2012 Annual Meeting Abstracts

Name Disclosures  Author(s)  Awards 
Introduction: Capnometry is becoming a standard for monitoring of spontaneously breathing patients during procedural sedation, during PCA and in the PACU. Because of the variable nature of spontaneous breathing in these conditions, identification of the start and end of each breath within the CO2 signal can be difficult. Extraction of an accurate breath rate measurement from the capnogram signal becomes more diffi- cult as the breathing becomes less mechanically controlled and as the sampling site moves away from the airway. Identifying breaths from the capnogram for a patient that is intubated and mechanically ventilated is trivial. On the other hand, if a patient is a sedated and breathing spontaneously and CO2 is sampled via a split-lumen nasal cannula which is also being used to deliver oxygen, accurate detection of the start and end of each breath is much more difficult. Present performance standards for capnometers only require accurate measurement of the con- centration of CO2. There are no performance standards for the algorithms used tocalculate breath rate or end-tidal CO2 from the CO2 waveform. We have developed a system that physically re-creates clinically recorded CO2 signals so that breath detection algorithms, as implemented in multiplecapnometers, can be compared using identical input data.
Joseph Orr, PhD, Christina Long, MS, Lara Brewer, PhD
Background: To date, there have been no prospective, randomized trials looking at the effect of automated alerts on the accuracy of time-based charges for anesthesiology services. We hypothesized that alerting providers to errors could result in more accurate documentation of anesthesia care and significantly improved revenue.
Robert E. Freundlich, MD, MS, Caryn S. Barnet, MD, Amy M. Shanks, MS, Kevin K. Tremper, PhD, MD, Sachin Kheterpal, MD, MBA
Background: Conventional method of delivering intravenous medication during anesthesia is timeconsuming, requiring 45 seconds and 41 steps to administer one medication. We introduce a robot to reduce the time and number of steps.
E. Yan, MD, Maxime Cannesson, MD, PhD
Many have observed that medical device clocks are not set to the correct time. This is due to a number of causes. Most medical devices lack automatic clock-setting capabilities and cannot set their clocks using a network time reference. Also, there is no adopted standard for medical device time management. Consequently, clocks are typically set manually twice yearly for DST.
Pratyusha Mattegunta1 , David Arney1, Julian M. Goldman1,2,3
Introduction: Anesthetics and surgery may impair thermoregulation thereby increasing the potential for adverse peri- operative events. Hypothermia has been shown to increase surgical wound infection, lengthen the duration of hospital- ization, increase intraoperative blood loss, slow drug metabolism and prolong recovery. Accordingly, the Surgical Care Improvement Project (SCIP) mandates that measures be taken to achieve a target temperature of 96.8oF within thirty minutes of procedure end or that active warming techniques be used.
Robert B. Bolash, MD, David C. Kramer, MD
Introduction: Multiple clinical organizational standards and recommendations recognize the importance of monitoring quality or ‘adequacy’ of ventilation during procedural sedation and when monitoring patients receiving post-operative opioids.i, ii, iii, iv, v, vi The American Society of Anesthesiologists (ASA) states, “All patients receiving neuraxial opioids should be monitored for adequacy of ventilation (e.g., RR, depth of respiration, oxygenation, and level of consciousness).” i The Joint Commission on the Accreditation of Healthcare Organizations recommends “respiratory frequency and adequacy of pulmonary ventilation should be continually monitored in patients undergoing conscious sedation.” vi
Greg Spratt, BS, RRT, CPFT, David Lain, PhD, JD, RRT
Background: Anesthesia technicians (tech) help ensure anesthesia providers have the necessary means to deliver safe and efficient patient care. It is vital for the anesthesia provider to be able to quickly contact their assigned tech at any time and from any location within the hospital. To improve the anesthesia provider’s ability to quickly and efficiently contact their currently assigned tech, the AnesthesiaTechManager and AnesthesiaTechFinder programs were created.
Frank Gencorelli, MD
Introduction: Undetected apnea can lead to hypoxic encephalopathy, bradycardia and even cardiac arrest. Tracheal sounds entropy has been proved to be a robust method for estimating respiratory flow,(1) thus maybe a more reliable way to detect apnea. Our study hypothesis is that changes in the entropy of tracheal sounds will provide an early warning of the onset of apnea in sedated patients, especially when the patients receive supplemental oxygen.
Lu Yu, MS1,2, Bryce Hill, PhD2, Ken Johnson, MD2, Talmage Egan, MD2, Chien-Kun Ting, MD3, Joseph Orr, PhD2, Dwayne Westenskow, PhD2
Introduction: Attestations made by physicians in the medical record play an important role in assessing compliance with regulatory agencies and various policies such as the Surgical Care Improvement Project (SCIP). We aimed to retrospec- tively examine the accuracy of three specific attestations of SCIP measures - antibiotic compliance, maintenance of nor- mothermia, and the use of standard central line sterility techniques.
Ira S. Hofer, MD, Ronald Kahn, MD
Introduction: Pulse oximetry is critically important in anesthesia as an early indicator of hypoxemia. Conventional pulse oximetry is widely used in the developed world, but many developing regions do not have access to this life saving tech- nology due to lack of infrastructure (such as electricity) and the prohibitive cost of devices. The use of the ubiquitous cell phone as a vehicle for pulse oximetry may be a way to address these issues 1. We describe a method for connecting an oximeter finger sensor directly to the generic audio port of a cell phone, thereby bringing cost to a minimum.
Christian L Petersen, J Mark Ansermino, Guy Dumont
Introduction: The purpose of this project is to derive an optimal algorithm to allow for automatic ultrasound (US) detec- tion of the sciatic nerve at the popliteal fossa.
M. Wehbe, J. Morse C. Zaouter, S. Cyr, Thomas Hemmerling, MD
Many have observed that medical device clocks are not set to the correct time. This is due to a number of causes. Most medical devices lack automatic clock-setting capabilities and cannot set their clocks using a network time reference. Also, there is no adopted standard for medical device time management. Consequently, clocks are typically set manually twice yearly for DST.
Christal L. Greene, MD, Stephen K. Patteson, MD
Traditionally, anesthesiologists administer oxygen and agent (AA) by manually adjusting vaporizer and FGF settings. However, it is technically possible to design a feedback system to automate manual adjustment. We did evaluate the end- tidal control (EtC) prototype designed for AisysTM (GE Healthcare) on the human subjects. Our aim was to access clini- cal performance vs. expectations of anesthesiologist, plus to compare behavior of the control system vs. technical specs.
Ilkka Kalli, MD, PhD, MBA
Background: In a previous publication (1) closed-loop fluid management was studied in-silico using pulse-pressure varia- tion (PPV) as a monitored system output. One limitation of this work was the fact that both the simulator and controller utilized the same PPV dataset, creating a possible bias. Additionally, PPV cannot be used in all patients, so a system depen- dent on PPV would be limited in scope. In this study, we compared the performance of a group of anesthesia providers in managing a simulated hemorrhage to closed-loop (LIRTM) fluid-management using stroke volume (SV), heart rate (HR), and mean-arterial pressure (MAP) alone.
E. Chung, M. Cannesson, J. Rinehart
Many have observed that medical device clocks are not set to the correct time. This is due to a number of causes. Most medical devices lack automatic clock-setting capabilities and cannot set their clocks using a network time reference. Also, there is no adopted standard for medical device time management. Consequently, clocks are typically set manually twice yearly for DST.
Joseph Rinehart, MD, Allen Kong, MD, Earl Steward, Christine Lee, Cecilia Canales, MPH, Maxime Cannesson, MD, PhD
Introduction: Recent advances in ultrasonography has allowed the general anesthesiologists to explore point-of-care assessment of: cardiopulmonary function, volume status, and evaluate for severe thoracic/abdominal injuries. The focus of this study was two-fold: 1) to introduce the concept of a perioperative ultrasound exam that focuses on the concepts listed above 2) to evaluate if a simulation/live-model based lecture would be a more effective method of teaching this topic to anesthesiology residents than a traditional didactic lecture.
Davinder Ramsingh, MD, W. Williams, MD, KV Le, D. Thuraisingham, MD, M. Cannesson, MD
Background: Esophagogastroduodenoscopy (EGD) and colonoscopy procedures are usually performed using conscious sedation 1, 2. Drug-induced respiratory depression is a major cause of serious adverse effects.Adequate oxygen saturation is very important for patient safety 2. Keeping the patient at higher oxygen saturation can reduce the severe complications.2, 3 The oxygen saturation level is affected not only by patient’s breathing, but whether supplemental oxygen is being sup- plied. Supplying the supplemental oxygen to a sedative patient is a common and standard practice3. The higher of oxygen saturation before apnea, the longer the patient can tolerate hypoventilation. During the past few years, manufacturers have introduced new models of bite block and nasal cannula that include CO2 sampling ports along with supplemental oxygen delivery. However, the oxygenation ability of these devices has not been evaluated. The current bench test study was designed to compare the FiO2 performance of these new nasal cannulas, masks, and bite block devices which are com- monly used during sedation for EGD, colonoscopy and other procedures.
Chien-Kun Ting, MD, PhD,1,2 Joseph A. Orr, PhD,2 Lu Yu, MS,2,3 Dwayne Westenskow PhD2
Introduction: Intraarterial catheters allow for continuous beat-to-beat monitoring of arterial blood pressure, as well as an estimation of fluid responsiveness, as determined by arterial respiratory variation. However, intraarterial catheter place- ment may be complicated by infection and thrombosis, and may be technically challenging in some patients. The T-line® Tensymeter is a potential non-invasive alternative to intraarterial blood pressure monitoring. We compared estimates of mean arterial pressure (MAP) and pulse pressure variability (PPV) from the T-line® with measurements of MAP and PPV taken from a radial artery.
Lauren K. Dunn, MD, PhD, Andrew Boryan, MD, Douglas A. Colquhoun, MB, ChB, MSc, Marcel E Durieux, MD, PhD, David L. Bogdonoff, MD, Robert H. Thiele, MD
Background: Performing a preoperative evaluation is a critical skill for anesthesiologists [1]. Training and assessing the performance of preoperative evaluations with standardized patients is expensive, time consuming, resource intensive. In certain cases, virtual humans may provide more fidelity than standardized patients for certain kinds of pathophysiology [2]. Residents are increasingly familiar and comfortable with virtual reality and this technology has the potential to offer a scalable, portable solution to such a problem.
Jason H Epstein, MD; Sam DeMaria, MD; Adam Levine, MD
Introduction: Anesthesia Information Management Systems (A.I.M.S.) have been in use for two decades. Their role has been expanded to include patient tracking, perioperative documentation, billing, quality assurance, and research. One common complaint is that it’s difficult to obtain specific information within their complex data structures. This project was undertaken to design a visual front-end interface for departmental members without extensive knowledge of database structure or sql language to query our clinical data repository.
David C. Kramer, MD1, Robert B. Bolash, MD1, Jolly Adebayo, MD1, Marina Krol, PhD2