Hypotension during kidney transplantation can be common. Vasopressor use during these procedures is often avoided, with a fear of decreasing renal perfusion in the transplanted kidney. However, adequate perfusion for the rest of the body is also necessary, and given that these patients often have underlying hypertension or other comorbid conditions, an appropriate mean arterial pressure (MAP) has to be maintained. Intramuscular injections of ephedrine have been studied in the anesthesiology literature in a variety of case types, and it is seen as a safe and effective method to boost MAP. We present a case series of three patients who underwent renal transplantation and who received an intramuscular injection of ephedrine for hypotension control. The medication worked well for increasing blood pressures without apparent side effects. All three patients were followed for more than one year, and all patients had good graft function at the end of that time period. This series shows that while further research is necessary in this arena, intramuscular ephedrine may have a place in the management of persistent hypotension in the operating room during kidney transplantation.

The electroencephalogram (EEG) has been extensively used to detect ischemia and the need for shunting during carotid endarterectomy. Limited literature exists using EEG data to detect ischemia in other surgeries. This case report depicts a 65-year-old man, with extensive vascular history including complete left carotid occlusion and severe right carotid stenosis, who presented for left first rib resection and left subclavian vein balloon angioplasty. Following induction of general anesthesia, frontal EEG (SedLine; Masimo Corporation, Irvine, CA, USA) demonstrated hemispheric asymmetry, which nearly resolved with vasoactive support. At three distinct periods, discordance reoccurred necessitating a higher mean arterial pressure threshold. This case demonstrates EEG patterns concerning for focal spectrographic ischemia and highlights the potential use of EEG signals to capture hypoperfusion and direct vasoactive therapy.

Background: The use of an anesthesiology rotation in the realm of surgical education is not very well studied. Several studies show the importance of an anesthesiology rotation in the grand scheme of undergraduate medical education. However, its importance in perioperative medicine and surgical education is not very well understood. This study attempts to look at this relationship and determine whether or not a temporal relationship between this anesthesiology rotation and a surgical rotation is important. Methods: I used an online survey tool to survey medical students who took the anesthesiology rotation (required rotation) in 2014 and 2015 (when rotation was coupled to surgical rotation) and compared those data to the data of students who took the rotation in 2016 (when the rotation was not coupled to surgery). I asked several questions looking at the importance of the anesthesiology rotation to surgical education and to perioperative medicine. Results: Having a required anesthesiology rotation appears to add value to the general surgery rotation in undergraduate medical education. Furthermore, when this rotation is paired with the general surgery rotation, it appears that the students learn more about perioperative medicine than when the rotation is paired with other "advanced" rotation. Conclusion: The pairing of anesthesiology with a general surgery rotation does indeed improve the perioperative medicine education and knowledge of students. Students appreciate having a week of anesthesiology with the surgical rotation, and they note that it adds value to the general surgery rotation.

Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure. We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.