Anesthesiology, Author Interviews, COVID -19 Coronavirus, OBGYNE / 13.04.2020 Interview with: Dr. Alicia Warlick, MD Anesthesiologist at UNC/Rex, American Anesthesiology Raleigh, North Carolina As a physician working on the frontlines of the COVID-19 battle, how are you addressing expecting mothers’ concerns about the disease and how it might impact their pregnancy? Response: While COVID-19 has disrupted nearly every aspect of healthcare, whether its virtual appointments or delayed surgeries; there are certain things that are inevitable – like childbirth. As this virus continues to take over the country and we learn more about it each day, pregnant women are facing new challenges and fears. For women approaching their due dates, questions about staying healthy, keeping their baby safe and limiting their risk of exposure while in the hospital are all leading to anxiety and stress. And while policies and guidelines are constantly changing, as physicians we need to remind our patients that we are there to alleviate their concerns, address their questions and remind them to not lose sight of the joy the comes with bringing a child into the world. It’s a scary time for everyone, but by working together and supporting one another, we will get through this. (more…)
Anesthesiology, Author Interviews, Geriatrics, NEJM / 23.06.2019 Interview with: Yahya Shehabi  PhD, FANZCA, FCICM, EMBA, GAICD Director of Research, Critical Care and Peri-operative Medicine, Monash Health Professor, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University Professor Intensive Care Medicine, Clinical School of Medicine, University New South Wales Critical Care and Peri-Operative Medicine Lead – Monash Health Translational Precinct What is the background for this study? Response: SPICE III was the final phase of a series of SPICE studies. SPICE I showed 2 important findings, first, deep sedation in the first 48 hours is strongly associated with higher mortality, longer ventilation time and higher risk of delirium. Second; that Dexmedetomidine is mainly used as an adjunct secondary agent 3-4 days after commencing mechanical ventilation and not as a primary sedative agent. In addition, albeit with several limitations, previous RCTs comparing Dexmedetomidine with conventional sedatives showed reduced iatrogenic coma, shortened ventilation time and reduced delirium with Dexmedetomidine treatment. So based on the above we hypothesized that using Dexmedetomidine soon after commencing ventilation as a primary sedative agent, through reducing early iatrogenic coma, ventilation time and delirium, would impact 90 day-mortality. (more…)
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 31.10.2017 Interview with: Philipp Gerner MD Candidate - Class of 2018 University of Massachusetts Medical School What is the background for this study? What are the main findings? Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids. As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients. Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain. (more…)
Anesthesiology, Author Interviews / 25.10.2016 Interview with: Dr. Richard Dutton, MD Chief quality officer U.S. Anesthesia Partners Dallas What is the background for this study? What are the main findings? Response: We wanted to document the change in national anesthesia practice over the past 5 years, specifically the increase in non-operating room anesthesia NORA. We found that non-operating room anesthesia now accounts for more than 1/3 of all anesthetics. The proportion continues to rise as minimally invasive procedures are developed in gastroenterology, cardiology, radiology and other non-surgical disciplines. These procedures are often performed in complex patients, and require anesthesia involvement to facilitate. (more…)
Anesthesiology, Author Interviews, Emergency Care, JAMA, Pediatrics / 31.08.2016 Interview with: Marc Auerbach, MD, FAAP, MSc Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education) Director, Pediatric Simulation Yale Center for Medical Simulation; What is the background for this study? What are the main findings? Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores. The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation. (more…)
Anesthesiology, Author Interviews, PLoS / 16.01.2016

More on Anesthesiology on Interview with: Srivas Chennu, PhD Senior Research Associate Clinical Neurosciences, University of Cambridge Visiting Scientist, MRC Cognition and Brain Sciences Unit College Research Associate, Homerton College Medical Research: What is the background for this study? Dr. Chennu:  Scientific understanding of how brain networks generate consciousness has seen rapid advances in recent years, but the application of this knowledge to accurately track transitions to unconsciousness during general anaesthesia has proven difficult. Crucially, one reason for this is the considerable individual variability in susceptibility to anaesthetic dosage.  To better understand the factors underlying this variability, we measured interconnected, oscillatory brain activity ('brain networks'), using non-invasive, high-density electroencephalography (EEG) from healthy volunteers while they were sedated with the common anaesthetic propofol. Alongside, we measured their behavioural responsiveness, and the actual concentration of the drug in their blood plasma.  (more…)
Anesthesiology, Author Interviews, Orthopedics, Surgical Research / 04.09.2015

Dr. Gregory M.T. Hare MD PhD Department of Anesthesia St. Michael's Interview with: Dr. Gregory M.T. Hare MD PhD Department of Anesthesia St. Michael's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Hare: While many randomized trials had demonstrated that tranexamic acid (TXA therapy) was effective at reducing surgical blood loss and red blood cell transfusion in patients undergoing hip and knee replacement surgery, our hospital and many other centers in Ontario were not fully utilizing this therapy. Part of the reason was a concern about drug safety and potential side effects. While no serious adverse events had been reported using TXA, we set out to assess the impact of a protocol designed to ensure that we administered TXA (20 mg/kg iv preoperatively) to all eligible patients undergoing hip and knee replacement and determining the effect on our red blood cell transfusion rate and adverse effects including blood clot, stroke, heart attack, kidney injury and death. We excluded patients at high risk of any thrombotic complication. After implementing our protocol, we increased utilization of the drug from 46% to 95% of eligible patients. With this increase in TXA use, we observed a 40% reduction in red blood cell transfusion. The impact was greater in patients with pre-operative anemia, but was also effective in non-anemic patients. The threshold for transfusion was not different after initiating our protocol and patients were discharged with higher red blood cell counts. Length of hospital stay remained constant and the incidence of adverse events did not increase. (more…)
Anesthesiology, Author Interviews, Emergency Care, JAMA / 21.06.2015 Interview with: Christoph Czarnetzki MD, MBA Division of Anesthesiology Geneva University Hospitals Geneva, Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Czarnetzki: In the US, about 40 million patients undergo a general anesthetic each year, and approximately 12,000 broncho-aspirate. Broncho-aspiration of gastric juice may lead to acute respiratory distress syndrome, carrying a 40% mortality rate. The risk is increased 10-fold in patients undergoing emergency surgery. Trauma patients may have ingested food before their accident, or have swallowed blood from oral or nasal injuries. Also, gastric emptying is delayed due to head injury, stress, pain, and opioid medication. Non-trauma patients may have delayed gastric emptying due to paralytic ileus and critical illness, leading to significant residual stomach content even after long fasting periods. Erythromycin, a macrolide antibiotic, and motilin receptor agonist induces antral contractions, and increases the lower esophageal sphincter tone, which is an important barrier against gastro-esophageal reflux. Although gastric emptying properties of erythromycin are well known, its efficacy in patients undergoing emergency surgery has never been investigated before to our knowledge. In our study we included 132 patients undergoing general anesthesia for emergency procedures and we could show that erythromycin increased the proportion of clear stomach and decreased acidity of residual gastric liquid. Dependent of the definition of empty stomach (less than 40 ml and absence of solid food or completely empty stomach) the absolute risk reduction ranged from 17% to 24%, equivalent to a number needed to treat of four to six patients to produce one completely cleared stomach. Erythromycin was particularly efficacious in non-trauma patients. Adverse effects were minor. (more…)
Anesthesiology, Author Interviews, Blood Pressure - Hypertension, Surgical Research / 31.05.2015

Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, Interview with: Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, WI Medical Research: What is the background for this study? What are the main findings? Dr. Sanders: While it is known that chronic raised blood pressure exerts important effects on long term health outcomes, it is unclear how pre-operative blood pressure levels effect risk from surgery. In this study we show that after adjustment for other diseases, high blood pressure does not increase perioperative risk. Rather low blood pressure is associated with an increase in risk of death following surgery and anesthesia. (more…)
Anesthesiology, Author Interviews / 22.01.2015

Daniel Sessler, M.D. Michael Cudahy Professor and Chair of the Department of Outcomes Research Cleveland Interview with: Daniel Sessler, M.D. Michael Cudahy Professor and Chair of the Department of Outcomes Research Cleveland Clinic Medical Research: What is the background for this study? What are the main findings? Dr. Sessler: That intraoperative hypothermia is well established. However, temperature patterns during surgery are not. We thus evaluated core temperature in more tan 50,000 surgical patients, all of whom were actively warmed with forced air. (more…)