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 ResearchRelationship Between Glucose Time in Range in Diabetic and Non-Diabetic Patients and Mortality in Critically Ill Patients
Ammar MA, Ammar AA, Wee T, Deshpande R, Band M, Akhtar S. Relationship Between Glucose Time in Range in Diabetic and Non-Diabetic Patients and Mortality in Critically Ill Patients. Journal Of Intensive Care Medicine 2022, 37: 1625-1633. PMID: 35491687, DOI: 10.1177/08850666221098383.Peer-Reviewed Original ResearchConceptsNon-diabetic patientsBlood glucose rangeDiabetic patientsIll patientsGlucose rangeTIR 70Hospital mortalityMortality rateHospital mortality rateNon-diabetic cohortLower mortality rateAdult patientsCohort studyMortality benefitSingle centerGlucose timePercentage of timeHigh incidencePatientsMortalityDlLtDiabeticsICUHyperglycemiaAssociation 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
Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience
Raredon MSB, Fisher C, Heerdt PM, Schonberger RB, Nargi A, Nivison S, Fajardo E, Deshpande R, Akhtar S, Greaney AM, Belter J, Raredon T, Zinter J, McKee A, Michalski M, Baevova P, Niklason LE. Pressure-Regulated Ventilator Splitting for Disaster Relief: Design, Testing, and Clinical Experience. Anesthesia & Analgesia 2021, 134: 1094-1105. PMID: 34928890, DOI: 10.1213/ane.0000000000005825.Peer-Reviewed Original ResearchConceptsPositive end-expiratory pressureClinical experienceIndividualized positive end-expiratory pressureIntensive care unitEnd-expiratory pressureCoronavirus disease 2019 (COVID-19) pandemicHealth care teamDisease 2019 pandemicVentilatory supportIll patientsCare unitCare teamVentilator sharingFuture clinical applicationsPatientsIndependent careVentilator capacityClinical applicationCOVID-19 pandemicVentilatorClinical environmentOutline recommendationsMass traumaPandemicHospitalPreoperative 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 changesHypertensionComorbiditiesSteatohepatitisReply to: Comment on: Variation in propofol induction doses administered to surgical patients over 65
Akhtar S, Bardia A, Schonberger RB. Reply to: Comment on: Variation in propofol induction doses administered to surgical patients over 65. Journal Of The American Geriatrics Society 2021, 69: 2680-2681. PMID: 34185888, PMCID: PMC8440365, DOI: 10.1111/jgs.17327.Peer-Reviewed Original ResearchVariation 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
2018
Pharmacological considerations in the elderly
Akhtar S. Pharmacological considerations in the elderly. Current Opinion In Anaesthesiology 2018, 31: 11-18. PMID: 29189287, DOI: 10.1097/aco.0000000000000544.Peer-Reviewed Original ResearchConceptsAnesthetic drugsNeurophysiological changesPoor perioperative outcomesCurrent practice patternsLarge database studiesDepth of anesthesiaIntraoperative hypotensionPerioperative outcomesElderly patientsAnesthetic medicationsDose adjustmentCNS depressionGeriatric patientsPractice patternsDrug managementPharmacologic studiesReceptor levelsPharmacological considerationsCurrent recommendationsDatabase studyElderly populationFunctional connectivityAnesthetic dosingHypotensionDrugs
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
Case 3–2015 Preventing Adverse Outcomes in the Very Elderly Cardiac Surgical Patients
Akhtar S, Morris B, Roy R, Balogun SA. Case 3–2015 Preventing Adverse Outcomes in the Very Elderly Cardiac Surgical Patients. Journal Of Cardiothoracic And Vascular Anesthesia 2014, 29: 510-521. PMID: 25440648, DOI: 10.1053/j.jvca.2014.07.014.Peer-Reviewed Original ResearchUtility of ultrasound in the ICU
Deshpande R, Akhtar S, Haddadin AS. Utility of ultrasound in the ICU. Current Opinion In Anaesthesiology 2014, 27: 123-132. PMID: 24589673, DOI: 10.1097/aco.0000000000000057.Peer-Reviewed Original ResearchConceptsAcute care settingPerioperative periodCare settingsAxillary vein cannulationUtility of ultrasoundImportant diagnostic modalityLung recruitmentPerioperative managementExtubation strategyUnstable patientsAbdominal examinationInferior venaDiaphragmatic movementLung ultrasoundVascular diseaseEndotracheal tubeCritical patientsVein cannulationCardiopulmonary resuscitationUltrasound guidanceDiagnostic modalitiesCare ultrasoundCardiac structureAbdominal organsPatient careGuidelines 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
2011
Perioperative glycemic management in 2011
Maerz LL, Akhtar S. Perioperative glycemic management in 2011. Current Opinion In Critical Care 2011, 17: 370-375. PMID: 21734491, DOI: 10.1097/mcc.0b013e328348beb7.Peer-Reviewed Original ResearchConceptsIntensive insulin therapyInsulin infusion protocolBlood glucose targetsAcute care settingGlycemic managementGlucose targetsCare settingsTarget blood glucose levelsAppropriate glycemic managementNICE-SUGAR trialPerioperative glycemic managementIncidence of hypoglycemiaBlood glucose levelsBlood glucose rangeLandmark studiesInsulin therapyPerioperative periodIntensive carePatient populationGlucose variabilityInfusion protocolGlucose levelsGlucose monitoring devicesGlucose rangeICU
2010
Coronary stents: factors contributing to perioperative major adverse cardiovascular events
Barash P, Akhtar S. Coronary stents: factors contributing to perioperative major adverse cardiovascular events. British Journal Of Anaesthesia 2010, 105: i3-i15. PMID: 21148653, DOI: 10.1093/bja/aeq318.Peer-Reviewed Original ResearchConceptsMajor adverse cardiovascular eventsAdverse cardiovascular eventsCardiovascular eventsStent thrombosisRisk factorsPerioperative major adverse cardiovascular eventsContinuation of aspirinDual antiplatelet therapyNon-cardiac surgeryRisk of bleedingPercutaneous coronary interventionCoronary blood flowMajor risk factorDominant risk factorBare metal stentsDrug-eluting stentsNeuraxial anesthetic techniquesHigh mortality rateClopidogrel therapyAntiplatelet therapyCoronary interventionEpidural haematomaElective surgeryAnesthetic techniqueMyocardial ischaemia