Latest Updates

Management of Drug Interactions between Anti-infective and Common Anesthetics 

Kevin McLaughlin, PharmD, BCPS, James Schurr, PharmD, BCPS, MD, Craig A Stevens, PharmD, BCPS
    • Rocuronium-induced neuromuscular blockade is potentiated by a synergistic effect of gentamicin and clindamycin, which may delay recovery.
    • Penicillins form a complex with sugammadex, which may interfere with the therapeutically intended sugammadex-rocuronium complex.
    • Ondansetron can decrease the analgesic efficacy of acetaminophen at high doses.
    • Anesthesiologists are positioned to manage interactions between anesthetic agents and antimicrobials in the operating room.

Ophthalmologic Anesthesia: Open Eye Injuries

Stephen R Estime, MD, Safa Rahmani, MD, MS
    • Administration of sugammadex to reverse profound neuromuscular blockade in the cannot intubate, cannot ventilate scenario
    • Using a remifentanil bolus as an alternative to neuromuscular blockade during intubation
    • Regional anesthesia as an alternative for traumatic eye injuries requiring surgery

Cerebral Metabolism and Blood Flow Following Traumatic Brain Injury

Kee D Kim, MD, Ryan Martin, MD, Kiarash Shahlaie, MD, PhD, Lara Zimmermann, MD, Marike Zwienenberg, MD
    • Following brain injury, mechanisms that match nutrient supply to the cerebral metabolic demand are disrupted, leading to changes in the intracranial pressure, cerebral blood flow, and ischemia.
    • Understanding the concept of cerebral autoregulation and what it means when it is disrupted can help the clinician prevent secondary brain injury and improve patient outcome.

Neonatal Physiology

Laura Downey, MD, Brian Frugoni, MD
    • Neonates and infants have a significant (22%) rate of postoperative nonsurgical complications, likely in part related to organ system immaturity, which far exceeds their rate of surgical complications. Hemodynamic compromise makes up half of the total complications.
    • Neonatal thermoregulation is immature, and they are prone to hypothermia due to a variety of mechanisms. Neonatal intensive care unit admission hypothermia has been associated with an increased risk of mortality at ages 1 to 28 days. Maintenance of normothermia is critically important in this population.
    • Acute kidney injury is more common than previously thought in the neonatal population and is associated with multiple risk factors including maternal nonsteroidal antiinflammatory drugs, low Apgar score, sepsis, and nephrotoxins. Patients with acute kidney injury are at an increased risk of later chronic kidney disease.

Breastfeeding

Marcie Richardson, MD
    • Breastfeeding initiation in America rates have improved from 28% in 1970 to 82.5% in 2014.
    • Conforming with AAP’s 2012 Policy ACOG’s 2018 Committee opinion states “exclusive breastfeeding is recommended for the first 6 months of life”.
    • The USPSTF in 2016 “found insufficient evidence to determine the direct effects of interventions to support breastfeeding on child and maternal health outcomes.”
    • Published data support the positive effects of breast milk on brain development especially in premature infants.

Pathophysiology and Treatment of Uric Acid Stones

Dean G Assimos, MD, Carter Boyd, Medical Student, Jacob Britt, Medical Student, Ava Saidian, MD, Dustin Whitaker, Medical Student, Kyle Wood, MD
    • Association of uric acid stones with insulin resistance and the metabolic syndrome
    • Physiology of decreased urinary ammonium production leads to low urine pH
    • Dual-energy CT imaging as diagnostic differentiator between uric acid and calcium stones

Breastfeeding

Marcie Richardson, MD
    • Breastfeeding initiation in America rates have improved from 28% in 1970 to 82.5% in 2014.
    • Conforming with AAP’s 2012 Policy ACOG’s 2018 Committee opinion states “exclusive breastfeeding is recommended for the first 6 months of life”.
    • The USPSTF in 2016 “found insufficient evidence to determine the direct effects of interventions to support breastfeeding on child and maternal health outcomes.”
    • Published data support the positive effects of breast milk on brain development especially in premature infants.

Infertility

Alan H. DeCherney, MD, Katherine A Green, MD, Eric D. Levens, MD
    • Updates regarding the assessment and treatment of ovulatory disorders
    • Ovulation induction with letrozole in anovulatory patients
    • Advances in in vitro fertilization, including genetic screening
    • Fertility preservation options, including in vitro oocyte maturation, ovarian tissue cryopreservation, and mature oocyte cryopreservation
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