Faculty Bibliography

OBJECTIVES/HYPOTHESIS: Cochlear implantation (CI) is effective in the treatment of childhood sensorineural hearing loss and is associated with minimal surgical complications. We investigated the incidence of anesthetic complications in young patients undergoing general anesthesia for CI. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review of 123 patients younger than 18 years, who underwent CI between 2007 and 2008, was conducted for identification of intra- and postoperative anesthesia-related complications. The relation of collected variable to the complication events was analyzed using logistic regression. RESULTS: Of the 123 CI procedures, eight patients had nine anesthesia-related complications, yielding a complication rate of 6.5% and included the following: postoperative wheezing/stridor (5 cases), laryngospasm (3 cases), and emesis during inhalational induction (1 case). Divided by age group, 12 patients were <12 months with one complication (8%), 18 patients were between 1 and 2 years with one complication (5.6%), 35 patients were between 2 and 5 years with one complication (3%), 39 patients were between 5 and 12 years with five complications (13%), and 19 patients were older than 12 years with no complication (0%). Logistic regression failed to identify a significant association of any collected variable(s) with the observed complications. The incidence of complications is similar to that previously reported in elderly patients (4.3%) (Pearson chi(2) , P = .523). CONCLUSIONS: General anesthesia is well tolerated by pediatric patients undergoing CI, even under 1 year of age. Significant perioperative complications are primarily respiratory, are usually free of long-term sequelae, and occur with an incidence similar to other reported age groups

OBJECTIVES/HYPOTHESIS: Most elderly patients with severe to profound hearing loss are not being referred for cochlear implantation (CI), the only intervention to significantly improve hearing and quality of life in this population. Possible concern over the risks of anesthetic in the elderly may be one of the foremost concerns. The authors investigated whether advanced age is a risk factor when undergoing general anesthesia for cochlear implantation. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review was conducted at a tertiary academic referral center of 70 patients older than 70 years, who underwent CI with general anesthesia between 1984 and 2007, and for whom anesthesia records were available. Patients were divided into anesthetic risk group A (American Society of Anesthesiologist classification [ASA] I/II) and B (ASA III/IV). Intraoperative and postoperative anesthesia-related complications were identified. RESULTS: Of the 70 patients, 44 were in group A and 26 were in group B, both with a mean age of 77. Four patients, one from group A and three from group B, required intraoperative pressors for blood pressure support. There were no anesthesia-related complications in group A, but there were three (12% of group B and 4% overall) in group B: delayed extubation, postoperative congestive heart failure, and urinary retention. There was no long-term morbidity or mortality. CONCLUSIONS: General anesthesia is well tolerated by elderly patients undergoing cochlear implantation. Preexisting medical condition of the patient as defined by ASA is a better predictor of intraoperative and postoperative complication than age alone

We describe the anesthetic management of a morbidly obese patient with obstructive sleep apnea who underwent awake craniotomy. The patient's personal continuous positive airway pressure (CPAP) machine was used to support ventilation intraoperatively. Dexmedetomidine was used as the primary sedative. During cortical mapping, the CPAP was discontinued. The patient was comfortable and able to cooperate with language testing

PURPOSE: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks. CLINICAL FEATURES: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia. CONCLUSIONS: Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks

BACKGROUND: Parenteral administration of opioids and NSAIDs has been the mainstay for postoperative pain control in patients undergoing laparoscopic adjustable gastric banding (LAGB). Both classes of drugs, however, are associated with serious adverse effects. An addition of complimentary analgesic techniques may decrease requirement for traditional analgesics, thus reducing the incidence of side-effects. We designed the study to evaluate the effectiveness of Lavender aromatherapy in reducing opioid requirements after LAGB. METHODS: A prospective randomized placebo controlled study was carried out on 54 patients undergoing LAGB. Upon arrival to the post-anesthesia care unit (PACU), patients in the study group were treated with lavender oil, which was applied to the oxygen face mask; the control group patients received nonscented baby oil. Postoperative pain was treated with morphine. Numerical rating scores (0-10) were used to measure the level of pain at 5, 30, and 60 min. Sedation was evaluated using the Observer Assessment of Alertness/Sedation scale (0-5). Data analyzed included the amount of opioids, NRS, OAA/S, PACU discharge time, as well as the incidence of side-effects. RESULTS: The two groups were comparable with regard to patient characteristics, intraoperative drug use, and surgical time. Significantly more patients in the Placebo group (PL) required analgesics for postoperative pain (22/27, 82%) than patients in the Lavender group (LAV) (12/26, 46%) (P = .007). Moreover, the LAV patients required significantly less morphine postoperatively than PL patients: 2.38 mg vs 4.26 mg, respectively (P = .04). There were no differences in the requirements for post-operative antiemetics, antihypertensives, or PACU discharge time. CONCLUSIONS: Our results suggest that lavender aromatherapy can be used to reduce the demand for opioids in the immediate postoperative period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations

BACKGROUND:The ACGME has proposed changes to the curriculum for anesthesia residents. These changes include increasing critical care from 2 to 4 months, pain from 1 to 3 months, and obstetrics, pediatric, neuroanesthesia, and cardio thoracic anesthesia from 1 to 2 months. In addition, they have included a preoperative clinic for 1 month. METHODS:With IRB approval, a survey of the anesthesia residents at New York University was distributed. The residents questioned ranged from the CA-1 to the Ca-3 class. The survey questioned the residents on their current curriculum and the proposed changes. RESULTS:22 Residents completed the questionnaire. Seventy-seven percent of the residents polled felt they had enough experience in critical care with the current requirements and 82% did not want the increase to 4 months (p=0.007). Seventy-three percent of the residents responded that their pain management exposure was sufficient and 82% did not want it increased (p=0.011). Overwhelmingly, 82% of those polled felt an entire month of preoperative clinic was not necessary. Seventy-three percent of those residents polled would not be comfortable on subspecialty rotations as early as August of their CA-1 year. 82% felt that too much of their training would be spent outside of the operating room, and the majority (59%) thought more residents would be on each rotation. Moreover, 55% think that the proposed changes will adversely affect residents in training. DISCUSSION/CONCLUSIONS:The results of this survey demonstrate that most residents at New York University do not think the current curriculum should change. The majority opinion is that it will negative impact their education.