Publications by authors named "Adrian Hendrickse"

12 Publications

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Adult liver transplant anesthesiology practice patterns and resource utilization in the United States: Survey results from the society for the advancement of transplant anesthesia.

Clin Transplant 2021 Oct 12:e14504. Epub 2021 Oct 12.

Department of Anesthesiology, University of Colorado, Aurora, CO.

Introduction: Liver transplant anesthesiology is an evolving and expanding subspecialty, and programs have, in the past, exhibited significant variations of practice at transplant centers across the United States. In order to explore current practice patterns, the Quality & Standards Committee from the Society for the Advancement of Transplant Anesthesia (SATA) undertook a survey of liver transplant anesthesiology program directors.

Methods: Program directors were invited to participate in an online questionnaire. A total of 110 program directors were identified from the 2018 Scientific Registry of Transplant Recipients (SRTR) database. Replies were received from 65 programs (response rate of 59%).

Results: Our results indicate an increase in transplant anesthesia fellowship training and advanced training in transesophageal echocardiography (TEE). We also find that the use of intraoperative TEE and viscoelastic testing is more common. However, there has been a reduction in the use of veno-venous bypass, routine placement of pulmonary artery catheters and the intraoperative use of anti-fibrinolytics when compared to prior surveys.

Conclusion: The results show considerable heterogeneity in practice patterns across the country that continues to evolve. However, there appears to be a movement towards the adoption of specific structural and clinical practices. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/ctr.14504DOI Listing
October 2021

Transitioning to Virtual Meetings: Experiences From the Society for Education in Anesthesia Virtual Fall 2020 Meeting.

J Educ Perioper Med 2021 Jul-Sep;23(3):E667. Epub 2021 Jul 1.

The COVID-19 pandemic has forced organizers of traditional in-person continuing medical education conferences to transition to a virtual format. There are both advantages and disadvantages to this change in format. When planning a virtual meeting, several factors require consideration, including costs, virtual platforms, sponsorship, networking, and meeting logistics. This manuscript describes the authors' experiences of transforming the Society of Education in Anesthesia 2020 Fall Meeting into a virtual conference and explores the lessons learned and future impacts of this new medium.
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http://dx.doi.org/10.46374/volxxiii_issue3_martinelliDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491636PMC
July 2021

The Society for the Advancement of Transplant Anesthesia (SATA) enters a new partnership with Clinical Transplantation.

Clin Transplant 2021 02 21;35(2):e14203. Epub 2021 Jan 21.

Department of Anesthesiology and Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.

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http://dx.doi.org/10.1111/ctr.14203DOI Listing
February 2021

Opioid-Free Epidural-Free Anesthesia for Open Hepatectomy: A Case Report.

A A Pract 2020 Jun;14(8):e01238

Departments of Anesthesiology.

Opioid-free perioperative approaches hold promise to reduce opioid use after surgery and their associated side effects. Here, we report the perioperative analgesic plan of a patient who requested opioid-free care for an open partial hepatectomy. Opioid-free anesthesia care for abdominal surgery is usually dependent on epidural analgesia. However, as in this case, placing an epidural is not always an option due to contraindications such as infection, coagulopathy, or patient refusal. Our multimodal management plan provided an alternative opioid-free, epidural-free perioperative strategy that may prove useful for other patients undergoing similar surgeries.
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http://dx.doi.org/10.1213/XAA.0000000000001238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323843PMC
June 2020

Integrating a Cadaver Review Session into the Existing Regional Anesthesia Training for Anesthesiology Residents: An Initial Experience.

Med Sci Educ 2020 Jun 24;30(2):695-703. Epub 2020 Feb 24.

Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, CO USA.

The Department of Anesthesiology's Acute Pain Service (APS) places ultrasound-guided peripheral nerve blocks (PNBs) to manage acute peri-operative pain. PNB success is dependent on detailed anatomical knowledge which residents may not have formally reviewed since medical school. This study describes the integration of a cadaver review session (CRS) that reintroduces PNB-related anatomy into the existing APS rotation. During each CRS, an anatomist reviewed the major nerve and surrounding structures, while an APS attending integrated the anatomy with PNB techniques. During the pilot, 1st- and 3rd-year clinical anesthesia (CA) residents (9 CA1s, 7 CA3s) completed pre- and post-session surveys and rated the CRS's perceived value and impact on self-confidence with anatomical knowledge. Following the pilot, an additional 17 CA1s and 9 CA3s participated in the CRS and completed post-session surveys. Descriptive statistics were used to summarize responses and unpaired tests were used to compare pre- and post-session responses and responses between cohorts. All participants were overwhelmingly positive about the CRS and its value to the APS rotation, with 98% agreeing they recommend the CRS and found it accessible. Residents believed participation would improve board exam (average = 4.83 ± 0.66) and clinical performance (average = 4.86 ± 0.65), and self-reported increases in confidence with anatomical knowledge. Residents in the pilot group reported significantly greater confidence ( < 0.01) in their perceived anatomical knowledge after the CRS. The CRS positively impacted resident confidence in their anatomical knowledge and perceived ability to identify anatomical structures. Residents reported the CRS was a highly valued addition to regional anesthesia training.
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http://dx.doi.org/10.1007/s40670-020-00934-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368319PMC
June 2020

Service Requirements of Liver Transplant Anesthesia Teams: Society for the Advancement of Transplant Anesthesia Recommendations.

Liver Transpl 2020 04 10;26(4):582-590. Epub 2020 Mar 10.

Department of Anesthesiology, University of Colorado, Aurora, CO.

There are disparities in liver transplant anesthesia team (LTAT) care across the United States. However, no policies address essential resources for liver transplant anesthesia services similar to other specialists. In response, the Society for the Advancement of Transplant Anesthesia appointed a task force to develop national recommendations. The Conditions of Transplant Center Participation were adapted to anesthesia team care and used to develop Delphi statements. A Delphi panel was put together by enlisting 21 experts from the fields of liver transplant anesthesiology and surgery, hepatology, critical care, and transplant nursing. Each panelist rated their agreement with and the importance of 17 statements. Strong support for the necessity and importance of 13 final items were as follows: resources, including preprocedure anesthesia assessment, advanced monitoring, immediate availability of consultants, and the presence of a documented expert in liver transplant anesthesia credentialed at the site of practice; call coverage, including schedules to assure uninterrupted coverage and methods to communicate availability; and characteristics of the team, including membership criteria, credentials at the site of practice, and identification of who supervises patient care. Unstructured comments identified competing time obligations for anesthesia and transplant services as the principle reason that the remaining recommendations to attend integrative patient selection and quality review committees were reduced to a suggestion rather than being a requirement. This has important consequences because deficits in team integration cause higher failure rates in service quality, timeliness, and efficiency. Solutions are needed that remove the time-related financial constraints of competing service requirements for anesthesiologists. In conclusion, using a modified Delphi technique, 13 recommendations for the structure of LTATs were agreed upon by a multidisciplinary group of experts.
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http://dx.doi.org/10.1002/lt.25711DOI Listing
April 2020

Unexpected Complication of Hydroxocobalamin Administration for Refractory Vasoplegia in Orthotopic Liver Transplant: A Case Report.

Semin Cardiothorac Vasc Anesth 2019 Dec 15;23(4):409-412. Epub 2019 Apr 15.

University of Colorado Hospital, Aurora, CO, USA.

A 40-year-old male with alcoholic cirrhosis and end-stage renal disease presented for simultaneous liver and kidney transplantation. Hemodialysis was utilized intraoperatively during liver transplantation. During the procedure, the patient developed refractory hypotension and ultimately received hydroxocobalamin for vasoplegia. Shortly after administration, the hemodialysis machine ceased working after a "blood leak" alarm developed. Without the ability to continue intraoperative dialysis, the kidney transplantation portion of his surgery was postponed. The patient was transferred to the intensive care unit, where he underwent continuous renal replacement therapy overnight, and his kidney transplant proceeded the following morning.
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http://dx.doi.org/10.1177/1089253219842662DOI Listing
December 2019

Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents.

J Grad Med Educ 2017 Aug;9(4):485-490

Background : In a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions.

Objective : We hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach.

Methods : We completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention.

Results : Of 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%;  = .014;  = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%;  < .001).

Conclusions : The flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.
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http://dx.doi.org/10.4300/JGME-D-17-00128.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559245PMC
August 2017

Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression.

A A Case Rep 2017 Sep;9(6):178-181

From the Departments of *Otolaryngology-Head and Neck Surgery and †Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado.

This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation. Extensive retropharyngeal extension can cause supraglottic obstruction of the airway. In these cases, optimal management consists of a closely coordinated approach between anesthesia and surgery teams to establish a surgical airway.
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http://dx.doi.org/10.1213/XAA.0000000000000560DOI Listing
September 2017

The response to methylene blue in patients with severe hypotension during liver transplantation.

J Clin Anesth 2012 Jun;24(4):324-8

Department of Anesthesiology, University of Colorado, Anschutz Campus, Aurora, CO 80045, USA.

Methylene blue is a useful therapy for catecholamine-resistant vasoplegic shock. Three cases of methylene blue administration for the treatment of catecholamine-resistant hypotension during orthotopic liver transplantation are presented.
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http://dx.doi.org/10.1016/j.jclinane.2011.10.010DOI Listing
June 2012

Donation after cardiac death.

Curr Opin Organ Transplant 2007 Jun;12(3):298-302

Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, Colorado, USA.

Purpose Of Review: The present review will provide anesthesiologists with the scientific information and ethical arguments they need to make decisions about donation after cardiac death (DCD) for their clinical practices.

Recent Findings: Organs derived from DCD benefit patients who would otherwise die without transplantation. The practice of DCD ties the withdrawal of life support to organ donation. The close approximation of cessation of circulation to the recovery of organs demands a systematically structured approach to ensure that patient care at the end of life will not be sacrificed for organ donation. In response, the medical community has developed standards of care through expert opinion and consensus. There is general agreement that patients are entitled to expert care at the end of life whether or not they will be organ donors. Thus, abrupt transfer of patient care to an anesthesiologist is usually not in the best interest of the patient.

Summary: By 2007, all US hospitals will have protocols for DCD. Anesthesiologists should review existing protocols and participate in the development of new ones to ensure that the approach to DCD conforms to current standards and that patients have a designated care provider for the withdrawal of life support.
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http://dx.doi.org/10.1097/MOT.0b013e32814a591aDOI Listing
June 2007

Hepatopulmonary syndrome and portopulmonary hypertension.

Curr Treat Options Cardiovasc Med 2007 Apr;9(2):127-36

Department of Anesthesiology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA.

The incidence of pulmonary vascular disorders is significantly increased in patients with liver disease. Intrapulmonary shunting with hypoxemia in patients with liver disease is diagnosed as hepatopulmonary syndrome (HPS), whereas precapillary pulmonary vessel obliteration is identified as portopulmonary hypertension (PPHTN). Because the symptoms of liver disease can mimic those of pulmonary vascular disease, all patients with hepatic failure should be screened for these two diseases. Pulse oximetry effectively screens for hypoxemia associated with HPS, whereas an elevated right ventricular systolic pressure estimated by echocardiography identifies patients at risk of having PPHTN. Liver transplantation is the only effective medical therapy for HPS. However, those who have a resting arterial oxygenation less than 50 mm Hg or a shunt measured by scintigraphic perfusion greater than 20% have an unacceptably high mortality rate following surgery. Compared with HPS, there are more therapeutic options that can bridge patients with PPHTN to transplantation. Drugs used to manage idiopathic pulmonary hypertension have shown promise in the treatment of PPHTN. Prostanoids, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors have improved transplant survival. Despite treatment, however, perioperative mortality for patients with PPHTN remains high. Even with successful transplantation, HPS and PPHTN can persist or develop de novo. Long-term follow-up and surveillance of liver transplant recipients is thus indicated to identify HPS and PPHTN following surgery.
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http://dx.doi.org/10.1007/s11936-007-0006-5DOI Listing
April 2007
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