SleepTalker November 2021

Volume 36 Number 5 Stony Brook, NY  <       November 2021       > 
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Holiday Party STARS Match Day 2021 Dr. Xiaojun Guo Promoted
ASA 2021 Peek Behind the Pub Welcome Dr. Giuca John Fallon Retires
CRNA News Anesthesia Interest Groups It's A Girl! Why Anesthesiology?
New Publications Photography Corner Where on Campus is That? Monthly Muscle Chillaxant
Holiday Party

STARS: STaff Appreciation and Recognition

Marc A. Peluso, MS, CRNA

   I wanted to recognize members of our anesthesia team, specifically Drs. Meng Wang, Eric Zabirowicz, Jeremy Poppers, and Michael Hafeman. They were all instrumental in providing care for a special needs patient and their efforts resulted in a calm and comfortable environment for the patient and family as well as a controlled and safe induction and intubation. The teamwork was so seamless and natural that it wasn't even noticed until reflected upon afterwards. It's the small things that sometimes go unnoticed that can make all the difference and served as a reminder that the best thing about Stony Brook are the people we have here.

A patient wrote about the care she received.

   Dr. Eman Nada supervised the placement of the nerve block for my knee surgery. She was very thorough and clear and an overall excellent teacher for the resident, Dr. Patrick Diamond. The nerve block expedited my recovery. Patrick explained the nerve block thoroughly and performed it expertly. I was so happy that the nerve block worked and my pain was well managed with it. The nerve block's pain relief allowed me to set out and ambulate quickly and leave the hospital faster and more comfortable than my last knee surgery. Dr. Diamond and medical student Rachel Kim visited me post-op to check on me!
Match Day 2021

Congratulations to the CA3 Residents who have matched for Fellowships!
- Saamia Alam, Cardiac Anesthesiology Fellowship, Montefiore Medical Center
- Lucas Bracero, Pain Fellowship, Cornell
- Carlos Figueroa, Pediatric Anesthesiology Fellowship, Hofstra
- Ramanjot Kang, Pain Fellowship, Cornell
- Ishu Kant, Pain Fellowship, Mt Sinai West
- Benjamin Kim, Pain Fellowship, Mt Sinai
- Ashley Mathew, Pediatric Anesthesiology Fellowship, DC Childrens
- Karim Shuaib, Obstetric Anesthesiology Fellowship, Columbia Presbyterian
Dr. Xiaojun Guo Promoted

James P. Dilger, PhD

  Dr. Xiaojun Guo was promoted to Clinical Associate Professor of Anesthesiology. He has been a member of our faculty since August 2000. Congratulations!

  Dr. Guo received his medical training at Peking Union Medical College, Beijing, China. He then came to the US to do postdoctoral training at Mt. Sinai and Cornell in NYC, After an internship at New York Flushing Hospital, Dr. Guo did his anesthesiology residency at Columbia Presbyterian Hospital and Montefiore Medical Center. He then arrived at our department.

  Dr. Guo has provided anesthesia care to patients in a variety of divisions including general, neuro, ENT, pediatric, ortho, cardiac, vascular and psychiatric procedure, and in the AICU. He established Stony Brook's acupuncture clinic in 2012 where he teaches acupuncture to anesthesia residents, provides acupuncture care, and does research on acupuncture. He is co-Pi with Dr. Bennett-Guerrero on the project "Randomized controlled pragmatic trial of Acupressure on PONV".

  During his postdoctoral training, he did research on Tyrosine Phosphatase Gamma, Familial Adenomatous Polyposis, and X-Linked Sideroblastic Anemia. He has seven peer-reviewed publications and one book chapter. Again, congratulations Dr. Guo!
ASA Meeting 2021

   Here is an updated list of departmental presentations at the 2021 Annual Meeting. The photo gallery can be viewed here.

Jin Z, Daksla N, Schabel JE, Gan TJ. Efficacy Of Nk-1 And 5-ht 3 Antagonist Combination For Ponv Prophylaxis, A Systematic Review And Meta-analysis
• Freedenberg A, Pan C-H, Hearing J, Romeiser J, Bennett-Guerrero E. Comparison of Neutralizing Capacity of Plaque Reduction Assay to Novel Pseudovirus Assay for SARS-CoV-2
Nada E, Rajpal G, Chan AW, Kadiyala M, Emmerick I, Maxfie M. Comparison of Ultrasound Guided Versus Thoracoscopic Guided Intercostal Nerve Block with Liposomal Bupivacaine for Minimally Invasive Thoracic Surgery: A Pilot Study
Nada E, Chepanoske M, Mallari O, Alper E, Heard SO. Association Between Previous Cervical Spine Fusion And Failed First Attempt Of Intubation: A Retrospective Chart Review
Qureshi F, Abola R, Shah S. Review of Hospital Admissions Emergency Department Visits after Surgery at Stony Brook Ambulatory Surgery Care Center.
Qureshi F, Abola R. Peri-induction Cardiac Arrest Review.
Kang RS, Bracero LA, Figueroa C, Shuaib K, Watson E, Xiao A, Gidicsin C, Romeiser J, Costa AC, Bennett-Guerrero E. AIRWAY: Improving Preparation for Floor Intubations.
Mitchell D, Pasillao J, Siddique U, Shuminov R, Taft A, Ma S, Miles J, Costa A, Romeiser J, Azim S. Impact of Patient Education on Satisfaction, Anxiety, and Knowledge in Patients Undergoing Adductor Canal Blocks.

Medically Challenging Cases
Figueroa C, Bracero L, Jacob Z. Quick Recognition And Management of Tension Pneumothorax In A Neonate With Trisomy 18 Under General Anesthesia.
Kang RS, Kim Y, Tateosian V. Perioperative Management of a Patient with Heterotaxy Syndrome.
Kang RS, Nguyen CP, Bennici LA. Perioperative Management Of Autoimmune Polyglandular Syndrome Type 1.
Kang RS, Taft A, Wu D, Gupta AK. Airway Management Of A Patient With Zonisamide Induced Toxic Epidermal Necrolysis.
Kant I, Poovathoor S. Massive Transfusion Protocol in Ruptured Spleen.
Kim B, Xiao A, Jiang Y, Caldwell WM. Fluoroscopic Guided Aspiration And Caudal Epidural For Treatment Of Symptomatic Tarlov Cyst.
Kozlowski P, Christophides AH, Izrailtyan I. To Sedate Or Intubate? A Case Report Highlighting The Anesthetic Management Of Cardiac Tamponade.
Kozlowski P, Gupta AK. Superior Hypogastric Plexus Block For Chronic Bladder Pain: Two Case Studies.
Kozlowski P, Gupta AK. Myofascial Pain After Covid-19 Vaccination And After Recovery From Covid-19: A Case Series.
Mathew A, Christophides AH, Balaguer JM, Izrailtyan I. Bilateral Abnormal Ultrasound Allen Test: A Management Dilemma.
Mathew A, Christophides AH, Basishvili G, McLarty AJ, Gross ER, Fischl AM. Anesthetic Management of Patient with Anterior Mediastinal Mass.
Mathew A, Scott BH. Nutcracker Syndrome: A Case Report.
Mena S, Desai A. Pain Management in a Parturient on Suboxone with a Complex Right Hip Fracture.
Mena S, Gruttadauria M, Factor M, DeLemos M. Spinal Anesthesia in Suspected Brugada Syndrome.
Mena S, Ma S, Kaushal A. Persistent Hiccups after a Cervical Epidural Steroid Injection.
Mena S, Oleszak S. Airway Management with an Arteriovenous Malformation.
Parikh S, Alam S, Costa A, Angelo T. Anesthesia For Cesarean Section In A Parturient With Alagille Syndrome.
Scorsese G, Poppers J. Native Valve Infective Endocarditis Causing Intraoperative Acute Limb Ischemia.
Seiter C, Kim B, Zabirowicz E, Poppers J. Anesthetic Considerations And Alternatives For A Patient With Severe Hypertrophic Cardiomyopathy Presenting For Orthopedic Surgery.
Shafai A, Desai A. To decrease or continue high dose buprenorphine periop.
Shafai A, Kozlowski P, Kang RS, Oleszak SP. Development of Subglottic Stenosis Following Tracheostomy for COVID-19.
Turkiew E, Alam S, Schabel J. Peripartum Anesthetic Management Of A Patient With Glanzmanns Thrombasthenia.
Watson E, Costa A. Considerations for Endotracheal Intubation Management in COVID-19 Patients with Permissive Hypoxemia.
Watson E, Usama S, Moore R. Coordinated Tumor Manipulation and Ventilation in a Pediatric Endobronchial Lesion with Intermittent Airway Occlusion.
Xiao A, Tai J, Christophides A, Gavalas M, Price L, Sun E, Izrailtyan I. Do No Harm: Intraoperative Management Of An Unstable Patient Undergoing Multiple Procedures.
Zhu M, Jin Z, Gupta AK. Stellate Ganglion Block For Unstable Ventricular Tachycardia In Anticoagulated Patient.

Snap Talks
Richman D. Preoperative Optimization: Small Things You Can Do to Make a Big Difference: Advanced Directives
Richman D. New problems in Perioperative Medicine: Leadless pacemakers
Richman D. New problems in Perioperative Medicine: Wireless pulmonary artery hemodynamic monitors
Moore RP. Pediatric Enhanced Recovery Pathways: Lessons Learned and Tips for Successful Implementation.

Gan TJ. 2020 Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: What's New?
A Peek Behind the Publication

Syed Azim, MD

Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, Menio D, Ayad S, Stone T, Papp S, Schwenk ES, Elkassabany N, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes RA, Chin KJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Giska M, Ranganath Y, Tedore T, Choi S, Li J, Kwofie MK, Nader A, Sanders RD, Allen BFS, Vlassakov K, Kates S, Fleisher LA, Dattilo J, Tierney A, Stephens-Shields AJ, Ellenberg SS; REGAIN Investigators. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021 Oct 9

    There has been a long debate in the Anesthesia fraternity as to whether regional anesthesia (spinal) works better than general anesthesia for older patients with hip fractures. Many small studies using short term outcome measures have been performed, but the results have been inconclusive. In December 2015, I received a phone call from Mark Neuman, an anesthesiologist at the University of Pennsylvania. He had performed a five-year retrospective analysis looking adult patients with hip fractures. He concluded that the type of anesthesia was not associated with 30-day mortality. However, regional anesthesia was associated with a modestly shorter length of stay (JAMA. 2014 Jun 25;311(24):2508-17). This study did not consider the effect of anesthetic choice on the patient's ability to walk after surgery.

    After many rounds of discussion and study planning, I joined Dr. Neuman's multi-institutional team to conduct a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The goal in this study was very clear: consider the primary outcome as a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. The secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days.

   This was really a difficult study with long list of exclusions. Stony Brook, being a major trauma center, does perform many hip fracture surgeries. However, patients had to qualify for both type of anesthesia. Consenting was challenging because when given the choice, patients or family members often expressed a preference for one technique over the other and declined to be randomized! We identified 409 patients, out of which 69 patients were approached for consent and we were able to randomize 45 patients at Stony Brook. Overall, the multi-center project enrolled 1600 patients over 5 years.

   We concluded that spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia. I think the debate is over now as our finding of similar outcomes at 60 days with either technique suggests that anesthesia choices for hip-fracture surgery may be based on patient preference rather than on anticipated differences in clinical outcomes.

   This was long and challenging study generously funded by Patient-Centered Outcomes Research Institute, I was grateful to participate and to receive the support of our department. Moreover, I was fortunate to have wonderful group of trial coordinators including Sabeen Rizwan, and Darcy Halper, who helped me from the beginning through completion.

   Editor's note: This is the first paper affiliated with our department to be published in NEJM! Congratulations, Syed!
Welcome Dr. Giuca

Joy Schabel, MD

   Just passing along the wonderful news that Dr. Matthew Giuca has been named the new Chief of Anesthesiology at the VA Hospital in Northport. Dr. Giuca is a former Physician Assistant and Army Medical Officer who served with the 101st Airborne. He is replacing Dr. Liu who was serving as the Interim Chief after Dr. Barcelon’s retirement last winter.

   Dr. Giuca developed a profound appreciation for Northport when he was a medical student here 17 years ago. He considers it an honor to care for our veterans and to continue the longstanding tradition of education here at Northport. Dr. Giuca is also the Director of Pre-Admission Testing and will be utilizing his background in perioperative optimization to help improve the care and coordination of our veterans undergoing surgical procedures.

   Dr. Giuca is well known to the Stony Brook education community. He served as the WUH anesthesiology site director for Stony Brook School of Medicine for many years when WUH was affiliated with Stony Brook. He has guided and supported many students in their decision making to pursue anesthesiology (including our own Dr. Morgane Factor) and has won several Stony Brook Medicine teaching awards. Dr. Giuca completed his anesthesiology residency training at the Brigham and Women’s Hospital along with Drs. Angelo and Poppers. I am thrilled to have the opportunity to work with Dr. Giuca, and I am sure you all will too!

   Welcome Dr. Giuca!
John Fallon Retires

On October 25, we held a luncheon in honor of the retirement of John Fallon, CRNA. John has been associated with the department since 1980 and has been the driving force in developing an effective and thriving CRNA program. He and Rachel will remain on Long Island where they can enjoy their children and grandchildren. Best wishes, John!

Stony Brook Anesthesia CRNAs represent Stony Brook at the New York State Association of Nurse Anesthetist fall Educational Meeting: Advancing and Reuniting CRNAs in New York State

Joseph Gnolfo III, DNP, MS, ACNP, CRNA

   This year the NYSANA Fall Educational Meeting was held in Riverhead Long Island for the first time ever. The Fall Educational Meeting offers recruitment opportunity, lectures on topics relevant to anesthesia is today's complex environment, networking,, and socializing opportunities for CRNAs across the state. Our Stony Brook CRNAs represented the largest, non-student, group at the event. I would like acknowledge Dr. Gary Yam, DNP, CRNA and Mr. Elvin Aguliar, MS, CRNA for helping me to represent the SB Anesthesia Team at our booth and the CRNAs who attended, both in person or virtually, for their support and representation of our outstanding team of CRNAs here at SB!
Anesthesia Interest Groups and More!

   Ursula N. Landman, DO FAOCA

   The Stony Brook Anesthesia Interest Group met on Monday October 18. I gave an introductory talk about anesthesiology. I invited some osteopathic students from Kansas City to join us. The Kansas City COM is just forming an Anesthesiology Interest Group and I’m helping them get started. I gave the same talk for the NYIT-COM group on Tuesday October 5. In addition, residents Drs. Chris Seiter and Giacomo Scorcese conducted an airway workshop. The students in both groups are very enthusiastic and the meetings have been very well attended.

   We are pleased that TBR News Media ran an article about Stony Brook's Walk-with-a-Doc program.

   On October 23, I was an official mentor speaker at the virtual OMED (Osteopathic Medical Education Conference). OMS 3 and OMS 4 students met mentors from around the United States. It is always very rewarding to speak with the students and encourage them on their journey in anesthesiology. The absolute best part is later hearing about where they match to and subsequently where they end up practicing!
It's a Girl!

Jonathon Schwartz, MD

   My wife Rebecca and I finally welcomed our little girl Miriam into the world on 10/2/2021. We had a fantastic experience with all the teams caring for Miriam and her mom. Special shoutout to the OB anesthesia team for the fantastic epidural! She is now a proud member of the pro-epidural community without any persuasive efforts on my part.
Why Choose Anesthesiology?

Srinivas Pentyala, PhD

   The November issue of Anesthesiology, includes a "Letter to Medical Students from an Anesthesiologist". After reading the letter from Michale Sung-jin Ok, M.D., you might want to share your thoughts about your chosen field on social media.
New Publications

  • Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, Menio D, Ayad S, Stone T, Papp S, Schwenk ES, Elkassabany N, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes RA, Chin KJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Giska M, Ranganath Y, Tedore T, Choi S, Li J, Kwofie MK, Nader A, Sanders RD, Allen BFS, Vlassakov K, Kates S, Fleisher LA, Dattilo J, Tierney A, Stephens-Shields AJ, Ellenberg SS; REGAIN Investigators. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021 Oct 9
  • Guo L, Jin Z, Gan TJ, Wang E. Silent Hypoxemia in Patients with COVID-19 Pneumonia: A Review. Med Sci Monit. 2021 Oct 12;27
Photography Corner

James P. Dilger, PhD

Human Sundial at West Meadow Beach (far end of Trustees Road)
Where on Campus is That?

Deborah Richman, MBChB, FFA(SA)

The Simons Center is hosting M.C. Escher® : A Mini-Retrospective through Nov 19. Register here.

Monthly Muscle Chillaxant

   Stony Brook Fire Department Engine Co #1 hosted the Halloween Monster Dash 5k on Oct 30th. Several members of Stony Brook Medicine came together to support the fundraising efforts for the fire department. Stony Brook Anesthesiology’s own Adrian Fischl managed to get 2nd place overall while Chris Gidicsin and his fiancé Anjali Narayan (Psychiatry Fellow) won the costume contest. Adrian’s wife Jenn and their daughter Scarlett also participated in the run with the Rubano family. Rich Scriven, Pediatric Surgeon and firefighter, helped organize and support this wonderful event for the community.

  Way to go guys!

SleepTalker, the Stony Brook Anesthesiology Newsletter is published by the Department of Anesthesiology
Stony Brook Medicine, Stony Brook, NY
Tong Joo Gan, M.D., MHS, FRCA, MBA, Chairman
Editorial Board: James P. Dilger, Ph.D.; Stephen A. Vitkun, M.D., M.B.A., Ph.D.; Marisa Barone-Citrano, M.A.; Ramanjot S. Kang, M.D.