SleepTalker November 2021

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!

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!

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!

   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!

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.

James P. Dilger, PhD

   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!