Device for the Capture and Extraction of Waste Anesthetic Gas

Background: Leaks occur often throughout the process of delivering inhaled anesthesia prior to and during surgery. Leaks typically occur around the patient’s mouth, nose, and eyes. Potent inhaled anesthetics (PIAs) include halothane, sevoflurane, desflurane, and isoflurane. All PIAs, to one degree or another, pose hazards to human health. PIAs are associated with reproductive toxicity, spontaneous miscarriages in pregnant persons as well as an increased risk of congenital abnormalities in offspring. In other words, PIAs are thought to be both abortifacients as well as teratogens. PIAs are also associated with hepatotoxicity, neurotoxicity, cognitive impairment, as well as increased incidence of malignancy. Methods: Preliminary interviews with stakeholders were conducted to assess the desirability, viability, and utility of a product to trap and remove waste anesthetic gas (WAG) from the perifacial region before it diffuses into the ambient air. We used wearable detector badges (similar to a dosimeter) from Assay Technology Inc. for qualitative measurements of WAG levels in several operating rooms. We used low-fidelity mockups for early prototyping, FDM and SLA 3D printing techniques, and urethane casts for high-fidelity working prototypes. We also performed real-time simulations using a visible aerosol agent in order to record and study the efficacy of our device. Results: We found dramatically elevated levels of sevoflurane in the operating room, with our highest readings at ~10x NIOSH permissible exposure limits. With our visual simulation we saw a markedly reduced flow of WAG into the surrounding air. Conclusions: Our device adequately addresses a significant and unaddressed issue in healthcare and shows viability from an economic standpoint as well. We are currently designing a study to further evaluate levels of WAG and exploring potential studies with live anesthetic agents

Scavenger of Waste Anesthetic

Waste anesthetic gases (WAGs) are associated with spontaneous miscarriages in pregnant persons, an increased risk of congenital abnormalities, hepatotoxicity, neurotoxicity, and cognitive impairment. Through monitoring anesthesiologists we found levels of WAGs to be 5-10x the current standard inside the OR. Currently, no solutions exist for the mitigation of WAG release. Remora is a solution to removing WAGs that fits on top of existing anesthesia masks. A flexible skirt is joined to a rigid ring, which deforms under hand pressure to facilitate effective hand-to-mask placement. The suction system is plugged into an unused suction port to create an area under the anesthesia mask that is depressurized, creating circumferential suction around the mask. The negative pressure gradient between the Remora-mask unit and room air pulls WAGs into the gap between the anesthesia mask and Remora, and then into the anesthesia machine\u27s suction system. From there, WAGs are exhausted into the air handling system which receives other waste gases. Using visible gas we were able to show how much WAGs may be escaping during induction and the amount Remora was able to scavenge. While we were unable to quantify our results, we were able to qualitatively show that the amount of gas was significantly less once Remora was turned on. Our hope is to perform further studies to prove that with the use of Remora the concentration of WAGs will decrease in the OR and decrease the negative side effects associated with WAGs

Analysis and Forecasting of Anesthesia Manpower in Cuyahoga County, Ohio

This report discusses the major aspects of a recent study which was concerned with the supply and demand projections for anesthesia manpower in Cuyahoga County in Ohio for a ten year planning horizon (1970-1980); the identification of the constraints which contribute to the gap between current and \u27ideal\u27 manpower levels of anesthesiology; the development of an approach to the recruitment and training of anesthesiology manpower and the generation of information which would be useful in developing approaches to the improvement of anesthesia manpower utilization. The latter aspect of the study extends a previous effort by the authors which employed an Industrial Engineering technique known as Point Method of Job Evaluation. Tasks relating to pre-, intra- and post-operative phases of anesthesia administration are described and rated on the basis of skill, responsibility and effort for a representative sample of four hospitals in Cuyahoga County. This analysis of tasks together with their distribution in anesthesia leads to the development of a curriculum for training non-physician anesthesia personnel. The projections for the desirable levels of anesthesia personnel up to 1980 are made through the following three types of models: 1. considering demand for surgical procedures classified according to sex and age; 2. using regression models based on the relationship of supply of anesthesiologists to certain important demographic factors; and 3. using the Delphi method conducted among experts in the health care area to enrich the projections and obtain such information that could not be generated by the foregoing two models. The results of the study show a striking agreement in the predictions made through different models. The constraints that contribute to the gap between current and \u27ideal\u27 manpower levels in anesthesiology are identified and ranked in order of their importance through the Delphi exercise. The study also developed an extensive data base for the 22 hospitals in the county to provide a framework for major research work dealing with the problem of identifying the optimal manpower mix and levels for Cuyahoga County over the next 10 years

Simulation of Obstetrical Anesthesia Team Configurations Managerial Report

A research group, comprised of faculty and graduate students from the School of Medicine and from the Department of Operations Research of Case Western Reserve University, investigated ways to alleviate the shortage of anesthesiologists in obstetric practices. The nationwide problem is acknowledged by, and the project was sponsored by the Maternal and Child Health Division of the U.S. Department of Health, Education, and Welfare. The three project stages were: survey and detailed analysis of the existing situation in one region of the United States, the construction and validation of a computer simulation model to study alternative practice modes with speed, economy and non-human experimentation, and the establishing of a methodology for selecting an optimal anesthesia manpower team configuration. This methodology, which incorporates the simulation model provides team design charts based upon examining tradeoffs between personnel-associated costs and the quality of service to the patient. Service quality is measured in terms of the unavailability of anesthesia personnel for certain tasks. Actual data collected from one of the twenty hospitals participating in the study provided the data base for use as input in the simulation model, in generating realistic team configuration selection strategies. This report documents the general project mission, the data base and the methodologies used, and the study results and conclusions. For technical details and documentation see the Project Technical Report [10]

Carnitine and Dehydroepiandrosterone Sulfate Induce Protein Synthesis in Porcine Primary Osteoblast-Like Cells

Age-related bone loss eventually leads to osteopenia in men and women. The etiology of age-related bone loss is currently unknown; however, decreased osteoblast activity contributes to this phenomenon. In turn, osteoblast proliferation and function is dependent on energy production, thus the loss of energy production that occurs with age may account for the deficient osteoblast activity. Carnitine and dehydroepiandrosterone-sulfate (DHEAS), both of which decline with age, promote energy production through fatty acid metabolism. Thus, we hypothesized that carnitine and DHEAS would increase osteoblast activity in vitro . Accordingly, we measured the effect of carnitine and DHEAS on palmitic acid oxidation as a measure of energy production, and alkaline phosphatase (ALP) activity and collagen type I (COL) as indices of osteoblast function in primary porcine osteoblast-like cell cultures. Carnitine (10 −3 and 10 −1 M) but not DHEAS (10 −9 , 10 −8 , and 10 −7 M) increased carnitine levels within the cells. Carnitine alone and in combination with DHEAS increased palmitic acid oxidation. Both carnitine and DHEAS alone and in an additive fashion increased ALP activity and COL levels. These results demonstrate that in osteoblast-like cells in vitro, energy production can be increased by carnitine and osteoblast protein production can be increased by both carnitine and DHEAS. These data suggest that carnitine and DHEAS supplementation in the elderly may stimulate osteoblast activity and decrease age-related bone loss.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42359/1/223-64-6-527_64n6p527.pd

Obstetrical Anesthesia Manpower Planning Study Progress Report I

This report discusses the progress to date of the initial phase of the obstetrical anesthesia manpower planning study in Cuyahoga County, Ohio, being performed under the sponsorship of the Maternal and Child Health Service, Health Services and Mental Health Administration, Department of Health, Education and Welfare. This study is organized into five major sections. First, the organization of the problem and of the research team is described, the steps employed during this phase to achieve the project\u27s objectives are listed, the scope of the information base is defined, and the relevant literature is discussed. Second, definitions of the types of delivery and of anesthesia are presented, an obstetrical anesthesia system is described, and the patient process flow is discussed. Third, the various methods used to obtain both qualitative and attitudinal information, e.g., questionnaires, interviews, and time-data collection, are listed. Fourth, several significant results to date are discussed, including a classification of patient conditions to assess their risk level, the description and analysis of obstetric anesthesia tasks, the possibility of correlation of time-data with patient classifications, an analysis of these correlations, a discussion of anesthesia team design and a stochastic model for use in describing arrival and service time distributions. Fifth, preliminary results of both facts and attitudes concerning the obstetric practices are presented. These were obtained through three surveys: to the Hospital Administrators and to the Directors of Anesthesia Departments of 20 major hospitals in the Greater Cleveland area, and to Anesthesiologists practicing in Cuyahoga County. The conclusion outlines future work to be performed both in this and subsequent phases of the study

Anesthesiology Manpower Planning Study Phase III - Final Report

This document outlines the progress and proposed work in a project focused on anesthesia services in Cuyahoga County, Ohio. It includes projections of the demand for anesthesia services and the supply of anesthesiologists up to 1980, using various models such as demand extrapolation, regression models, and expert opinions. The chapter details the classification of anesthesia-related tasks and personnel, the development of a patient condition scale for surgical risk assessment, and the design of optimal anesthesia teams. It also discusses the economic analysis of team configurations, computer simulations of operating room practices, and the use of telemedicine for remote anesthesiologist consultations

Forest City/University Hospitals Telemedicine System Project Evaluation: Progress Report II

In June 1974, a task force comprised of faculty from the School of Medicine and faculty and graduate students from the Department of Operations Research, Case Western Reserve University, in association with the staff of Forest City Hospital, Cleveland, initiated an evaluation study of a proposed Telemedicine Link between University Hospitals of Cleveland and Forest City Hospital. The different stages of the Telemedicine study completed to date are: a definition of the project goals and objectives; formulation of parameters relevant to an evaluation of Telemedicine\u27s impact on the quality of care delivered; design of data gathering instruments; and, finally, the collection of data itself. This report documents progress through each of the above stages. Since the study is ongoing, this is an interim report, reflecting the current status of the evaluation. The report concludes by indicating what further work remains to be done to complete the study

Incidence, Seasonality and Mortality Associated with Influenza Pneumonia in Thailand: 2005–2008

Data on the incidence, seasonality and mortality associated with influenza in subtropical low and middle income countries are limited. Prospective data from multiple years are needed to develop vaccine policy and treatment guidelines, and improve pandemic preparedness.During January 2005 through December 2008, we used an active, population-based surveillance system to prospectively identify hospitalized pneumonia cases with influenza confirmed by reverse transcriptase–polymerase chain reaction or cell culture in 20 hospitals in two provinces in Thailand. Age-specific incidence was calculated and extrapolated to estimate national annual influenza pneumonia hospital admissions and in-hospital deaths.Influenza was identified in 1,346 (10.4%) of pneumonia patients of all ages, and 10 influenza pneumonia patients died while in the hospital. 702 (52%) influenza pneumonia patients were less than 15 years of age. The average annual incidence of influenza pneumonia was greatest in children less than 5 years of age (236 per 100,000) and in those age 75 or older (375 per 100,000). During 2005, 2006 and 2008 influenza A virus detection among pneumonia cases peaked during June through October. In 2007 a sharp increase was observed during the months of January through April. Influenza B virus infections did not demonstrate a consistent seasonal pattern. Influenza pneumonia incidence was high in 2005, a year when influenza A(H3N2) subtype virus strains predominated, low in 2006 when A(H1N1) viruses were more common, moderate in 2007 when H3N2 and influenza B co-predominated, and high again in 2008 when influenza B viruses were most common. During 2005–2008, influenza pneumonia resulted in an estimated annual average 36,413 hospital admissions and 322 in-hospital pneumonia deaths in Thailand.Influenza virus infection is an important cause of hospitalized pneumonia in Thailand. Young children and the elderly are most affected and in-hospital deaths are more common than previously appreciated. Influenza occurs year-round and tends to follow a bimodal seasonal pattern with substantial variability. The disease burden varies significantly from year to year. Our findings support a recent Thailand Ministry of Public Health (MOPH) decision to extend annual influenza vaccination to older adults and suggest that children should also be targeted for routine vaccination

Epidemiology, clinical features, and antimicrobial resistance of invasive Escherichia coli disease in patients admitted in tertiary care hospitals

Background Invasive Escherichia coli disease (IED), including bloodstream infection, sepsis, and septic shock, can lead to high hospitalization and mortality rates. This multinational study describes the clinical profile of IED in tertiary care hospital patients. Methods We applied clinical criteria of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock to hospitalized patients with culture-confirmed E. coli from urine or a presumed sterile site. We assessed a proposed clinical case definition against physician diagnoses. Results Most IED patients (N=902) were adults aged ≥60 years (76.5%); 51.9%, 25.1%, and 23.0% of cases were community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA), respectively. The urinary tract was the most common source of infection (52.3%). SIRS, sepsis, and septic shock were identified in 77.4%, 65.3% and 14.1% of patients, respectively. Patients >60 years were more likely to exhibit organ dysfunction than those ≤60 years; this trend was not observed for SIRS. The case fatality rate (CFR) was 20.0% (60–75 years, 21.5%; ≥75 years, 22.2%), with an increase across IED acquisition settings (HA, 28.3%; HCA, 21.7% vs. CA, 15.2%). Noticeably, 77.8% of patients initiated antibiotic use on the day of culture sample collection. 65.6% and 40.8% of E. coli isolates were resistant to ≥1 agent in ≥1 or ≥2 drug class(es). A 96.1% agreement was seen between the proposed clinical case definition and physician’s diagnoses of IED. Conclusion This study contributes valuable real-world data about IED severity. An accepted case definition could promote timely and accurate diagnosis of IED and inform the development of novel preventative strategies