2010 MSARF Symposium Participants - Foundation for Anesthesia ...

Thus colloids guarantee better hemodynamic stability as well as better perfusion and tissue oxygenation. In a large multicenter
study we are currently assessing the effect of goal directed crystalloid (lactated Ringer) and colloid (HES 130/0.4)
administration on 30-day morbidity. As a component of this study, we assessed the effect of colloid versus crystalloid
administration on time-weighted average (TWA) of intraoperative corrected flow time, cardiac output, and stroke volume
in the first 38 patients enrolled at the Cleveland Clinic. We used student t test or Wilcoxon rank sum test, as appropriate.
The observed medians of the total amounts of colloid and crystalloid were 0.9 [Q1, Q3: 0.5, 1.1] L and 1.6 [1.0, 1.9] L in
the colloid group, and 0 [0, 0] L and 2.9 [1.9, 6.1] L in the crystalloid group, respectively. No difference was observed
between the colloid and the crystalloid groups on the TWA of corrected flow time (median [Q1, Q3]: 366 [352, 407] vs.
360 [338, 376] ms; P = 0.16), TWA of cardiac output (mean ± SD: 5.7 ± 1.1 vs. 5.7 ± 1.2 L; P > 0.99), or TWA of stroke
volume (71.6 ± 8.8 vs. 74.6 ± 17.5 mL; P = 0.54). In summary, hemodynamic parameters were comparable in both
groups.
Student Name: Christa Schueller
Host Department: Regents of the University of Michigan
Primary Mentor Name: Chad Brummett, MD
Additional Mentors: Amy Shanks MS, Brian Hallstrom, MD, Andrew Urquhart MD, Daniel J. Clauw MD
Title of Research Project: The Impact of Comorbid Fibromyalgia on Acute Postoperative Pain and Perioperative
Opioid Consumption in the Lower Extremity Joint Arthroplasty Population
Purpose: This study was designed to study the hypothesis that patients with comorbid fibromyalgia undergoing total knee
and hip arthroplasty (TKA and THA) would describe more acute postoperative pain as measured by pain scores and
opioid consumption.
Methods: This is a secondary analysis of patients prospectively recruited into a study investigating the chronic pain
outcomes of TKA and THA. The American College of Rheumatology (ACR) fibromyalgia survey was used to calculate a
fibromyalgianess score (0-31). Fibromyalgia (FM+) was classified as >= 13. Perioperative opioid consumption was
analyzed in relationship to fibromyalgianess using non-parametric tests (alpha =0.05).
Results: The mean fibromyalgianess score was 7 (+/-4), with 24 of the 311 patients defined as FM+ (7.7%). There were a
higher proportion of female patients in the FM+ group (70.8% vs 50.9%, p = 0.06).
There were no differences between the groups in the use of regional anesthesia or intraoperative opioid dosing. FM+
received significantly more opioids in the PACU (median [IQR] FM+ 10 [0-20] vs. FM- 4 [0-10] mg IV morphine
equivalents [IVME], p = 0.034) and for the remainder of their inpatient course (FM+ 74.1 [42.5-117.2] vs. FM- 50 [28.5-
72.5] mg IVME, p = 0.005). FM+ reported higher pain scores in the PACU (FM+ 8 [5-10] vs. FM- 6 [3-9], p = 0.024).
Discussion: This is the first study to demonstrate that comorbid fibromyalgia impacts perioperative pain and opioid
consumption. Given the known neurophysiologic alterations in fibromyalgia, future studies should consider alternative
treatments, such as gabapentinoids and/or serotonin-norepinephrine reuptake inhibitors.
Student Name: Chirag Shah
Host Department: University of Colorado Denver
Primary Mentor Name: Ana Fernandez-Bustamante, MD, PhD
Title of Research Project: Effect of obesity on ICU admission after prolonged abdominal surgery
Introduction: To determine the effect of obesity on the incidence of postoperative ICU admission.
Methods: We performed a retrospective cross-sectional study in our electronic database including all adult patients
undergoing elective abdominal surgery of >=4h duration during a 3 year period. Demographic, preoperative
(comorbidities), intraoperative (i.e. ventilatory settings, fluid administration) and postoperative (outcomes) information
was collected and analyzed. Patients were classified based on their Body Mass Index (BMI) as “obese” (BMI>=30) and
“non-obese” (BMI