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The role of the anesthesiologist in tips and tips revision
10-77 O u t c o m e s Analysis of Patients Undergoing Mesenteric Arteriography for I s c h e m i c Bowel Disease George J. Ferrone, MD, Albany Medical Center, Albany, N Y Gary P. Siskind, MD, Brian F. Stainken, MD, Kyran Dowling, MD, Allen M. Herr, MD P u r p o s e : To study the surgical outcomes of patients undergoing mesenteric arteriography for suspected mesenteric isehemia. M a t e r i a l s a n d M e t h o d s : A retrospective analysis of 61 patients w h o u n d e r w e n t mesenteric arteriography for suspected ischemic bowel disease over a 5 year period was performed. Angiographic findings were correlated with presenting clinical history and surgical outcomes. Results: A significant stenosis or embolic disease in either the celiac axis or superior mesenteric artery was found in 29 patients (47.5%). A smoking history (p--O.O03), nausea/vomiting (p=0.01), and diarrhea (p=O.05) were m o r e prevalent in patients with positive arteriograms. 24 of 29 patients (82.8%) with positive arteriograms proceeded to surgery; 50% of those patients had ischemic, nonviable bowel requiring resection. 10 of 32 patients (31.3%) with negative arteriograms were surgically explored; 20% of these patients had ischemic bowel. Odds ratio results indicate that patients with positive arteriograms were 4.0X more likely to have ischemic bowel at surgery than patients with negative arteriograms. C o n c l u s i o n : Patients with a significant stenosis in at least one mesenteric artery are 4.0X m o r e likely to manifest ischemic bowel reqttifing resection at surgery, stressing the importance of diagnostic arteriography in patients suspected of mesenteric ischemia. These findings challenge the belief that single vessel disease is not typically associated with ischemic bowel and raises the need for future studies concerning the role of percutaneous revascularization in patients with single-vessel occlusive disease. L e a r n i n g Objectives: 1.To understand w h i c h factors in a patient's history are related to positive findings on mesententeric arteriography. 2.To determine the relationship b e t w e e n findings on mesenteric arteriography and the presence of ischemic, nonviable bowel at surgery.
10-78 T h e Role of t h e A n e s t h e s i o l o g i s t in Tips a n d Tips Revision Kristin S. Carano, MD, Beth Israel Medical Center, New York, N Y James E. Silberzweig, MD, Merceditas Lagmay, MD, Harold A. Mitty, MD P u r p o s e : TIPS procedures can be painful and; lengthy and are often performed in uncooperative and hemodynamically trustable patients. The p u r p o s e of this study is to identify the contributions of the anesthesiologist to the performance of TIPS and TIPS revision. M a t e r i a l s a n d M e t h o d s : During a 36-month period, general endotracheal anesthesia (GETA) was administered for 47 TIPS and 9 TIPS revisions and monitored anesthesia care (MAC) was administered for 7 TIPS and 3 TIPS revisions. Nineteen emergent and 47 elective procedures were performed. The ASA class, type of anesthesia, episodes of hypotension, episodes of oxygen desaturation, fluid and blood product administration, and anesthesia-related complications were retrospectively reviewed. Results: Patients were categorized as ASA class 3 or 4 (80%) and class 4E or 5E (20%). Thirty-three patients (50%) required blood product administration and/or 31000 ml IV crystalloid administration during the procedure. No hypotensive episodes or anesthesia-related complications occurred during the procedures. One elective TIPS procedure was converted, without complication, from MAC to GETA due to oxygen desaturation shortly after initial administration of intravenous sedation. C o n c l u s i o n s : The anesthesiologist plays an important role in the monitoring and resuscitation of patients w h o undergo TIPS and TIPS revisions.
10-79 Imagery Content during N o n p h a r m a c o l o g i c A n a l g e s i a in t h e Procedure Suite: W h e r e Your Patients Would R a t h e r Be Lauri J. Fick, BS, University o f Iowa Hospitals & Clinics, Iowa City, /A, Eric Benotsch, BS, John M. Tentinger, Elvira V. Lang, MD P u r p o s e : To elucidate scenarios of patients' relaxation preferences during invasive procedures M e t h o d s : Two medical students and one psychology student were trained with class room exercises and teaching materials developed for a curriculum in nonpharmacologic analgesia. They guided 68 patients t h r o u g h arteriography or n e p h r o s t o m y with a self-hypnotic imagery process that was s h o w n in a concurrent prospective randomized pilot study (I1=52) to significantly decrease anxiety, and drug use as compared to the standard of care and an attention control. Scenarios of the patients' imagery of choice were recorded. Results: Thirty patients (44%) chose scenes in nature s u c h as beaches, mountains, or fields of grain. Sixteen patients (24%) elected personal skills and hobbies (e.g. w o o d working, canning vegetables, playing dominoes); 6 patients (9%) spent time with their families. Three patients (4%) elected religious scenarios (e.g. sitting with Jesus, visiting a church). Thirteen (19%) chose a variety of settings including dog racing, smoking with Jerry Garcia during a Grateful Dead concert, floating over the angiography table). Procedure stimuli were easily integrated into the imagery context. Threatening scenarios were rare and were converted to scenarios with emotionally acceptable content. C o n c l u s i o n : W h e n guided appropriately patients can experience comforting scenarios during invasive procedures. (Supported by NIMH/OAM RO1 56274.) L e a r n i n g Objectives: 1.To provide insights into biobehavioral methods of nonpharmacologic analgesia in the radiology department 2. To familiarize the audience with scenarios of imagery 3. To provide guidance for structure of a nonpharmacologi c analgesia process
11-80 T h e Radiology-Pathology Corpse.-A N e w Approach to Sophomore Medical S t u d e n t T e a c h i n g J o h n C. Holder, MD, University o f Arkansas f o r Medical Science, Little Rock, AR, Devon L. Holder, C. Barry Buckner, MD P u r p o s e : The traditional m e t h o d for teaching s o p h o m o r e medical students has been the lectures multiple senior faculty. This is not ideal for teaching problem-solving approaches. The response of the Department of Radiology has been the CORPSE (Clinically Oriented Problem Solving Exercise). M e t h o d : Each CORPSE presents one subject and reflects the role radiology plays in differential diagnosis. Cases s h o w n are clear-cut diagnostic examples. Students received a key for each CORPSE that includes one case history and open-ended questions. They review four radiographs (CT scans, MR images, angiograms, etc.) prior to each session and match t h e m to the appropriate history. A CORPSE is simultaneously presented in small informal student groups by faculty m e m b e r s or senior residents using a standardized faculty key, showing twenty-five 3 5 m m slides, and encouraging student interaction. Results: Four lectures and four CORPSE sessions were given. Student evaluations s h o w e d preference for the CORPSE sessions as vehicles for imparting information. Exam performance for CORPSE material was equal to or greater than that for lectures. C o n c l u s i o n : The CORPSE approach of presenting a few detailed radiographic subjects is an excellent way to demonstrate diagnostic radiology in clinical medicine to s o p h o m o r e medical students. L e a r n i n g Objective: The objective of this presentation is to present a n e w approach to teaching medical students in small interactive groups using radiology~pathology correlations.
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10-78 T h e Role of t h e A n e s t h e s i o l o g i s t in Tips a n d Tips Revision Kristin S. Carano, MD, Beth Israel Medical Center, New York, N Y James E. Silberzweig, MD, Merceditas Lagmay, MD, Harold A. Mitty, MD P u r p o s e : TIPS procedures can be painful and; lengthy and are often performed in uncooperative and hemodynamically trustable patients. The p u r p o s e of this study is to identify the contributions of the anesthesiologist to the performance of TIPS and TIPS revision. M a t e r i a l s a n d M e t h o d s : During a 36-month period, general endotracheal anesthesia (GETA) was administered for 47 TIPS and 9 TIPS revisions and monitored anesthesia care (MAC) was administered for 7 TIPS and 3 TIPS revisions. Nineteen emergent and 47 elective procedures were performed. The ASA class, type of anesthesia, episodes of hypotension, episodes of oxygen desaturation, fluid and blood product administration, and anesthesia-related complications were retrospectively reviewed. Results: Patients were categorized as ASA class 3 or 4 (80%) and class 4E or 5E (20%). Thirty-three patients (50%) required blood product administration and/or 31000 ml IV crystalloid administration during the procedure. No hypotensive episodes or anesthesia-related complications occurred during the procedures. One elective TIPS procedure was converted, without complication, from MAC to GETA due to oxygen desaturation shortly after initial administration of intravenous sedation. C o n c l u s i o n s : The anesthesiologist plays an important role in the monitoring and resuscitation of patients w h o undergo TIPS and TIPS revisions.
10-79 Imagery Content during N o n p h a r m a c o l o g i c A n a l g e s i a in t h e Procedure Suite: W h e r e Your Patients Would R a t h e r Be Lauri J. Fick, BS, University o f Iowa Hospitals & Clinics, Iowa City, /A, Eric Benotsch, BS, John M. Tentinger, Elvira V. Lang, MD P u r p o s e : To elucidate scenarios of patients' relaxation preferences during invasive procedures M e t h o d s : Two medical students and one psychology student were trained with class room exercises and teaching materials developed for a curriculum in nonpharmacologic analgesia. They guided 68 patients t h r o u g h arteriography or n e p h r o s t o m y with a self-hypnotic imagery process that was s h o w n in a concurrent prospective randomized pilot study (I1=52) to significantly decrease anxiety, and drug use as compared to the standard of care and an attention control. Scenarios of the patients' imagery of choice were recorded. Results: Thirty patients (44%) chose scenes in nature s u c h as beaches, mountains, or fields of grain. Sixteen patients (24%) elected personal skills and hobbies (e.g. w o o d working, canning vegetables, playing dominoes); 6 patients (9%) spent time with their families. Three patients (4%) elected religious scenarios (e.g. sitting with Jesus, visiting a church). Thirteen (19%) chose a variety of settings including dog racing, smoking with Jerry Garcia during a Grateful Dead concert, floating over the angiography table). Procedure stimuli were easily integrated into the imagery context. Threatening scenarios were rare and were converted to scenarios with emotionally acceptable content. C o n c l u s i o n : W h e n guided appropriately patients can experience comforting scenarios during invasive procedures. (Supported by NIMH/OAM RO1 56274.) L e a r n i n g Objectives: 1.To provide insights into biobehavioral methods of nonpharmacologic analgesia in the radiology department 2. To familiarize the audience with scenarios of imagery 3. To provide guidance for structure of a nonpharmacologi c analgesia process
11-80 T h e Radiology-Pathology Corpse.-A N e w Approach to Sophomore Medical S t u d e n t T e a c h i n g J o h n C. Holder, MD, University o f Arkansas f o r Medical Science, Little Rock, AR, Devon L. Holder, C. Barry Buckner, MD P u r p o s e : The traditional m e t h o d for teaching s o p h o m o r e medical students has been the lectures multiple senior faculty. This is not ideal for teaching problem-solving approaches. The response of the Department of Radiology has been the CORPSE (Clinically Oriented Problem Solving Exercise). M e t h o d : Each CORPSE presents one subject and reflects the role radiology plays in differential diagnosis. Cases s h o w n are clear-cut diagnostic examples. Students received a key for each CORPSE that includes one case history and open-ended questions. They review four radiographs (CT scans, MR images, angiograms, etc.) prior to each session and match t h e m to the appropriate history. A CORPSE is simultaneously presented in small informal student groups by faculty m e m b e r s or senior residents using a standardized faculty key, showing twenty-five 3 5 m m slides, and encouraging student interaction. Results: Four lectures and four CORPSE sessions were given. Student evaluations s h o w e d preference for the CORPSE sessions as vehicles for imparting information. Exam performance for CORPSE material was equal to or greater than that for lectures. C o n c l u s i o n : The CORPSE approach of presenting a few detailed radiographic subjects is an excellent way to demonstrate diagnostic radiology in clinical medicine to s o p h o m o r e medical students. L e a r n i n g Objective: The objective of this presentation is to present a n e w approach to teaching medical students in small interactive groups using radiology~pathology correlations.
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