Jessica Brodt

All Publications

• Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report. A&A practice McAvoy, J., Jaffe, R., Brock-Utne, J., Lopez, J., Brodt, J. 2019

  Abstract

  Cerebral oximetry is commonly being advocated as a monitor for regional cerebral tissue oxygenation during cardiac surgery. We have increasing concern about the accuracy of this monitor, including the current systems entering the market, with new probes and algorithms. We present 2 cases where cerebral oximetry failed to accurately portray cerebral oxygenation. In the current form, cerebral oximetry may at best be an expensive tool without any benefit on outcomes. In addition, it may contribute to misleading and confusing clinical data.

  View details for PubMedID 30663993

• Opioid-Free Ultra-Fast-Track On-Pump Coronary Artery Bypass Grafting Using Erector Spinae Plane Catheters. Journal of cardiothoracic and vascular anesthesia Chanowski, E. J., Horn, J., Boyd, J. H., Tsui, B. C., Brodt, J. L. 2018

  View details for PubMedID 30424939

• Case Report of an Awake Craniotomy in a Patient With Eisenmenger Syndrome. A&A practice Heifets, B. D., Crawford, E., Jackson, E., Brodt, J., Jaffe, R. A., Burbridge, M. A. 2018; 10 (9): 219–22

  Abstract

  We present a detailed report of an awake craniotomy for recurrent third ventricular colloid cyst in a patient with severe pulmonary arterial hypertension in the setting of Eisenmenger syndrome, performed 6 weeks after we managed the same patient for a more conservative procedure. This patient has a high risk of perioperative mortality and may be particularly susceptible to perioperative hemodynamic changes or fluid shifts. The risks of general anesthesia induction and emergence must be balanced against the risks inherent in an awake craniotomy on a per case basis.

  View details for PubMedID 29708913

• Where the Cath Lab and the Pump Room Meet: Anesthesia for Hybrid Procedures. International anesthesiology clinics Brodt, J. L. 2018; 56 (4): 64–73

  View details for PubMedID 30204608

• Case Report of an Awake Craniotomy in a Patient With Eisenmenger Syndrome. A & A case reports Heifets, B. D., Crawford, E., Jackson, E., Brodt, J., Jaffe, R. A., Burbridge, M. A. 2017

  Abstract

  We present a detailed report of an awake craniotomy for recurrent third ventricular colloid cyst in a patient with severe pulmonary arterial hypertension in the setting of Eisenmenger syndrome, performed 6 weeks after we managed the same patient for a more conservative procedure. This patient has a high risk of perioperative mortality and may be particularly susceptible to perioperative hemodynamic changes or fluid shifts. The risks of general anesthesia induction and emergence must be balanced against the risks inherent in an awake craniotomy on a per case basis.

  View details for DOI 10.1213/XAA.0000000000000664

  View details for PubMedID 29135526

• Changes in cerebral oxygen saturation during transcatheter aortic valve replacement. Journal of clinical monitoring and computing Brodt, J., Vladinov, G., Castillo-Pedraza, C., Cooper, L., Maratea, E. 2016; 30 (5): 649-653

  Abstract

  Cerebral oxygen saturation (rSO2) is a non-invasive monitor used to monitor cerebral oxygen balance and perfusion. Decreases in rSO2 >20 % from baseline have been associated with cerebral ischemia and increased perioperative morbidity. During transcatheter aortic valve replacement (TAVR), hemodynamic manipulation with ventricular pacing up to 180 beats per minute is necessary for valve deployment. The magnitude and duration of rSO2 change during this manipulation is unclear. In this small case series, changes in rSO2 in patients undergoing TAVR are investigated. Ten ASA IV patients undergoing TAVR with general anesthesia at a university hospital were prospectively observed. Cerebral oximetry values were analyzed at four points: pre-procedure (baseline), after tracheal intubation, during valve deployment, and at procedure end. Baseline rSO2 values were 54.5 ± 6.9 %. After induction of general anesthesia, rSO2 increased to a mean of 66.0 ± 6.7 %. During valve deployment, the mean rSO2 decreased <20 % below baseline to 48.5 ± 13.4 %. In two patients, rSO2 decreased >20 % of baseline. Cerebral oxygenation returned to post-induction values in all patients 13 ± 10 min after valve deployment. At procedure end, the mean rSO2 was 67.6 ± 8.1 %. As expected, rapid ventricular pacing resulting in the desired decrease in cardiac output during valve deployment was associated with a significant decrease in rSO2 compared to post-induction values. However, despite increased post-induction values in all patients, whether related to increased inspired oxygen fraction or reduced cerebral oxygen consumption under anesthesia, two patients experienced a significant decrease in rSO2 compared to baseline. Recovery to baseline was not immediate, and took up to 20 min in three patients. Furthermore, baseline rSO2 in this population was at the lower limit of the published normal range. Significant cerebral desaturation during valve deployment may potentially be limited by maximizing rSO2 after anesthetic induction. Future studies should attempt to correlate recovery in rSO2 with recovery of hemodynamics and cardiac function, provide detailed neurological assessments pre and post procedure, determine the most effective method of maximizing rSO2 prior to hemodynamic manipulation, and provide the most rapid method of recovery of rSO2 following valve deployment.

  View details for DOI 10.1007/s10877-015-9758-8

  View details for PubMedID 26969373

• Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery. Annals of cardiac anaesthesia Degnan, M., Brodt, J., Rodriguez-Blanco, Y. 2016; 19 (4): 676-686

  Abstract

  The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery.This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality.Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable.During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure.At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.

  View details for DOI 10.4103/0971-9784.191545

  View details for PubMedID 27716699

• Ventriculoperitoneal Shunt Insertion Under Monitored Anesthesia Care in a Patient With Severe Pulmonary Hypertension. A & A case reports Burbridge, M. A., Brodt, J., Jaffe, R. A. 2016; 7 (2): 27-29

  Abstract

  A 32-year-old man with severe pulmonary arterial hypertension and Eisenmenger syndrome secondary to congenital ventricular septal defects presented for ventriculoperitoneal shunt insertion. Consultation between surgical and anesthesia teams acknowledged the extreme risk of performing this case, but given ongoing symptoms related to increased intracranial pressure from a large third ventricle colloid cyst, the case was deemed urgent. After a full discussion with the patient, including an explanation of anesthetic expectations and perioperative risks, the case was performed under monitored anesthesia care. Anesthetic management included high-flow nasal cannula oxygen with capnography and arterial blood pressure monitoring, dexmedetomidine infusion, boluses of midazolam and ketamine, and local anesthetic infiltration of the cranial and abdominal incisions as well as the catheter track. Hemodynamic support was provided with an epinephrine infusion, small vasopressin boluses, and inhaled nitric oxide. The patient recovered without any significant problems and was discharged home on postoperative day 3.

  View details for DOI 10.1213/XAA.0000000000000329

  View details for PubMedID 27224039

• Scleroderma and pulmonary hypertension complicating two pregnancies: use of neuraxial anesthesia, general anesthesia, epoprostenol and a multidisciplinary approach for cesarean delivery INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA Moaveni, D., Cohn, J., BRODT, J., Hoctor, K., Ranasinghe, J. 2015; 24 (4): 375-387

  Abstract

  Literature regarding the anesthetic care of patients with scleroderma during labor and delivery is limited to remote case reports. No recent publications provide information on the anesthetic management of patients with coexisting pulmonary hypertension. This report describes the anesthetic and multidisciplinary management of two pregnant patients with concomitant scleroderma and pulmonary hypertension undergoing cesarean delivery; one with neuraxial anesthesia and one with general anesthesia. Considerations for neuraxial and general anesthesia in patients with concurrent scleroderma and pulmonary hypertension are discussed.

  View details for DOI 10.1016/j.ijoa.2015.08.015

  View details for Web of Science ID 000364255300011

  View details for PubMedID 26119257

• Orbital Compartment Syndrome Following Extracorporeal Support JOURNAL OF CARDIAC SURGERY Brodt, J., Gologorsky, D., Walter, S., Pham, S. M., Gologorsky, E. 2013; 28 (5): 522-524

  Abstract

  Orbital compartment syndrome (OCS) is a rare, catastrophic, but potentially treatable complication. It requires prompt diagnosis and immediate intervention, as critical period for possible functional recovery is very short. This report adds to our understanding of potential mechanisms of perioperative blindness, and suggests extracorporeal circulatory support, systemic inflammatory response, and massive blood and fluid resuscitation as potential risk factors for perioperative OCS.

  View details for DOI 10.1111/jocs.12196

  View details for Web of Science ID 000324070400013

  View details for PubMedID 23898881

• Subclavian Vein Catheterization, Chapter 3 Anesthesia Unplugged Brodt, J., Diez, C. McGraw-Hill Professional. 2012; 2
• The omega-atracotoxins: Selective blockers of insect M-LVA and HVA calcium channels BIOCHEMICAL PHARMACOLOGY Chong, Y., Hayes, J. L., Sollod, B., Wen, S., Wilson, D. T., Hains, P. G., Hodgson, W. C., Broady, K. W., King, G. F., Nicholson, G. M. 2007; 74 (4): 623-638

  Abstract

  The omega-atracotoxins (omega-ACTX) are a family of arthropod-selective peptide neurotoxins from Australian funnel-web spider venoms (Hexathelidae: Atracinae) that are candidates for development as biopesticides. We isolated a 37-residue insect-selective neurotoxin, omega-ACTX-Ar1a, from the venom of the Sydney funnel-web spider Atrax robustus, with high homology to several previously characterized members of the omega-ACTX-1 family. The peptide induced potent excitatory symptoms, followed by flaccid paralysis leading to death, in acute toxicity tests in house crickets. Using isolated smooth and skeletal nerve-muscle preparations, the toxin was shown to lack overt vertebrate toxicity at concentrations up to 1 microM. To further characterize the target of the omega-ACTXs, voltage-clamp analysis using the whole-cell patch-clamp technique was undertaken using cockroach dorsal unpaired median neurons. It is shown here for the first time that omega-ACTX-Ar1a, and its homolog omega-ACTX-Hv1a from Hadronyche versuta, reversibly block both mid-low- (M-LVA) and high-voltage-activated (HVA) insect calcium channel (Ca(v)) currents. This block occurred in the absence of alterations in the voltage-dependence of Ca(v) channel activation, and was voltage-independent, suggesting that omega-ACTX-1 family toxins are pore blockers rather than gating modifiers. At a concentration of 1 microM omega-ACTX-Ar1a failed to significantly affect global K(v) channel currents. However, 1 microM omega-ACTX-Ar1a caused a modest 18% block of insect Na(v) channel currents, similar to the minor block of Na(v) channels reported for other insect Ca(v) channel blockers such as omega-agatoxin IVA. These findings validate both M-LVA and HVA Ca(v) channels as potential targets for insecticides.

  View details for DOI 10.1016/j.bcp.2007.05.017

  View details for Web of Science ID 000248657900009

  View details for PubMedID 17610847