Spanning the Gamut of Scientific Investigations in Perioperative Care

By Douglas A. Colquhoun, MB ChB, from the IARS, AUA and SOCCA 2019 Annual Meetings*

The AUA Annual Meeting on Thursday adjourned after a Moderated Poster Discussion Session. It featured over 120 posters from more than 65 institutions and covered the entire range of scientific investigation in perioperative care. Engaged presenters showcased their work with the meeting attendees and fielded questions on the implications of their ongoing study.

A small number of presenters embraced the visual abstract format, whereby the key message of their poster was presented using a small number of words and prominent illustrations. In addition, the impact of social media was noted with websites, twitter handles and hashtags appearing prominently on a number of posters.

Dr. Behrouz Ashrafi and colleagues from the University of Miami, Miller School of Medicine presented their preliminary work on the delivery of Isoflurane in the IV route via preparation in nano-emulsion in an abstract titled, “Total Intravenous Anesthesia with a Novel Formulation of Isoflurane Perfluorocarbon-Based Nano-Emulsion: Safety, Efficacy and Toxicity in Drugs.” They discussed the successful use of this preparation in four dogs undergoing three separate anesthetics one week apart.

The phenomena of bradycardia after sugammadex administration was described by Dr. Matthew Weis and colleagues from Emory University in a poster presentation entitled, “Prevalence of Bradycardia Associated with Sugammadex Administration in a Single-Center Retrospective Analysis of Electronic Medical Record Data.” Via electronic query of the electronic anesthesia records, they reviewed over 18,000 administrations of sugammadex and found an incidence of bradycardia in 66 cases (0.35%).

Simulation was used to explore the effect of music in the operating room in response times to alarms and in provider communication. In work conducted at Vanderbilt University, Dr. Clayton Rothwell and colleagues from The Ohio State University College of Medicine simulated both provider-to-provider communication and response to critical alarms by 25 anesthesia residents and found impairment in response times (by 0.2s) and accuracy of communication (by 39%) in a study entitled, “Background Music Contributes to Error in Operating Room.” The music used for the study was described only as “non-lyrical, subjectively energizing, jazz/funk with a tempo of at least 120 beats per minute.”

In their presentation, Tymosteusz Kajstura, a medical student, and colleagues from The Johns Hopkins Hospital described variation in the guideline concordance of blood transfusion orders between medical and surgical specialties with variation also noted by provider type in their abstract, “Variation in Transfusion Guideline Compliance Among Provider Types and Between Medical and Surgical Services.” Based on these findings, the authors believed that different educational interventions should be created to bring care into concordance with clinical guidelines with essential modifications for the providers and specialties reflected.

The advancement of faculty within academic anesthesia departments was described by Dr. Brenda Lee and colleagues from Tufts Medical Center in a study entitled, “Faculty Gender Specific Academic Advancement in U.S. Anesthesiology Teaching Programs and Examination of Contributing Factors Based on Publicly Available Data.” Their work examined the differential attainment of “Senior Academic Rank (SAR)” by male and female anesthesia faculty. They found that proportionately fewer female faculty obtained SAR, with additional variation noted based on departmental features and geographic location.

Potential influences on cognitive outcomes in the postoperative period was explored in a number of submissions. Dr. Bradley Fritz and colleagues from Washington University School of Medicine in St. Louis described the impact of EEG suppression during anesthesia and subsequent occurrence of delirium in a high-risk population undergoing surgical care in his study, “Intraoperative Electroencephalogram Suppression Mediates the Relationship Between a Preoperative ‘Vulnerable Brain’ Phenotype and Postoperative Delirium.” They found that eliminating EEG suppression during anesthesia care could result in lower rates of delirium with a NNT of 28. Two groups additionally discussed work on medications, which are likely to have deliriogenic potential in older patients (Beers Criteria or Potentially Inappropriate Medications (PIM)).

From University of Pennsylvania, Dr. Audrey Spelde and colleagues found an incidence of 25.6% of patients aged 70 years or older receiving at least one PIM agent in their study, “Beers Criteria in the Perioperative Period: Incidence of Perioperative Diphenhydramine, Midazolam and Scopolamine Use in Elderly Surgical Patients.” However, this had declined over the six-year study period. Dr. Anne Donovan and colleagues from University of California, San Francisco described the impact of developing a PACU order set stratified by delirium risk and educational interventions designed to reduce the usage of PIMs in their study, “Impact of a Delirium Reduction PACU Order Set on Administration of Beers Criteria Medications to Older Adults.” This resulted in reduced use in the PACU of any one of four described PIMs from 4.66% to 3.29% in review of over 15,000 patients.

Six award-winning submissions were, in addition, presented in separate sessions as oral presentations on Thursday, May 16. The winning submissions are available online at https://auahq.org/wp-content/uploads/2019/05/AUA-2019-Annual-Meeting-Program.pdf. All e-Posters are available for viewing at https://tinyurl.com/AM19eposters.

*Coverage from the AUA Moderated Poster Discussion Session I during the AUA 2019 Annual Meeting