Jan Boublik

All Publications

• Utility of Electrical Stimulation for Correct Placement and Neuromodulation of the Erector Spinae Plane Block for Total Shoulder Arthroplasty: A Case Report. A&A practice Boublik, J., Kim, R. K., Tsui, B. C. 2023; 17 (5): e01680

  Abstract

  The role of neuromodulation in fascial plane blocks is unknown. This case report presents a complex patient who underwent shoulder arthroplasty with a high thoracic-erector spinae plane (HT-ESP) catheter that provided electrical and chemical neuromodulation, highlighting the potential of electrical stimulation in the identification of and therapy at the fascial plane level.

  View details for DOI 10.1213/XAA.0000000000001680

  View details for PubMedID 37146218

• Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training. Regional anesthesia and pain medicine Porter, S., Prendiville, E., Allen, B. F., Booth, G., Boublik, J., Burnett, G. W., Elkassabany, N., Hausman, J., Klesius, L., Le-Wendling, L., Machi, A. T., Maniker, R., Parra, M., Rosenquist, R., Spofford, C. M., Suresh, S., Tedore, T., Wilson, E. H., Zhou, J. Y., Woodworth, G. 2022

  Abstract

  INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows.METHODS: A panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones.RESULTS: Participants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed.DISCUSSION: A list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.

  View details for DOI 10.1136/rapm-2022-103854

  View details for PubMedID 35878963

• Bloc continu interscalenique versus bloc des muscles erecteurs du rachis thoracique haut avec epargne nerveuse phrenique pour larthroplastie totale de lepaule : une etude randomisee controlee. Canadian journal of anaesthesia = Journal canadien d'anesthesie Sun, L. Y., Basireddy, S., Gerber, L. N., Lamano, J., Costouros, J., Cheung, E., Boublik, J., Horn, J. L., Tsui, B. C. 2022

  Abstract

  PURPOSE: The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty.METHODS: Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care (Palo Alto, CA, USA) were enrolled in a double-blind randomized controlled trial. We randomized 28 patients to receive either an interscalene or HT-ESPB perineural catheter preoperatively; 26 patients were included in the final analysis. The study was powered for the primary outcome of incidence of hemidiaphragmatic paralysis in the postanesthesia care unit (PACU). Other outcome measures included incentive spirometry volume, brachial plexus motor and sensory exams, adverse events, pain scores, and opioid consumption.RESULTS: The incidence of hemidiaphragmatic paralysis in the HT-ESPB catheter group was significantly lower than in the interscalene catheter group (0/12, 0% vs 14/14, 100%; P < 0.001). No statistically significant differences were found in pain scores and opioid consumption (in oral morphine equivalents) between the interscalene and HT-ESPB groups through postoperative day (POD) 2. Nevertheless, the mean (standard deviation) point estimates for opioid consumption for the HT-ESPB group were higher than for the interscalene group in the PACU (HT-ESPB: 24.8 [26.7] mg; interscalene: 10.7 [21.7] mg) and for POD 0 (HT-ESPB: 20.5 [25.0] mg; interscalene: 6.7 [12.0] mg). In addition, cumulative postoperative opioid consumption was significantly higher at POD 0 (PACU through POD 0) in the HT-ESPB group (45.3 [39.9] mg) than in the interscalene group (16.6 [21.9] mg; P = 0.04).CONCLUSIONS: This study suggests that continuous HT-ESPB can be a phrenic nerve-sparing alternative to continuous interscalene brachial plexus blockade, although the latter provided superior opioid-sparing in the immediate postoperative period. This was a small sample size study, and further investigations powered to detect differences in analgesic and quality of recovery score endpoints are needed.STUDY REGISTRATION: www.ClinicalTrials.gov (NCT03807505); registered 17 January 2019.

  View details for DOI 10.1007/s12630-022-02216-1

  View details for PubMedID 35237953

• Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project. Regional anesthesia and pain medicine Ahmed, H. M., Atterton, B. P., Crowe, G. G., Barratta, J. L., Johnson, M., Viscusi, E., Adhikary, S., Albrecht, E., Boretsky, K., Boublik, J., Breslin, D. S., Byrne, K., Ch'ng, A., Chuan, A., Conroy, P., Daniel, C., Daszkiewicz, A., Delbos, A., Dirzu, D. S., Dmytriiev, D., Fennessy, P., Fischer, H. B., Frizelle, H., Gadsden, J., Gautier, P., Gupta, R. K., Gurkan, Y., Hardman, H. D., Harrop-Griffiths, W., Hebbard, P., Hernandez, N., Hlasny, J., Iohom, G., Ip, V. H., Jeng, C. L., Johnson, R. L., Kalagara, H., Kinirons, B., Lansdown, A. K., Leng, J. C., Lim, Y. C., Lobo, C., Ludwin, D. B., Macfarlane, A. J., Machi, A. T., Mahon, P., Mannion, S., McLeod, D. H., Merjavy, P., Miscuks, A., Mitchell, C. H., Moka, E., Moran, P., Ngui, A., Nin, O. C., O'Donnell, B. D., Pawa, A., Perlas, A., Porter, S., Pozek, J., Rebelo, H. C., Roques, V., Schroeder, K. M., Schwartz, G., Schwenk, E. S., Sermeus, L., Shorten, G., Srinivasan, K., Stevens, M. F., Theodoraki, K., Turbitt, L. R., Valdes-Vilches, L. F., Volk, T., Webster, K., Wiesmann, T., Wilson, S. H., Wolmarans, M., Woodworth, G., Worek, A. K., Moran, E. M. 2022

  Abstract

  BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement.RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29.CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

  View details for DOI 10.1136/rapm-2021-103136

  View details for PubMedID 35193970

• Diagnostic Point-of-Care Ultrasound: Recommendations From an Expert Panel. Journal of cardiothoracic and vascular anesthesia Bronshteyn, Y. S., Anderson, T. A., Badakhsh, O., Boublik, J., Brady, M. B., Charnin, J. E., Coker, B. J., Deriy, L. B., Hardman, H. D., Haskins, S. C., Hollon, M., Hsia, H. J., Neelankavil, J. P., Panzer, O. P., Perlas, A., Ramsingh, D., Sharma, A., Shore-Lesserson, L. J., Zimmerman, J. M., American Society of Anesthesiologists Ad Hoc Committee on PoCUS 2021

  Abstract

  Diagnostic point-of-care ultrasound (PoCUS) has emerged as a powerful tool to help anesthesiologists guide patient care in both the perioperative setting and the subspecialty arenas. Although anesthesiologists can turn to guideline statements pertaining to other aspects of ultrasound use, to date there remains little in the way of published guidance regarding diagnostic PoCUS. To this end, in 2018, the American Society of Anesthesiologists chartered an ad hoc committee consisting of 23 American Society of Anesthesiologists members to provide recommendations on this topic. The ad hoc committee convened and developed a committee work product. This work product was updated in 2021 by an expert panel of the ad hoc committee to produce the document presented herein. The document, which represents the consensus opinion of a group of practicing anesthesiologists with established expertise in diagnostic ultrasound, addresses the following issues: (1) affirms the practice of diagnostic PoCUS by adequately trained anesthesiologists, (2) identifies the scope of practice of diagnostic PoCUS relevant to anesthesiologists, (3) suggests the minimum level of training needed to achieve competence, (4) provides recommendations for how diagnostic PoCUS can be used safely and ethically, and (5) provides broad guidance about diagnostic ultrasound billing.

  View details for DOI 10.1053/j.jvca.2021.04.016

  View details for PubMedID 34059438

• Superficial Cervical Plexus Block for Awake Large-Bore Central Line Placement in Parturients: A Case Series. A&A practice Sheikh, M., Carvalho, B., Boublik, J., Ansari, J. 2021; 15 (3): e01429

  Abstract

  Pregnant patients with high-risk conditions including abnormal placentation or severe cardiovascular disease may require large-bore central venous access at the time of delivery. Central lines are generally inserted while obstetric patients are awake, either because neuraxial anesthesia is planned or to minimize fetal exposure to anesthetic medications. Despite local infiltration, the procedure can cause significant patient discomfort. This case series describes use of a superficial cervical plexus block (SCPB) to facilitate line placement in 4 pregnant women with high-risk conditions. SCPB is technically straightforward with low reported complication rates and should be considered for pregnant patients requiring large-bore central lines.

  View details for DOI 10.1213/XAA.0000000000001429

  View details for PubMedID 33740791

• American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: recommendations. Regional anesthesia and pain medicine Haskins, S. C., Bronshteyn, Y., Perlas, A., El-Boghdadly, K., Zimmerman, J., Silva, M., Boretsky, K., Chan, V., Kruisselbrink, R., Byrne, M., Hernandez, N., Boublik, J., Manson, W. C., Hogg, R., Wilkinson, J. N., Kalagara, H., Nejim, J., Ramsingh, D., Shankar, H., Nader, A., Souza, D., Narouze, S. 2021

  Abstract

  Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It also discusses barriers to POCUS education and training and proposes a list of educational resources. For each POCUS section, learning goals and specific skills were presented in the Indication, Acquisition, Interpretation, and Medical decision-making framework.

  View details for DOI 10.1136/rapm-2021-102561

  View details for PubMedID 33632777

• American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part I: clinical indications. Regional anesthesia and pain medicine Haskins, S. C., Bronshteyn, Y., Perlas, A., El-Boghdadly, K., Zimmerman, J., Silva, M., Boretsky, K., Chan, V., Kruisselbrink, R., Byrne, M., Hernandez, N., Boublik, J., Manson, W. C., Hogg, R., Wilkinson, J. N., Kalagara, H., Nejim, J., Ramsingh, D., Shankar, H., Nader, A., Souza, D., Narouze, S. 2021

  Abstract

  Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. The guidelines were written by content and educational experts and approved by the Guidelines Committee and the Board of Directors of the ASRA. In part I of this two-part series, clinical indications for POCUS in the perioperative and chronic pain setting are described. The clinical review addresses airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma examination and focused cardiac ultrasound for the regional anesthesiologist and pain physician. It also provides foundational knowledge regarding ultrasound physics, discusses the impact of handheld devices and finally, offers insight into the role of POCUS in the pediatric population.

  View details for DOI 10.1136/rapm-2021-102560

  View details for PubMedID 33632778

• Alternating Side Programmed Intermittent Repeated (ASPIRe) Bolus Regimen for Delivering Local Anesthetic via Bilateral Interfascial Plane Catheters. Journal of cardiothoracic and vascular anesthesia Tsui, B. C., Brodt, J., Pan, S., Caruso, T. J., Kim, R., Horn, J. L., Boublik, J., Tsui, J. H. 2021

  View details for DOI 10.1053/j.jvca.2021.02.036

  View details for PubMedID 33731299

• Comparison of Postoperative Pain From Catheter Over the Needle (CON) Versus Catheter Through Needle (CTN) Techniques for Erector Spinae Plane Blockade in Patients Undergoing Open Heart Surgery: A Single-Center Retrospective Review. Journal of cardiothoracic and vascular anesthesia Pfaff, K., Brodt, J., Basireddy, S., Boyd, J., Boublik, J., Horn, J., Tsui, B. C. 2020

  View details for DOI 10.1053/j.jvca.2020.11.060

  View details for PubMedID 33342733

• Clinical effect of normal saline injectate into interscalene nerve block catheters given within one hour of local anesthetic bolus on analgesia and hemidiaphragmatic paralysis. Regional anesthesia and pain medicine Gerber, L. N., Sun, L. Y., Ma, W., Basireddy, S., Guo, N., Costouros, J., Cheung, E., Boublik, J., Horn, J., Tsui, B. C. 2020

  Abstract

  BACKGROUND: Previous case reports describe the reversal of phrenic nerve blockade from the interscalene nerve block using normal saline injectate washout. This randomized clinical trial aimed to evaluate whether using normal saline injectate to wash out local anesthetic from an interscalene nerve block catheter would restore phrenic nerve and diaphragm function, while preserving analgesia.METHODS: Institutional review board approval, clinical trial registration and consent were obtained for patients undergoing shoulder surgery with an interscalene nerve block catheter. 16 patients were randomized to receive three 10mL aliquots of normal saline injectate (intervention group, n=8) or three sham injectates (control group, n=8) via their perineural catheters in the postanesthesia care unit (PACU). Primary outcome measures were the effects on ipsilateral hemidiaphragmatic paralysis, and secondary outcome measures included PACU opioid consumption, pain scores and change in brachial plexus sensory examination and motor function.RESULTS: There was no significant difference in reversal of hemidiaphragmatic paralysis. However, there was a greater number of patients in the intervention group who ultimately displayed partial, as opposed to full, paralysis of the hemidiaphragm (p=0.03). There was no significant difference in pain scores, PACU opioid requirement, and brachial plexus motor and sensory examinations between the two groups.CONCLUSIONS: All patients had persistent hemidiaphragmatic paralysis after the intervention, but fewer patients in the intervention group progressed to full paralysis, suggesting that a larger bolus dose of normal saline may be needed to completely reverse hemidiaphragmatic paralysis. Although normal saline injectate in 10mL increments given through the interscalene nerve block catheter had no clinically significant effect on reversing phrenic nerve blockade, it also did not lead to a reduction in analgesia and may be protective in preventing the progression to full hemidiaphragmatic paralysis.TRAIL REGISTRATION NUMBER: NCT03677778.

  View details for DOI 10.1136/rapm-2020-101922

  View details for PubMedID 33184166

• Point-of-care ultrasound for the pediatric regional anesthesiologist and pain specialist: a technique review. Regional anesthesia and pain medicine Kars, M. S., Gomez Morad, A., Haskins, S. C., Boublik, J., Boretsky, K. 2020

  Abstract

  Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room.

  View details for DOI 10.1136/rapm-2020-101341

  View details for PubMedID 32928993

• One small step for mankind, a big step for PoCUS. Regional anesthesia and pain medicine Boublik, J., Haskins, S. C. 2019

  View details for DOI 10.1136/rapm-2019-100800

  View details for PubMedID 31678961

• Motor-sparing high-thoracic erector spinae plane block for proximal humerus surgery and total shoulder arthroplasty surgery: clinical evidence for differential peripheral nerve block? Canadian journal of anaesthesia = Journal canadien d'anesthesie Ma, W., Sun, L., Ngai, L., Costouros, J. G., Steffner, R., Boublik, J., Tsui, B. C. 2019

  View details for DOI 10.1007/s12630-019-01442-4

  View details for PubMedID 31290120

• Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist. Regional anesthesia and pain medicine Manson, W. C., Kirksey, M., Boublik, J., Wu, C. L., Haskins, S. C. 2019

  Abstract

  This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.

  View details for DOI 10.1136/rapm-2018-100312

  View details for PubMedID 30902912

• Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist REGIONAL ANESTHESIA AND PAIN MEDICINE Haskins, S. C., Kruisselbrink, R., Boublik, J., Wu, C. L., Perlas, A. 2018; 43 (7): 689–98

  Abstract

  This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.

  View details for PubMedID 30052550

• Ultrasound-Guided Regional Anesthesia and Standard of Care Reply REGIONAL ANESTHESIA AND PAIN MEDICINE Haskins, S. C., Boublik, J., Wu, C. L. 2018; 43 (1): 107–8

  View details for PubMedID 29261607

• Focused Cardiac Ultrasound Limitations and Source of Interpretation Errors Reply REGIONAL ANESTHESIA AND PAIN MEDICINE Haskins, S. C., Boublik, J., Sloth, E. 2018; 43 (1): 109–10

  View details for PubMedID 29261609

• Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist. Regional anesthesia and pain medicine Haskins, S. C., Tanaka, C. Y., Boublik, J., Wu, C. L., Sloth, E. 2017; 42 (5): 632-644

  Abstract

  This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic stenosis, hypovolemia, local anesthetic systemic toxicity, and massive pulmonary embolism.

  View details for DOI 10.1097/AAP.0000000000000650

  View details for PubMedID 28786898

• Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist REGIONAL ANESTHESIA AND PAIN MEDICINE Haskins, S. C., Tsui, B. C., Nejim, J. A., Wu, C. L., Boublik, J. 2017; 42 (3): 289-298

  Abstract

  In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

  View details for DOI 10.1097/AAP.0000000000000583

  View details for Web of Science ID 000399843400004

  View details for PubMedID 28282364

• Point-of-Care Ultrasound for the Regional Anesthesiologist and Pain Specialist: A Series Introduction. Regional anesthesia and pain medicine Haskins, S. C., Boublik, J., Wu, C. L. 2017; 42 (3): 281-282

  View details for DOI 10.1097/AAP.0000000000000570

  View details for PubMedID 28419046

• Prilocaine spinal anesthesia for ambulatory surgery: A review of the available studies ANAESTHESIA CRITICAL CARE & PAIN MEDICINE Boublik, J., Gupta, R., Bhar, S., Atchabahian, A. 2016; 35 (6): 417-421

  Abstract

  Transient neurologic symptoms (TNS) led to the abandonment of intrathecal lidocaine. We reviewed the published literature for information about the duration of action and side effects of intrathecal prilocaine, which has been recently reintroduced in Europe. Medline and EMBASE databases were searched for the time period from 1966 to 2015. Fourteen prospective and one retrospective study were retrieved. The duration of the surgical block can be adjusted using doses between 40 and 80mg. Hyperbaric prilocaine in doses as low as 10mg can be used for perianal procedures. Four cases of TNS in 486 patients were reported in prospective studies, and none in 5000 cases in a retrospective data set. Spinal prilocaine appears to be safe and reliable for day case anesthesia. However, as chloroprocaine has a shorter duration and a lower risk of TNS and urinary retention, the indications for prilocaine remain to be defined.

  View details for DOI 10.1016/j.accpm.2016.03.005

  View details for Web of Science ID 000392296100010

  View details for PubMedID 27352633

• Bioartiticial grafts for transmural myocardial restoration: a new cardiovascular tissue culture concept (Retracted article. See vol. 40, pg. 1555, 2011) EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY Kofidis, T., Lenz, A., Boublik, J., Akhyari, P., Wachsmann, B., Stahl, K. M., Haverich, A., Leyh, R. G. 2003; 24 (6): 906-911

  Abstract

  Survival of bioartificial grafts that are destined to restore cardiac function stands and falls with their nutrient supply. Engineering of myocardial tissue is limited because of lack of vascularization. We introduce a new concept to obtain bioartificial myocardial grafts in which perfusion by a macroscopic core vessel is simulated.We have designed an experimental reactor with multiple chambers for the production of bioartificial tissue or tissue precursors. By introduction of in- and output lines of distinct diameter and insertion of a core vessel into each chamber, we established pulsatile, continuous flow through the embodied three-dimensional tissue culture. In the present study, collagen components served as the ground matrix wherein neonatal rat cardiomyocytes were inoculated. For the assessment of cellular viability and distribution in comparison to static, non-perfused culture, fluor-desoxy-glucose-positron-emission-tomography and life/dead assays were employed.We obtained 3D constructs of 8-mm thickness, which display high viability and metabolism (6.0+/-1.3(e-03) in the perfused vs. 4.0+/-0.3(e-03) in the unperfused chambers). The core vessel has the size of a human coronary and remained patent during the entire culture process. We observed centripetal migration of the embedded cardiomyocytes to the site of the core vessel. Cardiomyocytes partially resumed a spindle like form without additional stretch.The present dynamic tissue culture concept is highly effective in manufacturing thick, viable grafts for cardiac muscle restoration, which could be surgically anastomosable. The bioreactor may accommodate multiple types of cells and tissues for innumerable in vitro and in vivo applications.

  View details for DOI 10.1016/S1010-7940(03)00577-3

  View details for Web of Science ID 000187363000008

  View details for PubMedID 14643807

• Pulsatile perfusion and cardiomyocyte viability in a solid three-dimensional matrix BIOMATERIALS Kofidis, T., Lenz, A., Boublik, J., Akhyari, P., Wachsmann, B., Mueller-Stahl, K., Hofmann, M., Haverich, A. 2003; 24 (27): 5009-5014

  Abstract

  The manufacture of full thickness three-dimensional myocardial grafts by means of tissue engineering is limited by the impeded cellular viability in unperfused in vitro systems. We introduce a novel concept of pulsatile tissue culture perfusion to promote ubiquitous cellular viability and metabolism.In a novel bioreactor we established pulsatile flow through the embedded three-dimensional tissue culture. Fibrin glue served as the ground matrix wherein neonatal rat cardiomyocytes were inoculated. Fluor-Deoxy-Glucose-Positron-Emission-Tomography (FDG-PET) and life/dead assays were employed for comparative studies of glucose uptake resp. cell viability.A solid 8 mm thick structure resulted. Cellular viability significantly increased in the perfused chambers. We observed centripetal migration of the embedded cardiomyocytes to the site of the core vessel. However, cellular viability was high in the periphery of the tissue block too. FDG-PET revealed enhanced metabolic activity in perfused chambers.The present concept is highly effective in enhancing cellular viability and metabolism in a three-dimensional tissue culture environment. It could be utilized for various co-culture systems and the generation of viable tissue grafts.

  View details for DOI 10.1016/S0142-9612(03)00429-0

  View details for Web of Science ID 000186267600013

  View details for PubMedID 14559014

• Clinically established hemostatic scaffold (tissue fleece) as biomatrix in tissue- and organ-engineering research (Retracted article. See vol. 18, pg. 1529, 2012) TISSUE ENGINEERING Kofidis, T., Akhyari, P., Wachsmann, B., Mueller-Stahl, K., Boublik, J., Ruhparwar, A., Mertsching, H., Balsam, L., Robbins, R., Haverich, A. 2003; 9 (3): 517-523

  Abstract

  Various types of three-dimensional matrices have been used as basic scaffolds in myocardial tissue engineering. Many of those are limited by insufficient mechanical function, availability, or biocompatibility. We present a clinically established collagen scaffold for the development of bioartificial myocardial tissue. Neonatal rat cardiomyocytes were seeded into Tissue Fleece (Baxter Deutschland, Heidelberg, Germany). Histological and ultrastructural examinations were performed by DAPI and DiOC(18) staining and electron microscopy, respectively. Force measurements from the spontaneously beating construct were obtained. The constructs were stimulated with agents such as adrenalin and calcium, and by stretching. Passive stretch curves were obtained. Spontaneous contractions of solid bioartificial myocardial tissue (BMT), 20 x 15 x 2 mm, resulted. Contractions continued to week 12 (40% of BMTs) in culture. Histology revealed intercellular and also cell-fibril junctions. Elasticity was similar to that of native rat myocardium. Contractile force increased after topical administration of Ca(2+) and adrenaline. Stretch led to the highest levels of contractile force. In summary, bioartificial myocardial tissue with significant in vitro longevity, spontaneous contractility, and homogeneous cell distribution was produced using Tissue Fleece. Tissue Fleece constitutes an effective scaffold to engineer solid organ structures, which could be used for repair of congenital defects or replacement of diseased tissue.

  View details for Web of Science ID 000183681200013

  View details for PubMedID 12857419