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Le PH, Philippeaux S, Mccollins T, Besong C, Kellar A, Klapper VG, De Witt AS, Drinkard J, Ahmadzadeh S, Shekoohi S, Varrassi G, Kaye A. Pathogenesis, Clinical Considerations, and Treatments: A Narrative Review on Leprosy. Cureus 2023; 15:e49954. [PMID: 38179342 PMCID: PMC10765565 DOI: 10.7759/cureus.49954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Hansen disease, known as Leprosy, is an infectious disease caused by Mycobacterium leprae. The disease was once thought to be highly contiguous, and patients with leprosy were treated poorly and had to face discrimination due to the gruesome disease's complications. Mycobacterium leprae, the bacterium causative of leprosy, can generally be found in the nine-banded armadillo. The bacterium is transmitted via aerosol droplets and broken skin-to-skin contact. Once M. leprae enters the body, it will target peripheral nerves and the lining mucosa of the skin and eyes, thus causing inflammation and tenderness of the affected area. Over time, this will lead to peripheral neuropathy and weakness of the affected body parts. Treatment of leprosy involves multi-drug combinations such as dapsone, rifampin, and clofazimine. Even though leprosy is curable, early detection and treatment are crucial to preventing irreversible damage and disabilities. Prevention measures include early detection, treatment regimen adherence, close contact prophylaxis, contact tracing, and community awareness. This review aims to provide the latest diagnostic and therapeutic recommendations for leprosy. It outlines the epidemiology, microbiology, clinical treatment, and immunological methods used to detect leprosy.
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Affiliation(s)
- Phat H Le
- School of Medicine, American University of the Caribbean, Miramar, USA
| | | | - Tiombee Mccollins
- School of Medicine, American University of the Caribbean, Miramar, USA
| | | | - Alexander Kellar
- School of Medicine, American University of the Caribbean, Miramar, USA
| | - Vincent G Klapper
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Adalyn S De Witt
- School of Medicine, Indiana School of Medicine, Indianapolis, USA
| | - Joseph Drinkard
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Alan Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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2
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Skidmore KL, Singh N, Kallurkar A, Cagle H, Smith Iii VS, Varrassi G, Shekoohi S, Kaye A. A Perioperative Blood Management Algorithm Aimed at Conservation of Platelets in Clinical Practice: The Role of the Anesthesiologist in Decision-Making. Cureus 2023; 15:e49986. [PMID: 38179382 PMCID: PMC10765273 DOI: 10.7759/cureus.49986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Platelet dysfunction and thrombocytopenia are associated with postoperative morbidity not only from modifiable preoperative factors but also from a lack of local patient blood management algorithms. In this regard, platelet transfusions have risen after the COVID-19 pandemic. Simultaneously, there has been a shortage of donors. It is logical, therefore, that each hospital should develop a triage tool, posting their algorithm on walls. Anesthesiologists should assist in planning a strategy to minimize blood transfusions while improving tissue oxygenation. A flowchart posted in each operating theatre may be customized per patient and hospital. Clinicians need reminders to draw a prothrombin time, fibrinogen, complete blood count every hour, and the appropriate threshold to transfuse. In summary, anesthesiologists are often unable to have a discussion with a patient until the preoperative day; thus, the onus falls on our surgical colleagues to reduce risk factors for coagulopathy or to delay surgery until after proper consultants have optimized a patient. The most important problems that an individual patient has ideally should be listed in a column where an anesthesiologist can write a timeline of key steps across a row, corresponding to each problem. If a handoff in the middle of the case is required, this handoff tool is superior to simply checking a box on an electronic medical record. In summary, in the operating suite, an anesthesiologist should emphasize the importance of a multidisciplinary approach. Continuing education, regular stakeholder meetings, and posters can assist in reinforcing algorithms in clinical practice.
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Affiliation(s)
- Kimberly L Skidmore
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Naina Singh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Anusha Kallurkar
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Hayden Cagle
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Van S Smith Iii
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Shehata I, Hashim A, Elsaeidy A, Nair A, Urits I, Viswanath O, Kaye A, Habib M. Cannabinoids and Their Role in Chronic Pain Treatment: Current Concepts and a Comprehensive Review. Health Psychol Res 2022; 10:35848. [PMID: 36628124 PMCID: PMC9820704 DOI: 10.52965/001c.35848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
For decades, chronic pain was managed with an almost conventional approach of using a wide range of analgesic spectrum, surgical approaches and complex interventional pain techniques to modulate or even interrupt pain pathways. These different approaches carry many pharmacological hazards together with the lack of efficacy and safety of many interventional and surgical management techniques for chronic pain have mandated searching for other effective therapies including alternative treatments. Cannabinoids are naturally occurring substances that are derived from Cannabis sativa L. The usage of cannabinoids and their related synthetic chemical compounds has emerged as a choice in the management of different chronic pain conditions is being evaluated, however, the efficacy is still not consistently established. In the present investigation, therefore, we discuss the different aspects related to cannabinoids and their implications in the management of chronic pain conditions. This review will also discuss the safety profile of the cannabinoids together with the legal considerations that hinder their use in different countries.
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Affiliation(s)
| | | | | | | | - Ivan Urits
- Louisiana State University Health Sciences Center
| | | | - Alan Kaye
- Louisiana State University Health Sciences Center
| | - Marian Habib
- Hurghada General Hospital, Department of Cardiology, Hurghada, Egypt
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4
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Robinson CL, Berger A, Sottosanti E, Li M, Kaneb A, Keefe J, Kim E, Kaye A, Viswanath O, Urits I. Acupuncture as Part of Multimodal Analgesia for Chronic Pain. Orthop Rev (Pavia) 2022; 14:38321. [DOI: 10.52965/001c.38321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Chronic pain is a multifactorial condition that is afflicting populations worldwide causing an increasing economic, physical, mental, and emotional burden. Treatments range from medications to interventional procedures to complementary and alternative medicine (CAM), such as acupuncture. This review aims to discuss the use of acupuncture in the treatment of chronic pain, proposed mechanisms, indications, and efficacy for various chronic pain conditions. Results Evidence is varied on the efficacy and quality of data on the use of acupuncture in the treatment of chronic pain. Recent studies have demonstrated promising results in the support of acupuncture for the use in the treatment of cancer, neck, and back pain, functional dyspepsia, and various chronic abdominal pain syndromes. Conclusion Acupuncture, deemed well-tolerated and safe to use, has been increasingly studied and is regarded as effective in clinical practice, but its efficacy is limited by the lack of well-conducted, high-quality clinical trials, lower quality evidence, and conflicting study results. Additionally, the exact analgesic mechanism of acupuncture remains to be fully elucidated. Increasing evidence supports the role of acupuncture as therapy in the treatment of cancer, neck, and back pain and functional dyspepsia. Further rigorous studies are needed to fully assess the use of acupuncture in various chronic pain conditions, determine its indications, and optimal treatment schedule. Overall, future studies could benefit from better designed experimental studies, larger groups, and more objectives ways to measure pain reduction and symptom improvement.
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Li N, Amarasinghe S, Boudreaux K, Fakhre W, Sherman W, Kaye A. Spondylolysis. Orthop Rev (Pavia) 2022; 14:37470. [PMID: 36045696 DOI: 10.52965/001c.37470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Spondylolysis is a bony defect of the pars interarticularis and most often results from repetitive stress. Although spondylolysis is usually asymptomatic, symptomatic spondylolysis is the most common cause of identifiable back pain in children and adolescent athletes. A thorough history and physical exam, as well as appropriate imaging studies are helpful in diagnosis. General first-ine therapy for spondylolysis is conservative and consists of rest from sports, core strengthening, as well as spinal bracing. Patients who have failed conservative therapy may consider surgical repair. This article aims to review the epidemiology, pathophysiology, presentation, and treatment options of spondylolysis.
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Affiliation(s)
| | - Sam Amarasinghe
- Louisiana State University Health Sciences Center - Shreveport
| | - Kyle Boudreaux
- Louisiana State University Health Sciences Center - Shreveport
| | - Waddih Fakhre
- Louisiana State University Health Sciences Center - Shreveport
| | | | - Alan Kaye
- Louisiana State University Shreveport
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6
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Robinson CL, Supra R, Downs E, Kataria S, Parker K, Kaye A, Viswanath O, Urits I. Daridorexant for the Treatment of Insomnia. Health Psychol Res 2022; 10:37400. [PMID: 36045942 DOI: 10.52965/001c.37400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review Insomnia is a complex sleeping disorder that affects the lives of many individuals worldwide. Insomnia often occurs in the presence of coexisting comorbidities making it a complex disorder that requires a multifactorial approach to therapy. First-line therapy is cognitive-behavioral therapy for insomnia (CBT-I). Pharmacotherapy for insomnia falls into four classes based on mechanism of action: benzodiazepine receptor agonists (BZRAs), histamine receptor antagonists, melatonin receptor agonists, and dual orexin receptor antagonists (DORAs). Recent Findings Daridorexant is a dual orexin type 1 and types 2 (OX1 and OX2) receptor antagonist that was recently approved by the US FDA for the treatment of adults suffering from insomnia. It was shown to be effective in reducing insomnia symptoms, increasing daytime functioning, and improving the overall quality of sleep. Daridorexant offers patients relief from insomnia while avoiding the severe side effects and dependency issues of traditional treatments like benzodiazepines and sedatives. Summary In this article, we review the most recent data on insomnia treatments and summarize the safety and efficacy of daridorexant in treating insomnia.
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Affiliation(s)
| | | | - Evan Downs
- Louisiana State University Health New Orleans School of Medicine
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Science Center at Shreveport
| | - Katelyn Parker
- Louisiana State University Health New Orleans School of Medicine
| | - Alan Kaye
- Department of Anesthesia, Louisiana State University Health New Orleans School of Medicine
| | - Omar Viswanath
- Envision Physician Services, Valley Anesthesiology and Pain Consultants
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Chitneni A, Hasoon J, Urits I, Viswanath O, Berger A, Kaye A. Peripheral Nerve Stimulation for Chronic Shoulder Pain Due to Rotator Cuff Pathology. Orthop Rev (Pavia) 2022; 14:37494. [DOI: 10.52965/001c.37494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic shoulder pain affects millions of patients each year. Various conditions can result in shoulder pain ranging from rotator cuff injury, subacromial impingement, post-surgical pain, bursitis, adhesive capsulitis, and osteoarthritis. Typically, rotator cuff pathology is diagnosed by physical exam maneuvers along with advanced imaging modalities. Initial treatment for rotator cuff injury typically consists of physical therapy, NSAIDs, and possible injections depending on the extent of the injury. If conservative measures fail or the injury is too substantial, surgery is typically the appropriate treatment for healthy patients. For patients who are not surgical candidates or refuse surgery, peripheral nerve stimulation (PNS) can be considered. With the use of PNS, the suprascapular and axillary nerves can be targeted to provide pain relief for a variety of chronic shoulder pain issues. We describe the use of PNS in 2 patients with significant rotator cuff pathology who were not surgical candidates.
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Affiliation(s)
- Ahish Chitneni
- Department of Physical Medicine & Rehabilitation, New York-Presbyterian (Columbia/Cornell), New York, NY
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesia and Pain Medicine, Houston, TX
| | - Ivan Urits
- Department of Anesthesia and Pain Management, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Omar Viswanath
- Department of Anesthesia and Pain Management, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Amnon Berger
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alan Kaye
- Department of Anesthesia and Pain Management, Louisiana State University Health Sciences Center, Shreveport, LA
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8
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Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia) 2022; 14:36917. [PMID: 35910544 DOI: 10.52965/001c.36917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
Abstract
Spondylolisthesis refers to the anterior, lateral, or posterior slippage of a superior vertebral disc over the adjacent inferior disc, and is often separated into categories based on the causative etiology. Spondylolisthesis is often asymptomatic but may present with low back pain and neurogenic claudication which is worsened with spinal extension and activity. A detailed history and physical exam, along with appropriate imaging tests are useful in making the diagnosis. Conservative therapy is first-line and includes pain management with physical therapy. Patients who fail conservative therapy may consider surgical decompression, stabilization, and fusion. This review aims to discuss the epidemiology, pathophysiology, presentation, and treatment options of spondylolisthesis.
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Affiliation(s)
| | | | | | | | | | - Alan Kaye
- Louisiana State University Shreveport
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9
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Han A, Montgomery C, Zamora A, Winder E, Kaye A, Carroll C, Aquino A, Kakazu J, Kaye A. Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options. Health Psychol Res 2022; 10:36042. [PMID: 35774913 DOI: 10.52965/001c.36042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. Recent Findings An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. Summary While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.
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Affiliation(s)
- Andrew Han
- School of Medicine, Georgetown University School of Medicine
| | | | | | | | - Adam Kaye
- Pharmacy and Health Sciences, Thomas J. Long School of Pharmacy and Health Sciences
| | | | | | - Juyeon Kakazu
- School of Medicine, Georgetown University School of Medicine
| | - Alan Kaye
- Louisiana State University Shreveport
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Gupta H, Perkins W, Stark C, Kikkeri S, Kakazu J, Kaye A, Kaye A. deutetrabenazine for the treatment of chorea associated with Huntington's disease. Health Psychol Res 2022; 10:36040. [PMID: 35774908 DOI: 10.52965/001c.36040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
This is a comprehensive review of the literature regarding the use of Deutetrabenazine in treating chorea associated with Huntington's disease. Unfortunately, treatment has been limited for many aspects of this neurodegenerative disease. The present investigation presents the background, evidence, and indications for the use Deutetrabenazine in the setting of Huntington's disease. Huntington's disease is characterized by a variety of motor, psychiatric, and cognitive symptoms with chorea being one of the more notable ones. Chorea is a movement disorder present in multiple neurologic diseases that causes involuntary and irregular muscle movements theorized to be stemming from high dopamine levels. Deutetrabenazine is thought to function as an inhibitor of the VMAT2 vesicular monoamine transporter resulting in decreased monoamine release, including dopamine, in the synaptic cleft which has a therapeutic effect in management of chorea. This drug was approved by the FDA in 2017 with a specific indication for tardive dyskinesia and choreiform movement in Huntington's disease. Currently, there is no definitive treatment for Huntington's disease. Thus, management is primarily focused on symptom management with the use of a variety of pharmaceutical agents. Chorea is one of the many manifestations that significantly alter the quality of life of many patients. Deutetrabenazine is a promising new option for the treatment of chorea in the setting of Huntington's disease. Although studies so far have displayed mixed results, further research, including head-to-head studies, is necessary to elucidate the true potential of this drug.
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Affiliation(s)
| | - Wil Perkins
- School of Medicine, Louisiana State University Shreveport School of Medicine
| | - Cain Stark
- School of Medicine, Medical College of Wisconsin
| | - Sathya Kikkeri
- School of Osteopathic Medicine, Alabama College of Osteopathic Medicine
| | - Juyeon Kakazu
- School of Medicine, Georgetown University School of Medicine
| | - Adam Kaye
- School of Pharmacy, Thomas J. Long School of Pharmacy and Health Sciences
| | - Alan Kaye
- Anesthesiology, Louisiana State University Shreveport
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Dalal S, Chitneni A, Mahmood S, Kaye A, Hasoon J. 10 kHz Spinal Cord Stimulation for the Treatment of Non-Surgical Refractory Back Pain: A Case Report. Orthop Rev (Pavia) 2022; 14:31891. [DOI: 10.52965/001c.31891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/20/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Suhani Dalal
- A.T. Still University School of Medicine, Mesa, AZ
| | | | - Syed Mahmood
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Alan Kaye
- Louisiana State University Health Sciences Center, Shreveport, LA
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12
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Herman J, Urits I, Eskander J, Kaye A, Viswanath O. Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty. Cureus 2020; 12:e10566. [PMID: 33101812 PMCID: PMC7577298 DOI: 10.7759/cureus.10566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Total knee arthroplasty (TKA) is among the most commonly performed orthopedic procedures. Controlling the pain of this patient population is essential in improving outcomes such as opioid consumption, hospital length of stay, overall function, and rehabilitation participation following their procedure. Local anesthetic infiltration of the interspace between the popliteal artery and capsule of the posterior knee, known as the IPACK block, combined with an adductor canal block (ACB) can be used to reduce pain in the challenging area of the posterior knee after knee surgery without compromising motor function of the quadriceps muscles. One limiting factor to this combination of techniques is the duration of analgesia provided. This case series demonstrates the combination of dexmedetomidine and dexamethasone (Dex-Dex) as local anesthetic adjuvants to significantly prolong the analgesic duration of ACB (in addition to IPACK block) in three patients undergoing TKA. Preoperative ACB and IPACK blocks were performed for postoperative analgesia in three TKA patients. The anesthetic mixture was 10 cc 0.2% ropivacaine combined with 25 mcg of dexmedetomidine and 5-mg preservative-free dexamethasone for the ACB, and 0.2% ropivacaine combined with 5-mg preservative-free dexamethasone was utilized for the IPACK block. Two of the patients reported experiencing four days of analgesia and one patient reported five days of analgesia following the ACB + IPACK block. Two of the patients required no opioid analgesics postoperatively. An ACB utilizing 0.75% ropivacaine has been demonstrated to provide approximately 10.8 hours of analgesia. Our series demonstrates a significantly prolonged duration of analgesia from this injectate combination. Few studies have utilized the Dex-Dex combination. The combination, however, was previously proven to safely increase the analgesic duration of a caudal block prior to hypospadias surgeries in pediatrics. More studies are needed to understand a potential synergistic effect of Dex-Dex, which could have a substantial impact on postoperative analgesia for TKA patients.
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Affiliation(s)
- Jared Herman
- Anesthesiology, Mount Sinai Medical Center, Miami Beach, USA
| | - Ivan Urits
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Jonathan Eskander
- Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA
| | - Alan Kaye
- Anesthesiology, Louisiana State University Health Shreveport, Shreveport, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
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13
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Noor NA, Urits I, Viswanath O, Kaye A, Eskander J. Synergistic Effect of Perineural Dexamethasone and Dexmedetomidine (Dex-Dex) Prolong Analgesic Effect of a Preoperative Interscalene Block. Cureus 2020; 12:e9473. [PMID: 32874802 PMCID: PMC7455378 DOI: 10.7759/cureus.9473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The brachial plexus is often a target of regional anesthesia for procedures involving the upper extremities. These include the supraclavicular, infraclavicular, interscalene, and axillary blocks. The cases we present involve the use of an ultrasound-guided interscalene block using 20 mL 0.2% ropivacaine with dexamethasone and 25 mcg dexmedetomidine as the injectate. This particular block technique has proven to be a very useful adjunct to the perioperative anesthetic care and enhanced recovery after surgery (ERAS) protocol for these patients. The series of cases we present include patients receiving the dexamethasone and dexmedetomidine (Dex-Dex) combination in their local anesthetic injectate for the ultrasound-guided interscalene block. Two of the patients underwent arthroscopic shoulder procedures and one underwent a shoulder total arthroplasty with biceps tenodesis. None of the patients required any postoperative opioids for analgesia. Though the technique is fairly new, with only a limited number of case studies described its efficacy, the understanding of the benefits of ERAS has helped it gain some traction in the field of regional anesthesia. Conduction of further large clinical trials is the next step in providing a better understanding of the Dex-Dex adjuvant method as it moves towards becoming a commonly used component of ERAS protocols in the perioperative period.
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Affiliation(s)
- Nazir A Noor
- Anesthesiology and Critical Care, Mount Sinai Medical Center, Miami Beach, USA
| | - Ivan Urits
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | - Alan Kaye
- Anesthesiology, Louisiana State University Shreveport, Shreveport, USA
| | - Jonathan Eskander
- Anesthesiology and Pain Medicine, Portsmouth Anesthesia Associates, Portsmouth, USA
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14
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Orhurhu V, Schwartz R, Potts J, Peck J, Urits I, Orhurhu MS, Odonkor C, Viswanath O, Kaye A, Gill J. Role of Alpha-2-Microglobulin in the Treatment of Osteoarthritic Knee Pain: a Brief Review of the Literature. Curr Pain Headache Rep 2019; 23:82. [PMID: 31502073 DOI: 10.1007/s11916-019-0822-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Chronic knee pain remains a debilitating condition that remains difficult to manage. The purpose of this review, therefore, is to summarize current understanding of alpha-2-microglobulin in the treatment of osteoarthritic knee pain. Furthermore, we investigate its role in the anti-inflammatory properties of platelet-rich plasma (PRP). RECENT FINDINGS Alpha-2-microglobulin, a 720-kD protein complex, is an active protease inhibitor with tremendous anti-inflammatory properties in animal models. A growing body of evidence suggests that this complex is the most instrumental factor for cartilage preservation in PRP injections. As an active component of platelet-rich plasma's anti-inflammatory properties, alpha-2-microglobulin has been shown to be an active inhibitor of joint degeneration, cartilage preservation, and improvement in quality of life for patients with knee osteoarthritis compared with a multitude of other modalities.
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Affiliation(s)
- Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center of Florida, Miami, FL, USA
| | - Jacob Potts
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Jacqueline Peck
- Department of Anesthesiology, Mount Sinai Medical Center of Florida, Miami, FL, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mariam Salisu Orhurhu
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Charles Odonkor
- Department of Anesthesia, Critical Care and Pain Medicine, Division of Pain, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Alan Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jatinder Gill
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Liu H, Kaye A, Comarda N, Li M. Corrigendum to "Paradoxical postural cerebrospinal fluid leak-induced headache: Report of two cases" [J Clin Anesth 20 (5) (2008 Aug) 383-5]. J Clin Anesth 2018; 50:64. [PMID: 29980004 DOI: 10.1016/j.jclinane.2018.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Henry Liu
- Department of Anesthesiology, Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA 70112, USA; Parish Anesthesia Associates, Metairie, LA 70002, USA; Gasliu Corporation, New Orleans, LA 70131, USA.
| | - Alan Kaye
- Department of Anesthesiology, LSUHSC, 2020 Gravier St, Suite 775, New Orleans, LA 70112, USA
| | - Neal Comarda
- Parish Anesthesia Associates, West Jefferson Medical Center, Marrero, LA 70002, USA
| | - Marilyn Li
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA; Hayward Genetic Center, Tulane University Medical Center, New Orleans, LA 70112, USA
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16
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Affiliation(s)
- A. Kaye
- JET Joint Undertaking9, Abingdon, Oxfordshire OX 14 3EA, United Kingdom
| | - J. Jacquinot
- JET Joint Undertaking9, Abingdon, Oxfordshire OX 14 3EA, United Kingdom
| | - P. Lallia
- JET Joint Undertaking9, Abingdon, Oxfordshire OX 14 3EA, United Kingdom
| | - T. Wade
- JET Joint Undertaking9, Abingdon, Oxfordshire OX 14 3EA, United Kingdom
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Morokoff A, Bennett I, Paradiso L, Luwor R, Koldej R, Li J, Ma C, Drummond K, Kaye A, Siegal T. P08.44 Preoperative serum microRNA profiles as a diagnostic tool in glioma. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ma C, Nguyen H, Paradiso L, Putz U, Luwor R, Kaye A, Morokoff A. P08.35 Exosomes derived from Glioma Stem Cells (GSCs) promote cell migration, proliferation and radiation resistance in brain cancer. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruan X, Luo J, Kaye A. Efficacy and Tolerability of Co-Administering Full µ-Opioid Receptor Agonists with Buprenorphine and Mixed Opioid Agonists. Drug Res (Stuttg) 2016; 67:189-190. [DOI: 10.1055/s-0042-119946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Xiulu Ruan
- Adjunct Clinical Associate Professor of Anesthesia Department of Anesthesiology, Louisiana State University Health Science Center Tulane Ave. New Orleans, LA
| | - Jinjun Luo
- Professor of Neurology and Pharmacology, Director, EMG/Neuromuscular Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Alan Kaye
- Professor, Program Director, and Chairman of Anesthesia, Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA
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Liu H, Sangkum L, Liu G, Green M, Li M, Kaye A. Effects of epinephrine on angiogenesis-related gene expressions in cultured rat cardiomyocytes. J Biomed Res 2016; 30:380-385. [PMID: 27845301 PMCID: PMC5044710 DOI: 10.7555/jbr.30.20160024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/18/2016] [Accepted: 03/29/2016] [Indexed: 12/15/2022] Open
Abstract
Epinephrine is often used for the treatment of patients with heart failure, low cardiac output and cardiac arrest. It can acutely improve hemodynamic parameters; however, it does not seem to improve longer term clinical outcomes. Therefore, we hypothesized that epinephrine may induce unfavorable changes in gene expression of cardiomyocyte. Thus, we investigated effects of epinephrine exposure on the mediation or modulation of gene expression of cultured cardiomyocytes at a genome-wide scale. Our investigation revealed that exposure of cardiomyocytes to epinephrine in an in vitro environment can up-regulate the expression of angiopoietin-2 gene (+2.1 times), and down-regulate the gene expression of neuregulin 1 (−3.7 times), plasminogen activator inhibitor-1 (−2.4 times) and SPARC-related modular calcium-binding protein-2 (−4.5 times). These changes suggest that epinephrine exposure may induce inhibition of angiogenesis-related gene expressions in cultured rat cardiomyocytes. The precise clinical significance of these changes in gene expression, which was induced by epinephrine exposure, warrants further experimental and clinical investigations.
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Affiliation(s)
- Henry Liu
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA;
| | - Lisa Sangkum
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Geoffrey Liu
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Michael Green
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Marilyn Li
- Division of Genomic Diagnostics, Dept. of Pathology & Laboratory Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alan Kaye
- Department of Anesthesiology, LSUHSC-New Orleans, New Orleans, LA 70112, USA
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Davis SF, Altstadt T, Flores R, Kaye A, Oremus G. Report of seizure following intraoperative monitoring of transcranial motor evoked potentials. Ochsner J 2013; 13:558-560. [PMID: 24358008 PMCID: PMC3865838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Transcranial motor evoked potentials are used to detect iatrogenic injury to the corticospinal tracts and vascular territory of the anterior spinal artery. Tongue and lip lacerations are the most common complication of this modality. Theoretical complications include cardiac arrhythmia and seizure although there are no published reports of either. CASE REPORT We report a case of postoperative seizure following motor evoked potential testing in a patient without a seizure history. Although anecdotal reports exist, ours is the first known published report of seizure following transcranial electrical stimulation. CONCLUSION The intent of this novel report is to encourage the use of anesthetic regimens that raise seizure threshold, decrease stimulation threshold, and increase the specificity of motor evoked potentials. Providers should be prepared to treat intraoperative or perioperative seizure activity when the monitoring protocol includes transcranial motor evoked potentials.
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Affiliation(s)
- Scott F. Davis
- Department of Anesthesiology, Tulane University and Louisiana State University Schools of Medicine, New Orleans, LA
- PhysIOM, Ft. Collins, CO
| | - Thomas Altstadt
- Southern Oregon Neurological and Spine Associates, Medford, OR
| | | | - Alan Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA
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Stylli S, Hill J, Sawyer W, Kaye A. Aluminium phthalocyanine mediated photodynamic therapy in experimental malignant glioma. J Clin Neurosci 2012; 2:146-51. [PMID: 18638801 DOI: 10.1016/0967-5868(95)90008-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/1994] [Accepted: 11/15/1994] [Indexed: 11/15/2022]
Abstract
The efficacy of aluminium tetrasulfonated phthalocyanine (AISPc) as a photosensitizer for photodynamic therapy (PDT) was investigated in the C6 glioma model in Wistar rats. The depth and extent of tumour necrosis was dependent on both the dosage of intravenously (IV) administered AISPc, and the dose and time post-sensitization of 675 nm light administration. There was no effect on tumour or normal brain if the sensitizer dose was less than 0.5 mg/kg. Selective necrosis of tumour was evident 6 hours post-sensitization at an AISPc dose up to 1 mg/kg and light doses up to 200 J/cm(2). Necrosis occurred in normal brain at higher doses of light and sensitizer. There was no photosensitizer effect in animals treated 24 hours post AISPc administration. The ability of AISPc to act as a selective photosensitizer causing photonecrosis provides a basis for the generation of modified AISPc species as future agents in the PDT of brain tumours, especially as these sensitizers absorb light at a higher wavelength than those that are currently available.
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Affiliation(s)
- S Stylli
- The Melbourne Neuroscience Centre, University of Melbourne, ParkvilleAustralia; Departments of Neurosurgery and Surgery, Royal Melbourne Hospital, Australia
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Abstract
Although the association of epilepsy with cerebral tumours is well recognized, the reported incidence of seizures and relationship to tumour pathology varies significantly. This study assessed retrospectively the incidence of seizures, relationship to tumour pathology, natural history of epilepsy and prognostic significance of presentation with a seizure in 120 consecutive adults with histologically proven primary cerebral hemisphere tumours including meningiomas. 52% had a seizure and most were at presentation. Seizures were more common with anaplastic astrocytoma (AA) (18 23 ) than glioblastoma multiforme (21 56 ) (p = 0.001) and seizure occurrence was associated with cortical invasion. 52% of meningioma patients had a seizure. Seizures recurred in 34%, more frequently with glioma (19 of 46) than meningioma (1 of 15) (p < 0.05). Patients with AA presenting with a seizure had a longer survival (28 months) than patients without seizure (8 months) (p = 0.05 one sided). In conclusion, seizures are a common complication of cerebral tumours, usually at presentation and correlate with tumour pathology. A seizure at presentation in AA correlates with longer survival.
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Affiliation(s)
- C Kilpatrick
- Department of Neurology Royal Melbourne Hospital, Australia
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Niekrash R, McLean C, Kaye A, Hjorth R, Desmond P, Sinicaks V, Gonzales M. Rapidly progressive Whipple's disease of the central nervous system. J Clin Neurosci 2012; 2:171-6. [PMID: 18638806 DOI: 10.1016/0967-5868(95)90013-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/1993] [Accepted: 12/15/1993] [Indexed: 11/30/2022]
Abstract
We describe a patient with rapidly progressive Whipple's disease confined to the central nervous system (CNS). The diagnosis was made pre-mortem following stereotactic and open brain biopsis and confirmed at autopsy. Despite appropriate antibiotic treatment, the disease ran a fulminant course to death after nine weeks.
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Affiliation(s)
- R Niekrash
- Department of Neurosurgery, The Melbourne Neuroscience, Centre, Parkville, Victoria, Australia
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25
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Li Y, Johnson R, Gonzales M, Kaye A. Diffuse Large B-Cell Lymphoma Involving the Pituitary Gland. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Hall J, Kaye A, Fallis S, Barsoum G, Youssef H. What is the negative appendicectomy rate in women having diagnostic laparoscopy? Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Hall J, Kaye A, Fallis S, Barsoum G, Youssef H. Outcomes for surgical female patients admitted to a surgical assessment unit with right iliac fossa pain - Is it time for a multidisciplinary approach? Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Vrancken M, Lerche E, Blackman T, Durodié F, Evrard M, Graham M, Jacquet P, Kaye A, Mayoral ML, Nightingale M, Ongena J, Van Eester D, Van Schoor M. Performance of the Scattering Matrix Arc Detection System on the JET ITER-like ICRF antenna. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.02.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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de Lloyd L, Bovington R, Kaye A, Collis R, Rayment R, Sanders J, Rees A, Collins P. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth 2011; 20:135-41. [DOI: 10.1016/j.ijoa.2010.12.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/15/2010] [Accepted: 12/14/2010] [Indexed: 11/25/2022]
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30
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Durodié F, Nightingale M, Argouarch A, Berger-By G, Blackman T, Caughman J, Cocilovo V, Dumortier P, Edwards P, Fanthome J, Frigione D, Goulding R, Graham M, Hobrik J, Huygen S, Jachmich S, Jacquet P, Kaye A, Lamalle P, Lerche E, Loarer T, Mayoral ML, Messiaen A, Monakhov I, Nave M, Nicholls K, Ongena J, Rimini F, Van Eester D, Vervier M, Vrancken M, Sozzi C, Stork D, Tsalas M, Walden A, Whitehurst A, Zastrow KD. Commissioning of the ITER-like ICRF antenna for JET. Fusion Engineering and Design 2009. [DOI: 10.1016/j.fusengdes.2009.01.074] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Jin-Cheng L, Wen Y, Zhao Y, Quan-Yu Z, Shu-Miao Z, Hai-Tao G, Hui B, Yue-Min W, Xin S, Liang C, Qin C, Shi-Qiang Y, Kaye A, Ding-Hua Y, Jian-Ming P. Anti-arrhythmic Effects of κ-Opioid Receptor and Its Changes in Ischemia and Reperfusion. Arch Med Res 2008; 39:483-8. [DOI: 10.1016/j.arcmed.2008.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 02/21/2008] [Indexed: 11/30/2022]
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Saleh O, Baluch A, Kaye AJ, Kaye A. Arteriovenous malformation, complications, and perioperative anesthetic management. Middle East J Anaesthesiol 2008; 19:737-756. [PMID: 18630762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Arteriovenous malformations (AVMs) are the most common intracranial vascular malformation, with an estimated occurrence of 1:5000-1:2000 persons. The repair requires careful embolization, often followed by stereotactic radiosurgery and can also include open craniotomy. Preoperatively, patients may be healthy or dramatically unstable, as 30-50% of these cases present with acute cerebral hemorrhage. One of the most important considerations for the anesthesiologist should be attempting to achieve hemodynamic stability in the face of potential increased intracranial pressure and subsequent vulnerability of the tissues to ischemic insult. Knowledge of the risks and hazards of the procedure and collaboration with specialists, including neuroradiologists, critical care physicians, and potentially neurosurgeons, ultimately form the basis for appropriate management. AVM's can lead to potentially fatal ischemic or hemorrhagic complications that may occur in up to 8% of cases. The protection of the airway, adequate monitoring, and maintaining cardiovascular and neurological stability, are critical. Further, in the setting of a radiological suite, peripheral location considerations involving equipment, monitors, and appropriate drugs and sustaining the patient's immobility during the radiological procedures, while managing potential perioperative complications are all essential.
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Affiliation(s)
- Omar Saleh
- University of Mississippi School of Medicine, Jackson, MS, USA
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Baluch A, Janoo A, Lam K, Hoover J, Kaye A. Septic shock: review and anesthetic considerations. Middle East J Anaesthesiol 2007; 19:71-86. [PMID: 17511184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Sepsis and shock are severe conditions that, when together, may cause multiple organ failure. The anesthesiologist must be able to take a careful history and physical, as well as be aware that additional tests are necessary to assess the patient status, as preoperative systemic blood pressure is not indicative of adequate volume status. In preparation for surgery, one must anticipate dysfunction and have adequate blood products and antibiotic at hand. Ketamine is notable for induction in these patients because it is less likely to decrease systemic vascular resistance too quickly. One must not take this lightly, as death may ensue if proper management is not taken.
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Affiliation(s)
- Amir Baluch
- Texas Tech University Health Science Center, Lubbock, TX, USA
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35
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Lester N, Durazzo T, Kaye A, Ahl M, Forman HP. Referring Physicians' Attitudes Toward International Interpretation of Teleradiology Images. AJR Am J Roentgenol 2007; 188:W1-8. [PMID: 17179319 DOI: 10.2214/ajr.05.1303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated referring physician attitudes toward the international interpretation of radiologic images. MATERIALS AND METHODS A five-question, scenario-based survey describing features of a hypothetic local radiology firm compared with those of its hypothetic overseas counterpart, international radiology, was sent by mail to 350 physicians from a broad range of medical and surgical specialties. One hundred nineteen physicians responded, for a response rate of 34%. Referring physicians were asked to indicate their preference for local versus international interpretation in each scenario using a 5-point Likert scale, with a score of -2 indicating a strong preference for international services, 0 indicating no preference, and 2 indicating a strong preference for local services. RESULTS When all variables are held to be equal, referring physicians strongly prefer local services (mean score, 1.77; SD, 0.77). When international teleradiology provides either a 2-day faster turnaround time for reports or a 30 dollars lower out-of-pocket cost to the patient, referring physicians still prefer local services, although less than they did with all variables held equal (mean score, 0.42-0.44; SD, 1.30-1.40). When international teleradiology provides both a 2-day faster turnaround time and a 30 dollars lower out-of-pocket cost to the patient, referring physicians preferred international teleradiology, albeit only slightly (mean, -0.25; SD, 1.50). Finally, when the credentials of the international radiologists are perceived to be less than those of the local radiologists, even in the face of faster turnaround time and 30 dollars lower cost to the patient, referring physicians overall strongly prefer local services (mean, 1.51; SD, 0.86). CONCLUSION Referring physicians prefer local interpretation of radiologic images to international interpretation when all things are equal. However, the timeliness of image interpretation and the cost to the patient are important factors in this decision.
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Affiliation(s)
- Neil Lester
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA.
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36
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Dakour R, Baluch A, Saleh O, Patel R, Kaye A, Frost E. Anesthetic considerations for outpatient colonoscopy. Middle East J Anaesthesiol 2006; 18:1019-42. [PMID: 17263261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Ramzi Dakour
- Texas Tech University Health Science Center, Lubock, USA
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37
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Kaye A, Newton SD. Keeping up appearances--ultrasound imaging in a digital age. Ultrasound Obstet Gynecol 2006; 27:239-42. [PMID: 16482612 DOI: 10.1002/uog.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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38
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Kozmenko V, Morgan B, Kaye A, Wren K, Hilton C. 205 IMMERSIVE HIGH-FIDELITY SIMULATOR-BASED TEACHING FOR ANESTHESIOLOGY NURSING STUDENTS RESULTS IN STEADY PERFORMANCE PATTERNS IN TRAINEES. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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39
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Chappuis P, Portafaix C, Thomas E, Bertrand B, Walton R, Riccardo V, Baker R, Barlow I, Kaye A, Lorenz A, Durodier F. Design of a limiter for the JET EP ICRH antenna. Fusion Engineering and Design 2005. [DOI: 10.1016/j.fusengdes.2005.06.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Frass M, Dielacher C, Linkesch M, Endler C, Muchitsch I, Schuster E, Kaye A. Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients. Chest 2005; 127:936-41. [PMID: 15764779 DOI: 10.1378/chest.127.3.936] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Stringy, tenacious tracheal secretions may prevent extubation in patients weaned from the respirator. This prospective, randomized, double-blind, placebo-controlled study with parallel assignment was performed to assess the influence of sublingually administered potassium dichromate C30 on the amount of tenacious, stringy tracheal secretions in critically ill patients with a history of tobacco use and COPD. METHODS In this study, 50 patients breathing spontaneously with continuous positive airway pressure were receiving either potassium dichromate C30 globules (group 1) [Deutsche Homoopathie-Union, Pharmaceutical Company; Karlsruhe, Germany] or placebo (group 2). Five globules were administered twice daily at intervals of 12 h. The amount of tracheal secretions on day 2 after the start of the study as well as the time for successful extubation and length of stay in the ICU were recorded. RESULTS The amount of tracheal secretions was reduced significantly in group 1 (p < 0.0001). Extubation could be performed significantly earlier in group 1 (p < 0.0001). Similarly, length of stay was significantly shorter in group 1 (4.20 +/- 1.61 days vs 7.68 +/- 3.60 days, p < 0.0001 [mean +/- SD]). CONCLUSION These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.
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Affiliation(s)
- Michael Frass
- Ludwig Boltzmann Institute for Homeopathy, Duerergasse 4, A 8010 Graz, Austria.
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41
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Kaye A, Kucera IJ, Heavner J, Gelb A, Anwar M, Duban M, Arif AS, Craen R, Chang CT, Trillo R, Hoffman M. The Comparative Effects of Desflurane and Isoflurane on Lumbar Cerebrospinal Fluid Pressure in Patients Undergoing Craniotomy for Supratentorial Tumors. Anesth Analg 2004; 98:1127-1132. [PMID: 15041612 DOI: 10.1213/01.ane.0000105862.78906.3d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We compared the effects of desflurane and isoflurane on cerebral perfusion pressure (CPP), lumbar cerebrospinal fluid pressure (LCSFP), and mean arterial blood pressure (MAP) in patients anesthetized with desflurane or isoflurane undergoing craniotomy for supratentorial mass lesions. Additionally, emergence from anesthesia was examined to determine if neurologic function could be assessed earlier after isoflurane or desflurane anesthesia. Thirty-six patients were randomized to receive either desflurane or isoflurane for maintenance of anesthesia at 1.2 minimum alveolar concentration (MAC). Patients were hyperventilated (PaCO(2), 30 +/- 2 mm Hg) after baseline LCSFP was obtained via the subarachnoid catheter. At a MAC of 1.2, mean LCSFP was not statistically different between the two study groups either before or after hyperventilation. Additionally, CPP was not significantly different between the two groups. Finally, patient's time to respond to commands was 50% shorter in the desflurane group (30 +/- 36 min) (mean +/- SD) when compared with the isoflurane group (72 +/- 126 min); however, this was not significant (P = 0.17). In patients undergoing craniotomy for supratentorial mass lesions, desflurane and isoflurane have similar effects on CPP and MAP. Additionally, desflurane in the setting of hyperventilation does not cause significant changes in LCSFP. IMPLICATIONS This is the largest study to date comparing the effects of desflurane and isoflurane on patients undergoing craniotomy for supratentorial mass lesion with evidence of midline shift or edema. Neither desflurane nor isoflurane significantly altered lumbar cerebrospinal fluid pressure when moderate hypocapnia was maintained.
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Affiliation(s)
- Alan Kaye
- From the Department of Anesthesiology, Texas Tech University, Lubbock, Texas
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42
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Affiliation(s)
- Gregory Iafrate
- Department of Radiology, Bridgeport Hospital, Bridgeport, CT 06610, USA.
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Verhoeven A, Bongers W, Elzendoorn B, Graswinckel M, Hellingman P, Kooijman W, Kruijt O, Maagdenberg J, Ronden D, Stakenborg J, Sterk A, Tichler J, Alberti S, Henderson M, Hoekzema J, Fernandez A, Likin K, Bruschi A, Cirant S, Novak S, Piosczyk B, Thumm M, Guigon A, Damiani C, Pamela J, Kaye A, Fleming C, Zohm H. Design and R&D of an ECRH system on JET. Fusion Engineering and Design 2003. [DOI: 10.1016/s0920-3796(03)00250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kaye A, Saunders DW. A concentric cylinder viscometer for the measurement of flow birefringence and viscosity in concentrated polymer solutions. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0950-7671/41/3/308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jackson R, Kaye A. The measurement of the normal stress differences in a liquid undergoing simple shear flow using a cone-and-plate total thrust apparatus only. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0508-3443/17/10/314] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Greven KM, Levenback C, Chao CK, Delaney T, Del Priore G, Eifel P, Erickson BA, Followill D, Gaffney D, Garcia M, Gerszten K, Grigsby P, Henderson R, Hricak H, Hsu J, Jhingrin A, Kaye A, Kudelka A, Lukka H, Mutch D, Nag S, Rotman M, Shefter T, Smith W, Stehman F, Souhami L, Wenzel L, Winter KA, Wolfson A. Radiation Therapy Oncology Group. Research Plan 2002-2006. Gynecology Cancer Working Group. Int J Radiat Oncol Biol Phys 2002; 51:58-9. [PMID: 11641017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Layne E, Segal G, Foust R, Kaye A, Leider S, Leupold S, Porterfield H, Kim P, Unger D, DiBona AM, Kulm P, Larrick J, Leifeste K, Rhode J, Rhodes LL, Stetz JA. Radiation Therapy Oncology Group. Research Plan 2002-2006. Patient Advocacy Committee. Int J Radiat Oncol Biol Phys 2002; 51:120-1. [PMID: 11641027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Affiliation(s)
- U Novak
- Dept. of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, 3050, Australia.
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