For patients with a true penicillin allergy, we recommend broader gram-negative coverage with alternative antibiotics, such as cefuroxime, when undergoing free tissue transfer in the head and neck.

No abstract

The anesthesiologist has been recognized as an integral member of the liver transplant team, and previous studies have demonstrated that inter-anesthesiologist variability can be a driver of outcomes for high-risk patients. We hypothesized that anesthesiologist experience, defined as the number of previous liver transplants performed at our institution, the Icahn School of Medicine at Mount Sinai, would be independently associated with outcomes for liver transplant patients. Eight hundred forty-nine liver transplants performed between January 2003 and January 2013 with a total of 22 anesthesiologists were analyzed. Each transplant was assigned an incremental case number that corresponded to the number of transplants that the attending anesthesiologist had already performed at our institution. Several perioperative covariates were controlled for in the context of a generalized linear mixed effects model to detail the influence of threshold levels of the incremental case number on the primary outcome, 30-day mortality, and a secondary outcome, 30-day graft failure. Sensitivity analyses were conducted to confirm the robustness of these findings. An incremental case number 5 was associated with a significantly greater risk of 30-day mortality (odds ratio 5 2.24, 95% confidence interval 5 1.11-4.54, P 5 0.025), and there was evidence suggestive of a greater risk of 30-day graft failure (odds ratio 5 1.93, 95% confidence interval 5 0.95-3.93, P 5 0.071). Sensitivity analyses ruled out threats to the validity of these findings, including dropout effects and time trends in the overall performance of the transplantation unit. In conclusion, this study shows that an anesthesiologist's level of experience has a significant effect on outcomes for liver transplant recipients, with increased mortality and possibly graft failure during a provider's first 5 cases. These findings may indicate the need for increased training and supervision for anesthesiologists joining the liver transplant team. Liver Transpl 21:89-95, 2015. V C 2014 AASLD.Received May 18, 2014; accepted September 14, 2014. Intraoperative anesthetic management has been increasingly identified as a driver of perioperative outcomes.1-4 Although anesthesiologists are recognized as integral members of the transplant team, [4][5][6][7] there is a paucity of data regarding the effects of intraoperative anesthetic interventions on orthotopic liver transplantation (OLT) outcomes. Furthermore, the potential effect of anesthesia practitioner experience is often not considered; most publications concentrate on the optimization of OLT recipient outcomes by appropriate risk stratification and sound surgical technique. 8,9

Extracellular water (ECW) is a large and clinically important body compartment that varies widely in volume both in health and disease. Interpretation of ECW measurements in the clinical setting requires consideration of potential influencing factors such as age, race, sex and other variables that influence fluid status. An important gap in physiological research is a lack of normative ECW values against which to reference perturbations in fluid homeostasis. The current study's aim was to develop conditional quantile equations for ECW based on weight, height, age, sex and race using a large (n = 1538, 854 females and 684 males) healthy adult multi-ethnic (African American, Asian, European American, Hispanic) sample. ECW was derived from total body water and potassium measured by isotope dilution and whole-body 40K counting, respectively. Quantile regression methods were used to identify five percentile levels (10th, 25th, 50th, 75th, 90th). Weight and height were significant variables at each quantile in both males and females; age made a significant contribution in the male but not the female sample. These regression equations provide ECW quantile reference values based on a large multi-ethnic adult population that should not only prove useful in clinical settings and physiological research, but serve as a model approach for developing body composition normative ranges.