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4 results on '"Barry Kussman"'

1. Preventing Pediatric Chronic Postsurgical Pain: Time for Increased Rigor

Author

Christine B. Sieberg, Keerthana Deepti Karunakaran, Barry Kussman, and David Borsook

Subjects
chronic pain, surgery, postoperative pain, biomarker, fnirs, cognitive-behavioral therapy, analgesia, opioids, Medicine (General), R5-920, Therapeutics. Pharmacology, RM1-950
Abstract

Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous system following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient’s risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the peri-surgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an 8-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized, precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.

Published
2022
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2. fNIRS brain measures of ongoing nociception during surgical incisions under anesthesia

Author

Stephen, Green, Keerthana Deepti, Karunakaran, Robert, Labadie, Barry, Kussman, Arielle, Mizrahi-Arnaud, Andrea Gomez, Morad, Delany, Berry, David, Zurakowski, Lyle, Micheli, Ke, Peng, and David, Borsook

Subjects
Paper, cortex, Radiological and Ultrasound Technology, brain, neural blockade, Neuroscience (miscellaneous), knee, anterior cruciate ligament repair, Radiology, Nuclear Medicine and imaging, nociception, orthopedic, Research Papers
Abstract

Significance: Functional near-infrared spectroscopy (fNIRS) has evaluated pain in awake and anesthetized states. Aim: We evaluated fNIRS signals under general anesthesia in patients undergoing knee surgery for anterior cruciate ligament repair. Approach: Patients were split into groups: those with regional nerve block (NB) and those without (non-NB). Continuous fNIRS measures came from three regions: the primary somatosensory cortex (S1), known to be involved in evaluation of nociception, the lateral prefrontal cortex (BA9), and the polar frontal cortex (BA10), both involved in higher cortical functions (such as cognition and emotion). Results: Our results show three significant differences in fNIRS signals to incision procedures between groups: (1) NB compared with non-NB was associated with a greater net positive hemodynamic response to pain procedures in S1; (2) dynamic correlation between the prefrontal cortex (PreFC) and S1 within 1 min of painful procedures are anticorrelated in NB while positively correlated in non-NB; and (3) hemodynamic measures of activation were similar at two separate time points during surgery (i.e., first and last incisions) in PreFC and S1 but showed significant differences in their overlap. Comparing pain levels immediately after surgery and during discharge from postoperative care revealed no significant differences in the pain levels between NB and non-NB. Conclusion: Our data suggest multiple pain events that occur during surgery using devised algorithms could potentially give a measure of “pain load.” This may allow for evaluation of central sensitization (i.e., a heightened state of the nervous system where noxious and non-noxious stimuli is perceived as painful) to postoperative pain levels and the resulting analgesic consumption. This evaluation could potentially predict postsurgical chronic neuropathic pain.

Published
2022
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3. Cardiopulmonary Bypass and Mechanical Support : Principles and Practice

Author

Glenn P. Gravlee, Richard F. Davis, John Hammon, Barry Kussman, Glenn P. Gravlee, Richard F. Davis, John Hammon, and Barry Kussman

Subjects
Surgery--Complications--Prevention, Heart, Mechanical, Cardiopulmonary bypass--Side effects, Cardiopulmonary bypass--Methods
Abstract

Offering a unique, multidisciplinary approach to the complexities of CPB, the 4th Edition of Cardiopulmonary Bypass and Mechanical Support: Principles & Practice remains the gold standard in the field. This edition brings you fully up to date with every aspect of cardiopulmonary bypass, including new information on management of pediatric patients, CPB's role with minimally invasive and robotic cardiac surgery, mechanical circulatory support, miniaturized circuits and CPB, sickle cell disease and CPB management, and much more. A newly expanded title reflects the rapidly evolving nature of extracorporeal technology, encompassing both short-term and long-term forms of cardiac and pulmonary support.

Published
2016

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