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Borst AJ, Bonfield CM, Deenadayalan PS, Le CH, Xu M, Reddy SK. Measuring coagulopathy in pediatric craniofacial surgery. Blood Coagul Fibrinolysis 2023; 34:403-407. [PMID: 37395200 DOI: 10.1097/mbc.0000000000001234] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The goal of this study was to describe hematologic and coagulation laboratory parameters and identify if these laboratory studies could predict blood loss in a cohort of pediatric patients undergoing complex cranial vault reconstruction (CCVR) for repair of craniosynostosis. We reviewed records from 95 pediatric CCVR patients between 2015 and 2019. Primary outcome measures were hematologic and coagulation laboratory parameters. Secondary outcome measures were intraoperative and postoperative calculated blood loss (CBL). Preoperative laboratory values were within normal limits and did not predict outcomes. Intraoperative platelet count and fibrinogen predicted CBL but without clinically relevant thrombocytopenia or hypofibrinogenemia. Intraoperative prothrombin time (PT) and partial thromboplastin time (PTT) predicted perioperative CBL, possibly reflecting surgically induced coagulopathy. Postoperative laboratory values did not predict postoperative blood loss. We found that standard hematologic and coagulation laboratory parameters predicted intraoperative and postoperative blood loss but provided limited mechanistic information to improve our understanding of coagulopathy in craniofacial surgery.
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Affiliation(s)
- Alexandra J Borst
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania
| | | | | | - Chi H Le
- Vanderbilt University School of Medicine
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY
| | | | - Srijaya K Reddy
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Matava CT, Tighe NTG, Baerschiger R, Wilder RT, Correll L, Staffa SJ, Zurakowski D, Kato MA, Meier PM, Raman V, Reddy SK, Roque RA, Peterson MB, Zhong J, Edala T, Greer TJ, von Ungern-Sternberg BS, Cravero J, Simpao AF. Patient and Process Outcomes Among Pediatric Patients Undergoing Appendectomy During the COVID-19 Pandemic - an International Retrospective Cohort study. Anesthesiology 2023:138035. [PMID: 37014980 DOI: 10.1097/aln.0000000000004570] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. We hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy. METHODS We conducted a retrospective, international, multicenter study using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients < 18 years old were matched using age, ASA-PS status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April-May 2020) compared to pre-pandemic (April-May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis. RESULTS 3351 cases from 28 institutions were available with 1684 cases in the pre-pandemic cohort matched to 1618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 hours (IQR: 18, 67) in the pandemic cohort versus 28 hours (IQR: 18, 79) in the pre-pandemic cohort (adjusted coefficient, 1; 95% CI 0.39 to 1.61, P<0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period compared to the pre-pandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, pre-pandemic 313 (18.6%) versus pandemic 389 (24.1%), absolute difference of 5.5% (adjusted OR, 1.32; [95% CI 1.1 to 1.59]; P=0.003). Preoperative SARS CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 minutes (IQR: 430, 1112) with testing versus 414 minutes (IQR: 231, 770) without testing, adjusted coefficient, 306 minutes, (95% CI 241 to 371, P <0.001), and longer hospital length of stay, 31 hours (IQR: 20, 83) with testing versus 24 hours (IQR: 14, 68) without testing, adjusted coefficient, 7.0, (95% CI 2.7 to 11.3, P=0.002). DISCUSSION For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.
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Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children. Toronto, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto. Toronto, Canada
| | - Nathaniel T G Tighe
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Reto Baerschiger
- Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robert T Wilder
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Lynnie Correll
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, NY
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Meridith A Kato
- Oregon Health & Science University, Doernbecher Children's Hospital, Portland, OR, United States
| | - Petra M Meier
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Vidya Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Remigio A Roque
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Melissa Brooks Peterson
- Department of Anesthesiology, Children's Hospital Colorado / University of Colorado School of Medicine, Aurora, CO, United States
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Anesthesiology, Children's Health of Dallas, Dallas, TX, United States
| | - Thejovathi Edala
- Department of Pediatric Anesthesiology, Arkansas Children's Hospital, Little Rock, AR, United States
| | - Timothy J Greer
- Department of Anaesthesia & Pain Management, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia & Pain Management, Perth Children's Hospital, Perth, Western Australia, Australia
- Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Cravero
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Allan F Simpao
- Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia. Philadelphia, PA
- Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine. Philadelphia, PA
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Borst AJ, Bonfield CM, Deenadayalan PS, Le CH, Xu M, Sobey JH, Reddy SK. ε-Aminocaproic acid versus tranexamic acid in children undergoing complex cranial vault reconstruction for repair of craniosynostosis. Pediatr Blood Cancer 2021; 68:e29093. [PMID: 34003588 DOI: 10.1002/pbc.29093] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/15/2021] [Indexed: 11/08/2022]
Abstract
Complex cranial vault reconstruction (CCVR) for pediatric craniosynostosis is a high blood loss surgery, for which antifibrinolytic agents have been shown to reduce bleeding and transfusion requirements. The relative efficacy of ε-aminocaproic acid (EACA) versus tranexamic acid (TXA) has not yet been evaluated in this population. The aim of this retrospective study was to compare perioperative blood loss and transfusion in CCVR patients receiving EACA versus TXA. In a CCVR cohort of 95 children, 47 received EACA and 48 received TXA. We found no differences in demographics, adverse outcomes, calculated blood loss (CBL), or transfusion requirements between the two antifibrinolytic groups.
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Affiliation(s)
- Alexandra J Borst
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Division of Pediatric Neurological Surgery, Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Chi H Le
- Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Meng Xu
- Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital/Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Adams CD, Reddy SK, Phillips JD, Emerson BR. Hypoglossal nerve stimulator placement in a child with severe refractory OSA: a novel procedure in the paediatric population. BMJ Case Rep 2021; 14:14/5/e242592. [PMID: 33947679 PMCID: PMC8098956 DOI: 10.1136/bcr-2021-242592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Clayton D Adams
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - James D Phillips
- Department of Otolaryngology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Brian R Emerson
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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5
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Derderian CK, Derderian CA, Fernandez A, Glover CD, Goobie S, Hansen JK, King M, Kugler J, Lang SS, Meier-Haran P, Nelson O, Reddy SK, Reid R, Ricketts K, Rottgers SA, Singh D, Szmuk P, Taicher BM, Taylor J, Stricker PA. The Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference Methodology. Paediatr Anaesth 2021; 31:145-149. [PMID: 33174262 DOI: 10.1111/pan.14066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This article describes the methodology used for the Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference. DESIGN This is a novel Consensus Conference of national experts in Pediatric Craniofacial Surgery and Anesthesia, who will follow standards set by the Institute of Medicine and using the Research and Development/University of California, Los Angeles appropriateness method, modeled after the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Topics related to pediatric craniofacial anesthesia for open cranial vault surgery were divided into twelve subgroups with a systematic review of the literature. SETTING A group of 20 content experts met virtually between 2019 and 2020 and will collaborate in their selected topics related to perioperative management for pediatric open cranial vault surgery for craniosynostosis. These groups will also identify where future research is needed. CONCLUSIONS Experts in pediatric craniofacial surgery and anesthesiology are developing recommendations on behalf of the Pediatric Craniofacial Collaborative Group for perioperative management of patients undergoing open cranial vault surgery for craniosynostosis and identifying future research priorities.
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Affiliation(s)
- Courtney K Derderian
- Department of Anesthesia and Pediatric Anesthesia, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Christopher A Derderian
- Department of Plastic Surgery and Craniofacial Surgery, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Allison Fernandez
- Department of Anesthesia and Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Chris D Glover
- Department of Anesthesia and Pediatric Anesthesia, Baylor University School of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Susan Goobie
- Department of Anesthesia and Pediatric Anesthesia, Harvard University School of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer K Hansen
- Department of Anesthesiology, Pediatric Division, Department of Anesthesiology, The University of Kansas Health System, Kansas City, KS, USA
| | - Michael King
- Department of Anesthesiology and Pediatric Anesthesiology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jane Kugler
- Department of Anesthesiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Shih-Shan Lang
- Department of Neurosurgery and Pediatric Neurosurgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Petra Meier-Haran
- Department of Anesthesia and Pediatric Anesthesia, Harvard University School of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Olivia Nelson
- Department of Anesthesia and Pediatric Anesthesia, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Srijaya K Reddy
- Department of Anesthesia and Pediatric Anesthesia, University of Vanderbilt School of Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Russell Reid
- Department of Plastic and Reconstructive Surgery, University of Chicago School of Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Karene Ricketts
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Stephen A Rottgers
- Department of Plastic Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Davinder Singh
- Department of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Peter Szmuk
- Department of Anesthesia and Pediatric Anesthesia, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Brad M Taicher
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Jesse Taylor
- Department of Plastic Surgery and Craniofacial Surgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paul A Stricker
- Department of Anesthesia and Pediatric Anesthesia, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Chang D, Leisy PJ, Sobey JH, Reddy SK, Brophy C, Alvis BD, Hocking K, Polcz M. Physiology and clinical utility of the peripheral venous waveform. JRSM Cardiovasc Dis 2020; 9:2048004020970038. [PMID: 33194174 PMCID: PMC7605016 DOI: 10.1177/2048004020970038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/05/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 12/19/2022] Open
Abstract
The peripheral venous system serves as a volume reservoir due to its high compliance and can yield information on intravascular volume status. Peripheral venous waveforms can be captured by direct transduction through a peripheral catheter, non-invasive piezoelectric transduction, or gleaned from other waveforms such as the plethysmograph. Older analysis techniques relied upon pressure waveforms such as peripheral venous pressure and central venous pressure as a means of evaluating fluid responsiveness. Newer peripheral venous waveform analysis techniques exist in both the time and frequency domains, and have been applied to various clinical scenarios including hypovolemia (i.e. hemorrhage, dehydration) and volume overload.
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Affiliation(s)
- Devin Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Philip J Leisy
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville TN, USA
| | - Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville TN, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville TN, USA
| | - Colleen Brophy
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville TN, USA
| | - Bret D Alvis
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Hocking
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica Polcz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Nelson JH, Brackett SL, Oluigbo CO, Reddy SK. Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases. Children (Basel) 2020; 7:children7080094. [PMID: 32784564 PMCID: PMC7465763 DOI: 10.3390/children7080094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.
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Affiliation(s)
- Jonathon H. Nelson
- Division of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
- Correspondence:
| | - Samantha L. Brackett
- Division of Anesthesiology, Pain and Perioperative Medicine, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
| | - Chima O. Oluigbo
- Division of Neurosurgery, Children’s National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC 20010, USA;
| | - Srijaya K. Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
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Reddy SK, Jones JJ, Gordish-Dressman H, Pestieau SR. Dexmedetomidine as an Opioid-Sparing Agent in Pediatric Craniofacial Surgery. Children (Basel) 2020; 7:children7070068. [PMID: 32630167 PMCID: PMC7401866 DOI: 10.3390/children7070068] [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] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings.
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Affiliation(s)
- Srijaya K. Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology—Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, 2200 Children’s Way Suite 3116, Nashville, TN 37232, USA
- Correspondence:
| | - Jacob J. Jones
- Division of Anesthesiology, Pain and Perioperative Medicine—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA; (J.J.J.); (S.R.P.)
| | - Heather Gordish-Dressman
- Center for Translational Research—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA;
| | - Sophie R. Pestieau
- Division of Anesthesiology, Pain and Perioperative Medicine—Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC 20010, USA; (J.J.J.); (S.R.P.)
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Sobey JH, Menser CC, Reddy SK, Hughes EM. Successful utilisation of epidural analgesia for perioperative pain management in a child with sodium voltage-gated channel alpha subunit (SCN1A) gene mutation. BMJ Case Rep 2020; 13:13/6/e234314. [PMID: 32532910 DOI: 10.1136/bcr-2020-234314] [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] [Indexed: 11/04/2022] Open
Abstract
Sodium voltage-gated channel alpha subunit (SCN1A) gene mutation is a rare disorder with a large spectrum of clinical presentations. Little is known regarding anaesthetic and analgesic management of these patients. We present a case of a child with SCN1A gene mutation that was successfully managed with an epidural for perioperative analgesia for an abdominal surgery.
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Affiliation(s)
- Jenna H Sobey
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Carrie C Menser
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Elisabeth M Hughes
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Affiliation(s)
- Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andreas C Plackis
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Division of Pediatric Neurological Surgery, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Fernandez AM, Reddy SK, Gordish-Dressman H, Muldowney BL, Martinez JL, Chiao F, Stricker PA, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falcon R, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Masel B, Medellin E, Meier P, Mitzel Levy H, Muhly WT, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Ramesh Parekh U, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction. Anesth Analg 2019; 129:1069-1078. [DOI: 10.1213/ane.0000000000003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Staudt GE, Reddy SK, Moore AD. Apneic oxygenation via nasal cannula for intubation of a premature neonate with multiple airway anomalies. BMJ Case Rep 2019; 12:12/3/e227494. [PMID: 30842134 DOI: 10.1136/bcr-2018-227494] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intubating a neonate under non-emergent conditions may be quite stressful, even for experienced providers, due to the potential for rapid oxygen desaturation. Pulmonary physiology and increased metabolic oxygen demand in this patient population contribute to accelerated oxygen desaturation during induction of anaesthesia and intubation. Using a nasal cannula, placed prior to induction of anaesthesia and left in place until the airway is secured, is a simple and effective way to provide apneic oxygenation and may help maintain adequate oxygen saturation. This technique may be particularly useful for patients who require additional time for intubation, including those with suspected difficult airways.
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Affiliation(s)
- Genevieve E Staudt
- Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Alexander D Moore
- Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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14
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Brenn BR, Reddy SK, Van Arendonk KJ, Morgan WM. Perioperative management of an anterior mediastinal teratoma in an infant: one more tool in the toolbox. BMJ Case Rep 2018; 2018:bcr-2018-227022. [PMID: 30389739 DOI: 10.1136/bcr-2018-227022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/04/2022] Open
Abstract
Anterior mediastinal masses present a significant challenge in the perioperative period. Standard anaesthetic induction and airway management are often not feasible due to the risk of complete respiratory and/or cardiovascular collapse. Invasive manoeuvres, such as extracorporeal membrane oxygenation, cardiac bypass, or tracheal or bronchial stenting, are sometimes not applicable due to significant anatomic aberration. We present a case of anterior mediastinal mass in a 5-month-old infant where typical management techniques in the treatment algorithm were not possible.
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Affiliation(s)
- Bruce R Brenn
- Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Srijaya K Reddy
- Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Kyle J Van Arendonk
- Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Walter M Morgan
- Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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15
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Affiliation(s)
- Collin F Mulcahy
- Division of Otolaryngology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Srijaya K Reddy
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, DC, USA
| | - Emily E Wikner
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Pamela A Mudd
- Division of Otolaryngology, Children's National Health System, Washington, DC, USA
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16
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Fayed IF, Chang Y, Keating RF, Reddy SK. Spontaneous subdural haematoma in a paediatric patient on anticoagulant therapy. BMJ Case Rep 2017; 2017:bcr-2017-223041. [PMID: 29102978 DOI: 10.1136/bcr-2017-223041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Islam F Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Yonmee Chang
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, District of Columbia, USA
| | - Robert F Keating
- Division of Neurosurgery, Children's National Health System, Washington, District of Columbia, USA
| | - Srijaya K Reddy
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, District of Columbia, USA
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17
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Park EJ, Espinel AG, Shah RK, Reddy SK. Challenging airway in a paediatric patient impaled by a freezer pop stick. BMJ Case Rep 2017; 2017:bcr-2017-220620. [PMID: 28775104 DOI: 10.1136/bcr-2017-220620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Edward J Park
- Department of Anaesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Alexandra G Espinel
- Division of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Rahul K Shah
- Division of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Srijaya K Reddy
- Division of Anaesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, District of Columbia, USA
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18
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Tsering D, Tochen L, Lavenstein B, Reddy SK, Granader Y, Keating RF, Oluigbo CO. Considerations in deep brain stimulation (DBS) for pediatric secondary dystonia. Childs Nerv Syst 2017; 33:631-637. [PMID: 28247116 DOI: 10.1007/s00381-017-3361-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/24/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE There is a paucity of effective long-term medication treatment for secondary dystonias. In situations where significantly impairing secondary dystonias fail to respond to typical enteral medications and intrathecal (or even intraventricular) baclofen, consideration should be given to the use of deep brain stimulation (DBS). While Level I evidence and long-term follow-up clearly demonstrate the efficacy of DBS for primary dystonia, the evidence for secondary dystonia remains mixed and unclear. In this study, we report our experience with pediatric subjects who have undergone DBS for secondary dystonia. METHODS We discuss the indications and outcomes of DBS procedures completed at our center. We also present a detailed discussion of the considerations in the management of these patients as well as a literature review. RESULTS Of the four cases retrospectively examined here, all subjects experienced reductions in the severity of their dystonia (ranging from 0 to 100% on both the Barry-Albright Dystonia (BAD) and Burke-Fahn-Marsden Dystonia Rating Scale-Motor (BFMDRS-M) scales). CONCLUSIONS Pallidal DBS should be considered among children with functionally debilitating, medication-resistant secondary dystonia. Patients without fixed skeletal deformities who have experienced a short duration of symptoms are most likely to benefit from this intervention.
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Affiliation(s)
- Deki Tsering
- Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Laura Tochen
- Division of Neurology, Children's National Health System, Washington, DC, USA
| | - Bennett Lavenstein
- Division of Neurology, Children's National Health System, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Srijaya K Reddy
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Anesthesiology, Children's National Health System, Washington, DC, USA
| | - Yael Granader
- Division of Neuropsychology, Children's National Health System, Washington, DC, USA
| | - Robert F Keating
- Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Health System, 4th Floor, Suite 100, 111 Michigan Avenue NW, Washington, DC, 20010, USA. .,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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19
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Morparia KG, Reddy SK, Olivieri LJ, Spaeder MC, Schuette JJ. Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia. J Clin Monit Comput 2017; 32:221-226. [PMID: 28299589 DOI: 10.1007/s10877-017-0013-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/27/2016] [Accepted: 03/07/2017] [Indexed: 01/25/2023]
Abstract
The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use. Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values. We performed a prospective, observational study at a single tertiary care pediatric center. Twenty-one children with normal cardiorespiratory status undergoing general anesthesia for neurosurgery were enrolled. Respiratory variation in peak aortic velocity (ΔVpeak ao) was measured both before and after volume expansion using a bedside ultrasound device. Pulse pressure variation (PPV) value was obtained from the bedside monitor. All patients received a 10 ml/kg fluid bolus as volume expansion, and were qualified as responders if stroke volume increased >15% as a result. Utility of ΔVpeak ao and PPV and to predict responsiveness to volume expansion was investigated. A baseline ΔVpeak ao value of greater than or equal to 12.3% best predicted a positive response to volume expansion, with a sensitivity of 77%, specificity of 89% and area under receiver operating characteristic curve of 0.90. PPV failed to demonstrate utility in this patient population. Respiratory variation in peak aortic velocity is a promising marker for optimization of perioperative fluid therapy in the pediatric population and can be accurately measured using bedside ultrasonography. More research is needed to evaluate the lack of effectiveness of pulse pressure variation for this purpose.
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Affiliation(s)
- Kavita G Morparia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, 201 Lyons Avneue, Newark, NJ, USA.
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Medical Center, George Washington University, NW, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, George Washington University, 111 Michigan Avenue NW, Washington, DC, USA
| | - Michael C Spaeder
- Division of Pediatric Critical Care Medicine, UVA Children's Hospital, University of Virginia, Charlottesville, VA, USA
| | - Jennifer J Schuette
- Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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20
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Goobie SM, Cladis FP, Glover CD, Huang H, Reddy SK, Fernandez AM, Zurakowski D, Stricker PA, Gries H, Soneru C, Falcon R, Petersen T, Kowalczyk‐Derderian C, Dalesio N, Budac S, Groenewald N, Rubens D, Thompson D, Watts R, Gentry K, Ivanova I, Hetmaniuk M, Hsieh V, Collins M, Wong K, Binstock W, Reid R, Poteet‐Schwartz K, Gries H, Hall R, Koh J, Colpitts K, Scott L, Bannister C, Sung W, Jain R, Chaudhry R, Fernandez A, Tuite GF, Ruas E, Drozhinin O, Tetreault L, Muldowney B, Ricketts K, Fernandez P, Sohn L, Hajduk J, Taicher B, Burkhart J, Wright A, Kugler J, Barajas‐DeLoa L, Gangadharan M, Busso V, Stallworth K, Staudt S, Labovsky K, Glover C, Huang H, Karlberg‐Hippard H, Capehart S, Streckfus C, Nguyen K, Manyang P, Martinez JL, Hansen J, Brzenski A, Chiao F, Ingelmo P, Mujallid R, Bosenberg A, Meier P, Haberkern C, Nguyen T, Benzon H. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Paediatr Anaesth 2017; 27:271-281. [PMID: 28211198 DOI: 10.1111/pan.13076] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. AIMS The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics. METHODS The database was queried for cases of open cranial vault reconstructive surgery. Less invasive procedures such as neuro-endoscopic and spring-mediated cranioplasties were excluded. The outcomes evaluated included any perioperative neurological adverse event including seizures or seizure-like movements and thromboembolic events. RESULTS Thirty-one institutions reported a total of 1638 cases from 2010 to 2015. Total antifibrinolytic administration accounted for 59.5% (tranexamic acid, 36.1% and aminocaproic acid, 23.4%), with 40.5% not receiving any antifibrinolytic. The overall incidence of postoperative seizures or seizure-like movements was 0.6%. No significant difference was detected in the incidence of postoperative seizures between patients receiving tranexamic acid and those receiving aminocaproic acid [the odds ratio for seizures being 0.34 (95% confidence interval: 0.07-1.85) controlling for American Society of Anesthesia (ASA) physical class] nor in patients receiving antifibrinolytics compared to those not administered antifibrinolytics (the odds ratio for seizures being 1.02 (confidence interval 0.29-3.63) controlling for ASA physical class). One complicated patient in the antifibrinolytic group with a femoral venous catheter had a postoperative deep venous thrombosis. CONCLUSIONS This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure-like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high-risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses.
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Affiliation(s)
- Susan M Goobie
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Franklyn P Cladis
- Department of Anesthesiology, The Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chris D Glover
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Henry Huang
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Health System, Washington, DC, USA
| | - Allison M Fernandez
- Department of Anesthesiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Nelson JH, Deutsch N, Cohen IT, Reddy SK. Are Prior Experience and Subspecialty Training Time Predictive of Pediatric Anesthesia Exit Exam Scores for Rotating CA-2 Residents? J Educ Perioper Med 2017; 19:E504. [PMID: 28377944 PMCID: PMC5327926] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Anesthesiology residency programs commonly have rotations at free-standing children's hospitals to provide and/or supplement their residents' training in pediatric anesthesia. Length and timing of these rotations differ from program to program as can their residents' existing medical knowledge and clinical skills. We predicted that residents with prior pediatric anesthesia experience, who rotate at our pediatric institution for two consecutive months, will score higher on an exit exam compared to residents without prior pediatric experience or those that only rotate for one month. METHODS A 50-question multiple choice test was created using pediatric questions released from The American Board of Anesthesiology (ABA) written examinations. The test was administered and proctored at the end of each rotation. Study participants came from three different programs: Program A offers prior pediatric anesthesia experience and a one month rotation; Program B - offers prior pediatric anesthesia experience and a two month rotation; and Program C - does not offer prior pediatric anesthesia experience but includes a two month rotation. RESULTS The 2014-2015 cohort consisted of 26 rotating second-year clinical anesthesia (CA-2) residents. One resident's exam scores were excluded from this study due to protocol violation. Mean exam scores for Program A, B, and C were 70.5% ± 5.7, 64.2% ± 7.0, and 67.3% ± 4.3, respectively. There was no statistically significant difference in the exit exam scores among the three groups. CONCLUSIONS Prior pediatric anesthesia experience or length of time for subspecialty rotation was not associated with any significant difference in exit exam scores for CA-2 residents.
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Affiliation(s)
- Jonathon H. Nelson
- Division of Anesthesiology and Pain Medicine, Children’s National Health System / The George Washington University School of Medicine and Health Sciences, Washington, DC / USA
| | - Nina Deutsch
- Division of Anesthesiology and Pain Medicine, Children’s National Health System / The George Washington University School of Medicine and Health Sciences, Washington, DC / USA
| | - Ira T. Cohen
- Division of Anesthesiology and Pain Medicine, Children’s National Health System / The George Washington University School of Medicine and Health Sciences, Washington, DC / USA
| | - Srijaya K. Reddy
- Division of Anesthesiology and Pain Medicine, Children’s National Health System / The George Washington University School of Medicine and Health Sciences, Washington, DC / USA
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22
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Reddy SK, Swink JM, Rogers GF, Myseros JS, Keating RF, Santos DN. Transfusion-Free Calvarial Vault Reconstruction Using Multimodal Blood Conservation Strategies in Two Pediatric Jehovah’s Witness Patients With Craniosynostosis. ACTA ACUST UNITED AC 2016; 7:33-6. [DOI: 10.1213/xaa.0000000000000334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Hari K, Jena A, Chowhan AK, Patnayak R, Reddy SK, Manilal B. The unnoticed umbilical nodule of ovarian malignancy with seudomyxomaperitonei: A rare presentation. Indian J Cancer 2016; 52:705-7. [PMID: 26960526 DOI: 10.4103/0019-509x.178394] [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: 11/04/2022]
Affiliation(s)
- K Hari
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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24
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Jani JM, Oluigbo CO, Reddy SK. Anesthesia for deep brain stimulation in traumatic brain injury-induced hemidystonia. Clin Case Rep 2015; 3:492-5. [PMID: 26185655 PMCID: PMC4498869 DOI: 10.1002/ccr3.289] [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: 07/10/2014] [Revised: 12/04/2014] [Accepted: 02/20/2015] [Indexed: 11/25/2022] Open
Abstract
Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.
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Affiliation(s)
- Jill M Jani
- Division of Anesthesiology, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences Washington, District of Columbia
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences Washington, District of Columbia
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences Washington, District of Columbia
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25
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Cardinal JS, Reddy SK, Tsung A, Marsh JW, Geller DA. Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci 2013; 20:114-9. [PMID: 23053353 DOI: 10.1007/s00534-012-0553-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laparoscopic liver resections are being performed with increasing frequency, with several groups having reported minimally invasive approaches for major anatomic hepatic resections. Some surgeons favor a pure laparoscopic approach, while others prefer a hand-assisted approach for major laparoscopic liver resections. There are clear advantages and disadvantages to a hand-assisted technique. The purpose of this study is to summarize the literature comparing pure laparoscopic and hand-assisted approaches for minimally invasive hepatic resection, and to describe our approach in 432 laparoscopic liver resections.
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Affiliation(s)
- J S Cardinal
- University of Pittsburgh Medical Center, Liver Cancer Center, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA
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26
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Reddy SK, Kumar SA, Kumar VD, Ganapaty S. Anti-inflammatory and Analgesic Activities of <i>Amorphophallus bulbifer</i> (Roxb) <i>Kunth</i> Whole Plant. TROP J PHARM RES 2013. [DOI: 10.4314/tjpr.v11i6.14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
The mandibular second molars can become impacted beneath the crown of the first molars due to various causes and fail to erupt normally. Presented herewith is a case report of orthodontic uprighting of a mesioangular impacted mandibular right permanent second molar. Though various treatment options were available, an uprighting push spring appliance was used as it is easy to fabricate and produces distal tipping and uprighting of the impacted tooth without the necessity of surgical assistance, bone removal, or splinting. The uprighting of the mandibular second molar was achieved within two months.
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Affiliation(s)
- S K Reddy
- Department of Pediatric Dentistry, College of Dental Sciences and Hospital, Davangere-577 004, Karnataka, India
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28
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Reddy SK, Rape M, Margansky WA, Kirschner MW. Ubiquitination by the anaphase-promoting complex drives spindle checkpoint inactivation. Nature 2007; 446:921-5. [PMID: 17443186 DOI: 10.1038/nature05734] [Citation(s) in RCA: 277] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 02/08/2007] [Indexed: 11/08/2022]
Abstract
Eukaryotic cells rely on a surveillance mechanism known as the spindle checkpoint to ensure accurate chromosome segregation. The spindle checkpoint prevents sister chromatids from separating until all kinetochores achieve bipolar attachments to the mitotic spindle. Checkpoint proteins tightly inhibit the anaphase-promoting complex (APC), a ubiquitin ligase required for chromosome segregation and progression to anaphase. Unattached kinetochores promote the binding of checkpoint proteins Mad2 and BubR1 to the APC-activator Cdc20, rendering it unable to activate APC. Once all kinetochores are properly attached, however, cells inactivate the checkpoint within minutes, allowing for the rapid and synchronous segregation of chromosomes. How cells switch from strong APC inhibition before kinetochore attachment to rapid APC activation once attachment is complete remains a mystery. Here we show that checkpoint inactivation is an energy-consuming process involving APC-dependent multi-ubiquitination. Multi-ubiquitination by APC leads to the dissociation of Mad2 and BubR1 from Cdc20, a process that is reversed by a Cdc20-directed de-ubiquitinating enzyme. The mutual regulation between checkpoint proteins and APC leaves the cell poised for rapid checkpoint inactivation and ensures that chromosome segregation promptly follows the completion of kinetochore attachment. In addition, our results suggest a mechanistic basis for how cancer cells can have a compromised spindle checkpoint without corresponding mutations in checkpoint genes.
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Affiliation(s)
- S K Reddy
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Between July 1994 and June 2004, 60 patients with 76 slipped upper femoral epiphyses were managed within the adult trauma service of three hospitals. Treatment was by a single cannulated screw. Of these cases, 53 were unilateral, in 17 of which uncomplicated prophylactic fixation of the contralateral hip was performed. Of the other 36 cases, nine presented with a subsequent slip despite ongoing out-patient care. The subsequent slip was unpredictable in timing and unrelated to the age at the initial slip. It was more often unstable and in one case avascular necrosis developed. The overall rate of avascular necrosis, although in accordance with the literature, was 60% in acute unstable slips with a slip angle greater than 40°. In our experience, prophylactic fixation was safer than continued observation of the contralateral hip.
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Affiliation(s)
- J G B MacLean
- Perth Royal Infirmary, Perth and Ninewells Hospital Medical School, Scotland.
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30
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Dhaliwal RS, Reddy SK, Luthra S, Mehta S, Singh H. Peak blood lactate levels during cardiopulmonary bypass and post-operative outcome in open heart surgery. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0658-x] [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: 10/22/2022] Open
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31
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Affiliation(s)
- S K Reddy
- M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Ethanol consumption and cigarette smoking are common in societies worldwide and have been identified as injurious to human health. This study was undertaken to examine the interactive effects of chronic ethanol and nicotine consumption on the antioxidant defense system in different tissues of rat. Male Fisher-344 rats were divided into four groups of five animals each and treated for 6.5 weeks as follows: (1) Control rats were administered normal saline orally; (2) ethanol (20% [wt./vol.]) was given orally at a dose of 2 g/kg; (3) nicotine was administered subcutaneously at a dose of 0.1 mg/kg; and (4) a combination of ethanol plus nicotine was administered by the route and at the dose described above. The animals were killed 20 h after the last treatment, and liver, lung, kidney, and testes were isolated and analyzed. Chronic ingestion of ethanol resulted in a significant depletion of glutathione (GSH) content in liver, lung, and testes, whereas chronic administration of nicotine significantly depleted GSH content in liver and testes. The combination of ethanol plus nicotine resulted in a significant depletion of GSH content in liver, lung, and testes. Ethanol, nicotine, or a combination of ethanol plus nicotine significantly increased superoxide dismutase (SOD) activity in liver and decreased SOD activity in kidney. Ethanol, nicotine, or a combination of ethanol plus nicotine significantly decreased catalase (CAT) activity in liver and increased CAT activity in kidney and testes. Chronic ingestion of ethanol resulted in a significant decrease in glutathione peroxidase (GSH-Px) activity in liver and kidney, whereas a combination of ethanol plus nicotine increased GSH-Px activity in liver and decreased GSH-Px activity in kidney and testes. Ethanol, nicotine, or a combination of ethanol plus nicotine significantly increased lipid peroxidation, respectively, in liver. It is suggested that prolonged exposure to ethanol and nicotine produce similar, and in some cases additive, oxidative tissue injuries in rat.
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Affiliation(s)
- K Husain
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL 62794-9629, USA
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Reddy SK, Kamireddi M, Dhanireddy K, Young L, Davis A, Reddy PT. Eukaryotic-like adenylyl cyclases in Mycobacterium tuberculosis H37Rv: cloning and characterization. J Biol Chem 2001; 276:35141-9. [PMID: 11431477 DOI: 10.1074/jbc.m104108200] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [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: 11/06/2022] Open
Abstract
Screening the Mycobacterium tuberculosis H37Rv genomic library for complementation of catabolic defect for cAMP-dependent expression of maltose operon produced the adenylyl cyclase gene (Mtb cya, (1997)) annotated later as Rv1625c (Cole, S. T., Brosch, R., Parkhill, J., Garnier, T., Churcher, C., Harris, D., Gordon, S. V., Eiglmeier, K., Gas, S., Barry, C. E., III, et al. (1998) Nature 393, 537-544). The deduced amino acid (aa) sequence (443 aa) encoded by Mtb cya contains a single hydrophobic domain of six transmembrane helices (152 aa) in the amino-terminal half of the protein. Flanking this domain are an arginine-rich (17%) amino-terminal cytoplasmic tail (46 aa) and a carboxyl-terminal cytoplasmic domain (245 aa) with extensive homology to the catalytic core of eukaryotic adenylyl cyclases. Site-directed mutagenesis of Arg(43) and Arg(44) to alanine/glycine showed a loss of adenylyl cyclase activity, whereas mutagenesis to lysine restored the activity. Hence it is proposed that the formation of the catalytic site in Mtb adenylyl cyclase requires an interaction between Arg(43) and Arg(44) residues in the distal cytoplasmic tail and the carboxyl-terminal cytoplasmic domain. Mtb adenylyl cyclase activity at the physiological concentration of ATP (1 mm) was 475 nmol of cAMP/min/mg of membrane protein in the presence of Mn(2+) but only 10 nmol of cAMP/min/mg of membrane protein in the presence of Mg(2+). The physiological significance of the activation of Mtb adenylyl cyclase by Mn(2+) is discussed in view of the presence of manganese transporter protein in mycobacteria and macrophages wherein mycobacteria reside.
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Affiliation(s)
- S K Reddy
- DNA Technologies Group, Biotechnology Division, Chemical Science and Technology Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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Grasso YZ, Reddy SK, Rosenfeld CR, Hussein WI, Hoogwerf BJ, Faiman C, Gupta MK. Autoantibodies to IA-2 and GAD65 in patients with type 2 diabetes mellitus of varied duration: prevalence and correlation with clinical features. Endocr Pract 2001; 7:339-45. [PMID: 11585368 DOI: 10.4158/ep.7.5.339] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the prevalence of autoantibodies to IA-2 (IA-2Ab) and glutamic acid decarboxylase (GADAb) in type 2 diabetes, their relationship to disease duration, and their importance in management decisions. METHODS We undertook a study of 101 patients with type 2 diabetes (defined as nonketotic hyperglycemia at diagnosis) of varied duration (median, 4 years). Results were compared with those from 36 patients with type 1 diabetes also of varied duration (median, 2 years). IA-2Ab and GADAb were measured by radioligand-binding assays with use of in vitro-synthesized, 35S-labeled antigens. RESULTS Of the 101 patients with type 2 diabetes, 20 (20%) were positive for GADAb; only 4 of these 20 were positive for IA-2Ab. In comparison, 75% of patients with type 1 diabetes were positive for GADAb, IA-2Ab, or both (P<0.0001). The coincidence of IA-2Ab positivity in GADAb-positive patients with type 2 diabetes was significantly lower than in patients with type 1 diabetes (20% versus 73%, respectively; P = 0.002). All four IA-2Ab- and GADAb-positive patients with type 2 diabetes required insulin and were younger than those positive for GADAb alone (P = 0.018). GADAb positivity in patients with type 2 diabetes was highly associated with insulin requirement (P = 0.004), with an odds ratio of 5.8 in predicting insulin dependence. Among patients with type 2 diabetes receiving insulin therapy, disease duration was significantly shorter (P = 0.025) and body mass index was significantly lower (P<0.001) in GADAb-positive versus GADAb-negative patients. In contrast to type 1 diabetes, in which GADAb values were negatively correlated with disease duration (r = -0.34; P = 0.044), no significant correlation with disease duration was observed in type 2 diabetes (r = -0.166; P = 0.48). CONCLUSION Irrespective of duration of disease, measurement of IA-2Ab and GADAb can help to identify those patients with type 2 diabetes most likely to require insulin therapy.
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Affiliation(s)
- Y Z Grasso
- Department of Clinical Pathology, L30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Abstract
Breakthrough pain is a well recognized but ill-defined phenomenon that occurs commonly in the presence of otherwise stable, persistent pain. It is defined now as a "transient pain episode that occurs, or breaks through from the otherwise stable background pain." Breakthrough pain is usually associated with moderate to severe pain and may form a predictor of poor response to treatment with routine pharmacotherapy. Breakthrough pain is also associated with functional impairment and psychological distress. The assessment and treatment should be multidimensional. Although primary therapies such as chemotherapy, radiation treatment, and surgical options are explored, the mainstay of treatment is pharmacotherapy. Nonpharmacologic methods, such as orthotic devices and joint stabilizations along with behavioral methods, should be explored. Anesthetic and neurosurgical procedures are performed on a limited number of patients based on the prognosis, intractable nature of pain, and favorable risk/benefit ratio. Newer oral transmucosal fentanyl offers a favorable pharmacokinetic and pharmacodynamic profile and ease of administration.
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Affiliation(s)
- S K Reddy
- MD Anderson Cancer Center, Department of Symptom Control and Palliative Care, 1515 Holcombe Avenue, Houston, TX 77030, USA
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Angtuaco TL, Reddy SK, Drapkin S, Harrell LE, Howden CW. The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center. Am J Gastroenterol 2001; 96:1782-5. [PMID: 11419829 DOI: 10.1111/j.1572-0241.2001.03871.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Urgent colonoscopy is often recommended to evaluate acute rectal bleeding. However, it may not identify a source because of blood in the lumen or inadequate preparation. Our aim was to determine the utility of urgent colonoscopy as the initial test for acute rectal bleeding. METHODS This was a retrospective chart review of all patients discharged in 1997 and 1998 with an International Classification of Diseases, 9th Revision, code for hematochezia or rectal bleeding. RESULTS We identified 514 charts but excluded 424 because of inaccurate coding. In the 90 with confirmed acute rectal bleeding, colonoscopy was the initial test in 39; age, sex, and race distributions were similar to those who did not have colonoscopy. A definite source of bleeding was seen at colonoscopy in only three patients, a probable source in 26, and no source in 10. Therapeutic intervention in four patients with a definite or probable source was successful in three. The commonest reasons for not performing urgent colonoscopy were bleeding from presumed hemorrhoids or bleeding that was clinically insignificant. Spontaneous resolution of bleeding and length of hospital stay were not affected by urgent colonoscopy. Five patients had surgery for unrelated reasons. In-hospital mortality was 2% and was unrelated to bleeding. CONCLUSION Urgent colonoscopy as the initial investigation in acute lower GI tract bleeding probably does not alter the outcome in most cases. Identification of a definite bleeding source leading to successful therapeutic intervention is rare. Spontaneous resolution is frequent, length of hospital stay is similar, and clinical outcome is excellent regardless of whether or not urgent colonoscopy is performed.
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Affiliation(s)
- T L Angtuaco
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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Abstract
The present study was conducted to evaluate a statement in ancient yoga texts that suggests that a combination of both "calming" and "stimulating" measures may be especially helpful in reaching a state of mental equilibrium. Two yoga practices, one combining "calming and stimulating" measures (cyclic meditation) and the other, a "calming" technique (shavasan), were compared. The oxygen consumption, breath rate, and breath volume of 40 male volunteers (group mean +/- SD, 27.0 +/- 5.7 years) were assessed before and after sessions of cyclic meditation (CM) and before and after sessions of shavasan (SH). The 2 sessions (CM, SH) were 1 day apart. Cyclic meditation includes the practice of yoga postures interspersed with periods of supine relaxation. During SH the subject lies in a supine position throughout the practice. There was a significant decrease in the amount of oxygen consumed and in breath rate and an increase in breath volume after both types of sessions (2-factor ANOVA, paired t test). However, the magnitude of change on all 3 measures was greater after CM: (1) Oxygen consumption decreased 32.1% after CM compared with 10.1% after SH; (2) breath rate decreased 18.0% after CM and 15.2% after SH; and (3) breath volume increased 28.8% after CM and 15.9% after SH. These results support the idea that a combination of yoga postures interspersed with relaxation reduces arousal more than relaxation alone does.
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Affiliation(s)
- S Telles
- Vivekananda Kendra Yoga Research Foundation, No. 9, 1st Main, Appajappa Agrahara, Chamarajpet, Bangalore 560 018, India.
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Abstract
Management of cancer pain has made sidnificant progress in recent years, partly due to the Agency for Health Care Policy and Research (AHCPR) guidelines, but mostly it seems to be due to the death and dying movement in the world. However, cancer pain on occasion poses significant problems and needs accurate diganosis and appropriate intervention. Pharmacotherapy remains the mainstay of treating cancer pain. Most cancer pain syndromes present with moderate to severe pain, associated with several comorbid problems necessitating the multidisciplinary approach to optimally treat it. The psychologic factors associated wth serious illness, terminal prognoses, and dying complicate the scenario even more as compared with that of nonmalignant pain. Although such patients are entitled to more aggressive analgesic therapy, it is unfortunate that this is not achieved in a significant percentage of cases. In this review, we address some of the above issues and attempt to summarize the traditional pharmacologic therapies highlighting their modern modes of implementation in cancer pain management. Special emphasis on the state-of-the art innovations in this field wil be noted.
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Affiliation(s)
- HA Zekry
- Department of Symptom Control and Palliative Care, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston TX 77030, USA.
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Abstract
Neural blockade, like other accepted treatments for persistent pain, is not a panacea. Careful assessment is required to elicit the need for complementary interventions, including pharmacological management and psychobehavioral and rehabilitative approaches, combined with attention to the palliation of other symptoms. Celiac and superior hypogastric plexus blocks are well-accepted, effective, and minimally hazardous means for providing palliation of visceral abdominopelvic pain. Although they require radiological imaging, they are relatively undemanding of the experienced anesthesiologist pain specialist and do not deplete patients' limited resources and energy. Because of their uniquely favorable risk:benefit ratio, these procedures should be considered early in the course of treating patients with abdominopelvic pain that is expected to persist.
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Affiliation(s)
- R B Patt
- Department of Anesthesiology and Critical Care, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Telles S, Ramaprabhu V, Reddy SK. Effect of yoga training on maze learning. Indian J Physiol Pharmacol 2000; 44:197-201. [PMID: 10846635] [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: 02/16/2023]
Abstract
The performance in a maze learning task was assessed in adults of either sex (n = 31) before and after 30 days of yoga training and in an age and gender matched control group of subjects who did not receive training in yoga. Subjects were blind folded and used the dominant hand to trace the path in a wooden pencil maze. At each assessment, subjects were given 5 trials, without a gap between them. Performance was based on the time taken to complete the maze and the number of blind alleys taken. The time and error scores of Trial 1 were significantly less after yoga (two-factor ANOVA, Tukey test). Repeating trials significantly decreased time scores at Trial 5 versus Trial 1, for both groups on Day 1 and for the control group on Day 30. Hence the yoga group showed improved performance in maze tracing at retest 30 days later, which may be related to this group being faster learners and also the effect of yoga itself. Yoga training did not influence maze learning, based on the performance in 5 repeat trials.
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Affiliation(s)
- S Telles
- Vivekananda Kendra Yoga Research Foundation, Appajappa Agrahara
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Reddy SK, Husain K, Schlorff EC, Scott RB, Somani SM. Dose response of ethanol ingestion on antioxidant defense system in rat brain subcellular fractions. Neurotoxicology 1999; 20:977-87. [PMID: 10693979] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This study investigated the response of the antioxidant defense system in brain subcellular fractions after oral graded doses of ethanol to rat. Four groups of male Fischer-344 rats were orally administered saline, ethanol 2 g, 4 g, and 6 g/kg, respectively, and sacrificed 1 hour post treatment. Brain cytosol, synaptosomes, microsomes and mitochondria were separated by density gradient differential centrifugation and assayed for antioxidant system. A significant and dose-dependent-decrease in superoxide dismutase (SOD) activity was observed in all brain subcellular fractions. Catalase (CAT) activity was significantly decreased in brain mitochondria (67% and 80% of control) at higher doses of ethanol; whereas, CAT activity was significantly increased in cytosol, synaptosomes and microsomes. Glutathione peroxidase (GSH-Px) activity was significantly increased in all brain subcellular fractions except in cytosol at higher dose of ethanol. Malondialdehyde (MDA) content was significantly increased in all brain subcellular fractions showing dose response of ethanol-induced oxidative stress. The increase in MDA levels in the brain synaptosomes and microsomes were higher at 6 g dose of ethanol (155% and 163% of control) when compared to mitochondria and cytosol. Glutathione (GSH) levels were significantly increased in brain cytosol and microsomes at higher dose of ethanol (164% and 159% of control); whereas, the GSH concentration was significantly decreased in brain synaptosomes and mitochondria. The antioxidant enzyme (AOE) activity ratios (GSH-Px/SOD and GSH-Px + CAT/SOD) were dose dependently increased in all brain subcellular fractions, particularly in synaptosomes. The GSH/GSSG ratio was dose dependently increased in brain microsomes. The perturbations in the antioxidant defense system and enhanced lipid peroxidation following graded doses of ethanol ingestion indicate a dose-dependent-oxidative 2133stress response in brain subcellular compartments of rats.
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Affiliation(s)
- S K Reddy
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield 62794-9629, USA
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Affiliation(s)
- S K Reddy
- Division of Gastroenterology, Miami VA Medical Center/Jackson Memorial Medical Center, University of Miami School of Medicine, Miami 33125, Florida, USA
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Abstract
Head and neck cancers are relatively uncommon malignancies and the characteristics of pain and functional impairments in survivors are not well studied. To characterize the incidence, location, severity, types and causes of pain; associated functional impairments, and pain management methods, the medical charts of 40 consecutive outpatients with biopsy-proven head and neck cancers were reviewed. Pain was severe in 52% (N = 21), and was located near sites of tumor origin. Pain was caused by tumor recurrence in 35% (N = 14), treatment sequelae in 30% (N = 12), multiple etiologies in 25% (N = 10), and unrelated causes in 10% (N = 4). Pains were mixed nociceptive and neuropathic pain in 37.5% (N = 15), nociceptive pain in 32.5% (N = 13), myofascial in 13.0% (N = 6), neuropathic in 7.5% (N = 3); and other mixed types in 7.5% (N = 3). Despite the high prevalence of dysphagia (82%), 60% used orally administered opioid-nonopioid analgesics. Physical disfigurement (87.5%; N = 35), dysphagia (62.5%, N = 25), and jaw dysfunction (40.0%; N = 16) were the most frequent physical impairments. Multiple regression analysis showed that the presence of skull base or mandibular bone involvement had significant influence on the severity of pain (P = 0.03, adjusted R2 0.25) We conclude that pain in head and neck cancer can be chronic, severe, and persistent despite completion of oncologic treatment.
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Affiliation(s)
- K S Chua
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore
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Ahern-Djamali SM, Bachmann C, Hua P, Reddy SK, Kastenmeier AS, Walter U, Hoffmann FM. Identification of profilin and src homology 3 domains as binding partners for Drosophila enabled. Proc Natl Acad Sci U S A 1999; 96:4977-82. [PMID: 10220404 PMCID: PMC21802 DOI: 10.1073/pnas.96.9.4977] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Drosophila Enabled (Ena) was first identified as a genetic suppressor of mutations in the Abelson tyrosine kinase and subsequently was shown to be a member of the Ena/vasodilator-stimulated phosphoprotein family of proteins. All members of this family have a conserved domain organization, bind the focal adhesion protein zyxin, and localize to focal adhesions and stress fibers. Members of this family are thought to be involved in the regulation of cytoskeleton dynamics. The Ena protein sequence has multiple poly-(L-proline) residues with similarity to both profilin and src homology 3 binding sites. Here, we show that Ena can bind directly to the Drosophila homolog of profilin, chickadee. Furthermore, Ena and profilin were colocalized in spreading cultured cells. We report that the proline-rich region of Ena is responsible for this interaction as well as for mediating binding to the src homology 3 domain of the Abelson tyrosine kinase. These data support the hypothesis that Ena provides a regulated link between signal transduction and cytoskeleton assembly in the developing Drosophila embryo.
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Affiliation(s)
- S M Ahern-Djamali
- McArdle Laboratory for Cancer Research and Laboratory of Genetics, University of Wisconsin Medical School, 1400 University Avenue, Madison, WI 53706, USA.
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Ahern-Djamali SM, Comer AR, Bachmann C, Kastenmeier AS, Reddy SK, Beckerle MC, Walter U, Hoffmann FM. Mutations in Drosophila enabled and rescue by human vasodilator-stimulated phosphoprotein (VASP) indicate important functional roles for Ena/VASP homology domain 1 (EVH1) and EVH2 domains. Mol Biol Cell 1998; 9:2157-71. [PMID: 9693373 PMCID: PMC25470 DOI: 10.1091/mbc.9.8.2157] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/1998] [Accepted: 06/05/1998] [Indexed: 12/19/2022] Open
Abstract
Drosophila Enabled (Ena) was initially identified as a dominant genetic suppressor of mutations in the Abelson tyrosine kinase and, more recently, as a member of the Ena/human vasodilator-stimulated phosphoprotein (VASP) family of proteins. We have used genetic, biochemical, and cell biological approaches to demonstrate the functional relationship between Ena and human VASP. In addition, we have defined the roles of Ena domains identified as essential for its activity in vivo. We have demonstrated that VASP rescues the embryonic lethality associated with loss of Ena function in Drosophila and have shown that Ena, like VASP, is associated with actin filaments and focal adhesions when expressed in cultured cells. To define sequences that are central to Ena function, we have characterized the molecular lesions present in two lethal ena mutant alleles that affected the Ena/VASP homology domain 1 (EVH1) and EVH2. A missense mutation that resulted in an amino acid substitution in the EVH1 domain eliminated in vitro binding of Ena to the cytoskeletal protein zyxin, a previously reported binding partner of VASP. A nonsense mutation that resulted in a C-terminally truncated Ena protein lacking the EVH2 domain failed to form multimeric complexes and exhibited reduced binding to zyxin and the Abelson Src homology 3 domain. Our analysis demonstrates that Ena and VASP are functionally homologous and defines the conserved EVH1 and EVH2 domains as central to the physiological activity of Ena.
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Affiliation(s)
- S M Ahern-Djamali
- McArdle Laboratory for Cancer Research and Laboratory of Genetics University of Wisconsin Medical School, Madison, Wisconsin 53706, USA
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Stratta RJ, Gaber AO, Shokouh-Amiri MH, Reddy SK, Elmer DS. ALLOGRAFT PANCREATECTOMY AFTER PANCREAS TRANSPLANTATION: A COMPARISON OF SYSTEMIC-BLADDER VERSUS PORTAL-ENTERIC DRAINAGE. Transplantation 1998. [DOI: 10.1097/00007890-199805131-00367] [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: 11/25/2022]
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Reddy SK, Suresh M, Karaca K, Sharma JM, McMillen J, Schwartz RD. Antigen-specific lymphoproliferative responses to tetanus toxoid: a means for the evaluation of Marek's disease virus-induced immunosuppression in chickens. Vaccine 1996; 14:1695-702. [PMID: 9032901 DOI: 10.1016/s0264-410x(96)00067-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/03/2023]
Abstract
Antigen-specific lymphoproliferative responses were examined in chickens following immunization with tetanus toxoid (Ttx). The immune competence of chickens was assessed by mitogen assay utilizing phytohemagglutinin (PHA)-stimulation and Ttx-specific antigen proliferation assay (Ttx-APA). Immune spleen cells but not peripheral blood leucocytes demonstrated specific proliferation following stimulation in vitro in a Ttx-APA. In this study, we examined firstly the effects of Marek's disease (MD)-associated immunosuppression on specific immune responses. The humoral and cell-mediated immune responses were monitored by enzyme-linked immunosorbent assay (ELISA) and Ttx-APA, respectively. Secondly, we examined if vaccination against MD using a conventional herpesvirus of turkeys (HVT) vaccine and two recombinant HVT (rHVT) vaccines would affect the development of Ttx-specific immune responses. The rHVT vaccines used in this study included two constructs: one expressing both Newcastle disease virus (NDV) and MD virus (MDV) genes (HVT/NDV/MDV), and another expressing only MDV genes (HVT/MDV). The mitogenic responses of spleen cells of the vaccinated chickens were inconsistent allowing no definitive conclusions about vaccinal immunosuppression. The results of the Ttx-APA indicated that Ttx-specific lymphoproliferative responses provide a meaningful measure of immunosuppression. The MDV-induced immunosuppression resulted in the inhibition of Ttx-specific lymphoproliferation in vitro. Both HVT and rHVT vaccines were not immunosuppressive as indicated by the development of normal Ttx-specific lymphoproliferative responses in chickens. These results indicate that vaccination against MD results not only in the prevention of tumor formation but also protection from possible virus-induced immunosuppression.
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Affiliation(s)
- S K Reddy
- College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA
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Abstract
We describe here an assay to measure responses of T cells to in vitro stimulation with antigens and a T cell mitogen (ConA). Spleen cells from chickens immunized with live viruses and an inactivated antigen produced macrophage activating factors (MAF) in response to in vitro stimulation with homologous antigens. The production of MAF, quantitated by the induction of NO in a retrovirus transformed macrophage cell line, HD11 (Beug et al., 1979, Cell 18, 375) was antigen-specific and correlated well with T cell proliferation. Further studies showed that production of MAF was abrogated by cyclosporin A, anti-CD4 and anti-CD8 monoclonal antibodies. These data suggested that production of MAF required T cell activation and can be used as measure of antigen and mitogen-specific T cell responses in chickens.
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Affiliation(s)
- K Karaca
- University of Minnesota, College of Veterinary Medicine, Department of Veterinary PathoBiology, St. Paul 55108, USA
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Reddy SK, Sharma JM, Ahmad J, Reddy DN, McMillen JK, Cook SM, Wild MA, Schwartz RD. Protective efficacy of a recombinant herpesvirus of turkeys as an in ovo vaccine against Newcastle and Marek's diseases in specific-pathogen-free chickens. Vaccine 1996; 14:469-77. [PMID: 8782342 DOI: 10.1016/0264-410x(95)00242-s] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [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: 02/02/2023]
Abstract
We investigated the potential of a herpesvirus of turkey (HVT)-based recombinant virus (rHVT) as an in ovo vaccine to protect specific-pathogen-free chickens against Newcastle disease (ND) and Marek's disease (MD). The rHVT, designed to express fusion (F) and hemagglutinin-neuraminidase (HN) glycoproteins of the lentogenic Hitchner B1 strain of ND virus (NDV), as well as glycoproteins A and B of the GA strain of serotype 1 MD virus (MDV) was efficacious in protecting chickens against ND and MD. No adverse effects on hatchability or the survival of chickens were observed following in ovo vaccination with rHVT. A single administration at embryonation day 18 (ED18) or at hatch protected chickens against challenge-exposures with virulent MDV strain RB-1B and velogenic NDV strain GB-Texas (NDV-GB-TX). Vaccinated chickens developed antibodies against both viruses as detected by serological tests, namely, hemagglutination inhibition, virus neutralization and western immunoblotting for NDV, and immunofluorescence and radioimmunoprecipitation assays for MDV. PCR analysis showed that in ovo vaccination with rHVT resulted in a persistent infection leading to systemic immunity against ND for up to 8 weeks of age, the longest period of time tested in this study. However, virus isolation tests indicated that rHVT-vaccinated chickens were only partially protected from the replication of NDV-GB-TX in the trachea. The results of the study indicate that rHVT is safe for both ED18 and posthatch vaccination for ND and MD, and because the vaccine persists, it may induce longer lasting immunity than conventional live NDV vaccines.
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Affiliation(s)
- S K Reddy
- Department of Veterinary PathoBiology, College of Veterinary Medicine, University of Minnesota, St. Paul 55108, USA
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