Scholarly Commons @ Baystate Health

D\u27Souza, Stanlies

Baystate Health Scholarly Commons @ Baystate Health All Scholarly Works 10-2020 Trigeminal-Cardiac Reflex during Temporal Cranioplasty Stanlies D'Souza Baystate Health, dsouzastan@yahoo.com Follow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/all_works  Part of the Medicine and Health Sciences Commons Recommended Citation D’Souza S. Trigeminal-Cardiac Reflex during Temporal Cranioplasty. The American Society of Anesthesiologists (ASA) Virtual Meeting, Oct 2020. This Presentations, Research is brought to you for free and open access by Scholarly Commons @ Baystate Health. It has been accepted for inclusion in All Scholarly Works by an authorized administrator of Scholarly Commons @ Baystate Health.   Stanlies D’Souza, MD Department of Anesthesiology at Baystate Medical Center / University of Massachusetts Medical School  DISCUSSION   The TCR pathway follows from the ventral trigeminal nucleus, through the short nerve fibers in the reticular formation of the brainstem, and  then synapses on efferent cholinergic premotor parasympathetic cardio-inhibitory neurons in the nucleus ambiguous.1  Suggested Predisposing Factors of TCR1  Individuals with high vagal tone  Preoperative beta blockade Hypoxia Hypercarbia  Sudden stimulation  Surgeries that can precipitate TCR  Maxillofacial surgeries (orbital surgery; eyelid surgery; fixation of mid-facial fractures; orthognathic procedures)  Temporal craniotomy cranioplasty Resection of cerebellopontine angle tumors  Trigeminal neurolysis Microvascular decompression of the trigeminal nerve  Clinical Features of TCR 1,2,3  1. Bradycardia 2. Asystole  3. Apnea in spontaneously breathing patients 4. Gastric hypermotility 5. Hypotension  Sinus bradycardia is the most common clinical finding, followed by asystole; hypotension is rarely seen.   Introduction   Stimulation of one of the three branches of the trigeminal nerve can elicit trigeminal cardiac reflex (TCR), resulting most commonly in bradycardia and, more rarely, hypotension. During temporal craniotomy, stimulating the maxillary division of the trigeminal nerve can also elicit this reflex.     Case Description   A 67-year-old female had a temporal cranioplasty under general anesthesia (oxygen, air, sevoflurane, fentanyl, hydromorphone) with an endotracheal tube under positive pressure ventilation aided by rocuronium. During surgical dissection in the temporal region,  the patient's heart rate dropped to the low 30s from a mid-50s baseline. This was promptly ameliorated by stopping the surgical stimulus and subsequently performing gentle surgical dissection.  The subsequent perioperative course was uneventful.   CONCLUSION  We managed TCR during a temporal cranioplasty by avoiding sudden surgical stimulus, stopping the surgical stimulus and performing gentle surgical dissection for subsequent stimulus.   REFERENCES:  1. Amirjamshidi A, Abbassioun K, Etezadi F, Ghasemi SB. Trigeminocardiac reflex in neurosurgical practice: Report of two new cases. Surg Neurol Int. 2013; 4:126.  2. Lübbers HT, Zweifel D, Grätz KW, Kruse A. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010;68(6):1317-132.  3. Chowdhury T, Schaller B. The Role of Acute Trigemino-cardiac reflex in unusual, non-Surgical cases: A Review. Front Neurol. 2016; 7:186.    Trigeminal-Cardiac Reflex during Temporal Cranioplasty   Management of TCR 1,2  1.  Stopping  the surgical stimulus is the most effective measure  2.  Subsequent gentle surgical stimulus (rather than sudden traction) 3.  Glycopyrrolate/atropine or smaller dose of epinephrine in severe cases. 4.  Prophylaxis  

English

Trigeminal-Cardiac Reflex during Temporal Cranioplasty

Health Sciences Library Newsletter - Winter 2015https://scholarlycommons.libraryinfo.bhs.org/library_newsletters/1004/thumbnail.jp

Roman, Maria

Baystate HealthScholarly Commons @ Baystate HealthLibrary Newsletters Scholarly Commons @ Baystate: Images & ArchivesWinter 2015Baystate Health Sciences Library Newsletter -Winter 2015Maria RomanBaystate Health, maria.roman@bhs.orgFollow this and additional works at: http://scholarlycommons.libraryinfo.bhs.org/library_newslettersPart of the Medicine and Health Sciences CommonsThis Book is brought to you for free and open access by the Scholarly Commons @ Baystate: Images & Archives at Scholarly Commons @ BaystateHealth. It has been accepted for inclusion in Library Newsletters by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationRoman, Maria, "Baystate Health Sciences Library Newsletter - Winter 2015" (2015). Library Newsletters. Book 5.http://scholarlycommons.libraryinfo.bhs.org/library_newsletters/5             Publications of Baystate authors are listed in the HS Library’s institutional repository called Scholarly Commons http://scholarlycommons.libraryinfo.bhs.org/  We are now using those records to create your Scholarly Commons Personal Researcher Page featuring basic profile information that already appears on Baystate’s “Find a Doctor” section of the public website.  Let us create your page for you or, you may follow simple instructions appearing on one of the Library subject guides to do it yourself.  Your profile may even link to your resume if you wish.  Your publications or other scholarly output already in Scholarly Commons can be automatically added and collected when your page is created – so, there’s no need to type in individual citations!  BMC History Book Published   Arcadia Publishing, as part of its Images of America series, has published a book on Baystate Medical Center’s history. The book was written by Thomas Higgins, MD, vice chair, Clinical Affairs, Department of Medicine and Linda Baillargeon, manager of Internal Medicine Residency Programs. It contains over 200 images beginning from the late 1800’s gathered from hospital archives at the Wood Museum of Springfield History and Baystate Health Sciences Library. It’s currently for sale on Amazon.com , the Health Sciences Library, the Marketplace, BMC (Daly 3), the Wesson Baby Shop, and Baystate Mary Lane Hospital Gift Shop. Purchases can be payroll deducted. All proceeds will go to BMC’s Internal Medicine Residency Education & Research Fund.           The Health Sciences Library recently established the Dr. Erik A. Rosenthal Hand Surgery Library Collection, consisting of several books and journals that once were part of the professional collection of Dr. Rosenthal, a distinguished orthopedic surgeon. Dr. Rosenthal introduced hand surgery as a surgical subspecialty to Western Massachusetts. He was Clinical Professor of Orthopaedic Surgery at Tufts Medical School and served as the first Chief of the Hand Surgery Service at Baystate Medical Center from 1977 until 2001. He joined the Springfield Hospital medical staff in 1969, among the vanguard of young surgeons with subspecialty training who initiated a fundamental change in the delivery of surgical care in Western Massachusetts. Their qualifications changed traditional concepts regarding the scope of the primary specialties. Clinical benefits of subspecialty expertise became more evident as technological advancements made surgical care increasingly complex. Formation of a Hand Surgery Service was entertained at then Springfield Hospital Medical Center in 1972. The Hand Surgery Service was approved by the Board of Trustees of Baystate Medical Center in 1977, an integrated Service that included qualified General, Orthopaedic and Plastic Surgeons.  His personal library of some 244 books includes publications from the numerous disciplines that contribute to Hand Surgery and Hand Therapy as regional subspecialties. The Journal Hand Surgery (American), The Hand - replaced by the Journal of Hand Surgery (British) - and the Journal of Hand Therapy all include volume 1.  The volumes are cataloged and held in a climate controlled setting and are available for local scholars doing research or tracking the evolution of hand surgery. The archival collection will also ensure the preservation of this resource for future professionals devoted to hand and upper limb surgery and rehabilitation. Noted in the Health Sciences Library online catalog, a complete inventory of the collection is available upon request.                      At a time of rapid advances in medicine, many patient encounters give rise to clinical questions requiring further investigation - requiring a quick call to the Health Sciences Library. Whether there’s a need for reliable information on the part of the patient or her family or for the provider, seeking the best evidence-based information to provide the highest quality of care possible, the Health Sciences Library is one of the best ways to tap into accurate and current information tailored to your question.  By entering your search inquiry into the library search request form, one of our Information and Knowledge Services Librarians will run a comprehensive search of the literature and send you a list of search results customized to your specifications.  We will respond at once to urgent patient care requests and provide you with the actual journal articles, point-of-care information or any additional source material - especially when seconds count.  For an informed approach to patient care, call the  Library at X 4-1865.  Ellen Brassil MSLS, MAT, AHIP, Director, Health Sciences Library           Ellen Brassil MSLS, MAT, AHIP, Director, Health Sciences Library               Library’s Researcher Gallery Improved Browse Books@Ovid Interface Erik A. Rosenthal, MD Hand Surgery Library Collection  A local scholar browses the collection          Subscribe to Newsletter   |  Unsubscribe     |   Past Issues                                                                                                 Winter 2015  Introducing a new and improved Browse Books@Ovid Interface offering users quicker and easier access to the books you have through Ovid!    The new Browse Books@Ovid Interface offers:  User-Friendly Interface – The newly refreshed interface provides intuitive toggle functionality to browse books by A-Z or by Subject  Browsing Flexibility - Choose which view to browse through   your books – Citation, Newsstand or Hybrid   

Baystate Health Sciences Library Newsletter -  Winter 2015

Adler, Adam, MD

Chahla, Toni, MD

Gutta, Srinivasa, MD

D\u27Souza, Stanlies, MD

Baystate HealthScholarly Commons @ Baystate HealthAll Scholarly Works10-2012A case of paroxysmal obstruction of right coronaryostiumAdam Adler MDBaystate Health, adam.adler@baystatehealth.orgToni Chahla MDBaystate Health, toni.chahla@baystatehealth.orgSrinivasa Gutta MDBaystate Health, srinivasgutta@yahoo.comStanlies D'Souza MDBaystate Health, dsouzastan@yahoo.comFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/all_worksPart of the Medicine and Health Sciences CommonsThis Presentations, Research is brought to you for free and open access by Scholarly Commons @ Baystate Health. It has been accepted for inclusion inAll Scholarly Works by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationAdler A, Chahla T, Gutta S, D'Souza S. A case of paroxysmal obstruction of right coronary ostium. American Society ofAnesthesiologists Annual Meeting, Oct 13-17, 2012, Washington, DC. Figure 3 Gross tissue specimen  Figure 4  Fibroelastoma – H&E 4x  Figure 2 Intra-op view of mass resection A Case of Paroxysmal Obstruction of Right Coronary Ostium   Adam C. Adler MD, Toni Chahla MD, Stanlies D’Souza MD, Srinivasa Gutta MD  Department of Anesthesiology, Baystate Medical Center/Tufts University School of Medicine, Springfield, MA INTRODUCTION  Papillary fibroelastomas (PFE) are the second most common primary cardiac neoplasm and the most common valvular tumor.1,2 Frequently arising at areas of high flow, PFEs are potential causes of ostial obstruction leading to myocardial ischemia and hemodynamic instability.3           CASE DESCRIPTION     A 61-year-old female presented after experiencing severe chest pain. EKG was normal however serum troponin was elevated. She underwent emergent catheterization during which a mobile mass was observed to be adjacent to and occasionally obstructing the right coronary ostia. She was scheduled for elective surgery, however, she developed transient EKG changes and hypotension overnight and was taken to the OR for emergent resection. She was prepped, draped with defibrillation pads in place prior to induction, with the surgeons scrubbed and gowned, ready to open the chest. Arterial and central venous lines were placed awake with 5mg midazolam titrated in at 0.5mg over 1 hour. Due to baseline hemodynamic instability with hypotension, a phenylephrine infusion was started targeting to systolic blood pressures of >160. Induction of anesthesia for endotracheal intubation was accomplished with 2mg midazolam, 30mg propofol, 150mcg fentanyl and 120mg succinylcholine. She was intubated uneventfully, and without desaturation and scopolamine 0.4mg IV was given. The patient was systemically heparinized and cannulated in the aorta and right atrium for cardiopulmonary bypass. Transverse aortotomy was performed revealing a 2 x 2 cm friable mass attached to a portion of the right coronary cusp free edge of the aortic valve.  The patient was transferred to the cardiac intensive care unit and extubated on the day of surgery. The following morning, the patient was resting comfortably and had no memories of the awake preparation in the OR.  REFERENCES   1. Bruno VD, Mariscalco G, De Vita  S, Piffaretti G, Nassiascos D, Sala A. Aortic valve papillary fibroelastoma: a rare cause of angina. Tex Heart Inst J 2011;38:456–7  2. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 2003;146:404-10  3. Mariscalco G, Bruno VD, Borsani P, Dominici C, Sala A. Papillary fibroelastoma: insight to a primary cardiac valve tumor.  J Card Surg 2010;25:198-205 DISCUSSION      Papillary fibroelastomas adjacent to coronary ostia can obstruct the coronary arteries leading to acute ischemia changes and hemodynamic instability.3 In this case, the anesthetic management was aimed at preventing hypotension and thus, coronary ischemia. Additionally, preparation was made for possible emergency defibrillation and the surgical, anesthesia and perfusion teams were ready to initiate CPB immediately should hemodynamic instability occur.  The use of carefully titrated midazolam and scopolamine was incorporated to ensure amnesia and improve patient satisfaction.   Figure 1 TEE of mass at the right coronary ostia 

A case of paroxysmal obstruction of right coronary ostium

Van, Long-Chau, DO

Baystate HealthScholarly Commons @ Baystate HealthAll Scholarly Works10-2017A Case of Intractable Postoperative Nausea andVomiting (PONV)Long-Chau Van DOBaystate Health, long-chau.van@baystatehealth.orgStanlies D'SouzaBaystate Health, dsouzastan@yahoo.comFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/all_worksPart of the Medicine and Health Sciences CommonsThis Presentations, Research is brought to you for free and open access by Scholarly Commons @ Baystate Health. It has been accepted for inclusion inAll Scholarly Works by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationVan L-C, D'Souza S, D'Souza N. A Case of Intractable Postoperative Nausea and Vomiting (PONV). ASA Annual Meeting, Oct 2017.A Case of Intractable Postoperative Nausea and Vomiting (PONV)  Long-Chau Van DO, Stanlies D’Souza MD, Nishal D’Souza  Department of Anesthesiology at Baystate Medical Center/University of Massachusetts Medical School  CASE DESCRIPTION  A 43-year-old female with prior history of intractable postoperative nausea and vomiting (PONV) under general anesthesia (GA) presented for open reduction and internal fixation of left patella for a malunion fracture.  An ultrasound-guided femoral nerve block was placed prior to GA with 25cc of 0.25% bupivacaine. GA with LMA was maintained under total intravenous anesthesia with propofol, midazolam and fentanyl. Her PONV prophylaxis included scopolamine dermal patch, intravenous (IV) dexamethasone, and ondansetron. She was hydrated with two (2) liters of LR. She did not have PONV for the first time in her anesthetic history.  CASE DISCUSSION Mechanism of Nausea and Vomiting   The chemoreceptor trigger zone (CRTZ), located at the caudal end of the fourth ventricle in the area prostrema, and the nucleus tractus solitaries (NTS), are centrally-located structures in the brain responsible for nausea  and vomiting.   The CTRZ receives input from the GI tract via vagal afferents.  It can also detect emetogenic toxins from blood and CSF. It lacks blood brain barrier. The CRTZ projects neurons to the NTS, which receives input from vagal afferents and the limbic system. NTS triggers vomiting by stimulating the rostral nucleus, the nucleus ambiguous, the ventral respiratory group, and the dorsal motor nucleus of the vagus.1    CONCLUSION   Patients with PONV often exhibit nausea, gagging and vomiting for the first two days post-surgery. Since PONV is a high contributor to patient dissatisfaction, it is highly important to take preventive measures against it.  While it may be difficult to eliminate PONV, it is essential to reduce it.   Female patients are more susceptible to experiencing PONV compared to male patients.4 Additionally, patients who are younger, abstain from smoking, and have a past history of motion sickness are more subject to suffer from PONV.4  Preoperative opioid use, nitrous oxide, and volatile anesthesia can significantly increase the risk of PONV, as can certain surgical procedures, including laparoscopic, gynecological and abdominal surgery.    Hydrating the patient5,6, limiting nitrous oxide and volatile anesthetic use, and using propofol for induction and maintenance, can prevent PONV. Studies have shown that high IV fluids therapy (30mL/kg) is associated with less emesis, however there is no significant difference between crystalloid vs. colloid fluids.5 Additionally, regional rather than general anesthesia can significantly reduce PONV. Therapies combining antiemetic prophylaxis with multimodal strategies for non-opioid postoperative pain control, such as regional anesthesia, acetaminophen, and NSAIDs, may reduce the risk of PONV. Acupressure wristbands used before emetic stimulus exposure (i.e. anesthetic agents) for short surgeries have also proved a beneficial preventative measure.6 REFERENCES  1. Continuing Education in Anaesthesia, Critical Care & Pain 2013; 13.  2.  Apfel CC, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88:659-68. 3. Wallenborn J, et al.  The impact of isoflurane, desflurane, or sevoflurane on the frequency and severity of postoperative nausea and vomiting during lumbar disc surgery. J Clin Anesth. 2007; 19:180-5. 4. . Apfel CC, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109 (5); 742 – 753. 2012. 5. Gan TJ, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118 (1): 85 – 113. 2014. 6. Feinleib J, et al. Postoperative nausea and vomiting.  UpToDate. September 8, 2017.  Risk Factors for PONV1                  The use of the volatile anesthetic agent is a main risk factor for PONV.  Incidence of PONV depends on duration and the concentration of volatile anesthetic agent used.2  There is no difference in incidence between sevoflurane, desflurane and isoflurane. 2,3  Pharmacological Antiemetic Prophylaxis   Serotonin antagonists (5 HT3): Ondansetron  Corticosteroids: Dexamethasone  Anticholinergic agents: Transdermal scopolamine  Dopaminergic antagonists (D2): Haloperidol, Metoclopramide  Antihistaminic agents: Diphenhydramine   Neurokinin 1 receptor antagonists: Aprepitant, Rolapitant Patient-related: Female gender; children; past history of PONV; motion sickness; nonsmoking status Surgery-related: Eye surgery (Strabismus surgery); ENT surgery; gynecological surgery; thyroid surgery; surgery duration >1 hour Anesthesia-related: Volatile anesthetic agents; opiates; nitrous oxide Figure 16: Postoperative nausea and vomiting may occur via multiple peripheral and central mechanisms, mediated by a variety of neurotransmitters and receptors. NTS: nucleus tractus solitarius; AP: area postrema; CPG: central pattern generator; NK1: neurokinin 1; 5 HT3:5-hydroxytryptamine (serotonin); GI: gastrointestinal; CNS: central nervous system. [Feinleib, et al. UpToDate, Copyright 2017.]  

A Case of Intractable Postoperative Nausea and Vomiting (PONV)

Baystate Library & Knowledge Services Newsletter - Fall 2021https://scholarlycommons.libraryinfo.bhs.org/library_newsletters/1036/thumbnail.jp

Health Sciences Library, Baystate

Baystate Health Scholarly Commons @ Baystate Health Library Newsletters Newsletters, Blogs, and Journals Fall 2021 Library & Knowledge Services Newsletter - Fall 2021 Baystate Health Sciences Library Follow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/library_newsletters  Part of the Medicine and Health Sciences Commons Please see The Baystate Phoenix 2020-2021 Edition – “This is the culmination of work done by the members in the Internal Medicine and Medicine Pediatrics residencies Humanities Track.   Over the course of the last year, the track participants explored    FAST ACCESS TO RELIABLE HEALTH SCIENCES INFORMATION Newsletter – Fall 2021 It’s time once again to recognize October as National Medical Librarians Month! We have much to celebrate, from outstanding library staff members to an enviable collection of both print and digital resources and services that support the high-quality care that is associated with Baystate Health. We also ask for your feedback at any time to tell us what services are most helpful or what new services might be worth consideration. The challenge of identifying and locating the most relevant and timely information is made more challenging today by the exponential growth of biomedical and health sciences information, and is compounded by quantities of unreliable information from popular media and other sources. The Library and its staff together are essentially “your ultimate search engine,” as the Medical Library Association itself has often said, and are here to efficiently deliver trustworthy, pertinent information that helps foster clinical excellence and scholarly success! While modern libraries are still vibrant information nodes and sources of lifelong learning, peer reviewed studies have even shown that libraries can reduce unnecessary readmissions and other avoidable costs. The Library will provide any refreshers or consultations on topics and varied as: remote access, to systematic reviews to optimal PubMed searching to managing your citations or drug information sources – just to name a few.  For more information be sure to visit the physical Health Sciences Library in the Chestnut Building or else explore our website anytime. We can be reached by contacting us at library@bhs.org or contact us at: 794-1865. Library Space    Announcements   Baystate Library     & Knowledge Services      The Library continues to adhere to strict safety measures, following Baystate guidelines and CDC recommendations. We will continue to make available distanced seating, hand sanitizer etc. and uphold the mask requirement for all library users.  __________ Entry to the library is by BADGE ACCESS ONLY.  If your badge is not working, please contact security or submit a Badge Access Request Form.  Programs may also forward names of groups of individual employees and their badge numbers for badge access.    Ellen Brassil, MLIS, MAT AHIP The library provides remote access to many of our databases, journals, eBooks and other electronic resources through OpenAthens. This type of access is an alternative to logging in to the network through Citrix or VMware. Once you have an OpenAthens account, you can go directly to the library website from any location, select the resource you would like to use, then choose the “OpenAthens”.                      Baystate login (EN# and password).  To register for an OpenAthens account, just fill out the OpenAthens Request.  Once you receive notification from IT that your account has been created, check out this OpenAthens Handout for more details on how to use your new account.   OpenAthens for Remote Access Message from the Librarian The Health Sciences Library is located in the Chestnut Building where we provide public and private space conducive to learning, studying, meetings and teaching.  Your login will be the same as your   Computer Lab - Provides 15 PCs and a large monitor, an ideal space for teaching and/or training.*  Small Conference Room - Includes a conference table with seating for up to 8 people. The room also has a PC, a large dry/erase board and now includes a display monitor.  In addition to the large laptop room we have a smaller private conference room in the back of the library for 2-3 people. Lastly, we have designated areas for collaborative learning for your convenience one of which now includes a table with seating for up to 4 people plus a bonus large monitor. You can reserve the conference rooms online or by calling ext. 41982  *Pease adhere to the current COVID-19 guidelines for meetings.    • Aminoff's neurology and general medicine. 2021   • Anatomic exposures in vascular surgery. Fourth edition. 2021 • Anesthesia equipment : principles and applications. Third edition. 2021 • Atlas of minimally invasive techniques in upper gastrointestinal surgery. 2021 • Atlas of pediatric laparoscopy and thoracoscopy. Second edition. 2021 • Atlas of pelvic anatomy and gynecologic surgery. Fifth edition. 2021 • Block's disinfection, sterilization, and preservation. 2021 • Core radiology : a visual approach to diagnostic imaging. Second edition. 2021 • Decision making in perioperative medicine : clinical pearls. 2021 • Decision-making in adult neurology. 2021 • Firestein & Kelley's textbook of rheumatology. 2021  • Fundamentals of musculoskeletal imaging. Fifth edition. 2021 • Guyton and Hall textbook of medical physiology. 14th edition. 2021 • Local flaps in facial reconstruction. Fourth edition. 2022 • Muscle biopsy : a practical approach. Fifth edition. 2021 • Next-generation interstitial lung disease. 2021 • Operative techniques in orthopaedic surgery. Third edition. 2022 • Pathomechanics of common foot disorders. 2021 • Pulmonary hypertension. 2021 • Sickle cell disease. 2021 • Sleisenger and Fordtran's gastrointestinal and liver disease : review and assessment. 2021               Subscribe to Newsletter   |  Unsubscribe     |   Past Issues                                 Fall 2021                                                                                                            Selected New Features from Ovid  Ovid resources recently announced several new features of interest to our Library patrons.  Ask us about group instruction and consultations on these and other search tips! Platform Updates when searching on Ovid • Term Finder – This new feature provides Ovid MEDLINE users with easy access to relevant definitions, MeSH terms, and keywords as they construct their expert search in the Ovid Advanced Search mode. Term Finder provides automatic retrieval of relevant Definition, MeSH Subject headings, Used for Terms, Scope Note, Subheadings, Permuted Index and UMLS Terms. To learn more, view this brainshark video. • New Book Reader –Books@Ovid is updated to include: o New responsive reading  o Search within the book right from the reader o Table of contents navigation o Full-screen view o User options for scrolling, two-page layout, one-page layout, font size, font alignment, font type, line spacing, mode, and margins. o More information can be found here. • Search Sharing – we launched search sharing in March to all customers after a successful beta launch.  We received great positive feedback from users during the beta launch, including: o “That’s going to make documenting systematic reviews and sharing the search strategies for peer review so much easier” o “As a librarian, this is a very easy way for us to ask students to share their searches with us! So incredibly helpful!” o With this functionality it’s now quick and easy to share and launch hundred-line search strategies! Users can: • Use ‘Email All Search History’ to share searches with colleagues, students, and patrons • Use ‘Copy Search History Link’ to easily share searches with colleagues as well as to seamlessly integrate searches in educational materials and websites • Use ‘Copy Search History Details’ to easily inset your Ovid search strategy into documentation for publications, dissertations, and student assignments • If you’d like to learn more, please watch and share this short training video  • Coming Soon! Enhanced Auto Alerts and Saved Searches - Ovid users can accumulate a large volume - sometimes hundreds - of saved searches and alerts in their accounts and we are excited to make the management of saved searches & alerts easier!  Users will be able to:  o Quickly locate frequently used searches and searches ‘in-progress’ o Manage saved searches and alerts in an interface that is clear and easy to navigate o To learn more, please watch this training video   Recent Additions to the Library Catalog    

Library & Knowledge Services Newsletter - Fall 2021

Health Sciences Newsletter - Winter 2017/2018https://scholarlycommons.libraryinfo.bhs.org/library_newsletters/1020/thumbnail.jp

Baystate HealthScholarly Commons @ Baystate HealthLibrary Newsletters Scholarly Commons @ Baystate: Images & ArchivesWinter 2018Baystate Health Sciences Library Newsletter -Winter 2017/2018Maria RomanBaystate Health, maria.roman@bhs.orgFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/library_newslettersThis Book is brought to you for free and open access by the Scholarly Commons @ Baystate: Images & Archives at Scholarly Commons @ BaystateHealth. It has been accepted for inclusion in Library Newsletters by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationRoman, Maria, "Baystate Health Sciences Library Newsletter - Winter 2017/2018" (2018). Library Newsletters. 21.https://scholarlycommons.libraryinfo.bhs.org/library_newsletters/21  Use TurningPoint with your mobile device   PowerPoint or other presentations can  be easily configured to include polling  with the same powerful features that   TurningPoint has provided for years to  achieve optimal audience engagement – but without using the clickers! Responding with your browser turns a web-enabled mobile  device or tablet into a virtual clicker. You are now able to respond to polling questions through a Wi-Fi or data connection. Baystate employees can now use their smart phones and tablets to send polling data while TurningPoint software can also embed the actual surveys in presentations that even reach remote users off site. Meet Responseware, TurningPoint’s cloud based polling software that can help make your next presentation more interactive and accessible to your audience than ever before! It allows you to respond to multiple question types, such as multiple-choice, alphanumeric, multiple response and essay questions. Questions and answer choices are displayed on the web-enabled device while polling is open.  For more details, contact the Health Sciences Library.              Mes                                                                                                                            Cardiac-Vascular Nu    Winter 2017/2018   Health Sciences Library Newsletter  Newsletter If you haven’t visited our virtual Library recently you’re in for a great surprise!,   Kudos to the Library’s Web Services Coordinator, Maria Roman, for her outstanding work guiding and designing the latest version of our website.  Springhare’s upgrade to Version II reflects the latest enhancements to their LibGuide software that hosts our site.  This new version optimizes all available functionality to provide easy and effective navigation that saves you time and gets best results.  Maria also puts her skills to work with sections of our Scholarly Commons Repository such as the  Archives and Images Gallery and Selected Works Author Gallery to ensure that our website stays innovative and connects you with the digital information you need.  Message from the Librarian   Ellen Burchill Brassil, MSLS, MAT, AHIP  Ellen Burchill Brassil, MSLS, MAT, AHIP    Lexicomp Patient Information Baystate’s drug information tool, Lexicomp, provides patient education a few different ways, start by selecting the Patient Education tab and explore many features:   Pediatric Surgery NaT        In need of a current reference tool for the general surgical care of children? Check out Pediatric Surgery NaT (“Not a Textbook”)! Updated regularly by and for pediatric surgeons, the NaT is formatted into modules and learning objectives and contains high-resolution images, videos of procedures, and links to MOC CME and the medical literature. The NaT also includes a mobile app for your smart phone or tablet, making it an accessible and practical reference tool for both practicing and in-training pediatric surgeons.            1.    Medication and Patient Education for HCAHPS. Helps as a guide for anyone educating a patient on a medication to ensure they are covering everything included in the HCAHPS survey they will receive.    2.    Teach-Back:  Helping Patients Understand – This field is at the bottom of all Lexicomp Discharge Instructions.  Included are 3-4 bullet points or concepts for the patient to communicate back to the educator after reviewing the information with them. 3.    Patient Education in up to 19 languages for all medications using the Patient Education Module, and in both English and Spanish for all health information topics.  4.    Store Patient Education Packets – In the Patient Education Module, Lexicomp helps provide a login so administrators can create patient education packets for staff to access more easily.  For example, if every patient with DVT should receive the following XYZ patient education, you can create a DVT packet with . those topics  Black History Month In Commemoration of Black History Month the Health Sciences Library will conduct a book discussion on Thursday, February 22nd at noon in the Library’s laptop room on the extraordinary book titled,  The Immortal Life of Henrietta Lacks, by author Rebecca Skloot. Bring your lunch and a copy of your book and join in the discussion.       Additions to our Catalog   Cardiovascular Nursing: Scope and Standards of Practice (2015 Cardiac-Vascular Nursing Review and Resource Manual (2015)        Subscribe to Newsletter   |  Unsubscribe     |   Past Issues                                                                                                                             Winter 2017/18                                                                                                                                           ubscribe to Newsletter   |  Unsubscribe     |   Past Issues                                                                            Fall 2017                                                                                                                                           

Baystate Health Sciences Library Newsletter - Winter 2017/2018

Baystate Library & Knowledge Services Newsletter - Winter 2020https://scholarlycommons.libraryinfo.bhs.org/library_newsletters/1029/thumbnail.jp

Baystate Health Scholarly Commons @ Baystate Health Library Newsletters Newsletters and Blogs Winter 2020 Library & Knowledge Services Newsletter - Winter 2020 Maria Roman Follow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/library_newsletters  Part of the Medicine and Health Sciences Commons           Mes                                                                                                                                              Ellen Burchill Brassil, MSLS, MAT, AHIP                                  Ellen Burchill Brassil, MSLIS, MAT, AHIP        Ellen Brassil, MSLIS, MAT, AHIP     Mobile-friendly – the new design and layout are much more compatible with mobile devices than the previous version.  Article snippets – your search results show fragments from the abstract that contain your keywords for easier skimming.  Best Match – the Best Match algorithm has been improved, so your list of results are presented in a more relevant order (but you can still order them by Most Recent date, instead).  Results by Year graph – there is a graph on the left side of your results where you can see the number of papers published by year and quickly limit to a particular date range.  Citation options – click on the new Cite button to view/copy the article citation in AMA, APA, MLA, and NLM format or to download the citation as a RIS file for your reference manager program.  Share options – select Share to post a link to the abstract on Twitter or Facebook, or to copy the link and share it anywhere else.   Article-specific content – there are several new features available on the individual abstract page, such as a Similar Articles list, a Cited By list (when available), and a References list (when available).  Overall, the new version of PubMed is not very different from the original version, but the developers incorporated some modern features that have the potential to make your searching, browsing and sharing more practical and seamless. However, we recognize that any change in this type of resource can be disruptive to your workflow, so please reach out to the library (794-1865) if you have any questions about the new PubMed. The library will also be hosting open workshops every Friday in February (12-1pm) if you’d like to come and check out the new PubMed! Message from the Librarian:  Knowledge comes packaged in many different ways but everyone who has ever used a medical atlas agrees that a picture says a thousand words. Meet VisualDx, a clinical decision support tool that’s new to Baystate and helps clinicians quickly identify presenting conditions that they encounter in patient care settings each day. Accessible on the Hub or as a Library database link, VisualDx can also be accessed within CIS or using the mobile app. VisualDx helps the clinician build a differential diagnosis, and is a comprehensive source of over 25,000 quality images covering thousands of medical conditions. It will access peer-reviewed therapies for over 1,000 different diagnoses, and integrates with UpToDate search results.  A convenient way to earn CME/CE credit, VisualDx supports teaching and learning and connects clinicians to specific images to use in presentations. Contact the Library to get started or for help creating a personal account, or to learn about remote access.    Ellen Burchill Brassil, MSLIS, MAT, AHIP    FALL 2019  Newsletter  | Winter 2020 Library  & Knowledge Services Fast access to reliable health sciences information Fast access to reliable health sciences information   NEW PubMed  Some of you may have noticed a banner at the top of PubMed recently, announcing a new version of this popular biomedical database. The new PubMed interface is available to use now for those eager to try it (just click on the banner), and it is slated to become the official version of PubMed sometime in the next few weeks. The basic functions of the new PubMed are the same as the original version, such as the ability to use keywords and/or MeSH subject headings in your search, saving items to the temporary Clipboard or to your permanent Collections in MyNCBI, sending abstracts to your Email, etc. In fact, most of these functions can even be found in the same location in the new PubMed (thankfully!). However, there are several new features and enhancements to the original version that are worth mentioning:             Subscribe to Newsletter   |  Unsubscribe     |   Past Issues                                                                                                                                   Winter 2020                                                       CONFUSED ABOUT WHAT HEALTH INFORMATION YOU CAN TRUST?                                                                                              OUR HEALTH SCIENCE LIBRARIANS WILL HELP YOU!   A serious diagnosis is scary. Under stress like this, comprehension plummets. Often, we stop hearing what the doctor is saying, or we can't remember later what we were told.  Then it is very common to seek out information, usually by consulting "Dr. Google." Anyone can publish anything on the internet. There is good, sound medical information online—and a lot of inaccurate, even dangerous, information.  Read more… Glazer, G. (2019, Dec. 31) Confused about what Health Information you can trust?  Retrieved from https://www.baystatehealth.org/news/2020/01/ask-a-librarian      NEW TITLES ADDED TO OUR COLLECTION        NOVEL CORONAVIRUS INFORMATION CENTER      MOBILE DEVICE CHARGING STATION!                            Subscribe to Newsletter   |  Unsubscribe     |   Past Issues                                                                                                                                   Winter 2020                               William’s Textbook of Endocrinology – 14the ed. 2020  GLAUCOMA SURGERY. 2019  Stop wasting words: leading through conscious communication. 2019  Current surgical therapy. 13th edition. 2020  Anesthesiologist's manual of surgical procedures. Sixth edition. 2020  Enzinger and Weiss's soft tissue tumors. Seventh edition. 2020  Video atlas of anterior segment repair and reconstruction : managing challenges in. 2020  Handbook of coronary stents. Fourth edition. 2019  Medical ethics in clinical practice. 2019     The library now has a charging station for your smartphones, tablets, and e-readers while you read, study, or just relax. You don't need to bring your own charger, and there is no fee for charging!   As with books and your personal belongings, please do not leave devices unattended while charging.  The library is not responsible for lost or damaged devices.    For the benefit of healthcare professionals, medical researchers and the public, Elsevier has created a Novel Coronavirus Information Center with freely available information in English and Mandarin Chinese on the novel coronavirus 2019-nCoV, including new information about the recent outbreak in China   

Library & Knowledge Services Newsletter - Winter 2020

Baystate HealthScholarly Commons @ Baystate HealthAll Scholarly Works10-2016Perioperative Care of the Child withArthrogryposisStanlies D'SouzaBaystate Health, dsouzastan@yahoo.comFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/all_worksPart of the Medicine and Health Sciences CommonsThis Presentations, Research is brought to you for free and open access by Scholarly Commons @ Baystate Health. It has been accepted for inclusion inAll Scholarly Works by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationAdwoa Andoh N, D'Souza N. D'Souza S. Perioperative Care of the Child with Arthrogryposis. ASA Annual Meeting, Oct 2016.CASE DISCUSSION   Patients with AMC present with a wide variety of clinical features which must be taken into consideration prior to administering an anesthetic to  ensure safe delivery of anesthesia. Clinical features include1,2,3:   Difficult airway: Micrognathia, high arched palate, cervical spine instability  Intraoperative hyperthermia: Unclear Malignant Hyperthermia risk   Difficult IV access due to reduced subcutaneous tissue   Difficult positioning  Difficult regional blockade  Myopathy: Prolonged duration of neuromuscular blockade  Cardiorespiratory status: Sensitivity to anesthetic agents and high risk of aspiration or post-operative respiratory support needs   CONCLUSION   The overall prevalence of arthrogryposis multiplex congenita is estimated at 1 in 3000 live births. Anesthesiologists need to appreciate the multiple clinical  presentations and anesthetic risks to help formulate an appropriate anesthetic plan for pediatric patients presenting for multiple corrective procedures.   INTRODUCTION  Arthrogryposis multiplex congenita (AMC) is a rare condition characterized by congenital joint contractures throughout the body which results from fetal akinesis due to extrinsic factors or primary neurogenic or myopathic conditions of the fetus.  Children with arthrogryposis often require multiple orthopedic corrective procedures. There are three major recognized groups: Amyoplasia, distal arthrogryposis and syndromic arthrogryposis, all of which present various anesthetic challenges. 1  REFERENCES  1. Bamshad M, Van Heest AE, Pleasure D. Arthrogryposis: a review and update. J Bone Joint Surg Am. 2009;91 Suppl.  4:40-46.  2. Nguyen NH, Morvant EM, Mayhew JF. Anesthestic mangement for patients with arthrogryposis multiplex congenital and severe micrognathia.: case reports.  J Clin Anesth. 2000; 12(3):227-230.  3. Pujari VS et al. Arthrogryposis multiplex congenita: an anesthetic challenge. Anesthesia Essays and Researches. 2013; 6:78-80.  CASE DESCRIPTION   An eight year old female weighing 20kg, with distal arthrogryposis,  presented for a right foot cast change and wound check. She had a history of significant right foot fixed equinus contracture;  a right foot contracture release and Achilles tendon lengthening had been performed under general anesthesia a month prior to presentation.   Patient was brought into the operating room, standard monitors placed and inhalational induction performed with Oxygen/Nitrous oxide and sevoflurane. A 22G left peripheral access was obtained post-induction  and the airway secured with a laryngeal mask airway size 2.5.   The anesthetic was maintained with sevoflurane and fentanyl.  Intra-operatively, her vitals remained stable and nasopharyngeal temperatures were normal. She was successfully extubated in the operating room and post-operative course was uneventful.     Perioperative Care of the Child with Arthrogryposis   Nana  Adwoa Andoh MD, Nishal D’Souza, Stanlies D’Souza  MD   Department of Anesthesiology at Baystate Medical Center/University of Massachusetts Medical School  Bilateral clubfoot deformity in a newborn with arthrogryposis. Arthrogryposis: Ferguson J. Orthopaedics and Trauma, Volume 27, Issue 3, 171-180. Copyright ©  2013  by Elsevier. Etiology of arthrogryposis. (Modified from: Hall JG. Arthrogryposis multiplex congenital: etiology, genetics, classification, diagnostic approach, and general aspects. J Pediatr Orthop B. 1996; 6:159–166). Arthrogryposis: Horstmann HM. Nelson Textbook of Pediatrics, Chapter 682, 3310-3314.e1. Copyright © 2016 by Elsevier. 

Perioperative Care of the Child with Arthrogryposis

Baystate HealthScholarly Commons @ Baystate HealthAll Scholarly Works10-2018A case of Pheochromocytoma presenting foradrenalectomyStanlies D'SouzaBaystate Health, dsouzastan@yahoo.comFollow this and additional works at: https://scholarlycommons.libraryinfo.bhs.org/all_worksPart of the Medicine and Health Sciences CommonsThis Presentations, Research is brought to you for free and open access by Scholarly Commons @ Baystate Health. It has been accepted for inclusion inAll Scholarly Works by an authorized administrator of Scholarly Commons @ Baystate Health.Recommended CitationD'Souza S. A case of Pheochromocytoma presenting for adrenalectomy. American Society of Anesthesiologists (ASA) Conference,October 13-17, 2018, San Francisco, CA.CASE DESCRIPTION A 75- year- old with left adrenal mass, hypertension and atrial fibrillation with elevated metanephrine and normetanephrine was diagnosed with pheochromocytoma. Adequate preoperative alpha blockade was established with oral doxazocin. General anesthesia with endotracheal tube was performed for laparoscopic left adrenalectomy. Perioperative blood pressure was closely monitored with an arterial line. Hypotension in the post-induction period was effectively managed with vasopressin. Hypertension during resection and hypotension following resection was were not encountered as this patient was adequately alpha- blocked preoperatively. A Case of Pheochromocytoma Presenting for Adrenalectomy   Stanlies D’Souza MD, Nishant D’Souza  Department of Anesthesiology at Baystate Medical Center / University of Massachusetts Medical School REFERENCES: 1. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young WF Jr, and Endocrine Society: Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:1915-42. 2. Ramakrrishna H: Pheochromocytoma resection: Current concepts in anesthetic management. J Anaesthesiol Clin Pharmacol 2015: 31: 317–23.  3. Goldstein DP,  Voigt MR,  Ruan D Current preoperative preparation of pheochromocytoma/ Paraganglioma Syndrome. Clinics in Surgery 2017; 2:1517.  4. Mellom MJ,  Sundaram CP: Laparoscopic Adrenalectomy for Pheochromocytoma Versus Other Surgical Indications . JSLS. 2008; 12: 380–38.  5. Lord MS, Augoustides JG: Perioperative management of pheochromocytoma: focus on magnesium, clevidipine, and vasopressin.  Cardiothoracic Vasc Anesth. 2012: 26:526-31. CONCLUSION   Preoperatively, adequate selective alpha2 blockade with doxazocin minimizes hypertensive and hypotensive episodes during pheochromocytoma resection.3  INTRODUCTION Adequate preparation with alpha blockade is important  in a patient presenting for pheochromocytoma resection. Use of vasopressin is indicated to treat intraoperative hypotension refractory to alpha agonistic agents. Clevidipine is a new, novel agent effective in the management of hypertensive episodes.   PRE-OP CLINICAL FEATURES: Headaches, Palpitations, Diaphoresis , Severe  Hypertension , Postural Hypotension, Tachyarrhythmias, Diabetes mellitus,  Pallor,  Weight Loss, Cardiomyopathy PREFERRED DIAGNOSTIC TESTS for Pheochromocytoma (per Task Force of the Endocrine Society):1 1. Plasma metanephrine: Sensitivity 96%, specificity 85% 2. 24-hr collection of urinary catecholamines: Sensitivity 87.5%, specificity 99.7% PREOPERATIVE PREPARATION: 1. Initiate alpha blockage 10-14 days before surgery 2. Initiate beta blockade only after complete alpha blockade ALPHA BLOCKERS for preoperative preparation:2,3  1. Phenoxybenzamine:  Non-selective; prolonged half-life; causes reflex tachycardia; should be stopped within 24-48 hours 2. Doxazocin:  Selective Alpha 2 antagonist; doesn’t cause reflex tachycardia; reduced incidence of intraop hypertension and postop hypotension PREOPERATIVE OBJECTIVES  for adequate  alpha  blockade:2   1. Control hypertension.  2.  Reverse  circulating blood volume. 3.  Control heart rate and arrhythmia.  4. EEG free of ST segment and T wave changes.  5.  Reverse hyperglycemia and electrolyte abnormalities.  PREOPERATIVE TARGETS of adequate alpha blockade:2 1. In-hospital blood pressure below 160/90 mmHg for 24 hours prior to surgery. 2. No orthostatic hypotension with blood pressure <80/45 mmHg. 3. EKG free of ST and T wave changes for one week prior to surgery. 4. Fewer than five (5) premature ventricular contractions per minute.  INTRA-OP DRUGS TO AVOID INTRAOPERATIVELY2,3 (Laparoscopic adrenalectomy is currently the surgical method of choice)  Histamine releasing drugs (morphine, atracurium)  Vagolytic agent (pancuronium)  Ketamine CRITICAL PERIODS OF HEMODYNAMIC CHANGES DURING RESECTION2,3  Catecholamine surge leading to hypertensive episode:   Laryngoscopy;  peritoneal insufflation; tumor manipulation  Hypotension due to catecholamine decline:  Tumor ligation ANESTHETIC GOALS2,3 1.  Avoid or reduce catecholamine release due to surgical and anesthetic techniques 2.  Avoid drugs that release catecholamines or histamines 3.  Minimize the hypertensive response during tumor handling. 4.  Minimize the hypotensive response following tumor resection.  PHARMACOLOGICAL AGENTS TO CONTROL HEMODYNAMIC CHANGES DURING SURGERY5 CLEVIDIPINE is effective in controlling hypertension during tumor handling. VASOPRESSIN is the agent of choice to treat hypotension resistant to alpha adrenergic agonistic agents. 

A case of Pheochromocytoma presenting for adrenalectomy

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