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Eric Adams

Publications and source records attributed to Eric Adams.

5 recordsLinked to original sources
PubMed2006

The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass.

OBJECTIVE: Three main types of anesthesia are used for infrainguinal bypass: general endotracheal anesthesia (GETA), spinal anesthesia (SA), and epidural anesthesia (EA). We analyzed a large clinical database to determine whether the type of anesthesia had any effect on clinical outcomes in lower extremity bypass. METHODS: This study is an analysis of a prospectively collected database by the National Surgical Quality Improvement Program (NSQIP) of the Veterans Affairs Medical Centers. All patients from 1995 to 2003 in the NSQIP database who underwent infrainguinal arterial bypass were identified via Current Procedural Terminology codes. The 30-day morbidity and mortality outcomes for various types of anesthesia were compared by using univariate analysis and multivariate logistic regression to control for confounders. RESULTS: The NSQIP database identified 14,788 patients (GETA, 9757 patients; SA, 2848 patients; EA, 2183 patients) who underwent a lower extremity infrainguinal arterial bypass during the study period. Almost all patients (99%) were men, and the mean age was 65.8 years. The type of anesthesia significantly affected graft failure at 30 days. Compared with SA, the odds of graft failure were higher for GETA (odds ratio, 1.43; 95% confidence interval [CI], 1.16-1.77; P = .001). There was no statistically significant difference in 30-day graft failure between EA and SA. Regarding cardiac events, defined as postoperative myocardial infarction or cardiac arrest, patients with normal functional status (activities of daily living independence) and no history of congestive heart failure or stroke did worse with GETA than with SA (odds ratio, 1.8; 95% CI, 1.32-2.48; P < .0001). There was no statistically significant difference between EA and SA in the incidence of cardiac events. GETA, when compared with SA and EA, was associated with more cases of postoperative pneumonia (odds ratio: 2.2 [95% CI, 1.1-4.4; P = .034]. There was no significant difference between EA and SA with regard to postoperative pneumonia. Compared with SA, GETA was associated with an increased odds of returning to the operating room (odds ratio, 1.40; 95% CI, 1.20-1.64; P < .001), as was EA (odds ratio, 1.17; 95% CI, 1.05-1.31; P = .005). GETA was associated with a longer surgical length of stay on univariate analysis, but not after controlling for confounders. There was no significant difference in 30-day mortality among the three groups with univariate or multivariate analyses. CONCLUSIONS: Although GETA is the most common type of anesthesia used in infrainguinal bypasses, our results suggest that it is not the best strategy, because it is associated with significantly worse morbidity than regional techniques.

Aged↗
PubMed2006

Upper extremity arterial combat injury management.

Traumatic hemorrhage and vascular injury management have been concerns for both civilian and military physicians. During the 20th century, advances in technique allowed surgeons to focus on vascular repair, restoration of perfusion, limb salvage, and life preservation. Military surgeons such as Makins, DeBakey, Hughes, Rich, and others made significant contributions to the field of surgery in general and vascular surgery in particular. Casualties from combat in Afghanistan and Iraq confront physicians and surgeons with devastating injuries. The current generation of providers is challenged with applying contemporary care while expanding upon the lessons taught by our predecessors. The objective of this report is to review the historical experience with managing military upper extremity arterial injuries and compare that experience with current management.

Arteries↗
PubMed2003

CO2 hydrate composite for ocean carbon sequestration.

Rapid CO2 hydrate formation was investigated with the objective of producing a negatively buoyant CO2-seawater mixture under high-pressure and low-temperature conditions, simulating direct CO2 injection at intermediate ocean depths of 1.0-1.3 km. A coflow reactor was developed to maximize CO2 hydrate production by injecting water droplets (e.g., approximately 267 microm average diameter) from a capillary tube into liquid CO2. The droplets were injected in the mixing zone of the reactor where CO2 hydrate formed at the surface of the water droplets. The water-encased hydrate particles aggregated in the liquid CO2, producing a paste-like composite containing CO2 hydrate, liquid CO2, and water phases. This composite was extruded into ambient water from the coflow reactor as a coherent cylindrical mass, approximately 6 mm in diameter, which broke into pieces 5-10 cm long. Both modeling and experiments demonstrated that conversion from liquid CO2 to CO2 hydrate increased with water flow rate, ambient pressure, and residence time and decreased with CO2 flow rate. Increased mixing intensity, as expressed by the Reynolds number, enhanced the mass transfer and increased the conversion of liquid CO2 into CO2 hydrate. Using a plume model, we show that hydrate composite particles (for a CO2 loading of 1000 kg/s and 0.25 hydrate conversion) will dissolve and sink through a total depth of 350 m. This suggests significantly better CO2 dispersal and potentially reduced environmental impacts than would be possible by simply discharging positively buoyant liquid CO2 droplets. Further studies are needed to address hydrate conversion efficiency, scale-up criteria, sequestration longevity, and impact on the ocean biota before in-situ production of sinking CO2 hydrate composite can be applied to oceanic CO2 storage and sequestration.

Carbon Dioxide↗