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Journal of cardiothoracic and vascular anesthesia 10/2010; 24(5):845-58. · 1.06 Impact Factor
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ABSTRACT: Informatics is a broad field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. The goal of this review is to illustrate how Web 2.0 information technologies could be used to improve anesthesia education.
Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education of housestaff. These technologies include microblogging, blogs, really simple syndication (RSS) feeds, podcasts, wikis, and social bookmarking and networking. 'Anesthesia 2.0' reflects our expectation that these technologies will foster innovation and interactivity in anesthesia-related web resources which embraces the principles of openness, sharing, and interconnectedness that represent the Web 2.0 movement. Although several recent studies have shown benefits of implementing these systems into medical education, much more investigation is needed.
Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold great promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed. Thoughtful research to maximize implementation of these technologies should be a priority for development by academic anesthesiology departments. Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.
Current opinion in anaesthesiology 04/2010; 23(2):218-27.
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International anesthesiology clinics 01/2010; 48(3):xi-xii.
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Viji Kurup
International anesthesiology clinics 01/2010; 48(3):123-9.
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Viji Kurup
International anesthesiology clinics 01/2010; 48(3):13-25.
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International anesthesiology clinics 01/2010; 48(3):61-82.
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ABSTRACT: Direct thrombin inhibitors (DTIs) provide an alternative method of anticoagulation for patients with a history of heparin-induced thrombocytopenia (HIT) or HIT with thrombosis (HITT) undergoing cardiopulmonary bypass (CPB). In the following report, a 65-year-old critically ill patient with a suspected history of HITT was administered argatroban for anticoagulation on bypass during heart transplantation. The patient required massive transfusion support (55 units of red blood cells, 42 units of fresh-frozen plasma, 40 units of cryoprecipitate, 40 units of platelets, and three doses of recombinant Factor VIIa) for severe intraoperative and postoperative bleeding.
Plasma samples from before and after CPB were analyzed postoperatively for argatroban concentration using a modified ecarin clotting time (ECT) assay.
Unexpectedly high concentrations of argatroban were measured in these samples (range, 0-32 microg/mL), and a prolonged plasma argatroban half life (t(1/2)) of 514 minutes was observed (published elimination t(1/2) is 39-51 minutes [< or = 181 minutes with hepatic impairment]).
Correlation of plasma argatroban concentration versus the patient's coagulation variables and clinical course suggest that prolonged elevated levels of plasma argatroban may have contributed to the patient's extended coagulopathy. Because DTIs do not have reversal agents, surgical teams and transfusion services should remain aware of the possibility of massive transfusion events during anticoagulation with these agents. This is the first report to measure plasma argatroban concentration in the context of CPB and extended coagulopathy.
Transfusion 12/2009; 50(4):801-7. · 3.22 Impact Factor
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ABSTRACT: There has been an explosion of medical information in the past decade. Current clinical practice demands that anesthesiologists be aware of current treatments and procedures, along with the latest practice standards and guidelines. The need to be able to rapidly retrieve relevant, accurate clinical information at the point of care is now felt more than ever. This review explores the impact of clinical medical librarians, with particular emphasis on their application in the perioperative setting.
An increasing number of hospitals are turning to medical librarians to help clinicians improve their information-seeking skills. As a result, the role of medical librarians has expanded dramatically. Most studies evaluating the effectiveness of clinical medical librarian programs support their value in clinical teams, yet the studies rely primarily on descriptive surveys and qualitative data.
Anesthesiologists have particular information needs for which the physical library is no longer sufficient. New outcome measures to define the 'success' of clinical medical librarian programs need to be formulated, and economic considerations need to be factored into these programs.
Current Opinion in Anaesthesiology 01/2008; 20(6):585-9. · 2.21 Impact Factor
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Anesthesia and analgesia 04/2007; 104(3):507-8. · 3.08 Impact Factor
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ABSTRACT: Patients who have valvular heart disease coming for surgery present many challenges to the anesthesiologist. Over the past 3 decades there has been a persistent improvement in our understanding of the pathophysiology of valvular heart disease and in the surgical techniques for correcting it. With the development of efficient and safe noninvasive monitoring of cardiac function, new surgical techniques, better designs of prosthetic valves, and the development of useful guidelines for choosing the proper timing of surgical intervention, patients who have valvular disease with varying physiology can be encountered in the perioperative period. The perioperative physician has to be aware of the varying effects of hemodynamic variables on this subpopulation of patients.
Anesthesiology Clinics 10/2006; 24(3):487-508, vi.
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ABSTRACT: Heparin-induced thrombocytopenia (HIT) is being recognized in an increasing number of patients referred for cardiac surgery, as a result of previous exposure to heparin. We present a case of a patient with HIT scheduled for aortic valve replacement and coronary bypass graft surgery, who was managed with the direct thrombin inhibitor, argatroban for anticoagulation during cardiopulmonary bypass (CPB). The patient sustained continued bleeding in excess of the acknowledged half-life of the drug and required a substantial number of blood products to restore coagulation following CPB. Pertinent reports using argatroban for cardiac surgery with CPB are reviewed in the context of the present case report. The pharmacologic basis, cost analysis and resource utilization of heparin substitutes are discussed for the patient with HIT requiring CPB.
Connecticut medicine 05/2006; 70(4):245-50.
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ABSTRACT: Neuraxial blockade is known to have a sedative effect, decreasing the need for inhalational and iv anesthetic agents. The purpose of the present study was to quantify the sedative effect of spinal anesthesia and to determine the time of maximum sedation.
This is an observational study in which 20 unsedated patients were scheduled to undergo urologic and orthopedic surgeries under spinal anesthesia. Patients with pre-existing neurological conditions or receiving psychotropic medications were excluded from the study. All received 1.5 mL (11.25 mg) of hyperbaric bupivacaine 0.75% intrathecally. No sedative or narcotic was administered intravenously or intrathecally. The Patient State Analyzer, (PSA-4000) was used to monitor sedation along with Observer's Assessment of Alertness and Sedation (OAA/S) scores every five minutes. Differences in patient state index (PSI) and OAA/S scores are expressed as median and range and were evaluated by Wilcoxon's signed rank test for non-parametric data; P < 0.05 was considered significant. PSI, OAA/S and time at lowest score are expressed as median(range).
PSI scores decreased from baseline 99 (96-99) to 78 (56-87) at 35(14.5-54) min into the spinal anesthetic (P < 0.05). OAA/S scores decreased from baseline 5 to 4 (range 3-5) at the time of the lowest PSI scores (P < 0.05).
In this elderly patient population, spinal anesthesia induced changes in the processed electroencephalogram with reduction in PSI and OAA/S scores. The reduction in afferent input to the reticular activating system could possibly explain the sedation that has been observed and the reduction in the PSA scores.
Canadian Journal of Anaesthesia 51(6):562-5. · 2.35 Impact Factor
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Regional anesthesia and pain medicine 34(5):527-8. · 4.16 Impact Factor
