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8. Neuroanesthesia Guidelines for Optimizing Transcranial Motor Evoked Potential Neuromonitoring During Deformity and Complex Spinal Surgery: A Delphi Consensus Study

Author

Walker, Corey T., Kim, Han Jo, Park, Paul, Lenke, Lawrence G., Weller, Mark A., Smith, Justin S., Nemergut, Edward C., Sciubba, Daniel M., Wang, Michael Y., Shaffrey, Christopher, Deviren, Vedat, Mummaneni, Praveen V., Chang, Joyce M., Mummaneni, Valli P., Than, Khoi D., Berjano, Pedro, Eastlack, Robert K., Mundis, Gregory M., Jr., Kanter, Adam S., Okonkwo, David O., Shin, John H., Lewis, Jason M., Koski, Tyler, Hoh, Daniel J., Glassman, Steven D., Vinci, Susan B., Daniels, Alan H., Clavijo, Claudia F., Turner, Jay D., McLawhorn, Marc, and Uribe, Juan S.

Published
2020
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14. List of Contributors

Author

Aghi, Manish K., primary, Ali, Zarina S., additional, Altschul, Dorothea, additional, Anastasian, Zirka H., additional, Ansari, Safdar, additional, Ares, William J., additional, Attiah, Mark, additional, Avellino, Anthony M., additional, Avitsian, Rafi, additional, Badjatia, Neeraj, additional, Bailey, Robert L., additional, Bastidas, Nicholas, additional, Bhalla, Paulomi, additional, Bhimraj, Adarsh, additional, Billingsley, Joshua T., additional, Bleck, Thomas P., additional, Boone, Christine, additional, Brem, Steven, additional, Buch, Vivek, additional, Byrne, Richard W., additional, Cahill, Daniel P., additional, Caplan, Justin M., additional, Chalouhi, Nohra, additional, Chang, Catherine S., additional, Chang, Jason J., additional, Chang, Steven D., additional, Chaudhary, Navjot, additional, Isaac Chen, H., additional, Chesnut, Randall M., additional, Chiocca, E. Antonio, additional, Chitale, Rohan, additional, Clavijo, Claudia F., additional, Curry, William T., additional, Dailey, Andrew, additional, Damani, Rahul, additional, DiLorenzo, Daniel J., additional, Dowd, Christopher F., additional, Eskanadar, Emad N., additional, Evans, James J., additional, Fahy, Brenda G., additional, Farrell, Christopher J., additional, Finley Caulfield, Anna K., additional, Flexman, Alana M., additional, Furtado, Sunil V., additional, Gamble, Alexander J., additional, Gardner, Paul A., additional, Gaudet, John G., additional, Gilmore, Emily J., additional, Goodwin, C. Rory, additional, Gormley, William B., additional, Sean Grady, M., additional, Grandhi, Ramesh, additional, Gruenbaum, Benjamin F., additional, Gruenbaum, Shaun E., additional, Harrop, James S., additional, Hemphill, J. Claude, additional, Herrington, Todd M., additional, Hirsch, Lawrence J., additional, Hobbs, Kyle S., additional, Hoh, Brian L., additional, Hu, Yin C., additional, Huang, Christina, additional, Huang, Judy, additional, Hurst, Robert W., additional, Ivan, Michael E., additional, Jabbour, Pascal, additional, Kaminsky, Ian, additional, Kanchwala, Suhail, additional, Kapinos, Gregory, additional, Kilburg, Craig, additional, Kla, Koffi M., additional, Kofke, W. Andrew, additional, Kung, David, additional, Lang, Shih-Shan, additional, Lavine, Sean D., additional, Le Roux, Peter, additional, Lee, Lorri A., additional, Lew, Vincent, additional, Loomis, Caitlin, additional, Lucas, Timothy, additional, Kevin Luk, K.H., additional, Ma, Tracy S., additional, Mac Grory, Brian, additional, Macyszyn, Luke, additional, Magill, Stephen T., additional, Manley, Geoffrey T., additional, Manno, Edward M., additional, Marupudi, Neena I., additional, Masoud, Hesham, additional, Maulucci, Christopher M., additional, Melinosky, Christopher, additional, Miller, Jennifer Gutwald, additional, Molyneaux, Bradley J., additional, Moore, Bryan, additional, Musolino, Patricia L., additional, Narayan, Raj K., additional, Narayanan, Sandra, additional, Naval, Neeraj, additional, Nguyen, Cuong, additional, Nguyen, Peggy, additional, Nguyen, Thanh, additional, Nogueira, Raul G., additional, Norbash, Alexander, additional, Okonkwo, David, additional, Oppenlander, Mark E., additional, Ortega Gutierrez, Santiago, additional, Pukenas, Bryan A., additional, Quiñones-Hinojosa, Alfredo, additional, Ramchand, Preethi, additional, Rincon-Torroella, Jordina, additional, Rosand, Jonathan, additional, Rosenwasser, Robert H., additional, Rutledge, W. Caleb, additional, Schlichter, R. Alexander, additional, Schuster, James M., additional, Sciubba, Daniel M., additional, Scott, Benjamin K., additional, Pokmeng See, Alfred, additional, Shankar, Ganesh M., additional, Shapira, Yoram, additional, Sharma, Deepak, additional, Sheth, Kevin N., additional, Shutter, Lori A., additional, Siegler, James E., additional, Smith, Michelle J., additional, Snyderman, Carl H., additional, Steinberg, Gary K., additional, Stiefel, Michael F., additional, Stricsek, Geoffrey P., additional, Suarez, Jose I., additional, Sung, Gene, additional, Syre, Peter, additional, Talke, Pekka O., additional, Tamargo, Rafael J., additional, Taylor, Robert, additional, Tewari, Anurag, additional, Tjoumakaris, Stavropoula, additional, Venkatasubramanian, Chitra, additional, Venteicher, Andrew S., additional, Weinstein, Michael S., additional, White, Peggy, additional, Wilson, Anthony J., additional, Wright, James M., additional, Yi, Debbie, additional, Zadnik, Patricia, additional, Zager, Eric L., additional, Zanaty, Mario, additional, and Zlotnik, Alexander, additional

Published
2018
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16. Toxicology Screening Testing in Patients Undergoing Spine Surgery: A Prospective Observational Pilot Study

Author

Clavijo, Claudia F., primary, Oliva, Anthony M., additional, Dingmann, Colleen, additional, Kaizer, Alexander, additional, Christians, Uwe, additional, Burger, Evalina, additional, Patel, Vikas, additional, Kleck, Christopher J., additional, Vogel, Scott A., additional, Scott, Benjamin K., additional, Janik, Daniel J., additional, Jameson, Leslie C., additional, and Ginde, Adit A., additional

Published
2020
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25. Implementation of a Standardized Protocol for Recurrent Laryngeal Nerve Monitoring Reduces False Negative Results During Neck Surgery: A Quality Control Case Study.

Author

Simmons, Colby G., Montejano, Julio, Eagleston, Lauren, Cao, Scott, Kaizer, Alexander M., Jameson, Leslie, Oliva, Anthony M., and Clavijo, Claudia F.

Subjects
*RECURRENT laryngeal nerve, *VOCAL cords, *ENDOTRACHEAL tubes, *NECK injuries, *NERVOUS system injuries, *LARYNGEAL nerves
Abstract

Recurrent laryngeal nerve (RLN) injury during neck surgery can cause significant morbidity related to vocal cord (VC) dysfunction. VC electromyography (EMG) is used to aid in the identification of the RLN and can reduce the probability of inadvertent surgical injury. Errors in the placement of specialized EMG endotracheal tubes (ETT) can result in unreliable signals, false-negative responses, or no response when stimulating the RLN. We describe a novel educational protocol developed to optimize uniformity in the placement of ETTs to improve the reliability of RLN monitoring. An intraoperative neuromonitoring database was queried for all neck surgeries requiring RLN monitoring. Data points extracted for all cases requiring EMG monitoring for neck procedures. Free running and stimulated EMG were monitored and continuously recorded by a certified technologist. Alerts were compared between 2013–14 and 2015–18 using a two-sample test of proportions. Significant reductions in alerts were demonstrated after protocol implementation (7.5% pre-implementation to 2.1% post). Alerts were compared between 2013–14 (overall alert rate of 1.8%, pre-implementation period) and 2015–18 (overall alert rate of 2.8%, post-implementation period). Protocolization for placement of EMG-ETT improved accuracy in EMG monitoring. In the follow-up cohort of 1,080 patients, use of this protocol continued to reduce the rate of alerts related to ETT malposition, confirming the sustainability of this intervention through routine education. The risk of nerve injury is reduced when the rate of alerts is minimized. Scheduled or continuous protocol education of anesthesia personnel should continue to ensure compliance with protocol. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Association Between English Proficiency and Postoperative Pain Management for Adult Patients Undergoing Gynecologic Surgery: A Retrospective Cohort Study.

Author

Gamboa JE, Nofal SS, Pattee J, Guess MK, and Clavijo CF

Abstract

Purpose: To determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery., Design: A retrospective cohort study was performed., Methods: The electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest., Findings: All patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance., Conclusions: Language barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Published
2024
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