Michael C. Banks, MD
(Co-Course Director)

Assistant Professor Anesthesiology and Critical Care Medicine
The Johns Hopkins Hospital
Baltimore, Maryland

Kevin Driscoll, MSN, CRNA
(Co-Course Director)

Rebecca Barshick, RN, MSN (Nurse Planner)
Nurse Educator
Institute for Johns Hopkins Nursing
The Johns Hopkins Hospital
Baltimore, Maryland

Participating Faculty

Keith Candiotti, MD
Anesthesiology and Internal Medicine
University of Miami
Miami, Florida

Aaron LacKamp, MD
Assistant Professor
Department of Anesthesiology and Critical Care Medicine Johns Hopkins
University School of Medicine Baltimore, Maryland

Maria van Pelt, PhD(c), CRNA, MS, MSN
Nurse Anesthetist
Massachusetts General Hospital
Boston, Massachusetts

Mary Scott-Herring, MSN, CRNA
Clinical Coordinator of Graduate Nurse Anesthesia Education
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland

Ashish C. Sinha, MD, PhD
Professor and Vice Chair (Research) Anesthesiology and Perioperative Medicine
Drexel University College of Medicine
Philadelphia, Pennsylvania

Carolyn Srinivasan, CRNA
Nurse Anesthetist
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Tracey L. Stierer, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
Assistant Professor of Otolaryngology-Head and Neck Surgery
Director of Ambulatory Anesthesia Division Johns Hopkins University School of Medicine
Baltimore, Maryland

Kelly L. Wiltse Nicely, PhD, CRNA
Assistant Professor of Nursing
Anesthesia Center for Health Outcomes and Policy Research
Department of Biobehavioral and Health Sciences
University of Pennsylvania School of Nursing
Philadelphia, Pennsylvania

R. Jason Yong, MD, MBA
Medical Director
Pain Management Center
Brigham and Women's Faulkner Hospital
Boston, Massachusetts

News Feed
Phase II and III trials recently demonstrated that sugammadex is not associated with an increased risk of postoperative hemorrhage or hypersensitivity reaction. A pooled analysis of more than 1850 patients showed that there were less drug-related adverse events in patients treated with sugammadex versus neostigmine/glycopyrrolate.  The study also found that sugammadex eliminated incidences of residual paralysis in PACU and decreased time between reversal and of the patient being OR discharge ready.

Do your patients suffer from adverse outcomes related to residual NMB in the PACU? Surprising results from the RECITE study showed that 65% of patients have a TOF ratio below 0.9 at extubation. Dr Hoeft concluded, “The majority of patients are extubated too early.”

RBC transfusions may increase risk of infection: A recent study published in JAMA demonstrates that risk of infection is 17% with liberal RBC transfusion versus 12% with restrictive transfusion strategy (Hb <7). Notably, in orthopedic surgery, restrictive transfusion strategy reduced the risk for infection by 30%.

Should all patients in the PACU have ETCO2 monitoring? APSF President, Dr Robert K. Stoelting, noted, “Continuous electronic monitoring of oxygenation and/or ventilation may allow for more rapid diagnosis and prevention of drug-induced, postoperative respiratory depression.” EtCO2 monitoring can help practitioners recognize opioid-induced respiratory depression before patient harm occurs.

Can anesthesia personnel safely utilize the beach chair position in the OR? Research shows that the beach chair (barbershop) position decreases cerebral perfusion pressure by 15% and BP by 28% to 42%. Anesthetists should remember that BP is lower in the brain than the arm in the sitting position, and that lack of brain profusion can place patients at risk for ischemic brain injury.

POISE-2 trial data disappoints as no reduction in perioperative MI or mortality was found when aspirin or clonidine was administered perioperatively. In addition, major postsurgical bleeding risk was increased in the aspirin group. Since 8% of adults over 45 years old undergoing noncardiac surgery experience perioperative MIs, anesthetists must continue to look for effective pharmacological prevention measures.

Hypothermia may be more common than anesthetists might predict, and it can contribute to prolonged hospital stays and increased transfusion rates. A recent study demonstrated that approximately 10% of patients undergoing noncardiac surgery had core temperatures of 35°C (95°F) at the end of surgery. Study authors recommend prewarming patients or developing more effective intraoperative warming systems.

Do safety checklists reduce complications following surgery? According to a meta-analysis of 7 cohort studies involving 37 339 patients, the use of such checklists reduced complications, wound infections, and blood loss, but had no impact on mortality, pneumonia, or an unplanned return to the operating room.

Anesthetic neurotoxicity may significantly impact cognitive performance at both extremes of age. While preclinical studies point to harm, definitive clinical data remain elusive.

Postoperative apnea following adenotonsillectomy in children with obstructive sleep apnea is more common than previously thought and can result in death or neurologic injury. This is a preventable event, and obese children with comorbidities are at a higher risk for this poor outcome. Risk assessment is essential in identifying these patients who should not be managed on an outpatient basis following day surgery.

The Wake-Up Safe initiative is a multi-institutional registry that tracks serious adverse events in pediatric anesthesia patients. As of March 2013, there were 19 member institutions, 736 365 anesthetics, and 734 serious adverse events, which were recorded by the second year of membership. A resulting rate of 1.4 serious adverse events per 1000 anesthetics was calculated.

Myocardial injury following noncardiac surgery (MINS) is common and associated with substantial mortality. An international multicenter study aimed to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of patients who experienced MINS. Researchers prospectively followed 15 065 patients 45 years or older; 1200 patients (8%) experienced MINS with 260 (2%) deaths at 30 days.

Does the location of neuromuscular monitoring matter? A recent study suggests that patients whose NM function is monitored on the face are 3.5 times more likely to experience residual paralysis than those monitored at the wrist. In discussing the study’s importance, study investigator, Stephan Thilen, MD, MS, noted that anesthesia providers tend to “…underestimate the importance of residual paralysis as a risk factor for immediate postoperative complications in the recovery room.” Click here for complete study results.

Do intermediate-acting NMBs increase the risk of adverse postoperative respiratory events? A recent study demonstrated that NMB with vecuronium, rocuronium, and cisatracurium was associated with increased risks for hypoxic events after extubation and increased risk for reintubation. In addition, only half of the clinicians in this study used neuromuscular monitoring and less than two-thirds used reversal agents.

Supported by educational grants from Merck & Co, Inc. and Hospira, Inc.

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