Carin Hagberg | The University of Texas Health Science Center at Houston (original) (raw)

Papers by Carin Hagberg

Research paper thumbnail of Endotrol-tracheal tube assisted endotracheal intubation during video laryngoscopy

Internal and emergency medicine, 2012

Video laryngoscopes allow indirect visualization of the glottis and provide superior views of the... more Video laryngoscopes allow indirect visualization of the glottis and provide superior views of the glottis compared to direct laryngoscopes in patients with both normal and difficult airways, but it may be difficult to advance the endotracheal tube (ETT) through the vocal cords into the trachea, unless a stylet is used. We propose that the Endotrol(®) ETT may be an effective tool to facilitate video laryngoscope-assisted orotracheal intubation without the use of a stylet. After obtaining written and oral informed consent, 60-adult patients scheduled for elective surgery requiring general anesthesia with orotracheal intubation were enrolled. Patients were randomized, respectively, to 1 of 4 groups: Group A(1), (15 patients): McGrath(®) with Endotrol(®) ETT; Group A(2), (15 patients): McGrath(®) with GlideRite(®)-styletted standard ETT; Group B(1), (15 patients): GlideScope(®) with Endotrol(®) ETT; Group B(2), (15 patients): GlideScope(®) with GlideRite(®)-styletted standard ETT. Stati...

Research paper thumbnail of In response

Research paper thumbnail of The Effect of Cricoid Pressure on the Unstable Cervical Spine

The Journal of emergency medicine, Jan 13, 2015

It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to... more It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to neurologic deterioration. We sought to examine the amount of motion cricoid pressure could cause at an unstable subaxial cervical spine injury, and whether posterior manual support is of any benefit. Five fresh, whole cadavers had complete segmental instability at C5-C6 surgically created by a fellowship-trained spine surgeon. Cricoid pressure was applied to the anterior cricoid by an attending anesthesiologist. In addition, the effect of posterior cervical support was tested during the trials. The amount of angular and linear motion between C5 and C6 was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). When cricoid pressure is applied, the largest angular motion was 3 degrees and occurred in flexion-extension at C5-C6. The largest linear displacement was 1.36 mm and was in anterior-posterior displacement of C5-C6. When...

Research paper thumbnail of L’incidence de reflux gastro-œsophagien et d’aspiration trachéale détectés au moyen d’électrodes à pH est similaire avec l’usage du Laryngeal Mask Airway® ou du Esophageal Tracheal Combitube® — une étude pilote

Research paper thumbnail of Inclusion of financial issues in the surgery cancellation categories introduced by Emanuel et al

Anaesthesia and intensive care, 2015

Research paper thumbnail of Laryngeal mask placement in a teaching institution: analysis of difficult placements

F1000Research, 2015

Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Alth... more Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program. This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved. Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%. In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.

Research paper thumbnail of Important Dose Correction

Journal of the American Academy of Child & Adolescent Psychiatry, 1993

Research paper thumbnail of Pharmacological Management of Pain in Children

Journal of the American Academy of Child & Adolescent Psychiatry, 1993

This article examines the use of analgesics and psychopharmacological adjuvants in children exper... more This article examines the use of analgesics and psychopharmacological adjuvants in children experiencing pain. Peripheral analgesics are effective for mild to moderate pain. Narcotics are effective but may produce dependence and tolerance as well as untoward side effects. Major tranquilizers, minor tranquilizers, tricyclic antidepressants, and stimulants have all been used as adjuvants in pain management. Major tranquilizers are now discouraged because of potential serious adverse effects. Benzodiazepines are relatively safe and decrease anxiety accompanying pain. Tricyclics may be used with caution. Stimulants have received little attention but may be useful in treating both pain and depression in the physically ill.

Research paper thumbnail of Associated malformations in infants with cleft lip and palate: A prospective, population-based study

Journal of Oral and Maxillofacial Surgery, 1998

Infants with cleft lip and palate may often have other associated congenital defects although the... more Infants with cleft lip and palate may often have other associated congenital defects although the reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalence of associated malformations in a geographically defined population. The prevalence of associated malformations in infants with clefts were collected prospectively between 1975 to 1992 on all infants born in greater Stockholm, Sweden. The patient records were also compared with data from the National Malformation Registry and other hospital records if any. Of the 616 cleft infants (367 boys, 249 girls) born during this period, 21% had associated malformations that either required follow-up or treatment. Associated malformations were more frequent in infants who had both cleft lip and palate (28%) than in infants with isolated cleft palate (22%) or infants with isolated cleft lip (8%). Malformations of the upper or lower limbs or the vertebral column were the most common other anomalies and accounted for 33% of all associated defects. Twenty-four percent of associated malformations were in the cardiovascular system and congenital heart disease was the most common isolated associated malformation. Fifteen percent of all associated malformations were multiple and they were frequently associated with mental retardation or chromosomal anomalies. Twenty-two percent of infants with associated malformations were born preterm, compared with an expected 5% incidence of preterm delivery in Sweden. A more extensive cleft seems to be associated with a higher risk for associated malformations. Although many associated congenital defects can be detected at a physical examination, the high prevalence of congenital heart disease (16 times that of general population) may justify a routine echocardiographic screening.

Research paper thumbnail of A two-person technique for fiberscope-aided tracheal extubation/reintubation in intensive care unit (ICU) patients

Journal of Clinical Anesthesia, 2003

The technique of fiberoptic-aided intubation for management of a difficult airway is often limite... more The technique of fiberoptic-aided intubation for management of a difficult airway is often limited in the presence of blood or secretions and conditions in which the passage of a fiberoptic bronchoscope ("fiberscope") beneath the epiglottis and into the glottic opening may prove difficult. Direct laryngoscopy can be utilized in combination with the fiberscope as a two-person technique to overcome these challenges. We report the usefulness of a two-person technique using the flexible fiberscope in combination with direct laryngoscopy for extubation/reintubation in two intensive care unit patients with known difficult airways.

Research paper thumbnail of Reply

Journal of Clinical Anesthesia, 2010

Research paper thumbnail of Use of the DCI video laryngoscope system in a pediatric patient with amniotic band syndrome and craniofacial abnormalities affecting the airway

Journal of Clinical Anesthesia, 2012

A 14 month old, 19 kg female infant with aminotic band syndrome and severe craniofacial malformat... more A 14 month old, 19 kg female infant with aminotic band syndrome and severe craniofacial malformations presented for placement of an open gastrostomy tube. Spontaneous ventilation was maintained while an "awake look" was performed with the video laryngoscope using intravenous propofol (30 mg total) for sedation. A Grade I Cormack-Lehane score was obtained on the monitor. Succinylcholine was then administered intravenously and orotracheal intubation was performed on the first attempt with a size 4.5 endotracheal tube.

Research paper thumbnail of The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases

Journal of Clinical Anesthesia, 2004

The anesthetic management of three pediatric patients who underwent awake craniotomy with a combi... more The anesthetic management of three pediatric patients who underwent awake craniotomy with a combined, continuous intravenous infusion of propofol and alfentanil is described. The Laryngeal Mask Airway was effective in airway management during resection of epileptic foci with intraoperative cortical mapping and neuropsychological (speech) evaluation.

Research paper thumbnail of Training of residents in peripheral nerve blocks during anesthesiology residency

Journal of Clinical Anesthesia, 2002

To survey American anesthesiology residency program directors to determine the availability and e... more To survey American anesthesiology residency program directors to determine the availability and extent of training in peripheral nerve block techniques. Survey questionnaire was mailed and faxed to 132 American anesthesiology residency program directors and followed up 4 weeks later with another mailing to nonresponders. University medical center. Of the 132 American anesthesiology residency program directors surveyed, 69 (52%) responded. Of the responders, 40 (58%) offered a specific peripheral nerve block rotation. The rotation was of 1 month's duration in 61% of these programs. Formal instruction was administered during the rotation in 69%. The regional instruction approach consisted of a nerve stimulator (98%), paresthesia (75%), and transarterial (85%). Multimedia, mannequins, and cadaver dissection were used infrequently (13-25%). During the rotation, residents performed a variety of blocks, but the number of each block varied from 2 (supraclavicular) to 10 (axillary). These blocks were performed in the operating room in 48% of programs. Finally, in the programs with a specific peripheral nerve block rotation, residents were evaluated. Specific peripheral nerve block rotations are not always included in anesthesiology residents' curriculum. In addition, residents in programs with a specific nerve block rotation are exposed to a greater number of peripheral nerve block techniques than those who do not have such a rotation included in their curriculum.

Research paper thumbnail of Successful airway management of a patient with a known difficult airway with the Direct Coupler Interface Video Laryngoscope

Journal of Clinical Anesthesia, 2007

We present the case of a patient who first presented with unexpected difficult laryngoscopy and i... more We present the case of a patient who first presented with unexpected difficult laryngoscopy and intubation after induction of general anesthesia. After multiple failed attempts using direct laryngoscopy, tracheal intubation was successfully performed with the Intubating Laryngeal Mask Airway. He returned to the operating room 5 days later for another surgical procedure, and intubation was performed with the Direct Coupler Interface Video Laryngoscope on the first attempt by the same anesthesiologist.

Research paper thumbnail of A retrospective analysis of airway management in obese patients at a teaching institution

Journal of Clinical Anesthesia, 2009

To identify patient characteristics that influence the choice of awake fiberoptic intubation (AFI... more To identify patient characteristics that influence the choice of awake fiberoptic intubation (AFI) versus intubation after general anesthesia in obese patients. Retrospective study. Memorial Hermann Hospital, Houston, TX. Perioperative records of 283 obese patients [body mass index (BMI) >34 kg/m2] who underwent elective surgery between January 1991 and December 1999 were studied. Patients' data were divided into two groups according to method of induction and intubation: asleep direct laryngoscopy versus AFI. Patient demographics, BMI, Mallampati airway classification, history of gastroesophageal reflux disease, peptic ulcer disease, hiatal hernia, and obstructive sleep apnea syndrome were compared between the two groups. Bivariate and multivariate analyses were performed. AFI was performed in 12 (4.2%) obese patients, and direct laryngoscopy was performed in 271 (95.8%) obese patients. Difficult intubation was reported in 21 (7.4%) cases, and there were no reported cases of failed intubations. Bivariate analyses demonstrated that AFI patients were more likely to have a BMI > or = 60 kg/m2 (P < 0.001), Mallampati class III or IV airway (P < 0.001), and be men (P = 0.004). These three factors were also statistically significant in the multivariate logistic regression. In particular, each one kg/m(2) increase in BMI was associated with a 7% increased likelihood of AFI. Men were approximately 4 times likelier than women to have an AFI. Compared with patients with a Mallampati Class I or II airway, those with Mallampati Classes III or IV were about 26 times as likelier to have an AFI. Patients selected for AFI were predominantly men, with a Mallampati Class III or IV airway, and BMI > or = 60 kg/m2.

Research paper thumbnail of Class zero airway

European Journal of Anaesthesiology, 2013

Research paper thumbnail of The incidence of gastroesophageal reflux and tracheal aspiration detected with pH electrodes is similar with the Laryngeal Mask Airway® and Esophageal Tracheal Combitube® — a pilot study

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2004

Aspiration as a result of gastroesophageal reflux (GER) and regurgitation remains a serious poten... more Aspiration as a result of gastroesophageal reflux (GER) and regurgitation remains a serious potential problem in anesthetized patients. The incidence of GER with either the Esophageal Tracheal Combitube (ETC) or the laryngeal mask airway (LMA) was investigated using tracheal and esophageal pH electrodes. Following approval by the Institutional Review Board and written informed consent, 57 patients of ASA physical status I to III were randomly assigned to receive either an LMA (Group I, n = 28) or an ETC (Group II, n = 29) during general anesthesia. All patients were paralyzed and received positive pressure ventilation. Two monocrystalline antimony catheters were used for pH monitoring: one unipolar catheter with a single pH sensor for tracheal pH measurements and one bipolar catheter with proximal and distal sensors for pharyngeal and esophageal pH measurements, respectively. One episode of GER occurred in a patient in Group II, yet there were no pH changes reflected in the oropharyngeal or tracheal regions. There were 3/25 (12%) patients in Group I vs 1/25 (4%) patients in Group II that met the pH criterion for aspiration (pH below 4.0 that lasted at least 15 sec), yet no patient developed any clinical signs of aspiration. In all patients, hemodynamic and respiratory variables remained stable throughout the period of measurement (data not included). In this pilot study, the ETC appears comparable to the LMA regarding the incidence of GER and tracheal acid aspiration.

Research paper thumbnail of Room H, 10/17/2000 2: 00 PM - 4: 00 PM (PS) Teaching Peripheral Nerve Blocks to Anesthesiology Residents

Research paper thumbnail of An Evaluation of the Insertion and Function of a New Supraglottic Airway Device, the King LT ???, During Spontaneous Ventilation

Anesthesia & Analgesia, 2006

Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of... more Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I-III, Mallampati I-III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 microg/kg fentanyl and 1.5-2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. Insertion time, oropharyngeal leak pressures, fiberoptic position, and spirometry and hemodynamic data were recorded. Any complications were noted. Insertion was determined to be easy and a patent airway was achieved in all patients. First, second, and third attempt insertion rates were 86%, 12%, and 2%, respectively. Time to place the King LT trade mark was <5 s in 90% of cases. Baseline leak pressures were 31 +/- 8.8 cm H2O (17-50 cm H2O). Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT trade mark is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.

Research paper thumbnail of Endotrol-tracheal tube assisted endotracheal intubation during video laryngoscopy

Internal and emergency medicine, 2012

Video laryngoscopes allow indirect visualization of the glottis and provide superior views of the... more Video laryngoscopes allow indirect visualization of the glottis and provide superior views of the glottis compared to direct laryngoscopes in patients with both normal and difficult airways, but it may be difficult to advance the endotracheal tube (ETT) through the vocal cords into the trachea, unless a stylet is used. We propose that the Endotrol(®) ETT may be an effective tool to facilitate video laryngoscope-assisted orotracheal intubation without the use of a stylet. After obtaining written and oral informed consent, 60-adult patients scheduled for elective surgery requiring general anesthesia with orotracheal intubation were enrolled. Patients were randomized, respectively, to 1 of 4 groups: Group A(1), (15 patients): McGrath(®) with Endotrol(®) ETT; Group A(2), (15 patients): McGrath(®) with GlideRite(®)-styletted standard ETT; Group B(1), (15 patients): GlideScope(®) with Endotrol(®) ETT; Group B(2), (15 patients): GlideScope(®) with GlideRite(®)-styletted standard ETT. Stati...

Research paper thumbnail of In response

Research paper thumbnail of The Effect of Cricoid Pressure on the Unstable Cervical Spine

The Journal of emergency medicine, Jan 13, 2015

It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to... more It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to neurologic deterioration. We sought to examine the amount of motion cricoid pressure could cause at an unstable subaxial cervical spine injury, and whether posterior manual support is of any benefit. Five fresh, whole cadavers had complete segmental instability at C5-C6 surgically created by a fellowship-trained spine surgeon. Cricoid pressure was applied to the anterior cricoid by an attending anesthesiologist. In addition, the effect of posterior cervical support was tested during the trials. The amount of angular and linear motion between C5 and C6 was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). When cricoid pressure is applied, the largest angular motion was 3 degrees and occurred in flexion-extension at C5-C6. The largest linear displacement was 1.36 mm and was in anterior-posterior displacement of C5-C6. When...

Research paper thumbnail of L’incidence de reflux gastro-œsophagien et d’aspiration trachéale détectés au moyen d’électrodes à pH est similaire avec l’usage du Laryngeal Mask Airway® ou du Esophageal Tracheal Combitube® — une étude pilote

Research paper thumbnail of Inclusion of financial issues in the surgery cancellation categories introduced by Emanuel et al

Anaesthesia and intensive care, 2015

Research paper thumbnail of Laryngeal mask placement in a teaching institution: analysis of difficult placements

F1000Research, 2015

Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Alth... more Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program. This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved. Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%. In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.

Research paper thumbnail of Important Dose Correction

Journal of the American Academy of Child & Adolescent Psychiatry, 1993

Research paper thumbnail of Pharmacological Management of Pain in Children

Journal of the American Academy of Child & Adolescent Psychiatry, 1993

This article examines the use of analgesics and psychopharmacological adjuvants in children exper... more This article examines the use of analgesics and psychopharmacological adjuvants in children experiencing pain. Peripheral analgesics are effective for mild to moderate pain. Narcotics are effective but may produce dependence and tolerance as well as untoward side effects. Major tranquilizers, minor tranquilizers, tricyclic antidepressants, and stimulants have all been used as adjuvants in pain management. Major tranquilizers are now discouraged because of potential serious adverse effects. Benzodiazepines are relatively safe and decrease anxiety accompanying pain. Tricyclics may be used with caution. Stimulants have received little attention but may be useful in treating both pain and depression in the physically ill.

Research paper thumbnail of Associated malformations in infants with cleft lip and palate: A prospective, population-based study

Journal of Oral and Maxillofacial Surgery, 1998

Infants with cleft lip and palate may often have other associated congenital defects although the... more Infants with cleft lip and palate may often have other associated congenital defects although the reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalence of associated malformations in a geographically defined population. The prevalence of associated malformations in infants with clefts were collected prospectively between 1975 to 1992 on all infants born in greater Stockholm, Sweden. The patient records were also compared with data from the National Malformation Registry and other hospital records if any. Of the 616 cleft infants (367 boys, 249 girls) born during this period, 21% had associated malformations that either required follow-up or treatment. Associated malformations were more frequent in infants who had both cleft lip and palate (28%) than in infants with isolated cleft palate (22%) or infants with isolated cleft lip (8%). Malformations of the upper or lower limbs or the vertebral column were the most common other anomalies and accounted for 33% of all associated defects. Twenty-four percent of associated malformations were in the cardiovascular system and congenital heart disease was the most common isolated associated malformation. Fifteen percent of all associated malformations were multiple and they were frequently associated with mental retardation or chromosomal anomalies. Twenty-two percent of infants with associated malformations were born preterm, compared with an expected 5% incidence of preterm delivery in Sweden. A more extensive cleft seems to be associated with a higher risk for associated malformations. Although many associated congenital defects can be detected at a physical examination, the high prevalence of congenital heart disease (16 times that of general population) may justify a routine echocardiographic screening.

Research paper thumbnail of A two-person technique for fiberscope-aided tracheal extubation/reintubation in intensive care unit (ICU) patients

Journal of Clinical Anesthesia, 2003

The technique of fiberoptic-aided intubation for management of a difficult airway is often limite... more The technique of fiberoptic-aided intubation for management of a difficult airway is often limited in the presence of blood or secretions and conditions in which the passage of a fiberoptic bronchoscope ("fiberscope") beneath the epiglottis and into the glottic opening may prove difficult. Direct laryngoscopy can be utilized in combination with the fiberscope as a two-person technique to overcome these challenges. We report the usefulness of a two-person technique using the flexible fiberscope in combination with direct laryngoscopy for extubation/reintubation in two intensive care unit patients with known difficult airways.

Research paper thumbnail of Reply

Journal of Clinical Anesthesia, 2010

Research paper thumbnail of Use of the DCI video laryngoscope system in a pediatric patient with amniotic band syndrome and craniofacial abnormalities affecting the airway

Journal of Clinical Anesthesia, 2012

A 14 month old, 19 kg female infant with aminotic band syndrome and severe craniofacial malformat... more A 14 month old, 19 kg female infant with aminotic band syndrome and severe craniofacial malformations presented for placement of an open gastrostomy tube. Spontaneous ventilation was maintained while an "awake look" was performed with the video laryngoscope using intravenous propofol (30 mg total) for sedation. A Grade I Cormack-Lehane score was obtained on the monitor. Succinylcholine was then administered intravenously and orotracheal intubation was performed on the first attempt with a size 4.5 endotracheal tube.

Research paper thumbnail of The laryngeal mask airway for awake craniotomy in the pediatric patient: report of three cases

Journal of Clinical Anesthesia, 2004

The anesthetic management of three pediatric patients who underwent awake craniotomy with a combi... more The anesthetic management of three pediatric patients who underwent awake craniotomy with a combined, continuous intravenous infusion of propofol and alfentanil is described. The Laryngeal Mask Airway was effective in airway management during resection of epileptic foci with intraoperative cortical mapping and neuropsychological (speech) evaluation.

Research paper thumbnail of Training of residents in peripheral nerve blocks during anesthesiology residency

Journal of Clinical Anesthesia, 2002

To survey American anesthesiology residency program directors to determine the availability and e... more To survey American anesthesiology residency program directors to determine the availability and extent of training in peripheral nerve block techniques. Survey questionnaire was mailed and faxed to 132 American anesthesiology residency program directors and followed up 4 weeks later with another mailing to nonresponders. University medical center. Of the 132 American anesthesiology residency program directors surveyed, 69 (52%) responded. Of the responders, 40 (58%) offered a specific peripheral nerve block rotation. The rotation was of 1 month's duration in 61% of these programs. Formal instruction was administered during the rotation in 69%. The regional instruction approach consisted of a nerve stimulator (98%), paresthesia (75%), and transarterial (85%). Multimedia, mannequins, and cadaver dissection were used infrequently (13-25%). During the rotation, residents performed a variety of blocks, but the number of each block varied from 2 (supraclavicular) to 10 (axillary). These blocks were performed in the operating room in 48% of programs. Finally, in the programs with a specific peripheral nerve block rotation, residents were evaluated. Specific peripheral nerve block rotations are not always included in anesthesiology residents' curriculum. In addition, residents in programs with a specific nerve block rotation are exposed to a greater number of peripheral nerve block techniques than those who do not have such a rotation included in their curriculum.

Research paper thumbnail of Successful airway management of a patient with a known difficult airway with the Direct Coupler Interface Video Laryngoscope

Journal of Clinical Anesthesia, 2007

We present the case of a patient who first presented with unexpected difficult laryngoscopy and i... more We present the case of a patient who first presented with unexpected difficult laryngoscopy and intubation after induction of general anesthesia. After multiple failed attempts using direct laryngoscopy, tracheal intubation was successfully performed with the Intubating Laryngeal Mask Airway. He returned to the operating room 5 days later for another surgical procedure, and intubation was performed with the Direct Coupler Interface Video Laryngoscope on the first attempt by the same anesthesiologist.

Research paper thumbnail of A retrospective analysis of airway management in obese patients at a teaching institution

Journal of Clinical Anesthesia, 2009

To identify patient characteristics that influence the choice of awake fiberoptic intubation (AFI... more To identify patient characteristics that influence the choice of awake fiberoptic intubation (AFI) versus intubation after general anesthesia in obese patients. Retrospective study. Memorial Hermann Hospital, Houston, TX. Perioperative records of 283 obese patients [body mass index (BMI) >34 kg/m2] who underwent elective surgery between January 1991 and December 1999 were studied. Patients' data were divided into two groups according to method of induction and intubation: asleep direct laryngoscopy versus AFI. Patient demographics, BMI, Mallampati airway classification, history of gastroesophageal reflux disease, peptic ulcer disease, hiatal hernia, and obstructive sleep apnea syndrome were compared between the two groups. Bivariate and multivariate analyses were performed. AFI was performed in 12 (4.2%) obese patients, and direct laryngoscopy was performed in 271 (95.8%) obese patients. Difficult intubation was reported in 21 (7.4%) cases, and there were no reported cases of failed intubations. Bivariate analyses demonstrated that AFI patients were more likely to have a BMI > or = 60 kg/m2 (P < 0.001), Mallampati class III or IV airway (P < 0.001), and be men (P = 0.004). These three factors were also statistically significant in the multivariate logistic regression. In particular, each one kg/m(2) increase in BMI was associated with a 7% increased likelihood of AFI. Men were approximately 4 times likelier than women to have an AFI. Compared with patients with a Mallampati Class I or II airway, those with Mallampati Classes III or IV were about 26 times as likelier to have an AFI. Patients selected for AFI were predominantly men, with a Mallampati Class III or IV airway, and BMI > or = 60 kg/m2.

Research paper thumbnail of Class zero airway

European Journal of Anaesthesiology, 2013

Research paper thumbnail of The incidence of gastroesophageal reflux and tracheal aspiration detected with pH electrodes is similar with the Laryngeal Mask Airway® and Esophageal Tracheal Combitube® — a pilot study

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2004

Aspiration as a result of gastroesophageal reflux (GER) and regurgitation remains a serious poten... more Aspiration as a result of gastroesophageal reflux (GER) and regurgitation remains a serious potential problem in anesthetized patients. The incidence of GER with either the Esophageal Tracheal Combitube (ETC) or the laryngeal mask airway (LMA) was investigated using tracheal and esophageal pH electrodes. Following approval by the Institutional Review Board and written informed consent, 57 patients of ASA physical status I to III were randomly assigned to receive either an LMA (Group I, n = 28) or an ETC (Group II, n = 29) during general anesthesia. All patients were paralyzed and received positive pressure ventilation. Two monocrystalline antimony catheters were used for pH monitoring: one unipolar catheter with a single pH sensor for tracheal pH measurements and one bipolar catheter with proximal and distal sensors for pharyngeal and esophageal pH measurements, respectively. One episode of GER occurred in a patient in Group II, yet there were no pH changes reflected in the oropharyngeal or tracheal regions. There were 3/25 (12%) patients in Group I vs 1/25 (4%) patients in Group II that met the pH criterion for aspiration (pH below 4.0 that lasted at least 15 sec), yet no patient developed any clinical signs of aspiration. In all patients, hemodynamic and respiratory variables remained stable throughout the period of measurement (data not included). In this pilot study, the ETC appears comparable to the LMA regarding the incidence of GER and tracheal acid aspiration.

Research paper thumbnail of Room H, 10/17/2000 2: 00 PM - 4: 00 PM (PS) Teaching Peripheral Nerve Blocks to Anesthesiology Residents

Research paper thumbnail of An Evaluation of the Insertion and Function of a New Supraglottic Airway Device, the King LT ???, During Spontaneous Ventilation

Anesthesia & Analgesia, 2006

Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of... more Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I-III, Mallampati I-III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 microg/kg fentanyl and 1.5-2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. Insertion time, oropharyngeal leak pressures, fiberoptic position, and spirometry and hemodynamic data were recorded. Any complications were noted. Insertion was determined to be easy and a patent airway was achieved in all patients. First, second, and third attempt insertion rates were 86%, 12%, and 2%, respectively. Time to place the King LT trade mark was <5 s in 90% of cases. Baseline leak pressures were 31 +/- 8.8 cm H2O (17-50 cm H2O). Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT trade mark is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.