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2. New Training Paradigms

Author

Richard P. Dutton, Thomas M. McLoughlin, Joseph W. Szokol, Martin J. Kungl, and Jonathan Gal

Subjects
General Engineering, General Earth and Planetary Sciences, General Environmental Science
Published
2022

3. Perioperative Management of Patients on Maintenance Medication for Addiction Treatment: The Development of an Institutional Guideline

Author

Gillian A, Beauchamp, Jill L, Hanisak, Alexandra M, Amaducci, Andrew L, Koons, Jason, Laskosky, Bernadette M, Maron, and Thomas M, McLoughlin

Subjects
Analgesics, Opioid, Opiate Substitution Treatment, Humans, Opioid-Related Disorders, Methadone, Naltrexone, Buprenorphine
Abstract

With a brief summary of selected literature identified by a multidisciplinary panel of subject matter experts, the authors share their experience with the development of an institutional perioperative pain management guideline for patients on maintenance medication for addiction treatment (MAT), stressing the importance of perioperative continuation of opioid agonists such as methadone and partial agonists such as buprenorphine; and the discontinuation of opioid antagonists, such as naltrexone. The authors' protocol is appended as an example of a standardized approach to perioperative management of patients on MAT.

Published
2022

4. A Coronavirus Disease 2019 Pandemic Pivot: Development of the American Board of Anesthesiology's Virtual APPLIED Examination

Author

Thomas M. McLoughlin, Huaping Sun, Mark T. Keegan, Margaret M Pisacano, Ann E. Harman, John E Fiadjoe, David O. Warner, and Andrew J Patterson

Subjects
Medical education, medicine.medical_specialty, Certification, Coronavirus disease 2019 (COVID-19), Objective structured clinical examination, business.industry, COVID-19, Internship and Residency, United States, Anesthesiology and Pain Medicine, Anesthesiology, Specialty Boards, Pandemic, medicine, Oral examination, Humans, The Internet, Clinical Competence, Educational Measurement, business, Computer-Assisted Instruction
Abstract

In 2020, the coronavirus disease 2019 (COVID-19) pandemic interrupted the administration of the APPLIED Examination, the final part of the American Board of Anesthesiology (ABA) staged examination system for initial certification. In response, the ABA developed, piloted, and implemented an Internet-based "virtual" form of the examination to allow administration of both components of the APPLIED Exam (Standardized Oral Examination and Objective Structured Clinical Examination) when it was impractical and unsafe for candidates and examiners to travel and have in-person interactions. This article describes the development of the ABA virtual APPLIED Examination, including its rationale, examination format, technology infrastructure, candidate communication, and examiner training. Although the logistics are formidable, we report a methodology for successfully introducing a large-scale, high-stakes, 2-element, remote examination that replicates previously validated assessments.

Published
2021

5. Preface

Author

Laurence C. Torsher, Richard P. Dutton, Thomas M. McLoughlin, and Francis V. Salinas

Subjects
Anesthesiology and Pain Medicine
Published
2021

6. Anesthesia Practice on the Rise

Author

Laurence C. Torsher, Francis V. Salinas, Thomas M. McLoughlin, and Richard P. Dutton

Subjects
Anesthesiology and Pain Medicine, Text mining, Anesthesiology, business.industry, Humans, Medicine, Anesthesia, Professional Practice, Medical emergency, business, medicine.disease, Perioperative Care
Published
2019

8. Anesthesiology at the Cutting Edge

Author

Thomas M. McLoughlin, Richard P. Dutton, Laurence C. Torsher, and Francis V. Salinas

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, Anesthesiology, business.industry, MEDLINE, Humans, Library science, Medicine, Edge (geometry), business, Introductory Journal Article
Published
2018

9. Preface

Author

Thomas M, McLoughlin, Francis V, Salinas, and Laurence C, Torsher

Subjects
Anesthesiology and Pain Medicine, Anesthesiology, Humans, Periodicals as Topic
Published
2017

11. Commentary

Author

Brian A. Nester, Nanette M. Schwann, and Thomas M. McLoughlin

Subjects
Social Values, Episode of Care, General Practice, Mindset, Medical Oncology, Health Services Accessibility, Resource Allocation, Education, Health care rationing, Quality of life (healthcare), Cost Savings, Patient-Centered Care, Health care, Humans, Medicine, Cooperative Behavior, health care economics and organizations, Patient Care Team, business.industry, Health Policy, Behavior change, Health services research, General Medicine, Public relations, United States, Physician Incentive Plans, Incentive, Health Care Reform, Interdisciplinary Communication, Health Services Research, Health care reform, business, Delivery of Health Care
Abstract

How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.

Published
2012

12. Advances in Anesthesia

Author

Thomas M. McLoughlin

Subjects
Anesthesiology and Pain Medicine
Published
2017

13. Welcome to Advances in Anesthesia, 2015

Author

Francis V. Salinas, Thomas M. McLoughlin, and Laurence C. Torsher

Subjects
Anesthesiology and Pain Medicine, business.industry, Anesthesia, Medicine, business
Published
2015

14. Point-of-care electronic prompts: an effective means of increasing compliance, demonstrating quality, and improving outcome

Author

Deborah A. Fry, Thomas M. McLoughlin, Michelle Beck, Terry L. Burger, David Romancheck, Frederick Ackler, Anthony J. Ardire, Paul Evans, Harry Lukens, Nanette M. Schwann, Sherrine Eid, and Karen A. Bretz

Subjects
Adult, Male, medicine.medical_specialty, Quality management, Time Factors, Point-of-Care Systems, Reminder Systems, Risk Assessment, Drug Administration Schedule, Perioperative Care, Risk Factors, Medicine, Humans, Surgical Wound Infection, Prospective Studies, Practice Patterns, Physicians', Prospective cohort study, Aged, Quality Indicators, Health Care, Chi-Square Distribution, business.industry, Incidence (epidemiology), Absolute risk reduction, Middle Aged, Pennsylvania, Decision Support Systems, Clinical, Quality Improvement, Surgery, Anti-Bacterial Agents, Anesthesiology and Pain Medicine, Logistic Models, Outcome and Process Assessment, Health Care, Treatment Outcome, Surgical Care Improvement Project, Emergency medicine, Practice Guidelines as Topic, Hospital Information Systems, Female, Guideline Adherence, business, Risk assessment, Anesthesia Department, Hospital, Surgical incision, Chi-squared distribution, Program Evaluation
Abstract

BACKGROUND: Incentives based on quality indicators such as the Surgical Care Improvement Project core measures (SCIP 1) encourage implementation of evidence-based guidelines consistently into clinical practice. Information systems with point-of-care electronic prompts (POCEPs) can facilitate adoption of processes and benchmark performance. We evaluated the effectiveness of POCEPs on rates of antibiotic administration within 60 minutes of surgical incision and effect on outcome in a prospective observational trial. METHODS: SCIP 1 compliance and the corresponding outcome variable (surgical site infection [SSI]) were examined prospectively over 2 consecutive 6-month periods before (A) and after (B) POCEPs implementation at a regional health system. Secondary analysis extended the observation to two 12-month periods (A and B). A 2-year (C and D) sustainability phase followed. RESULTS: The 19,744 procedures included 9127 and 10,617 procedures before (A) and after (B) POCEPs implementation, respectively. POCEPs increased compliance with SCIP indicators in period B by 31% (95% CI, 30.0%–32.2%) from 62% to 92% (P 0.001) and were associated with a sustainable, contemporaneous decrease in the incidence of SSI from 1.1% to 0.7% (P 0.003; absolute risk reduction, 0.4%; 95% CI, 0.1%–0.7%). Secondary and sustainability analysis revealed that compliance rates remained 95% with mean SSI rates lower for all periods compared with pre-POCEPs SSI rates (0.8%, 0.7%, and 0.5% vs 1.1%; P 0.001). CONCLUSIONS: POCEPs increased compliance with SCIP indicators by 30% and were associated with a 0.4% absolute risk reduction in the incidence of SSI. POCEPs may be useful to modulate provider behavior and demonstrate intraoperative quality and value. (Anesth Analg 2011;113:869–76)

Published
2011

16. Coagulopathy, Factor IX Deficiency

Author

Thomas M. McLoughlin

Subjects
medicine.medical_specialty, Factor IX deficiency, business.industry, Internal medicine, medicine, Coagulopathy, business, medicine.disease, Gastroenterology
Published
2011

17. Contributors

Author

Sanjib Adhikary, Jorge Aguilar, Charles Ahere, Moustafa Ahmed, Jane C. Ahn, Shamsuddin Akhtar, David B. Albert, Nasrin N. Aldawoodi, John T. Algren, Gracie Almeida-Chen, David Amar, Zirka H. Anastasian, Stephen Aniskevich, Solomon Aronson, Harendra Arora, Amit Asopa, Joshua H. Atkins, John G. Augoustides, Mohammad Fareed Azam, Catherine R. Bachman, Douglas R. Bacon, Andrew D. Badley, Emily Baird, Alethia Baldwin, Ryan Ball, Amir Baluch, David Bandola, Shawn Banks, Paul G. Barash, Kathleen E. Barrett, Shawn T. Beaman, Jonathan C. Beathe, Christopher D. Beatie, W. Scott Beattie, Perry S. Bechtle, G. Richard Benzinger, Lauren Berkow, Jeffrey M. Berman, Wendy K. Bernstein, Arnold J. Berry, Frederic Berry, Ulrike Berth, Walter Bethune, Sumita Bhambhani, Shobana Bharadwaj, Neil Bhatt, Frederic T. Billings, Wendy B. Binstock, David J. Birnbach, Michael Bishop, Stephanie Black, Mary A. Blanchette, James M. Blum, Krishna Boddu, Lara Bonasera, Richard L. Boortz-Marx, Cecil O. Borel, Gregory H. Botz, Charles D. Boucek, William Bradford, Jason C. Brainard, Michelle Braunfeld, Ferne R. Braveman, Caridad Bravo-Fernandez, Peter H. Breen, Marjorie Brennan, Tricia Brentjens, Megan A. Brockel, Jay B. Brodsky, Todd A. Bromberg, Adam J. Broussard, Chris Broussard, Carmen Labrie-Brown, Robert H. Brown, Charles S. Brudney, Sorin J. Brull, Claude Brunson, Trent Bryson, Jacob M. Buchowski, Stefan Budac, Zachary D. Bush, John Butterworth, Lisbeysi Calo, Christopher Canlas, Ayana Cannon, Shawn M. Cantie, Lisa Caplan, Marco Caruso, Davide Cattano, Charles B. Cauldwell, Laura Cavallone, Maurizio Cereda, Thomas M. Chalifoux, Susan Chan, Theodore G. Cheek, Alexander Chen, Samuel A. Cherry, Albert T. Cheung, Grace L. Chien, Peter T. Choi, Christopher Ciarallo, Franklyn Cladis, Anthony J. Clapcich, Richard B. Clark, Mindy Cohen, Neal H. Cohen, Robert I. Cohen, Stephan J. Cohn, Aisling Conran, Richard I. Cook, Randall F. Coombs, David M. Corda, Daniel Cormican, Darren Cousin, Vincent S. Cowell, Lyndsey Cox, Paula A. Craigo, Richard C. Cross, Roy F. Cucchiara, William H. Daily, Gaurang Dalal, Priti Dalal, Michael Danekas, Ahmed M. Darwish, Ribal Darwish, Suanne M. Daves, Kathleen Davis, Peter J. Davis, Bracken J. De Witt, Ellise Delphin, Seema Deshpande, Dawn P. Desiderio, Tricia Desvarieux, Laura K. Diaz, Christian Diez, Sanjay Dixit, Meenakshi Dogra, Karen B. Domino, Kathryn Dorhauer, Todd Dorman, Don D. Doussan, James Duke, Ann C. Duncan, Frank W. Dupont, Andrew Dziewit, L. Jane Easdown, R. Blaine Easley, Thomas J. Ebert, David M. Eckmann, Talmage D. Egan, Seth Eisdorfer, Nabil M. Elkassabany, Ryan P. Ellender, Logan S. Emory, Monique Espinosa, Lucinda L. Everett, Nauder Faraday, James J. Fehr, James M. Feld, Lynn A. Fenton, Laura H. Ferguson, Matthew Fiegel, Aaron M. Fields, Gordon N. Finlayson, Alan Finley, Gregory W. Fischer, Gary Fiskum, Molly Fitzpatrick, Russell Flatto, Lee A. Fleisher, Ronda Flower, Annette G. Folgueras, Patrick J. Forte, Joseph F. Foss, Charles J. Fox, William R. Furman, Robert Gaiser, David R. Gambling, Scott Gardiner, Matthew L. Garvey, Abraham C. Gaupp, Steven Gayer, Jeremy M. Geiduschek, Frank Gencorelli, Eric Gewirtz, Ghaleb A. Ghani, Charles P. Gibbs, Jeremy L. Gibson, Lori Gilbert, Kevin J. Gingrich, Gregory Ginsburg, Christopher Giordano, Christine E. Goepfert, Hernando Gomez, Santiago Gomez, Alanna E. Goodman, Stephanie R. Goodman, Alexandru Gottlieb, Ori Gottlieb, Allan Gottschalk, Basavana Gouda Goudra, Harry J. Gould, Nikolaus Gravenstein, Megan Graybill, William J. Greeley, Patrick Guffey, Ala Sami Haddadin, John G. Hagen, Karim Abdel Hakim, Michael Hall, N. James Halliday, Raafat S. Hannallah, Jeremy Hansen, C. William Hanson, Charles B. Hantler, Andrew P. Harris, Jonathan Hastie, Henry A. Hawney, Stephen O. Heard, James E. Heavner, James G. Hecker, Elizabeth A. Hein, Eugenie Heitmiller, Mark Helfaer, Lori B. Heller, Andrew Hemphill, Adrian Hendrickse, Frederick A. Hensley, Ian A. Herrick, Douglas Hester, Eric J. Heyer, Michael S. Higgins, Roberta Hines, Charles W. Hogue, Kenneth J. Holroyd, Natalie F. Holt, Simon J. Howell, Faisal Huda, Keith E. Hude, Hayden R. Hughes, James M. Hunter, Brad J. Hymel, James W. Ibinson, Karen E. Iles, Robert M. Insoft, Shiroh Isono, Yulia Ivashkov, Bozena R. Jachna, Anna Jankowska, Norah Janosy, Arun L. Jayaraman, Nathalia Jimenez, Judy G. Johnson, Lyndia Jones, Edmund H. Jooste, Zeev N. Kain, Maudy Kalangie, Philip L. Kalarickal, Ihab Kamel, Mia Kang, Ivan Kangrga, Ravish Kapoor, Helen W. Karl, Christopher Karsanac, Swaminathan Karthik, Jeffrey A. Katz, Alan Kaye, Adam M. Kaye, A. Murat Kaynar, Nancy B. Kenepp, Miklos D. Kertai, Mary A. Keyes, Sarah Khan, Swapnil Khoche, David Y. Kim, Jerry H. Kim, Kimberly M. King, Jeffrey Kirsch, Matthew A. Klopman, Paul R. Knight, Donald D. Koblin, W. Andrew Kofke, Vincent J. Kopp, Joseph R. Koveleskie, Courtney Kowalczyk, Valeriy V. Kozmenko, Kaylyn Krummen, Sapna R. Kudchadkar, Nathan Kudrick, Adrienne Kung, C. Dean Kurth, Robert Kyle, J. Lance LaFleur, Jason G. Lai, Kirk Lalwani, William L. Lanier, Dawn M. Larson, Richard M. Layman, Chris C. Lee, Mark J. Lema, W. Casey Lenox, Jacqueline M. Leung, Roy C. Levitt, Jerrold H. Levy, J. Lance Lichtor, Charles Lin, Sharon L. Lin, Karen S. Lindeman, Lesley Lirette, Ronald S. Litman, Qianjin Liu, Renyu Liu, Wen-Shin Liu, Justin Lockman, Stanley L. Loftness, Martin J. London, Philip D. Lumb, M. Concetta Lupa, Anne Marie Lynn, Devi Mahendran, Jeffrey Mako, Anuj Malhotra, Vinod Malhotra, Andrew M. Malinow, Mark G. Mandabach, Dennis T. Mangano, Sobia Mansoor, Inna Maranets, Jonathan B. Mark, Sinisa Markovic, H. Michael Marsh, Choendal Martin, Nicole D. Martin, Douglas Martz, Veronica A. Matei, Letha Mathews, Lynne G. Maxwell, Philip McArdle, John P. McCarren, Brenda C. McClain, Brian McClure, William A. McDade, Kathryn E. McGoldrick, Brian J. McGrath, Gregory L. McHugh, David McIlroy, Jason McKeown, Thomas M. McLoughlin, R. Yan McRae, William L. Meadow, Sameer Menda, William T. Merritt, David G. Metro, Berend Mets, Hosni Mikhaeil, David W. Miller, Jessica Miller, Mohammed Minhaj, Marek A. Mirski, Nanhi Mitter, Alexander J.C. Mittnacht, Raj K. Modak, Pierre Moine, Constance L. Monitto, Richard C. Month, Richard E. Moon, Laurel E. Moore, Roger A. Moore, Thomas A. Moore, Debra E. Morrison, Jonathan Moss, John R. Moyers, Jesse J. Muir, Adam J. Munson-Young, Stanley Muravchick, John M. Murkin, Peter Nagele, Peter A. Nagi, Daniel A. Nahrwold, Michael L. Nahrwold, Madhavi Naik, Manchula Navaratnam, Stephan P. Nebbia, Priscilla Nelson, Thai T. Nguyen, Viet Nguyen, Stavroula Nikolaidis, Zoulfira Nisnevitch, Dolores B. Njoku, Mary J. Njoku, Edward J. Norris, Omonele O. Nwokolo, Daniel Nyhan, William T. O'Byrne, Edward A. Ochroch, Andrew Oken, Nathan Orgain, Nancy E. Oriol, Pedro Orozco, Andreas M. Ostermeier, Andranik Ovassapian, Mehmet S. Ozcan, Ira Padnos, Sheela S. Pai, Nirvik Pal, Dhamodaran Palaniappan, Susan K. Palmer, Howard D. Palte, Wei Pan, Oliver Panzer, Sibi Pappachan, Anthony Passannante, Dennis A. Patel, Dilipkumar K. Patel, Kirit M. Patel, Samir Patel, Shalin Patel, Sanup Pathak, Minda L. Patt, Ronald W. Pauldine, Olga Pawelek, Tim Pawelek, Kiarash Paydar, Ronald G. Pearl, Christine Peeters-Asdourian, Padmavathi R. Perela, Charise T. Petrovitch, Patricia H. Petrozza, Dennis Phillips, Mark C. Phillips, Christine Piefer, Edgar J. Pierre, S. William Pinson, Evan G. Pivalizza, Raymond M. Planinsic, Don Poldermans, Joel M. Pomerantz, Jason E. Pope, Wanda M. Popescu, Vivian H. Porche, Jahan Porhomayon, Dmitry Portnoy, Corinne K. Postle, Paul J. Primeaux, Donald S. Prough, Ferenc Puskas, Carlos A. Puyo, Forrest Quiggle, Mary Rabb, Bronwyn R. Rae, Muhammad B. Rafique, Jesse M. Raiten, Arvind Rajagopal, Srinivasan Rajagopal, Gaurav Rajpal, Chandra Ramamoorthy, Ira J. Rampil, James G. Ramsay, James A. Ramsey, Vidya N. Rao, Joana Ratsiu, Selina Read, Ronjeet Reddy, Leila L. Reduque, David L. Reich, Karene Ricketts, Cameron Ricks, Bernhard Riedel, Jyotsna Rimal, Joseph Rinehart, James M. Riopelle, Stacey A. Rizza, Amy C. Robertson, Stephen Robinson, Peter Rock, Yillam F. Rodriguez-Blanco, Michael F. Roizen, Daniel M. Roke, Ryan Romeo, Joseph Rosa, David A. Rosen, Kathleen Rosen, Stanley H. Rosenbaum, Andrew D. Rosenberg, Andrew L. Rosenberg, Henry Rosenberg, Meg A. Rosenblatt, Steven Roth, Brian Rothman, Justin L. Rountree, Matthew J. Rowan, Marc Rozner, Ryan Rubin, Stephen M. Rupp, W. John Russell, Thomas A. Russo, Alecia L. Sabartinelli, Tetsuro Sakai, Orlando J. Salinas, Paul L. Samm, Jibin Samuel, Tor Sandven, Ted J. Sanford, Joshua W. Sappenfield, Ponnusamy Saravanan, Subramanian Sathishkumar, R. Alexander Schlichter, Eric Schnell, David L. Schreibman, Armin Schubert, Peter Schulman, Todd A. Schultz, Alan Jay Schwartz, Jamie McElrath Schwartz, Jeffrey J. Schwartz, Benjamin K. Scott, Joseph L. Seltzer, Tamas Seres, Daniel I. Sessler, Navil F. Sethna, Amar Setty, Paul W. Shabaz, Pranav Shah, Saroj Mukesh Shah, Milad Sharifpour, Joanne Shay, Jay Shepherd, Jeffrey S. Shiffrin, Marina Shindell, Daniel Siker, Richard Silverman, Brett A. Simon, Nina Singh, Ashish C. Sinha, Robert N. Sladen, Kieran A. Slevin, Tod B. Sloan, Kathleen Smith, Timothy E. Smith, Victoria Smoot, Denis Snegovskikh, Betsy Ellen Soifer, Molly Solorzano, James M. Sonner, Aris Sophocles, James A. Sparrow, Joan Spiegel, Bruce D. Spiess, Ramprasad Sripada, Stanley W. Stead, Joshua D. Stearns, Kelly Stees, Clinton Steffey, Christopher Stemland, John Stene, Christopher T. Stephens, Tracey L. Stierer, O. Jameson Stokes, Bryant W. Stolp, David F. Stowe, Ted Strickland, Suzanne Strom, Erin A. Sullivan, Michele Sumler, Dajin Sun, Lena Sun, Esther Sung, Veronica C. Swanson, Judit Szolnoki, Joe Talarico, Gee Mei Tan, Darryl T. Tang, Paul Tarasi, René Tempelhoff, John E. Tetzlaff, Alisa C. Thorne, Arlyne Thung, Vasanti Tilak, Kate Tobin, Joseph R. Tobin, Michael J. Tobin, R. David Todd, Matthew Tomlinson, Thomas J. Toung, Lien B. Tran, Minh Chau Joe Tran, Kevin K. Tremper, Sanyo Tsai, George S. Tseng, Kenneth J. Tuman, Avery Tung, Cynthia Tung, Rebecca Twersky, Mark Twite, John A. Ulatowski, Michael Urban, Manuel C. Vallejo, Andrea Vannucci, Albert J. Varon, Anasuya Vasudevan, Susheela Viswanathan, Alexander A. Vitin, Wolfgang Voelckel, Ann Walia, Russell T. Wall, Terrence Wallace, Shu-Ming Wang, David C. Warltier, Lucy Waskell, Scott Watkins, Denise Wedel, Stuart J. Weiss, Charles Weissman, Nathaen Weitzel, Gregory Weller, Gina Whitney, Robert A. Whittington, Danny Wilkerson, Nancy C. Wilkes, Michael Williams, Jimmy Windsor, Bernard Wittels, Gregory A. Wolff, Andrew K. Wong, Stacie N. Woods, A.J. Wright, Zheng Xie, Christopher C. Young, Ian Yuan, Francine S. Yudkowitz, James R. Zaidan, Paul Zanaboni, Warren M. Zapol, Angela Zimmerman, and Maurice S. Zwass

Published
2011

18. Endotoxin enhances hypoxic constriction of rat aorta and pulmonary artery through induction of EDRF/NO synthase

Author

R A Johns, Thomas M McLoughlin Jr, and Pjotr A Zelenkov Md

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Endothelium, Physiology, Indomethacin, In Vitro Techniques, Pulmonary Artery, Arginine, Nitric Oxide, Nitric oxide, Rats, Sprague-Dawley, Phenylephrine, chemistry.chemical_compound, Physiology (medical), medicine.artery, Hypoxic pulmonary vasoconstriction, Internal medicine, medicine, Animals, Thoracic aorta, Cycloheximide, Hypoxia, Cyclic GMP, Aorta, Dose-Response Relationship, Drug, Chemistry, Endothelium-derived relaxing factor, Cell Biology, Hypoxia (medical), Rats, Endotoxins, Endocrinology, medicine.anatomical_structure, Vasoconstriction, Enzyme Induction, Anesthesia, Amino Acid Oxidoreductases, Nitric Oxide Synthase, medicine.symptom
Abstract

The vascular response to hypoxia in endotoxin (lipopolysaccharide; LPS)-exposed rat pulmonary artery (PA) and thoracic aorta (AO) was investigated and the mechanism of the observed hypoxic responses defined. In isometric tension studies, LPS-treated AO and PA rings, with and without endothelium, demonstrated decreased (P < 0.05) contractile response to phenylephrine (PE EC50), and the dose response was shifted to the right (P < 0.01) compared with non-LPS treated rings. Both vessel types responded to hypoxia with a markedly increased (P < 0.01) and sustained (P < 0.01) constriction when preexposed to LPS. Control non-LPS rings with endothelium intact had a transient vasoconstriction in early hypoxia, which was abolished with removal of the endothelium. N omega-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthase, increased the PE EC50 tension in LPS-treated rings, markedly reduced the duration and magnitude of the hypoxic vasoconstriction in LPS-treated rings, and attenuated the transient vasoconstriction seen in endothelium-intact, non-LPS rings (all P < 0.05). L-Arginine reversed the L-NAME effects. Hypoxia decreased guanosine 3',5'-cyclic monophosphate (cGMP) content 54 +/- 4% in all LPS and 33 +/- 4% in the non-LPS intact rings (P < 0.05). L-NAME reduced cGMP content 90 +/- 5% in all LPS rings. Indomethacin inhibited formation of a constriction factor in aortic LPS-treated rings (P < 0.01) that was endothelium dependent and unaffected by the presence of L-NAME.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1993

19. Preface

Author

Thomas M. McLoughlin, Francis Salinas, and Laurence Torsher

Subjects
Anesthesiology and Pain Medicine
Published
2014

20. Splenic infarction caused by a large thoracic aortic thrombus

Author

Michael C. Sinclair, James J. Goodreau, Kamalesh T. Shah, Thomas M. McLoughlin, and Stefano F Agolini Md

Subjects
Male, medicine.medical_specialty, Aortic Diseases, Aorta, Thoracic, medicine.artery, medicine, Thoracic aorta, Humans, Splenic Infarction, Esophagus, Aortic thrombus, business.industry, Vascular disease, Thrombosis, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Splenic infarction, cardiovascular system, Radiology, Splenic disease, Cardiology and Cardiovascular Medicine, business, Complication, Echocardiography, Transesophageal
Abstract

We report on a patient with left upper quadrant pain as a result of splenic infarction; the patient was subsequently found to have a thoracoabdominal aortic thrombus extending through the celiac axis. The patient was successfully treated with an aortic thrombectomy guided by intraoperative transesophageal echocardiography. (J Vasc Surg 1997;26:1069-72.)

Published
1998

21. Profound normovolemic hemodilution: hemostatic effects in patients and in a porcine model

Author

John L. Fontana, Paul D. Mongan, Barbara M. Alving, Rolf Bünger, and Thomas M. McLoughlin

Subjects
Adolescent, Swine, Blood volume, Hematocrit, Fibrinogen, Hemoglobins, Oxygen Consumption, medicine, Coagulopathy, Animals, Humans, Blood coagulation test, Prothrombin time, Hemodilution, Hemostasis, medicine.diagnostic_test, business.industry, Platelet Count, medicine.disease, Blood Coagulation Factors, Oxygen, Anesthesiology and Pain Medicine, Scoliosis, Anesthesia, Female, Blood Coagulation Tests, business, Partial thromboplastin time, medicine.drug
Abstract

Previous systematic investigations of the hemostatic effects of normovolemic hemodilution (NHD) have not explored the influence of hematocrits less than 20% in humans or animals. However, clinical interest in maximizing the perioperative conservation of erythrocytes may involve profound NHD beyond traditionally accepted empiric end points. We report here on coagulation data in eight healthy adolescent patients undergoing profound NHD in concert with surgical correction of idiopathic scoliosis, and in 29 swine undergoing experimental stepwise NHD until death. Blood was replaced with 5% albumin in 0.9% saline in our patients, and with 5% albumin in lactated Ringer's solution in our pigs. A 75% blood volume exchange in our patients yielded a platelet count (PLT) of 158 +/- 26 x 10(3)/microL, fibrinogen concentration (FIB), 50 +/- 7 mg/dL, prothrombin time (PT), 25.4 +/- 2.6 s, activated partial thromboplastin time (aPTT), 87 +/- 15s, and a nadir hemoglobin of 2.8 +/- 0.2 g/dL; however, global oxygen delivery as assessed by body oxygen consumption remained adequate. Coagulation during the experimental porcine hemodilution was assessed by measuring PLT, FIB, PT, and aPTT, as well as by measurement of coagulation factor activities. In neither species did clinically significant thrombocytopenia (PLT < 100 x 10(3)/ microL) become manifest prior to clinical or other laboratory evidence of coagulopathy. Rather, a combined deficiency of coagulation factors explains the coagulopathy developing during NHD in both patients and swine. Abnormal hemostasis develops prior to compromise of global tissue oxygenation, assessed by mixed venous oxygen saturation and total body oxygen consumption, during NHD in healthy patients anesthetized as described. Therefore, NHD may be more limited by preservation of normal coagulation than of global oxygen delivery and consumption.

Published
1996

22. Case 2--1995. Continuous retrograde cerebral perfusion as an adjunct to brain protection during deep hypothermic systemic circulatory arrest

Author

Thomas M. McLoughlin, Christopher D. King, and Wallace R. Carter

Subjects
Adult, Male, Catheterization, Central Venous, Aortic Valve Insufficiency, law.invention, Brain Ischemia, law, Hypothermia, Induced, medicine.artery, medicine, Cardiopulmonary bypass, Humans, Cerebral perfusion pressure, Hypoxia, Brain, Aorta, Cardiopulmonary Bypass, Aortic Aneurysm, Thoracic, business.industry, Electroencephalography, Hypoxia (medical), Hypothermia, Aortic Aneurysm, Perfusion, Anesthesiology and Pain Medicine, Anesthesia, Cerebrovascular Circulation, Heart Valve Prosthesis, Circulatory system, Deep hypothermic circulatory arrest, Heart Arrest, Induced, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Published
1995

23. Differences between aortic and radial artery pressure associated with cardiopulmonary bypass

Author

Thomas M McLoughlin Jr, Robert E. Lubanski, and George F. Rich

Subjects
Nitroprusside, Hemodynamics, Blood Pressure, law.invention, Phenylephrine, law, medicine.artery, medicine, Cardiopulmonary bypass, Humans, Radial artery, Pressure gradient, Aorta, Cardiopulmonary Bypass, business.industry, Middle Aged, Forearm, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Blood pressure, Anesthesia, Vascular resistance, Vascular Resistance, business, Artery
Abstract

Previous investigators have identified an aortic-to-radial artery pressure gradient thought to develop during rewarming and discontinuation of cardiopulmonary bypass. The authors measured mean aortic and radial artery pressures before, during, and after cardiopulmonary bypass in 30 patients, to determine when the pressure gradient develops. The pressure gradient was also measured before and after intravenous injections of sodium nitroprusside (1 microgram/kg) and phenylephrine (7 micrograms/kg) to determine the effect of changes in systemic vascular resistance. A significant (P less than 0.05) pressure gradient (mean +/- SEM = 4.9 +/- 0.7 mmHg) developed upon initiation of cardiopulmonary bypass. This gradient did not change significantly during the middle of bypass (4.2 +/- 0.5 mmHg), with rewarming (4.8 +/- 0.7 mmHg), immediately prior to discontinuation of bypass (4.6 +/- 0.7), or 5 and 10 min following bypass (4.9 +/- 0.9 and 4.8 +/- 0.7 mmHg). Sodium nitroprusside significantly decreased systemic vascular resistance, by 15 +/- 2%, during the middle of bypass but did not affect the pressure gradient. Likewise, phenylephrine increased the systemic vascular resistance by 52 +/- 6% and 34 +/- 4% during the middle of bypass and rewarming, respectively, without affecting the pressure gradient. Although the exact mechanisms responsible for the pressure gradient remain unknown, these results suggest its etiology is associated with events occurring during initiation of cardiopulmonary bypass rather than with rewarming or discontinuation of cardiopulmonary bypass.

Published
1992

24. Introduction

Author

Thomas M. McLoughlin

Subjects
Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine
Published
1999

26. Cardiac arrest after intrauterine instillation of 32% dextran-70 during hysteroscopy

Author

Paul J. Kuzma, Thomas M. McLoughlin, and Renata J.M. Engler

Subjects
medicine.medical_specialty, Pain medicine, Tryptase, Hysteroscopy, Sufentanil, chemistry.chemical_compound, Anesthesiology, medicine, Humans, Anaphylaxis, medicine.diagnostic_test, biology, business.industry, Dextrans, General Medicine, medicine.disease, Heart Arrest, Dextran 70, Anesthesiology and Pain Medicine, Dextran, chemistry, Anesthesia, biology.protein, Female, business, medicine.drug
Published
1995

28. More on Back Pain After Nesacaine-MPF

Author

Cosmo A. DiFazio and Thomas M. McLoughlin

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, business.industry, Physical therapy, Back pain, Medicine, Nesacaine MPF, medicine.symptom, business
Published
1990

29. Attenuation of the hemodynamic responses to endotracheal intubation with preinduction intravenous labetalol

Author

John R. Plachetka, R. W. Kalayjian, Thomas M. McLoughlin, and John B. Leslie

Subjects
Adult, Male, medicine.medical_treatment, Hemodynamics, Placebo, Tachycardia, Heart rate, Intubation, Intratracheal, medicine, Humans, Intubation, Labetalol, Infusions, Intravenous, Saline, business.industry, Tracheal intubation, Middle Aged, Anesthesiology and Pain Medicine, Anesthesia, Hypertension, Female, business, Diazepam, Preanesthetic Medication, medicine.drug
Abstract

Endotracheal intubation following anesthesia induction frequently produces hypertension and tachycardia. This study evaluated the efficacy of preinduction IV labetalol for attenuating the hemodynamic responses to intubation following thiopental and succinylcholine induction of anesthesia. Two hours after diazepam (10 mg by mouth), 60 patients were randomized in a double-blind manner and received IV saline or labetalol at doses of 0.25, 0.5, 0.75, or 1 mg/kg in a parallel design study. Five minutes later, thiopental (4 mg/kg) and succinylcholine (1 mg/kg) were administered, and the trachea was intubated in 2 minutes. Nitrous oxide (70%) anesthesia was maintained for 10 minutes. Hemodynamic parameters were grouped and analyzed for significance (p less than 0.05) by two-way repeated measures analysis of variance and t-test with Bonferroni adjustments. Baseline group demographics and hemodynamics were comparable. All doses of labetalol significantly attenuated the rate-pressure product increase immediately postintubation versus placebo. There was a dose-dependent attenuation of the increases in heart rate and the systolic, diastolic, and mean blood pressures versus placebo following intubation. IV labetalol at doses up to 0.75 mg/kg offers an effective pharmacologic means of attenuating preoperative hemodynamic responses to endotracheal intubation.

Published
1989

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