Scholars@Duke
Dhanesh Kumar Gupta

Dhanesh Kumar Gupta

Professor of Anesthesiology
Anesthesiology, Neuroanesthesia
dhanesh.gupta@duke.edu
DUMC Box 3094, Durham, NC 27710

Selected Publications

The "In-Parallel" Technique for Awake, Bilateral Simultaneous Minimally Invasive Transforaminal Lumbar Interbody Fusion and Multilevel Lumbar Decompression.

Journal Article Oper Neurosurg · March 1, 2023 BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) and MIS lumbar decompression have been successfully undertaken in the absence of general anesthesia in well-selected patients. By leveraging spinal anesthesia, surgeons may sa ... Full text Link to item Cite

Perioperative outcomes of general versus spinal anesthesia in the lumbar spine surgery population: A systematic review and meta-analysis of data from 2005 through 2021.

Journal Article J Clin Orthop Trauma · July 2022 STUDY DESIGN: Meta-analysis. OBJECTIVES: Perform a systematic review and meta-analysis to determine the perioperative utility of general versus spinal anesthesia in the lumbar spine surgery population. METHODS: PubMed and Embase were queried for manuscript ... Full text Link to item Cite

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

Journal Article Br J Anaesth · December 2021 BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled fo ... Full text Open Access Link to item Cite

Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion-Initial Case Series Investigating Safety and Efficacy.

Journal Article Oper Neurosurg · November 15, 2021 BACKGROUND: Minimally invasive spine surgery (MISS) has the potential to further advance with the use of robot-assisted (RA) techniques. While RA pedicle screw placement has been extensively investigated, there is a lack of literature on the use of the rob ... Full text Link to item Cite

Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study.

Journal Article Clin Neurol Neurosurg · January 2021 BACKGROUND CONTEXT: Preoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of p ... Full text Open Access Link to item Cite

Carotid and Intracranial Surgery

Chapter · January 1, 2021 Carotid surgeries that are performed to prevent strokes are carotid endarterectomy (CEA), carotid angioplasty/stenting, and transcarotid artery revascularization. CEA is the most frequently performed surgical procedure to prevent stroke in the United State ... Full text Cite

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Journal Article J Neurol · July 2020 OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort st ... Full text Link to item Cite

Awake percutaneous transforaminal lumbar interbody fusion with expandable cage and robotic-assisted navigation and instrumentation: Case report and review of literature

Journal Article Interdisciplinary Neurosurgery Advanced Techniques and Case Management · June 1, 2020 Awake surgeries are commonly performed in many specialties through the use of local or regional anesthesia. These methods avoid the risks associated with general endotracheal anesthesia and allow faster recovery times. In neurosurgery, awake surgeries are ... Full text Cite

Identifying Components Necessary for an Enhanced Recovery After Surgery Pathway for Elective Intracranial Surgery: An Improvement Project Using the Quality of Recovery-15 Score.

Journal Article World Neurosurg · October 2019 OBJECTIVE: To identify the domains of recovery, as determined by the Quality of Recovery-15 (QoR-15) score, that needed improvement to develop initial interventions for an enhanced recovery after surgery protocol for patients undergoing elective intracrani ... Full text Link to item Cite

Paradox of age: older patients receive higher age-adjusted minimum alveolar concentration fractions of volatile anaesthetics yet display higher bispectral index values.

Journal Article Br J Anaesth · September 2019 BACKGROUND: Minimum alveolar concentration (MAC) and MAC-awake decrease with age. We hypothesised that, in clinical practice, (i) end-tidal MAC fraction in older patients would decline by less than the predicted age-dependent MAC decrease (i.e. older patie ... Full text Link to item Cite

Low-Dose Ketamine Infusion to Decrease Postoperative Delirium for Spinal Fusion Patients.

Journal Article J Perianesth Nurs · August 2019 PURPOSE: The primary aim of this project was to decrease the incidence of postoperative delirium after spine surgery. DESIGN: A prospective preimplementation and postimplementation design was used. METHODS: A reduced dose ketamine protocol was implemented ... Full text Link to item Cite

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery.

Journal Article J Perianesth Nurs · August 2019 PURPOSE: The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery. DESIGN: The structure of this project was a preim ... Full text Link to item Cite

Laboratory Monitoring and Transfusion Guidelines to Influence Care in Patients Undergoing Multilevel Spinal Fusion Surgery.

Journal Article J Perianesth Nurs · August 2019 PURPOSE: The purpose of this project was to determine whether the use of the modified Northwestern high risk spine protocol in patients undergoing multilevel spinal fusion surgery would result in improved transfusion practices. DESIGN: Preimplementation an ... Full text Link to item Cite

Implementation of Physiological Scoring to Determine Discharge Readiness for Patients Undergoing Otolaryngology Head and Neck Procedures.

Journal Article J Perianesth Nurs · June 2019 PURPOSE: This quality improvement project examined whether the use of a validated physiological scoring protocol to determine discharge readiness for surgical procedures proximal to the airway would decrease the time at which discharge criteria were met an ... Full text Link to item Cite

A Randomized Controlled Trial of Low-Dose Tranexamic Acid versus Placebo to Reduce Red Blood Cell Transfusion During Complex Multilevel Spine Fusion Surgery.

Journal Article World Neurosurg · February 2018 BACKGROUND: Multilevel spine fusion surgery for adult deformity correction is associated with significant blood loss and coagulopathy. Tranexamic acid reduces blood loss in high-risk surgery, but the efficacy of a low-dose regimen is unknown. METHODS: Sixt ... Full text Link to item Cite

Preprocedural Checklist for Magnetic Resonance Imaging Patients Undergoing General Anesthesia: A Process Improvement Plan to Enhance Reimbursement.

Journal Article Health Care Manag (Frederick) · 2018 Thorough documentation is essential for hospital reimbursement from payors such as the Centers for Medicare & Medicaid Services. Inconsistencies and incomplete documentation can occur if workflow is not standardized especially in cases with interdisciplina ... Full text Open Access Link to item Cite

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults.

Journal Article Front Syst Neurosci · 2017 Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, incr ... Full text Open Access Link to item Cite

Frequency and pattern of radiological and laboratory investigations in patients with mental illnesses: A study from North Rajasthan

Journal Article Indian Journal of Psychiatry · April 1, 2016 Background: There are widespread perceptions that excessive and unnecessary investigations are done in many patients with mental illnesses. There are no studies from India looking into this issue. Aims: (i) To study the frequency and pattern of various inv ... Full text Cite

In Response.

Journal Article Anesth Analg · November 2015 Full text Link to item Cite

Intraoperative Methadone for the Prevention of Postoperative Pain: A Randomized, Double-blinded Clinical Trial in Cardiac Surgical Patients.

Journal Article Anesthesiology · May 2015 BACKGROUND: The intensity of pain after cardiac surgery is often underestimated, and inadequate pain control may be associated with poorer quality of recovery. The aim of this investigation was to examine the effect of intraoperative methadone on postopera ... Full text Link to item Cite

A comparison of hemoglobin measured by co-oximetry and central laboratory during major spine fusion surgery.

Journal Article Anesth Analg · January 2015 BACKGROUND: Many factors affect the accuracy of hemoglobin concentration values. In this study, we evaluated whether the hemoglobin concentration obtained by means of arterial blood gas (ABG) co-oximetry and complete blood count (CBC) central laboratory te ... Full text Link to item Cite

Nicardipine is superior to esmolol for the management of postcraniotomy emergence hypertension: a randomized open-label study.

Journal Article Anesth Analg · January 2015 BACKGROUND: Emergence hypertension after craniotomy is a well-documented phenomenon for which natural history is poorly understood. Most clinicians attribute this phenomenon to an acute and transient increase in catecholamine release, but other mechanisms ... Full text Link to item Cite

The implementation and efficacy of the Northwestern High Risk Spine Protocol.

Journal Article World Neurosurg · December 2014 OBJECTIVE: The aims of this study were to determine the efficacy and feasibility of implementation of the intraoperative component of a high risk spine (HRS) protocol for improving perioperative patient safety in complex spine fusion surgery. METHODS: In t ... Full text Link to item Cite

Predicting major adverse cardiac events in spine fusion patients: is the revised cardiac risk index sufficient?

Journal Article Spine (Phila Pa 1976) · August 1, 2014 STUDY DESIGN: Observational cohort study. OBJECTIVE: To determine the accuracy of the Revised Cardiac Risk Index (RCRI) in predicting major adverse cardiac events in patients undergoing spine fusion surgery of 3 levels or more. SUMMARY OF BACKGROUND DATA: ... Full text Link to item Cite

Development and validation of a generalizable model for predicting major transfusion during spine fusion surgery.

Journal Article J Neurosurg Anesthesiol · July 2014 BACKGROUND: Surgery for posterior spine instrumentation often requires major transfusion. The aim of this study was to develop and test the validity of a model for predicting intraoperative major transfusion (>4 U total red blood cells), based on preoperat ... Full text Link to item Cite

Effect of ritonavir-induced cytochrome P450 3A4 inhibition on plasma fentanyl concentrations during patient-controlled epidural labor analgesia: a pharmacokinetic simulation.

Journal Article Int J Obstet Anesth · February 2014 BACKGROUND: Ritonavir inhibition of cytochrome P450 3A4 decreases the elimination clearance of fentanyl by 67%. We used a pharmacokinetic model developed from published data to simulate the effect of sample patient-controlled epidural labor analgesic regim ... Full text Open Access Link to item Cite

The incidence of unacceptable movement with motor evoked potentials during craniotomy for aneurysm clipping.

Journal Article World Neurosurg · January 2014 OBJECTIVE: To review the experience at a single institution with motor evoked potential (MEP) monitoring during intracranial aneurysm surgery to determine the incidence of unacceptable movement. METHODS: Neurophysiology event logs and anesthetic records fr ... Full text Open Access Link to item Cite

Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation does not worsen neurologic outcome.

Journal Article Anesth Analg · November 2013 BACKGROUND: When temporary arterial occlusion of the parent artery is difficult for anatomical reasons, or when inadvertent aneurysmal rupture occurs during surgical dissection, adenosine administration can be used to produce flow arrest and brief, profoun ... Full text Link to item Cite

Principles of clinical pharmacology

Chapter · March 1, 2013 Cite

Drug shortages in the United States: a critical evaluation of root causes and the need for action.

Journal Article Clin Pharmacol Ther · February 2013 Every day it is easy to find news articles detailing the impact of drug shortages on patients. Where this was once only a concern of patients with rare, orphan diseases, it is now the concern of patients receiving even the most common chemotherapeutic regi ... Full text Link to item Cite

The effect of furosemide on intravascular volume status and electrolytes in patients receiving mannitol: an intraoperative safety analysis.

Journal Article J Neurosurg Anesthesiol · January 2013 BACKGROUND: Mannitol is often used during intracranial surgery to improve surgical exposure. Furosemide is often added to mannitol to augment this effect. The concern exists, however, that the augmented diuresis caused by the addition of furosemide to mann ... Full text Link to item Cite

In reply

Journal Article Anesthesiology · June 1, 2012 Full text Cite

Rational opioid dosing in the elderly: dose and dosing interval when initiating opioid therapy.

Journal Article Clin Pharmacol Ther · February 2012 Opioids are the mainstay of treatment for moderate to severe pain. However, opioid therapy in the elderly is often associated with significant morbidity because of excessive ventilatory depression. The large amount of interindividual variability in opioid ... Full text Link to item Cite

Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period.

Journal Article Anesthesiology · November 2011 BACKGROUND: The subjective experience of residual neuromuscular blockade after emergence from anesthesia has not been examined systematically during postanesthesia care unit (PACU) stays. The authors hypothesized that acceleromyography monitoring would dim ... Full text Link to item Cite

Adenosine for temporary flow arrest during intracranial aneurysm surgery: a single-center retrospective review.

Journal Article Neurosurgery · October 2011 BACKGROUND: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility ... Full text Link to item Cite

Association of intracranial aneurysm and Loeys-Dietz syndrome: case illustration, management, and literature review.

Journal Article Neurosurgery · August 2011 BACKGROUND AND IMPORTANCE: Loeys-Dietz syndrome (LDS) is a newly described connective tissue disease associated with aortic aneurysms. A strong association between LDS and intracranial aneurysms has not yet been documented in the literature. We present the ... Full text Link to item Cite

Compartment syndrome caused by a properly functioning infusion pump.

Journal Article J Clin Anesth · March 2011 Compartment syndrome caused by an infiltrated intravenous catheter has been previously reported, but there are no reports of compartment syndrome caused by fluids and/or medications dispensed by a properly functioning drug infusion pump. A case in which a ... Full text Link to item Cite

Open Surgical Approaches

Journal Article Hemorrhagic and Ischemic Stroke: Medical, Imaging, Surgical and Interventional Approaches · 2011 Cite

An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

Journal Article Anesth Analg · August 2010 INTRODUCTION: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a r ... Full text Open Access Link to item Cite

Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

Journal Article Anesthesiology · August 2010 BACKGROUND: Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dy ... Full text Link to item Cite

Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: dose-response data and safety profile.

Journal Article Anesth Analg · May 1, 2010 BACKGROUND: Adenosine-induced transient flow arrest has been used to facilitate clip ligation of intracranial aneurysms. However, the starting dose that is most likely to produce an adequate duration of profound hypotension remains unclear. We reviewed our ... Full text Open Access Link to item Cite

Alternative anterior reference sites for measuring posterior tibial nerve somatosensory evoked potentials.

Journal Article J Clin Monit Comput · April 2010 OBJECTIVE: The purpose of this study was to examine the utility and feasibility of using alternative anterior reference leads when measuring left posterior tibial nerve somatosensory evoked potentials (SEPs). METHODS: With IRB approval, 12 patients were mo ... Full text Link to item Cite

No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

Journal Article Anesthesiology · January 2010 BACKGROUND: Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surger ... Full text Link to item Cite

Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage.

Journal Article Neurosurgery · May 2009 OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological S ... Full text Link to item Cite

Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery.

Journal Article Anesthesiology · March 2009 BACKGROUND: The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion ... Full text Link to item Cite

Corrigendum: Editorial (Clinical Pharmacology Therapeutics (2008) 84, (3-6) DOI: 10.1038/clpt.2008.99)

Journal Article Clinical Pharmacology and Therapeutics · September 1, 2008 Full text Cite

Inhaled anesthesia: the original closed-loop drug administration paradigm.

Journal Article Clin Pharmacol Ther · July 2008 We administer anesthetics to obtain therapeutic effects and minimize untoward side effects. Anesthetists can precisely control inhaled anesthetic concentrations by controlling end-tidal volatile anesthetic concentrations. This degree of control eliminates ... Full text Link to item Cite

An evaluation of remifentanil propofol response surfaces for loss of responsiveness, loss of response to surrogates of painful stimuli and laryngoscopy in patients undergoing elective surgery.

Journal Article Anesth Analg · February 2008 INTRODUCTION: In this study, we explored how a set of remifentanil-propofol response surface interaction models developed from data collected in volunteers would predict responses to events in patients undergoing elective surgery. Our hypotheses were that ... Full text Link to item Cite

Revascularization for complex intracranial aneurysms.

Journal Article Neurosurg Focus · 2008 The modern management of intracranial aneurysms includes both constructive and deconstructive strategies to eliminate the aneurysm from the circulation. Both microsurgical and endovascular techniques are used to achieve this goal. Although most aneurysms c ... Full text Link to item Cite

Untitled (vol 84, pg 3, 2008)

Journal Article CLINICAL PHARMACOLOGY & THERAPEUTICS · 2008 Cite

Total intravenous anesthesia: advantages for intracranial surgery.

Journal Article Neurosurgery · November 2007 OBJECTIVE: Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated I ... Full text Link to item Cite

The effects of systemic phenylephrine and epinephrine on pedicle artery and microvascular perfusion in a pig model of myoadipocutaneous rotational flaps.

Journal Article Plast Reconstr Surg · October 2007 BACKGROUND: Anesthesiologists and reconstructive surgeons have differing views regarding the control of rotational flap perfusion. Anesthesiologists view the entire body as having flow that is dependent on systemic perfusion pressure, whereas plastic surge ... Full text Link to item Cite

When is a bispectral index of 60 too low?: Rational processed electroencephalographic targets are dependent on the sedative-opioid ratio.

Journal Article Anesthesiology · March 2007 BACKGROUND: Opioids are commonly used in conjunction with sedative drugs to provide anesthesia. Previous studies have shown that opioids reduce the clinical requirements of sedatives needed to provide adequate anesthesia. Processed electroencephalographic ... Full text Link to item Cite

Can 1% Sevoflurane with 5 ng/ml Remifentanil Prevent Implicit Memory?

Journal Article Anesthesiology-Hagerstown · 2007 Cite

Opioid-volatile anesthetic synergy: a response surface model with remifentanil and sevoflurane as prototypes.

Journal Article Anesthesiology · August 2006 BACKGROUND: Combining a hypnotic and an analgesic to produce sedation, analgesia, and surgical immobility required for clinical anesthesia is more common than administration of a volatile anesthetic alone. The aim of this study was to apply response surfac ... Full text Link to item Cite

Cerebral blood flow changes after endovascular treatment of cerebrovascular stenoses.

Journal Article AJNR Am J Neuroradiol · March 2005 BACKGROUND AND PURPOSE: Symptomatic cerebral hyperperfusion has an incidence of 5% after endovascular stent placement. We hypothesized that increases in cerebral blood flow (CBF) after endovascular stent placement are positively correlated with the severit ... Link to item Cite

Opioid sparing during endotracheal intubation using McCoy laryngoscope in neurosurgical patients: the comparison of haemodynamic changes with Macintosh blade in a randomized trial.

Journal Article J Postgrad Med · 2005 BACKGROUND: There is conflicting data in literature to show that the McCoy laryngoscope is less stressful and opioids can actually be avoided during laryngoscopy and intubation with the use of this laryngoscope. AIM: A comparison of hemodynamic changes wit ... Link to item Cite

Increased cerebral blood flow after brain arteriovenous malformation resection is substantially independent of changes in cardiac output.

Journal Article J Neurosurg Anesthesiol · July 2002 Brain arteriovenous malformation (BAVM) resection can result in an acute increase in cerebral blood flow (CBF) of unclear etiology. This observational study investigated the relationship between changes in CBF and cardiac output (CO) in patients undergoing ... Full text Link to item Cite

Interventional neuroradiology--anesthetic considerations.

Journal Article Anesthesiol Clin North Am · June 2002 Interventional neuroradiologic procedure represents treatment of central nervous system disease by endovascular access for the purpose of delivering therapeutic agents, including both drugs and devices. For optimal anesthetic management, anesthesiologists ... Full text Link to item Cite

Characterization of the cerebral blood flow response to balloon deflation after temporary internal carotid artery test occlusion.

Journal Article J Neurosurg Anesthesiol · April 2002 The authors tested the hypothesis that cerebral blood flow (CBF) would increase after acute and relatively brief internal carotid artery (ICA) test occlusion, and examined the relationship of the postdeflation CBF to the development of neurologic symptoms. ... Full text Link to item Cite

The effects of thiopental on spinal motor neurons

Conference ANESTHESIA AND ANALGESIA · 2000 Cite

Recirculatory pharmacokinetic models of markers of blood, extracellular fluid and total body water administered concomitantly.

Journal Article J Pharmacol Exp Ther · September 1996 Pharmacokinetic models were developed to describe the disposition of markers of extracellular fluid (inulin) and total body water (antipyrine) from the moment of injection to incorporate the intravascular mixing component, determined by a marker of intrava ... Link to item Cite

Extracellular Fluid and Total Body Water Administered Concomitantly1

Journal Article THE JOURNAL (iF PHARMAc0L0 (; y AN!) · 1996 Cite

Effect of infusion rate on thiopental dose-response relationships. Assessment of a pharmacokinetic-pharmacodynamic model.

Journal Article Anesthesiology · August 1994 BACKGROUND: The rate of administration of an intravenous anesthetic induction agent is an important variable determining the total dose required to reach a given endpoint, such as loss of consciousness (LOC). The influence of infusion rate on the dose-resp ... Link to item Cite

Recirculatory kinetics of ICG, inulin, and antipyrine

Conference CLINICAL PHARMACOLOGY & THERAPEUTICS · 1993 Cite

Thiopental dose requirements with different rates of infusion

Conference CLINICAL PHARMACOLOGY & THERAPEUTICS · 1993 Cite