Department of Anesthesia

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https://hdl.handle.net/1805/9167

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Browsing Department of Anesthesia by Author "Adams, David C."

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    Adaptation and restructuring of an academic anesthesiology department during the COVID-19 pandemic in New York City: Challenges and lessons learned
    (Elsevier, 2021) Shaparin, Naum; Mann, Glenn E.; Streiff, Agathe; Kiyatkin, Michael E.; Choice, Curtis; Ramachandran, Sujatha; Delphin, Ellise; Adams, David C.; Anesthesia, School of Medicine
    The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.
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    Impact of intravenous antihypertensive therapy on cerebral blood flow and neurocognition: a systematic review and meta-analysis
    (Elsevier, 2025) Meacham, Kylie S.; Schmidt, Jacob D.; Sun, Yanhua; Rasmussen, Mads; Liu, Ziyue; Adams, David C.; Backfish-White, Kevin M.; Meng, Lingzhong; Anesthesia, School of Medicine
    Background: Intravenous antihypertensivedrugs are commonly used in acute care settings, yet their impact on cerebral blood flow (CBF) remains uncertain. Methods: A systematic review and meta-analysis of 50 studies evaluated the effects of commonly used i.v. antihypertensive agents on CBF in normotensive, hypertensive, and intracranial pathology populations. Meta-analyses used standardised mean differences (SMD), stratified by population type, consciousness state, antihypertensive agent, and CBF measurement method. Results: Intravenous antihypertensivedrug therapy significantly reduced CBF in normotensive individuals without intracranial pathology (SMD -0.31, 95% confidence interval -0.51 to -0.11), primarily driven by nitroprusside and nitroglycerin in awake subjects (SMD -0.80, 95% confidence interval -1.15 to -0.46), with a median CBF decrease of 14% (interquartile range 13-16%) and a median mean arterial pressure reduction of 17% (interquartile range 9-22%). Other antihypertensives showed no significant effects on CBF in normotensive individuals, nor were changes observed in hypertensive patients or those with intracranial pathology when the median mean arterial pressure reduction was ∼20%. No correlation was found between mean arterial pressure reduction and CBF change, supporting intact cerebral autoregulation. Historical data revealed neurocognitive changes when CBF fell to ∼30 ml 100 g-1 min-1, associated with a 58% mean arterial pressure reduction and a 38% CBF reduction. Conclusions: Most i.v. antihypertensive agents do not significantly affect CBF in clinical dose ranges; however, nitroprusside and nitroglycerin can reduce CBF under specific clinical conditions. The certainty of evidence remains low. Neurocognitive changes appear to depend on the magnitude of blood pressure and CBF reductions.