Peter R Lichtenthal

Interests

Research

Investigational drugs and devices;Post operative pediatric analgesia

Courses

Scholarly Contributions

Journals/Publications

• Kanaparthi, A., Chung, F., Lichtenthal, P., Sprung, J., & Weingarten, T. (2024). PRODIGY score predicts respiratory depression in the post-anesthesia care unit: A post-hoc analysis. Biomolecules and Biomedicine, 24(6). doi:10.17305/bb.2024.10585
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  Surgical patients who experience respiratory depressive episodes (RDEs) during their post-anesthesia care unit (PACU) admission are at a higher risk of developing subsequent respiratory complications in general care wards. A risk assessment tool for PACU RDEs has not been previously assessed. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) score is an assessment tool that uses baseline patient variables to categorize patients into low-, intermediate-, or high-risk groups for RDEs in general care wards. This study assessed whether PRODIGY groups are associated with PACU RDEs. This analysis utilized data from a previous observational trial of PACU RDEs detected by capnography. PRODIGY scores were retrospectively calculated, and the number and duration of respiratory alerts were compared among PRODIGY groups. Twenty-six (29.9%) patients were classified as low risk, 29 (33.3%) as intermediate risk, and 32 (36.8%) as high risk. A total of 3580 alerts were recorded in the PACU, 47% of which were apnea episodes lasting ≥ 10 s. The total number and duration of alerts were highest in high-risk group patients (median 56 [IQR 12–87] alerts per patient vs 22 [9–37] in low-risk and 26 [13–42] in intermediate-risk patients, P = 0.035; 303 [123–885] s vs 177 [30–779] in low-risk and 301 [168–703] in intermediate-risk patients, P = 0.042).Poisson regression analysis indicated thatthe rate of RDEs in the high PRODIGY risk group was higher than in the intermediate (rate ratio estimate = 2.01 [95% CI 1.86–2.18], P < 0.001) and low (rate ratio estimate = 2.25 [95% CI 2.07–2.45], P < 0.001) risk groups. This analysis suggests that the PRODIGY score may be useful in assessing the risk of PACU RDEs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT02707003.
• Lichtenthal, P. R. (2023). Response to society for Healthcare Epidemiology (SHEA) recommendations for ventilator-associated pneumonia (VAP). Infection Control & Hospital Epidemiology (2023), 1-2, 1-2. doi:10.1017/ice.2022.278
• Chung, F., Lichtenthal, P. R., Mestek, M. L., Niebel, K. H., & Wong, J. (2020). Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial. Journal of Clinical Monitoring and Computing. doi:10.1007/s10877-019-00333-9
• Chung, F., Wong, J., Mestek, M., Niebel, K., & Lichtenthal, P. (2020). Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial. Journal of Clinical Monitoring and Computing, 34(3). doi:10.1007/s10877-019-00333-9
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  The utility of capnography to detect early respiratory compromise in surgical patients after anesthesia is unclear due to limited prospective data. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the post-anesthesia care unit (PACU). In this prospective observational trial, 250 consenting patients undergoing elective surgery with general anesthesia were monitored by standard monitoring together with blinded capnography and pulse oximetry monitoring. The capnography notification settings were adjusted to match nursing (Level II) and physician (Level I) alarm thresholds. 163 (95%) patients had a Level II notification and 135 (78%) had a Level I notification during standard monitoring. The most common events detected by the capnography monitor included hypocapnia, apnea, tachypnea, bradypnea and hypoxemia, with silent notification duration for these events ranging from 17 ± 13 to 189 ± 127 s. During standard monitoring, 15 respiratory adverse events were reported, with 8 events occurring when valid blinded/silenced capnography and pulse oximetry data was collected simultaneously. Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min. Three patients’ blinded capnography was unblinded to facilitate clinical care. Respiratory adverse events are frequent in the PACU, and the addition of capnography and IPI to current standard monitoring provides potentially clinically relevant information on respiratory status, including early warning of some respiratory adverse events. Trial registration ClinialTrials.gov Identifier NCT02707003 (https://clinicaltrials.gov/ct2/show/NCT02707003).
• Chan, H., Lichtenthal, P. R., Valencia, O. M., & Valencia, F. (2019). Does the addition of steroid to peripheral nerve blocks improve the perioperative experience for children and families undergoing orthopedic surgical procedures: Is it possible to have quality care and generate cost savings?. Pediatrics, 144(2_MeetingAbstract), 119-119. doi:10.1542/peds.144.2_meetingabstract.119
• Chung, F., Wong, J., Mestek, M. L., Niebel, K. H., & Lichtenthal, P. (2019). Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial. Journal of clinical monitoring and computing.
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  The utility of capnography to detect early respiratory compromise in surgical patients after anesthesia is unclear due to limited prospective data. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the post-anesthesia care unit (PACU). In this prospective observational trial, 250 consenting patients undergoing elective surgery with general anesthesia were monitored by standard monitoring together with blinded capnography and pulse oximetry monitoring. The capnography notification settings were adjusted to match nursing (Level II) and physician (Level I) alarm thresholds. 163 (95%) patients had a Level II notification and 135 (78%) had a Level I notification during standard monitoring. The most common events detected by the capnography monitor included hypocapnia, apnea, tachypnea, bradypnea and hypoxemia, with silent notification duration for these events ranging from 17 ± 13 to 189 ± 127 s. During standard monitoring, 15 respiratory adverse events were reported, with 8 events occurring when valid blinded/silenced capnography and pulse oximetry data was collected simultaneously. Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min. Three patients' blinded capnography was unblinded to facilitate clinical care. Respiratory adverse events are frequent in the PACU, and the addition of capnography and IPI to current standard monitoring provides potentially clinically relevant information on respiratory status, including early warning of some respiratory adverse events.Trial registration ClinialTrials.gov Identifier NCT02707003 ( https://clinicaltrials.gov/ct2/show/NCT02707003 ).
• Chan, H. S., Lichtenthal, P. R., & Valencia, F. (2018). Does Planned Pain Management Improve the Preoperative Experience for Children Undergoing Orthopedic Surgery. Pediatrics, 142(1_MeetingAbstract), 264-264. doi:10.1542/peds.142.1_meetingabstract.264
• Lichtenthal, P. R. (2017). Inaccuracy of a continuous arterial pressure waveform monitor when used for congenital cardiac catheterization. Congenital Heart Disease. doi:10.1111/chd.12517
• Seckeler, M. D., Typpo, K., Deschenes, J., Higgins, R., Samson, R., & Lichtenthal, P. (2017). Inaccuracy of a continuous arterial pressure waveform monitor when used for congenital cardiac catheterization. Congenital heart disease, 12(6), 815-819.
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  To determine the accuracy of a continuous cardiac output monitor (FloTrac sensor) for measuring cardiac index in children with congenital heart disease undergoing cardiac catheterization. Cardiac index is a critical hemodynamic parameter measured during catheterizations in children with congenital heart disease. This has been challenging to measure accurately and many clinicians rely on predictive equations for calculating cardiac index.
• Lichtenthal, P., Borg, U., & Lockett, W. (2015). Does Endotracheal Tube Design Affect Cuff Seal, Safety, and Subglottic Suction Performance?. International Journal of Anesthesiology and Research, 3(10), 166-171.
• Borg, U., & Lichtenthal, P. R. (2014). Does cost affect endotracheal tube performance?. Critical Care. doi:10.1186/cc13509
• Borg, U., Lichtenthal, P. R., & Maul, D. (2011). Do tracheal tubes prevent microaspiration?. BJA: British Journal of Anaesthesia. doi:10.1093/bja/aer312
• Lichtenthal, P., Maul, D., & Borg, U. (2011). Do tracheal tubes prevent microaspiration?. British Journal of Anaesthesia, 107(5). doi:10.1093/bja/aer312
• Borg, U., Lichtenthal, P. R., & Maul, D. (2010). Do endotracheal tubes prevent microaspiration?. Critical Care. doi:10.1186/cc8461
• Burstow, D. J., Copeland, J. G., Lichtenthal, P. R., Phillips, R. A., Sloniger, J., & West, M. J. (2009). Noninvasive Cardiac Output Measurement in Heart Failure Subjects on Circulatory Support. Anesthesia & Analgesia. doi:10.1213/ane.0b013e318193174b
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  Pulmonary artery catheter (PAC) thermodilution is commonly used in the perioperative cardiac surgical intensive care unit for measurement and management of central hemodynamics despite questions about effectiveness, difficulty of use, and safety. USCOM is a noninvasive continuous wave Doppler device for direct measurement of cardiac output (CO) and is an alternative to PAC. USCOM validation has predominantly been in the cardiac surgical intensive care unit against PAC, despite the recognized limitations in reliability of the method. We compared USCOM CO measurements with the CardioWest, an orthotopic total artificial heart (TAH), in heart failure (HF) subjects during controlled interventions.CO, stroke volume (SV), and heart rate (HR) were measured in a blinded fashion using the CardioWest and the USCOM device in TAH HF patients. Five-hundred eight paired measures from 18 examinations of seven subjects were acquired as flow was varied by the CardioWest controller. Bland-Altman analysis was used to compare agreement.Mean values and standard deviations (+/-SD) for CO, SV, and HR by CardioWest and USCOM were 7.33 +/- 0.46 and 7.34 +/- 0.51 L/min, 56.2 +/- 3.8 and 56.6 +/- 3.8 mL, and 131 +/- 3 and 130 +/- 4 bpm, respectively. CO ranged from 5.2 to 9.3 L/min. The mean differences between methods for CO, SV, and HR were -0.01 +/- 0.23 L/min, -0.34 +/- 1.97 mL, and 0.9 +/- 2.3 bpm, respectively, with mean percentage differences of -0.3%, -0.6%, and 0.7%. The percentage limits of agreement for CO, SV, and HR were 6.4%, 7.1%, and 3.6%.USCOM is a feasible and accurate method for noninvasive measurement and monitoring of CO in TAH HF patients and may have a wider application in diagnosis and management of cardiovascular disease.
• Phillips, R., Lichtenthal, P., Sloniger, J., Burstow, D., West, M., & Copeland, J. (2009). Noninvasive cardiac output measurement in heart failure subjects on circulatory support. Anesthesia and Analgesia, 108(3). doi:10.1213/ane.0b013e318193174b
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  BACKGROUND: Pulmonary artery catheter (PAC) thermodilution is commonly used in the perioperative cardiac surgical intensive care unit for measurement and management of central hemodynamics despite questions about effectiveness, difficulty of use, and safety. USCOM is a noninvasive continuous wave Doppler device for direct measurement of cardiac output (CO) and is an alternative to PAC. USCOM validation has predominantly been in the cardiac surgical intensive care unit against PAC, despite the recognized limitations in reliability of the method. We compared USCOM CO measurements with the CardioWest, an orthotopic total artificial heart (TAH), in heart failure (HF) subjects during controlled interventions. METHOD: CO, stroke volume (SV), and heart rate (HR) were measured in a blinded fashion using the CardioWest and the USCOM device in TAH HF patients. Five-hundred eight paired measures from 18 examinations of seven subjects were acquired as flow was varied by the CardioWest controller. Bland-Altman analysis was used to compare agreement. RESULTS: Mean values and standard deviations (±sd) for CO, SV, and HR by CardioWest and USCOM were 7.33 ± 0.46 and 7.34 ± 0.51 L/min, 56.2 ± 3.8 and 56.6 ± 3.8 mL, and 131 ± 3 and 130 ± 4 bpm, respectively. CO ranged from 5.2 to 9.3 L/min. The mean differences between methods for CO, SV, and HR were -0.01 ± 0.23 L/min, ±0.34 ±1.97 mL, and 0.9 ± 2.3 bpm, respectively, with mean percentage differences of ±0.3%, ±0.6%, and 0.7%. The percentage limits of agreement for CO, SV, and HR were 6.4%, 7.1%, and 3.6%. DISCUSSION: USCOM is a feasible and accurate method for noninvasive measurement and monitoring of CO in TAH HF patients and may have a wider application in diagnosis and management of cardiovascular disease. © 2009 International Anesthesia Research Society.
• Lichtenthal, P. R., & Tinker, F. (2008). TruCCOMS: real-time continuous cardiac output?. Critical Care. doi:10.1186/cc6317
• Burstow, D. J., Hood, S. G., Jacobson, B., Lichtenthal, P. R., May, C. N., Phillips, R. A., & West, M. J. (2006). CARDIAC OUTPUT DETERMINATION BY CONTINUOUS WAVE DOPPLER IN PERIOPERATIVE PEDIATRIC HEART SURGERY.. Critical Care. doi:10.1186/cc4677
• Barker, S. J., & Lichtenthal, P. R. (2002). An Evaluation of Pulse Oximetry-Pre, during, and Post-Cardiopulmonary Bypass. Anesthesiology. doi:10.1097/00000542-200209002-00598
• Bose, R. K., Copeland, J. G., Lichtenthal, P. R., Malan, T. P., Nolan, P. E., Polson, J. S., & Tebich, S. L. (2001). Severe, Refractory Hypotension during Anesthesia in a Patient on Chronic Clomipramine Therapy. Anesthesiology. doi:10.1097/00000542-200107000-00040
• Malan, T., Nolan, P., Lichtenthal, P., Polson, J., Tebich, S., Bose, R., & Copeland, J. (2001). Severe, refractory hypotension during anesthesia in a patient on chronic clomipramine therapy. Anesthesiology, 95(1). doi:10.1097/00000542-200107000-00040
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  HYPOTENSION is a risk when therapy with tricyclic antidepressants (TCAs) is administered. Severe hypotension is rare with therapeutic doses of TCAs; however, severe hypotension may occur during overdose. The risk of hypotension in patients to whom therapeutic doses of TCAs are administered and who undergo general anesthesia seems to be low. A literature search yielded only a single case report in the English language, describing significant hypotension after induction of general anesthesia in a patient undergoing TCA therapy who also had a functioning epidural in place. A second case report, in the Spanish-language literature, described a patient to whom TCAs were administered and in whom significant hypotension developed after dosing of an epidural catheter during combined general-epidural anesthesia. We report herein a case of vasodilation and hypotension during general anesthesia that we believe was caused by long-term clomipramine therapy. Our case differs from previous cases in that this patient underwent general anesthesia alone, without epidural blockade.
• Lichtenthal, P. R., & Wolf, A. D. (1999). A MULTI-FUNCTIONAL VENOUS ACCESS DEVICE - A NEW ANSWER TO AN OLD PROBLEM?. Critical Care Medicine. doi:10.1097/00003246-199901001-00311
• Lichtenthal, P. R., & Wolf, A. D. (1999). A.V.A.: a novel approach to venous access. Critical Care. doi:10.1186/cc434
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  Central venous access is an integral part of patient care. The dilemma was whether to insert an introducer or multilumen catheter for access. However, the Advanced Venous Access device (A.V.A.) from Baxter now offers the option of a single device to accomplish multiple functions with one stick. The object of this study was to compare maximal flow rates of this new device with other introducers utilizing the Haemonetics Rapid Infusion System (R.I.S.) and the more traditional pressurized I.V. system
• Lichtenthal, P., & De Wolf, A. (1999). A multi-functional venous access device - A new answer to an old problem?. Critical Care Medicine, 27(1). doi:10.1097/00003246-199901001-00311
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  Introduction: Central venous access has been a matter of choices. Should it be a triple lumen for fluids, a wide-bore for infusion, or an introducer for a pulmonary artery (PA) catheter? A new cannula from Baxter now offers one the option of a single device to accomplish multiple functions with one stick. The object of this study was to compare maximal flow rates of this new device with a traditional 9F introducer, utilizing the Haemonetics Rapid Infusion System (R.I.S.). Methods: Devices tested were the Baxter Advanced Venous Access device (AVA model M3L9F) which incorporates a 9F PA access with one distal (D) and two proximal lumens (P1&P2); and an Arrow 9F introducer (model SI-09903-E). Fluids measured were Normal Saline and a Blood/Plasma mixture. The RIS was set up in a manner to continually infuse fluids through the device tested, using a cut-off pressure of 300 mmHg to judge maximum flow. Devices were tested with PA catheters (7.5F & 8F). Results for the AVA are shown in various configurations: AVA(1)=D+P1; AVA(2)=P1+P2; AVA(3)=D+P1+P2. Results: Flow rate results are below: (Figure Presented) Conclusion: In all categories, the Advanced Venous Access device delivered higher flows than the Arrow 9F introducer. Compared to previous triple lumen flow rates, the AVA device delivers significantly higher flows. Therefore, the AVA device offers a new dimension in central access for trauma, critical care, and high blood loss surgeries (i.e., liver transplants). It now gives us the ability to monitor the circulation and infuse fluids with fewer venous punctures.
• Lichtenthal, P. R., & Nguyen, Q. (1998). MAXIMUM FLOW RATES THROUGH TRIPLE LUMEN CATHETERS - WHO HAS THE HIGHEST FLOW?. Critical Care Medicine. doi:10.1097/00003246-199801001-00243
• Lichtenthal, P. R., & Wade, L. D. (1998). EVALUATION OF THE VIA BLOOD GAS AND CHEMISTRY MONITOR USED ON PATIENTS UNDERGOING CARDIAC SURGERY. Anesthesiology. doi:10.1097/00000542-199809110-00018
• Lichtenthal, P., & Ngnyen, Q. (1998). Maximum flow raies through triple lumen catheters - who has the highest flow?. Critical Care Medicine, 26(1).
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  Introduction: Over five million multi-lumen central venous catheters are used annually worldwide'. Although in common use, no studies have been done to document maximum flow rates among competitive triple lumen catheters. The purpose of this study was to measure maximum flow rates through all three lumens of these catheters to determine which has the highest flow. Method: The following manufacturers' catheters were tested: Abbott, Braun, Arrow, Cook, and Baxter. Fluids used for measurement were Lacated Ringers, Bovine Blood and DMW (Parentcral Nutrition) The infusion system consisted of fluid bags pressurized to 300 mmHg raised 40 in. (101.6 cm) above level. Standard IV tubing was employed and connected in sequence to each lumen tested. On release of a clamp, fluid volume was measured after 3 minutes in a graduated cylinder. Testing was done in duplicate, with results arranged and extrapolated to ml/hour. Results: Row rates for two solutions are shown below: (Figure Presented) Conclusion: Flow rates between triple lumen central venous catheters tested varied by manufacturer. When measuring total flow rates of all three solutions (bovine blood, lactated ringers and D50W), the Baxter catheter had higher flow rales over the other catheters.
• Gordan, D., & Lichtenthal, P. R. (1996). Testing the safety of baxter continuous cardiac output monitoring system. Journal of clinical monitoring. doi:10.1007/bf00857646
• Lichtenthal, P. R. (1996). Monitoring and equipment. Current Opinion in Anesthesiology. doi:10.1097/00001503-199612000-00007
• Lichtenthal, P. R., Moen, S. G., Noskin, G. A., Peruzzi, W. T., Shapiro, B. A., & Yungbluth, M. (1996). Microbial contamination of blood conservation devices during routine use in the critical care setting. Critical Care Medicine. doi:10.1097/00003246-199607000-00015
• Lichtenthal, P., & Gordan, D. (1996). Testing the safety of Baxter continuous cardiac output monitoring system. Journal of Clinical Monitoring, 12(3). doi:10.1007/BF00857646
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  The safety of a new continuous cardiac output monitoring system, recently introduced by Baxter Healthcare Corporation's Edwards Critical- Care Division, was evaluated in normal sheep. The study compared the biocompatibility and safety of the Vigilance® CCO Monitoring System, which employs a continuous cardiac output (CCO) catheter with Baxter Edwards' standard Paceport(TM) pulmonary artery catheter. The CCO catheter, which monitors hemodynamic pressures and provides continuous measurement of cardiac output based on the thermodilution principle, contains a thermal filament that is powered and controlled by a unique cardiac output monitor. Parameters were measured periodically in conscious animals and complete necropsies were performed after each study. Time Control, Paceport(TM), and four CCO groups were studied. Selected groups were studied for 3 days (acute), 7 days (subacute), and/or 4 weeks after 3 days of continuous use (recovery). Results showed no significant differences between the CCO and Paceport(TM) catheters in any of the parameters studied. On gross pathology, observations were similar. The only difference between catheters were microscopic findings of focal subendothelial or subendocardial changes correlated with areas that could have come into contact with the CCO catheter. In acute groups, these changes consisted of a localized myofiber degeneration or necrosis, while in subacute and recovery groups, consisted only of fibrosis. None of the changes were clinically significant. Thus, the CCO catheter, used in conjunction with the Vigilance® CCO Monitoring System, appears to pose no additional risk over a standard Paceport(TM) catheter in normal sheep after continuous use for up to 7 days. Baxter Healthcare Corp. has developed a new continuous cardiac output monitoring system called the Vigilance CCO Monitoring System. The system features a flow-directed pulmonary artery catheter with a thermal filament wound on a 10 cm segment located 14 to 25 cm from the distal tip. An experiment was conducted to test the biocompatibility and safety of Vigilance using normal sheep. Parameters were measured periodically in conscious animals and complete necropsies were performed after each study. Results indicate that the CCO catheter, when used in conjunction with the Vigilance System, pose no additional risk over a standard PaceportTM catheter in normal sheep after continuous use for up to 7 days.
• Peruzzi, W., Noskin, G., Moen, S., Yungbluth, M., Lichtenthal, P., & Shapiro, B. (1996). Microbial contamination of blood conservation devices during routine use in the critical care setting: Results of a prospective, randomized trial. Critical Care Medicine, 24(7). doi:10.1097/00003246-199607000-00015
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  Objectives: To compare microbial contamination of two different blood conservation devices; to determine if there was an association between contamination of the blood conservation devices and clinical infections; to determine if there was a significant user preference for either of the two devices. Design: Prospective, randomized trial. Setting: Medical, neurosurgical, and spinal cord intensive care units of an urban, university hospital. Patients: Forty patients who required clinically indicated intraarterial catheters placed at new sites. Interventions: The two most widely available blood conservation devices at the time of the study (Venous Arterial blood Management Protection system(TM) [VAMP], Baxter Edwards Critical Care, Irvine, CA; and Safe Draw(TM), Ohmeda, Madison, WI) were chosen for comparison. After the normal 48 to 72 hrs of device use, the blood conservation systems were removed and semiquantitative and quantitative cultures were taken from comparable sites of the two devices. Positive cultures from the patients were recorded and correlated with cultures obtained from the devices. In order to assess preference for either device, a survey tool was administered to the nursing staff who participated in the study. Measurements and Main Results: Quantitative cultures from all sites cultured in both groups demonstrated mean colony counts of
• Lichtenthal, P. R., Moen, S. G., Noskin, G. A., Peruzzi, W. T., & Yungbluth, M. (1995). CONTAMINATION OF BLOOD CONSERVATION DEVICES IN INTENSIVE CARE UNIT PATIENTS.. Critical Care Medicine. doi:10.1097/00003246-199501001-00017
• Lichtenthal, P. R., Shapiro, B. A., Stautzenbach, A. M., & Wad, L. (1995). Perioperative cardiac anesthesia and early extubation The keys to decreasing costs in the cardiac surgery ICU. Anesthesiology (Hagerstown).
• Lichtenthal, P. R., & Wade, L. D. (1994). Continuous cardiac output measurements. Journal of Cardiothoracic and Vascular Anesthesia. doi:10.1016/1053-0770(94)90200-3
• Lichtenthal, P., & Wade, L. (1994). Continuous cardiac output measurements. Journal of Cardiothoracic and Vascular Anesthesia, 8(6). doi:10.1016/1053-0770(94)90200-3
• Ahmad, S., & Lichtenthal, P. (1993). Anesthetic management of a patient with a single ventricle and modified Fontan procedure. Journal of Cardiothoracic and Vascular Anesthesia, 7(6). doi:10.1016/1053-0770(93)90061-O
• Ahmad, S., & Lichtenthal, P. R. (1993). Anesthetic management of a patient with a single ventricle and modified Fontan procedure. Journal of Cardiothoracic and Vascular Anesthesia. doi:10.1016/1053-0770(93)90061-o
• Blake, M. J., Cochran-Zull, C., Lichtenthal, P. R., Parker, M., Peruzzi, W. T., & Toth, B. (1993). A clinical evaluation of a blood conservation device in medical intensive care unit patients. Critical Care Medicine. doi:10.1097/00003246-199304000-00007
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  This study was designed to a) document the efficacy of a device intended to conserve blood in critically ill patients; b) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions; c) determine if the blood conservation device resulted in interference with arterial pressure waveforms; d) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers.Prospective, randomized, controlled trial. A clinical trial using prospective, random allocation of consecutive eligible patients.The medical intensive care unit (ICU) of a university hospital located in a large metropolitan area.A total of 100 patients who were admitted to the medical ICU, required arterial line monitoring for clinical purposes, and were managed by the ICU medical service. Exclusion criteria included active bleeding or chronic renal failure at the time of ICU admission.Patients in the experimental group had a blood conservation device incorporated into the arterial pressure monitoring system, while patients in the control group received a conventional arterial pressure monitoring system.Data gathered included: age; gender; ICU discharge status; the duration of ICU stay; time in the study; volume of all blood drawn, discarded, or lost due to leakage; hemoglobin concentrations; blood transfusions; and accidental needle injuries. Arterial pressure waveforms were recorded and inspected for dampening or other deformation. Mean hemoglobin concentrations were compared on ICU admission and at 12-hr intervals. Demographic and clinical characteristics of the two groups were not significantly different. The volume of blood drawn and discarded from arterial catheters was significantly lower in the blood conservation group (blood conservation device: 5.7 +/- 7.5 mL; control: 96.4 +/- 88.5 mL; p < .0001), as was the total volume of blood discarded (blood conservation device: 19.4 +/- 47.4 mL; control: 103.5 +/- 99.9 mL; p < .0001). Mean hemoglobin concentration on admission was similar in the two groups (blood conservation device group: 11.8 +/- 2.5 g/dL; control group: 12.6 +/- 2.3 g/dL). In both groups, the mean hemoglobin concentration declined most rapidly in the first 24 hrs of ICU care and, thereafter, declined more slowly. Although the mean hemoglobin concentration was higher in the blood conservation group after 6 days, statistical significance was not reached until 9.5 days of ICU care. The mean change in hemoglobin concentration (overall: 1.2 +/- 2.2 g/dL) during the study represents a statistically significant (p < .0001) decrease of 9.7%. Hemoglobin concentration during the study decreased by 1.4 +/- 2.2 g/dL in the control group and 1.0 +/- 2.3 g/dL in the blood conservation group (p = nonsignificant). Univariate and multiple regression analysis demonstrated discarded blood volume to be a significant and independent predictor of the decline in hemoglobin concentration. Transfusion requirements were similar in both groups. The blood conservation system did not alter or interfere with pressure waveforms. There were no accidental needle injuries noted.The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers. Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration. With devices as described here, there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error.
• Lichtenthal, P. R., & Shapiro, B. A. (1993). Inhalation-based anesthetic techniques are the key to early extubation of the cardiac surgical patient. Journal of Cardiothoracic and Vascular Anesthesia. doi:10.1016/1053-0770(93)90204-x
• Lichtenthal, P. R., & Wade, L. D. (1993). CLINICAL EVALUATION OF A CONTINUOUS CARDIAC OUTPUT SYSTEM IN POST-OP CARDIAC SURGICAL PATIENTS. Critical Care Medicine. doi:10.1097/00003246-199304001-00166
• Peruzzi, W., Parker, M., Lichtenthal, P., Cochran-Zull, C., Toth, B., & Blake, M. (1993). A clinical evaluation of a blood conservation device in medical intensive care unit patients. Critical Care Medicine, 21(4). doi:10.1097/00003246-199304000-00007
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  Objectives: This study was designed to a) document the efficacy of a device intended to conserve blood in critically ill patients; b) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions; c) determine if the blood conservation device resulted in interference with arterial pressure waveforms; d) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers. Design: Prospective, randomized, controlled trial. A clinical trial using prospective, random allocation of consecutive eligible patients. Setting: The medical intensive care unit (ICU) of a university hospital located in a large metropolitan area. Patients: A total of 100 patients who were admitted to the medical ICU, required arterial line monitoring for clinical purposes, and were managed by the ICU medical service. Exclusion criteria included active bleeding or chronic renal failure at the time of ICU admission. Interventions: Patients in the experimental group had a blood conservation device incorporated into the arterial pressure monitoring system, while patients in the control group received a conventional arterial pressure monitoring system. Measurements and Main Results: Data gathered included: age; gender; ICU discharge status; the duration of ICU stay; time in the study; volume of all blood drawn, discarded, or lost due to leakage; hemoglobin concentrations; blood transfusions; and accidental needle injuries. Arterial pressure waveforms were recorded and inspected for dampening or other deformation. Mean hemoglobin concentrations were compared on ICU admission and at 12-hr intervals. Demographic and clinical characteristics of the two groups were not significantly different. The volume of blood drawn and discarded from arterial catheters was significantly lower in the blood conservation group (blood conservation device: 5.7 ± 7.5 mL; control: 96.4 ± 88.5 mL; p < .0001), as was the total volume of blood discarded (blood conservation device: 19.4 ± 47.4 mL; control: 103.5 ± 99.9 mL; p < .0001). Mean hemoglobin concentration on admission was similar in the two groups (blood conservation device group: 11.8 ± 2.5 g/dL; control group: 12.6 ± 2.3 g/dL). In both groups, the mean hemoglobin concentration declined most rapidly in the first 24 hrs of ICU care and, thereafter, declined more slowly. Although the mean hemoglobin concentration was higher in the blood conservation group after 6 days, statistical significance was not reached until 9.5 days of ICU care. The mean change in hemoglobin concentration (overall: 1.2 ± 2.2 g/dL) during the study represents a statistically significant (p < .0001) decrease of 9.7%. Hemoglobin concentration during the study decreased by 1.4 ± 2.2 g/dL in the control group and 1.0 ± 2.3 g/dL in the blood conservation group (p = nonsignificant). Univariate and multiple regression analysis demonstrated discarded blood volume to be a significant and independent predictor of the decline in hemoglobin concentration. Transfusion requirements were similar in both groups. The blood conservation system did not alter or interfere with pressure waveforms. There were no accidental needle injuries noted. Conclusions: The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers. Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration. With devices as described here, there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error.
• Shapiro, B., & Lichtenthal, P. (1993). Inhalation-based anesthetic techniques are the key to early extubation of the cardiac surgical patient. Journal of Cardiothoracic and Vascular Anesthesia, 7(2). doi:10.1016/1053-0770(93)90204-X
• Blake, M. J., Davison, R., Lichtenthal, P. R., Parker, M., Peruzzi, W. T., Shapiro, B. A., & Toht, B. (1991). CLINICAL EVALUATION OF THE VENOUS ARTERIAL BLOOD MANAGEMENT SYSTEM. Anesthesiology. doi:10.1097/00000542-199109001-00473
• Lichtenthal, P. R., Rossi, E. C., & Wade, L. D. (1989). CONTROL OF BLOOD PRESSURE AFTER CORONARY ARTERY BYPASS SURGERY WITH I.V. KETANSERIN. Anesthesiology. doi:10.1097/00000542-198909001-00067
• Lichtenthal, P. R., Rossi, E. C., & Wade, L. D. (1987). The Effect of Ketanserin on Blood Pressure and Platelets during Cardiopulmonary Bypass. Anesthesia & Analgesia. doi:10.1213/00000539-198711000-00014
• Lichtenthal, P., Wade, L., & Rossi, E. (1987). The effect of ketanserin on blood pressure and platelets during cardiopulmonary bypass. Anesthesia and Analgesia, 66(11). doi:10.1213/00000539-198711000-00014
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  Ketanserin, a serotonin antagonist, was used to control blood pressure during cardiopulmonary bypass in 12 patients having cardiac surgery. The drug was administered as a 10 mg bolus followed by a continuous infusion of either 40, 80, or 120 mg/hr to maintain mean arterial blood pressure below 70 mm Hg. There were 16 hypertensive episodes of which 15 (93.7%) were successfully controlled with ketanserin. Mean arterial prressure decreased significantly from an average of 72 ± 3 to 52 ± 9 mm Hg after 1 min. The effect that ketanserin had on platelets was also evaluated. Neither adverse nor salutary effects were seen in the platelet count, though a significant inhibition of serotonin-induced platelet aggregation was observed. Ketanserin proved effective for controlling hypertension during cardiopulmonary bypass but, despite inhibition of serotonin-induced platelet aggregation, it did not prevent thrombocytopenia.
• Fung, H., Lichtenthal, P. R., Louis, G., Michaelis, L. L., Patrignani, P., Rehnberg, K. A., Rossi, E. C., & Wade, L. (1985). Dose-related Prolongation of the Bleeding Time by Intravenous Nitroglycerin. Anesthesia & Analgesia. doi:10.1213/00000539-198501000-00006
• Kinzer, J. B., Lichtenthal, P. R., & Wade, L. D. (1985). Loss of Radial Artery Pressure Trace During Internal Mammary Artery Dissection for Coronary Artery Bypass Graft Surgery. Anesthesia & Analgesia. doi:10.1213/00000539-198511000-00019
• Kinzer, J., Lichtenthal, P., & Wade, L. (1985). Loss of radial artery pressure trace during internal mammary artery dissection for coronary artery bypass graft surgery. Anesthesia and Analgesia, 64(11). doi:10.1213/00000539-198511000-00019
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  Recently reported results have led to increased use of IMA grafts for CABG surgery at our institution. However, we have encountered a recurring monitoring problem that is related not to equipment malfunction but rather to distortion of normal anatomy. We describe a case in which we lost the capability to monitor systemic blood pressure via the radial artery during IMA dissection.
• Lichtenthal, P., Rossi, E., & Louis, G. (1985). Dose-relatd prolongation of the bleeding time by intravenous nitroglycerin. Anesthesia and Analgesia, 64(1).
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  The effects of intravenous nitroglycerin (NTG) upon the bleeding time, platelet aggregation response, and plasma 6-keto-PGF(1α) concentration were measured in 17 patients about to undergo coronary bypass grafting. NTG produced a dose-related prolongation of the bleeding time that correlated with the accompanying decrease in systolic blood pressure. Platelet aggregation was not affected and measurements of 6-keto-PGF(1α) failed to reveal detectable levels (< 10 pg/ml) either before or after NTG infusion. This suggests that the prolonged bleeding time associated with NTG infusion may be due to vasodilatation and increased venous capacitance, rather than altered vascular-platelet interaction.
• Lichtenthal, P. R., Loeb, J. M., & deTarnowsky, J. M. (1984). Parasympathomimetic effects of fentanyl on the canine sinus node. Journal of the autonomic nervous system. doi:10.1016/0165-1838(84)90010-9
• Lichtenthal, P. R., Niemyski, P. R., Shapiro, B. A., & Wade, L. D. (1984). Respiratory Management After Cardiac Surgery with Inhalation Anesthesia. Survey of Anesthesiology. doi:10.1097/00132586-198406000-00090
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  Improvements in cardiac surgery techniques and anesthetic management have given us cause to re-evaluate the necessity for postoperative mechanical ventilation and delayed extubation after open-heart surgery with inhalational anesthesia. One hundred consecutive patients undergoing various types of cardiac surgery were entered into this study; 94 patients met the requirements for spontaneous ventilation in the immediate postoperative time period and mechanical ventilation was not utilized. Of these 94 patients, 40 (45%) met extubation requirements within 90 min and were subsequently extubated. No patient required reintubation. Six (6%) patients failed to meet the requirements for spontaneous ventilation and, therefore, required mechanical ventilatory assistance postoperatively. In the majority of cardiac patients, the anesthetic technique determines postoperative ventilatory needs. Very poor preoperative physical status and unusually long procedures, however, will probably preclude early extubation or spontaneous ventilation and dictate the need for mechanical ventilation regardless of the anesthetic technique.
• Loeb, J., Lichtenthal, P., & deTarnowsky, J. (1984). Parasympathomimetic effects of fentanyl on the canine sinus node. Journal of the Autonomic Nervous System, 11(1). doi:10.1016/0165-1838(84)90010-9
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  The bradycardia coincident with fentanyl administration has been reported to result from a centrally-mediated decrease in sympathetic tone, coupled with a centrally-mediated increase in vagal tone [2,3]. Reitan et al. [8] reported that about 90% of the bradycardic action of fentanyl resulted from an enhancement of vagal efferent traffic from the central nervous system, whereas only 10% resulted from the attenuation of sympathetic neural tone. More recently, Inoue et al. [1] suggested that fentanyl has a rather specific action on individual populations of cardiac vagal fibers associated closely with heart rate changes. The present study was undertaken to analyze (1) whether fentanyl might have a direct negative chronotropic effect upon the sinus node, irrespective of autonomic neural input to the node and (2) whether fentanyl might potentiate the actions of vagally-released acetylcholine on the sinus node. Mongrel dogs (n = 10) were premedicated with morphine sulfate (3 mg/kg) and anesthetized with alpha chloralose (75 mg/kg). Animals were intubated and ventilated using a positive pressure pump. The femoral vein and artery were catheterized respectively for the maintenance of fluid balance and measurement of arterial pressure. Both vagi were isolated in the cervical region and transected. A right thoracotomy was performed and a pericardial cradle was constructed. Both stellate ganglia were exposed and the ansae subclavia were sectioned bilaterally. This procedure (coupled with bilateral vagotomy) has been shown to be analogous to total cardiac denervation [7]. Electrograms were recorded from the sinus node, right atrium, right ventricle and His bundle and a lead II electrocardiogram was recorded. © 1984.
• Collins, J. J., Lichtenthal, P. R., & Wade, L. (1983). Multipurpose Pulmonary Artery Catheter. The Annals of Thoracic Surgery. doi:10.1016/s0003-4975(10)60496-1
• Lichtenthal, P. R., Michaelis, L. L., Moran, J. M., Roberts, A. J., Sanders, J. H., & Spies, S. (1983). Changes in Left Ventricular Performance Related to Perioperative Myocardial Infarction in Coronary Artery Bypass Graft Surgery. The Annals of Thoracic Surgery. doi:10.1016/s0003-4975(10)60425-0
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  Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.
• Lichtenthal, P. R., Niemyski, P. R., Shapiro, B. A., & Wade, L. D. (1983). Respiratory management after cardiac surgery with inhalation anesthesia. Critical Care Medicine. doi:10.1097/00003246-198308000-00004
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  Improvements in cardiac surgery techniques and anesthetic management have given us cause to re-evaluate the necessity for postoperative mechanical ventilation and delayed extubation after open-heart surgery with inhalational anesthesia. One hundred consecutive patients undergoing various types of cardiac surgery were entered into this study; 94 patients met the requirements for spontaneous ventilation in the immediate postoperative time period and mechanical ventilation was not utilized. Of these 94 patients, 40 (45%) met extubation requirements within 90 min and were subsequently extubated. No patient required reintubation. Six (6%) patients failed to meet the requirements for spontaneous ventilation and, therefore, required mechanical ventilatory assistance postoperatively. In the majority of cardiac patients, the anesthetic technique determines postoperative ventilatory needs. Very poor preoperative physical status and unusually long procedures, however, will probably preclude early extubation or spontaneous ventilation and dictate the need for mechanical ventilation regardless of the anesthetic technique.
• Lichtenthal, P., Wade, L., & Collins, J. (1983). Multipurpose Pulmonary Artery Catheter. Annals of Thoracic Surgery, 36(4). doi:10.1016/S0003-4975(10)60496-1
• Lichtenthal, P., Wade, L., Niemyski, P., & Shapiro, B. (1983). Respiratory management of cardiac surgery with inhalation anesthesia. Critical Care Medicine, 11(8). doi:10.1097/00003246-198308000-00004
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  Improvements in cardiac surgery techniques and anesthetic management have given us cause to re-evaluate the necessity for postoperative mechanical ventilation and delayed extubation after open-heart surgery with inhalational anesthesia. One hundred consecutive patients undergoing various types of cardiac surgery were entered into this study; 94 patients met the requirements for spontaneous ventilation in the immediate postoperative time period and mechanical ventilation was not utilized. Of these 94 patients, 40 (45%) met extubation requirements within 90 min and were subsequently extubated. No patient required reintubation. Six (6%) patients failed to meet the requirements for spontaneous ventilation and, therefore, required mechanical ventilatory assistance postoperatively. In the majority of cardiac patients, the anesthetic technique determines postoperative ventilatory needs. Very poor preoperative physical status and unusually long procedures, however, will probably preclude early extubation or spontaneous ventilation and dictate the need for mechanical ventilation regardless of the anesthetic technique.
• Roberts, A., Spies, S., Lichtenthal, P., Moran, J., Sanders, J., & Michaelis, L. (1983). Changes in Left Ventricular Performance Related to Perioperative Myocardial Infarction in Coronary Artery Bypass Graft Surgery. Annals of Thoracic Surgery, 35(5). doi:10.1016/S0003-4975(10)60425-0
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  Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-py-rophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups. © 1983, The Society of Thoracic Surgeons. All rights reserved.
• Feldman, R., Pepine, C., Conti, C., Lichtenthal, P., Loeb, J., Sanders, J., Gerstenblith, G., Ouyang, P., Achuff, S., Bulkley, B., Becker, L., Mellits, E., Baughman, K., Weiss, J., Flaherty, J., Kallman, C., Llewellyn, M., & Weisfeldt, M. (1982). Nifedipine in Unstable Angina. New England Journal of Medicine, 307(10). doi:10.1056/NEJM198209023071015
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  To the Editor: The article by Gerstenblith and his colleagues (April 15 issue), comparing the use of nifedipine and placebo in patients with unstable angina admitted to a coronary-care unit,* is an important contribution to the treatment of this subgroup of patients with angina at rest. These patients had a moderate but significant reduction in ischemia-related events (sudden death, myocardial infarction, and bypass surgery) when nifedipine was added to long-acting nitrate and propranolol treatment. Analysis of the data suggests two potentially important points not discussed by the authors. First of all, although the apparent benefit of nifedipine therapy was shown. © 1982, Massachusetts Medical Society. All rights reserved.
• Kaplan, K., Lichtenthal, P. R., Michaelis, L. L., Moran, J. V., Roberts, A. J., Sanders, J. H., & Spies, S. (1982). Clinical Evaluation of the Relative Effectiveness of Multidose Crystalloid and Cold Blood Potassium Cardioplegia in Coronary Artery Bypass Graft Surgery: A Nonrandomized Matched-Pair Analysis. The Annals of Thoracic Surgery. doi:10.1016/s0003-4975(10)60780-1
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  Controversy exists concerning the most effective method of myocardial protection during coronary artery bypass graft operations. Accordingly, we performed a matched-pair analysis between 25 patients receiving multidose hypothermic potassium crystalloid cardioplegia and 25 other patients receiving cold blood potassium cardioplegia. Patients were matched on the basis of preoperative ejection fraction (EF) and the number of anatomically similar stenotic coronary arteries. The adequacy of myocardial protection was assessed by serial perioperative determinations of radionuclide ventriculography, hemodynamic measurements, analyses of electrocardiograms and serum levels of MB-CK. We found that the level of myocardial protection was similar between unstratified groups. However, when subgroups were selected on the basis of prolonged aortic cross-clamp time (greater than ninety minutes) or impaired preoperative left ventricular function (EF less than 40%), there was a suggestion that cold blood cardioplegia may be advantageous.
• Roberts, A., Moran, J., Sanders, J., Spies, S., Lichtenthal, P., Kaplan, K., & Michaelis, L. (1982). Clinical Evaluation of the Relative Effectiveness of Multidose Crystalloid and Cold Blood Potassium Cardioplegia in Coronary Artery Bypass Graft Surgery: A Nonrandomized Matched-Pair Analysis. Annals of Thoracic Surgery, 33(5). doi:10.1016/S0003-4975(10)60780-1
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  Controversy exists concerning the most effective method of myocardial protection during coronary artery bypass graft operations. Accordingly, we performed a matched-pair analysis between 25 patients receiving multidose hypothermic potassium crystalloid cardioplegia and 25 other patients receiving cold blood potassium cardioplegia. Patients were matched on the basis of preoperative ejection fraction (EF) and the number of anatomically similar stenotic coronary arteries. The adequacy of myocardial protection was assessed by serial perioperative determinations of radionuclide ventriculography, hemodynamic measurements, analyses of electrocardiograms, and serum levels of MB-CK. We found that the level of myocardial protection was similar between unstratified groups. However, when subgroups were selected on the basis of prolonged aortic cross-clamp time (> ninety minutes) or impaired preoperative left ventricular function (EF < 40%), there was a suggestion that cold blood cardioplegia may be advantageous. © 1982, The Society of Thoracic Surgeons. All rights reserved.
• Kaplan, K., Lichtenthal, P. R., Michaelis, L. L., Moran, J. M., Roberts, A. J., Sanders, J. H., & Spies, S. (1981). Nonrandomized Matched Pair Analysis of Intermittent Ischemic Arrest versus Potassium Crystalloid Cardioplegia during Myocardial Revascularization. The Annals of Thoracic Surgery. doi:10.1016/s0003-4975(10)61339-2
• Lichtenthal, P. R., Michaelis, L. L., Moran, J. V., Roberts, A. J., Sanders, J. H., Spies, S., White, R. D., & Wilkinson, C. J. (1981). Serial assessment of left ventricular performance following coronary artery bypass grafting. Early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia.. The Journal of Thoracic and Cardiovascular Surgery.
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  Forty patients who recently underwent coronary artery bypass graft (CABG) operations had serial hemodynamic and scintigraphic studies. Multidose hypothermic potassium crystalloid cardioplegia was used for myocardial protection and newer techniques in anesthetic management and perioperative patient care were also employed. The method of equilibrium cardiac gated blood pool (GBP) scintigraphy was used to obtain perioperative changes in global ejection fraction (EF) and regional wall motion (RWM). Ninety percent of patients displayed a decrease in EF 2 hours postoperatively when compared to their preoperative values. This change was also associated with a fall in cardiac index (CI) and left ventricular stroke work index (LVSWI). Twenty-four hours postoperatively, EF and CI recovered to preoperative levels, but LVSWI remained depressed. Seven days postoperatively, global EF had improved to a value greater than the preoperative one (50% +/- 3% versus 57% +/- 4%, p < 0.05). Perioperative changes in RWM followed the same pattern as EF, but recovery in this index of regional contractility was faster than EF, since maximal improvement was observed 24 hours postoperatively. Thus transient left ventricular dysfunction is common immediately after CABG, but recent advances in myocardial protection and perioperative management are associated with short-term increases in regional and global left ventricular function documented by noninvasive GBP imaging.
• Lichtenthal, P., Rossi, E., & Louis, G. (1981). Bleeding time and platelet aggregation following nitroglycerin. Anesthesiology, 55(3).
• Roberts, A., Sanders, J., Moran, J., Kaplan, K., Lichtenthal, P., Spies, S., & Michaelis, L. (1981). Nonrandomized Matched Pair Analysis of Intermittent Ischemic Arrest versus Potassium Crystalloid Cardioplegia during Myocardial Revascularization. Annals of Thoracic Surgery, 31(6). doi:10.1016/S0003-4975(10)61339-2
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  The quest for the ideal method of myocardial preservation during coronary artery bypass graft (CABG) surgery continues at a rapid pace. Nevertheless, in the present clinical practice of cardiac surgery, the choice is chiefly between hypothermic intermittent ischemic arrest and hypothermic potassium cardioplegia. This study applies newer techniques in radionuclear cardiology, as well as more conventional enzymatic, electrocardiographic, and hemodynamic determinations, to the evaluation of the effectiveness of the previously mentioned modes of myocardial protection. Serial assessments are made preoperatively as well as during the first ten days postoperatively. We find that the perioperative incidence of myocardial damage and changes in left ventricular performance are almost identical using either method in patients with relatively normal preoperative left ventricular performance who do not have severe preoperative refractory ischemia or necrosis. © 1981, The Society of Thoracic Surgeons. All rights reserved.
• Roberts, A., Spies, S., Sanders, J., Moran, J., Wilkinson, C., Lichtenthal, P., White, R., & Michaelis, L. (1981). Serial assessment of left ventricular performance following coronary artery bypass grafting. Early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia. Cardiology, 81(1). doi:10.1016/s0022-5223(19)37662-7
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  Forty patients who recently underwent coronary artery bypass graft (CABG) operations had serial hemodynamic and scintigraphic studies. Multidose hypothermic potassium crystalloid cardioplegia was used for myocardial protection and newer techniques in anesthetic management and perioperative patient care were also employed. The method of equilibrium cardiac gated blood pool (GBP) scintigraphy was used to obtain perioperative changes in global ejection fraction (EF) and regional wall motion (RWM). Ninety percent of patients displayed a decrease in EF 2 hours postoperatively when compared to their preoperative values. This change was also associated with a fall in cardiac index (CI) and left ventricular stroke work index (LVSWI). Twenty-four hours postoperatively, EF and CI recovered to preoperative levels, but LVSWI remained depressed. Seven days postoperatively, global EF had improved to a value greater than the preoperative one (50% ± 3% versus 57% ± 4%, p < 0.05). Perioperative changes in RWM followed the same pattern as EF, but recovery in this index of regional contractility was faster than EF, since maximal improvement was observed 24 hours postoperatively. Thus transient left ventricular dysfunction is common immediately after CABG, but recent advances in myocardial protection and perioperative management are associated with short-term increases in regional and global left ventricular function documented by noninvasive GBP imaging.
• G, K., Hs, H., & Lichtenthal, P. R. (1980). Unusual Case of Recovery Room Air Pollution. Anesthesia & Analgesia. doi:10.1213/00000539-198009000-00018
• Lichtenthal, P. R., Meyers, S. N., Michaelis, L. L., Moran, J. V., Roberts, A. J., Sanders, J. H., & Spies, S. (1980). Early and long-term improvement in left ventricular performance following coronary bypass surgery.. Surgery.
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  Changes in left ventricular performance after coronary artery bypass grafting (CABG) have been variable. Earlier studies based on contrast left ventriculography have shown occasional improvement in left ventricular function in patients with unstable angina or abnormal preoperative ventricular performance, but for the most part repeat cardiac catheterization several months after operation has shown no significant changes in global left ventricular contraction. In the past few years, advances in radiopharmaceutical technology have made the characterization of left ventricular wall motion accurate and highly reproducible. Since prognosis in patients with coronary artery disease and survival after CABG have been related to global ejection fraction (EF), we employed prospectively on analysis of short-term and long-term changes in EF after CABG utilizing multidose hypothermic potassium crystalloid cardioplegia as the method of myocardial protection. Concomitantly, newer techniques in anesthesia and perioperative patient management were employed to minimize myocardial damage in these patients. Postoperative scintigraphic evaluation showed a transient (2-hour) depression in left ventricular function, followed by recovery to preoperative levels at 24 hours and significant improvement in EF at 7 days. From 7 days to 8 months postoperatively, there was no further change in resting EF, but there was another significant exercise-induced increase in EF at the long-term examination. Thus, present advances in the multidisciplinary management of patients with coronary artery disease are associated with improvement in resting and exercise-related EF postoperatively.
• Lichtenthal, P., Katele, G., & Holley, H. (1980). Unusual case of recovery room air pollution. Anesthesia and Analgesia, 59(9). doi:10.1213/00000539-198009000-00018
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  The increasing concern over operating room pollution will, no doubt, affect the fashion in which anesthesia is practiced. However, one should realize that operating room pollution is not always attributable to trace anesthetic gases, as demonstrated in this letter.
• Roberts, A., Spies, S., Meyers, S., Moran, J., Sanders, J., Lichtenthal, P., & Michaelis, L. (1980). Early and long-term improvement in left ventricular performance following coronary bypass surgery. Surgery (United States), 88(4).
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  Changes in left ventricular performance after coronary artery bypass grafting (CABG) have been variable. Earlier studies based on contrast left ventriculography have shown occasional improvement in left ventricular function in patients with unstable angina or abnormal preoperative ventricular performance, but for the most part, repeat cardiac catheterization several months after operation has shown no significant changes in global left ventricular contraction. In the past few years, advances in radiopharmaceutical technology have made the characterization of left ventricular wall motion accurate and highly reproducible. Since prognosis in patients with coronary artery disease and survival after CABG have been related to global ejection fraction (EF), we employed prospectively an analysis of short-term and long-term changes in EF after CABG utilizing multidose hypothermic potassium crystalloid cardioplegia as the method of myocardial protection. Concomitantly, newer techniques in anesthesia and perioperative patient management were employed to minimize myocardial damage in these patients. Postoperative scintigraphic evaluation showed a transient (2-hour) depression in left ventricular function, followed by recovery to preoperative levels at 24 hours and significant improvement in EF at 7 days. From 7 days to 8 months postoperatively, there was no further change in resting EF, but there was another significant exercise-induced increase in EF at the long-term examination. Thus, present advances in the multidisciplinary management of patients with coronary artery disease are associated with improvement in resting and exercise-related EF postoperatively. © 1980, All rights reserved.
• Adams, A., Brunner, E. A., DeBoer, D., Lichtenthal, P. R., Wade, L. D., & Wilkinson, C. J. (1979). Raising Cost Consciousness in Anesthesia. Anesthesiology. doi:10.1097/00000542-197909001-00353
• Roberts, A., Spies, S., Lichtenthal, P., Moran, J., Sanders, J., & Michaelis, L. (1979). Multidose hypothermic potassium cardioplegia: clinical study of relationship between continuous aortic cross-clamp time and LV performance.. Surgical Forum, 30.
• Lichtenthal, P., Philip, J., Sloss, L., Gabel, R., & Lesch, M. (1977). Administration of nitrous oxide in normal subjects. Evaluation of systems of gas delivery for their clinical use and hemodynamic effects. Anesthesia and Analgesia, 72(3). doi:10.1378/chest.72.3.316
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  Nitrous oxide (concentrations of 30 to 50%) was administered to 22 healthy volunteer subjects via nasal prongs, rebreathing mask, and an airlines mask to assess the efficiency of systems of delivery and the hemodynamic effects. The end expired concentration of nitrous oxide, expressed as a percentage of the inspired concentration of nitrous oxide, was 19% for nasal prongs, 34% for the rebreathing mask, and 95% for the airlines mask (most accurate delivery). The pulse rate fell from a mean of 79 ± 3 beats per min to 67 ± 2 with nasal prongs, to 64 ± 2 with the rebreathing mask, and to 64 ± 2 with the airlines mask. Both systolic and diastolic pressures fell from means of 122 ± 4 and 74 ± 2 mm Hg, respectively, to 98 ± 3 mm Hg and 64 ± 2 mm Hg, respectively, with the airlines apparatus. The fall in systolic blood pressure (slope, -0.79) exceeded that in the diastolic (slope, -0.35). In an additional 8 normal subjects, administration of 30% nitrous oxide via airlines mask produced identical changes in blood pressure and pulse rate, but there was no effect from 30 min of administration of 30% nitrous oxide on the end systolic volume index, cardiac index, ejection fraction, normalized wall velocity determined echocardiographically, ejection time, or the ratio of preejection period to ejection time.
• Lichtenthal, P. R., & Roberts, R. B. (1973). The effect of volatile anesthetic agents upon the conductivity of anesthetic circuits.. Anesthesia & Analgesia.
• Lichtenthal, P., & Roberts, R. (1973). The effect of volatile anesthetic agents upon the conductivity of anesthetic circuits.. Anesthesia and analgesia, 52(1). doi:10.1213/00000539-197301000-00036

Proceedings Publications

• Borg, U. R., & Lichtenthal, P. R. (2011). Endotracheal Tube (ETT) Cuff Pressure - The Role Of Tracheal Size And Inflation Volume. In ASA.

Presentations

• Lichtenthal, P. R. (2023). "Does Intravenous or Perineural Dexamethasone Prolong Peripheral Nerve Block Analgesia Similarly in Children Undergoing Lower Extremity Orthopedic Surgery?". EACD. Ljubljana, Slovenia.
• Lichtenthal, P. R. (2019, March/Spring). Adequate Pain Control in Pediatric Orthopedic Surgery: Increases Patient Satisfaction and Reduces Hospital Costs.. New Zealand Pain Society. Aukland, New Zealand: New Zealand Pain Society.
• Lichtenthal, P. R. (2019, May/Summer). Pain Management and Capnostream Project. Medtronic. Boulder, CO.
• Lichtenthal, P. R. (2019, September/Fall). Perioperative Anesthesia/Surgical Collaboration: Working Together to Maximize Outcomes and Enhance the Patient/Family Surgical Experience. American Academy for Cerebral Palsy and Developmental Medicine 73rd Annual and IAACD 2nd Triannual Meeting. Anaheim, CA: American Academy for Cerebral Palsy and Developmental Medicine.
• Lichtenthal, P. R., Chan, H., Valencia, F. G., & Stoike, D. (2016, May). Does Planned Pain Management Improve Experience for Children Undergoing Orthopedic Surgery. European Society of Anesthesiology. London, England.
• Lichtenthal, P. R., Marsh, M., & Encinas, A. (2015, November). Conflict of Interest, A National Perspective. Prim&R Advancing Ethical Research Conference. Boston, MA.
• Record, B. C., & Lichtenthal, P. R. (2015, October). Anesthetic Management of a Patient with Leigh's Disease in the Setting of WPW: A Case Report. American Society of Anesthesiologists.

Poster Presentations

• Lichtenthal, P. R. (2023). "A-153 Sealing performance of taper shaped cuff for pediatric use". ISICEM.
• Lichtenthal, P. R. (2019, June/Summer). The Effect of Adequate Pain Relief on Cost and Patient Attitudes in Pediatric Orthopedic Surgery. European Society of Anesthesiologists Annual Meeting. Vienna.
• Lichtenthal, P. R. (2019, September/Fall). Impact of Blood Recovery on Transfusion Rates in Children Undergoing Lower Extremity Orthopedic Procedures. 2019 Social, Behavioral and Educational Research Conference. Boston, MA: Public Responsibility in Medicine and Research.
• Lichtenthal, P. R., & Valencia, F. G. (2016, April). Peripheral Nerve Blocks for Postoperative Pain Control in Pediatric Orthopedic Surgeries. Western Anesthesia Residents Conference. San Francisco, CA.

Others

• Garcia, P., Lee, S., & Lichtenthal, P. R. (2021, January). Cost Burden of Increased Utilization of Hospital Services Associated with Post Anesthesia Care Delirium. Society for Technology and Anesthesia.
  More info

  Abstract for Society for Technology and AnesthesiaJanuary 13-16/2021