Head to Toe: A Perioperative Surgical Home Approach to Sepsis and Airway Obstruction in a Geriatric Patient.

The perioperative surgical home (PSH) is a care delivery model designed to improve the perioperative and long-term outcomes of patients undergoing surgery by promoting holistic care and seamless cooperation between different services and subspecialties. An aging population and increased surgical complexity have led to renewed interest in PSH models. An 86-year-old female with diabetes and critical limb ischemia presented with sepsis due to right calcaneal gangrene.

Multimodal Pain Control Utilizing Buprenorphine for Robotic-assisted Laparoscopic Prostatectomy: A Quality Improvement Comparison to Conventional Opioid Management.

Introduction: This study investigated the effectiveness of buprenorphine as an alternative to the use of conventional opioids perioperatively in an effort to help mitigate the impact of the use of perioperative conventional opioids for patients undergoing robotic-assisted laparoscopic prostatectomy.

Methods: Outcomes of patients with localized prostate cancer undergoing robotic-assisted laparoscopic prostatectomy were examined before and after implementation of novel quality improvement study that included receiving buprenorphine compared to conventional opioids for pain control intraoperatively and postoperatively. The primary end point was adequate pain control with secondary end points being analgesic consumption at home, opioid-related side effects, and patient satisfaction.

Automating Anesthesiology Resident Case Logs Reduces Reporting Variability.

Background: The Accreditation Council for Graduate Medical Education (ACGME) case log system for anesthesiology resident training relies on subjective categorization of surgical procedures and lacks clear guidelines for assigning credit roles. Therefore, resident reporting practices likely vary within and between institutions. Our primary aim was to develop a systematic process for generating automated case logs using data elements extracted from the electronic health care record.

Signatures of the Evolution of Parthenogenesis and Cryptobiosis in the Genomes of Panagrolaimid Nematodes.

Most animal species reproduce sexually and fully parthenogenetic lineages are usually short lived in evolution. Still, parthenogenesis may be advantageous as it avoids the cost of sex and permits colonization by single individuals. Panagrolaimid nematodes have colonized environments ranging from arid deserts to Arctic and Antarctic biomes.

Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative.

Introduction: The utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).

Anesthesiologists as perioperative hospitalists and outcomes in patients undergoing major urologic surgery: a historical prospective, comparative effectiveness study.

Background: Perioperative care has been identified as an area of wide variability in quality, with conflicting models, and involving multiple specialties. In 2014, the Loma Linda University Departments of Anesthesiology and Urology implemented a perioperative hospitalist service (PHS), consisting of anesthesiology-trained physicians, to co-manage patients for the entirety of their perioperative period. We hypothesized that implementation of this PHS model would result in an improvement in patient recovery.

Pharmacological Management Options to Prevent and Reduce Ischemic Hemorrhagic Transformation.

Background: Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality.

Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study.

Objective: This study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type.

Methods: The 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study.

What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment.

Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity.

Ischemic conditioning-induced endogenous brain protection: Applications pre-, per- or post-stroke.

In the area of brain injury and neurodegenerative diseases, a plethora of experimental and clinical evidence strongly indicates the promise of therapeutically exploiting the endogenous adaptive system at various levels like triggers, mediators and the end-effectors to stimulate and mobilize intrinsic protective capacities against brain injuries. It is believed that ischemic pre-conditioning and post-conditioning are actually the strongest known interventions to stimulate the innate neuroprotective mechanism to prevent or reverse neurodegenerative diseases including stroke and traumatic brain injury. Recently, studies showed the effectiveness of ischemic per-conditioning in some organs.

Telemedicine pre-anesthesia evaluation: a randomized pilot trial.

Objective: Pre-anesthesia evaluation allows discovery of conditions affecting perioperative planning, but when inadequate it may be associated with delays, cancellations, and preventable adverse events. Not all patients who could benefit will keep appointments. Telemedicine pre-anesthesia evaluation may provide for safe patient care while reducing patient inconvenience and cost.

Granulocyte colony-stimulating factor treatment provides neuroprotection in surgically induced brain injured mice.

Surgically induced brain injury (SBI) is a common concern after a neurosurgical procedure. Current treatments aimed at reducing the postoperative sequela are limited. Granulocyte-colony stimulating factor (G-CSF), a hematopoietic growth factor involved in the inflammatory process, has been shown in various animal models to be neuroprotective.

Endothelin receptor-A (ETa) inhibition fails to improve neonatal hypoxic-ischemic brain injury in rats.

Cerebral hypoxia-ischemia (HI) is an important cause of mortality and disability in newborns. It is a result of insufficient oxygen and glucose circulation to the brain, initiating long-term cerebral damage and cell death. Emerging evidence suggests that endothelin receptor-A (ETA) activation can play an important role in mediating brain damage.

Isoflurane posttreatment reduces brain injury after an intracerebral hemorrhagic stroke in mice.

Background: Intracerebral hemorrhage (ICH) is a devastating stroke subtype affecting 120,000 Americans annually. Of those affected, 40%to 50% will die within the first 30 days, whereas the survivors are left with a lifetime of neurobehavioral disabilities. Recently, it has been shown that volatile anesthetics such as isoflurane can reduce brain injury after an ischemic stroke.

3% hypertonic saline following subarachnoid hemorrhage in rats.

Background: Hypertonic saline (HTS) has been proposed as a treatment after aneurysmal subarachnoid hemorrhage (SAH) to minimize ischemic brain injury due to its osmotic and rheologic properties. Although the benefits of 7.2% HTS use in brain injury have been studied, there is a paucity of data on the use of 3%HTS.

Simvastatin treatment in surgically induced brain injury in rats.

Background: HMG-CoA reductase inhibitors (Statins) have been shown to reduce blood brain barrier (BBB) disruption and improve neurologic outcome in cerebrovascular disorders. Brain injury due to neurosurgical procedures can lead to post-operative complications such as brain edema and altered neurologic function. The objective of this study was to evaluate whether simvastatin reduces brain edema by preventing BBB disruption and improves neurologic status after surgically-induced brain injury (SBI).

The antioxidant effects of melatonin in surgical brain injury in rats.

Background: Surgical brain injury (SBI) to normal brain tissue can occur as inevitable sequelae of neurosurgical operations. SBI can contribute to post-operative complications such as brain edema following blood-brain barrier (BBB) disruption leading to neurological deficits. Melatonin is a commonly used drug with known antioxidant properties and neuroprotective effects in experimental animal studies (Chen et al.

The postoperative care of adult patients exposed to deep hypothermic circulatory arrest.

Deep hypothermic circulatory arrest with cardiopulmonary bypass is indicated for complex surgical operations in adult patients involving the aortic arch, thoracoabdominal aorta, cerebral vasculature, and tumors extending into the vena cava and heart. Understanding the principles of ischemic-reperfusion injury and the effects of hypothermia in attenuating this process is fundamental to the delivery of effective postoperative care. Neurologic injury is the most troublesome adverse effect after the use of deep hypothermic circulatory arrest and cardiopulmonary bypass, presenting as either a transient neurologic deficit (5.