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1. Transport of Critically Ill Patients by the Anesthesia Versus the Intensive Care Unit Service

Author

Thomas W. Cutter, Ori Gottlieb, Avery Tung, Sajid Shahul, Silas Joseph, Frank W. Dupont, Anne S. Pohlman, and Michael O'Connor

Subjects
Adult, Male, Critical Illness, health care facilities, manpower, and services, Workflow, law.invention, law, Humans, Medicine, Aged, Retrospective Studies, Before after study, Service (business), business.industry, Critically ill, Middle Aged, Anesthesia department, Intensive care unit, Intensive Care Units, Transportation of Patients, Anesthesiology and Pain Medicine, Anesthesia, Female, Anesthesia Department, Hospital, business
Abstract

We implemented a new policy at our institution where the responsibility for intensive care unit (ICU) patient transports to the operating room (OR) was changed from the anesthesia to the ICU service. We hypothesized that this approach would be associated with increased on-time starts and decreased turnover times.In the historical model, intubated patients or those on mechanical circulatory assistance (MCA) were transported by the anesthesia service to the OR ("pre-ICU Pickup"). In our new model, these patients are transported by the ICU service to the preoperative holding area (Pre-op) where care is transferred to the anesthesia service ("post-ICU Transfer"). If judged necessary by the ICU or anesthesia attending, the patient was transported by the anesthesia service ("post-ICU Pickup"). We retrospectively reviewed case tracking data for patients undergoing surgery before (January 2014 to May 2015) and after implementation (July 2016 to June 2017) of the new policy. The primary outcome was the proportion of elective, weekday first-case, on-time starts. To adjust for confounders including comorbidities and time trends, we performed a segmented logistic regression analysis assessing the effect of our intervention on the primary outcome. Secondary outcomes were turnover times and compliance with preoperative checklist documentation.We identified 95 first-start and 86 turnover cases in the pre-ICU Pickup, 70 first-start and 88 turnover cases in the post-ICU Transfer, and 6 turnover cases in the post-ICU Pickup group. Ignoring time trends, the crude proportion of on-time starts increased from 32.6% in the pre-ICU Pickup to 77.1% in the post-ICU Transfer group. After segmented logistic regression adjusting for age, sex, American Society of Anesthesiologists (ASA) physical status, Sequential Organ Failure Assessment (SOFA) score, respiratory failure, endotracheal intubation, MCA, congestive heart failure (CHF), valvular heart disease, and cardiogenic and hemorrhagic shock, the post-ICU Transfer group was more likely to have an on-time start at the start of the intervention than the pre-ICU Pickup group at the end of the preintervention period (odds ratio, 11.1; 95% confidence interval [CI], 1.3-125.7; P = .043). After segmented linear regression adjusting for the above confounders, the estimated difference in mean turnover times between the post-ICU Pickup and pre-ICU Transfer group was not significant (-6.9 minutes; 95% CI, -17.09 to 3.27; P = .17). In post-ICU Transfer patients, consent, history and physical examination (HP), and site marking were verified before leaving the ICU in 92.9%, 93.2%, and 89.2% of the cases, respectively. No adverse events were reported during the study period.A transition from the anesthesia to the ICU service for transporting ICU patients to the OR did not change turnover times but resulted in more on-time starts and high compliance with preoperative checklist documentation.

Published
2019

2. Gastrostomy tube placement is safe in advanced amyotrophic lateral sclerosis

Author

Bobbie Jean Sweitzer, Joumana Baroody, Betty Soliven, Steven R. White, Carol E. Semrad, Manisha Kak, Amy S. Guralnick, Raymond P. Roos, Naoum P. Issa, Ori Gottlieb, and Kourosh Rezania

Subjects
Male, Vital capacity, medicine.medical_specialty, Visual Analog Scale, medicine.medical_treatment, Sedation, Vital Capacity, 03 medical and health sciences, FEV1/FVC ratio, 0302 clinical medicine, Enteral Nutrition, Postoperative Complications, Percutaneous endoscopic gastrostomy, Medicine, Humans, Longitudinal Studies, Amyotrophic lateral sclerosis, Aged, Gastrostomy tube placement, Gastrostomy, business.industry, Respiratory dysfunction, Amyotrophic Lateral Sclerosis, General Medicine, Middle Aged, medicine.disease, Survival Analysis, Surgery, Treatment Outcome, Neurology, Gastrostomy tube, Anesthesia, 030211 gastroenterology & hepatology, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Objectives: To evaluate the safety and effect on survival of insertion of a gastrostomy tube (G-tube) in patients with amyotrophic lateral sclerosis (ALS) who have upright forced vital capacity (uFVC) ≤ 50% predicted. Current guidelines, which are based on higher rates of post-procedure complications in ALS patients with advanced respiratory dysfunction, have led to a recommendation to perform G-tube insertion before the FVC drops to Methods: We assessed 41 ALS patients who received a G-tube, mostly by insertion of a percutaneous endoscopic gastrostomy (PEG) tube by a dedicated team that included a gastroenterologist and one of two anesthesiologists using Monitored Anesthesia Care with deep sedation, and 61 patients who did not receive a G-tube. uFVC was ≤50% predicted in 12 of 41 patients who received a G-tube and in 18 of 61 who did not. Results: The procedure was safe regardless of FVC status, with low rates of post-operative complications in both low and high FVC groups. There was no survival benefit for patients who received a G-tube when compared with those who did not. Discussion: PEG insertion is safe in ALS patients with significant respiratory muscle weakness when performed by a dedicated team, which suggests that the recommendation for G-tube placement should not be based on the patient’s respiratory status.

Published
2020
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3. A Brave New World: Artificial Intelligence, Ethics and the O.R

Author

Sesh Mudumbai, Mark Banoub, Ori Gottlieb, and Samir Kendale

Subjects
Engineering, business.industry, General Engineering, General Earth and Planetary Sciences, Artificial intelligence, business, General Environmental Science
Published
2020

5. Anesthesia Information Management Systems (AIMS) for the OOOR Setting

Author

Keith J. Ruskin and Ori Gottlieb

Subjects
Management information systems, Computer science, medicine, Medical emergency, medicine.disease
Abstract

Anesthesia information management systems (AIMS) offer significant benefits to an anesthesiologist who practices beyond the operating room. AIMS systems have the potential to improve patient care because they deliver a customized, legible anesthesia record while storing the patient’s physiologic data in an easily searchable database. An electronic workflow allows the anesthesiologist to focus on patient care while facilitating tasks such as quality assurance, compliance, research, and billing.

Published
2018

6. Anesthesia Information Management Systems in the Ambulatory Setting

Author

Ori Gottlieb

Subjects
Management information systems, Anesthesiology and Pain Medicine, Anesthesia information management system, business.industry, Electronic health record, Informatics, Anesthesia, Champion, Electronic medical record, Medicine, General Medicine, business, Shadow (psychology)
Abstract

Adopting an anesthesia information management system (AIMS) is a challenge for anesthesia departments. The transition requires a physician champion and the support of members in every section. This change can be facilitated by visiting similar institutions that are already using AIMS, shadow charting for a sufficient period of time, and understanding that optimization continues after the go-live date. Once implemented, the benefits outweigh the challenges, but understanding where the potential obstacles lie is critical to removing them efficiently and effectively. As different AIMS continue to spread throughout the medical world, so will their benefits.

Published
2014

7. A Positive Study Despite Negative Results

Author

Ori Gottlieb and Richard P. Dutton

Subjects
Male, medicine.medical_specialty, business.industry, Blood Pressure, Decision Support Systems, Clinical, Anesthesiology and Pain Medicine, Blood pressure, Clinical Alarms, Monitoring, Intraoperative, Medicine, Humans, Female, Hypotension, business, Intensive care medicine
Published
2015

8. Venous thromboembolism after Diaphragm Pacing in amyotrophic lateral sclerosis

Author

Ori Gottlieb, Bobbie Jean Sweitzer, Steven R. White, Raymond P. Roos, Amy S. Guralnick, Vivek N. Prachand, Kourosh Rezania, and Wickii T. Vigneswaran

Subjects
medicine.medical_specialty, Physiology, business.industry, Deep vein, Incidence (epidemiology), Perioperative, medicine.disease, Thrombosis, Pulmonary embolism, Surgery, Cellular and Molecular Neuroscience, Diaphragm pacing, medicine.anatomical_structure, Physiology (medical), Anesthesia, medicine, cardiovascular diseases, Neurology (clinical), Amyotrophic lateral sclerosis, business, Venous thromboembolism
Abstract

Introduction: Patients with amyotrophic lateral sclerosis (ALS) are prone to venous thromboembolism (VTE) and secondary complications. Because there is an increased incidence of VTE after surgical procedures, placement of a Diaphragm Pacing System (DPS) in ALS patients as treatment for respiratory muscle weakness could potentially increase the incidence of VTE, especially in patients with limited mobility. Methods: We implanted a DPS in 10 ALS patients who met the criteria for this procedure. They underwent a preoperative evaluation as recommended by the guidelines. Results: We report 2 patients with no symptoms of deep vein thrombosis (DVT) before the surgical procedure who then developed perioperative VTE. Conclusions: These patients highlight the need to consider preoperative screening for DVT and postoperative thromboprophylaxis in high-risk ALS patients who undergo DPS placement. Muscle Nerve 50: 863–865, 2014

Published
2014

9. Venous thromboembolism after diaphragm pacing in amyotrophic lateral sclerosis

Author

Kourosh, Rezania, Ori, Gottlieb, Amy, Guralnick, Vivek, Prachand, Bobbie J, Sweitzer, Wickii, Vigneswaran, Steven R, White, and Raymond P, Roos

Subjects
Male, Venous Thrombosis, Amyotrophic Lateral Sclerosis, Diaphragm, Humans, Female, Middle Aged, Respiration Disorders
Abstract

Patients with amyotrophic lateral sclerosis (ALS) are prone to venous thromboembolism (VTE) and secondary complications. Because there is an increased incidence of VTE after surgical procedures, placement of a Diaphragm Pacing System (DPS) in ALS patients as treatment for respiratory muscle weakness could potentially increase the incidence of VTE, especially in patients with limited mobility.We implanted a DPS in 10 ALS patients who met the criteria for this procedure. They underwent a preoperative evaluation as recommended by the guidelines.We report 2 patients with no symptoms of deep vein thrombosis (DVT) before the surgical procedure who then developed perioperative VTE.These patients highlight the need to consider preoperative screening for DVT and postoperative thromboprophylaxis in high-risk ALS patients who undergo DPS placement.

Published
2014

10. Anesthesia information management systems in the ambulatory setting: benefits and challenges

Author

Ori, Gottlieb

Subjects
Ambulatory Surgical Procedures, Medical Records Systems, Computerized, Anesthesiology, Information Management, Humans, Anesthesia
Abstract

Adopting an anesthesia information management system (AIMS) is a challenge for anesthesia departments. The transition requires a physician champion and the support of members in every section. This change can be facilitated by visiting similar institutions that are already using AIMS, shadow charting for a sufficient period of time, and understanding that optimization continues after the go-live date. Once implemented, the benefits outweigh the challenges, but understanding where the potential obstacles lie is critical to removing them efficiently and effectively. As different AIMS continue to spread throughout the medical world, so will their benefits.

Published
2014

11. No difference in blood loss during endoscopic sinus surgery with total intravenous anesthesia--reply

Author

Mohamad R. Chaaban, Fuad M. Baroody, Ori Gottlieb, and Robert M. Naclerio

Subjects
Male, Methyl Ethers, medicine.medical_specialty, Total intravenous anesthesia, business.industry, MEDLINE, Blood Loss, Surgical, Endoscopy, Surgery, Endoscopic sinus surgery, Otorhinolaryngology, Blood loss, medicine, Anesthesia, Intravenous, Humans, Female, business, Anesthesia, Inhalation, Propofol
Published
2013

12. 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

15. The course of myalgia and headache after electroconvulsive therapy

Author

Stephen H. Dinwiddie, Ori Gottlieb, and Dezheng Huo

Subjects
musculoskeletal diseases, myalgia, Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Neuroscience (miscellaneous), Pain, macromolecular substances, Neurological disorder, Electroconvulsive therapy, stomatognathic system, parasitic diseases, medicine, Humans, Electroconvulsive Therapy, Headache epidemiology, business.industry, Incidence (epidemiology), Incidence, Follow up studies, Headache, virus diseases, medicine.disease, Psychiatry and Mental health, Time course, Physical therapy, Female, medicine.symptom, business
Abstract

Headache and myalgia seem to be common, though generally mild, complications of electroconvulsive therapy. Relatively little is known regarding the usual severity and time course of these complaints.This study examines the incidence, severity, and time course of myalgia and headache after electroconvulsive therapy.Patients rated severity of myalgia and headache immediately before treatment and again after recovery and at 2, 6, 12, and 24 hours posttreatment on a 10-point visual analog scale. Data were analyzed using random-effects linear models.Severity of headache peaked 2 hours after treatment, returning to baseline by 24 hours and was relatively consistent within individuals between treatments. More severe posttreatment headache was reported by patients with a history of incapacitating headache and by those younger than 45 years. Headache was associated with increased duration of seizure. By contrast, myalgia was substantially more pronounced and lasted longer after the first treatment as compared with subsequent treatments. Severity of myalgia was not predicted by degree of fasciculations or motor activity, but was worse in patients younger than 45 years.Posttreatment headache and myalgia are common but usually mild. Routine pretreatment using non-depolarizing agents is probably unnecessary in most cases but may have a role during the first treatment in a series. By contrast, preventive treatment may be warranted in those with history of severe headache and those who previously have had significant post-ECT headache.

Published
2009

16. Blood Loss During Endoscopic Sinus Surgery With Propofol or Sevoflurane

Author

Fuad M. Baroody, Robert M. Naclerio, Ori Gottlieb, and Mohamad R. Chaaban

Subjects
medicine.medical_specialty, business.industry, Subgroup analysis, Perioperative, Intraoperative Hemorrhage, Sevoflurane, Surgery, law.invention, Anesthesia Procedure, Otorhinolaryngology, Randomized controlled trial, law, Anesthesia, medicine, business, Propofol, Prospective cohort study, medicine.drug
Abstract

Importance Total intravenous anesthesia (TIVA) with propofol has been associated with reduced operative time, decreased perioperative risks, and decreased intraoperative blood loss compared with inhalational anesthesia (IA). During endoscopic sinus surgery (ESS), reduced bleeding from the mucosal surfaces could improve visualization of the anatomy and decrease the risk of serious complications. Objective To compare blood loss during ESS between patients receiving TIVA with propofol and those receiving IA with sevoflurane. Design, Setting, and Participants Prospective, randomized study of 33 patients undergoing ESS in an academic medical center. Interventions Patients received either TIVA or IA. Main Outcomes and Measures The primary outcome was rate of blood loss in milliliters per hour. The secondary outcomes included the quality of visibility measured by the surgeon's numeric rating score, ease of anesthesia as measured by the anesthesiologist's numeric rating score, and total blood loss. Results The mean (SEM) blood loss per hour in the TIVA group was 78.5 (14) mL/h, and in the IA group it was 80.3 (17) mL/h (P = .93). A post hoc subgroup analysis found that in patients with a Lund-Mackay score of 12 or lower, the propofol TIVA group had a lower rate of blood loss compared with the sevoflurane IA group (mean blood loss, approximately 18 mL/h vs approximately 99 mL/h). The anesthesiologist's numeric rating score was significantly higher (indicating greater ease of performance) in the IA group than in the TIVA group. There was no statistically significant difference in the surgical numeric rating score between the 2 groups. Conclusions and Relevance In this comparative study, our results did not show any difference in blood loss and surgical conditions between the TIVA and IA groups. Even further study is not likely to show a difference in blood loss between TIVA and IA during ESS.

Published
2013

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