Shields Anesthesia Research Day

68 Pages·2017·1.04 MB·English

Annual Shields Research Day
38th Research in Progress Meeting Friday, April 28, 2017
Department of Anesthesia Arcadian Court, 401 Bay Street
University of Toronto Simpson Tower, 8th Floor
Toronto, Ontario

07:15 Breakfast, Registration
Location: Arcadian Court – Ballroom, 8th Floor

08:00 Welcome
Location: Arcadian Court – Ballroom, 8th Floor
Brian Kavanagh, Chair, Anesthesia
Trevor L. Young, Dean, Faculty of Medicine
Zeev Friedman, Chair, Annual Shields Research Day 2017

08:30 Session A – Oral Presentations
Location: Arcadian Court – Ballroom, 8th Floor
Chairs: Dr. Chung, Dr. Hare

A1 Diaphragm atrophy and clinical outcomes in A2 Virtual Reality for educating and reducing
mechanically ventilated adults preoperative anxiety in children – Phase 1: Design,
Michael Sklar – Resident face validity and acceptability by healthcare
St. Michael's Hospital professionals
Ben O’Sullivan – Fellow
Hospital for Sick Children

A3 Impact of lung microenvironment on the A4 A systematic review and meta-analysis of
protective vs. detrimental effects of MSC erythropoietin and intravenous iron therapy to
administration in experimental acute lung injury reduce red blood cell transfusion in patients
Diana Islam – Fellow undergoing surgery
St. Michael’s Hospital Tiffanie Kei – Graduate Student
St. Michael's Hospital

A5 Intraoperative handover: What are we missing? A6 The effect of anesthetic technique on mortality
Sophia Lane – Resident and major morbidity following hip fracture
Sinai Health System fixation. A retrospective, propensity-matched
cohort study
Laith Malhas – Fellow
UHN-Toronto Western Hospital

A7 Deflation injury following release of sustained
PEEP
Bhushan Katira – Fellow
Hospital for Sick Children
09:15 Session B - Poster Session
Location: Gallery Level, 9th Floor

B1 A multidisciplinary team consensus on the B2 Does the presence of an Anesthesiologist improve
allocation of resources, roles and the outcome after endovascular treatment for
responsibilities at emergency crash cesarean acute ischemic stroke?
deliveries Gabriela Alcaraz García-Tejedor – Fellow
Ibukun Adedugbe – Fellow UHN-Toronto Western Hospital
Sinai Health System

B3 Hippocampal volume determines the quality B4 Pediatric regional Anesthesia workshops for faculty
of emergence from anesthesia development: Curriculum design, implementation
Sujoy Banik – Fellow and evaluation
UHN-Toronto Western Hospital Abhijit Biswas – Fellow
Hospital for Sick Children

B5 Programmed intermittent epidural bolus for B6 Complex airway management of symptomatic
labor analgesia during first stage of labor: A cricoid tumor
biased-coin up and down sequential Jaclyn DesRoches – Resident
allocation trial to determine the optimum UHN-Toronto Western Hospital
interval time between boluses of a fixed
volume of 5ml of bupivacaine 0.125% plus
fentanyl 2 cg/ml.
Ricardo Bittencourt – Fellow
Sinai Health System

B7 Maximizing efficacy of simulation-based B8 Thoracic epidural placement in a preoperative
anesthesiology training: Rapid cycle block area improves OR efficiency and decreases
deliberate practice versus traditional medical epidural failure rate
simulation Josh Gleicher – Fellow
Danelle Dower – Fellow Sunnybrook Health Sciences Centre
Hospital for Sick Children

B9 Comparison of forces generated by direct and B10 Preoperative predictors of severe postoperative
indirect laryngoscopy using the GlideScope® pain in women undergoing cesarean deliveries
T-MAC blade in a manikin under spinal anesthesia
Joanna Gordon – Fellow Jennifer Guevara Velandia – Fellow
UHN-Toronto General Hospital Sinai Health System

B11 Sleep-disordered breathing and delirium B12 Recovery of oxytocin responsiveness in pregnant
Enoch Lam – Graduate Student human myometrial explants after oxytocin-induced
UHN-Toronto Western Hospital desensitization: An in-vitro analysis of oxytocin
receptor expression and signalling
Alice Luca – Graduate Student
Sinai Health System
B13 A propensity-matched comparison of the
analgesic effects of superficial versus deep
serratus fascial plane block for ambulatory
breast cancer surgery
David MacLean – Resident
UHN-Toronto Western Hospital

10:00 Session C – Oral Presentations
Location: Arcadian Court – Ballroom, 8th Floor
Chairs: Dr. Karkouti, Dr. Cuthbertson

C1 Surface echocardiography in the assessment of C2 Cost of inpatient craniotomy is double that of
left ventricular function during ex vivo heart outpatient craniotomy for brain tumors
perfusion: Comparison of 2D and 3D Elyana Wohl – Fellow
echocardiography UHN-Toronto Western Hospital
Giulia Maria Ruggeri – Fellow
UHN-Toronto General Hospital

C3 The effects of pre-operative cannabis use on C4 Pharmacologically inhibiting GABA-A receptors
opioid consumption following elective reverses impaired synaptic plasticity and
Inflammatory Bowel Disease surgery memory loss after traumatic brain injury
Noreen Jamal – Graduate Student Shahin Khodaei – Graduate Student
Sinai Health System Sunnybrook Health Sciences Centre

C5 The effect of analgesics on cancer growth and C6 The influence of anesthesia on intraoperative
metabolism neuromonitoring changes in high-risk spinal
Doorsa Tarazi – Graduate Student surgery
Hospital for Sick Children Nathan Royan – Fellow
UHN-Toronto Western Hospital

C7 Analgesic effect of adductor canal block after
knee surgery: a systematic review and meta-
analysis
David Goodick – Fellow
Hospital for Sick Children

10:45 Session D – Poster Session
Location: Gallery Level, 9th Floor

D1 Selective cannabinoids for chronic neuropathic D2 Increased cerebrovascular reactivity during
pain: a systematic review and meta-analysis anemia: a potential novel indicator of anemia-
Howard Meng – Resident induced brain hypoxia?
UHN-Toronto Western Hospital Nikhil Mistry – Graduate Student
St. Michael's Hospital
D3 Anesthetic challenges during interventional D4 Assessment of dexmedetomidine and scalp block
management of extra-cranial vascular to facilitate intraoperative brain mapping for
malformations awake craniotomy
Bahadur Niazi – Fellow Stuart Nicholson – Fellow
UHN-Toronto Western Hospital St. Michael's Hospital

D5 A survey of Canadian anesthesiologists and D6 Cardiac toxicity of bupivacaine is mediated via
residency program directors and department altered calcium dynamics in stem cell-derived
chiefs assessing current environmentally cardiomyocytes
sustainable anesthesiology practice Julia Plakhotnik – Graduate Student
Maria-Alexandra Petre – Resident Hospital for Sick Children
St. Michael's Hospital

D7 Role of screening questionnaires and D8 Beyond masks and syringes: Early ideas of
quantitative sensory testing in detecting Anesthesiology in Canada - A critical historical
neuropathic pain in osteoarthritis: a scoping analysis
review Richa Sharma – Resident
Rajendra Kumar Sahoo – Fellow
UHN-Toronto Western Hospital

D9 Choice of intraoperative resuscitation fluid D10 Discharge opioid prescription practices in a
during cardiac bypass surgery: A cost Pediatric teaching hospital
effectiveness analysis Naiyi Sun – Fellow
Lavarnan Sivanathan – Resident Hospital for Sick Children
Sunnybrook Health Sciences Centre

D11 Rapid cycle deliberate practice in simulation- D12 Risk factors for failure of patient-controlled oral
based medical education: A systematic review Analgesia after total hip and knee arthroplasty: A
Jillian Taras – Resident retrospective cohort study
Hospital for Sick Children Leon Vorobeichik – Resident
UHN-Toronto Western Hospital

D13 Esophageal manometry in Acute Respiratory
Distress Syndrome (ARDS): Safer expiration,
safer inspiration
Takeshi Yoshida – Fellow
Hospital for Sick Children

11:30 Session E – Oral Presentations
Location: Arcadian Court – Ballroom, 8th Floor
Chairs: Dr. Orser, Dr. Wijeysundera

E1 The universal definition of perioperative bleeding E2 Blood brain barrier integrity after moderate
(UDPB) in cardiac surgery: Validation of a traumatic brain injury is improved with human
consensus-based bleeding endpoint for use in umbilical cord perivascular cell therapy
clinical trials Tanya A. Barretto – Graduate Student
Justyna Bartoszko – Resident St. Michael's Hospital
UHN-Toronto General Hospital
E3 Ketamine reverses postanesthetic increase in E4 Opioid prescription following discharge in
extrasynaptic GABA-A receptor function in patients undergoing total knee arthroplasty
hippocampal neurons Hawn Trinh – Fellow
Kirusanthy Kaneshwaran – Graduate Student Sunnybrook Health Sciences Centre
Sunnybrook Health Sciences Centre

E5 A novel brain stress test: Combined controlled E6 A population-based study evaluating the
end-tidal CO2 and MRI imaging to assess stroke association between pediatric surgical activity at
risk the weekend and perioperative adverse
Jay Shou Han – Resident outcomes
UHN-Toronto Western Hospital Asad Siddiqui – Resident
Hospital for Sick Children

E7 MicroRNA-200b protects neuronal cells from
reactive oxygen species (ROS)
Joshua Bell – Resident

12:15 Lunch Break and Poster Viewing

13:00 Anesthesia in the News:
Dr. Brian Kavanagh: “Academic Anesthesia in Toronto 2050”

13:30 Annual Shields Lecture:
Dr. Hugh C. Hemmings: “The synaptic pharmacology of general anesthesia”

14:15 Shields Day Award Presentation Session
Bateman, Hammell, Rothbart, Byrick, Bryan, Orser, Best Poster at Shields Day, Awards for Clinical
Excellence, Residents and Fellows Tuition Awards, Laws Travel Awards

14:45 Departure

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification
Program of the Royal College of Physicians and Surgeons of Canada, approved by Continuing Professional
Development, Faculty of Medicine, and University of Toronto up to a maximum of 4.5 Hours
Annual Shields Lecture – Dr. Hugh C. Hemmings

“The synaptic pharmacology of general anesthesia”
Hugh C. Hemmings Jr., MD, PhD, FRCA is the Joseph F. Artusio Jr. Professor and
Chair of Anesthesiology and Professor of Pharmacology at Weill Cornell Medical
College, and Anesthesiologist-in-Chief at NewYork-Presbyterian Hospital/Weill
Cornell Medical Center. Dr. Hemmings earned a BS in Biochemistry from Yale
College, a PhD in pharmacology from Yale Graduate School, and an MD from Yale
Medical School. His graduate work in the laboratory of Paul Greengard, PhD was
cited in his 2000 Nobel Prize in Physiology and Medicine. He completed
postdoctoral work at The Rockefeller University, a residency in anaesthesia at the
Massachusetts General Hospital, and a fellowship in cardiac anesthesia at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, where he has been a
faculty member for 25 years.
An internationally recognized neuropharmacologist, Dr. Hemmings is an expert in the synaptic effects of
general anesthetics and mechanisms of neuronal signal transduction. His research in these areas is
supported by grants from the National Institutes of Health. He is active in several national and
international societies for anesthesiology and neuroscience, and serves as Editor-in-Chief of the British
Journal of Anaesthesia. He has been elected Fellow of the Royal College of Anaesthetists and is a
member of the Association of University Anesthesiologists. Dr. Hemmings has authored more than 110
articles in anesthesiology and neuroscience, and has edited four books, including Pharmacology &
Physiology for Anesthesia: Foundations and Clinical Application published in 2013.
The Awards

Dr. Evelyn Bateman Award Dr. Thomas Donald Hammell Award

Named in honor of Dr. Evelyn Bateman, Chief of The Thomas Donald Hammell Memorial Award
Anesthesia at the Women’s College Hospital in Anesthesia recognizes outstanding
from 1956-1972, this award recognizes contributions to the Residency Program (as
excellence in anesthesia at the undergraduate chosen by other residents).
level.
Dr. Alan K. Laws Travel Fellowship Award
Dr. David Bevan Award
The Laws Travel Fellowship Award one of two
The Dr. David Bevan Award is awarded to the awards given by the Department of Anesthesia
presenter of the best overall research poster at in honor and memory of Dr. Alan Laws. This
the Annual Shields Research Day award provides travel support for senior
residents or fellows to advance their research
Dr. A.C. Bryan Award programs in anesthesia.

The A.C. Bryan Award is Awarded to a graduate The Marion and Earl Orser Prize in Anesthesia and
student judged to have presented the best Sleep Medicine
research project at the Annual Shields Research
Day. The Marion and Earl Orser Prize in Anesthesia
and Sleep Medicine is awarded to residents,
Dr. R.J. Byrick Award clinical fellows, post-doctoral fellows or
graduate students in support of research in
The R.J. Byrick Award recognizes the best clinical sciences as well as basic/translational
fellow’s research paper presented at the Annual sciences.
Shields research Day. Dr. Byrick was the
Department’s 6th Chair of Anesthesia, serving Dr. Hynek Rothbart Award
from 1993-2003. He was then Vice-Dean of
Clinical Affairs for the Faculty of Medicine, The Dr. Hynek Rothbart Award is awarded to the
University of Toronto, until 2007. Dr. Byrick is best paper presented by a resident at the
currently a clinician at St. Michael’s Hospital. Annual Shields Research Day.

Awards for Clinical Excellence UT Anesthesia Resident and Fellows Tuition
Awards
For excellent clinical skills (Anesthesia and
Critical Care Medicine) and consistent Awarded to meritorious Anesthesia residents
demonstration of exemplary patient service. and/or fellows who are engaged in graduate
studies that are clearly integrated into their
existing residency/fellowship program, and are
linked with their overall career plan.
Abstracts

A1 ● Diaphragm atrophy and clinical outcomes in mechanically ventilated adults

Michael Sklar – Resident
St. Michael's Hospital

Background
Prolonged mechanical ventilation is associated with poor long-term outcomes and substantial
healthcare costs. Studies demonstrate that ventilation can cause diaphragm atrophy and dysfunction,
but it is unknown whether this substantially impacts clinical outcomes.

Methods
In adult patients requiring invasive mechanical ventilation, diaphragm thickness was measured daily by
ultrasound. Diaphragm atrophy was defined as a decrease in thickness exceeding 10% of baseline. The
primary outcome was time to liberation from ventilation. Secondary outcomes included complications
of acute respiratory failure (composite of at least one of reintubation, tracheostomy, ventilation longer
than 14 days, or death in hospital). The association between diaphragm atrophy and the daily
probability of liberation from ventilation was assessed using Cox proportional hazards modelling with
time-varying covariates adjusting for severity of illness, sepsis, sedation, neuromuscular blockade,
baseline thickness, and comorbidity.

Findings
A total of 211 patients were enrolled. By median day 4 of ventilation, thickness decreased by more than
10% in 78 patients (41%) and increased by more than 10% in 47 (25%). In the primary analysis,
diaphragm atrophy was associated with a lower probability of liberation from ventilation on any given
day (adjusted hazard ratio 0.67, 95% CI 0.53-0.85, per 10% decrease in thickness from baseline). The
development of diaphragm atrophy was also associated with prolonged ICU admission (adjusted
duration ratio 1.71, 95% CI 1.29-2.27), and an increased risk of complications (adjusted odds ratio 3.00,
95% CI 1.34-6.72). Increased diaphragm thickness during ventilation was associated with prolonged
ventilation (adjusted relative duration 1.38, 95% CI 1.00-1.90) but this association was not significant in
the primary model (adjusted hazard ratio 0.79, 95% CI 0.60-1.03, per 10% increase in thickness from
baseline).

Interpretation
Diaphragm atrophy during ventilation is associated with markedly prolonged ventilation and an
increased risk of complications.
Figure 1. Diaphragm atrophy during mechanical ventilation delays liberation from mechanical
ventilation. Left: the adjusted relative hazard of liberation from mechanical ventilation at any given time
is reduced with progressively greater decreases in diaphragm thickness (T ) (adjusted hazard ratio 0·67,
di
95% CI 0·53-0·85, per 10% decrease in T below baseline). The association between increases in T
di di
above baseline and the adjusted relative hazard of liberation from ventilation did not reach significance
(adjusted HR 0·79, 95% CI 0·60-1·03, per 10% increase in T above baseline). Grey shaded areas
di
represent 95% confidence intervals for estimated hazards computed by Cox proportional hazards
regression. Right: to evaluate the effect of diaphragm atrophy on the duration of ventilation, estimated
hazards for liberation derived from the Cox proportional hazards model were employed to predict the
probability of remaining on mechanical ventilation over time for varying degrees of diaphragm atrophy.