Department of Anesthesia, Mount Sinai Hospital, University Health Network, University of Toronto, Canada
| | - David Backstein
- Department of Orthopedic Surgery, Mount Sinai Hospital, University Health Network, University of Toronto, Canada
| | - Naveed Siddiqui
- From the Department of Anesthesia, Mount Sinai Hospital, University Health Network, University of Toronto, Canada.
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Siddiqui N, Faiyaz T, Tari VS. Ganga and Yamuna Rivers: Through the Lens of the National Green Tribunal. Nat Env Poll Tech 2022. [DOI: 10.46488/nept.2022.v21i04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Despite the country’s extensive environmental jurisprudence and many historic rulings in which the courts have rescued worsening environmental situations, river (Ganga and Yamuna) water does not match the mandated minimum “bathing quality.” Rivers like the Ganga and Yamuna, which flow through numerous states and towns, would be in a different situation. Without strict monitoring and enforcement of the measures, no action plan can work. Punishment of defaulters can serve as deterrence while also instilling fear in other non-compliant enterprises. In comparison to environmental legislation, the NGT Act allows for substantially harsher fines and penalties. River rejuvenation plans must be carefully monitored to ensure that they do not suffer the same fate. Making action plans will not improve river water quality unless they are implemented with sincerity and consistency, as well as continuous monitoring and severe enforcement.
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van den Bosch OFC, Gleicher Y, Arzola C, Siddiqui N, Downey K, Carvalho JCA. Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals. Reg Anesth Pain Med 2022; 47:775-779. [PMID: 36215115 DOI: 10.1136/rapm-2022-103948] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ultrasound is commonly used to facilitate epidural catheter placement. However, data are lacking regarding its potential to confirm its position in the epidural space. Our aim was to visualize flow in the epidural space of patients receiving epidural analgesia for labor using color flow Doppler ultrasound. METHODS We conducted a prospective observational cohort study that included patients who had delivered vaginally under epidural analgesia. We used a 5-2 mHz curvilinear probe in a left and right paramedian longitudinal oblique view to visualize the anterior and posterior complex at the interspace of epidural catheter insertion, one and two interspaces above and below. At each window, the color flow Doppler function was used to visualize flow within the epidural space on injection of normal saline (1 mL). If no flow was visualized at any interspace, one assessment at the level of insertion was repeated with a 1 mL air/saline mixture. We studied a convenience sample size of 40 patients. RESULTS We visualized flow in the epidural space in all 40 patients. Flow was visualized on injection of 1 mL of saline in 37/40 patients (93%). In the remaining 3/40 patients (7%), flow was visualized with an air/saline mixture. Flow on injection of saline was visualized only at the interspace of insertion in 26/37 patients (70%), at the interspace of insertion and one interspace above in 10/37 (27%), or only at one interspace above in 1/37 (3%). Flow was visualized only on the left or on the right paramedian view in 19/37 patients (51%), despite a symmetrical sensory block in all patients. CONCLUSION Color flow Doppler ultrasound is a feasible and fast way to determine flow in the epidural space in the obstetric population. Its potential clinical uses are confirmation of the epidural catheter position after placement, as well as troubleshooting of unsatisfactory epidural analgesia. Interestingly, our results suggest that epidural catheters predominantly remain at the interspace of insertion. TRIAL REGISTRATION NUMBER NCT05126745.
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Affiliation(s)
- Oscar F C van den Bosch
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cristian Arzola
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristi Downey
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jose C A Carvalho
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Zasso FB, Lait D, Siddiqui N, Perelman VS, Ye XY, You-Ten KE. Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study. CAN J EMERG MED 2022; 24:862-866. [PMID: 36346398 DOI: 10.1007/s43678-022-00399-6] [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: 04/05/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE A large vertical incision is recommended when performing front-of-neck access in patients with impalpable neck landmarks during a cannot intubate-cannot oxygenate (CICO) scenario. We investigated the impact of ultrasonography on vertical incision size of a front-of-neck access on an ultrasound-compatible impalpable porcine larynx model. METHODS Emergency medicine and anesthesia trainees were randomized to the Ultrasound (US, n = 21) and Non-Ultrasound (NUS, n = 21) groups. Within 1 week after a teaching session on airway ultrasound and Scalpel-Bougie-Tube (SBT) technique, participants were instructed to perform cricothyroidotomy on the model during a simulated cannot intubate-cannot oxygenate scenario. The primary outcome was a vertical size incision. Secondary outcomes were procedural completion time, horizontal size incision, tissue injury severity, and correct tube placement. RESULTS The ultrasound group performed a significantly smaller vertical incision [median (IQR), 35.0 (15, 40) vs 65.0 (52, 100) mm (95% CI) - 30.0 (- 55.1, - 4.9), p = 0.02] and took longer total time to complete the procedure [median (IQR), 200.5 (126, 267) vs 93.5 (71.0, 167.5) secs (95% CI) 91.0 (3.73, 178.3), p = 0.04]. Tissue injury severity and correct tube placement were similar between groups. CONCLUSIONS Ultrasound-guided identification of the cricothyroid membrane significantly reduced the recommended vertical incision size with similar success rates. However, there was an increased time when performing a Scalpel-Bougie-Tube cricothyroidotomy on an impalpable porcine larynx model by physicians in training. Ultrasonography should not be used in an emergency scenario of airway rescue. Its potential use to pre-mark the cricothyroid membrane should be considered in difficult airway management of impalpable neck.
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Affiliation(s)
- Fabricio Batistella Zasso
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, 7-405, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Dekel Lait
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, 7-405, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, 7-405, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Vsevolod S Perelman
- Department of Family Medicine-Emergency Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Xiang Y Ye
- MiCcare Research Centre, Mount Sinai Hospital-Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Kong Eric You-Ten
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, 7-405, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Wong J, Doherty HR, Singh M, Choi S, Siddiqui N, Lam D, Liyanage N, Tomlinson G, Chung F. The prevention of delirium in elderly surgical patients with obstructive sleep apnea (PODESA): a randomized controlled trial. BMC Anesthesiol 2022; 22:290. [PMID: 36104664 PMCID: PMC9472354 DOI: 10.1186/s12871-022-01831-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with neurocognitive impairment - a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty. METHODS We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were [Formula: see text]0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea-hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery. RESULTS Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups. CONCLUSIONS We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty. TRIAL REGISTRATION This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016.
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Affiliation(s)
- Jean Wong
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Department of Anesthesiology and Pain Medicine, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Helen R. Doherty
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Mandeep Singh
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Department of Anesthesiology and Pain Medicine, Women’s College Hospital, Toronto, ON Canada
| | - Stephen Choi
- grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Canada
| | - Naveed Siddiqui
- grid.17063.330000 0001 2157 2938Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, ON Canada
| | - David Lam
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - Nishanthi Liyanage
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | - George Tomlinson
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, Department of Medicine, University of Toronto, Toronto, ON M5G 2C4 Canada
| | - Frances Chung
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada
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Jayaraj AK, Siddiqui N, Abdelghany SMO, Balki M. Management of difficult and failed intubation in the general surgical population: a historical cohort study in a tertiary care centre. Can J Anaesth 2022; 69:427-437. [PMID: 34907502 DOI: 10.1007/s12630-021-02161-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 05/14/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The objective of this study was to describe the incidence, management, and complications of difficult and failed endotracheal intubation in a general surgical population. METHODS This historical cohort study included all cases of difficult endotracheal intubation in general surgical patients at Mount Sinai Hospital (Toronto, ON, Canada) from 1 January 2011 to 31 December 2017. Patient charts and electronic records were reviewed to collect data on airway management and complications. Endotracheal intubation was graded as "difficult" if more than two attempts with direct laryngoscopy or if additional equipment for second or subsequent attempts was required, and "failed" if it could not be achieved despite the attempts. The primary outcome was the incidence of difficult and failed intubation. The secondary outcomes were complications, difficult airway parameters, mask ventilation, number of intubation attempts, and rescue devices including the eventually successful method. RESULTS We identified 111 cases of difficult intubation (0.26%) and 14 cases of failed intubation (0.03%) in 42,805 surgical cases requiring endotracheal intubation over the seven-year period. The incidence was highest in 2012 (0.36%) and lowest in 2017 (0.13%). Difficulty was anticipated in 84 (76%) patients. The median (range) number of intubation attempts was 2 (2-5). Videolaryngoscopy was the eventually successful method in those with unsuccessful first attempt direct laryngoscopy (n = 91) and videolaryngoscopy (n = 17) in 71% and 77% cases, respectively. Intubation failed in 14 patients, three of whom required a surgical airway because the lungs could not be ventilated. Poor visualization of the glottis (93%) and airway bleeding (36%) were the leading causes of failed intubation. Desaturation was seen in 8%, airway bleeding in 7%, and airway edema in 6% of cases of difficult intubation. CONCLUSION The incidences of difficult and failed intubations in our study were 2.6 and 0.3 per 1,000 surgeries requiring laryngoscopies, respectively, with a decrease over time. Videolaryngoscopy showed a high success rate as a rescue device.
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Affiliation(s)
- Ashok Kumar Jayaraj
- Advanced Airway Management, Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Mrinalini Balki
- Department of Anesthesiology and Pain Medicine, Department of Obstetrics & Gynaecology, and Department of Physiology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 7-405, Toronto, ON, M5G 1X5, Canada.
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.
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Jiwani R, Wang J, Li C, Dennis B, Patel D, Gelfond J, Liu Q, Siddiqui N, Bess C, Monk S, Serra M, Espinoza S. A Behavioral Lifestyle Intervention to Improve Frailty in Overweight or Obese Older Adults with Type 2 Diabetes: A Feasibility Study. J Frailty Aging 2022; 11:74-82. [PMID: 35122094 PMCID: PMC8068458 DOI: 10.14283/jfa.2021.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality. OBJECTIVES To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D. DESIGN, SETTING, AND PARTICIPANTS Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes. RESULTS Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=<0.001). CONCLUSION This study provides evidence for the feasibility of a behavioral lifestyle intervention in overweight/obese older adults with T2D and preliminary results support its potential efficacy in improving frailty score.
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Affiliation(s)
- R Jiwani
- Rozmin Jiwani, PhD, RN, 7703 Floyd Curl Drive, San Antonio, Texas, 78229, Phone: 210-450-8498, Fax: 210-567-5822,
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Dos Santos Fernandes H, Siddiqui N, Peacock S, Vidal E, Wolfstadt J, Gleicher Y. Inter-fascial space between SArtorius muscle and FEmoral artery (ISAFE): A suggested approach for Adductor Canal catheter placement. J Clin Anesth 2021; 76:110571. [PMID: 34763273 DOI: 10.1016/j.jclinane.2021.110571] [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] [Received: 09/20/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | - Naveed Siddiqui
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Peacock
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ezequiel Vidal
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Sinai Health, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yehoshua Gleicher
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
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Srivastava P, May-Miller H, Gilroy JA, Blackie K, Worku D, Siddiqui N, Tweddle A, Droney J, Gruber P. 1442O Proactive early palliative care referral for cancer patients in the intensive care unit: Implementing a novel “triggers” checklist. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Siddiqui N, Whitehouse K. P.83 Administration of low-molecular weight heparin following caesarean section for the prevention of venous thromboembolism. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Mohamed M, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas M. Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.
Purpose
To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.
Methods
All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Results
Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).
Conclusion
Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.
Odds of management and clinical outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Mohamed
- Keele University, Cardiology, Keele, United Kingdom
| | - M Rashid
- Keele University, Keele, United Kingdom
| | - S Farooq
- Keele University, Keele, United Kingdom
| | - N Siddiqui
- Nevill Hall Hospital, Abergavenny, United Kingdom
| | - P Parwani
- Loma Linda University Medical Center, Loma Linda, United States of America
| | - D Shiers
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - R Thamman
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States of America
| | - M Gulati
- University of Arizona College of Medicine, Phoenix, United States of America
| | - A Shoaib
- Keele University, Cardiology, Keele, United Kingdom
| | | | - M.A Mamas
- Keele University, Cardiology, Keele, United Kingdom
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20
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Balki I, Khan JS, Staibano P, Duceppe E, Bessissow A, Sloan EN, Morley EE, Thompson AN, Devereaux B, Rojas C, Rojas C, Siddiqui N, Sessler DI, Devereaux PJ. Effect of Perioperative Active Body Surface Warming Systems on Analgesic and Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg 2020; 131:1430-1443. [PMID: 33079867 DOI: 10.1213/ane.0000000000005145] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 01/15/2023]
Abstract
BACKGROUND Inadvertent perioperative hypothermia is a common complication of surgery, and active body surface warming (ABSW) systems are used to prevent adverse clinical outcomes. Prior data on certain outcomes are equivocal (ie, blood loss) or limited (ie, pain and opioid consumption). The objective of this study was to provide an updated review on the effect of ABSW on clinical outcomes and temperature maintenance. METHODS We conducted a systematic review of randomized controlled trials evaluating ABSW systems compared to nonactive warming controls in noncardiac surgeries. Outcomes studied included postoperative pain scores and opioid consumption (primary outcomes) and other perioperative clinical variables such as temperature changes, blood loss, and wound infection (secondary outcomes). We searched Ovid MEDLINE daily, Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Web of Science from inception to June 2019. Quality of evidence (QoE) was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Subgroup analysis sought to determine the effect of preoperative + intraoperative warming versus intraoperative warming alone. Metaregression evaluated the effect of year of publication, use of neuromuscular blockers, anesthesia, and surgery type on outcomes. RESULTS Fifty-four articles (3976 patients) were included. Pooled results demonstrated that ABSW maintained normothermia compared to controls, during surgery (30 minutes postinduction [mean difference {MD}: 0.3°C, 95% confidence interval {CI}, 0.2-0.4, moderate QoE]), end of surgery (MD: 1.1°C, 95% CI, 0.9-1.3, high QoE), and up to 4 hours postoperatively (MD: 0.3°C, 95% CI, 0.2-0.5, high QoE). ABSW was not associated with difference in pain scores (<24 hours postoperatively, moderate to low QoE) or perioperative opioid consumption (very low QoE). ABSW increased patient satisfaction (MD: 2.2 points, 95% CI, 0.9-3.6, moderate QoE), reduced blood transfusions (odds ratio [OR] = 0.6, 95% CI, 0.4-1.0, moderate QoE), shivering (OR = 0.2, 95% CI, 0.1-0.4, high QoE), and wound infections (OR = 0.3, 95% CI, 0.2-0.7, high QoE). No significant differences were found for fluid administration (low QoE), blood loss (very low QoE), major adverse cardiovascular events (very low QoE), or mortality (very low QoE). Subgroup analysis and metaregression suggested increased temperature benefit with pre + intraoperative warming, use of neuromuscular blockers, and recent publication year. ABSW seemed to confer less temperature benefit in cesarean deliveries and neurosurgical/spinal cases compared to abdominal surgeries. CONCLUSIONS ABSW is effective in maintaining physiological normothermia, decreasing wound infections, shivering, blood transfusions, and increasing patient satisfaction but does not appear to affect postoperative pain and opioid use.
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Affiliation(s)
- Indranil Balki
- From the Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James S Khan
- From the Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Phillip Staibano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Emmanuelle Duceppe
- Department of Medicine, Centre hospitalier de l'Université de Montréal, l'Université de Montréal, Montreal, Quebec, Canada
| | - Amal Bessissow
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Erin N Sloan
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin E Morley
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra N Thompson
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Breagh Devereaux
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Camila Rojas
- Department of Anesthesia, Clinica Universidad de Los Andes, Universidad de Los Andes, Bogota, Colombia
| | - Naveed Siddiqui
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Daniel I Sessler
- (DIS) Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - P J Devereaux
- Department of Health Research Methods, Evidence and Impact
- Population Health Research Institute, and
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Zasso FB, You-Ten KE, Ryu M, Losyeva K, Tanwani J, Siddiqui N. Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review. BMC Anesthesiol 2020; 20:216. [PMID: 32854626 PMCID: PMC7450579 DOI: 10.1186/s12871-020-01135-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. Methods This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to 7 days) and late (beyond 7 days of the procedure). Results We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20–0.22), p < 0.0001]. Conclusions Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways.
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Affiliation(s)
- Fabricio Batistella Zasso
- MD, Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Kong Eric You-Ten
- MD, Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Ryu
- MLIS, Information Specialist, Sidney Liswood Health Science Library, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Khrystyna Losyeva
- Summer Research Student, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jaya Tanwani
- Medical Student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- MD, Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Adedugbe IO, Carvalho JCA, Downey K, Whittle W, Watts N, Siddiqui N. A team consensus on the allocation of resources, roles and tasks for emergency crash cesarean deliveries. J Clin Anesth 2020; 67:109972. [PMID: 32653752 DOI: 10.1016/j.jclinane.2020.109972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ibukun O Adedugbe
- Department of Anesthesia and Pain Management, University of Toronto, Canada
| | - Jose C A Carvalho
- Department of Anesthesia and Pain Management, University of Toronto, Canada; Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Canada
| | - Kristi Downey
- Department of Anesthesia and Pain Management, University of Toronto, Canada
| | - Wendy Whittle
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Canada
| | - Nancy Watts
- Department of Nursing, Mount Sinai Hospital, University of Toronto, Canada
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, University of Toronto, Canada.
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Zasso F, You-Ten K, Ryu M, Losyeva K, Tanwani J, Siddiqui N. Complications of cricothyrotomy and tracheostomy in emergency surgical airway management: a systematic review. Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Illahi Y, Siddiqui N, Nadeem M. WITHDRAWN: Diagnostic accuracy of folate receptor-positive circulating tumor cells detected by ligand-targeted polymerase chain reaction in patients with non-small-cell lung cancer: A meta-analysis. Hematol Oncol Stem Cell Ther 2020:S1658-3876(20)30035-2. [PMID: 32417031 DOI: 10.1016/j.hemonc.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/07/2019] [Indexed: 10/24/2022] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Rai Y, Siddiqui N. The role of ultrasound in front-of-neck access (FONA) for cricothyroid membrane identification: a systematic review. Trends in Anaesthesia and Critical Care 2020. [DOI: 10.1016/j.tacc.2019.12.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharkey AM, Siddiqui N, Downey K, Ye XY, Guevara J, Carvalho JCA. Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries. Anesth Analg 2019; 129:1312-1318. [DOI: 10.1213/ane.0000000000003704] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Malik AH, Siddiqui N, Shetty S, Godara A, Khan Z, El Accaoui R. P6535Atrial fibrillation and its impact in hospitalised cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is associated with increased morbidity and mortality. However, its impact on outcomes of cancer patients is largely unknown. We sought to determine the prevalence and effect of AF on in-hospital outcomes of patients admitted with AF in the United States.
Methods
We obtained and analyzed data from Nationwide Inpatient Sample (NIS 2002- 2014). The study population included all adults (>18 years old) with the discharge diagnosis of cancer and the associated secondary diagnosis of AF. The associations of AF with in-hospital complications, procedures, discharge outcomes, and mortality, were analyzed after adjusting for potential confounders using logistic regression analyses.
Results
During the study period, 12,410,290 patients were admitted with cancer; of which, 1,013,735 (8.2%) had AF. Patients with AF were likely to be male (51.1% vs 42.7%), white (86.3% vs 73.6%), and had significantly higher rates comorbidities including hypertension (59.6% vs 44.6%), diabetes (20.9% vs 15.8%), heart failure (23.8% vs 4.5%), and stroke (1.3% vs 0.7%). Similarly, in-hospital complications (including infections, venous thromboembolism, gastrointestinal bleeding, myocardial infarction) and hospital procedures (including cardiac catheterization, intubation, blood transfusion, percutaneous coronary intervention) were found at a significantly higher rate in cancer patients with AF compared to without AF (p-value for all <0.0001). After adjusting for all confounding factors, cancer patients in the AF group had higher odds of in-hospital death (odds ratio, 1.26; 95% confidence interval, 1.23–1.28; P<0.0001). The presence of AF conferred on average three days of extra inpatient stay in patients with cancer. Mortality in the cancer patients admitted with a concomitant diagnosis of AF has gradually increased from 7.2% to 9.7% over the 13-year study period.
Table 1. Multivariate model showing Atrial fibrillation as an independent risk factor of inpatient mortality in cancer patients Unadjusted univariate model Multivariate model adjusted for age, sex, race and potential confounders* Odds ratio (95% confidence interval P-value Odds ratio (95% confidence interval P-value Discharged alive Reference Reference In-hospital mortality 2.08 (2.07, 2.10) <0.0001 1.26 (1.23, 1.28) <0.0001 *Confounders adjusted for include all clinical comorbidities and in-hospital complications and procedures.
Conclusions
In patients with cancer, AF confers significant in-hospital burden by increasing the hospital stay by 3 days. AF is also associated with significantly higher rates of in-hospital procedures and complications in cancer patients and is an independent risk factor of in-hospital mortality.
Acknowledgement/Funding
None
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Affiliation(s)
- A H Malik
- New York Medical College, Internal medicine, Valhalla, United States of America
| | - N Siddiqui
- Tufts Medical Center, Boston, United States of America
| | - S Shetty
- University of Iowa, Medicine, Iowa City, United States of America
| | - A Godara
- Tufts Medical Center, Boston, United States of America
| | - Z Khan
- Tufts Medical Center, Boston, United States of America
| | - R El Accaoui
- University of Iowa, Medicine, Iowa City, United States of America
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Jayaraj A, Balachander H, Kuppusamy SK, Arusamy S, Rai Y, Siddiqui N. Comparison of meperidine, tramadol and fentanyl for post-spinal shivering prevention during cesarean delivery: A double-blind randomized controlled trial. J Obstet Gynaecol Res 2019; 45:2202-2208. [PMID: 31486253 DOI: 10.1111/jog.14106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/11/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
AIM To assess the effects of intravenously administered meperidine, fentanyl and tramadol in reducing the incidence, onset time and severity of the shivering response in parturients during cesarean delivery under spinal anesthesia. Secondary outcomes included patient satisfaction and sedation scores. METHODS After Ethics board approval and informed written consent, 350 parturients (ASA physical status I or II), between 20 and 40 years of age, undergoing emergency or elective cesarean delivery under spinal anesthesia were recruited. Parturients were then randomly allocated to seven study groups: normal saline (control), low-dose meperidine (0.5 mg/kg), high-dose meperidine (0.75 mg/kg), low-dose fentanyl (0.5 mcg/kg), high-dose fentanyl (0.75 mcg/kg), low-dose tramadol (0.5 mg/kg) and high-dose tramadol (0.75 mg/kg). The incidence, onset time and severity of shivering, along with patient satisfaction and sedation scores were measured. RESULTS All study drugs showed significant reduction in incidence, onset time and severity of shivering and greater satisfaction scores compared to the control group (P < 0.01). Within each drug class, no significant differences in shivering were found between the high-dose and low-dose groups. Among study drugs, low-dose tramadol was superior due to shivering prevention and significantly reduced sedation. CONCLUSION Intravenously administered meperidine, fentanyl and tramadol reduce shivering incidence, onset time and severity in parturients undergoing cesarean delivery following spinal anesthesia. Importantly, low-dose intravenous tramadol (0.5 mg/kg) allowed shivering prevention and low sedation scores, thereby offering greater parturient satisfaction and better maternal-newborn bonding.
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Affiliation(s)
- Ashokkumar Jayaraj
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Hemavathi Balachander
- Department of Anesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Suresh K Kuppusamy
- Department of Anesthesia and Critical Care, Manakulavinayagar Medical College and Hospital, Pondicherry, India
| | - Sivakumar Arusamy
- Department of Anesthesia and Critical Care, Aster Hospital, Dubai, United Arab Emirates
| | - Yeshith Rai
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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29
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Candiotti KA, Kranke P, Bergese SD, Melson TI, Motsch J, Siddiqui N, Chung F, Rodriguez Y, Minkowitz HS, Ayad SS, Diemunsch P, Fox G. Randomized, Double-Blind, Placebo-Controlled Study of Intravenous Amisulpride as Treatment of Established Postoperative Nausea and Vomiting in Patients Who Have Had No Prior Prophylaxis. Anesth Analg 2019; 128:1098-1105. [PMID: 31094774 DOI: 10.1213/ane.0000000000003733] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/05/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) occurs commonly in surgical patients despite widespread prophylactic antiemetic use. Rescue options are currently limited. 5HT3 antagonists are most frequently used for prophylaxis, but if they fail, additional doses are not effective as rescue medication. Intravenous (IV) amisulpride, a well-studied D2/D3 antagonist, has been shown in trials to prevent PONV. This study was designed to determine if amisulpride could be used to treat established PONV in patients at low-to-moderate risk of PONV who had not received any prior prophylaxis. METHODS Men and women aged over 18 years were permitted to enroll if they were to undergo general inhalational anesthesia, expected to last at least 1 hour, for an outpatient or inpatient surgical procedure. Patients who then suffered PONV were randomized equally to 1 of 3 single-dose IV regimens: placebo or 5 or 10 mg amisulpride. The primary end point was complete response, defined as no emesis in the period 30 minutes to 24 hours after study drug treatment and no use of rescue medication in the entire 24-hour period. RESULTS One thousand nine hundred eighty-eight patients were enrolled preoperatively, of whom 560 were randomized to a treatment arm. Complete response occurred in 39 of 181 patients (21.5%) in the placebo group compared to 60 of 191 patients (31.4%; P = .016) and 59 of 188 patients (31.4%; P = .016) in the amisulpride 5 and 10 mg groups, respectively. The adverse event profile of amisulpride at either dose was similar to placebo. CONCLUSIONS IV amisulpride at 5 and 10 mg was safe and efficacious in the treatment of established PONV in surgical patients undergoing general anesthesia with no prior PONV prophylaxis.
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Affiliation(s)
- Keith A Candiotti
- From the Department of Anesthesiology, Jackson Memorial Hospital, Miami, Florida
| | - Peter Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Würzburg, Germany
| | - Sergio D Bergese
- Department of Anesthesiology, Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - Timothy I Melson
- Department of Anesthesia, Helen Keller Hospital, Sheffield, Alabama
| | - Johann Motsch
- Department of Anesthesiology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Naveed Siddiqui
- Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Yiliam Rodriguez
- From the Department of Anesthesiology, Jackson Memorial Hospital, Miami, Florida
| | | | - Sabry S Ayad
- Anesthesiology Institute, Outcomes Research, Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio
| | - Pierre Diemunsch
- Service d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France
| | - Gabriel Fox
- Department of Clinical Development, Acacia Pharma, Cambridge, United Kingdom
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30
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Shakeel M, Abduulah S, Shahzad M, Mahmood T, Siddiqui N. Averaging aggregation operators with pythagorean trapezoidal fuzzy numbers and their application to group decision making. IFS 2019. [DOI: 10.3233/jifs-17238] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Shakeel
- Department of Mathematics, Hazara University Mansehra, KPK, Pakistan
| | - S. Abduulah
- Department of Mathematics, Abdul Wali Khan University Mardan, KPK, Pakistan
| | - M. Shahzad
- Department of Mathematics, Hazara University Mansehra, KPK, Pakistan
| | - T. Mahmood
- Department of Electronics Engineering, University of Engineering and Technology Taxila Sub Campus, Chakwal, Pakistan
| | - N. Siddiqui
- Department of Basic Sciences, University of Engineering and Technology Taxila, Pakistan
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31
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You-Ten KE, Wong DT, Ye XY, Arzola C, Zand A, Siddiqui N. Practice of Ultrasound-Guided Palpation of Neck Landmarks Improves Accuracy of External Palpation of the Cricothyroid Membrane. Anesth Analg 2018; 127:1377-1382. [DOI: 10.1213/ane.0000000000003604] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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32
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Ohashi Y, Farzi S, Siddiqui N. The use of lumbar spine and gastric ultrasound in perioperative obstetric anesthesia. Hypertens Res Pregnancy 2018. [DOI: 10.14390/jsshp.hrp2018-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yayoi Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group
| | - Sahar Farzi
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Clinician Scientist, Lunenfeld-Tanenbaum Research Institute
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33
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Siddiqui N, Pramanik K. Improvement of cellular responses of genipin cross-linked chitosan/nano
β
-TCP composite scaffolds by surface modification with fibrin. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aacad1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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34
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Siddiqui N, Marashi S. Response to the Letter to the Editor. Pain Pract 2018; 19:132. [PMID: 29802675 DOI: 10.1111/papr.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shaqayeq Marashi
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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35
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Nadeem A, Al-Harbi NO, Ahmad SF, Ibrahim KE, Siddiqui N, Al-Harbi MM. Glucose-6-phosphate dehydrogenase inhibition attenuates acute lung injury through reduction in NADPH oxidase-derived reactive oxygen species. Clin Exp Immunol 2018; 191:279-287. [PMID: 29277898 DOI: 10.1111/cei.13097] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/10/2017] [Revised: 12/01/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023] Open
Abstract
Acute lung injury (ALI) is a heterogeneous disease with the hallmarks of alveolar capillary membrane injury, increased pulmonary oedema and pulmonary inflammation. The most common direct aetiological factor for ALI is usually parenchymal lung infection or haemorrhage. Reactive oxygen species (ROS) generated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX2) are thought to play an important role in the pathophysiology of ALI. Glucose-6-phosphate dehydrogenase (G6PD) plays an important role both in production of ROS as well as their removal through the supply of NADPH. However, how G6PD modulation affects NOX2-mediated ROS in the airway epithelial cells (AECs) during acute lung injury has not been explored previously. Therefore, we investigated the effect of G6PD inhibitor, 6-aminonicotinamide on G6PD activity, NOX2 expression, ROS production and enzymatic anti-oxidants in AECs in a mouse model of ALI induced by lipopolysaccharide (LPS). ALI led to increased G6PD activity in the AECs with concomitant elevation of NOX2, ROS, SOD1 and nitrotyrosine. G6PD inhibitor led to reduction of LPS-induced airway inflammation, bronchoalveolar lavage fluid protein concentration as well as NOX2-derived ROS and subsequent oxidative stress. Conversely, ALI led to decreased glutathione reductase activity in AECs, which was normalized by G6PD inhibitor. These data show that activation of G6PD is associated with enhancement of oxidative inflammation in during ALI. Therefore, inhibition of G6PD might be a beneficial strategy during ALI to limit oxidative damage and ameliorate airway inflammation.
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Affiliation(s)
- A Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - N O Al-Harbi
- Department of Pharmacology and Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - S F Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
| | - K E Ibrahim
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - N Siddiqui
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - M M Al-Harbi
- Department of Pharmacology and Toxicology, College of Pharmacy, Riyadh, Saudi Arabia
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36
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Wong J, Lam D, Choi S, Singh M, Siddiqui N, Sockalingam S, Chung F. The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial. BMC Anesthesiol 2018; 18:1. [PMID: 29298664 PMCID: PMC5751872 DOI: 10.1186/s12871-017-0465-5] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 01/23/2023] Open
Abstract
Background Delirium is a common problem that occurs in 5–50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway – are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium. However, few studies have investigated the effect of perioperative treatment of OSA to prevent postoperative delirium. Methods This multi-centre randomized controlled trial will enrol 634 elderly patients undergoing elective hip/knee replacement surgery. The study has been approved by the Research Ethics Boards of the three participating institutions. Patients will be screened with the STOP-Bang questionnaire. Those with a score of 3 or greater will have a portable home sleep study using the ApneaLink™ Air device. Patients identified to have OSA will be randomized to 1) Auto-titrating continuous positive airway pressure (APAP) applied during sleep for 72 h after surgery or until discharge if they are discharged before 72 h or 2) Control group – routine care, no APAP. All patients will be evaluated for delirium for 72 h after surgery or until discharge if they are discharged before 72 h. The primary outcome is the occurrence of delirium – assessed twice daily using the Confusion Assessment Method for 72 h or until discharge if the hospital stay is <72 h. Discussion Delirium is associated with increased morbidity and mortality, and higher healthcare costs. With the aging population, the incidence of postoperative delirium will likely increase as the number of elderly individuals undergoing surgery rises. The results of our study will be published in a peer-reviewed journal and presented at local and international medical conferences. Our study findings may lead to improved surgical outcomes, enhanced patient safety and reduced healthcare costs. Trial registration This study was retrospectively registered at clinicaltrials.gov NCT02954224 on November 3, 2016.
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Affiliation(s)
- Jean Wong
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
| | - David Lam
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Stephen Choi
- Department of Anaesthesia, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Mandeep Singh
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.,Toronto Sleep and Pulmonary Center, Toronto, ON, Canada
| | - Naveed Siddiqui
- Department of Anaesthesia, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Centre for Mental Health, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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37
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Bell JD, Higgie K, Joshi M, Rucker J, Farzi S, Siddiqui N. Anesthetic Management of Mitochondrial Encephalopathy With Lactic Acidosis and Stroke-Like Episodes (MELAS Syndrome) in a High-Risk Pregnancy: A Case Report. ACTA ACUST UNITED AC 2017; 9:38-41. [PMID: 28398928 DOI: 10.1213/xaa.0000000000000520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered. This is to our knowledge the first case report of obstetric complications in MELAS syndrome and highlights the salient metabolic sequelae of this syndrome.
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Affiliation(s)
- Josh D Bell
- From the *Department of Anesthesiology, University of Toronto; and †Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
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38
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Choi YJ, Zhu J, Chung S, Siddiqui N, Feng Q, Stathopulos PB. Targeting Cysteine Thiols for in Vitro Site-specific Glycosylation of Recombinant Proteins. J Vis Exp 2017. [PMID: 29053695 DOI: 10.3791/56302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Stromal interaction molecule-1 (STIM1) is a type-I transmembrane protein located on the endoplasmic reticulum (ER) and plasma membranes (PM). ER-resident STIM1 regulates the activity of PM Orai1 channels in a process known as store operated calcium (Ca2+) entry which is the principal Ca2+ signaling process that drives the immune response. STIM1 undergoes post-translational N-glycosylation at two luminal Asn sites within the Ca2+ sensing domain of the molecule. However, the biochemical, biophysical, and structure biological effects of N-glycosylated STIM1 were poorly understood until recently due to an inability to readily obtain high levels of homogeneous N-glycosylated protein. Here, we describe the implementation of an in vitro chemical approach which attaches glucose moieties to specific protein sites applicable to understanding the underlying effects of N-glycosylation on protein structure and mechanism. Using solution nuclear magnetic resonance spectroscopy we assess both efficiency of the modification as well as the structural consequences of the glucose attachment with a single sample. This approach can readily be adapted to study the myriad glycosylated proteins found in nature.
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Affiliation(s)
- Yoo Jung Choi
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Jinhui Zhu
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Steve Chung
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Naveed Siddiqui
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Qingping Feng
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Peter B Stathopulos
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario;
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Abstract
Intracellular transport along microtubules enables cellular cargoes to efficiently reach the extremities of large, eukaryotic cells. While it would take more than 200 years for a small vesicle to diffuse from the cell body to the growing tip of a one-meter long axon, transport by a kinesin allows delivery in one week. It is clear from this example that the evolution of intracellular transport was tightly linked to the development of complex and macroscopic life forms. The human genome encodes 45 kinesins, 8 of those belonging to the family of kinesin-3 organelle transporters that are known to transport a variety of cargoes towards the plus end of microtubules. However, their mode of action, their tertiary structure, and regulation are controversial. In this review, we summarize the latest developments in our understanding of these fascinating molecular motors.
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Affiliation(s)
- N Siddiqui
- Centre for Mechanochemical Cell Biology, University of Warwick, Coventry, CV4 7AL, UK.
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40
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Abstract
The 'irritable hip' continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.
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Affiliation(s)
- J Hiddema
- Kingston Hospital NHS Foundation Trust , UK
| | - S Hassan
- Kingston Hospital NHS Foundation Trust , UK
| | - N Mangat
- Kingston Hospital NHS Foundation Trust , UK
| | - N Siddiqui
- Kingston Hospital NHS Foundation Trust , UK
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41
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Patel R, Carvalho JCA, Downey K, Kanczuk M, Bernstein P, Siddiqui N. Intraperitoneal Instillation of Lidocaine Improves Postoperative Analgesia at Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial. Anesth Analg 2017; 124:554-559. [PMID: 27984226 DOI: 10.1213/ane.0000000000001799] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cesarean delivery is a commonly performed procedure worldwide. Despite improvements in balanced multimodal analgesia, there remains a proportion of women for whom postoperative pain relief and patient satisfaction are still inadequate. Intraperitoneal instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the effect of intraperitoneal instillation of lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen. METHODS We studied women scheduled for elective cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 0.75% hyperbaric bupivacaine, fentanyl, and morphine. At the end of the cesarean delivery, immediately before parietal peritoneum or fascia closure, patients were randomized to receive either lidocaine (20 mL 2% lidocaine with epinephrine) or placebo (20 mL normal saline) instilled into the peritoneal cavity. The primary outcome was pain score on movement at 24 hours. Secondary outcomes were pain score at rest and on movement at 2, 24, and 48 hours; maternal satisfaction score; analgesic consumption; incidence of nausea, vomiting, and itching; and return of bowel function. RESULTS Two hundred four women were recruited. Baseline characteristics were similar between the lidocaine and placebo groups. Pain scores at 24 hours postcesarean delivery on movement (parameter estimate 0.02 [95% confidence interval {CI} -0.14 to 0.18]; P = .823) and at rest (parameter estimate 0.00 [95% CI -0.32 to 0.33]; P = .986) were similar in both groups. Pain scores at 2 hours postcesarean delivery on movement (parameter estimate -0.58 [95% CI -0.90 to -0.26]; P = .001) and at rest (parameter estimate -1.00 [95% CI -1.57 to -0.43]; P = .001) were lower in the lidocaine group. Subgroup analysis of patients with peritoneum closure revealed significantly lower pain scores at 24 hours on movement (parameter estimate -0.33 [95% CI -0.64 to -0.03]; P = .032) in the lidocaine group. The number of women requesting postoperative opioids for breakthrough pain was significantly lower in the lidocaine group compared with that of the placebo (40 [40%] vs 61 [65%], respectively, relative risk 0.59 [95% CI 0.43-0.81]; P = 0.001). CONCLUSIONS The use of intraperitoneal instillation of lidocaine improves early postoperative pain management after cesarean delivery. Furthermore, it reduces the number of women requesting systemic opioids in the immediate postpartum period. Women undergoing peritoneal closure may particularly benefit from this intervention.
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Affiliation(s)
- Ruchira Patel
- From the Departments of *Anesthesia and Pain Management and †Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and Departments of ‡Laboratory Medicine and Pathobiology and §Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
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Patel R, Carvalho JCA, Downey K, Kanczuk M, Bernstein P, Siddiqui N. In Response. Anesth Analg 2017; 125:352-353. [DOI: 10.1213/ane.0000000000002135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Siddiqui N. Greek refugee camps: One year on. Br Dent J 2017; 222:832. [PMID: 28703176 DOI: 10.1038/sj.bdj.2017.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Oliveira KF, Arzola C, Ye XY, Clivatti J, Siddiqui N, You-Ten KE. Determining the amount of training needed for competency of anesthesia trainees in ultrasonographic identification of the cricothyroid membrane. BMC Anesthesiol 2017; 17:74. [PMID: 28577552 PMCID: PMC5457559 DOI: 10.1186/s12871-017-0366-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/24/2017] [Indexed: 12/13/2022] Open
Abstract
Background Airway guidelines recommend the use of ultrasound to localize the cricothyroid membrane prior to airway manipulation in difficult airways. In this study, we aimed to determine the amount of training anesthesia trainees would need to achieve competence in bedside ultrasound to identify the cricothyroid membrane. Methods This is a prospective non-randomized cohort study in the Department of Anesthesia at Mount Sinai Hospital (Toronto, Ontario, Canada). Following institutional ethics approval, six anesthesia trainees consisting of four residents and two fellows underwent a 2-h training session on neck ultrasound to identify neck landmarks and the cricothyroid membrane. The trainees had no previous airway ultrasound experience. One-two weeks later, each trainee performed consecutive neck ultrasound scans on 20 healthy volunteers to identify the cricothyroid membrane. Cumulative sum (CUSUM) learning curves were constructed for each trainee. Primary outcome was the number of ultrasound examinations required to achieve competence, defined as 90% success rate in a series of 20 ultrasound scans. Secondary outcomes were the overall success rate, the time (sec.) required to perform the task, and 3-month skills assessment. Results CUSUM analysis showed four trainees achieved competence with a mean [range] success rate of 94.0% [90–100%] and a median [range] number of attempts of 14 [9–18]. Two trainees did not achieve competence, but obtained a success rate of 75.0 and 80.0% each. Overall (number of attempts) success rate was 88.3% (106/120) with a mean (SD) time of 36.9 (9.0) sec. Three months after training, ultrasound of five consecutive neck scans showed a mean success rate of 86.7% (26/30) and mean (SD) time of 47.7 (16.0) sec. Conclusions After a short 2-h training session, most anesthesia trainees (n = 4/6) achieved competence in ultrasound-identification of the cricothyroid membrane with less than 20 scans in a mean time less than 60 s., and that they remain reasonably competent 3 months later. The learning curve for ultrasound identification of the cricothyroid membrane seems to be short even without prior airway ultrasound experience.
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Affiliation(s)
- Katia F Oliveira
- Department of Anesthesia and Pain Management, Mount Sinai Hospital-Mount Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Cristian Arzola
- Department of Anesthesia and Pain Management, Mount Sinai Hospital-Mount Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Xiang Y Ye
- Micare Research Centre, Mount Sinai Hospital-Sinai Health System, 700 University Ave, Toronto, ON, M5G 1X6, Canada
| | - Jefferson Clivatti
- Department of Anesthesia and Pain Management, Mount Sinai Hospital-Mount Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Management, Mount Sinai Hospital-Mount Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Kong E You-Ten
- Department of Anesthesia and Pain Management, Mount Sinai Hospital-Sinai Health System, University of Toronto, 600 University Avenue, Rm 19-104, Toronto, ON, M5G 1X5, Canada.
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Dong Z, Shanmughapriya S, Tomar D, Siddiqui N, Lynch S, Nemani N, Breves SL, Zhang X, Tripathi A, Palaniappan P, Riitano MF, Worth AM, Seelam A, Carvalho E, Subbiah R, Jaña F, Soboloff J, Peng Y, Cheung JY, Joseph SK, Caplan J, Rajan S, Stathopulos PB, Madesh M. Mitochondrial Ca 2+ Uniporter Is a Mitochondrial Luminal Redox Sensor that Augments MCU Channel Activity. Mol Cell 2017; 65:1014-1028.e7. [PMID: 28262504 DOI: 10.1016/j.molcel.2017.01.032] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [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: 10/18/2016] [Revised: 12/02/2016] [Accepted: 01/26/2017] [Indexed: 12/13/2022]
Abstract
Ca2+ dynamics and oxidative signaling are fundamental mechanisms for mitochondrial bioenergetics and cell function. The MCU complex is the major pathway by which these signals are integrated in mitochondria. Whether and how these coactive elements interact with MCU have not been established. As an approach toward understanding the regulation of MCU channel by oxidative milieu, we adapted inflammatory and hypoxia models. We identified the conserved cysteine 97 (Cys-97) to be the only reactive thiol in human MCU that undergoes S-glutathionylation. Furthermore, biochemical, structural, and superresolution imaging analysis revealed that MCU oxidation promotes MCU higher order oligomer formation. Both oxidation and mutation of MCU Cys-97 exhibited persistent MCU channel activity with higher [Ca2+]m uptake rate, elevated mROS, and enhanced [Ca2+]m overload-induced cell death. In contrast, these effects were largely independent of MCU interaction with its regulators. These findings reveal a distinct functional role for Cys-97 in ROS sensing and regulation of MCU activity.
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Affiliation(s)
- Zhiwei Dong
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing 400038, PRC
| | - Santhanam Shanmughapriya
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Dhanendra Tomar
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Naveed Siddiqui
- Department of Physiology and Pharmacology, Western University, London, ON N6A 5C1, Canada
| | - Solomon Lynch
- Department of Biological Sciences, Delaware Biotechnology Institute, University of Delaware, Newark, DE 19711, USA
| | - Neeharika Nemani
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Sarah L Breves
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Xueqian Zhang
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Aparna Tripathi
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Palaniappan Palaniappan
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Massimo F Riitano
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Alison M Worth
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ajay Seelam
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Edmund Carvalho
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ramasamy Subbiah
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Fabián Jaña
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Jonathan Soboloff
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Yizhi Peng
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing 400038, PRC
| | - Joseph Y Cheung
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Suresh K Joseph
- MitoCare Center, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jeffrey Caplan
- Department of Biological Sciences, Delaware Biotechnology Institute, University of Delaware, Newark, DE 19711, USA
| | - Sudarsan Rajan
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
| | - Peter B Stathopulos
- Department of Physiology and Pharmacology, Western University, London, ON N6A 5C1, Canada
| | - Muniswamy Madesh
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
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Hannan A, Ali S, Siddiqui N, Kazmi S, Muzaffar N. 264P Is cisplatin a risk factor for vascular events in patients with germ cell tumor. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv524.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khan JS, Yousuf M, Victor JC, Sharma A, Siddiqui N. An estimation for an appropriate end time for an intraoperative intravenous lidocaine infusion in bowel surgery: a comparative meta-analysis. J Clin Anesth 2015; 28:95-104. [PMID: 26342631 DOI: 10.1016/j.jclinane.2015.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 05/15/2014] [Revised: 05/29/2015] [Accepted: 07/13/2015] [Indexed: 01/31/2023]
Abstract
STUDY OBJECTIVE There exists no commonly accepted regimen for an intravenous lidocaine infusion (IVLI). This study aims to determine an appropriate end time for an IVLI during bowel surgery. DESIGN A systematic search for randomized controlled trials assessing IVLI for bowel surgery was conducted using Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Google Scholar, hand-searching references, and grey literature. Data were pooled for studies that stopped IVLI ≤60 minutes (intraoperative IVLI) after skin closure and where IVLI continued >60 minutes after surgery (postoperative continued IVLI). Quantitative analysis was done using the random-effects model. MAIN RESULTS Seven studies (n = 362) were identified after the systematic search. Three studies (n = 160) and 4 studies (n = 202) used an intraoperative and postoperative continued IVLI, respectively. An intraoperative IVLI significantly reduced pain scores at rest for 48 hours (standardized mean difference on a 0-10 scale, -1.24; 95% confidence interval, -1.93 to -0.56) and 72 hours (standardized mean difference, -1.12; 95% confidence interval, -1.79 to -0.44) compared with postoperative IVLI (test for interaction: P < .001 and P = .003, respectively). Although intraoperative IVLI reduced 24-hour pain scores on movement, this was not statistically different than pain scores in the postoperative IVLI group (test of interaction: P = 0.68). There were no differences between intraoperative IVLI and postoperative IVLI for postoperative in-hospital nausea, vomiting, time to bowel movement, and length of hospital stay. CONCLUSION Continuing an IVLI beyond 60 minutes after surgery has no added analgesic or gastrointestinal benefit. Further research is needed to clarify an optimal IVLI regimen and end time.
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Affiliation(s)
- James S Khan
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada.
| | - Maaz Yousuf
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada
| | - J Charles Victor
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Abhinav Sharma
- Mazankowski Alberta Heart Institute, Department of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Naveed Siddiqui
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada; Department of Anesthesia, Mount Sinai Hospital, Toronto, Canada
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You-Ten KE, Desai D, Postonogova T, Siddiqui N. Accuracy of conventional digital palpation and ultrasound of the cricothyroid membrane in obese women in labour. Anaesthesia 2015; 70:1230-4. [PMID: 26186092 DOI: 10.1111/anae.13167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 02/01/2023]
Abstract
Success of cricothyroidotomy depends on accurate identification of anatomical neck landmarks. Anaesthetists palpated the cricothyroid membrane of 28 obese and 28 non-obese women in labour (cut-off BMI 30 kg.m(-2) ) and marked the entry point for device insertion with an ultraviolet invisible pen. Ultrasonography was used to mark the midpoint of the cricothyroid membrane and the distance between the two marks was measured. The median (IQR [range]) distance between the two marks was significantly greater in the obese than the non-obese patients (5 (2-9.5 [0-34]) mm vs 1.8 (0.1-6 [0-15]) mm, respectively; p = 0.02). The cricothyroid membrane was accurately identified with digital palpation in only 39% (11/28) of obese compared with 71% (20/28) of non-obese patients (p = 0.03). Increased neck circumference in obese patients was significantly associated with inaccuracy in locating the cricothyroid membrane. Percutaneous identification of the cricothyroid membrane in obese women in labour was poor. Pre-procedural ultrasound may help improved the identification of neck landmarks for cricothyroidotomy.
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Affiliation(s)
- K E You-Ten
- Department of Anaesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - D Desai
- Department of Anaesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - T Postonogova
- Department of Anaesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - N Siddiqui
- Department of Anaesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada
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Nadeem A, Siddiqui N, Alharbi NO, Alharbi MM. Airway and systemic oxidant-antioxidant dysregulation in asthma: A possible scenario of oxidants spill over from lung into blood. Pulm Pharmacol Ther 2014; 29:31-40. [DOI: 10.1016/j.pupt.2014.06.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/10/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
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Desai D, You-Ten K, Arzola C, Friedman Z, Siddiqui N. Improved cricothyrotomy outcomes in human cadavers using ultrasound-guided compared to conventional digital palpation. J Clin Anesth 2014. [DOI: 10.1016/j.jclinane.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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