Jay B. Brodsky

All Publications

• Caroline B. Palmer: Pioneer Physician Anesthetist and First Chair of Anesthesia at Stanford ANESTHESIA AND ANALGESIA Brodsky, J. B., Saidman, L. J. 2015; 121 (6): 1623-1626

  View details for DOI 10.1213/ANE.0000000000000995

  View details for Web of Science ID 000365499800006

• Con: A Bronchial Blocker Is Not a Substitute for a Double-Lumen Endobronchial Tube JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Brodsky, J. B. 2015; 29 (1): 237-239

  View details for DOI 10.1053/j.jvca.2014.07.027

  View details for Web of Science ID 000349426800035

  View details for PubMedID 25440656

• Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis PEERJ Kadry, B., Press, C. D., Alosh, H., Opper, I. M., Orsini, J., Popov, I. A., Brodsky, J. B., Macario, A. 2014; 2

  View details for DOI 10.7717/peerj.530

  View details for Web of Science ID 000347619100001

• Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis. PeerJ Kadry, B., Press, C. D., Alosh, H., Opper, I. M., Orsini, J., Popov, I. A., Brodsky, J. B., Macario, A. 2014; 2

  Abstract

  Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P < 0.001) for morbidly obese patients. At a BMI > 35 kg/m(2) each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  View details for DOI 10.7717/peerj.530

  View details for PubMedID 25210656

• The dose of succinylcholine in morbid obesity ANESTHESIA AND ANALGESIA Lemmens, H. J., Brodsky, J. B. 2006; 102 (2): 438-442

  Abstract

  The appropriate dose of succinylcholine (SCH) in morbidly obese patients is unknown. We studied 45 morbidly obese (body mass index >40 kg/m2) adults scheduled for gastric bypass surgery. The response to ulnar nerve stimulation of the adductor pollicis muscle at the wrist was recorded using the TOF-Watch SX acceleromyograph. In a randomized double-blind fashion, patients were assigned to one of three study groups. In Group I, patients received SCH 1 mg/kg ideal body weight, in Group II 1 mg/kg lean body weight, and in Group III 1 mg/kg total body weight. After SCH administration, endotracheal intubating conditions were scored. The recovery from neuromuscular block was recorded for 20 min. There was no difference in the onset time of maximum neuromuscular blockade among groups, but maximum block was significantly less in Group I. The recovery intervals were significantly shorter in Groups I and II. In one third of the patients in Group I, intubating conditions were rated poor, whereas no patient in Group III had poor intubating conditions. Our study demonstrates that for complete neuromuscular paralysis and predictable laryngoscopy conditions, SCH 1 mg/kg total body weight is recommended.

  View details for DOI 10.1213/01.ane.0000194876.00551.0e

  View details for Web of Science ID 000234912900022

  View details for PubMedID 16428539

• The evolution of thoracic anesthesia. Thoracic surgery clinics Brodsky, J. B. 2005; 15 (1): 1-10

  Abstract

  The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.

  View details for PubMedID 15707342

• Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions OBESITY SURGERY Collins, J. S., Lemmens, H. J., Brodsky, J. B., Brock-Utne, J. G., Levitan, R. M. 2004; 14 (9): 1171-1175

  Abstract

  The effect of patient position on the view obtained during laryngoscopy was investigated.60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained.The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037).The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.

  View details for Web of Science ID 000224972600005

  View details for PubMedID 15527629

• Left double-lumen tubes: Clinical experience with 1,170 patients JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Brodsky, J. B., Lemmens, H. J. 2003; 17 (3): 289-298

  View details for DOI 10.1016/S1053-0770(03)00046-6

  View details for Web of Science ID 000183865000002

  View details for PubMedID 12827573

• Morbid obesity and tracheal intubation ANESTHESIA AND ANALGESIA Brodsky, J. B., Lemmens, H. J., Brock-Utne, J. G., Vierra, M., Saidman, L. J. 2002; 94 (3): 732-736

  Abstract

  The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. We studied 100 morbidly obese patients (body mass index >40 kg/m(2)) to identify which factors complicate direct laryngoscopy and tracheal intubation. Preoperative measurements (height, weight, neck circumference, width of mouth opening, sternomental distance, and thyromental distance) and Mallampati score were recorded. The view during direct laryngoscopy was graded, and the number of attempts at tracheal intubation was recorded. Neither absolute obesity nor body mass index was associated with intubation difficulties. Large neck circumference and high Mallampati score were the only predictors of potential intubation problems. Because in all but one patient the trachea was intubated successfully by direct laryngoscopy, the neck circumference that requires an intervention such as fiberoptic bronchoscopy to establish an airway remains unknown. We conclude that obesity alone is not predictive of tracheal intubation difficulties.In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (greater-than-or-equal to 3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation.

  View details for Web of Science ID 000174031800047

  View details for PubMedID 11867407

• Tracheal diameter predicts double-lumen tube size: A method for selecting left double-lumen tubes ANESTHESIA AND ANALGESIA Brodsky, J. B., Macario, A., Mark, J. B. 1996; 82 (4): 861-864

  View details for Web of Science ID A1996UC48200032

  View details for PubMedID 8615510

• DEPTH OF PLACEMENT OF LEFT DOUBLE-LUMEN ENDOBRONCHIAL TUBES ANESTHESIA AND ANALGESIA Brodsky, J. B., Benumof, J. L., Ehrenwerth, J., OZAKI, G. T. 1991; 73 (5): 570-572

  Abstract

  Data on the normal depth of insertion of double-lumen tubes have not been published. We studied 101 adult patients undergoing thoracic operations whose tracheas were intubated with a left double-lumen tube. A fiberoptic bronchoscope was introduced into the tracheal lumen, and the tube position was adjusted until the cephalad surface of the bronchial cuff was immediately below the carinal bifurcation. The average depth of insertion for both male and female patients 170 cm tall was 29 cm, and for each 10-cm increase or decrease in height, average placement depth was increased or decreased 1 cm. The correlation between depth of insertion and height was highly significant (P less than 0.0001) for both male and female patients. As depth of DLT insertion at any given height was normally distributed, a technique to confirm correct double-lumen tube position always should be used after initial placement.

  View details for Web of Science ID A1991GL86500010

  View details for PubMedID 1952136

• Bariatric Surgery Operating Room Time-Size Matters OBESITY SURGERY Sanford, J. A., Kadry, B., Brodsky, J. B., Macario, A. 2015; 25 (6): 1078-1085

  Abstract

  The goal of this study was to document the relationship between BMI and the components of bariatric surgical operating room (OR) time.The Stanford Translational Research Integrated Database Environment identified all patients who underwent laparoscopic Roux-en-Y gastric bypass procedures at Stanford University Medical Center between May 2008 and November 2013. The 434 patients were divided into 3 groups: group 1 (n = 213) BMI ≥35 to <45 kg/m(2), group 2 (n = 188) BMI ≥45.0 to <60 kg/m(2), and group 3 (n = 33) BMI ≥60 kg/m(2). The primary variable measured was total operating room time, defined as beginning when the patient entered the OR until the moment the patient physically left the OR. Secondary variables were anesthetic induction time, nursing preparation time, operation time, time for emergence from anesthesia, and total length of hospital stay.Increasing BMI was associated with increased total OR time (group 1 = 202 min, group 2 = 215 min, group 3 = 235 min), mainly due to longer operation time (group 1 = 147 min, group 2 = 154 min, group 3 = 163 min). Anesthetic induction (group 1 = 17 min, group 2 = 18 min, group 3 = 23 min) and emergence times (group 1 = 12 min, group 2 = 12 min, group 3 = 22 min) were also significantly longer in the largest patients.Operating room schedules and plans for resource utilization should recognize that the same bariatric procedure will require more time for patients with BMI >60 kg/m(2) than for smaller bariatric patients.

  View details for DOI 10.1007/s11695-015-1651-5

  View details for Web of Science ID 000354216500022

• Intraoperative fluid management and bariatric surgery. International anesthesiology clinics Ingrande, J., Brodsky, J. B. 2013; 51 (3): 80-89

  View details for DOI 10.1097/AIA.0b013e3182960847

  View details for PubMedID 23797647

• Comparison of Procedural Times for Ultrasound-Guided Perineural Catheter Insertion in Obese and Nonobese Patients JOURNAL OF ULTRASOUND IN MEDICINE Mariano, E. R., Brodsky, J. B. 2011; 30 (10): 1357-1361

  Abstract

  Perineural catheter insertion with ultrasound guidance alone has been described, but it remains unknown whether this new technique results in the same procedural time and success rate for obese and nonobese patients. We therefore tested the hypothesis that obese patients require more time for perineural catheter insertion compared to nonobese patients despite using ultrasound.Data from 5 previously published randomized clinical trials comparing ultrasound- and stimulation-guided perineural catheter insertion techniques were reviewed, and patients who received ultrasound-guided catheters were divided into 2 groups: obese (body mass index ?30 kg/m(2)) and nonobese (body mass index <30 kg/m(2)). A standardized ultrasound-guided nonstimulating catheter technique was used with mepivacaine, 1.5% (40 mL), as the initial bolus via the placement needle for the primary surgical nerve block. The primary outcome was the procedural time for perineural catheter insertion. Secondary outcomes included block efficacy, procedure-related pain, fluid leakage, vascular puncture, and catheter dislodgment.A sample of 120 patients was identified: 51 obese and 69 nonobese. All obese patients had successful catheter placement compared to 68 of 69 (98%) nonobese patients (P = .388). The time for perineural catheter insertion [median (10th-90th percentiles)] was 7 (4-12) minutes for obese patients versus 7 (4-15) minutes for nonobese patients (P = .732). There were no statistically significant differences in other secondary outcomes.On the basis of this retrospective analysis, perineural catheter insertion is not prolonged in obese patients compared to nonobese patients when an ultrasound-guided technique is used. However, these results are only suggestive and require confirmation through prospective study.

  View details for Web of Science ID 000295551300006

  View details for PubMedID 21968486

• Endotracheal kinking of a double-lumen tube: a potential complication of inappropriate size tube selection EUROPEAN JOURNAL OF ANAESTHESIOLOGY Ambrosio, C., Leykin, Y., Pellis, T., Brodsky, J. B. 2011; 28 (8): 607-608

  View details for DOI 10.1097/EJA.0b013e3283474b53

  View details for Web of Science ID 000292496100011

  View details for PubMedID 21670689

• Lean Body Weight Scalar for the Anesthetic Induction Dose of Propofol in Morbidly Obese Subjects ANESTHESIA AND ANALGESIA Ingrande, J., Brodsky, J. B., Lemmens, H. J. 2011; 113 (1): 57-62

  Abstract

  The unique anesthetic risks associated with the morbidly obese (MO) population have been documented. Pharmacologic management of these patients may be altered because of the physiologic and anthropometric changes associated with obesity. Unfortunately, studies examining the effects of extreme obesity on the pharmacology of anesthetics have been sparse. Although propofol is the induction drug most frequently used in these patients, the appropriate induction dosing scalar for propofol remains controversial in MO subjects. Therefore, we compared different weight-based scalars for dosing propofol for anesthetic induction in MO subjects.Sixty MO subjects (body mass index ?40 kg/m(2)) were randomized to receive a propofol infusion (100 mg · kg(-1) · h(-1)) for induction of anesthesia based on total body weight (TBW) or lean body weight (LBW). Thirty control subjects (body mass index ?25 kg/m(2)) received a propofol infusion (100 mg · kg(-1) · h(-1)) based on TBW. Syringe drop was used as the marker for loss of consciousness (LOC), at which point the propofol infusion was stopped. The propofol dose required for syringe drop and time to LOC were recorded.Total propofol dose (mg/kg) required for syringe drop and time to LOC were similar between control subjects and MO subjects given propofol based on LBW. MO subjects receiving a propofol infusion based on TBW had a significantly larger propofol dose and significantly shorter time to LOC. There was a strong relationship between LBW and total propofol dose received in all 3 groups.LBW is a more appropriate weight-based scalar for propofol infusion for induction of general anesthesia in MO subjects.

  View details for DOI 10.1213/ANE.0b013e3181f6d9c0

  View details for Web of Science ID 000291971900011

  View details for PubMedID 20861415

• Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best practice & research. Clinical anaesthesiology Brodsky, J. B., Mariano, E. R. 2011; 25 (1): 61-72

  Abstract

  Obesity is associated with a number of anaesthetic-related risks. Regional anaesthesia offers many potential advantages for the obese surgical patient. Advantages include a reduction in systemic opioid requirements and their associated side effects, and possible avoidance of general anaesthesia in select circumstances, with a lower rate of complications. Historically, performing regional anaesthesia procedures in the obese has presented challenges due to difficulty in identifying surface landmarks and availability of appropriate equipment. Ultrasound guidance may aid the regional anaesthesia practitioner with direct visualisation of underlying anatomic structures and real-time needle direction. Further research is needed to determine optimal regional anaesthesia techniques, local anaesthetic dosage and perioperative outcomes in obese patients.

  View details for PubMedID 21516914

• Cardiac Arrest During Laparoscopic Roux-en-Y Gastric Bypass in a Bariatric Patient with Drug-Associated Long QT Syndrome OBESITY SURGERY Woodard, G., Brodsky, J. B., Morton, J. M. 2011; 21 (1): 134-137

  Abstract

  Obese patients often may demonstrate an acquired prolonged QTc interval due to alteration in cardiac physiology, electrolyte disturbances, and/or medication use. Intraoperatively, bariatric surgery may further contribute additional cardiac stressors to obese patients with long QT syndrome (LQTS). We present a case report of an obese woman with LQTS who underwent laparoscopic Roux-en-Y gastric bypass surgery and sustained an intraoperative cardiac arrest. We discuss identification, prevention, and treatment strategies for LQTS in the bariatric surgery patient.

  View details for DOI 10.1007/s11695-010-0137-8

  View details for Web of Science ID 000286423600020

  View details for PubMedID 20383601

• Intraoperative Fluid Replacement and Postoperative Creatine Phosphokinase Levels in Laparoscopic Bariatric Patients OBESITY SURGERY Wool, D. B., Lemmens, H. J., Brodsky, J. B., Solomon, H., Chong, K. P., Morton, J. M. 2010; 20 (6): 698-701

  Abstract

  Morbid obesity and bariatric surgery are both risk factors for the development of postoperative rhabdomyolysis (RML). RML results from injury to skeletal muscle, and a serum creatine phosphokinase (CK) level >1,000 IU/L is considered diagnostic of RML. The aim of this study was to determine if intraoperative intravenous fluid (IVF) volume affects postoperative CK levels following laparoscopic bariatric operations.Prospective, single blinded, and randomized trial was conducted.Patients scheduled to undergo laparoscopic sleeve gastrectomy, adjustable gastric band, or Roux-en-Y gastric bypass operations were randomized into two groups. Subjects in Group A received 15 ml/kg total body weight (TBW) of IV crystalloid solution during surgery, while subjects in Group B received 40 ml/kg TBW. Preoperative and postoperative CK and creatinine levels and intra- and postoperative urine output were monitored and recorded.Forty-seven patients were assigned to Group A and 53 patients to Group B. Group B patients had significantly higher urine output in the operating room, in the post-anesthesia care unit (PACU), and on postoperative days 0 and 1. Group B patients also had significantly lower serum creatinine level in the PACU and a trend towards lower creatinine levels on postoperative days 0, 1, and 2. There were no statistical differences in CK levels at any time between the two groups. Four patients in Group A and three patients in Group B developed postoperative RML.Conservative (15 ml/kg) versus liberal (40 ml/kg) intraoperative IVF administration did not change the incidence of RML in patients undergoing laparoscopic bariatric operations. Since the occurrence of RML in this patient population is relatively high, postoperative CK levels should be routinely obtained in patients at special risk.

  View details for DOI 10.1007/s11695-010-0092-4

  View details for Web of Science ID 000278289500004

  View details for PubMedID 20198451

• Succinylcholine and Morbid Obesity: The Debate ContinuesaEuro broken vertical bar OBESITY SURGERY Brodsky, J. B., Lemmens, H. J. 2010; 20 (1): 132-132

  View details for DOI 10.1007/s11695-009-9992-6

  View details for Web of Science ID 000273470100022

  View details for PubMedID 19813064

• Lung separation and the difficult airway. British journal of anaesthesia Brodsky, J. B. 2009; 103: i66-75

  Abstract

  Selective collapse of a lung and one-lung ventilation (OLV) is now performed for most thoracic surgical procedures. Modern double-lumen endobronchial tubes and bronchial blockers have made lung separation safe and relatively easy to achieve. However, OLV in the patient with a 'difficult airway' can present a challenge to the anaesthesiologist. This review considers the different techniques used to achieve lung separation and their application to the patient with a difficult airway.

  View details for DOI 10.1093/bja/aep262

  View details for PubMedID 20007992

• Regional anesthesia and obesity CURRENT OPINION IN ANESTHESIOLOGY Ingrande, J., Brodsky, J. B., Lemmens, H. J. 2009; 22 (5): 683-686

  Abstract

  Worldwide, the number of overweight and obese patients has increased dramatically. As a result, anesthesiologists routinely encounter obese patients daily in their clinical practice. The use of regional anesthesia is becoming increasingly popular for these patients. When appropriate, a regional anesthetic offers advantages and should be considered in the anesthetic management plan of obese patients. The following is a review of regional anesthesia in obesity, with special consideration of the unique challenges presented to the anesthesiologist by the obese patient.Recent studies report difficulty in achieving peripheral and neuraxial blockade in obese patients. For example, there is an increased incidence of failed blocks in obese patients compared with similar, normal weight patients. Despite difficulties, regional anesthesia can be used successfully in obese patients, even in the ambulatory surgery setting.Successful peripheral and neuraxial blockade in obese patients requires an anesthesiologist experienced in regional techniques, and one with the knowledge of the physiologic and pharmacologic differences that are unique to the obese patient.

  View details for DOI 10.1097/ACO.0b013e32832eb7bd

  View details for Web of Science ID 000270051500024

  View details for PubMedID 19550304

• Succinylcholine: A Useful Drug in Bariatric Surgery OBESITY SURGERY Brodsky, J. B., Lemmens, H. J., Morton, J. M. 2009; 19 (4): 537-537

  View details for DOI 10.1007/s11695-008-9795-1

  View details for Web of Science ID 000264848100027

  View details for PubMedID 19089518

• Is Europe ready for the ultra-obese? Acta anaesthesiologica Belgica Brodsky, J. B. 2009; 60 (3): 157-?

  View details for PubMedID 19961110

• Update on local and regional anesthesia in obesity. Acta anaesthesiologica Belgica Brodsky, J. B., Lemmens, H. J. 2009; 60 (3): 181-183

  View details for PubMedID 19961116

• Intraoperative contralateral tension pneumothorax during pneumonectomy ANESTHESIA AND ANALGESIA Finlayson, G. N., Chiang, A. B., Brodsky, J. B., Cannon, W. B. 2008; 106 (1): 58-60

  Abstract

  Unrecognized tension pneumothorax can have catastrophic consequences. We report a case of a patient who developed a contralateral tension pneumothorax during thoracotomy without the classic signs of marked hypoxemia and hemodynamic instability. A tension pneumothorax should be considered in any patient who develops high peak inspiratory pressures during one-lung ventilation with an open chest, even in the absence of the classic signs of hypoxemia and hypotension.

  View details for DOI 10.1213/01.ane.0000287685.02860.47

  View details for Web of Science ID 000251824300009

  View details for PubMedID 18165551

• The history of anesthesia for thoracic surgery MINERVA ANESTESIOLOGICA Brodsky, J. B., Lemmens, H. J. 2007; 73 (10): 513-524

  Abstract

  Today, thoracic surgeons routinely perform complex operations on even the most complicated patient. However, just 75 years ago the ability to operate within the chest was strictly limited to only the simplest and quickest procedures. The dramatic advances in the specialty of thoracic surgery have closely paralleled the introduction of new anesthetic practices, equipment and drugs. This review will identify major events in the history of anesthesia for thoracic surgery.

  View details for Web of Science ID 000250234700006

  View details for PubMedID 17380101

• Regional anesthesia and obesity OBESITY SURGERY Brodsky, J. B., Lemmens, H. J. 2007; 17 (9): 1146-1149

  Abstract

  The potential advantages of regional anesthesia include minimal airway intervention, less cardiopulmonary depression, excellent postoperative analgesia, less postoperative nausea and vomiting, and shorter recovery room and hospital stays. These concerns are particularly important for the obese surgical patient. This review discusses the application of regional anesthetic techniques in obesity. Further clinical studies are needed to fill the knowledge gap about regional anesthesia and outcome in obese and morbidly obese patients.

  View details for Web of Science ID 000249112000002

  View details for PubMedID 18074486

• Isolation of the right upper-lobe with a left-sided double-lumen tube after left-pneumonectomy ANESTHESIA AND ANALGESIA Scholten, K. J., Kulkarni, V., Brodsky, J. B. 2007; 105 (2): 330-331

  Abstract

  A patient with a prior left pneumonectomy required surgical drainage of a right upper lobe aspergilloma. A left double-lumen endobronchial tube was placed in the right bronchus intermedius, isolating the right upper lobe while allowing ventilation of the right middle and lower lobes.

  View details for DOI 10.1213/01.ane.0000270106.22502.e2

  View details for Web of Science ID 000248343400008

  View details for PubMedID 17646485

• Anesthesia for thoracic surgery in morbidly obese patients CURRENT OPINION IN ANESTHESIOLOGY Lohser, J., Kulkarni, V., Brodsky, J. B. 2007; 20 (1): 10-14

  Abstract

  This review considers the anesthetic management of obese patients undergoing thoracic surgery. Extremely or morbidly obese patients differ from patients of normal weight in several ways. Obese patients have altered anatomy and physiology, and usually have associated comorbid medical conditions that may complicate their operative course and increase their risks for postoperative complications.During anesthetic induction and laryngoscopy for tracheal intubation the morbidly obese patient should be in the reverse Trendelenburg position with the head and neck elevated above the table. Placement of a double-lumen tube should be no more difficult in an obese patient than in a normal-weight patient. There are no clear advantages for any of the commonly available inhalational anesthetic agents and each can be used for general anesthesia.With proper attention to their special needs, the morbidly obese patient can safely undergo thoracic surgery and one-lung ventilation.

  View details for Web of Science ID 000209632400003

• Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: Hospital course and outcomes OBESITY SURGERY Leykin, Y., Pellis, T., Del Mestro, E., Marzano, B., Fanti, G., Brodsky, J. B. 2006; 16 (12): 1563-1569

  Abstract

  Although the implications for the anesthetic and perioperative care of severely obese patients undergoing weight loss operations are considerable, current anesthetic management of super-obese (SO) patients (BMI > or =50 kg/m(2)), including super-super-obese (BMI > or =60) derives from experience with morbidly obese (MO) patients (BMI 40-49.9 kg/m(2)). We compared anesthetic and perioperative data of SO patients and MO patients undergoing weight loss operations to evaluate if anesthetic management influenced outcome.A retrospective analysis was performed on data from 150 consecutive patients (119 MO, 31 SO) undergoing bariatric surgery between May 2000 and March 2005. Data analyzed included preoperative anesthetic assessment, anesthetic management, postoperative care, and intra- or postoperative complications.There were no differences in anesthetic management or in postoperative course or outcome between MO and SO patients. Intraoperative surgical complications occurred in 26% (n=8) in the SO group and 14% (n=15) in the MO group (P<0.01).No differences in outcome occurred between MO and SO patients undergoing bariatric operations under similar anesthetic management. Anesthesia for weight loss surgery can be safely performed on SO patients with the understanding that these patients are not at risk per se due to their higher BMI. The degree of obesity influenced only the incidence of intraoperative surgical complications.

  View details for Web of Science ID 000242902700003

  View details for PubMedID 17217630

• Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery OBESITY SURGERY Schuster, R., Alami, R. S., Curet, M. J., Paulraj, N., Morton, J. M., Brodsky, J. B., Brock-Utne, J. G., Lemmens, H. J. 2006; 16 (7): 848-851

  Abstract

  Laparoscopic Roux-en-Y gastric bypass (RYGBP) is a commonly performed operation for morbid obesity. A significant number of patients experience postoperative nausea and vomiting (PONV) following this procedure. The aim of this study was to determine the effect, if any, of intra-operative fluid replacement on PONV.Patients who underwent laparoscopic (RYGBP) for morbid obesity during a 12-month period were included in this retrospective analysis. Demographic data including age, gender, and body mass index (BMI) were collected. Perioperative data also included total volume of intra-operative fluids administered, rate of administration, urine output, length of surgery, and incidence of PONV as determined by nursing or anesthesia records in the postanesthesia care unit (PACU). Data were analyzed by t-test.The table below depicts demographic and perioperative data, comparing patients who experienced PONV (n=125) in the PACU with those who did not (n=55). Values are mean +/- standard deviation.PONV is a common complication after laparoscopic RYGB. Patient who did not experience PONV received a larger volume of intravenous fluid at a faster rate than similar patients who complained of PONV.

  View details for Web of Science ID 000239131000007

  View details for PubMedID 16839481

• Anesthetic drugs and bariatric surgery. Expert review of neurotherapeutics Lemmens, H. J., Brodsky, J. B. 2006; 6 (7): 1107-1113

  Abstract

  The prevalence of obesity is increasing worldwide. For severely obese patients, bariatric surgery is the only effective option for sustained weight loss and associated health improvement. As a consequence, the number of bariatric surgical procedures being performed is growing exponentially. Systematic knowledge regarding the effect of obesity on the pharmacokinetics and pharmacodynamics of anesthetic agents is generally lacking, and data for morbidly obese (body mass index [BMI] 40-49 kg/m2)) and super-obese patients (BMI > 50 kg/m2) are almost completely non-existent. Most drug-dosing guidelines are based on results from relatively small studies in moderately obese patients. Future systematic pharmacological research is needed for improved and more rational peri-operative care of morbidly obese patients.

  View details for PubMedID 16831123

• Estimating blood volume in obese and morbidly obese patients OBESITY SURGERY Lemmens, H. J., Bernstein, D. P., Brodsky, J. B. 2006; 16 (6): 773-776

  Abstract

  Preoperative assessment of blood volume (BV) is important for patients undergoing surgery. The mean value for indexed blood volume ((In)BV) in normal weight adults is 70 mL/kg. Since (In)BV decreases in a non-linear manner with increasing weight, this value cannot be used for obese and morbidly obese patients. We present an equation that allows estimation of (In)BV over the entire range of body weights.

  View details for Web of Science ID 000238156200017

  View details for PubMedID 16756741

• Obesity, surgery, and inhalation anesthetics - Is there a "drug of choice"? OBESITY SURGERY Brodsky, J. B., Lemmens, H. J., Saidman, L. J. 2006; 16 (6): 734-734

  View details for Web of Science ID 000238156200009

  View details for PubMedID 16756733

• Orogastric tube complications in Laparoscopic Roux-en-Y gastric bypass OBESITY SURGERY Sanchez, B. S., Safadi, B. Y., Kieran, J. A., Hsu, G. P., Brodsky, J. B., Curet, M. J., Morton, J. M. 2006; 16 (4): 443-447

  Abstract

  Recent national efforts have focused on improving patient safety in surgical procedures including examining adverse events. An adverse event in laparoscopic Roux-en-Y gastric bypass (LRYGBP) which has not received much scrutiny involves orogastric tube complications during gastric pouch formation.Retrospective review was conducted of all LRYGBPs (n=727) performed by 5 surgeons over 5 years at 2 institutions. Cases with intraoperative orogastric tube (OGT) related complications (n=9) were identified.9 patients (1.2%) had preventable orogastric tube-related complications. Mean patient demographics were as follows: age 47 years, female 56%, pre-op BMI 52 kg/m(2), co-morbidities 3.5 and mortality 0%. 7 of 9 patients' cases were complicated by stapling of an orogastric tube during gastric pouch formation. The remaining 2 patients had complications involving suturing of the Levacuator tube during gastrojejunostomy formation. All complications required gastric pouch or anastomotic revision. 2 patients required conversion to an open procedure, 2 required re-operation for anastomotic leak, and 1 had respiratory failure and prolonged hospital stay.Orogastric tube complications can occur during laparoscopic RYGBP, but are seldom reported and can be associated with significant morbidity. Treatment options are dependent upon the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or manipulation of an OGT prior to stapling or suturing, use of large bore OGTs for increased visual or tactile recognition, retraction of the OGT proximal to the anastomosis during gastrojejunal construction and employing alternatives to esophageal temperature probes (i.e. Foley temperature probes).

  View details for Web of Science ID 000236566000166

  View details for PubMedID 16608608

• Central venous access in obese patients: A potential complication ANESTHESIA AND ANALGESIA Ottestad, E., Schmiessing, C., Brock-Utne, J. G., Kulkarni, V., Parris, D., Brodsky, J. B. 2006; 102 (4): 1293-1294

  View details for Web of Science ID 000236371100072

  View details for PubMedID 16551951

• Bronchial stenting through a ProSeal laryngeal mask airway JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Lohser, J., Brodsky, J. B. 2006; 20 (2): 227-228

  View details for DOI 10.1053/j.jvca.2005.01.036

  View details for Web of Science ID 000237072000017

  View details for PubMedID 16616665

• Obesity and difficult intubation: Where is the evidence? ANESTHESIOLOGY Couins, J. S., Lemmens, H. J., Brodsky, J. B. 2006; 104 (3): 617-617

  View details for Web of Science ID 000235766400035

  View details for PubMedID 16508416

• Silbronco double-lumen tube JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Lohser, J., Brodsky, J. B. 2006; 20 (1): 129-131

  View details for DOI 10.1053/j.jvca.2005.03.035

  View details for Web of Science ID 000235490300034

  View details for PubMedID 16458237

• Case 5 - 2005 - Anesthetic management of major hemorrhage during mediastinoscopy JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Lohser, J., Donington, J. S., Mitchell, J. D., Brodsky, J. B., Raman, J., Slinger, P. 2005; 19 (5): 678-683

  View details for DOI 10.1053/j.jvca.2005.07.016

  View details for Web of Science ID 000233054400023

  View details for PubMedID 16202909

• Estimating ideal body weight - A new formula OBESITY SURGERY Lemmens, H. J., Brodsky, J. B., Bernstein, D. P. 2005; 15 (7): 1082-1083

  Abstract

  A simple formula for estimating ideal body weight (IBW) in kilograms for both men and women is presented. The equation IBW = 22 x H2, where H is equal to patient height in meters, yields weight values midway within the range of weights obtained using published IBW formulae.

  View details for Web of Science ID 000231046800299

  View details for PubMedID 16105412

• Tracheal width and teft double-lumen tube size: a formula to estimate teft-bronchial width JOURNAL OF CLINICAL ANESTHESIA Brodsky, J. B., Lemmens, H. J. 2005; 17 (4): 267-270

  Abstract

  To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen.Prospective study.University medical center.Three hundred twenty-one consecutive patients scheduled for thoracic surgery and for whom there was a chest radiograph and for whom tracheal width (TW) and LBW could be measured.Tracheal width and LBW were directly measured from the chest radiograph. Patient demographic data were recorded and then analyzed to see which factor(s) best predicted LBW. Parameters often used for DLT selection (age, sex, height, and weight) as well as TW were compared by univariate and multivariate statistical analysis to see which factor(s) most accurately predicted LBW.There were weak but significant correlations between age and height and LBW in men, and height and LBW in women. Multivariate statistical analysis showed that, for both men and women, TW was the best predictor of LBW. Sex, height, and weight did not improve predictability over TW alone. The equation that best predicts LBW for both sexes is: LBWmm = (0.50)(TWmm) + 3.7 mm. This model explains 46% of the variance in LBW. As structures measured from a chest radiograph are magnified by 10%, the formula to predict LBW, which normalizes for this magnification factor, is: LBWmm = (0.45)(TWmm(CXR)) + 3.3 mm.Direct airway measurement is the most accurate way to select an appropriate DLT. However, when direct measurement of LBW cannot be performed, estimating LBW from TW is a better predictor of LBW than either sex, height, or weight.

  View details for DOI 10.1016/j.jclinane.2004.07.008

  View details for Web of Science ID 000230236200006

  View details for PubMedID 15950850

• Limitations of impedance cardiography OBESITY SURGERY Bernstein, D. P., Lemmens, H. J., Brodsky, J. B. 2005; 15 (5): 659-660

  View details for Web of Science ID 000229492900012

  View details for PubMedID 17080563

• The preoperative anesthesia evaluation. Thoracic surgery clinics Schmiesing, C. A., Brodsky, J. B. 2005; 15 (2): 305-315

  Abstract

  Thorough and timely anesthesia preoperative evaluation is essential for good patient outcomes. Perioperative care is becoming more complex and comprehensive, while older and sicker patients are being considered for major thoracic surgery. In addition to pulmonary and wound care, prevention of cardiac complications with beta-blocker therapy, multimodal pain control, tighter glycemic control, nutritional support, and prevention of thromboembolism are important perioperative goals. Early identification of significant medical and nonmedical issues allows for complete evaluation and planning and decreases the likelihood of delays, cancellations, and complications. Good communication and preparation benefit everyone. The implementation of an anesthesia preoperative assessment program or clinic can help achieve these important goals.

  View details for PubMedID 15999528

• Nitrous oxide and laparoscopic bariatric surgery OBESITY SURGERY Brodsky, J. B., Lemmens, H. J., Collins, J. S., Morton, J. M., Curet, M. J., Brock-Utne, J. G. 2005; 15 (4): 494-496

  Abstract

  Nitrous oxide (N2O) is frequently used to supplement more potent anesthetic agents. One side-effect of N2O is its ability to expand an air-containing space. We investigated if N2O adversely affected operating conditions by distending normal bowel during laparoscopic bariatric procedures.50 morbidly obese patients were divided into 2 study groups. Group 1 patients were ventilated with a halogenated anesthetic/oxygen/air mixture, while Group 2 received a halogenated anesthetic/oxygen/N2O mixture. At 30, 60, and 90 min intervals during the operation, the surgeon was asked if N2O was being used.The surgeons responded correctly only 42% (30 min), 50% (60 min), and 48% (90 min) of the time. In Group 2 (N2O) patients, they incorrectly answered that N2O was not being used 88% (30 min), 68% (60 min), and 68% (90 min); and in Group 1 (air) patients, they incorrectly answered that N2O was being used 28% (30 min), 32% (60 min), and 36% (90 min) of the time.We found that using N2O did not cause noticeable bowel distention during laparoscopic bariatric procedures of relatively short duration.

  View details for Web of Science ID 000228911000006

  View details for PubMedID 15946427

• Fiberoptic bronchoscopy need not be a routine part of double-lumen tube placement. Current opinion in anaesthesiology Brodsky, J. B. 2004; 17 (1): 7-11

  Abstract

  The debate continues as to whether a fiberoptic bronchoscope must be used to position a double-lumen tube. This review supports the argument that although bronchoscopy is extremely helpful, it is not always needed for the routine placement of left double-lumen tubes.Several recent clinical reports have demonstrated that an experienced anesthesiologist can safely and consistently position double-lumen tubes without bronchoscopic assistance. In order to do so several important factors must be considered. These include the appropriate choice of tube (left or right), size of tube, and endpoint for the depth of insertion.Although bronchoscopy is useful, no double-lumen tube positioning method is fail-safe. The choice of which approach to use, 'blind' versus fiberoptic bronchoscope-assisted, is influenced by many factors. Operator experience with any method increases the likelihood of success. A fiberoptic bronchoscope is not always needed for left double-lumen tube placement.

  View details for PubMedID 17021523

• Bronchoscopic procedures for central airway obstruction JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Brodsky, J. B. 2003; 17 (5): 638-646

  View details for DOI 10.1053/S1053-0770(03)00212-X

  View details for Web of Science ID 000186144400016

  View details for PubMedID 14579222

• Anesthetic considerations for bariatric surgery: Proper positioning is important for laryngoscopy ANESTHESIA AND ANALGESIA Brodsky, J. B., Lemmens, H. J., Brock-Utne, J. G., Saidman, L. J. 2003; 96 (6): 1841-1842

  View details for DOI 10.1213/01.ANE.0000063165.15467.1B

  View details for Web of Science ID 000183148900060

  View details for PubMedID 12761028

• Anesthesia for pulmonary stent insertion. Current opinion in anaesthesiology Brodsky, J. B. 2003; 16 (1): 65-67

  Abstract

  To familiarize anesthesiologists with recent advances in endoscopic pulmonary stenting. These interventions have replaced surgical procedures for the relief of central airway obstructions.A pulmonary stent can provide immediate relief of symptoms and improvement in pulmonary function for both intrinsic and extrinsic airway lesions. The current indications for the use of both silicone-rubber stents and expandable metal stents are reviewed. Considerations for the anesthetic management of patients undergoing pulmonary stent placement are also discussed.Tracheo-bronchial stenting procedures are being employed with increasing frequency. The practicing anesthesiologist must be familiar with the management of patients undergoing airway stenting procedures.

  View details for PubMedID 17021444

• Positioning the morbidly obese patient for anesthesia OBESITY SURGERY Brodsky, J. B. 2002; 12 (6): 751-758

  Abstract

  Each of the different positions employed during surgery can compromise cardiopulmonary function in the morbidly obese patient. An understanding of the physiologic changes that can occur is essential for the successful management of these patients.

  View details for Web of Science ID 000180505600007

  View details for PubMedID 12568178

• The relationship between tracheal width and left bronchial width: Implications for left-sided double-lumen tube selection JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Brodsky, J. B., Malott, K., Angst, M., Fitzmaurice, B. G., Kee, S. P., Logan, L. 2001; 15 (2): 216-217

  Abstract

  To determine if there is a relationship between tracheal width (TW) and left bronchial width (LBW).Three-dimensional chest computed tomography (CT) scans were used to reconstruct major airways for measurement of TW and LBW.Stanford University Medical Center, Stanford, California.Thirty-one adult patients undergoing chest CT scans.Cursors were used to directly measure internal diameter from coronal images of the trachea at midclavicular level and the left main bronchus at a level 1 cm below the carina.TW and LBW, but not the LBW-to-TW ratio, were significantly larger in men than in women. The LBW-to-TW ratio was consistent for men (0.75 +/- 0.09) and women (0.77 +/- 0.10).LBW is proportional to TW. If LBW cannot be measured directly but TW can, the ratio of LBW to TW can be used to predict LBW. An appropriate-sized left double-lumen tube can then be selected for the patient.

  View details for Web of Science ID 000168082600014

  View details for PubMedID 11312482

• Approaches to hypoxemia during single-lung ventilation. Current opinion in anaesthesiology Brodsky, J. B. 2001; 14 (1): 71-76

  Abstract

  Modern techniques to isolate the lungs, coupled with accurate continuous non-invasive monitoring, have made single-lung ventilation safe and easy to perform. Most patients maintain an adequate arterial oxygen tension during single-lung ventilation. In order to maximize oxygenation, efforts are directed towards optimizing perfusion and ventilation to the ventilated lung or increasing the oxygen content of blood returning from the collapsed lung.

  View details for PubMedID 17016387

• Modern anesthetic techniques for thoracic operations WORLD JOURNAL OF SURGERY Brodsky, J. B., Fitzmaurice, B. 2001; 25 (2): 162-166

  Abstract

  Continuing advances in anesthesiology enable surgeons to perform more and more complex operations. Nowhere is this relation more important than for the patient undergoing thoracic surgery. Specialized anesthetic techniques including safe lung separation, the maintenance of oxygenation during selective one-lung ventilation, and effective postoperative analgesia allow procedures such as lung volume reduction surgery and lung transplantation to be performed routinely. This paper reviews modern clinical practices in the field of thoracic anesthesia.

  View details for Web of Science ID 000168131500011

  View details for PubMedID 11338017

• Bearded Sikhs and tracheal intubation ANESTHESIA AND ANALGESIA Brock-Utne, J. G., Brodsky, J. B., Haddow, G. R. 2000; 91 (2): 494-494

  View details for Web of Science ID 000088450100051

  View details for PubMedID 10910875

• Video-assisted thoracoscopic surgery. Current opinion in anaesthesiology Brodsky, J. B., Cohen, E. 2000; 13 (1): 41-45

  Abstract

  Video-assisted thoracoscopic surgery is finding an ever-increasing role in the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The potential advantages of video-assisted thoracoscopic surgery include less postoperative pain, fewer operative complications, shortened hospital stay and reduced costs. The following review examines the surgical and anesthetic considerations of video-assisted thoracoscopic surgery, with an emphasis on recently published articles.

  View details for PubMedID 17016278

• Methods for single-lung ventilation in pediatric patients ANESTHESIA AND ANALGESIA Hammer, G. B., Fitzmaurice, B. G., Brodsky, J. B. 1999; 89 (6): 1426-1429

  View details for Web of Science ID 000083982400019

  View details for PubMedID 10589621

• Airway rupture from double-lumen tubes JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Fitzmaurice, B. G., Brodsky, J. B. 1999; 13 (3): 322-329

  View details for Web of Science ID 000080974400017

  View details for PubMedID 10392687

• Anesthetic management of a patient with relapsing polychondritis JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Fitzmaurice, B. G., Brodsky, J. B., Kee, S. T., Foppiano, L. E., McNutt, J. 1999; 13 (3): 309-311

  View details for Web of Science ID 000080974400013

  View details for PubMedID 10392683

• What intraoperative monitoring makes sense? CHEST Brodsky, J. B. 1999; 115 (5): 101S-105S

  Abstract

  The routine practice of monitoring oxygenation, ventilation, circulation, and temperature during surgery is now the standard of care. However, with the possible exception of pulse oximetry and capnography, extensive physiologic monitoring has not been shown to reduce the incidence of adverse anesthetic-related events. Monitors are useful adjuncts, but they alone cannot replace careful observation by a vigilant anesthesiologist.

  View details for Web of Science ID 000080356600013

  View details for PubMedID 10331341

• Selecting double-lumen tubes for small patients ANESTHESIA AND ANALGESIA Brodsky, J. B., Fitzmaurice, B. G., Macario, A. 1999; 88 (2): 466-466

  View details for Web of Science ID 000078404300050

  View details for PubMedID 9972778

• Airway obstruction caused by an oleothorax JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Patterson, A. J., Leong, M. S., Brodsky, J. B., Mark, J. B. 1998; 12 (2): 189-191

  View details for Web of Science ID 000073194700015

  View details for PubMedID 9583553

• Single-lung ventilation in pediatric patients ANESTHESIOLOGY Hammer, G. B., MANOS, S. J., Smith, B. M., Skarsgard, E. D., Brodsky, J. B. 1996; 84 (6): 1503-1506

  View details for Web of Science ID A1996UQ74400029

  View details for PubMedID 8669693

• Modified BronchoCath double-lumen tube JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Brodsky, J. B., Macario, A. 1995; 9 (6): 784-785

  View details for Web of Science ID A1995TM82400028

  View details for PubMedID 8664477

• BLIND PLACEMENT OF PLASTIC LEFT DOUBLE-LUMEN TUBES ANAESTHESIA AND INTENSIVE CARE Brodsky, J. B., Macario, A., Cannon, W. B., Mark, J. B. 1995; 23 (5): 583-586

  Abstract

  A prospective analysis of placement of left-sided plastic double-lumen tubes in 100 patients is presented. Intubation of the left bronchus was successfully accomplished using only auscultation and clinical signs ("blind" placement) in 91 patients. Double-lumen tubes were positioned in less than five minutes in 84 patients. The most common problem encountered (30%) was initial intubation of the right main bronchus. Seven of these patients required bronchoscopic assistance to guide the tube into the left bronchus. There were four minor intraoperative complications due to DLT malposition that were recognized and corrected by withdrawing the tube slightly back in the bronchus. The plastic double-lumen tubes functioned properly during the procedure in all 100 patients.

  View details for Web of Science ID A1995RX49400009

  View details for PubMedID 8787258

• PAIN OUTCOMES AFTER THORACOTOMY - LUMBAR EPIDURAL HYDROMORPHONE VERSUS INTRAPLEURAL BUPIVACAINE JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Gaeta, R. R., Macario, A., Brodsky, J. B., BROCKUTNE, J. G., MARK, B. D. 1995; 9 (5): 534-537

  Abstract

  To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.A randomized, prospective, double-blind study.A university-affiliated medical center.Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia.Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.

  View details for Web of Science ID A1995TB74600009

  View details for PubMedID 8547554

• IS NITROUS-OXIDE SAFE FOR BONE-MARROW HARVEST ANESTHESIA AND ANALGESIA Lederhaas, G., BROCKUTNE, J. G., Negrin, R. S., Riley, E., Brodsky, J. B. 1995; 80 (4): 770-772

  Abstract

  Patients with non-Hodgkins lymphoma undergoing autologous bone marrow harvest were studied in a prospective, randomized fashion. All patients received a general anesthetic consisting of intravenous thiopental, fentanyl, and vecuronium and were ventilated with oxygen and isoflurane. Group I (19) patients also were ventilated with nitrous oxide (70%) whereas patients in Group II (19) did not receive nitrous oxide. Bone marrow samples were obtained at the beginning and end of the harvest. Viability of bone marrow mononuclear cells was assessed with a colony-forming unit-granulocyte macrophage (CFU-GM) assay, CFU-GM growth is a marker for myeloid progenitor cells and is dependent on intact deoxyribonucleic acid synthesis. Rate of neutrophil engraftment after autologous bone marrow transplantation was also studied. Both groups of patients were statistically similar in age, weight, anesthetic duration, CFU-GM counts at both sample draws, and the time for successful engraftment. There appears to be no difference in bone marrow viability as assayed by both CFU-GM colony growth and engraftment in human bone marrow exposed to a general anesthetic with nitrous oxide.

  View details for Web of Science ID A1995QP46200021

  View details for PubMedID 7893033

• COMPARISON OF ARTERIAL TONOMETRY WITH RADIAL ARTERY CATHETER MEASUREMENTS OF BLOOD-PRESSURE IN ANESTHETIZED PATIENTS ANESTHESIOLOGY Siegel, L. C., BROCKUTNE, J. G., Brodsky, J. B. 1994; 81 (3): 578-584

  Abstract

  Arterial tonometry has been introduced for continuous noninvasive measurement of blood pressure. The accuracy of this method depends on the performance of two components: a piezoelectric crystal array and an oscillometric cuff. This study evaluates overall performance of arterial tonometry in terms of the performance of these two components by comparing it with simultaneous recording of blood pressure from an intraarterial catheter.Seventeen adult patients were studied during general anesthesia. Blood pressure was measured with an intraarterial catheter and with an arterial tonometry system. Analog pressure waveforms were sampled at 100 Hz. Blood pressure measurements obtained by oscillometry were recorded by computer. Comparisons of mean blood pressure on a beat-by-beat basis were made with and without correction for the calibration error introduced by oscillometry.The difference between pairs of blood pressure determined by arterial tonometry and intraarterial measurement was 1.3 +/- 9.4 mmHg (mean +/- SD, bias +/- precision) with 88,158 pairs of measurements. The difference between blood pressure determined by oscillometry and intraarterial measurement was 2.4 +/- 7.5 mmHg (mean +/- SD) with 401 comparisons. After correcting for calibration error, the difference between the tonometry measurements and intraarterial measurements was -1.0 +/- 5.6 mmHg. Continuous episodes of discrepancy from intraarterial measurements in excess of 10 mmHg and lasting 5-60 s occurred 4.6 +/- 0.8 times per hour with tonometry and 12.6 +/- 1.4 times per hour with oscillometry.Discrepancies in blood pressure readings by arterial tonometry versus intraarterial measurement result from both the piezoelectric crystal array and the oscillometry used for calibration. Accuracy for individual measurement is inferior to oscillometry alone. The ability to detect significant changes of blood pressure more rapidly than with oscillometry alone is limited by the accuracy of the piezoelectric crystal component but is enhanced by the reduced interval between measurements.

  View details for Web of Science ID A1994PG11900007

  View details for PubMedID 8092502

• Spontaneous pneumothorax in early pregnancy: successful management by thoracoscopy. Journal of cardiothoracic and vascular anesthesia Brodsky, J. B., Eggen, M., Cannon, W. B. 1993; 7 (5): 585-587

  View details for PubMedID 8268441

• BALLOON METHOD FOR DETECTING INADEQUATE DOUBLE-LUMEN TUBE CUFF SEAL ANNALS OF THORACIC SURGERY Brodsky, J. B., Mark, J. B. 1993; 55 (6): 1584-1584

  Abstract

  A method for detecting air leak when using a double-lumen endobronchial tube is described. The ventilatory circuit is directly attached to the lumen of the ventilated lung. A balloon is fitted snugly over the open lumen of the tube to the nonventilated lung. If lung separation is incomplete, the balloon will inflate with each ventilation.

  View details for Web of Science ID A1993LH44100048

  View details for PubMedID 8512424

• MORPHINE AND HYDROMORPHONE EPIDURAL ANALGESIA - A PROSPECTIVE, RANDOMIZED COMPARISON ANESTHESIOLOGY Chaplan, S. R., Duncan, S. R., Brodsky, J. B., Brose, W. G. 1992; 77 (6): 1090-1094

  Abstract

  Because evidence from uncontrolled, unblinded studies suggested fewer side effects from epidural hydromorphone than from epidural morphine, we employed a randomized, blinded study design to compare the side effects of lumbar epidural morphine and hydromorphone in 55 adult, non-obstetric patients undergoing major surgical procedures. A bolus dose of epidural study drug was given at least 1 h prior to the conclusion of surgery, followed by a continuous infusion of the same drug for two postoperative days. Infusions were titrated to patient comfort. Visual analog scale (VAS) pain scores, VAS sedation scores, and subjective ratings of nausea and pruritus were assessed twice daily. The two treatments provided equivalent analgesia. Sedation scores and prevalence of nausea did not differ significantly between groups. Prevalence of pruritus, however, differed significantly on postoperative day 1, with moderate to severe pruritus reported by 44.4% of patients in the morphine group versus 11.5% in the hydromorphone group (P < .01). On post-operative day 2, reports of pruritus by patients receiving morphine remained higher than those among the hydromorphone-treated subjects, although this difference was no longer statistically significant (32% vs. 16.7%, P = .18). We conclude that lumbar epidural morphine and hydromorphone afford comparable analgesia, but the occurrence of moderate to severe pruritus on the first postoperative day is reduced by the use of hydromorphone.

  View details for Web of Science ID A1992KC86500008

  View details for PubMedID 1281625

• EVALUATION OF A RESPIRATORY RATE MONITOR IN POSTSURGICAL PATIENTS JOURNAL OF CLINICAL ANESTHESIA ANDERSON, W., BROCKUTNE, A. J., BROCKUTNE, J. G., Brodsky, J. B. 1992; 4 (4): 289-291

  Abstract

  To evaluate the clinical use of a cardiorespiratory rate monitor in patients receiving epidural opioids following major surgery.For 6 hours during the night following surgery, patients were continuously monitored with a cardiorespiratory rate monitor and a pulse oximeter, as well as by an in-room observer.Postoperative surgical ward at a university hospital.Eight ASA physical status I and II patients ages 30 to 76 years.Any bradypneic, hypoxemic, bradycardic, or tachycardic event was confirmed by the observer and recorded.The cardiorespiratory rate monitor accurately identified true bradypneic episodes in five of the eight patients. There were no false-positive alarms. The respiratory rate monitor and the pulse oximeter identified one episode of hypoxemia. There were no episodes of bradycardia or tachycardia.The cardiorespiratory rate monitor is useful in patients at risk for bradypnea following surgery.

  View details for Web of Science ID A1992JP81600006

  View details for PubMedID 1384579

• Bronchial cuff pressures of two tubes used in thoracic surgery. Journal of cardiothoracic and vascular anesthesia Kelley, J. G., Gaba, D. M., Brodsky, J. B. 1992; 6 (2): 190-192

  Abstract

  The pressure/volume characteristics of the bronchial cuff of a polyvinylchloride (PVC) double-lumen endobronchial tube (DLT) was compared with the inflatable cuff of a bronchial blocker. At the volumes needed to seal a series of rigid model bronchi the PVC DLT bronchial cuff consistently generated significantly lower pressures than the bronchial blocker cuff.

  View details for PubMedID 1568005

• CLINICAL-SEPARATION OF THE LUNGS ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION Brodsky, J. B. 1992; 11 (2): 178-192

  View details for Web of Science ID A1992HP46100011

  View details for PubMedID 1503292

• DIFFICULT LARYNGOSCOPY MASKED BY PREVIOUS COSMETIC SURGERY PLASTIC AND RECONSTRUCTIVE SURGERY BROCKUTNE, J. G., Brodsky, J. B., Haddow, G. R., AZAR, D. R., Kaye, B. 1991; 87 (6): 1143-1144

  View details for Web of Science ID A1991FP12600029

  View details for PubMedID 2034742

• A HAIRY PROBLEM ANESTHESIA AND ANALGESIA Brodsky, J. B., BROCKUTNE, J. G., Haddow, G. R., AZAR, D. R. 1991; 72 (6): 839-839

  View details for Web of Science ID A1991FN04200024

  View details for PubMedID 2035871

• CSF AND BLOOD PHARMACOKINETICS OF HYDROMORPHONE AND MORPHINE FOLLOWING LUMBAR EPIDURAL ADMINISTRATION PAIN Brose, W. G., Tanelian, D. L., Brodsky, J. B., Mark, J. B., Cousins, M. J. 1991; 45 (1): 11-15

  Abstract

  Sixteen consenting patients scheduled for elective thoracotomy were enrolled into a randomized trial of epidural morphine and hydromorphone. Each patient had a lumbar epidural catheter placed preoperatively for the purpose of post-thoracotomy analgesia. Shortly before the end of the operative procedure each patient received 5 mg of morphine and 0.75 mg of hydromorphone via the epidural catheter. Blood was sampled at regular intervals following the opiate administration and patients were randomized to 1 of 7 cervical CSF sampling times. Blood and CSF samples were assayed for morphine and hydromorphone concentration to determine blood and CSF pharmacokinetic profiles. A maximum blood morphine concentration of 60 +/- 25 ng/ml (mean +/- S.D.) was obtained at 11 +/- 6 min (mean +/- S.D.). The blood hydromorphone peak of 14 +/- 13 ng/ml (mean +/- S.D.) occurred 8 +/- 6 min (mean +/- S.D.). The mean peak CSF opioid concentrations of 1581 ng/ml for morphine and 309 ng/ml for hydromorphone occurred 60 min after epidural administration. The blood and CSF pharmacokinetic profiles for morphine and hydromorphone are presented. These profiles are similar for the two drugs after lumbar epidural administration.

  View details for Web of Science ID A1991FJ99300003

  View details for PubMedID 1713663

• End-tidal CO2 monitoring for patients receiving epidural opiates. Journal of cardiothoracic and vascular anesthesia Brodsky, J., Brock-Utne, J. G. 1991; 5 (1): 102-103

  View details for PubMedID 1907867

• CONTINUOUS EPIDURAL HYDROMORPHONE FOR POSTTHORACOTOMY PAIN RELIEF ANNALS OF THORACIC SURGERY Brodsky, J. B., Chaplan, S. R., Brose, W. G., Mark, J. B. 1990; 50 (6): 888-893

  Abstract

  Forty-four patients were treated with a continuous infusion of lumbar epidural hydromorphone (0.05%) after thoracic operations. Postoperatively, visual analog pain scores were obtained. On postoperative day 1 and 2, more than 90% of the patients experienced either no pain (visual analog pain scale = 0) or mild pain (visual analog pain score = 1 to 3) at rest. The incidence of side effects (hypoventilation, pruritus, and nausea) was less than reported with other epidurally administered opioids. Continuous infusion of lumbar epidural hydromorphone produced safe, predictable analgesia after thoracotomy.

  View details for Web of Science ID A1990EL24100006

  View details for PubMedID 1700682

• Systemic tumor embolism following thoracotomy partially masked by postoperative epidural analgesia. Journal of cardiothoracic anesthesia Brodsky, J. B., Brose, W. G., Cannon, W. B., MCKLVEEN, R. E. 1990; 4 (1): 95-96

  View details for PubMedID 1720030

• BRONCHIAL CUFF PRESSURES OF DOUBLE-LUMEN TUBES ANESTHESIA AND ANALGESIA Brodsky, J. B., ADKINS, M. O., Gaba, D. M. 1989; 69 (5): 608-610

  Abstract

  Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes (DLTs). We compared the pressure/volume characteristics of the bronchial cuffs of three different polyvinylchloride (PVC) DLTs and an equivalent sized red-rubber Robertshaw DLT. At the volume needed to seal effectively our bronchial model, two of the three PVC tube cuffs tested generated significantly less pressure than did that of the cuffs of the third PVC and the red-rubber Robertshaw tubes.

  View details for Web of Science ID A1989AX41300010

  View details for PubMedID 2802196

• Unsuccessful unilateral bronchopulmonary lavage for a patient with severe cystic fibrosis. Journal of cardiothoracic anesthesia ADKINS, M. O., Chan, J. C., Brodsky, J. B. 1989; 3 (4): 481-485

  View details for PubMedID 2520924

• PROFOUND INTRAOPERATIVE ATELECTASIS BRITISH JOURNAL OF ANAESTHESIA SAMUELS, S. I., Brodsky, J. B. 1989; 62 (2): 216-218

  Abstract

  Severe intraoperative hypoxaemia occurred in a previously healthy 19-yr-old accident victim. Although rare, major lung collapse secondary to mucous plugging should be considered in the differential diagnosis of intraoperative hypoxaemia, particularly following major trauma.

  View details for Web of Science ID A1989T064000021

  View details for PubMedID 2923772

• DIFFUSION HYPOXIA - A REAPPRAISAL USING PULSE OXIMETRY JOURNAL OF CLINICAL MONITORING Brodsky, J. B., MCKLVEEN, R. E., ZELCER, J., MARGARY, J. J. 1988; 4 (4): 244-246

  Abstract

  Sixty healthy surgical patients were monitored during surgery with a pulse oximeter. At the completion of the operation, nitrous oxide and oxygen were discontinued abruptly in 50 of these patients. During air breathing, a small drop in arterial hemoglobin oxygen saturation (SaO2), to about 4% below preoperative values, was observed in all patients. In 10 patients, only oxygen was given before removal of the mask. There was no sudden drop in SaO2 in these patients, but by 5 minutes after discontinuation there was no difference between the two groups of patients--SaO2 was reduced 2 to 3% below preoperative values in both groups. For patients without cardiopulmonary disease, the phenomenon of "diffusion hypoxia" is a mild and transient event. Clinically significant hypoxemia (SaO2 less than 90%) after removal of nitrous oxide/oxygen at the completion of the anesthetic occurred in 3 patients (6%) and was associated with airway obstruction in each case.

  View details for Web of Science ID A1988Q419800003

  View details for PubMedID 3193147

• CAUDAL EPIDURAL MORPHINE FOR POST-THORACOTOMY PAIN ANESTHESIA AND ANALGESIA Brodsky, J. B., KRETZSCHMAR, K. M., Mark, J. B. 1988; 67 (4): 409-410

  View details for Web of Science ID A1988M768100023

  View details for PubMedID 3354877

• Con: proper positioning of a double-lumen endobronchial tube can only be accomplished with the use of endoscopy. Journal of cardiothoracic anesthesia Brodsky, J. B. 1988; 2 (1): 105-109

  View details for PubMedID 2979124

• Nitrous oxide and male fertility. Reproductive toxicology Buckley, D. N., Brodsky, J. B. 1987; 1 (2): 93-97

  View details for PubMedID 2980375

• SPERM STUDIES IN ANESTHESIOLOGISTS Wyrobek, A. J., Brodsky, J. B., Moore, D., WATCHMAKER, G., Cohen, E. N. WILLIAMS & WILKINS. 1981: 281-281

  View details for Web of Science ID A1981LL61600085

• SPERM STUDIES IN ANESTHESIOLOGISTS ANESTHESIOLOGY Wyrobek, A. J., Brodsky, J., Gordon, L., Moore, D. H., WATCHMAKER, G., Cohen, E. N. 1981; 55 (5): 527-532

  Abstract

  Semen samples were collected from 46 anesthesiologists each of whom had worked a minimum of one year in hospital operating rooms ventilated with modern gas-scavenging devices. Samples collected from 26 beginning residents in anesthesiology served as controls. Concentrations of sperm and percentages of sperm having abnormal head shapes were determined for each sample. No significant differences were found between anesthesiologists and beginning residents. Limiting the analyses to men having no confounding factors (varicocele, recent illness, medications, heavy smoking, frequent sauna use) did not change the results. The sperm concentration and morphology in 13 men did not change significantly after one year of exposure to anesthetic gases. However, the group of mean who had one or more confounding factors (excluding exposure to anesthetic gases) showed significantly higher percentages of sperm abnormalities than did the group of men without such factors. These results suggest that limited exposure to anesthetic gases does not significantly affect sperm production as judged by changes in sperm concentration and morphology. These data are reassuring, but since the hospitals surveyed used modern gas-scavenging devices, men who are occupationally exposed to anesthetic gases without this protection should be studied for fuller assessment of the possible human spermatotoxic effects.

  View details for Web of Science ID A1981MP58900008

  View details for PubMedID 7294406

• POSTOPERATIVE MUSCLE PAINS AND SUXAMETHONIUM BRITISH JOURNAL OF ANAESTHESIA Brodsky, J. B., Ehrenwerth, J. 1980; 52 (2): 215-218

  Abstract

  Two matched groups of patients with Hodgkin's disease undergoing a staging laparotomy received thiopentone, pancuronium bromide or suxamethonium 1.0 mg kg-1 (group 2) to facilitate tracheal intubation. There were no differences in the sites or degree of postoperative myalgia between the groups. It is concluded that efforts to reduce the frequency of suxamethonium muscle pains in patients having major abdominal operations are not justified.

  View details for Web of Science ID A1980JE97400012

  View details for PubMedID 7362724

• DOES SELF-TAMING WITH SUCCINYLCHOLINE PREVENT POST-OPERATIVE MYALGIA ANESTHESIOLOGY Brodsky, J. B., BROCKUTNE, J. G. 1979; 50 (3): 265-267

  View details for Web of Science ID A1979GP62000027

  View details for PubMedID 434522

• PANCURONIUM PRETREATMENT AND POST-SUCCINYLCHOLINE MYALGIAS ANESTHESIOLOGY Brodsky, J. B., BROCKUTNE, J. G., SAMUELS, S. I. 1979; 51 (3): 259-261

  View details for Web of Science ID A1979HL46100017

  View details for PubMedID 475029

• MIXING LOCAL-ANESTHETICS BRITISH JOURNAL OF ANAESTHESIA Brodsky, J. B., BROCKUTNE, J. G. 1978; 50 (12): 1269-1269

  View details for Web of Science ID A1978GD35900024

  View details for PubMedID 34414