Utility of Point of Care Ultrasound to evaluate gastric contents in patients taking glucagon-like peptide 1 (GLP-1) agonists
Faculty Information
Name:
Dr. Meghan Brennan
Email
mbrennan@anest.ufl.edu
Phone
(352) 872-8017
Faculty Department/Division
Anesthesiology
This project is primarily:
Clinical
Research Project Description:
Aspiration of gastric contents during airway manipulation is a risk when
undergoing general anesthesia and is associated with significant morbidity and
mortality. Due to delayed gastric emptying and long half-lives associated with
GLP-1 agonists, it is hypothesized that patients taking GLP-1 agonists exhibit
increased gastric content volumes compared to age-matched control patients
after a minimum 8-hour fasting period for both groups, thereby increasing their
risk for aspiration. The goal of this project is to utilize point of care gastric ultrasounds
on participants taking a stable GLP-1 agonists following an 8-hour fasting period in both
the supine and right lateral decubitus positions at an outpatient family medicine
clinic and on matched control patients in the preoperative area.
Students working on this project will be trained in point of care gastric ultrasound and perform gastric ultrasounds in outpatient clinics and the preoperative area. They will be involved in patient identification, enrollment, abstract preparation, data analysis and potentially manuscript preparation. This is the second year of the project. They will spend time in both the outpatient and inpatient settings and work with attendings in family medicine and anesthesiology.
Does this project have an international component or travel?
No
Use of Prothrombin Complex Concentrate in Liver Transplant Surgery and Its Associated Perioperative Thrombotic Complications
Faculty Information
Name:
Dr. Asad Bashir
Email
asad.bashir@ufl.edu
Phone
(352) 265-0077
Faculty Department/Division
Anesthesiology
This project is primarily:
Clinical
Research Project Description:
Introduction:
Liver transplant patients have hemostatic changes that promote both thrombosis and bleeding. Decreased levels of ADAM-TS13, proteins C and S, antithrombin, α-2 macroglobulin, heparin factor II, plasminogen, and elevated levels of VWF along with FVIII are the main culprits that promote thrombosis in these patients. However, these patients can also be hypocoagulable. In advanced liver disease, the liver’s capacity to produce clotting factors (e.g., factors II, V, VII, IX, X, XI) decreases, leading to a predisposition to bleeding. Portal hypertension causes splenic sequestration of platelets, leading to thrombocytopenia. This is compounded by vitamin K deficiency, consumptive coagulopathy, hyperfibrinolysis due to impaired clearance of tissue plasminogen activator, and low antiplasmin levels. To address these deficits, Prothrombin Complex Concentrate (PCC) is administered during surgery to manage bleeding. However, the use of PCC in liver transplantation is a double-edged sword.
PCC contains the coagulation factors II, VII, IX, and X, as well as the natural coagulation inhibitors protein C and protein S. Its administration depends on blood loss, hemostatic disturbances, current coagulation requirements, and anesthesiologist and surgeon preference. While PCC effectively raises clotting factor levels, reducing the bleeding risks, its administration may overcorrect the coagulation profile, tipping the balance towards hypercoagulability. This can lead to severe thrombotic complications such as portal vein thrombosis (PVT), hepatic artery thrombosis (HAT), pulmonary embolism, and thrombosis of the inferior vena cava. Thrombotic events are associated with complications such as organ dysfunction, acute graft loss, and increased need for retransplantation, as well as leading to higher mortality rates. There is no universally accepted protocol for PCC dosing in liver transplantation, making it challenging to balance efficacy with safety. The appropriate dose may vary widely based on individual patient factors, such as MELD score and the extent of intraoperative bleeding.
Aim:
This study aims to investigate the relationship between PCC dosing and perioperative outcomes in liver transplant recipients, with a specific focus on thrombotic and bleeding complications. Key variables of interest will include the dose of PCC administered, the type of complications observed (thrombosis vs. bleeding), thrombus location, time to complication development, and the Model for End-Stage Liver Disease (MELD) score of patients prior to transplant.
Methods:
This retrospective cohort study with post hoc analysis will include all liver transplant surgeries performed at the University of Florida, Department of Anesthesiology, since the program’s inception to date. After IRB approval, de-identified patient data will be retrieved and analyzed. Data points will include demographic information, Model of End-stage Liver Disease (MELD) score, clinical parameters including CMV status, previous abdominal surgery, retransplantations, duration of surgery, length of ICU and hospital stay, previous myocardial infarction, coronary heart disease and its treatment, history of stroke, previous deep vein thrombosis, HAT, PVT, vena cava inferior thrombosis, PCC dosing, and perioperative outcomes will be collected from the electronic patient file and the transplant surgery database. Specific analyses will include:
-Characterization of PCC dosing and its variability across cases.
-Correlation of PCC doses with the occurrence of thrombotic and bleeding complications.
-Analysis of thrombus location and timing of complication onset.
-Exploration of relationships between MELD scores and complication rates.
-Standard statistical models, including logistic regression and time-to-event analysis, will be used to assess these relationships. Findings will help inform clinical practice by balancing the benefits of PCC administration against potential thrombotic risks.
Role of Medical Student:
-Conduct data collection from electronic medical records (EMR).
-Assist with the extraction and organization of relevant variables.
-Participate in scientific writing for manuscript development and conference presentations.
-Gain exposure to clinical research methodologies and statistical analysis techniques.
Does this project have an international component or travel?
No
If your project has an international component please give details (where, when, data collection involved, etc.):
n/a
Single-Institution Retrospective Analysis of Esophageal Varices Grading and Intraoperative Blood Loss Associated with Transesophageal Echocardiography in Liver Transplant Surgery
Faculty Information
Name:
Dr. Asad Bashir
Email
asad.bashir@ufl.edu
Phone
(352) 265-0077
Faculty Department/Division
Anesthesiology
This project is primarily:
Clinical
Research Project Description:
Introduction:
Esophageal varices are a common complication in patients undergoing liver transplantation due to portal hypertension and coagulopathy. Intraoperative transesophageal echocardiography (TEE) is a minimally invasive monitoring tool that can provide real-time visual information on cardiac function and hemodynamic stability in patients undergoing liver transplant surgery. However, TEE probe placement in patients with esophageal varices poses a risk of bleeding, which can contribute to significant intraoperative blood loss.
There continues to be a debate surrounding whether the presence of portal hypertension and varices is a relative or absolute contraindication to TEE. American Society of Anesthesiology guidelines cite equivocal opinions about the absolute or relative contraindication of esophageal varices to TEE due to insufficient evidence. However, current American Society of Echocardiography guidelines consider esophageal varices a relative contraindication for TEE.
Aim:
The aim of this study is to evaluate the relationship between the grade of esophageal varices, as classified by various grading systems (American Association for the Study of Liver Diseases Classification, Japanese Classification, Westaby Grading System, and Baveno VI Consensus), and documented intraoperative blood loss during liver transplantation with transesophageal echocardiography (TEE) probe placement. Additionally, the study seeks to identify TEE findings specific to each phase (pre-anhepatic, anhepatic, reperfusion, and neohepatic) in liver transplantation with the ultimate goal of optimizing perioperative management and improving surgical outcomes.
Methods:
This retrospective cohort study with post hoc analysis will analyze data from all liver transplant surgeries performed at the University of Florida, Department of Anesthesiology, since the program’s inception to date. After IRB approval, de-identified patient data will be retrieved and analyzed. Data points will include demographic information, underlying liver pathology, grade of esophageal varices based on imaging and endoscopic findings as classified by different grading systems, quantified blood loss with TEE probe placement, and Model of End-stage Liver Disease (MELD) score before transplantation. Other perioperative variables such as TEE findings in each phase of the transplant, duration of surgery, coagulation profiles, difficulty and timing of TEE probe placement, level of training held by individuals performing TEE, and transfusion requirements will also be studied. Data will be collected from the electronic patient file and the transplant surgery database. Specific analyses will include:
-Correlation between varices grades and intraoperative blood loss.
-Influence of demographic and clinical variables on blood loss.
-Relationship between MELD score and risk of bleeding.
-Standard statistical models using descriptive and inferential statistics will be used. Multivariable regression models will be used to evaluate the independent effect of varices grading on intraoperative blood loss and adjust for potential confounders.
Role of Medical Student:
-Conduct data collection from electronic medical records (EMR).
-Assist with the extraction and organization of relevant variables.
-Participate in scientific writing for manuscript development and conference presentations.
-Gain exposure to clinical research methodologies and statistical analysis techniques.
Does this project have an international component or travel?
No
If your project has an international component please give details (where, when, data collection involved, etc.):
n/a
Identifying Current Applications and Trends of the use of Artificial Intelligence in Healthcare
Faculty Information
Name:
Dr. Meghan/Everett Brennan/Jones
Email
mbrennan@anest.ufl.edu
Phone
(352) 273-6575
Faculty Department/Division
Anesthesiology
This project is primarily:
Translational
Research Project Description:
Applications of artificial intelligence (AI) are rapidly evolving in the healthcare industry. AI algorithms are being used to enhance diagnostic testing, optimize resource allocation, assist in medical education, and provide support to enhance operational efficiency. For example – AI algorithms used in medical imaging have shown significant promise in interpreting X-rays, MRIs, and CT scans potentially with greater accuracy than human physicians. AI is also being used to streamline administrative tasks in healthcare settings. AI-driven tools can automate scheduling, billing, and certain aspects of patient communication. AI-driven chat bots are being used in many healthcare systems across the country to assist patients with commonly asked questions or to help navigate their care. Given the rapidly evolving use of AI applications in healthcare our primary aim is to identify and categorize the applications of AI including diagnostic testing, predictive analytics, medical education, administrative support, and virtual healthcare that are currently in use. We additionally aim to evaluate the impact of these applications, examine potential ethical/legal/practical challenges to the use of AI applications in healthcare, and identify any geographic or other trends involving the use of AI applications in healthcare. Finally, we aim to explore future trends and gaps in the use of AI applications in healthcare.
The project will involve a systematic review of the current (in the last 5 years) peer-reviewed literature to categorize these applications of AI in healthcare by technology type, geographic area, and implementation outcomes if available. The medical student participating in this project will play an active role in all aspects of the research project, specifically, conducting literature searches across scientific databases, assist in extracting data from relevant literature, organizing information, and identifying areas requiring further investigation. They can expect to meet with project mentors to discuss relevant literature and refine their focus based on emerging articles, read and review relevant articles, extract and analyze data from these articles, assist in preparation of findings, assist in preparation of abstracts, papers, and presentations.
Does this project have an international component or travel?
No