- |||||||||| fentanyl citrate / Generic mfg., Oxytocin 5 IU / Generic mfg.
A Tale of Tracing Issues, Thromboprophylaxis, Troubleshooting and TOLACs (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2877;
The patient's FHR improves and is now category I. Induction of labor is initiated with Pitocin and cervical foley placement...You withdraw the epidural catheter 1 cm, place patient on her right side and give an additional bolus dose of 0.25% bupivacaine with fentanyl 100mcg epidurally...•How do you manage this patient? •Is intubation necessary?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., rocuronium / Generic mfg.
Labor Epidural Struggles Lead to Cesarean Delivery Troubles on a TOLAC Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2836;
The patient expresses a preference to avoid another neuraxial technique and you decide to bolus the labor epidural catheter with fentanyl 100 mcg and then with lidocaine 2% in 5 ml increments as you transport her urgently to the operating room...Is there any advantage in using succinylcholine or rocuronium?...What if the patient received intrathecal morphine as part of a spinal anesthetic? Does an intraoperative transversus abdominus block performed under direct visualization by the obstetrician have any additional benefit?
- |||||||||| fentanyl citrate / Generic mfg., ketamine / Generic mfg.
[VIRTUAL] Preoperative Inflammation And Fentanyl Consumption After Cardiac Surgery (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2812;
Conclusions Preoperative NLR could not predict IV PCA consumption although higher IVPCA consumption is related to worse outcomes after cardiac surgery. For effective IVPCA regimens on ERAS program, we need further studies to clarify whether inflammation increases opioid consumption.
- |||||||||| midazolam hydrochloride / Generic mfg.
[VIRTUAL] Virtual Reality During Major Orthopedic Surgery In Five Patients In Late Decades Of Life: A Case Series (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2640;
Success depends on: 1) Ability to understand and willingness to use VR 2) Detailed preoperative patient education 3) Effective and continuous intra-operative communication with the patient on comfort like pressure, sound level, temperature etc., and what sensation to expect such as noise, vibration, impacts etc. right before it happens 4) Assessing and accommodating hearing and vison impairment devices 5) Buy-in from all members of the surgical and anesthesia team. Several studies using VR in different patient populations are currently underway in our institution.
- |||||||||| fentanyl citrate / Generic mfg.
The Parturient with Surgically Corrected Scoliosis and a Non-reassuring Fetal Heart Rate (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2612;
You thread an epidural catheter 5 cm past the tip of the needle and use it to administer 15 ml of a solution of 0.08% bupivacaine + 2 mcg/mL fentanyl...Should you intubate? How do you manage her partner, who is seated next to her at the head of the OR table and appears frightened and bewildered as this scene unfolds?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., tranexamic acid oral / Generic mfg.
Obstetric Hemorrhage: Be Ready, Prepare and Recognize (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2610;
A CSE is placed (1.5cc, hyperbaric 0.75% bupivacaine + fentanyl 15 mcg + preservative free morphine 150 mcg) in the OR and the surgery started...The MTP is continued and you request cryoprecipitate and tranexamic acid...On postoperative day two the patient's trachea is extubated and she is transferred to the postpartum floor on postoperative day three. The patient and her neonate are discharged home on postoperative day five.
- |||||||||| fentanyl citrate / Generic mfg., hydromorphone hydrochloride / Generic mfg.
[VIRTUAL] Pain Control For Epidural Hydromorphone And Fentanyl Pca Vs. I.v. Hydromorphone Pca After Anterior Scoliosis Repair (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2597;
With respect to length of stay, there was also no benefit with the fentanyl PCEA, as patients who received fentanyl PCEA had a longer stay than those who received hydromorphone PCA. With the lack of improvements in pruritus, hospital length of stay, and nausea in the hydromorphone and fentanyl PCEA groups, it is worthwhile to rethink the benefit of PCEA use in anterior tethering scoliosis correction surgery.
- |||||||||| The Age Old Dilemma: How Do We Fix a Broken Hip? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2367;
The patient takes an 81 mg aspirin daily and is allergic to Penicillins...He is a retired engineer and, at one point, is noted to have been on coumadin...After an awake arterial line, you gently induce your patient with fentanyl, low dose propofol and rocuronium...What can we do to help this patient in the PACU? . . . Further discussion regarding postoperative delirium, postoperative cognitive decline, frailty, among other topics (if time allows.)
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Ketamine As An Opioid Sparing Agent In Pre-hospital Trauma Casualty Care (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2336;
The opioid-sparing effect was mainly due to a reduction in the use of OTFC in patients receiving ketamine (41.4% vs. 60.2% of patients, p=0.001). Conclusion The use of ketamine in the prehospital setting as part of a pain management protocol has a significant opioid-sparing effect while maintaining a non-inferior analgesic effect.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., hydromorphone hydrochloride / Generic mfg.
[VIRTUAL] Pectoralis I And Serratus Anterior Plane Block Analgesia For Bilateral Mastectomy And Reconstruction: A Retrospective Analysis (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2315;
While our analysis did show a reduction in intraoperative opioid consumption, we did not see a significant postoperative benefit in either pain scores, opioid consumption, or LOS. This may be in part due to inadequate analgesia to the medial portion of the breast, as the PECS I/SAP combination might not anesthetize the anterior cutaneous branches of the intercostal nerves supplying the skin medial to the midclavicular line.3
- |||||||||| Bridion (sugammadex) / Merck (MSD)
Surgeon Promises: Just a Five-Minute Case. Options for Airway and Neuromuscular Blockade Management in a Morbidly Obese Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2191;
He remained intubated and sedated on fentanyl and propofol infusions...The resident calls from the pharmacy to inform you that the hospital does not presently have sufficient sugammadex in stock...11.What common problems are associated with this method of induction?12.Would you give any premedication to minimize potential adverse effects? Which one(s)?13.What doses of remifentanil and propofol would you use?
- |||||||||| midazolam hydrochloride / Generic mfg.
The Leadless Pacemaker, Treat It Like Any Pacemaker? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2168;
After tracheal intubation with a double-lumen tube, general anesthesia was maintained with sevoflurane at a MAC level of 0.8...The surgery took place without complication, ondansetron was administered and the patient was extubated after emergence without issues...The surgical team plans for an emergent re-exploration for presumed bleeding. What is your plan for management of this CIED in an emergent scenario?
- |||||||||| The Changing Face of Buprenorphine: To Stop or Not to Stop? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2077;
Buprenorphine patch (Butrans®)?...Hydromorphone 1mg is bolused every 15 minutes with some decrease in blood pressure and heart rate...The fentanyl infusion is decided to be continued post-operatively for pain control as well as to prevent opioid withdrawal...Hypothetically, let's assume this patient was not on Suboxone® and instead received a naltrexone IM injection yesterday. 19) What are your concerns with a recent naltrexone injection versus after two weeks?20) What would be your concerns if this patient had a pre-existing subcutaneous naltrexone implant that was placed one month ago?
- |||||||||| Vecuron (vecuronium) / Sun Pharma
LTR: Laryngotracheal Reconstruction or Logistical Train W(r)eck (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2024;
You are keeping the patient sedated with dexmedetomidine, fentanyl, and vecuronium infusions...The ICU then gave a bolus of rocuronium and deepened the sedation...What post-operative factors could have contributed to the loss of the posterior rib graft. What system changes could aid in preventing similar events in the future?
- |||||||||| Vecuron (vecuronium) / Sun Pharma
LTR: Laryngotracheal Reconstruction or Logistical Train W(r)eck (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2009;
You are keeping the patient sedated with dexmedetomidine, fentanyl, and vecuronium infusions...The ICU then gave a bolus of rocuronium and deepened the sedation...What post-operative factors could have contributed to the loss of the posterior rib graft. What system changes could aid in preventing similar events in the future?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., sevoflurane / Generic mfg.
[VIRTUAL] Reduced Postoperative Pain In Patients Receiving Nociception Monitor Guided Analgesia During Elective Surgery (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2002;
We attribute this to more timely, objective and personalized fentanyl dosing based on improved tritation of opioids to individual patient's response to nociceptive stimuli during anesthesia resulting in beneficial effects on pain experience. This study confirms the results of a previous pilot study conducted by Meijer et al., and further demonstrates that the benefits of NOL-Guided analgesia titration may be achieved independently of depth of anesthesia monitoring which may increase its adoption in routine clinical practice.
- |||||||||| [VIRTUAL] Temperature Agreement During Anesthesia Between Neck With Zero-heat-flux Thermometry And Esophageal (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1832;
General anesthesia was induced by propofol (1.5-2.0 mg/kg), fentanyl (1.0-2.0 μg/kg), and rocuronium (0.9 mg/kg) and the tracheal intubation was performed...Anesthesia was maintained with 1.5% sevoflurane or 4.5% desflurane, and 0.1-0.2 μg/kg/min remifentanil... This study revealed the agreement between neck and esophageal temperature, suggesting that neck is also a reliable site for measuring core temperature during general anesthesia.
- |||||||||| fentanyl citrate / Generic mfg., cefazolin / Generic mfg., azithromycin / Generic mfg.
Converting Labor Epidural Analgesia to Cesarean Delivery Anesthesia: A Case of a Good Epidural Gone Bad (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1829;
You elect to proceed with a combined spinal epidural for labor analgesia, and deposit a spinal dose of 2.5cc of bupivacaine 0.0625%-fentanyl 2 mcg/mL...You give prophylactic IV cefazolin and IV azithromycin...23. How would you follow up with this patient after PACU?
- |||||||||| Chronogesic (sufentanil) / Durect
[VIRTUAL] Anesthetic Consideration For SEEG Placement (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1691;
Retrospective analyses show that patients recover well, requiring minimal time in the ICU. There is low risk of inducing seizures during placement as only 3 patients required rescue AEDs.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., rocuronium / Generic mfg.
Labor Epidural Struggles Lead to Cesarean Delivery Troubles on a TOLAC Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1657;
The patient expresses a preference to avoid another neuraxial technique and you decide to bolus the labor epidural catheter with fentanyl 100 mcg and then with lidocaine 2% in 5 ml increments as you transport her urgently to the operating room...Is there any advantage in using succinylcholine or rocuronium?...What if the patient received intrathecal morphine as part of a spinal anesthetic? Does an intraoperative transversus abdominus block performed under direct visualization by the obstetrician have any additional benefit?
- |||||||||| fentanyl citrate / Generic mfg.
[VIRTUAL] Fetal Late Decelerations During Labor Analgesia: Which Factor Are Involved? A Retrospective Analysis (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1609;
Despite a growing trend in the use of CSE for its fast pain relief, it seems that not all CSEs are the same; episodes of late decelerations are more frequent with intrathecal fentanyl. Contrary to the American College of Obstetrics and Gynecologist (ACOG) guidelines, which states that labor analgesia is to be provided upon patient request, an earlier offer and placement of neuraxial analgesia may result in patient benefits such as better pain control and improved rest and satisfaction before delivery, all while potentially decreasing the risks of fetal late decelerations and emergency cesarean section.
- |||||||||| fentanyl citrate / Generic mfg., Oxytocin 5 IU / Generic mfg.
A Tale of Tracing Issues, Thromboprophylaxis, Troubleshooting and TOLACs (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1597;
The patient's FHR improves and is now category I. Induction of labor is initiated with Pitocin and cervical foley placement...You withdraw the epidural catheter 1 cm, place patient on her right side and give an additional bolus dose of 0.25% bupivacaine with fentanyl 100mcg epidurally...•How do you manage this patient? •Is intubation necessary?
- |||||||||| midazolam hydrochloride / Generic mfg.
The Leadless Pacemaker, Treat It Like Any Pacemaker? (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1431;
After tracheal intubation with a double-lumen tube, general anesthesia was maintained with sevoflurane at a MAC level of 0.8...The surgery took place without complication, ondansetron was administered and the patient was extubated after emergence without issues...The surgical team plans for an emergent re-exploration for presumed bleeding. What is your plan for management of this CIED in an emergent scenario?
- |||||||||| Is My Patient Suitable for Ambulatory Outpatient Surgery? How to Balance Morbid Obesity, Obstructive Sleep Apnea, Diabetes, and Opiates in the Ambulatory Surgical Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1303;
Her current medications include oxycodone, 5 mg 4 time a day as needed, lisinopril, 10 mg at bedtime, gliburide, 10 mg once per day, NPH insulin, 40 units subcutaneously at bedtime, and regular insulin, as needed on a sliding scale for blood glucose greater than 200 mg/dL...You discuss your plans for general anesthesia with the patient, and plan premedication with gabapentin, acetaminophen, and a scopolamine patch.What general anesthetic technique would you plan for this patient?Why?...Additionally, you titrate fentanyl, 100 mcg, and 0.5mg hydromorphone and maintain the patient on sevoflurane for the surgery which takes one hour...What pain medications should she be instructed to avoid? Why?
- |||||||||| Is My Patient Suitable for Ambulatory Outpatient Surgery? How to Balance Morbid Obesity, Obstructive Sleep Apnea, Diabetes, and Opiates in the Ambulatory Surgical Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1299;
Her current medications include oxycodone, 5 mg 4 time a day as needed, lisinopril, 10 mg at bedtime, gliburide, 10 mg once per day, NPH insulin, 40 units subcutaneously at bedtime, and regular insulin, as needed on a sliding scale for blood glucose greater than 200 mg/dL...You discuss your plans for general anesthesia with the patient, and plan premedication with gabapentin, acetaminophen, and a scopolamine patch.What general anesthetic technique would you plan for this patient?Why?...Additionally, you titrate fentanyl, 100 mcg, and 0.5mg hydromorphone and maintain the patient on sevoflurane for the surgery which takes one hour...What pain medications should she be instructed to avoid? Why?
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Novel Non-opioid Anesthetic Mixture More Effective Than Opioid-based 6-2-2 For Ocular Block And Ophthalmic Surgery (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1254;
The novel non-opioid multimodal single syringe 6:2:2 mixture with propofol, ketamine and etomidate is superior to the opioid-based 6:2:2 mixtures with average 36 seconds for patient readiness for ocular block and 98% painless response without head movement, while maintaining airway patency and hemodynamic stability for ophthalmic surgery. It can potentially be used in other surgical and diagnostic procedures under MAC.
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] The Novel 6-2-2 Sedation Method: Safe In The Elderly And Morbidly Obese Patients For Ocular Blocks And Ophthalmic Surgery (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1200;
Examination of different mixtures demonstrates unique potential benefits for cases requiring patient-centric prioritization of hemodynamic goals, anxiolysis, or avoidance of apnea. This retrospective study demonstrates that although the anesthetic management of the high-risk groups, specifically the elderly and the obese can be a challenge, through our methods of utilizing a mixture of propofol with narcotics (alfentanil, fentanyl, hydromorphone) and lidocaine/or ketamine an anesthesia provider can provide adequate sedation and analgesia for ophthalmic blocks and surgery while maintaining hemodynamic stability and airway patency comparable to the younger or normal weight patients.
- |||||||||| ketamine / Generic mfg.
The Heartbreak of Severe Aortic Stenosis in Pregnancy (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1190;
If she received ketamine supplementation for her previous C-section do you think that any of the responsibility for her post-partum mental health problems can be laid at the feet of ketamine?...After LOR was achieved at a different intervertebral level this time with CSF return, PF morphine 100 ug and fentanyl 10 ug are administered intrathecally and the epidural catheter is threaded...What should you do now? If you choose to use an intrathecal catheter how should it be dosed for c-section anesthesia?
- |||||||||| fentanyl citrate / Generic mfg.
Trauma Code Trepidation: Level One Trauma Activation in a Parturient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1166;
How will you manage hemodynamic goals and what will your ventilation strategy be?The patient is unable to cooperate well with preoxygenation or sterile prep/drape and a member of the anesthesia team gives the patient 100mcg of fentanyl without discussion...What unique concerns exist in a trauma patient who has also undergone cesarean delivery? Should she go to the PACU, an OB PACU or directly to the Trauma ICU?
- |||||||||| fentanyl citrate / Generic mfg.
Trauma Code Trepidation: Level One Trauma Activation in a Parturient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_960;
How will you manage hemodynamic goals and what will your ventilation strategy be?The patient is unable to cooperate well with preoxygenation or sterile prep/drape and a member of the anesthesia team gives the patient 100mcg of fentanyl without discussion...What unique concerns exist in a trauma patient who has also undergone cesarean delivery? Should she go to the PACU, an OB PACU or directly to the Trauma ICU?
- |||||||||| ketamine / Generic mfg.
Opioids and the Operating Room: Peri-operative Wean, Intra-operative Care, and Post-operative Pain Management (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_895;
Since she fell and fractured her ankle, she has been taking hydrocodone/acetaminophen 10/325 mg 6-8 times a day, prescribed by the emergency department...What if she were on chronic opioids such as morphine and hydrocodone, would a peri-operative wean be necessary?...You proceed with the surgery and take the patient to the operating room where you induce general anesthesia with propofol, fentanyl, and rocuronium uneventfully...The ketamine infusion is weaned and she is started on oral methadone 20mg three times daily with a fentanyl patient controlled analgesia (PCA) for break through pain...How will you discharge the patient from the hospital with treatment for the pain and addiction? Is it safe to prescribe a recovering opioid addict short-acting agents?
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