A1098 Factors Associated With Difficult Endotracheal Tube Passage Through the Glottis With Use of the GlideScope® System
   Samuel A. Schechtman, M.D., Michael R. Mathis, M.D., Amy Shanks, Ph.D., Aleda Thompson, M.S., Geoffrey Muller, M.B.,Ch.B., Benjamin J. Stam, M.D., Kevin K. Tremper, M.D.,Ph.D., David Healy, M.D.
   Successful GlideScope® use has been attributed to an improved view of the glottis secondary to its angulated blade and video capabilities. In contrast to direct laryngoscopy, one mechanism of failure happens during endotracheal tube passage despite a good glottic view1. The current study examines the occurrence of difficult video laryngoscopic view and difficult tube passage encountered during GlideScope® use. Specific predictors of difficult endotracheal tube passage were identified in our study of 6,097 GlideScope® attempts. The study revealed an 11% difficult endotracheal tube passage incidence with a 0.4% overall procedural failure rate. Independent risk factors predicting difficulty during GlideScope® video laryngoscopy included female gender and laryngoscopic grade views (2a, 2b, and 3). View:
A1099 Realtime Double Lumen Endobronchial Tube Insertion Using Wireless Malleable Videostylet
   Ping-Tang Chen, M.D.
   Abstract Summary:<br></br>Optimal position of double lumen endotracheal tube (DLET) is crucial in one lung ventilation. The new wireless malleable videostylet placed in the tracheal lumen could provide realtime DLET insertion to be clinically useful in facilitating correct placement of DLET and decreasing the intubation time. Acoustic and bronchoscopic confirmation of correct endobronchial position is no longer required for the new method. View:
A1100 Mechanical Strain to Maxillary Incisors During Direct Laryngoscopy
   Milo Engoren, M.D., Lauryn R. Rochlen, M.D., Matthew V. Diehl, M.S., Sarah Stojsih, M.S., Elizabeth Jewell, M.S., Mary Golinski, C.R.N.A, John M. Cavanaugh, M.D.
   During oral endotracheal intubation, the laryngoscope may contact the teeth and produce damage. Using a mannequin model of 4 different direct laryngoscopy techniques, we measured the strain produced on the maxillary incisors and found that intubators with high strain with one technique tended to have high strain with other techniques. A protective pad decreased strain rate but not strain. View:
A1101 Efficacy of Pharyngeal Oxygen Delivery is Dependent on Oxygen Mask System
   Alexander Y. Fu, M.D., Jeffrey R. Kirsch, M.D.
   A wide variety of oxygen delivery systems are used to treat or prevent hypoxemia. Our knowledge of FiO2 delivered by the OxyMask is based on gas sampled at the patient&#8217;s lips. It is unknown if FiO2 at the lips is predictive of FiO2 measured at the pharynx. We recruited 10 healthy volunteers to test whether FiO2 measured at the patient&#8217;s lips was predictive of FiO2 measured at the pharynx for four commonly used oxygen mask systems at high flow rates. We found that pharyngeal FiO2 is significantly lower than that measured at the lips for the simple mask, non-rebreather mask, and OxyMask. Both the simple and non-rebreather masks deliver significantly greater pharyngeal FiO2 than the OxyMask at high oxygen flow rates. Pharyngeal FiO2 should be used as the benchmark for any newly developed masks in the future. View:
A1102 Association of Cerebral and Muscular Tissue Oxygen Saturation With Perioperative Outcomes in Major Spine Surgery
   Lingzhong Meng, M.D., Jerry Xiao, B.S., Koa Gudelunas, B.S., Zhaoxia Yu, Ph.D., Shaun E. Gruenbaum, M.D., Philip E. Bickler, M.D., Xiao Hu, Ph.D.
   Tissue oxygenation is associated with perioperative outcomes including LOH, length of ICU stay, and composite complication. Covariates derived from tissue oxygenation monitoring have prognostic value of the perioperative outcome. Tissue oxygenation monitored at a peripheral location (e.g. SmtO2 on the leg) is a valuable addition to that monitored at a central location (SctO2 on the forehead). View:
A1103 Impact of Continuous Perioperative SpHb Monitoring
   Nathalie Nathan, M.D., Sebastien Ponsonnard, M.D., Sandra Yonnet, M.D., Fran[ent]#231;ois Dalmay, Ph.D., Benoit Marin, M.D., Anais Drouet, M.D.
   Monitoring SpHb and PVI integrated in a vascular filling algorithm allowed earlier transfusion and reduces mortality View:
A1104 Evaluation of End-tidal CO2 Measurement During Supplemental Oxygen Delivery Using a Prototype Intelligent Oxygen Flowmeter
   Joseph A. Orr, Ph.D., Kyle M. Burk, B.S.
   Supplemental oxygen given through a nasal cannula causes errors in end-tidal CO<sub>2</sub> measurement. We evaluated a prototype system that only gives oxygen during the inspiratory phase of the breath in volunteers. No oxygen induced errors in end-tidal CO<sub>2</sub> were observed using the prototype system. View:
A1105 Post-Operative Hypoxia During Transport to the PACU in Patients Monitored With Continuous Pulse Oximetry
   Olga Eydlin, M.D., Levon M. Capan, M.D., Andrew D. Rosenberg, M.D., Germaine Cuff, Ph.D., Samuel M. Galoyan, M.D.
   This study examined the incidence of post-operative hypoxia during transport to the PACU. All patients that received an anesthetic for a procedure or surgery at our institution (n=3,440) from September 2015 to March 2016 were monitored with a portable pulse-oximeter during transport to the PACU. SpO2 values were recorded prior to leaving the OR, during transport and immediately upon arrival to PACU. Cases were examined based on level of experience of the transporter, ASA classification, type of anesthetic and the presence of co-morbidities. Additionally, we evaluated whether the patient was transported intubated or spontaneously breathing on room air versus supplemental oxygen. View:
A1128 Predictors of Difficult Acute-Angle Video Laryngoscopy: A Secondary Analysis From a Large Comparative Video Laryngoscopy Trial
   Michael F. Aziz, M.D., Emine Bayman, Ph.D., Michael M. Van Tienderen, B.S., Michael M. Todd, M.D., Ron O. Abrons, M.D., Davide Cattano, M.D.,Ph.D., David E. Swanson, M.D., Carin A. Hagberg, M.D., Ansgar Brambrink, M.D.,Ph.D.
   Predictors of difficult acute angle video laryngoscopy are identified from a secondary analysis of a large clinical trial. The supine sniffing position is associated with greater difficulty than other patient positions during airway management, and can be easily avoided. View:
A1129 Modified Stylet Angulation Reduced Time to Intubation With the GlideScope&#174; in Asian Population
   Hyun-Chang Kim, M.D.
   In summary, the use of modified 60&#176; angle stylet decreased the time to intubation with the GlideScope&#174; and the intubation difficulty in Asian Population, suggesting that the modified 60&#176; angle stylet is superior to the conventional 90&#176; angel stylet. We recommend use of modified 60&#176; angle stylet for intubation by the GlideScope&#174; in Asian population. View:
A1130 A Randomized Clinical Trial Investigating the C-MAC Videolaryngoscope for Emergent Rapid Sequence Induction
   Kurt Ruetzler, M.D., Simon Sulser, M.D., Dirk Ubmann, M.D., Martin Schlaepfer, M.D., Leif Saager, M.D.
   We performed a randomized clinicla trial investigating the hypothesis, that C-MAC videolaryngoscopes improves first-attempt intubation success rate in the emergency room setting<br></br>Our study demonstrates that visualization of the vocal cords was clearly improved using the C-MAC videolaryngoscopy, compared to direct laryngoscopy. Although this was not associated with increased successful first-attempt intubation, we suggest implementing videolaryngoscopes as the standard first-line intubation tool in the emergency department. View:
A1131 Comparison of Blind Intubation Through i-gelTM and Through Air-QTM With Different Types of Tracheal Tube (Parker Frex-TipTM Tracheal Tube and Standard Tube): A Manikin Study
   Soshi Iwasaki, M.D.,Ph.D., Takahashi Kazunobu, M.D.,Ph.D., Michiaki Yamakage, M.D.,Ph.D.
   Summary: Blind intubation through i-gelTM and that trough air-QTM with different types of tracheal tube were compared. No superiority of the P tube was seen in the manikin study. When using either of the SGAs, the rate of successful intubation was about 70% in this manikin model. By adjusting the depth by evaluating the results, the success rate of blind intubation through SGAs can be increased. View:
A1132 Laryngeal Mucosal Pressure Exerted by i-gelTM: An Experimental Study in Japanese Human Cadavers
   Tomohiko Kimijima, M.D., Mitsutaka Edanaga, M.D.,Ph.D., Michiaki Yamakage, M.D.,Ph.D.
   In this experimental study, we investigated direct laryngeal mucosal pressure exerted by i-gelTM in Japanese human cadavers. Measurement was done with DigiTacts sensorTM (models #5421 and 5422, two of each; Pressure Profile Systems Inc., CA) that was attached to the cuff of the i-gel. Mucosal pressure exerted by the i-gel was different depending on gender, and there was an area on which relatively high pressure was exerted in female cadavers. Therefore, there might be room for improvement of the SAD to make it suitable for Japanese patients. View:
A1133 Comparison of Performance of I-gel, Supreme and Proseal Laryngeal Mask Airways in Elective Surgery
   Geoffrey Liew, M.B.,B.Ch., Jia Xin Chai, M.B.,B.S., Harikrishnan Kothandan, M.B.,B.S.
   The Supreme, i-gel and Proseal are second-generation supraglottic airways. We test the hypothesis that there are differences in performance among the devices during spontaneous ventilation anesthesia. 150 patients who underwent general anesthesia for elective surgery were randomly allocated into three groups, comparing the three devices in terms of oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion and airway safety. In conclusion, we have demonstrated that the Proseal, Supreme and i-gel provide a safe airway in our study. We have also shown that the three devices were comparable in terms of ease and duration of placement, but the i-gel was superior and more favourable with regards to initial oropharyngeal leak pressures and airway morbidity compared with the Proseal and Supreme. View:
A1134 Effectiveness and Hemodynamic Response With Non-traumatic Flexible Metallic Guide Blind Intubation Versus Ligthed Stylet Intubation Techniques
   Oswaldo Amaya, M.D., Enrique Arango, M.D., Leopoldo Ferrer, M.D., William Amaya, M.D., Daniela Baron, M.D.
   We present a randomized, controlled, double blind study of 224 patients in which we compare the success rate at the first attempt and the hemodynamic response of a Non-traumatic Flexible Metallic Guide Blind Intubation Technique with the already known Lighted Stylet Intubation Technique. This study demonstrates that there are no differences between both techniques, making this new approach useful in situations in which there are no conventional devices available. View:
A1135 Comparing Hemodynamic Responses After Orotracheal Intubation Between the Shikani Stylet and Macintosh Laryngoscope
   Lorenzo C. Rafer, M.D., Srikantha Rao, M.B.,B.S., Octavio Falcucci, M.D., Sonia Vaida, M.D.
   This prospective randomized clinical trial compared the hemodynamic response to intubation between the Macintosh laryngoscope and Shikani optical stylet in patients with normal airways. View:
A1136 Relationship Between Intracuff Pressure of the Endotracheal Tube and Exerted Pressure on the Inner Tracheal Wall
   Tomohiko Kimijima, M.D., Mitsutaka Edanaga, M.D.,Ph.D., Syunsuke Hayashi, No Degree, Michiaki Yamakage, M.D.,Ph.D.
   We measured directly measured exerted pressure on the tracheal wall by using special pressure sensors and a three-dimensional (3D) printed model of the human trachea. Exerted pressure on the tracheal wall of each endotracheal model increased gradually with increase (inflation) in intracuff pressure. Interestingly, there was no significant difference between tube size, tracheal size, or type of endotracheal tube. View:
A1137 Modifiable and Not Modifiable Risk Factors for Intraoperative Supraglottic Airway Devices Failure
   Andrea Vannucci, M.D., Isabella T. Rossi, MD, Govind . Rangrass, MD, David . DeCresce, MD, Daniel Brennan, D.Phil., Lashman Neel, Student, Dorina Kallogjeri, M.D., Daniel L. Helsten, M.D., Laura F. Cavallone, M.D.
   Supraglottic airways failure can be associated with severe perioperative complications. Identified risk factors for these occurrences are mainly patient or procedure-related, and therefore useful for risk stratification rather than for guiding intraoperative anesthetic management to minimize complications. This study aimed at identifying risk factors that are under the control of the anesthesia team and that can be modified in the clinical setting to prevent or mitigate those adverse events. Our results suggest that, there are a few risk factors for initial and intraoperative SGA failure that are under the control of the anesthesia team, such as the use of specific ventilation modes and inhalational agents. Dissemination and implementation of this new information, on modifiable risk factors for SGA failure may help reduce the incidence of occurrences. View:
A1138 Oxygen Reserve Index Provides Safer Airway Management During Awake Fiberoptic Intubation and Rapid Sequence Intubation: Case Series
   Naoyuki Hirata, M.D.,Ph.D., Tomohiro Chaki, M.D., Michiko Osuda, M.D., Michiaki Yamakage, M.D.,Ph.D.
   We used ORI monitoring during awake fiberoptic and rapid sequence intubation and established intubation without desaturation. ORI may enable optimal oxygenation in difficult and/or emergent airway management. View:
A1139 Reducing Operating Room Fire Risk: Development of the Fire Safety Oxygen Mask
   William C. Culp, M.D., Sarah Luna, A.A., Aris J. Maguddayao, A.A.
   Operating room fires are associated with open oxygen sources. The fire safety oxygen mask is a novel oxygen mask that ports excess oxygen away from the patient and surgical field. By avoiding oxygen contamination, operating room fire risk should be greatly reduced. View:
A1140 Extubation Strategy for Reconstructive Head and Neck (H&#38;N) Using the Cook Staged Extubation Set (SES)
   Carmen Lopez Soto, M.D., Helen Goddard, M.D.,F.R.C.A
   Management of the difficult airway (DA) should include a strategy for safer approach to both tracheal intubation and extubation. In the intra-oral Reconstructive Head and Neck (H&amp;N) surgery, the risk of re-intubation for post-operative complications is increased<br></br>The Staged Extubation Set (SES) can be used as part of a proactive extubation strategy by placing a wire that would remain in the airway and would help facilitate access if reintubation is needed. We retrospectively analysed its use in patients that underwent intra-oral reconstructive H&amp;N surgery to look for potential complications of its use. Major complications were not reported although minor effects like irritation of airway can be potentially common. SES can help maintaining access to airway for more than 6hr post-extubation.<br></br>Although further experience is needed, SES appears to be a useful, easy to use and safe device to be included in a proactive extubation strategy View:
A1141 Comparison of Internal Neck Anatomy With Extraglottic Airway Device Dimensions Using Radiographic Imaging
   Davide Cattano, M.D.,Ph.D., Steven Lee, B.S., Ruggero Corso, M.D., Carin A. Hagberg, M.D., Jacek A. Wojtczak, M.D.,Ph.D.
   Extraglottic airway devices (EADs) are important tools to maintain the airway during surgery. These devices vary according to design and sizing among different brands, which complicates the selection of these devices. Internal neck landmarks (INLs) have not been previously tested to show evidence toward the concordance with EADs. EAD dimensions significantly overestimate INLs.<b></b><br></br> View:
A1142 Individually Confirm the Depth of Endotracheal Tube by Ultrasound
   Yansong Li, Ph.D., Jing Wang, M.D., Xinchuan Wei, M.D., Haibo Song, M.D.,Ph.D., Yunxia Zuo, M.D.,Ph.D.
   This study aimed to prove if a novel approach could be used to individually confirm the depth of the endotracheal tube under the help of ultrasound. View:
A1143 Alkaline Battery Limitations Rapidly Affect Brightness of Halogen Laryngoscopes
   Isaac Luria, M.S., Nikolaus Gravenstein, M.D.
   The luminous intensity of a laryngoscope lamp is an important consideration in one&#8217;s ability to successfully intubate an airway during direct laryngoscopy. An alkaline battery&#8217;s capacity to maintain nominal voltage across electrodes is dependent on current load. This current-dependent voltage can lead to different brightness over time profiles for laryngoscope lamps. View:
A2017 Comparison of the FORE-SIGHT ELITE and the INVOS 5100C: Effects of Hemoglobin Concentration, Area of the Cerebrospinal Fluid Layer, and PaCO2 on rSO2 Values
   Tomoyuki Iwai, M.D., Kenji Yoshitani, M.D., Kohshi Hattori, M.D., Eiki Kanemaru, M.D., Yuki Nakamori, M.D., Yoshihiko Ohnishi, M.D.
   We compared FORE-SIGHT ELITE with INVOS-5100C to examine whether both devices are influenced by skull thickness (t-skull), cerebrospinal fluid layer (a-CSFL) and hemoglobin concentration.<br></br>40 patients were recruited. Regional cerebral oxygen saturation (rSO2) at forehead were measured sequentially by the two devices. Simultaneously, mean arterial pressure, hemoglobin concentration, and carbon dioxide partial pressure of arterial blood (PaCO2) were measured. The t-skull and a-CSFL were calculated by using computed tomography slice of the forehead.<br></br>Multiple regression analysis showed that a-CSFL ( r = -0.23, P = 0.02), Hemoglobin concentration (r = 3.78, P&#60; 0.001) were significant determinants of rSO2 measured by INVOS-5100C. On the other hand, PaCO2 (t= 3.55, P= 0.0011) was significant determinant of rSO2 measured by FORE-SIGHT ELITE. View:
A2018 Measurement of Non-Invasive Cerebral Flow During Hypocapnia &amp; Hypercapnia
   David B. MacLeod, M.B.,B.S., Daniel K. DeMasi, B.S., Antoinette Santoro, R.R.T.
   We measured the Ornim c-FLOW CFI during a change from deliberate hypocapnia to hypercapnia in a cohort of healthy volunteers. An increase in PaCO2 from 23 to 50 mmHg did not result in a significant change in CFI. View:
A2019 Frontal Electroencephalography Analysis With Empirical Mode Decomposition During Induction Period
   Alice Feng-Fang Tsai, M.D., Xiyuan Hu, Ph.D., Yi-Shiuan Lin, M.D., Shou-Zen Fan, M.D.,Ph.D.
   The results, suggest that facing the EEG signals, the IMFs are useful to determine the particular bandwidth changing in which synchronization phenomena occur. The HHT can decompose EEG and quantify the real-time frequency chance and energy change, which is more useful and practical for clinical design.<br></br>Anesthesiologists keep applying different tools on EEG analyze, the HHT can decompose EEG and quantify the real-time frequency chance and energy change, which is more useful and practical for clinical design. View:
A2020 The Validity of Entropy Values Obtained From a Laterofacial Electrodes
   Hisanori Yogo, M.D., Yusuke Kasuya, M.D.
   When it is difficult to attach an entropy sensor on the forehead because of the surgical field, the sensor needs to be dislocated. Response Entropy (RE) and State Entropy (SE) values from laterofacial region demonstrated high correlation with RE and SE values from standard forehead region. It might support potential clinical usefulness of the dislocated entropy sensor. View:
A2021 Agreement Between Analgesia/Nociception Index (ANI) and a New Photoplethysmographic Sensor (ANIp) for the Assessment of the Relative Parasympathetic Tone During General Anesthesia
   Emmanuel Boselli, M.D.,Ph.D., Julien de Jonckheere, Ph.D., Mathieu Jeanne, M.D.,Ph.D., Bernard Allaouchiche, M.D.,Ph.D., Lionel Bouvet, M.D.,Ph.D., R[ent]#233;gis Logier, Ph.D.
   The Analgesia/Nociception Index (ANI) is a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. A new photoplethysmographic sensor has been recently developed to measure the ANI from the pulse wave (ANIp), showing good agreement with ANI in healthy volunteers. We assessed the agreement between both methods during general anesthesia in 15 patients. We observed a positive linear relationship between ANIp and ANI with a mean bias of 4.4 (limits of agreement : -39.2 ; 48) and a percentage error of 60%. This study shows that the relative parasympathetic tone may be estimated using ANIp during general anesthesia. The large limits of agreement and the percentage error &gt;30% may not allow to conclude that both methods are interchangeable. These results are however encouraging to further evaluate the interest of ANIp in awake or anesthetized patients. View:
A2022 Comparison of Utility and Safety of Visual Evoked Potential Monitoring Using SightSaver&#8482; During Spine Surgeries
   Alberto A. Uribe, M.D., Ehud Mendel, M.D., Zoe A. Peters, B.A., Brooke E. McNermy, Student, Ana Mavarez, M.D., Alicia A. Gonzalez, M.D., Fabrizzio Sacchet, M.D., Muhammad Shabsigh, M.D., Mahmoud Abdel, M.S., Sergio D. Bergese, M.D.
   Our results showed that SightSaver&#8482; visual stimulator was a reliable method for eliciting intraoperative VEP. In addition, our data suggested that TIVA is associated with higher VEP amplitude and shorter latencies than balanced general anesthesia; therefore, TIVA is the most efficient anesthesia regimen for VEP monitoring. Further studies incorporating a larger variety of surgical procedures should be performed to better prove the efficiency and safety of SightSaver&#8482; visual stimulator. View:
A2023 A Novel Method for Quantifying the Depth of Anesthesia; Based on Physiological Signal Model
   Hyub Huh, M.D., Jang-Eun Cho, M.D.,Ph.D., Choon Hak Lim, M.D.,Ph.D., Hye Won Shin, M.D.,Ph.D., Hae Ja Lim, M.D.,Ph.D., Hye Won Lee, M.D.,Ph.D., Sung-Uk Choi, M.D.,Ph.D., Ji Yong Park, M.D.,Ph.D., Seung Zhoo Yoon, M.D.,Ph.D.
   The CAI based on a physiological signal model which suggests the intrinsic relationship between the depth of anesthesia and the waveform of EEG may be proposed as an anesthetic depth index. View:
A2024 Quantified Analgesic Effect of Intraoperative 50% N2O Inhalation by the NoL and ANI Nociception Indices
   Philippe G. Richebe, M.D.,Ph.D., Elizabeth Decary, M.D., Rami Issa, M.D., Sarah Maximos, M.S., Louis-Philippe Fortier, M.D.,Ph.D., Olivier Verdonck, M.D., M.S.
   These preliminary results (10 patients out of a total of 40 to be included) show that the analgesic effect of N2O set at ET of 50% is present and is well monitored by the NoL variations after standard stimulus. View:
A2025 Acute Opioid-Induced Respiratory Depression (OIRD): Serial Arterial Blood Gas Measurements Following Remifentanil 1 mcg/kg
   David B. MacLeod, M.B.,B.S., Daniel K. DeMasi, B.S., Antoinette Santoro, R.R.T.
   Administration of remifentanil bolus to healthy volunteers under conditions of normoxia and hyperoxia. View:
A2026 Accuracy of the Pulse Oximetry-derived Respiratory Rate: Comparison With Capnometry
   Hideaki Ebana, M.D., Masahiro Murakawa, M.D., Yoshie Noji, M.D., Keisuke Yoshida, M.D., Rieko Oishi, M.D., Yuzo Iseki, M.D., Makiko Hasegawa, M.D., Tsuyoshi Isosu, M.D.
   In the patients who underwent scheduled surgery under spinal anesthesia with intravenous propofol sedation, we compared the pulse oximetry-derived respiratory rate(RRpulse) with the respiratory rate measured using a capnography(RRcapno). The bias and precision (1SD) were 0.80(2.46) brpm for RRpluse compared with capnography. Bland-Altman plots showed limits of agreement of -4.75 to 4.91 brpm for RRpulse vs RRcapno. Differences in respiration rate of 3 brpm or more between the two devices led to 6.9 %. The pulse oximetry derived respiratory rate monitoring is useful as a new respiratory monitor during surgery and during treatment under sedation. View:
A2027 The Impact of Midazolam Premedication on Surgical Pleth Index: A Pilot Study
   Soeun Jeon, M.D., Hyeonjeong Lee, M.D., Hae-Kyu Kim, M.D.
   Premedication of midazolam does not affect SPI value. During the induction of anesthesia, SPI value demonstrated significant correlation with percent changes of mean blood pressure but not percentage changes of heart rate. In conclusion, SPI could be a predictive tool for changes of hemodynamics during induction of anesthesia. View:
A2028 Respiratory Well-being Index Messages Selected by Domain Experts
   Lara Brewer, Ph.D., Joseph A. Orr, Ph.D.
   <b>Summary:</b> We tested how often a new Respiratory Well-being Index System provided messages which concurred with domain expert opinion. View:
A2029 Fully Automated Anesthesia and Fluid Management Optimization Using Multiple Physiologic Closed-loop Systems in a Patient Undergoing a High-risk Surgery: A Case Report
   Alexandre P. Joosten, M.D., Amelie Delaporte, M.D., Maxime Cannesson, Ph.D., Joseph B. Rinehart, M.D., Luc Van Obbergh, Ph.D., Luc Barvais, Ph.D.
   Fully automated anesthesia View:
A2030 Performance Measures of a Novel Controller for Automated Titration of Vasopressor Infusion
   Michael Ma, B.S., Michael-David Calderon, B.S., Maxime Cannesson, M.D.,Ph.D., Joseph B. Rinehart, M.D.
   We developed a mixed proportional-integrative and rule-based controller for automatic titration of vasopressor infusion in critical care settings. The purpose of this analysis was to examine its performance. View:
A2031 Comparison Study Between Nellcor Respiration Rate Technology (RRoxi) and Masimo Acoustic Respiration Rate (RRa)
   Michal E. Eisenberg, M.D., Raz Levin, Ph.D., Dalia Givony, M.S., Frank J. Overdyk, M.D.
   Respiration rate (RR) is the most sensitive vital sign in aiding timely recognition of patient deterioration. This study was conducted to compare between RRoxi and RRa reliably. ASA I and II subjects were asked to breathe in low, normal and high RR. Additionally, the test devices were evaluated for their reliably when the subject performed daily activities. This study results suggests that RRoxi may be more accurate than RRa during development of bradypnea, and display a RR value more reliably during routine patient activities. View:
A2032 Superiority of Nellcor&#8482; PM1000N Versus Masimo Radical-7&#174; for Detecting Apnea in Volunteer
   Chanatthee Kitsiripant, M.D., Tomoko Fukada, M.D., Yuri Tsuchiya, D.D.S., Akiko Zaitsu, No Degree, Hiroko Iwakiri, M.D., Makoto Ozaki, M.D., Minoru Nomura, M.D.
   Masimo Radical-7&#174; is a superior monitor compared with Nellcor&#8482; PM1000N for detecting apnea in volunteers. View:
A3039 Blood Clotting Function and Platelet Function Monitoring by Sonoclot&#174; on the Day of the Operation After Discontinuation of Antiplatelet and Anticoagulant Administration
   Tomoe Hoshi, M.D., Mitsutaka Edanaga, M.D.,Ph.D., Ryoichi Kawaguchi, M.D.,Ph.D., Michiaki Yamakage, M.D.,Ph.D.
   There are currently no guidelines in Japan for regional anesthesia after discontinuation of antiplatelet and anticoagulant administration. We prospectively evaluated clotting function and platelet function determined by Sonoclot&#174; on the day of the operation after discontinuation of antiplatelet and anticoagulant administration for qualitative assessment of blood coagulation.<br></br>There were 5 patients who had abnormal values of platelet function even though standard blood analysis showed normal values in those patients. Therefore, our results suggested that point-care-of monitoring by a device such as Sonoclot&#174; might be necessary for the decision regarding adaptation of regional anesthesia after discontinuation of antiplatelet or/and anticoagulant administration. View:
A3040 Arterial and Venous Impacts of Transdermally Administered Vasodilators on the Local Microvasculature
   George Guo, B.A., Katherine Chuang, B.S., Nitin Sukumar, M.S., Feng Dai, Ph.D., David G. Silverman, M.D., Kirk H. Shelley, M.D.,Ph.D., Tyler J. Silverman, DPM, M.D., Aymen A. Alian, M.D.
   We aimed to better elucidate the effects of various transdermal vasodilators on the forehead microvasculature. Arteriolar and venule effects were characterized by AC and DC respectively using photoplethysmography. We found significant increases in AC with each drug but only significant AC and DC increases with NTG and observed rivastigmine to have a potentially slower vasodilatory effect on the microvasculature. View:
A3041 The Intraoperative Physiologic Changes of Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Prospective Observational Study
   Young Chul Yoo, M.D.,Ph.D., Myoung Hwa Kim, M.D., Ki Young Lee, M.D.,Ph.D., Yun Hee Kim, M.D., Na Hyun Min, M.D.
   During HIPEC, the anesthesiologists face the pathophysiological alterations including hyperdynamic circulation status, decreased microcirculation, and fluid shifting. View:
A3042 Acute Opioid-Induced Respiratory Depression (OIRD): Comparison of Integrated Pulmonary Index Under Conditions of Normoxia and Hyperoxia
   David B. MacLeod, M.B.,B.S., Antoinette Santoro, R.R.T., Daniel K. DeMasi, B.S.
   Comparison of respiratory index under different conditions of normoxia &amp; hyperoxia View:
A3043 Noninvasive Continuous Blood Pressure Monitoring Facilitates Earlier Detection of Hypotensive Events During Surgery
   Markus Hollmann, M.D.,Ph.D., Bart F. Geerts, M.D.,Ph.D., Christine Lee, M.Sc., Jos Settels, Ph.D., Feras Hatib, Ph.D., Denise Veelo, M.D.,Ph.D.
   Hypotension is independenty related to morbidity. We compared the amount of hypotensive events registered by brachial cuff (NIBP) as compared to continuous noninvasive BP (cNIBP). Of a total of 606, 212 (35%) hypotensive events were not registered with NIBP. Accordingly, cNIBP facilitates complete and early event detection and may be a useful addition in the perioperative care of patients without indication for an arterial line. View:
A3044 Validation of Inflationary Non-invasive Blood Pressure Monitoring in Small Children
   Mariko Hara, M.D., Osamu Uchida, M.D.
   Inflationary non-invasive blood pressure monitoring (iNIBP) is a new technology with which blood pressure is measured during inflation of a cuff. Validation study of iNIBP was performed in small children. Successful blood pressure measurement was achieved in 73% of the attempts in iNIBP. Time to determine blood pressure was significantly shorter in iNIBP than that in conventional NIBP. Inflationary NIBP can be applicable in small children. View:
A3045 The Effect of Bodyweight on Non-invasive Blood Pressure-derived Cardiac Output Calculations in Morbidly Obese Patients
   Chantal A. Boly, M.D., Floris van Raalten, M.D., Pieter Schraverus, M.D., Berend Westerhof, Ph.D., Jan-Willem Coumou, M.D., Christa Boer, Ph.D., Simone Van Kralingen, M.D.,Ph.D.
   Morbidly obese patients may benefit from non-invasive monitoring of cardiac output with the Nexfin device in the perioperative period, however agreement with thermodilution seems low. Here we demonstrate that the excessive bodyweight plays a role in this and that agreement improves when adjusted bodyweight is used as input in the Nexfin device. This implies that using derivatives of bodyweight instead of actual bodyweight may lead to more accurate intraoperative CO-monitoring in morbidly obese patients. View:
A3046 Bladder Pressure Measurement is Useful to Detect CO2 Gas-related Adverse Events During Peroral Endoscopic Myotomy
   Mari Ichimura, M.D., Makoto Sasoh, M.D., Emiko Toyama, M.D., Ryosuke Mimata, M.D., Kanefumi Yamashita, M.D.,Ph.D., Hironari Shiwaku, M.D., Yuichi Yamashita, M.D.,Ph.D., Ken Yamaura, M.D.,Ph.D.
   We verified the usability of bladder pressure monitoring as an index of the pneumoperitoneum during peroral endoscopic myotomy (POEM).<br></br>During POEM, in patients observed abdominal distention, increased bladder pressure was significantly higher compared with in patients without distention. There was no significant difference in decreased lung compliance between the patients.<br></br>Bladder pressure monitoring might be useful to evaluate CO2 gas-related adverse events during POEM. View:
A3047 Difference in Specificities According to Systemic Vascular Resistance Index Between Simultaneous Measurements by the Flo Trac and LiDCO Rapid Systems During Cardiac Surgery
   YUSUKE TAKEI, M.D., YUTAKA EJIMA, Ph.D., HIROAKI TOYAMA, Ph.D., Masanori Yamauchi, Ph.D.
   The aim of this study was to assess the accuracy and precision of CIFT (Flo Trac system) and CILR (LiDCO Rapid system) in comparison with those of ICI (intermittent thermodilution technique) and to demonstratethe specificity of both devices by performing a subgroup analysis according to systemic vascular resistance index (SVRI) in 18 patients. The latest fourth-generation Flo Trac or LiDCO Rapid system showed moderate agreements and has potentially available monitors in clinical settings. However, CIFTandCILRdid not co-efficiently achieve acceptable agreement with ICI in terms of bias (&#8722;0.73 and &#8722;0.61 L/min/m2, respectively), % error (36.3% and 48.6%, respectively), and linear regression (0.63 and 0.50, respectively)during cardiovascular surgery. The accuracy and agreement of the fourth-generation FloTrac system was not affected by the SVRI, but those of CILR were attenuated bya higher SVRI. View:
A3048 The Validity of Cardiac Output Measurement Using Pulse Wave Transit Time: A Comparison With Arterial Pressure-based Cardiac Output
   Takeshi Suzuki, M.D.,Ph.D., Tomomi Ueda, M.D.,Ph.D., Jun Okuda, M.D., Yurika Endo, M.D., Yuta Suzuki, M.D., Takuya Kurazumi, M.D., Tomohiro Suhara, M.D.,Ph.D., Nobuyuki Katori, M.D.,Ph.D., Hiroshi Morisaki, M.D.,Ph.D.
   We evaluated the validity of the estimated continuous cardiac output (esCCO) system, which measures CO based on pulse wave transit time, as compared with arterial pressure-based cardiac output (APCO) system in post cardiac surgery patients. Correlation and precision analysis were performed by Spearman and Bland-Altman analysis. CO measured by esCCO was correlated well with the value of APCO (r=0.7, p &lt; 0.01) and the bias was 0.17 L/min, which indicated that esCCO could be used as a reliable non-invasive monitor. View:
A3049 Non-invasive Assessment of Cardiac Index in Morbidly Obese Patients Scheduled for Laparoscopic Bariatric Surgery
   Jochen Renner, Ph.D., Jonathan Aly, M.D., Pohlmann Markus, M.D., Jan H[ent]#246;cker, Ph.D., Markus Ahrens, Ph.D., Matthias Gruenewald, Ph.D., Ole Broch, Ph.D.
   Today, only few data are available regarding the performance of non-invasive cardiac index (CI) measurements based on finger cuff technology in comparison to an invasive measure of CI, using pulse wave analysis, in morbidly obese patients. Our preliminary data suggest that the non-invasive assessment of cardiac index can not be used interchangeable to the invasive approach of cardiac index measurement on the basis of pulse wave analysis. Likewise, as it stands today in this patient population, the ability of the non-invasive Nexfin device to enable a trending of cardiac index is not given. View:
A3050 Feasibility Evaluation of Non-Invasive Cardiac Function Technology During Cardiac Stress Testing
   Michael Ma, B.S., John W. Patton, B.S., Benjamin Shanker, M.D., Justin Dang, B.S., Stephen R. Au, M.D., Davinder S. Ramsingh, M.D.
   Recent technology has allowed clinicians to obtain cardiac function data non-invasively by finger cuff with a photo-plethysmograph to monitor arterial volume (ccNexfin system - Edwards Life Sciences, Irvine CA). This study seeks to evaluate the use of this device to detect hemodynamic changes that occur in patients who are undergoing cardiac stress testing. Specifically, the primary goal is to assess the ability of this device to detect positive cardiac stress events. Adults patients scheduled for cardiac stress testing (both treadmill and dobutamine) were consented for this observational study. Patients received standard patient care for their cardiac stress test as well a cuff based hemodynamic sensor (Nexfin system). Comparisons of the data from the hemodynamic sensor were compared to the findings of the stress echo examinations. View:
A3051 Hypotension Probability Algorithm Accuracy on MIMIC II ICU Patients
   Christine Lee, B.S., Feras Hatib, Ph.D., Zhongping Jian, Ph.D., Sai Buddi, Ph.D., Maxime Cannesson, M.D.,Ph.D.
   Patients in critical care settings are often at risk of developing hypotension, which can lead to poor outcomes. Current hemodynamic parameters for monitoring such hypotension often exhibit pronounced changes only when the hypotensive event is already occurring or when it is too late. We have developed a hypotension probability algorithm to predict hypotensive episodes based on machine learning techniques. The objective of this study is to test the accuracy of the hypotension probability algorithm on a completely independent test data set of ICU patients, not used in the development of the algorithm. 326 patients were taken from the MIMIC II MIT Research Database and tested for event detection accuracy. In conclusion, these test results on a completely independent data set indicate that the hypotension probability algorithm is capable of detection as well as prediction of hypotensive events with high reliability. View:
A3052 Feasibility of Real-Time Prescriptive Analytics to Make Predictions and Suggests Decision Options for the Prevention of Hypotension During Surgery
   Christine Lee, B.S., Feras Hatib, Ph.D., Maxime Cannesson, Ph.D.
   Patients undergoing high risk surgery are often at risk of developing intraoperative hypotension. To address this need for early detection of hypotensive events, we have developed a hypotension probability algorithm. The hypotension probability algorithm was tested and demonstrated sensitivity and specificity of 89%, 85% and 83%, for event detection respectively at 0, 5, 10, and 15 minutes prior to its start. In this study, we evaluate the use of stroke volume (SV), cardiac output (CO), stroke volume variation (SVV), dynamic elastance (Ea dyn), systemic vascular resistances (SVR), and dP/dt to classify patients into 4 prescriptive groups: 1) Decreased preload as the reason for a hypotensive event, 2) Decreased afterload, 3) Decreased contractility, and 4) Uncertain. In conclusion, the underlying cause of a hypotensive event can potentially be seen and classified into 1 of 4 groups up to 10 minutes prior to the start of an event. View:
A3053 Prediction of Hypotensive Episodes With Noninvasive Continuous Waveform Analysis
   Markus Hollmann, M.D.,Ph.D., Denise Veelo, M.D.,Ph.D., Zhongping Jian, Ph.D., Jos Settels, Ph.D., Feras Hatib, Ph.D., Bart Geerts, M.D.,Ph.D.
   Machine-learning algorithms may predict hypotensive events based on pressure pulse wave characteristics. We trained a machine-learning algorithm to predict hypotension and assessed its reliability. Our algorithm was able to predict hypotension with a sensitivity of 92%, 89% and 87%, and a specificity of 92%, 89% and 87%, 5min, 10 mins and 15 mins prior to the event respectively. Hypotensive events were predicted on average 17.5 mins before the event. View:
A3054 Feasibility of Hypotension Probability Algorithm to Predict Intraoperative Hypotensive Episodes Using Continuous, Real-time Machine Learning Analytics
   Christine Lee, B.S., Feras Hatib, Ph.D., Zhongping Jian, Ph.D., Joseph B. Rinehart, M.D., Howard A. Schwid, M.D., Shermeen B. Vakharia, M.D., Cecilia Canales, M.P.H., Joseph J. De Los Santos, B.S., Maxime Cannesson, M.D.,Ph.D.
   Patients undergoing high-risk surgeries are often at risk of developing intraoperative hypotension. Studies have shown that hypotension can be detected earlier by analyzing the complex changes and relationships in multiple hemodynamic variables that are undetectable by the naked eye. We developed a hypotension probability algorithm based on a machine learning model for real-time prediction of intraoperative hypotension using large surgical databases and Big Data analytics. The model is based on real-time continuous analysis of a large number of hemodynamic features extracted from the arterial pressure waveform. We assessed the performance of the model on an independent patient data being collected at University of California, Irvine (UCI) Medical Center. Our algorithm was able to predict hypotension with a sensitivity and specificity of 89%, 85% and 83%, 5min, 10 mins and 15 mins prior to the event respectively. View:
A4001 Photoplethysmography Signals Analysis Via Artificial Neural Networks to Model Surgical Stress Index Based on Anesthesiologists Experience
   Alice Feng-Fang Tsai, M.D., Ming-Ya Hung, M.A., Jiann-Shing Shieh, Ph.D., Shou-Zen Fan, M.D.,Ph.D.
   SSI index is still a novel topic which is just invented in recent years. So, more attention is needed on how to measure it and prove it to be correct in the near future. The developed ANN model may reasonably be utilized to estimate degree of surgical stress as well as to guide anesthesiologist on the conduct of anesthesia. This is hoped to help clinical researcher step further to measure the stress level and avoid critical medical situations. View:
A4002 Comparison of Plethysmographic Augmented Index at Finger and Forehead
   Tiantian Shi, B.S., Christopher Choi, M.D., Mahmoud Ahmed, M.B.,B.Ch., Kirk H. Shelley, M.D.,Ph.D., David G. Silverman, M.D., Aymen A. Alian, M.D.
   <b>Summary:</b> The present study introduces the augmentation index of the PPG waveform as a tool to compare the changes in vascular tone at the finger and forehead during mild to moderate hypovolemia. During progressive lower body negative pressure, the index, defined as the ratio of the height of the dicrotic notch to that of the pulse, increased to a significantly greater degree in the finger. View:
A4003 Assessing the Efficacy of Inflationary Noninvasive Blood Pressure Technology During the Induction Period of General Anesthesia for Patients With Arteriosclerosis
   Ken-Ichiro Kikuchi, M.D., Naoyuki Hirata, M.D.,Ph.D., Michiaki Yamakage, M.D.,Ph.D., Manami Koyanagawa, M.D., Mitsuru Uduki, M.D.,Ph.D., Shoji Kawachi, M.D.,Ph.D.
   Inflationary noninvasive blood pressure (iNIBP) technology can measure blood pressure during cuff inflation and determine blood pressure in a short time. Last year, we reported that iNIBP technology was useful during the induction period of general anesthesia for patients with no comorbidity (ASA 2015; A2171). In the present study, we investigated the efficacy of iNIBP technology during the anesthetic induction for patients with arteriosclerosis risk factors, because hemodynamics might change more intensely in such patients. Our results showed that iNIBP could determine blood pressure more quickly than the conventional deflationary mode. iNIBP technology could determine blood pressure by the iNIBP mode regardless of high blood pressure variation. Our results revealed the usefulness of iNIBP technology during anesthetic induction for not only patients with no comorbidity but also patients with arteriosclerosis. View:
A4004 Two Statistical Methods of Analyzing Cardiac Output Data From Three Devices During Elective Cardiac Surgery
   John E. Sagar, Student, Sudhakar Subramani, M.D.
   This study was a comparison between two statistical methods of measuring agreement between cardiac output monitors used in cardiac surgery. The devices were the pulmonary artery catheter as the gold standard and the LiDCOrapid&#8482; and TEE, two minimally-invasive devices. 100 patients undergoing elective cardiac surgery were included. We wanted to compare Bland-Altman plots to polar plots and gauge their relative usefulness in this setting. Bland-Altman plots were to found to be more useful in measuring at individual points, while polar plots were useful in trending data, or the change in CO over time. View:
A4005 Using Hot Wire Anemometry to Determine Isoflurane Gas Concentration
   Patrick R. Kolbay, B.S., Joseph A. Orr, Ph.D., Kai Kuck, Ph.D.
   Current volatile anesthetic monitoring technology uses side stream infrared analysis to determine anesthetic agent concentration with high accuracy, but is cost prohibitive in both small practice environments and low resource areas. A variety of physical and chemical property differences between volatile anesthetic gases and common atmospheric gases can help to determine gas concentration. In this study, a hot wire anemometer was used to estimate isoflurane concentration and compared to a standard infrared gas bench. The estimated isoflurane concentration was highly correlative with the measured infrared gas bench isoflurane concentration with an average error of 0% isoflurane and standard deviation of 0.04% isoflurane. View:
A4006 Calibration of Volatile Propofol Measured by Ion-mobility Spectrometry (P-IMS)
   Sascha Kreuer, M.D.,Ph.D., Teodora Shopova, Pharm.D, Dominik P. Lorenz, M.D., Tobias Fink, M.D.,Ph.D., Thomas Volk, M.D.,Ph.D., J[ent]#246;rg I. Baumbach, Ph.D., Felix Maurer, Ph.D.
   The combination of Hovacal and P-IMS leads to a calibration curve with a R&#178;=0.99. The limit of detection is very low. From a clinical point of view, the current linear measurement range of the P-IMS is too short. Therefore, further technical changes are necessary to achieve a linear calibration range between1 and 60 ppbv. View:
A4007 Intraoperative Neuromuscular Site of Monitoring is Not Associated With Adverse Respiratory Outcomes
   Timur Dubovoy, M.D., Elizabeth Jewell, M.S., Milo Engoren, M.D., Satya-Krishna Ramachandran, M.D.
   In this retrospective observation study we investigated the impact of facial vs ulnar site of neuromuscular monitoring on adverse respiratory complications following neuromuscular blockade in 58,363 cases. Monitoring of the facial nerve was not associated with increased risk of reintubation or need for mechanical ventilation in PACU compared to ulnar nerve site: 0.2% vs 0.3% (p=0.902) and 1.5% vs 1.3% (p=0.072). In the multivariate regression model, facial nerve monitoring was not significantly associated with adverse respiratory outcomes, odds ratio 1.058, 95% CI 0.91 - 1.231, (p=0.462). Cases where facial nerve monitoring was used received higher doses of NMB agents in ED95 equivalents per hour of NMB, 1.86 + 1.04 vs 1.77 + 0.98 (p&lt;0.001) and had earlier recovery of neuromuscular function as demonstrated by higher percentage of 4/4 TOF counts prior to reversal: 71.3% vs 64.9% (p&lt;0.001). View:
A4008 The Impact of Quantitative Monitoring on Dosing and Antagonism of Residual Neuromuscular Block
   Anastasia Grivoyannis, M.D., Virginia Tangel, M.A., Christian P. Tope, B.S., Cynthia A. Lien, M.D.
   A significant number of patients who receive neuromuscular blocking agents arrive in the PACU with residual paralysis. Monitoring depth of neuromuscular block decreases the incidence of residual paralysis. Aims of this retrospective study are to determine the impact of neuromuscular monitoring, specifically, acceleromyography (AMG) on dosing of NMBAs, the requirement for oxygen supplementation following extubation and on clinician vigilance. Clinical practice may be altered by the use of the AMG, especially in instances in which the provider records TOF ratio(s) during cases. View:
A4037 Bladder Temperature Could Not Evaluate Core Temperature Accurately in Laparoscopic Colorectal Resection
   Kaori Shimizu, M.D., Kunihisa Hotta, M.D.,Ph.D., Takashi Igarashi, M.D.,Ph.D., Mamoru Takeuchi, M.D.,Ph.D.
   This study retrospectively evaluated the reliability of bladder temperature in laparoscopic colorectal resection. Bladder temperature showed lower temperature than core temperature measured by esophageal temperature during abdominal insufflation with carbon dioxide gas at room temperature. View:
A4038 Monitoring Temperature of the Brain Thermal Tunnel: Is It Influenced by Facial Temperature?
   David G. Silverman, M.D., Ala S. Haddadin, M.D., Tyler Silverman, DPM, B.A., Trevor M. Banack, M.D., Marc M. Abreu, M.D.
   The present study was undertaken to determine whether temperature measurements at the site of emergence of a fat-lined tunnel via the medial eyelid is independent of temperature of the forehead. During rewarming after hypothermic cardiopulmonary bypass, temperature over the brain thermal tunnel (BTT) exceeded, while that at the forehead was below, that of blood returning to the extracorporeal circuit. View:
A4039 Resistive-polymer Versus Forced-air Warming: Comparable Efficacy in Robot-assisted Laparoscopic Radical Prostatectomy
   Yosuke Katsuda, M.D., Daizoh Satoh, M.D.,Ph.D., Izumi Kawagoe, M.D.,Ph.D., Eichi Inada, M.D.,Ph.D.
   Two patient warming systems, forced-air (FA) and resistive-polymer (RP) systems, are standard procedures used to maintain normothermia during anesthesia. Here we compared the efficacy of FA and RP systems in a prospective, randomized clinical study during RALP.RP warming system was as efficient as FA warming system in patients undergoing RALP. View:
A4040 Usefulness of a Non-invasive Core Body Temperature Monitoring System, Temple Touch Pro&#8482;, During General Anesthesia
   Yutaro Chida, M.D., Shunsuke Tachibana, M.D., Keiko Wakasugi, M.D., Michiaki Yamakage, M.D.,Ph.D.
   We examined the usefulness of TTP&#8482;, which can measure core body temperature easily and non-invasively, by comparing with esophageal temperature. Ten patients were enrolled in this study. A Bland-Altman plot showed that mean bias of T<sub>TTP</sub> was 0.00&#176;C with T<sub>eso</sub> and that 2SD was &#177;0.53&#176;C. Pearson&#8217;s correlation coefficient (r) was 0.75. This study showed that TTP&#8482; can monitor core body temperature accurately, continuously and easily. View:
A4041 Some Like It Hot: Optimal Temperature Management During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
   Carla R. Cordova, M.D., Joni Maga, M.D., Richard H. Epstein, M.D.
   Cytoreductive surgery followed by HIPEC is used to improve survival in a select population with peritoneal carcinomatosis. The chemotherapeutic agent is heated to 43&#176;C infused and re-circulated into the peritoneum for 90 minutes. The heat has important preferential effects on malignant vs. normal cells. We performed this study to evaluate our current temperature monitoring strategy, which involves the measurement of both bladder and esophageal temperature. We found that the use of bladder probe as a sole measurement site might overestimate the core temperature and cause overly aggressive cooling of the patient during HIPEC; potentially reducing the effectiveness of treatment. Using an alternative core anatomic site, like tympanic membrane, pulmonary artery, distal esophagus or nasopharynx for temperature measurement is recommended. View:
A4042 Feasibility Study of Real-time Two-/Three-dimensional Optical Coherence Tomography for Epidural Space of Piglet
   Chien-Kun Ting, M.D.,Ph.D., Wen-Chuan Kuo, Ph.D., Meng-Chun Kao, M.S.
   In this preliminary experimental series carried out on experimental piglet , we demonstrate intraoperative of real-time two-dimention(2D) and reconstructed three-dimention(3D) image of epidural space by optical coherence tomography (OCT). Concurrently, we aimed to demonstrate that the 3D OCT image with dural puncture and process of blood patches View:
A4043 Calibrating Cardiac Output Measured by Electrical Cardiometry With Transthoracic Echocardiography
   Clemens M. Ortner, M.D., Marita Windpassinger, M.D., Rainer Thell, M.D., Johannes Oswald, Jr., Gabriel Wasinger, Jr., Thomas L. Archer, M.D.
   This study evaluated agreement in measuring cardiac output (CO) and stroke volume (SV) derived from electrocardiometry (EC) versus transthoracic echo (TTE). It further evaluated a recently published calibration formula improving agreement between both methods by measuring left ventricular outflow tract area (LVOT area) and applying the following formula: SVEC_Modified = 2.2 * LVOTarea^(0.705) * SV_EC^(0.388) * Weight^(0.21). In 55 patients undergoing routine echocardiography cardiac output measured with TTE and EC was compared. Correlation and Bland-Altman analysis were performed. CO and SV between both methods did not correlate. Mean percentage error calibrating SV with LVOTarea remained above 30%. The study concludes that both methods do not agree in CO and SV measurements. Calibrating EC with LVOT-area obtained from TTE measurement improves correlation but mean percentage error remains unacceptably high. View:
A4044 Comparison of Two Different Methods of Obtaining Strain by Perioperative Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Grafting: An Observational Study
   Alok Kumar, M.D., Goverdhan Puri, M.D., ravi raj, M.D., banashree mandal, M.D.
   In this study, LV GLS calculated using 2D speckle tracking correlates well with LV GLS derived from DTI using TEE. The LV GLS also correlated well with the 3D LVEF. View:
A4045 Second Generation Pocket-Sized Ultrasound Systems
   Jacek A. Wojtczak, M.D.,Ph.D., Peter Bonadonna, No Degree, Pawel Andruszkiewicz, M.D.,Ph.D.
   Two pocket-sized ultrasound systems (Philips Lumify and GE Vscan DP) were<br></br>compared in pork/bovine lung models and<br></br>hybrid models. Their image quality, mobility and connectivity were rated. View:
A4046 Evaluation of Sterile Saline as a Conduction Medium for Sonographic Acquisition of Images of Internal Jugular Vein and Carotid Artery
   George Williams, M.D., Mahammad Hussain, M.D., Chunyan Cai, Ph.D., Carlos A. Artime, M.D., Dalia Teima, M.D., Andrea M. Velez, M.D., Andrew Emerald, M.D., Karuna Puttur Rajkumar, M.D., Tyrone Burnett, B.S., Tariq A. Syed, M.S.
   It is estimated that approximately 5 million central venous catheters are inserted annually in the United States [1]. Unfortunately, problems may arise from this invasive procedure, a 2001 estimate of failure rates in establishing central venous access may be as high as 20%, or 1 million of the previously mentioned 5 million cannulations[2]. In an effort to decrease failure rates, the utilization of ultrasound guidance in establishing central venous access has become standard practice associated with its higher success rate. Our study sought to evaluate time taken to visualize the internal jugular vein and carotid arteries on an ultrasound model using both traditional ultrasound gel and normal saline while also evaluating its subsequent image quality. We hypothesize that the times and image quality will be comparable between these two conduction mediums. View:
A4047 Evaluating the Clinical Utility of Using Commercially Available Video Conferencing Devices to Direct Untrained Non-Medical Personnel to Perform a Rapid Trauma Ultrasound Examination
   Michael Ma, B.S., Danny Le, Student, Warren B. Davis, M.D., Cameron J. Ricks, M.D., Maxime Cannesson, M.D., Davinder S. Ramsingh, M.D.
   We sought to determine the feasibility of remotely guiding non-medically trained individuals in performing a POCUS examination. We used a combination of FaceTime and Google Glass technologies to connect the user and ultrasound expert. In previous works, we described preliminary data on the feasibility of using these technologies as well as examinee and examiner satisfaction scores. The purpose of this analysis was to quantify the clinical value of the images obtained. View:
A4048 Hemodynamic Measurement Applications for Mobile Devices: Does Lack of Oversite Pose a Risk to the Public?
   Troy T. Ruff, B.S., Michael-David Calderon, B.S., Michael Ma, B.S., Joseph B. Rinehart, M.D.
   In mobile phone app markets, there exist a number of applications that a user can download which claim to measure one or more hemodynamic variables. In phase one of this study, the top 30 apps each from the Apple and Android markets were evaluated by the authors in three-dimensions which are readily available to the average consumer in the marketplace: 1) perceived authority of publisher; 2) professional appearance; 3) face-value probability that app can do what it claims. View:
A4049 Extracorporeal Membrane Oxygenation in Lung Transplantation: Causes and Complications
   Julien Fessler, M.D., Antoine Roux, M.D., Malek Ben Chehida, Sr., Marie-Louise Felten, M.D., Edouard Sage, M.D.,Ph.D., Jean-Yves Marandon, M.D., Fran[ent]#231;ois Parquin, M.D., Charles Cerf, M.D., Marc Fischler, M.D.,Ph.D., Morgan Le Guen, M.D.,Ph.D.
   This study assesses the predictive factors of ECMO and its complications during bilateral lung transplantation (LTx). From January 2012 to July 2015, 105 patients did not need ECMO, 55 a &#8220;short duration ECMO&#8221;, and 37 a &#8220;long duration ECMO&#8221; during LTx. Patients with idiopathic pulmonary fibrosis, preoperative pulmonary hypertension, or under the &#8220;High Emergency LTx&#8221; program required ECMO more often than others. The in-hospital length of stay and post-operative complications was similar between &#8220;no ECMO&#8221; and &#8220;short duration ECMO&#8221; groups, but it was higher for the &#8220;long duration ECMO&#8221; group. Short duration ECMO is safe and did not worsen patients' outcome. Maintenance of ECMO after the surgical procedure is associated to poorer outcome. View:
A4050 Intranasal Medication Administration Using a Squeeze Bottle Atomizer Results in Overdosing if Deployed in Supine Patients
   Mark A. Dobish, M.D., Jordan E. Goldhammer, M.D., Joshua McAnulty, M.D., Todd J. Smaka, M.D., Richard H. Epstein, M.D.
   Vasoconstrictors and local anesthetics are commonly applied to the nasal mucosa using squeeze bottle atomizers to reduce edema, limit bleeding, and provide analgesia. This study examined the difference in the amount of liquid delivered to a patient's nasal mucosa in the supine versus upright position and found a fourteen-fold increase in the volume (i.e. dose) when the bottle was used in the supine versus upright position. The minimum angle of administration to prevent an unintended overdose is 45&#176;, however we recommend administering the drug with the patient in the sitting position and with the bottle at 90&#176;. View:
A4051 Accuracy and Reliability of Continuous Blood Glucose Monitoring During Pediatric Cardiopulmonary Bypass
   Shiho Satomi, M.D., Shinji Kawahito, M.D., Tomohiro Soga, M.D., Naoji Mita, M.D., Nami Kakuta, M.D., Eisuke Hamaguchi, M.D., Kazumi Takaishi, D.D.S., Hiroshi Kitahata, M.D., Yasuo M. Tsutsumi, M.D., Katsuya Tanaka, M.D.
   Use of continuous blood glucose monitoring system (newly developed, next-generation artificial endocrine pancreas: STG-55) during CPB for pediatric cardiovascular surgery proved to be remarkably reliable. View:
A4052 Non-invasive Hemoglobin Measurement Using Pulse Oximetry Technology in Infants and Neonates: Latest Software Update
   Helga Francksen, M.D., Matthias Gruenewald, M.D., Jens Scheewe, M.D., Schubert Tabea, Student, Ole Broch, M.D., Jochen Renner, M.D.
   <br></br>According<br></br>to our data, interchangeability of non-invasive SpHb assessment with the invasive<br></br>diagnosis is not given. SpHb showed an unacceptable trending ability in<br></br>comparison to POCHb. In 25% of all infants and neonates the difference between POCHb<br></br>and SpHb was more than 2 g/dl. View:
JS01 Anticoagulation Based on Heparin Dose Response Technique Fails to Predict Heparin Bolus Dose Requirement During Cardiac Surgery
   Junko Ichikawa, M.D., Takahito Marubuchi, M.D., Tetsu Mori, M.D., Mitsuharu Kodaka, M.D., Makiko Komori, M.D.
   The Hepcon HMS system poorly estimates heparin bolus requirements to achieve target ACT. The ACT response to a known concentration of heparin in vivo was different based on the result of wide discrepancy in calculated versus measured HDR, although predicted and measured heparin concentration were linearly related. View: