Regional Anesthesia use in Pediatric Burn Surgery: A Retrospective Observational Cohort Study

AbstractApproximately 77,000 children 16 years or less suffered burn injuries in the United States in 2018. Treatment, reconstruction, and rehabilitation are painful experiences. For some, the experience triggers post-traumatic stress disorder (PTSD) and/or a chronic pain syndrome. Given the role pain plays as a major secondary disease, it must be addressed to achieve optimal healing. Regional anesthesia has been used extensively to manage postoperative pain and reduce the need for opioids following other surgical procedures in children. Nevertheless, regional anesthesia has not yet been widely used in pediatric burn care. We present a demonstration project utilizing regional anesthesia in 15 pediatric burn patients over an eight-month period. Our results indicate that the use of regional anesthesia reliably reduces perioperative pain and opioid requirements in the immediate peri-operative period. In this cohort, 93% of patients scored a 0/10 on a FLACC scale for pain by post-anesthesia care unit (PACU) discharge, with an average PACU stay of 70 minutes. Thirty-three percent of patients received no opioids, and the average opioid dose was only 0.06mg/kg morphine equivalents. We conclude that regional anesthesia can be used to improve patient comfort and decrease opioid requirement.

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A Qualitative Survey Study of United States Burn Units: Pathways to a Career in Burn Surgery

Journal of Burn Care & Research ◽

10.1093/jbcr/irz071 ◽

2019 ◽

Vol 40 (5) ◽

pp. 595-600

Author(s):

Francesco M Egro ◽

Erica D Johnson ◽

Elizabeth M Kenny ◽

Aaron M Foglio ◽

Brandon T Smith ◽

...

Keyword(s):

United States ◽

Critical Care ◽

Wound Care ◽

The United States ◽

Fellowship Training ◽

Training Requirements ◽

Burn Care ◽

Burn Unit ◽

Burn Units ◽

Burn Surgery

Abstract With current changes in training requirements, it is important to understand the venues in the United States for a general surgery (GS) and plastic surgery (PS) resident interested in pursuing a burn surgery career. The study aims to evaluate the pathways to a career in burn surgery and the current state of leadership. A cross-sectional study was conducted between August and September 2017. A 12-question survey was sent to all burn unit directors in the United States, asking about their background, who manages various aspects of burn care and the hiring requirements. Responses were received from 55 burn unit directors (47% response rate). Burn units are lead most commonly by physicians who received GS training (69%), but the majority either did not undergo fellowship training (31%) or completed a burn surgery fellowship (29%). While surgical care (GS = 51%, PS = 42%) and wound care (GS = 51%, PS = 42%) were predominantly managed by GS- or PS-trained burn teams, management of other aspects of burn care varied depending on the institution, demonstrating that a shift in burn care management. The desired hiring characteristics, including GS (67%) or PS residency (44%) and a burn surgery (55%), trauma surgery (15%), or critical care (44%) fellowship. Directors’ training significantly influenced their preferences for hiring requirements. While leadership in burn surgery is dominated by GS-trained physicians, the surgical and wound care responsibilities are shared among PS and GS. Although one third of current directors did not undergo fellowship training, aspiring surgeons are advised to obtain a burn surgery and/or critical care fellowship.

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Racial and Ethnic Disparities Among Burn Surgery Leadership

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa026 ◽

2020 ◽

Vol 41 (3) ◽

pp. 714-721 ◽

Cited By ~ 2

Author(s):

Caroline E Kettering ◽

Francesco M Egro ◽

Anisha Konanur ◽

Brandon T Smith ◽

Alain C Corcos ◽

...

Keyword(s):

Minority Groups ◽

Minority Group ◽

Ethnic Disparities ◽

The United States ◽

Academic Rank ◽

H Index ◽

Burn Care ◽

Burn Center ◽

Major Burn ◽

Burn Surgery

Abstract The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P < .01), graduated more recently (2003 vs 1996; P < .01), and had a lower h-index (9.5 vs 17.4; P < .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.

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Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study

VASA ◽

10.1024/0301-1526/a000745 ◽

2019 ◽

Vol 48 (1) ◽

pp. 89-97

Author(s):

Karin Yeung ◽

Jonas Peter Eiberg ◽

Henrik Kehlet ◽

Eske Kvanner Aasvang

Keyword(s):

Lower Limb ◽

Severe Pain ◽

Observational Cohort Study ◽

Limb Ischaemia ◽

Post Anaesthesia Care Unit ◽

Lower Limb Ischaemia ◽

Acute Complications ◽

Observational Cohort ◽

Anaesthesia Care ◽

Pacu Stay

Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.

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Orexin receptor antagonists reverse aberrant dopamine neuron activity and related behaviors in a rodent model of stress-induced psychosis

Translational Psychiatry ◽

10.1038/s41398-021-01235-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hannah B. Elam ◽

Stephanie M. Perez ◽

Jennifer J. Donegan ◽

Daniel J. Lodge

Keyword(s):

United States ◽

Sensorimotor Gating ◽

The United States ◽

Dopamine Neuron ◽

Neuron Activity ◽

Sprague Dawley ◽

Post Traumatic Stress ◽

Neuron Population ◽

Population Activity ◽

Novel Approach

AbstractPost-traumatic stress disorder (PTSD) is a prevalent condition affecting approximately 8% of the United States population and 20% of United States combat veterans. In addition to core symptoms of the disorder, up to 64% of individuals diagnosed with PTSD experience comorbid psychosis. Previous research has demonstrated a positive correlation between symptoms of psychosis and increases in dopamine transmission. We have recently demonstrated projections from the paraventricular nucleus of the thalamus (PVT) to the nucleus accumbens (NAc) can regulate dopamine neuron activity in the ventral tegmental area (VTA). Specifically, inactivation of the PVT leads to a reversal of aberrant dopamine system function and psychosis-like behavior. The PVT receives dense innervation from orexin containing neurons, therefore, targeting orexin receptors may be a novel approach to restore dopamine neuron activity and alleviate PTSD-associated psychosis. In this study, we induced stress-related pathophysiology in male Sprague Dawley rats using an inescapable foot-shock procedure. We observed a significant increase in VTA dopamine neuron population activity, deficits in sensorimotor gating, and hyperresponsivity to psychomotor stimulants. Administration of selective orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R) antagonists (SB334867 and EMPA, respectively) or the FDA-approved, dual-orexin receptor antagonist, Suvorexant, were found to reverse stress-induced increases in dopamine neuron population activity. However, only Suvorexant and SB334867 were able to reverse deficits in behavioral corelates of psychosis. These results suggest that the orexin system may be a novel pharmacological target for the treatment of comorbid psychosis related to PTSD.

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641 North American Practices for Facial Massage and Stretching Post Facial Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.291 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S176-S177

Author(s):

Alexa Barwick ◽

Dana Y Nakamura ◽

James H Holmes ◽

Joseph Molnar

Keyword(s):

North American ◽

Service Providers ◽

Multiple Choice ◽

Scar Tissue ◽

The United States ◽

Burn Care ◽

Speech Language Pathologist ◽

Specific Protocol ◽

Facial Burns ◽

Therapy Interventions

Abstract Introduction Facial burns can be complicated by the development of scar tissue and contractures, resulting in decreased flexibility of the tissue involved in swallowing, facial expression, and verbal communication. Maximizing functional range of motion is an important preventative measure for improving functional outcomes for swallowing, communication, and for the prevention of microstomia. A range of therapy interventions including stretching, massage, compression, and use of appliances has been reported in the literature; however, there is limited to no information on current practice patterns amongst North American providers (MD, DO, PA, NP, etc.) or therapists (PT, OT, and SLP). Methods A RedCap survey was developed by a Speech-Language Pathologist and Occupational Therapist involved in burn care. The survey consisted of 18 total questions, with participants responding to between 12–13 questions due to branching logic. Questions were related to demographic and service provision related to facial massage and stretching. Survey questions were multiple choice, multiple answer multiple choice, or contained text boxes. The survey was distributed to Providers and Therapists from the United Stated of America and Canada who were members of the American Burn Association (ABA). Results A total of 69 surveys were collected, with 57 surveys meeting criteria for inclusion. Respondents consisted of therapists 68%, providers 23%, and other health professionals 9%. Forty-six ABA burn centers from across the United States and Canada were represented. The majority of respondents had over 10 years of experience working with burn patients. 91% of respondents reported that facial massage and stretching was used as a tool at their facility. Respondents, who report facial massage is utilized at their facility, report OT as being the primary discipline responsible for assessing (67%) and completing (65%) facial massage, with 85% reporting additional discipline(s) also participating in facial massage. 9% of respondents report that facial massage and stretching is not utilized at their facility following facial burns. Of those who responded that facial massage and stretching is not utilized following facial burns, 40% felt this would be beneficial to patients, while 60% were unsure. Conclusions Facial scar management is an important part of burn care, with the majority of respondents reporting completion of facial massage and stretching as part of the services provided to patients who have suffered facial burns. OTs are the primary service providers for facial massage and stretching post facial burn. Practices for facial massage varies greatly, with the majority of respondents reporting no specific protocol for facial massage and stretching is followed.

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304 The relationship between basic personality, subjective sleep duration, and psychological distress during a military deployment

SLEEP ◽

10.1093/sleep/zsab072.303 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A121-A121

Author(s):

Walter Sowden ◽

Alexxa Bessey ◽

Julie Merrill ◽

Ashlee Mckeon ◽

Jake Choynowski ◽

...

Keyword(s):

Psychological Distress ◽

Personality Traits ◽

Sleep Duration ◽

Big Five ◽

Military Personnel ◽

The United States ◽

Post Traumatic Stress ◽

Medicine Research ◽

Subjective Sleep ◽

The Relationship

Abstract Introduction Extended, overseas operations (deployments) increase the likelihood that military personnel will experience psychological distress. Reduced sleep during deployments is a key correlate of psychological distress. Thus, it is imperative to identify mechanisms that adaptively modulate the relationship between insufficient sleep and psychological distress. Research has recently connected basic personality traits (i.e., the Big Five: extraversion, agreeableness, conscientiousness, neuroticism, and openness) to more sleep. The current project aimed to examine the relationship between basic personality traits, subjective sleep duration (SSD), and psychological distress during an operational deployment. Methods 488 soldiers took surveys both prior to and half-way through a nine-month deployment. The pre-deployment survey included the Big Five Index, and three standardized measures of psychological distress commonly used to screen military personnel for anxiety (Generalized Anxiety Disorder; GAD-7), depression (Patient Health Questionnaire; PHQ-8), and post-traumatic stress (Posttraumatic Symptom Disorder Checklist; PCL-4). The mid-deployment survey included an item from the Pittsburgh Sleep Quality Index measuring SSD and the same psychological distress measures from the pre-deployment survey. General linear models were used to test the interaction between SSD and each basic personality trait on each measure of psychological distress at mid-deployment while accounting for psychological distress at pre-deployment. Results Of the Big Five, conscientiousness was the only trait to significantly moderate the relationship between SSD and anxiety, t = 2.11, p = .035, where higher conscientiousness weakened the relationship. Further only agreeableness attenuated the relationship between depression and SSD, t = 2.10, p = .036. Interestingly, the only Big Five trait that moderated the relationship between SSD and PTS was openness, insomuch that openness strengthened the relationship, t = -1.92, p = .055. Conclusion The relationship between SSD and psychological distress was uniquely impacted by different personality traits. These results reinforce the age-old concept that behavior is the product of a complex, nuanced, and puzzling interaction between the individual and the environment. The current research motivates further research into personality as an adaptive mechanism for optimizing military wellbeing. Support (if any) Support for this study came from the Military Operational Medicine Research Program (MOMRP) of the United States Army Medical Research and Development Command (USAMRDC).

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Association Between Intimate Partner Violence Subtypes and Post-traumatic Stress Disorder Symptoms and Hazardous Substance Use

Journal of Interpersonal Violence ◽

10.1177/08862605211021963 ◽

2021 ◽

pp. 088626052110219

Author(s):

Matthew M. Yalch ◽

Sloane R. M. Rickman

Keyword(s):

Substance Use ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Partner Violence ◽

The United States ◽

Cumulative Effects ◽

Hazardous Substance ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Intimate partner violence (IPV) is a common problem for women in the United States and is associated with symptoms of post-traumatic stress disorder (PTSD) as well as hazardous use of substances like alcohol and drugs. However, not all subtypes of IPV (i.e., physical, sexual, and psychological) are equally predictive of PTSD and hazardous substance use. Although previous research suggests that psychological IPV has the strongest relative effect on PTSD symptoms and substance use, there is less research on IPV subtypes’ cumulative effects. In this study, we examined the relative and cumulative effects of physical, sexual, and psychological IPV on PTSD symptoms and hazardous substance use in a sample of women in the United States recruited via Amazon’s Mechanical Turk ( N = 793) using bootstrapped multiple regression and configural frequency analyses. Results suggest that physical IPV had the most pronounced influence (medium-large effect sizes) on substance use across women, but that the cumulative effects of all three IPV subtypes were most closely associated with diagnostic levels of both PTSD and substance use at the level of groups of women. These findings clarify and extend previous research on the differential effects of IPV subtypes and provide directions for future research and clinical intervention.

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