Bio

Clinical Focus


  • Anesthesia

Academic Appointments


Professional Education


  • Medical Education:Aberdeen University Medical School (1988) Scotland
  • Residency:Royal Hallamshire Hospital (1997) UK
  • Residency:York District Hospial (1992) England
  • Internship:Pinderfields General Hospital (1989) United Kingdom

Research & Scholarship

Clinical Trials


  • Postoperative Pain and Functional Patient Outcomes After Functional Endoscopic Sinus Surgery Not Recruiting

    The aim of the study is to quantify postoperative pain after functional endoscopic sinus surgery (FESS) and investigate whether preemptive analgesia may positively impact intraoperative anesthetic management, decrease patient postoperative pain and discomfort, and improve patient functional outcomes.

    Stanford is currently not accepting patients for this trial. For more information, please contact David Drover, (650) 725 - 0364.

    View full details

Publications

Journal Articles


  • ED50 and ED95 of Intrathecal Bupivacaine in Morbidly Obese Patients Undergoing Cesarean Delivery ANESTHESIOLOGY Carvalho, B., Collins, J., Drover, D. R., Ralls, L. A., Riley, E. T. 2011; 114 (3): 529-535

    Abstract

    It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients.Morbidly obese parturients (body mass index equal to or more than 40) undergoing elective cesarean delivery were enrolled in this double-blinded study. Forty-two patients were randomly assigned to receive intrathecal hyperbaric bupivacaine in doses of 5, 6, 7, 8, 9, 10, or 11 mg (n = 6 per group) coadministered with 200 ?g morphine and 10 ?g fentanyl. Success (induction) was defined as block height to pinprick equal to or more than T6 and success (operation) as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED(50)/ED(95) values were determined using a logistic regression model.ED(50) and ED(95) (with 95% confidence intervals) for success (operation) were 9.8 (8.6-11.0) and 15.0 (10.0-20.0), respectively, and were similar to corresponding values of a nonobese population determined previously using similar methodology. We were unable to measure ED(50)/ED(95) values for success (induction) because so few blocks failed initially, even at the low-dose range. There were no differences with regard to secondary outcomes (i.e., hypotension, vasopressor use, nausea, and vomiting).Obese and nonobese patients undergoing cesarean delivery do not appear to respond differently to modest doses of intrathecal bupivacaine. This dose-response study suggests that doses of intrathecal bupivacaine less than 10 mg may not adequately ensure successful intraoperative anesthesia. Even when the initial block obtained with a low dose is satisfactory, it will not guarantee adequate anesthesia throughout surgery.

    View details for DOI 10.1097/ALN.0b013e318209a92d

    View details for Web of Science ID 000287660300012

    View details for PubMedID 21307769

  • Securing the airway of a 'super sized' patient: another use for the Aintree Catheter (R) EUROPEAN JOURNAL OF ANAESTHESIOLOGY Schmiesing, C., Collins, J., Ottestad, E., Kulkarni, V., Brock-Utne, J. 2006; 23 (12): 1064-1066

    View details for Web of Science ID 000242303600016

    View details for PubMedID 17042968

  • 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

  • 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

  • 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

Conference Proceedings


  • The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery Cho, D., Drover, D. R., Nekhendzy, V., Butwick, A. J., Collins, J., Hwang, P. H. WILEY-BLACKWELL. 2011: 212-218

    Abstract

    The sphenopalatine ganglion block (SPGB) with local anesthetic is used to treat facial pain and headache of various etiologies; it has been widely used during functional endoscopic sinus surgery (FESS). The purpose of this study was to investigate whether preemptive SPGB may positively impact postoperative pain and functional outcomes after FESS.A prospective, double-blind, randomized, placebo-controlled study was performed. A total of 60 patients (18-70 years), undergoing general anesthesia for bilateral FESS, were randomly assigned to receive SPGB with either 2 mL 0.25% bupivacaine with epinephrine 1:100,000 (BP, treatment group) or normal saline (NS, control group). SPGB was performed preemptively 10 minutes before the start of surgery. Preoperative and postoperative (day 0, day 7, and day 30) visual analog pain scale, Sino-Nasal Outcome Test (SNOT-20), computed tomography (CT) and endoscopic scores were compared between the 2 groups.A total of 29 patients were enrolled in BP, and 27 were enrolled in NS. Three patients withdrew from the study, and 1 was withdrawn by the investigator due to severe hypertension after induction of anesthesia. There were no differences in patient demographic characteristics between the study groups. On day 7, the mean visual analog pain scales were 1.12 ± 0.3 in NS and 0.48 ± 0.23 in BP (p = 0.053). There were no statistical differences in other outcome measures (SNOT-20, CT and endoscopic scores) between the 2 groups.A limited trend toward reduced postoperative pain after FESS was noted with bupivacaine compared to saline, but statistical significance was not achieved. Preemptive SPGB may offer sinonasal symptomatic benefits for patients undergoing FESS, but larger studies are warranted.

    View details for DOI 10.1002/alr.20040

    View details for Web of Science ID 000308912700014

    View details for PubMedID 22287376

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