Journal-related Activities and Other Special Activities at the 2020 American Society of Anesthesiologists Meeting

As in previous years, Anesthesiology will sponsor several sessions at the annual meeting of the American Society of Anesthesiologists, Anesthesiology 2020. Because of COVID-19, this meeting will be 100% virtual. Details about the format and meeting attendance can be found on the website, asahq.org/annualmeeting.Anesthesiology will sponsor two Best Abstract sessions this year, one in basic science and another in clinical science. These abstracts were chosen by a panel of editors who examined the highest-scoring abstracts from the American Society of Anesthesiologists (ASA; Schaumburg, Illinois) subcommittees, choosing those with important scientific and clinical application and novelty. Subsequently, a combination of these editors and appointees from the ASA chose one abstract in each category to receive the Best Abstract award for basic and clinical sciences at the virtual meeting. The following are summaries of the excellent abstracts that will be presented.Saturday, October 3, 2020, 1:00 to 2:30pmCDTVirtualModerators: Michael J. Avram, Ph.D., Assistant Editor-in-Chief, Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Deborah J. Culley, M.D., Executive Editor, Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Martin J. London, M.D., Editor, Anesthesiology, University of California, San Francisco School of Medicine and the Veterans Affairs Medical Center, San Francisco, CaliforniaThe Dural Puncture Epidural Technique: An Investigation with Porcine Epidural and Spinal Spaces by Bushra Taha, M.D., Christopher J. Richey, B.A., Lawrence C. Tsen, M.D.; Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts. The dural puncture epidural technique involves placing a 17-gauge Weiss needle in the epidural space, introducing a 25-gauge Whitacre needle via the Weiss needle to puncture the dural sac, and threading a catheter into the epidural space. A fluoroscopy and necropsy study was conducted in female pigs to elucidate the mechanism, spread, and distribution of epidural, dural puncture epidural, and combined-spinal epidural techniques. Fluoroscopic images demonstrated segmental spread with combined-spinal epidural > dural puncture epidural > epidural techniques throughout the 3-h study period. Dye was visualized in the epidural space with an epidural and in both epidural and subarachnoid spaces with a dural puncture epidural, although less than with a combined-spinal epidural at both 3 and 6 h.The Roles of Mitophagy Defect in Propofol Infusion Syndrome by Takahiko Tamura, M.D., Ph.D., Nobuo Yasuda, Ph.D., Hiroyuki Morinaga, M.D., Masao Kaneki, M.D., Ph.D., Joseph A. Jeevendra Martyn, M.D., F.R.C.A., Shingo Yasuhara, M.D., Ph.D.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and Department of Liberal Arts, University of Tokyo, Tokyo, Japan. Propofol infusion syndrome is a rare but lethal condition characterized by metabolic acidosis, myocardial failure, rhabdomyolysis, and death. The hypothesis that underlying defective mitophagy (autophagic degradation of mitochondria) in critical illnesses can play a significant role in the onset of propofol infusion syndrome was tested in several in vitro paradigms. Propofol treatment produced mitochondrial fragmentation and induced mitophagy in normal conditions, suggesting mild but direct mitochondrial toxicity. When mitophagy was blocked pharmacologically, the propofol-induced fragmentation was exacerbated, with increased production of superoxide from mitochondria resulting in an elevated level of cell death. Under burn injury stress, propofol-induced mitophagosome maturation was perturbed compared to sham burn, suggesting that burn injury leads to the blockade of mitophagy maturation.Dynamics of Active Awakening α2-Adrenergic Agonist-induced Unconsciousness in Primates by Yumiko Ishizawa, M.D., Ph.D., Jesus J. Ballesteros, Ph.D., Jessica Briscoe, M.S.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. Intracortical neuronal dynamics during transitions of loss of consciousness with the α2-adrenergic agonist dexmedetomidine, return of consciousness, and active awakening by the α2-adrenergic antagonist atipamezole were studied in a functionally interconnecting neocortical network in two macaque monkeys. Loss of consciousness, return of consciousness, and performance return were all associated with distinct neural changes in the cortical dynamics. The early recovery stage between return of consciousness and performance return had characteristic dynamics distinguished by sustained high spindle activities with rapidly fluctuating behavioral responses. The α2-adrenergic antagonist atipamezole induced an instant return of the top task performance while dexmedetomidine was still being infused.The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurologic Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation by Takamitsu Ikeda, M.D., Ph.D., Yusuke Miyazaki, M.D., Ph.D., Eizo Marutani, M.D., Fumito Ichinose, M.D., Ph.D.; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. The burden of neurologic injury after cardiac arrest is high. Quantitative electroencephalography analysis was performed in a mouse model of cardiac arrest to determine the effects of sedation with propofol or dexmedetomidine on neurologic outcomes after cardiac arrest. Immediately after return of spontaneous circulation, mice received a continuous intravenous infusion of propofol, dexmedetomidine, or normal saline with targeted temperature management for 2 h. Cerebral blood flow was measured for 4 h after return of spontaneous circulation. Sedation after return of spontaneous circulation was associated with improved neurologic outcomes and survival. The beneficial effects of sedation were associated with reduced cerebral blood flow and an increase in the electroencephalogram power in the alpha and theta bands.In Vivo Knockdown of Snail Is a Novel Therapeutic Strategy for Right Ventricular Failure by Varina R. Clark, B.S., Nicole Yin, M.D., Somanshu Banerjee, Ph.D., John F. Park, Ph.D., Michael Zargari, Student, Emma Said, Student, Darnell Bagsik, Student, Gregory Fishbein, M.D., Louis A. Saddic, M.D., Ph.D., Soban Umar, M.D., Ph.D.; David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. Snail is a transcription factor involved in endothelial-to-mesenchymal transition (EndMT), a process by which endothelial cells transform into fibroblast-like cells. This transition process contributes to cardiac fibrosis, a common feature of patients with heart failure. The hypothesis that pulmonary hypertension-induced right ventricular failure is associated with EndMT driven by Snail was tested in two rat models of pulmonary hypertension-induced right ventricular failure and pulmonary hypertension patients. RNA sequencing demonstrated EndMT to be the top upregulated pathway in the right ventricles of both rat models, and human right ventricles had increased Snail nuclear immunolabeling (activation). Snail knockdown decreased right ventricular Snail expression and right ventricular hypertrophy and improved right ventricular function in rats.Cxcr3 Antagonist Rescues Pulmonary Hypertension in Female Rats by Blocking Sex-dependent Chemokine Effects by Christine Cunningham, B.S., Soban Umar, M.D., Ph.D., Min Li, Ph.D., Mitali Doshi, B.S., Gregoire N. Ruffenach, Ph.D., Jason Hong, M.D., Haley Hrncir, B.S., Arthur P. Arnold, Ph.D., Mansoureh Eghbali, Ph.D.; Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California. Females are up to four times more likely than males to be diagnosed with idiopathic pulmonary arterial hypertension. The Y-chromosome has been reported to be protective against hypoxia-induced pulmonary hypertension in mice. Knockdown of the Y-Chrm gene Uty, but none of the other genes, in male mice resulted in more severe hypoxia-induced pulmonary hypertension. Analysis of RNA sequencing data revealed an increase in proinflammatory cytokines, including Cxcl9 and Cxcl10, in Uty-knockdown mice. Inhibition of Cxcl9 and Cxcl10 activity in female rats with pulmonary hypertension by blocking their receptor, Cxcr3, with the Cxcr3 antagonist, AMG487, resulted in less severe pulmonary hypertension.Mapping Inhibitory Neurosteroid Binding Sites in γ-Aminobutyric Acid Type A Receptors by Lei Wang, M.D., Ph.D., Ziwei Chen, Ph.D., John Bracamontes, B.A., Mingxing Qian, Ph.D., Kathiresan Krishnan, Ph.D., Yusuke Sugasawa, M.D., Ph.D., Gustav Akk, Ph.D., Douglas F. Covey, Ph.D., Alex S. Evers, M.D., Ph.D., Departments of Anesthesiology and Developmental Biology, Washington University in St. Louis School of Medicine, St. Louis, Missouri. Neurosteroids are endogenous modulators of γ-aminobutyric acid type A (GABAA) receptors. The sulfated neurosteroids pregnenolone sulfate and dehydroepiandrosterone are the primary negative allosteric modulators of GABAA receptor activity in brain. This study describes development of pregnenolone sulfate-analog photoaffinity labeling reagents, MQ189 and KK238, and their application to identifying the sites of pregnenolone sulfate binding and action on the GABAA receptors. MQ189 is a negative allosteric modulator of GABAA receptor activity that closely mimics the actions of pregnenolone sulfate. KK238 is a positive allosteric modulator of GABAA receptor activity that does not appear to act at the classic positive allosteric modulator of GABAA receptor activity-neurosteroid binding sites.Substituted Cysteine Modification and Protection with Alkyl-methanethiosulfonate Reagents Estimates Etomidate-to-Residue Distances in γ-Aminobutyric Acid Type A Receptors by Ryan Fantasia, B.S., Stuart A. Forman, M.D., Ph.D.; Department of Anesthesia Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. Etomidate acts at transmembrane β+/α− interfaces of GABAA receptors. Amino acid residues lining the etomidate site, including β3M286, have been identified using photolabeling and substituted cysteine modification and protection methods. The hypothesis that applying substituted cysteine modification and protection methods with a series of n-alkyl-methanethiosulfonate cysteine-selective modifying reagents could provide more precise information about the distance between etomidate and nearby amino acid residues was tested in α1β3M286Cγ2L GABAA receptors using two-electrode voltage-clamp electrophysiology to assess modification. Accounting for the different side-chain lengths of methionine and cysteine, the results indicate that etomidate is located 1.25 to 2.5 Å from β3M286.Saturday, October 3, 2020, 2:30 to 4:00pmCDTModerators: Michael J. Avram, Ph.D., Assistant Editor-in-Chief, Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Deborah J. Culley, M.D., Executive Editor, Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Martin J. London, M.D., Editor, Anesthesiology, University of California, San Francisco School of Medicine and the Veterans Affairs Medical Center, San Francisco, CaliforniaSevere Maternal Morbidity and Hospital Level Disparities: A Multistate Analysis, 2007–2014 by Robert White, M.D., M.S., Dahniel Sastow, B.A., Sillis Y. Jiang, Ph.D., Virginia E. Tangel, M.S., Kathy C. Matthews, M.D., Corrina M. Oxford-Horrey, M.D., Sharon E. Abramovitz, M.D.; Departments of Anesthesiology and Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York; and Icahn School of Medicine at Mount Sinai, New York, New York. The prevalence of severe maternal morbidity increased 200% between 1993 and 2014. Majority black-serving hospitals and hospital safety net burden have been associated with poorer patient outcomes. The association of both of these hospital-level characteristics with severe maternal morbidity was studied using generalized linear mixed models of data from 6,879,332 delivery hospitalization records from 707 hospitals in 5 states collected between 2007 and 2014. After adjusting for patient- and hospital-level confounders, the level of black-serving hospital was significantly associated with severe maternal morbidity, but hospital safety net burden was not significantly associated with it.Genome-wide Association Study of Patients with Postpartum Hemorrhage Identifies Genetic Loci Related to Immunity and Cell Interactions by Vesela Kovacheva, M.D., Ph.D., Kathryn Gray, M.D., Ph.D., Jacqueline Lane, Ph.D., Hassan Dashti, Ph.D., Brian T. Bateman, M.D., Richa Saxena, Ph.D.; Departments of Anesthesiology and Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts; and Massachusetts General Hospital, Boston, Massachusetts. Postpartum hemorrhage is the leading cause of maternal mortality. Epidemiologic studies have shown that 41% of postpartum hemorrhage risk is familial, with 18% attributable to maternal genetic factors. A genome-wide association study was conducted in 1,424 postpartum hemorrhage cases and 4,272 matched controls with at least one live birth and no postpartum hemorrhage from the UK Biobank to identify novel genetic variants associated with increased postpartum hemorrhage risk. Several putative novel genetic loci were identified near genes involved in cell interactions and immunity. The top single nucleotide polymorphism was near the LGALS3BP gene that modulates cell–cell and cell–matrix interactions and the immune response associated with natural killer and lymphokine-activated killer cytotoxicity.The Effect of Diabetes Mellitus and Preoperative Opioid Use on Gastric Emptying by Omer Bakal, M.D., Kamal Maheshwari, M.D., Kenneth C. Cummings, M.D., M.S., Guangmei Mao, Ph.D., Eva Rivas Ferreira, M.D., Hesham Elsharkawy, M.D., M.B.A., Daniel I. Sessler, M.D., Sekar S. Bhavani, M.D., B.S., M.B.; Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, Ohio. Perioperative pulmonary aspiration of gastric contents causes much morbidity and mortality. The associations between gastric volume directly measured by endoscopic examination and preoperative HbA1C, duration of diabetes, and chronic opioid use were assessed in 145 patients who had diabetes mellitus or chronic opioid use and who had single or dual bowel preparations for gastrointestinal endoscopy between 2017 and 2019. Among 131 diabetic patients, neither HbA1C nor duration of diabetes was associated with gastric volume. Chronic opioid use was not significantly associated with gastric volume in the 14 patients with chronic opioid use. The median difference between gastric volume measured using ultrasound and endoscopic measurement was 18 ml.Clinical Validation of the Eleveld Propofol Pharmacokinetic–Pharmacodynamic Model Used in General Anesthesia by Remco Vellinga, M.D., Laura Hannivoort, M.D., Ph.D., Michele Introna, M.D., Daan Touw, Pharm.D, Ph.D., Anthony R. Absalom, M.D., Ph.D., Douglas J. Eleveld, Ph.D., Michel M.R.F Struys, M.D., Ph.D.; Departments of Anesthesiology and Pharmacology, University Medical Center Groningen, Groningen, Netherlands; and University of Milan, Milan, Italy. Current target-controlled drug infusion systems use pharmacokinetic models developed for specific patient groups. The aim of the current study was to validate a propofol pharmacokinetic–pharmacodynamic model developed for broad application in groups of 25 pediatric, adult, elderly, and obese adult patients undergoing elective surgery. Anesthesiologists were instructed to adjust the target propofol concentration to maintain the Bispectral Index in the range 40 to 60. For pharmacokinetic predictive accuracy, the model showed acceptable bias (less than ±20%) in children, adults, and the obese, but there was some bias (−27%) in the elderly. Precision was acceptable (less than 30%) for all groups. For Bispectral Index, bias and precision were smaller than ±2 and 10 Bispectral Index units, respectively, for all groups.Intraoperative Frontal Electroencephalography Substitutes for Age in a Predictive Model of Postanesthesia Care Unit Delirium by Joseph Pena, M.D., Xiao Shi, M.S., Amy Gaskell, M.D., Ph.D., Matthias Kreuzer, Ph.D., Jamie Sleigh, Ch.B., M.B., Paul S. Garcia, M.D., Ph.D.; Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York; Department of Anesthesiology, Waikato Clinical School, University of Auckland, Hamilton, New Zealand; and Clinic of Anaesthesiology, Technische Universitat Munchen, Munchen, Germany. Intraoperative frontal electroencephalography (EEG) allows for noninvasive monitoring of cortical activity, and specific EEG patterns are associated with delirium in the postanesthesia care unit. The performance of two predictive logistic regression models of postanesthesia care unit delirium derived and validated using data from a prospective multicenter observational study of 649 patients who underwent noncardiac surgery requiring general anesthesia were compared: one that included intraoperative frontal EEG data and one that did not include this information. The inclusion of intraoperative frontal EEG data resulted in an improved predictive model of postanesthesia care unit delirium in which chronological age and history of neurodegenerative disease no longer contributed significantly to the model.Predicting Death in Emergency Laparotomy: An Uncertainty-aware Model Developed Using Data from 179 United Kingdom Hospitals by Finneas Catling, M.Sc., Jakob Mathiszig-Lee, F.R.C.A., S. Ramani Moonesinghe, M.B., Ch.B., F.R.C.P., F.R.C.A., FFICM, Stephen J. Brett, M.D., F.R.C.A.; Department of Surgery and Cancer, Imperial College London, London, United Kingdom, and Centre for Perioperative Medicine, University College London, London, United Kingdom. Current models of emergency laparotomy mortality risk only make point predictions, masking uncertainty in the predictions that can lead to overconfident decision making. A generalized additive model of 60-day mortality risk was developed to predict distributions over mortality risk and validated, using data from 127,148 United Kingdom patients who had emergency laparotomies between 2013 and 2019. Predictor variables and interactions were chosen on the basis of clinical plausibility. The model accounts for the effect of missing computerized tomography scans and blood tests and for complex relationships between variables, improving clinical plausibility while remaining straightforward to interpret.High Mobilization Dose Decreases Adverse Discharge Disposition Risk in Intensive Care Unit Patients by Flora Scheffenbichler, M.D., Bijan Jamil Teja, M.D., M.B.A., Karuna Wongtangman, M.D., Karen Waak, D.P.T., Stefan J. Schaller, M.D., Ph.D., Jessica M. Cassavaugh, M.D., Ph.D., Manfred Blobner, M.D., Ph.D., Carol Hodgson, Ph.D., Nicola Latronico, M.D., Ph.D., Matthias Eikermann, M.D., Ph.D.; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts; Klinik für Anästhesie, Charité Department of Anesthesiology and Intensive Care Medicine, University of Department of and Medicine, and New Intensive Care and Department of Anesthesia, Critical Care and University Hospital, University of in the care unit has been shown to be associated with improved outcomes for patients, including increased and The hypothesis that high is associated with a risk of was tested in a observational study of patients who were functionally and were to in the care unit for at least h using a to that the and duration of was associated with at care unit and hospital and improved 3 after 2 a for by M.D., M.S., Wang, M.D., Ph.D., Ph.D., M.D., Ph.D., M.D., M.D., M. Department of Anesthesiology, Surgery and School of Medicine, The expression of 2 was in the right of patients undergoing cardiac surgery to this is in heart Quantitative of was to of other and was in of patients with disease or and gene level was directly to gene for and but not Cardiac was increased in patients with a history of chronic pulmonary disease and and those with and October 2020, to M.D., Executive Editor, Anesthesiology, University School of Medicine, and Daniel I. Sessler, M.D., Editor, Anesthesiology, Cleveland Cleveland, on M.D., Northwestern University Feinberg School of Medicine, Chicago, M.D., University Medical Center Daniel I. Sessler, M.D., Cleveland Cleveland, for is to maintain this is more complex of the of patients, and and monitoring techniques to in clinical The are and have from clinical and monitoring on the by of abstracts that were their to the The for each abstract can be found at the ASA abstract to and of and during by M.D., B.S., Eva Rivas Ferreira, M.D., Ph.D., M.Sc., B.S., M.S., M.S., M.D., Daniel I. Sessler, M.D.; Cleveland Cleveland, Ohio. or on be between the process of patients and blood and Among patients with continuous and blood there were and The results showed that of the and of the did not 10 of a and be and are on are and Outcomes in Cardiac Patients by M.B., B.S., S. M.D., M.D., Ryan Jason M.D., A. M.D., M.D., R. M.B., University Medical Center, and University of The tested the hypothesis that management and outcomes after surgery. a in and patients, the found that care unit duration and use were both reduced with and via and following Cardiac An Outcomes Study by Michael M.D., S. M.S., C. M.D.; University of The with cardiac and the with are validated but a analysis of patients, the found that decreased but not the was associated with mortality or The be into other the Index Analysis and of Perioperative by M.D., M.D., M.D., M.D., M.D., M.D.; Hospital University Hospital of Germany. The Index intraoperative The tested the hypothesis that the Index in combination with a treatment intraoperative of less than a analysis in patients, patients by the Index had and and less of a for Ventricular by M.B., Ch.B., Paul M. M.D., Ph.D.; School of Medicine, New of the is the in arterial which is a the be is a function of and is measured during than during The compared with over with suggesting that is for direct measurement of Infusion in Patients to A by Joseph M.D., M.D., M.D., M.D., S. M.D., M.D., M.D., M.D., Ph.D., P. M.D., Ph.D.; University of California Hospital, Hospital, University of California San San Hospital and University of California Los Angeles, Los Angeles, California. The tested the hypothesis that controls arterial than patients surgery were to The primary was the of during surgery a patient had a arterial of less than of the The was common in patients in were Cardiopulmonary in the Risk of by by M.D., M.D., M.D., M.D., M.D., M.D., Li, M.D.; Center for of Medical and Medical flow during in The arterial with flow less other outcomes flow be for the of in the Intensive Care Unit by M.D., Ph.D., M.D., M.B., B.S., Bijan Teja, M.D., M.B.A., Student, M.D., S. M.D., T. Ph.D., Matthias Eikermann, M.D., Ph.D.; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Hospital, St. Hospital, and Massachusetts General Hospital, Boston, Massachusetts. an the for intravenous and care unit a the adult patients with requiring a intravenous for at least h. A of patients were to receive or h. The for intravenous was not and the to and hospital of and did not between groups. does not nor October 2020, to Deborah J. Culley, M.D., Executive Editor, Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; M.D., Ph.D., Editor-in-Chief, Anesthesiology, is at the of the The will provide a for of clinical is for and with a important primary October 2020, to The will be different of clinical and their and identify and to and specific of in anesthesia and methods to assess for of and the of for clinical This to provide a panel of to the and clinical or in the of clinical in are for those with to level of in the will provide a broad on current and of to studies in different the of F. M.D., Ph.D., Editor, Anesthesiology, Harvard Medical School, Massachusetts General Hospital, Boston, of and J. M.D., Ph.D., Departments of Medicine, of and Clinical and Hamilton, for to from T. Ph.D., Editor, Anesthesiology, Harvard Medical School, Massachusetts General Hospital, Boston, and and after S. M.D., University of for Clinical The M.D., Executive Editor, Anesthesiology, The Hospital and the University of in and M.D., Harvard Medical School, Hospital, Boston, in Clinical and M.D., Ph.D., University of no

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.