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Research paper thumbnail of Measuring Clinical Productivity of Anesthesiology Groups

Anesthesiology, Feb 1, 2019

Research paper thumbnail of Snapshot of the Impact of the COVID-19 Pandemic on Academic Anesthesiology Departments' Staffing and Compensation

Research paper thumbnail of Pain on Injection of Rocuronium Bromide

Anesthesia & Analgesia, 1997

We read with interest the letter of Steegers and Robertson (1). The authors report pain on inject... more We read with interest the letter of Steegers and Robertson (1). The authors report pain on injection of subparalyzing doses of rocuronium. We agree with the authors that injection of rocuronium can cause pain that may sometimes be severe. The factors that may affect the degree of pain are the site of injection, the dose of rocuronium, and prior administration of drugs such as midazolam, opioids, and lidocaine. We have noted that administration of midazolam, 2 mg, and fentanyl, 100 pg, prior to rocuronium, 0.06 mg/ kg, prevents the pain on injection. Steegers and Robertson suggest that rocuronium is not suitable for administration prior to succinylcholine or for priming. However, we have used rocuronium, 0.06 mg/ kg, prior to succinylcholine (2) and for priming (3) without complaints of pain on injection. This suggests that, with adequate precautions, the pain on injection can be avoided.

Research paper thumbnail of Patients Presenting for Hepatic Transplantation

Anesthesia & Analgesia, Feb 1, 1988

Research paper thumbnail of Effects of atropine pretreatment on the revascularization syndrome

Research paper thumbnail of The Influence of Crystalloid and Colloid Replacement Solutions in Acute Normovolemic Hemodilution: A Preliminary Survey of Hemostatic Markers

Anesthesia & Analgesia, Feb 1, 2003

Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I,... more Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I, II, and III patients scheduled for acute normovolemic hemodilution during radical prostatectomy. Interventions: Patients were randomly assigned to four replacement fluid groups to receive 1) Ringer's lactate, 2) 5% albumin, 3) 6% dextran 70, or 4) 6% hetastarch. A standardized general anesthetic was used, and patients underwent moderate hemodilution to a target hemoglobin of 9 gm/dL. Measurements: Hemodynamic variables were recorded using standard monitors, 5-lead electrocardiography, radial arterial catheter, and pulmonary artery catheter. Red blood cell loss for the entire hospitalization was calculated. Main Results: Demographic and clinical outcome data were similar among the groups. During acute normovolemic hemodilution, heart rate and pulmonary capillary wedge pressure were unchanged from baseline in all groups, but patients receiving Ringer's lactate or albumin had greater declines in mean arterial pressure at the end of acute normovolemic hemodilution. Cardiac and oxygen consumption indexes were stable during acute normovolemic hemodilution, but oxygen extraction increased. Conclusions: During hemodilution, anesthetized patients maintain whole body oxygenation by increasing oxygen extraction. The administration of hetastarch or dextran as the replacement fluid during acute normovolemic hemodilution is associated with a more stable mean arterial pressure, but overall acute normovolemic hemodilution is well tolerated irrespective of the replacement fluid used.

Research paper thumbnail of Influence of crystalloid and colloid replacement solutions on hemodynamic variables during acute normovolemic hemodilution

Journal of Clinical Anesthesia, Feb 1, 2004

Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I,... more Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I, II, and III patients scheduled for acute normovolemic hemodilution during radical prostatectomy. Interventions: Patients were randomly assigned to four replacement fluid groups to receive 1) Ringer's lactate, 2) 5% albumin, 3) 6% dextran 70, or 4) 6% hetastarch. A standardized general anesthetic was used, and patients underwent moderate hemodilution to a target hemoglobin of 9 gm/dL. Measurements: Hemodynamic variables were recorded using standard monitors, 5-lead electrocardiography, radial arterial catheter, and pulmonary artery catheter. Red blood cell loss for the entire hospitalization was calculated. Main Results: Demographic and clinical outcome data were similar among the groups. During acute normovolemic hemodilution, heart rate and pulmonary capillary wedge pressure were unchanged from baseline in all groups, but patients receiving Ringer's lactate or albumin had greater declines in mean arterial pressure at the end of acute normovolemic hemodilution. Cardiac and oxygen consumption indexes were stable during acute normovolemic hemodilution, but oxygen extraction increased. Conclusions: During hemodilution, anesthetized patients maintain whole body oxygenation by increasing oxygen extraction. The administration of hetastarch or dextran as the replacement fluid during acute normovolemic hemodilution is associated with a more stable mean arterial pressure, but overall acute normovolemic hemodilution is well tolerated irrespective of the replacement fluid used.

Research paper thumbnail of A142 the Effect of Replecement Fluid Choice on Coagulation Variables and Blood Loss in Patients Undergoing Acute Normovolemic Hemodilution

Anesthesiology, Sep 1, 1997

Research paper thumbnail of Altered Neurohumoral Response to Head-Up Tilt is Associated with Post-Induction Hypotension in Cardiac Surgical Patients

Anesthesiology, Sep 1, 1992

Research paper thumbnail of Using Revenue Confounds Comparisons of Clinical Productivity between Anesthesiology Groups

Research paper thumbnail of Comparing Clinical Productivity Measurements: Subgroup Comparisons in an Industry-Wide Survey of Academic Anesthesiology Groups

Research paper thumbnail of A142 the Effect of Replecement Fluid Choice on Coagulation Variables and Blood Loss in Patients Undergoing Acute Normovolemic Hemodilution

Research paper thumbnail of Room G, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Influence of Aspirin on the Contribution of Platelets, Hemotocrit and Fibrinogen in Predicting the Thromboelastographic Maximum Amplitude (TEG: MA) 

Research paper thumbnail of Changes in IL-6 During Orthotopic Hepatic Transplantation

Research paper thumbnail of Hormonal Influences on Renal Function During Orthotopic Liver Transplantation

Research paper thumbnail of Altered Neurohumoral Response to Head-Up Tilt is Associated with Post-Induction Hypotension in Cardiac Surgical Patients

Research paper thumbnail of How Does Epidural Anesthesia and Analgesia Influence Perioperative Coagulability?

Anesthesia & Analgesia, 1992

Research paper thumbnail of Upper extremity neuropathy after orthotopic hepatic transplantation: A retrospective analysis

Transplantation Proceedings, 1988

Research paper thumbnail of Quantifying Net Staffing Costs Due to Longer-than-average Surgical Case Durations

Anesthesiology, 2004

Background Anesthesiology departments incur staffing costs that are not covered by revenue becaus... more Background Anesthesiology departments incur staffing costs that are not covered by revenue because the operating room (OR) time allocation and case scheduling are not done to maximize OR efficiency and because surgical durations are longer than average. The purpose of this article is to demonstrate a method to quantify net anesthesia staffing costs due to longer-than-average surgical durations and evaluate the factors that influence staffing costs. Methods Data collected from two anesthesiology departments in academic hospitals for 1 yr included date of surgery, time that patients entered the OR, time that patients exited the OR, surgical service, and the Current Procedural Terminology code for the primary surgical procedure. Anesthesia care performed outside the main surgical suite and services not billed with American Society of Anesthesiologists units were excluded. National average surgical durations were determined from the Current Procedural Terminology code from the Centers f...

Research paper thumbnail of Antiemetic Activity of Propofol after Sevoflurane and Desflurane Anesthesia for Outpatient Laparoscopic Cholecystectomy

The Journal of the American Society of Anesthesiologists, Oct 1, 1998

Background Controversy exists regarding the effectiveness of propofol to prevent postoperative na... more Background Controversy exists regarding the effectiveness of propofol to prevent postoperative nausea and vomiting. This prospective, randomized, single-blinded study was designed to evaluate the antiemetic effectiveness of 0.5 mg/kg propofol when administered intravenously after sevoflurane- compared with desflurane-based anesthesia. Methods Two hundred fifty female outpatients undergoing laparoscopic cholecystectomy were assigned randomly to one of four treatment groups. All patients were induced with intravenous doses of 2 mg midazolam, 2 microg/kg fentanyl, and 2 mg/kg propofol and maintained with either 1-4% sevoflurane (groups 1 and 2) or 2-8% desflurane (groups 3 and 4) in combination with 65% nitrous oxide in oxygen. At skin closure, patients in groups 1 and 3 were administered 5 ml intravenous saline, and patients in groups 2 and 4 were administered 0.5 mg/kg propofol intravenously. Recovery times were recorded from discontinuation of anesthesia to awakening, orientation, and readiness to be released home. Postoperative nausea and vomiting and requests for antiemetic rescue medication were evaluated during the first 24 h after surgery. Results Propofol, in an intravenous dose of 0.5 mg/kg, administered at the end of a sevoflurane-nitrous oxide or desflurane-nitrous oxide anesthetic prolonged the times to awakening and orientation by 40-80% and 25-30%, respectively. In group 2 (compared with groups 1, 3, and 4), the incidences of emesis (22% compared with 47%, 53%, and 47%) and requests for antiemetic rescue medication (19% compared with 42%, 50%, and 47%) within the first 6 h after surgery were significantly lower, and the time to home-readiness was significantly shorter in duration (216 +/- 50 min vs. 249 +/- 49 min, 260 +/- 88 min, and 254 +/- 72 min, respectively). Conclusions A subhypnotic intravenous dose of propofol (0.5 mg/kg) administered at the end of outpatient laparoscopic cholecystectomy procedures was more effective in preventing postoperative nausea and vomiting after a sevoflurane-based (compared with a desflurane-based) anesthetic.

Research paper thumbnail of Measuring Clinical Productivity of Anesthesiology Groups

Anesthesiology, Feb 1, 2019

Research paper thumbnail of Snapshot of the Impact of the COVID-19 Pandemic on Academic Anesthesiology Departments' Staffing and Compensation

Research paper thumbnail of Pain on Injection of Rocuronium Bromide

Anesthesia & Analgesia, 1997

We read with interest the letter of Steegers and Robertson (1). The authors report pain on inject... more We read with interest the letter of Steegers and Robertson (1). The authors report pain on injection of subparalyzing doses of rocuronium. We agree with the authors that injection of rocuronium can cause pain that may sometimes be severe. The factors that may affect the degree of pain are the site of injection, the dose of rocuronium, and prior administration of drugs such as midazolam, opioids, and lidocaine. We have noted that administration of midazolam, 2 mg, and fentanyl, 100 pg, prior to rocuronium, 0.06 mg/ kg, prevents the pain on injection. Steegers and Robertson suggest that rocuronium is not suitable for administration prior to succinylcholine or for priming. However, we have used rocuronium, 0.06 mg/ kg, prior to succinylcholine (2) and for priming (3) without complaints of pain on injection. This suggests that, with adequate precautions, the pain on injection can be avoided.

Research paper thumbnail of Patients Presenting for Hepatic Transplantation

Anesthesia & Analgesia, Feb 1, 1988

Research paper thumbnail of Effects of atropine pretreatment on the revascularization syndrome

Research paper thumbnail of The Influence of Crystalloid and Colloid Replacement Solutions in Acute Normovolemic Hemodilution: A Preliminary Survey of Hemostatic Markers

Anesthesia & Analgesia, Feb 1, 2003

Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I,... more Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I, II, and III patients scheduled for acute normovolemic hemodilution during radical prostatectomy. Interventions: Patients were randomly assigned to four replacement fluid groups to receive 1) Ringer's lactate, 2) 5% albumin, 3) 6% dextran 70, or 4) 6% hetastarch. A standardized general anesthetic was used, and patients underwent moderate hemodilution to a target hemoglobin of 9 gm/dL. Measurements: Hemodynamic variables were recorded using standard monitors, 5-lead electrocardiography, radial arterial catheter, and pulmonary artery catheter. Red blood cell loss for the entire hospitalization was calculated. Main Results: Demographic and clinical outcome data were similar among the groups. During acute normovolemic hemodilution, heart rate and pulmonary capillary wedge pressure were unchanged from baseline in all groups, but patients receiving Ringer's lactate or albumin had greater declines in mean arterial pressure at the end of acute normovolemic hemodilution. Cardiac and oxygen consumption indexes were stable during acute normovolemic hemodilution, but oxygen extraction increased. Conclusions: During hemodilution, anesthetized patients maintain whole body oxygenation by increasing oxygen extraction. The administration of hetastarch or dextran as the replacement fluid during acute normovolemic hemodilution is associated with a more stable mean arterial pressure, but overall acute normovolemic hemodilution is well tolerated irrespective of the replacement fluid used.

Research paper thumbnail of Influence of crystalloid and colloid replacement solutions on hemodynamic variables during acute normovolemic hemodilution

Journal of Clinical Anesthesia, Feb 1, 2004

Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I,... more Operating room of a tertiary-care university hospital. Patients: 40 adult, ASA physical status I, II, and III patients scheduled for acute normovolemic hemodilution during radical prostatectomy. Interventions: Patients were randomly assigned to four replacement fluid groups to receive 1) Ringer's lactate, 2) 5% albumin, 3) 6% dextran 70, or 4) 6% hetastarch. A standardized general anesthetic was used, and patients underwent moderate hemodilution to a target hemoglobin of 9 gm/dL. Measurements: Hemodynamic variables were recorded using standard monitors, 5-lead electrocardiography, radial arterial catheter, and pulmonary artery catheter. Red blood cell loss for the entire hospitalization was calculated. Main Results: Demographic and clinical outcome data were similar among the groups. During acute normovolemic hemodilution, heart rate and pulmonary capillary wedge pressure were unchanged from baseline in all groups, but patients receiving Ringer's lactate or albumin had greater declines in mean arterial pressure at the end of acute normovolemic hemodilution. Cardiac and oxygen consumption indexes were stable during acute normovolemic hemodilution, but oxygen extraction increased. Conclusions: During hemodilution, anesthetized patients maintain whole body oxygenation by increasing oxygen extraction. The administration of hetastarch or dextran as the replacement fluid during acute normovolemic hemodilution is associated with a more stable mean arterial pressure, but overall acute normovolemic hemodilution is well tolerated irrespective of the replacement fluid used.

Research paper thumbnail of A142 the Effect of Replecement Fluid Choice on Coagulation Variables and Blood Loss in Patients Undergoing Acute Normovolemic Hemodilution

Anesthesiology, Sep 1, 1997

Research paper thumbnail of Altered Neurohumoral Response to Head-Up Tilt is Associated with Post-Induction Hypotension in Cardiac Surgical Patients

Anesthesiology, Sep 1, 1992

Research paper thumbnail of Using Revenue Confounds Comparisons of Clinical Productivity between Anesthesiology Groups

Research paper thumbnail of Comparing Clinical Productivity Measurements: Subgroup Comparisons in an Industry-Wide Survey of Academic Anesthesiology Groups

Research paper thumbnail of A142 the Effect of Replecement Fluid Choice on Coagulation Variables and Blood Loss in Patients Undergoing Acute Normovolemic Hemodilution

Research paper thumbnail of Room G, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Influence of Aspirin on the Contribution of Platelets, Hemotocrit and Fibrinogen in Predicting the Thromboelastographic Maximum Amplitude (TEG: MA) 

Research paper thumbnail of Changes in IL-6 During Orthotopic Hepatic Transplantation

Research paper thumbnail of Hormonal Influences on Renal Function During Orthotopic Liver Transplantation

Research paper thumbnail of Altered Neurohumoral Response to Head-Up Tilt is Associated with Post-Induction Hypotension in Cardiac Surgical Patients

Research paper thumbnail of How Does Epidural Anesthesia and Analgesia Influence Perioperative Coagulability?

Anesthesia & Analgesia, 1992

Research paper thumbnail of Upper extremity neuropathy after orthotopic hepatic transplantation: A retrospective analysis

Transplantation Proceedings, 1988

Research paper thumbnail of Quantifying Net Staffing Costs Due to Longer-than-average Surgical Case Durations

Anesthesiology, 2004

Background Anesthesiology departments incur staffing costs that are not covered by revenue becaus... more Background Anesthesiology departments incur staffing costs that are not covered by revenue because the operating room (OR) time allocation and case scheduling are not done to maximize OR efficiency and because surgical durations are longer than average. The purpose of this article is to demonstrate a method to quantify net anesthesia staffing costs due to longer-than-average surgical durations and evaluate the factors that influence staffing costs. Methods Data collected from two anesthesiology departments in academic hospitals for 1 yr included date of surgery, time that patients entered the OR, time that patients exited the OR, surgical service, and the Current Procedural Terminology code for the primary surgical procedure. Anesthesia care performed outside the main surgical suite and services not billed with American Society of Anesthesiologists units were excluded. National average surgical durations were determined from the Current Procedural Terminology code from the Centers f...

Research paper thumbnail of Antiemetic Activity of Propofol after Sevoflurane and Desflurane Anesthesia for Outpatient Laparoscopic Cholecystectomy

The Journal of the American Society of Anesthesiologists, Oct 1, 1998

Background Controversy exists regarding the effectiveness of propofol to prevent postoperative na... more Background Controversy exists regarding the effectiveness of propofol to prevent postoperative nausea and vomiting. This prospective, randomized, single-blinded study was designed to evaluate the antiemetic effectiveness of 0.5 mg/kg propofol when administered intravenously after sevoflurane- compared with desflurane-based anesthesia. Methods Two hundred fifty female outpatients undergoing laparoscopic cholecystectomy were assigned randomly to one of four treatment groups. All patients were induced with intravenous doses of 2 mg midazolam, 2 microg/kg fentanyl, and 2 mg/kg propofol and maintained with either 1-4% sevoflurane (groups 1 and 2) or 2-8% desflurane (groups 3 and 4) in combination with 65% nitrous oxide in oxygen. At skin closure, patients in groups 1 and 3 were administered 5 ml intravenous saline, and patients in groups 2 and 4 were administered 0.5 mg/kg propofol intravenously. Recovery times were recorded from discontinuation of anesthesia to awakening, orientation, and readiness to be released home. Postoperative nausea and vomiting and requests for antiemetic rescue medication were evaluated during the first 24 h after surgery. Results Propofol, in an intravenous dose of 0.5 mg/kg, administered at the end of a sevoflurane-nitrous oxide or desflurane-nitrous oxide anesthetic prolonged the times to awakening and orientation by 40-80% and 25-30%, respectively. In group 2 (compared with groups 1, 3, and 4), the incidences of emesis (22% compared with 47%, 53%, and 47%) and requests for antiemetic rescue medication (19% compared with 42%, 50%, and 47%) within the first 6 h after surgery were significantly lower, and the time to home-readiness was significantly shorter in duration (216 +/- 50 min vs. 249 +/- 49 min, 260 +/- 88 min, and 254 +/- 72 min, respectively). Conclusions A subhypnotic intravenous dose of propofol (0.5 mg/kg) administered at the end of outpatient laparoscopic cholecystectomy procedures was more effective in preventing postoperative nausea and vomiting after a sevoflurane-based (compared with a desflurane-based) anesthetic.