Paul C Fitzgerald

University of Illinois at Chicago, Chicago, Illinois, United States

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Publications (35)96.38 Total impact

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    ABSTRACT: To estimate an effect size for the transversus abdominis plane (TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40 (QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range (IQR)] of 175.5 (170-189) compared to 170 (160-175) in the control group (P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median (IQR) of 7.5 (2.5-11.5) mg iv morphine equivalents compared to 13 (7-21.5) in the control group (P = 0.07). Correlation analysis (Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores, -0.49 (P = 0.03). The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.
    World journal of gastrointestinal surgery. 02/2014; 6(2):27-32.
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    ABSTRACT: Background: It remains to be determined if perioperative systemic magnesium can improve postoperative quality of recovery of patients undergoing ambulatory procedures. The main objective of the current investigation was to evaluate the effect of systemic magnesium on postoperative quality of recovery in patients undergoing outpatient segmental mastectomies. Methods: The study was a prospective randomized, double-blind, placebo-controlled, clinical trial. Female subjects were randomized to receive intravenous magnesium (MgSO4 50mg/kg in 100 mL of normal saline over 15 min before anesthesia induction, followed by an infusion of 15 mg/kg/hour) or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Results: 50 subjects were recruited and 46 completed the study. Patients in the magnesium group had better global Quality of Recovery scores compared with the saline group, with a median difference of 24 (99% CI, 3 to 33), P<0.001. After discharge from hospital, subjects in the magnesium group required less oral opioids, median (IQR) of 10 (0 to 20) (oral milligrams of morphine equivalents) than the saline group, 30 (20 to 40) (P<0.001). The postoperative systemic magnesium concentrations were substantially higher in the magnesium group, 1.25 ± 0.28 mmol/L compared to control, 0.71 ± 0.11 mmol/L, P<0.0001. Simple linear regression demonstrated a direct linear relationship between the postoperative systemic magnesium concentrations and 24 hour postoperative quality of recovery scores (P = 0.004), and also an inverse relationship with pain burden in the postoperative care unit (P = 0.01). Conclusions: Systemic magnesium improves postoperative quality of recovery in patients undergoing outpatient segmental mastectomy. Systemic magnesium is a safe, inexpensive, efficacious strategy to improve quality of recovery after ambulatory surgery.
    Magnesium research: official organ of the International Society for the Development of Research on Magnesium 02/2014; · 1.38 Impact Factor
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    ABSTRACT: To compare if mastectomy with reconstructive surgery had greater incidence of chronic pain compared to mastectomy surgery alone. The study was a retrospective cohort. Patients who underwent mastectomies with and without reconstruction responded to the modified short form Brief Pain Inventory and the short form McGill pain questionnaire to identify and characterize pain at least 6 months after the surgical procedure. Propensity matching analysis was used to control for covariates differences in the study groups. 310 subjects were included and 132 patients (43%) reported the presence of chronic pain. After propensity score matching to adjust for covariate imbalances, the incidence of chronic pain in the mastectomy group who had additional surgery for breast reconstruction was not different compared to the group who had mastectomy surgery alone, 26 out of 68 (38%) and 27 out of 68 (39%), respectively P = 1.0. Among patients who had chronic pain, breast reconstruction did not increase the intensity of worst pain in the last 24 h, median (IQR) of 2 (1-5) compared to 4 (1-5) in the no reconstruction group, P = 0.41. Type of reconstruction (breast implants vs. flap tissue) did not result in greater incidence and/or intensity of chronic pain. Breast reconstruction after mastectomy does not result in a greater incidence of chronic pain compared to mastectomy alone. Female patients undergoing breast cancer surgery should not incorporate chronic pain in their decision to undergo reconstructive surgery after mastectomy.
    Breast (Edinburgh, Scotland) 01/2014; · 2.09 Impact Factor
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    ABSTRACT: Basic science studies suggest that perioperative immune impairment may augment the risk of cancer recurrence after otherwise potentially curative surgery. Despite its immunosuppressant properties, dexamethasone is commonly given to oncologic patients in an effort to reduce postoperative nausea and vomiting. We therefore tested the hypothesis that perioperative dexamethasone administration increases the risk of ovarian cancer recurrence. Women who had primary ovarian cytoreductive surgery between January 1997 and October 2007 were identified using a database maintained by the division of Gynecologic Oncology at Northwestern University. Tumor recurrence in women given perioperative systemic dexamethasone (4-10 mg) was compared with those who did not receive dexamethasone. The primary outcome was the propensity-matched time to cancer recurrence. Recurrence was defined by a carcinoantigen 125 >21 U/mL or computerized tomography evidence of the disease followed by tissue confirmation. Median difference and 95% confidence interval between the propensity-matched groups were calculated using a 10,000 sample bootstrap. Among 260 women having primary cytoreductive surgery for ovarian cancer that met our inclusion criteria, 102 subjects were given perioperative systemic dexamethasone. Cancer recurrence was observed in 178 subjects, and the overall unadjusted median (IQR) time to recurrence was 18 (7-50) months. Eighty-seven cases and 87 controls were propensity matched to adjust for confounding covariates. After propensity matching the groups for confounding covariates, the median (IQR) time to recurrence in the dexamethasone group was 23 (6-46) compared with 18 (8-53) months in the control group (P = 0.63) with a median (95% confidence interval) difference of time to recurrence between the dexamethasone and the control group of 5 (-8 to 17) months. We could not find evidence for an association between perioperative systemic dexamethasone administration and ovarian cancer recurrence after primary cytoreductive surgery. Our results do not support avoiding low-dose perioperative dexamethasone for prevention of postoperative nausea, vomiting, and pain in ovarian cancer patients.
    Anesthesia and analgesia 12/2013; · 3.08 Impact Factor
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    ABSTRACT: Hypoventilation is a major cause of morbidity and mortality in patients having procedures under sedation. Few clinical strategies have been evaluated to reduce intraoperative hypoventilation during surgical procedures under deep sedation. The primary objective of this investigation was to examine the effect of ketamine on hypoventilation in patients receiving deep sedation for surgery with midazolam and propofol. The study was a randomised, placebo-controlled, double-blind clinical trial. Intraoperative. Healthy women undergoing breast surgery. Randomised to receive ketamine (0.5 mg kg bolus, followed by an infusion of 1.5 μg kg min) or isotonic saline. Duration of hypercapnia measured continuously with a transcutaneous carbon dioxide (TCO2) monitor. Fifty-four participants were recruited. Patient and surgical characteristics were similar between the study groups. The median percentage of the sedation time with TCO2 more than 6.7 kPa in participants in the ketamine group, 1.2% (95% confidence interval, CI, 0 to 83), was less than that in the isotonic saline group (65%, 95% CI, 0 to 88; P = 0.01). Severe hypoventilation (TCO2 >8.0 kPa) was also less in the ketamine group, median 0% (95% CI, 0 to 11.7) compared with 28% (95% CI, 0 to 79.3; P = 0.0002) for the isotonic saline group. The ketamine group required less airway manoeuvres (chin lift) to keep the SaO2 greater than 95% median (95% CI) [0 (0 to 3) compared with 3 (0 to 16) in the isotonic saline group] (P = 0.004). Ketamine decreased the duration and severity of hypercapnia in patients undergoing deep sedation with propofol. The addition of ketamine may reduce hypoventilation and adverse effects in patients having procedures under sedation. clinicaltrials.gov identifier: NCT01535976.
    European Journal of Anaesthesiology 11/2013; · 2.79 Impact Factor
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    ABSTRACT: To compare time to awakening and upper airway morbidity between desflurane and sevoflurane using a Laryngeal Mask Airway (LMA) and a balanced anesthetic regimen inclusive of opioids. Randomized, double-blinded, placebo-controlled clinical trial. Ambulatory surgery unit of a university hospital. 80 subjects receiving general anesthesia for outpatient gynecological surgery using a LMA. Desflurane/fentanyl or sevoflurane/fentanyl was used for anesthetic maintenance. Patients were randomly assigned to receive desflurane or sevoflurane. The primary outcome was time to awakening as determined by an observer who was blinded to study group allocation. Secondary outcomes included the frequency of sore throat, cough, and pain perioperatively and at 2 and 24 hours postoperatively. Quality of recovery (QoR; via QoR-40 questionnaire) at 24 hours also was determined. The median (IQR) time to eye opening following desflurane was 6.8 (5.0 - 9.8) minutes versus 11.8 (8.8 - 14.6) minutes following sevoflurane (P < 0.001), or a difference 5.0 (99% CI 2.3 - 6.8) minutes. The median difference in response to verbal commands was 5.3 (99% CI 2.4 - 7.1) minutes. The frequency of cough, laryngospasm, sore throat, and hoarseness did not differ between groups. Quality of recovery at 24 hours was better in the desflurane group: difference in medians 6 (99% CI 0 - 12; P = 0.003). Desflurane retains faster awakening properties than does sevoflurane when used in combination with fentanyl as part of an anesthetic maintenance in outpatient surgery with a LMA. The balanced anesthetic maintenance regimen seems to reduce potential airway reactivity properties of desflurane.
    Journal of clinical anesthesia 10/2013; · 1.32 Impact Factor
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    ABSTRACT: Few multimodal strategies to minimize postoperative pain and improve recovery have been examined in morbidly obese patients undergoing laparoscopic bariatric surgery. The main objective of this study was to evaluate the effect of systemic intraoperative lidocaine on postoperative quality of recovery when compared to saline. The study was a prospective randomized, double-blinded placebo-controlled clinical trial. Subjects undergoing laparoscopic bariatric surgery were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the quality of recovery 40 questionnaire at 24 h after surgery. Fifty-one subjects were recruited and 50 completed the study. The global QoR-40 scores at 24 h were greater in the lidocaine group median (IQR) of 165 (151 to 170) compared to the saline group, median (IQR) of 146 (130 to 169), P = 0.01. Total 24 h opioid consumption was lower in the lidocaine group, median (IQR) of 26 (19 to 46) mg IV morphine equivalents compared to the saline group, median (IQR) of 36 (24 to 65) mg IV morphine equivalents, P = 0.03. Linear regression demonstrated an inverse relationship between the total 24 h opioid consumption (IV morphine equivalents) and 24 h postoperative quality of recovery (P < 0.0001). Systemic lidocaine improves postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery. Patients who received lidocaine had a lower opioid consumption which translated to a better quality of recovery.
    Obesity Surgery 09/2013; · 3.10 Impact Factor
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    ABSTRACT: We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.
    Anaesthesia 08/2013; · 3.49 Impact Factor
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    ABSTRACT: To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA). Systematic review and meta-analysis of randomized controlled trials (RCTs). Operating room of an academic medical center. Following PRISMA guidelines, we performed a systematic review of RCTs of patients receiving general anesthesia with a LMA. Sevoflurane and desflurane were used for maintenance of anesthesia in the RCTs. A wide search was performed to identify RCTs comparing desflurane with sevoflurane on the incidence of upper respiratory adverse events in patients undergoing surgery with a LMA. The primary outcomes were incidence of cough and laryngospasm. A random-effects model was used to perform quantitative analysis. Data originating from 7 studies comprising 657 subjects were analyzed. The confidence interval (CI) was large relative to a clinically significant difference in the incidence of overall cough and laryngospasm in patients receiving desflurane versus sevoflurane (odds ratio [OR; 95% CI] of 1.44 [0.49 - 4.1] and 3.06 [0.43 - 21.62]), respectively. The incidence of cough at emergence was greater in subjects receiving desflurane compared with sevoflurane (OR [95% CI] of 2.43 [1.2 - 4.7], number needed to harm [NNH] = 9.0); however, the analysis was limited by the presence of an asymmetric funnel plot suggesting the possibility of publication bias. There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.
    Journal of clinical anesthesia 08/2013; · 1.32 Impact Factor
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    ABSTRACT: BACKGROUND:The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.METHODS:A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees' demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.RESULTS:There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference -2; 99.6% CI, -1 to -2; P < 0.001) or high risk of burnout and depression (difference -4; 99.6% CI, -3 to -6; P < 0.001) were lower than scores of residents at low risk for burnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).CONCLUSION:Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.
    Anesthesia and analgesia 05/2013; · 3.08 Impact Factor
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    ABSTRACT: BACKGROUND:Poor supervision of physician trainees can be detrimental not only to resident education but also to patient care and safety. Inadequate supervision has been associated with more frequent deaths of patients under the care of junior residents. We hypothesized that residents reporting more medical errors would also report lower quality of supervision scores than the ones with lower reported medical errors. The primary objective of this study was to evaluate the association between the frequency of medical errors reported by residents and their perceived quality of faculty supervision.METHODS:A cross-sectional nationwide survey was sent to 1000 residents randomly selected from anesthesiology training departments across the United States. Residents from 122 residency programs were invited to participate, the median (interquartile range) per institution was 7 (4-11). Participants were asked to complete a survey assessing demography, perceived quality of faculty supervision, and perceived causes of inadequate perceived supervision. Responses to the statements "I perform procedures for which I am not properly trained," "I make mistakes that have negative consequences for the patient," and "I have made a medication error (drug or incorrect dose) in the last year" were used to assess error rates. Average supervision scores were determined using the De Oliveira Filho et al. scale and compared among the frequency of self-reported error categories using the Kruskal-Wallis test.RESULTS:Six hundred four residents responded to the survey (60.4%). Forty-five (7.5%) of the respondents reported performing procedures for which they were not properly trained, 24 (4%) reported having made mistakes with negative consequences to patients, and 16 (3%) reported medication errors in the last year having occurred multiple times or often. Supervision scores were inversely correlated with the frequency of reported errors for all 3 questions evaluating errors. At a cutoff value of 3, supervision scores demonstrated an overall accuracy (area under the curve) (99% confidence interval) of 0.81 (0.73-0.86), 0.89 (0.77-0.95), and 0.93 (0.77-0.98) for predicting a response of multiple times or often to the question of performing procedures for which they were not properly trained, reported mistakes with negative consequences to patients, and reported medication errors in the last year, respectively.CONCLUSIONS:Anesthesiology trainees who reported a greater incidence of medical errors with negative consequences to patients and drug errors also reported lower scores for supervision by faculty. Our findings suggest that further studies of the association between supervision and patient safety are warranted.
    Anesthesia and analgesia 02/2013; · 3.08 Impact Factor
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    ABSTRACT: Background. The mechanism for pain associated with intravenous administration of propofol is believed to be related to the release of nitric oxide. We hypothesized that pain following propofol injection would be reduced by pretreatment with dexamethasone. Methods. One hundred fourteen female subjects received 5 mL of preservative-free saline, 0.5 mg · kg(-1) of lignocaine hydrochloride 10 mg · mL(-1) or 0.25 mg · kg(-1) of dexamethasone, intravenously, following exsanguination and occlusion of the veins of the arm. This was followed by a 0.5 mg · kg(-1) injection of propofol. Pain scores, facial grimacing, arm withdrawal, and vocalization were recorded prior to and at 15 and 30 seconds following the injection of propofol. Results. The incidence of moderate to severe pain following the injection of propofol was significantly decreased with both lidocaine and dexamethasone. Hand withdrawal was also significantly decreased in comparison to saline. Conclusion. Low dose dexamethasone is commonly used as an antiemetic, and, in larger doses, it has been demonstrated to provide prolonged postoperative analgesia. At higher analgesic doses, dexamethasone may also reduce pain associated with the injection of propofol. This effect is probably related to the effect of the steroid on nitric oxide production associated with intravenous propofol injection.
    Pain research and treatment. 01/2013; 2013:734531.
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    ABSTRACT: Admission to an anesthesiology residency in the United States is competitive, and the odds associated with a successful match based on the applicants' characteristics have not been determined. The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. The study was a retrospective cohort evaluation of the 2010 to 2011 residency applicants. Applicants' characteristics and objective factors used to select trainees were extracted. The primary outcome was a successful match to an anesthesiology residency. Data were analyzed using conditional inference tree analysis and propensity score matching. Data available from 1,976 applications were examined corresponding to 58% of the national sample. The odds (99% CI) for successful match were 3.6 (3.1-4.2) for U.S. medical school graduates, 2.6 (2.3 to 3.0) for applicants with United States Medical Licensing Examination Step 2 scores more than 210, and 1.2 (1.1 to 1.3) for female applicants. The odds (99% CI) for a successful match for international and U.S. graduate applicants younger than 29 yr was 3.3 (2.0-5.4) and (1.9 to 4.2), respectively, even after propensity matching for medical school, exam scores, and gender. The average applicant had no peer-reviewed scholarly productivity. Although anesthesiology residency acceptance was primarily associated with U.S. medical school attendance and United States Medical Licensing Examination Step 2 scores, our study suggest an influence of age and gender bias in the selection process. Peer-reviewed scholarly production among applicants and prior graduate education did not appear to influence candidate selection.
    Anesthesiology 06/2012; 117(2):243-51. · 5.16 Impact Factor
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    ABSTRACT: Perioperative systemic lidocaine has been shown to have beneficial postoperative analgesic effects. The only previous study examining the use of lidocaine in the outpatient setting did not detect an opioid-sparing effect after hospital discharge. More importantly, it is unknown whether systemic lidocaine provides a better postoperative quality of recovery to patients undergoing ambulatory surgery. Our objective in the current study was to examine the effect of systemic lidocaine on postoperative quality of recovery in patients undergoing outpatient laparoscopic surgery. The study was a prospective, randomized, double-blind, placebo-controlled clinical trial. Healthy female subjects were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the Quality of Recovery-40 questionnaire at 24 hours after surgery. A 10-point difference represents a clinically relevant improvement in quality of recovery based on previously reported values on the mean and range of the Quality of Recovery-40 score in patients after anesthesia and surgery. Other data collected included opioid consumption, pain scores, and time to meet hospital discharge. Data were compared using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman ρ. P < 0.01 was used to reject the null hypothesis for the primary outcome. Seventy subjects were recruited and 63 completed the study. There were no baseline differences regarding subject and surgical characteristics between the study groups. Patients in the lidocaine group had better global quality of recovery scores compared with the saline group, median difference of 16 (99% confidence interval [CI], 2-28), P = 0.002. Patients in the lidocaine group met hospital discharge criteria faster than the saline group, mean difference of -26 minutes (95% CI, -6 to -46 minutes) (P = 0.03). After hospital discharge, subjects in the lidocaine group required less oral opioids, median difference of -10 (95% CI, 0 to -30) (oral milligrams morphine equivalents), than the saline group (P = 0.01). There was an inverse association between postoperative opioid consumption and quality of recovery (ρ = 0.64, P < 0.001). Systemic lidocaine improves postoperative quality of recovery in patients undergoing outpatient laparoscopy. Patients who received lidocaine had less opioid consumption, which translated to a better quality of recovery. Lidocaine is a safe, inexpensive, effective strategy to improve quality of recovery after ambulatory surgery.
    Anesthesia and analgesia 05/2012; 115(2):262-7. · 3.08 Impact Factor
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    ABSTRACT: Publication bias occurs because positive finding studies are more likely to be published. The dearth of studies of negative or equivalence findings can erroneously affect future research and potentially clinical care of patients. We hypothesized that positive studies were more likely to be published than negative studies in anesthesiology journals with a higher impact and circulation. A PubMed search for controlled trials in humans published in peer-reviewed anesthesiology journals during 2008 and 2009 was performed. Fourteen anesthesiology journals and 1163 studies were evaluated. The average clinical trial impact factor (average citations per article) for each journal was determined. The quartiles for the clinical trial impact factor for the journals included in the analysis were 4, 6.1, and 9.1. Studies were scored by 2 raters as positive or negative results of the primary stated outcome. Factors previously associated with publication were also extracted. The primary outcome, the proportion of positive and negative studies in the journals in the upper quartile of the clinical trial impact factor to the lower quartiles was compared using the Fisher exact test. The odds ratio for the effect of positive study results adjusted for other characteristics associated with publication was determined using binary logistic regression. A multinomial logistic regression model was fitted for the journals with an impact factor in the upper quartile with adjustment for study trial registration, origin of publication, positive study findings, reporting of treatment blinding, reporting of subject withdrawals, study sponsorship, and description of the randomization method. Positive finding studies were identified in 72% (425 of 588) of articles in journals with a clinical trial impact factor >9.1 compared with 53% (308 of 575) in journals <9.1 (P < 0.001). After adjusting for factors associated with publication, positive study results had an odds ratio (95% confidence interval) of 2.28 (1.76-3.01) for publication in an anesthesiology journal in the upper quartile. Multinomial logistic regression identified positive study findings associated with an increased likelihood of publication in 3 of the 4 anesthesiology journals with a clinical trial impact factor >9.1. This study reports the presence of publication bias in the anesthesiology literature especially in higher clinical trial impact factor journals. Publication bias can have potential implications for future research and the clinical care of patients. Authors should be encouraged to submit negative studies to high impact journals and the journals should be encouraged to evaluate the editorial process as the cause of publication bias.
    Anesthesia and analgesia 02/2012; 114(5):1042-8. · 3.08 Impact Factor
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    ABSTRACT: To evaluate the association between perioperative blood transfusion on the recurrence and survival of patient with advanced ovarian cancer. Cytoreductive surgery for ovarian cancer can be an extensive procedure often requiring allogeneic blood transfusions. Blood transfusions can have detrimental effects on immune function which can lead to a decrease in the organism ability to detect and destroy metastasis. The study was a retrospective cohort investigation. Patients with advanced ovarian cancer (stage III) undergoing cytoreductive surgery were stratified by the need for perioperative blood transfusion. Allogeneic transfusions were non-leucodepleted. Primary outcome included time to recurrence and survival. Data were extracted from the gynaecology oncology database at Northwestern University. Times to event outcomes were evaluated by constructing Kaplan-Meyer curves and Cox regression. The charts of 136 subjects were evaluated. Seventy-six received blood transfusion. Median [95% confidence interval (CI)] time to recurrence for the non-transfusion group was longer, i.e. 17 (6-27) months, compared to 11 (8-14) months for the transfused group (P = 0.03). Median (95% CI) survival following surgery was longer in the non-transfused group, i.e. 58 (43-73) months, compared to 36 (28-44) months for the transfused group (P = 0.04). Cox regression showed that transfused subjects had shorter median times to recurrence and mortality after adjusting for age and tumour grade. There is an association between ovarian cancer recurrence and allogeneic perioperative blood transfusion in patients with advanced ovarian cancer undergoing cytoreductive surgery. These findings may have important implications in the perioperative management of those patients.
    Transfusion Medicine 12/2011; 22(2):97-103. · 1.26 Impact Factor
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    ABSTRACT: To examine the effect of a preoperative transversus abdominis plane infiltration on postoperative quality of recovery and analgesia in patients undergoing laparoscopic hysterectomy. The study was a randomized, double-blinded, placebo-controlled trial. Seventy-five healthy women were randomized to receive a preoperative infiltration with 0.5% ropivacaine, 0.25% ropivacaine, or saline. Postoperative quality of recovery score (QoR-40), pain, and opioid consumption were assessed up to 24 hours after the surgical procedure. Data were analyzed using Kruskal-Wallis test. Post hoc pair-wise comparisons were made using Dunn test. P<.05 was required to reject the null hypothesis. Sixty-six patients completed the study. Patients' baseline characteristics and surgical factors were not different between groups. The ropivacaine group experienced a better quality recovery and less postoperative pain than the saline group. The median difference (99.2% confidence interval) in global recovery scores at 24 hours after surgery was 28 (QoR score 4-39, P=.001) for ropivacaine 0.5% and 28 (QoR score 10-43, P<.001) for ropivacaine 0.25% compared with saline, respectively. The 0.5% ropivacaine group also had less pain, lower opioid consumption, and faster postanesthesia care unit discharge than the saline group. Linear regression demonstrated an inverse relationship between opioid consumption and global quality of recovery at 24 hours (P<.001). The transversus abdominis plane infiltration improves quality of recovery. There was an inverse linear relationship between postoperative opioid consumption and quality of recovery. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01074229. I.
    Obstetrics and Gynecology 12/2011; 118(6):1230-7. · 4.80 Impact Factor
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    ABSTRACT: Processed EEG monitoring during cardiopulmonary bypass (CPB) may help determine loss of consciousness and depth of anesthesia. This study compared the SNAP(™) II and BIS Vista monitors in patients undergoing isoflurane anesthesia with normothermic CPB. 40 subjects undergoing CPB with isoflurane anesthesia were enrolled. Subjects were premedicated with 1-2 mg midazolam approximately 5 min prior to acquisition of baseline index values and anesthesia induced with midazolam and fentanyl. Anesthesia was maintained with isoflurane, midazolam, and fentanyl and a cis-atracurium infusion. SNAP(™) II (version 1.2.9 algorithm 1.88) and BIS Vista (application version 3.00 platform version 2.03) indices were recorded at baseline, pre-induction, post-intubation, incision, start of CPB, every 15 min during CPB, end of CPB, and end of case. Agreement between methods was determined using Pearson correlation and the Bland-Altman method with repeated observa- tions. Twenty-four male and 12 female subjects completed the analysis. The correlation between SNAP(™) II and BIS Vista index values was 0.61 (P < 0.005). A linear relationship between the difference in the indices and the average index values was observed following the induction of anesthesia. In awake subjects, the bias between the SNAP(™) II and BIS Vista was 5 (95% CI 3-7). The limits of agreement were 23 (95% CI 19-26) and -13 (95% CI -9--16). During anesthesia, the mean difference on a log scale was 0.11 (95% CI 0.09-0.12). The limits of agreement were 0.43 (95% CI 0.40-0.45) and -0.21 (95% CI -0.18--0.24). The antilog of the mean difference demonstrated that the SNAP(™) II value was 28% (95% CI 24-33%) higher than the BIS Vista value following induction of anesthesia. The SNAP(™) II monitor demonstrates a consistently positive bias during cardiopulmonary bypass under isoflurane anesthesia compared with the BIS Vista.
    International Journal of Clinical Monitoring and Computing 11/2011; 25(6):365-70.
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    ABSTRACT: Postoperative pain can delay functional recovery after outpatient surgery. Multimodal analgesia can improve pain and possibly improve quality of recovery. In this study, we evaluated the dose-dependent effects of a preoperative transversus abdominis plane (TAP) block on patient recovery using the Quality of Recovery 40 (QoR-40) questionnaire after ambulatory gynecological laparoscopic surgery. Global QoR-40 scores range from 40 to 200, representing very poor to outstanding quality of recovery, respectively. Healthy women undergoing outpatient gynecological laparoscopy were randomly allocated to receive a preoperative TAP block using saline, ropivacaine 0.25%, or ropivacaine 0.5%. Needle placement for the TAP blocks was performed using ultrasound guidance and 15 mL of the study solution was injected bilaterally by a blinded investigator. QoR-40 score and analgesic use were assessed 24 hours postoperatively. The primary outcome was global QoR-40 score at 24 hours after surgery. Data were analyzed using the Kruskal-Wallis test. Post hoc pairwise comparisons were made using the Dunn test with P values and 95% confidence intervals Bonferroni corrected for 6 comparisons. Seventy-five subjects were enrolled and 70 subjects completed the study. The median (range) for the QoR-40 score after the TAP block was 157 (127-193), 173 (133-195), and 172 (130-196) for the saline group and 0.25% and 0.5% ropivacaine groups, respectively. The median difference (99.2% confidence interval) in QoR-40 score for 0.5% bupivacaine (16 [1-30], P=0.03) and 0.25% bupivacaine (17 [2-31], P=0.01) was more than saline but not significantly different between ropivacaine groups (-1 [-16 to 12], P=1.0). Increased global QoR-40 scores correlated with decreased area under the pain score time curve during postanesthesia recovery room stay (ρ=-0.56, 99.2% upper confidence limit [UCL]=-0.28), 24-hour opioid consumption (ρ=-0.61, 99.2% UCL=-0.34), pain score (0-10 scale) at 24 hours (ρ=-0.53, 99.2% UCL=-0.25), and time to discharge readiness (ρ=-0.65, 99.2% UCL=-0.42). The aforementioned variables were lower in the TAP block groups receiving ropivacaine compared with saline. The TAP block is an effective adjunct in a multimodal analgesic strategy for ambulatory laparoscopic procedures. TAP blocks with ropivacaine 0.25% and 0.5% reduced pain, decreased opioid consumption, and provided earlier discharge readiness that was associated with better quality of recovery.
    Anesthesia and analgesia 09/2011; 113(5):1218-25. · 3.08 Impact Factor
  • Canadian Anaesthetists? Society Journal 07/2011; 58(7):664-5. · 2.31 Impact Factor