Past Annual Meetings

2011 Annual Meeting

Annual Mtg Onsite Materials:

Speaker Handouts:




Name Author(s) 
Introduction: While the selection and timing of prophylactic antibiotics for surgery moves toward a system-based approach, most institutions and Operating Room Information Systems (ORIS) rely on individual health care provider preferences. We describe the development and implementation of a procedure-based institutional protocol for the administration of prophylactic antibiotics at Wake Forest University Baptist Medical Center (WFUBMC).
JC Gerancher, MD
At the University of Iowa Hospitals, we use Epic as our hospital information system. On November 8, 2010, we brought up the intraoperative module that allowed us to dispense with the paper record for the majority of our anesthetizing locations. A primary consideration in data integrity was what to do when the flow of data from the patient monitor and the anesthesia machine was interrupted. Our data flow starts with the RS-232 stream from the monitor and machine and is coverted to TCP-IP by a Capsule Neuron that then sends the data over our Ethernet backbone to the Capsule server. This server translates the data to HL-7 and sends it to Epic via a Cloverleaf server. The Neuron and the Capsule servers are capable of caching data indefinitely if there is a failure further down the data stream.
Frank Scamman, MD
Background: Our question was whether the diurnal pattern of postoperative pain is influenced by time of the operation completed. We evaluated the changes of circadian pattern of pain using patient-controlled analgesia (PCA).
Kwang Suk Seo, MD
Introduction: Regulations and guidelines from entities such as CMS and the ASA toward ensuring compliant and complete postoperative anesthesiology assessments necessitate improved methods of recording and tracking these visits. We expanded and existing perioperative documentation suite to include an integrated postoperative component. We then created an iPad application to facilitate data entry while visiting the patient postoperatively at the bedside.
Jason Lane, MD, MPH
Introduction: End tidal carbon dioxide (CO2) correlates with cardiac output during cardiopulmonary resuscitation in cardiac arrest patients. Increasing CO2 during CPR can also indicate the return of spontaneous circulation.
Harish Manyam, MD
While upgrading and standardizing the software on all of our institution's Phillips monitors, the wrong configuration was used to clone the anesthesia monitors. Ove the course of a few days, 19 of our monitors were reprogrammed to default the NIBP to manual instead of automatic cycling q3min. Most providers recognized a problem and simply adjusted their monitor settings. Twenty-seven cases (of 303 at risk) went for periods of greater than five minutes (up to 27 minutes) without BP cuff recycling or an alternative method of blood pressure monitoring. nine days passed before an anesthesia provider reported the errant monitor behavior. Retrospective chart review showed that no patient had an adverse outcome related to the monitor failure.
Stephen Robinson, MD
Introduction: Anesthetics impair postural steadiness leading to increased risk of falls. The residual effects of these drugs restrict outpatient throughput due to safe discharge considerations. A practical method to predict the fitness for ambulation and hence a safe discharge time could decrease the risk of postprocedure falls.
Aino Tietavainen, MSc
Introduction: Laparoscopic surgery presents unique hemodynamic challenges for the anesthetic management of patients. Hemodynamic changes induced by pneumoperitoneum were measured using a new noninvasive device, the Endotracheal Cardiac Output Monitor (ECOM) (ConMed Corp, Utica, NY). This monitor provides measurements - including cardiac output (CO), systemic vascular resistance (SVR), and stroke volume variation (SVV) - that were previously unavailable noninvasively. A better understanding of the applicability and reliability of this new technology in the clinical setting is important for patient safety.
Timothy Shine, MD
Background: Appropriate blood component therapy might be different between patients who receive elective surgery causing massive bleeding and patients who receive emergency surgery after traumatic massive bleeding, because trauma patients bleed undiluted blood initially and replacement typically lags behind blood loss. We compared them using computer simulation in assumption that coagulopathy begins in less bleeding volume.
Jong Hun Jun, MD
HYPER-ALGESIA is a perception of pain out of the proportion to a given stimulus. This is a poorly understood condition that may impact outcomes of patient care and long term pain-control. A stimulus of pain that activates a cascade in the pre-synaptic neurons at NMDAR causes repeated messages via the dorsal horn of the spinal column.
Donna Nelson, RN
Introduction: Lower body negative pressure (LBNP) is an excellent model for hypovolemic circulatory stress, since it rapidly decreases central blood volume by sequestering blood in the lower extremities through application of negative pressure around the legs and abdomen. We hypothesize that during a hypovolemic challenge such as Lower body negative pressure (LBNP), a preservation of ear PPG characteristics and a decrease in finger PPG characteristics will be seen. Our study sought to explore changes in PPG waveform parameters; height, peak area, width 50, maximum and minimum slope (figure 1) and to determine which components of the PPG waveform could serve as early indicators of reduction in central blood volume during LBNP in spontaneously breathing volunteers. Previous work has demonstrated a differential vasoconstrictive response in the finger vs. ear during cold pressor testing, the decreased height of the finger was attributable to greater adrenergic activity in this region.
Aymen Alian, MD
Background: The photoplethysmographic (PPG) waveforms are modulated by respiratory, cardiac and autonomic nervous systems. PPG had two components; the AC component reflects arterial pulse volume variation while the DC component reflects the constant absorption and scattering of light by bone and non-pulsatile venous blood. Lower blood negative pressure (LBNP) has been used as an experimental tool to simulate loss of central blood volume (e.g., hemorrhage) in humans. Heart rate variability has been reported to reflect autonomic (sympathetic and vagal) activities. The efferent vagal activity is a major contributor to the HR component (0.15-0.4 Hz), while the LF component (0.04-0.15 Hx), which is considered as a parameter that includes both sympathetic and vagal influences. It has been shown that the standard deviation of the R-R interval (RRISD) can be used as an index of cardiac vagal tone. The aim of our research is to understanding the physiology of progressive central hypovolemia that leads to cardiovascular decompensation and try to develop effective indicators that predict the magnitude and/or rate of progressive hemorrhage before the onset of hemorrhagic shock.
Aymen Alian, MD
Background: The black rhinoceros (Diceros bicornis) is critically endangered with just over 4,000 animals surviving in southern Africa. Conservation efforts utilize potent opioids as a foundation for chemical restraint, resulting in respiratory depression, hypoventilation, hypoxemia, and hypercarbia. Preliminary data on the influence of posture on respiratory function was reported here (STA, 2009) but the debate over optimal positioning of rhinos during anesthesia continues. The purpose of this study was to expand on earlier findings and characterize the effects of posture on respiration during field anesthesia of free-ranging black rhinoceros.
Arthur Taft, PhD, RRT
Introduction: Team use of checklists prior to complex or critical procedures improves safety by ensuring that all key factors have been considered prior to beginning. In the operating room, a presurgical time out or safety checklist have been recommended. However, ensuring compliance with this protocol has been problematic. In order to improve compliance with a standardized process, we developed and implemented a stepwise "time out" checklist as an interactive component of an existing perioperative documentation system.
Paul St. Jacques, MD
Introduction: Hospital patients require physiological monitoring throughout their stay. Monitoring requirements depend on the hospital unit (e.g. Admission, OR, ICU, ward). Currently, monitoring devices are stationary and are connected by wires to sensors and patient. This is cumbersome for both patient and health care providers, and sensors must be disconnected when the patient is prepared for transfer between units. Further, sensors located in one unit are often incompatible with those in another. We propose a novel concept that simplifies patient monitoring throughout the hospital.
Walter Karlen, PhD
Introduction: Our initial work, with Automating Data collection from a CPB system, captured pump outlet pressure through use of a conventional pressure transducer connected to our physiologic monitoring system (Intellivue - Phillips). This technique permitted direct export of the pump outlet pressure into our AIMS database. Additional flow rate and temperature data from the pump were then obtained by an RS-232 Communication Module (CM) obtained from our Terumo-Sarns rep. Our AIMS cannot interface directly with an RS-232 port and an Asus Eee PC 901 captured the CM output. As we continued our data collection we noted that some bypass cases had frequent, very large excursions, of brief duration, in the pump outlet pressure and arterial flow rate. A review of the literature revealed the potential of these excursions to alter the cognitive outcomes of patients requiring bypass. Thus we decided to investigate (both in vivo and ex vivo) the measurement of the pressure drop across the CPB Oxygenator (OX) as a means of monitoring the aforementioned flow variations.
Matthew Joy, MD
Introduction: Blood pressure measurements in children during anesthesia are routinely performed and change alerts typically use absolute threshold values. As intraoperative hypertension is uncommon in children, a literature review yielded no previous publications addressing the event. In adults, however, acute intraoperative increases of blood pressure >20% are considered hypertensive emergencies (1). We recently completed an evaluation of intraoperative hypotension rules for use in children (2). The same cases and method of evaluation were employed to define rules for the automated detection of hypertension.
Jonathan Stinson, BSc
Background: We have developed a proportional-integral-derivative controller allowing closed-loop propofol and remifentanil administration guided by the Bispectral (BIS) monitor. Nitrous oxide (N2O) has a hypnotic and analgesic effect. We investigated whether the coadministration of N2O would reduce the amount of propofol and remifentanil required during closed-loop anesthesia maintenance. Drug consuption in all patients, in both men and women was analyzed.
Ngai Liu, MD, PhD
Background: At BC Children's Hospital, anesthesia assistants (AAs) help the attending anesthesiologist to keep the patient safe by ensuring that equipment and tools are maintained and readily available, and by providing an "extra pair of hands" when needed. However, requesting their presence using a phone-based paging system is cumbersome and hard to perform from the anesthesia workstation. Therefore, an integrated mobile application facilitating information exchange and communication tasks (such as paging) is proposed.
Matthias Gorges, PhD
Introduction: Previous reports have detailed our use of Windows API Calls to automate data extraction from our AIMS server via the CompuRecord Research Module(RM). This report details extensive trials of a QI system based on this automated, "real time" data extraction and analysis of anesthesia case data from all of our anesthetizing locations.
Alfred C. Pinchak, PhD, MD