Erin Stewart

All Publications

• Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement. British journal of anaesthesia Oprea, A. D., Ostapenko, L. J., Sweitzer, B., Selzer, A., Irizarry-Alvarado, J. M., Hurtado Andrade, M. D., Mendez, C. E., Kelley, K. D., Stewart, E., Fernandez Robles, C. R., Chadha, R. M., Camilleri, M., Mathur, R., Umpierrez, G. E., Hepner, D. L. 2025

  Abstract

  The perioperative management of patients using glucagon-like peptide 1 receptor agonists remains a topic of debate. While several multisociety statements have been published recently, the recommendations vary significantly in terms of medication management and preoperative fasting protocols for these patients. This document represents a multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI). It provides updated recommendations based on a modified Delphi process and supported by a systematic review of the current literature. The recommendations address management of the glucagon-like peptide 1 receptor agonists perioperatively, and preoperative fasting times for both solids and liquids. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42023438624).

  View details for DOI 10.1016/j.bja.2025.04.001

  View details for PubMedID 40379536

• Enhanced recovery after surgery for liver transplantation: a review of recent literature. Current opinion in organ transplantation Crouch, C. E., Stewart, E., Hendrickse, A. 2024; 29 (1): 64-71

  Abstract

  This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.

  View details for DOI 10.1097/MOT.0000000000001117

  View details for PubMedID 37937584

• The in-vitro influence of urea concentration on thromboelastrography in patients with and without end stage renal disease. American journal of surgery Kukreja, N., Rodriguez, I. E., Moore, H. B., LaRiviere, W., Crouch, C., Stewart, E., Nydam, T. L., Kennealey, P., Hendrickse, A. D., Pomfret, E. A., Fernandez-Bustamante, A. 2023; 226 (6): 817-822

  Abstract

  End stage renal disease (ESRD) is associated with platelet dysfunction but also thromboembolic complications. The specific role of increased blood urea nitrogen (BUN) on coagulation is unclear. We aimed to characterize thromboelastography (TEG) parameters from males and females with ESRD and normal kidney function and evaluate if exogenous urea in vitro reproduced those TEG differences.We collected blood samples from 20 living kidney donors and 20 kidney recipients. TEG was performed without and with two increasing urea concentrations in vitro. TEG parameters were compared between recipients and donors.Blood from kidney recipients showed baseline increased maximum amplitude (MA) and shortened time to maximum amplitude (TMA) compared to donors. These differences were not confirmed in females. In all patients, BUN was inversely correlated with TMA (r = -0.342; p = 0.031). In males, BUN and creatinine concentrations showed a direct correlation with MA (0.583; p = 0.007) and an inverse correlation with TMA (r = -0.520; p = 0.019). Urea in vitro decreased R-time (p = 0.005) and increased LY30 (p = 0.009) in donors but not recipients.ESRD is associated with increased MA and decreased TMA on TEG. No change in MA was observed with increasing urea concentrations in vitro. Gender-specific variability in TEG parameters were observed.

  View details for DOI 10.1016/j.amjsurg.2023.06.025

  View details for PubMedID 37407391

  View details for PubMedCentralID PMC10733546

• Quantitative Assessment of Postoperative Hypoventilation After Kidney Transplantation Surgery Fernandez-Bustamante, A., Fioravanti, M., Carrico, J., Stewart, E. LIPPINCOTT WILLIAMS & WILKINS. 2023: 963-964

  View details for Web of Science ID 001058985600345

• Viscoelastic Management of Coagulopathy during the Perioperative Period of Liver Transplantation. Seminars in thrombosis and hemostasis Stewart, E., Nydam, T. L., Hendrickse, A., Pomposelli, J. J., Pomfret, E. A., Moore, H. B. 2023; 49 (2): 119-133

  Abstract

  Viscoelastic testing (VET) in liver transplantation (LT) has been used since its origin, in combination with standard laboratory testing (SLT). There are only a few, small, randomized controlled trials that demonstrated a reduction in transfusion rates using VET to guide coagulation management. Retrospective analyses contrasting VET to SLT have demonstrated mixed results, with a recent concern for overtreatment and the increase in postoperative thrombotic events. An oversight of many studies evaluating VET in LT is a single protocol that does not address the different phases of surgery, in addition to pre- and postoperative management. Furthermore, the coagulation spectrum of patients entering and exiting the operating room is diverse, as these patients can have varying anatomic and physiologic risk factors for thrombosis. A single transfusion strategy for all is short sighted. VET in combination with SLT creates the opportunity for personalized resuscitation in surgery which can address the many challenges in LT where patients are at a paradoxical risk for both life-threatening bleeding and clotting. With emerging data on the role of rebalanced coagulation in cirrhosis and hypercoagulability following LT, there are numerous potential roles in VET management of LT that have been unaddressed.

  View details for DOI 10.1055/s-0042-1758058

  View details for PubMedID 36318962

  View details for PubMedCentralID PMC10366939

• WHOLE BLOOD RESUSCITATION IN LIVER TRANSPLANTATION: IS IT TIME FOR IMPLEMENTATION? Klingenberg, K., Stewart, E., Rodriguez, I., Hadley, K., Pomposelli, J., Hendrickse, A., Cullen, J., Nydam, T., Berg, M., Pomfret, E., Bates, S., Moore, H. ELSEVIER SCIENCE INC. 2023: S55

  View details for Web of Science ID 000994636600112

• Using 'Plan, Do, Study, Act' (PDSA) Cycles to Improve an Ultrasound Guided Vascular Access Course Tran, T., Vitter, J., Stewart, E. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: 1173

  View details for Web of Science ID 000840283001143

• Preoperative optimization of diabetes. International anesthesiology clinics Stewart, E., Selzer, A. 2022; 60 (1): 8-15

  View details for DOI 10.1097/AIA.0000000000000351

  View details for PubMedID 34897217

• Dabigatran Reversal With Idarucizumab in 2 Patients With Portal Vein Thrombosis Undergoing Orthotopic Liver Transplantation. Seminars in cardiothoracic and vascular anesthesia Williams, C., Stewart, E., Conzen, K. D., Wolf, S., Tran, T. T. 2021; 25 (3): 200-207

  Abstract

  There are limited data to guide the use of anticoagulation in cirrhotic patients prior to liver transplantation especially when using direct oral anticoagulants. In this article, we present 2 cases. The first is a 42-year-old male with cirrhosis complicated by portal vein thrombosis (PVT) treated with dabigatran who underwent orthotopic liver transplantation without complication. The second case is a 65-year-old man with alcoholic cirrhosis complicated by PVT treated with dabigatran who underwent orthotopic liver transplantation and required reoperation for surgical bleeding. Both patients were treated with dabigatran's reversal agent idarucizumab prior to incision. In this case series, we discuss the treatment of cirrhotic patients with various anticoagulants, considerations for anticoagulant selection and reversal prior to liver transplant, and questions for future investigation.

  View details for DOI 10.1177/1089253220982183

  View details for PubMedID 33393437

• SIMULATION FOR IDENTIFICATION OF KNOWLEDGE GAPS AMONG TRAINEES IN CRITICAL CARE SCENARIOS Stewart, E., Kugler, J., Lin, M. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000498593402086

• Oxygen regulates tissue nitrite metabolism. Antioxidants & redox signaling Curtis, E., Hsu, L. L., Noguchi, A. C., Geary, L., Shiva, S. 2012; 17 (7): 951-61

  Abstract

  Once dismissed as an inert byproduct of nitric oxide (NO) auto-oxidation, nitrite (NO(2)(-)) is now accepted as an endocrine reservoir of NO that elicits biological responses in major organs. While it is known that tissue nitrite is derived from NO oxidation and the diet, little is known about how nitrite is metabolized by tissue, particularly at intermediate oxygen tensions. We investigated the rates and mechanisms of tissue nitrite metabolism over a range of oxygen concentrations.We show that the rate of nitrite consumption differs in each organ. Further, oxygen regulates the rate and products of nitrite metabolism. In anoxia, nitrite is reduced to NO, with significant formation of iron-nitrosyl proteins and S-nitrosothiols. This hypoxic nitrite metabolism is mediated by different nitrite reductases in each tissue. In contrast, low concentrations (∼3.5 μM) of oxygen increase the rate of nitrite consumption by shifting nitrite metabolism to oxidative pathways, yielding nitrate. While cytochrome P(450) and myoglobin contribute in the liver and heart, respectively, mitochondrial cytochrome c oxidase plays a significant role in nitrite oxidation, which is inhibited by cyanide. Using cyanide to prevent artifactual nitrite decay, we measure metabolism of oral and intraperitoneally administered nitrite in mice.These data provide insight into the fate of nitrite in tissue, the enzymes involved in nitrite metabolism, and the role of oxygen in regulating these processes.We demonstrate that even at low concentrations, oxygen is a potent regulator of the rate and products of tissue nitrite metabolism.

  View details for DOI 10.1089/ars.2011.4242

  View details for PubMedID 22098300

  View details for PubMedCentralID PMC3411351

• Nitrite Potently Inhibits Hypoxic and Inflammatory Pulmonary Arterial Hypertension and Smooth Muscle Proliferation via Xanthine Oxidoreductase-Dependent Nitric Oxide Generation CIRCULATION Zuckerbraun, B. S., Shiva, S., Ifedigbo, E., Mathier, M. A., Mollen, K. P., Rao, J., Bauer, P. M., Choi, J. J., Curtis, E., Choi, A. M., Gladwin, M. T. 2010; 121 (1): 98-109

  Abstract

  Pulmonary arterial hypertension is a progressive proliferative vasculopathy of the small pulmonary arteries that is characterized by a primary failure of the endothelial nitric oxide and prostacyclin vasodilator pathways, coupled with dysregulated cellular proliferation. We have recently discovered that the endogenous anion salt nitrite is converted to nitric oxide in the setting of physiological and pathological hypoxia. Considering the fact that nitric oxide exhibits vasoprotective properties, we examined the effects of nitrite on experimental pulmonary arterial hypertension.We exposed mice and rats with hypoxia or monocrotaline-induced pulmonary arterial hypertension to low doses of nebulized nitrite (1.5 mg/min) 1 or 3 times a week. This dose minimally increased plasma and lung nitrite levels yet completely prevented or reversed pulmonary arterial hypertension and pathological right ventricular hypertrophy and failure. In vitro and in vivo studies revealed that nitrite in the lung was metabolized directly to nitric oxide in a process significantly enhanced under hypoxia and found to be dependent on the enzymatic action of xanthine oxidoreductase. Additionally, physiological levels of nitrite inhibited hypoxia-induced proliferation of cultured pulmonary artery smooth muscle cells via the nitric oxide-dependent induction of the cyclin-dependent kinase inhibitor p21(Waf1/Cip1). The therapeutic effect of nitrite on hypoxia-induced pulmonary hypertension was significantly reduced in the p21-knockout mouse; however, nitrite still reduced pressures and right ventricular pathological remodeling, indicating the existence of p21-independent effects as well.These studies reveal a potent effect of inhaled nitrite that limits pathological pulmonary arterial hypertrophy and cellular proliferation in the setting of experimental pulmonary arterial hypertension.

  View details for DOI 10.1161/CIRCULATIONAHA.109.891077

  View details for Web of Science ID 000273267700014

  View details for PubMedID 20026772

• Depletion and restoration of the intravascular nitrite (NO2-) reserve modulate susceptibility to liver vaso-occlusive-infarction in sickle cell trasgenic mice Hsu, L. L., Shiva, S., Noguchi, A., Curtis, E., MacArthur, P., Raat, N. H., Diwan, B. A., Schechter, A. N., Noguchi, C., Gladwin, M. T. AMER SOC HEMATOLOGY. 2007: 258A

  View details for DOI 10.1182/blood.V110.11.841.841

  View details for Web of Science ID 000251100801110

• Tissue dependent nitrite metabolism and NO production is regulated by oxygen Shiva, S., Curtis, E., Liu, G., Gladwin, M. T. ELSEVIER SCIENCE INC. 2007: S80

  View details for Web of Science ID 000250835900207