General/Preoperative

GENERAL ANESTHESIOLOGY

PROJECT TITLE: Comparison of Two Sedation Regimens for Awake Fiberoptic Intubation 
PROJECT FACULTY: David Glick, MD, MBA
PROJECT DESCRIPTION: 
There are a number of methods for intubating patients with airways too difficult to manage using direct laryngoscopy. The most frequently used method is intubation with a fiberoptic bronchoscope. This method is well described, but significant work remains to optimize the technique, identify its pitfalls, and select the best drugs for patients undergoing “awake” fiberoptic intubations. 

PROJECT TITLE: The Incidence of Perioperative Deep Venous Thromboses of the Lower Extremities 
PROJECT FACULTY: David Glick, MD, MBA
PROJECT DESCRIPTION: 
The development of postoperative Deep Venous Thromboses (DVTs) is a great concern both clinically and administratively. Prevention of DVTs is one of the quality standards by which hospitals are ranked. This study will determine the incidence of DVTs immediately before surgery and examine the impact of various anesthetic techniques on the rate of intraoperative development of DVTs. 

PROJECT TITLE: The Use of Digital Recording of Family Members to Improve Emergence from Anesthesia 
PROJECT FACULTY: David Glick, MD, MBA
PROJECT DESCRIPTION: 
As patients awaken from general anesthetics they may experience periods of confusion and disorientation. Disorientation is especially difficult for patients who do not speak English or for whom English is a second language. Our project is an ongoing effort to identify phrases and instructions used by an anesthesiologist at emergence and to translate them into the patient’s native tongue. The project has grown to encompass the post-anesthetic care of our patients and to identify and translate the necessary phrases in that venue as well. Recorded messages from parents also have been played back for pediatric patients (English-speaking and non-English-speaking) at emergence. 

PROJECT TITLE: Use of the BIS Monitor To Decrease the Incidence of Intraoperative Awareness
PROJECT FACULTY: David Glick, MD, MBA
PROJECT DESCRIPTION: 
This project evaluates the effects of various perioperative medications on the ability to form memories and the simultaneous effects these mediations have on the bispectral index, a processed EEG algorithm that determines depth of anesthesia.

PROJECT TITLE:  Protective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in Obese Patients - The PROBESE Randomized, Controlled Trial
PROJECT FACULTY:  Aalok Kacha, MD, PhD
PROJECT DESCRIPTION:  Postoperative respiratory failure, particularly after surgery under general anesthesia, adds to the morbidity and mortality of patients. The optimal ventilatory strategy for the care of patients with BMI > 35 is not known. This international multicenter randomized, controlled trial is designed to compare a ventilation strategy using higher levels of PEEP with recruitment maneuvers (transient increases in transpulmonary pressure) with one using lower levels of PEEP without recruitment maneuvers in obese patients at an intermediate–to–high risk for postoperative pulmonary complications (PPCs). The primary endpoint is the proportion of patients with PPCs. Secondary endpoints include intraoperative complications, need for postoperative ventilatory support (invasive or non–invasive ventilation), need for unexpected ICU admission or ICU readmission, the number of hospital–free days and 90-day survival or mortality.
 

PREOPERATIVE MEDICINE

PROJECT TITLE: The Economic Impact of the Preoperative Clinic 
PROJECT FACULTY: David Glick, MD, MBA
PROJECT DESCRIPTION: 
Over the past several years we have examined the causes of day-of-surgery case cancellations and delays. At first the impact of the anesthesia preoperative clinic on case cancellations and delays was studied. Subsequently, we evaluated the demographic characteristics that place a patient at higher risk for a day-of-surgery case cancellation. The long-term goal of the project is to create a model for predicting case cancellations and delays.