Difference between revisions of "OHSU Research Ideas"
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| − | * | + | https://www.mediawiki.org/wiki/Extension:CollapsibleSections |
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| − | * Does change in PPV/CO after SCD activation predict fluid responsiveness and how does it compare to SLR? | + | =Ideas= |
| + | |||
| + | ==QI== | ||
| + | * What is the optimal number of evals for residents and attending to fill out? Would having fewer result in higher quality? How often do residents and attendings look at their medhub evals? Does anyone find them useful? If they are not useful, lets stop doing them, or tweak it (to be less frequent) | ||
| + | * Having anesthesia residents/attendings assigned some complex cases 1 month in advance and then have them do the pre-anesthetic eval and interim optimization for that patient. Perhaps even a post-op follow-up call or visit. | ||
| + | * [[Low-flow anesthesia]] real-time decision support built into EPIC (or laminated card reminder placed on workstations). See Baby Miller pg. 877. | ||
| + | * Is there anyway to educate providers on how (or if) anesthetic management decisions affect the bill the patient sees? | ||
| + | * Recycling and waste sortage in the OR. Also, getting rid of ProVu! | ||
| + | |||
| + | ==Good== | ||
| + | * [[SCD Fluid Bolus|Does change in PPV/CO after SCD activation predict fluid responsiveness and how does it compare to SLR?]] | ||
| + | * Alpha band dropout and gamma band increase as [[Objective Measurement of Pain|objective measurement of pain]]. | ||
| + | * Does sugammadex interfere with HRT in post-menopausal and/or lactating women? (0 articles mentioning both Sugammadex and Menopause) | ||
* EEG/MEP/SSEP patterns in monkeys/humans taking THC vs controls | * EEG/MEP/SSEP patterns in monkeys/humans taking THC vs controls | ||
| − | * | + | * Buprenorphine for induction or acute pain treatment in perioperative setting |
| + | * Surgical TAP block vs US guided | ||
| + | * [[Choice of anesthetic for cancer resection]]. Is TIVA superior to inhaled anesthesia for recurrence free survival in cancer surgery? | ||
| + | * [[Xenon recycling]] (7 relevant papers) | ||
| + | * Yohimbine for precedex reversal | ||
| + | * [[Estimating VO2|Can the difference between FiO2 and ETO2 be used to estimate VO2?]] | ||
| + | * Does normocytic hemodilution reduce RBC transfusion? | ||
| + | * What do we know about the very low frequency EEG power bands? i.e. the stuff that is less than 0.2 Hz and is usually filtered out. Analogous to looking at the tides when everyone else is looking at the waves. | ||
| + | * [[Young blood transfusions]] | ||
| + | * Why does albumin not stay intravascular? Why can't you replete hypoalbuminemia via TPN? | ||
| + | |||
| + | ==Very Ambitious, But Still Cool== | ||
* NIBP monitoring from head/neck | * NIBP monitoring from head/neck | ||
| + | * Can you [[Bohr Effect Modulation|modulate the strength of the Bohr effect]]? | ||
* Better way of determining fluid status | * Better way of determining fluid status | ||
| + | * Novel reversal agents (e.g. volatile anesthetics, propofol, precedex) | ||
| + | * Permanently inhibit a nerve to prevent phantom pain after amputation. | ||
| + | * Reversible chemical/optical/electromagnetic knockdown/inhibition/interference of pain nuclei/DRG/dorsal column/STT activity in rodents/primates. https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejp.1136 | ||
| + | * Fentanyl patch instead of remifentanil infusion? What other anesthetics could you deliver via patch? Could you do a patch induction for Peds? There is no remifentanil or sufentanil patch. | ||
| + | * What is the MoA of APAP? | ||
| + | * [[Transfusion thresholds]] | ||
| + | |||
| + | ==Already Done== | ||
| + | * Wearable clinical alarms (2 relevant results, 1 highly relevant result) | ||
| + | * VR for IV placement peds (6 articles spanning 2020-2022, 5 RCTs, and a systematic-review and meta-analysis) | ||
| + | * Does precedex really delay emergence? ([https://journals.lww.com/anesthesia-analgesia/fulltext/2022/06000/the_effect_of_dexmedetomidine_on_postanesthesia.17.aspx 2022 Anesthesia and Analgesia Systematic Review and Meta-Analysis] says "NO"). | ||
| + | |||
| + | ==Not Super Exciting/Impactful== | ||
| + | * Which findings on the preop note predict pressors use during the case? | ||
* EPIC timeline builder | * EPIC timeline builder | ||
| + | * Does setting realistic pain expectations in pre-op decrease self-reported pain scores in PACU? | ||
| + | * Ultrasound vs blind A-line first attempt success rate and complications? | ||
| + | * [[Epidural Effect on Gastric Emptying|How do epidurals affect gastric emptying?]] | ||
=Resources= | =Resources= | ||
| Line 18: | Line 59: | ||
* Dale Hodges | * Dale Hodges | ||
* Liz Moss | * Liz Moss | ||
| − | + | * Jeff Davis | |
| − | + | * Brandon Togioka | |
| − | * | ||
| − | * | ||
Latest revision as of 14:54, 2 October 2024
https://www.mediawiki.org/wiki/Extension:CollapsibleSections
Ideas
QI
- What is the optimal number of evals for residents and attending to fill out? Would having fewer result in higher quality? How often do residents and attendings look at their medhub evals? Does anyone find them useful? If they are not useful, lets stop doing them, or tweak it (to be less frequent)
- Having anesthesia residents/attendings assigned some complex cases 1 month in advance and then have them do the pre-anesthetic eval and interim optimization for that patient. Perhaps even a post-op follow-up call or visit.
- Low-flow anesthesia real-time decision support built into EPIC (or laminated card reminder placed on workstations). See Baby Miller pg. 877.
- Is there anyway to educate providers on how (or if) anesthetic management decisions affect the bill the patient sees?
- Recycling and waste sortage in the OR. Also, getting rid of ProVu!
Good
- Does change in PPV/CO after SCD activation predict fluid responsiveness and how does it compare to SLR?
- Alpha band dropout and gamma band increase as objective measurement of pain.
- Does sugammadex interfere with HRT in post-menopausal and/or lactating women? (0 articles mentioning both Sugammadex and Menopause)
- EEG/MEP/SSEP patterns in monkeys/humans taking THC vs controls
- Buprenorphine for induction or acute pain treatment in perioperative setting
- Surgical TAP block vs US guided
- Choice of anesthetic for cancer resection. Is TIVA superior to inhaled anesthesia for recurrence free survival in cancer surgery?
- Xenon recycling (7 relevant papers)
- Yohimbine for precedex reversal
- Can the difference between FiO2 and ETO2 be used to estimate VO2?
- Does normocytic hemodilution reduce RBC transfusion?
- What do we know about the very low frequency EEG power bands? i.e. the stuff that is less than 0.2 Hz and is usually filtered out. Analogous to looking at the tides when everyone else is looking at the waves.
- Young blood transfusions
- Why does albumin not stay intravascular? Why can't you replete hypoalbuminemia via TPN?
Very Ambitious, But Still Cool
- NIBP monitoring from head/neck
- Can you modulate the strength of the Bohr effect?
- Better way of determining fluid status
- Novel reversal agents (e.g. volatile anesthetics, propofol, precedex)
- Permanently inhibit a nerve to prevent phantom pain after amputation.
- Reversible chemical/optical/electromagnetic knockdown/inhibition/interference of pain nuclei/DRG/dorsal column/STT activity in rodents/primates. https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejp.1136
- Fentanyl patch instead of remifentanil infusion? What other anesthetics could you deliver via patch? Could you do a patch induction for Peds? There is no remifentanil or sufentanil patch.
- What is the MoA of APAP?
- Transfusion thresholds
Already Done
- Wearable clinical alarms (2 relevant results, 1 highly relevant result)
- VR for IV placement peds (6 articles spanning 2020-2022, 5 RCTs, and a systematic-review and meta-analysis)
- Does precedex really delay emergence? (2022 Anesthesia and Analgesia Systematic Review and Meta-Analysis says "NO").
Not Super Exciting/Impactful
- Which findings on the preop note predict pressors use during the case?
- EPIC timeline builder
- Does setting realistic pain expectations in pre-op decrease self-reported pain scores in PACU?
- Ultrasound vs blind A-line first attempt success rate and complications?
- How do epidurals affect gastric emptying?
Resources
- Schnell lab
- Leimer/Lo lab (THC, NHPs)
- Saugstad lab (EVs)
- Schennings (Gas vs. TIVA risk of post-op delirium, assessed via CAM)
- Schulman (interrogate ICDs for EMI after surgery)
- Austin Peters
- Selva Balkan
- Dale Hodges
- Liz Moss
- Jeff Davis
- Brandon Togioka