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Article ; Online: Venous air embolus during scalp incision.

Spence, Nicole Z / Faloba, Kathryn / Sonabend, Adam M / Bruce, Jeffrey N / Anastasian, Zirka H

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2016 Volume 28, Page(s) 170–171

Abstract: Venous air embolism (VAE) is a known complication of sitting craniotomy. Clinical consequences of VAE can range from tachypnea to cardiovascular collapse. The entrainment of air typically occurs during bone work, but we describe a case in which a VAE was ...

Abstract	Venous air embolism (VAE) is a known complication of sitting craniotomy. Clinical consequences of VAE can range from tachypnea to cardiovascular collapse. The entrainment of air typically occurs during bone work, but we describe a case in which a VAE was recognized while working on the scalp. Monitoring techniques are critical for early treatment of VAE to avoid more serious complications, and our case illustrates the need to implement monitors early and remain vigilant throughout the procedure.
MeSH term(s)	Craniotomy/adverse effects ; Embolism, Air/diagnosis ; Embolism, Air/etiology ; Female ; Humans ; Middle Aged ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Scalp/surgery ; Surgical Wound/complications
Language	English
Publishing date	2016-06
Publishing country	Scotland
Document type	Case Reports ; Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2015.11.019
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Article ; Online: What matters during endovascular therapy for acute stroke: anesthesia technique or blood pressure management?

Heyer, Eric J / Anastasian, Zirka H / Meyers, Philip M

Anesthesiology

2011 Volume 116, Issue 2, Page(s) 244–245

MeSH term(s)	Anesthesia/methods ; Endovascular Procedures/methods ; Female ; Humans ; Male ; Stroke/therapy
Language	English
Publishing date	2011-12-21
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0b013e318242b1e3
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Article ; Online: Attending Handoff Is Correlated with the Decision to Delay Extubation After Surgery.

Anastasian, Zirka H / Kim, Minjae / Heyer, Eric J / Wang, Shuang / Berman, Mitchell F

Anesthesia and analgesia

2015 Volume 122, Issue 3, Page(s) 758–764

Abstract: Background: Factors including ASA physical status, blood loss, and case length have been described as correlating with the decision to delay tracheal extubation after specific surgical procedures. In this retrospective study, we investigated whether ... ...

Abstract	Background: Factors including ASA physical status, blood loss, and case length have been described as correlating with the decision to delay tracheal extubation after specific surgical procedures. In this retrospective study, we investigated whether handoffs by anesthesia attendings were associated with delayed extubation after general anesthesia for a broad range of surgical procedures. Methods: We reviewed the records of 37,824 patients who underwent general anesthesia with an endotracheal tube for surgery (excluding tracheostomy surgery, cardiac surgeries, and liver and lung transplant surgeries) from 2008 to 2013 at Columbia University Medical Center. Our primary outcome was whether the patient was extubated at the end of the surgical case. We hypothesized that attending handoff was a factor that would independently affect the decision of the anesthesiologist to extubate at the end of the surgical case. In addition, we investigated whether the association between handoff and extubation was affected by the timing of the procedure (ending in the daytime versus evening hours) by including an interaction term in the analysis. We adjusted for other variables affecting the decision to delay extubation. Results: Patients (5.4%, n = 2033) were not extubated in the operating room after the completion of their surgery. Cases with an attending handoff appeared to have a greater risk of delayed extubation with an adjusted risk ratio (aRR) of 1.14 (95% confidence interval [CI], 1.03-1.25). Further analysis demonstrated that the attending handoff had a significant effect in daytime cases (aRR, 1.62; 95% CI, 1.29-2.04) but not in evening cases (aRR, 1.07; 95% CI, 0.97-1.19). Conclusions: Attending handoff was an independent significant factor that increased the risk for the delay of extubation at the end of a surgical case.
MeSH term(s)	Airway Extubation ; Anesthesia, General ; Clinical Decision-Making ; Female ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Operating Rooms/organization & administration ; Patient Handoff/organization & administration ; Postoperative Care ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2015-06-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000001069
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Zs.MO 149: Show issues

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Article: Delayed arousal.

Anastasian, Zirka H / Ornstein, Eugene / Heyer, Eric J

Anesthesiology clinics

2009 Volume 27, Issue 3, Page(s) 429–50, table of contents

Abstract: Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. ... ...

Abstract	Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. Delayed arousal, therefore, may arise from structural problems that are pre-existent or new, or metabolic or functional disorders such as convulsive or nonconvulsive seizures. Determining the cause of delayed arousal may require clinical, chemical, and structural tests. Structural problems that impair consciousness arise from a small number of focal lesions to specific areas of the central nervous system, or from pathology affecting the cerebrum. In general, focal or multifocal lesions can be identified by computerized tomography, or diffusion-weighted imaging. An algorithm is presented that outlines a workup for an elderly patient with delayed arousal.
MeSH term(s)	Aged ; Anesthesia Recovery Period ; Arousal/drug effects ; Arousal/physiology ; Brain/physiology ; Consciousness/drug effects ; Consciousness/physiology ; Female ; Humans ; Neural Pathways/physiology ; Neuroma, Acoustic/complications ; Neuroma, Acoustic/surgery ; Postoperative Complications/therapy ; Seizures/complications
Language	English
Publishing date	2009-10-13
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2228899-5
ISSN	2210-3538 ; 1932-2275 ; 0889-8537
ISSN (online)	2210-3538
ISSN	1932-2275 ; 0889-8537
DOI	10.1016/j.anclin.2009.07.007
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Article ; Online: Assembly of a multichannel video system to simultaneously record cerebral emboli with cerebral imaging.

Stoner-Duncan, Benjamin / Kim, Sae Jin / Mergeche, Joanna L / Anastasian, Zirka H / Heyer, Eric J

Journal of neurosurgical anesthesiology

2011 Volume 23, Issue 3, Page(s) 247–250

Abstract: Stroke remains a significant risk of carotid revascularization for atherosclerotic disease. Emboli generated at the time of treatment either using endarterectomy or stent-angioplasty may progress with blood flow and lodge in brain arteries. Recently, the ...

Abstract	Stroke remains a significant risk of carotid revascularization for atherosclerotic disease. Emboli generated at the time of treatment either using endarterectomy or stent-angioplasty may progress with blood flow and lodge in brain arteries. Recently, the use of protection devices to trap emboli created at the time of revascularization has helped to establish a role for stent-supported angioplasty compared with endarterectomy. Several devices have been developed to reduce or detect emboli that may be dislodged during carotid artery stenting to treat carotid artery stenosis. A significant challenge in assessing the efficacy of these devices is precisely determining when emboli are dislodged in real time. To address this challenge, we devised a method of simultaneously recording fluoroscopic images, transcranial Doppler data, vital signs, and digital video of the patient/physician. This method permits accurate causative analysis and allows procedural events to be precisely correlated to embolic events in real time.
MeSH term(s)	Brain/diagnostic imaging ; Fluoroscopy/methods ; Humans ; Intracranial Embolism/diagnosis ; Intracranial Embolism/diagnostic imaging ; Ultrasonography, Doppler, Transcranial/methods ; Video Recording/methods ; Vital Signs
Language	English
Publishing date	2011-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1018119-2
ISSN	1537-1921 ; 0898-4921
ISSN (online)	1537-1921
ISSN	0898-4921
DOI	10.1097/ANA.0b013e318210419a
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Article ; Online: Effect of atropine dose on heart rate during electroconvulsive therapy.

Anastasian, Zirka H / Khan, Nayema / Heyer, Eric J / Berman, Mitchell F / Ornstein, Eugene / Prudic, Joan / Brady, Joanne E / Berman, Joshua A

The journal of ECT

2014 Volume 30, Issue 4, Page(s) 298–302

Abstract: Introduction: Transient bradycardia during the stimulation phase of electroconvulsive therapy (ECT) is a well-known clinical observation. The optimal dose of atropine needed to prevent bradycardia has not been determined. This study was designed to ... ...

Abstract	Introduction: Transient bradycardia during the stimulation phase of electroconvulsive therapy (ECT) is a well-known clinical observation. The optimal dose of atropine needed to prevent bradycardia has not been determined. This study was designed to investigate the effect of low doses of atropine on heart rate during ECT. Methods: Patients who received at least 2 different doses of atropine over their series of right unilateral ECT were included in the analysis. The anesthetic consisted of 0, 0.2, 0.3, or 0.4 mg of atropine, methohexital, and succinylcholine. Heart rate was measured by the RR interval, the time between sequential R waves on the electrocardiogram. Analysis was performed using logistic multivariate regression and repeated-measures multivariate analysis of variance. Results: One hundred eighteen ECT sessions were identified from 19 patients. Patients were grouped into 4 groups by atropine dose (0, 0.2, 0.3, or 0.4 mg) with 9, 33, 13, and 63 ECT sessions identified for each dose, respectively. Patients who received atropine had significantly less bradycardia after electrical stimulus and a faster heart rate through the seizure than patients who did not receive atropine. There was no significant difference in heart rate between patients receiving 0.2, 0.3, and 0.4 mg of atropine at any time point. There was no significant difference in heart rate at time points after the seizure conclusion in any group of patients. Conclusion: Low-dose atropine results in significantly less bradycardia after electrical stimulus. There was no significant difference in heart rate across low doses of atropine.
MeSH term(s)	Adult ; Aged ; Anesthesia ; Anti-Arrhythmia Agents/administration & dosage ; Anti-Arrhythmia Agents/pharmacology ; Atropine/administration & dosage ; Atropine/pharmacology ; Bradycardia/etiology ; Bradycardia/prevention & control ; Dose-Response Relationship, Drug ; Electrocardiography/drug effects ; Electroconvulsive Therapy/adverse effects ; Electroencephalography ; Female ; Heart Rate/drug effects ; Humans ; Male ; Middle Aged ; Retrospective Studies
Chemical Substances	Anti-Arrhythmia Agents ; Atropine (7C0697DR9I)
Language	English
Publishing date	2014-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1426385-3
ISSN	1533-4112 ; 1095-0680
ISSN (online)	1533-4112
ISSN	1095-0680
DOI	10.1097/YCT.0000000000000123
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Article ; Online: Radiation exposure of the anesthesiologist in the neurointerventional suite.

Anastasian, Zirka H / Strozyk, Dorothea / Meyers, Philip M / Wang, Shuang / Berman, Mitchell F

Anesthesiology

2011 Volume 114, Issue 3, Page(s) 512–520

Abstract: Background: Scatter radiation during interventional radiology procedures can produce cataracts in participating medical personnel. Standard safety equipment for the radiologist includes eye protection. The typical configuration of fluoroscopy equipment ... ...

Abstract	Background: Scatter radiation during interventional radiology procedures can produce cataracts in participating medical personnel. Standard safety equipment for the radiologist includes eye protection. The typical configuration of fluoroscopy equipment directs radiation scatter away from the radiologist and toward the anesthesiologist. This study analyzed facial radiation exposure of the anesthesiologist during interventional neuroradiology procedures. Methods: Radiation exposure to the forehead of the anesthesiologist and radiologist was measured during 31 adult neuroradiologic procedures involving the head or neck. Variables hypothesized to affect anesthesiologist exposure were recorded for each procedure. These included total radiation emitted by fluoroscopic equipment, radiologist exposure, number of pharmacologic interventions performed by the anesthesiologist, and other variables. Results: Radiation exposure to the anesthesiologist's face averaged 6.5 ± 5.4 μSv per interventional procedure. This exposure was more than 6-fold greater (P < 0.0005) than for noninterventional angiographic procedures (1.0 ± 1.0) and averaged more than 3-fold the exposure of the radiologist (ratio, 3.2; 95% CI, 1.8-4.5). Multiple linear regression analysis showed that the exposure of the anesthesiologist was correlated with the number of pharmacologic interventions performed by the anesthesiologist and the total exposure of the radiologist. Conclusions: Current guidelines for occupational radiation exposure to the eye are undergoing review and are likely to be lowered below the current 100-150 mSv/yr limit. Anesthesiologists who spend significant time in neurointerventional radiology suites may have ocular radiation exposure approaching that of a radiologist. To ensure parity with safety standards adopted by radiologists, these anesthesiologists should wear protective eyewear.
MeSH term(s)	Adult ; Anesthesia/statistics & numerical data ; Anesthesiology ; Angiography ; Eye/radiation effects ; Eye Injuries/prevention & control ; Eye Protective Devices ; Face ; Female ; Fluoroscopy ; Guidelines as Topic ; Health Personnel ; Humans ; Linear Models ; Male ; Occupational Exposure/prevention & control ; Radiation Dosage ; Radiation Injuries/prevention & control ; Radiography, Interventional ; Radiology ; Radiometry ; Scattering, Radiation
Language	English
Publishing date	2011-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0b013e31820c2b81
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Uk I Zs.133: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The effect of antihypertensive class on intraoperative pressor requirements during carotid endarterectomy.

Anastasian, Zirka H / Gaudet, John G / Connolly, E Sander / Arunajadai, Srikesh / Heyer, Eric J

Anesthesia and analgesia

2011 Volume 112, Issue 6, Page(s) 1452–1460

Abstract: Background: Certain classes of antihypertensive drugs have been associated with intraoperative hypotension, and frequently, patients are receiving multiple classes of antihypertensive medications. We sought to determine whether one class of ... ...

Abstract	Background: Certain classes of antihypertensive drugs have been associated with intraoperative hypotension, and frequently, patients are receiving multiple classes of antihypertensive medications. We sought to determine whether one class of antihypertensive medication either alone, or in combination with other classes of antihypertensive medications, increased the probability of intraoperative hypotension, determined by the amount of vasopressor required during carotid endarterectomy (CEA) performed under general anesthesia with specific arterial blood pressure management. Methods: This is a post hoc analysis of 252 patients scheduled for elective CEA under general anesthesia, all of whom participated in a prospective evaluation of cognitive dysfunction. Patients were characterized by class and number of preoperative antihypertensive medications taken. A predetermined anesthetic regimen was administered to all patients, with a phenylephrine infusion titrated to maintain mean arterial blood pressure at baseline before clamping the carotid artery, and approximately 20% above baseline during clamping. Computerized anesthesia records were used to record hemodynamics and to quantify medication administered intraoperatively. Results: Patients taking diuretics as part of their antihypertensive regimen required significantly more (1.6 times) total intraoperative phenylephrine than those not taking diuretics, independently of the number of other antihypertensive medications. This difference in the phenylephrine requirement occurs only during the preclamp period, i.e., from induction to application of carotid artery clamping for the maintenance of preoperative blood pressure. However, in contrast to this result, there is no difference in pressor requirement comparing classes of antihypertensive medications to increase the mean arterial blood pressure 20% above baseline during the period when the carotid artery is clamped. Conclusion: Diuretics are associated with increased vasopressor requirements in patients having a CEA under general anesthesia in the preclamp period, which is likely true for any patient having a general anesthetic.
MeSH term(s)	Aged ; Anesthesia/methods ; Anesthesia, General ; Anesthetics/administration & dosage ; Antihypertensive Agents/classification ; Antihypertensive Agents/pharmacology ; Blood Pressure ; Comorbidity ; Drug Interactions ; Elective Surgical Procedures/methods ; Endarterectomy, Carotid/adverse effects ; Endarterectomy, Carotid/methods ; Female ; Hemodynamics ; Humans ; Hypertension/complications ; Hypertension/drug therapy ; Male ; Middle Aged ; Phenylephrine/pharmacology ; Probability
Chemical Substances	Anesthetics ; Antihypertensive Agents ; Phenylephrine (1WS297W6MV)
Language	English
Publishing date	2011-04-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0b013e318212d6a9
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Article ; Online: Factors that correlate with the decision to delay extubation after multilevel prone spine surgery.

Anastasian, Zirka H / Gaudet, John G / Levitt, Laura C / Mergeche, Joanna L / Heyer, Eric J / Berman, Mitchell F

Journal of neurosurgical anesthesiology

2013 Volume 26, Issue 2, Page(s) 167–171

Abstract: Background: Multilevel spinal decompressions and fusions often require long anesthetic and operative times, which may result in airway edema and prolonged postoperative intubation. Delayed extubation can lead to bronchopulmonary infections and other ... ...

Abstract	Background: Multilevel spinal decompressions and fusions often require long anesthetic and operative times, which may result in airway edema and prolonged postoperative intubation. Delayed extubation can lead to bronchopulmonary infections and other complications. This study analyzed which factors correlated with the decision to delay extubation after multilevel spine surgery. Methods: We reviewed the records of 289 patients who underwent multilevel spine surgery lasting ≥8 hours in the prone position from 2006 to 2012. Variables hypothesized to affect the decision of the anesthesiologist to delay extubation at the end of the surgery were collected. These included preoperative factors (age, sex, ASA class, history of obstructive sleep apnea, BMI, previous spine surgery, current cervical surgery, anterior in addition to posterior spine surgery, emergency surgery) and intraoperative factors (difficult intubation, number of surgical levels, case time, estimated blood loss, fluid and blood administration, attending handoff and resident handoff, and case end time). We also compared the incidence of pulmonary postoperative complications between patients extubated at the end of the case to patients who had a delayed extubation. Results: A total of 126 patients (44%) were kept intubated after multilevel spine surgery. Multiple linear regression analysis showed factors that correlated with prolonged intubation which included age, ASA class, procedure duration, extent of surgery, total crystalloid volume administered, total blood volume administered, and the case end time. Patients who had a delayed extubation had a 3-fold higher rate of postoperative pneumonia. Conclusions: Our study found that age, ASA class, procedure duration, extent of surgery, and total crystalloid and blood volume administered correlate with the decision to delay extubation in multilevel prone spine surgery. It also finds that the time the case ends is an independent variable that correlates with the decision not to extubate at the end of a long multilevel spinal surgery. The incidence of postoperative pneumonia is higher in patients who had a delayed extubation after surgery.
MeSH term(s)	Acute Lung Injury/epidemiology ; Acute Lung Injury/etiology ; Acute Lung Injury/therapy ; Aged ; Airway Extubation/methods ; Airway Management/methods ; Decompression, Surgical/methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/therapy ; Prone Position/physiology ; Regression Analysis ; Risk Factors ; Spinal Fusion/methods ; Spine/surgery
Language	English
Publishing date	2013-11-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1018119-2
ISSN	1537-1921 ; 0898-4921
ISSN (online)	1537-1921
ISSN	0898-4921
DOI	10.1097/ANA.0000000000000028
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Article ; Online: Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction.

Heyer, Eric J / Mergeche, Joanna L / Anastasian, Zirka H / Kim, Minjae / Mallon, Kaitlin A / Connolly, E Sander

Neurosurgery

2013 Volume 74, Issue 3, Page(s) 245–51; discussion 251–3

Abstract: Background: A common practice during cross-clamp of carotid endarterectomy (CEA) is to manage mean arterial pressure (MAP) above baseline to optimize the collateral cerebral blood flow and reduce the risk of ischemic stroke.: Objective: To determine ... ...

Abstract	Background: A common practice during cross-clamp of carotid endarterectomy (CEA) is to manage mean arterial pressure (MAP) above baseline to optimize the collateral cerebral blood flow and reduce the risk of ischemic stroke. Objective: To determine whether MAP management ≥20% above baseline during cross-clamp is associated with lower risk of early cognitive dysfunction, a subtler form of neurological injury than stroke. Methods: One hundred eighty-three patients undergoing CEA were enrolled in this ad hoc study. All patients had radial arterial catheters placed before the induction of general anesthesia. MAP was managed at the discretion of the anesthesiologist. All patients were evaluated with a battery of neuropsychometric tests preoperatively and 24 hours postoperatively. Results: Overall, 28.4% of CEA patients exhibited early cognitive dysfunction (eCD). Significantly fewer patients with MAP ≥20% above baseline during cross-clamp exhibited eCD than those managed <20% above (11.6% vs 38.6%, P < .001). In a multivariate logistic regression model, MAP ≥20% above baseline during the cross-clamp period was associated with significantly lower risk of eCD (odds ratio [OR], 0.18 [0.07-0.40], P < .001), whereas diabetes mellitus (OR, 2.73 [1.14-6.61], P = .03) and each additional year of education (OR, 1.19 [1.06-1.34], P = .003) were associated with significantly higher risk of eCD. Conclusion: The observations of this study suggest that MAP management ≥20% above baseline during cross-clamp of the carotid artery may be associated with lower risk of eCD after CEA. More prospective work is necessary to determine whether MAP ≥20% above baseline during cross-clamp can improve the safety of this commonly performed procedure.
MeSH term(s)	Aged ; Aged, 80 and over ; Blood Pressure/physiology ; Case-Control Studies ; Cognition Disorders/diagnosis ; Cognition Disorders/etiology ; Endarterectomy, Carotid/adverse effects ; Female ; Humans ; Hypertension/surgery ; Male ; Neuropsychological Tests ; Postoperative Complications/physiopathology ; Regression Analysis ; Retrospective Studies
Language	English
Publishing date	2013-12-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/NEU.0000000000000256
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