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McSweeney MD, Alnajjar S, Schaefer AM, Richardson Z, Wolf W, Stewart I, Sriboonyapirat P, McCallen J, Farmer E, Nzati B, Lord S, Farrer B, Moench TR, Kumar PA, Arora H, Pickles RJ, Hickey AJ, Ackermann M, Lai SK. Inhaled "Muco-Trapping" Monoclonal Antibody Effectively Treats Established Respiratory Syncytial Virus (RSV) Infections. Adv Sci (Weinh) 2024; 11:e2306729. [PMID: 38225749 DOI: 10.1002/advs.202306729] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/12/2023] [Indexed: 01/17/2024]
Abstract
Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in infants, the immunocompromised, and the elderly. RSV infects the airway epithelium via the apical membrane and almost exclusively sheds progeny virions back into the airway mucus (AM), making RSV difficult to target by systemically administered therapies. An inhalable "muco-trapping" variant of motavizumab (Mota-MT), a potent neutralizing mAb against RSV F is engineered. Mota-MT traps RSV in AM via polyvalent Fc-mucin bonds, reducing the fraction of fast-moving RSV particles in both fresh pediatric and adult AM by ≈20-30-fold in a Fc-glycan dependent manner, and facilitates clearance from the airways of mice within minutes. Intranasal dosing of Mota-MT eliminated viral load in cotton rats within 2 days. Daily nebulized delivery of Mota-MT to RSV-infected neonatal lambs, beginning 3 days after infection when viral load is at its maximum, led to a 10 000-fold and 100 000-fold reduction in viral load in bronchoalveolar lavage and lung tissues relative to placebo control, respectively. Mota-MT-treated lambs exhibited reduced bronchiolitis, neutrophil infiltration, and airway remodeling than lambs receiving placebo or intramuscular palivizumab. The findings underscore inhaled delivery of muco-trapping mAbs as a promising strategy for the treatment of RSV and other acute respiratory infections.
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Affiliation(s)
| | - Sarhad Alnajjar
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Alison M Schaefer
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Whitney Wolf
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ian Stewart
- RTI International, Research Triangle Park, NC, 27709, USA
| | | | - Justin McCallen
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ellen Farmer
- Inhalon Biopharma, Research Triangle Park, NC, 27707, USA
| | | | - Sam Lord
- Inhalon Biopharma, Research Triangle Park, NC, 27707, USA
| | - Brian Farrer
- Inhalon Biopharma, Research Triangle Park, NC, 27707, USA
| | | | - Priya A Kumar
- Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
- Outcomes Research Consortium, Cleveland, OH, 44195, USA
| | - Harendra Arora
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Raymond J Pickles
- Department of Microbiology & Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Mark Ackermann
- USDA/ARS-National Animal Disease Center, Ames, IA, 50010, USA
| | - Samuel K Lai
- Inhalon Biopharma, Research Triangle Park, NC, 27707, USA
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology & Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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2
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Jia S, Caranasos TG, Kumar PA. Pro: Advantages of Using TransMedics Organ Care System Heart in Heart Transplantation. J Cardiothorac Vasc Anesth 2024; 38:569-572. [PMID: 38042742 DOI: 10.1053/j.jvca.2023.11.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Shawn Jia
- University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Thomas G Caranasos
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Priya A Kumar
- University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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3
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Smeltz AM, Farber MA, Parodi FE, An X, Kirsch RJ, Hipp JS, Kumar PA, Arora H. Comparison of Landmark-Guided Versus Fluoroscopy-Guided Cerebrospinal Fluid Drain-Related Complications After Aortic Repairs. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00358-0. [PMID: 37328307 DOI: 10.1053/j.jvca.2023.05.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Cerebrospinal fluid drains (CSFDs) are efficacious in preventing spinal cord injury after thoracic or thoracoabdominal aortic repair with extensive coverage. Increasingly, fluoroscopy is used to guide placement instead of the traditional landmark-based approach, but it is unknown which approach is associated with fewer complications. DESIGN A retrospective cohort study. SETTING In the operating room. PARTICIPANTS Patients having undergone thoracic or thoracoabdominal aortic repair with a CSFD over a 7-year period at a single center. INTERVENTIONS No intervention. MEASUREMENTS AND MAIN RESULTS Groups were reviewed and statistically compared with respect to baseline characteristics, ease of CSFD placement, and major and minor complications directly related to placement. A total of 150 CSFDs were placed with landmark guidance as opposed to 95 with fluoroscopy guidance. Compared to the landmark group, patients with fluoroscopy-guided CSFDs were older (p < 0.008), had lower American Society of Anesthesiologists physical status scores (p = 0.008), required fewer CSFD placement attempts (p = 0.011), had the CSFD in place for longer duration (p < 0.001), and had a similar incidence of CSFD-related complications (p > 0.999). Composites of both major (4.5% of cases) and minor CSFD-related complications (6.1% of cases), the primary outcomes of the study, occurred with similar incidences between the 2 groups (p > 0.999 for both comparisons) after adjusting potential confounders. CONCLUSIONS In patients undergoing thoracic or thoracoabdominal aortic repairs, there were no significant differences in the risk of major and minor CSFD-related complications between fluoroscopic guidance and the landmark approach. Although the authors' institution is a high-volume center for this type of procedure, the study was limited by a small sample size. Hence, regardless of the technique used for the placement of CSFD, the risks related to the placement should be balanced carefully against the potential benefits resulting from spinal cord injury prevention. Fluoroscopy-aided insertion of CSFD requires fewer attempts and, hence, may be better tolerated by patients.
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Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Mark A Farber
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - F Ezequiel Parodi
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Xinming An
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rachel J Kirsch
- Department of Anesthesiology, University of California, San Francisco, CA
| | - John S Hipp
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Harendra Arora
- Outcomes Research Consortium, Cleveland, OH; Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS
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Markovetz MR, Hibbard JE, Plott LM, Bacudio LG, Kissner WJ, Ghio A, Kumar PA, Arora H, Hill DB. Normalizing salt content by mixing native human airway mucus samples normalizes sample rheology. Front Physiol 2023; 14:1111647. [PMID: 36969580 PMCID: PMC10036356 DOI: 10.3389/fphys.2023.1111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Across the globe, millions of people are affected by muco-obstructive pulmonary diseases like cystic fibrosis, asthma, and chronic obstructive pulmonary disease. In MOPDs, the airway mucus becomes hyperconcentrated, increasing viscoelasticity and impairing mucus clearance. Research focused on treatment of MOPDs requires relevant sources of airway mucus both as a control sample type and as a basis for manipulation to study the effects of additional hyperconcentration, inflammatory milieu, and biofilm growth on the biochemical and biophysical properties of mucus. Endotracheal tube mucus has been identified as a prospective source of native airway mucus given its several advantages over sputum and airway cell culture mucus such as ease of access and in vivo production that includes surface airway and submucosal gland secretions. Still, many ETT samples suffer from altered tonicity and composition from either dehydration, salivary dilution, or other contamination. Herein, the biochemical compositions of ETT mucus from healthy human subjects were determined. Samples were characterized in terms of tonicity, pooled, and restored to normal tonicity. Salt-normalized ETT mucus exhibited similar concentration-dependent rheologic properties as originally isotonic mucus. This rheology agreed across spatial scales and with previous reports of the biophysics of ETT mucus. This work affirms previous reports of the importance of salt concentration on mucus rheology and presents methodology to increase yield native airway mucus samples for laboratory use and manipulation.
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Affiliation(s)
- Matthew R. Markovetz
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jacob E. Hibbard
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lucas M. Plott
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lawrence G. Bacudio
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - William J. Kissner
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrew Ghio
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, United States
| | - Priya A. Kumar
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Harendra Arora
- Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Outcomes Research Consortium, Cleveland, OH, United States
| | - David B. Hill
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: David B. Hill,
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Jia S, Kumar PA, Bhatia M. Con: Regional Anesthesia With Thoracic Fascial Plane Blocks Should Not Be Routinely Used for Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:1046-1048. [PMID: 36894465 DOI: 10.1053/j.jvca.2023.02.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Shawn Jia
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | | | - Meena Bhatia
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
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Rosenkrans D, Kumar PA. Pro: General Anesthesia Should Be Used for Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2023; 37:827-828. [PMID: 36732131 DOI: 10.1053/j.jvca.2022.12.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Daniel Rosenkrans
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Bhatia M, Smeltz AM, Desai CS, Arora H, Kumar PA. Treatment of type B lactic acidosis with N-acetylcysteine and levocarnitine. Anaesth Intensive Care 2023; 51:75-78. [PMID: 36373414 DOI: 10.1177/0310057x221105300] [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: 11/15/2022]
Affiliation(s)
- Meena Bhatia
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA
| | - Alan M Smeltz
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA
| | - Chirag S Desai
- Department of Surgery, University of North Carolina, Chapel Hill, USA
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA.,Outcomes Research Consortium, Cleveland, USA
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA.,Outcomes Research Consortium, Cleveland, USA
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Bhatia M, Kumar PA. Con: Lumbar Drains Should Routinely Be Placed by a Landmark Approach and Not by Fluoroscopic Guidance for Elective Thoracic Aortic Repairs. J Cardiothorac Vasc Anesth 2023; 37:183-186. [PMID: 36280577 DOI: 10.1053/j.jvca.2022.09.089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Meena Bhatia
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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9
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Arora H, Encarnacion JA, Li Q, Liu Y, Kumar PA, Smeltz AM. Hypothermia and Prolonged Time From Procedure End to Extubation After Endovascular Thoracic Aortic Surgery. J Cardiothorac Vasc Anesth 2022; 36:4320-4326. [PMID: 36216686 DOI: 10.1053/j.jvca.2022.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Perioperative hypothermia (core temperature <36°C) occurs in 50%-to-80% of patients recovering from thoracic aortic surgery, though its effects have not been described fully in this context. The authors, therefore, sought to characterize the incidence of perioperative hypothermia and its association with time from procedure end to extubation in endovascular aortic surgical patients. DESIGN A retrospective cohort study. SETTING At a single academic tertiary center. PARTICIPANTS Patients recovering from thoracic aortic surgery with lumbar drains. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS A total of 196 patients were included in this study, 55 of whom were hypothermic with temperatures <35.0°C at the end of surgery. Though the unadjusted time to extubation was not statistically different in the hypothermic group (median 8 minutes, IQR 5-13.5 minutes) compared to the normothermic group (median 7 minutes, IQR 4-12 minutes; p = 0.062), multivariate predictors of increased time from procedure end to extubation included hypothermia (p = 0.011), age (p = 0.009), diabetes (p = 0.015), history of carotid disease (p = 0.040), and crystalloid volume (p = 0.019). CONCLUSIONS Hypothermia in patients recovering from endovascular aortic surgery was associated with prolonged time from procedure end to extubation. Because of the retrospective observational nature of the authors' analysis, it was not possible to determine the extent to which prolonged mechanical ventilation was influenced by low temperature.
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Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - John A Encarnacion
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
| | - Yutong Liu
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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10
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Bhatia M, Jia S, Smeltz A, Kumar PA. Right Heart Failure Management: Focus on Mechanical Support Options. J Cardiothorac Vasc Anesth 2022; 36:3278-3288. [DOI: 10.1053/j.jvca.2022.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
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11
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Doan V, Liu Y, Teeter EG, Smeltz AM, Vavalle JP, Kumar PA, Kolarczyk LM. Propofol Versus Remifentanil Sedation for Transcatheter Aortic Valve Replacement: A Single Academic Center Experience. J Cardiothorac Vasc Anesth 2022; 36:103-108. [PMID: 34074554 PMCID: PMC8563487 DOI: 10.1053/j.jvca.2021.04.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Comparison of remifentanil versus propofol for sedation during transcatheter aortic valve replacement (TAVR) procedures to analyze the risk of sedation-related hypoxemia and hypotension. Secondary outcomes included the rate of conversion to general anesthesia, procedure length, rate of intensive care unit (ICU) admission, ICU and hospital lengths of stay, and 30-day mortality. DESIGN Retrospective cohort study. SETTING A single tertiary teaching hospital. PARTICIPANTS Two hundred fifty-nine patients who had propofol or remifentanil sedation for TAVR between March 2017 and March 2020. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS There were 130 patients (50.2%) in the propofol cohort and 129 patients (49.8%) in the remifentanil cohort. The primary outcomes were oxygen saturation nadir values and vasopressor infusion use. Remifentanil was associated with a lower oxygen saturation nadir, as compared to propofol (91.3% v . 95.4%, p < 0.001). Risk factors associated with hypoxemia (defined as <92%) were body mass index (p = 0.0004), obstructive sleep apnea (p = 0.004), and remifentanil maintenance (p < 0.001). Vasopressor infusion use was significantly higher with propofol (64.9% v . 8.5%, p < 0.001). Propofol maintenance and angiotensin-converting enzyme inhibitor/angiotensin II receptor-blocker use were the only variables identified as risk factors for vasopressor use (p < 0.001 and p = 0.009). CONCLUSIONS For patients undergoing TAVR with conscious sedation, remifentanil was associated with more hypoxemia while propofol was associated with a higher rate of vasopressor use.
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Affiliation(s)
- Vivian Doan
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC 27599
| | - Yutong Liu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599
| | - Emily G. Teeter
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC 27599
| | - Alan M. Smeltz
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC 27599
| | - John P. Vavalle
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals, Chapel Hill, NC 27599
| | - Priya A. Kumar
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC 27599,Outcomes Research Consortium, Cleveland, OH 44103
| | - Lavinia M. Kolarczyk
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC 27599
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12
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Bhatia M, Kumar PA. Con: Extubating in the Operating Room After Cardiac Surgery Is Not Necessary. J Cardiothorac Vasc Anesth 2021; 36:1491-1493. [PMID: 34991957 DOI: 10.1053/j.jvca.2021.12.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Meena Bhatia
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Outcomes Research Consortium, Cleveland, OH
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13
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Bhatia M, Kumar PA. Con: Routine Use of Fresh Frozen Plasma Should Not Be Used to Prime Cardiopulmonary Bypass Circuits During Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 35:3122-3124. [PMID: 34119415 DOI: 10.1053/j.jvca.2021.05.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Meena Bhatia
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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14
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Smeltz AM, Kumar PA. Pro: General Anesthesia Is Superior to Regional Anesthesia for Patients with Pulmonary Hypertension Undergoing Noncardiac Surgery. J Cardiothorac Vasc Anesth 2021; 35:1884-1887. [PMID: 33516605 DOI: 10.1053/j.jvca.2020.12.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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15
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Arora H, Kumar PA. Erratum to 'Ruptured Sinus of Valsalva Aneurysms: Does Transesophageal Echocardiography Have a Role in the Era of Sophisticated Cardiac Imaging?' [Journal of Cardiothoracic and Vascular Anesthesia 34 (2020) 3382-3384]. J Cardiothorac Vasc Anesth 2020; 35:1248. [PMID: 33342738 DOI: 10.1053/j.jvca.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Smeltz AM, Kumar PA, Arora H. Anesthesia for Combined Heart and Liver Transplantation. J Cardiothorac Vasc Anesth 2020; 35:3350-3361. [PMID: 33384228 DOI: 10.1053/j.jvca.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/23/2023]
Abstract
A heart or liver transplantation procedure performed in isolation itself presents multiple challenges for the perioperative team. Accordingly, combining both transplants yields a vastly more complicated surgery, with many unique multisystem and multidisciplinary considerations. Although combined heart and liver transplantations are being performed with increasing frequency, nationwide experience is relatively limited at most institutions. The aim of this review is to discuss the perioperative challenges presented to the anesthesiology teams and provide evidence-based guidance for the management of these daunting procedures.
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Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Bhatia M, Kumar PA. Pro: Venoarterial ECMO Should Be Considered in Patients With COVID-19. J Cardiothorac Vasc Anesth 2020; 35:703-706. [PMID: 33288430 PMCID: PMC7672337 DOI: 10.1053/j.jvca.2020.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Meena Bhatia
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Arora H, Kumar PA. Case Series of Vacuum-Assisted Thrombectomy: An Acceptable Trade-Off in Evidence-Based Methodology? J Cardiothorac Vasc Anesth 2020; 35:1046-1048. [PMID: 33234466 DOI: 10.1053/j.jvca.2020.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Smeltz AM, Kumar PA. An Unusual Left Ventricular Outflow Tract Obstruction, or Just Another Artifact? J Cardiothorac Vasc Anesth 2020; 35:1541-1543. [PMID: 33139161 DOI: 10.1053/j.jvca.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/03/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Arora H, Kumar PA. Ruptured Sinus of Valsalva Aneurysms: Does Transesophageal Echocardiography Have a Role in the Era of Sophisticated Cardiac Imaging? J Cardiothorac Vasc Anesth 2020; 34:3382-3384. [PMID: 32921611 DOI: 10.1053/j.jvca.2020.08.046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Sessler DI, Conen D, Leslie K, Yusuf S, Popova E, Graham M, Kurz A, Villar JC, Mrkobrada M, Sigamani A, Biccard BM, Meyhoff CS, Parlow JL, Guyatt G, Xavier D, Chan MTV, Kumar PA, Forget P, Malaga G, Fleischmann E, Amir M, Torres D, Wang CY, Paniagua P, Berwanger O, Srinathan S, Landoni G, Manach YL, Whitlock R, Lamy A, Balasubramanian K, Gilron I, Turan A, Pettit S, Devereaux PJ. One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery. Anesthesiology 2020; 132:692-701. [PMID: 32022771 DOI: 10.1097/aln.0000000000003158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown. METHODS The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h. RESULTS Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1). CONCLUSIONS Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect.
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Affiliation(s)
- Daniel I Sessler
- From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S., A.K., A.T.) Population Health Research Institute (D.I.S., D.C., S.Y., Y.L.M., A.L., K.B., S.P., P.J.D.) Department of Medicine (D.C., S.Y., G.G., P.J.D.) Department of Health Research Methods, Evidence, and Impact (D.C., S.Y., G.G., Y.L.M., A.L., P.J.D.) Faculty of Health Sciences, Department of Anesthesia (Y.L.M.) Department of Surgery (R.W., A.L.), McMaster University, Hamilton, Ontario, Canada Department of Anaesthesia and Pain Management, Royal Melbourne Hospital and Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia (K.L.) Public Health and Clinical Epidemiology-Iberoamerican Cochrane Centre, Barcelona, Spain (E.P.) University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (M.G.) Department of Research, Foundation for Pediatric Cardiology, Institute of Cardiology and Faculty of Health Sciences (Departamento de Investigaciones, Fundación Cardioinfantil-Instituto de Cardiología and Facultad de Ciencias de la Salud), Universidad Autónoma de Bucaramanga, Colombia (J.C.V.) University of Western Ontario, London, Ontario, Canada (M.M.) Department of Clinical Research, Narayana Hrudayalaya Limited, Bangalore, India (A.S.) University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (B.M.B.) Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark (C.S.M.) Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Canada (J.L.P., I.G.) St. John's Medical College and Research Institute, Bangalore, Karnataka, India (D.X.) Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong (M.T.V.C.) University of North Carolina School of Medicine, Chapel Hills, North Carolina (P.A.K.) NHS Grampian and the University of Aberdeen, Aberdeen, United Kingdom (P.F.) Knowledge and Evidence Unite (Unidad de Conocimiento y Evidencia), Universidad Peruana Cayetano Heredia, Lima, Peru (G.M.) Department of Anaesthesia, Intensive Care, and Pain Medicine, Medical University of Vienna, Vienna, Austria (E.F.) Shifa International Hospitals, Islamabad, Pakistan (M.A.) University of the Andes and Santa Maria Clinic (Universidad de Los Andes and Clinica Santa María), Santiago, Chile (D.T.) Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.) Biomedical Research Institute (IIB - Sant Pau), Barcelona, Spain (P.P.) Hospital Israelita Albert Einstein, São Paulo, Brazil (O.B.) Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada (S.S.) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (G.L.)
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Smeltz AM, Bhatia M, Arora H, Long J, Kumar PA. Anesthesia for Resection and Reconstruction of the Trachea and Carina. J Cardiothorac Vasc Anesth 2020; 34:1902-1913. [DOI: 10.1053/j.jvca.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
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Smeltz AM, Arora H, Kumar PA. Con: The New United Network for Organ Sharing Heart Allocation System Is Not a Positive Change in Listing Patients for Transplantation. J Cardiothorac Vasc Anesth 2020; 34:1968-1971. [DOI: 10.1053/j.jvca.2020.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/24/2020] [Indexed: 01/06/2023]
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Smeltz AM, Kumar PA. Con: Qualitative Left Ventricular Ejection Fraction Is Not Sufficient for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:335-338. [PMID: 32620495 DOI: 10.1053/j.jvca.2020.06.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Arora H, Kumar PA. Time to Simplify Transesophageal Echocardiography for Liver Transplantation? J Cardiothorac Vasc Anesth 2020; 34:1833-1835. [PMID: 32402700 DOI: 10.1053/j.jvca.2020.03.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Harendra Arora
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel hill, NC and Outcomes Research Consortium, Cleveland, OH
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel hill, NC and Outcomes Research Consortium, Cleveland, OH
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Manning MW, Kumar PA, Maheshwari K, Arora H. Post-Reperfusion Syndrome in Liver Transplantation—An Overview. J Cardiothorac Vasc Anesth 2020; 34:501-511. [DOI: 10.1053/j.jvca.2019.02.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/15/2019] [Accepted: 02/28/2019] [Indexed: 01/13/2023]
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Bhatia M, Kumar PA. Pro: Venoarterial Extracorporeal Membrane Oxygenation Is Superior to Impella for Cardiogenic Shock. J Cardiothorac Vasc Anesth 2020; 34:278-282. [DOI: 10.1053/j.jvca.2019.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/30/2019] [Indexed: 11/11/2022]
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28
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Smeltz AM, Kumar PA. Functional Tricuspid Regurgitation or Rare Congenital Condition? J Cardiothorac Vasc Anesth 2019; 34:837-839. [PMID: 31761654 DOI: 10.1053/j.jvca.2019.10.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/16/2019] [Accepted: 10/20/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Yang B, Schaefer A, Wang YY, McCallen J, Lee P, Newby JM, Arora H, Kumar PA, Zeitlin L, Whaley KJ, McKinley SA, Fischer WA, Harit D, Lai SK. ZMapp Reinforces the Airway Mucosal Barrier Against Ebola Virus. J Infect Dis 2019; 218:901-910. [PMID: 29688496 DOI: 10.1093/infdis/jiy230] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Filoviruses, including Ebola, have the potential to be transmitted via virus-laden droplets deposited onto mucus membranes. Protecting against such emerging pathogens will require understanding how they may transmit at mucosal surfaces and developing strategies to reinforce the airway mucus barrier. Here, we prepared Ebola pseudovirus (with Zaire strain glycoproteins) and used high-resolution multiple-particle tracking to track the motions of hundreds of individual pseudoviruses in fresh and undiluted human airway mucus isolated from extubated endotracheal tubes. We found that Ebola pseudovirus readily penetrates human airway mucus. Addition of ZMapp, a cocktail of Ebola-binding immunoglobulin G antibodies, effectively reduced mobility of Ebola pseudovirus in the same mucus secretions. Topical delivery of ZMapp to the mouse airways also facilitated rapid elimination of Ebola pseudovirus. Our work demonstrates that antibodies can immobilize virions in airway mucus and reduce access to the airway epithelium, highlighting topical delivery of pathogen-specific antibodies to the lungs as a potential prophylactic or therapeutic approach against emerging viruses or biowarfare agents.
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Affiliation(s)
- Bing Yang
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Alison Schaefer
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Ying-Ying Wang
- Department of Biophysics, Johns Hopkins University, Baltimore, Maryland
| | - Justin McCallen
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Phoebe Lee
- University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina
| | - Jay M Newby
- Department of Mathematics and Applied Physical Sciences, Chapel Hill, North Carolina
| | - Harendra Arora
- Department of Anesthesiology, School of Medicine, Chapel Hill, North Carolina
| | - Priya A Kumar
- Department of Anesthesiology, School of Medicine, Chapel Hill, North Carolina
| | | | | | - Scott A McKinley
- Mathematics Department, Tulane University, New Orleans, Louisiana
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Chapel Hill, North Carolina
| | - Dimple Harit
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Samuel K Lai
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, Chapel Hill, North Carolina.,University of North Carolina/North Carolina State University Joint Department of Biomedical Engineering, Chapel Hill, North Carolina.,Department of Microbiology & Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Henley MD, Arora H, Farber MA, Caranasos TG, Teeter EG, Kumar PA. Anesthetic Considerations for 3-Branch Endovascular Total Aortic Arch Aneurysm Repair. J Cardiothorac Vasc Anesth 2019; 33:1714-1721. [DOI: 10.1053/j.jvca.2018.11.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Indexed: 11/11/2022]
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Bhatia M, Kumar PA. Pro: Venoarterial Extracorporeal Membrane Oxygenation Should Always Include Placement of a Left Ventricular Vent. J Cardiothorac Vasc Anesth 2019; 33:1159-1162. [DOI: 10.1053/j.jvca.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/11/2022]
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Abstract
Tracheal laceration during cardiac surgery is a rarely reported form of iatrogenic tracheal injury. During dissection prior to sternotomy, the interclavicular ligament must be divided. This structure overlies the proximal trachea, predisposing the trachea to injury at this location. Challenges related to tracheal laceration in cardiac surgery include patients with already tenuous cardiopulmonary status, surgical positioning that increases the risk of injury, obscured traditional clinical findings causing delayed recognition, increased risk of mediastinitis, and a heightened risk of airway fire. The incidence, mechanism, and ideal management of sternotomy-related tracheal injury, though a life-threatening complication, is rarely described in the literature. Consensus is lacking regarding the necessity and timing of tracheal repair versus conservative management, whether to proceed with the initially planned procedure, and the optimal timing of airway exchange in the event of endotracheal tube cuff rupture. In this article, we present the management of a full-thickness thermal tracheal injury due to electrocautery, resulting in a large air leak treated with delayed endotracheal tube exchange and tracheal repair after cardiopulmonary bypass.
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Affiliation(s)
| | - Priya A. Kumar
- University of North Carolina at Chapel Hill, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
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Bhatia M, Kidd B, Kumar PA. Pro: Mechanical Ventilation Should Be Continued During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2018; 32:1998-2000. [DOI: 10.1053/j.jvca.2018.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 11/11/2022]
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Arora H, Kumar PA. Prophylactic Cerebrospinal Fluid Drainage for High-Risk Thoracic Endovascular Aortic Repair: Safe and Effective? J Cardiothorac Vasc Anesth 2018; 32:890-892. [DOI: 10.1053/j.jvca.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marino M, Frangopoulos C, Kumar PA, Bhatia M. Unusual Echolucency Seen After Bacterial Endocarditis. J Cardiothorac Vasc Anesth 2018; 32:1087-1089. [DOI: 10.1053/j.jvca.2017.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Indexed: 01/08/2023]
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Graham MM, Sessler DI, Parlow JL, Biccard BM, Guyatt G, Leslie K, Chan MTV, Meyhoff CS, Xavier D, Sigamani A, Kumar PA, Mrkobrada M, Cook DJ, Tandon V, Alvarez-Garcia J, Villar JC, Painter TW, Landoni G, Fleischmann E, Lamy A, Whitlock R, Le Manach Y, Aphang-Lam M, Cata JP, Gao P, Terblanche NCS, Ramana PV, Jamieson KA, Bessissow A, Mendoza GR, Ramirez S, Diemunsch PA, Yusuf S, Devereaux PJ. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery. Ann Intern Med 2018; 168:237-244. [PMID: 29132159 DOI: 10.7326/m17-2341] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 11/22/2022] Open
Abstract
BACKGROUND Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. OBJECTIVE To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. DESIGN Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment. (ClinicalTrials.gov: NCT01082874). SETTING 135 centers in 23 countries. PATIENTS Adults aged 45 years or older who had or were at risk for atherosclerotic disease and were having noncardiac surgery. Exclusions were placement of a bare-metal stent within 6 weeks, placement of a drug-eluting stent within 1 year, or receipt of nonstudy aspirin within 72 hours before surgery. INTERVENTION Aspirin therapy (overall trial, n = 4998; subgroup, n = 234) or placebo (overall trial, n = 5012; subgroup, n = 236) initiated within 4 hours before surgery and continued throughout the perioperative period. Of the 470 subgroup patients, 99.9% completed follow-up. MEASUREMENTS The 30-day primary outcome was death or nonfatal myocardial infarction; bleeding was a secondary outcome. RESULTS In patients with prior PCI, aspirin reduced the risk for the primary outcome (absolute risk reduction, 5.5% [95% CI, 0.4% to 10.5%]; hazard ratio [HR], 0.50 [CI, 0.26 to 0.95]; P for interaction = 0.036) and for myocardial infarction (absolute risk reduction, 5.9% [CI, 1.0% to 10.8%]; HR, 0.44 [CI, 0.22 to 0.87]; P for interaction = 0.021). The effect on the composite of major and life-threatening bleeding in patients with prior PCI was uncertain (absolute risk increase, 1.3% [CI, -2.6% to 5.2%]). In the overall population, aspirin increased the risk for major bleeding (absolute risk increase, 0.8% [CI, 0.1% to 1.6%]; HR, 1.22 [CI, 1.01 to 1.48]; P for interaction = 0.50). LIMITATION Nonprespecified subgroup analysis with small sample. CONCLUSION Perioperative aspirin may be more likely to benefit rather than harm patients with prior PCI. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Michelle M Graham
- University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (M.M.G.)
| | | | - Joel L Parlow
- Queen's University, Kingston, Ontario, Canada (J.L.P.)
| | - Bruce M Biccard
- Groote Schuur Hospital and University of Cape Town, Western Cape, South Africa (B.M.B.)
| | - Gordon Guyatt
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Kate Leslie
- Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, and Monash University, Melbourne, Victoria, Australia (K.L.)
| | | | - Christian S Meyhoff
- Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark (C.S.M.)
| | - Denis Xavier
- St. John's Medical College and Research Institute, Bangalore, India (D.X.)
| | | | - Priya A Kumar
- University of North Carolina, Chapel Hill, North Carolina (P.A.K.)
| | - Marko Mrkobrada
- Schulich School of Medicine & Dentistry at Western University, London, Ontario, Canada (M.M.)
| | - Deborah J Cook
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Vikas Tandon
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Jesus Alvarez-Garcia
- Sant Pau Hospital and Biomedical Research Institute, Autonomous University of Barcelona, Research Center of Cardiovascular Diseases (CIBERCV), Barcelona, Spain (J.A.)
| | - Juan Carlos Villar
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia, and Department of Medicine, Universidad Autónoma de Bucaramanga, Santander, Colombia (J.C.V.)
| | - Thomas W Painter
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (T.W.P.)
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy (G.L.)
| | | | - Andre Lamy
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Richard Whitlock
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Yannick Le Manach
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - Meylin Aphang-Lam
- Hospital Arzobispo Loayza, Universidad Peruana Cayetano Heredia, Lima, Peru (M.A.)
| | - Juan P Cata
- The University of Texas MD Anderson Cancer Center, Houston, Texas (J.P.C.)
| | - Peggy Gao
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | | | | | | | - Amal Bessissow
- McGill University Health Centre, Montréal, Québec, Canada (A.B.)
| | | | - Silvia Ramirez
- Hospital Universitario Fundación Hospital Alcorcon, Madrid, Spain (S.R.)
| | - Pierre A Diemunsch
- Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France (P.A.D.)
| | - Salim Yusuf
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
| | - P J Devereaux
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.)
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Isaak RS, Kumar PA, Arora H. PRO: Transesophageal Echocardiography Should Be Routinely Used for All Liver Transplant Surgeries. J Cardiothorac Vasc Anesth 2017; 31:2282-2286. [DOI: 10.1053/j.jvca.2016.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 11/11/2022]
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Affiliation(s)
- Megan D Henley
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Wang YY, Harit D, Subramani DB, Arora H, Kumar PA, Lai SK. Influenza-binding antibodies immobilise influenza viruses in fresh human airway mucus. Eur Respir J 2017; 49:13993003.01709-2016. [PMID: 28122865 DOI: 10.1183/13993003.01709-2016] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Ying-Ying Wang
- Dept of Biophysics, Johns Hopkins University, Baltimore, MD, USA.,These authors contributed equally
| | - Dimple Harit
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.,These authors contributed equally
| | - Durai B Subramani
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Harendra Arora
- Dept of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Priya A Kumar
- Dept of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Samuel K Lai
- Division of Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA .,UNC/NCSU Joint Dept of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA.,Dept of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
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41
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Martinelli SM, Lobonc A, Wallen EM, Stansfield WE, Selph JP, Calvo B, Kumar PA. Combined Aortic Valve Replacement and Renal Cell Carcinoma Thrombectomy. Semin Cardiothorac Vasc Anesth 2016; 21:95-98. [PMID: 26620136 DOI: 10.1177/1089253215616498] [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] [Indexed: 11/15/2022]
Abstract
Although nephrectomy for renal cell carcinoma with inferior vena cava invasion is a common procedure, it is rare to have level IV invasion necessitating cardiopulmonary bypass (CPB). Furthermore, it is exceptionally rare to perform cardiac surgery concomitantly with this resection. We report a case in which an aortic valve replacement was done in the same surgical setting as a level IV thrombectomy. We have demonstrated that although it can be difficult to manage the coagulopathy post-CPB, this can be successfully accomplished with adequate prior preparation and a coordinated team effort.
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Affiliation(s)
| | - Andrew Lobonc
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - Eric M Wallen
- 1 University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - Priya A Kumar
- 1 University of North Carolina, Chapel Hill, NC, USA.,3 Outcomes Research Consortium, Cleveland, OH, USA
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Bhatia M, Arora H, Kumar PA. Pro: ACE Inhibitors Should Be Continued Perioperatively and Prior to Cardiovascular Operations. J Cardiothorac Vasc Anesth 2016; 30:816-9. [DOI: 10.1053/j.jvca.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Indexed: 11/11/2022]
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43
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Teeter EG, Barrick BP, Kumar PA, Haithcock BE, Karenz AR, Martinelli SM. Anesthetic Management of a Patient With Situs Inversus for Bilateral Orthotopic Lung Transplantation. J Cardiothorac Vasc Anesth 2016; 30:1641-1644. [PMID: 27179614 DOI: 10.1053/j.jvca.2016.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Benjamin E Haithcock
- Department of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Asgarian CD, Martinelli SM, Mark JB, Kumar PA. Partial Anomalous Hepatic Venous Return: A Systematic Intraoperative Exclusion of Other Serious Diagnoses. Anesth Analg 2016; 122:349-53. [PMID: 26797550 DOI: 10.1213/ane.0000000000001051] [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: 11/05/2022]
Affiliation(s)
- Camellia D Asgarian
- From the *Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; †Department of Anesthesiology, Duke University Medical Center, Anesthesiology Service, Veterans Affairs Medical Center, Durham, North Carolina; and ‡Outcomes Research Consortium, Cleveland, Ohio
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Teeter EG, Kumar PA. Pro: Thoracic Epidural Block Is Superior to Paravertebral Blocks for Open Thoracic Surgery. J Cardiothorac Vasc Anesth 2015; 29:1717-9. [DOI: 10.1053/j.jvca.2015.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/11/2022]
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47
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Arora H, Ullery BW, Kumar PA, Cheung AT. Pro: Patients at Risk for Spinal Cord Ischemia After Thoracic Endovascular Aortic Repairs Should Receive Prophylactic Cerebrospinal Fluid Drainage. J Cardiothorac Vasc Anesth 2015; 29:1376-80. [DOI: 10.1053/j.jvca.2015.05.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 11/11/2022]
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Abstract
A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations.
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Affiliation(s)
| | | | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA
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49
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Barrick BP, Smeltz A, Ganesh A, Arora H, Kumar PA. Aortic Valve Thrombus in a Patient With an Extracorporeal Left Ventricular Assist Device: The Dilemma of Management. J Cardiothorac Vasc Anesth 2015; 30:196-9. [PMID: 26142364 DOI: 10.1053/j.jvca.2015.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Brian P Barrick
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Alan Smeltz
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Arun Ganesh
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH.
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Abstract
A double-walled interatrial septum is a rare congenital cardiac anomaly characterized by a distinct echolucent cavity between the atria formed by 2 separate interatrial septae. It may be a variant of other well-recognized cardiac anomalies such as persistent venous valve of the sinus venosus or cor triatriatum. Although uncommon, it may be associated with thromboembolic disease due to stagnant flow in the septal cavity. Awareness of this rare entity and its clinical significance along with a thorough echocardiographic examination to rule out similarly presenting or coexisting conditions are the key to an accurate diagnosis and appropriate management.
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Affiliation(s)
- Priya A. Kumar
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Susan M. Martinelli
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert W. Kyle
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
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