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Study Objective: The purpose of this study was to assess the workflow interruptions on an anesthesiology clinical director (CD). By assessing the interruptions on the CD, we hypothesize that these frequent interruptions would prohibit the CD from medical direction of residents or certified nurse anesthetists in operating rooms., Design: Cellular phone data were obtained from Verizon Wireless statements over 10 months, August 2012 through May 2013. These data were from a single cellular phone carried by the anesthesia CD and subsequent overnight anesthesiologist 24 hours a day. The data obtained from the billing records included number of calls, date and time call occurred, number of minutes per call, and number of texts received., Setting: These calls occurred in the operating room., Patients: Not applicable., Intervention: Not applicable., Measurements: Phone calls, texts, and pager interruptions., Main Results: A total of 19,924 calls and 19,803 texts were received by the CD. The phone calls minutes for this period were 31,236 minutes. A total of 15,831 (80%) of the calls occurred during this period (0600-1800). A total of 24 489 minutes (78%) of the total minutes occurred during this time., Conclusion: This study revealed that distracting events are frequent for an anesthesiology CD. The quantity of cellular phone interruptions, both calls and texts, by the anesthesiology CD was considered high. These calls occurred mainly during prime operating room time and utilization. As the CD is an integral part of the perioperative management team, they are expected to answer and return calls and texts promptly. Operating room efficiency and staff satisfaction decline if responses to these calls and texts are delayed. Although the nature of these distractions and interruptions can be viewed as having a positive or negative effect, many of these events are necessary to efficiently run the operating rooms., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies., Design: Data were collected retrospectively from the electronic medical record and institutional echocardiography database., Setting: Single university hospital., Participants: A total of 100 patients undergoing OLT via total cavaplasty technique., Interventions: Intraoperative TEE was performed in all 3 phases of OLT., Measurement and Main Results: TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40%), isolated right ventricular dysfunction (n = 22, 22%), and intracardiac thromboemboli (n = 20, 20%)., Conclusions: Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Previous case-control studies showed that genetic variation in the fibrinogen gamma gene (FGG) increased the risk for deep vein thrombosis (VT) in adults. We investigated the association between the fibrinogen alpha (FGA) and FGG haplotypes, the factor V(Leiden)-mutation, and pediatric VT and thromboembolic stroke (TS) in 2 independent study samples. Association analysis revealed that the FGA-H1 and FGG-H2 haplotypes were significantly overtransmitted to VT patients (FGA-H1, P = .05; FGG: H2, P = .032). In contrast, the FGG-H3 haplotype was undertransmitted (P = .022). In an independent study sample, FGA-H1 (P = .008) and FGG-H2 (P = .05) were significantly associated with TS. The association of FGA and FGG haplotypes with VT was more pronounced in FV(Leiden)-negative families (FGA-H1, P = .001; FGG-H2, P = .001), indicating a genetic interaction between both risk factors. The risk-conferring FGG-H2 and the protective FGG-H3 haplotypes correlated with low (FGG-H2) and high (FGG-H3) levels of the gamma' chain variant, respectively. These results provide independent and novel evidence that FGA-H1 and FGG-H2 variants are associated with an increased risk of VT and TS in children. The observed negative correlation of genetic VT risk with the plasma levels of the fibrinogen gamma' variant suggests that FGG-H2 and -H3 haplotypes modify thrombosis risk by controlling the level of this FGG splice isoform.