Jeffrey W Steiner

Publications (2)6.17 Total impact

• Article: Intraocular Pressure in Pediatric Patients During Prone Surgery.

  Peter Szmuk, Jeffrey W Steiner, Radu B Pop, Jing You, David R Weakley, Dale M Swift, Daniel I Sessler
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  ABSTRACT: BACKGROUND:Intraoperative intraocular pressure (IOP) in the prone position and IOP changes over time have not been evaluated in pediatric surgical patients. We sought to determine time-dependent changes in IOP in children undergoing surgery in prone position.METHODS:Thirty patients undergoing neurosurgical procedures in prone position were included. Using a pulse-mode pneumatonometer, IOP was measured in supine position after induction and before emergence of anesthesia and in prone position before the start and after the end of surgery. IOP changes over time in the prone position were assessed with a linear mixed model (i.e., random slope and intercept model) to adjust for the within-patient correlation.RESULTS:IOP in prone position increased by an average of 2.2 mm Hg per hour (P < 0.001). Sixty-three percent of patients (95% confidence interval [CI], 46%-81%) had at least 1 IOP value exceeding 30 mm Hg, and 13% (95% CI, 1%-25%) had at least 1 IOP value exceeding 40 mm Hg while prone. Mean IOP increased 7 mm Hg (95% CI, 6-9) during the position change from supine to prone (P < 0.001) and decreased 10 mm Hg (95% CI, 9-12) after changing the position from prone back to supine (P < 0.001).CONCLUSIONS:Changing position from supine to prone significantly increases IOP in anesthetized pediatric patients. Moreover, the IOP continued to increase during surgery and reached potentially harmful values, especially when combined with low mean arterial blood pressures that are common during major surgery.
  Anesthesia and analgesia 04/2013; · 3.08 Impact Factor
• Article: Anesthesiology residents' medical school debt influence on moonlighting activities, work environment choice, and debt repayment programs: a nationwide survey.

  Jeffrey W Steiner, Radu B Pop, Jing You, Stephen Q Hoang, Charles W Whitten, Catherine Barden, Peter Szmuk
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  ABSTRACT: The amount of education debt incurred by medical school graduates in the United States has grown considerably over the last 30 years; it has outpaced inflation to reach a mean of $158,000. With this dramatic increase in education debt, there has been limited information on how medical school debt loads of anesthesiology physicians impact their decisions concerning moonlighting and future career choices. Our aim was to survey current anesthesiology interns, residents, and fellows to assess the correlation between the amount of medical school debt they had collected and (1) their outlook toward moonlighting activities, (2) future career plans, and (3) choice of employer with a debt repayment program. We developed a web-based survey instrument and contacted residency training programs to obtain access to their anesthesiology interns, residents, and fellows (residents). We assessed each relationship of interest using a multivariable proportional odds model, adjusting for all available baseline potential confounding factors. Second, we compared participants with >$150,000 medical school debt versus participants with no debt on the same questions of interest, each using a multivariable proportional odds model with the same covariable adjustment. We had access to 2386 residents through their training programs and 537 completed the survey. Those respondents with a 1-category-larger amount of medical school debt (i.e., $30,000) were associated with 7%(99.3% confidence interval: 0%, 13%) increased odds of having the desire to moonlight during residency/fellowship, and were associated with 7% (1%, 13%) decreased odds of saying they would choose a career as an academic faculty, respectively. Also, those with a larger amount of medical school debt were more likely to be swayed to be interested in an anesthesiology group with an education debt repayment program (odds ratio: 1.3 [1.22, 1.39] for 1-category increase in the debt amount); furthermore, the corresponding odds ratio was increased to 4.6 (2.8, 7.5) comparing those with >$150,000 debt with those without debt. In an effort to compete with private practice anesthesiology groups and to reduce the impact of debt on future career choices of residents/fellows, academic anesthesiology groups would do well to (1) promote moonlighting activities that are within the Accreditation Council for Graduate Medical Education and institutional guidelines, (2) develop financial curriculum for residents/fellows, and (3) offer debt repayment programs as an incentive for new faculty to join academic medicine.
  Anesthesia and analgesia 02/2012; 115(1):170-5. · 3.08 Impact Factor