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Item Gastric Ultrasound Education: Participant Survey Data from a Statewide Gastric POCUS Workshop(2025-04-26) Libiran, Nicole Bianca; Mohammed, Azam; Tanner, Brandon; Boyer, Tanna; PackiasabapathyPOCUS education has grown significantly in the past two decades, impacting various medical specialties. Prior studies implementing POCUS into medical education through standardized workshops have been shown to improve knowledge and POCUS confidence. In one study, implementation of a 6-hour-workshop with faculty showed increased confidence in teaching POCUS to medical students, a 36% increase in POCUS knowledge, and an increase in correct identification of anatomic structures1. Likewise, hands-on training and asynchronous online modules increased PGY-1 residents’ confidence in obtaining POCUS images, recognizing anatomical structures, and incorporating POCUS into clinical practice2. Our study aims to reinforce these findings in the population of practicing anaesthesiologists, with an emphasis on the use of gastric ultrasound. Gastric ultrasound can be a vital tool for anaesthesiologists in determining an appropriate anaesthesia induction and maintenance technique when a patient’s fasting status is uncertain3. Attendees of the 2024 Indiana Society of Anaesthesiologists annual meeting participated in a hands-on gastric point-of-care ultrasound workshop. The workshop included 10 stations, each with a standardized patient model and anaesthesiologists competent in gastric ultrasound to offer immediate feedback and assistance in obtaining images. Using deliberate practice, participants rotated through all 10 standardized patients and faculty. They completed pre- and post-workshop surveys to assess their knowledge and confidence with gastric ultrasound using a 5-point Likert scale. The post-workshop survey also tested participants’ ability to correctly identify structures on classic gastric ultrasound images. Data was analysed using two-tailed Fisher's exact tests, with statistical significance set at p < 0.05. 37 participants completed the pre-workshop survey, and 25 completed the post-workshop survey. Statistically significant improvement after the workshop was found in physicians' confidence in obtaining gastric images (p<0.0001), interpreting gastric ultrasound (p<0.0001), and confidence in incorporating gastric POCUS into practice (p=0.0003) [Fig. 1]. No significant difference was found in general POCUS confidence (p=0.5336). Anaesthesia faculty who attended the workshop reported increased confidence with gastric POCUS, demonstrated improved skills in identifying structures, and reported greater confidence in integrating it into clinical practice, suggesting the addition of deliberate practice was very positive. Russell, F. et al. (2020) Cureus 12: e11821 Ferre, R. et al. (2024) BMC Medical Education 24:843 Gagey, AC. et al. (2017) Anaesthesia 73: 304-312Item Pitfalls in Diagnosing Left Atrial Appendage Thrombus: Lessons from a False-Positive TEE in Mitral Valve Surgery.(2025-10-12) Libiran, Nicole Bianca; Mohiuddin, Amer; Kataoka, MakotoA 47-year-old female with severe mitral stenosis underwent open mitral valve replacement. Preoperative and intraoperative TEE suggested a left atrial appendage thrombus, but no thrombus was found when the atrium was opened. While TEE is the gold standard for LAAT diagnosis, its accuracy can be affected by trabeculations, reverberation artifacts, and spontaneous echogenic contrast. Adjunct imaging techniques, including color flow Doppler, left atrial appendage outflow velocity, and contrast-enhanced imaging, can improve accuracy. Cardiac CT is also a valuable alternative. In this case, the mass may have resulted from blood stasis rather than a true thrombus, complicating diagnosis.Item Gastric Point-of-Care Ultrasound by Nicole Bianca Libiran, MD Candidate Class of 2026(2022-03-22) Libiran, Nicole Bianca; Yu, Corinna; Packiasabapathy, Senthil; Mohammed, Azam; Tanner, Brandon; Boyer, TannaItem Gastric Ultrasound Education: Participant Survey Data from a Statewide Gastric POCUS Workshop(2025-04-04) Libiran, Nicole Bianca; Mohammed, Azam; Tanner, Brandon; Boyer, Tanna; Packiasabapathy, SenthilObjectives POCUS education has grown significantly in the past two decades, impacting various medical specialties. This study aimed to assess practicing anaesthesiologist’s confidence, knowledge, and skill in performing gastric POCUS before and after a focused workshop that used deliberate practice. Methods Attendees of the 2024 Indiana Society of Anesthesiologists annual meeting participated in an included hands-on gastric point-of-care ultrasound workshop. The workshop included 10 stations, each with a standardized patient model and anaesthesiologists competent in gastric ultrasound to offer immediate feedback and assistance in obtaining images. Standardized patient models were either Nil oral or had clear liquids or normal meal. Participants rotated through all 10 standardized patients and faculty, performing deliberate practice, and completed pre- and post-workshop surveys to assess their knowledge and confidence with gastric ultrasound with questions using a 5-point Likert scale. The post-workshop survey also tested participant’s ability to correctly identify structures on classic gastric ultrasound images. This study is a prospective analysis of pre- and post-workshop survey data. Data was analysed using two-tailed Fisher's exact tests, with statistical significance set at p < 0.05. Results 37 participants completed the pre-workshop survey, and 25 completed the post-workshop survey. Statistically significant differences were found in physicians' confidence in obtaining gastric images (p<0.0001), interpreting gastric ultrasound (p<0.0001), and confidence in incorporating gastric POCUS into practice (p=0.0003) [Fig. 1]. No significant difference was found in general POCUS confidence (p=0.5336). Discussion Prior studies implementing POCUS into medical education through standardized workshops have been shown to improve knowledge and POCUS comfort. In one study, implementation of a 6-hour-workshop with faculty showed increased confidence in teaching POCUS to medical students, a 36% increase in POCUS knowledge, and an increase in correct identification of anatomic structures1. Likewise, hands-on training and asynchronous online modules increased PGY-1 residents’ confidence in obtaining POCUS images, recognizing anatomical structures, and incorporating POCUS into clinical practice2. Our study reinforces these findings in the population of practicing anesthesiologists, with an emphasis on the use of gastric ultrasound. Gastric ultrasound can be a vital tool for anesthesiologists in determining an appropriate anesthesia induction and maintenance technique when a patient’s fasting status is uncertain3. The use of gastric ultrasound is increasingly relevant given recent conflicting recommendations between the ASA and AGA surrounding duration of fasting status before elective surgeries in patients on GLP-1 agonists.4 References 1. Russell et al, PMID: 33415026. 2. Ferre et al, PMID: 39107748. 3. Gagey et al, PMID: 29265174. 4. Phan et al, PMID: 39016372.Item Pitfalls in Diagnosing Left Atrial Appendage Thrombus: Lessons from a False-Positive TEE in Mitral Valve Surgery(2025-10-12) Libiran, Nicole Bianca; Mohiuddin, Amer; Kataoka, MakotoA 47-year-old female with severe mitral stenosis underwent open mitral valve replacement. Preoperative and intraoperative TEE suggested a left atrial appendage thrombus, but no thrombus was found when the atrium was opened. While TEE is the gold standard for LAAT diagnosis, its accuracy can be a"ected by trabeculations, reverberation artifacts, and spontaneous echogenic contrast. Adjunct imaging techniques, including color flow Doppler, left atrial appendage outflow velocity, and contrast-enhanced imaging, can improve accuracy. Cardiac CT is also a valuable alternative. In this case, the mass may have resulted from blood stasis rather than a true thrombus, complicating diagnosis.Item The Utility of Gastric Ultrasound in Anaesthesia Education: Participant Survey Data from a Statewide Gastric POCUS Workshop(2025-03-08) Libiran, Nicole Bianca; Mohammed, Azam; Packiasabapathy, Senthil; Tanner, Brandon; Boyer, TannaIntroduction POCUS education has grown significantly in the past two decades, impacting various medical specialties. Prior studies implementing POCUS into medical education through standardized workshops have been shown to improve knowledge and POCUS confidence. In one study, implementation of a 6-hour-workshop with faculty showed increased confidence in teaching POCUS to medical students, a 36% increase in POCUS knowledge, and an increase in correct identification of anatomic structures1. Likewise, hands-on training and asynchronous online modules increased PGY-1 residents’ confidence in obtaining POCUS images, recognizing anatomical structures, and incorporating POCUS into clinical practice2. Our study aims to reinforce these findings in the population of practicing anaesthesiologists, with an emphasis on the use of gastric ultrasound. Gastric ultrasound can be a vital tool for anaesthesiologists in determining an appropriate anaesthesia induction and maintenance technique when a patient’s fasting status is uncertain3. Methods Attendees of the 2024 Indiana Society of Anesthesiologists annual meeting participated in a hands-on gastric point-of-care ultrasound workshop. The workshop included 10 stations, each with a standardized patient model and anaesthesiologists competent in gastric ultrasound to offer immediate feedback and assistance in obtaining images. Using deliberate practice, participants rotated through all 10 standardized patients and faculty. They completed pre- and post-workshop surveys to assess their knowledge and confidence with gastric ultrasound using a 5-point Likert scale. The post-workshop survey also tested participants’ ability to correctly identify structures on classic gastric ultrasound images. This study is a prospective analysis of pre- and post-workshop survey data. Data was analysed using two-tailed Fisher's exact tests, with statistical significance set at p < 0.05. Results 37 participants completed the pre-workshop survey, and 25 completed the post-workshop survey. Statistically significant differences were found in physicians' confidence in obtaining gastric images (p<0.0001), interpreting gastric ultrasound (p<0.0001), and confidence in incorporating gastric POCUS into practice (p=0.0003) [Fig. 1]. No significant difference was found in general POCUS confidence (p=0.5336). Conclusions With the recent conflicting guidelines between the ASA and AGA surrounding duration of fasting status before elective surgeries in patients on GLP-1 agonists, the use of gastric ultrasound is of increasing relevance4. Anaesthesia faculty who attended the workshop reported increased confidence with gastric POCUS, demonstrated improved skills in identifying structures, and reported greater confidence in integrating it into clinical practice, suggesting the addition of deliberate practice was very positive. References 1. Russell et al, PMID: 33415026. 2. Ferre et al, PMID: 39107748. 3. Gagey et al, PMID: 29265174. 4. Phan et al, PMID: 39016372.Item It is all about POCUS!: Participant Survey Data from a Statewide Gastric POCUS Workshop(2025-03-28) Mohammed, Azam; Libiran, Nicole Bianca; Tanner, Brandon; Boyer, Tanna; Packiasabapathy, SenthilObjectives POCUS education has grown significantly in the past two decades, impacting various medical specialties. This study aimed to assess practicing anaesthesiologists' confidence, knowledge, and skill in performing gastric POCUS before and after a focused workshop that used deliberate practice. Methods Attendees of the 2024 Indiana Society of Anesthesiologists annual meeting participated in an included hands-on gastric point-of-care ultrasound workshop. The workshop included 10 stations, each with a standardized patient model and anesthesiologist competent in gastric ultrasound to offer immediate feedback and assistance in obtaining images. Participants rotated through all 10 standardized patients and faculty, performing deliberate practice without realizing that’s what they were doing. Participants completed pre- and post-workshop surveys to assess their knowledge and confidence with gastric ultrasound with X questions using a 5-point Likert scale. The post-workshop survey also tested participant’s ability to correctly identify structures on classic gastric ultrasound images. This study is a prospective analysis of pre- and post-workshop survey data. Data was analysed using two-tailed Fisher's exact tests, with statistical significance set at p < 0.05. Results 37 participants completed the pre-workshop survey, and 25 completed the post-workshop survey. Statistically significant differences were found in physicians' confidence in obtaining gastric images (p<0.0001), interpreting gastric ultrasound (p<0.0001), and confidence in incorporating gastric POCUS into practice (p=0.0003) [Fig. 1]. No significant difference was found in general POCUS confidence (p=0.5336). Discussion Prior studies implementing POCUS into medical education through standardized workshops have been shown to improve knowledge and POCUS comfort. In one study, implementation of a 6-hour-workshop with faculty showed increased confidence in teaching POCUS to medical students, a 36% increase in POCUS knowledge, and an increase in correct identification of anatomic structures1. Likewise, hands-on training and asynchronous online modules increased PGY-1 residents’ confidence in obtaining POCUS images, recognizing anatomical structures, and incorporating POCUS into clinical practice2. Our study reinforces these findings in the population of practicing anesthesiologists of all ages for gastric ultrasound. In the face of increased use of GLP-1 agonists, gastric ultrasound is a vital tool for anesthesiologists to appraise a patient’s fasting status and determine a safe induction plan3. One of our more grey-haired attendees said, “Wow, I actually think I can now do this in clinical practice, and I did not think this workshop would be so helpful.” Conclusion Anesthesia faculty who attended the workshop reported increased confidence with gastric POCUS, demonstrated improved skills in identifying structures, and reported greater confidence in integrating it into clinical practice, suggesting the addition of deliberate practice was very positive. References 1. Russell et al, PMID: 33415026. 2. Ferre et al, PMID: 39107748. 3. Gagey et al, PMID: 29265174.Item Comparing general and regional anesthesia in patients undergoing primary total hip arthroplasty: analysis of national health insurance data in Korea(Frontiers Media, 2025-03-17) Lee, Seungyoung; Ahn, Eunjin; Kim, Min Kyoung; White, Fletcher A.; Chung, Euiheon; Chung, YongHun; Anesthesia, School of MedicineObjectives: To compare the effects of general and regional anesthesia on clinical outcomes following primary total hip arthroplasty (THA). Methods: This retrospective study using data from the Korean National Health Insurance Research Database included 1,522 patients who underwent THA under general anesthesia (n = 640) or regional anesthesia (n = 882) between 2002 and 2015. We compared the mortality and complication rates within 30 days after surgery. Results: Prosthesis failure (1.56% vs. 0.45%, p = 0.025), admission to the intensive care unit (9.53 vs. 5.44%, p = 0.0023), and total cost (₩7,332,515 vs. ₩6,833,295, p < 0.0001) were higher in the general anesthesia group than in the regional anesthesia group. No significant differences were observed in mortality (0.94% vs. 0.57%, p = 0.54), transfusion rate (81.1% vs. 80.9%, p = 0.94), length of hospital stay (45 vs. 45 days, p = 0.23), or other complications between the groups. Similar results were observed in propensity-score matched analysis (n = 640 patients per group). Conclusion: Our study showed that both anesthesia types resulted in comparable mortality and complication rates in patients who underwent THA, but the costs differed.Item Cardiovascular outcomes of a positive nuclear stress test but negative coronary angiography in a multiethnic male predominant cohort(Nigerian Medical Association, 2014) Addison, Daniel; Singh, Vinita; Okyere-Asante, K.; Okafor, Henry; Anesthesia, School of MedicineBackground: Patients presenting with chest pain and evidence of functional ischemia by myocardial perfusion imaging (MPI), but lacking commensurate angiographic disease pose a diagnostic and therapeutic dilemma. They are often dismissed as having 'false-positive MPI'. Moreover, a majority of the available long-term outcome data for it has been derived from homogenous female populations. In this study, we sought to evaluate the long-term outcomes of this presentation in a multiethnic male-predominant cohort. Materials and methods: We retrospectively identified 47 patients who presented to our institution between 2002 and 2005 with chest pain and evidence of ischemia on MPI, but with no significant angiographic disease on subsequent cardiac catheterization (cases). The occurrence of adverse cardiovascular outcomes (chest pain, congestive heart failure, acute myocardial infarction and stroke) post-index coronary angiogram was tracked. Similar data was collected for 37 patients who also presented with chest pain, but normal MPI over the same period (controls). Overall average follow-up was over 22 months. Results: Fifty-three percent (26/47) of the cases had one or more of the adverse outcomes as compared with 22% (8/37) of controls (P < 0.01). Of these, 13 (50.0%) and 3 (37.5%) were males, respectively. Conclusions: Ischemia on MPI is predictive of long-term adverse cardiovascular outcomes despite normal ('false-negative') coronary angiography. This appears to be gender-neutral.Item Carbamazepine Potentiates the Effectiveness of Morphine in a Rodent Model of Neuropathic Pain(Public Library of Science, 2014-09-15) Due, Michael R.; Yang, Xiao-Fang; Allette, Yohance M.; Randolph, Aaron L.; Ripsch, Matthew S.; Wilson, Sarah M.; Dustrude, Erik T.; Khanna, Rajesh; White, Fletcher A.; Anesthesia, School of MedicineApproximately 60% of morphine is glucuronidated to morphine-3-glucuronide (M3G) which may aggravate preexisting pain conditions. Accumulating evidence indicates that M3G signaling through neuronal Toll-like receptor 4 (TLR4) may be central to this proalgesic signaling event. These events are known to include elevated neuronal excitability, increased voltage-gated sodium (NaV) current, tactile allodynia and decreased opioid analgesic efficacy. Using an in vitro ratiometric-based calcium influx analysis of acutely dissociated small and medium-diameter neurons derived from lumbar dorsal root ganglion (DRG), we observed that M3G-sensitive neurons responded to lipopolysaccharide (LPS) and over 35% of these M3G/LPS-responsive cells exhibited sensitivity to capsaicin. In addition, M3G-exposed sensory neurons significantly increased excitatory activity and potentiated NaV current as measured by current and voltage clamp, when compared to baseline level measurements. The M3G-dependent excitability and potentiation of NaV current in these sensory neurons could be reversed by the addition of carbamazepine (CBZ), a known inhibitor of several NaV currents. We then compared the efficacy between CBZ and morphine as independent agents, to the combined treatment of both drugs simultaneously, in the tibial nerve injury (TNI) model of neuropathic pain. The potent anti-nociceptive effects of morphine (5 mg/kg, i.p.) were observed in TNI rodents at post-injury day (PID) 7-14 and absent at PID21-28, while administration of CBZ (10 mg/kg, i.p.) alone failed to produce anti-nociceptive effects at any time following TNI (PID 7-28). In contrast to either drug alone at PID28, the combination of morphine and CBZ completely attenuated tactile hyperalgesia in the rodent TNI model. The basis for the potentiation of morphine in combination with CBZ may be due to the effects of a latent upregulation of NaV1.7 in the DRG following TNI. Taken together, our observations demonstrate a potential therapeutic use of morphine and CBZ as a combinational treatment for neuropathic pain.