A5055415791- Cardiac, Anesthesia and Surgical Outcomes
- Cardiac and Coronary Surgery Techniques
- Anesthesia and Pain Management
- Anesthesia and Sedative Agents
- Intensive Care Unit Cognitive Disorders
- Anesthesia and Neurotoxicity Research
- Nausea and vomiting management
- Hemodynamic Monitoring and Therapy
- Cardiac Arrest and Resuscitation
- Traumatic Brain Injury and Neurovascular Disturbances
- Cardiac Valve Diseases and Treatments
- Aortic Disease and Treatment Approaches
- Cardiac Ischemia and Reperfusion
- Blood transfusion and management
- Cardiac Health and Mental Health
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Blood Pressure and Hypertension Studies
- Healthcare Policy and Management
- Acute Myocardial Infarction Research
- Acute Ischemic Stroke Management
- Ultrasound in Clinical Applications
- Nicotinic Acetylcholine Receptors Study
- Cardiovascular Function and Risk Factors
- Enhanced Recovery After Surgery
- Heart Rate Variability and Autonomic Control
MedStar National Rehabilitation Hospital
2020-2021
International Spine, Pain & Performance
2021
Augusta University
2021
MedStar Georgetown University Hospital
2020-2021
Georgetown University
2020-2021
Aintree University Hospitals NHS Foundation Trust
2019
University of Liverpool
2019
Duke Medical Center
2007-2016
Duke University
2003-2016
Duke University Hospital
2006-2016
BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines range of interventions enable early mobilization and feeding surgery. We investigated the feasibility, clinical effectiveness, cost savings an ERAS program at major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal during 2 time periods, before implementation protocol. included patient demographics, operative,...
The importance of perioperative cognitive decline has long been debated. We recently demonstrated a significant correlation between and long-term dysfunction. Despite this association, some still question the these changes in function to quality life patients their families. purpose our investigation was determine association dysfunction after cardiac surgery.After institutional review board approval patient informed consent, 261 undergoing surgery with cardiopulmonary bypass were enrolled...
The absence of a widely available and sensitive diagnostic test for acute cerebral ischemia remains significant limitation in the diagnosis management stroke. objective this study was to examine feasibility developing panel blood-borne biochemical markers ischemia.Serial blood samples were obtained from patients (n=65 with suspected ischemic stroke, n=157 control subjects) presenting an academic medical center emergency department. We analyzed 26 believed play role cascade created 3-variable...
Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from continuous peripheral nerve block, with reliable method of insertion, self-contained infusion system would valuable asset short-stay care. We compared the efficacy single injection to an insulated Tuohy disposable pump. Forty adult patients scheduled open rotator cuff...
Aprotinin has recently been associated with adverse outcomes in patients undergoing cardiac surgery. We reviewed our experience this agent surgery at Duke University Medical Center.We retrieved data on 10,275 consecutive surgical coronary revascularization between January 1, 1996, and December 31, 2005. fit to a logistic-regression model predicting each patient's likelihood of receiving aprotinin the basis preoperative characteristics models long-term survival (up 10 years) decline renal...
Postoperative delirium, a common complication in the elderly, can occur following any type of surgery and is associated with increased morbidity mortality; it may also be subsequent cognitive problems. Effective therapy for postoperative delirium remains elusive because causative factors are likely multiple varied.Patients 65 yr or older undergoing elective knee arthroplasty were prospectively evaluated Diagnostic Statistical Manual Mental Disorders-IV delirium. Exclusion criteria included...
In Brief BACKGROUND: The administration of prophylactic phenylephrine infusions in combination with fluid cohydration significantly reduces the incidence hypotension women having cesarean delivery under spinal anesthesia. ideal dosing regimen for this purpose is not known. study, we investigated dose that, when administered as a fixed rate infusion, associated least interventions needed to maintain maternal systolic blood pressure (SBP) within 20% baseline. METHODS: Women undergoing elective...
AbstractAbstract The authors performed a retrospective observational study of the association between postoperative nadir platelet counts, acute kidney injury, and mortality in coronary artery bypass grafting (CABG) surgery. found significant independent after CABG work suggests that potential platelet-related ischemic events during surgery warrant further investigation. Supplemental Digital Content is available text. Background Cardiac requiring cardiopulmonary associated with activation....
Abstract Background: Mortality after noncardiac surgery has been associated with the “triple low state,” a combination of mean arterial blood pressure (<75 mmHg), bispectral index (<45), and minimum alveolar concentration volatile anesthesia (<0.70). The authors set out to determine whether duration triple state aggregate risk individual diagnostic procedure codes are independently perioperative intermediate-term mortality. Methods: studied 16,263 patients (53 ± 16 yr)...
Although approximately 2,000 medical practice guidelines have been proposed, few successfully implemented and sustained. We hypothesized that we could develop institute to promote more appropriate use of costly anesthetics, generate sustain widespread compliance from a large physician group, decrease costs without adversely affecting clinical outcomes.A prospective before after comparison study was performed at tertiary care center. Clinical outcomes data times indicative perioperative...
Abstract —Cardiac G protein–coupled receptors that couple to Gα s and stimulate cAMP formation (eg, β-adrenergic, histamine, serotonin, glucagon receptors) play a key role in cardiac inotropy. Recent studies rodent myocytes transfected cells have revealed one of these receptors, the β 2 -adrenergic receptor (AR), also couples inhibitory protein i (activation which inhibits formation). If ARs could be shown human heart, it would important ramifications, because levels increase with age...
Background Despite significant advances in cardiopulmonary bypass (CPB) technology, surgical techniques, and anesthetic management, central nervous system complications occur a large percentage of patients undergoing surgery requiring CPB. Many centers are switching to normothermic CPB because shorter operating room times improved myocardial protection. The authors hypothesized that, compared with normothermia, hypothermic would result superior neurologic neurocognitive function after...
Background Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen thoracoscopy unknown. The purpose of this trial was to compare efficacy from preoperative bupivacaine paravertebral nerve blockade with that placebo injections. Methods Eighty adult patients undergoing unilateral procedures were enrolled in a prospective, double-blinded, randomized clinical preoperative, multilevel, single-dose blockade....
Postoperative nausea and vomiting (PONV) occur commonly after craniotomy. In patients receiving prophylaxis with ondansetron dexamethasone, occurred in 45% of at 48 hours. addition to causing patient discomfort, the physical act may increase intracranial pressure or cerebral intravascular pressure, jeopardizing hemostasis perfusion. Aprepitant is a neurokin-1 receptor antagonist long duration action no sedative side effect. large multicenter study undergoing abdominal surgery, aprepitant was...
Swimming-induced pulmonary edema (SIPE) occurs during swimming or scuba diving, often in young individuals with no predisposing conditions, and its pathophysiology is poorly understood. This study tested the hypothesis that artery wedge pressures are higher SIPE-susceptible submerged exercise than general population reduced by sildenafil.
Background Estimates of blood loss in the operating room are typically performed as a visual assessment by providers, despite multiple studies showing this to be inaccurate. Use less subjective measurement such direct hemoglobin (Hb) mass lost from surgical field may better quantify bleeding. The objective investigation was compare anesthesiologist estimates intraoperative with measured Hb loss. Study Design and Methods Sixty patients undergoing posterior spine surgery were enrolled...
Objectives To look for changes in intrinsic functional brain connectivity associated with postoperative cognition, a common complication seniors undergoing major surgery, using resting‐state magnetic resonance imaging. Design Objective cognitive testing and imaging were prospectively performed at preoperative baseline 6 weeks after surgery the same time intervals nonsurgical controls. Setting Academic medical center. Participants Older adults cardiac (n = 12) older adult controls history of...