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Shields Anesthesia Research Day PDF

68 Pages·2017·1.04 MB·English
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Annual Shields Research Day 38th Research in Progress Meeting Friday, April 28, 2017 Department of Anesthesia Arcadian Court, 401 Bay Street University of Toronto Simpson Tower, 8th Floor Toronto, Ontario 07:15 Breakfast, Registration Location: Arcadian Court – Ballroom, 8th Floor 08:00 Welcome Location: Arcadian Court – Ballroom, 8th Floor Brian Kavanagh, Chair, Anesthesia Trevor L. Young, Dean, Faculty of Medicine Zeev Friedman, Chair, Annual Shields Research Day 2017 08:30 Session A – Oral Presentations Location: Arcadian Court – Ballroom, 8th Floor Chairs: Dr. Chung, Dr. Hare A1 Diaphragm atrophy and clinical outcomes in A2 Virtual Reality for educating and reducing mechanically ventilated adults preoperative anxiety in children – Phase 1: Design, Michael Sklar – Resident face validity and acceptability by healthcare St. Michael's Hospital professionals Ben O’Sullivan – Fellow Hospital for Sick Children A3 Impact of lung microenvironment on the A4 A systematic review and meta-analysis of protective vs. detrimental effects of MSC erythropoietin and intravenous iron therapy to administration in experimental acute lung injury reduce red blood cell transfusion in patients Diana Islam – Fellow undergoing surgery St. Michael’s Hospital Tiffanie Kei – Graduate Student St. Michael's Hospital A5 Intraoperative handover: What are we missing? A6 The effect of anesthetic technique on mortality Sophia Lane – Resident and major morbidity following hip fracture Sinai Health System fixation. A retrospective, propensity-matched cohort study Laith Malhas – Fellow UHN-Toronto Western Hospital A7 Deflation injury following release of sustained PEEP Bhushan Katira – Fellow Hospital for Sick Children 09:15 Session B - Poster Session Location: Gallery Level, 9th Floor B1 A multidisciplinary team consensus on the B2 Does the presence of an Anesthesiologist improve allocation of resources, roles and the outcome after endovascular treatment for responsibilities at emergency crash cesarean acute ischemic stroke? deliveries Gabriela Alcaraz García-Tejedor – Fellow Ibukun Adedugbe – Fellow UHN-Toronto Western Hospital Sinai Health System B3 Hippocampal volume determines the quality B4 Pediatric regional Anesthesia workshops for faculty of emergence from anesthesia development: Curriculum design, implementation Sujoy Banik – Fellow and evaluation UHN-Toronto Western Hospital Abhijit Biswas – Fellow Hospital for Sick Children B5 Programmed intermittent epidural bolus for B6 Complex airway management of symptomatic labor analgesia during first stage of labor: A cricoid tumor biased-coin up and down sequential Jaclyn DesRoches – Resident allocation trial to determine the optimum UHN-Toronto Western Hospital interval time between boluses of a fixed volume of 5ml of bupivacaine 0.125% plus fentanyl 2 cg/ml. Ricardo Bittencourt – Fellow Sinai Health System B7 Maximizing efficacy of simulation-based B8 Thoracic epidural placement in a preoperative anesthesiology training: Rapid cycle block area improves OR efficiency and decreases deliberate practice versus traditional medical epidural failure rate simulation Josh Gleicher – Fellow Danelle Dower – Fellow Sunnybrook Health Sciences Centre Hospital for Sick Children B9 Comparison of forces generated by direct and B10 Preoperative predictors of severe postoperative indirect laryngoscopy using the GlideScope® pain in women undergoing cesarean deliveries T-MAC blade in a manikin under spinal anesthesia Joanna Gordon – Fellow Jennifer Guevara Velandia – Fellow UHN-Toronto General Hospital Sinai Health System B11 Sleep-disordered breathing and delirium B12 Recovery of oxytocin responsiveness in pregnant Enoch Lam – Graduate Student human myometrial explants after oxytocin-induced UHN-Toronto Western Hospital desensitization: An in-vitro analysis of oxytocin receptor expression and signalling Alice Luca – Graduate Student Sinai Health System B13 A propensity-matched comparison of the analgesic effects of superficial versus deep serratus fascial plane block for ambulatory breast cancer surgery David MacLean – Resident UHN-Toronto Western Hospital 10:00 Session C – Oral Presentations Location: Arcadian Court – Ballroom, 8th Floor Chairs: Dr. Karkouti, Dr. Cuthbertson C1 Surface echocardiography in the assessment of C2 Cost of inpatient craniotomy is double that of left ventricular function during ex vivo heart outpatient craniotomy for brain tumors perfusion: Comparison of 2D and 3D Elyana Wohl – Fellow echocardiography UHN-Toronto Western Hospital Giulia Maria Ruggeri – Fellow UHN-Toronto General Hospital C3 The effects of pre-operative cannabis use on C4 Pharmacologically inhibiting GABA-A receptors opioid consumption following elective reverses impaired synaptic plasticity and Inflammatory Bowel Disease surgery memory loss after traumatic brain injury Noreen Jamal – Graduate Student Shahin Khodaei – Graduate Student Sinai Health System Sunnybrook Health Sciences Centre C5 The effect of analgesics on cancer growth and C6 The influence of anesthesia on intraoperative metabolism neuromonitoring changes in high-risk spinal Doorsa Tarazi – Graduate Student surgery Hospital for Sick Children Nathan Royan – Fellow UHN-Toronto Western Hospital C7 Analgesic effect of adductor canal block after knee surgery: a systematic review and meta- analysis David Goodick – Fellow Hospital for Sick Children 10:45 Session D – Poster Session Location: Gallery Level, 9th Floor D1 Selective cannabinoids for chronic neuropathic D2 Increased cerebrovascular reactivity during pain: a systematic review and meta-analysis anemia: a potential novel indicator of anemia- Howard Meng – Resident induced brain hypoxia? UHN-Toronto Western Hospital Nikhil Mistry – Graduate Student St. Michael's Hospital D3 Anesthetic challenges during interventional D4 Assessment of dexmedetomidine and scalp block management of extra-cranial vascular to facilitate intraoperative brain mapping for malformations awake craniotomy Bahadur Niazi – Fellow Stuart Nicholson – Fellow UHN-Toronto Western Hospital St. Michael's Hospital D5 A survey of Canadian anesthesiologists and D6 Cardiac toxicity of bupivacaine is mediated via residency program directors and department altered calcium dynamics in stem cell-derived chiefs assessing current environmentally cardiomyocytes sustainable anesthesiology practice Julia Plakhotnik – Graduate Student Maria-Alexandra Petre – Resident Hospital for Sick Children St. Michael's Hospital D7 Role of screening questionnaires and D8 Beyond masks and syringes: Early ideas of quantitative sensory testing in detecting Anesthesiology in Canada - A critical historical neuropathic pain in osteoarthritis: a scoping analysis review Richa Sharma – Resident Rajendra Kumar Sahoo – Fellow UHN-Toronto Western Hospital D9 Choice of intraoperative resuscitation fluid D10 Discharge opioid prescription practices in a during cardiac bypass surgery: A cost Pediatric teaching hospital effectiveness analysis Naiyi Sun – Fellow Lavarnan Sivanathan – Resident Hospital for Sick Children Sunnybrook Health Sciences Centre D11 Rapid cycle deliberate practice in simulation- D12 Risk factors for failure of patient-controlled oral based medical education: A systematic review Analgesia after total hip and knee arthroplasty: A Jillian Taras – Resident retrospective cohort study Hospital for Sick Children Leon Vorobeichik – Resident UHN-Toronto Western Hospital D13 Esophageal manometry in Acute Respiratory Distress Syndrome (ARDS): Safer expiration, safer inspiration Takeshi Yoshida – Fellow Hospital for Sick Children 11:30 Session E – Oral Presentations Location: Arcadian Court – Ballroom, 8th Floor Chairs: Dr. Orser, Dr. Wijeysundera E1 The universal definition of perioperative bleeding E2 Blood brain barrier integrity after moderate (UDPB) in cardiac surgery: Validation of a traumatic brain injury is improved with human consensus-based bleeding endpoint for use in umbilical cord perivascular cell therapy clinical trials Tanya A. Barretto – Graduate Student Justyna Bartoszko – Resident St. Michael's Hospital UHN-Toronto General Hospital E3 Ketamine reverses postanesthetic increase in E4 Opioid prescription following discharge in extrasynaptic GABA-A receptor function in patients undergoing total knee arthroplasty hippocampal neurons Hawn Trinh – Fellow Kirusanthy Kaneshwaran – Graduate Student Sunnybrook Health Sciences Centre Sunnybrook Health Sciences Centre E5 A novel brain stress test: Combined controlled E6 A population-based study evaluating the end-tidal CO2 and MRI imaging to assess stroke association between pediatric surgical activity at risk the weekend and perioperative adverse Jay Shou Han – Resident outcomes UHN-Toronto Western Hospital Asad Siddiqui – Resident Hospital for Sick Children E7 MicroRNA-200b protects neuronal cells from reactive oxygen species (ROS) Joshua Bell – Resident 12:15 Lunch Break and Poster Viewing 13:00 Anesthesia in the News: Dr. Brian Kavanagh: “Academic Anesthesia in Toronto 2050” 13:30 Annual Shields Lecture: Dr. Hugh C. Hemmings: “The synaptic pharmacology of general anesthesia” 14:15 Shields Day Award Presentation Session Bateman, Hammell, Rothbart, Byrick, Bryan, Orser, Best Poster at Shields Day, Awards for Clinical Excellence, Residents and Fellows Tuition Awards, Laws Travel Awards 14:45 Departure This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by Continuing Professional Development, Faculty of Medicine, and University of Toronto up to a maximum of 4.5 Hours Annual Shields Lecture – Dr. Hugh C. Hemmings “The synaptic pharmacology of general anesthesia” Hugh C. Hemmings Jr., MD, PhD, FRCA is the Joseph F. Artusio Jr. Professor and Chair of Anesthesiology and Professor of Pharmacology at Weill Cornell Medical College, and Anesthesiologist-in-Chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Hemmings earned a BS in Biochemistry from Yale College, a PhD in pharmacology from Yale Graduate School, and an MD from Yale Medical School. His graduate work in the laboratory of Paul Greengard, PhD was cited in his 2000 Nobel Prize in Physiology and Medicine. He completed postdoctoral work at The Rockefeller University, a residency in anaesthesia at the Massachusetts General Hospital, and a fellowship in cardiac anesthesia at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, where he has been a faculty member for 25 years. An internationally recognized neuropharmacologist, Dr. Hemmings is an expert in the synaptic effects of general anesthetics and mechanisms of neuronal signal transduction. His research in these areas is supported by grants from the National Institutes of Health. He is active in several national and international societies for anesthesiology and neuroscience, and serves as Editor-in-Chief of the British Journal of Anaesthesia. He has been elected Fellow of the Royal College of Anaesthetists and is a member of the Association of University Anesthesiologists. Dr. Hemmings has authored more than 110 articles in anesthesiology and neuroscience, and has edited four books, including Pharmacology & Physiology for Anesthesia: Foundations and Clinical Application published in 2013. The Awards Dr. Evelyn Bateman Award Dr. Thomas Donald Hammell Award Named in honor of Dr. Evelyn Bateman, Chief of The Thomas Donald Hammell Memorial Award Anesthesia at the Women’s College Hospital in Anesthesia recognizes outstanding from 1956-1972, this award recognizes contributions to the Residency Program (as excellence in anesthesia at the undergraduate chosen by other residents). level. Dr. Alan K. Laws Travel Fellowship Award Dr. David Bevan Award The Laws Travel Fellowship Award one of two The Dr. David Bevan Award is awarded to the awards given by the Department of Anesthesia presenter of the best overall research poster at in honor and memory of Dr. Alan Laws. This the Annual Shields Research Day award provides travel support for senior residents or fellows to advance their research Dr. A.C. Bryan Award programs in anesthesia. The A.C. Bryan Award is Awarded to a graduate The Marion and Earl Orser Prize in Anesthesia and student judged to have presented the best Sleep Medicine research project at the Annual Shields Research Day. The Marion and Earl Orser Prize in Anesthesia and Sleep Medicine is awarded to residents, Dr. R.J. Byrick Award clinical fellows, post-doctoral fellows or graduate students in support of research in The R.J. Byrick Award recognizes the best clinical sciences as well as basic/translational fellow’s research paper presented at the Annual sciences. Shields research Day. Dr. Byrick was the Department’s 6th Chair of Anesthesia, serving Dr. Hynek Rothbart Award from 1993-2003. He was then Vice-Dean of Clinical Affairs for the Faculty of Medicine, The Dr. Hynek Rothbart Award is awarded to the University of Toronto, until 2007. Dr. Byrick is best paper presented by a resident at the currently a clinician at St. Michael’s Hospital. Annual Shields Research Day. Awards for Clinical Excellence UT Anesthesia Resident and Fellows Tuition Awards For excellent clinical skills (Anesthesia and Critical Care Medicine) and consistent Awarded to meritorious Anesthesia residents demonstration of exemplary patient service. and/or fellows who are engaged in graduate studies that are clearly integrated into their existing residency/fellowship program, and are linked with their overall career plan. Abstracts A1 ● Diaphragm atrophy and clinical outcomes in mechanically ventilated adults Michael Sklar – Resident St. Michael's Hospital Background Prolonged mechanical ventilation is associated with poor long-term outcomes and substantial healthcare costs. Studies demonstrate that ventilation can cause diaphragm atrophy and dysfunction, but it is unknown whether this substantially impacts clinical outcomes. Methods In adult patients requiring invasive mechanical ventilation, diaphragm thickness was measured daily by ultrasound. Diaphragm atrophy was defined as a decrease in thickness exceeding 10% of baseline. The primary outcome was time to liberation from ventilation. Secondary outcomes included complications of acute respiratory failure (composite of at least one of reintubation, tracheostomy, ventilation longer than 14 days, or death in hospital). The association between diaphragm atrophy and the daily probability of liberation from ventilation was assessed using Cox proportional hazards modelling with time-varying covariates adjusting for severity of illness, sepsis, sedation, neuromuscular blockade, baseline thickness, and comorbidity. Findings A total of 211 patients were enrolled. By median day 4 of ventilation, thickness decreased by more than 10% in 78 patients (41%) and increased by more than 10% in 47 (25%). In the primary analysis, diaphragm atrophy was associated with a lower probability of liberation from ventilation on any given day (adjusted hazard ratio 0.67, 95% CI 0.53-0.85, per 10% decrease in thickness from baseline). The development of diaphragm atrophy was also associated with prolonged ICU admission (adjusted duration ratio 1.71, 95% CI 1.29-2.27), and an increased risk of complications (adjusted odds ratio 3.00, 95% CI 1.34-6.72). Increased diaphragm thickness during ventilation was associated with prolonged ventilation (adjusted relative duration 1.38, 95% CI 1.00-1.90) but this association was not significant in the primary model (adjusted hazard ratio 0.79, 95% CI 0.60-1.03, per 10% increase in thickness from baseline). Interpretation Diaphragm atrophy during ventilation is associated with markedly prolonged ventilation and an increased risk of complications. Figure 1. Diaphragm atrophy during mechanical ventilation delays liberation from mechanical ventilation. Left: the adjusted relative hazard of liberation from mechanical ventilation at any given time is reduced with progressively greater decreases in diaphragm thickness (T ) (adjusted hazard ratio 0·67, di 95% CI 0·53-0·85, per 10% decrease in T below baseline). The association between increases in T di di above baseline and the adjusted relative hazard of liberation from ventilation did not reach significance (adjusted HR 0·79, 95% CI 0·60-1·03, per 10% increase in T above baseline). Grey shaded areas di represent 95% confidence intervals for estimated hazards computed by Cox proportional hazards regression. Right: to evaluate the effect of diaphragm atrophy on the duration of ventilation, estimated hazards for liberation derived from the Cox proportional hazards model were employed to predict the probability of remaining on mechanical ventilation over time for varying degrees of diaphragm atrophy.

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will then build a practical guideline/algorithm that details resource and task allocations as well as . The Pediatric Regional Anesthesia Network (PRAN) describes the applications of regional anesthesia in of the UDPB definition, its association with redo and complex procedures was compared.
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