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Search Results: 1 - 10 of 170077 matches for " Dennis E. Feierman "
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Another Way to Use the Laryngeal Mask Airway (LMA)  [PDF]
James Smit, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.64011
Abstract: The laryngeal mask airway (LMA) has changed airway management. Besides its use as an airway conduit, it is also used to help obtain a secure airway, i.e., it is used to facilitate the placement of an endotracheal tube. We describe a new technique to use in potential difficult pediatric airway.
Occult Hemothorax after Transcatheter Aortic Valve Implantation (TAVI)  [PDF]
Kenneth D. Eichenbaum,Bryan Noorda,Walter Bethune,Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.35059
Abstract: We present a case of occult hemothorax, a rare but dangerous complication resulting from cannulation of the internal jugular vein. To date we are not aware of any case reports of bleeding sequelae resulting from direct parenchymal lung injury. The insidious nature of this complication, in which the clinical presentation occurred several hours after central venous cannulation, provides an important reminder for clinicians to follow up central line placement with imaging studies. In this case, the latent period prior to the appearance of clinical manifestations of hemorrhage along with the patient’s subsequent acute decompensation raises questions as to the nature of the underlying injury and mechanisms of both detection and prevention. The patient underwent two right video-assisted thoracoscopic surgical explorations, the first revealed ongoing venous bleeding from within the parenchyma of the right upper lobe which was controlled by a wedge resection. She was ultimately discharged home and, as of the time of this writing, appears to have recovered completely, suffering no long-term sequelae as a result of this complication.
Occult Hemothorax after Transcatheter Aortic Valve Implantation (TAVI)  [PDF]
Kenneth D. Eichenbaum, Bryan Noorda, Walter Bethune, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.35059
Abstract:

We present a case of occult hemothorax, a rare but dangerous complication resulting from cannulation of the internal jugular vein. To date we are not aware of any case reports of bleeding sequelae resulting from direct parenchymal lung injury. The insidious nature of this complication, in which the clinical presentation occurred several hours after central venous cannulation, provides an important reminder for clinicians to follow up central line placement with imaging studies. In this case, the latent period prior to the appearance of clinical manifestations of hemorrhage along with the patient’s subsequent acute decompensation raises questions as to the nature of the underlying injury and mechanisms of both detection and prevention. The patient underwent two right video-assisted thoracoscopic surgical explorations, the first revealed ongoing venous bleeding from within the parenchyma of the right upper lobe which was controlled by a wedge resection. She was ultimately discharged home and, as of the time of this writing, appears to have recovered completely, suffering no long-term sequelae as a result of this complication.

Ultrasound-Guided Axillary Block in an Anticoagulated Patient after Heartmate II Implantation  [PDF]
Giuseppe Trunfio, Boris Yaguda, Paul C. Saunders, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2014, DOI: 10.4236/ojanes.2014.47022
Abstract:

Objective: This case exemplifies the understanding of the physiological changes associate with 1) Left Ventricular Assist Devices, 2) monitoring challenges associated with Left Ventricular Assist Devices and 3) the usefulness of peripheral nerve blocks in this subset of patients. Case report: A 73-year-old man was scheduled for left wrist arthroscopy and debridement to treat a very painful septic joint. He had undergone Heartmate II Left Ventricular Assist Device implantation uneventfully for Destination Therapy 4 months prior. The patient required maintenance of therapeutic anticoagulation. We elected for an ultrasound-guided axillary block, which limits the risks of vascular injury in presence of high INR. The axillary nerve block enabled us to overcome potential anesthetic problems in a patient with a continuous flow LVAD. Conclusion: The physiologic principles of Left Ventricular Assist Device function should be understood before the initiation of anesthesia. Regional Anesthesiologists can offer a very significant contribution to the safe care of patients with heart failure requiring a continuous flow Left Ventricular Assist Device.

Negative Pressure Pulmonary Edema on Extubation of a 9-Month-Old Baby Boy  [PDF]
Dennis E. Feierman, Katerina Svigos, Evan P. Salant, Agnes Miller
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.55018
Abstract: Background: Negative Pressure Pulmonary Edema (NPPE) is an uncommon, but well recognized clinical entity that continues to be reported as a complication of upper airway obstructions during induction or emergence. It results from the negative intrathoracic pressure generated with spontaneous ventilation with concurrent upper airway obstruction. Aim: To present an unusual case of NPPE and review the pathophysiology and treatment. Case: It usually occurs in young healthy athletic adults. We are reporting NPPE in a nine-month-old ex-premature baby. We discuss his intraoperative events leading to NPPE, subsequent intraoperative course and treatment. Conclusion: NPPE needs to be promptly recognized and treated. If the edema resolves, the patient can be successfully extubated, but should be observed overnight.
Preoperative Atrial Fibrillation and T-Wave Inversion Associated with Postoperative Pulmonary Edema  [PDF]
Thomas Hong, Benson George, Mohamad Hashim, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.610027
Abstract:
Background: Atrial fibrillation (AF) and T wave inversion (TWI) are occasionally found on pre-operative electrocardiograms (EKG) of patients with long standing hy-pertension (HTN) associated with left ventricular hypertrophy (LVH). Each of these two pathologies, AF and LVH, can impose negative hemodynamic effects on the car-diac function. Case: We present a case of a patient with AF, TWI and long standing HTN that went into post-operative pulmonary edema. Conclusion: Even returning to base line poorly controlled hypertension, and even more so during a hypertensive cri-sis, their concurrent presence may inflict even more detrimental effect manifested by elevation of pulmonary venous pressure and pulmonary edema.
Use of Liposomal Bupivacaine (Exparel) for Reduction in the Use of Postoperative Narcotics in an Obese Patient Undergoing Modified Radical Mastectomy  [PDF]
Charles Keilin, Evan P. Salant, Charusheela Andaz, Reet Lawhon, Piyush Gupta, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.56021
Abstract: Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics.
Improved Hemodynamics with the Use of Prophylactic Infusion of Epinephrine and/or Norepinephrine during Transcatheter Aortic Valve Replacement (TAVR)  [PDF]
Walter Bethune, Steven Konstadt, Giuseppe Trunfio, Lynn Belliveau, Mark Kronenfeld, Charles Keilin, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.56024
Abstract: Background: Transcatheter Aortic Valve Replacement (TAVR) is a new minimally-invasive surgical procedure in which a bioprosthetic aortic valve is placed via a small skin incision in the groin, over either the left or right iliac artery. TAVR was recently approved by the FDA as a treatment option for aortic stenosis in patients who may be too frail to undergo open heart surgery. Anesthetic management of TAVR is complicated by the fact that rapid left ventricular pacing (to at least 180 beats per minute) is required at multiple points throughout the procedure. Aim: This rapid pacing creates a profound pathophysiologic stress on the heart, sometimes leading to severe left ventricular dysfunction and resultant complete hemodynamic collapse. We report that the use of prophylactic infusion of epinephrine and/or norepinephrine in patients undergoing TAVR results in improved recovery from rapid pacing as reflected by intraoperative trends in systolic systemic blood pressure and systolic pulmonary arterial pressure. Cases: Here we report three cases. During the first of these, we reacted to intraoperative hemodynamic changes by administering boluses of vasoactive medications as needed. During the other two cases, we preemptively infused vasopressors to facilitate a more rapid recovery from some of the hemodynamic disturbance associated with either TAVR or rapid pacing. Conclusion: The two patients in this series who were managed with a preemptive strategy had higher ratios of systemic systolic blood pressure to pulmonary arterial systolic blood pressure at the end of the case than did the patient who was managed reactively. This suggests that the preemptive strategy may lead to decreased left ventricular impairment and improved overall cardiac function after TAVR.
Chart Review of PACU Outcomes for Patients Who Had Ambulatory Shoulder Surgery with Peripheral Nerve Block (PNB) and General Anesthesia Compared to General Anesthesia (GA)  [PDF]
Dennis E. Feierman, Eliezer Klinkowitz, Charles Keilin, Mark Kronenfeld, David Rahmani, Darlene Saberito, Piyush Gupta
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.57031
Abstract: Introduction: Today, regional anesthetics are frequently used in combination with general anesthesia. The purpose of two different techniques is to attain distinct goals. We believed that the use of PNB with the minimization of GA in the ambulatory setting would result in a decreased opioid requirement and subsequently fewer treatment-related side effects, more awake and pain free patients and shorter PACU stays and earlier discharges when compared with general anesthesia alone. Methods: Prior to the start of this retrospective chart review, IRB approval was obtained. Patient’s charts were selected based on the following criteria: The control group had a general anesthetic (GA) and did not have a PNB, and the experimental group (PNB/GA) had a PNB and a general anesthetic. Our primary endpoints were PACU length of stay, pain scores, use of opioids and uses of anti-emetics. Results: We found that patient with blocks used less analgesic in the PACU, 3.97 mg vs. 1.39 mg (morphine equivalents). They also appeared to use less antiemetic drugs: 14/19 (patient s without PNB) vs. 7/18. Additionally, the patients that received a block had a statistically shorter PACU stay 107 min vs. 163 min. Conclusion: Patients that did not receive PNB had a significantly longer PACU stay. Additionally the data suggest that the use of PNB’s reduces the use of post-op narcotics, which may be related to the lower use of postoperative antiemetic drugs observed.
The Use of Caudal/Epidural Catheter as the Primary Anesthetic with Dexmedetomidine Secondary to High Risk of Post-Operative Apnea in Premature Infants  [PDF]
Joel Waring, Alyssa Lowenwirt, Miriam Flaum, Eduard Logvinskiy, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.64010
Abstract: Life threatening post-operative apnea is a known complication of general anesthesia in premature infants. Neuraxial anesthesia has been associated with reduced risk of post-operative apnea. We report two cases, presenting for bilateral inguinal hernia repair, where we used a caudal/epidural catheter for the neuraxial block combined with dexmedetomidine for sedation in preterm infants at high risk for postoperative respiratory complications. Dexmedetomidine assisted in providing both favorable surgical conditions via its well proven sedative effects without respiratory comprised and decreased the discomfort and stress to the child during placement of the epidural catheter and the neuraxial anesthesia provided excellent analgesia and surgical conditions.
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