Richard K. Kim

All Publications

• Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the 'neuro-storm'. Regional anesthesia and pain medicine Lee, M. C., Bartuska, A., Chen, J., Kim, R. K., Jaradeh, S., Mihm, F. 2023

  Abstract

  Paroxysmal sympathetic hyperactivity (PSH) is an autonomic disorder affecting patients with severe acquired brain injury characterized by intermittent sympathetic discharges with limited therapeutic options. We hypothesized that the PSH pathophysiology could be interrupted via stellate ganglion blockade (SGB).A patient with PSH after midbrain hemorrhage followed by hydrocephalus obtained near-complete resolution of sympathetic events for 140 days after SGB.SGB is a promising therapy for PSH, overcoming the limitations of systemic medications and may serve to recalibrate aberrant autonomic states.

  View details for DOI 10.1136/rapm-2023-104399

  View details for PubMedID 37230754

• Characterization of Epidural Analgesia Interruption and Associated Outcomes After Esophagectomy. The Journal of surgical research Byrd, C. T., Kim, R. K., Manapat, P., He, H., Tsui, B. C., Shrager, J. B., Berry, M. F., Backhus, L. M., Lui, N. S., Liou, D. Z. 2023; 290: 92-100

  Abstract

  Interruption of thoracic epidural analgesia may impact the postoperative course following esophagectomy. This study investigates the incidence and causes of epidural interruption in esophagectomy patients along with associated postoperative outcomes.This single-institution retrospective analysis examined patients undergoing esophagectomy who received a thoracic epidural catheter from 2016 to 2020. Patients were stratified according to whether epidural catheter infusion was interrupted or not postoperatively. Outcomes were compared between the two groups, and predictors of epidural interruption and postoperative complications were estimated using multivariable logistic regression.Of the 168 patients who received a thoracic epidural before esophagectomy, 60 (35.7%) required epidural interruption and 108 (64.3%) did not. Interruption commonly occurred on postoperative day 1 and was due to hypotension 80% of the time. Heart failure (10.0% versus 0.9%, P = 0.009), atrial fibrillation (20.0% versus 3.7%, P = 0.002), preoperative opioid use (30.0% versus 16.7%, P = 0.043), and higher American Society of Anesthesiology classification (88.4% versus 70.4%, P = 0.008) were more prevalent in the epidural interruption cohort. The female gender was associated with epidural interruption on multivariable logistic regression (adjusted odds ratio [AOR] 2.45, P = 0.039). Patients in the epidural interruption cohort had a higher incidence of delirium (30.5% versus 13.9%, P = 0.010), sepsis (13.6% versus 3.7%, P = 0.028), and severe anastomotic leak (18.3% versus 7.4%, P = 0.032). On adjusted analysis, heart disease (AOR 4.26, P = 0.027), BMI <18.5 (AOR 9.83, P = 0.031), and epidural interruption due to hypotension (AOR 3.51, P = 0.037) were associated with severe anastomotic leak.Early epidural interruption secondary to hypotension in esophagectomy patients may be a harbinger of postoperative complications such as sepsis and severe anastomotic leak. Patients requiring epidural interruption due to hypotension should have a low threshold for additional workup and early intervention.

  View details for DOI 10.1016/j.jss.2023.04.009

  View details for PubMedID 37224609

• 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

• Continuous Serratus Anterior Plane Block: A Team Approach JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Kim, R. K., Brodt, J., MacArthur, J. W., Tsui, B. H. 2022; 36 (4): 1217-+

  View details for DOI 10.1053/j.jvca.2021.09.014

  View details for Web of Science ID 000767605200043

• Toward precision regional anesthesia: is the PENG block appropriate for all hip fracture surgeries? REGIONAL ANESTHESIA AND PAIN MEDICINE Kim, R., Tsui, B. H. 2022; 47 (1): 76-+

  View details for DOI 10.1136/rapm-2021-102926

  View details for Web of Science ID 000726952100016

• 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

• Utilization of Magnesium in Opioid-Free Anesthesia for Peroral Endoscopic Myotomy: A Case Report. A&A practice Kim, R. K., Hwang, J. H., Tsui, B. C. 2021; 15 (1): e01372

  Abstract

  Optimal anesthetic management has not been studied for peroral endoscopic myotomy (POEM). This case report documents 2 patients with esophageal motility disorders who underwent POEM with opioid-free, magnesium-based anesthesia. Both patients had no postoperative esophageal complications nor need for opioid therapy. We further describe the therapeutic potential of magnesium for management of esophageal pain.

  View details for DOI 10.1213/XAA.0000000000001372

  View details for PubMedID 33449540

• Perioperative analgesic administration during the 2018 parenteral opioid shortage in the United States - A retrospective analysis. Journal of clinical anesthesia Kim, R. K., Gao, Z. n., Hastie, T. n., Obal, D. n. 2020; 66: 109892

  View details for DOI 10.1016/j.jclinane.2020.109892

  View details for PubMedID 32502773

• INTRAOPERATIVE ANALGESIA PATTERNS AT AN ACADEMIC TERTIARY MEDICAL CENTER DURING THE 2018 PARENTERAL OPIOID SHORTAGE Kim, R. K., Schmiesing, C. LIPPINCOTT WILLIAMS & WILKINS. 2019: 766–67

  View details for Web of Science ID 000619263200356

• Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Zhang, L. Y., Zhang, J., Kim, R. K., Matthews, J. L., Rudich, D. S., Greer, D. M., Lesser, R. L., Amin, H. 2018; 38 (3): 328-333

  Abstract

  To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology.Retrospective, cross-sectional study.Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included.A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital. Patients were included if vision loss was unilateral and due to transient monocular vision loss (TMVL), central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Any patients with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, nonvascular intraocular pathology, and intracranial pathology other than ischemic stroke.The presence or absence of acute stroke on diffusion-weighted imaging (DWI) on brain MRI.A total of 641 records were reviewed, with 293 patients found to have MVL. After excluding those with focal neurologic deficits, there were 41 patients who met the inclusion criteria and received a brain MRI. Eight of the 41 subjects (19.5%) were found to have findings on brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in TMVL subjects, 4/12 (33.3%) in CRAO subjects, and 2/5 (40%) in BRAO subjects. Brain computed tomography (CT) scans were not able to identify the majority of acute stroke lesions in this study.Patients with MVL of vascular etiology such as TMVL, CRAO, or BRAO may have up to 19.5% risk of concurrent ischemic stroke, even when there are no other neurologic deficits. These strokes were detected acutely with brain MRI using DWI but were missed on CT.

  View details for DOI 10.1097/WNO.0000000000000613

  View details for PubMedID 29369960

• Four Cancers and a Rash: Henoch-Schonlein Purpura AMERICAN JOURNAL OF MEDICINE Kim, R. K., Thomas, A. R., Card, M., Malhotra, D., Holleck, J. L. 2017; 130 (10): 1158–60

  View details for DOI 10.1016/j.amjmed.2017.06.015

  View details for Web of Science ID 000410998300030

  View details for PubMedID 28711558

• Glucagon-induced hypertensive emergency: a case report. Journal of clinical anesthesia Legler, A., Kim, R. K., Chawla, N. 2016; 35: 493-496

  Abstract

  Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control. Nitroglycerin acted as a key agent to decrease the patient's blood pressure as well as a secondary relaxant of the sphincter of Oddi. The patient had no radiographic evidence of pheochromocytoma. As out-of-operating room and intraoperative uses of glucagon continue to increase, perioperative physicians should be aware of its potential hemodynamic effects even in healthy populations.

  View details for DOI 10.1016/j.jclinane.2016.08.033

  View details for PubMedID 27871582

• Efficacy and Safety of Nonopioid Analgesics in Perioperative Pain Control. Current drug safety Thomas, D. A., West, M., Legler, A., Maslin, B., Kim, R. K., Vadivelu, N. 2016; 11 (3): 196-205

  Abstract

  Opioids have been the mainstay for management of acute postoperative pain for several decades. Extensive use, however, has been associated with multiple side effects. Multimodal approaches that incorporate nonopioid medications and techniques have been observed to achieve optimum pain control whilst decreasing side effects. Such strategies are particularly important to consider for opioid-dependent and tolerant patients with various comorbidities undergoing different types of surgery. This review assesses recent data on nonopioid analgesics for postoperative pain control, highlighting evidence of their safety profiles in contemporary pain management.

  View details for DOI 10.2174/1574886311666160426130444

  View details for PubMedID 27113953

• Tumor necrosis factor disrupts claudin-5 endothelial tight junction barriers in two distinct NF-κB-dependent phases. PloS one Clark, P. R., Kim, R. K., Pober, J. S., Kluger, M. S. 2015; 10 (3): e0120075

  Abstract

  Capillary leak in severe sepsis involves disruption of endothelial cell tight junctions. We modeled this process by TNF treatment of cultured human dermal microvascular endothelial cell (HDMEC) monolayers, which unlike human umbilical vein endothelial cells form claudin-5-dependent tight junctions and a high-resistance permeability barrier. Continuous monitoring with electrical cell-substrate impedance sensing revealed that TNF disrupts tight junction-dependent HDMEC barriers in discrete steps: an ~5% increase in transendothelial electrical resistance over 40 minutes; a decrease to ~10% below basal levels over 2 hours (phase 1 leak); an interphase plateau of 1 hour; and a major fall in transendothelial electrical resistance to < 70% of basal levels by 8-10 hours (phase 2 leak), with EC50 values of TNF for phase 1 and 2 leak of ~30 and ~150 pg/ml, respectively. TNF leak is reversible and independent of cell death. Leak correlates with disruption of continuous claudin-5 immunofluorescence staining, myosin light chain phosphorylation and loss of claudin-5 co-localization with cortical actin. All these responses require NF-κB signaling, shown by inhibition with Bay 11 or overexpression of IκB super-repressor, and are blocked by H-1152 or Y-27632, selective inhibitors of Rho-associated kinase that do not block other NF-κB-dependent responses. siRNA combined knockdown of Rho-associated kinase-1 and -2 also prevents myosin light chain phosphorylation, loss of claudin-5/actin co-localization, claudin-5 reorganization and reduces phase 1 leak. However, unlike H-1152 and Y-27632, combined Rho-associated kinase-1/2 siRNA knockdown does not reduce the magnitude of phase 2 leak, suggesting that H-1152 and Y-27632 have targets beyond Rho-associated kinases that regulate endothelial barrier function. We conclude that TNF disrupts TJs in HDMECs in two distinct NF-κB-dependent steps, the first involving Rho-associated kinase and the second likely to involve an as yet unidentified but structurally related protein kinase(s).

  View details for DOI 10.1371/journal.pone.0120075

  View details for PubMedID 25816133

  View details for PubMedCentralID PMC4376850