Past Annual Meetings

2015 Annual Meeting

Annual Mtg Onsite Materials:

Speaker Handouts:




Name Author(s) 
Introduction: Postoperative nausea and vomiting (PONV) is a significant perioperative issue facing patients and healthcare systems in ambulatory and inpatient settings. Risk factors may place surgical patients at a 20-80% likelihood of PONV. While the Society for Ambulatory Anesthesia (SAMBA) recently established a new set of expert guidelines, little literature exists that addresses practical implementation aspects of information availability within the context of perioperative medical decision-making in a modern perioperative information management system.
Dr. Brian Rothman, MD, Vanderbilt University, Department of Anesthesiology, Dr. Michael Bernell, MD, Vanderbilt University, Department of Anesthesiology.
Background: One of the main drawbacks of current monitors’ displays is the limited options of reviewing parameters trends. The trend is typically a single line presenting a specific parameter’s values over time. Here we propose two distinct display options that are composed of complex not-easily discerned information from CO2 waveforms. These trend views promote a comprehensible and simpler means of recognizing patterns and trends that are indicative of patient physiology and condition.
Joshua L. Colman BSc, Keren Davidpur BSc, Yossef Cohen BSc, Eylon Katz BSc and Michal Ronen PhD, Covidien - Respiratory and Monitoring Solutions, Jerusalem
Background/Introduction: Patient care handoff from one team of providers to another is a critical moment highly prone to medical errors1,2. Transfer of care at the end of surgery between anesthesia and nursing teams is a typical example when inaccurate and incomplete transfer of relevant clinical information could increase the risk of inadvertent medical mistakes. We describe the development of a tool that provides a customized report of intraoperative data to facilitate safe handoff. Additionally, the tool also notifies the recovery team of patient transport, with the handoff summary report produced prior to the patient actually arriving at the recovery bed. Advance notice and upfront availability of handoff information could better prepare the recovery team for a smoother transfer of care.
Aalap Shah MD1, Anna Xue BS2, Daniel Oh BA, MS2, John D Lang MD1, Bala G Nair PhD1 1Department of Anesthesiology 2School of Medicine, University of Washington, Seattle, WA
Background: Several measured physiological parameters provide recurring signals and waveforms, e.g., CO2 in the breath. These waveform shapes, dimensions and recurring patterns may provide clinicians valuable information regarding the patient physiology. Typically, the relevant waveforms are presented in monitoring displays as a moving wave in real time. This type of presentation does not lend itself to evaluation of either their characteristic and dominant waveform shapes or the patterns they create. A tool has been developed help provide bedside clinicians an enhanced ability to easily to recognize, analyze, compare and evaluate the information that may be hidden within waveforms.
Michal Ronen PhD, Keren Davidpur BSc, Yossef Cohen BSc, Eylon Katz BSc and Joshua L. Colman BSc, Covidien - Respiratory and Monitoring Solutions, Jerusalem
Introduction: Anesthesia information management systems (AIMS) typically record intraoperative data q 1 minute, with some allowing up to q 15 sec resolution. These intervals are inadequate for capturing transient changes in airway parameters, necessary in our ongoing study of bronchospasm in pediatric retinoblastoma patients undergoing ophthalmic artery intra-arterial chemotherapy (IAC). We describe the technical details of configuring such a system to capture airway parameters at much higher resolutions.
Ian Yuan, MD, MEng*; Robert Machnicki Jr., MD; Matthew Hirschfeld, MD; Anna Rabinowitz, MD; Michael J Williams, MD; Richard H Epstein, MD. Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA. *Presenting author.
Introduction: Pulse pressure variation (PPV) remains a good predictor of fluid responsiveness in the OR. However, PPV can be time-consuming to calculate (manual determination), is not always displayed on monitoring screens nor reliable through visual assessment and needs additional devices to be displayed. A new Android application (Captesia) automatically calculates the PPV utilizing a digital photograph of the arterial waveform from the monitor. The application determines the PPVapp by selecting peaks and troughs of the arterial curve. The aim of this pilot study was to test its accuracy against a hemodynamic simulator.
Olivier Desebbe, MD, Department of Anesthesiology & Perioperative Care, University of California Irvine, Mfonobong Essiet; Alexandre Joosten; Koichi Suheiro; Joseph Rinehart; Maxime Cannesson
Background: The Patient Reported Outcomes Measurement Information System (PROMIS) is an NIH- funded system of highly reliable, precise question-and-answer measures of patient-reported physical, social, and mental well being that can be administered via paper-based or electronic means. Adenotonsillectomy (T&A) procedures are one of the most common procedures performed at our institution, yet systematic measurement of patient-reported health status was not routinely performed. We initiated the pre- and post-surgery administration of PROMIS tools using tablet computers and e-mail to T&A patients at our ambulatory surgery centers.
Allan F. Simpao, MD, Elicia C. Wartman; Jorge A. Galvez, MD; Arul Lingappan, MD; Luis M. Ahumada, MSCS; Abbas F. Jawad, PhD; Mohamed A. Rehman, MD
Introduction: Annually, more than 13 million children die from sepsis caused by conditions such as pneumonia and diarrhea due to a lack of resources and clinical expertise [1]. An objective test for which children should be referred to a facility would help community healthcare workers to best utilize resources. Mobile phones are now widely used even in low resource settings and provide an ideal platform for both vital signs assessment and automatic diagnosis. The first step is to identify differences in objective measures between children who need to be admitted and those who can return home.
Dustin Dunsmuir*, Ainara Garde†, Guohai Zhou#, Shahreen Raihana^, Tanvir Huda^, Walter Karlen~, Parastoo Dehkordi†, Shams El Arifeen^, J Mark Ansermino* Departments of *Anesthesiology, Pharmacology & Therapeutics, †Electrical & Computer Engineering, and #Statistics, The University of British Columbia, Vancouver, Canada ^International Centre for Diarrhoeal Disease Research, Bangladesh ~Department of Health Sciences and Technology, ETH Zurich, Switzerland
Background/Introduction: Fingerprint entry systems are marketed as providing improvements over passcodes and proximity cards as they theoretically prove each user’s identity. These security systems are not perfect and have been breached with simple techniques, such as fingerprint molds. Biometrics in healthcare represents a challenge due to hand washing protocols, environmental conditions, and the consequences of a high false accept rate when securing controlled substances. We report our initial attempts at breaching a fingerprint­secured automated medication dispenser that utilizes multispectral imaging with “liveness detection” technology.
James Lamberg, DO; Penn State Hershey Medical Center, James Mooney, MD; Penn State Hershey Medical Center
Introduction: Consistently providing equitable relief from clinical duties may be an important element in fostering and maintaining team morale. Achieving this in complex work environments such as academic medical centers can be challenging. Relief decisions could potentially be facilitated by the use of automated tools integrated with anesthesia information management systems (AIMS). We conducted a survey of trainee opinions on such a tool and describe its implementation.
Jonathan P. Wanderer, MD, MPhil, Vanderbilt University, Departments of Anesthesiology and Biomedical Informatics, Leslie C. Fowler, M.Ed; Stephanie Reed, MD; Jesse M. Ehrenfeld, MD, MPH; Matthew D. McEvoy, MD. Vanderbilt University, Department of Anesthesiology
Introduction: The American Society of Anesthesiology (ASA) developed guidelines supporting the routine use of capnography to assess ventilatory status during all moderate or deep sedation procedures attended by an anesthesiologist. Other professional societies and many hospitals have yet to develop or implement similar guidelines citing cost concerns. Capnography has been shown to increase the detection of respiratory depression by a factor of 17.6 times, giving providers an early indication of potential problems with respiration or airway obstruction enabling an immediate intervention [Waugh, et al, 2011]. We developed a hospital cost-avoidance model to assess the net economic impact of capnography monitoring during sedation procedures for a typical hospital.
Michael Jopling MD, Mount Carmel St. Ann’s Hospital, David Trost MD, Weill Cornell Medical Center; Timothy Kofol, MBA, S2N Health; Erin Warner, S2N Health
Introduction: The consumer market for pulse oximetry is rapidly growing. A number of low-cost products are available, ranging from finger clips with integrated read-out to inline oximeter modules with separate sensors. The former are currently the least expensive and readily available online from overseas distributors. In this study we compare the operating range of devices in different categories with respect to peripheral perfusion and optical transmittance (influenced by skin pigmentation).
Tso P Chen1, Christian L Petersen1, J Mark Ansermino1 and Guy A Dumont2 Departments of Anesthesiology, Pharmacology & Therapeutics1, and Electrical and Computer Engineering2, The University of British Columbia, Vancouver, Canada
Background/Introduction: Ideally, 100% of the oxygen delivered by a nasal cannula reaches the lungs when the patient inhales completely or partially through the nostrils. 100% efficient cannulas are ideal because they deliver all of the oxygen to the lungs and none to the surrounding air, minimizing operating room fire hazard and oxygen desaturation events. Several different nasal cannulas are available for delivering supplemental oxygen. We evaluated the oxygen delivery efficiency of these cannulas for various combinations of inhalation flow rate, oxygen flow rate and mouth opening. To do this, we designed a bench test to evaluate the fraction of oxygen that is inhaled and to compare the oxygen delivery efficiency of five different cannulas. We then compared the theoretical (ideal) oxygen delivery against the actual volume inhaled by simulating supplemental oxygen delivery and measuring resultant FiO2.
Kyle Burk, University of Utah, Salt Lake City, UT, Joseph Orr, PhD, University of Utah, Salt Lake City, UT
Background/Introduction: Low flow anesthesia using Desflurane is known to produce cost savings compared to normal flow, but Desflurane is also more expensive than Sevoflurane. To our knowledge, no study has been done for low flow anesthesia using Sevoflurane. One of the limitations has been the commonly recommended 2 L/min fresh gas flow during Sevoflurane anesthesia to minimize Compound A. Because of the new technology in soda lime production from Drager, its Dragersorb Free absorber does not generate Compound A, in contrast to the traditional absorber Dragersorb 800+. Therefore, it is now feasible to study the cost effectiveness of low flow Sevoflurane anesthesia vs. normal flow conditions. We hypothesize that low flow Sevoflurane anesthesia is more cost effective and efficient, even taking into account of the higher cost of the special Dragersorb Free absorber.
Fawn W. Atchison, MD, PhD, Cuyuna Regional Medical Center, Crosby, MN 56441, Mark W. Gujer, MD, Cuyuna Regional Medical Center, Crosby, MN 56441
Introduction: Many studies have sought to determine the relationship between ibuprofen or NSAID use and post-tonsillectomy hemorrhage rates. Few studies have evaluated the relationship to increased severity of bleeding associated with ibuprofen use.
Jorge A. Gálvez, MD; Pamela Mudd, MD; Teresa Giordano, DNP, CRNP, CORLN; Ralph Wetmore, MD; Lisa Elden MD, MSc, FRCS(C), FAAP; Allan F. Simpao, MD; Arul Lingappan, MD; Mohamed Rehman, MD; David Friedman, MD; Abbas Jawad, PhD; Luis Ahumada, MSCS
Introduction: AQI’S National Anesthesia Clinical Outcomes Registry includes more than 22 million anesthesia cases. AQI collects clinical, quality, and administrative with detailed ‘sensory’ perioperative data, medications administration, and unique events recorded in real time in electronic record systems. Thus, one case may consist of thousands of time dependent measurements. With the above constraints, the computational time required to develop and test data mining algorithms becomes a major issue. The abstract outlines AQI’s data mining infrastructure (Figure 1).
Hubert Kordylewski, PhD, Anesthesia Quality Institute (AQI), IL, Benjamin Westlake, Anesthesia Quality Institute, IL, Richard Dutton, MD, MBA, Anesthesia Quality Institute, IL, Lance Mueller, MS, Anesthesia Quality Institute, IL
Introduction: At many hospitals, the primary surgeon delegates incision closure to an assistant (e.g., resident, fellow, surgical first assistant). After scrubbing out of the case, the surgeon often engages in clinical activities such as working in another operating room (OR), examining and the marking the surgical site of the next patient, contacting the current patient’s family, dictating the operative report, etc. However, when the surgeon leaves the OR suite, this may lead to delays in starting the next case due to lack of situational awareness that the next patient has entered the OR. At some institutions, the room status is displayed on large video terminals in multiple perioperative locations. However, these displays may be out of view and the surgeon must continually scan the screens to determine when his or her next patient arrives in the OR. We desired a system that would automatically page the surgeon when his or her next patient entered the OR. We also wanted automated notification during pediatric intra-arterial chemotherapy (IAC) cases (for retinoblastoma) where the surgeon wanted to be present following transfer of the patient from the fluoroscopy table to the stretcher to remove the arterial catheter and hold pressure on the femoral artery.
Richard H. Epstein, MD, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, Ian Yuan, MD, ME, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
Introduction: Although direct laryngoscopy is a reliable method for endotracheal intubation, there are situations when direct visualization of the vocal cords may be difficult or impossible. For example, if blood or gastric secretions have compromised the airway, it may be impossible to visualize the vocal cords using any optical means. Another method of endotracheal intubation involves using a lighted stylet. The light transilluminates through the tissues of the anterior neck to help guide the endotracheal tube into the trachea. This technique can also be useful in the setting of suspected or known neck injury, where neck manipulation should be avoided. Despite its benefits, the transillumination technique does have some limitations, which include 1) need for a dark or dimly lit environment, 2) impaired transillumination in obese patients with significant redundant neck tissue, and 3) impaired transillumation in patients with darkly pigmented skin. To overcome these limitations, a device was developed that detects and visually represents the location of a magnetic intubation sylet and helps guide the stylet into the trachea via magnetic field sensing.
Barrett Larson, MD, Stanford University
Introduction: Numerous case reports, articles, standards committees (ISO TC 121), regulatory bodies and the recent AAMI Ventilator Summit have identified a need for a standardized vocabulary for patient ventilators to decrease use error.
Steven Dain MD, FRCPC, Department of Anesthesia, Woodstock Hospital, Adjunct Associate Professor, Electrical and Computer Engineering, University of Waterloo
Introduction: Studies from John Hopkins and the University of Utah have shown apnea alarms are either ignored or incorrect as much as 90% of the time in the clinical setting. Looking at apnea-related studies, there appears to be a lack of consensus about the definition of ‘apnea’. The literature cites acceptable apnea definitions between ten and twenty seconds since the last breath. The FDA acknowledges ‘type 1’ apnea as lasting ten to twenty seconds while ‘type 2’ apnea lasts more than twenty seconds. Among commercial clinical monitors, most alarms allow the physician to set the alarm within the ten to sixty second range. Given the statistics on reported false-positives and ignored alarms, one must wonder which of these definitions, if any, is ‘correct’ or at least clinically significant. We studied the length of time between breaths in healthy volunteers receiving target controlled infusions of sedatives and hypnotics to learn whether a clear cutoff is evident between hypoventilation and apnea.
Sean Ermer, B.S. 1 Joseph Orr, Ph.D1, Kai Kuck, Ph.D1, Lara Brewer, Ph.D1 1 University of Utah