2022
Response to comment on: “Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65”
Bardia A, Akhtar S, Schonberger RB. Response to comment on: “Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65”. Journal Of Clinical Anesthesia 2022, 81: 110911. PMID: 35780644, PMCID: PMC11146281, DOI: 10.1016/j.jclinane.2022.110911.Peer-Reviewed Original ResearchAssociation of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65
Schonberger RB, Dai F, Michel G, Vaughn MT, Burg MM, Mathis M, Kheterpal S, Akhtar S, Shah N, Bardia A. Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65. Journal Of Clinical Anesthesia 2022, 80: 110846. PMID: 35489305, PMCID: PMC11150018, DOI: 10.1016/j.jclinane.2022.110846.Peer-Reviewed Original ResearchConceptsPropofol induction doseGeneral anesthetic inductionSevere hypotensionInduction doseBlood pressure measurementsYears of ageSurgical patientsEndotracheal intubationAnesthetic inductionInvasive blood pressure measurementsGeriatric surgical patientsNon-vascular surgeryDose of propofolNon-invasive blood pressure measurementBlood pressure dropSignificant independent associationPostoperative morbidityRetrospective observationalTotal patientsMulticenter cohortPrimary outcomeAnesthesia inductionPrimary exposureIndependent associationSurgical incision
2021
Preoperative evaluation of geriatric patients undergoing liver transplantation
Akhtar S. Preoperative evaluation of geriatric patients undergoing liver transplantation. Current Opinion In Anaesthesiology 2021, 35: 96-104. PMID: 34878418, DOI: 10.1097/aco.0000000000001084.Peer-Reviewed Original ResearchConceptsLiver transplantationNonalcoholic steatohepatitisGeriatric patientsElderly patientsPreoperative evaluationIncidence of NASHAge-related physiological changesPercent of patientsHepatitis C virusPortopulmonary hypertensionCirrhotic cardiomyopathyHepatopulmonary syndromeMultiple comorbiditiesPulmonary evaluationMetabolic syndromeFrailty evaluationPractice advisoryHepatocellular carcinomaPatientsTransplantationSyndromePhysiological changesHypertensionComorbiditiesSteatohepatitisVariation in propofol induction doses administered to surgical patients over age 65
Schonberger RB, Bardia A, Dai F, Michel G, Yanez D, Curtis JP, Vaughn MT, Burg MM, Mathis M, Kheterpal S, Akhtar S, Shah N. Variation in propofol induction doses administered to surgical patients over age 65. Journal Of The American Geriatrics Society 2021, 69: 2195-2209. PMID: 33788251, PMCID: PMC8373684, DOI: 10.1111/jgs.17139.Peer-Reviewed Original ResearchConceptsPropofol induction dosesInduction dosesEndotracheal intubationGeneral anesthetic inductionPropofol induction dosePercent of patientsRetrospective observational studyLarge multicenter cohortSurgical patientsMulticenter cohortPropofol doseBolus doseGeneral anesthesiaInduction dosePropofol inductionPresent studyAnesthetic inductionDose administrationAdvanced agePatient variablesObservational studyProvider practicesAnaesthetic practiceClinical consequencesDosing decisions
2020
Regional Anesthesia is Underutilized for Carotid Endarterectomy Despite Improved Perioperative Outcomes Compared with General Anesthesia
Lumas S, Hsiang W, Akhtar S, Ochoa Chaar CI. Regional Anesthesia is Underutilized for Carotid Endarterectomy Despite Improved Perioperative Outcomes Compared with General Anesthesia. Annals Of Vascular Surgery 2020, 73: 336-343. PMID: 33373769, DOI: 10.1016/j.avsg.2020.11.035.Peer-Reviewed Original ResearchConceptsNational Surgical Quality Improvement ProgramCarotid endarterectomyGeneral anesthesiaRegional anesthesiaImproved outcomesSurgeons National Surgical Quality Improvement ProgramChronic obstructive pulmonary diseaseOutcomes of CEASurgical Quality Improvement ProgramCombined end pointObstructive pulmonary diseaseChoice of anestheticQuality Improvement ProgramAnesthesia typeHospital lengthPerioperative outcomesBaseline characteristicsPatient characteristicsCarotid surgeryHeart failurePropensity matchingPulmonary diseaseGA patientsMyocardial infarctionAmerican CollegeAn Analysis of Anesthesia Induction Dosing in Female Older Adults
Chen EY, Michel G, Zhou B, Dai F, Akhtar S, Schonberger RB. An Analysis of Anesthesia Induction Dosing in Female Older Adults. Drugs & Aging 2020, 37: 435-446. PMID: 32300966, PMCID: PMC7359723, DOI: 10.1007/s40266-020-00760-3.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPostinduction hypotensionGeneral anesthesiaPresent cohortPostoperative acute kidney injuryLarge tertiary teaching hospitalOlder adultsFrailty of patientsGynecologic oncology surgeryImmediate hemodynamic effectsPropofol induction dosesPercentage of patientsRetrospective observational studyTertiary teaching hospitalPerioperative vital signsHigher propofol dosesFemale older adultsAKI associationInotrope administrationKidney injurySurgical populationHemodynamic effectsDose adjustmentPrimary outcomeFemale patients
2017
Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery
Tantawy H, Li A, Dai F, Elgammal M, Sukumar N, Elefteriades J, Akhtar S. Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery. Journal Of Cardiothoracic And Vascular Anesthesia 2017, 32: 1225-1232. PMID: 29402623, DOI: 10.1053/j.jvca.2017.12.033.Peer-Reviewed Original ResearchConceptsCoronary artery bypass graft surgeryPacked red blood cellsArtery bypass graft surgeryRed blood cell transfusionTertiary care academic medical centerBypass graft surgeryBlood cell transfusionAcademic medical centerMortality rateCABG surgeryCell transfusionGraft surgeryMedical CenterAdult cardiac surgery patientsLong-term mortality outcomesRetrospective medical record reviewCardiothoracic intensive care unitPropensity Score Matching AnalysisCardiac surgery patientsLong-term mortalityMedical record reviewIntensive care unitSignificant differencesStatistical significant differenceHospital mortalityA Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia
Chen EY, Sukumar N, Dai F, Akhtar S, Schonberger RB. A Pilot Analysis of the Association Between Types of Monitored Anesthesia Care Drugs and Outcomes in Transfemoral Aortic Valve Replacement Performed Without General Anesthesia. Journal Of Cardiothoracic And Vascular Anesthesia 2017, 32: 666-671. PMID: 29277298, PMCID: PMC5766429, DOI: 10.1053/j.jvca.2017.07.009.Peer-Reviewed Original ResearchConceptsTransfemoral aortic valve replacementMonitored Anesthesia CareAortic valve replacementGeneral anesthesiaValve replacementAge incrementsMedication dose adjustmentUse of dexmedetomidineRetrospective observational studyType of sedationTertiary teaching hospitalHospital lengthPostoperative deliriumTAVR patientsDose adjustmentConscious sedationAnesthesia careCare drugsPossible differential effectsTeaching hospitalObservational studyAnesthetic agentsDose reductionDrug dosingPilot analysis
2016
A Retrospective Observational Study of Anesthetic Induction Dosing Practices in Female Elderly Surgical Patients: Are We Overdosing Older Patients?
Akhtar S, Heng J, Dai F, Schonberger RB, Burg MM. A Retrospective Observational Study of Anesthetic Induction Dosing Practices in Female Elderly Surgical Patients: Are We Overdosing Older Patients? Drugs & Aging 2016, 33: 737-746. PMID: 27581549, DOI: 10.1007/s40266-016-0394-x.Peer-Reviewed Original ResearchConceptsDoses of fentanylOlder patientsFemale patientsInduction dosesGeneral anesthesiaObservational studyTertiary care academic hospitalElderly surgical patientsIncidence of hypotensionDose of propofolRetrospective observational studyOld female patientIntravenous anesthetic agentPost-induction hypotensionAge-associated differencesQuality improvement effortsResultsOlder patientsVasopressor therapyElderly patientsSurgical patientsYounger patientsBlood pressureHemodynamic outcomesASA-PSStudy designWeDoes intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice
Akhtar S, Liu J, Heng J, Dai F, Schonberger RB, Burg MM. Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice. Journal Of Clinical Anesthesia 2016, 33: 208-215. PMID: 27555166, DOI: 10.1016/j.jclinane.2016.02.001.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAgingAlgorithmsAnesthesia, IntravenousAnesthetics, IntravenousBody WeightDigestive System Surgical ProceduresFemaleFentanylGuidelines as TopicHumansHypotensionIntraoperative ComplicationsMaleMidazolamMiddle AgedPropofolRetrospective StudiesSeverity of Illness IndexConceptsASA-PS classAge groupsInduction dosesSurgical proceduresAnesthesiologists physical status classMean arterial pressure changesYounger groupOlder groupAge-adjusted doseRate of hypotensionMean arterial pressureRetrospective chart reviewAnesthetic induction agentGastrointestinal surgical proceduresArterial pressure changesGI surgical proceduresAcademic medical centerCochran-Armitage trend testDifferent age groupsPostinduction hypotensionOlder patientsAdult patientsArterial pressureChart reviewIntravenous induction
2015
Geriatric Pharmacology
Akhtar S, Ramani R. Geriatric Pharmacology. Anesthesiology Clinics 2015, 33: 457-469. PMID: 26315631, DOI: 10.1016/j.anclin.2015.05.004.Peer-Reviewed Original ResearchConceptsElderly patientsLong-term outcomesEnd-organ sensitivityFurther pharmacologic studiesOlder patientsAnesthetic medicationsGeriatric pharmacologyPharmacologic studiesAnesthetic drugsPatientsDrug overdosingDecreased volumePhysiologic processesContinuous variablesTrue extentMedicationsAnesthetics
2014
Guidelines and Perioperative Care of the Elderly
Akhtar S. Guidelines and Perioperative Care of the Elderly. International Anesthesiology Clinics 2014, 52: 64-76. PMID: 25268865, DOI: 10.1097/aia.0000000000000033.Peer-Reviewed Original Research
2009
Fat Embolism
Akhtar S. Fat Embolism. Anesthesiology Clinics 2009, 27: 533-550. PMID: 19825491, DOI: 10.1016/j.anclin.2009.07.018.Peer-Reviewed Original ResearchConceptsFat embolism syndromeFat embolismProgressive respiratory insufficiencyHours of injuryPetechial rashClinical sequelaeRespiratory insufficiencyClinical presentationSerious manifestationsMental statusOrthopedic injuriesClinical signsLung microcirculationEmbolismPathologic consequencesInjuryFat dropletsRashSequelaePrognosisPathophysiologySyndromeEtiologyInsufficiencyMicrocirculation
2008
Preoperative β-blocker use: impact of national guidelines on clinical practice
Akhtar S, Assaad, Amin M, Holt NF, Barash PG, Silverman DG. Preoperative β-blocker use: impact of national guidelines on clinical practice. Journal Of Clinical Anesthesia 2008, 20: 122-128. PMID: 18410867, DOI: 10.1016/j.jclinane.2007.09.012.Peer-Reviewed Original ResearchConceptsBeta-blocker groupPost-guideline patientsPre-guideline groupVascular surgery patientsCoronary artery bypassTarget HRArtery bypassSurgery patientsPerioperative beta-blocker therapyPreoperative beta-blocker useTertiary care teaching hospitalMean HRElective vascular surgeryPost-guideline groupVascular surgery groupBeta-blocker therapyBeta-blocker useUnpaired t-testEligible patientsSurgery groupPreanesthetic evaluationVascular surgeryPresurgical patientsTeaching hospitalObservational study
2007
An Inflammatory Pathway of IFN-γ Production in Coronary Atherosclerosis
Ranjbaran H, Sokol SI, Gallo A, Eid RE, Iakimov AO, D’Alessio A, Kapoor JR, Akhtar S, Howes CJ, Aslan M, Pfau S, Pober JS, Tellides G. An Inflammatory Pathway of IFN-γ Production in Coronary Atherosclerosis. The Journal Of Immunology 2007, 178: 592-604. PMID: 17182600, DOI: 10.4049/jimmunol.178.1.592.Peer-Reviewed Original ResearchConceptsIL-12/ILIFN-gamma-inducible chemokinesCoronary atherosclerosisIL-12IL-18IFN-gammaPlasma levelsT cellsTh1-type cytokine productionHuman atherosclerotic coronary arteriesAcute coronary syndromeSubset of patientsHuman coronary atherosclerosisTh1-type cytokinesC-reactive proteinIFN-γ productionElevated plasma levelsPlasma of patientsInnate immune responseAtherosclerotic coronary arteriesCoronary syndromeSystemic inflammationCardiac catheterizationCardiopulmonary bypassGamma secretion
2005
Intermittent Cardiac Troponin-I Screening is an Effective Means of Surveillance for a Perioperative Myocardial Infarction
Martinez EA, Nass CM, Jermyn RM, Rosenbaum SH, Akhtar S, Chan DW, Malkus H, Weiss JL, Fleisher LA. Intermittent Cardiac Troponin-I Screening is an Effective Means of Surveillance for a Perioperative Myocardial Infarction. Journal Of Cardiothoracic And Vascular Anesthesia 2005, 19: 577-582. PMID: 16202889, DOI: 10.1053/j.jvca.2005.07.002.Peer-Reviewed Original ResearchConceptsHigh diagnostic yieldPositive predictive valueDiagnosis of MIPostoperative day 1Myocardial infarctionDiagnostic yieldCardiac troponinNoncardiac surgeryCardiac injuryCreatine kinaseDay 1Surveillance strategiesIncidence of MIPerioperative cardiac injuryHigh-risk patientsPerioperative myocardial infarctionSubset of patientsIU/LGreater positive predictive valueTotal creatine kinaseCK-MB massCardiac protein markersPerioperative incidencePerioperative surveillanceCohort studyPreoperative β-blocker use: is titration to a heart rate of 60 beats per minute a consistently attainable goal?
Akhtar S, Amin M, Tantawy H, Senior A, Barash PG, Silverman DG. Preoperative β-blocker use: is titration to a heart rate of 60 beats per minute a consistently attainable goal? Journal Of Clinical Anesthesia 2005, 17: 191-197. PMID: 15896586, DOI: 10.1016/j.jclinane.2004.06.020.Peer-Reviewed Original ResearchConceptsPreinduction heart ratePerioperative beta-blocker useBeta-blocker useHeart rateCABG patientsEligible patientsSurgery patientsCoronary artery bypass graft surgeryArtery bypass graft surgeryTertiary care teaching hospitalBeta-blocker intoleranceCABG surgery patientsBeta-blocker therapyBypass graft surgeryVascular surgery patientsRetrospective observational studyUnpaired t-testBlocker groupGraft surgeryNoncardiac surgeryVascular patientsVascular surgeryTeaching hospitalObservational studyCurrent recommendations
1999
The Effect of Heart Rate Control on Myocardial Ischemia Among High-Risk Patients After Vascular Surgery
Raby K, Brull S, Timimi F, Akhtar S, Rosenbaum S, Naimi C, Whittemore A. The Effect of Heart Rate Control on Myocardial Ischemia Among High-Risk Patients After Vascular Surgery. Anesthesia & Analgesia 1999, 88: 477-482.. DOI: 10.1213/00000539-199903000-00002.Peer-Reviewed Original ResearchConceptsHeart rate controlMean heart ratePostoperative cardiac eventsHigh-risk patientsST-segment depressionIschemic thresholdPostoperative ischemiaMyocardial ischemiaVascular surgeryHeart rateCardiac eventsEsmolol patientsPlacebo patientsPreoperative ischemiaCardiac complicationsHigh riskHigh-risk vascular surgery patientsBeta-adrenergic blocker therapyMajor postoperative cardiac eventsStrict heart rate controlElective vascular surgeryIncidence of ischemiaPostoperative heart ratePostoperative myocardial ischemiaPreoperative myocardial ischemiaThe effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery.
Raby K, Brull S, Timimi F, Akhtar S, Rosenbaum S, Naimi C, Whittemore A. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesthesia & Analgesia 1999, 88: 477-82. PMID: 10071990, DOI: 10.1097/00000539-199903000-00002.Peer-Reviewed Original ResearchConceptsHeart rate controlMean heart ratePostoperative cardiac eventsHigh-risk patientsST-segment depressionIschemic thresholdPostoperative ischemiaMyocardial ischemiaVascular surgeryHeart rateCardiac eventsEsmolol patientsPlacebo patientsPreoperative ischemiaCardiac complicationsHigh riskHigh-risk vascular surgery patientsBeta-adrenergic blocker therapyMajor postoperative cardiac eventsStrict heart rate controlElective vascular surgeryIncidence of ischemiaPostoperative heart ratePostoperative myocardial ischemiaPreoperative myocardial ischemia