Scholars@Duke
Nicole Renee Guinn

Nicole Renee Guinn

Professor of Anesthesiology
Anesthesiology, Neuroanesthesia
nicole.guinn@duke.edu
DUMC Box 3094, Durham, NC 27710
2301 Erwin Road, 5670 Hafs Building, Durham, NC 27710
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Selected Publications

Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Journal Article J Thorac Cardiovasc Surg · December 2023 BACKGROUND: Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high-dose o ... Full text Link to item Cite

The Year in Coagulation and Transfusion: Selected Highlights from 2022.

Journal Article J Cardiothorac Vasc Anesth · December 2023 This is an annual review to cover highlights in transfusion and coagulation in patients undergoing cardiovascular surgery. The goal of this article is to provide readers with a focused summary of the most important transfusion and coagulation topics publis ... Full text Link to item Cite

Perioperative Blood Management Protocols Improve Outcomes: What Does the Future Hold?

Journal Article Current Anesthesiology Reports · December 1, 2023 Purpose of Review: This manuscript aims to review the current state of perioperative blood management as well as prognosticate future directions for the field. Recent Findings: Perioperative blood management is a broad topic with a core tenet of conserving ... Full text Cite

Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.

Journal Article World Neurosurg · August 2023 OBJECTIVE: There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal ... Full text Open Access Link to item Cite

Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.

Journal Article Neurochirurgie · May 2023 BACKGROUND: Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make p ... Full text Open Access Link to item Cite

In Response.

Journal Article Anesth Analg · January 1, 2023 Full text Link to item Cite

The association between intravenous iron for antenatal anemia and postnatal depression: a retrospective cohort study.

Journal Article Arch Gynecol Obstet · November 2022 PURPOSE: Determine if intravenous iron for antenatal anemia is associated with reduced incidence of postnatal depression (PND) within 12 months. METHODS: This retrospective cohort study included adult women with antenatal anemia (hemoglobin value of < 11.0 ... Full text Link to item Cite

Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients.

Journal Article Anesth Analg · September 1, 2022 Preoperative anemia is common in patients presenting for cardiac surgery, with a prevalence of approximately 1 in 4, and has been associated with worse outcomes including increased risk of blood transfusion, kidney injury, stroke, infection, and death. Iro ... Full text Link to item Cite

Controversies in enhanced recovery after cardiac surgery.

Journal Article Perioper Med (Lond) · April 28, 2022 Advances in cardiac surgical operative techniques and myocardial protection have dramatically improved outcomes in the past two decades. An unfortunate and unintended consequence is that 80% of the preventable morbidity and mortality following cardiac surg ... Full text Link to item Cite

Treatment through a preoperative anemia clinic is associated with a reduction in perioperative red blood cell transfusion in patients undergoing orthopedic and gynecologic surgery.

Journal Article Transfusion · April 2022 BACKGROUND: Preoperative anemia is associated with increased morbidity, mortality, and risk of transfusion. Treatment through a preoperative anemia clinic (PAC) may improve outcomes. STUDY DESIGN AND METHODS: Adult patients undergoing elective orthopedic a ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · June 1, 2021 Full text Link to item Cite

Blood Substitutes and Oxygen Therapeutics: A Review.

Journal Article Anesth Analg · January 2021 Despite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood tr ... Full text Link to item Cite

Surgical management of ovarian carcinosarcoma with inferior vena cava extension into the right atrium.

Journal Article J Surg Case Rep · December 2020 Gynecological carcinosarcomas are aggressive tumors with rare occurrence and high rates of metastases. We present the case of a 49-year-old woman with vaginal bleeding and abdominal distension who was found to have a large ovarian carcinosarcoma invading t ... Full text Link to item Cite

Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Journal Article J Thorac Cardiovasc Surg · December 2023 BACKGROUND: Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high-dose o ... Full text Link to item Cite

The Year in Coagulation and Transfusion: Selected Highlights from 2022.

Journal Article J Cardiothorac Vasc Anesth · December 2023 This is an annual review to cover highlights in transfusion and coagulation in patients undergoing cardiovascular surgery. The goal of this article is to provide readers with a focused summary of the most important transfusion and coagulation topics publis ... Full text Link to item Cite

Perioperative Blood Management Protocols Improve Outcomes: What Does the Future Hold?

Journal Article Current Anesthesiology Reports · December 1, 2023 Purpose of Review: This manuscript aims to review the current state of perioperative blood management as well as prognosticate future directions for the field. Recent Findings: Perioperative blood management is a broad topic with a core tenet of conserving ... Full text Cite

Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study.

Journal Article World Neurosurg · August 2023 OBJECTIVE: There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal ... Full text Open Access Link to item Cite

Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.

Journal Article Neurochirurgie · May 2023 BACKGROUND: Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make p ... Full text Open Access Link to item Cite

In Response.

Journal Article Anesth Analg · January 1, 2023 Full text Link to item Cite

The association between intravenous iron for antenatal anemia and postnatal depression: a retrospective cohort study.

Journal Article Arch Gynecol Obstet · November 2022 PURPOSE: Determine if intravenous iron for antenatal anemia is associated with reduced incidence of postnatal depression (PND) within 12 months. METHODS: This retrospective cohort study included adult women with antenatal anemia (hemoglobin value of < 11.0 ... Full text Link to item Cite

Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients.

Journal Article Anesth Analg · September 1, 2022 Preoperative anemia is common in patients presenting for cardiac surgery, with a prevalence of approximately 1 in 4, and has been associated with worse outcomes including increased risk of blood transfusion, kidney injury, stroke, infection, and death. Iro ... Full text Link to item Cite

Controversies in enhanced recovery after cardiac surgery.

Journal Article Perioper Med (Lond) · April 28, 2022 Advances in cardiac surgical operative techniques and myocardial protection have dramatically improved outcomes in the past two decades. An unfortunate and unintended consequence is that 80% of the preventable morbidity and mortality following cardiac surg ... Full text Link to item Cite

Treatment through a preoperative anemia clinic is associated with a reduction in perioperative red blood cell transfusion in patients undergoing orthopedic and gynecologic surgery.

Journal Article Transfusion · April 2022 BACKGROUND: Preoperative anemia is associated with increased morbidity, mortality, and risk of transfusion. Treatment through a preoperative anemia clinic (PAC) may improve outcomes. STUDY DESIGN AND METHODS: Adult patients undergoing elective orthopedic a ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · June 1, 2021 Full text Link to item Cite

Blood Substitutes and Oxygen Therapeutics: A Review.

Journal Article Anesth Analg · January 2021 Despite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood tr ... Full text Link to item Cite

Surgical management of ovarian carcinosarcoma with inferior vena cava extension into the right atrium.

Journal Article J Surg Case Rep · December 2020 Gynecological carcinosarcomas are aggressive tumors with rare occurrence and high rates of metastases. We present the case of a 49-year-old woman with vaginal bleeding and abdominal distension who was found to have a large ovarian carcinosarcoma invading t ... Full text Link to item Cite

The Association of Increased FFP:RBC Transfusion Ratio to Primary Graft Dysfunction in Bleeding Lung Transplantation Patients.

Journal Article J Cardiothorac Vasc Anesth · November 2020 OBJECTIVES: Lung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product require ... Full text Link to item Cite

How do I develop a process to effectively treat parturients with iron deficiency anemia?

Journal Article Transfusion · November 2020 Anemia is common in pregnant women and is associated with increased morbidity for the mother and the fetus, including increased risk of allogeneic blood transfusion. Iron deficiency is the most common etiology for anemia during pregnancy. Oral iron therapy ... Full text Link to item Cite

Essential Role of Patient Blood Management in a Pandemic: A Call for Action.

Journal Article Anesth Analg · July 2020 The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread ... Full text Link to item Cite

Use of a preoperative screening tool to optimize patients with anemia before cardiac valve procedures

Journal Article MEDSURG Nursing · July 1, 2020 This quality improvement project focused on identifying and treating preoperative anemia in patients undergoing cardiac valve surgery. A standardized screening checklist and proce-dure for patient referral to a preoperative anemia clinic were developed and ... Cite

Lower hemoglobin concentration decreases time to death in severely anemic patients for whom blood transfusion is not an option.

Journal Article J Trauma Acute Care Surg · June 2020 BACKGROUND: Anemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option. METHOD ... Full text Link to item Cite

Perioperative Anemia: Prevention, Diagnosis, and Management Throughout the Spectrum of Perioperative Care.

Journal Article Anesth Analg · May 2020 Anemia is common in the perioperative period and is associated with poor patient outcomes. Remarkably, anemia is frequently ignored until hemoglobin levels drop low enough to warrant a red blood cell transfusion. This simplified transfusion-based approach ... Full text Link to item Cite

Perioperative Characteristics Associated with Transfusion-Free Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Blood transfusion during lung transplantation (LT) surgery is common. There is little evidence to identify potential candidates for transfusion-free LT surgery. We describe patient and procedural characteristics of LT patients in the era of ECMO a ... Full text Cite

Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient-When Blood Is Not an Option.

Journal Article Anesth Analg · January 2019 Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has ... Full text Link to item Cite

Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty.

Journal Article J Healthc Qual · 2019 To improve quality and outcomes, a preoperative anemia clinic (PAC) was established to screen, evaluate, and manage preoperative anemia. A retrospective review of primary and revision hip and knee arthroplasty patients from August 2013 to September 2017 wa ... Full text Link to item Cite

Severe anemia associated with increased risk of death and myocardial ischemia in patients declining blood transfusion.

Journal Article Transfusion · October 2018 BACKGROUND: There are limited data on morbidity and mortality in severely anemic patients for whom blood transfusion is not an option, with most data coming only from surgical patients and no data on the rate of myocardial ischemia associated with severe a ... Full text Link to item Cite

Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study.

Journal Article Anesth Analg · August 2018 BACKGROUND: Erythropoiesis-stimulating agents, such as erythropoietin (EPO), can be used to treat preoperative anemia. Some studies suggest an increased risk of mortality and thrombotic events, and use in cardiovascular surgery remains off-label. This stud ... Full text Open Access Link to item Cite

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.

Journal Article Anesth Analg · February 2018 Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinar ... Full text Link to item Cite

Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.

Journal Article Can J Anaesth · January 2018 BACKGROUND: Preoperative and postoperative anemia have been identified individually as potential risk factors for postoperative complications after coronary artery bypass grafting (CABG) surgery. Their interrelationship with acute kidney injury (AKI) and l ... Full text Link to item Cite

No association between donor age and recipient outcomes: transfusion of plasma in patients undergoing coronary artery bypass grafting surgery.

Journal Article Transfusion · July 2016 BACKGROUND: Recent animal studies suggest that transfusion of plasma from young donors reverses age-related neurologic and cardiac changes in older recipients. Associations between age of blood product donors and corresponding outcomes in recipients have n ... Full text Link to item Cite

Blood-Conservation Strategies in a Blood-Refusal Parturient with Placenta Previa and Placenta Percreta.

Journal Article A A Case Rep · March 1, 2016 Abnormal placentation can be associated with significant blood loss and massive blood transfusions. Caring for parturients with abnormal placentation who refuse blood transfusion is very challenging. We present a 35-year-old, gravida 3, para 1, Jehovah's W ... Full text Link to item Cite

How do we develop and implement a preoperative anemia clinic designed to improve perioperative outcomes and reduce cost?

Journal Article Transfusion · February 2016 Treatment of anemia is one of the four pillars of patient blood management programs. Preoperative anemia is common and associated with increased perioperative morbidity after surgery and increased rates of blood transfusion. Effective treatment of preopera ... Full text Link to item Cite

Cardiopulmonary bypass cases: To hemodilute or not?

Chapter · January 1, 2016 As we dropped our patient off in the intensive care unit (ICU), I took a look at the chest tubes: bone dry. We had just finished a Bentall (aortic root plus valve replacement) in a middle-aged patient with a stenotic, bicuspid aortic valve and aortic root ... Full text Cite

Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study.

Journal Article Transfusion · December 2015 BACKGROUND: Although numerous studies have demonstrated the feasibility of cardiac surgery for blood refusal patients, few studies match to controls, and fewer examine cost. This historical cohort study aims to compare costs and outcomes after cardiac surg ... Full text Link to item Cite

Bloodless Orthotopic Heart Transplantation in a Jehovah's Witness.

Journal Article A A Case Rep · May 15, 2015 We present the case of a 53-year-old female Jehovah's Witness with nonischemic cardiomyopathy who successfully underwent a bloodless heart transplantation using fibrinogen concentrate (RiaSTAP; CSL Behring, King of Prussia, PA) and other blood-conservation ... Full text Link to item Cite

Jehovah's Witnesses and cardiac surgery: a single institution's experience.

Journal Article Transfusion · October 2014 BACKGROUND: Based on biblical doctrines, patients of the Jehovah's Witness faith refuse allogeneic blood transfusion. Cardiac surgery carries a high risk of blood transfusion, but has been performed in Jehovah's Witnesses for many years. The literature con ... Full text Open Access Link to item Cite

Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery.

Journal Article Transfusion · November 2013 BACKGROUND: Estimates of blood loss in the operating room are typically performed as a visual assessment by providers, despite multiple studies showing this to be inaccurate. Use of a less subjective measurement of blood loss such as direct measurement of ... Full text Open Access Link to item Cite

The Use of Adenosine in Cerebral Aneurysm Clipping: A Review

Journal Article Current Anesthesiology Reports · September 1, 2013 Management of intracranial aneurysms continues to evolve, with coiling of aneurysms becoming an increasingly used modality. However, for aneurysms which are considered to be “complex” due to their size, position, or morphology, clipping continues to be the ... Full text Cite

Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review.

Journal Article J Neurosurg Anesthesiol · January 2011 UNLABELLED: BRIEF SUMMARY: We describe the use of adenosine-induced cardiac arrest to facilitate intracranial aneurysm clip ligation. BACKGROUND: Cerebral aneurysms are highly variable which may result in difficult surgical exposure for clip ligation in se ... Full text Link to item Cite

Invited commentary.

Journal Article Ann Thorac Surg · December 2010 Full text Link to item Cite

A survey of anesthesiologists' and nurses' attitudes toward the implementation of an Anesthesia Information Management System on a labor and delivery floor.

Journal Article Int J Obstet Anesth · January 2009 BACKGROUND: An anesthesia information management system (AIMS) is most frequently used in the operating room, but not on labor and delivery (L&D). The purpose of this study is to describe the implementation of an AIMS on L&D and the attitudes of practition ... Full text Link to item Cite

Local anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine.

Journal Article Anesth Analg · September 2007 BACKGROUND: The influence of the labor epidural local anesthetic (LA) on mode of delivery has not been adequately studied. In this study, we sought to determine if there is a difference in mode of delivery among parturients who receive epidural bupivacaine ... Full text Link to item Cite

Response.

Chapter · 1987 Link to item Cite