The Invisible Force: Optimizing Novel Approaches in Anesthesiology and Infectious Diseases

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This work encompasses a theme revolving the OR: specifically, preoperatively, perioperatively, and postoperatively. Chapter 1 describes a novel method whereby biofilm is destroyed using Alternating Magnetic Fields (AMF). Using S. aureus grown on steel washers to simulate prosthetic joints, we were able to intermittently deliver 3s pulses for 15, 30, or 60 minutes to reduce bacterial load. Combined treatment with AMF and ceftriaxone (or linezolid) showed a 5-log decrease in bacterial load after 24 hours, whereas singular treatment with AMF or abx alone showed total regrowth or moderate decrease in bacterial load respectively. Chapter 2 describes a meta-analysis conducted to assess the safety and efficiency of sugammadex versus neostigmine as neuromuscular blockade (NMB) reversal agents. Neostigmine has been implemented in ORs for many years, but has disadvantages to using neostigmine including autonomic dysfunction like bradycardia and post-operative nausea & vomiting (PONV), and the necessity to administer the drug at the correct time due to its lag time in effect. Sugammadex appears to circumnavigate these problems, but the literature is still not definitive. We performed a meta-analysis that showed sugammadex as having a milder side effect profile compared to neostigmine with reduction in pneumonia (RR = 0.593, 95% CI (0.361, 0.671) and bradycardia (RR = 0. 535, 95% CI (0.424, 0.675), higher PONV risk (RR = 1.21, 95% CI (1.05, 1.39)), and with faster turnaround times. Chapter 3 describes a survey sent out to ambulatory surgical centers (ASC) on management of patients with obstructive sleep apnea (OSA). The need for a CPAP device in the immediate postoperative period at ambulatory surgical centers remains controversial because these ambulatory patients are healthier and have fewer complications. Only 59.7% of ASCs required their patients to bring their CPAP devices on the day of surgery, and 25.37% reported using a CPAP machine postoperatively within the past 2 years, with the highest CPAP usage at one facility being 20 times in that 2-year period. Studies further in-depth are necessary to assess postoperative complications that require a CPAP device to determine the urgency of ASCs implementing SAMBA's recommendations.

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