Past Annual Meetings

2011 Annual Meeting

Annual Mtg Onsite Materials:

Speaker Handouts:

 


 

Abstracts 

Name Author(s) 
Background: Intraoperative volume status assessment is important for guiding fluid therapy and optimizing hemodynamic management. Traditional accepted methods of volume assessment include measurements of left ventricular end-diastolic volume (LVEDV), central venous pressure (CVP), and pulmonary artery diastolic pressure (PAD). However, these methods are invasive, expensive, and can potentially subject the patient to complications and therefore, are not applicable in all surgical populations. Instead, less invasive and more reliable methods of evaluating a patient's volume status are being sought. A recent pilot study reports the successful utilization of ultrasonography of the internal jugular vein (IJV) as a noninvasive tool to predict CVP in spontaneously breathing critical care patients (1). No study to date has performed ultrasound assessment of the IJV as a possible tool in the operating room to assess volume status and guide fluid management in the surgical patient under general anesthesia. This study aims to compare correlations of sonographic measurements of the IJV, CVP, and PAD to LVEDV in this popular subset. Additionally, current literature suggests positive correlations between pulse pressure variation percent (PPV%) and left ventricular end-diastolic area as a reliable measure of fluid responsiveness (2). Thus, as a secondary endpoint, we will also evaluate the correlation between PPV% and LVEDV.
Brooke Albright, MD
The University of Iowa recently went live with electronic anesthesia records by EPIC systems. At our hospital we have different generations of GE/Datex-Ohmeda anesthesia machines, with different generations of Datex-Ohmeda S/5a monitors attached to them. The output of these is RS-232. The Capsule device, Neurona, translates these data streams into TCP/IP and sends them over the hospital Ethernet backbone to the Capsule server. This server then translates the data streams to HL-7 and sends them through the Cloverleaf data switch to Epic. During the process of testing the integration of data from these machines and monitors of EPIC electronic anesthesia records, it was identified that these different generations of monitors had various versions of software, firmware and output levels. this could cause issues not only in the initial data validation and for downtime situations, but also would need more resources assigned for future updates and maintenance. Both of Department of Anesthesia and the Hospital Information Systems department were concerns about this. One example of problems with data flow was, older versions of S/5 monitor will not transmit entropy and NMT data into EPIC even though we could do real time monitoring, unless it was a certain level of Datex Record Interface level.
Frank Scamman, MD
The University of Iowa went live with electronic anesthesia records on November 8, 2010. We are a major university hospital with more than 180 clinical providers including trainees and multiple anesthetizing locations. Transitioning from paper anesthesia records to electronic anesthesia records required adequate preparation and thorough training of all clinical providers. Classroom training is valuable in the early stages, but it has limitations.
Frank Scamman, MD
Introduction: Capnography or end-tidal carbon dioxide (etCO2) is used to monitor ventilation, provide respiratory rate and measure adequacy of ventilation through the measurement of exhaled carbon dioxide. In addition, waveforms provide continuous and real-time feedback on airflow (i.e., apnea) and visual analysis of waveform shape is an indicator of airway obstruction/hypopneas, abnormal ventilatory patterns (hypo/hyperventilation), and as a diagnostic indicator for diseases with airway constriction. Usage has become the standard of care for monitoring ventilation in anesthetized patients in the Operating Room (OR) and is commonplace in the Intensive Care Unit (ICU) for intubated patients. Since the commercialization of sidestream capnography technology and non-invasive exhaled CO2 oral/nasal sampling interfaces, the use of non-intubated capnography has expanded outside of the OR and ICU into environments of the hospital where caregivers may be less familiar with these monitors (e.g., Procedural Sedation, Patient Controlled Analgesia, Emergency Department, and General Floor). The alarm settings on these monitors are important and have the potential to prevent untoward events and even deaths by alerting caregivers to dangerous situations such as apnea and significant changes in CO2 levels. However, excessive alarms including clinically-irrelevant alarms ('nuisance alarms' or false-positive alarms created by artifact) have been shown to desensitize caregivers to clinically-significant alarms and become a threat to patient safety. In addition, they are a source of aggravation to patients and family members, potentially reducing compliance with monitoring. Recently, algorithms have been developed which have been shown to significantly reduce such clinically insignificant alarms. Additionally, frequent non-clinical alarms may be created by inappropriately setting alarm limits at levels too close to normal ranges. Literature on how best to set alarm limits currently used is lacking. Our goal was to survey experienced users of capnography to determine the ranges of capnography alarm settings commonly used. Such information may be useful to new users in developing their own alarm limit protocols or defaults.
Greg Spratt, BS, RRT, CPFT
Background: The TibbleCap (TM) (ActMD Inc., San Diego, CA) is a novel universal airway circuit cap connector that allows "classic" style laryngeal masks to function as intubating conduits, provides life-saving oxygen through the outer cannula of a tracheostomy, doubles as a replacement endotracheal tube cap, and finally, simplifies transtracheal jet ventilation. Upon first examination of its structure, the practitioner often voices legitimate concerns regarding the air flow resistance imparted by the TibbleCap (TM). In this study, the resistance profile of the TibbleCap (TM) is compared to various endotracheal tube sizes. Using Ohm's law that resistance is directly related to the change in pressure divided by flow (R=?P/Flow)2, a proximal pressure created by each resistor was measured at identical air flow rates to obtain resistance profiles for each tube or cap.
Adam Tibble, MD
Introduction: Intra-operative fluid management requires the anesthesiologist to spend time in calculations in order to give the patient the exact volume of fluids according to a vast number of variables, such as patients' anthropometric data, type of surgery, duration of procedure, blood loss, etc, in a fine balance between inputs and outputs. We designed a novel system (Fluidometer(TM)), as an aid for intraoperative fluid management.
Thomas Hemmerling, MSc, MD
The IPI is a software tool that constitutes a representation of 4 parameters: End tidal CO2 (EtCO2), respiratory rate (RR), Oxygen saturation (SpO2) and pulse rate (PR), already displayed on a monitor, in the form of a single index value ranging from 1 to 10 with trend information. The IPI index has been validated for adults and for children older than 1 year of age. In this study we aimed to study the value of IPI monitoring using Capnostream20 during pediatric endoscopic procedures under general anesthesia (GA) and conscious sedation (CS). We specifically aimed to assess whether 1) IPI monitoring improves patient safety in the pediatric GI suite by reducing hypoxemia and respiratory depression events compared to regular monitoring with oxygen saturation and 2) to assess the safety net of different sedative medications as to adverse respiratory events and patient recovery. The IPI signal was monitored and analysed in order to detect IPI changes due to various parameters changes such as drug dosage per weight, drug type, and the presence of an anesthetist.
Rachel Weissbrod, B. Pharm, MBA
Introduction: Tele-medicine has been used in different fields of medicine to overcome the lack of specialist and improve health care. The aim of the study is to determine how anesthesia delivery can be achieved remotely.
Thomas Hemmerling, MSc, MD
Human Patient Stimulations Labs are designed to train clinicians by using simulated clinical scenarios and to improve psychomotor skills. We describe a novel use of the patient simulation laboratory to design, validate data and test downtime situations of a new electronic anesthesia record system that the Department of Anesthesia was implementing.
Frank Scamman, MD
Electronic Medical Records are becoming the standard across the country. Many physicians would be using tablet computers for accessing electronic records for the purpose of data entry and for reviewing clinical records in the near future. University of Iowa Hospitals recently went live with EPIC Electronic Anesthesia records. During the process of designing and testing the interface for Intraop Record, we decided to do a Quality Improvement study to compare comparing 2 different simulated layouts for medications order entry in electronic anesthesia record. One layout had medications arranged in an alphabetical arrangement and the other had medications arranged in a categorical arrangement. From the results of this Departmental QI project we designed the EPIC Intraoperative Anesthesia Record.
Frank Scamman, MD
The Department of Anesthesia at the University of Iowa Hospitals went live with the Epic intraoperative anesthesia module on November 8, 2010. For the interface between the anesthesia physiologic monitor and the anesthesia machine and Epic, we chose the Neuron, a relatively new product from Capsule. After extensive testing, for the fixed locations, we hard wired the Neuron into our Ethernet backbone. Having many satellite locations where hard wiring was impractical or impossible, we used the wireless feature of the Neuron to provide connectivity. After verifying that the wireless strength (WiFi) in all of the satellite locations was satisfactory, we installed the Neuron on 4 roaming anesthesia machines. For our Epic workstations, we use a Dell Latitude laptop as the CPU with a slaved touch-screen monitor and slide-pad keyboard mounted on an articulated arm on the right-had side of the machine. In the satellite locations, the Dell also operates wirelessly. The Neuron uses a digital interface module to identify the device it is connected to. All the electrical mains connections-machine, laptop, anesthesia machine, Neuron, and touch screen come to a common power strip. On arrival at a new location, the provider plugs the power strip into an electrical outlet and then turns on the Neuron and the laptop. While both are booting, the provider establishes the gas connections and checks out the machine. To initiate electronic record keeping, the provider opens the Epic applications, selects the patient, launches the intraoperative module and starts data collection. The provider enters drugs and events as necessary.
Frank Scamman, MD
Introduction: Securing venous access can be technically challenging and may require significant time. A vein finding device (VF) that is minimally invasive and portable would allow for improved patient care. We studied a VF (VueTek Scientific) that uses digitized infrared imaging on a head mounted display. It is designed to improve visualization of superficial veins.
Franklin Chiao, MD, MSc
Introduction: There is generally a lack of agreement about what constitutes a valid breath. A clear definition is particularly important to developers of computer based algorithms which estimate clinically important measures such as a respiratory rate, tidal volume and end-tidal gas measurements that are considered critical in the management of patients in clinical environments ranging from pre-hospital to the OR and ICU.
Michael Jaffe, PhD