Anuj Aggarwal

All Publications

• Evidence for Continuing Buprenorphine in the Perioperative Period. The Clinical journal of pain Li, A. H., Schmiesing, C., Aggarwal, A. K. 2020

  Abstract

  OBJECTIVES: Given there are conflicting recommendations for the perioperative management of buprenorphine, we conducted a retrospective cohort study of our surgery patients on buprenorphine whose baseline dose had been preoperatively continued, tapered or discontinued.METHODS: With IRB approval, we reviewed charts from January 1, 2013 to June 30, 2016 of patients on buprenorphine who had received elective surgery at Stanford Healthcare. Our primary outcome of interest was the change in pain score, defined as mean postoperative pain score - preoperative pain score. We also collected data on patients' tapering procedure and any postoperative non-buprenorphine opioid requirements.RESULTS: Out of approximately 1200 patients on buprenorphine, 121 had surgery of which 50 were admitted and included in the study. Perioperative continuation of transdermal buprenorphine resulted in a lower change in pain score postoperatively (0.606±0.878) than discontinuation (4.83±1.23, P=0.012). Among sublingual patients, there was no difference in the change in pain score between those who were tapered to a non-zero dose versus discontinued (P=0.55). Continuation of sublingual buprenorphine resulted in fewer non-buprenorphine scheduled opioid prescriptions than its taper or discontinuation (P=0.028). Finally, tapers were performed with great variability in the tapering team and rate of taper.DISCUSSION: Based on our findings, we implemented a policy at our institution for the continuation of perioperative buprenorphine whenever possible. Our work reveals crucial targets for the education of perioperative healthcare providers and the importance of coordination amongst all perioperative services and providers.

  View details for DOI 10.1097/AJP.0000000000000858

  View details for PubMedID 32520814

• Comparison of intravenous lidocaine versus epidural anesthesia for traumatic rib fracture pain: a retrospective cohort study. Regional anesthesia and pain medicine Lii, T. R., Aggarwal, A. K. 2020

  Abstract

  BACKGROUND: Effective analgesia is essential in managing traumatic rib fractures. Intravenous lidocaine (IVL) is effective in treating perioperative pain, acute pain in the emergency department, cancer pain in hospice, and outpatient chronic neuropathic pain. Our study examined the associations between IVL versus epidural analgesia (EA) and pain for the treatment of acute rib fracture in the inpatient setting.METHODS: We performed a retrospective study involving adults admitted to an academic level I trauma center from June 1, 2011 to June 1, 2016 with consults to the pain service for acute rib fracture pain. Eighty-nine patients were included in the final analysis (54 IVL and 35 EA patients). Both groups had usual access to opioid medications. The primary outcome was absolute change in numeric pain scores during 0-24 and 24-48hours after initiating IVL or EA, compared with baseline. Secondary outcomes include opioid consumption, incentive spirometry, supplemental oxygens, pneumonia, endotracheal intubation and length of hospital stay.RESULTS: Numeric pain scores differed at baseline (mean 5.6 for IVL vs 4.5 for EA, p=0.01), while age, injury severity, and number of fractured ribs were similar. IVL and EA were associated with similar reductions in numeric pain scores within 0-24 and 24-48hours (mean -2.9 for IVL vs -2.3 for EA during both periods, p=0.19and p=0.17 respectively) . There was greater non-neuraxial opioid consumption with IVL compared with EA (98.6 vs 22.3 mg morphine equivalents (MME) at 0-24hours, p=0.0005; 105.6 vs 18.9 MME at 24-48hours, p<0.0001). When epidural opioids were analyzed, the EA group was exposed to higher total MME at 0-24hours (655.2 vs 98.6 MME, p<0.0001) and 24-48hours (586 vs 105.6 MME, p=0.0001), suggesting an opioid sparing effect of IVL.CONCLUSION: Our results suggest that IVL is similar to EA in numeric pain score reduction, and that IVL may have an opioid sparing effect when taking neuraxial opioids into account. IVL may be an effective alternative to epidurals for the treatment of rib fracture pain. It should be considered for patients who have contraindications to epidurals or are unable to receive an epidural in a timely manner.

  View details for DOI 10.1136/rapm-2019-101120

  View details for PubMedID 32503863

• INTRAVENOUS LIDOCAINE INFUSION FOR MANAGEMENT OF PAIN IN THE INTENSIVE CARE UNIT Jung, S., Ottestad, E., Aggarwal, A., Flood, P., Nikitenko, V. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000530000201415

• Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy. Anesthesiology clinics Harrison, T. K., Kornfeld, H., Aggarwal, A. K., Lembke, A. 2018; 36 (3): 345?59

  Abstract

  As part of a national effort to combat the current US opioid epidemic, use of currently Food and Drug Administration-approved drugs for the treatment of opioid use disorder/opioid addiction (buprenorphine, methadone, and naltrexone) is on the rise. To provide optimal pain control and minimize the risk of relapse and overdose, providers need to have an in-depth understanding of how to manage these medications in the perioperative setting. This article reviews key principles and discusses perioperative considerations for patients with opioid use disorder on buprenorphine, methadone, or naltrexone.

  View details for PubMedID 30092933

• Qualitative Assessment of Clerkship Students' Perspectives of the Topics of Pain and Addiction in their Preclinical Curriculum Academic Psychiatry Raber, I., Ball, A., Papac, J., Aggarwal, A., Sussman, R., Basaviah, P., Newmark, J., Lembke, A. 2018: 664?67

  Abstract

  A majority of physicians feel poorly trained in the treatment of chronic pain and addiction. As such, it is critical that medical students receive appropriate education in both pain management and addiction. The purpose of this study was to assess the pre-clinical curriculum in pain medicine and addiction from the perspective of students after they had completed their pre-clinical training and to assess what they perceived as the strengths and weaknesses of their training.The authors conducted focused interviews among clinical medical students who had completed at least 6 months of clerkships. The interviews targeted the students' retrospective opinions about the pre-clinical curriculum and their preparedness for clinical encounters with either pain or addiction-related issues during their rotations. Coders thematically analyzed the de-identified interview transcripts, with consensus reached through discussion and code modification.Themes that emerged through the focused interviews included: fragmented curricular structure (and insufficient time) for pain and addiction medicine, not enough specific treatment strategies for pain or addiction, especially for complex clinical scenarios, and lack of a trained work-force to provide guidance in the management of pain and addiction.This study demonstrated the feasibility of gathering student perspectives to inform changes to improve the pre-clinical curriculum in pain and addiction medicine. Students identified multiple areas for improvement at the pre-clerkship level, which have informed updates to the curriculum. More research is needed to determine if curricular changes based on student feedback lead to improved learning outcomes.

  View details for DOI 10.1007/s40596-018-0927-1

• Qualitative Assessment of Clerkship Students' Perspectives of the Topics of Pain and Addiction in their Preclinical Curriculum. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Raber, I., Ball, A., Papac, J., Aggarwal, A., Sussman, R., Basaviah, P., Newmark, J., Lembke, A. 2018; 42 (5): 664?67

  Abstract

  A majority of physicians feel poorly trained in the treatment of chronic pain and addiction. As such, it is critical that medical students receive appropriate education in both pain management and addiction. The purpose of this study was to assess the pre-clinical curriculum in pain medicine and addiction from the perspective of students after they had completed their pre-clinical training and to assess what they perceived as the strengths and weaknesses of their training.The authors conducted focused interviews among clinical medical students who had completed at least 6 months of clerkships. The interviews targeted the students' retrospective opinions about the pre-clinical curriculum and their preparedness for clinical encounters with either pain or addiction-related issues during their rotations. Coders thematically analyzed the de-identified interview transcripts, with consensus reached through discussion and code modification.Themes that emerged through the focused interviews included: fragmented curricular structure (and insufficient time) for pain and addiction medicine, not enough specific treatment strategies for pain or addiction, especially for complex clinical scenarios, and lack of a trained work-force to provide guidance in the management of pain and addiction.This study demonstrated the feasibility of gathering student perspectives to inform changes to improve the pre-clinical curriculum in pain and addiction medicine. Students identified multiple areas for improvement at the pre-clerkship level, which have informed updates to the curriculum. More research is needed to determine if curricular changes based on student feedback lead to improved learning outcomes.

  View details for PubMedID 29704194

• Ehlers Danlos, POTS, and Occult Cerebrospinal Fluid Leak: A Case Report Journal of Anesthesia Pain Medicine Aggarwal, A. K., Carroll, I. 2017; 2 (1)
• Subpleural Cystic Lung Disease In Severe H1n1 Influenza-Induced Acute Respiratory Distress Syndrome (ards) Matusov, Y., Aggarwal, A., Sager, J. S. AMER THORACIC SOC. 2016

  View details for Web of Science ID 000390749601034

• Effect of General Anesthesia in Infancy on Long-Term Recognition Memory in Humans and Rats NEUROPSYCHOPHARMACOLOGY Stratmann, G., Lee, J., Sall, J. W., Lee, B. H., Alvi, R. S., Shih, J., Rowe, A. M., Ramage, T. M., Chang, F. L., Alexander, T. G., Lempert, D. K., Lin, N., Siu, K. H., Elphick, S. A., Wong, A., Schnair, C. I., Vu, A. F., Chan, J. T., Zai, H., Wong, M. K., Anthony, A. M., Barbour, K. C., Ben-Tzur, D., Kazarian, N. E., Lee, J. Y., Shen, J. R., Liu, E., Behniwal, G. S., Lammers, C. R., Quinones, Z., Aggarwal, A., Cedars, E., Yonelinas, A. P., Ghetti, S. 2014; 39 (10): 2275-2287

  Abstract

  Anesthesia in infancy impairs performance in recognition memory tasks in mammalian animals, but it is unknown if this occurs in humans. Successful recognition can be based on stimulus familiarity or recollection of event details. Several brain structures involved in recollection are affected by anesthesia-induced neurodegeneration in animals. Therefore, we hypothesized that anesthesia in infancy impairs recollection later in life in humans and rats. Twenty eight children ages 6-11 who had undergone a procedure requiring general anesthesia before age 1 were compared with 28 age- and gender-matched children who had not undergone anesthesia. Recollection and familiarity were assessed in an object recognition memory test using receiver operator characteristic analysis. In addition, IQ and Child Behavior Checklist scores were assessed. In parallel, thirty three 7-day-old rats were randomized to receive anesthesia or sham anesthesia. Over 10 months, recollection and familiarity were assessed using an odor recognition test. We found that anesthetized children had significantly lower recollection scores and were impaired at recollecting associative information compared with controls. Familiarity, IQ, and Child Behavior Checklist scores were not different between groups. In rats, anesthetized subjects had significantly lower recollection scores than controls while familiarity was unaffected. Rats that had undergone tissue injury during anesthesia had similar recollection indices as rats that had been anesthetized without tissue injury. These findings suggest that general anesthesia in infancy impairs recollection later in life in humans and rats. In rats, this effect is independent of underlying disease or tissue injury.

  View details for DOI 10.1038/npp.2014.134

  View details for Web of Science ID 000340308400002

  View details for PubMedID 24910347

• Demographic Factors Affect Willingness to Register as an Organ Donor More Than a Personal Relationship with a Transplant Candidate DIGESTIVE DISEASES AND SCIENCES Regalia, K., Zheng, P., Sillau, S., Aggarwal, A., Bellevue, O., Fix, O. K., Prinz, J., Dunn, S., Biggins, S. W. 2014; 59 (7): 1386-1391

  Abstract

  Transplant candidate caregivers (TCCs) are an under-utilized but potentially devoted pool of advocates who themselves may be recruited to register for deceased organ donation.The purpose of this study was to assess and compare recruitment barriers to deceased donor registration efforts in TCCs and health fair attendees (HFAs).A 42-item questionnaire assessing willingness to register as an organ donor and perceptions and knowledge about organ donation was administered to 452 participants (174 in Denver, 278 in San Francisco). Logistic regression, stratified by study site, was used to assess associations between explanatory variables and willingness to register as an organ donor.In Denver, 83 % of TCCs versus 68 % of HFAs indicated a willingness to register (p = 0.03). Controlling for study group (TCC vs HFA), predictors of willingness to register were female gender [odds ratio (OR) 2.4], Caucasian race (OR 2.3), college graduate (OR 11.1), married (OR 2.4) and higher positive perception of organ donation (OR 1.2), each p < 0.05. In San Francisco, 58 % of TCCs versus 70 % of HFAs indicated a willingness to register (p = 0.03). Controlling for study group (TCC vs HFA), predictors of willingness to register were Caucasian race (OR 3.5), college graduate (OR 2.2), married (OR 1.9), higher knowledge (OR 1.6) and higher positive perception of organ donation (OR 1.2), each p < 0.05. In both locales, Caucasians were more likely to have positive perceptions about organ donation and were more willing to register.Demographic characteristics, not personal connection to a transplant candidate, explain willingness to register as an organ donor.

  View details for DOI 10.1007/s10620-014-3053-2

  View details for Web of Science ID 000338344500011

  View details for PubMedID 24519521

  View details for PubMedCentralID PMC4071122

• Mental Illness Among Us: A New Curriculum to Reduce Mental Illness Stigma Among Medical Students ACADEMIC PSYCHIATRY Aggarwal, A. K., Thompson, M., Falik, R., Shaw, A., O'Sullivan, P., Lowenstein, D. H. 2013; 37 (6): 385?91

  Abstract

  Medical students have been shown to have high levels of psychological distress, including self-stigmatization and unwillingness to seek care. The authors hypothesized that a student-led curriculum involving personal mental illness experience, given during the first-year neuroscience course, and titled "Mental Illness Among Us (MIAU)," would reduce stigma of mental illness.In 2010 and 2011, students completed voluntary pre- and post-MIAU surveys measuring attitudes regarding mental illness in relation to MIAU. Also, in 2011, the authors categorized topics mentioned in student responses to an open-ended, free-response question on the course final examination.Of 298 enrolled students, 250 submitted surveys that were matched pre- and post-intervention. Participants in the curriculum showed a significant difference in Social Distance, indicating an increased willingness to interact with individuals with mental illness, and a significant difference in the Mental Illness: Clinicians' Attitudes (MICA) score representing a stronger agreement with positive statements regarding mental illness. The non-participants' scores showed no changes in measures from pre- to post. Respondents most frequently reported that the neuroscience course prepared them to be a physician because it taught about compassion and the importance of treating the whole patient.The results indicate that participation in MIAU leads to a decrease in stigmatization of mental illness and a greater sense of compassion among UCSF medical students. This finding is consistent with previous research suggesting social and cognitive congruence among peers and peer-teachers can result in meaningful learning experiences. MIAU may represent a sustainable model to supplement current systems to promote well-being of medical trainees.

  View details for DOI 10.1007/BF03340074

  View details for Web of Science ID 000326561500004

  View details for PubMedID 24185285