WorldWideScience

Sample records for anesthesiology

  1. [Quality control in anesthesiology].

    Science.gov (United States)

    Muñoz-Ramón, J M

    1995-03-01

    The process of quality control and auditing of anesthesiology allows us to evaluate care given by a service and solve problems that are detected. Quality control is a basic element of care giving and is only secondarily an area of academic research; it is therefore a meaningless effort if the information does not serve to improve departmental procedures. Quality assurance procedures assume certain infrastructural requirements and an initial period of implementation and adjustment. The main objectives of quality control are the reduction of morbidity and mortality due to anesthesia, assurance of the availability and proper management of resources and, finally, the well-being and safety of the patient. PMID:7777688

  2. Leadership Challenges in Academic Anesthesiology.

    Science.gov (United States)

    Mets, Berend

    2005-01-01

    The leadership challenge for academic anesthesiology lies in developing leadership at all levels in the department to create a meaningful, equitable, academic environment, with an attractive culture which challenges but supports and mentors individual growth and in so doing retains faculty. Education, research and clinical care, important as they are, are not ends in themselves, but a means to personal fulfillment lending meaning and identity to the individual which would be different from that which might be achieved in a private practice setting. The concepts of leadership from contemporary business literature are reviewed and a framework within which leadership can occur is described. This framework is based on an understanding of the role that the development of a departmental vision plays. This vision should be based on shared values as well as the mission of the department and should draw on the concepts of strategy, and commitment to realize the departmental goals. Based on these ideas, suggestions are made to illustrate how these business concepts might be applied in academic anesthesia departments.

  3. Job burnout in 159 anesthesiology trainees

    Directory of Open Access Journals (Sweden)

    Yesim Cokay Abut

    2012-01-01

    Full Text Available Background: Anesthesiology may be stressful and most anesthesiologists develop mechanisms for coping. However, inexperienced trainee anesthesiologists seem to be vulnerable. We studied stress perception and job burnout in trainee anesthesiologists. Methods: Responses to perceived stress scale (PSS and Maslach Burnout Inventory (MBI were evaluated in 159 trainee anesthesiologists. Results: In our results, when perceived stress was increased, emotional exhaustion and depersonalization increased but personal accomplishment decreased, as expected. Perceived stress was very high in the early years of training. There was a negative correlation between age and emotional exhaustion and depersonalization, but positive correlation with personal accomplishment. Female anesthesiologists had higher personal accomplishment, but lower depersonalization points than male anesthesiologists in our study. There was no statistical association between marital status, PSS, and MBI; ≥2 children group had a significant high personal accomplishment but low depersonalization and emotional exhaustion scores. Line regression analysis showed a statistically significant relationship between PSS and emotional exhaustion and between age and depersonalization. Conclusions: Social factors such as gender and number of children affect the work life of our trainees.

  4. Recruitment of House Staff into Anesthesiology: Factors Responsible for House Staff Selecting Anesthesiology as a Career and Individual Training Program

    OpenAIRE

    Wass, C. Thomas; Rose, Steven H.; Faust, Ronald J.; Offord, Kenneth P.; Harris, Ann M

    1999-01-01

    Due to a variety of factors, there was a recent redistribution of graduating American medical students toward primary care specialties and a decline in the number of applicants seeking training positions in anesthesiology. In the present study, factors responsible for Mayo house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career, and Mayo Clinic as their training program, were identified. We also evaluated their level of satisfaction with their choice of career ...

  5. Plagiarism in Personal Statements of Anesthesiology Residency Applicants.

    Science.gov (United States)

    Parks, Lance J; Sizemore, Daniel C; Johnstone, Robert E

    2016-02-15

    Plagiarism by residency applicants in their personal statements, as well as sites that sell personal statements, have been described, and led in 2011 to advice to avoid plagiarism and the caution that plagiarism detection software was available. We screened personal statements of 467 anesthesiology residency applicants from 2013-2014 using Viper Plagiarism Scanner software, and studied them for plagiarism. After quotes and commonly used phrases were removed, 82 statements contained unoriginal content of 8 or more consecutive words. After the study, 13.6% of personal statements from non-United States medical school graduates, and 4.0% from United States medical school graduates, contained plagiarized material, a significant difference. Plagiarized content ranged up to 58%. Plagiarism continues to occur in anesthesiology residency personal statements, with a higher incidence among graduates of non-United States medical schools.

  6. Plagiarism in Personal Statements of Anesthesiology Residency Applicants.

    Science.gov (United States)

    Parks, Lance J; Sizemore, Daniel C; Johnstone, Robert E

    2016-02-15

    Plagiarism by residency applicants in their personal statements, as well as sites that sell personal statements, have been described, and led in 2011 to advice to avoid plagiarism and the caution that plagiarism detection software was available. We screened personal statements of 467 anesthesiology residency applicants from 2013-2014 using Viper Plagiarism Scanner software, and studied them for plagiarism. After quotes and commonly used phrases were removed, 82 statements contained unoriginal content of 8 or more consecutive words. After the study, 13.6% of personal statements from non-United States medical school graduates, and 4.0% from United States medical school graduates, contained plagiarized material, a significant difference. Plagiarized content ranged up to 58%. Plagiarism continues to occur in anesthesiology residency personal statements, with a higher incidence among graduates of non-United States medical schools. PMID:26462161

  7. Patient simulation: a literary synthesis of assessment tools in anesthesiology.

    Science.gov (United States)

    Edler, Alice A; Fanning, Ruth G; Chen, Michael I; Claure, Rebecca; Almazan, Dondee; Struyk, Brain; Seiden, Samuel C

    2009-01-01

    High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required. PMID:20046456

  8. Management of large mediastinal masses: surgical and anesthesiological considerations

    Science.gov (United States)

    van Boven, Wim Jan P.; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; de Mol, Bas A.J.M.

    2016-01-01

    Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished. PMID:27076967

  9. Competency-based education in anesthesiology: history and challenges.

    Science.gov (United States)

    Ebert, Thomas J; Fox, Chris A

    2014-01-01

    The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of residents. The confines of the time-based residency will be relaxed. Curriculum must be redesigned and assessments will need to be precise and in-depth. Core anesthesiology faculty will be identified and will be the "trained observers" of the residents' progress. There will be logistic challenges requiring creative management by program directors. There may be residents who achieve "expert" status earlier than the required 36 months of clinical anesthesia education, whereas others may struggle to achieve acceptable status and will require additional education time. Faculty must accept both extremes without judgment. Innovative new educational opportunities will need to be created for fast learners. Finally, it will be important that residents embrace this change. This will require programs to clearly define the specific aims and measurement endpoints for advancement and success.

  10. [European Foundation for Education in Anesthesiology (FEEA): the first steps in Russia].

    Science.gov (United States)

    Scherperel, F; Lebedinskiĭ, K M; Gordeev, V I; Obolenskiĭ, S V; Pogorel'chuk, V V; Aleksandrovich, Iu S; Koriachkin, V A; Glushchenko, V A

    2007-01-01

    The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 centers being located in Europe, Central and South Americas, Africa, and Asia, are described in the article. The first FEEA seminars in Russia were organized in St. Petersburg in 2006-2007 by the Association and Society of Anesthesiologists and by all the anesthesiology departments of the city. Today's geography of FEEA seminars dedicated to European Society of Anesthesiology diploma exam training is expanding in Russia.

  11. Research and Scholarly Activity in US Anesthesiology Residencies: A Survey of Program Directors and Residents

    OpenAIRE

    Roman Schumann; Iwona Bonney; Iqbal Ahmed; Nasr, Viviane G.

    2012-01-01

    Background. Effective 2007, the ACGME required scholarly activity during residency. Although many programs have ongoing research, residents' involvement may be limited. This US anesthesiology residency survey assesses the current scholarly environment, research activity and program support during training. Methods. Following IRB approval, 131 US anesthesiology program directors were invited to participate in a web-based survey. Questions to directors and residents included program structure, ...

  12. [The Foundation for European Education in Anesthesiology (FEEA): the first steps in Russia].

    Science.gov (United States)

    Scherperel, F; Lebedinskiĭ, K M; Gordeev, V I; Obolenskiĭ, S V; Pogorel'chuk, V V; Aleksandrovich, Iu S; Koriachkin, V A; Glushchenko, V A

    2009-01-01

    The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 regional centers in Europe, Central and South America, Africa, and Asia, which are organized in 2006-2007 in Saint Petersburg by the Association and Society of Anesthesiologists and all the Anesthesiology Departments of the city are given. Today's geography of FEEA, dedicated to ESA diploma (DESA) exam training, is expanding in Russia.

  13. Anesthesiology Journal club assessment by means of semantic changes

    Directory of Open Access Journals (Sweden)

    Joaquim Edson Vieira

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: the interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically. METHODS: this study reports the performance of medical residents in anesthesiology from the Clinics Hospital - University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree-disagree-not sure-agree-totally agree, each related to one of the chosen articles. The results were evaluated by means of item analysis - difficulty index and discrimination power. RESULTS: residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51, July 2012 (n = 66 and December 2012 (n = 56. The first exam presented all items with straight statement, second and third exams presented mixed items. Separating "totally agree" from "agree" increased the difficulty indices, but did not improve the discrimination power. CONCLUSIONS: the use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.

  14. Simulation of spinal nerve blocks for training anesthesiology residents

    Science.gov (United States)

    Blezek, Daniel J.; Robb, Richard A.; Camp, Jon J.; Nauss, Lee A.; Martin, David P.

    1998-06-01

    Deep nerve regional anesthesiology procedures, such as the celiac plexus block, are challenging to learn. The current training process primarily involves studying anatomy and practicing needle insertion is cadavers. Unfortunately, the training often continues on the first few patients subjected to the care of the new resident. To augment the training, we have developed a virtual reality surgical simulation designed to provide an immersive environment in which an understanding of the complex 3D relationships among the anatomic structures involved can be obtained and the mechanics of the celiac block procedure practiced under realistic conditions. Study of the relevant anatomy is provided by interactive 3D visualization of patient specific data nd the practice simulated using a head mounted display, a 6 degree of freedom tracker, and a haptic feedback device simulating the needle insertion. By training in a controlled environment, the resident may practice procedures repeatedly without the risks associated with actual patient procedures, and may become more adept and confident in the ability to perform nerve blocks. The resident may select a variety of different nerve block procedures to practice, and may place the virtual patient in any desired position and orientation. The preliminary anatomic models used in the simulation have been computed from the Visible Human Male; however, patient specific models may be generated from patient image data, allowing the physician to evaluate, plan, and practice difficult blocks and/or understand variations in anatomy before attempting the procedure on any specific patient.

  15. [Anesthesiological approach for patients with spinal cord injuries].

    Science.gov (United States)

    Rand, A; Litz, R J; Zahn, P

    2016-07-01

    Spinal cord injuries (SCI) are serious medical conditions, which are associated with severe and potentially fatal risks and complications depending on the location and extent of injury. Traffic accidents, falls and recreational activities are the leading causes for traumatic SCI (TSCI) worldwide whereas non-traumatic spinal cord injuries (NTSCI) are mostly due to tumors and congenital diseases. As chronification of the injuries progresses other organ systems are affected including anatomical changes, the respiratory and cardiovascular systems and endocrinological pathways. All these effects have to be considered in the anesthesiological management of patients with SCI. Autonomic dysreflexia (AD) is the most dangerous and life-threatening complication in patients with chronic SCI above T6 that results from an overstimulation of sympathetic reflex circuits in the upper thoracic spine and can be fatal. This article summarizes the specific pathophysiology of SCI and how AD can be avoided as well as also providing anesthetists with strategies for perioperative and intensive care management of patients with SCI. PMID:27371543

  16. A Critical Analysis of Anesthesiology Podcasts: Identifying Determinants of Success

    Science.gov (United States)

    Singh, Devin; Matava, Clyde

    2016-01-01

    than two-thirds (16/22=73%) of podcasts demonstrated evidence of peer review with podcasts targeting anesthesiologists most strongly associated with peer-reviewed podcasts (Spearman R=0.886; P=.004) Conclusions We present the first report on the scope of anesthesia podcasts in Canada. We have developed a novel tool for assessing the success of an anesthesiology podcast series and identified factors linked to this success measure as well as evidence of a peer-review process for a given podcast. To enable advancement in this area of anesthesia e-resources, podcast creators and users should consider factors associated with success when creating podcasts. The lack of these aspects may be associated with the early demise of a podcast series.

  17. [Anesthesiological systems "Polinarkon-Vita" with microprocessor for artificial lung ventilation apparatuses and monitoring].

    Science.gov (United States)

    Trushin, A I; Uliakov, G I; Reĭderman, E N

    2005-01-01

    The anesthesiological systems Polinarkon-Vita for adults and children are described. These systems were developed at VNIIMP-VITA, Ltd. on the basis of basic model of the anesthesiological system Polinarkon-E-Vita. The following new important units of the fifth generation apparatuses for inhalation anesthesia (IA) are described: Anestezist-4 monocomponent evaporator for liquid anesthetics (enfluran and isofluran); Diana, Diana-Det, and Elan-NR apparatuses for mechanical lung ventilation (MLV); dosimeters of medical gases, etc. These systems implement monitoring of vitally important functions of patient and parameters of IN and MLV. The anesthesiological systems Polinarkon-Vita are recommended for medical practice and commercially available from VNIIMP-VITA, Ltd. as small lots.

  18. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training.

    Science.gov (United States)

    Alem, Navid; Cohen, Neal; Cannesson, Maxime; Kain, Zeev

    2016-06-15

    Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents. PMID:27166744

  19. A Survey of Simulation Utilization in Anesthesiology Residency Programs in the United States.

    Science.gov (United States)

    Rochlen, Lauryn R; Housey, Michelle; Gannon, Ian; Tait, Alan R; Naughton, Norah; Kheterpal, Sachin

    2016-06-01

    Given the evolution of competency-based education and evidence supporting the benefits of incorporating simulation into anesthesiology residency training, simulation will likely play an important role in the training and assessment of anesthesiology residents. Currently, there are little data available regarding the current status of simulation-based curricula across US residency programs. In this study, we assessed simulation-based training and assessment in US anesthesiology programs using a survey designed to elicit information regarding the type, frequency, and content of the simulation courses offered at the 132 Accreditation Council of Graduate Medical Education-certified anesthesiology training programs. The response rate for the survey was 66%. Although most of the responding programs offered simulation-based courses for interns and residents and during CA-1 orientation, the curriculum varied greatly among programs. Approximately 40% of responding programs use simulation for resident assessment and remediation. The majority of responding programs favored standard simulation-based training as part of residency training (89%), and the most common perceived obstacles to doing so were time, money, and human resources. The results from this survey highlight that there are currently large variations in simulation-based training and assessment among training programs. It also confirms that many program directors feel that standardizing some components of simulation-based education and assessment would be beneficial. Given the positive impact simulation has on skill retention and operating room preparedness, it may be worthwhile to consider developing a standard curriculum. PMID:26934609

  20. A Survey of Simulation Utilization in Anesthesiology Residency Programs in the United States.

    Science.gov (United States)

    Rochlen, Lauryn R; Housey, Michelle; Gannon, Ian; Tait, Alan R; Naughton, Norah; Kheterpal, Sachin

    2016-06-01

    Given the evolution of competency-based education and evidence supporting the benefits of incorporating simulation into anesthesiology residency training, simulation will likely play an important role in the training and assessment of anesthesiology residents. Currently, there are little data available regarding the current status of simulation-based curricula across US residency programs. In this study, we assessed simulation-based training and assessment in US anesthesiology programs using a survey designed to elicit information regarding the type, frequency, and content of the simulation courses offered at the 132 Accreditation Council of Graduate Medical Education-certified anesthesiology training programs. The response rate for the survey was 66%. Although most of the responding programs offered simulation-based courses for interns and residents and during CA-1 orientation, the curriculum varied greatly among programs. Approximately 40% of responding programs use simulation for resident assessment and remediation. The majority of responding programs favored standard simulation-based training as part of residency training (89%), and the most common perceived obstacles to doing so were time, money, and human resources. The results from this survey highlight that there are currently large variations in simulation-based training and assessment among training programs. It also confirms that many program directors feel that standardizing some components of simulation-based education and assessment would be beneficial. Given the positive impact simulation has on skill retention and operating room preparedness, it may be worthwhile to consider developing a standard curriculum.

  1. [Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients].

    Science.gov (United States)

    Luger, Thomas J; Luger, Markus F

    2016-04-01

    Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient. PMID:27090913

  2. The preanesthetic interview by anesthesiology residents: analysis of time and content

    OpenAIRE

    Kim, Deokkyu; Lee, Sung Nyu; Kim, Dong-Chan; Lee, Jeongwoo; Ko, Seonghoon; Lee, Sang-Kyi; Son, Ji-Seon

    2012-01-01

    Background A preanesthetic visit can increase a patient's satisfaction. However, it is uncertain whether a preanesthetic visit by an anesthesiology resident can achieve the goal. We studied the time distribution for content of preanesthetic interviews (PI) and evaluated the patient's satisfaction with the PI. Methods We recorded the PI duration of 200 patients by a voice recorder. The degrees of patient satisfaction with the PI and the changes of anxiety level after the PI were quantified by ...

  3. [The treasure of the American Society of Anesthesiologists: Wood Library-Museum of Anesthesiology].

    Science.gov (United States)

    Ikeda, Shigemasa

    2014-09-01

    The origin of the American Society of Anesthesiologists Wood Library of Museum (WLM) can be traced back to the early 1930s when Dr. Paul Meyer Wood donated his collection of books and medical devices to the New York Society of Anesthetists. The WLM's current activities go beyond collection and preservation of the historical materials and publication and sale of history-related books. The WLM publishes and sells history-related books, and provides anesthesia related materials and information to the society members, as well as the public in general. The on-going programs initiated by the WLM encourage one to study history (WLM Fellowship in Anesthesiology) and honor the established anesthesia historians (WLM Laureate of History of Anesthesia). At the annual ASA meeting, the WLM has also its own lectures and symposium sessions, such as 'Patrick Sim Forum on the History of Anesthesiology' 'Lewis H. Wright Memorial Lecture' and 'History Panel'. These activities are partly supported by a group of anesthesiologist-historians (Friends of WLM). The Japanese Society of Anesthesiologists' Museum was founded in 2011 and it is still in its infancy. In order for the museum to be fully functional, Japanese anesthesiologists will be able to learn from the well-established anesthesiology museum/libraries, such as the WLM.

  4. Scientific publications in anesthesiology journals from East Asia: a 10-year survey of the literature.

    Science.gov (United States)

    Li, Zhi; Qiu, Li-Xin; Wu, Fei-Xiang; Yang, Li-Qun; Sun, Yu-Ming; Yu, Wei-Feng

    2011-04-01

    The scientific publications in anesthesiology research from East Asian authors have not been reported yet. The present study was designed to analyze the contribution of articles from East Asia to anesthesiology research. Articles published in 17 journals in anesthesiology originating from Japan, China, and South Korea from 2000 to 2009 were retrieved from the PubMed database and Web of Science. From 2000 to 2009, there were 3,076 articles published from East Asia. During this period, there were a notable decrease in publications from Japan and modest increases in publications from both China and South Korea. The average 5-year impact factor of the published articles was similar among the three regions, and China had the highest average number of citations to each article. Anesthesia & Analgesia published more articles than any other journal from all three regions. Our analysis showed that Japan was the most productive region in East Asia, but there was a notable decrease in publications from Japan in 2000-2009. The impact factor of the articles suggests similar levels of scholarship. Anesthesia & Analgesia was the most popular journal in East Asia.

  5. The Development of Dental Anesthesiology As a Discipline and Its Role As a Model of Interdisciplinary Collaboration.

    Science.gov (United States)

    Giovannitti, Joseph A; Montandon, Richard J; Herlich, Andrew

    2016-08-01

    The majority of dental procedures can be performed with an awake patient and the use of a local anesthetic, but when deep sedation and general anesthesia are needed, they typically are provided by those dentists with advanced training in anesthesiology, i.e., oral and maxillofacial surgeons and dentist anesthesiologists. Dental anesthesiology began with the discovery of anesthesia by a dentist in 1844 and has been recognized as a separate discipline in dentistry for nearly 70 years. Training over this time evolved from apprenticeships to one-year training programs, and in 2007, the Commission on Dental Accreditation (CODA) began accrediting two-year dental anesthesiology training programs. Since 2015, in recognition of the increasing complexity of the discipline, training has required three years of postgraduate study. The number of dentist anesthesiologists has grown with the increasing demand for anesthesia services by both the public and the profession. However, the present number of dentist anesthesiologists is not sufficient to meet the demand, so additional programs and growth in current programs are needed. Another valuable aspect of this discipline is its role as a positive example of interdepartmental collaboration since dental anesthesiology faculty, as members of a support discipline, typically work across many of the other departments in a dental school. This article reviews the history of the discipline, describes the educational goals and CODA standards for dental anesthesiology programs, using one program as an example, and discusses the needs and challenges that will shape the discipline's development in the future. PMID:27480705

  6. Anesthesiological Management of a Patient with Williams Syndrome Undergoing Spine Surgery

    Directory of Open Access Journals (Sweden)

    Federico Boncagni

    2016-01-01

    Full Text Available Williams Syndrome (WS is a complex neurodevelopmental disorder associated with a mutation on chromosome 7. Patients with WS usually display dysmorphic facial and musculoskeletal features, congenital heart diseases, metabolic disturbances and cognitive impairment. Structural cardiovascular abnormalities are present in the majority of the children and may provide a substrate for perioperative Sudden Cardiac Death, as presented by several reports, something that creates a great challenge to the anesthetic conduct. We present the case of a 12-year old girl who required anesthetic care for surgical correction of an acquired kyphoscoliosis. Potential anesthesiological implications of WS are subsequently reviewed.

  7. [The Formative Years of Modern Anesthesiology in Japan--A Dialogue between Hideo Yamamura and Akitomo Matsuki].

    Science.gov (United States)

    Yamamura, Hideo; Matsuki, Akitomo

    2016-06-01

    In a dialogue with Akitomo Matsuki as the moderator, Hideo Yamamura, the first Professor of Anesthesiology in Japan at the University of Tokyo who had enormously contributed toward improving the standard of the specialty in Japan, gave detailed accounts of following topics: his training as a surgeon, Saklad's lectures in 1950, the establishment of a departmental anesthesia group, the conversion to anesthesiologist, studying in the United States, the foundation of the Japan Society of Anesthesiology, movements for the governmental approval of registered anesthesiologists and the qualification system of board certified anesthesiologists, international activities in holding the Second Asian Australasian Congress of Anaesthesiologists in 1966 and the Fifth World Congress of Anaesthesiologists in 1972, and the opening of pain clinics and the foundation of its society. Yamamura's accounts illustrate unknown episodes in the history of the formative period of modern anesthesiology in Japan.

  8. Toward a general theory of unconscious processes in psychoanalysis and anesthesiology.

    Science.gov (United States)

    Mashour, George A

    2008-03-01

    Psychoanalysis and anesthesiology appear radically different in their clinical practice, yet they share a focus of inquiry: unconscious processes. Despite this common domain, there has been no exploration of the relationship between "the unconscious" as conceived by psychoanalysts and "surgical unconsciousness" as conceived by anesthesiologists. This is likely due to the fact that general anesthesia has been assumed to be a state in which the brain is simply "turned off." More recent neuroscientific data invalidate this assumption by demonstrating that the anesthetized brain is both cognitively dynamic and capable of implicit learning. Current perspectives on anesthetic mechanisms suggest that general anesthesia is characterized not simply by the absence of cognitive activity, but by the disintegration of cognitive activity. The cognitive unbinding paradigm of general anesthesia is discussed and its application to Wilfred Bion's theory of thinking, as well as his concept of attacks on linking, is elucidated. Based on the common structure and function of unconscious processes in psychoanalysis and anesthesiology, the foundation of a general theory is established.

  9. Marketing or strategy? Defining the best approach to expand the anesthesiology workforce in Israel.

    Science.gov (United States)

    Lewis, Michael C; Grant, Gilbert J

    2015-01-01

    There is a chronic shortage of anesthesiologists in Israel. The study by Cohen et al. suggests that a marketing campaign may be one method of addressing this shortage. This commentary argues for a more comprehensive strategy based on the US experience. This would not only involve marketing as suggested by Cohen et al. but would also involve a fundamental change in the Israel anesthesia care model, as well as providing substantial financial incentives to young physicians. We believe that a combination of these approaches will help to alleviate the shortage of anesthesia providers in Israel. Creating a new class of physician extenders, namely, anesthesiologist assistants, would also provide an employment pathway for the skilled medical technicians trained by the Israel Defense Forces, and other non-physicians with an interest in anesthesiology.

  10. [Pain and anesthesiology : aspects of the development of modern pain therapy in the twentieth century].

    Science.gov (United States)

    Witte, W

    2011-06-01

    The connection between the development of anesthesiology and pain therapy in the twentieth century is close. The optimistic idea to overcome pain by using general anesthesia derives from the nineteenth century. Treatment of nonsurgical pain remained in the background for a long time and innovations in pain medicine did not improve the insufficient care for patients with postoperative pain. Therapy of chronic pain was mainly surgical and the extreme of this surgical approach was psychosurgery. In the years following World War II leucotomy and lobotomy were established as methods to separate the psychological processing of pain from the experience of pain. Meanwhile, the French "pain surgeon" René Leriche elaborated a theory of pain where chronic pain was no longer seen as a symptom but as a "douleur-maladie", a pain disease. His theory was considered on various occasions but did not gain acceptance before the 1950s. Research in anesthesiology, such as that conducted by the American scientist Henry Beecher separated psyche and physiology with respect to pathological pain. This was contrasted by the approach of clinical anesthesia to pain therapy, which was based on regional anesthesia. The first "pain clinics" were "nerve block clinics". John Bonica, a regional anesthesiologist, extended the framework of pain therapy by introducing multidisciplinary teamwork into the therapy of chronic pain. From today's viewpoint his 1953 monograph The Management of Chronic Pain is a milestone in the development of modern pain therapy. However, Bonica's work did not attain major importance until 1960 when he was appointed to a newly established chair. Gradually, chronic pain was recognized as an independent illness and differentiated as such from acute pain. In 1965 the gate control theory by Melzack and Wall offered a possible explanation for the mechanisms of chronic pain. By the end of the 1970s the spectrum was extended to the biopsychosocial approach which was foremost

  11. Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study

    OpenAIRE

    Vadi, Marissa G.; Malkin, Mathew R.; Lenart, John; Stier, Gary R.; Gatling, Jason W; Applegate II, Richard L.

    2016-01-01

    Objectives This study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type. Methods The 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants select...

  12. Comparison of the ease of tracheal intubation by postgraduate residents of anesthesiology using Airtraq™ and Macintosh laryngoscopes: An observational study

    OpenAIRE

    Yallapragada, Srivishnu Vardhan; Parasa, Mrunalini; Vemuri, Nagendra Nath; Shaik, Mastan Saheb

    2016-01-01

    Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which facilitates easy visualization of glottis through a matrix of sequentially arranged lenses and mirrors. In this observatory study, we sought to compare the ease of tracheal intubation with Airtraq™ and Macintosh laryngoscope when performed by 2nd year postgraduate residents of Anesthesiology in NRI Medical College, Mangalagiri. Aims: To compare the ease of tracheal intubation by Airtraq™ laryngoscop...

  13. Implementation of a residency program in anesthesiology in the Northeast of Brazil: impact on work processes and professional motivation

    OpenAIRE

    Cláudia Regina Fernandes; Rafael Queiroz de Sousa; Francisco Sávio Alves Arcanjo; Gerardo Cristino de Menezes Neto; Josenília Maria Alves Gomes; Renata Rocha Barreto Giaxa

    2015-01-01

    BACKGROUND AND OBJECTIVES: To understand, through the theory of social representations, the influence exerted by the establishment of a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil. METHOD: Qualitative methodology. The theoretical framework comprised the phenomenology and the social representation theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, ...

  14. Changing of an anesthesiology clinical base year to create an integrated 48-month curriculum: experience of one program.

    Science.gov (United States)

    Staszak, John; Dorotta, Ihab; Steckner, Karen; Mossad, Emad; Estafanous, F George; Tetzlaff, John E

    2005-05-01

    To allow for growth in our anesthesiology residency, we assumed control of the clinical base year (postgraduate year 1[PGY-1]) and adjusted the curriculum to accommodate the expanded size. With this opportunity to change the curriculum, we created a clinical base year to prepare PGY-1 for clinical anesthesia training in PGY-2 to PGY-4 using, for this purpose, the best resources of our clinical site. We describe the process and preliminary results of the change. PMID:15896594

  15. Anesthesiology residents’ perspective about good teaching – a qualitative needs assessment

    Directory of Open Access Journals (Sweden)

    Ortwein, Heiderose

    2014-02-01

    Full Text Available [english] Background: Germany, like many other countries, will soon have a shortage of qualified doctors. One reason for the dissatisfaction amongst medical residents are the relatively unstructured residency training programs despite increasing importance of outcome-based education. The aim of our study was to identify characteristics and requirements for good teaching during anesthesiology residency training from the resident’s point of view. Methods: A consensus workshop with residents from all medical universities in Germany was held. Participants were allocated to one of the three topics, chosen based on a 2009 nationwide evaluation of residency. The three topics were (A characteristics of helpful/good teachers, haracteristics of helpful/good conditions and (C characteristics of helpful/good curricular structure. Each group followed a nominal group technique consensus process to define and rank characteristics for a good residency.Results: 31 (79.5% resident representatives were present. The consented results put emphasis on the importance of structured curricula including transparent goals and objectives, in training formative assessments and quality assurance measures for the program. Residents further long for trained trainers with formal teaching qualifications and protected teaching time.Conclusions: Good residency training requires careful consideration of all stakeholders’ needs. Results reflect and extend previous findings and are at least to some degree easily implemented. These findings are an important step to establish a broader consensus within the discipline.

  16. 50th Year Anniversary of Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University.

    Science.gov (United States)

    Lertakyamanee, Jariya

    2016-05-01

    Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, has started to be a formal anesthesia division, divided from division of Surgery in 1965; hence our 50th year anniversary in 2015. Research is now a priority and mandatory mission, according to the vision of Mahidol University. Second mission is to teach and train, and we produce the highest number of states-of-the-art anesthesiologists and anesthetic nurses each year Curriculum and training are being continuously improved. From a small unit, now it is one of the largest departments and extends the service, our third mission, to more than only in the operating theaters. We look after pre-anesthesia assessment, inside and outside operating room anesthesia, post-operative pain relief Intensive Care Unit, and chronic pain management. The number of patients and their diseases increase; so do the complexities of surgeries. There are tremendous changes in drugs and equipment. There is the fourth mission on administration, IT and resource management. And the fifth mission which is corporate social responsibility. However, we still believe that compassion, responsibility and integrity are most important. We have taught and tried to live by the teaching of HRH the King's Father. And these will contribute to our progress and shine in the next 50 years. PMID:27501620

  17. [HOLDING OBJECTIVE STRUCTURED CLINICAL EXAMINATIONS FOR ANESTHESIOLOGY AND INTENSIVE CARE CLINICAL RESIDENCY IN STATE GRADUATES CERTIFICATION].

    Science.gov (United States)

    Schegolev, A V; Andreenko, A A; Ershov, E N; Lahin, R E; Makarenko, E P

    2016-01-01

    The modern system of medical education requires objective methods to assess clinical competence of medical specialists. Application of objective structured clinical examination (OSCE) during the final certification of graduates of clinical residency allows to evaluate the theoretical knowledge, manual skills. Enabling simulation scenarios in the program makes it possible to objectively evaluate the important non-technical skills of anesthesiologists, identify gaps in the system of training and modify it. The experience of the objective structured clinical examination as part of the state certification of graduates of clinical residency of the Department ofAnesthesiology and Intensive Care, Military MedicalAcademy after C M Kirov allows us to consider this technique in an objective way a comprehensive assessment of the competence of health professionals. Students confirmed its highly realistic, they have revealed the presence of emotional stress during the simulation sessions, the majority agreed that the simulation session increased the level of their readiness to address these situations in clinical practice. Staff of the department is planning to testing and introduction rating scales into a system of assessment, to improved exam program, increasing the number of clinical scenarios for simulation sessions. PMID:27192861

  18. Implementation of a residency program in anesthesiology in the Northeast of Brazil: impact on work processes and professional motivation

    Directory of Open Access Journals (Sweden)

    Cláudia Regina Fernandes

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: To understand, through the theory of social representations, the influence exerted by the establishment of a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil. METHOD: Qualitative methodology. The theoretical framework comprised the phenomenology and the social representation theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, five anesthesiologists, two nurses, and five nursing technicians, who work in operating rooms and post-anesthesia care units, all with a prior and a posteriori experience to the establishment of residency. RESULTS: From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, and recognition of weaknesses in the perioperative process. It was evident from upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed. CONCLUSION: The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries.

  19. Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael;

    2011-01-01

    Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications...... compared to surgical tracheostomy, anaesthesia and technique, decannulation strategy, as well as training and education....

  20. The Evaluation of the Distribution and Antimcrobial Susceptibility Profile of the Strains Isolated at Anesthesiology Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Gulfem Ece

    2013-10-01

    Full Text Available Aim: Hospital infections are important uptodate health problems because of high mortality and increased cost. The increment in antimicrobial resistance is progressing though new antimicrobial agents are arising. This leads to an increase in hospital infections and difficulty in treatment. In our study we aimed to evaluate the antimicrobial susceptibility of the strains isolated at Anesthesiology Intensive Care Unit. Material and Method: The antimicrobial susceptibility of the strains isolated at Anesthesiology Intensive Care Unit between April 1st 2012- October 25th 2012 were included. The identification and the antimicrobial susceptibility were studied by automatized Vitek version 2.0 (Biomerieux, France. Results: A total of 155 strains isolated from wound, blood, tracheal secretion, sputum and urine samples were included. They are consisted of 40 A. baumannii, 24 E.coli, 25 P. aeruginosa, 20 K.pneumoniae, 12 Methicilin Resistant Coagulase Negative Staphylococci (MRCoNS, nine Methiciline Susceptible S.aureus (MSSA, eight C.albicans, four Methicilin Resistant S.aureus (MRSA, one C.famata, one C.tropicalis, three E.faecalis, two E.faecium, three S.marsecens, two P. mirabilis and one H.influenzae. Clinical samples were 81 tracheal secretions, 25 wound specimen, 23 blood culture, 18 urine, seven sputum, and one BAL. All the Gram positive strains were susceptible to glycopeptides. Enterobacteriaceae members were susceptible to imipenem and meropenem. Discussion: Antimicrobial resistance is an important issue worldwide. Multidiciplinary approach is needed as in ICUs where the complicated patients are followed. Monitoring antibiotic resistance profile contributes to treatment and decreasing resistance rates. The resistance profile will guide the antibiotic use policy. Increment in number of isolates in future will help to obtain the antimicrobial resistance profile.

  1. Accreditation council for graduate medical education (ACGME annual anesthesiology residency and fellowship program review: a "report card" model for continuous improvement

    Directory of Open Access Journals (Sweden)

    Long Timothy R

    2010-02-01

    Full Text Available Abstract Background The Accreditation Council for Graduate Medical Education (ACGME requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships. Methods A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card." Results Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations, accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process. Conclusions An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.

  2. Designing and Implementing a Competency-Based Training Program for Anesthesiology Residents at the University of Ottawa

    Directory of Open Access Journals (Sweden)

    Emma J. Stodel

    2015-01-01

    Full Text Available Competency-based medical education is gaining traction as a solution to address the challenges associated with the current time-based models of physician training. Competency-based medical education is an outcomes-based approach that involves identifying the abilities required of physicians and then designing the curriculum to support the achievement and assessment of these competencies. This paradigm defies the assumption that competence is achieved based on time spent on rotations and instead requires residents to demonstrate competence. The Royal College of Physicians and Surgeons of Canada (RCPSC has launched Competence by Design (CBD, a competency-based approach for residency training and specialty practice. The first residents to be trained within this model will be those in medical oncology and otolaryngology-head and neck surgery in July, 2016. However, with approval from the RCPSC, the Department of Anesthesiology, University of Ottawa, launched an innovative competency-based residency training program July 1, 2015. The purpose of this paper is to provide an overview of the program and offer a blueprint for other programs planning similar curricular reform. The program is structured according to the RCPSC CBD stages and addresses all CanMEDS roles. While our program retains some aspects of the traditional design, we have made many transformational changes.

  3. 麻醉科毒麻精神药品管理的改进与体会%Improved Drug Hemp and Experience Anesthesiology Management of Psychotropic Drugs

    Institute of Scientific and Technical Information of China (English)

    张云; 郑艳萍; 周艳

    2014-01-01

    Ensure the safe use of toxic hemp drugs is an important part of the work of drug administration in anesthesiology department. During our work, we found that there are some loopholes in administration of toxic hemp psychotropic drugs in anesthesiology department of our hospital. We propose a combination of the psychotropic drugs management experience from anesthesiology department of PLA general hospital and drug hemp content in spiritual Narcotic Drugs and Drug Regulations, to improve and perfect the regulation of anesthesiology department. The operating room nurses are united with anesthesiology nurses, to jointly manage toxic hemp medicines and ensure that every aspect of the use of psychotropic drugs is under the control of regulation, to prevent the outlfow of narcotic drugs, and to ensure that the process of psychotropic drugs use in security, legalization, standardized and orderly.%保证毒麻药品的安全使用是麻醉科药品管理工作的重要内容之一,在工作中发现我院麻醉科毒麻精神药品管理存在一些漏洞。现将解放军总医院麻醉科毒麻精神药品的管理经验与《麻醉药品精神药品管理条例》内容相结合,对我院麻醉科的管理制度进行改进与完善,联合麻醉科护士与手术室护士共同对毒麻药品进行管理,确保毒麻药品精神药品每个使用环节都有监管,杜绝麻醉药品外流。保证毒麻精神药品使用过程中的安全性、合法化、规范化、有序化。

  4. 非言语行为在麻醉教学中的应用%Effects of nonverbal behavior on anesthesiology teaching

    Institute of Scientific and Technical Information of China (English)

    任力; 闵苏

    2015-01-01

    As the burden of anesthesiology teaching is heavy in undergraduate course, teachers can communicate with the students by nonverbal behaviors, such as eye contact, silent language, facial expression, paralanguage, which can make class atmosphere active, develop harmonious teacher-student relationship, and improve the quality of class teaching. Teachers of anesthesiology should take some measures, such as rehearsing lessons, summing up the experience of the lessons in time, accu-mulating the experience of nonverbal behaviors, and doing some exercise for the nonverbal behavior as much as possible, so as to set up an excellent atmosphere for teaching ,and meanwhile improve the quality of anesthesiology teaching.%本科麻醉学教学课程负担较重,教师在课堂上可以通过丰富的目光语、沉默语、面部表情、副语言等非言语行为与学生积极交流,从而活跃课堂气氛,促进和谐师生关系的发展,进而提高课堂教学质量。麻醉专业授课教师可以通过实施有效的试讲制度、总结授课经验、注重非语言行为的累积、加强非言语行为的训练,逐渐形成授课教师优良的教学风格,从整体上提高麻醉学教学质量。

  5. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study

    Directory of Open Access Journals (Sweden)

    Golzari Samad EJ

    2011-06-01

    Full Text Available Abstract Background Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. Methods A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1 were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software. Results Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49 and 16.6% (CI 0-0.34 respectively. After the additional training program in the

  6. Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study

    Science.gov (United States)

    Malkin, Mathew R.; Lenart, John; Stier, Gary R.; Gatling, Jason W.; Applegate II, Richard L.

    2016-01-01

    Objectives This study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type. Methods The 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants selected face-to-face interviews, 53 applicants selected web-based interviews, and 17 applicants declined to interview. Data regarding applicants' reasons for selecting a particular interview type were gathered using an anonymous online survey after interview completion. Residency program admission rates and survey answers were compared between applicants completing face-to-face versus web-based interviews. Results One hundred twenty-seven (75.1%) applicants completed face-to-face and 42 (24.9%) completed web-based interviews. The admission rate to our residency program was not significantly different between applicants completing face-to-face versus web-based interviews. One hundred eleven applicants completed post-interview surveys. The most common reasons for selecting web-based interviews were conflict of interview dates between programs, travel concerns, or financial limitations. Applicants selected face-to-face interviews due to a desire to interact with current residents, or geographic proximity to the residency program. Conclusions These results suggest that completion of web-based interviews is a viable alternative to completion of face-to-face interviews, and that choice of interview type does not affect the rate of applicant admission to the residency program. Web-based interviews may be of particular interest to applicants applying to a large number of programs, or with financial limitations. PMID:27039029

  7. First Job Search of Residents in the United States: A Survey of Anesthesiology Trainees' Interest in Academic Positions in Cities Distant from Previous Residences.

    Science.gov (United States)

    Dexter, Franklin; De Oliveira, Gildasio S; McCarthy, Robert J

    2016-01-15

    We surveyed anesthesiology residents to evaluate the predictive effect of prior residence on desired location for future practice opportunities. One thousand five hundred United States anesthesiology residents were invited to participate. One question asked whether they intend to enter academic practice when they graduate from their residency/fellowship training. The analysis categorized the responses into "surely yes" and "probably" versus "even," "probably not," and "surely no." "After finishing your residency/fellowship training, are you planning to look seriously (e.g., interview) at jobs located more than a 2-hour drive from a location where you or your family (e.g., spouse or partner/significant other) have lived previously?" Responses were categorized into "very probably" and "somewhat probably" versus "somewhat improbably" and "not probable." Other questions explored predictors of the relationships quantified using the area under the receiver operating characteristic curve (area under the curve) ± its standard error. Among the 696 respondents, 36.9% (N = 256) would "probably" consider an academic practice. Fewer than half of those (P < 0.0001) would "very probably" consider a distant location (31.6%, 99% CI 24.4%-39.6%). Respondents with prior formal research training (e.g., PhD or Master's) had greater interest in academic practice at a distant location (AUC 0.63 ± 0.03, P = 0.0002). Except among respondents with formal research training, a good question to ask a job applicant is whether the applicant or the applicant's family has previously lived in the area. PMID:26422456

  8. Training clinical skills and scientific thinking for postgraduates of anesthesiology%麻醉学硕士研究生临床技能与科研思维的培养

    Institute of Scientific and Technical Information of China (English)

    李冬梅; 杨迎春; 隋海静; 杨雪; 张瑞芹; 李文志

    2013-01-01

    Training anesthesiology postgraduates should be started with clinical skill and scien-tific thinking. This article advocated setting up a multi-level and multi-mode training strategy based on theoretical study ,clinical skill training and scientific ability development according to the features of anesthesiology. Meanwhile,the training should have focus and orientation for postgraduates at different grades. This study solved the problems of training for postgraduates of anesthesiology and made a feasible training strategy to develop the clinical and scientific ability of postgraduates.%麻醉学硕士研究生的培养应从掌握临床技能和建构科研思维方向入手,结合麻醉学科的特点,建立完善的教学模式;从理论学习、临床技能训练和科研能力开发等进行多层次、多形式教育;并针对不同年级硕士研究生进行有重点、有方向的培训。解决麻醉学硕士研究生临床与科研中遇到的问题,制定切实可行的培养计划,使其临床技能和科研能力共同提高。

  9. [Relations of German anesthesiology to east European societies of anesthesiology].

    Science.gov (United States)

    Benad, G

    2003-01-01

    On the occasion of the 50th anniversary of the foundation of the "German Society of Anaesthesiology" (DGA)--later called "German Society of Anaesthesiology and Intensive Care Medicine" (DGAI)--which was founded on 10 April 1953, and in memory of the foundation of the "Section of Anaesthesiology", which was founded in East-Berlin ten years later on 25 October 1963 and later called "Society of Anaesthesiology and Intensive Therapy of the GDR" (GAIT), the development of relations between German anaesthetists and anaesthesiological societies in East Europe are described. The limited economic base of the medical-technical and pharmaceutical industries, a chronic lack of hard currencies and economic and political restrictions on travel activities by East German and East European anaesthetists to West European countries resulted in improved contacts between East German and East European anaesthesiological societies. This, in turn, led to the holding of "International Anaesthesiological Congresses" of the so-called socialist countries and "Bilateral Symposia of the Anaesthesiological Societies of Czechoslovakia and the GDR" and also bilateral meetings of nurses of anaesthesiology and intensive therapy from both countries. These congresses and in particular the "3rd European Congress of Anaesthesiology", which was hosted by the "Czechoslovak Society of Anaesthesiology and Resuscitation" in Prague in 1970, were of high value for the further development of anaesthesiology in these countries. Furthermore, congresses held in East Europe but outside the GDR, were especially important for meetings between East German anaesthetists and their West German colleagues, who regularly took part in these congresses as invited speakers, because West German anaesthetists were not allowed to participate in East German anaesthesia congresses, on the one hand, and East Germans were not allowed to attend West German anaesthesia congresses, on the other. There were also regular meetings of the boards of East European anaesthesia societies in order to discuss the further development of anaesthesiology as an independent new academic field of medicine. Both East and West German anaesthetists were very often invited as guest lecturers by various East European societies and anaesthesiological departments. They were always deeply impressed by the tremendous hospitality of their hosts. During the "Cold War", many anaesthetists from East European countries were also invited as guests by anaesthesia departments of East and West Germany. Most of the East European anaesthetists preferred West German departments because they were better equipped and some of them used these trips to the West also to escape from communism. Shortly before and mainly after the political changes in 1989 and the dissolving of the "Society of Anaesthesiology and Intensive Therapy of the GDR" in 1990, the "German Society of Anaesthesiology and Intensive Care Medicine" improved its contacts to the East European anaesthesiological societies. The "Bavarian Section" of the "German Society of Anaesthesiology and Intensive Care Medicine" organized joint meetings with the Romanian, Bulgarian, Latvian and Russian societies of anaesthesiology in Bucharest (1987), Riga (1989), Moscow (1989) and Sofia (1991). In 1996, an "Association of German and Russian Anaesthetists" (ADRA) was founded in Moscow, which now has both a German (Prof. Dr. Dr. h.c. Joachim Nadstawek/Bonn) and a Russian (Prof. Dr. Armen Buniatian/Moscow) President. The German members of this association, in particular its Secretary-General, Prof. Dr. Reinhard Purschke/Dortmund, organize postgraduate courses including theoretical lectures and practical work not only in Russia but also in Armenia and Usbekistan.

  10. A serendipidade na medicina e na anestesiologia A serendipidade en la medicina y en la anestesiologia Serendipity in medicine and anesthesiology

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2005-04-01

    biología, anatomía, física, química, fisiología, farmacología, astronomía, arqueología y... mucha suerte. CONCLUSIONES: Aunque accidentes en la pesquisa y en la sala de operación sean lamentables, hay aquéllos que acontecen y, a veces, pueden llevar a avances espectaculares, como tratamientos heroicos y hasta Premios Nobel. Mantener la mente abierta es un trazo común a aquellos que desean contar con la gran suerte, como afirmaba el físico americano Henry (1842: "Las semillas del hallazgo flotan constantemente alrededor nuestro, pero apenas lanzan raíces en las mentes bien preparadas para recibirlas".BACKGROUND AND OBJECTIVES: This study has evaluated more than a hundred of the most fortunate couplings of a brilliant mind with fortunate luck (serendipity, through the re-reading of most relevant histories on science-related (n = 46 and anesthesiology-related (n = 16 inventions and discoveries. CONTENTS: This educational article encourages anesthesiologists to appreciate events related to scientific inventions and discoveries, showing that serendipity is possible, provided it is expected. Each discovery or invention includes history, references and scientific or anecdotal explanation. In addition to traditional discoveries, such as wine, gravity, photograph, Velcro, airbag, etc., there are other Medicine-related (microscope, X-rays, vaccine, penicillin, insulin, laser, Paps smear, etc. and Anesthesiology-related (isometry, gloves, N2O, ether, barbiturates, benzodiazepines, blood patch, etc. discoveries. Creativity and serendipity may act as cornerstones for clinical and basic research of pioneer inventions for medical and anesthesiologic advances. In fact, topics related to biology, anatomy, physics, chemistry, physiology, pharmacology, astronomy and archeology should be master and … lots of luck. CONCLUSIONS: Although research and operating room accidents are regrettable, some of them happen and may sometimes lead to spectacular advances, such as heroic

  11. Anesthesiology and the cytokine network

    Directory of Open Access Journals (Sweden)

    Barbara Lisowska

    2013-08-01

    Full Text Available The immune response is a highly specific reaction carried out by means of specialized cells that belong to the immune system. There are two types of immune response mechanisms aimed towards pathogens: non-specific, innate reactions, and specific, acquired reactions. Acquired immunity, characterized by its specificity, is comprised of lymphocytes, including both T cell and B cell populations. The role of B lymphocytes is not limited to the humoral response, though the cellular immune response is carried out mainly by various T lymphocyte subpopulations. The reactions of the humoral and cellular responses complement and stimulate one another mutually – cytokines are their common linking element. The attachment of cytokines to their specific receptors activates a sequence of signals – either intracellular or between the cells of various systems. This organization of respective connections and reactions, including the functional relations between cells of the immune response, in its complexity, is best described as a cytokine network. The response of the immune system to surgical trauma can be looked at from both a local and a general perspective. Not only surgical trauma caused by tissue damage, however, influences the functioning of the immune system, but also the drugs and techniques used during anesthesia. Our article is a presentation of the effects of medications used in anesthesia with respect to their influence on the cytokine network.

  12. The Superiority,Opportunity and Challenge for Anesthesiology in Comfortable Medicine%麻醉学科与舒适医疗:优势、挑战与机遇

    Institute of Scientific and Technical Information of China (English)

    张铁铮; 于冬梅

    2015-01-01

    随着医学技术、社会经济的发展和对疾病、疼痛的深入认识和研究,舒适医疗应运而生。在这种新的医疗服务模式下,麻醉学科表现出无可比拟的学科优势,在保证医疗安全的前提下,已经广泛开展了术后镇痛、无痛分娩、无痛人流、无痛宫腔镜、无痛胃肠镜、无痛支气管镜、无痛拔牙、无痛美容手术等工作,在一定范围内真正实现了舒适医疗。然而,在舒适医疗进程中麻醉学科仍然面临诸多挑战,如学科地位、发展不平衡和麻醉医生数量与质量等问题。尽管如此,机遇与挑战并存,麻醉工作者应积极参与、不断提高技术和提升理念、完善相关制度和工作流程、加强学科间的通力合作,逐渐推进舒适医疗全面走向成熟。%With the development of medical technology and society economic ,as well as the deep recognition and research of pain ,painless comfortable medical service emerges . Under the new medical service mode , anesthesiology owns the superiority and position in hospital . The anesthesiology is taking responsibility for comfortable medicine , such as postoperative analgesia , labor analgesia , painless induced abortion , painless uteroscopy , painless gastrointestinal endoscopy and treatment ,painless bronchoscopy ,orthopedic and cosmetic operation ,painless tooth extraction so on ,which is the embody of comfortable medical within a certain range .However the anesthesiology still face some challenges ,such as low discipline status ,unbalanced development ,the defect of quantity and quality of anaesthetist and so on .Opportunity is always aside with challenge .The anesthetists must actively participate in the comfortable medicine ,continuously improve skills and recognition associated with comfortable medicine ,complete the regulations and working process ,enhance the cooperation between different disciplines ,and facilitate the entirety comfortable medical

  13. 麻醉护士的工作范畴及在麻醉科的作用研究%Anesthesia Nurses Job Category and Research in the Department of Anesthesiology Effect

    Institute of Scientific and Technical Information of China (English)

    谢振凤

    2014-01-01

    In the process of anesthesia in today's medical is very common, and the implementation of anesthesia is anesthesia nurses. Anesthesia nurses as a special medical staff has been widely used in the hospital, this paper will detail the anesthesia nurse’s job category and function in the department of anesthesiology, the training content of nurse anesthesia, and goals.%麻醉在现今的医疗过程中十分常见,而实施麻醉的就是麻醉护士。麻醉护士作为特殊的医务人员在医院中得到广泛的运用,本文将详述麻醉护士的工作范畴及在麻醉科的作用、麻醉护士的培训内容和目标。

  14. 麻醉学PBL教学中不同角色对教学效果的反馈%The Feedback of Different Roles on the Teaching Effect in the Problem-Based Learning in Anesthesiology

    Institute of Scientific and Technical Information of China (English)

    支延康; 黄燕

    2015-01-01

    Objective To investigate the advantages and disadvantages of problem-based learning in anesthesiology.Methods Ten typical PBL plans of anesthesiology were designed. Fifty students were taught by PBL methods.Results were assessed by questionnaire survey. Results A majority of students like this model and think it can improve the ability of autonomic learning and solving problem, it can also benefit the reinforce of the knowledge, as well as the ability of autonomic learning and teamwork. The discussion will urge the teachers to keep learning for seek of better educational results. For further clinical management, PBL learning can help the students to get their thoughts into shapes and improve clinical competences. The disadvantage is time-consuming.Conclusions The PBL teaching method can arouse interest of study and improve the quality of teaching.%目的:探讨麻醉学PBL教学的方法和利弊。方法精心选题并设计了10个典型的麻醉方法和心肺复苏案例,设计PBL教学教案,对某院10级临床医学5年制本科50名学生进行麻醉学PBL教学,教学结束对学生进行问卷调查,并收集授课老师的反馈意见。结果84%学生表示喜欢这种教学模式,认为这种教学模式有以下优点:激发学习积极性;有利于相关知识的理解和巩固;有助于独立思考,提高处理临床实际问题的能力;提高自学和团队协作能力;同学能力的提升也可以促进教学相长。缺点是同学们课外耗时多。结论麻醉学PBL教学能调动学生的学习兴趣,提高教学质量,促进学生素质的全面提升。

  15. Riscos e doenças ocupacionais relacionados ao exercício da anestesiologia Riesgos y enfermedades ocupacionales relacionados con el ejercicio de la anestesiología Occupational hazards and diseases related to the practice of anesthesiology

    Directory of Open Access Journals (Sweden)

    Daniel Volquind

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O exercício da anestesiologia não é isento de riscos para o anestesiologista. Considerada um local de trabalho insalubre em razão dos riscos potenciais que oferece, a sala de operações (SO é o local no qual o anestesiologista passa a maior parte do tempo. Nesta revisão, propomos uma análise dos riscos ocupacionais aos quais estão expostos os anestesiologistas em sua prática diária. CONTEÚDO: Apresentamos a classificação dos riscos e suas relações com as doenças ocupacionais. CONCLUSÃO: O controle dos riscos ocupacionais, aos quais os anestesiologistas são expostos diariamente, se faz necessário para o desenvolvimento de um local de trabalho adequado e com riscos reduzidos para a boa prática da anestesiologia. Isso contribui para a diminuição do absenteísmo, a melhora da assistência prestada ao paciente e da qualidade de vida do anestesiologista.JUSTIFICATIVA Y OBJETIVOS: El ejercicio de la anestesiología no está exento de riesgos para el anestesiólogo. Considerado como un local de trabajo insalubre a causa de los riesgos potenciales a que conlleva, el quirófano es el local en donde el anestesiólogo pasa la mayor parte del tiempo. En esta revisión, proponemos un análisis de los riesgos ocupacionales a los que están expuestos los anestesiólogos en su práctica diaria. CONTENIDO: Presentamos una clasificación de los riesgos y sus relaciones con las enfermedades ocupacionales. CONCLUSIONES: El control de los riesgos ocupacionales a los que están expuestos los anestesiólogos diariamente es necesario para lograr un local de trabajo adecuado y con riesgos reducidos para la buena práctica de la anestesiología, lo que contribuye para la disminución del absentismo, la mejoría de la asistencia prestada al paciente y de la calidad de vida del anestesiólogo.BACKGROUND AND OBJECTIVES: The practice of anesthesiology is not without risks to the anesthesiologist. The operating room (OR, in

  16. 陕西省二级及以上医院麻醉科护士人力资源情况及任职资格需求的调查研究%Nursing Human Resource Allocation and Its Qualification Requirements in Anesthesiology Department

    Institute of Scientific and Technical Information of China (English)

    段娜; 李婵; 李小妹

    2016-01-01

    Objective To investigate the nursing human resource allocation, job responsibility and qualifications in anesthesiology department in second-level or above hospitals in Shanxi Province and to provide references for nursing human resource allocation and nurse training in anesthesiology department. Methods Self-designed questionnaires including general information questionnaire, questionnaire on current nursing human resource allocation in anesthesiology department, questionnaire on current status of nurses in anesthesiology department and questionnaire on job responsibilities and post qualifications of anesthesia nurses were applied to survey leaders of anesthesiology departments in 95 second-level or above hospitals in Shanxi Province. Results In 32.6%of the surveyed hospitals, there were totally 180 anesthesia nurses but 90.4% of them in third-level hospitals and 76.8% of the surveyed hoped that there would be anesthesia nurses in the hospital in the near 5 years. Surveyed leaders knew exactly about the job responsibilities and post qualifications of anesthesia nurses. Of the job responsibilities, the items of nursing in PACU (post anesthesia care unit) and with anesthesia specialized knowledge and skills were in the most important ones. Conclusion There is urgent need of anesthesia nurses in Shanxi Province and leaders of anesthesiology department hope there will be adequate qualified nurses in the near 5 years.%目的:通过调查陕西省二级及以上医院麻醉科护士人力资源、岗位职责及任职资格现状,为麻醉科护士人力资源配置及护士培养提供参考。方法2014年10月—2015年4月,采用自行设计的调查问卷,对陕西省95所二级及以上医院麻醉科负责人进行调查,研究工具包括专家基本信息,麻醉科现况调查表,麻醉护士现况调查表,及专家对麻醉护士任职资格及岗位职责的需求调查表。结果32.6%医院现设有麻醉科护士,共有护士180名,90

  17. Anesthesia and Monitoring in Small Laboratory Mammals Used in Anesthesiology, Respiratory and Critical Care Research: A Systematic Review on the Current Reporting in Top-10 Impact Factor Ranked Journals.

    Directory of Open Access Journals (Sweden)

    Christopher Uhlig

    Full Text Available This study aimed to investigate the quality of reporting of anesthesia and euthanasia in experimental studies in small laboratory mammals published in the top ten impact factor journals.A descriptive systematic review was conducted and data was abstracted from the ten highest ranked journals with respect to impact factor in the categories 'Anesthesiology', 'Critical Care Medicine' and 'Respiratory System' as defined by the 2012 Journal Citation Reports. Inclusion criteria according to PICOS criteria were as follows: 1 population: small laboratory mammals; 2 intervention: any form of anesthesia and/or euthanasia; 3 comparison: not specified; 4 primary outcome: type of anesthesia, anesthetic agents and type of euthanasia; secondary outcome: animal characteristics, monitoring, mechanical ventilation, fluid management, postoperative pain therapy, animal care approval, sample size calculation and performed interventions; 5 study: experimental studies. Anesthesia, euthanasia, and monitoring were analyzed per performed intervention in each article.The search yielded 845 articles with 1,041 interventions of interest. Throughout the manuscripts we found poor quality and frequency of reporting with respect to completeness of data on animal characteristics as well as euthanasia, while anesthesia (732/1041, 70.3% and interventions without survival (970/1041, 93.2% per se were frequently reported. Premedication and neuromuscular blocking agents were reported in 169/732 (23.1% and 38/732 (5.2% interventions, respectively. Frequency of reporting of analgesia during (117/610, 19.1% and after painful procedures (38/364, 10.4% was low. Euthanasia practice was reported as anesthesia (348/501, 69%, transcardial perfusion (37/501, 8%, carbon dioxide (26/501, 6%, decapitation (22/501, 5%, exsanguination (23/501, 5%, other (25/501, 5% and not specified (20/501, 4%, respectively.The present systematic review revealed insufficient reporting of anesthesia and euthanasia

  18. Simulation in Medical Education: Focus on Anesthesiology

    OpenAIRE

    Doyle, D. John

    2009-01-01

    Simulation refers to the artificial representation of a complex real-world process with sufficient fidelity to achieve a particular objective, usually for the purposes of training or performance testing. While simulation has been important from early times (as in the rehearsal of animal hunting activities or preparing for warfare), the needs of World War II greatly accelerated simulation technology for use in flight training. With the available of inexpensive computer technology in recent yea...

  19. [Pneumodynamics: Respiratory Physiology Related to Anesthesiology].

    Science.gov (United States)

    Kitaoka, Hiroko; Hirata, Haruhiko; Kijima, Takashi

    2016-05-01

    Although pneumodynamics is the most basic research field in the respiratory management, the number of the researchers is rapidly decreasing in this century. This is not because of the maturing of pneumodynamics but because the conventional theory has been wrong. The authors have been investigating this area theoretically and experimentally for more than ten years and propsed novel pneumodynamics based on dynamic imaging technique during breathing and computational fluid dynamics. In this paper, we first indicate the dynamic collapse of the intra-mediastinal airway during maximum forced expiration in emphysematous patients visualized by 4D-CT images, and explain its mechanism in terms of fluid dynamics where the turbulence of airflow in the large airway plays an important role. Although conventional pneumodynamics is based on electric circuit analogy, it has a crucial defect that the turbulence of airflow is never contained. Then, we will introduce a 4D alveolar model which explains how the alveolar shape changes during breathing based on experimental images, and indicate that the essential morphological change in diffuse alveolar damage (DAD) is the alveolar collapse, which has been misrecognized as "thickening of the alveolar wall". The new era of respiratory physiology has just begun in Japan. PMID:27319089

  20. Data, Big Data, and Metadata in Anesthesiology.

    Science.gov (United States)

    Levin, Matthew A; Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2015-12-01

    The last decade has seen an explosion in the growth of digital data. Since 2005, the total amount of digital data created or replicated on all platforms and devices has been doubling every 2 years, from an estimated 132 exabytes (132 billion gigabytes) in 2005 to 4.4 zettabytes (4.4 trillion gigabytes) in 2013, and a projected 44 zettabytes (44 trillion gigabytes) in 2020. This growth has been driven in large part by the rise of social media along with more powerful and connected mobile devices, with an estimated 75% of information in the digital universe generated by individuals rather than entities. Transactions and communications including payments, instant messages, Web searches, social media updates, and online posts are all becoming part of a vast pool of data that live "in the cloud" on clusters of servers located in remote data centers. The amount of accumulating data has become so large that it has given rise to the term Big Data. In many ways, Big Data is just a buzzword, a phrase that is often misunderstood and misused to describe any sort of data, no matter the size or complexity. However, there is truth to the assertion that some data sets truly require new management and analysis techniques. PMID:26579664

  1. An anesthesiological approach to nerve agent victims.

    Science.gov (United States)

    Cosar, Ahmet; Kenar, Levent

    2006-01-01

    The potential use of weapons of mass destruction has recently become a real threat even in the areas of ongoing armed conflicts. Mass casualty victims can suffer from psychological and physical trauma. The exposure of physically injured patients to a toxic substance, in a scenario of mass injury, has recently gained major attention among planners of future protocols for emergency medical services. Because rapid deterioration and multiorgan involvement are to be expected after physical injuries, proper organization and complex but efficient acute medical care systems must be organized and deployed to ensure a maximal number of saved lives. These victims will inevitably require urgent surgical intervention and prolonged perioperative care. Understanding the interdependence between the toxic and traumatic occurrences and the drugs used to prevent or treat nerve agent intoxication (pyridostigmine bromide, a reversible inhibitor of acetylcholinesterase; atropine, a muscarinic receptor antagonist that is one of the on-site, first aid, pharmacological resuscitation drugs; and oxime-like pralidoxime chloride or obidoxime chloride, acetylcholinesterase reactivators) is vital. In addition, the administration of anesthesia and emergency surgery pose further unpredictable threats to the central nervous system, the cardiovascular system, and respiratory function, all of which may be compromised after chemical intoxication and physical trauma. It is noteworthy that information concerning the effects of nerve agent intoxication among human subjects is derived largely from reports of incidents of intentional terrorist attacks or of accidental exposure to organophosphate pesticides, compounds that are chemically related to nerve agents. PMID:16532866

  2. Importância do treinamento de residentes em eventos adversos durante anestesia: experiência com o uso do simulador computadorizado Importancia del entrenamiento de los practicantes (médicos en ejercicio en eventos adversos durante la anestesia: experiencia con el uso del simulador computadorizado Importance of critical events training for anesthesiology residents: experience with computer simulator

    Directory of Open Access Journals (Sweden)

    Domingos Dias Cicarelli

    2005-04-01

    durante los procedimientos anestésicos. Sin embargo, continua importante el entrenamiento de los médicos practicantes para este tipo de ocurrencia. El objetivo de este estudio fue evaluar el desempeño práctico de los médicos practicantes de Anestesiología en eventos adversos durante una anestesia simulada. MÉTODO: Fueron evaluados 17 médicos en especialización de primero y segundo años de Anestesiología (ME1 y ME2 y 5 instructores del Centro de Enseñanza y Entrenamiento (CEE del HCFMUSP (Título Superior en Anestesiología - TSA. Fue utilizado el simulador computadorizado Anesthesia Simulator Consultant (ASC versión 2.0 - 1995/Anesoft para realización de las simulaciones de los eventos. Los incidentes críticos escogidos fueron fibrilación ventricular (FV y choque anafiláctico. Después de la realización de la simulación, fueron impresos los resultados de cada participante, evaluados y puntuados las conductas adoptadas para resolver los incidentes críticos pre-determinados. Los participantes evaluaron el simulador a través de un cuestionario para ser respondido. RESULTADOS: No hubo diferencia estadística entre las medias obtenidas por los grupos, sin embargo, se notó una tendencia de un desempeño mejor de los grupos TSA y ME2 en la simulación de FV. En relación al choque anafiláctico, hubo una tendencia de desempeño mejor del grupo TSA. CONCLUSIONES: El entrenamiento para el diagnóstico y conductas en eventos adversos debe ser un foco de atención durante el entrenamiento de médicos practicantes y en la actualización de anestesiologistas. El uso del simulador puede ser una de las formas de realizar el entrenamiento en estas situaciones.BACKGROUND AND OBJECTIVES: Because of monitoring and drugs evolution, there has been a decrease in the incidence of critical events during anesthetic procedures. Despite this low frequency, critical event training for Anesthesiology residents remains important. This study aimed at evaluating Anesthesiology

  3. A research on the influence of undergraduate intellectual training process models of anesthesiology and medical imaging on profession access of medical students%麻醉医学和医学影像学本科人才培养过程对行业准人影响的研究

    Institute of Scientific and Technical Information of China (English)

    石云霞; 毛广运; 林陈钏; 卢丽笋

    2012-01-01

    目的 通过比较医学影像学、麻醉医学与临床医学专业毕业生校内学业成绩、毕业实习评价、医师资格考试的差异以及用人单位的问卷调查结果,了解麻醉医学、医学影像学专业本科人才培养过程存在的问题及对毕业生行业准入产生的影响.方法 采用SAS 9.2英文版统计软件进行数据管理和分析.结果 连续3年,麻醉医学、医学影像学专业毕业生从校内临床核心课程学习阶段,到毕业实习、毕业综合考试以及毕业后的执业医师资格考试,都与临床医学专业毕业生存在着显著性差距;毕业后一年内不规范的住院医师培训,进一步拉大了与临床医学专业毕业生的差距.结论 现行的麻醉医学、医学影像学人才培养模式存在弊端,不利于毕业生有效达成行业准入标准,需要进行改革与调整.%Objective Through the comparison of the results of medical license examination and on-campus academic performance between medical graduates from secondary disciplines of medical imaging,anesthesiology and first discipline of clinical medicine,this thesis try to analyze whether the discipline design,orientation and scheme of intellectual training of current clinical medicine education can effectively help the profession access of medical students.It will also be a strategic reference to the reform of intellectual training process and specialty structure regulation of clinical medicine.Methods English version SAS 9.2 was used for data management and analysis.The past rate of medical license examination,mastering rate of the three main subjects and the difference among the scores of core subjects at every stage during the school time were compared respectively among students from different disciplines.Results For both medical license examination and most clinical core subjects examinations during the school time,scores of students majored in anesthesiology and medical imaging were obviously lower

  4. Tutoria com médicos residentes em anestesiologia: o programa da Irmandade da Santa Casa de Misericórdia de São Paulo Tutoría con médicos practicantes en anestesiologia: el programa de la Hermandad Santa Casa de Misericordia de São Paulo Mentoring during residency in anesthesiology: the Irmandade da Santa Casa de Misericórdia, São Paulo program

    Directory of Open Access Journals (Sweden)

    José Álvaro Marques Marcolino

    2004-06-01

    médicos practicantes de primero y segundo año a respecto de la formación médica en Anestesiología fue desarrollado con doce preguntas y tres respuestas para cada uno, siendo aplicado antes y en el fin del programa. Fueron constituidos cuatro grupos de practicantes: practicantes del 1º ano; practicantes del 2º ano; practicantes del 1º ano y 2º ano (2. Las reuniones de tutoría ocurrieron mensualmente los jueves, 7h00, con duración de una hora. RESULTADOS: El cotidiano del practicante fue considerado adecuado. Hubo reducción en la frustración y mejoría en la auto-confianza. Un número elevado describió mayor entusiasmo por la Anestesiología y expectativas más elevadas en relación al futuro después del aprendizaje. Los tutores relataron la importancia de reuniones obligatorias, la posibilidad de discutir la humanización y la posibilidad de despreparo de los tutores como un factor de la limitación. CONCLUSIONES: El programa de tutoría puede ser considerado como un instrumento para la adaptación de los residentes en el programa de Anestesiología.BACKGROUND AND OBJECTIVES: Medical training programs may bring emotional distress. The main objective of this study was describes a mentoring program during the residence training period of physicians in Anesthesiology. METHODS: The program was instituted at the Central Hospital of the Irmandade da Santa Casa de Misericórdia, São Paulo. In this program were included 27 residents in Anesthesiology and 4 health professionals that made up the mentoring team. The study was made through a evaluation of a questionnaire applied on first and second-year residents' opinion about education in Anesthesiology. It was developed, with twelve questions and three answers for each question, which has been applied before and after the program. Residents were divided in four groups: first year residents; second year residents; first and second-year residents (2 groups. Mentoring meetings were monthly held on Thursdays, 7 a

  5. [Anesthesiological management of the high-risk surgical patient].

    Science.gov (United States)

    Bertoldi, G; Avalle, M

    1980-03-01

    Evaluation of the anaesthesiological risk in surgical patients is described and an account is given of results obtained with an association of ketamin and NLA II in 57 high-risk patients subjected to general surgical management.

  6. The Evaluation of a Graphical Pulmonary Display in Anesthesiology

    OpenAIRE

    Wachter, S. Blake; Syroid, Noah; Agutter, James; Albert, Robert; Drews, Frank; Westenskow, Dwayne

    2003-01-01

    We have developed graphic technology to display data from the respiratory monitors used during anesthesia. The display uses color, texture, shape and emergent features to highlight abnormal pulmonary physiology. Nineteen anesthesiologists participated in a simulator based evaluation (METI, Sarasota, FL.). Half the subjects used the metaphor display and half did not. Each subject was trained for 10 minutes on the pulmonary display. The time difference during the obstructed endotracheal tube di...

  7. Analysis of Resident Case Logs in an Anesthesiology Residency Program.

    Science.gov (United States)

    Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested; Macario, Alex

    2016-04-15

    Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the resident with the most patients, and in 2014, this equaled 48%. There were residents who had 75% more than the class average number of cases for several of the 12 case types and 3 procedure types required by the Accreditation Council for Graduate Medical Education. Also, there were residents with fewer than half as many for some of the required cases or procedure types. Some of the variability may have been because of the hazards of self-reporting.

  8. PECULIARITIES OF ANESTHESIOLOGY OF MINIMAL INVASIVE SPINE SURGERY

    OpenAIRE

    Hakobyan, Arman; Abrahamyan, Samvel

    2014-01-01

    The 204 percutant RX-controled lumbal disc extractions have been done in our department. The transforaminal approach was preformed, the disc herniation was extracted under endoscopic control. In all cases the epidural anesthesia was performed. We would like to introduce the peculiarities, complications of epidural anesthesia.

  9. Needs assessment for business strategies of anesthesiology groups' practices.

    Science.gov (United States)

    Scurlock, Corey; Dexter, Franklin; Reich, David L; Galati, Maria

    2011-07-01

    Progress has been made in understanding strategic decision making influencing anesthesia groups' operating room business practices. However, there has been little analysis of the remaining gaps in our knowledge. We performed a needs assessment to identify unsolved problems in anesthesia business strategy based on Porter's Five Forces Analysis. The methodology was a narrative literature review. We found little previous investigation for 2 of the 5 forces (threat of new entrants and bargaining power of suppliers), modest understanding for 1 force (threat of substitute products or services), and substantial understanding for 2 forces (bargaining power of customers and jockeying for position among current competitors). Additional research in strategic decisions influencing anesthesia groups should focus on the threat of new entrants, bargaining power of suppliers, and the threat of substitute products or services. PMID:21490085

  10. Prevalence of Hospital Acquired Infections in Anesthesiology Intensive Care Unit

    OpenAIRE

    ÇELİK, İlhami; İNCİ, Nuran; Denk, Affan; SEVİM, Erol; YAŞAR, Demet; YAŞAR, M. Akif

    2005-01-01

    Objectives: To determine the prevalence of infections, predominant organisms and their resistance pattern. Materials and Methods: Prospective cohort study. All patients over 16 years old were occupying an intensive care unit bed over a 24-hour period. All patients admitted to the unit were evaluated on a daily basis for nosocomial infections in compliance with National Nosocomial Infections Surveillance System (NNISS) methodology. Infection site definitions were in agreement with Center fo...

  11. Hypoglycaemia in anesthesiology practice: Diagnostic, preventive, and management strategies

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2013-01-01

    Full Text Available Diabetes mellitus has emerged as one of the fastest growing non communicable diseases worldwide. Management of diabetic patients during surgical and critically illness is of paramount challenge to anesthesiologist and intensivist. Among its major acute complications, hypoglycemia has been given lesser attention as compared to other major acute complications; diabetic ketoacidosis and hyperosmolar non ketotic coma. However, newer studies and literary evidence have established the serious concerns of morbidity and mortality, both long- and short-term, related to hypoglycemia. basis. Invariably, diabetic patients are encountered in our daily routine practice of anesthesia. During fasting status as well as the perioperative period, it is hypoglycemia that is of high concern to anesthesiologist. Management has to be based on clinical, pharmacological, social, and psychological basis, so as to completely prevent the complications arising from an acute episode of hypoglycemia. This review aims to highlight various aspects of hypoglycemia and its management both from endocrine and anesthesia perspective.

  12. Systematic reviews of anesthesiologic interventions reported as statistically significant

    DEFF Research Database (Denmark)

    Imberger, Georgina; Gluud, Christian; Boylan, John;

    2015-01-01

    be implemented by an anesthesiologist during the perioperative period. We randomly selected 50 meta-analyses that reported a statistically significant dichotomous outcome in their abstract. We applied TSA to these meta-analyses by using 2 main TSA approaches: relative risk reduction 20% and relative risk...... reduction consistent with the conventional 95% confidence limit closest to null. We calculated the power achieved by each included meta-analysis, by using each TSA approach, and we calculated the proportion that maintained statistical significance when allowing for sparse data and repeated updates. RESULTS...

  13. Implementing a successful journal club in an anesthesiology residency program.

    Science.gov (United States)

    Pitner, Nathaniel D; Fox, Chris A; Riess, Matthias L

    2013-01-01

    Journal clubs are an integral element of residency training. We report the successful implementation of a monthly structured journal club in our anesthesia residency program. Based on resident surveys before and one year after its start, the journal club led to a significantly higher confidence in how to critically appraise literature and present a manuscript. The journal club also improved the residents' ability to search the literature and their statistical knowledge, skills that are essential in the practice of evidence-based medicine. We describe key features that may aid other training programs in organizing a stimulating an educational and sustainable journal club. PMID:24358844

  14. Atitudes atuais de anestesiologistas e médicos em especialização com relação à anestesia venosa total Actitudes actuales de anestesiólogos y médicos en especialización con relación a la anestesia venosa total Current attitude of anesthesiologists and anesthesiology residents regarding total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: No passado, tempo, custos, informações, treinamento e avaliação da profundidade da anestesia limitavam a aceitação da anestesia venosa total (TIVA. O objetivo deste estudo foi determinar atitudes de anestesiologistas e médicos em especialização com relação à anestesia venosa total. MÉTODO: Um questionário foi enviado a 150 anestesiologistas e 102 residentes. A concordância (C e discordância (D em cada item foram comparadas por testes z (consenso, se p JUSTIFICATIVA Y OBJETIVOS: Antiguamente, tiempo, costes, informaciones, capacitación y evaluación de la profundidad de la anestesia limitaban la aceptación de la anestesia venosa total (TIVA. El objetivo de este estudio fue el de determinar las actitudes de anestesiólogos y médicos en especialización con relación a la anestesia venosa total. MÉTODO: Un cuestionario fue enviado a 150 anestesiólogos y 102 residentes. La concordancia (C y discordancia (D en cada ítem se compararon por pruebas z (consenso, si p BACKGROUND AND OBJECTIVES: In the past, time, cost, information, training, and the evaluation of the plane of anesthesia limited the acceptance of total intravenous anesthesia (TIVA. The objective of this study was to determine the attitude of anesthesiologists and other anesthesiology residents regarding total intravenous anesthesia. METHODS: A questionnaire was sent to 150 anesthesiologists and 102 residents. The concordance (C and disaccord (D of each item were compared by z tests (consensus if p < 0.05. RESULTS: There were 98 responses. The data represent the number of answers for each category. The majority of the participants agreed that the quality of the awakening stimulates the use of the TIVA (C/D = 86/8; p < 0.05; that the future depends on the development of drugs with a fast onset of action and immediate recovery (C/D = 88/5; p < 0.05; that they would like to use TIVA more often (C/D = 72/21; p < 0.05; and to have more information

  15. Bases teóricas para a implementação do aprendizado orientado por problemas na residência médica em anestesiologia Bases teóricas para la implementación del aprendizaje orientado por problemas en la práctica médica en anestesiología Theoretical basis for the implementation of problem-oriented learning in anesthesiology residency programs

    Directory of Open Access Journals (Sweden)

    Getúlio Rodrigues de Oliveira Filho

    2003-04-01

    higher level of students and professors satisfaction, a wider source of queries and search for knowledge and more time spent with individual learning. Since the method has no disadvantages as compared to traditional methods, it could be considered a valid alternative for teaching Anesthesiology in Medical Residency Programs.

  16. Simulação de bloqueios periféricos guiados por ultra-som: curva de aprendizado dos residentes de anestesiologia do CET-SMA/HSL Simulacro de bloqueos periféricos guiados por ultrasonido: curva de aprendizaje de los residentes de anestesiología del CET-SMA/HSL Simulation of ultrasound-guided peripheral nerve block: learning curve of CET-SMA/HSL anesthesiology residents

    Directory of Open Access Journals (Sweden)

    Marilia Bonifácio Baranauskas

    2008-04-01

    por ultrasonido a través de modelo experimental de gelatina. MÉTODO: Fue desarrollado un modelo experimental con un recipiente lleno de gelatina y aceituna sumergida. Nueve residentes se distribuyeron aleatoriamente en tres grupos (G1, G2, G3 compuestos cada uno, por un R1, un R2 y un R3. Los tres grupos recibieron una explicación teórica. El G1 recibió dos horas de entrenamiento práctico, el G2 una hora y el G3 no fue entrenado. Acto seguido, se les solicitó a los participantes que pusiesen la aguja en el punto medio de la pared de la aceituna, cerca del transductor y reposicionar la aguja entre la aceituna y el fondo del recipiente, simulando la inyección perineural del anestésico. Se evaluaron la velocidad y la eficacia de las tareas, además de las fallas técnicas. RESULTADOS: El G1 presentó un promedio de tiempo para la realización de las tareas de 37,63 segundos, sin fallas técnicas; en el G2 se observó un promedio de 64,40 segundos, ocurriendo dos fallas técnicas y el G3 presentó un promedio de 93,83 segundos, con doce fallas técnicas. CONCLUSIONES: El estudio permite concluir que el mayor tiempo de entrenamiento en un modelo experimental de bloqueos periféricos guiados por ultrasonido mejoró la curva de aprendizaje en el simulacro de la técnica.BACKGROUND AND OBJECTIVES: The use of ultrasound imaging in peripheral nerve block has been increasing. However, there are few reports in the literature on the learning curve of the ultrasound technique. The objective of this report was to evaluate the learning curve of CET-SMA/HSL Anesthesiology residents of ultrasound-guided peripheral block using an experimental agar model. METHODS: An experimental model was developed by filling a bowl with agar and olives. Nine residents were randomly divided in three groups (G1, G2, and G3, each one with a R1, a R2, and a R3. All three groups received theoretical explanation. G1 also had two hours of practical training, G2 had one hour, and G3 had no training

  17. Professional risk in anesthesiology. Riesgo profesional en anestesiología

    Directory of Open Access Journals (Sweden)

    Madga Robaina

    2006-04-01

    Full Text Available Working with the profession is an exercise that implies a risk that is related to the characteristics of the job, that is why anaesthesiology can cause diseases due to the exposition to the stress of surgical and urgency environment, inhalation and contact with anaesthetic teratogenic and carciogenic agents and to the eventual exposition to iozining radiation among other dangers.
    Se ha señalado que el ejercicio de la profesión lleva implícito un riesgo que está muy relacionado con las características de su desempeño. Es por ello que la anestesiología puede traer aparejado la aparición de enfermedades por la exposición al estrés del ambiente quirúrgico y de la emergentología, la inhalación y contacto con agentes anestésicos teratogénicos y carcinogénicos y la eventual exposición a radiaciones ionizantes, entre otros peligros.

  18. Simulation in Medical Education: Focus on Anesthesiology and Critical Care Medicine

    OpenAIRE

    D. John Doyle

    2002-01-01

    Simulation refers to the artificial representation of a complex real-world process with sufficient fidelity to achieve a particular objective, usually for the purposes of training or performance testing. While simulation has been important from early times (as in the rehearsal of animal hunting activities or preparing for warfare), the needs of World War II greatly accelerated simulation technology for use in flight training. With the available of inexpensive computer technology in recent yea...

  19. [Influence of some anesthesiologic methods on blood loss in procedures for voluntary termination of pregnancy].

    Science.gov (United States)

    Venuti, F S; Granese, D; Fattori, A

    1980-03-01

    120 patients in good health, aged 25-38, all in the first trimester of pregnancy, and requesting interruption of pregnancy, were divided into 4 groups and given different types of anesthesia; 1) general anesthesia with volatile anesthetics; 2) general anesthesia without volatile anesthetics; 3) dissociated anesthesia with Ketamin; and, 4) paracervical block with Mepivacain 1%. All interventions were done through curettage, and lasted 7-18 minutes; in all cases blood loss was carefully collected and measured. Minimum amount of bleeding was noted with paracervical block; maximum amount with volatile anesthetics such as ethrane. For every type of anesthesia blood loss increased with age of pregnancy. There were no postoperative complications. As confirmed by the published literature anesthesia by paracervical block is an easy, uncomplicated method, which requires little preparation time and which can be done at low cost.

  20. Professional risk in anesthesiology. Riesgo profesional en anestesiología

    OpenAIRE

    Madga Robaina; Carlos M. Hernández Dávila; Evangelina Dávila Cabo; Marlene Alejo Aris

    2006-01-01

    Working with the profession is an exercise that implies a risk that is related to the characteristics of the job, that is why anaesthesiology can cause diseases due to the exposition to the stress of surgical and urgency environment, inhalation and contact with anaesthetic teratogenic and carciogenic agents and to the eventual exposition to iozining radiation among other dangers.
    Se ha señalado que el ejercicio de la profesión lleva implícito un riesgo...

  1. Impact of an Innovative Classroom-Based Lecture Series on Residents' Evaluations of an Anesthesiology Rotation.

    Science.gov (United States)

    Tanaka, Pedro; Yanez, David; Lemmens, Hendrikus; Djurdjulov, Adam; Scotto, Lena; Borg, Lindsay; Walker, Kim; Bereknyei Merrell, Sylvia; Macario, Alex

    2016-01-01

    Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents' rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was "overall teaching quality of this rotation." We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on "overall teaching quality of this rotation" increased significantly from 3.9 (SD 0.8) to 4.2 (SD 0.7) after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series.

  2. Impact of an Innovative Classroom-Based Lecture Series on Residents’ Evaluations of an Anesthesiology Rotation

    Directory of Open Access Journals (Sweden)

    Pedro Tanaka

    2016-01-01

    Full Text Available Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents’ rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was “overall teaching quality of this rotation.” We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on “overall teaching quality of this rotation” increased significantly from 3.9 (SD 0.8 to 4.2 (SD 0.7 after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series.

  3. 78 FR 1158 - Anesthesiology Devices; Reclassification of Membrane Lung for Long-Term Pulmonary Support...

    Science.gov (United States)

    2013-01-08

    ... bypass following cardiac surgery. An acute reversible or treatable cause of respiratory and/or cardiac... Accessories for Long-Term Pulmonary/Cardiac Support AGENCY: Food and Drug Administration, HHS. ACTION... separate from cardiopulmonary bypass following cardiac surgery. A membrane lung for long-term...

  4. Unexpected High Sensory Blockade during Continuous Spinal Anesthesiology (CSA in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    R. Ketelaars

    2012-01-01

    Full Text Available A 98-year-old woman presented for a hemiarthroplasty of the left hip. Because of her age and cardiac and pulmonary co-existing diseases we decided to provide adequate regional anesthesia by continuous spinal anesthesia. Fragmented doses of isobaric bupivacaine 0.5% were administered through a system consisting of a spinal catheter connected to an antimicrobial filter. After an uneventful surgical procedure, prior to removal of the catheter, this system was flushed with 10 mL of normal saline in order to try to prevent post-dural-puncture headache. After arrival at the postanesthesia care unit and fifteen minutes after removal of the catheter the patient suffered an unexpected high thoracic sensory blockade and hypotension requiring treatment. The continuous spinal anesthesia technique can be used in selected cases to be able to administer local anesthetic agents in a slow and controlled manner to reach the desired effect. The risk of post-dural-puncture headache using this technique in elderly patients is very low and therefore precludes the need to try to prevent it. We have described a potentially dangerous complication of flushing a bupivacaine-filled system into the spinal canal of an elderly patient resulting in an undesirable high sensory blockade.

  5. Basics, common errors and essentials of statistical tools and techniques in anesthesiology research

    Science.gov (United States)

    Bajwa, Sukhminder Jit Singh

    2015-01-01

    The statistical portion is a vital component of any research study. The research methodology and the application of statistical tools and techniques have evolved over the years and have significantly helped the research activities throughout the globe. The results and inferences are not accurately possible without proper validation with various statistical tools and tests. The evidencebased anesthesia research and practice has to incorporate statistical tools in the methodology right from the planning stage of the study itself. Though the medical fraternity is well acquainted with the significance of statistics in research, there is a lack of in-depth knowledge about the various statistical concepts and principles among majority of the researchers. The clinical impact and consequences can be serious as the incorrect analysis, conclusions, and false results may construct an artificial platform on which future research activities are replicated. The present tutorial is an attempt to make anesthesiologists aware of the various aspects of statistical methods used in evidence-based research and also to highlight the common areas where maximum number of statistical errors are committed so as to adopt better statistical practices. PMID:26702217

  6. Impact of an Innovative Classroom-Based Lecture Series on Residents' Evaluations of an Anesthesiology Rotation.

    Science.gov (United States)

    Tanaka, Pedro; Yanez, David; Lemmens, Hendrikus; Djurdjulov, Adam; Scotto, Lena; Borg, Lindsay; Walker, Kim; Bereknyei Merrell, Sylvia; Macario, Alex

    2016-01-01

    Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents' rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was "overall teaching quality of this rotation." We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on "overall teaching quality of this rotation" increased significantly from 3.9 (SD 0.8) to 4.2 (SD 0.7) after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series. PMID:26989407

  7. The Use of Cognitive Task Analysis to Capture Expertise for Tracheal Extubation Training in Anesthesiology

    Science.gov (United States)

    Embrey, Karen K.

    2012-01-01

    Cognitive task analysis (CTA) is a knowledge elicitation technique employed for acquiring expertise from domain specialists to support the effective instruction of novices. CTA guided instruction has proven effective in improving surgical skills training for medical students and surgical residents. The standard, current method of teaching clinical…

  8. Simulation in Medical Education: Focus on Anesthesiology and Critical Care Medicine

    Directory of Open Access Journals (Sweden)

    D. John Doyle

    2002-12-01

    Full Text Available Simulation refers to the artificial representation of a complex real-world process with sufficient fidelity to achieve a particular objective, usually for the purposes of training or performance testing. While simulation has been important from early times (as in the rehearsal of animal hunting activities or preparing for warfare, the needs of World War II greatly accelerated simulation technology for use in flight training. With the available of inexpensive computer technology in recent years, simulation technology has blossomed again, especially in the field of medicine, where applications range from scientific modeling to clinical performance appraisal in the setting of crisis management.

  9. PULMONARY PATHOPHYSIOLOGY AND LUNG MECHANICS IN ANESTHESIOLOGY: A CASE-BASED OVERVIEW

    OpenAIRE

    Vidal Melo, Marcos F.; Musch, Guido; Kaczka, David W.

    2012-01-01

    The induction and maintenance of anesthesia, surgical requirements, and patients’ unique pathophysiology all combine to create a setting in which our accumulated knowledge of respiratory physiology and lung mechanics take on immediate and central importance in patient management. In this review we will take a case-based approach to illustrate how the complex interactions between anesthesia, surgery, and patient disease impact patient care with respect to pulmonary pathophysiology and clinical...

  10. Hotly debated topics in obstetric anesthesiology 2008: a theory of relativity.

    Science.gov (United States)

    Birnbach, D J; Soens, M A

    2008-01-01

    This paper reviews and discusses three controversial subjects regarding treatment of intraoperative nausea and other complications experienced by patients undergoing cesarean delivery under spinal anesthesia: (1) the administration of supplemental oxygen, (2) prophylactic vasopressors and (3) the use of low-dose combined spinal epidural anesthesia (CSE). While not universally acknowledged, recent data suggest that the routine administration of supplemental oxygen to normal-weight, healthy patients undergoing elective cesarean delivery is unnecessary, especially when spinal hypotension is minimized. Supplemental oxygen administration does not prevent intraoperative or postoperative nausea and vomiting. Additionally, although higher inspired oxygen fractions modestly increase fetal oxygenation, they also cause a concomitant increase in oxygen free radical activity in both mother and fetus, which may weaken the infant's ability to withstand subsequent neonatal insult. The use of prophylactic vasopressor infusions may benefit some patients, but parenteral preanesthetic ephedrine administration is not warranted. Heart rate variability guided therapy could help identify patients at risk for developing severe hypotension after spinal anesthesia. High-dose phenylephrine infusion in conjunction with rapid co-hydration is efficient, but is unfortunately associated with a relatively high incidence of maternal bradycardia. Oxygen, fluid administration and prophylactic vasopressors may not be the solution to hypotension, nausea and vomiting associated with spinal anesthesia during cesarean delivery. Lower dose spinal anesthesia as part of a CSE technique reduces the incidence of maternal hypotension, and in our opinion is the best option currently available.

  11. Director of anesthesiology for liver transplantation: existing practices and recommendations by the United Network for Organ Sharing.

    Science.gov (United States)

    Mandell, M Susan; Pomfret, Elizabeth A; Steadman, Randall; Hirose, Ryutaro; Reich, David J; Schumann, Roman; Walia, Ann

    2013-04-01

    A new Organ Procurement and Transplantation Network/United Network for Organ Sharing bylaw recommends that all centers appoint a director of liver transplant anesthesia with a uniform set of criteria. We obtained survey data from the Liver Transplant Anesthesia Consortium so that we could compare existing criteria for a director in the United States with the current recommendations. The data set included responses from adult academic liver transplant programs before the new bylaw. The respondent rates were within statistical limits to exclude sampling bias. All centers had a director of liver transplant anesthesia. The criteria varied between institutions, and the data suggest that the availability of resources influenced the choice of criteria. The information suggests that the criteria used in the new bylaw reflect existing practices. The bylaw plays an important role in supporting emerging leadership roles in liver transplant anesthesia and brings greater uniformity to the directorship position. PMID:23447113

  12. La anestesiología, profesión signada por la drogadicción Anesthesiology and drug addiction

    OpenAIRE

    Tiberio Alvarez Echeverri

    1994-01-01

    Se informa sobre la prevalencia de drogadicción y alcoholismo entre los anestesiólogos, cuyas cifras alcanzan el 2% del total. Las drogas más utilizadas son: fentanil y otros opioides, diazepam, alcohol, anestésicos inhalados, ketamina, barbitúricos, sulfentanil, cocaína, morfina y heroína. Entre los factores de riesgo figuran algunos comunes a la población adicta en general (predisposición genética, exposición ...

  13. La anestesiología, profesión signada por la drogadicción Anesthesiology and drug addiction

    Directory of Open Access Journals (Sweden)

    Tiberio Alvarez Echeverri

    1994-03-01

    Full Text Available

    Se informa sobre la prevalencia de drogadicción y alcoholismo entre los anestesiólogos, cuyas cifras alcanzan el 2% del total. Las drogas más utilizadas son: fentanil y otros opioides, diazepam, alcohol, anestésicos inhalados, ketamina, barbitúricos, sulfentanil, cocaína, morfina y heroína. Entre los factores de riesgo figuran algunos comunes a la población adicta en general (predisposición genética, exposición ambiental, falta de educación, de programas preventivos y de estrategias de control, estrés y otros peculiares a estos profesionales: disponibilidad de las drogas, autoprescripción, actitud permisiva de los colegas. El tratamiento tiene como objetivos desintoxicar a la persona y lograr que viva sin usar fármacos, que recupere sus aspectos social y ocupacional, que mantenga el tratamiento interdisciplinario, se vincule a grupos de soporte y psicoterapia y se reintegre plenamente a las actividades de la vida diaria una vez haya signos de franca recuperación. Incluye, además, identificar los problemas psiquiátricos de fondo, establecer metas de recuperación a largo plazo y utilizar, si es necesario, drogas antagonistas.

    Prevalence of drug addiction and alcoholism among anesthesiologists has been reported to be around 2%. Most frequently utilized drugs are phentanyl and other opioids, diazepam, alcohol, inhaled anesthetics, ketamine, barbiturates, sulphentanyl, cocaine, morphine and heroine. Besides risk factors that are common to the whole population (genetic predisposition, environmental exposure, stress and lack of education, preventive programs and control strategies, there are others peculiar to anes. thesiologists: availability of drugs, self. prescription and permissivenes of colleagues. Objectives of treatment are: to achieve detoxification and a drug-free life, to recuperate the social and occupational aspects of life, to adhere to interdisciplinary schemes of treat. ment with long.term goals, to enter support and psychotherapy groups, to identify and treat underlying psychiatric disorders and, if neces. sary, to utilize antagonist drugs.

  14. Reflective Practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States

    Science.gov (United States)

    Miller Juve, Amy Katrina

    2012-01-01

    The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge…

  15. A Review on John Snow’s (1813-1858 CE) Contributions to the Epidemiology and Anesthesiology

    OpenAIRE

    Samad EJ Golzari; Zahid Hussain Khan; Ali Dabbagh; Hadiseh Kavandi; Ata Mahmoodpoor; Babak Sabermarouf; Hassan Soleimanpour; Kazem Khodadoust; Behnam Dalfardi; Mojtaba Heydari; Kamyar Ghabili

    2015-01-01

    “In riding his hobby very hard, he has fallen down through a gully hole and has never since been able to get out again” “Has he any facts to show in proof? No!”** From an Editorial on John Snow’s theories published in the Lancet in 1855 BiographyJohn Snow, the famous physician, epidemiologist and anesthetist, was born on March 15th, 1813 in York, England (Image 1). He was the eldest of nine children born to William and Frances Snow in their North Street home. His first 12 years of life were s...

  16. [New study on the history of anesthesiology--(12). A biography of Seigo Minami, the first to describe crush syndrome].

    Science.gov (United States)

    Matsuki, Akitomo

    2006-02-01

    Crush syndrome causes a social concern as we experienced in the devastating earthquake in Kobe area in 1995. In the laboratory of Prof. Pick of Berlin, Seigo Minami (1893-1975), a dermatologist, made a detailed microscopic study of the kidneys of three German soldiers in 1922. They had died from renal failure caused by traumatic injuries during the World War 1. Minami concluded that the common cause of their deaths was "Autointoxication" due to necrotic breakdown of damaged muscles. His paper appeared in Virchows Archiv in 1923. This is the first description of crush syndrome in the world. Thereafter Minami joined the members of Prof. Warburg, Kaiser-Wilhelm Institute to investigate respiration and glycolysis of cancer tissues of rats. This research made an important contribution to the works of Prof. Warburg to whom a Nobel prize for medicine and physiology was awarded in 1931. Minami's name as the first describer of crush syndrome remains quite unknown in Japan, although almost all Japanese dermatologists know him by Minami Prize of Japanese Society of Dermatology.

  17. A Review on John Snow’s (1813-1858 CE Contributions to the Epidemiology and Anesthesiology

    Directory of Open Access Journals (Sweden)

    Samad EJ Golzari

    2015-10-01

    Full Text Available “In riding his hobby very hard, he has fallen down through a gully hole and has never since been able to get out again” “Has he any facts to show in proof? No!”** From an Editorial on John Snow’s theories published in the Lancet in 1855 BiographyJohn Snow, the famous physician, epidemiologist and anesthetist, was born on March 15th, 1813 in York, England (Image 1. He was the eldest of nine children born to William and Frances Snow in their North Street home. His first 12 years of life were spent in a poor and unsanitary area in Michaelgate. River Ouse, which provided the drinking water for the people and often contaminated with excreta, was in the vicinity of his home. This exposed him and his family to the danger of flooding and contamination with excrements of drinking water (1.After financial status of his father improved, they moved to a more wholesome area which was appropriate for the children's education. When he was 14, he was apprenticed to William Hardcastle, a surgeon in Newcastle upon Tyne School of Medicine. Later, he attended in lectures and visited the different wards of the local infirmary (2.His apprenticeship was finished in 1833. Between 1833 and 1836 Snow worked as an assistant to a colliery surgeon. He returned to London after completing his education to get a London degree and became a student in the Royal College of Surgeons and began working at the Westminster Hospital. Snow finished his education in 1844. Then he was elected as the chancellor of the London Medical Society. Snow suffered a stroke while working in his London office on June 10th, 1858. He was 45 years old at the time. This valuable and memorable researcher and scientist died in London on June 16th, 1858 aged 45 years from a stroke. He was buried in Brompton Cemetery (3. Many books, papers, and letters to journals on various topics such as rickets, chest deformities, the circulation of the blood, lead poisoning, and scarlet fever have been written by Snow during his short life (4.

  18. Implementing a successful journal club in an anesthesiology residency program [v1; ref status: indexed, http://f1000r.es/xe

    Directory of Open Access Journals (Sweden)

    Nathaniel D Pitner

    2013-01-01

    Full Text Available Journal clubs are an integral element of residency training. We report the successful implementation of a monthly structured journal club in our anesthesia residency program. Based on resident surveys before and one year after its start, the journal club led to a significantly higher confidence in how to critically appraise literature and present a manuscript. The journal club also improved the residents' ability to search the literature and their statistical knowledge, skills that are essential in the practice of evidence-based medicine. We describe key features that may aid other training programs in organizing a stimulating an educational and sustainable journal club.

  19. Application of seminar teaching in resident training of anesthesiology%Seminar教学在麻醉学住院医师培训中的应用

    Institute of Scientific and Technical Information of China (English)

    钟河江; 杨天德

    2010-01-01

    Seminar是培养麻醉学住院医师独立思维及科研能力的一种有效的教学方法.通过简要介绍seminar教学的基本概念,讨论了seminar教学在麻醉学住院医师培训中的应用及其意义.seminar教学在培养麻醉学住院医师主动探索和学习知识,加深对麻醉学基本理论知识的理解及提高其综合素质等方面都具有促进作用.

  20. Comparison of the Clinical Use of Macintosh and Miller Laryngoscopes for Orotracheal Intubation by Second-Month Nurse Students in Anesthesiology

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2010-01-01

    Full Text Available Aim. The aim of this study is to compare the clinical feasibility of Macintosh and Miller laryngoscopes for tracheal intubation in non-experienced users in anesthetized patients. Patients and Methods. 119 patients were randomized into the Macintosh group (59 and the Miller group (60. The primary outcome variable was successful tracheal intubation. The secondary outcome variables were number of insertion attempt, intubation time needed, total time to intubation, hemodynamic change and complications. Results. All patients were successfully intubated using the Macintosh, whereas 13 patients (21.6% were failed with the Miller (<.001. The Macintosh significantly reduced the mean total time to intubation (<.001. There were significant differences in the mean blood pressure at 2 minutes after laryngoscope insertion, immediately, and 2 minutes after tracheal intubation and in the mean heart rate at the laryngoscope insertion, immediately, and at 2 minutes after tracheal intubation between the two groups. Overall complications in both were not significantly different. Conclusion. Orotracheal intubation using the Macintosh is an effective and safe technique in non-experienced hands with significantly increased success rate as well as decreased mean total time to intubation as compare to the Miller. However, these intubations only apply to selected patients deemed to have normal airways.

  1. [Management of war injuries from the anesthesiologic point of view: a report of experiences from the IKRK hospital in Kabul, September 1990].

    Science.gov (United States)

    Ursprung, T

    1991-01-01

    We report the medical experience during a 3 week stay in the ICRC hospital of Kabul as anaesthesist. 170 war wounded patients had been treated following clear and simple rools of war surgery. The anaesthetic management and the important role of Ketamin is explained.

  2. Randomized crossover study evaluating the effect of a hand sanitizer dispenser on the frequency of hand hygiene among anesthesiology staff in the operating room.

    Science.gov (United States)

    Munoz-Price, L Silvia; Patel, Zalak; Banks, Shawn; Arheart, Kristopher; Eber, Scott; Lubarsky, David A; Birnbach, David J

    2014-06-01

    Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers. PMID:24799649

  3. [Dependence of the operation stress degree from the kind of operative intervention for an acute cholecystitis in the patients with high operative-anesthesiological risk].

    Science.gov (United States)

    Bezruchko, M V; Malyk, S V; Kravchenko, S P; Osipov, O S; Sytnik, D A

    2013-03-01

    The results of comparison between the operation stress degree in various kinds of surgical interventions, performed for an acute cholecystitis, using determination of cortizol, prolactin and glucose content before the operation, intraoperatively and postoperatively in 50 patients, are adduced. There was established, that the largest (in 5.3 times) and the most durable (more than 24 hours) intr erative raising of the cortizol level in the blood serum was noted in patients, to whom open cholecystectomy (OCH) was done, and the minimal (in 2.2 times) and the least durable (up to 1 hour)--while performing transcutaneous transhepatic draining (TTD) of gallbladder under ultrasonographic control. While performance of laparoscopic cholecystectomy (LCH) there was noted the most pronounced intraoperative raising of prolactin level (in 3.6 times) and more rapid its lowering (during 24 hours) in comparison with such while the OCH performance (during 72 hours). In TTD there was observed the minimal intraoperative inhancing of the prolactin level (in 2.3 times) and its duration (during 1 hour) postoperatively. The above mentioned have witnessed, that while TTD of gallbladder performance stimulation of the anterior hypophysis is significantly lesser, than while LCH and OCH.

  4. 药箱式管理在麻醉科特殊药品中的应用%The use of medical kit for special drugs management in department of anesthesiology

    Institute of Scientific and Technical Information of China (English)

    刘红波; 邹春招; 曾顺芳

    2015-01-01

    Objective:To explore Methods to improve the efficiency of drug administration in the anesthesia department. Methods:We apply medical kit in drugs manangement,14 special drugs were chosen to meet the basic anesthesia need. The anesthist get the kit before the anesthesia,and return the kit after work. Results:Medical kit management help anaethetist in getting,using and returning the drugs,the time for getting drugs was decreased from 7 minutes to 3 minutes,and the time for returning the drugs was decreased from 6 minutes to 2 minutes,then patient safety would be ensured,and the satisfaction for anes-thist to PACU nurses was enhanced. Conclusion:The special medicine for the special drugs in the special drugs can improve the operation efficiency and safety of the drug delivery and use.%目的:探讨提高麻醉科药品管理工作效率的方法. 方法:结合我院麻醉科实际情况,对特殊药品实施药箱式管理,药箱配备保证麻醉的14种基本用药,麻醉医师每日麻醉前领取药箱,下班前归还药箱. 结果:药箱式的管理方法方便了麻醉医师领取、使用和归还药品,较传统领药方法领药时间从原来的平均7 min减少到现在的平均3 min,还药时间从原来的平均6 min减少到现在的平均2 min,提高了药品使用效率,同时也保证了患者用药安全,提高了麻醉医师对复苏室的满意度. 结论:麻醉科特殊药品实施药箱式管理,可提高麻醉科药品交接与使用工作效率,确保用药安全.

  5. A farmacobotânica, ainda tem lugar na moderna anestesiologia? ¿La farmacobotánica, aún tiene lugar en la moderna anestesiología? Is there still a place for pharmacobotany in modern anesthesiology?

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Recentemente, o uso de chás medicinais - infusões, decoctos, tisanas, tinturas - ou medicamentos de origem vegetal vem sendo retomado de maneira sistemática e crescente na profilaxia e tratamento das doenças, ao lado da terapêutica convencional, na maioria dos países ocidentais. A presente revisão objetiva analisar as principais plantas que serviram como base de progresso para a moderna terapêutica anestesiológica através de sua utilização como modelos moleculares para síntese orgânica na moderna química fina de ponta, bem como fornecer mais embasamento sobre benefícios, potenciais efeitos adversos, interações e risco de efeitos colaterais que possam afetar o ato anestésico no paciente cirúrgico usuário habitual de fitoterapia. CONTEÚDO: Considerações anestesiológicas selecionadas são discutidas focalizando uma pequena revisão sobre ervas medicinais mais populares que foram essenciais no desenvolvimento de uma farmacologia anestesiológica e, ainda, as potenciais interações de plantas medicinais usadas por pacientes para tratar suas doenças ou controlar seus sintomas com drogas sintéticas usadas na anestesia. CONCLUSÕES: Enquanto a Medicina especializada fascina-se cada vez mais com a tecnologia avançada de novos fármacos e de fantásticos monitores, cresce em vários países o número de pacientes que desejam uma abordagem mais holística com rejeição dos modernos métodos de tratamento, optando por chás, meditações, dietas vegetarianas, anti-oxidantes, entre outros. Cabe ao anestesiologista avaliar quanto o conhecimento de farmacognosia e de farmacobotânica pode ajudá-lo na prática anestésica e, principalmente, na segurança de seu paciente.JUSTIFICATIVA Y OBJETIVOS: Recientemente, el uso de tés medicinales - infusiones, decocciones, tisanas, tinturas - o medicamentos de origen vegetal viene siendo retomado de manera sistemática y creciente en la profilaxis y tratamiento de las enfermedades al lado de la terapéutica convencional en la mayoría de los países occidentales. La presente revisión objetiva analizar las principales plantas que servirán como base de progreso para la moderna terapéutica anestesiólogica a través de su utilización como modelos moleculares para síntesis orgánica en la moderna química fina de punta, bien como suministrar más fundamento sobre beneficios, potenciales efectos adversos, interacciones y riesgo de efectos colaterales que puedan afectar el acto anestésico en el paciente cirúrgico usuario habitual de la fitoterapia. CONTENIDO: Son discutidas las consideraciones anestesiológicas seleccionadas, focalizando una pequeña revisión sobre hierbas medicinales más populares que fueron esenciales en el desenvolvimiento de una farmacología anestesiológica y aún, las potenciales interacciones de plantas medicinales usadas por pacientes para tratar sus enfermedades o controlar sus síntomas con drogas sintéticas usadas en la anestesia. CONCLUSIONES: En cuanto la Medicina especializada se fascina cada vez más con la tecnología avanzada de nuevos fármacos y de fantásticos monitores, crece en varios países el número de pacientes que desean una abordaje mas holística con rechazo de los modernos métodos de tratamiento, optando por tés, meditaciones, dietas vegetarianas, anti-oxidantes, entre otros. Cabe al anestesiologista evaluar cuanto el conocimiento de farmacognosia y de farmacobotánica puede ayudarlo en la práctica anestésica y, principalmente, en la seguridad de su paciente.BACKGROUND AND OBJECTIVES: Recently, the use of medicinal teas - infusions, decoction, tisanes, dyeings - or drugs of vegetal origin are being systematically and increasingly revived to prevent and treat diseases together with conventional medicine in most Western countries. This review aimed at analyzing major herbs that were the basis for the progress of modern anesthetic therapy through their use as molecular models for organic synthesis in fine leading edge modern chemistry, as well as shedding more light

  6. Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Fonsmark, Lise; Hein, Lars; Nibroe, Helle;

    2015-01-01

    should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough...

  7. 浅析本科导师制在麻醉学临床带教中的利与弊%Pros and cons of the Undergraduates Tutoring System in Clinical anesthesiology Practice Teaching

    Institute of Scientific and Technical Information of China (English)

    张迎宪

    2011-01-01

    @@ 麻醉学基本理论掌握与临床技能运用是中西医结合专业课程设置的最终目的及任务,而本科导师制(Undergraduate Course Conscientious Teacher,UCCT) 临床带教是实现这一目标的重要阶段.以问题为基础学习并具有针对性地理论联系实际解决临床问题,力求把学习设置到复杂而有意义的问题情境中去,通过构建与设计问题,启发学生自主学习,拓展思路,加深对麻醉学基础理论的理解与应用,提高学生解决临床实际问题的综合能力[1~3].

  8. A farmacobotânica, ainda tem lugar na moderna anestesiologia? ¿La farmacobotánica, aún tiene lugar en la moderna anestesiología? Is there still a place for pharmacobotany in modern anesthesiology?

    OpenAIRE

    Nilton Bezerra do Vale

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: Recentemente, o uso de chás medicinais - infusões, decoctos, tisanas, tinturas - ou medicamentos de origem vegetal vem sendo retomado de maneira sistemática e crescente na profilaxia e tratamento das doenças, ao lado da terapêutica convencional, na maioria dos países ocidentais. A presente revisão objetiva analisar as principais plantas que serviram como base de progresso para a moderna terapêutica anestesiológica através de sua utilização como modelos moleculares p...

  9. Avaliação da qualidade dos ensaios clínicos aleatórios em anestesia publicados na Revista Brasileira de Anestesiologia no período de 2005 a 2008 Evaluación de la calidad de los ensayos clínicos aleatorios en anestesia publicados en la Revista Brasileña de Anestesiología en el período de 2005 a 2008 Assessing the quality of random clinical anesthesiology trials published on the Brazilian Journal of Anesthesiology from 2005 to 2008

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2009-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O ensaio clínico aleatório (ECA é definido como um estudo que envolve grupos de intervenção e controle, com alocação aleatória dos participantes. O objetivo deste trabalho foi avaliar a qualidade dos artigos de ECA em anestesia publicados num determinado período. Desenho do estudo: descritivo. MÉTODO: Foi realizada busca manual dos artigos publicados na Revista Brasileira de Anestesiologia entre janeiro de 2005 e fevereiro de 2008, que tivessem características de ECA. A variável primária foi a qualidade dos ECA; as variáveis secundárias foram: encaminhamento da pesquisa para o Comitê de Ética em Pesquisa (CEP, utilização do termo de consentimento livre e esclarecido (TCLE, descrição da fonte de fomento, realização do cálculo do tamanho da amostra, número de autores, local de origem, teste estatístico utilizado, nível de significância adotado na pesquisa e classificação do tipo de estudo. Foi utilizada a escala de qualidade para avaliar a qualidade dos ECA, estatística descritiva e o cálculo do intervalo de 95% de confiança. RESULTADOS: Dos 114 artigos originais, 42 foram identificados como ECA. Destes, somente 3 (7,1% foram classificados como de boa qualidade metodológica, considerando distribuição aleatória, encobrimento duplamente encoberto, perdas e exclusões. Dos 114 artigos, 107 foram encaminhados ao CEP, 67 utilizaram TCLE, em nenhum houve descrição do fomento, em 17 houve cálculo do tamanho da amostra, o número médio de autores por artigo foi 4,49; São Paulo contribuiu com 60 publicações, o teste t de Student foi o mais utilizado (47,4%, o nível de significância de 5% foi adotado em 97 e 42 foram ECA. CONCLUSÕES: Após a busca manual, 7,1% dos ensaios clínicos aleatórios foram considerados de boa qualidade metodológica.JUSTIFICATIVA Y OBJETIVOS: El ensayo clínico aleatorio (ECA se define como un estudio que involucra a grupos de intervención y control, con la ubicación aleatoria de los participantes. El objetivo de este trabajo fue evaluar la calidad de los artículos de ECA en anestesia publicados en un determinado período. Diseño del estudio: descriptivo. MÉTODO: Se realizó una búsqueda manual de los artículos publicados en la Revista Brasileña de Anestesiología entre enero de 2005 y febrero de 2008, que tuviesen características de ECA. La variable primaria fue sobre la calidad de los ECA; las variables secundarias de los artículos fueron las siguientes: elevar la investigación al Comité de Ética en Investigación (CEP, utilización del término de consentimiento informado (TCI, descripción de la fuente de fomento, realización del cálculo del tamaño de la muestra, número de autores, local de origen, test estadístico utilizado, nivel de significancia adoptado en la investigación y clasificación del tipo de estudio. Se utilizó la escala de calidad para evaluar la calidad de los ECA, estadística descriptiva y el cálculo del intervalo de un 95% de confianza. RESULTADOS: De los 114 artículos originales, 42 fueron identificados como ECA. De ellos, solamente 3 (7,1% se clasificaron como siendo de buena calidad metodológica, considerando la distribución aleatoria, el encubrimiento doble ciego, las pérdidas y exclusiones. De los 114 artículos, 107 fueron elevados al CEP, 67 utilizaron TCLE, en ninguno de ellos hubo descripción del fomento, en 17 hubo cálculo del tamaño de la muestra, el número promedio de autores por artículo fue 4,49; São Paulo contribuyó con 60 publicaciones, el teste t de Student fue el más utilizado (47,4%, el nivel de significancia de 5% fue adoptado en 97 y 42 fueron ECA. CONCLUSIONES: Después de la búsqueda manual, 7,1% de los ensayos clínicos aleatorios fueron considerados como siendo de buena calidad metodológica.BACKGROUND AND OBJECTIVES: A random clinical trial (RCT is defined as a study involving intervention and control groups with random distribution of the participants. The objective of the present study was to assess the quality of RCT in anesthesi

  10. A Tribute to Dr. Paul A. J. Janssen: Entrepreneur Extraordinaire,Innovative Scientist, and Significant Contributor to Anesthesiology%纪念保罗·杨森博士——一位卓越的企业家和勇于创新、对麻醉学做出突出贡献的科学家

    Institute of Scientific and Technical Information of China (English)

    黄小静; 李士通; Theodore H. Stanley; Talmage D. Egan; Hugo Van Aken

    2009-01-01

    保罗·杨森博士是杨森制药公司的创始人,研发了80多种已被证实对人类、植物及动物都有极大帮助的药品.他和他的同事们合成了芬太尼家族,还有许多其他强效镇痛剂、氟哌啶、依托咪酯等.另外,他们还合成了许多重要药物,在精神病学、寄生虫学、胃肠病、心脏病学、病毒学和免疫学领域发挥了极大作用.杨森博士非凡的智慧、卓越的创造力、积极进取的精神推动了麻醉学及整个医学界的进步.

  11. 75 FR 81618 - Request for Notification From Consumer Organizations Interested in Participating in the Selection...

    Science.gov (United States)

    2010-12-28

    ... Respiratory Therapy Devices 20993-0002; phone: 301-796-6639; e-mail: Panel and General Hospital Shanika.Craig...., Immunology Devices Panel, Bldg. 66, rm. 1611, Silver Spring, MD Dental Products Devices 20993-0002; phone... Anesthesiology and Respiratory 1-Nonvoting....... 12/01/10. Therapy Devices: Knowledgeable in anesthesiology...

  12. 78 FR 9060 - Request for Nominations for Voting Members on Public Advisory Panels or Committees

    Science.gov (United States)

    2013-02-07

    ... Radiological Health, Food and Drug Assurance Advisory Committee. Administration, 10903 New Hampshire Dental... Anesthesiology and Respiratory Spring, MD 20993, 301-796-6639, email: Therapy Devices Panel. Shanika.Craig@fda... Approximate date needed needed vacancies Anesthesiology and 3 December 1, 2013. Respiratory Therapy...

  13. 75 FR 22819 - Center for Scientific Review; Notice of Closed Meetings

    Science.gov (United States)

    2010-04-30

    ...: National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD 20892 (Virtual Meeting). Contact Person... (Virtual Meeting). Contact Person: Soheyla Saadi, PhD, Scientific Review Officer, Center for Scientific... Sciences, Biomedical Imaging and Bioengineering Integrated Review Group; Surgery, Anesthesiology and...

  14. Critical Care Team

    Science.gov (United States)

    ... of these areas: Surgery Internal medicine Pediatrics Anesthesiology Critical care nurse: A highly skilled nurse who provides all aspects ... and can often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with ...

  15. Physical Therapy and Facioscapulohumeral Muscular Dystrophy (FSHD)

    Science.gov (United States)

    ... of a ventilator. In standard practice, trauma (ER, ICU), surgery and anesthesiology settings, care should be taken ... balanced against the need for post operative immobilization, rehabilitation and complications such as stretching of the slings, ...

  16. Anti-nerve growth factor in pain management: current evidence

    OpenAIRE

    Chang DS; Hsu E; Hottinger DG; Cohen SP

    2016-01-01

    David S Chang,1 Eugene Hsu,2 Daniel G Hottinger,1 Steven P Cohen1,3–5 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 2Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, 3Department of Anesthesiology, 4Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda 5Department of Physical Medicine and Rehabilitation, Johns Hopki...

  17. Tapentadol extended release in the management of peripheral diabetic neuropathic pain

    OpenAIRE

    Vadivelu N; Kai A; Maslin B; Kodumudi G; Legler A; Berger JM

    2015-01-01

    Nalini Vadivelu,1 Alice Kai,2 Benjamin Maslin,1 Gopal Kodumudi,3 Aron Legler,1 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Stony Brook University School of Medicine, Stony Brook, NY, USA; 3Department of Structural and Cellular Biology, Tulane University, New Orleans, LA, USA; 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Tapentadol, a µ-opioid ago...

  18. Demand in Pediatric Dentistry for Sedation and General Anesthesia by Dentist Anesthesiologists: A Survey of Directors of Dentist Anesthesiologist and Pediatric Dentistry Residencies

    OpenAIRE

    Hicks, C. Gray; Jones, James E.; Saxen, Mark A.; Maupome, Gerardo; Sanders, Brian J.; Walker, LaQuia A.; Weddell, James A.; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 1...

  19. Treatment of localized neuropathic pain after disk herniation with 5% lidocaine medicated plaster

    OpenAIRE

    Likar, Rudolf; Kager,Ingo; Obmann,; Pipam, Wolfgang; Sittl, Reinhard

    2012-01-01

    Rudolf Likar,1 Ingo Kager,1 Michael Obmann,1 Wolfgang Pipam,1 Reinhard Sittl21Department of Anesthesiology and Intensive Care, Klagenfurt Hospital, Klagenfurt, Austria; 2Department of Anesthesiology, Interdisciplinary Pain Center, University Hospital Erlangen, Erlangen, GermanyObjective: To assess treatment with the 5% lidocaine medicated plaster for peripheral neuropathic pain after disk herniation.Study design: Case series, single center, retrospective data.Patients and methods: Data of 23 ...

  20. Differential diagnosis and clinical management of diastolic heart failure: current best practice

    OpenAIRE

    Gelzinis, Theresa A.; Tawil,Justin

    2016-01-01

    Justin Tawil,1 Theresa A Gelzinis2 1Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, 2Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA Abstract: As the population ages, the prevalence of diastolic dysfunction and heart failure with preserved ejection fraction is rising. The presentation and management of these patients is increasing in frequency and requires an understanding of its pathophysiology, diagnostic methodology, as well as modern ...

  1. <教育>安心・納得できる歯科治療を提供するための北海道医療大学歯学部附属病院における歯科麻酔科のリスク・マネージメント

    OpenAIRE

    工藤,勝/大桶,華子/河合,拓郎/加藤,元康/國分,正廣/新家,昇; クドウ,マサル/オオケ,ハナコ/カワイ,タクロウ/カトウ,モトヤス/コクブ,マサヒロ/シンヤ,ノボル; KUDO,Masaru/OHKE,Hanako/SHINYA,Noboru

    2002-01-01

    Press news of medical malpractice and related judicial proceedings have increased in recent years. A survey conducted by the Japanese Society of Dental Anesthesiology indicated several cases per year involving death induced by injection of local anesthesia. Additionally, preventive measures such as health care risk management (RM) and informed consent in various medical practices have been reported. The Dental Clinic Department of Anesthesiology of the School of Dentistry of the Health Univer...

  2. Anecdotes from the history of anesthesia in dentistry.

    OpenAIRE

    Trieger, N.

    1995-01-01

    I believe that dentists have made important contributions to anesthesiology and patient care. Medical anesthesiology is now being required to provide more same-day or ambulatory care. Where it was once good sport to criticize dentists providing brief anesthesia services for their patients, it has now become appropriate for physician anesthesiologists to use shorter-acting agents, improved physiologic monitoring, reversal agents, and early discharge as part of their care of patients. Anecdotes...

  3. Topical local anesthesia: focus on lidocaine–tetracaine combination

    OpenAIRE

    Giordano, Davide

    2015-01-01

    Davide Giordano,1 Maria Gabriella Raso,2 Carmine Pernice,1 Vanni Agnoletti,3 Verter Barbieri1 1Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, 2Anesthesiology, Intensive Care, and Pain Medicine Unit, Department of Surgical Sciences, University Hospital of Parma, Parma, 3Anesthesiology and Intensive Care Unit, Department of Cardiology, Thoracic and Vascular Surgery, and Critical Care Medicine, Arcispedale Santa Maria Nuova &n...

  4. Topical local anesthesia: focus on lidocaine–tetracaine combination

    OpenAIRE

    Giordano D.; Raso MG; Pernice C; Agnoletti V; Barbieri V

    2015-01-01

    Davide Giordano,1 Maria Gabriella Raso,2 Carmine Pernice,1 Vanni Agnoletti,3 Verter Barbieri1 1Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, 2Anesthesiology, Intensive Care, and Pain Medicine Unit, Department of Surgical Sciences, University Hospital of Parma, Parma, 3Anesthesiology and Intensive Care Unit, Department of Cardiology, Thoracic and Vascular Surgery, and Critical Care Medicine, Arcispedale Santa Maria Nuova – IR...

  5. Simulation in teaching regional anesthesia: current perspectives

    Directory of Open Access Journals (Sweden)

    Udani AD

    2015-08-01

    Full Text Available Ankeet D Udani,1 T Edward Kim,2,3 Steven K Howard,2,3 Edward R Mariano2,3On behalf of the ADAPT (Anesthesiology-Directed Advanced Procedural Training Research Group1Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 3Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USAAbstract: The emerging subspecialty of regional anesthesiology and acute pain medicine represents an opportunity to evaluate critically the current methods of teaching regional anesthesia techniques and the practice of acute pain medicine. To date, there have been a wide variety of simulation applications in this field, and efficacy has largely been assumed. However, a thorough review of the literature reveals that effective teaching strategies, including simulation, in regional anesthesiology and acute pain medicine are not established completely yet. Future research should be directed toward comparative-effectiveness of simulation versus other accepted teaching methods, exploring the combination of procedural training with realistic clinical scenarios, and the application of simulation-based teaching curricula to a wider range of learner, from the student to the practicing physician.Keywords: regional anesthesia, simulation, medical education, ultrasound, nerve block, simulator

  6. [Internal audit based on the recording critical incidents: the first results].

    Science.gov (United States)

    Terekhova, N N; Kazakova, E A; Sitnikov, A V

    2005-01-01

    The critical incident concept on which an internal medical audit is based has been proposed to comparatively assess different protocols of anesthesiological support. The purpose of this study was to develop a procedure and to implement it at an anesthesiological unit. The study included and analyzed 361 anesthesiological supports. The list of critical incidents (CIs) contained 53 items and was divided into 8 main groups. CIs were recorded in 42.1% of anesthesias: a total of 304 CIs were noted and the frequency of CIs (the number of recorded CIs per anesthesia was 0.84). The bulk of CIs was associated with the cardiovascular system and varying allergic reactions. The study also yielded data on the distribution of CIs in relation to the type of anesthesiological support, the type of a surgical intervention and the physical status of a patient (according to the ASA classification). This study has only opened a little way to internal audit and showed the importance of its routine use to assess different procedures for anesthesiological support.

  7. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Gadsden J

    2015-12-01

    Full Text Available Jeffrey Gadsden,1 Sabry Ayad,2 Jeffrey J Gonzales,3 Jaideep Mehta,4 Jan Boublik,5 Jacob Hutchins6,7 1Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, 3Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, 4Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, 5Department of Anesthesiology, NYU Langone Medical Center – Hospital for Joint Diseases, New York, NY, 6Department of Anesthesiology, 7Department of Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Transversus abdominis plane (TAP infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by

  8. Human Error in Throat Pack Management: Report of Two Cases.

    Science.gov (United States)

    Baranger, Violaine; Bon Mardion, Nicolas; Dureuil, Bertrand; Compère, Vincent

    2016-06-15

    Throat packs are frequently used after tracheal intubation during ear, nose, and throat surgery. We report 2 cases of complications related to throat packs retained at the end of surgery. Miscommunication between anesthesiology and surgery teams on throat pack management led to an upper gastrointestinal endoscopy examination under general anesthesia in the first case and to severe respiratory distress requiring tracheal reintubation in the second case. Our 2 case reports highlight the importance of good communication between anesthesiology and surgery teams and of standardized procedures and checklists for the management of throat packs to ensure patient safety. PMID:27301056

  9. 21 CFR 868.6225 - Nose clip.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nose clip. 868.6225 Section 868.6225 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6225 Nose clip. (a) Identification. A nose clip is a device...

  10. 21 CFR 868.5780 - Tube introduction forceps.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tube introduction forceps. 868.5780 Section 868.5780 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5780 Tube introduction forceps....

  11. 21 CFR 868.1720 - Oxygen gas analyzer.

    Science.gov (United States)

    2010-04-01

    ... gases by techniques such as mass spectrometry, polarography, thermal conductivity, or gas chromatography... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oxygen gas analyzer. 868.1720 Section 868.1720...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1720 Oxygen gas analyzer....

  12. A pharmacokinetic-pharmacodynamic model for neuromuscular blocking agents to predict train-of-four twitches

    NARCIS (Netherlands)

    Eleveld, D.J.; de Haes, A.; Proost, Hans; Wierda, J.M.

    2003-01-01

    The train-of-four (TOF) stimulation pattern consists of 4 stimuli (T1, T2, T3, and T4) at 2 Hz, and is used in daily anesthesiological practice to determine the degree of relaxation caused by muscle relaxants. At a surgical levels of relaxation the degree of relaxation can be estimated by counting t

  13. 21 CFR 868.1670 - Neon gas analyzer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neon gas analyzer. 868.1670 Section 868.1670 Food... DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1670 Neon gas analyzer. (a) Identification. A neon gas analyzer is a device intended to measure the concentration of neon in a gas mixture exhaled by...

  14. 21 CFR 868.5540 - Rigid laryngoscope.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Rigid laryngoscope. 868.5540 Section 868.5540 Food... DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5540 Rigid laryngoscope. (a) Identification. A rigid laryngoscope is a device used to examine and visualize a patient's upper airway and aid...

  15. 21 CFR 868.5530 - Flexible laryngoscope.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Flexible laryngoscope. 868.5530 Section 868.5530...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5530 Flexible laryngoscope. (a) Identification. A flexible laryngoscope is a fiberoptic device used to examine and visualize a patient's...

  16. Evaluation of intra ocular pressure and hemodynamic change following intubation with Maccoy, Macintosh and Video laryngoscope

    OpenAIRE

    Hamid Khosro Zamiri; Mehrdad Noroozi; Siavash Moradi; Mohammad Shabani; Ali Sharifi; Mohammad Ali Haghbin

    2013-01-01

    Background & Objective: The induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic response and increased intraocular pressure. The aim of this study was to evaluate intraocular pressure and hemodynamic changes after laryngoscopy and endotracheal intubation with three methods of laryngoscopy (Macintosh, Maccoy and Video laryngoscope).Materials & Methods: One hundred and eighty patients with American Society of Anesthesiology (ASA) classifi...

  17. 21 CFR 868.1730 - Oxygen uptake computer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oxygen uptake computer. 868.1730 Section 868.1730...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1730 Oxygen uptake computer. (a) Identification. An oxygen uptake computer is a device intended to compute the amount of oxygen consumed by...

  18. A Medical Student Workshop in Mechanical Ventilation.

    Science.gov (United States)

    And Others; Kushins, Lawrence G.

    1980-01-01

    In order to teach applied respiratory physiology to medical students, the anesthesiology faculty at the University of Florida College of Medicine has designed and implemented a course that includes a laboratory workshop in mechanical ventilation of an animal model that allows students to apply and expand their knowledge. (JMD)

  19. Leroy D Vandam, MD: an anesthesia journey.

    Science.gov (United States)

    Ortega, Rafael A

    2005-08-01

    Leroy D Vandam, MD was a remarkable man--an intricate amalgamation of an artist, scientist, and physician. He was a bastion of medical historical knowledge. Dr Vandam became a most influential anesthesiologist, some say, a giant. He was an example of someone who, with resolve, overcame adversity. His artwork is displayed in countless places, and several of his paintings form part of the Wood Library Museum Heritage Series. Dr Vandam was first a surgeon, but he abandoned surgery and pursued a career in anesthesiology under the leadership of Robert Dripps. He completed his residency training at the University of Pennsylvania and joined its staff in 1949. When he arrived at Brigham and Women's Hospital in the 1950s as director of anesthesia, he embarked on one of the most illustrious careers in American anesthesiology. Dr Vandam published more than 250 original articles, chapters, abstracts, and other reports on a wide variety of subjects including history, art, and pharmacology. His classic article on the complications of neuroaxial blocks is a seminal work in anesthesiology. This article describes how an anesthesiologist who shared an interest with Dr Vandam in the history of anesthesiology came to produce a movie based on his career, the evolution of anesthesia equipment, and the transformation of our specialty.

  20. 21 CFR 868.5220 - Blow bottle.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blow bottle. 868.5220 Section 868.5220 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5220 Blow bottle. (a) Identification. A blow bottle is a device that is intended for medical purposes to induce a forced expiration from a patient. The patient...

  1. 21 CFR 868.5995 - Tee drain (water trap).

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tee drain (water trap). 868.5995 Section 868.5995...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5995 Tee drain (water trap). (a) Identification. A tee drain (water trap) is a device intended to trap and drain water that collects in...

  2. 21 CFR 868.5690 - Incentive spirometer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Incentive spirometer. 868.5690 Section 868.5690...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5690 Incentive spirometer. (a) Identification. An incentive spirometer is a device that indicates a patient's breathing volume or flow and...

  3. Perioperative medicine. The surgeons point of view

    DEFF Research Database (Denmark)

    Kehlet, H

    2001-01-01

    A satisfactory postoperative outcome goes through the control of several factors, to ensure well-being and free-pain state. A multi-disciplinary effort is necessary to achieve this goal, and the adjustment of postoperative surgical care is as important as the supply of anesthesiological techniques....

  4. 21 CFR 868.5440 - Portable oxygen generator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Portable oxygen generator. 868.5440 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5440 Portable oxygen generator. (a) Identification. A portable oxygen generator is a device that is intended to release oxygen for...

  5. 21 CFR 868.2500 - Cutaneous oxygen (PcO2) monitor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cutaneous oxygen (PcO2) monitor. 868.2500 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2500 Cutaneous oxygen (PcO2) monitor. (a) Identification. A cutaneous oxygen (PcO2) monitor is a noninvasive, heated sensor (e.g.,...

  6. 21 CFR 868.5350 - Nasal oxygen catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  7. 21 CFR 868.5655 - Portable liquid oxygen unit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Portable liquid oxygen unit. 868.5655 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5655 Portable liquid oxygen unit. (a) Identification. A portable liquid oxygen unit is a portable, thermally insulated container of liquid oxygen...

  8. 21 CFR 868.5710 - Electrically powered oxygen tent.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electrically powered oxygen tent. 868.5710 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5710 Electrically powered oxygen tent. (a) Identification. An electrically powered oxygen tent is a device that encloses a...

  9. 21 CFR 868.5700 - Nonpowered oxygen tent.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonpowered oxygen tent. 868.5700 Section 868.5700...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5700 Nonpowered oxygen tent. (a) Identification. A nonpowered oxygen tent is a device that encloses a patient's head and upper body to...

  10. 21 CFR 868.5340 - Nasal oxygen cannula.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient...

  11. Measuring Information through Topical Subheadings of the Medline Database: A Case Study.

    Science.gov (United States)

    Alvarez, P.; Pulgarin, A.

    1999-01-01

    Describes a method for measuring research information from thematic references such as headings and subheadings that are used in indexing, cataloging, and online searching, using the Rasch model as the measuring instrument. Discusses results of a search of anesthesiology in the Medline database that was used as a case study. (Author/LRW)

  12. 21 CFR 868.1640 - Helium gas analyzer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Helium gas analyzer. 868.1640 Section 868.1640...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1640 Helium gas analyzer. (a) Identification. A helium gas analyzer is a device intended to measure the concentration of helium in a...

  13. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into...

  14. 21 CFR 868.5760 - Cuff spreader.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cuff spreader. 868.5760 Section 868.5760 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5760 Cuff spreader. (a) Identification. A cuff spreader is a device used to install tracheal tube cuffs on tracheal or tracheostomy tubes. (b) Classification. Class...

  15. 21 CFR 868.5330 - Breathing gas mixer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing gas mixer. 868.5330 Section 868.5330...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5330 Breathing gas mixer. (a) Identification. A breathing gas mixer is a device intended for use in conjunction with a respiratory...

  16. 21 CFR 868.6885 - Medical gas yoke assembly.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical gas yoke assembly. 868.6885 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6885 Medical gas yoke assembly. (a) Identification. A medical gas yoke assembly is a device intended to connect medical gas cylinders to...

  17. 21 CFR 868.5180 - Rocking bed.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Rocking bed. 868.5180 Section 868.5180 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5180 Rocking bed. (a) Identification. A rocking bed is a...

  18. 21 CFR 868.5310 - Carbon dioxide absorber.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carbon dioxide absorber. 868.5310 Section 868.5310...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5310 Carbon dioxide absorber. (a) Identification. A carbon dioxide absorber is a device that is intended for medical purposes and that is used in...

  19. Simulation and psychology

    DEFF Research Database (Denmark)

    Dieckmann, Peter; Krage, Ralf

    2013-01-01

    Psychology is relevant for improving the use of simulation in anesthesiology, as it allows us to describe, explain and optimize the interactions of learners and instructors as well as the design of simulation scenarios and debriefings. Much psychological expertise is not used for simulation...

  20. 21 CFR 868.5580 - Oxygen mask.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  1. 21 CFR 868.2775 - Electrical peripheral nerve stimulator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Electrical peripheral nerve stimulator. 868.2775... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2775 Electrical peripheral nerve stimulator. (a) Identification. An electrical peripheral nerve stimulator (neuromuscular blockade monitor)...

  2. 21 CFR 868.2380 - Nitric oxide analyzer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nitric oxide analyzer. 868.2380 Section 868.2380...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2380 Nitric oxide analyzer. (a) Identification. The nitric oxide analyzer is a device intended to measure the concentration of nitric oxide...

  3. 21 CFR 868.5165 - Nitric oxide administration apparatus.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nitric oxide administration apparatus. 868.5165... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5165 Nitric oxide administration apparatus. (a) Identification. The nitric oxide administration apparatus is a device used to add...

  4. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to...

  5. Results of Surgery for Perforated Gastroduodenal Ulcers in a Dutch Population

    NARCIS (Netherlands)

    Hemmer, P. H. J.; de Schipper, J. S.; van Etten, B.; Pierie, J. P. E. N.; Bonenkamp, J. J.; de Graaf, P. W.; Karsten, T. M.

    2011-01-01

    Objective: Despite improvements in anesthesiology and intensive care medicine, mortality for perforated gastroduodenal ulcer disease remains high. This study was designed to evaluate the results of surgery for perforated ulcer disease and to identify prognostic factors for mortality in order to opti

  6. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

    Science.gov (United States)

    Hicks, C Gray; Jones, James E; Saxen, Mark A; Maupome, Gerardo; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

  7. A Web-Based Operating Room Management Educational Tool.

    Science.gov (United States)

    Tsai, Mitchell H; Haddad, Daniel J; Friend, Alexander F; Bender, S Patrick; Davidson, Melissa L

    2016-08-01

    In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics. PMID:27258181

  8. A Web-Based Operating Room Management Educational Tool.

    Science.gov (United States)

    Tsai, Mitchell H; Haddad, Daniel J; Friend, Alexander F; Bender, S Patrick; Davidson, Melissa L

    2016-08-01

    In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics.

  9. No Silver Medal for Nobel Prize Contenders: Why Anesthesia Pioneers Were Nominated for but Denied the Award.

    Science.gov (United States)

    Hansson, Nils; Fangerau, Heiner; Tuffs, Annette; Polianski, Igor J

    2016-07-01

    Taking the examples of the pioneers Carl Ludwig Schleich, Carl Koller, and Heinrich Braun, this article provides a first exploratory account of the history of anesthesiology and the Nobel Prize for physiology or medicine. Besides the files collected at the Nobel Archive in Sweden, which are presented here for the first time, this article is based on medical literature of the early 20th century. Using Nobel Prize nominations and Nobel committee reports as points of departure, the authors discuss why no anesthesia pioneer has received this coveted trophy. These documents offer a new perspective to explore and to better understand aspects of the history of anesthesiology in the first half of the 20th century. PMID:26982509

  10. Pierre Robin Sequence: a perioperative review.

    Science.gov (United States)

    Cladis, Franklyn; Kumar, Anand; Grunwaldt, Lorelei; Otteson, Todd; Ford, Matthew; Losee, Joseph E

    2014-08-01

    The clinical triad of micrognathia (small mandible), glossoptosis (backward, downward displacement of the tongue), and airway obstruction defines the Pierre Robin sequence (PRS). Airway obstruction and respiratory distress are clinical hallmarks. Patients may present with stridor, retractions, and cyanosis. Severe obstruction results in feeding difficulty, reflux, and failure to thrive. Treatment options depend on the severity of airway obstruction and include prone positioning, nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis, and tracheostomy. The neonate and infant with PRS require care from multiple specialists including anesthesiology, plastic surgery, otolaryngology, speech pathology, gastroenterology, radiology, and neonatology. The anesthesiologist involved in the care of patients with PRS will interface with a multidisciplinary team in a variety of clinical settings. This perioperative review is a collaborative effort from multiple specialties including anesthesiology, plastic surgery, otolaryngology, and speech pathology. We will discuss the background and clinical presentation of patients with PRS, as well as some of the controversies regarding their care.

  11. Advanced course for doctors as Departmental IT Network Administrators in anesthesia and intensive care units.

    Science.gov (United States)

    Lanza, Vincenzo; Huang, Chun-Hsi

    2006-10-01

    The design and administration of a departmental computer network (Local Area Network) in anesthesiology and intensive care offer the opportunity to manage clinical information and control the work-flow. To improve the local network, after basic design, intelligence is necessary to maintain its efficiency. For this reason the role of a medical administrator of the network is fundamental because he is a qualified figure who recognizes the most important characteristics that a network must have, knows the users of the system, represents a valid consultant for the technician that has to build the network, and is able to face possible breakdowns. This paper illustrates the structure of a course to train a medical network administrator in anesthesiology and critical care.

  12. No Silver Medal for Nobel Prize Contenders: Why Anesthesia Pioneers Were Nominated for but Denied the Award.

    Science.gov (United States)

    Hansson, Nils; Fangerau, Heiner; Tuffs, Annette; Polianski, Igor J

    2016-07-01

    Taking the examples of the pioneers Carl Ludwig Schleich, Carl Koller, and Heinrich Braun, this article provides a first exploratory account of the history of anesthesiology and the Nobel Prize for physiology or medicine. Besides the files collected at the Nobel Archive in Sweden, which are presented here for the first time, this article is based on medical literature of the early 20th century. Using Nobel Prize nominations and Nobel committee reports as points of departure, the authors discuss why no anesthesia pioneer has received this coveted trophy. These documents offer a new perspective to explore and to better understand aspects of the history of anesthesiology in the first half of the 20th century.

  13. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

    OpenAIRE

    Liu, Weijun

    2016-01-01

    Weijun Liu,1,* Ling Hu,2,* Po-Hsin Chou,3 Ming Liu,1 Wusheng Kan,1 Junwen Wang1 1Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Anesthesiology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, People’s Republic of China; 3Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Schoo...

  14. Comparison of anterior decompression and fusion versus laminoplasty in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a systematic review and meta-analysis

    OpenAIRE

    Liu W; Hu L; Chou PH; Liu M; Kan W; Wang J.

    2016-01-01

    Weijun Liu,1,* Ling Hu,2,* Po-Hsin Chou,3 Ming Liu,1 Wusheng Kan,1 Junwen Wang1 1Department of Orthopedics, Pu Ai Hospital, Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Anesthesiology, Tianyou Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, People’s Republic of China; 3Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, School of Medicin...

  15. A large animal neuropathic pain model in sheep: a strategy for improving the predictability of preclinical models for therapeutic development

    OpenAIRE

    Wilkes D; Li G; Angeles CF; Patterson JT; Huang LY

    2012-01-01

    Denise Wilkes,1 Guangwen Li,2 Carmina F Angeles,3 Joel T Patterson,4 Li-Yen Mae Huang21Department of Anesthesiology, 2Department of Neuroscience and Cell Biology, 3Department of Neurosurgery University of Texas Medical Branch, Galveston, TX, USA; 4Neurospine Institute, Eugene, OR, USABackground: Evaluation of analgesics in large animals is a necessary step in the development of better pain medications or gene therapy prior to clinical trials. However, chronic neuropathic pain models in large ...

  16. Randomized controlled trials – a matter of design

    OpenAIRE

    Spieth PM; Kubasch AS; Penzlin AI; Illigens BM; Barlinn K; Siepmann T

    2016-01-01

    Peter Markus Spieth,1,2 Anne Sophie Kubasch,3 Ana Isabel Penzlin,4 Ben Min-Woo Illigens,2,5 Kristian Barlinn,6 Timo Siepmann2,6,7 1Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, 2Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, 3Pediatric Rheumatology and Immunology, Children’s Hospital, University Hospital Carl Gustav Carus, Te...

  17. Marfan syndrome with acute abdomen: a case report

    OpenAIRE

    Beyazit Zencirci

    2010-01-01

    Beyazit ZencirciKahramanmaras Sutcu Imam University Medical Faculty, Department of Anesthesiology and Reanimation Kahramanmaras, TurkeyIntroduction: Marfan syndrome is an autosomal dominant connective tissue disorder characterized by a combination of clinical manifestations in different organ systems. Patients with Marfan syndrome (MFS) whose lifetimes are extended may be encountered as acute abdomen (appendicitis) cases apart from the obligatory reasons and emergencies arising naturally out ...

  18. [The Eppendorf University Hospital, Hamburg--a cradle of German- speaking anesthesia?].

    Science.gov (United States)

    Goerig, M

    1999-10-01

    "The time will come when German medicine, too, will have to concern itself with the issue of a professional narcotiseur. Until then it will be our duty to keep the interest in narcosis, which has increased satisfactorily in the past years, alive." With this statement the editors of the journal "Der Schmerz" substantiated the publication og a German-speaking anestesiological journal in 1928. Ernst von der Porten, a professional anesthesist working in Hamburg was the chief initiator for the appearance of the new journal. Possible he was incited by his former teacher, the Eppendorf surgeon Paul Sudeck, to delve deeper into our special field. Very early Sudeck himself began to concern himself with anesthesiological questions and he found an ardent supporter of the idea of specialisation in anesthesiology (quite unheard of in Germany at that time) in Helmut Schmidt, a staff member. Schmidt habilitated on an anesthesiological theme and that again was reason enough for the editors to write an editorial about. Schmidt who one of the chief organizers of the "90. Tagung Deutscher Naturforscher und Arzte" in the late summer of 1928 was hindered by the surgeons on founding the Deutsche Narkosege-sellschaft (German Narcosis Society) with colleagues. After World War II German surgeons rethought their position, mainly influenced by Anglo-American narcosis specialists. After the foundation of the Deutsche Gesellschaft für Anaesthesiein the year 1953, the first professorate for the special field of anesthesiology was given to Karl Horatz--one of the founding members--10 years later. Not surprisingly the professorate was instituted at the university hospital in Eppendorf which could be called the cradle of German-speaking anesthesia. The following concerns itself with some of the impulses that were given by the "Neues Allgemeines Krankenhaus Eppendorf" and became important stepping stones in our special field through the decades. PMID:10548957

  19. Acupressure versus dilution of fentanyl to reduce incidence of fentanyl-induced cough in female cancer patients: a prospective randomized controlled study

    OpenAIRE

    Solanki, Sohan Lal; Doctor, Jeson Rajan; Kapila, Savi J; Gehdoo, Raghbirsingh P; Divatia, Jigeeshu V.

    2016-01-01

    Background Fentanyl-induced cough (FIC) is a transient condition with a reported incidence of 18% to 65% depending on the dose and route of administration of fentanyl. Nonpharmacological methods to prevent FIC are more cost-effective than medications. Dilution of fentanyl has a proven role in the prevention of FIC. Acupressure can also prevent FIC because it has a proven role in the treatment of cough. Methods This study included 225 female patients with an American Society of Anesthesiologis...

  20. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

    OpenAIRE

    Yvette RBM van Gestel; Sanne E Hoeks; Don D Sin; Henk Stam; Frans W Mertens; Bax, Jeroen J.; van Domburg, Ron T.; Don Poldermans

    2009-01-01

    Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medica...

  1. Optimizing pain control through the use of implantable pumps

    OpenAIRE

    Ilias, Wilfried

    2008-01-01

    Wilfried Ilias1, Boris Todoroff21Dept Anesthesiology, Intensive Care Medicine and Pain Therapy, Academic Teaching Hospital St. John of God, Vienna, Austria; 2Dept. Plastic and Reconstructive Surgery, Hospital of St. Vincent, Vienna, AustriaAbstract: Intrathecal therapy represents an effective and well established treatment of nonmalignant as well as malignant pain. Devices available include mechanical constant flow pumps as well as electronic variable flow pumps with patient-controlled bolus ...

  2. Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

    OpenAIRE

    Narain S; Al-Khoury L; Chang E

    2015-01-01

    Sachin Narain,1 Lama Al-Khoury,2 Eric Chang3–6 1Department of Anesthesiology and Perioperative Care, 2Department of Neurology, 3Department of Physical Medicine and Rehabilitation, 4Department of Neurosurgery, 5Department of Orthopedics, 6Reeve-Irvine Research Center for Spinal Cord Injury, University of California Irvine, Irvine, CA, USA Background: Migraine headaches are a common and functionally debilitating disorder affecting approximately 17% of women and 5.6% of men. Compared ...

  3. Ketofol for monitored anesthesia care in shoulder arthroscopy and labral repair: a case report

    OpenAIRE

    Lee KC; Shi H.; Lee BC

    2016-01-01

    Kevin C Lee,1 Hanyuan Shi,2 Brian C Lee3 1Columbia University College of Dental Medicine, New York, NY, 2Vanderbilt University School of Medicine, Nashville, TN, 3Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA Abstract: A 21-year-old male (body mass index: 28.3) with a history of asthma and reactive airway disease since childhood underwent left shoulder arthroscopy and labral repair surgery under monitored anesthesia care. Because the procedure was perform...

  4. Patient considerations in the use of tapentadol for moderate to severe pain

    OpenAIRE

    Vadivelu, Nalini

    2013-01-01

    Nalini Vadivelu, Yili Huang, Brian Mirante, Michael Jacoby, Ferne R Braveman, Roberta L Hines, Raymond SinatraDepartment of Anesthesiology, Yale University, New Haven, CT, USAAbstract: Poorly controlled acute and chronic pain can increase morbidity, impair quality of life and prolong disability. Over 80 percent of post surgical patients report moderate to severe uncontrolled postoperative pain. Over-reliance on potent opioid agonists can lead to several opioid related side effects such as gas...

  5. The unsolved case of “bone-impairing analgesics”: the endocrine effects of opioids on bone metabolism

    OpenAIRE

    Coluzzi, Flaminia

    2015-01-01

    Flaminia Coluzzi,1,2 Joseph Pergolizzi,3,4 Robert B Raffa,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine – Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 4Naples Anesthesia and Pain Associat...

  6. The unsolved case of “bone-impairing analgesics”: the endocrine effects of opioids on bone metabolism

    OpenAIRE

    Coluzzi F; Pergolizzi J; Raffa RB; Mattia C

    2015-01-01

    Flaminia Coluzzi,1,2 Joseph Pergolizzi,3,4 Robert B Raffa,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine – Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 4Naples Anesthesia and Pain Associates, ...

  7. Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain

    OpenAIRE

    Smith, Howard

    2009-01-01

    Howard S Smith,1 Timothy R Deer21Albany Medical College, Department of Anesthesiology, Albany, New York, USA; 2The Center for Pain Relief, Clinical Professor, West Virginia, University, Charleston, West Virginia, USAAbstract: Ziconotide is a conopeptide intrathecal (IT) analgesic which is approved by the US Food and Drug Administration (FDA) for the management of severe chronic pain. It is a synthetic equivalent of a naturally occurring conopeptide found in the venom of the fish-eating marine...

  8. Psychological therapies for the management of chronic pain

    OpenAIRE

    Sturgeon JA

    2014-01-01

    John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy fo...

  9. Možnosti umělé plicní ventilace v přednemocniční neodkladné péči a anesteziologicko-resuscitačních odděleních

    OpenAIRE

    BINTEROVÁ, Jana

    2010-01-01

    The aim was to explore the possibilities of mechanical ventilation in prehospital emergency care and Anesthesiology and Intensive Care qualitative research method. The first part of the research was focused on finding out how the use, including the most frequently used modes of ventilation, and frequency of artificial ventilation. Research has found that in pre-hospital care are used methods of invasive and noninvasive ventilation and ventilatory modes most widely used in prehospital care are...

  10. Refractory headaches treated with bilateral occipital and temporal region stimulation

    OpenAIRE

    Zach KJ; Trentman TL; Zimmerman RS; DW, Dodick

    2014-01-01

    Kelly J Zach,1 Terrence L Trentman,1 Richard S Zimmerman,2 David W Dodick31Department of Anesthesiology, 2Department of Neurosurgery, 3Department of Neurology, Mayo Clinic in Arizona, Phoenix, AZ, USAObjectives: To describe use of bilateral temporal and occipital stimulator leads for a refractory headache disorder.Materials and methods: A 31-year-old female had a 10-year history of chronic, severe occipital and temporal region headaches. The patient underwent permanent implant of an occipital...

  11. Drug use among anesthesiologists in the context of working relations

    OpenAIRE

    Marcelo Niel; Alessandra Maria Julião; Denise Martin; Dartiu Xavier da Silveira Filho

    2008-01-01

    Objective: To understand the use of drugs by anesthesiologists focused on the context of working relations. Methods: It was a qualitative research, with a phenomenological approach. Data were collected by in-depth interviews. The subjects were fifteen Anesthesiology doctors. The content analysis of the interviews was accomplished from the organization in relevant categories, such as, evidencing the use of drugs in professional context, the easy access to drugs and the difficulty in dealing wi...

  12. Unexpected difficult airway with hypogonadotropic hypogonadism

    OpenAIRE

    Ferda Yaman, Ferda

    2014-01-01

    Ferda Yaman,1 Bengi Arslan,2 Ercan Yuvanç,3 Ünase Büyükkoçak1 1Anesthesiology and Reanimation Department, 2Otorhinolaryngology Head and Neck Surgery Department, 3Urology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Background: A critical aspect of safe general anesthesia is providing adequate ventilation and oxygenation. Failed endotracheal intubation and inadequate ventilation with insufficient oxygenation may lead...

  13. Unexpected difficult airway with hypogonadotropic hypogonadism

    OpenAIRE

    Yaman F; Arslan B; Yuvanç E; Büyükkoçak Ü

    2014-01-01

    Ferda Yaman,1 Bengi Arslan,2 Ercan Yuvanç,3 Ünase Büyükkoçak1 1Anesthesiology and Reanimation Department, 2Otorhinolaryngology Head and Neck Surgery Department, 3Urology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Background: A critical aspect of safe general anesthesia is providing adequate ventilation and oxygenation. Failed endotracheal intubation and inadequate ventilation with insufficient oxygenation may lead to serious complica...

  14. Management of chronic pain in the elderly: focus on transdermal buprenorphine

    OpenAIRE

    Vadivelu, Nalini

    2008-01-01

    Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration ...

  15. Options for perioperative pain management in neurosurgery

    OpenAIRE

    Vadivelu, Nalini

    2016-01-01

    Nalini Vadivelu,1 Alice M Kai,2 Daniel Tran,1 Gopal Kodumudi,3 Aron Legler,1 Eugenia Ayrian,4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3California Northstate University College of Medicine, Elk Grove, 4Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA Abstract: Moderate-to-severe pain following neurosurgery is common but often does not get attention and is...

  16. Caroline B. Palmer: Pioneer Physician Anesthetist and First Chair of Anesthesia at Stanford.

    Science.gov (United States)

    Brodsky, Jay B; Saidman, Lawrence J

    2015-12-01

    Caroline B. Palmer was appointed as Chief of Anesthesia at Cooper Medical College (soon renamed as Stanford Medical School) in 1909. For the next 28 years, she was an innovative leader, a clinical researcher, and a strong advocate for recognition of anesthesiology as a medical specialty. To honor her accomplishments, the operating room suite in the new Stanford Hospital will be named after this pioneering woman anesthesiologist.

  17. DNA fingerprinting for sample authentication in biobanking: recent perspectives

    OpenAIRE

    Palmirotta, Raffaele

    2015-01-01

    Raffaele Palmirotta,1,2,* Maria Laura De Marchis,1,3,* Cristiano Ialongo,4 Costanza Majorani,5 Jhessica Alessandroni,1 Antonella Spila,1 Maria Giovanna Valente,6 David Della-Morte,1,7 Patrizia Ferroni,1,2 Fiorella Guadagni1,2 1Interinstitutional Multidisciplinary Biobank, IRCCS San Raffaele Pisana, 2Telematic University San Raffaele, 3Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiological Sciences, Sapienza University, 4Department of Internal Medicine, Tor Ver...

  18. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Circulation, O2 Transport and Haematology”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (MPT),...

  19. Thoracic epidural analgesia to control malignant pain until viability in a pregnant patient

    OpenAIRE

    Mehta, Jaideep

    2016-01-01

    Jaideep H Mehta,1 Mary Elizabeth Gibson,2 David Amaro-Driedger,3 Mahammad N Hussain1 1Department of Anesthesiology, UT Health, McGovern Medical School, Houston, TX, 2Orlando Health, Orlando, FL, 3UT Health, McGovern Medical School, Houston, TX, USA Abstract: Management of nonobstetric pain in the pregnant patient presents unique challenges related to transplacental fetal exposure to opioids and the subsequent risk of neonatal withdrawal syndrome. We present the case of a pregnant patient suff...

  20. Nanomedicine in cerebral palsy

    OpenAIRE

    Balakrishnan B; Nance E; Johnston MV; Kannan R; Kannan S

    2013-01-01

    Bindu Balakrishnan,1 Elizabeth Nance,1 Michael V Johnston,2 Rangaramanujam Kannan,3 Sujatha Kannan1 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; Baltimore, MD, USA; 2Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA; 3Department of Ophthalmology, Center for Nanomedicine, Johns Hopkins University, Baltimore, MD, USA Abstract: Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the...

  1. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Brain & Development”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (MPT), supp...

  2. Training program conference of "Good Pain Management Ward" was launched in Wuhan

    Institute of Scientific and Technical Information of China (English)

    Yi Cheng

    2012-01-01

    @@ On March 6th, the training program conference of "Good Pain Management Ward" (GPM ward) was launched in the conference hall of Westin Hotel, Wuhan.The conference was hosted by Clinics Medical Secretary, Ministry of Health, and undertaken by CSCO and Mundipharma (China) Pharmaceutical Co., Ltd.Three hundreds experts, doctors and nurses, from departments of oncology, pain, anesthesiology and pharmacy, in 6 provinces (including Hubei, Hunan, Jiangxi, Shanxi, Shanxi, Henan), attended the conference.

  3. The prevention and regression of atherosclerotic plaques: emerging treatments

    OpenAIRE

    Kalanuria AA; Nyquist P; Ling G

    2012-01-01

    Atul Ashok Kalanuria,1 Paul Nyquist,1 Geoffrey Ling1,21Division of Neuro Critical Care, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, 2Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USAAbstract: Occlusive vascular diseases, such as sudden coronary syndromes, stroke, and peripheral arterial disease, are a huge burden on the health care systems of developed and developing countri...

  4. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Pharmacology”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (...

  5.  α-Cyclodextrin dimer complexes of dopamine and levodopa derivatives to assess drug delivery to the central nervous system: ADME and molecular docking studies

    OpenAIRE

    Shityakov S; Broscheit J; Förster C

    2012-01-01

    Sergey Shityakov, Jens Broscheit, Carola FörsterDepartment of Anesthesiology and Critical Care, University of Würzburg, Würzburg, GermanyAbstract: This paper attempts to predict and emphasize molecular interactions of dopamine, levodopa, and their derivatives (Dopimid compounds) containing 2-phenyl-imidazopyridine moiety with the α-cyclodextrin dimer in order to assess and improve drug delivery to the central nervous system. The molecular docking method is...

  6. α-Cyclodextrin dimer complexes of dopamine and levodopa derivatives to assess drug delivery to the central nervous system: ADME and molecular docking studies

    OpenAIRE

    Shityakov, Sergey

    2012-01-01

    Sergey Shityakov, Jens Broscheit, Carola FörsterDepartment of Anesthesiology and Critical Care, University of Würzburg, Würzburg, GermanyAbstract: This paper attempts to predict and emphasize molecular interactions of dopamine, levodopa, and their derivatives (Dopimid compounds) containing 2-phenyl-imidazopyridine moiety with the α-cyclodextrin dimer in order to assess and improve drug delivery to the central nervous system. The molecular docking method is...

  7. Ophthalmic regional blocks: management, challenges, and solutions

    OpenAIRE

    Palte HD

    2015-01-01

    Howard D Palte Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL, USA Abstract: In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye car...

  8. Interprofessional Learning – Development and Implementation of Joint Medical Emergency Team Trainings for Medical and Nursing Students at Universitätsmedizin Greifswald

    OpenAIRE

    Partecke, Maud; Balzer, Claudius; Finkenzeller, Ingmar; Reppenhagen, Christiane; Hess, Ulrike; Hahnenkamp, Klaus; Meissner, Konrad

    2016-01-01

    Introduction: Interprofessional collaboration is of great importance in clinical practice, particularly in the field of emergency medicine. The professions involved in providing emergency care must work hand in hand, and tasks and routines must be coordinated effectively. However, medical and nursing students have only few opportunities to experience interprofessional cooperation during their formal training. Addressing this situation, the Department of Anesthesiology and the Vocational Schoo...

  9. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Nutrition and gastroenterology”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (MPT),...

  10. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    OpenAIRE

    Hammoud MM; Morgan HK; Edwards ME; Lyon JA; White C.

    2012-01-01

    Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an ...

  11. Difficult Airway due to Retropharyngeal Hematoma after Stabbing to the Neck

    Directory of Open Access Journals (Sweden)

    Kouhei Iwashita

    2014-07-01

    Full Text Available Reports of retropharyngeal hematoma have been scarce in the anesthesiology literature. We report a patient whose trachea was difficult to intubate due to retropharyngeal hematoma after stabbing to the neck. A woman with a knife injury to the common carotid artery required emergency carotid arterioplasty. When tracheal intubation was attempted, marked swelling of the posterior pharyngeal wall made the vocal cords impossible to visualize. Preoperative computed tomography showed a retropharyngeal hematoma. The patient required mechanical ventilation for 2 days.

  12. Xerostomia induced by radiotherapy

    OpenAIRE

    Alimi, David

    2015-01-01

    David Alimi Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAWe read with great interest the excellent review on xerostomia induced by radiotherapy, by Pinna et al.1 The authors should be congratulated for a very detailed review of the physiopathology, clinical symptoms, and therapeutic management of an extremely difficult condition. Although we agree that the use of anticholinergic medication represents treatment, it requires the patient to have resi...

  13. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Pulmonology”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (...

  14. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

    OpenAIRE

    Nermin Gogus; Belgin Akan; Nurten Serger; Mustafa Baydar

    2014-01-01

    Background and objectives: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Methods: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study...

  15. DO PREOPERATIVE PSYCHOLOGICAL CONDITION AND Μ1-OPIOID RECEPTOR GENE POLYMORPHISM 118A>G AFFECT OPIOID ANALGESIA EFFICACY AFTER MAJOR UROLOGICAL SURGERIES?

    OpenAIRE

    Boiarkina, A.V.; Potapov, A.L.; Babanin, A.A.; Pivovarenko, S.A.; Fedosov, I.E.; Skoritskiy, I.V.

    2013-01-01

    Background. Effective postoperative analgesia remains an essential problem in modern anesthesiology. The search of factors affecting the pain intensity after the surgery is of significant practical importance. It is known, that personal experience, psychological and social state may be related to the level of postoperative pain syndrome. At the same time, genetic factors regulating opioid pharmacodynamics contribute to the large interpatient variability in postoperative opioid requirements. T...

  16. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015; Session “Other”

    OpenAIRE

    Various Authors

    2015-01-01

    Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015); Budapest (Hungary); September 16-20, 2015ORGANIZING INSTITUTIONSEuropean Society for Neonatology (ESN), European Society for Paediatric Research (ESPR), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI), with the local host of Hungarian Society of Perinatology and Obstetric Anesthesiology, Hungarian Society of Perinatology (MPT),...

  17. Tapentadol extended-release for treatment of chronic pain: a review

    OpenAIRE

    Vadivelu N; Timchenko A; Huang Y.; Sinatra R

    2011-01-01

    Nalini Vadivelu1, Alexander Timchenko1, Yili Huang2, Raymond Sinatra11Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; 2Internal Medicine, North Shore-LIJ Plainview Hospital, Plainview, NY, USAAbstract: Tapentadol is a centrally acting analgesic with a dual mechanism of action of mu receptor agonism and norepinephrine reuptake inhibition. Tapentadol immediate-release is approved by the US Food and Drug Administration for the management of moderate-to-severe acu...

  18. Review of oral oxymorphone in the management of pain

    OpenAIRE

    Paul Sloan

    2008-01-01

    Paul SloanUniversity of Kentucky Medical Center, Department of Anesthesiology, Lexington, KY, USAAbstract: Chronic cancer and nonmalignant pain (CNMP) is a common and major health problem afflicting approximately 40 million persons in the US. Most cancer patients, and many patients with CNMP, require opioid analgesics to obtain adequate pain relief. Oral oxymorphone is a new formulation of an existing parenteral opioid that has become available for the treatment of significant pain: acute pos...

  19. Neurorestoratology: one of the most promising new disciplines at the forefront of neuroscience and medicine

    OpenAIRE

    Huang H; Sharma HS

    2013-01-01

    Hongyun Huang,1 Hari Shanker Sharma2 1Department of Neurosurgery, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, People's Republic of China; 2Laboratory of Cerebrovascular Research, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, University Hospital, Uppsala University, SwedenNeurorestoratology is a new and emerging distinct discipline put forward on the basis of nervous restorable (neurorestorable) theory, which states that nerve da...

  20. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    OpenAIRE

    Lin Y; Li Q; Yang R; Liu J

    2016-01-01

    Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred ...

  1. Povědomí sester pracujících na odděleních ARO a JIP o kompetencích vyplývajících z vyhlášky č. 424/2004 Sb.

    OpenAIRE

    MARTÍNKOVÁ, Petra

    2010-01-01

    This paper investigates the competences of nurses on staff of the anesthesiology & resuscitation departments and the intensive care units as such competences are defined in Decree 424/2004 Coll. The paper has been split into two sections: theoretical and practical. The theoretical section looks into the roles and competencies assigned to the non-specialized nurses and to those who have completed a specialism course, specifically the "intensive-care general nurses", and describes the kinds of ...

  2. No-fault compensation for ventilator-dependent children: a reasonable settlement value for lifetime attendant care

    OpenAIRE

    Boelens, Brian; Jenkins, Randall; Aasheim,Kari; Gravenstein, Nikolaus

    2016-01-01

    Randall C Jenkins,1–3 Brian W Boelens,1 Kari L Aasheim,1 Nikolaus Gravenstein4–5 1University of Florida Self-Insurance Program, 2University of Florida Healthcare Education Insurance Company, 3Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, 4Department of Anesthesiology, 5Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: Severe neurological out...

  3. Transition to a novel advanced integrated vitrectomy platform: comparison of the surgical impact of moving from the Accurus vitrectomy platform to the Constellation Vision System for microincisional vitrectomy surgery

    OpenAIRE

    Murray TG; Layton AJ; Tong KB; Gittelman M; Latiff A; Gologorsky D; Vigoda MM

    2013-01-01

    Timothy G Murray,1,2 Andrew J Layton,3 Kuo B Tong,3 Michael Gittelman,2 Azeema Latiff,1,2 Daniel Gologorsky,2 Michael M Vigoda21Murray Ocular Oncology and Retina, Miami, FL, USA; 2Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Departments of Ophthalmology, Anesthesiology and Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; 3Quorum Consulting, San Francisco, CA, USABackground: Microincisional vitrectomy surgery (MIVS) is the current standard surgi...

  4. Retrospective Outcomes Evaluation of 100 Parenteral Moderate and Deep Sedations Conducted in a General Practice Dental Residency

    OpenAIRE

    Messieha, Zakaria; Cruz-Gonzalez, Wanda; Hakim, Michel I

    2008-01-01

    An abstract of this study was presented at the American Association for Dental Research (AADR) Dental Anesthesiology Research Group in Honolulu, Hawaii, in March of 2004. This study was conducted to correlate the intraoperative and postoperative morbidity associated with moderate and deep sedation, also known as monitored anesthesia care (MAC), provided in a General Practice Residency (GPR) clinic under the supervision of a dentist anesthesiologist. After internal review board approval was ob...

  5. Post-dural puncture headache

    Directory of Open Access Journals (Sweden)

    Ghaleb A

    2012-01-01

    Full Text Available Ahmed Ghaleb1, Arjang Khorasani2, Devanand Mangar31Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, 2Anesthesiology Residency Program, Advocate Illinois Masonic Medical Center, Chicago, IL, 3Florida Gulf to Bay Anesthesiology, Tampa General Hospital, Tampa, FL, USAAbstract: Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle. A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24–48 hours of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP are rare.Keywords: post-dural puncture headache, gauge, needles, cause, risk, incidence

  6. The postgraduate hospital educational environment measure (PHEEM questionnaire identifies quality of instruction as a key factor predicting academic achievement

    Directory of Open Access Journals (Sweden)

    Joaquim Edson Vieira

    2008-01-01

    Full Text Available OBJECTIVE: This study analyzes the reliability of the PHEEM questionnaire translated into Portuguese. We present the results of PHEEM following distribution to doctors in three different medical residency programs at a university hospital in Brazil. INTRODUCTION: Efforts to understand environmental factors that foster effective learning resulted in the development of a questionnaire to measure medical residents' perceptions of the level of autonomy, teaching quality and social support in their programs. METHODS: The questionnaire was translated using the modified Brislin back-translation technique. Cronbach's alpha test was used to ensure good reliability and ANOVA was used to compare PHEEM results among residents from the Surgery, Anesthesiology and Internal Medicine departments. The Kappa coefficient was used as a measure of agreement, and factor analysis was employed to evaluate the construct strength of the three domains suggested by the original PHEEM questionnaire. RESULTS: The PHEEM survey was completed by 306 medical residents and the resulting Cronbach's alpha was 0.899. The weighted Kappa was showed excellent reliability. Autonomy was rated most highly by Internal Medicine residents (63.7% ± 13.6%. Teaching was rated highest in Anesthesiology (66.7% ± 15.4%. Residents across the three areas had similar perceptions of social support (59.0% ± 13.3% for Surgery; 60.5% ± 13.6% for Internal Medicine; 61.4% ± 14.4% for Anesthesiology. Factor analysis suggested that nine factors explained 58.9% of the variance. CONCLUSIONS: This study indicates that PHEEM is a reliable instrument for measuring the quality of medical residency programs at a Brazilian teaching hospital. The results suggest that quality of teaching was the best indicator of overall response to the questionnaire.

  7. Prognostic factors for mortality among patients above the 6th decade undergoing non-cardiac surgery: cares - clinical assessment and research in elderly surgical patients

    Directory of Open Access Journals (Sweden)

    Adriana Nunes Machado

    2008-01-01

    Full Text Available PURPOSE: To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients >55 years who undergo non-cardiac surgery. METHODS: A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky's modified cardiac risk index - American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS: The mean age of the subjects was 70.8 ± 8.1 years. The "very old" (>80 years represented 14%. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02 and/or valvular heart disease (OR: 31.79; p=0.006 were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016. Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63%. DISCUSSION: The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality.

  8. Exploration of patients’ and doctors’ perceptions of the role of anesthesiologist and anesthesia

    Directory of Open Access Journals (Sweden)

    Panagiota Ntouma

    2015-04-01

    Full Text Available Introduction: Anesthesiology is a medical specialty with rapid development in the recent decades. The work of anesthetists, however, is not recognized in the medical circles and research reports that patients have incomplete knowledge about anesthesia and the anesthesiologist. Purpose: The purpose of the present research was to assess the views of patients and doctors of other specialties in Greece, for the role of the anesthesiologist and anesthesia. Material and Methods: The study was conducted at the General Hospital of Thessaloniki, Papageorgiou, with the use of questionnaires, during January-March 2014, and data were analyzed with SPSS 15. The study included 100 participants from the surgical clinics and 50 doctors from other specialties. Results: The vast majority of patients (> 90%, who took part in the research, are aware that the anesthesiologist is a physician but are not aware of the specific tasks undertaken in the peri-operative period. Also, they have knowledge for several of their out of surgery activities, except from their involvement in the radiology department (16%, the pain clinic (23% and the psychiatric clinic (20%. The same lack of knowledge is evident for the latter by the other physicians too (only 22% was aware as well as for the necessary preoperative withhold of food and drink (34%, and the involvement of anesthesiologist in cardiology (44%, psychiatric (22% clinics and radiology department (42%. However, they are generally aware of most of anesthesiologist’s tasks and anesthesia’s complications. Conclusions: The research shows the need to intensify efforts from anesthesiologists to inform patients about issues related to anesthesiology. Doctors of other specialties lack expertise in specific issues of anesthesiology; therefore they need additional training in order to contribute in informing patients.

  9. Ultrasound for the Anesthesiologists: Present and Future

    Directory of Open Access Journals (Sweden)

    Abdullah S. Terkawi

    2013-01-01

    Full Text Available Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD measurement and transcranial color coded duplex (TCCD are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE and transesophageal (TEE echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum.

  10. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  11. Perioperative communication practices of anesthesiologists: A need to introspect and change

    Science.gov (United States)

    Hemanth Kumar, V. R.; Jahagirdar, Sameer Mahamud; Ravishankar, M.; Athiraman, Umesh Kumar; Maclean, Jennyl; Parthasarathy, S.

    2016-01-01

    Background: We conducted an audit of various communication practices during perioperative care among anesthesiology resident (R), faculties (F), and private practitioners (PP) in South India. We also documented the level of psycho-social support given to the patient and patient relatives and communication with the surgical colleagues during perioperative care. Methodology: A 15-point questionnaire based on communication practices was distributed in three major anesthesiology conferences requesting anesthesiologists to answer and drop the forms in the drop box provided. Resident and consultant level anesthesiologists of various Medical Schools in South India and private practitioners were involved in the study. The answers were analyzed to find out the various communication practices in perioperative care. Results: The freelancing private practitioners (PP) were more communicative to patient and relatives especially in complicated cases (Q1 - 45.6%, Q2 - 97.8%, Q4 - 94.4%, Q8 - 98.9%, respectively) in comparison with institutionalized practitioners. The choice of anesthesia and discussion related to the advantages of one mode of anesthesia over other was the most neglected part of communication (R - 14.2%, F - 17.6%, and PP - 5.6%). The PP's (95.6%) are more concerned about intraoperative communication (R - 27.6%, F - 39.2%). The discussion of postoperative pain management plan with the surgeon is not given priority in the communication by postgraduates (7.9%) and teaching faculties (8.8%). Conclusion: There is an urgent need to introspect and change the communication practices. We strongly recommend that communications skills should be introduced in anesthesiology resident curriculum. PMID:27212751

  12. [Preoperative assessment for extended hepatic resection].

    Science.gov (United States)

    Martin, David; Roulin, Didier; Takamune, Yamaguchi; Demartines, Nicolas; Halkic, Nermin

    2016-06-15

    The number of major hepatectomy performed for the treatment of primary or secondary liver cancer has increased over the past two decades. By definition, a major hepatectomy includes the resection of at least three liversegments. Advances in anesthesiology, surgical and radiological techniques and perioperative management allowed a broad patient selection with increased security. Every case must be discussed in multidisciplinary tumor board, and preoperative assessment should include biological, volumetric and functional hepatic parameters. In case of preoperative insufficient liver volume, portal vein embolization allows increasing the size of liver remnant. This paper aims describing preoperative work-up. PMID:27487623

  13. [Perioperative Challenges and Strategies for Patent Foramen Ovale Patients Undergoing Non-cardiac Surgery].

    Science.gov (United States)

    Wang, Tian; Zhu, Bin

    2015-08-01

    The close relationship between patent foramen ovale(PFO)and cryptogenic ischemic cerebrovascular disease and migraine has been concerned for years. However,in the field of non-cardiac surgery and anesthesiology, PFO and related clinical problems are less recognized. Under perioperative circumstances,PFO may generate many challenges such as paradoxical systematic embolism and severe hypoxemia. This article briefly introduces the epidemiology, paradoxical embolism, and detection methods of PFO and discribes the perioperative complications and corresponding perioperative strategies for prevention and cure. PMID:26564467

  14. Differential laundering practices of white coats and scrubs among health care professionals.

    Science.gov (United States)

    Munoz-Price, L Silvia; Arheart, Kristopher L; Lubarsky, David A; Birnbach, David J

    2013-06-01

    The role played by health care worker's uniforms on the horizontal transmission of organisms within the hospital is still controversial. To determine the differential laundering practices in regards to white coats and scrubs, we surveyed physicians present at the 3 weekly academic conferences with largest attendance at our hospital (medicine, pediatrics, and anesthesiology). Out of 160 providers, white coats were washed every 12.4 ± 1.1 days and scrubs every 1.7 ± 0.1 days (mean ± standard error; P scrubs more frequently than house staff (1.0 vs 1.9 days, respectively, P = .018), and no differences were observed among specialties. PMID:23219673

  15. Meandering Musings by Linus Pauling: "American Scientists and the Spirit of the Frontier".

    Science.gov (United States)

    Bause, George S

    2016-04-01

    Hoping to raise funds in 1975 for his namesake institute, Linus Pauling submitted to Esquire magazine a 32-page handwritten manuscript, "American Scientists and the Spirit of the Frontier." Angered when his submission for publication was declined, Pauling eventually gifted the original manuscript in 1986 to his friend, Linus Pauling Institute fundraiser Stephen Maddox, who would sell it in 2004 to the Wood Library-Museum of Anesthesiology. Published accurately here for the first time, the manuscript captures not only Pauling's sweeping metaphor of scientists as frontiersmen but also the creative process by which Pauling formulated his hydrate microcrystal theory of general anesthesia.

  16. An Unusual Cause of Carbon Monoxide Poisoning: Narghile Smoking

    Science.gov (United States)

    Ateş, Alpay; Arikan, Müge; Özgök, Ayşegül

    2016-01-01

    Patient: Male, 27 Final Diagnosis: Carbon monoxide poisoning Symptoms: Dizziness • nausea • Syncope Medication: — Clinical Procedure: O2 treatment Specialty: Anesthesiology Objective: Challenging differential diagnosis Background: Carbon monoxide (CO) poisoning is commonly seen during the winter season in Turkey due to use of charcoal stoves and water heaters, but narghile smoking is a rare cause of CO poisoning. Case Report: In this paper, we report a CO poisoning case caused by narghile smoking. The patient was admitted to the ED with nausea, dizziness, vertigo, and syncope. Conclusions: The diagnosis of CO poisoning depends on suspicious anamnesis. The major treatment of CO poisoning is oxygen supply. PMID:27618983

  17. Quality and safety in anesthesia and perioperative care

    CERN Document Server

    Ruskin, Keith J; Rosenbaum, Stanley H

    2016-01-01

    Quality and Safety in Anesthesia and Perioperative Care offers practical suggestions for improving quality of care and patient safety in the perioperative setting. The book highlights concepts such as situation awareness, staff resource management, threat and error management, checklists, explicit practices for monitoring, and safety culture. Quality and Safety in Anesthesia and Perioperative Care is a must-have resource for those preparing for the quality and safety questions on the American Board of Anesthesiology certification examinations and clinicians and trainees in all practice setting

  18. "What Have We Done for Us Lately?"--Defining Performance and Value at the Individual Clinician Level.

    Science.gov (United States)

    Dobie, Katherine H; Tiwari, Vikram; Sandberg, Warren S

    2015-12-01

    Consolidation in anesthesiology practice and the rest of health care creates pressure to improve the product offered by anesthesia professionals. Anesthesia professionals must offer more than a reliable stream of anesthetized, operated, and recovered patients to remain competitive. By pooling resources and application of leadership effort, large departments and group practices can conduct individual-level value assessments of clinicians. Individual clinicians can be incentivized to improve their personal value proposition. By creating an interlocking program of ongoing assessment, career development coaching and opportunities, as well as compensation, departments and group practices can return value to individual clinicians by curating and accelerating their career and capability development. PMID:26610622

  19. Pediatric pain management: the multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Odell S

    2013-11-01

    Full Text Available Shannon Odell,1,2 Deirdre E Logan1,21Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Department of Psychiatry, Harvard Medical School, Boston, MA, USAAbstract: Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain rehabilitation centers. This review offers a summary of the challenges faced by these programs and areas for future study.Keywords: pediatric pain rehabilitation, pediatric chronic pain, interdisciplinary, pain associated disability

  20. Morphology and topographic anatomy of the spinal cord of the red-footed tortoise (Geochelone carbonaria Spix, 1824)

    OpenAIRE

    Rafael C. Carvalho; Alana L. Sousa; Sâmia C.R Oliveira; Ana C.B.C.F. Pinto; José H Fontenelle; Silvia R.G. Cortopassi

    2011-01-01

    The aim of this study was to describe the topography of the spinal cord of the red-footed tortoise to establish a morphological basis for applied research in anesthesiology and morphology. Six tortoises from the state of Maranhão (Brazil) that had died of natural causes were used. The common carotid artery was used to perfuse the arterial system with saline solution (heated to 37ºC) and to fix the material with a 20% formaldehyde solution. The specimens were then placed in a modified decalcif...

  1. The anesthesia information management system for electronic documentation: what are we waiting for?

    Science.gov (United States)

    Bloomfield, Eric L; Feinglass, Neil G

    2008-01-01

    The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time. In this article, we describe challenges that must be overcome to establish an efficient electronic medical record system for anesthesiology. PMID:19011780

  2. Simulation for transthoracic echocardiography of aortic valve

    Science.gov (United States)

    Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra

    2016-01-01

    Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

  3. Efficacy and safety of intravenous nimodipine administration for treatment of hypertension in patients with intracerebral hemorrhage

    OpenAIRE

    Li YQ; Fang W.; Tao L; Li M; Yang YL; Gao YF; Ge SN; Gao L; Zhang B; Li ZH; Zhou W.; Wang BL; Li LH

    2015-01-01

    Yuqian Li,1,* Wei Fang,1,* Lei Tao,2,* Min Li,1 Yanlong Yang,1 Yafei Gao,1 Shunnan Ge,1 Li Gao,1 Bin Zhang,1 Zhihong Li,1 Wei Zhou,1 Boliang Wang,3 Lihong Li11Department of Neurosurgery, 2Department of Anesthesiology, 3Department of Emergency, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this studyBackground: Nicardipine (NC) is the most commonly used antihypertensive drug in neurologi...

  4. Efficacy and safety of intravenous nimodipine administration for treatment of hypertension in patients with intracerebral hemorrhage

    OpenAIRE

    Li, Lihong

    2015-01-01

    Yuqian Li,1,* Wei Fang,1,* Lei Tao,2,* Min Li,1 Yanlong Yang,1 Yafei Gao,1 Shunnan Ge,1 Li Gao,1 Bin Zhang,1 Zhihong Li,1 Wei Zhou,1 Boliang Wang,3 Lihong Li11Department of Neurosurgery, 2Department of Anesthesiology, 3Department of Emergency, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this studyBackground: Nicardipine (NC) is the most commonly used antihypertensive drug ...

  5. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass

    Science.gov (United States)

    Engelman, Richard; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina; Dickinson, Timothy A.; Shore-Lesserson, Linda; Hammon, John W.

    2015-01-01

    Abstract: To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation. PMID:26543248

  6. [Ernst von der Porten : looking for facts before and after forced emigration].

    Science.gov (United States)

    Goerig, M; Bruijn, L

    2014-10-01

    The Ernst von der Porten medal has been awarded for many years to exceptional personalities by the Alliance of German Anesthesiologists to honor the outstanding achievements of the physician Ernst von der Porten from Hamburg in the development of anesthesiology as an autonomous discipline Only recent access to hitherto inaccessible documents enabled the reconstruction of his final years. He was persecuted and excluded by the National Socialist (NS) regime due to his Jewish roots and finally forced to emigrate. Records revealed that even in the so-called safe exile, degrading treatment and humiliation continued for Ernst von der Porten and his family. He eventually evaded this situation by committing suicide.

  7. Journal of Clinical Monitoring and Computing 2015 end of year summary: anesthesia.

    Science.gov (United States)

    Hendrickx, Jan F A; De Wolf, Andre; Skinner, Stanley

    2016-02-01

    Clinical monitoring is an essential part of the profession of anesthesiology. It would therefore be impossible to review all articles published in the Journal of Clinical Monitoring and Computing that are relevant to anesthesia. Because other reviews will address monitoring of the respiratory and cardiovascular system, the current review will limit itself to topics uniquely related to anesthesia. The topics are organized according to the chronological order in which an anesthetic proceeds: secure the airway; ventilate and deliver anesthetic gases; monitor vital organ function and anesthetic depth; and ensure analgesia during/after emergence from anesthesia (locoregional anesthesia and pain control). PMID:26707866

  8. Xerostomia induced by radiotherapy

    Directory of Open Access Journals (Sweden)

    Alimi D

    2015-08-01

    Full Text Available David Alimi Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAWe read with great interest the excellent review on xerostomia induced by radiotherapy, by Pinna et al.1 The authors should be congratulated for a very detailed review of the physiopathology, clinical symptoms, and therapeutic management of an extremely difficult condition. Although we agree that the use of anticholinergic medication represents treatment, it requires the patient to have residual salivary gland function. Unfortunately, it is well established that in most cases radiotherapy destroys most of the salivary gland and associated salivary secretions.     

  9. Simultaneous management of renal carcinoma with caval vein thrombosis and double coronary artery disease

    Directory of Open Access Journals (Sweden)

    Marco Grasso

    2013-12-01

    Full Text Available Introduction: Recent advances in surgical and anesthesiology techniques allow simultaneous thoracic and abdominal operations to be performed for severe heart disease and benignant or malignant abdominal diseases. Case report: The simultaneous surgical management in a 75-year-old patient suffering from severe double coronary artery disease and a renal cell carcinoma with extended intravascular growth into the inferior vena cava is reported. Conclusion: The postoperative course was uneventful. Simultaneous surgery proved to be beneficial and safe, showing optimal results in our patient.

  10. The History of Geriatric Anesthesia in the United States and the Society for the Advancement of Geriatric Anesthesia.

    Science.gov (United States)

    Rooke, G Alec

    2015-09-01

    Creation of the American Society of Anesthesiologists Committee on Geriatric Anesthesia provided an opportunity for individuals to interact, strategize, and work with medical organizations outside of anesthesiology. These opportunities expanded with creation of the Society for the Advancement of Geriatric Anesthesia. The American Geriatrics Society provided a major boost when they realized it was important for surgical and related specialties to take an active role in the care of older patients. From this have come educational grants to improve residency training and establishment of a major research grant program now managed by the National Institutes of Health. Nevertheless, for improved care of the older patient, the level of involvement has to increase.

  11. Double-balloon endoscopy: Who needs it?

    DEFF Research Database (Denmark)

    Hendel, J.W.; Vilmann, P.; Jensen, T.

    2008-01-01

    Objective. Double-balloon endoscopy (DBE) made the small bowel accessible to inspection and therapy in its entirety. However, DBE is a time-consuming procedure that requires a highly skilled endoscopist, several nurses and - more often than not - anesthesiological support. This makes the selection...... of patients for DBE a pivotal point. The mainstay of this screening examination of the small bowel is capsule endoscopy (CE). The aim of this study was to describe the results of this screening procedure and the subsequent DBE in patients with suspected mid-gastrointestinal bleeding (MGIB). Material...

  12. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars;

    2016-01-01

    data from patients sedated with intermittent deep NAPS for ERCP, EUS or double balloon enteroscopy (DBE, since the method was implemented in May 2007 through December 2012 were included for evaluation in a retrospective case-control design. RESULTS: Data from 1899 patients undergoing 1899 procedures...... were included for evaluation. All but one procedure were completed with intermittent deep NAPS. The mean propofol dose was 397 mg (SD: 232.4) and the infusion rate was 23.9 mg/kg. The frequency of hypoxia was 4.3 % and 20 patients needed assisted ventilation (1.1 %). Anesthesiologic support...

  13. Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Joelle W Boeve

    2011-03-01

    Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

  14. Meandering Musings by Linus Pauling: "American Scientists and the Spirit of the Frontier".

    Science.gov (United States)

    Bause, George S

    2016-04-01

    Hoping to raise funds in 1975 for his namesake institute, Linus Pauling submitted to Esquire magazine a 32-page handwritten manuscript, "American Scientists and the Spirit of the Frontier." Angered when his submission for publication was declined, Pauling eventually gifted the original manuscript in 1986 to his friend, Linus Pauling Institute fundraiser Stephen Maddox, who would sell it in 2004 to the Wood Library-Museum of Anesthesiology. Published accurately here for the first time, the manuscript captures not only Pauling's sweeping metaphor of scientists as frontiersmen but also the creative process by which Pauling formulated his hydrate microcrystal theory of general anesthesia. PMID:27080503

  15. Essential training steps to achieving competency in the basic intraoperative transesophageal echocardiography examination for Chinese anesthesiologists.

    Science.gov (United States)

    Peng, Yong G; Song, Haibo; Wang, E; Wang, Weipeng; Liu, Jin

    2015-03-01

    Guidelines for the intraoperative transesophageal echocardiography (TEE) examination have defined a detailed standard for medical professionals, particularly anesthesiologists, on how a TEE exam should proceed. Over the years, TEE has gained substantial popularity and emerged as a preferred monitoring modality to aid in perioperative management and decision making during hemodynamic instability situations or critical care settings. TEE training pathways and practice guidelines have been well established in western countries and many regions of the world. However, TEE training and practice information for anesthesiologists are lacking in China. As innovative technologies develop, other educational models have emerged to aid in obtaining competency in basic TEE exam. Hence, establishing a consensus on the ideal TEE training approach for anesthesiologists in China is urgently needed. Developing an effective curriculum that can be incorporated into an anesthesiology resident's overall training is also necessary to provide knowledge and skills toward competency in basic TEE exam. With evolving medical system reforms and increasing demands for intraoperative hemodynamic monitoring to accommodate surgical innovations, anesthesiology professionals are increasingly obliged to perform intraoperative TEE exams in their current and future practices. To overcome obstacles and achieve significant progress in using the TEE modality to help in intraoperative management and surgical decision making, publishing basic TEE training guidelines for China's anesthesiologists is an important endeavor. PMID:25337689

  16. Tapentadol extended release in the management of peripheral diabetic neuropathic pain

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2015-01-01

    Full Text Available Nalini Vadivelu,1 Alice Kai,2 Benjamin Maslin,1 Gopal Kodumudi,3 Aron Legler,1 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Stony Brook University School of Medicine, Stony Brook, NY, USA; 3Department of Structural and Cellular Biology, Tulane University, New Orleans, LA, USA; 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Tapentadol, a µ-opioid agonist and norepinephrine reuptake inhibitor, has been found to be an effective medication for a wide variety of chronic pain conditions, including back pain, cancer-related pain, and arthritic pain. It has also been found to have fewer gastrointestinal side effects than more traditional opioid-based therapies. More recently, tapentadol extended release has been demonstrated to be effective in the management of painful diabetic neuropathy, an often debilitating condition affecting approximately one-third of all patients with diabetes. This review highlights the most up-to-date basic and clinical studies by focusing on the mechanisms of action of tapentadol and its clinical efficacy, especially with regard to painful diabetic neuropathy. Keywords: chronic pain, neuropathic pain, pharmacology, analgesia, pain management

  17. American-trained Chinese anesthesiologists: how are they doing?

    Science.gov (United States)

    Zhao, Peishan; Hu, Fengling

    2016-09-01

    More than 60 years have passed since 3 pioneer Chinese anesthesiologists were trained by American physicians. After returning to China, they applied their new knowledge and skills to develop a new anesthesia specialty in their own country. Over the past 2 decades, close to 600 Chinese medical graduates have been trained in the United States and have become part of the American anesthesia workforce. Unlike their elder generation, they did not go back to China after their training. People are always wondering how this new generation of American-trained Chinese anesthesiologists is doing in a different culture and different health care and political systems. This review indicates that these newly American-trained Chinese anesthesiologists not only provide high-quality patient care but also conduct outstanding anesthesia teaching and research. In addition, as their pioneer anesthesiologists did in China, they use professional organizations and publications as 2 major means to advance professional development and promote academic exchanges between Chinese and American anesthesiologists, through which American anesthesiology continues to have influence on modern Chinese anesthesiology. PMID:27555192

  18. Cognitive responses to hypobaric hypoxia: implications for aviation training

    Directory of Open Access Journals (Sweden)

    Neuhaus C

    2014-11-01

    Full Text Available Christopher Neuhaus,1,2 Jochen Hinkelbein2,31Department of Anesthesiology, Heidelberg University Hospital, Ruprecht Karls University of Heidelberg, Heidelberg, 2Emergency Medicine and Air Rescue Working Group, German Society of Aviation and Space Medicine (DGLRM, Munich, 3Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, GermanyAbstract: The aim of this narrative review is to provide an overview on cognitive responses to hypobaric hypoxia and to show relevant implications for aviation training. A principal element of hypoxia-awareness training is the intentional evocation of hypoxia symptoms during specific training sessions within a safe and controlled environment. Repetitive training should enable pilots to learn and recognize their personal hypoxia symptoms. A time span of 3–6 years is generally considered suitable to refresh knowledge of the more subtle and early symptoms especially. Currently, there are two different technical approaches available to induce hypoxia during training: hypobaric chamber training and reduced-oxygen breathing devices. Hypoxia training for aircrew is extremely important and effective, and the hypoxia symptoms should be emphasized clearly to aircrews. The use of tight-fitting masks, leak checks, and equipment checks should be taught to all aircrew and reinforced regularly. It is noteworthy that there are major differences in the required quality and quantity of hypoxia training for both military and civilian pilots.Keywords: cognitive response, aviation training, pilot, hypoxia, oxygen, loss of consciousness

  19. [Training -- competency-based education -- learning theory and practice].

    Science.gov (United States)

    Breuer, Georg

    2013-11-01

    A lifelong learning process is necessarily the basis for the specialization and expertise in the field of anesthesiology. Thus competency as a physician is a complex, multidimensional construction of knowledge, skills and attitudes to be able to solve and persist the complex daily work challenges in a flexible and responsible way. Experts therefore showflexible and intuitive capabilities in pursuing their profession. Accordingly modern competency based learning objectives are very helpful. The DGAI Commission for “Further Education” already thought ahead in defining a competencybased curriculum for the specialization in the field of anesthesiology and could be integrated into the frameworks of the German Medical Association. In addition to the curricular framework elements of assessment are necessary. A single oral exam is consequently not representative for different levels of competencies. However, there is beside the responsibility of the learners for their learning processalso a high obligation of the clinical teachers to attend the learning process and to ensure a positive learning atmosphere with scope for feedback. Some competencies potentially could be better learned in a “sheltered” room based on simulation outside the OR, for example to train rare incidents or emergency procedures. In general there should be ongoing effort to enhance the process of expertise development, also in context of patient safety and quality management.

  20. Anesthesia management of caesarean section for pregnant women complicated with Takayasu’s arteritis%合并大动脉炎产妇行剖宫产术的围术期管理

    Institute of Scientific and Technical Information of China (English)

    孙杰; 曾鸿; 王永清; 赵扬玉

    2016-01-01

    SUMMARY Takayasu’s arteritis is a rare,idiopathic,chronic inflammatory disease.Its course is un-predictable,but slow progression is usual,leading to stenosis,occlusion,or aneurismal degeneration of the aorta or its major branches.We present the anesthesia management of pregnancy in four women ad-mitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu’s arteritis and review this disease with special reference to natural history,diagnostic criteria, classification,prognostic factors,and anesthesia considerations.Anesthesiological data were retrospec-tively analyzed for clinical manifestations,anesthesia process,perioperative complications,and pregnan-cy outcome.One patient received only epidural anesthesia,while the other three patients received com-bined spinal and epidural anesthesia (CSEA).Surgeries for all the four patients were successful with sta-ble vital signs.We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diag-nosed with Takayasu’s arteritis.CSEA and continuous epidural block could be both used as anesthesio-logical method in patients with Takayasu’s arteritis.During the surgery,to avoid rapid hemodynamic fluctuations and protect the major organs’function is very essential to allow for a satisfactory outcome.

  1. Content and Phrasing in Titles of Original Research and Review Articles in 2015: Range of Practice in Four Clinical Journals

    Directory of Open Access Journals (Sweden)

    Mary Ellen Kerans

    2016-04-01

    Full Text Available Reporting guidelines for clinical research designs emerged in the mid-1990s and have influenced various aspects of research articles, including titles, which have also been subject to changing uses with the growth of electronic database searching and efforts to reduce bias in literature searches. We aimed (1 to learn more about titles in clinical medicine today and (2 to develop an efficient, reliable way to study titles over time and on the fly—for quick application by authors, manuscript editors, translators and instructors. We compared content and form in titles from two general medical journals—the New England Journal of Medicine (NEJM and the British Medical Journal—and two anesthesiology journals (the European Journal of Anaesthesiology and Anesthesiology; we also analyzed the inter-rater reliability of our coding. Significant content differences were found in the frequencies of mentions of methods, results (between general and subspecialty titles, and geographic setting; phrasing differences were found in the prevalence of full-sentence and compound titles (and their punctuation. NEJM titles were significantly shorter, and this journal differed consistently on several features. We conclude that authors must learn to efficiently survey titles for form and content patterns when preparing manuscripts to submit to unfamiliar journals or on resubmitting to a new journal after rejection.

  2. Topical local anesthesia: focus on lidocaine–tetracaine combination

    Directory of Open Access Journals (Sweden)

    Giordano D

    2015-11-01

    Full Text Available Davide Giordano,1 Maria Gabriella Raso,2 Carmine Pernice,1 Vanni Agnoletti,3 Verter Barbieri1 1Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, 2Anesthesiology, Intensive Care, and Pain Medicine Unit, Department of Surgical Sciences, University Hospital of Parma, Parma, 3Anesthesiology and Intensive Care Unit, Department of Cardiology, Thoracic and Vascular Surgery, and Critical Care Medicine, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: In recent years, the popularity of aesthetic and cosmetic procedures, often performed in outpatient settings, has strongly renewed interest in topical anesthetics. A number of different options are widely used, alone or in combination, in order to minimize the pain related to surgery. Moreover, interest in local anesthetics in the treatment of some painful degenerative conditions such as myofascial trigger point pain, shoulder impingement syndrome, or patellar tendinopathy is increasing. Numerous clinical trials have shown that lidocaine–tetracaine combination, recently approved for adults aged 18 or older, is effective and safe in managing pain. The present paper gives an overview of the recent literature regarding the efficacy and safety of lidocaine–tetracaine combination use. Keywords: lidocaine, tetracaine, local anesthetics, efficacy, safety

  3. Ultrasound guidance in regional anesthesia: state of the art review through challenging clinical scenarios

    Directory of Open Access Journals (Sweden)

    Brian D Sites

    2009-01-01

    Full Text Available Brian D Sites1, John G Antonakakis21Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; 2Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USAAbstract: Ultrasound guided regional anesthesia (UGRA for peripheral nerve blockade is becoming increasingly popular. The advantage of ultrasound technology is that it affords the anesthesiologist the real time ability to visualize neural structures, needle advancement, and local anesthetic spread. Recent data suggest that UGRA generates improved success rates and reductions in performance times in comparison to traditional approaches. Further, the use of ultrasound technology in peripheral nerve blocks has provided insight into needle–nerve interactions, revealing distinct limitations of nerve stimulator techniques. Given that UGRA requires a unique set of skills, formal standards and guidelines are currently being developed by leadership societies in order to foster education and training. This review article, in a case vignette format, highlights important techniques, concepts, and limitations regarding the use of ultrasound to facilitate regional anesthesia. Clinically relevant aspects of ultrasound physics are also discussed.Keywords: ultrasound, regional anesthesia

  4. The development of a specialty: an interview with Dr. Mark C. Rogers, a pioneering pediatric intensivist.

    Science.gov (United States)

    Mai, Christine L; Firth, Paul G; Ahmed, Zulfiqar; Rodriguez, Samuel; Yaster, Myron

    2014-09-01

    Dr. Mark C. Rogers (1942-), Professor of Anesthesiology, Critical Care Medicine, and Pediatrics at the Johns Hopkins University, was recruited by the Department of Pediatrics at Johns Hopkins Hospital in 1977 to become the first director of its pediatric intensive care unit. After the dean of the medical school appointed him to chair the Department of Anesthesia in 1979, Rogers changed the course and culture of the department. He renamed it the Department of Anesthesiology and Critical Care Medicine, and developed a long-term strategy of excellence in clinical care, research, and education. However, throughout this period, he never lost his connection to pediatric intensive care. He has made numerous contributions to pediatric critical care medicine through research and his authoritative textbook, Rogers' Textbook of Pediatric Intensive Care. He established a training programme that has produced a plethora of leaders, helped develop the pediatric critical care board examination, and initiated the first World Congress of Pediatric Intensive Care. Based on a series of interviews with Dr. Rogers, this article reviews his influential career and the impact he made on developing pediatric critical care as a specialty. PMID:25065470

  5. Anterior and posterior tibial anesthetic block in diabetic foot surgery.

    Directory of Open Access Journals (Sweden)

    José Julio Ojeda González

    2004-12-01

    Full Text Available Fundament: Diabetes Mellitus is a disease of high and increasing prevalence and its complications follow a parallel course. Its morbidity is derived from its own complications which are produced at a long or short term and peripheral vascular disease hihglights among them.Objective: to check the usefulness of the anterior and posterior blockade of the tibia for the surgery of the diabetic foot. Method: Prospective study carried out from January to December 2003 at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ to patients who are carriers of a diabetic foot and who were initially assisted at the service of Angiology and later at the service of Anesthesiology when the surgical procedures were decided. All the patients were applied an anterior and posterior blockade of the tibial nerve . The variables measured were: age, weight, height, surgical time, type of surgery, cardiac frequency medium arterial pressure, and classification of patients according to the American Association of Anesthesiology All the patients were applied a scale for assessing pain in three different moments.Result: There was a predominance of females . The blockade of the posterior tibial nerve with lidocaine 1 % in different points permitted the performance of the surgical techniques proposed. The anesthetic procedure was favorable, and economic since the patients did not requiere of the use of analgesic in the post operatory stage.

  6. The impact of anesthesia providers on major morbidity following screening colonoscopies

    Directory of Open Access Journals (Sweden)

    Lubarsky DA

    2015-05-01

    Full Text Available David A Lubarsky,1 Jason R Guercio,2 John W Hanna,3,4 Maria T Abreu,5 Qianli Ma,3 Claudia Uribe,3 David J Birnbach,1,6 David R Sinclair,1 Keith A Candiotti1 1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami – Miller School of Medicine, Miami, FL, USA; 2Department of Anesthesiology, Duke University, Durham, NC, USA; 3Humana, Comprehensive Health Insights, Miami, FL, USA; 4University of Miami – Miller School of Medicine, Miami, FL, USA; 5Department of Medicine, Division of Gastroenterology, University of Miami – Miller School of Medicine, Miami, FL, USA; 6Department of Public Health Sciences, University of Miami – Miller School of Medicine, Miami, FL, USA Background and aims: Few studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies. Methods: A propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO, preferred provider organization (PPO, and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI, new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers. Results: The presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national

  7. Management of postoperative pain: experience of the Niamey National Hospital, Niger

    Directory of Open Access Journals (Sweden)

    Chaibou MS

    2012-12-01

    Full Text Available Maman Sani Chaibou,1 Samuila Sanoussi,2 Rachid Sani,2 Nouhou A Toudou,1 Hadjara Daddy,1 Moussa Madougou,1 Idrissa Abdou,1 Habibou Abarchi,2 Martin Chobli31Department of Anesthesiology and Intensive Care, 2Department of Surgery, The Niamey National Hospital, Niamey, Republic of Niger; 3Department of Anesthesiology, Hubert K Maga University Teaching Hospital, Cotonou, BeninObjective: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital.Methods: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS, the numerical rating scale (NRS, or the visual analog scale (VAS. Patients were evaluated during the first 48 hours following surgery.Results: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. Conclusion: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results

  8. Soap-scented oil skin patch in the treatment of fibromyalgia: A case series

    Directory of Open Access Journals (Sweden)

    Yon Doo Ough

    2008-09-01

    Full Text Available Yon Doo OughDepartment of Anesthesiology, Beloit Memorial Hospital, Beloit, WI, USAAbstract: Treatment for fibromyalgia is largely empiric and supportive, and favors a multidisciplinary approach. Despite treatment, symptomatic relief is often inadequate and temporary. Over 90% of fibromyalgia patients seek alternative medical care. There is much anecdotal evidence that applying a bar of soap to the skin can relieve leg cramps. Expanding on this idea, I created a skin patch from soap-scented oil, which was used to treat muscular pain and spasms. After receiving positive feedback from several patients, I hypothesized that the scent of the oil itself, applied directly to the skin, is responsible for the pain-relieving and muscle-relaxant properties of the skin patch. Furthermore, I hypothesize that this soap-scented oil skin patch is an effective treatment for the pain associated with fibromyalgia.Keywords: fibromyalgia, headache, soap-scented oil skin patch

  9. Current role of non-anesthesiologist administered propofolsedation in advanced interventional endoscopy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Complex and lengthy endoscopic examinations likeendoscopic ultrasonography and/or endoscopic retrogradecholangiopancreatography benefit from deepsedation, due to an enhanced quality of examinations,reduced discomfort and anxiety of patients, as well asincreased satisfaction for both the patients and medicalpersonnel. Current guidelines support the use ofpropofol sedation, which has the same rate of adverseeffects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recoverytime. Non-anesthesiologist administered propofolsedation has become an option in most of the countries,due to limited anesthesiology resources and theincreasing evidence from prospective studies and metaanalysesthat the procedure is safe with a similar rate ofadverse events with traditional sedation. The advantagesinclude a high quality of endoscopic examination,improved satisfaction for patients and doctors, as wellas decreased recovery and discharge time. Despitethe advantages of non-anesthesiologist administeredpropofol, there is still a continuous debate related to thesuccessful generalization of the procedures.

  10. Reresection for recurrent stenosis after primary tracheal repair.

    Science.gov (United States)

    Madariaga, Maria Lucia; Gaissert, Henning A

    2016-03-01

    Failure of the anastomosis after primary tracheal reconstruction for benign disease is uncommon. Here we review the available evidence on tracheal restenosis and the results of second reconstructions. Factors associated with failed primary anastomosis are examined. Temporizing immediate and alternative long-term management with T-tube or tracheostomy is described, emphasizing the role of tracheal stenting in abating the urgency for reoperation. From available evidence, elective reoperative treatment of failed tracheal reconstruction should be considered in selected patients after careful review and reversal of patient- and operation-specific factors that initiated failure. Referral to a high-volume center with a deep bench of nursing, anesthesiologic and surgical expertise is recommended for reoperation. PMID:26981266

  11. A DOUBLE BLIND COMPARATIVE STUDY OF I.V. CLONIDINE AND FENTANYL TO SEE THE HAEMODYNAMIC RESPONSE DURING LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Nameirakpam

    2014-08-01

    Full Text Available In the present study we have compared Clonidine (1µg/kg and Fentanyl (2µg/kg with minimum equipotent doses to attenuate the pressure response and at the same time avoiding the adverse effects of the respective drugs. After getting permission from the Ethical committee, a randomized double blinded study carried out in Department of Anesthesiology, JNMC, Sawangi (Meghe, Wardha, Maharashtra (India. The study comprises of 100 patients of both gender between 25 to 65 yrs. with Mallampatti grade I & II between ASA grade 1&2. They were randomly allocated into 2 groups of 50 each. Statstical analyses were done with Z test. Intravenous Clonidine was found to be more effective than intravenous Fentanyl in attenuating pressure response to laryngoscopy and intubation with the minimum equipotent dose

  12. Pregnancy in a Previously Conjoined Thoracopagus Twin with a Crisscross Heart

    Directory of Open Access Journals (Sweden)

    Bassam H. Rimawi

    2015-01-01

    Full Text Available Background. Crisscross heart (CCH is a complex, rare, congenital, rotational, cardiac abnormality that accounts for <0.1% of congenital heart defects (CHD. CCH is characterized by the crossing of the inflow streams of the two ventricles due to an abnormal twisting of the heart. A case of maternal CCH has not been previously reported. Case. We report a case of a primigravida with a CCH, who was separated at birth from her thoracopagus conjoined twin. Pregnancy was managed by congenital cardiology, maternal-fetal medicine, anesthesiology, and obstetrics. She underwent a 39-week vaginal delivery without maternal or neonatal complication. Conclusion. A successful term pregnancy outcome was achieved in a patient with CCH using a multidisciplinary approach to address her cardiac condition.

  13. [Organization of medical services for the victims of the earthquake in the city of Spitak, Armenian S.S.R].

    Science.gov (United States)

    Satsukevich, V N; Smirnov, A D; Samandarov, V Kh; Zhidkov, S A; Urmancheev, A A

    1990-03-01

    Sanitary losses in the city of Spitak were about 47.8%, injures of the middle and critical degree being diagnosed in 9.5%. During the first period (from December 9 to 14, 1988) patients admitted to the hospitals predominantly had traumas of the head, chest, extremities, vertebral column (86.3%). The crush syndrome and position compressions and their combinations with total cooling during this time were diagnosed in 61 victims (19%), and during the whole period of work--in 63 (7.6%). Success of treatment of the patients with this pathology was promoted by their having obtained qualified surgical and anesthesiological aid before evacuation to medical institutions of the Center in full value in combination with temporary admittance to the hospital at an average for 12-18 hours up to complete arrest of shock. During the first steps of evacuation the amputation of extremities was fulfilled in 3 cases.

  14. 罗哌卡因可用于清醒开颅手术

    Institute of Scientific and Technical Information of China (English)

    史中华

    2004-01-01

    由于能进行求中神经功能测试,清醒开颅技术已越来越多地应用于脑功能区的手求。但这类手求要求在保证良好镇静镇痛的基础上保持病人的清醒合作,从而给麻醉医师带来了巨大的挑战。通常认为,局部麻醉的实施是成功开展这类手术的必备因素。新近,Davidson等(Davidson E M,Avidan A.Ropivacaine anesthesia combined with propofol and alfentanil sedation for awake craniotomy.Anesthesiology,2004;101:A912)试验使用罗哌卡因局麻实施清醒开颅求。

  15. Decontamination of laryngoscopes in The Netherlands.

    Science.gov (United States)

    Bucx, M J; Dankert, J; Beenhakker, M M; Harrison, T E

    2001-01-01

    In this study the decontamination procedures of laryngoscopes in Dutch hospitals are described, based on a structured telephone questionnaire. There were substantial differences between decontamination procedures in Dutch hospitals and the standards of the APIC (Association of Professionals in Infection Control and Epidemiology), CDC (Centers of Disease Control) and ASA (American Society of Anesthesiology) were met in full in 19.4% of the hospitals. The standards of manual decontamination, used in 78% of the 139 hospitals, were particularly disappointing; manual cleaning was considered inadequate in 22.9% of these hospitals and manual disinfection did not meet the standards of the APIC, CDC or ASA in any of these hospitals. Decontamination by instrument cleaning machines as a standard procedure was used in 30 (22%) hospitals. In three of these hospitals the blades were subsequently sterilized. We suggest adherence to the infection control guidelines of the CDC, APIC and ASA, until the safety of less conservative infection control practices are demonstrated. PMID:11575419

  16. A surprising cause of wheezing in a morbidly obese patient: a case report

    Directory of Open Access Journals (Sweden)

    Kurnutala LN

    2014-10-01

    Full Text Available Lakshmi N Kurnutala, Minal Joshi, Hattiyangadi Kamath, Joel Yarmush Department of Anesthesiology, New York Methodist Hospital, Brooklyn, NY, USA Abstract: A typical patient with chronic obstructive pulmonary disease has small airway disease, which often responds to bronchodilators. If the patient is obese, he or she may be further compromised and not tolerate being in the supine position. We present a case of a patient with history of chronic obstructive pulmonary disease and obstructive sleep apnea with acute renal failure and urosepsis scheduled for an emergent debridement of Fournier's gangrene. In this patient, the fiberoptic intubation was performed in semi-Fowler's position, and tracheomalacia was observed. Keywords: tracheomalacia, difficult airway, fiberoptic intubation, COPD

  17. Virtual Airway Skills Trainer (VAST) Simulator

    Science.gov (United States)

    DEMIREL, Doga; YU, Alexander; HALIC, Tansel; SANKARANARAYANAN, Ganesh; RYASON, Adam; SPINDLER, David; BUTLER, Kathryn L.; CAO, Caroline; PETRUSA, Emil; MOLINA, Marcos; JONES, Dan; DE, Suvranu; DEMOYA, Marc; JONES, Stephanie

    2016-01-01

    This paper presents a simulation of Virtual Airway Skill Trainer (VAST) tasks. The simulated tasks are a part of two main airway management techniques; Endotracheal Intubation (ETI) and Cricothyroidotomy (CCT). ETI is a simple nonsurgical airway management technique, while CCT is the extreme surgical alternative to secure the airway of a patient. We developed identification of Mallampati class, finding the optimal angle for positioning pharyngeal/mouth axes tasks for ETI and identification of anatomical landmarks and incision tasks for CCT. Both ETI and CCT simulators were used to get physicians’ feedback at Society for Education in Anesthesiology and Association for Surgical Education spring meetings. In this preliminary validation study, total 38 participants for ETI and 48 for CCT performed each simulation task and completed pre and post questionnaires. In this work, we present the details of the simulation for the tasks and also the analysis of the collected data from the validation study. PMID:27046559

  18. 浅谈局部麻醉药的研究进展

    Institute of Scientific and Technical Information of China (English)

    王建兵

    2014-01-01

    with the development of anesthesiology and related disciplines, the theory and method of local anaesthesia and clinical practice are made a long-term development, this article wil mainly introduce the current clinical commonly used local anesthetics, adverse reactions and new dosage forms. To the in-depth discussion of local anesthetics wil promote the development of local anesthetic techniques.%随着麻醉学及相关学科的发展,局部麻醉的理论、方法和临床实践均取得了长远的发展,本文将主要介绍目前临床常用局麻药、不良反应以及新剂型的研制。不断对局部麻醉药的深入探讨必将推动局部麻醉技术的发展。

  19. Chronic organophosphate-induced neuropsychiatric disorder: a case report

    Directory of Open Access Journals (Sweden)

    Ghimire SR

    2016-02-01

    Full Text Available Shree Ram Ghimire,1 Sarita Parajuli2 1Department of Psychiatry, National Medical College, Birgunj, 2Department of Anesthesiology, Kathmandu National Medical College, Anamnagar, Kathmandu, Nepal Abstract: Chronic organophosphate (OP-induced neuropsychiatric disorder is a rare condition following prolonged exposure to OP compounds. Due to the lack of valid diagnostic tools and criteria, very few cases are seen in clinical practice and are often misdiagnosed. Misdiagnosis can lead to inappropriate treatment that may increase the risk of morbidity or suicidality. In this paper, we present the case of a 35-year-old male who needed support in breathing from a mechanical ventilator and developed neuropsychiatric behavioral problems following ingestion of OP compounds, which lead to suicidality. The patient was treated by the psychiatric team with antipsychotic and antidepressants and improved following the regular use of medication. Keywords: COPIND, mood liability, suicidal thoughts

  20. Current status and prospect of therapy with advanced cancer

    International Nuclear Information System (INIS)

    Symtomatic or palliative therapy of the patients with advanced cancer must be directed to the relief of specific distressing symptoms caused by or associated with neoplasm. The radiotherapy must have a clear concepts of the potential accomplishments of other treatment modalities, such as neurosurgery, anesthesiology, chemotherapy, pharmacology and psychotherapy, so that he may use his own method in proper perspective. I discussed following is an list of contents in this papers. Relief of pain, Psychotherapy, SVC obstruction, Obstructive jaundice, Brain and lung metastasis, prevention of fracture, Skin metastasis, Liver metastasis and treatment of advanced pediaric tumor etc. For the future: 1) Establishment of Stage and Grade of advanced cancer. 2) Development of new chemotherapeutic drug and immunotherapy. 3) Combination of multidisciplinary team and multidisciplinary treatment. (author)

  1. An overview of anesthetic procedures, tools, and techniques in ambulatory care

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

    Full Text Available Zakaria Messieha Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Abstract: Ambulatory surgical and anesthesia care (ASAC, also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care. Keywords: ambulatory anesthesia, out-patient anesthesia, Day-Care anesthesia

  2. [The "Seville" Consensus Document on Alternatives to Allogenic Blood Transfusion. Sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) Trombosis y Hemostasia (SETH)].

    Science.gov (United States)

    Alberca, Ignacio; Asuero, Ma Soledad; Bóveda, José L; Carpio, Nelly; Contreras, Enric; Fernández-Mondéjar, Enrique; Forteza, Alejandro; García-Erce, José A; García de Lorenzo, Abelardo; Gomar, Carmen; Gómez, Aurelio; Llau, Juan V; López-Fernández, María F; Moral, Victoria; Muñoz, Manuel; Páramo, José A; Torrabadella, Pablo; Quintana, Manuel; Sánchez, Calixto

    2006-07-18

    The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.

  3. EEG-based "serious" games and monitoring tools for pain management.

    Science.gov (United States)

    Sourina, Olga; Wang, Qiang; Nguyen, Minh Khoa

    2011-01-01

    EEG-based "serious games" for medical applications attracted recently more attention from the research community and industry as wireless EEG reading devices became easily available on the market. EEG-based technology has been applied in anesthesiology, psychology, etc. In this paper, we proposed and developed EEG-based "serious" games and doctor's monitoring tools that could be used for pain management. As EEG signal is considered to have a fractal nature, we proposed and develop a novel spatio-temporal fractal based algorithm for brain state quantification. The algorithm is implemented with blobby visualization tools for patient monitoring and in EEG-based "serious" games. Such games could be used by patient even at home convenience for pain management as an alternative to traditional drug treatment.

  4. Crisis resource management: evaluating outcomes of a multidisciplinary team.

    Science.gov (United States)

    Jankouskas, Tara; Bush, Mary Chasko; Murray, Bosseau; Rudy, Sally; Henry, Jody; Dyer, Anne Marie; Liu, Wenlei; Sinz, Elizabeth

    2007-01-01

    Crisis resource management (CRM) is a team-training program that teaches nontechnical skills such as: collaboration, communication, task management, teamwork, and leadership. The purpose of this study was to evaluate improvement in the nontechnical skills of a multidisciplinary team of pediatric residents, anesthesiology residents and pediatric nurses following participation in the CRM educational program. Self-efficacy theory guided the teaching method used in the CRM program. The Collaboration and Satisfaction about Care Decisions instrument and the Anesthetists' Nontechnical Skills System served as outcome measures. Seven multidisciplinary groups were studied with a total of 40 subjects. A significant increase was found in posttest scores for perceived collaboration and satisfaction with care and in numerical ratings of observed team skills following the CRM program. The results suggest multidisciplinary team participation in the CRM program increased perceived team collaboration, satisfaction with care, and observed teamwork skills.

  5. LOCAL ANESTHETICS IN PATIENTS WITH CARDIOVASCULAR DISEASES.

    Directory of Open Access Journals (Sweden)

    risto Daskalov

    2015-03-01

    Full Text Available A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery.

  6. Clinical Assessment of Fluid Balance is Incomplete for Colorectal Surgical Patients

    DEFF Research Database (Denmark)

    Tolstrup, J; Brandstrup, B

    2015-01-01

    BACKGROUND AND AIMS: Fluid balance for the surgical patient has been proven very important for the postoperative outcome and development of complications. The aim of this study was to evaluate, for the first time in modern times, the accordance between nurse-based fluid charting (cumulated fluid...... balance) and body weight change for general surgical patients. MATERIAL AND METHODS: This was a descriptive study with prospectively collected data from two clinical randomized multicenter trials. A total of 113 patients from American Society of Anesthesiology group I-III undergoing elective colorectal...... cumulated fluid balance and body weight change for colorectal surgical patients is relatively good for the first four postoperative days, however, with large uncertainty, whereas on the fifth and sixth postoperative day, the discrepancy is statistically and clinically significant. The fluid chart cannot...

  7. Surgery of malignant pancreatic tumors

    International Nuclear Information System (INIS)

    Ductal adenocarcinoma is the most common malignant tumor of the pancreas. Despite great efforts in basic and clinical pancreatic cancer research, the prognosis remains poor with an overall 5-year survival rate of less than 5%. Complete surgical resection represents the only curative treatment option and 5-year survival rates of 20-25% can be achieved following curative resection and adjuvant chemotherapy. Although pancreatic surgery is considered one of the most technically demanding and challenging procedures, there has been constant progress in surgical techniques and advances in perioperative care with a modern interdisciplinary approach including anesthesiology, oncology, radiology and nursing. This has reduced morbidity and especially mortality rates in high-volume centers. Among extended resection procedures multivisceral and venous resections are technically feasible and should be considered if a complete tumor resection can be achieved. Multimodal regimens have shown promising results, however, only adjuvant chemotherapy is supported by solid evidence from randomized controlled trials. (orig.)

  8. Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich; Kunz, R.P.; Oberholzer, Katja; Neeb, Daniel; Gast, Klaus K.; Dueber, Christoph [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Ley, Sebastian [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); German Cancer Research Center, Department of Radiology, Heidelberg (Germany); Heussel, Claus-Peter [Johannes-Gutenberg-University, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Chest Clinic at University of Heidelberg, Department of Radiology, Heidelberg (Germany); Eberle, Balthasar [Johannes-Gutenberg-University, Department of Anesthesiology, Mainz (Germany); Inselspital, Department of Anesthesiology, Bern (Switzerland); Mayer, Eckhard [Johannes-Gutenberg-University, Department of Heart, Thorax and Vascular Surgery, Mainz (Germany); Kauczor, Hans-Ulrich [German Cancer Research Center, Department of Radiology, Heidelberg (Germany)

    2007-01-15

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease that has been ignored for a long time. However, with the development of improved therapeutic modalities, cardiologists and thoracic surgeons have shown increasing interest in the diagnostic work-up of this entity. The diagnosis and management of chronic thromboembolic pulmonary hypertension require a multidisciplinary approach involving the specialties of pulmonary medicine, cardiology, radiology, anesthesiology and thoracic surgery. With this approach, pulmonary endarterectomy (PEA) can be performed with an acceptable mortality rate. This review article describes the developments in magnetic resonance (MR) imaging techniques for the diagnosis of chronic thromboembolic pulmonary hypertension. Techniques include contrast-enhanced MR angiography (ce-MRA), MR perfusion imaging, phase-contrast imaging of the great vessels, cine imaging of the heart and combined perfusion-ventilation MR imaging with hyperpolarized noble gases. It is anticipated that MR imaging will play a central role in the initial diagnosis and follow-up of patients with CTEPH. (orig.)

  9. Physician migration to the U.S.--foreign aid for U.S. manpower.

    Science.gov (United States)

    Ronaghy, H A; Zeighami, E; Zeighami, B

    1976-06-01

    Data were obtained from the American Medical Association on Iranian physicians practicing in the U.S., and from the Iranian Medical Registry on U.S.-trained Iranian physicians who have returned to practice in Iran. There were 2,066 Iranian physicians practicing in the U.S. in 1972, 1,234 (60%) of whom were not undergoing any training. Only 600 of Iran's 9,535 physicians in 1972 had been trained in the United States. Thus, less than one-third of the specialists who have completed training in the U.S. have returned to practice in Iran. The specialist group with the highest rate of return is the combined surgery subspecialties (neurosurgery, thoracic surgery, orthopedic surgery, and plastic surgery). The specialist groups with the lowest rates of return were pathology, anesthesiology, and psychiatry. A comparison is made of the manpower problems Iran faces and the American problems in the area of physician manpower.

  10. Theoretical considerations to optimize transabdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

    Science.gov (United States)

    Zourabian, Anna; Boas, David A.

    2001-06-01

    Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are: the first in the range of 670-720nm and the second in the range of 825-925nm. Further we discuss the possible systematic errors during our measurements, and their contribution to the obtained saturation results.

  11. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  12. [A regular internal auditing and registration of critical incidents regarded as safety maintenance elements within the anesthetic management of patients].

    Science.gov (United States)

    Vinogradov, V L; Likhvantsev, V V; Alekseev, A A

    2004-01-01

    The paper summarizes a 5-year experience of evaluating the safety of anesthetic management of patients with thermal lesions treated at the department of thermal lesions of Vishnevsky's Institute of Surgery, Russia's Academy of Medical Sciences. Regular internal auditings, based on the principles of registering the critical incidents, the course of 1473 general anesthesia managements was analyzed in 168 patients. The conclusion is that the introduction of protocols of anesthetic management as well as a regular monitoring over meeting the fixed targets cut the total frequency of critical incidents from 2.85 to 1.19 as estimated per one general anesthesia. Finally the authors suggest a concept whose essence in that the operation of the modern anesthesiology department must be based on a scientifically substantiated technology of anesthetic management.

  13. MECHANICAL AND PHARMACOLOGICAL SUPPORT OF BLOOD CIRCULATION IN SURGICAL TREATMENT OF LEFT VENTRICLE POSTINFARCTION ANEURISMS

    Directory of Open Access Journals (Sweden)

    V. V. Vitsukaev

    2010-01-01

    Full Text Available Despite all successes of a modern heart surgery, anesthesiology and resuscitation till now actual there is a ques- tion of improvement of results of surgical treatment of patients with chronic left ventricle postinfarction aneu- risms. Аfter left ventricular reconstructive surgery preoperative risk factors of development heavy myocardial dysfunctions in the postoperative period aren’t defined accurately now. We have made the analysis of 168 similar operations and have defined preoperative risk factors of development of severe heart failure in the intraoperative and early postoperative period. We have suggested methods to improve the results of operations in these patients using mechanical and pharmacological support of blood circulation. Use our suggested methods of preoperative preparation (Intraaortic balloon counterpulsation (VABK and VABK + levosimendan had significantly impro- ved results and significantly reduce mortality in patients with high risk of surgical treatment. 

  14. The 2016 Hughes Lecture: What's new in maternal morbidity and mortality?

    Science.gov (United States)

    Arendt, K W

    2016-05-01

    Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. This 2016 Hughes Lecture review article focuses specifically on the 2014 publications that relate to maternal morbidity and mortality. It begins by discussing the 2014 research that was published on severe maternal morbidity and maternal mortality in developed countries. This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.

  15. The 2015 Gerard W. Ostheimer Lecture: What's New in Labor Analgesia and Cesarean Delivery.

    Science.gov (United States)

    Arendt, Katherine W

    2016-05-01

    Every year the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review the literature pertinent to obstetric anesthesiology published the previous calendar year. This individual selects the most notable contributions, creates a syllabus of the articles, and then presents his/her overview in an annual lecture named in honor of the late Gerard W. Ostheimer, a pioneering obstetric anesthesiologist from the Brigham and Women's Hospital. This article reviews the literature published in 2014 focusing on the themes of labor analgesia and cesarean delivery. Its contents were presented as the Gerard W. Ostheimer Lecture at the 47th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, May 16, 2015, in Colorado Springs, Colorado. The syllabus is available as Supplemental Digital Content (http://links.lww.com/AA/B397).

  16. Circumcision: pros and cons.

    Science.gov (United States)

    Burgu, Berk; Aydogdu, Ozgu; Tangal, Semih; Soygur, Tarkan

    2010-01-01

    Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer.

  17. A tribute to Dr Willem J. Kolff: innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.

    Science.gov (United States)

    Stanley, Theodore H

    2013-06-01

    Dr Willem J. Kolff was surely one of the greatest inventors/physicians/scientists/bioengineers of the last few hundred years. He was knighted (Commander of the Order of Oranje-Nassau) in 1970 by Queen Juliana of the Netherlands. In 1990, Life magazine published a list of its own 100 most important figures of the 20th century. Kolff stood in 99th place as the Father of Artificial Organs. Dr Kolff forged a path of innovative thinking and creativity that has had a huge impact on the quality of human life. His contributions to the development of the artificial kidney and dialysis, the heart-lung machine, the membrane oxygenator, potassium arrest of the heart, the AH, mechanical cardiac assistance, and other artificial organs, and his support and mentoring of hundreds to thousands of anesthesiologists, surgeons, and bioengineers throughout the world, have had a significant impact on anesthesiology and the medical community.

  18. [Development and Hosting of a Perioperative Advanced Life Support Training Course for Anesthesiologists].

    Science.gov (United States)

    Komasawa, Nobuyasu; Fujiwara, Shunsuke; Haba, Masanori; Ueshima, Hironobu; Okada, Daisuke; Minami, Toshiaki

    2015-05-01

    Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. However, crisis in the perioperative period can result from airway trouble, central venous catheter displacement, or massive hemorrhage. We report our experience of holding a problem- and learning-based perioperative advanced life support training course, Advanced Life Support for Operation (ALS-OP). Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety. PMID:26422971

  19. A case of gait disturbance caused by low-dose gabapentin

    Directory of Open Access Journals (Sweden)

    Kanao-Kanda M

    2016-06-01

    Full Text Available Megumi Kanao-Kanda, Hirotsugu Kanda, Osamu Takahata, Takayuki Kunisawa Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan Abstract: Gabapentin, an anticonvulsant agent, is now often used for the treatment of neuropathic pain all over the world. It is unclear whether the combined use of gabapentin, sodium valproate, and flunitrazepam results in enhancement of the side effect, a gait disturbance. A 60-year-old man was taking oral sodium valproate for symptomatic epilepsy after a brain contusion and flunitrazepam to relieve insomnia. Oral gabapentin therapy was started for suspected neuropathic pain. Although the initial dose of oral gabapentin (200 mg relieved the pain, the lower extremities became weak, resulting in a gait disturbance. The therapy was restarted with a halved dose, and this resolved the gait disturbance and relieved the pain. Keywords: gabapentin, gait disturbance, side effect, neuropathic pain

  20. Unexpected anterograde amnesia associated with Buscopan used as a predmedication for endocscopy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    It has been known that peripheral adverse event is caused by peripheral antimuscarinic action, from hyoscine butylbromide (Buscopan; Boehringer Ingelheim, Germany)used as a premedication for endoscopy. However,symptoms or signs associated with the central nervous system are rarely reported in the field of anesthesiology and peripartum labor. This central anticholinergic syndrome is likely caused by blockade of muscarinic cholinergic receptors in the central nervous system. There is no report on Buscopan-induced central anticholinergic syndrome in endoscopy room so far. Three middle-aged females unexpectedly suffered from anterograde amnesia after intramuscular injection of hyoscine butylbromide as an antispasmodic premedication for endoscopy at our endoscopy unit in the Health Promotion Center.

  1. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. DATA SYNTHESIS: Based on an increasing amount of multinational, multicenter cohort studies......, randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. CONCLUSION: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery...

  2. Update in perioperative medicine: practice-changing evidence published in 2015.

    Science.gov (United States)

    Sundsted, Karna K; Mohabbat, Arya B; Regan, Dennis W; Salonen, Bradley R; Daniels, Paul R; Mauck, Karen F

    2016-08-01

    Evidence in perioperative medicine is published in a wide variety of journals, given the multidisciplinary nature of its practice which spans medicine and its subspecialties, as well as surgery and anesthesiology. It can be difficult to identify new and important evidence, as perioperative practice continues to evolve in multiple areas such as medication management, anticoagulation and cardiac risk stratification, among others. New, high-quality evidence is published each year, and must be placed into the context of not only existing literature, but also practical real-world patient care. We sought to systematically identify, critically evaluate and concisely summarize the practice implications of 10 articles published in 2015 for the practicing perioperative clinician. PMID:27400757

  3. Low vitamin D concentration is not associated with increased mortality and morbidity after cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Alparslan Turan

    Full Text Available OBJECTIVE: To determine the effect of vitamin D on postoperative outcomes in cardiac surgical patients. DESIGN: Retrospective study. SETTING: Single institution-teaching hospital. PARTICIPANTS: Adult cardiac surgical patients with perioperative 25-hydroxyvitamin D measurements. INTERVENTIONS: None. We gathered information from the Cardiac Anesthesiology Registry that was obtained at the time of the patients' visit/hospitalization. MEASUREMENTS AND MAIN RESULTS: We used data of 18,064 patients from the Cardiac Anesthesiology Registry; 426 patients with 25-hydroxyvitamin D measurements met our inclusion criteria. Association with Vitamin D concentration and composite of 11 cardiac morbidities was done by multivariate (i.e., multiple outcomes per subject analysis. For other outcomes separate multivariable logistic regressions and adjusting for the potential confounders was used. The observed median vitamin D concentration was 19 [Q1-Q3∶12, 30] ng/mL. Vitamin D concentration was not associated with our primary composite of serious cardiac morbidities (odds ratio [OR], 0.96; 95% CI, 0.86-1.07. Vitamin D concentration was also not associated with any of the secondary outcomes: neurologic morbidity (P = 0.27, surgical (P = 0.26 or systemic infections (P = 0.58, 30-day mortality (P = 0.55, or length of initial intensive care unit (ICU stay (P = 0.04. CONCLUSIONS: Our analysis suggests that perioperative vitamin D concentration is not associated with clinically important outcomes, likely because the outcomes are overwhelmingly determined by other baseline and surgical factors.

  4. The topical 5% lidocaine medicated plaster in localized neuropathic pain: a reappraisal of the clinical evidence

    Directory of Open Access Journals (Sweden)

    de León-Casasola OA

    2016-02-01

    Full Text Available Oscar A de León-Casasola,1,2 Victor Mayoral3 1Department of Anesthesiology, Division of Pain Medicine, Roswell Park Cancer Institute, 2University at Buffalo, School of Medicine and Biomedical Sciences. NY, USA; 3Anesthesiology Department, Pain Management Unit, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Spain Abstract: Topical 5% lidocaine medicated plasters represent a well-established first-line option for the treatment of peripheral localized neuropathic pain (LNP. This review provides an updated overview of the clinical evidence (randomized, controlled, and open-label clinical studies, real-life daily clinical practice, and case series. The 5% lidocaine medicated plaster effectively provides pain relief in postherpetic neuralgia, and data from a large open-label controlled study indicate that the 5% lidocaine medicated plaster is as effective as systemic pregabalin in postherpetic neuralgia and painful diabetic polyneuropathy but with an improved tolerability profile. Additionally, improved analgesia and fewer side effects were experienced by patients treated synchronously with the 5% lidocaine medicated plaster, further demonstrating the value of multimodal analgesia in LNP. The 5% lidocaine medicated plaster provides continued benefit after long-term (≤7 years use and is also effective in various other LNP conditions. Minor application-site reactions are the most common adverse events associated with the 5% lidocaine medicated plaster; there is minimal risk of systemic adverse events and drug–drug interactions. Although further well-controlled studies are warranted, the 5% lidocaine medicated plaster is efficacious and safe in LNP and may have particular clinical benefit in elderly and/or medically compromised patients because of the low incidence of adverse events. Keywords: 5% lidocaine medicated plaster, clinical evidence, localized neuropathic pain, postherpetic neuralgia, review

  5. Interview: 21st century battlefield pain management.

    Science.gov (United States)

    Buckenmaier, Colonel Chester 'trip'

    2013-07-01

    Colonel Chester 'Trip' Buckenmaier 3rd, MD, speaks to Dominic Chamberlain, Assistant Commissioning Editor: Colonel Buckenmaier is the current Director of the Defense and Veterans Center for Integrative Pain Management (MD, USA) and Fellowship Director of the Acute Pain Medicine and Regional Anesthesia program at Walter Reed National Military Medical Center in Washington DC (USA). He is an Associate Professor in Anesthesiology at the Uniformed Services University of the Health Sciences in Bethesda (MD, USA), and a Diplomat with the American Board of Anesthesiology. He attended Catawba College (NC, USA), on a Reserve Officers' Training Corps (ROTC) scholarship, graduating with a degree in Biology and Chemistry in 1986. He then attended East Carolina University in Greenville (NC, USA), receiving a Master in Science in Biology in 1988. In 1992, he graduated from the Uniformed Services University of the Health Sciences, completing his Anesthesia Residency at Walter Reed. In addition, he completed a 1-year Fellowship in Regional Anesthesia at Duke University (NC, USA) in 2002, resulting in the creation of the only Acute Pain Medicine Fellowship in the US military at Walter Reed (Washington, DC, USA). In September 2003, he deployed with the 21st Combat Support Hospital to Balad (Iraq), and demonstrated that the use of advanced regional anesthesia can be accomplished in a forward deployed environment. He performed the first successful continuous peripheral nerve block for pain management in a combat support hospital. In April 2009, he deployed to Camp Bastion (Afghanistan) with the British military and ran the first acute pain service in a theater of war. The Defense and Veterans Center for Integrative Pain Medicine (DVCIPM) is dedicated to improving pain management throughout the continuum of care for service personnel and their families.

  6. The "Balanced Scorecard": development and implementation in an academic clinical department.

    Science.gov (United States)

    Rimar, S; Garstka, S J

    1999-02-01

    If quality medical education is to survive in the increasingly competitive marketplace, medical schools need to adopt new tools that measure the value of all initiatives, both financial and non-financial, so that they can make informed decisions about their missions and future direction. The authors describe a tool of this kind called the Balanced Scorecard (originally created for traditional businesses), outline the version of it that they developed for the Department of Anesthesiology at Yale University School of Medicine, and discuss the first year of implementation (which began in 1997). The Balanced Scorecard is a set of measures designed to examine an organization's performance from the following four perspectives and to answer the key question suggested by each perspective: (1) The learning and growth perspective: Can we continue to improve and create value? (2) The internal business perspective: What must we excel at? (3) The customer perspective: How do our customers see us? (4) The financial perspective: How do we look to our shareholders? The first year of implementation of this approach at the Department of Anesthesiology involved creating measures of the four perspectives, determining whether data could be found for each measure and whether the data were in usable forms, and educating and involving the faculty in the process. The authors discuss the pros and cons of the Balanced Scorecard approach that they observed during the first year, and conclude with a list of seven lessons learned (e.g., start with measures that already exist). Overall, they are convinced that the Balanced Scorecard can be of great value to a department, even if the full implementation takes several years to complete.

  7. Coping with disaster: relocating a residency program.

    Science.gov (United States)

    Conlay, Lydia A; Searle, Nancy S; Gitlin, Melvin C

    2007-08-01

    In September 2005, in the aftermath of Hurricane Katrina, the Tulane University School of Medicine relocated temporarily from New Orleans to the Baylor College of Medicine in Houston, Texas. For Tulane's residency program in anesthesiology, a training consortium was formed in Texas consisting of the University of Texas at Houston, Baylor College of Medicine, the University of Texas Medical Branch at Galveston, and the M.D. Anderson Cancer Center. The authors explain the collaborative process that allowed the consortium to find spaces to accommodate Tulane's 30 anesthesiology residents within 30 days after they left New Orleans, and they offer reflections and recommendations. The residents were grateful to continue training close to home, and for maintaining the Tulane program. The consortium successfully provided an administrative and academic framework, logistical support, clinical capacity for the residents to complete the required numbers and types of cases, and integration into preexisting didactic programs. Communications represented a major challenge; the importance of having an up-to-date disaster plan, including provisions for communication using more than one modality or provider, cannot be underestimated. Other challenges included resuming a training program without basic information regarding medical credentials or training status, competing for resources with businesses that had also relocated, maintaining a coordinated decision-making process, and managing the behavioral sequelae after the disaster. Of the original 30 Tulane residents, 23 (77%) relocated to Houston. Seventeen (74%) of those who relocated either graduated or returned with the program to New Orleans. The program has retained its status of full accreditation. PMID:17762250

  8. EMS-physicians' self reported airway management training and expertise; a descriptive study from the Central Region of Denmark

    Directory of Open Access Journals (Sweden)

    Rognås Leif K

    2011-02-01

    Full Text Available Abstract Background Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS. Methods The EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians. Results There are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s, 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management. Conclusions In this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed.

  9. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

  10. Clinical Anesthesia Curriculum Reconstruction by Inquiry Learning%探究性学习视域下的临床麻醉学课程重构

    Institute of Scientific and Technical Information of China (English)

    张勇; 谢芬

    2014-01-01

    开展探究性学习有利于培养学生的学习兴趣和创造性思维,增强学生自主学习和发现问题、探究问题、解决问题的能力,提高学生的合作意识。目前,在医学院校临床麻醉学课程建设中还存在诸多不利于探究性学习开展的因素,要真正发挥探究性学习在临床麻醉学课程教学中的作用,就必须遵循医学院校的培养目标,从探究性学习的视角,围绕课程目标、课程内容、课程策略以及课程管理等多个维度对临床麻醉学课程进行重构。%Inquiry learning is helpful to cultivate the students ’ interest in learning and creative think-ing ,enhance students’ autonomous learning ability and found problems ,inquiry problems ,solve prob-lems’ ability ,improve students’ awareness of cooperation .At present ,there are many unfavorable factors on inquiry learning practice in the construction of clinical anesthesiology curriculum .T his pa-per focus on how to reconstruct clinical anesthesiology curriculum in the multiple dimensions of tar-gets ,contents ,strategies and management to fulfill the study ,following the special training objectives of higher medical college .

  11. Safety and efficacy of nurse-controlled analgesia in patients less than 1 year of age

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    Walia H

    2016-06-01

    Full Text Available Hina Walia,1 Dmitry Tumin,1 Sharon Wrona,1 David Martin,1,2 Tarun Bhalla,1,2 Joseph D Tobias,1-3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology and Pain Medicine, 3Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Background: The management of acute pain presents unique challenges in the younger pediatric population. Although patient-controlled devices are frequently used in patients ≥6 years of age, alternative modes of analgesic delivery are needed in infants.Objective: To examine the safety and efficacy of nurse-controlled analgesia (NCA in neonates less than 1 year of age.Methods: Data from patients <1 year of age receiving NCA as ordered by the Acute Pain Service at our institution were collected over a 5-year period and reviewed retrospectively. The primary outcomes were activation of the institution’s Rapid Response Team (RRT or Code Blue, signifying severe adverse events. Pain score after NCA initiation was a secondary outcome.Results: Among 338 girls and 431 boys, the most common opioid used for NCA was fentanyl, followed by morphine and hydromorphone. There were 39 (5% cases involving RRT or Code Blue activation, of which only one (Code Blue was activated due to a complication of NCA (apnea. Multivariable logistic regression demonstrated morphine NCA to be associated with greater odds of RRT activation (OR=3.29, 95% CI=1.35, 8.03, P=0.009 compared to fentanyl NCA. There were no statistically significant differences in pain scores after NCA initiation across NCA agents.Conclusion: NCA is safe in neonates and infants, with comparable efficacy demonstrated for the three agents used. The elevated incidence of RRT activation in patients receiving morphine suggests caution in its use and consideration of alternative agents in this population. Keywords: nurse-controlled analgesia, pain medicine, Rapid Response Team

  12. [One stop surgery in pediatric surgery. Preliminary report].

    Science.gov (United States)

    Sanges, G; Astuto, M; Sentina, P; Morinello, E; Di Benedetto, A

    2002-01-01

    The One-Stop Surgery (OSS) is a new method of Day Surgery, which combines preoperative evaluation and subsequent operation into one visit. This report describes the initial experience of the authors. Referring physicians were informed by fax about method and selected surgical procedures. Included form helped them to gain anamnestic data and to inform parents about preoperative fast. Form was then sent back by fax to the pediatric surgeon and anesthesiologist who determined the patient suitability and scheduled the day of the surgery. At hospital admission, if the diagnosis was confirmed and no anesthesiologic contraindications were discovered, the patient underwent the prescheduled surgical procedure and was discharged as a day case. Another form containing informations about home postoperative care and telephone numbers for emergency call was gave to the parents. From November 2000 through February 2001 43 patients, aged from 2 to 7 years, underwent one-stop surgical procedure: central venous catheter removal (n = 16), umbilical (n = 2) and inguinal (n = 10) hernia repair, prepuce dorsal slit (n = 15). Recovery of all patient was uneventful. None of them called during the period considered necessary for postoperative follow-up. Decreased costs and increased satisfaction of the patients and parents are the most important advantages of the OSS. Potential disadvantages are a not appropriate indication for the planned procedure and/or an anesthesiologic contraindication at hospital admission. It could involve a waste of human and financial resources and an useless psychologic stress for the family. Authors conclude it is not advisable the OSS use on a large scale without a sound experience in pediatric Day Surgery.

  13. Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation

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    Josip Ivić

    2009-02-01

    Full Text Available Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT providedcardiopulmonary resuscitation (CPR during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU. Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80, mostly male (60%. Most frequent victims were neurological patients(42%, surgical patients (21% and neurosurgical patients (10%. The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%.Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.

  14. Presentation of research in anesthesia: Culmination into publication?

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    Asha Tyagi

    2013-01-01

    Full Text Available Background: To assess the quality of research presentations made in conferences, its success or failure to be published in a peer-reviewed journal is a well-accepted marker. However, there is no data regarding the publication of research presentations made in Indian conferences of anesthesiology. Objective: The primary objective was to determine publication rate of research presented at the largest and best attended national conference in anesthesiology, the Indian Society of Anaesthesiologists′ Conference (ISACON, and also compare it with the rate from an international conference American Society of Anesthesiologists (ASA annual meeting held in the same year. Materials and Methods: All 363 abstracts presented as poster or podium presentations at the ISACON, and an equal number of randomly selected abstracts presented at ASA annual meeting were searched on Pubmed and Google Scholar for their full-text publications in peer-reviewed journals using a standardized search strategy. As secondary observations, abstracts were assessed for completeness by noting certain components central to research methodology. Also, changes between abstract of the presentation and published paper were noted with respect to certain components. Results: The publication rate of presentations at ISACON and ASA meetings was 5% and 22%, respectively. The abstracts from ISACON lacked central components of research such as methods and statistical tests. The commonest change in the full-text publications as compared with the original abstract from both conferences was a change in authorship. Conclusion: Steps are required to augment full-text publication of Indian research, including a more rigorous peer review of abstracts submitted to ISACON to ensure their completeness.

  15. The future of anaesthesiology

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    Ankit Agarwal

    2012-01-01

    Full Text Available There was an era when bark of mandrake plant, boiled in wine was used to administer anesthesia. Ether, after reigning the kingdom of anaesthesiology for more than a century, came to be superseded by newer and newer agents. Anaesthesiology has witnessed tremendous developments since infancy. The introduction of advanced airway adjuncts, labour analgesia, patient controlled analgesia, fibreoptics, Bispectral Index monitors, workstations, simulators and robotic surgeries are only to name a further few. Anaesthesia for robotic surgery received much impetus and is still a dream to come true in many countries. But then, the rapid spin in technology and fast sophistication of medical field has even surpassed this. The next event to venture is entry of robots into human body made possible by a culmination of intricate medicine and fine technology that is Nanotechnology. This article briefly introduces the field of nanotechnology in relation to its potential benefits to the field of anaesthesiology. As with any new tecnique or application, nanotechnology as applied to anaesthesiology has tremendous potential for research and exploration. This article therefore orients the reader′s mind towards the immense potential and benefits that can be tapped by carrying out further studies and experimentations.The literature was searched using databases, peer reviewed journals and books for over a period of one year (till December 2011. The search was carried out using keywords as nanotechnology, robotics, anesthesiology etc. Initially a master database was formed including human as well as animal studies. Later on the broad topic area was narrowed down to developments in nanotechnology as applied to anesthesiology. Further filtering of search results were done based on selection of researches and developments relating to local, regional and general anesthesia as well as critical care and pain and palliative care.

  16. Sevoflurane mitigates shedding of hyaluronan from the coronary endothelium, also during ischemia/reperfusion: an ex vivo animal study

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    Chen C

    2016-04-01

    Full Text Available Congcong Chen,1,3 Daniel Chappell,2,3 Thorsten Annecke,2,3 Peter Conzen,2 Matthias Jacob,2,3 Ulrich Welsch,4 Bernhard Zwissler,2 Bernhard F Becker3 1Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; 2Clinic of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany; 3Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University, Munich, Germany; 4Institute of Anatomy, Ludwig-Maximilians-University, Munich, Germany Abstract: Glycosaminoglycan hyaluronan (HA, a major constituent of the endothelial glycocalyx, helps to maintain vascular integrity. Preconditioning the heart with volatile anesthetic agents protects against ischemia/reperfusion injury. We investigated a possible protective effect of sevoflurane on the glycocalyx, especially on HA. The effect of pre-ischemic treatment with sevoflurane (15 minutes at 2% vol/vol gas on shedding of HA was evaluated in 28 isolated, beating guinea pig hearts, subjected to warm ischemia (20 minutes at 37°C followed by reperfusion (40 minutes, half with and half without preconditioning by sevoflurane. HA concentration was measured in the coronary effluent. Over the last 20 minutes of reperfusion hydroxyethyl starch (1 g% was continuously infused and the epicardial transudate collected over the last 5 minutes for measuring the colloid extravasation. Additional hearts were fixed by perfusion after the end of reperfusion for immunohistology and electron microscopy. Sevoflurane did not significantly affect post-ischemic oxidative stress, but strongly inhibited shedding of HA during the whole period, surprisingly even prior to ischemia. Immunohistology demonstrated that heparan sulfates and SDC1 of the glycocalyx were also preserved by sevoflurane. Electron microscopy revealed shedding of glycocalyx caused by ischemia and a mostly intact glycocalyx in hearts exposed to sevoflurane. Coronary vascular permeability of the

  17. [Pharmacogenetics in anesthesia and intensive care medicine : Clinical and legal challenges exemplified by malignant hyperthermia].

    Science.gov (United States)

    Klingler, W; Pfenninger, E

    2016-05-01

    Pharmacotherapy is a key component of anesthesiology and intensive care medicine. The individual genetic profile influences not only the effect of pharmaceuticals but can also completely alter the mode of action. New technologies for genetic screening (e.g. next generation sequencing) and increasing knowledge of molecular pathways foster the disclosure of pharmacogenetic syndromes, which are classified as rare diseases. Taking into account the high genetic variability in humans and over 8000 known rare diseases, up to 20 % of the population may be affected. In summary, rare diseases are not rare. Most pharmacogenetic syndromes lead to a weakening or loss of pharmacological action. In contrast, malignant hyperthermia (MH), which is the most relevant pharmacogenetic syndrome for anesthesia, is characterized by a pharmacologically induced overactivation of calcium metabolism in skeletal muscle. Volatile anesthetic agents and succinylcholine trigger life-threatening hypermetabolic crises. Emergency treatment is based on inhibition of the calcium release channel of the sarcoplasmic reticulum by dantrolene. After an adverse pharmacological event patients must be informed and a clarification consultation must be carried out during which the hereditory character of MH is explained. The patient should be referred to a specialist MH center where a predisposition can be diagnosed by the functional in vitro contracture test from a muscle biopsy. Additional molecular genetic investigations can yield mutations in the genes for calcium-regulating proteins in skeletal muscle, e.g. ryanodine receptor 1 (RyR1) and calcium voltage-gated channel subunit alpha 1S (CACNA1S). Currently, an association to MH has only been shown for 35 mutations out of more than 400 known and probably hundreds of unknown genetic variations. Furthermore, MH predisposition is not excluded by negative mutation screening. For anesthesiological patient safety it is crucial to identify individuals at risk and

  18. Scientific fraud in 20 falsified anesthesia papers : detection using financial auditing methods.

    Science.gov (United States)

    Hein, J; Zobrist, R; Konrad, C; Schuepfer, G

    2012-06-01

    Data from natural sources show counter-intuitive distribution patterns for the leading digits to the left of the decimal point and the digit 1 is observed more frequently than all other numbers. This pattern, which was first described by Newcomb and later confirmed by Benford, is used in financial and tax auditing to detect fraud. Deviations from the pattern indicate possible falsifications. Anesthesiology journals are affected not only by ghostwriting and plagiarism but also by counterfeiting. In the present study 20 publications in anesthesiology known to be falsified by an author were investigated for irregularities with respect to Benford's law using the χ(2)-test and the Z-test. In the 20 retracted publications an average first-digit frequency of 243.1 (standard deviation SD ± 118.2, range: 30-592) and an average second-digit frequency of 132.3 (SD ± 72.2, range: 15-383) were found. The observed distribution of the first and second digits to the left of the decimal point differed significantly (p< 0.01) from the expected distribution described by Benford. Only the observed absolute frequencies for digits 3, 4 and 5 did not differ significantly from the expected values. In an analysis of each paper 17 out of 20 studies differed significantly from the expected value for the first digit and 18 out of 20 studies varied significantly from the expected value of the second digit. Only one paper did not vary significantly from expected values for the digits to the left of the decimal. For comparison, a meta-analysis using complex mathematical procedures was chosen as a control. The analysis showed a first-digit distribution consistent with the Benford distribution. Thus, the method used in the present study seems to be sensitive for detecting fraud. Additional statements of specificity cannot yet be made as this requires further analysis of data that is definitely not falsified. Future studies exploring conformity might help prevent falsified studies from being

  19. Treatment of localized neuropathic pain of different etiologies with the 5% lidocaine medicated plaster – a case series

    Directory of Open Access Journals (Sweden)

    Likar R

    2014-12-01

    Full Text Available Rudolf Likar,1 Susanne Demschar,1 Ingo Kager,1 Stefan Neuwersch,1 Wolfgang Pipam,1 Reinhard Sittl2 1Department of Anesthesiology and Intensive Care, Hospital Klagenfurt, Klagenfurt, Austria; 2Department of Anesthesiology, Interdisciplinary Pain Centre, University Hospital Erlangen, Erlangen, Germany Objective: To assess the efficacy and safety of the topical 5% lidocaine medicated plaster in the treatment of localized neuropathic pain. Study design: This was a case series at an Austrian pain clinic, using retrospective analysis. Patients and methods: Data of 27 patients treated for localized neuropathic pain with the 5% lidocaine medicated plaster were retrospectively analyzed. Assessment included changes in overall pain intensity, in intensity of different pain qualities, and of hyperalgesia and allodynia, and changes in sleep quality. Results: Patients (17 female, ten male; mean age 53.4±11.4 years presented mainly with dorsalgia (16 patients or postoperative/posttraumatic pain (seven patients; one patient suffered from both. The mean overall pain intensity prior to treatment with lidocaine medicated plaster was 8.4±1.2 on the 11-point Likert scale. In the majority of cases, the lidocaine plaster was applied concomitantly with preexisting pain medication (81.5% of the patients. During the 6-month observation period, overall mean pain intensity was reduced by almost 5 points (4.98 to 3.5±2.6. Substantial reductions were also observed for neuralgiform pain (5 points from 7.9±2.6 at baseline and burning pain (3 points from 5.2±4.1. Sleep quality improved from 4.6±2.6 at baseline to 5.5±1.8. Stratification by pain diagnosis showed marked improvements in overall pain intensity for patients with dorsalgia or postoperative/posttraumatic pain. The lidocaine plaster was well tolerated. Conclusion: Overall, topical treatment with the 5% lidocaine medicated plaster was associated with effective pain relief and was well tolerated. Keywords

  20. On the 40th anniversary of the Post graduate studies faculty of state establishment "Dnipropetrovsk Medical Academy of Health Ministry of Ukraine"

    Directory of Open Access Journals (Sweden)

    Snysar V.I.

    2013-12-01

    Full Text Available In 2013 post graduate studies faculty of SE "Dnipropetrovsk Medical Academy of the Health Ministry of Ukraine" celebrates the 40th anniversary. By Decree of the Council of Ministers of USSR and Ministry of Health of USSR № 124 from March 24, 1973 (rector’s order № 38 from 30.03.1973. Doctors’ advanced training faculty was founded on the basis of Dnipropetrovsk Medical Institute of Order of the Red Banner of Labor. For the first time in the Soviet Union it was situated at a distance of 150 km from the main base in the city of Krivoy Rog. Four departments in the main branches: therapy, surgery, pediatrics, obstetrics and gynecology were opened and began successful work. Further, the departments of clinical laboratory diagnostics (1974, traumatology and orthopedics (1975, three departments of stomatology (1976 were organized. Starting from 1979 the departments of Doctors’ advanced training faculty have been organized on the basis of Dnipropetrovsk medical institutions of. The Department of gastroenterology was established in 1979, the department of obstetrics, gynecology and perinatology was founded in 1989, the department of psychiatry - in 1986. The department of medical and social expertise of the Post graduate studies faculty was opened in 1979 by the initiative of the Rector of Dnipropetrovsk Medical Institute Prof. I.I. Krizhanovskaya. Since 1997 one of the departments of therapy has moved to the Post graduate studies faculty and was named "department of therapy of interns and family medicine". In 2005 it was renamed to the department of family medicine. In 1983 the qualification upgrading courses of health care managers were reformed in the department of social hygiene and public health organization of the Post graduate studies faculty. The department of anesthesiology, intensive care and emergency states of the Post graduate studies Faculty separated from the department of anesthesiology and intensive Care in 1986. The department

  1. General anesthetic and the risk of dementia in elderly patients: current insights

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    Hussain M

    2014-09-01

    Full Text Available Maria Hussain,1 Miles Berger,2 Roderic G Eckenhoff,3 Dallas P Seitz1 1Division of Geriatric Psychiatry, Department of Psychiatry, Queen’s University; 2Anesthesiology Department, Duke University Medical Center, Durham, NC, USA; 3Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Abstract: In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA, and dementia, particularly Alzheimer’s disease (AD. The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid-beta [Aß] and tau, inflammation, and neurotransmitter dysregulation. Many points in this complex pathogenesis can potentially be influenced by both surgery and anesthetics. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased aggregation and oligomerization of Aß peptide and enhanced accumulation and hyperphosphorylation of tau protein. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium and postoperative cognitive dysfunction, both of which occur more commonly in older adults after surgery and anesthesia. Neither the route of anesthesia nor the type of anesthetic appears to be significantly associated with the development of postoperative delirium or postoperative cognitive dysfunction. A meta-analysis of case-control studies found no association between prior exposure to surgery utilizing GA and incident AD (pooled odds ratio =1.05, P=0.43. The few cohort studies on this topic have shown varying associations between surgery, GA, and AD, with one showing an increased risk, and another demonstrating a decreased risk. A recent randomized trial has shown that patients who received sevoflurane during spinal surgery were more likely to have progression of preexisting mild cognitive impairment compared to

  2. Scientific fraud in 20 falsified anesthesia papers : detection using financial auditing methods.

    Science.gov (United States)

    Hein, J; Zobrist, R; Konrad, C; Schuepfer, G

    2012-06-01

    Data from natural sources show counter-intuitive distribution patterns for the leading digits to the left of the decimal point and the digit 1 is observed more frequently than all other numbers. This pattern, which was first described by Newcomb and later confirmed by Benford, is used in financial and tax auditing to detect fraud. Deviations from the pattern indicate possible falsifications. Anesthesiology journals are affected not only by ghostwriting and plagiarism but also by counterfeiting. In the present study 20 publications in anesthesiology known to be falsified by an author were investigated for irregularities with respect to Benford's law using the χ(2)-test and the Z-test. In the 20 retracted publications an average first-digit frequency of 243.1 (standard deviation SD ± 118.2, range: 30-592) and an average second-digit frequency of 132.3 (SD ± 72.2, range: 15-383) were found. The observed distribution of the first and second digits to the left of the decimal point differed significantly (p< 0.01) from the expected distribution described by Benford. Only the observed absolute frequencies for digits 3, 4 and 5 did not differ significantly from the expected values. In an analysis of each paper 17 out of 20 studies differed significantly from the expected value for the first digit and 18 out of 20 studies varied significantly from the expected value of the second digit. Only one paper did not vary significantly from expected values for the digits to the left of the decimal. For comparison, a meta-analysis using complex mathematical procedures was chosen as a control. The analysis showed a first-digit distribution consistent with the Benford distribution. Thus, the method used in the present study seems to be sensitive for detecting fraud. Additional statements of specificity cannot yet be made as this requires further analysis of data that is definitely not falsified. Future studies exploring conformity might help prevent falsified studies from being

  3. A matrix model for valuing anesthesia service with the resource-based relative value system

    Directory of Open Access Journals (Sweden)

    Sinclair DR

    2014-10-01

    Full Text Available David R Sinclair,1 David A Lubarsky,1 Michael M Vigoda,1 David J Birnbach,1 Eric A Harris,1 Vicente Behrens,1 Richard E Bazan,1 Steve M Williams,1 Kristopher Arheart,2 Keith A Candiotti1 1Department of Anesthesiology, Perioperative Medicine and Pain Management, 2Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA Background: The purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation. The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken. Results: Spearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94–0.96, P<0.001 for training, test, and overall. The proposed RBRVS-based billing matrix yielded payments that were 3.0%±1.34% less than would have been expected from commercial insurers, using standard rates for commercial ASA relative value units and RBRVS relative value units. Compared with current Medicare reimbursement under the ASA relative value guide, reimbursement would almost double when converting to an RBRVS billing model. The greatest increases in Medicare reimbursement between the current system and proposed billing model occurred as anesthetic management complexity increased. Conclusion: The new crosswalk correlates with existing evaluation and management and intensive care medicine codes in an

  4. Systematic Review and Meta-Analysis of the Impact of Computed Tomography-Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation.

    Science.gov (United States)

    van Vugt, J L A; Levolger, S; de Bruin, R W F; van Rosmalen, J; Metselaar, H J; IJzermans, J N M

    2016-08-01

    Liver transplant outcome has improved considerably as a direct result of optimized surgical and anesthesiological techniques and organ allocation programs. Because there remains a shortage of human organs, strict selection of transplant candidates remains of paramount importance. Recently, computed tomography (CT)-assessed low skeletal muscle mass (i.e. sarcopenia) was identified as a novel prognostic parameter to predict outcome in liver transplant candidates. A systematic review and meta-analysis on the impact of CT-assessed skeletal muscle mass on outcome in liver transplant candidates were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nineteen studies, including 3803 patients in partly overlapping cohorts, fulfilled the inclusion criteria. The prevalence of sarcopenia ranged from 22.2% to 70%. An independent association between low muscle mass and posttransplantation and waiting list mortality was described in 4 of the 6 and 6 of the 11 studies, respectively. The pooled hazard ratios of sarcopenia were 1.84 (95% confidence interval 1.11-3.05, p = 0.02) and 1.72 (95% confidence interval 0.99-3.00, p = 0.05) for posttransplantation and waiting list mortality, respectively, independent of Model for End-stage Liver Disease score. Less-consistent evidence suggested a higher complication rate, particularly infections, in sarcopenic patients. In conclusion, sarcopenia is an independent predictor for outcome in liver transplantation patients and could be used for risk assessment. PMID:26813115

  5. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  6. Psychological therapies for the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-04-01

    Full Text Available John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed. Keywords: pain management, multidisciplinary pain treatment, psychological therapy

  7. The effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

    International Nuclear Information System (INIS)

    We have hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously locked lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 (8.2) in the placebo and 35.17 mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group. p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine. (author)

  8. The Impact of Reverse Trendelenburg Versus Head-up Position on Intraoperative Bleeding of Elective Rhinoplasty

    Science.gov (United States)

    Nooraei, Navid; Dabbagh, Ali; Niazi, Feizolah; Mohammadi, Siamak; Mohajerani, Seyed Amir; Radmand, Golnar; Hashemian, Seyed Mohammad Reza

    2013-01-01

    Background: In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. Objective: In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. Methods: In this study, 30 ASA I (American Society of Anesthesiology physical condition classification) patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Results: Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ± 13.20 ml) than head-up position (83.33 ± 21.18 ml), although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Conclusions: Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry. PMID:24498500

  9. The impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty

    Directory of Open Access Journals (Sweden)

    Navid Nooraei

    2013-01-01

    Full Text Available Background: In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. Objective: In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. Methods: In this study, 30 ASA I (American Society of Anesthesiology physical condition classification patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Results: Our results showed that the mean amount of blood loss in reverse trendelenburg was lower (77.00 ΁ 13.20 ml than head-up position (83.33 ΁ 21.18 ml, although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Conclusions: Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry.

  10. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.

  11. The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs.

    Science.gov (United States)

    Looney, Andrea L; Bohling, Mark W; Bushby, Philip A; Howe, Lisa M; Griffin, Brenda; Levy, Julie K; Eddlestone, Susan M; Weedon, James R; Appel, Leslie D; Rigdon-Brestle, Y Karla; Ferguson, Nancy J; Sweeney, David J; Tyson, Kathy A; Voors, Adriana H; White, Sara C; Wilford, Christine L; Farrell, Kelly A; Jefferson, Ellen P; Moyer, Michael R; Newbury, Sandra P; Saxton, Melissa A; Scarlett, Janet M

    2008-07-01

    As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs. PMID:18593314

  12. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    Science.gov (United States)

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs. PMID:27379593

  13. Optimizing pain control through the use of implantable pumps

    Directory of Open Access Journals (Sweden)

    Boris Todoroff

    2008-10-01

    Full Text Available Wilfried Ilias1, Boris Todoroff21Dept Anesthesiology, Intensive Care Medicine and Pain Therapy, Academic Teaching Hospital St. John of God, Vienna, Austria; 2Dept. Plastic and Reconstructive Surgery, Hospital of St. Vincent, Vienna, AustriaAbstract: Intrathecal therapy represents an effective and well established treatment of nonmalignant as well as malignant pain. Devices available include mechanical constant flow pumps as well as electronic variable flow pumps with patient-controlled bolus release. The latter provide faster dose finding, individual pain control, and good acceptance by patients. New technologies such as membrane pumps and rechargeable devices are expected to be developed to clinical perfection. The available drugs for intrathecal therapy are listed according to the polyanalgesic consensus on intrathecal therapy. The integration of remote patient-controlled analgesia into electronic implantable devices, and the peptide analgesic ziconotide, have significantly improved intrathecal therapy. Complications include infections, catheter ruptures or disconnections, catheter granulomas, and technical dysfunctions. Further possibilities for optimizing intrathecal therapy include development of new drugs, drug side effects, catheter and pump technologies, and surgical techniques.Keywords: intrathecal therapy, implantable pumps, morphine pumps, intrathecal drugs, intrathecal catheters, intrathecal pain control

  14. UNUSUAL FUNDOPOSTERIOR RUPTURE OF SCARRED UTERUS IN THIRD TRIMESTER OF PREGNANCY

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi

    2015-03-01

    Full Text Available U terine rupture is a rare but serious catastrophe in obstetrical practice which is associated with high maternal and neonatal mortality . 1 Survivors are often impaired with reproductive function that results from surgical management which predisposes them to marital disharmony and psychological trauma . 2 Apart from this anemia , septicemia , obstetric fistula , which makes the recovery process prolonged and turbulent one . Uterine rupture is tearing of the uterine wall during pregnancy or delivery . It is divided in to two main categories complete and incomplete . 3 Complete - when it involves myometrium and serosa , incomplete - when only myometrium is involved with intact serosa . Although there is decline in incidence of uterine rupture in various studies but when it occurs it has a hazardous impact on mother and foetus . Surgical management depends on the type , site of rupture , parity , number of living issues and intra operative a ssessment of rupture . The surgical management may be : 1. Repair alone . 2. Repair with permanent sterilization . 3. Subtotal hysterectomy . 4. Total hysterectomy . With the availability of advances in treatment of shock , better anesthesiology , improved operative measures , control of infection , blood transfusion facilities with improved antenatal and intra partum care both maternal & foetal , mortality and morbidity have reduced . Here by we present a case of uterine rupture in third trimester pregnancy .

  15. Newer treatments for fibromyalgia syndrome

    Directory of Open Access Journals (Sweden)

    Richard E Harris

    2008-12-01

    Full Text Available Richard E Harris, Daniel J ClauwDepartment of Anesthesiology, The University of Michigan, Ann Arbor, MI, USAAbstract: Fibromyalgia syndrome is a common chronic pain disorder of unknown etiology. The lack of understanding of the pathophysiology of fibromyalgia has made this condition frustrating for patients and clinicians alike. The most common symptoms of this disorder are chronic widespread pain, fatigue, sleep disturbances, difficulty with memory, and morning stiffness. Emerging evidence points towards augmented pain processing within the central nervous system (CNS as having a primary role in the pathophysiology of this disorder. Currently the two drugs that are approved by the United States Food and Drug Administration (FDA for the management of fibromyalgia are pregabalin and duloxetine. Newer data suggests that milnacipran, a dual norepinephrine and serotonin reuptake inhibitor, may be promising for the treatment of fibromyalgia. A double-blind, placebo-controlled trial of milnacipran in 125 fibromyalgia patients showed significant improvements relative to placebo. Milnacipran given either once or twice daily at doses up to 200 mg/day was generally well tolerated and yielded significant improvements relative to placebo on measures of pain, patient’s global impression of change in their disease state, physical function, and fatigue. Future studies are needed to validate the efficacy of milnacipran in fibromyalgia.Keywords: fibromyalgia, pain, pharmacological, treatment

  16. No-fault compensation for ventilator-dependent children: a reasonable settlement value for lifetime attendant care

    Directory of Open Access Journals (Sweden)

    Jenkins RC

    2016-08-01

    Full Text Available Randall C Jenkins,1–3 Brian W Boelens,1 Kari L Aasheim,1 Nikolaus Gravenstein4–5 1University of Florida Self-Insurance Program, 2University of Florida Healthcare Education Insurance Company, 3Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, 4Department of Anesthesiology, 5Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: Severe neurological outcomes sustained in childhood often result in lifetime health care needs that are beyond the financial means of most families. When severe neurological deficits are alleged to have resulted from professional negligence, relief may be sought through litigation; however, the American tort system often yields inconsistent results or no compensation for patients. We sought to identify a reasonable, objective, and data-based monetary range for a no-fault compensation system with high- and low-financial limits for those with severe neurological deficits. Based on documented life expectancies and attendant care cost studies, the data analysis indicates a no-fault settlement payment ranging from US$479,712.24 to $3,098,504.16, reasonably ensures care and services for life. Keywords: cost of health care, health law, health regulation, long-term care, medical malpractice

  17. Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

    Directory of Open Access Journals (Sweden)

    Luo LL

    2015-05-01

    Full Text Available LinLi Luo,* Juan Ni,* Lan Wu, Dong Luo Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China  *These authors contributed equally to this work and should be considered co-first authors Abstract: Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. Keywords: anesthesia, regional, cesarean delivery, ketamine, ultrasound-guided

  18. [Occurrence and antimicrobial susceptibility of Morganella morganii strains isolated from clinical samples].

    Science.gov (United States)

    Zalas-Wiecek, Patrycja; Gospodarek, Eugenia; Wróblewska, Joanna

    2012-01-01

    The aim of this study was the evaluation of occurrence and antimicrobial susceptibility of M morganii rods isolated from clinical samples. This study included 201 strains isolated in the Clinical Microbiology Department of Dr. A. Jurasz University Hospital in 2008-2010. Identification to species was carried out on the basis of the results of biochemical reactions included in the tests ID 32E and VITEK2 GN. Antimicrobial susceptibility of M. morganii rods was determined by the disk-diffusion method on Mueller-Hinton II Agar. Strains of M morganii most commonly isolated from skin and soft tissue, and material taken from the urinary tract, mainly from patients of Anesthesiology and Intensive Care Unit, Department of General and Vascular Surgery and Department of General Surgery and Endocrinology. All of M morganii strains isolated during the three years were susceptible to carbapenems. We reported decrease of strains susceptible to piperacillin and chloramphenicol. In 2010 we showed a higher percentage of strains intermediate to tigecycline, compared with 2009. We observed increase in the percentage of strains resistant to cefoperazone with sulbactam and reported decrease in the percentage of strains resistant and intermediate to aminoglycosides. Extended Spectrum Beta-Lactamases were produced by 13 (6,5%) of M morganii strains.

  19. Role of preoperative tracheobronchoscopy in newborns with esophageal atresia:A review

    Institute of Scientific and Technical Information of China (English)

    Filippo; Parolini; Giovanni; Boroni; Stefania; Stefini; Cristina; Agapiti; Tullia; Bazzana; Daniele; Alberti

    2014-01-01

    Preoperative tracheobronchoscopy(TBS) in the diag-nostic assessment of newborns affected by esophageal atresia(EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included inthe diagnostic and therapeutic assessment in many in-ternational pediatric surgery settings. Routine preoper-ative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualiza-tion of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fog-arty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alterna-tive diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound.

  20. Dabrafenib: a new opportunity for the treatment of BRAF V600-positive melanoma

    Directory of Open Access Journals (Sweden)

    Banzi M

    2016-05-01

    Full Text Available Maria Banzi,1 Simona De Blasio,2 Aimilios Lallas,3 Caterina Longo,2 Elvira Moscarella,2 Roberto Alfano,4 Giuseppe Argenziano5 1Department of Medical Oncology, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 2Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 3First Department of Dermatology, Aristotle University, Thessaloniki, Greece; 4Department of Anesthesiology, Surgery and Emergency, 5Dermatology Unit, Second University of Naples, Naples, Italy Abstract: Prior to 2011, the 1-year survival rates for patients suffering from advanced or metastatic melanoma was as low as 33%, with a median overall survival of about 9 months. Several chemotherapeutic regimens have been applied, either as monochemotherapy or as polychemotherapy, overall not resulting in an improvement of progression-free or overall survival. Novel insights into the epidemiology and biology of melanoma allowed the development of newer therapies. The discovery of mutations in BRAF, a part of the mitogen-activated protein kinase, allowed the development of two BRAF inhibitors, vemurafenib and dabrafenib, which significantly improved the outcome of metastatic melanoma treatment. This article reviews the mechanism of action, efficacy, and safety profile of dabrafenib. An in-depth knowledge of this medication will encourage clinicians to select the appropriate therapeutic strategy for each patient, as well as to prevent or adequately manage side effects, optimizing, thus, the drug’s applicability. Keywords: melanoma, BRAF, target therapy, dabrafenib, melanoma survival

  1. Delayed recovery from anesthesia: A postgraduate educational review.

    Science.gov (United States)

    Misal, Ullhas Sudhakarrao; Joshi, Suchita Annasaheb; Shaikh, Mudassir Mohd

    2016-01-01

    Delayed awakening from anesthesia remains one of the biggest challenges that involve an anesthesiologist. With the general use of fast-acting anesthetic agents, patients usually awaken quickly in the postoperative period. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. The principal factors responsible for delayed awakening following anesthesia are anesthetic agents and medications used in the perioperative period. Nonpharmacological causes may have a serious sequel, hence recognizing these organic conditions is important. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uremia, and severe hypothyroidism may also be responsible for delayed recovery following anesthesia. Unexpected delayed emergence after general anesthesia may also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or thrombosis. Accurate diagnosis of the underlying cause is the key for the institution of appropriate therapy, but primary management is to maintain airway, breathing, and circulation. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology. PMID:27212741

  2. Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care.

    Science.gov (United States)

    Harris, Rachel C; Fries, Melissa H; Boyle, Annelee; Adeniji-Adele, Hassan; Cherian, Zacharia; Klein, Nancy; John, Anitha S

    2014-01-01

    With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published. The objective of this report is to describe the process of developing a detailed pregnancy and delivery care plan for three women with complex CHD, including perspectives from the multidisciplinary specialists involved in the process. This article demonstrates that collaboration between specialists in the fields of cardiology, anesthesiology, high-risk obstetrics, maternal fetal medicine, and neonatology results in clinically successful individualized treatment plans for the management of pregnancy in complex CHD. Multidisciplinary collaboration is a crucial element in the management of pregnancy in complex CHD. We provide a template used in three cases which can serve as a model for the design of future care plans.

  3. Preoperative patient education: can we improve satisfaction and reduce anxiety?

    Directory of Open Access Journals (Sweden)

    Jaime Ortiz

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. METHODS: A survey (Survey A in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. RESULTS: In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. CONCLUSIONS: Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery.

  4. A case of extra hepatic portal vein obstruction in pregnancy with superimposed pre-eclampsia

    Directory of Open Access Journals (Sweden)

    Bindu Nambisan

    2016-09-01

    Full Text Available Extra hepatic portal vein obstruction in pregnancy poses a clinical challenge by itself. We present here a case of a 19 year old primigravida with EHPVO who developed superimposed preeclampsia. She had a successful maternal and fetal outcome in a tertiary care centre owing to the team effort involving specialists from medical gastroenterology, nephrology, anesthesiology, and neonatology apart from senior obstetrician. EHPVO is an important cause of non-cirrhotic portal hypertension in third world countries. In pregnancy, the increased blood volume and cardiac output and mesenteric vasodilatation will increase portal flow and aggravate portal hypertension in these patients. The resultant hematemesis in such patients, can compromise the perinatal outcome. Endoscopic variceal ligation (EVL reduces the risk of variceal bleeding, and can improve the pregnancy outcome in these women. Thrombocytopenia due to splenomegaly is one of the major complications in these patients and has to be corrected before pregnancy. Platelet transfusion is required intrapartum if the count is less than 50,000/mm3 caesarean delivery is reserved only for obstetric indications. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3213-3215

  5. Postoperative Pain in Children After Dentistry Under General Anesthesia.

    Science.gov (United States)

    Wong, Michelle; Copp, Peter E; Haas, Daniel A

    2015-01-01

    The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

  6. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Ankeet D. Udani

    2014-01-01

    Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  7. Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

    Science.gov (United States)

    Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  8. Application of High-fidelity Human Patient Simulator in Training Anesthe-sia Skills%仿真模拟人在麻醉医生技能训练中的应用

    Institute of Scientific and Technical Information of China (English)

    刘枫; 徐颖

    2016-01-01

    High-fidelity human patient simulator, as a new model of teaching, plays a really important role in training anesthesia skills. Medical students can perform training of anesthesia skills on the model of high-fidelity human patient simulator, which can help to improve the teaching quality and avoid the anesthesia risks as well. The article is aimed to e-laborate the advantages and effects of high-fidelity human patient simulator teaching method and to introduce the commonly used simulation systems in anesthesiology teaching respectively, to discuss the limitations and the potential application prospect of high-fidelity human patient simulator teaching method in training anesthesia.%仿真模拟人教学作为一种新的教学模式,在麻醉技能训练中显得尤为重要。医学生可以在仿真模拟人模型上进行麻醉技能训练,在提高教学质量的同时,还能有效地规避麻醉风险。该研究对仿真模拟人教学的优势与作用进行阐述,分类介绍麻醉教学中常用的模拟系统,探讨仿真模拟人教学在麻醉技能训练中的局限性及应用前景。

  9. Job satisfaction among anesthesiologists at a tertiary hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Ambrose Rukewe

    2012-01-01

    Full Text Available Background : We assessed job satisfaction among anesthesiologists at a tertiary hospital in Nigeria and identified elements of job stress and dissatisfaction. Methods : A cross-sectional study design was employed; a structured self-administered questionnaire was distributed, which focused on sociodemographic data, rating of job satisfaction, identification of stressors, and work relationships. Results : Out of 55 questionnaires distributed, 46 (83.6% completed questionnaires were returned. Overall, 27 (58.7% of the anesthesiologists were satisfied with their job. While 8.7% were very satisfied (grade 5, 6.5% were very dissatisfied (grade 1 with their job. The stressors identified by the respondents were time pressures, long working hours with complaints of insufficient sleep, and employment status. Among the respondents, the medical officers were the most discontented (9 out of 12, 75%, followed by senior registrars (5 out of 9, 56%. A high percentage of participants (54.1% declared that the one change if implemented that would enhance their job satisfaction was having a definite closing time. Conclusion : Our results showed that despite the demanding nature of anesthesiology as a specialty, many anesthesiologists were contented with their job.

  10. [Correction of neurotrophic disorders in patients, suffering consequences of a spinal cord and peripheral nerves trauma].

    Science.gov (United States)

    2014-08-01

    On clinical base of cathedra of the disasters medicine, military medicine, anesthesiology and reanimatology in 2010 - 2013 yrs 62 patients were treated for neurotrophic disorders, in 12 of them the method was applied, elaborated in the clinic. For neurotrophic ulcers in 5 patients autodermoplasty was performed, using splitted cutaneous flap, in 1 for the wound defect on a forearm--plasty, using rotational cutaneo-adipose flap, based on axial blood supply. In 44 patients after a spinal cord trauma a neurotrophic defects degree III - IV have formed. The kind of operative intervention was selected depending on size of the defect, the wound depth and functional peculiarities of the injured area. Introduction of a new method of treatment of neurotrophic ulcers of the lower extremities, using preparation of hyaluronic acid with sodium succinate, expands the perspectives of treatment in patients, suffering defects of cover tissues. Differentiated approach to choice of the wound closure method, caused by damage of central and peripheral neural system, have permitted to achieve positive results in 98.1% of patients. PMID:25507021

  11. Genomics in cardiovascular diseases: analysis of the importance of the toll-like receptor signaling pathway

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    Bustamante J

    2012-10-01

    Full Text Available J Bustamante,1 E Tamayo,2 J Herreros3,41Department of Cardiovascular Surgery, Hospital Universitario La Princesa, Madrid, 2Department of Anesthesiology and Intensive Care, Hospital Clinico Universitario de Valladolid, Valladolid, 3Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Santander, 4Biomedical Engineering Institute of Santander, Santander, SpainAbstract: The development of techniques for genomics study makes it possible for us to further our knowledge about the physiopathology of various immunological or infectious diseases. These techniques improve our understanding of the development and evolution of such diseases, including those of cardiovascular origin, whilst they help to bring about the design of new therapeutic strategies. We are reviewing the genetic alterations of immunity in said field, and focusing on the signaling pathway of toll-like receptors because not only does this play a decisive role in response to microorganisms, it is also heavily involved in modulating the inflammatory response to tissue damage, a side effect of numerous cardiovascular diseases. These alterations in tissue homeostasis are present under a wide range of circumstances, such as reperfusion ischemia (myocardial infarction phenomena, arteriosclerosis, or valvulopathy.Keywords: genome-wide association study, single-nucleotide polymorphism, innate immune system, ischemic/reperfusion, myocardial infarction

  12. NEURONAS ESPEJO Y EL APRENDIZAJE EN ANESTESIA Learning anaesthesia and mirror neurons

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    John Bautista

    2011-12-01

    Full Text Available Las neuronas espejo fueron descritas inicialmente en primates de la especie Macaca nemestrina hacia el año 1990 por el neurofisiólogo Giacomo Rizzolatti y su grupo de la Universidad de Parma, en Italia. Son neuronas motoras que activan cuando el individuo observa la acción concreta para la que están predeterminadas sin generar ningún tipo de actividad motora. En la actualidad se considera que estas neuronas participan en procesos de adaptación al entorno social ya que permiten no solamente comprender las acciones sino también las intenciones de otros individuos. Se les atribuye función en los procesos de aprendizaje simple a través de la observación y la imitación que pueden ser aprovechados en la enseñanza de la anestesiología.Mirror neurons were initially described in primates from the Macaca nemestrina species around 1990 by the neurophysiologist Giacomo Rizzolatti and his group from Parma University in Italy. They are motor neurons which become activated when an individual observes a concrete action for which they are predetermined without any type of motor activity being produced. It is currently considered that these neurons participate in adapting to the social setting since they lead to understanding other individuals' actions and intensions. A function has been ascribed to them regarding simple learning through observation and imitation which can be exploited in teaching anesthesiology.

  13. MICROBIOLOGICAL SURVEILLANCE IN THE INTENSIVE CARE UNIT: A TERTIARY HOSPITAL EXPERIENCE IN KOSHI AREA (NORTHERN BIHAR INDIA

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    Chandan Kumar

    2014-08-01

    Full Text Available INTRODUCTION: Hospital infections are important because of increased risk of mortality and morbidity and their economic burden countries especially like India, most commonly seen in intensive care units (ICUs. We aimed to document the characteristics of patients at an ICU of Northern India, obtain bacteriologic samples, and determine the distribution of the isolated microorganisms. MATERIAL/METHODS: The study was conducted in the ICU of an anesthesiology and Surgery department. The characteristics of 200 patients treated there for a period of over two years were documented. The distribution of bacteriologic samples and isolated microorganisms and susceptibilities were investigated. The emerging hospital infections were determined using surveillance methods that were based on clinical and laboratory data. RESULTS: Intoxication was the most common cause of hospitalization, followed by respiratory insufficiency due to severe pneumonia and/or chronic obstructive respiratory disease, then trauma, postoperative conditions, and cerebrovascular problems. Cultures were most commonly obtained from patients with respiratory insufficiency and trauma. According to clinical specimens, the most commonly isolated microorganisms were E. coli (60.86% in urine, S. aureus (53.84% in blood, P. aeruginosa (26.22% in tracheal aspirates, and Acinetobacter spp. (50.00% in wounds. Considering all specimens, MRSA (24.00% was the most common microorganism. CONCLUSIONS: Hospital infections causes serious problem in an ICU setting. Surveillance studies comprise the basis for treatment of ICU infections

  14. 多学科合作救治严重产后出血

    Institute of Scientific and Technical Information of China (English)

    侯红瑛

    2014-01-01

    严重产后出血仍然是导致孕产妇死亡的重要原因。多学科合作在严重产后出血的救治中起着十分重要的作用。针对严重产后出血的原因,加强产科、麻醉科、影像科和输血科等多学科的协作;规范输血输液管理,提倡自体输血的应用,有利于严重产后出血的成功救治。%Severe postpartum hemorrhage is still the major cause of maternal death.Multiple discipline cooperation is very important in severe postpartum hemorrhage therapy.According to the etiology of severe postpartum hemorrhage, strengthen the teamwork ( including obstetrics, anesthesiology, radiology and transfusion ) , standardize the transfusion, and encourage autologous transfusion, all of these are beneficial to the rescue of severe postpartum hemorrhage.

  15. Bisphosphonate therapy and osteonecrosis of the jaw complicated with a temporal abscess in an elderly woman with rheumatoid arthritis: a case report

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    Manzon L

    2014-08-01

    Full Text Available Licia Manzon,1 Evaristo Ettorre,1 Giovanni Viscogliosi,1 Stefano Ippoliti,1 Fabio Filiaci,2 Claudio Ungari,2 Giovanni Fratto,1 Alessandro Agrillo2 1Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, 2Department of Odontology and Maxillofacial Surgery, “Sapienza” University, Rome, Italy Abstract: Bisphosphonate-related osteonecrosis of the jaw (BRONJ is an adverse drug reaction described as the progressive destruction and death of bone tissue of the mandible or maxilla, in the course of bisphosphonate therapy. Orally administered bisphosphonates, widely used for the treatment of osteoporosis, are rarely associated with BRONJ. Instead, the risk greatly increases whether the patient is concomitantly taking steroid and/or immunosuppressant agents. The aims of this paper are to briefly discuss the evidence of the associations between bisphosphonate therapy and BRONJ, and the effects of co-occurring factors such as the presence of rheumatoid arthritis, dental surgery, and concomitant corticosteroid therapy. In particular, we present the case of an elderly woman with BRONJ suffering from rheumatoid arthritis, with a recent dental extraction and with a very unusual complication: a temporal abscess, who was successfully treated. Keywords: bisphosphonate-related osteonecrosis of the jaw, BRONJ, adverse reaction, steroids

  16. New trends in the complex treatment in the Cleft Centre in Bratislava.

    Science.gov (United States)

    Kokavec, R; Hedera, J; Fedeles, J; Janovic, J; Kratka, E; Klimova, I

    2001-01-01

    The last decade of the second millennium has brought some major changes into the concept of comprehensive treatment of the cleft lip and palate patients commonly accepted by the cleft center in Bratislava. Important events occurred, which surely had and in future they probably still would have an important impact on the comprehensive medical care of children with cleft lip and palate. There is beyond any doubt that an ongoing application of new trends in such fields as plastic surgery, anesthesiology, maxillofacial surgery, orthodontics, phonetics, speech therapy, paediatrics, human genetics or teratology will contribute to the progress and improvement of functional and aesthetic results and to better social adaptation of the cleft lip and palate patients. The study focuses on the following issues: cleft incidence, timing of the primary surgical repair, as well as the need of secondary operations (closures of communications, bone grafts, pharyngeal flaps, corrections of the lip and nose) and the achieved standard of speech quality and articulation, as well as on the early and late otological states and phonation. (Tab. 7, Fig. 3, Ref. 8.)

  17. Medical devices for the anesthetist: current perspectives

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    Ingrande J

    2014-03-01

    Full Text Available Jerry Ingrande, Hendrikus JM LemmensDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USAAbstract: Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer. This review focuses on key medical devices such as cardiovascular monitors, airway equipment, neuromonitoring tools, ultrasound, and target controlled drug delivery software and hardware. This review demonstrates how advances in these areas have improved the safety and efficacy of anesthesia and facilitate its administration. When applicable, indications and contraindications to the use of these novel devices will be explored as well as the controversies surrounding their use.Keywords: catheters, echocardiography, ultrasound, fiberoptic bronchoscope, laryngeal mask airway, closed-loop anesthesia

  18. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone

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    Trigo P

    2011-12-01

    Full Text Available Paula Trigo, Gregory W FischerDepartment of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USAAbstract: Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can potentially lead to severe drug interactions. Furthermore, age-related changes in the cardiovascular system as well as other physiological changes result in altered drug pharmacokinetics. Dronedarone is a new drug recently approved for the treatment of arrhythmias, such as atrial fibrillation and/or atrial flutter. Dronedarone is a benzofuran amiodarone analog which lacks the iodine moiety and contains a methane sulfonyl group that decreases its lipophilicity. These differences in chemical structure are responsible for making dronedarone less toxic than amiodarone which, in turn, results in fewer side effects. Adverse events for dronedarone include gastrointestinal side effects and rash. No dosage adjustments are required for patients with renal impairment. However, the use of dronedarone is contraindicated in the presence of severe hepatic dysfunction.Keywords: atrial fibrillation, elderly, antiarrhythmic agents, amiodarone, dronedarone

  19. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions

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    Li J

    2015-08-01

    Full Text Available Jinlei Li, Thomas Halaszynski Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA Abstract: Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000. Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes. No laboratory model identifies patients at risk, and rarity of neuraxial hematoma defies prospective randomized study so “patient-specific” factors and “surgery-related” issues should be considered to improve patient-oriented outcomes. Details of advanced age, older females, trauma patients, spinal cord and vertebral column abnormalities, organ function compromise, presence of underlying coagulopathy, traumatic or difficult needle placement, as well as indwelling catheter(s during anticoagulation pose risks for significant bleeding. Therefore, balancing between thromboembolism, bleeding risk, and introduction of more potent antithrombotic medications in combination with regional anesthesia has resulted in a need for more than “consensus statements” to safely manage regional interventions during anticoagulant/thromboprophylactic therapy. Keywords: antithrombotics, novel oral anticoagulant, regional, neurologic dysfunction, hematoma, peripheral nerve blockade

  20. Duloxetine in the management of chronic musculoskeletal pain

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    Smith EJ

    2012-06-01

    Full Text Available Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor

  1. A single dose of propofol can produce excellent sedation and comparable amnesia with midazolam in cystoscopic examination

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    P Sajedi

    2006-07-01

    Full Text Available BACKGROUND: In this study we compared the sedative and amnesic effects of propofol with midazolam in cystoscopy examination. METHODS: This prospective clinical trial was done on 44 adults, with American Society of Anesthesiology physical status I, II, III, who were candidate for cystoscopic examination. Patients were recruited according to convenience sampling method and randomized into two equal groups. In study group, propofol plus fentanyl and in control group midazolam plus fentanyl were given intravenously. Vital signs and SaO2, the number of patients movements, presence of eyelid movements and verbal contact all at the first and 10th minutes after beginning the procedure were recorded. Also, frequency distributions of patients recalls, VAS (visual analog scale for pain and VAS for satisfaction scores were evaluated in recovery room. RESULTS: Frequency distribution of patients movements, frequency distribution of verbal contact and eyelid movements at the first and 10th minutes were higher in midazolam group (P<0.05. There were a lower VAS pain score and higher VAS satisfaction score in propofol group (P = 0.009 and P = 0.041 respectively. CONCLUSIONS: Propofol was more effective than midazolam in inducing deep sedation and immobility in patients undergoing cystoscopy examination, without interfacing patients with additional danger. KEYWORDS: Propofol, midazolam, cystoscopy.

  2. [Anesthetic Management of Cesarean Section in a Pregnant Woman with Advanced Tongue Cancer].

    Science.gov (United States)

    Kojima, Mikiko; Yoshie, Kazuka; Shimazaki, Azusa; Ohtsuka, Naoki; Otake, Hiroshi; Koide, Keiko; Sato, Youko

    2016-06-01

    It is very difficult to decide the best time to deliver the baby for a pregnant woman with advanced cancer. We experienced the perioperative and perinatal management of a 39-year-old pregnant woman with advanced tongue cancer. The cancer had already metastasized to the lung and lymph nodes. Furthermore a recurrent thumb-sized tumor was found in her mouth. She had firmly desired to discontinue all anticancer treatment for protecting the fetus. On the other hand, her family could not accept her determination yet. Therefore the medical team was organized with doctors and co-medicals from multiple departments such as gynecology, pediatrics, radiology, oncology, midwife, psychotherapy and anesthesiology. After several conferences including herself and family, finally cesarean section was scheduled for the 30th gestational week. Prepared for unexpected emergency delivery, airway stenosis was ruled out by fiberoptic laryngoscopy and the consent for emergency tracheostomy was obtained. The operation was performed successfully under spinal anesthesia without any severe troubles. Medical care as a team from early phase enabled elaborate observation and preparation through the perioperative and perinatal period. Furthermore, it was efficient to provide satisfaction to the patient and her family as well. PMID:27483663

  3. Management of chronic pain in the elderly: focus on transdermal buprenorphine

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    Nalini Vadivelu

    2008-09-01

    Full Text Available Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration have opened up new treatment options to meet this challenge. The transdermal buprenorphine matrix allows for slow release of buprenorphine and damage does not produce dose dumping. In addition the long-acting analgesic property and relative safety profile makes it a suitable choice for the treatment of chronic pain in the elderly. Its safe use in the presence of renal failure makes it an attractive choice for older individuals. Recent scientific studies have shown no evidence of a ceiling dose of analgesia in man but only a ceiling effect for respiratory depression, increasing its safety profile. It appears that transdermal buprenorphine can be used in clinical practice safely and efficaciously for treating chronic pain in the elderly.Keywords: transdermal buprenorphine, chronic pain, elderly

  4. Metabolic syndrome, inflammation and atherosclerosis

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    Rodolfo Paoletti

    2006-06-01

    Full Text Available Rodolfo Paoletti1,2, Chiara Bolego1, Andrea Poli2, Andrea Cignarella1,31Department of Pharmacological Sciences, University of Milan, Italy; 2Nutrition Foundation of Italy (NFI, Milan; 3Department of Pharmacology and Anesthesiology, University of Padova, ItalyAbstract: The inflammatory component of atherogenesis has been increasingly recognized over the last decade. Inflammation participates in all stages of atherosclerosis, not only during initiation and during evolution of lesions, but also with precipitation of acute thrombotic complications. The metabolic syndrome is associated with increased risk for development of both cardiovascular disease and type-2 diabetes in humans. Central obesity and insulin resistance are thought to represent common underlying factors of the syndrome, which features a chronic low-grade inflammatory state. Diagnosis of the metabolic syndrome occurs using defined threshold values for waist circumference, blood pressure, fasting glucose and dyslipidemia. The metabolic syndrome appears to affect a significant proportion of the population. Therapeutic approaches that reduce the levels of proinflammatory biomarkers and address traditional risk factors are particularly important in preventing cardiovascular disease and, potentially, diabetes. The primary management of metabolic syndrome involves healthy lifestyle promotion through moderate calorie restriction, moderate increase in physical activity and change in dietary composition. Treatment of individual components aims to control atherogenic dyslipidemia using fibrates and statins, elevated blood pressure, and hyperglycemia. While no single treatment for the metabolic syndrome as a whole yet exists, emerging therapies offer potential as future therapeutic approaches.Keywords: metabolic syndrome, systemic inflammation, coronary artery disease

  5. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine

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    Tanmoy Ghatak

    2010-01-01

    Full Text Available For treatment of intra and postoperative pain, no drug has yet been identified that specifically inhibits nociception without associated side effects. Magnesium has antinociceptive effects in animal and human models of pain. The current prospective randomised double-blind study was undertaken to establish the effect of addition of magnesium or clonidine, as adjuvant, to epidural bupivacaine in lower abdominal and lower limb surgeries. A total of 90 American Society of Anesthesiology (ASA grade I and II patients undergoing lower abdominal and lower limb surgeries were enrolled to receive either magnesium sulphate (Group B or clonidine (Group C along with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150 mcg clonidine in Group C, whereas in control group (Group A, patients received same volume of normal saline. Onset time, heart rate, blood pressure, duration of analgesia, pain assessment by visual analogue score (VAS and adverse effects were recorded. Onset of anaesthesia was rapid in magnesium group (Group B. In group C there was prolongation of duration of anaesthesia and sedation with lower VAS score, but the incidence of shivering was higher. The groups were similar with respect to haemodynamic variables, nausea and vomiting. The current study establishes magnesium sulphate as a predictable and safe adjunct to epidural bupivacaine for rapid onset of anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.

  6. Advances in the use of intravenous techniques in ambulatory anesthesia

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    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  7. Comparison of incidence of postoperative nausea and vomiting (PONV between children of smoker parent and children of non-smoker parents after surgery in Imam Khomeini and Children Medical Center Hospitals

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    Ghazi Saeidi K

    2001-10-01

    Full Text Available Postoperative nausea and vomiting is a common complication that all anesthesiologist are familiar with the problems of its consequences. Although continued research on the recognition of factors affecting the incidence of PONV is being done but they are not sufficient and the need for research along with advances in anesthesiology and newer drugs are considered. In this prospective cohort study 400 children of 3 to 12 age who has been operated for general surgery (other than eye, thorax and upper abdomen and orthopedic surgery in the Imam Khomeini and Children Medical Center Hospital has been evaluated. Of these, 200 children who had smoking parent and according to definition were passive smokers and the other 200 children had no smoking parents. Both the groups were matched for sex, age, and type of operation. With the analysis of data we noted that the incidence of PONV in both groups was 19.5 and there was no significant difference between the two groups. (Passive smoker 19 percent and non-passive smoker 20 percent. We also noted a relation between the duration and the incidence of PONV. So operation with more than 2 hours had higher incidence of PONV. There was also positive relation between PONV and controlled ventilation. However, there was no significant difference as the sex and type of operation was concerned. In conclusion, children of smoker parents suffer more PONV than children of non-smoker parents if operation takes longer than two hours or the patient is mechanically ventilated during operation.

  8. Regulatory mechanisms of apoptosis in regularly dividing cells

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    Ribal S Darwish

    2010-08-01

    Full Text Available Ribal S DarwishDepartment of Anesthesiology, Division of Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland, USAAbstract: The balance between cell survival and death is essential for normal development and homeostasis of organisms. Apoptosis is a distinct type of cell death with ultrastructural features that are consistent with an active, inherently controlled process. Abnormalities and ­dysregulation of apoptosis contribute to the pathophysiology of multiple disease processes. Apoptosis is strictly regulated by several positive and negative feedback mechanisms that regulate cell death and determine the final outcome after cell exposure to apoptotic stimuli. Mitochondria and caspases are central components of the regulatory mechanisms of ­apoptosis. Recently, noncaspase pathways of apoptosis have been explored through the studies of ­apoptosis-inducing factor and endonuclease G. Multiple difficulties in the apoptosis research relate to apoptosis detection and imaging. This article reviews current understanding of the regulatory mechanisms of apoptosis.Keywords: caspases, apoptosis-inducing factor, apoptosis inhibitory proteins, cytochrome c, mitochondria 

  9. Sertraline-induced pseudocholinesterase enzyme deficiency

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    Beyazit Zencirci

    2010-11-01

    Full Text Available Beyazit ZencirciMOSTAS Private Health Hospital, Department of Anesthesiology, Kahramanmaras, TurkeyAbstract: A 47-year-old Turkish male was scheduled for laparoscopic cholecystectomy under general anesthesia. The patient had 2 operations 28 and 19 years ago under general anesthesia. It was learned that the patient was administered succinylcholine during both of these previous operations and that he did not have a history of prolonged recovery or postoperative apnea. The patient had been using sertraline for 3 years before the operation. Pseudocholinesterase is a drug-metabolizing enzyme responsible for hydrolysis of the muscle-relaxant drugs mivacurium and succinylcholine. Deficiency of this enzyme from any cause can lead to prolonged apnea and paralysis following administration of mivacurium and succinylcholine. The diagnosis of pseudocholinesterase enzyme deficiency can be made after careful clinic supervision and peripheral nerve stimulator monitoring. A decrease in the activity of pseudocholinesterase enzyme and a decline in the block effect over time will help verify the diagnosis. Our patient’s plasma cholinesterase was found to have low activity. Instead of pharmacological interventions that may further complicate the situation in such cases, the preferred course of action should be to wait until the block effect declines with the help of sedation and mechanical ventilation. In our case, the prolonged block deteriorated in the course of time before any complications developed.Keywords: mivacurium, pseudocholinesterase deficiency, sertraline

  10.  α-Cyclodextrin dimer complexes of dopamine and levodopa derivatives to assess drug delivery to the central nervous system: ADME and molecular docking studies

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    Shityakov S

    2012-06-01

    Full Text Available Sergey Shityakov, Jens Broscheit, Carola FörsterDepartment of Anesthesiology and Critical Care, University of Würzburg, Würzburg, GermanyAbstract: This paper attempts to predict and emphasize molecular interactions of dopamine, levodopa, and their derivatives (Dopimid compounds containing 2-phenyl-imidazopyridine moiety with the α-cyclodextrin dimer in order to assess and improve drug delivery to the central nervous system. The molecular docking method is used to determine the energetic profiles, hydrogen bond formation, and hydrophobic effect of 14 host–guest complexes. The results show that the “chemical branching” represented by additional ethyl-acetate residue is energetically unfavorable and promotes a conformational shift due to the high root mean square deviation levels. This phenomenon is characterized by a low number of H-bonds and a significant decrease of the host–guest hydrophobic potential surface. Finally, the overall docking procedure presents a powerful rationale for screening and analyzing various sets of promising drug-like chemical compounds in the fields of supramolecular chemistry, molecular sensing, synthetic receptors, and nanobiotechnology.Keywords: dopamine, levodopa, Dopimid compounds, α-CD dimer, molecular docking, complexation

  11. Comparing ‘remifentanil-propofol’ and ‘fentanyl-propofol’ in patients undergoing craniotomy for supratentorial space-occupying lesions

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    S Yousef Zadeghan

    2012-12-01

    Full Text Available Background: Control of intracranial pressure (ICP before, during and after neurosurgical operations is crucially important. Therefore, trying different methods and drug combinations to attain this goal is an ongoing effort in anesthesiology. In this study we compared two combinations of a narcotic agent with propofol in neurosurgical operations to control intracranial pressure.Methods: In this prospective randomized double-blind clinical trial, we enrolled 34 patients with supratentorial brain tumors who were candidates for craniotomy in Alzahra Hospital in Isfahan, Iran from April 2008 to April 2009. The patients were randomly divided into two groups of 17, in whom the first and the second group, respectively, received a combination of "propofol and fentanyl" and a combination of "propofol and remifentanyl" as maintenance of anesthesia. The hemodynamic status, ICP during the surgery, and post-surgical complications in recovery unit were observed for and registered in a questionnaire.Results: Hemodynamic status was similar in both groups and they did not differ in recovery complications except for pain which was more prevalent in remifentanil group (P<0.03. Although the patients in fentanyl group better responded to the drug for lowering ICP than remifentanyl group, but the difference was not statistically significant.Conclusion: There is no difference between these two anesthetic agent combinations and both could be useful in the anesthesia of neurosurgical operations. However combination of propofol and fentanyl seem to be superior because of more pain relief and a smoother recovery period.  

  12. Endocrinopathies: The current and changing perspectives in anesthesia practice

    Science.gov (United States)

    Bajwa, Sukhminder Jit Singh; Kaur, Gurpreet

    2015-01-01

    The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer. PMID:26180760

  13. Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media.

    Science.gov (United States)

    Liccardi, G; Lobefalo, G; Di Florio, E; Di Iorio, C; Occhiochiuso, L; Romano, L; Savoia, G; Massa, R M; D'Amato, G

    2008-01-01

    General anesthetics and contrast media can cause anaphylactic as well as anaphylactoid reactions. These events are of great concern to radiologists and anesthesiologists because of their relatively high prevalence, possible threat to life, and medical-legal consequences. Points discussed in this review are the critical evaluation of risk factors affecting prevention strategies, the need to be aware of pathogenic mechanisms relevant to prevention strategies, the use of alternative products if a culprit agent is known, the recognition of early signs of a reaction, the need to keep records of reactions on a patient's medical chart, the planning of prophylactic therapy, recommended actions after a reaction to an anesthetic or contrast medium, and the suggested establishment of allergy-anesthesiology centers to improve cooperation, and medical-legal issues. As any drug or contrast medium administered during general anesthesia or a diagnostic procedure can induce a potentially life-threatening or fatal event even in the absence of any evident risk factor in the patient's medical history or clinical status, we usually premedicate susceptible individuals at least to attenuate the severity of an unpredictable reaction, although we cannot rely on the efficacy of premedication to completely prevent a severe event. These recommendations, which are based on the literature and on the experience of our working group, aim to provide useful information for physicians and other specialists who operate in the absence of an allergy consultant. PMID:18361095

  14. Trans-abdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

    Science.gov (United States)

    Zourabian, Anna; Siegel, Andrew M.; Chance, Britton; Ramanujam, Nirmala; Rode, Martha; Boas, David A.

    2000-10-01

    Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both the fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are the first in the range of 670 - 720 nm and the second in the range of 825 - 925 nm. Further, we discuss the possible systematic errors during our measurements and their contribution to the obtained saturation results. We present feasibility studies for fetal pulse oximetry, monitored noninvasively through the maternal abdomen. Our preliminary experiments show that the fetal pulse can be discriminated from the maternal pulse and thus, in principle, the fetal arterial oxygen saturation can be obtained. We present the methodology for obtaining these data, and discuss the dependence of our measurements on the fetal position with respect to the optode assembly.

  15. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review

    Directory of Open Access Journals (Sweden)

    Dovlo Delanyo

    2004-06-01

    Full Text Available Abstract Background Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. Methods A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. Results The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. Conclusions The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.

  16. Potential role of stem cells in management of COPD

    Directory of Open Access Journals (Sweden)

    Tillie L Hackett

    2010-03-01

    Full Text Available Tillie L Hackett1,2, Darryl A Knight1,2, Don D Sin1,31UBC James Hogg Research Centre, Heart and Lung Institute, St Paul’s Hospital, Vancouver, BC, Canada, V6Z 1Y6; 2Department of Anesthesiology, Pharmacology and Therapeutics, 3Department of Medicine, University of British Columbia, Vancouver, BC CanadaAbstract: Chronic obstructive pulmonary disease (COPD is a worldwide epidemic affecting over 200 million people and accounting for more than three million deaths annually. The disease is characterized by chronic inflammation of the airways and progressive destruction of lung parenchyma, a process that in most cases is initiated by cigarette smoking. Unfortunately, there are no interventions that have been unequivocally shown to prolong survival in patients with COPD. Regeneration of lung tissue by stem cells from endogenous and exogenous sources is a promising therapeutic strategy. Herein we review the current literature on the characterization of resident stem and progenitor cell niches within the lung, the contribution of mesenchymal stem cells to lung regeneration, and advances in bioengineering of lung tissue.Keywords: COPD, stem cell therapy, epithelial repair, regenerative medicine

  17. Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Qin Qin

    2016-04-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the value of real-time ultrasound (US guidance for axillary brachial plexus block (AXB through the success rate and the onset time. METHODS: The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, EMBASE, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. RESULTS: Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group and the controlled group included 885 patients (246 patients using traditional approach (TRAD and 639 patients using nerve stimulation (NS. Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p < 0.00001. The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. CONCLUSION: The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance.

  18. Tripartite comparison of single-incision and conventionallaparoscopy in cholecystectomy: A multicenter trial

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To compare the characteristics of two singleincisionmethods, and conventional laparoscopy incholecystectomy, and demonstrate the safety andfeasibility.METHODS: Three hundred patients with gallstonesor gallbladder polyps were admitted to two clinicalcenters from January 2013 to January 2014 and wererandomized into three groups of 100: single-incisionthree-device group, X-Cone group, and conventionalgroup. The operative time, intraoperative blood loss,complications, postoperative pain, cosmetic score,length of hospitalization, and hospital costs werecompared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males (47%) and 158 females(53%) were enrolled in this study. The populationcharacteristics of these three groups is no significantdifferences exist in terms of age, sex, body massindex and American Society of Anesthesiology (P 〉0.05). In results, there were no significant differencesin blood loss, length of hospitalization, postoperativecomplications.The operative time in X-Cone groupwas significantly longer than other groups.There weresignificant differences in postoperative pain scores andcosmetic scores at diffent times after surgery (P 〈 0.05).CONCLUSION: This study shows that this two singleincisionmethods are safe and feasible. Both methodsare superior to the conventional procedure in cosmeticand pain scores.

  19. Morphology and topographic anatomy of the spinal cord of the red-footed tortoise (Geochelone carbonaria Spix, 1824

    Directory of Open Access Journals (Sweden)

    Rafael C Carvalho

    2011-12-01

    Full Text Available The aim of this study was to describe the topography of the spinal cord of the red-footed tortoise to establish a morphological basis for applied research in anesthesiology and morphology. Six tortoises from the state of Maranhão (Brazil that had died of natural causes were used. The common carotid artery was used to perfuse the arterial system with saline solution (heated to 37ºC and to fix the material with a 20% formaldehyde solution. The specimens were then placed in a modified decalcifying solution for 72 hours to allow dorsal opening of the carapace with a chisel and an orthopedic hammer. Dissection of the dorsal musculature and sectioning of the vertebral arches were performed to access the spinal cord. The results revealed the spinal cord of G. carbonaria to be an elongated, whitish mass that reached the articulation between the penultimate and last caudal vertebrae. The cervical intumescence (Intumescentia cervicalis was located between vertebral segments C5 and T1, whereas the lumbosacral intumescence (Intumescentia lumbalis was located between T6 and Ca1.

  20. [Resolution of medical complaints by arbitration. Analysis of 140 cases].

    Science.gov (United States)

    Valle-González, A

    2000-01-01

    The author studied 140 complex medical complaints handled by an Alternative Disputes Resolution Institution (CONAMED), between June 1996 and December 1999. There were 79 females and 61 males, cases originated in public hospitals 93 (66.4%) and private hospitals or practitioners 47 (33.6%). Several cases were treated sequentially in both types of institutions. The medical specialties involved were in frequency order: Neurosurgery, General Surgery, Gyn-Ob, Anesthesiology, Traumatology and Orthopedics, Oncology, Emergency, and 22 others. The causes of complaints were: Surgical treatment, Medical treatment, Diagnosis, Anesthesia, and mixed causes. There were 59 deaths, 43 anatomic or functional loses, disability or sequelae; and 34 recoveries. CONAMED delivered 27 arbitration verdicts, 94 expert opinions asked by prosecutors or human rights organizations, and 1 technical advice to medical authorities. Some resolutions included more than one case. More than half of physicians involved were found not guilty of malpractice. Even though the main CONAMED purpose is to improve the quality of Medical Care acting as The Health Ombudsman, its performance may be on behalf of medical practitioners. PMID:10992645

  1. Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency

    Directory of Open Access Journals (Sweden)

    Wilkes D

    2014-10-01

    Full Text Available Denise Wilkes Department of Anesthesiology and Pain Medicine, University of Texas Medical Branch, Galveston, TX, USA Abstract: The management of chronic pain can be very challenging. Often, physicians employ intrathecal (IT drug delivery systems as a last resort to relieve intractable pain. The system consists of an implantable pump that stores and delivers medication through a catheter to the IT space. Programmability is achieved by positioning an external devise over the implanted pump to change the mode of drug delivery. The innovations in programmable IT drug delivery systems are expanding more rapidly than ever before. Unfortunately, the rapid expansion is accompanied by a lack of prospective randomized trials examining these new options. In an effort to improve results and reduce side effects, publications by experts or expert consensus panels provide guidance for the community. The purpose of this article is to provide a summary of high interest topics in recent publications. Keywords: intrathecal morphine, chronic pain, programmable drug delivery, implantable drug delivery

  2. Extended-release hydrocodone – gift or curse?

    Directory of Open Access Journals (Sweden)

    Krashin D

    2013-01-01

    Full Text Available Daniel Krashin,1 Natalia Murinova,2 Andrea M Trescot31Department of Anesthesiology and Pain Medicine, 2Department of Neurology University of Washington, Seattle, WA, USA 3Algone Pain Center, Wasilla, AK, USAAbstract: Hydrocodone is a semisynthetic opioid, which has been used for decades as a short-acting analgesic combined with acetaminophen (or less commonly ibuprofen. Several long-acting, non-acetaminophen-containing hydrocodone formulations are undergoing trials in the US under the auspices of the US Food and Drug Administration, and may be available shortly. This article reviews some of the advantages (including drug familiarity and lack of acetaminophen toxicity and potential disadvantages (including altered use patterns and high morphine equivalent dosing of such a medication formulation. We also discuss the abuse potential of long-acting versus short-acting opioids in general and hydrocodone specifically, as well as the metabolism of hydrocodone.Keywords: hydrocodone, long-acting opioids, opioid abuse, acetaminophen toxicity, tamper-resistant opioids

  3. Endocrinopathies: The current and changing perspectives in anesthesia practice

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2015-01-01

    Full Text Available The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer.

  4. Advances in the staging of renal cell carcinoma with high-resolution imaging; Fortschritte im Staging des Nierenzellkarzinoms mittels hochaufloesender Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Hallscheidt, P.; Noeldge, G.; Schawo, S.; Kauffmann, G.; Palmowski, M. [Abt. Radiodiagnostik, Radiologische Klinik, Univ. Heidelberg (Germany); Bartling, S. [Medizinische Physik, DKFZ Heidelberg (Germany); Pfitzenmaier, J. [Urologische Klinik, Univ. Heidelberg (Germany)

    2007-12-15

    Modern imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) allow high-resolution imaging of the abdomen. Modern scanners made high temporal as well as high spatial resolution available. Therapeutic approaches to the treatment of renal cell carcinoma have been improved over the recent years. Besides conventional and open laparoscopic tumor nephrectomy and nephron sparing, surgical approaches such as local tumor cryotherapy and radiofrequency ablation (RF) are ablative modalities and are used increasingly. Improved anesthesiological methods and new surgical approaches also allow curative treatment in extended tumors. Prerequisites for preoperative imaging modalities include visualization of the kidney tumor as well as its staging. Tumor-related infiltration of the renal pelvis or invasion of the perinephric fat and the renal hilus has to be excluded prior to nephron sparing surgery. In cases with extended tumors with infiltration of the inferior vena cava, it is necessary to visualize the exact extension of the tumor growth towards the right atrium in the vena cava. The radiologist should be informed about the diagnostic possibilities and limitations of the imaging modalities of CT and MRI in order to support the urologist in the planning and performance of surgical therapeutical approaches. (orig.)

  5. EXPERIENCE WITH ROBOTIC LUMЕNIS CO LASER IN ENDOSCOPIC LARYNGEAL SURGERY

    Directory of Open Access Journals (Sweden)

    E. N. Novozhilova

    2014-01-01

    Full Text Available  2 The paper describes the first experience in using robotic CO laser at the Department of Head and Neck Tumors, Moscow City Cancer Hospital Sixty-Two. With advances in endoscopic techniques and anesthesiology, there have been new possibilities of usingdirect (rigid larygoscopy in conjunction with laser systems.The Lumеnis laser assembly consists of three interconnected components: a videocamera, an operating microscope, and directly CO laser. It includes a computer system that sets a program to perform an operation.The heart of the laser system is a scanning Digital Acu Blade micromanipulator. This unique assembly makes itpossible to control the area and depth of incision, to cut intricate shapes in relation to the surface anatomy, and to precisely control ablation and hemostasis. The effect of tissue carbonization during surgery is minimal at the expense of the physical characteristics and different modes of radiation. It is noted that this system allows organ-sparing treatment in cancer patients and their prompt rehabilitation after surgical interventions.

  6. [Cardiac evaluation before non-cardiac surgery].

    Science.gov (United States)

    Menzenbach, Jan; Boehm, Olaf

    2016-07-01

    Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices. Application of diagnostic means, should be used adjusted to this risk estimation. Cardiac biomarkers are useful to discover risk of complications or mortality, that cannot be assessed by clinical signs. After preoperative optimization and perioperative cardiac protection, the observation of the postoperative period remains, to prohibit complications or even death. In consideration of limited resources of intensive care department, postoperative ward rounds beyond intensive care units are considered to be an appropriate instrument to avoid or recognize complications early to reduce postoperative mortality. PMID:27479258

  7. Pneumorrhachis, pneumomediastinum, pneumopericardium and subcutaneous emphysema as complications of bronchial asthma

    International Nuclear Information System (INIS)

    Pneumorrhachis (PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself as well as by its underlying pathology. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR, and its treatment is often individualized. Frequently, multidisciplinary approach and regimes are required for its management. PR associated with bronchial asthma is extremely rare, and only very few cases are reported in the literature. Here, we report a case of a 17-year-old Saudi male patient who is a known case of bronchial asthma; he presented with extensive subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumorrhachis as complications of an acute exacerbation of his primary ailment. (author)

  8. Program director and resident perspectives of a competency-based medical education anesthesia residency program in Canada: a needs assessment

    Science.gov (United States)

    2016-01-01

    Purpose: In July 2015, the University of Ottawa introduced a competency-based medical education (CBME) postgraduate program for anesthesia. Prior to program implementation, this study aimed to identify Canadian anesthesiology program directors perceptions of CBME and residents’ opinion on how the program should be designed and perceived consequences of CBME. Methods: This two-phase, qualitative study included semi-structured interviews with Canadian anesthesia program directors (Phase I) and a focus group interview with residents enrolled in the University of Ottawa time-based anesthesia program (Phase II). Both phases sought to gauge participant’s perceptions of CBME. Interviews were recorded, transcribed verbatim and thematically analyzed. Results: Data was combined to protect anonymity of the six participants (three program directors and three residents). Participants spoke about the perceived advantages of CBME, the need to establish definitions, and challenges to a CBME program highlighting logistical factors, implications for trainees and the role assessment plays in CBME. Conclusion: These findings will inform CBME implementation strategies in anesthesia programs across the country, and may assist other residency programs in the design of their programs. Furthermore, our findings may help identify potential challenges and issues that other postgraduate specialties may face as they transition to a CBME model. PMID:26913772

  9. Tapentadol extended-release for treatment of chronic pain: a review

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2011-08-01

    Full Text Available Nalini Vadivelu1, Alexander Timchenko1, Yili Huang2, Raymond Sinatra11Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; 2Internal Medicine, North Shore-LIJ Plainview Hospital, Plainview, NY, USAAbstract: Tapentadol is a centrally acting analgesic with a dual mechanism of action of mu receptor agonism and norepinephrine reuptake inhibition. Tapentadol immediate-release is approved by the US Food and Drug Administration for the management of moderate-to-severe acute pain. It was developed to decrease the intolerability issue associated with opioids. Tapentadol extended-release has a 12-hour duration of effect, and has recently been evaluated for pain in patients with chronic osteoarthritis, low back pain, and pain associated with diabetic peripheral neuropathy. Tapentadol extended-release was found to provide safe and highly effective analgesia for the treatment of chronic pain conditions, including moderate-to-severe chronic osteoarthritis pain and low back pain. Initial trials demonstrating efficacy in neuropathic pain suggest that tapentadol has comparable analgesic effectiveness and better gastrointestinal tolerability than opioid comparators, and demonstrates effectiveness in settings of inflammatory, somatic, and neuropathic pain. Gastrointestinal intolerance and central nervous system effects were the major adverse events noted. Tapentadol will need to be rigorously tested in chronic neuropathic pain, cancer-related pain, and cancer-related neuropathic pain.Keywords: osteoarthritis, neuropathic pain, analgesic, opioids, norepinephrine

  10. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  11. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

  12. Percutaneous dilational tracheotomy for airway management in a newborn with Pierre-Robin syndrome and a glossopharyngeal web.

    Science.gov (United States)

    Pirat, Arash; Candan, Selim; Unlükaplan, Aytekin; Kömürcü, Ozgür; Kuşlu, Selim; Arslan, Gülnaz

    2012-04-01

    Pierre-Robin syndrome (PRS) is often associated with difficulty in endotracheal intubation. We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day-old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from the base of the tongue to the posterior pharyngeal wall. The infant was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation was impossible, and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.71 mm guide wire was introduced through this catheter. Using 5 French, 7 French, 9 French, and 11 French central venous catheter kit dilators, staged tracheotomy stoma dilation was performed. By inserting a size 3.0 tracheotomy cannula, PDT was successfully completed in this newborn. This case describes the successful use of PDT for emergency airway management of a newborn with PRS and glossopharyngeal web.

  13. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  14. Some Reflexions on the Modified Appleby Procedure

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    Francisco José Morera-Ocon

    2009-11-01

    Full Text Available Context Resection of pancreatic cancer with vascular invasion is a controversial issue, especially when the arterial trunks, such as the celiac axis, are involved. The modified Appleby procedure deals with the problem of encasement of the celiac trunk. Case report Two patients with locally advanced pancreatic cancer are reviewed: a 65-year-old female and a 78-year-old male with pancreatic cancer and involvement of the celiac trunk and hepatic artery. The male patient received neoadjuvant chemoradiation. The former underwent an extended pancreatectomy with en-bloc resection of the hepatic artery, celiac trunk, gastric serosa and adrenal gland. Liberation of arterial trunk involvement in the second patient was performed. The margins were microscopically clear of tumor (R0 in both patients. The second patient died from cholecystitis owing to arterial insufficiency. Conclusions CT vascular encasement is not always synonymous with real tumoral vascular invasion. Improvement in the quality of anesthesiological and surgical techniques has allowed vascular resections with lower morbidity. A cholecystectomy should always be performed using the modified Appleby procedure.

  15. A study on the relationship between employee mental health and agility strategic readiness: A case study of Esfahan hospitals in Iran

    Directory of Open Access Journals (Sweden)

    Hassan Ghodrati

    2013-04-01

    Full Text Available This study investigates whether enhancing organizational agility and mental health of staff could increase strategic readiness for crises or not. In this study, descriptive statistics is used to present demographic data of the research, and P-Test is employed for analyzing the data. In addition, to examine research hypotheses, correlation coefficients and descriptive statistics are implemented. Finally, to rank the variables and indicators of the research, Friedman test and for comparison of indicators and components of the research, nonparametric Kruskal-Wallis test are used. The proposed study designs a questionnaire and The questionnaire and distributes it among some nurses in obstetrics and anesthesiology department and among supervisors. Cronbach's alpha is also employed for determining the reliability in this study. The results indicate that working conditions as well as employees’ mental health are in good conditions, the employees with higher levels of mental health have higher readiness to deal with potential crises, and the relationship between agility of hospitals and their strategic readiness for dealing with crises is confirmed.

  16. Role of clevidipine butyrate in the treatment of acute hypertension in the critical care setting: a review

    Directory of Open Access Journals (Sweden)

    Ahmed S Awad

    2010-06-01

    Full Text Available Ahmed S Awad, Michael E GoldbergDepartment of Anesthesiology, Cooper University Hospital, UMDNJ-Robert Wood Johnson Medical School, Camden Campus, Camden, New Jersey, USAAbstract: Acutely elevated blood pressure in the critical care setting is associated with a higher risk of acute end-organ damage (eg, myocardial ischemia, stroke, and renal failure and perioperative bleeding. Urgent treatment and careful blood pressure control are crucial to prevent significant morbidity. Clevidipine butyrate (Cleviprex™ is an ultrashort-acting, third-generation intravenous calcium channel blocker. It is an arterial-selective vasodilator with no venodilatory or myocardial depressive effects. Clevidipine has an extremely short half-life of approximately 1 minute as it is rapidly metabolized by blood and tissue esterases. These metabolites are then primarily eliminated through urine and fecal pathways. The rapid onset and the short duration of action permit tighter and closer adjustment of the blood pressure than is possible with other intravenous agents.Keywords: calcium channel blocker, antihypertensive medications, end-organ damage, hypertensive crisis, hypertensive urgency

  17. A fatal adverse effect of cefazolin administration: severe brain edema in a patient with multiple meningiomas

    Directory of Open Access Journals (Sweden)

    Tribuddharat S

    2016-02-01

    Full Text Available Sirirat Tribuddharat,1 Thepakorn Sathitkarnmanee,1 Amnat Kitkhuandee,2 Sunchai Theerapongpakdee,1 Kriangsak Ngamsaengsirisup,1 Sarinya Chanthawong,11Department of Anesthesiology, 2Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Abstract: Cefazolin is commonly administered before surgery as a prophylactic antibiotic. Hypersensitivity to cefazolin is not uncommon, and the symptoms mostly include urticaria, skin reaction, diarrhea, vomiting, and transient neutropenia, which are rarely life threatening. We present a rare case of fatal cefazolin hypersensitivity in a female who was diagnosed with multiple meningiomas and scheduled for craniotomy and tumor removal. Immediately after cefazolin IV administration, the patient developed acute hypertensive crisis, which resolved within 10 minutes after the treatment. This was followed by unexplained metabolic acidosis. The patient then developed severe brain edema 100 minutes later. The patient had facial edema when her face was exposed for the next 30 minutes. A computed tomography scan revealed global brain edema with herniation. She was admitted to the intensive care unit for symptomatic treatment and died 10 days after surgery from multiorgan failure. The serum IgE level was very high (734 IU/mL. Single-dose administration of cefazolin for surgical prophylaxis may lead to rare, fatal adverse reaction. The warning signs are sudden, unexplained metabolic acidosis, hypertensive crisis, tachycardia, and facial angioedema predominating with or without cutaneous symptoms like urticaria. Keywords: cefazolin, adverse effect, drug hypersensitivity, brain edema, hypertension

  18. The technology and progress of sedative and analgesia treatment in outpatient oral disease therapy%口腔疾病镇静痛治疗常用技术与进展

    Institute of Scientific and Technical Information of China (English)

    郁葱; 赵楠

    2013-01-01

    How to eliminate the fear or the pain of the pa-tients during dental therapy process has been paid more atten-tion by dentists across the country,as the dental painless ther-apeutic area involvs a wide range subjects,covering the stoma-tology,anesthesiology,hospital management,et al. We sum-marized the characteristics of sedative and analgesia technolo-gy during outpatient oral therapy,reviewed the common seda-tive and analgesia treatment technology,introduced our suc-cessful experience and predicted the trends of this area.%如何消除患者因口腔疾病及在牙病治疗过程中出现的疼痛或恐惧感逐渐受到全国口腔医疗专业人员的重视,由于口腔门诊无痛治疗领域涉及多个学科,故对该领域的临床实践与深入研究尚待加强。本文总结了实施口腔镇静镇痛治疗的特点,回顾了常用的技术,并对该领域的发展进行了阐述。

  19. Review of oral oxymorphone in the management of pain

    Directory of Open Access Journals (Sweden)

    Paul Sloan

    2008-09-01

    Full Text Available Paul SloanUniversity of Kentucky Medical Center, Department of Anesthesiology, Lexington, KY, USAAbstract: Chronic cancer and nonmalignant pain (CNMP is a common and major health problem afflicting approximately 40 million persons in the US. Most cancer patients, and many patients with CNMP, require opioid analgesics to obtain adequate pain relief. Oral oxymorphone is a new formulation of an existing parenteral opioid that has become available for the treatment of significant pain: acute postoperative, chronic arthritis, chronic low back, and chronic cancer pain. Oxymorphone is a typical mu-opioid agonist that is effective in both immediate- and extended-release (IR and ER formulations. Oxymorphone is more lipid soluble than morphine, resulting in a rapid onset of action when given in tablet formulation, with a duration of action of approximately 4–6 hours in IR and 12 hours in ER preparations. Oxymorphone provides excellent pain relief for significant pain, with typical opioid side effects that are usually mild or moderate in intensity. Multiple double-blind, prospective, placebo-controlled clinical trials have demonstrated the clinical efficacy and safety of this new oral opioid preparation. Oral oxymorphone is an effective opioid that provides a new therapeutic option for the physician.Keywords: chronic pain, oxymorphone, opioids, extended-release, sustained-release, cancer pain

  20. Career change: in quest of a controllable lifestyle.

    Science.gov (United States)

    Schwartz, R W; Simpson, W G; Strodel, W E; Jarecky, R K; Griffen, W O; Young, A B

    1989-09-01

    Over the past decade, top medical students are selecting "controllable lifestyle" (CL) specialties at an increasing rate. CL specialties include anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, pathology, psychiatry, and radiology. The choice of "noncontrollable lifestyle" (NCL) specialties such as family practice, internal medicine, obstetrics/gynecology, and pediatrics was negatively affected by this trend. The effect of CL on the selection of surgical training by top medical students was variable. The purpose of this study was to determine if CL is a factor in career change by young surgeons during and after residency. Graduates of the University of Kentucky College of Medicine from 1975 to 1983 (n = 796) were questioned regarding the specialty they entered after graduation and whether they remained in that specialty as of March, 1988. NCL and surgery specialties showed a net loss of practitioners during the study period (P less than 0.005) and CL showed a net gain (P less than 0.005). When physicians changed specialties, the direction of change occurred from NCL and surgery to CL (P less than 0.05). Change from CL to NCL and surgery occurred infrequently. PMID:2770274

  1. Neurorestoratology: one of the most promising new disciplines at the forefront of neuroscience and medicine

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    Huang H

    2013-10-01

    Full Text Available Hongyun Huang,1 Hari Shanker Sharma2 1Department of Neurosurgery, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, People's Republic of China; 2Laboratory of Cerebrovascular Research, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, University Hospital, Uppsala University, SwedenNeurorestoratology is a new and emerging distinct discipline put forward on the basis of nervous restorable (neurorestorable theory, which states that nerve damage to the central nervous system (CNS can be restored. Neurorestorable theory in CNS was proposed by Huang et al based on clinical achievements obtained from cell-based neurorestorative therapy1.  Neurorestoratology, same as neurology, neurosurgery, neurorehabilitation, etc is a distinct discipline in neuroscience and medicine. The Beijing Declaration of International Association of Neurorestoratology (IANR determined its definition in 2009.2 The aim of neurorestoratology is to restore or promote recovery of damaged or lost neuronal functions. As depicted in Figure 1,3 it can clearly be seen that there was a blank space – indicated by the question mark in the figure – that needed to be filled with a new discipline, neurorestoratology, so it can be likened to an inexorable biological law and its development to a natural process quite similar to that of the periodic law of chemistry discovered and proposed by Dmitri Mendeleev. In recent years, neurorestoratology has become one of the most interesting core areas of neuroscience and medicine worldwide, representing a novel aspect of translational medicine.

  2. Eye surgery in the elderly

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    Raczyńska D

    2016-04-01

    Full Text Available Dorota Raczyńska, Leopold Glasner, Ewelina Serkies-Minuth, Magdalena A Wujtewicz, Kamila Mitrosz Department of Ophthalmology, Medical University of Gdansk, Gdansk, Poland Abstract: Extending life expectancy is a human achievement. It does however entail problems. Ophthalmic treatments are widely recognized as having a low risk of general complications. A classic example is cataract surgery, considered to be one of the safest and most frequently performed surgical procedures in the world. However, advanced age brings with it risks that should be considered before surgery. Eye operations, as with procedures on other organs, are largely dependent on the quality of surgical tissues. Therefore, the elderly are at increased risk of complications. Improved general health and postoperative follow-up with the use of noninvasive technologies such as optical coherence tomography translate into lower intraoperative risk and better postoperative prognosis. In this review, we discuss the impact of general health on operational prognosis, therapeutic problems, and technical difficulties which a surgeon and anesthesiologist may encounter in the process. We also consider new technology and strategies specifically aimed at treating eye conditions in the elderly. Keywords: eye surgery, eye aging, anesthesiology in ophthalmology, cataract, glaucoma, vitrectomy, age-related macular degeneration

  3. [Obstetric and gynecologic anesthesia reported in the "Revista Española de Obstetricia y Ginecología" (1916-1936)].

    Science.gov (United States)

    Llorente, A; Giménez, M C; Figueira, A; Montero, G

    1994-01-01

    This study follows the evolution of anesthesia in gynecology and obstetrics in Spain between 1916 and 1936. Research included revising all articles and references concerning anesthesiology appearing in the Revista Española de Obstetricia y Ginecologia over the 20 years during which that journal was published. Eighty-three articles were found: 18 (21.6%) original research reports, 37 (44.6%) reviews of the Spanish professional literature and 28 (33.7%) summaries and descriptions of meetings of scientific organizations. Spanish references constituted 39.8% with the remaining 60.2% coming from European and Hispano-American sources. Twenty-four (34.9%) were related to spinal anesthesia, 15 (18%) covered various methods for analgesia during childbirth and 14 (16.8%) were on barbiturates. The remaining articles referred to rectally administered anesthesia, local anesthesia, inhalatory anesthesia and pain in gynecology. In conclusion, our review reveals the strong international contacts in Spanish gynecology during this period, as well as the interest of gynecologists and obstetricians in various anesthetic techniques and the rapid incorporation of new methods into their therapeutic arsenal.

  4. Rocuronium-Sugammadex in Anesthesia for Electroconvulsive Therapy

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    Nilay Tas

    2016-03-01

    Full Text Available Electroconvulsive therapy (ECT is a form of treatment which is very effective in many psychiatric disorders. The administration of anesthesia plays a positive role in the success of ECT and improves the oxygenation of the body during the process. Succinylcholine, is a depolarizing neuromuscular blocker of choice, the most common agent used to provide muscular relaxation during ECT. Alternative neuromusculer blokers have been used during anesthesia because of contraindications and serious side effects of succinylcholine. Rocuronium is a nondepolarizing neuromuscular blocker with inter-mediate time of action which may be used safely during ECT. Although relatively late onset of action and long half life compared to succinylcholine may seem as drawbacks, the new generation reversing agents like suggamadex have made these disadvantages ignorable. Sugammadex, a new generation neuromuscular blocker reversal agent, not having serious side effects as much as the classic reversals, such as cardiovascular side effects, is playing an important role in anesthesiology practice. In recent years, rocuronium-sugammadex combination is being included in the ECT practice extensively. In this paper, the usability of rocuronium-sugammadex combination as an alternative to succinylcholine has been revised. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(1: 76-84

  5. Percentage of beta 2 band power of quantitative pharmaco-electroencephalography decreases in propofol anesthetized rabbits A dose-dependent analysis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND:Quantitative pharmaco-electroencephalography can be used for studying the dose-effect and time-effect relationships of drugs affecting central nervous system.Therefore,it may become an effective means for monitoring the anesthetic degree of anesthetic drug in the operation.OBJECTIVE:To observe the dose-effect relationship of propofol influencing β2-band power of quantitative pharmaco-electroencephalography in rabbits.DESIGN:A randomized block design.SETTING:Department of Anesthesiology,Xuzhou Medical College.MATERIALS:Thirty-six healthy adult rabbits of either gender,weighing (2.4+0.5)kg,of clean grade,were provided by the Laboratory Animal Center of Xuzhou Medical College.The involved rabbits were randomly divided into 3 groups with 12 in each by table of random digit:high-dose propofol group,moderate-dose propofol group,and low-dose propofol group.The protocol was carried out in accordance with animal ethics guidelines for the use and care of animals.METHODS:This study was carried out in the Department of Anesthesiology,Xuzhou Medical College between August 1999 and April 2000.Rabbits in the high-dose propofol group,moderate-dose propofol group,and low-dose propofol group were injected with 10,5 and 2.5 mg/kg propofol (ZENECA Company,British,Batch No.032000),respectively.Before and after intravenous administration of propofol,percentage of β2-band power of quantitative pharmaco-electroencephalography was measured,and the latent and persistent periods when rabbit righting reflex disappeared were observed by quantitative pharmaco-electroencephalography and power spectrum analysis.MAIN OUTCOME MEASURES:① Percentage of β 2-band power of quantitative pharmaco-electroencephalography.②Latent period and persistent period of abolition of righting reflex of rabbits.RESULTS:Thirty-six rabbits were involved in the final analysis.①Effect of propofol on righting reflex of rabbits:Righting reflex disappeared within 1 minute after the rabbits being

  6. Effects of continuous peripheral nerve block by tetrodotoxin on growth associated protein-43 expression during neuropathic pain development

    Institute of Scientific and Technical Information of China (English)

    Chen Wang; Xiaoyu Huang

    2007-01-01

    BACKGROUND: Peripheral nerve injury may lead to neuropathic pain and cause a markedly increase expression of growth associated protein-43 (GAP-43) in the spinal cord and dorsal root ganglion, local anesthetics blocking electrical impulse propagation of nerve fibers may also affect the expression of GAP-43 in the spinal cord and dorsal root ganglion.OBJECTIVE: To determine the effects of continuous peripheral nerve block by tetrodotoxin before and after nerve injury on GAP-43 expression in the dorsal root ganglion during the development of neuropathic pain.DESIGN: A randomized controlled animal experiment.SETTINGS: Department of Anesthesiology, the Second Hospital of Xiamen City; Department of Anesthesiology, the Second Affiliated Hospital of Shantou University Medical College. MATERIALS: Thirty-five Sprague Dawley (SD) rats, weighing 200 - 250 g, were randomly divided into four groups: control group (n =5), simple sciatic nerve transection group (n =10), peripheral nerve block before and after sciatic nerve transection groups (n =10). All the sciatic nerve transection groups were divided into two subgroups according to the different postoperative survival periods: 3 and 7 days (n =5) respectively. Mouse anti-GAP-43 monoclonal antibody (Sigma Co., Ltd.), supervision TM anti-mouse reagent (HRP, Changdao antibody diagnosis reagent Co., Ltd., Shanghai), and HMIAS-100 image analysis system (Qianping Image Engineering Company, Tongji Medical University) were employed in this study. METHODS: This experiment was carried out hi the Department of Surgery and Pathological Laboratory, the Second Affiliated Hospital of Shantou University Medical College from April 2005 to April 2006.①The animals were anesthetized and the right sciatic nerve was exposed and transected at 1 cm distal to sciatic notch.②Tetrodotoxin 10 μg/kg was injected percutaneously between the greater trochanter and the posterior superior iliac spine of right hind limb to block the sciatic nerve proximally

  7. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-09-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3

  8. Motivos relacionados à escolha da medicina intensiva como especialidade por médicos residentes Reasons related to the choice of critical care medicine as a specialty by medical residents

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    Flávia Branco Cerqueira Serra Neves

    2009-06-01

    progress in Brazil. However, few physicians are willing to acquire this specialization. The main objective of this study was to describe the factors associated with choice of Critical Care Medicine as a specialty by medical residents of Salvador-BA. METHODS: A cross-sectional and descriptive study, in which a questionnaire was submitted to all residents of the specialties that are a prerequisite for Critical Care Medicine (Clinical Medicine, General Surgery and Anesthesiology, between October and December 2007. RESULTS: The study included 165 residents (89.7% of the total, in which 51.5% were clinical medicine residents, 25.5% were general surgery residents, and 23.0% were anesthesiology residents. Of the respondents, 14 (9.1% intended to enter Critical Care Medicine residency, although 90 (54.5% were willing to become intensive care unit physicians after their regular residency. The main reason stated to specialize in critical care medicine was to like work with critically ill patients (92.9%. The main reasons stated not to specialize in critical care medicine, however were related with the poorer quality of life and work. Residents who did intensive care unit initernship during medical studies were more likely to work in an intensive care units after residency. CONCLUSIONS: This population showed little interest to specialize in critical care medicine. The main reasons given for this limited interest were factors related to quality of life and intensive care unit environment. A national survey is required to identify the interventions needed to favor this specialization.

  9. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  10. Residents and Medical Students Correctly Answer Clinical Questions More Often with Google and UpToDate than With PubMed or Ovid MEDLINE. A Review of: Thiele, R. H., Poiro, N. C., Scalzo, D. C., & Nemergut, E. C. (2010. Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: Results of a randomised trial. Postgraduate Medical Journal, 86(1018, 459-465. doi:10.1136/pgmj.2010.098053

    Directory of Open Access Journals (Sweden)

    Theresa Arndt

    2011-06-01

    Full Text Available Objective – To determine which search tool (Google, UpToDate, PubMed or Ovid-MEDLINE produces more accurate answers for residents, medical students, and attending physicians searching on clinical questions in anesthesiology and critical care. Searcher confidence in the answers and speed with which answers were found were also examined.Design – Randomized study without a control group.Setting – Large university medical center.Subjects –Subjects included 15 fourth year medical students (third and fourth year, 35 residents, and 4 attending physicians volunteered and completed the study. One additional attending withdrew halfway through the study. The authors were unsuccessful in recruiting an equal number of subjects from each group.Methods – A set of eight anesthesia and critical care questions was developed, based on their commonality and importance in clinical practice and their answerability. Four search tools were employed: Google, UpToDate, PubMed, and Ovid MEDLINE. In part I, subjects were given a random set of four of the questions to answer with the search tool(s of their choice, but could use only one search tool per question. In part II, several weeks later, the same subjects were randomly assigned a search tool with which to answer all 8 questions. The authors state that “for data analysis, PubMed was arbitrarily chosen to be the “reference standard.”” Statistical analysis was used to identify significant differences between PubMed and the other search tools.Main Results – Part I: Subjects choosing a search tool were more likely to find a correct answer with Google or UpToDate. There were no statistically significant differences in confidence with answers between any of the search tools and PubMed.Part II: Though subjects were assigned a search tool, some questions were repeated from part I. For repeated questions, Ovid users (compared to PubMed users were significantly less likely to find the correct answer for

  11. Central and peripheral nervous complications of dental treatment Complicações de tratamento dentário afetando o sistema nervoso

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    Eva Olovsson Rossitti

    1995-09-01

    Full Text Available This review outlines the complications involving the central or peripheral nervous system arising from dental procedures reported in the last decade. By far the commonest complications were related to intraoperative mechanical peripheral nerve injury. Trauma to branches of the mandibular nerve occuring during oral operations may potentially result in varying degrees of hypoesthesia, paresthesia, dysesthesia or in chronic pain syndromes. An increase in malpractice suits related to such a complication has been recognized in the late years. A warning of the possibility of occurrence of this complication should to be given to all patients undergoing risky procedures as part of the process of obtaining informed consent to operation. Mandibular third molar extraction seems to be alone the most hazardous procedure related to mechanical nerve injuries and also with anesthesiological accidents. Severe but rather infrequent infectious (meningitis, brain abscess and cavernous sinus thrombophlebitis and anesthesiological complications (occular and facial palsies, optic nerve injury and complications related to general anesthesia were also reported in this period.Complicações, ou eventos inesperados e indesejáveis associados a terapia de uma dada condição, podem ser particularmente incapacitantes quando afetam o sistema nervoso. A proximidade de cavidade craniana e a rica inervação dos tecidos orais representam risco potencialmente alto de disseminação de infecções para o sistema nervoso central e de lesões de troncos nervosos em procedimentos dentários. Em vista do aumento da ocorrência de processos para compensação financeira após tais complicações, é provável que parcela considerável desses pacientes venham a ser examinados por neurologistas. As complicações de tratamento dentário afetando o sistema nervoso central e periférico referidas na literatura (1982-1994 são tema desta revisão. As complicações mais comuns foram as les

  12. 护理风险管理在麻醉科应用的效果

    Institute of Scientific and Technical Information of China (English)

    田小利

    2015-01-01

    Objective To study the clinical effect of nursing risk management in the anesthesiology department. Methods 30 in-service nurses worked from June 2014 to June 2015 in our hospital were selected. From June 2014 to December 2014, the conventional nursing was applied; from January 2015 to June 2015, the nursing risk management was applied. At this time period, 78 patients were also selected and divided into conventional group and intervention group, 39 cases each group. The incidence rate of accidents and improvements of professional skills for two groups was observed. Result The conventional group had 7 cases of accidents (17.9%); the intervention group had 1 case of accidents (2.6%); the incidence rate of accidents for intervention group was lower than that of conventional group (P<0.05); after intervention, the evaluation score of the nurse’s professional skill, mastery on the common disease and medication knowledge, sense of responsibility on the high quality nursing was higher than before (P<0.05). Conclusion In the anesthesiology department, it needs to set up the corresponding risk management system, enhance the medical staff’s risk awareness, learn the professional skill on time, conform to the strick standards, make an effective prevention on the potential risks, reduce the incidence rate of accidents and improve the nurse’s skills.%目的:研究在麻醉科实施护理风险管理的应用效果。方法选取该院于2014年6月—2015年6月期间麻醉科在职护理人员30例,于2014年6月—2014年12月期间实施一般护理模式,于2015年1月—2015年6月期间实施护理风险管理,选取同时段患者78例,常规组39例与干预组39例,观察两组出现安全事故情况及护理人员自身专业技能提升情况。结果常规组出现风险事故为7例(17.9%),干预组为1例(2.6%),干预组低于常规组(P<0.05)。实施前护士自身护理专业技能、科室常见疾病及用药知识掌握情况、提

  13. Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional Predictive factors associated with packed red cell transfusions in patients submitted to elective surgery of the digestive tract: an inter-institutional analysis

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    Antonio Sergio Barcala Jorge

    2010-01-01

    Full Text Available O objetivo desse estudo foi compreender os fatores determinantes da prática transfusional de concentrado de hemácias em cirurgias eletivas do aparelho digestivo em quatro unidades hospitalares em Montes Claros, Minas Gerais, Brasil. Foi realizado um estudo descritivo, analítico e retrospectivo através do levantamento de dados em prontuários clínicos de quatro unidades hospitalares de onde foram catalogados os dados de pacientes a partir de junho de 2007 a dezembro de 2008, referentes às cirurgias citadas. Os resultados evidenciaram 81 casos, sendo 42% do gênero feminino e 58% do masculino. A idade média foi de 55,5 anos (±19,11 anos. As enfermidades de base reportadas mais comuns foram os processos neoplásicos (42%. Desses 81 pacientes, 38 (47% foram hemotransfundidos no pré-operatório imediato, 28 (18% foram transfundidos no transcirúrgico e 37 (45,7% no pós-operatório imediato. Na análise univariada houve diferenças entre a prática transfusional pré-cirúrgica interinstitucional. Na fase cirúrgica houve relação entre a prática transfusional com a citação de motivos, fator RH (Rhesus, prática institucional e doença de base. Na fase pós-cirúrgica não foram demonstradas relações. Em todas as fases, não houve associação da prática transfusional com os tipos de procedimentos cirúrgicos, com o índice ASA (American Society of Anesthesiology e valores de hemoglobina e hematócrito. Concluindo, esse estudo revelou que a prática transfusional foi heterogênea entre instituições hospitalares, careceu de valores laboratoriais específicos, relacionou-se com a patologia de base mas não com o tipo de procedimento cirúrgico e foi norteada pelo critério de escolha do profissional.The objective of this study was to understand the determinative factors for packed red cell transfusions in elective digestive tract surgeries in four hospital units in Montes Claros, Minas Gerais, Brazil. Retrospective analyses were

  14. Determination of factor Xa inhibition doses of low-molecular heparin, nadroparin and reviparin in urological patients

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    Pavlović Svetlana

    2007-01-01

    Full Text Available Background/Aim. The inhibition of factor Xa (FX by the use of low-molecular heparin (LMH is important clinical procedure in patients with moderate and high risk for the developament of venous thromboembolism (VTE and pulmonary embolism (PE. The aim of this study was to determine the level of inhibition of FXa by the use of prophylactic doses of LMH nadroparin-calcium and reviparine-sodium which were applied in urological patients with moderate risk for VTE and PE. Methods. The examination included 80 urological patients divided into 4 groups after urological, uroradiological and anesthesiological preoperative preparation and categorization of anesthesiological risk according to the ASA III classification. The first two groups, of 20 patients each, received the recommended doses of LMH in accordance with the preoperative risk, and an inhibition of FXa 48 hours after the surgical operation and four hours after the administration of LMH was determined. Heptest and homogenous anti-Xa test were used for monitoring of FXa inhibition. Since the obtained anti-Xa values were not satisfactory, two more groups were formed and given double the recommended doses. In these new groups, inhibition of FXa was in recommended range. Standard descriptive statistical parameters were used for describing the charateristics of the people from the formed groups. Results. All the patients examined were clinically estimated as patients of moderate risk, for VTE and PE. There were no statistically singificant difference in body weight of the patients who received nadroparin-calcium 0.3 ml and reviparine-sodium 0.25 ml and those who received their double doses, respectively. The level of FXa inhibition in the group in which the dose of nadroparin-calcium of 0.6 ml was applied was statistically significantly higher than in the group which received the dose of 0.3 ml (Mann-Whitney U test: Z = 5.416; p < 0.0001. The level of FXa in the group given reviparine-sodium 0.5 ml was

  15. Long-term effect of ropivacaine nanoparticles for sciatic nerve block on postoperative pain in rats

    Directory of Open Access Journals (Sweden)

    Wang Z

    2016-05-01

    Full Text Available Zi Wang,1,* Haizhen Huang,2,* Shaozhong Yang,1 Shanshan Huang,1 Jingxuan Guo,1 Qi Tang,1 Feng Qi1 1Department of Anesthesiology, Qilu Hospital of Shandong University, 2Department of Anesthesiology, Stomatology Hospital of Shandong University, Jinan, Shandong, People’s Republic of China *These authors contributed equally to this work Purpose: The analgesic effect of ropivacaine (Rop for nerve block lasts only ~3–6 hours for single use. The aim of this study was to develop long-acting regional anesthetic Rop nanoparticles and investigate the effects of sciatic nerve block on postoperative pain in rats.Materials and methods: Rop nanoparticles were developed using polyethylene glycol-co-polylactic acid (PELA. One hundred and twenty adult male Wistar rats were randomly divided into four groups (n=30, each: Con (control group; 0.9% saline, 200 µL, PELA (PELA group; 10 mg, Rop (Rop group; 0.5%, 200 µL, and Rop-PELA (Rop-PELA group; 10%, 10 mg. Another 12 rats were used for the detection of Rop concentration in plasma. The mechanical withdrawal threshold and thermal withdrawal latency were measured at 2 hours, 4 hours, 8 hours, 1 day, 2 days, 3 days, 5 days, and 7 days after incision. The expression of c-FOS was determined by immunohistochemistry at 2 hours, 8 hours, 48 hours, and 7 days. Nerve and organ toxicities were also evaluated at 7 days.Results: The duration of Rop absorption in the plasma of the Rop-PELA group was longer (>8 hours than that of the Rop group (4 hours. Mechanical withdrawal threshold and thermal withdrawal latency in the Rop-PELA group were higher than that in other groups (4 hours–3 days. c-FOS expression in the Rop-PELA group was lower than that in the control group at 2 hours, 8 hours, and 48 hours and lower than that in the Rop group at 8 hours and 48 hours after paw incision. Slight foreign body reactions were observed surrounding the sciatic nerve at 7 days. No obvious pathophysiological

  16. Anterior and posterior tibial anesthetic block in diabetic foot surgery. Bloqueo anestésico tibial anterior y posterior en la cirugía del pie diabético

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    Obdulio Rodríguez García

    2004-12-01

    Full Text Available Fundament: Diabetes Mellitus is a disease of high and increasing prevalence and its complications follow a parallel course. Its morbidity is derived from its own complications which are produced at a long or short term and peripheral vascular disease hihglights among them.Objective: to check the usefulness of the anterior and posterior blockade of the tibia for the surgery of the diabetic foot. Method: Prospective study carried out from January to December 2003 at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ to patients who are carriers of a diabetic foot and who were initially assisted at the service of Angiology and later at the service of Anesthesiology when the surgical procedures were decided. All the patients were applied an anterior and posterior blockade of the tibial nerve . The variables measured were: age, weight, height, surgical time, type of surgery, cardiac frequency medium arterial pressure, and classification of patients according to the American Association of Anesthesiology All the patients were applied a scale for assessing pain in three different moments.Result: There was a predominance of females . The blockade of the posterior tibial nerve with lidocaine 1 % in different points permitted the performance of the surgical techniques proposed. The anesthetic procedure was favorable, and economic since the patients did not requiere of the use of analgesic in the post operatory stage.

    Fundamento:La diabetes mellitus es una enfermedad de prevalencia alta y creciente, y sus complicaciones siguen un curso paralelo. Su morbilidad se deriva de las propias complicaciones que se producen a mediano y largo plazo, entre las que se destaca la enfermedad vascular periférica. Objetivo: Comprobar la utilidad del bloqueo tibial anterior y posterior para la cirugía del pie

  17. MO-F-16A-06: Implementation of a Radiation Exposure Monitoring System for Surveillance of Multi-Modality Radiation Dose Data

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, B; Kanal, K; Dickinson, R; Zamora, D [University Washington, Seattle, WA (United States)

    2014-06-15

    Purpose: We have implemented a commercially available Radiation Exposure Monitoring System (REMS) to enhance the processes of radiation dose data collection, analysis and alerting developed over the past decade at our sites of practice. REMS allows for consolidation of multiple radiation dose information sources and quicker alerting than previously developed processes. Methods: Thirty-nine x-ray producing imaging modalities were interfaced with the REMS: thirteen computed tomography scanners, sixteen angiography/interventional systems, nine digital radiography systems and one mammography system. A number of methodologies were used to provide dose data to the REMS: Modality Performed Procedure Step (MPPS) messages, DICOM Radiation Dose Structured Reports (RDSR), and DICOM header information. Once interfaced, the dosimetry information from each device underwent validation (first 15–20 exams) before release for viewing by end-users: physicians, medical physicists, technologists and administrators. Results: Before REMS, our diagnostic physics group pulled dosimetry data from seven disparate databases throughout the radiology, radiation oncology, cardiology, electrophysiology, anesthesiology/pain management and vascular surgery departments at two major medical centers and four associated outpatient clinics. With the REMS implementation, we now have one authoritative source of dose information for alerting, longitudinal analysis, dashboard/graphics generation and benchmarking. REMS provides immediate automatic dose alerts utilizing thresholds calculated through daily statistical analysis. This has streamlined our Closing the Loop process for estimated skin exposures in excess of our institutional specific substantial radiation dose level which relied on technologist notification of the diagnostic physics group and daily report from the radiology information system (RIS). REMS also automatically calculates the CT size-specific dose estimate (SSDE) as well as provides

  18. Factors influencing antibiotic treatment cost and outcome in critically ill patients: A “real-life” study

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    Perić Aneta

    2014-01-01

    Full Text Available Background/Aim. Critically ill patients are at very high risk of developing severe infections in intensive care units (ICUs. Procalcitonin (PCT levels are eleveted in the circulation in patients with bacterial sepsis and PCT might be useful in guiding antibiotic treatment. The aim of this study was to estimate factors influencing patients survival and treatment cost in ICU with special emphasis on the impact of PCT serum levels use in guiding antimicrobial therapy. Methods. The study was conducted from August 2010 to May 2012 in the Intensive Therapy Unit, Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy (MMA, Belgrade, Serbia. All adult critically ill patients with sepsis and/or trauma admitted in the ICU were included in the study. This study included only the cost of antimicrobial therapy in the ICU and the cost for PCT analysis. We used prices valid in the MMA for the year 2012. PCT in serum was measured by homogeneous immunoassay on a Brahms Kryptor analyzer. Results. A total of 102 patients were enrolled. The mean patients age was 55 ± 19 years and 61.8% of patients were male. The mean length of stay (LOS in the ICU was 12 ± 21 days. There was a statistically significant difference (p < 0.001 between the sepsis and trauma group regarding outcome (higher mortality rate was in the sepsis group, particularly in the patients with peritonitis who were mostly women. The patients younger than 70 years had better chance of survival. LOS, the use of carbapenems and PCT-measurement influenced the cost of therapy in the ICU. Conclusions. The obtained results show that age, the diagnosis and gender were the main predictors of survival of critically ill patients in the ICU. The cost of ICU stay was dependent on LOS, use of carbapenems and PCT measurement although the influence of these three factors on the outcome in the patients did not reach a statistical significance.

  19. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D., E-mail: dfilippiadis@yahoo.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Anselmetti, G., E-mail: gc.anselmetti@fastwebnet.it [GVM Care and Research Maria Pia Hospital (Italy); Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Mavrogenis, A., E-mail: afm@otenet.gr; Papagelopoulos, P., E-mail: pjp@hol.gr [University General Hospital “ATTIKON”, A Orthopedic Clinic (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Martin, J.-B., E-mail: jbmartin@cird.ch [Centre Imaginerie Rive Droite & Gauche (Switzerland)

    2016-01-15

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.

  20. Accuracy and precision of four common peripheral temperature measurement methods in intensive care patients

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    Asadian S

    2016-09-01

    Full Text Available Simin Asadian,1 Alireza Khatony,1 Gholamreza Moradi,2 Alireza Abdi,1 Mansour Rezaei,3 1Nursing and Midwifery School, Kermanshah University of Medical Sciences, 2Department of Anesthesiology, 3Biostatistics & Epidemiology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran Introduction: An accurate determination of body temperature in critically ill patients is a fundamental requirement for initiating the proper process of diagnosis, and also therapeutic actions; therefore, the aim of the study was to assess the accuracy and precision of four noninvasive peripheral methods of temperature measurement compared to the central nasopharyngeal measurement. Methods: In this observational prospective study, 237 patients were recruited from the intensive care unit of Imam Ali Hospital of Kermanshah. The patients’ body temperatures were measured by four peripheral methods; oral, axillary, tympanic, and forehead along with a standard central nasopharyngeal measurement. After data collection, the results were analyzed by paired t-test, kappa coefficient, receiver operating characteristic curve, and using Statistical Package for the Social Sciences, version 19, software. Results: There was a significant meaningful correlation between all the peripheral methods when compared with the central measurement (P<0.001. Kappa coefficients showed good agreement between the temperatures of right and left tympanic membranes and the standard central nasopharyngeal measurement (88%. Paired t-test demonstrated an acceptable precision with forehead (P=0.132, left (P=0.18 and right (P=0.318 tympanic membranes, oral (P=1.00, and axillary (P=1.00 methods. Sensitivity and specificity of both the left and right tympanic membranes were more than for other methods. Conclusion: The tympanic and forehead methods had the highest and lowest accuracy for measuring body temperature, respectively. It is recommended to use the tympanic method (right and left for

  1. [Skilled communication as "intervention" : Models for systematic communication in the healthcare system].

    Science.gov (United States)

    Weinert, M; Mayer, H; Zojer, E

    2015-02-01

    Specific communication training is currently not integrated into anesthesiology curricula. At the same time communication is an important key factor when working with colleagues, in the physician-patient relationship, during management of emergencies and in avoiding or reducing the legal consequences of adverse medical events. Therefore, focused attention should be brought to this area. In other high risk industries, specific communication training has been standard for a long time and in medicine there is an approach to teach and train these soft skills by simulation. Systematic communication training, however, is rarely an established component of specialist training. It is impossible not to communicate whereby nonverbal indications, such as gestures, mimic expression, posture and tone play an important part. Miscommunication, however, is common and leads to unproductive behavior. The cause of this is not always obvious. This article provides an overview of the communication models of Shannon, Watzlawick et al. and Schulz von Thun et al. and describes their limitations. The "Process Communication Model®" (PCM) is also introduced. An overview is provided with examples of how this tool can be used to look at the communication process from a systematic point of view. People have different psychological needs. Not taking care of these needs will result in individual stress behavior, which can be graded into first, second and third degrees of severity (driver behavior, mask behavior and desperation). These behavior patterns become exposed in predictable sequences. Furthermore, on the basis of this model, successful communication can be established while unproductive behavior that occurs during stress can be dealt with appropriately. Because of the importance of communication in all areas of medical care, opportunities exist to focus research on the influence of targeted communication on patient outcome, complications and management of emergencies. PMID:25519190

  2. The Danish Anaesthesia Database

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    Antonsen K

    2016-10-01

    Full Text Available Kristian Antonsen,1 Charlotte Vallentin Rosenstock,2 Lars Hyldborg Lundstrøm2 1Board of Directors, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark; 2Department of Anesthesiology, Copenhagen University Hospital, Nordsjællands Hospital-Hillerød, Capital Region of Denmark, Denmark Aim of database: The aim of the Danish Anaesthesia Database (DAD is the nationwide collection of data on all patients undergoing anesthesia. Collected data are used for quality assurance, quality development, and serve as a basis for research projects. Study population: The DAD was founded in 2004 as a part of Danish Clinical Registries (Regionernes Kliniske Kvalitetsudviklings Program [RKKP]. Patients undergoing general anesthesia, regional anesthesia with or without combined general anesthesia as well as patients under sedation are registered. Data are retrieved from public and private anesthesia clinics, single-centers as well as multihospital corporations across Denmark. In 2014 a total of 278,679 unique entries representing a national coverage of ~70% were recorded, data completeness is steadily increasing. Main variable: Records are aggregated for determining 13 defined quality indicators and eleven defined complications all covering the anesthetic process from the preoperative assessment through anesthesia and surgery until the end of the postoperative recovery period. Descriptive data: Registered variables include patients' individual social security number (assigned to all Danes and both direct patient-related lifestyle factors enabling a quantification of patients' comorbidity as well as variables that are strictly related to the type, duration, and safety of the anesthesia. Data and specific data combinations can be extracted within each department in order to monitor patient treatment. In addition, an annual DAD report is a benchmark for departments nationwide. Conclusion: The DAD is covering the

  3. Interactions between medical residents and drug companies: a national survey after the Mediator® affair.

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    François Montastruc

    Full Text Available BACKGROUND: The present study aimed to describe exposure and attitudes of French medical residents towards pharmaceutical industry. The study was performed shortly after the Mediator affair which revealed several serious conflicts of interest inside the French health system. METHODS AND FINDINGS: A cross-sectional study was implemented among residents from 6 French medical faculties. Independent education in pharmacology, attitudes towards the practices of pharmaceutical sales representatives, opinions concerning the pharmaceutical industry, quality of information provided by the pharmaceutical industry, and opinions about pharmaceutical company sponsorship were investigated through a web-based questionnaire. We also assessed potential changes in resident attitudes following the Mediator affair. The mean value of exposure to drug companies was 1.9 times per month. Global opinions towards drug company information were negative for 42.7% of the residents and positive for only 8.2%. Surprisingly, 81.6% of residents claimed that they had not changed their practices regarding drug information since the Mediator affair. Multivariate analyses found that residents in anesthesiology were less likely to be exposed than others (OR = 0.17 CI95% [0.05-0.61], exposure was significantly higher at the beginning of residence (p<0.001 and residents who had a more positive opinion were more frequently exposed to drug companies (OR = 2.12 CI95% [1.07-4.22]. CONCLUSIONS: Resident exposure to drug companies is around 1 contact every 2 weeks. Global opinion towards drug information provided by pharmaceutical companies was negative for around 1 out of 2 residents. In contrast, residents tend to consider the influences of the Mediator affair on their practice as relatively low. This survey enabled us to identify profiles of residents who are obviously less exposed to pharmaceutical industry. Current regulatory provisions are not sufficient, indicating that

  4. Nanomedicine in cerebral palsy

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    Balakrishnan B

    2013-11-01

    Full Text Available Bindu Balakrishnan,1 Elizabeth Nance,1 Michael V Johnston,2 Rangaramanujam Kannan,3 Sujatha Kannan1 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; Baltimore, MD, USA; 2Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA; 3Department of Ophthalmology, Center for Nanomedicine, Johns Hopkins University, Baltimore, MD, USA Abstract: Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the developing brain that occurs either in utero or soon after birth can result in the motor, sensory, and cognitive deficits seen in cerebral palsy. Although the etiologies for cerebral palsy are variable, neuroinflammation plays a key role in the pathophysiology of the brain injury irrespective of the etiology. Currently, there is no effective cure for cerebral palsy. Nanomedicine offers a new frontier in the development of therapies for prevention and treatment of brain injury resulting in cerebral palsy. Nanomaterials such as dendrimers provide opportunities for the targeted delivery of multiple drugs that can mitigate several pathways involved in injury and can be delivered specifically to the cells that are responsible for neuroinflammation and injury. These materials also offer the opportunity to deliver agents that would promote repair and regeneration in the brain, resulting not only in attenuation of injury, but also enabling normal growth. In this review, the current advances in nanotechnology for treatment of brain injury are discussed with specific relevance to cerebral palsy. Future directions that would facilitate clinical translation in neonates and children are also addressed. Keywords: dendrimer, cerebral palsy, neuroinflammation, nanoparticle, neonatal brain injury, G4OH-PAMAM

  5. A brief history of corneal transplantation: From ancient to modern

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    Alexandra X Crawford

    2013-01-01

    Full Text Available This review highlights many of the fundamental concepts and events in the development of corneal transplantation - from ancient times to modern. Tales of eye, limb, and even heart transplantation appear in ancient and medieval texts; however, in the scientific sense, the original concepts of corneal surgery date back to the Greek physician Galen (130-200 AD. Although proposals to provide improved corneal clarity by surgical interventions, including keratoprostheses, were better developed by the 17 th and 18 th centuries, true scientific and surgical experimentation in this field did not begin until the 19 th century. Indeed, the success of contemporary corneal transplantation is largely the result of a culmination of pivotal ideas, experimentation, and perseverance by inspired individuals over the last 200 years. Franz Reisinger initiated experimental animal corneal transplantation in 1818, coining the term "keratoplasty". Subsequently, Wilhelmus Thorne created the term corneal transplant and 3 years later Samuel Bigger, 1837, reported successful corneal transplantation in a gazelle. The first recorded therapeutic corneal xenograft on a human was reported shortly thereafter in 1838-unsurprisingly this was unsuccessful. Further progress in corneal transplantation was significantly hindered by limited understanding of antiseptic principles, anesthesiology, surgical technique, and immunology. There ensued an extremely prolonged period of debate and experimentation upon the utility of animal compared to human tissue, and lamellar versus penetrating keratoplasty. Indeed, the first successful human corneal transplant was not performed by Eduard Zirm until 1905. Since that first successful corneal transplant, innumerable ophthalmologists have contributed to the development and refinement of corneal transplantation aided by the development of surgical microscopes, refined suture materials, the development of eye banks, and the introduction of

  6. Evaluation of intra ocular pressure and hemodynamic change following intubation with Maccoy, Macintosh and Video laryngoscope

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    Hamid Khosro Zamiri

    2013-09-01

    Full Text Available Background & Objective: The induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic response and increased intraocular pressure. The aim of this study was to evaluate intraocular pressure and hemodynamic changes after laryngoscopy and endotracheal intubation with three methods of laryngoscopy (Macintosh, Maccoy and Video laryngoscope.Materials & Methods: One hundred and eighty patients with American Society of Anesthesiology (ASA classification of I and II, aged 20-70 year, were enrolled in a randomized clinical trial (RCT. Anesthesia was induced by administration of Propofol 2 mg/kg, Fentanyl 1µg/kg and Cisatracurium 0.1mg/kg. the Hemodynamic information of the patients and intraocular pressures were documented and assessed in three stages (after induction of anesthesia and endotracheal intubation, and 5 minutes after endotracheal intubation using Maccoy, Macintosh and Video laryngoscope.Results: Hemodynamic parameters' of patients increased in these three groups compared with those of pre anesthesia measures, but this increase was not significant. Evaluation of intraocular pressure (IOP in Video laryngoscope group showed that there is a significant drop in intraocular pressure (IOP compared with other groups. There weren’t any significant differences of IOP after intubation in Maccoy compared to the Macintosh group. Nevertheless there was not any significant difference in IOP, before and five minutes after intubation in these groups.Conclusion: According to a low degree of augment of IOP in Video laryngoscope group and no changes in the Hemodynamic parameters, it seems that the use of Video laryngoscope in eye surgeries might be more suitable for endotracheal intubation.

  7. Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices

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    Jefferis JM

    2014-09-01

    may be beneficial. Keywords: dementia, cataract extraction, anesthesiology, qualitative research

  8. Local anesthetic failure associated with inflammation: verification of the acidosis mechanism and the hypothetic participation of inflammatory peroxynitrite

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    Takahiro Ueno

    2008-11-01

    Full Text Available Takahiro Ueno1, Hironori Tsuchiya2, Maki Mizogami1, Ko Takakura11Department of Anesthesiology, Asahi University School of Dentistry, Mizuho, Gifu, Japan; 2Department of Dental Basic Education, Asahi University School of Dentistry, Mizuho, Gifu, JapanAbstract: The presence of inflammation decreases local anesthetic efficacy, especially in dental anesthesia. Although inflammatory acidosis is most frequently cited as the cause of such clinical phenomena, this has not been experimentally proved. We verified the acidosis mechanism by studying the drug and membrane lipid interaction under acidic conditions together with proposing an alternative hypothesis. Liposomes and nerve cell model membranes consisting of phospholipids and cholesterol were treated at different pH with lidocaine, prilocaine and bupivacaine (0.05%–0.2%, w/v. Their membrane-interactive potencies were compared by the induced-changes in membrane fluidity. Local anesthetics fluidized phosphatidylcholine membranes with the potency being significantly lower at pH 6.4 than at pH 7.4 (p < 0.01, supporting the acidosis theory. However, they greatly fluidized nerve cell model membranes even at pH 6.4 corresponding to inflamed tissues, challenging the conventional mechanism. Local anesthetics acted on phosphatidylserine liposomes, as well as nerve cell model membranes, at pH 6.4 with almost the same potency as that at pH 7.4, but not on phosphatidylcholine, phosphatidylethanolamine and sphingomyelin liposomes. Since the positively charged anesthetic molecules are able to interact with nerve cell membranes by ion-paring with anionic components like phosphatidylserine, tissue acidosis is not essentially responsible for the local anesthetic failure associated with inflammation. The effects of local anesthetics on nerve cell model membranes were inhibited by treating with peroxynitrite (50 μM, suggesting that inflammatory cells producing peroxynitrite may affect local anesthesia

  9. Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain

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    Howard S Smith

    2009-07-01

    Full Text Available Howard S Smith,1 Timothy R Deer21Albany Medical College, Department of Anesthesiology, Albany, New York, USA; 2The Center for Pain Relief, Clinical Professor, West Virginia, University, Charleston, West Virginia, USAAbstract: Ziconotide is a conopeptide intrathecal (IT analgesic which is approved by the US Food and Drug Administration (FDA for the management of severe chronic pain. It is a synthetic equivalent of a naturally occurring conopeptide found in the venom of the fish-eating marine cone snail and provides analgesia via binding to N-type voltage-sensitive calcium channels in the spinal cord. As ziconotide is a peptide, it is expected to be completely degraded by endopeptidases and exopeptidases (Phase I hydrolytic enzymes widely located throughout the body, and not by other Phase I biotransformation processes (including the cytochrome P450 system or by Phase II conjugation reactions. Thus, IT administration, low plasma ziconotide concentrations, and metabolism by ubiquitous peptidases make metabolic interactions of other drugs with ziconotide unlikely. Side effects of ziconotide which tend to occur more commonly at higher doses may include: nausea, vomiting, confusion, postural hypotension, abnormal gait, urinary retention, nystagmus/amblyopia, drowsiness/somnolence (reduced level of consciousness, dizziness or lightheadedness, weakness, visual problems (eg, double vision, elevation of serum creatine kinase, or vestibular side effects. Initially, when ziconotide was first administered to human subjects, titration schedules were overly aggressive and led to an abundance of adverse effects. Subsequently, clinicians have gained appreciation for ziconotide’s relatively narrow therapeutic window. With appropriate usage multiple studies have shown ziconotide to be a safe and effective intrathecal analgesic alone or in combination with other intrathecal analgesics.Keywords: pain, ziconotide, intrathecal analgesics, safety, patient

  10. Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

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    Narain S

    2015-09-01

    Full Text Available Sachin Narain,1 Lama Al-Khoury,2 Eric Chang3–6 1Department of Anesthesiology and Perioperative Care, 2Department of Neurology, 3Department of Physical Medicine and Rehabilitation, 4Department of Neurosurgery, 5Department of Orthopedics, 6Reeve-Irvine Research Center for Spinal Cord Injury, University of California Irvine, Irvine, CA, USA Background: Migraine headaches are a common and functionally debilitating disorder affecting approximately 17% of women and 5.6% of men. Compared to episodic migraine patients, chronic migraineurs are more likely to be occupationally disabled, miss family activities, have comorbid anxiety and/or chronic pain disorders, and utilize significantly more health care dollars. Ziconotide is a calcium channel blocker used for the treatment of chronic severe pain without issues of tolerance or dependency found with opioid therapy. Case: A 59-year-old female had an intrathecal baclofen pump placed for spasticity secondary to multiple sclerosis. Her symptoms also included lower extremity neuropathic pain and severe migraine headaches with 22 migraine headache days per month. Prior treatments included nonsteroidal anti-inflammatory drugs, triptans, anticonvulsants, antihypertensives, and Botox injections which reduced her symptoms to four migraine days per month at best. While her spasticity had markedly improved with intrathecal baclofen, ziconotide was added to help her neuropathic pain complaints. Following initiation of low-dose ziconotide (1 µg/day, the patient noted both lower extremity pain improvement and complete resolution of migraine headaches resulting in zero migraine days per month. She has now been migraine free for 8 months. Conclusion: Upon review of the available literature, there are no published cases of migraine improvement with intrathecal ziconotide. This represents the first case describing resolution of migraine symptoms with low-dose ziconotide. Keywords: ziconotide, migraine, symptoms, chronic

  11. 氯胺酮的非麻醉应用%The non-anesthetic use of ketamine

    Institute of Scientific and Technical Information of China (English)

    沈杨; 张马忠

    2013-01-01

    Background Ketamine is a common clinical intravenous anaesthetics,which occupies a unique niche in infantile anesthesiology.But the side effects restricted the use of ketamine.Katamine faded out clinician perspective at one time.While in the past few years,ketamine was reported to have several new clinically beneficial properties such as prevention of hyperalgesia,neuroprotection,anti-depression,anti-tumour,anti-inflammatory and so on.Objective The non-anesthetic use of ketamine was reviewed.Content This article reviewed the analgesic effect of ketamine,neuroprotectiive effect,anti-depression,anti-tumour and anti-inflammatory effect and its mechanism.Trend To provide new ideas for the clinical use of ketamine.%背景 氯胺酮是一种临床常见的静脉麻醉药,尤其在小儿麻醉领域中占据着独特的地位.由于此药的一些副作用限制了它的运用,曾淡出临床医生的视野.近年来,氯胺酮又被陆续报道出有许多其他的药效,譬如:减少痛觉过敏、神经保护、抗抑郁、抗癌和抗炎等. 目的 综述近年来发现的氯胺酮的非麻醉应用. 内容 回顾氯胺酮的镇痛作用、神经保护作用、抗抑郁作用、抗肿瘤和抗炎作用及其机制. 趋向 为临床上氯胺酮的应用提供新的思路.

  12. Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

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    Rahşan Karayazılı

    2010-12-01

    Full Text Available Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain. Methods: Sixty pediatric patients (aged 2-12 years with American Society of Anesthesiology (ASA classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP, heart rates (HR, Ramsey sedation scores (Rss and sedation agitation scores (Sas were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2. Recovery times, Alderete scores and facial pain scores (FPS were recorded. Results: There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05. There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium. Conclusion: Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents. (The Medical Bulletin of Haseki 2010; 48: 146-52

  13. Diagnosis and management of pre-eclampsia: an update

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    Judi A Turner

    2010-09-01

    Full Text Available Judi A TurnerDepartment of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Pre-eclampsia is a significant, multifactorial, multiorgan disease affecting 5%–8% of all pregnancies in the US where it is the third leading cause of maternal mortality. Despite improvements in the diagnosis and management of pre-eclampsia, severe complications can occur in both the mother and the fetus, and there is no effective method of prevention. Early detection and identification of pregnant women most at risk of developing the disease have proven challenging, but recent efforts combining biochemical and biophysical markers are promising. Efforts at prevention of pre-eclampsia with aspirin and calcium have had limited success, but research on modifiable risk factors, such as obesity surgery, are encouraging. Obstetric management of severe pre-eclampsia focuses on medical management of blood pressure and prevention of seizures using magnesium sulfate, but the ultimate cure remains delivery of the fetus and placenta. Timing of delivery depends on several factors, including gestational age, fetal lung maturity, and most importantly, disease severity. Anesthetic management includes regional anesthesia with careful evaluation of the patient’s airway, volume status, and coagulation status to reduce morbidity and mortality. The potential complications of general anesthesia, including intracranial hemorrhage, in these patients make regional anesthesia the preferred choice in many cases. Nevertheless, it is important to be aware of the contraindications to neuraxial anesthesia and to prepare always for the possibility of encountering a difficult airway.Keywords: pre-eclampsia, diagnosis, risk factors, complications, management, anesthesia, prevention

  14. Morbidity of severe obesity.

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    Kral, J G

    2001-10-01

    Although obesity is an easy diagnosis to make, its etiologies, pathophysiology, and symptomatology are extraordinarily complex. Progress in surgical technique and anesthesiological management has substantially improved the safety of performing operations on the severely obese in the last 20 years. These improvements have occurred more or less empirically, without a full understanding of etiology or pathophysiology, although this has advanced concomitantly with improvements in practice. This review has attempted to provide a framework to facilitate progress in the neglected areas of patient selection and choice of operation, in an effort to improve long-term outcome. Despite the disparate etiologies of obesity and its diverse comorbidities and complications, there are unifying interdependent pathogenetic mechanisms of great relevance to the practice of antiobesity surgery. The rate of eating, whether driven by HPA dysfunction, ambient stress, or related hereditary susceptibility factors including the increased energy demands of an expanded body fat mass, participates in a cycle that results in disordered satiety (see Fig. 3). This leads to substrate overload, causing extensive metabolic abnormalities such as atherogenesis, insulin resistance, thrombogenesis, and carcinogenesis. This interpretation of the pathophysiology of obesity ironically accords with the original meaning of the word obesity: "to overeat." The ultimate solution to the problem of obesity--preventing it--will not be forthcoming until the food industry is forced to lower production and change its marketing strategies, as the liquor and tobacco industries in the United States were compelled to do. This cannot occur until the large and fast-growing populations of industrialized nations become educated in the personal implications of the energy principle. Regardless of whether school curricula are modified to prioritize health education, the larger problems of cultural and economic change remain for

  15. Population pharmacokinetics of olprinone in healthy male volunteers

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    Kunisawa T

    2014-03-01

    Full Text Available Takayuki Kunisawa,1 Hidefumi Kasai,2 Makoto Suda,2 Manabu Yoshimura,3 Ami Sugawara,3 Yuki Izumi,3 Takafumi Iida,3 Atsushi Kurosawa,3 Hiroshi Iwasaki3 1Surgical Operation Department, Asahikawa Medical University Hospital, Hokkaido, Japan; 2Clinical Study Management Division, Bell Medical Solutions Inc, Tokyo, Japan; 3Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Hokkaido, Japan Background: Olprinone decreases the cardiac preload and/or afterload because of its vasodilatory effect and increases myocardial contractility by inhibiting phosphodiesterase III. Purpose: The objective of this study was to characterize the population pharmacokinetics of olprinone after a single continuous infusion in healthy male volunteers. Methods: We used 500 plasma concentration data points collected from nine healthy male volunteers for the study. The population pharmacokinetic analysis was performed using the nonlinear mixed effect model (NONMEM® software. Results: The time course of plasma concentration of olprinone was best described using a two-compartment model. The final pharmacokinetic parameters were total clearance (7.37 mL/minute/kg, distribution volume of the central compartment (134 mL/kg, intercompartmental clearance (7.75 mL/minute/kg, and distribution volume of the peripheral compartment (275 mL/kg. The interindividual variability in the total clearance was 12.4%, and the residual error variability (exponential and additive were 22.2% and 0.129 (standard deviation. The final pharmacokinetic model was assessed using a bootstrap method and visual predictive check. Conclusion: We developed a population pharmacokinetic model of olprinone in healthy male adults. The bootstrap method and visual predictive check showed that this model was appropriate. Our results might be used to develop the population pharmacokinetic model in patients. Keywords: phosphodiesterase III inhibitor, men, pharmacokinetic model

  16. Educational experiences and preparedness in dental anesthesia: five-year outcome assessment and conclusions.

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    Moore, Paul A; Boynes, Sean G; Cuddy, Michael A; Giovannitti, Joseph A; Zovko, Jayme

    2009-12-01

    A mail survey of 2003-07 dental school graduates was undertaken by the Department of Anesthesiology at the University of Pittsburgh School of Dental Medicine to assess the strengths and weaknesses of the predoctoral curriculum in anesthesia and to determine the preparedness of practicing dentists to provide anesthesia services for their dental patients. Subsets of the survey responses were created to specifically evaluate the effectiveness of an advanced selective program in sedation offered to approximately twenty third- and fourth-year predoctoral students. This fourteen-month Anesthesia Selective Program provides advanced didactic instruction and clinical experiences needed to establish competence in minimal to moderate sedation. Overall, graduates reported being best prepared in assessment of medical histories, physiology, and pharmacology, while being least prepared in oral sedation, intravenous sedation, and general anesthesia. For graduates currently in general practice, those who had participated in the Anesthesia Selective Program reported being better prepared in most subjects relating to anesthesia and patient care. Participants in the selective were also more likely to treat special needs patients in their private practices. Respondents' written comments indicated a desire for a greater number of clinical experiences involving sedation procedures within the predoctoral curriculum. This outcome assessment indicated that a greater emphasis should be placed on instruction and training experiences for enteral sedation within the predoctoral dental curriculum. Advanced training and increased clinical experiences in anesthesia may also be an effective means to better prepare graduates to assess medical histories, to manage medical emergencies, and to be willing to treat medically complex patients as well as patients with special health care needs. PMID:20007493

  17. Radical hysterectomy in surgical treatment of invasive cervical cancer at the Department of gynecology and obstetrics in Novi Sad in the period 1993-2013.

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    Đurđević Srđan

    2015-01-01

    Full Text Available Introduction. During the period from 1993 - 2013, 175 women with invasive cervical cancer underwent radical hysterectomy sec. Wertheim-Meigs at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Indications for radical hysterectomy comprise histopathologically confirmed invasive cervical cancer in stages I B 1 - II B according to the International Federation of Gynecology and Obstetrics. Material and Methods. Stage of the disease or extent of the disease spread to the adjacent structures was assessed in accordance with the International Federation of Gynecology and Obstetrics staging system from 2009. Exclusion criteria were all other stages of this disease: I A and stages higher than II B, as well as the absence of definite histological confirmation of the cervical cancer (primary endometrial or vaginal cancer which infiltrates the uterine cervix. Prior the operation, the following had to be done: the imaging of pelvis and abdomen, chest X-ray in two directions, electrocardiography, internist and anesthesiological examination. Results. The patients’ age ranged from 24-79 years (x : 46 years, and the operation duration was 120-300 minutes (x : 210 min.. Stage I B 1 was found in 64.6% of operated patients, 14.8% of the patients were in stage I B 2, 9.1% were in stage II A and 11.4 % were in stage II B. Blood loss during the operation ranged from 50-800 ml (on average 300 ml, and the number of removed lymph nodes per operation was 14-75 (x : 32. Intraoperative and postoperative complications developed in 6.8% of and 17.7% of patients, respectively. Recurrence was reported in 22 (12.5% patients, most often in paraaortic lymph nodes (3.4% and parametria (2.8%, while the overall 5-year survival rate was 87% until 2008. Concluision. Wertheim-Meigs radical hysterectomy is a basic surgical technique for the treatment of initial stages of invasive cervical cancer.

  18. Costs of anesthetics and other drugs in anesthesia

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    Majstorović Branislava M.

    2012-01-01

    Full Text Available Introduction. Drugs are real and transparent costs of treatment, which are subject to constant monitoring and changes. The study was aimed at measuring and analyzing consumption of anesthetics and other drugs in anesthesia in the Clinical Centre of Serbia. Material and Methods. This paper is part of a five-year (2005-2009, academic, pharmacoeconomic retrospective-prospective study (the 4th phase. We calculated the costs of anesthetics and other drugs in all anesthetized patients at the Institute of Anesthesia and Reanimation, Clinical Center of Serbia in 2006. The data, obtained from the Clinical Centre of Serbia Database, were analyzed by descriptive statistical methods using computer program Microsoft Office Excel 2003 and the Statistical Package for the Social Sciences (SPSS for Windows. Results. The amount of money spent for the application of 33,187 general and 16,394 local anesthesia and 20,614 anesthesiology procedures was 83,322,046.36 RSD (Euros 1,054,705.4, which was 5.93% of the funds allocated for all drugs used at the Clinical Center of Serbia. Of the total fund for drugs, 57.8% was spent for anesthetics (local anesthetics 1.2% and muscle relaxants, whereas 42.2% was spent for other drugs in anesthesia. The highest amount was spent at the Emergency Center (35.8%, then at the Cardio-surgery (11.9% and the Neurosurgery (10.9% because of the large number and length of surgical interventions. Conclusion. There is no space for rationalizing the costs of anesthetics and other drugs in anesthesia.

  19. The Impact of Obesity on Surgical Outcome after Pancreaticoduodenectomy

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    Roger Noun

    2008-07-01

    Full Text Available Context The effect of obesity on surgical outcome is becoming an increasingly relevant issue given the growing rate of obesity worldwide. Objective To investigate the specific impact of obesity on pancreaticoduodenectomy. Design A retrospective comparative study of a prospectively maintained database was carried out to investigate the specific impact of obesity on the technical aspects and postoperative outcome of pancreaticoduodenectomy. Patients Between 1999 and 2006, 92 consecutive patients underwent pancreaticoduodenectomy using a standardized technique. The study population was subdivided according to the presence or absence of obesity. Results Nineteen (20.7% patients were obese and 73 (79.3% patients were non-obese. The two groups were comparable in terms of demographics, American Society of Anesthesiology (ASA score as well as nature and type of pancreatico-digestive anastomosis. The rate of clinically relevant pancreatic fistula (36.8% vs. 15.1%; P=0.050 and hospital stay (23.1±13.9 vs. 17.0±8.0 days; P=0.015 were significantly increased in obese vs. non-obese patients, respectively. Pancreatic fistula was responsible for one-half of the deaths (2/4 and two ruptured pseudoaneurysms. The incidence of the other procedure-related and general postoperative complications were not significantly different between the two groups. Intrapancreatic fat was increased in 10 obese patients (52.6% and correlated positively both with BMI (P=0.001 and with the occurrence of pancreatic fistula (P=0.003. Conclusion Obese patients are at increased risk for developing pancreatic fistula after pancreaticoduodenectomy. Special surgical caution as well as vigilant postoperative monitoring are therefore recommended in obese patients.

  20. Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

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    Edouard Matevossian

    2009-04-01

    Full Text Available Edouard Matevossian1, Dietrich Doll4, Jakob Säckl1, Inga Sinicina5, Jürgen Schneider2, Gerhard Simon3, Norbert Hüser11Department of Surgery, 2Department of Anesthesiology and Intensive-Care Medicine; 3Department of Radiology, Technische Universität of Munich, Germany; 4Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; 5Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, GermanyAbstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS device (Jolife, Lund, Sweden undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions. Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary

  1. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

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    Nermin Gogus

    2014-09-01

    Full Text Available Background and objectives: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Methods: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30 received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II (n = 30 received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation. Results: When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05. Conclusions: Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both.

  2. A COMPARATIVE STUDY OF THE EFFECT OF EPIDURAL BUPIVACAINE (0.125% VERSUS EPIDURAL BUPIVACAINE (0.125% AND BUTORPHANOL (2mg FOR POST-OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

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    Krishna

    2014-08-01

    Full Text Available BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine was varied from 4-8 minutes (mean 5.2 minutes and duration of analgesia lasted for 2-4 hours (mean 2.98(p<0.0001 where as in group BB patients (2mg butorphanol + 0.125% bupivacaine the onset was 2-4 minutes (mean 2.69 and duration of analgesia lasted for 6-8 hours (mean 6.98 (p<0.0001.The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001. CONCLUSION: This study concludes that addition of butorphanol (2mg to bupivacaine (0.125% gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without significant side effects.

  3. Critical appraisal of extended-release hydrocodone for chronic pain: patient considerations

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    Gould HJ III

    2015-10-01

    Full Text Available Harry J Gould III,1,3–7 Dennis Paul1–8 1Department of Neurology, 2Department of Pharmacology and Experimental Therapeutics, 3Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, 4Department of Anesthesiology, 5Neuroscience Center of Excellence, 6Center of Excellence for Oral and Craniofacial Biology, 7Pain Mastery Center of Louisiana, 8Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, USA Abstract: Opioid analgesics are currently the most effective pharmacologic option for the management of both acute and chronic forms of moderate-to-severe pain. Although the “as-needed” use of immediate-release formulations is considered optimum for treating acute, painful episodes of limited duration, the scheduled dosing of extended-release formulations with immediate-release supplementation for breakthrough pain is regarded to be most effective for managing chronic conditions requiring around-the-clock treatment. The recent introduction of extended-release formulations of the opioid analgesic hydrocodone potentially broadened the possibility of providing pain relief for individuals for whom current formulations are either ineffective or not tolerated. However, reaction to the approval of the new formulations has fueled controversy over the general safety and need for opioid medications, in light of their potential for misuse, abuse, diversion, and addiction. Here, we discuss how the approval of extended-release formulations of hydrocodone and the emotionally charged controversy over their release may affect physician prescribing and the care available to patients in need of chronic opioid therapy for the management of pain. Keywords: opioid analgesics, patient risks, patient benefits, misuse, addiction

  4. 1-1-12 one-step wash-in scheme for desflurane low flow anesthesia: performance without nitrous oxide

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    Sathitkarnmanee T

    2015-02-01

    Full Text Available Thepakorn Sathitkarnmanee, Sirirat Tribuddharat, Duangthida Nonlhaopol, Maneerat Thananun, Wilawan Somdee Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: We reported a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O low flow anesthesia that is simple, rapid, and predictable. There remain some situations where N2O should be avoided, which limits the generalizability of this wash-in scheme. The objective of our study was to determine the performance of this scheme in contexts where N2O is not used.Methods: We recruited 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow of air:O2 1:1 L/min and a vaporizer concentration of desflurane of 12%. Controlled ventilation was then adjusted to maintain PACO2 at 30–35 mmHg.Results: The alveolar concentration of desflurane (FAD rose rapidly from 0% to 6% in 4 minutes in the same pattern as observed in our previous study in which N2O was used. An FAD of 7% was achieved in 6 minutes. An FAD of 1% to 7% occurred at 0.6, 1, 1.5, 2, 3, 4, and 6 minutes. The rise in heart rate during wash-in was statistically significant, although not clinically so. There was a slight but statistically significant decrease in blood pressure, but this had no clinical significance.Conclusion: Performance of the 1-1-12 wash-in scheme is independent of the use of N2O. Respective FADs of 1%, 2%, 3%, 4%, 5%, 6%, and 7% can be expected at 0.6, 1, 1.5, 2, 3, 4, and 6 minutes. Keywords: low flow anesthesia, wash-in, desflurane, air

  5. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

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    Muhly WT

    2015-11-01

    Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

  6. Simplified local anesthesia technique for external dacryocystorhinostomy without nasal packing: a new technique and pilot study outcome

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    Tawfik HA

    2013-11-01

    Full Text Available Hatem A Tawfik,1 Osama R Youssef21Department of Ophthalmology, 2Department of Anesthesiology, Ain Shams University, Cairo, EgyptBackground: The purpose of this paper is to describe a simplified local anesthesia technique for external dacryocystorhinostomy (EXT-DCR.Methods: In this pilot, retrospective, noncomparative, interventional case series, 448 patients (480 eyes underwent EXT-DCR using a simplified local anesthesia technique. Nasal mucosal anesthesia was achieved using combined application of 6 mL of oxymetazoline 0.025% nasal spray and lidocaine 1% in the same spray bottle, without any packing of the nose with either pledgets or ribbon gauze. Local infiltration anesthesia consisted of subcutaneous injection of a 7 mL mixture of 2% lidocaine with 1:100,000 epinephrine injected on the flat side of the nose beneath the incision site, in addition to a second medial peribulbar injection (3 mL, 2% lidocaine without epinephrine.Results: Successful unilateral or bilateral EXT-DCR was achieved in 432/448 patients (96.4%. Four patients could not tolerate the procedure under local anesthesia and were converted to general anesthesia. Four patients required additional local anesthetic injections because of intolerable pain. Heavy sedation was essential in eight uncooperative patients because surgical manipulation was impossible. The remaining patients tolerated the procedure well. The intraoperative bleeding rate was very low except in one patient. Mean operative time was 16 minutes. Severe postoperative epistaxis was observed in four patients. Temporary anosmia developed in one patient.Conclusion: Our simplified local anesthesia approach of EXT-DCR is convenient for the patient because it avoids unnecessary nasal packing. It is also safe and effective, as evidenced by the high rate of successful completion of the procedure without conversion to general anesthesia or the need for supplemental local anesthesia.Keywords: local anesthesia, external

  7. Use of High-Frequency Jet Ventilation for Percutaneous Tumor Ablation

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    Denys, Alban, E-mail: alban.denys@chuv.ch; Lachenal, Yann; Duran, Rafael [Lausanne University Hospital, Department of Radiology and Interventional Radiology (Switzerland); Chollet-Rivier, Madeleine [Lausanne University Hospital, Department of Anesthesiology (Switzerland); Bize, Pierre [Lausanne University Hospital, Department of Radiology and Interventional Radiology (Switzerland)

    2013-05-02

    PurposeTo report feasibility and potential benefits of high-frequency jet ventilation (HFJV) in tumor ablations techniques in liver, kidney, and lung lesions.MethodsThis prospective study included 51 patients (14 women, mean age 66 years) bearing 66 tumors (56 hepatic, 5 pulmonary, 5 renal tumors) with a median size of 16 ± 8.7 mm, referred for tumor ablation in an intention-to-treat fashion before preoperative anesthesiology visit. Cancellation and complications of HFJV were prospectively recorded. Anesthesia and procedure duration, as well as mean CO{sub 2} capnea, were recorded. When computed tomography guidance was used, 3D spacial coordinates of an anatomical target <2 mm in diameter on 8 slabs of 4 slices of 3.75-mm slice thickness were registered.ResultsHFJV was used in 41 of 51 patients. Of the ten patients who were not candidate for HFJV, two patients had contraindication to HFJV (severe COPD), three had lesions invisible under HFJV requiring deep inspiration apnea for tumor targeting, and five patients could not have HFJV because of unavailability of a trained anesthetic team. No specific complication or hypercapnia related to HFJV were observed despite a mean anesthetic duration of 2 h and ventilation performed in procubitus (n = 4) or lateral decubitus (n = 6). Measured internal target movement was 0.3 mm in x- and y-axis and below the slice thickness of 3.75 mm in the z-axis in 11 patients.ConclusionsHFJV is feasible in 80 % of patients allowing for near immobility of internal organs during liver, kidney, and lung tumor ablation.

  8. Neurotoxicities and Potential Mechanisms of Inhalational Anesthetics%吸入麻醉药的神经毒性作用及其可能机制

    Institute of Scientific and Technical Information of China (English)

    郑少强

    2011-01-01

    吸入麻醉药广泛应用于各种手术的临床麻醉,其神经毒性一直是麻醉学领域的研究热点.近年研究发现,接受吸入性麻醉的患者术后会出现细胞凋亡、神经损伤.尤其是处于发育期的婴幼儿和大脑结构发生退行性变的老年人,对神经毒性物质异常敏感,暴露于吸入麻醉药后,可出现记忆、认知功能障碍.这种现象的产生可能与吸入麻醉药导致的海马神经元的凋亡、氨酪酸受体活性增强以及脑代谢改变相关.现就吸入麻醉药的神经毒性作用及其机制予以综述.%Inhalational anesthetics have heen widely used in clinical anesthesia for a wide range of surgeries. The neurotoxicities of inhalational anesthetics have been a research hotspot in anesthesiology. It has shown that patients receiving inhalational anesthetics are likely to be complicated with postoperative cell apoptosis and neural injuries. Of note, developing infants and aged patients with cerebral degeneration are more prone to neurotoxicities of inhalational anesthetics, exhibiting memory and cognitive dysfunction. This may be associated with hippocampal cell apoptosis , artivated GABA receptor , and cerebral metabolism alteration. This article reviews the neurotoxicities and potential mechanisms of inhalational anesthetics.

  9. The unsolved case of “bone-impairing analgesics”: the endocrine effects of opioids on bone metabolism

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    Coluzzi F

    2015-03-01

    Full Text Available Flaminia Coluzzi,1,2 Joseph Pergolizzi,3,4 Robert B Raffa,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine – Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 4Naples Anesthesia and Pain Associates, Naples, FL, 5Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA Abstract: The current literature describes the possible risks for bone fracture in chronic analgesics users. There are three main hypotheses that could explain the increased risk of fracture associated with central analgesics, such as opioids: 1 the increased risk of falls caused by central nervous system effects, including sedation and dizziness; 2 reduced bone mass density caused by the direct opioid effect on osteoblasts; and 3 chronic opioid-induced hypogonadism. The impact of opioids varies by sex and among the type of opioid used (less, for example, for tapentadol and buprenorphine. Opioid-associated androgen deficiency is correlated with an increased risk of osteoporosis; thus, despite that standards have not been established for monitoring and treating opioid-induced hypogonadism or hypoadrenalism, all patients chronically taking opioids (particularly at doses ≥100 mg morphine daily should be monitored for the early detection of hormonal impairment and low bone mass density. Keywords: opioids side effects, bone metabolism, fractures, OPIAD, endocrine system, chronic pain

  10. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes

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    Kim S

    2014-12-01

    Full Text Available Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. Keywords: frailty, mobility

  11. Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

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    Kakoma, Jean Baptiste

    2016-01-01

    The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that. PMID:27303587

  12. Analyze of Ventilator Associated Pneumonia

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    Aysel Sunnetcioglu

    2014-03-01

    Full Text Available Aim: Ventilator-associated pneumonia (VAP is the infection that is an important cause of morbidity and mortality developed in patients whom the invasive mechanical ventilation (MV were performed in intensive care units (ICU. In this study, the factors of VAP developing in patients whom the mechanical ventilation of ICU performed, antibiotic susceptibility to these factors and determining the risk factors were aimed. Material and Method: Between January 2009 and March 2013, 79 cases, followed with the mechanical ventilation for at least for 48 hours and developed VAP, were retrospectively reviewed at Anesthesiology and Intensive Care Unit of Reanimation at Faculty of Medicine at Yuzuncu Yil University, performing endotracheal intubation. The cases were evaluated in terms of microorganisms, antibiotic susceptibility and risk factors. Results: The rate of our VAP speed was calculated to be 19.68 on the day of 1000 ventilator. While a single microorganism could be isolated in 81.1% of the 74 VAP cases whose the active pathogen could be isolated, two or more than two microorganisms were isolated in 18.9% of them.While 83 of the strains (90.2% were gram-negative bacteria, 7 of them (7.6% were gram-positive bacteria. Acinetobacter spp. (40.2% was most commonly isolated as a gram-negative factor, but methicillin-resistant S. aureus (4.3% was isolated as a gram-positive factor. It was determined that the isolated factors in VAP cases were significantly resistant to the broad-spectrum antibiotics. Discussion: As a result, in patients with high-risk factors for the development of VAP, early and appropriate empirical antibiotic treatment should be started according to the results of the sensitivity of the unit and for the multi-drug-resistant microorganisms with common and high mortality.

  13. New treatment options for fibromyalgia: critical appraisal of duloxetine

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    Nurcan Üçeyler

    2008-06-01

    Full Text Available Nurcan Üçeyler1, Martin Offenbächer2, Frank Petzke3, Winfried Häuser4, Claudia Sommer11Department of Neurology, University of Würzburg, Germany; 2GRP – Generation Research Program, Human Science Center, University of Munich, Germany; 3Department of Anesthesiology, University of Cologne, Germany; 4Center of Pain Therapy, Klinikum Saarbrücken gGmbH, Winterberg 1, Saarbrücken, GermanyAbstract: Fibromyalgia syndrome (FMS is a chronic condition characterized by widespread pain, tender points, fatigue, and sleep disturbance. FMS leads to high disability levels, poor quality of life, and extensive use of medical care. Effective pharmacological treatment options are rare, and treatment effects are often of limited duration. Duloxetine is a new selective serotonin and norepinephrine reuptake inhibitor that is licensed for the treatment of pain in diabetic neuropathy. So far two randomized, placebo-controlled trials have investigated the short-term safety and efficacy of duloxetine 60 mg/day and 120 mg/day in patients suffering from FMS over a period of 12 weeks. Both dosages were superior to placebo in pain relief, and improvement in quality of life and depressive symptoms. The analgesic effect was largely independent of the antidepressant action of duloxetine. The higher dose of 120 mg/day further reduced the tender point count and elevated the tender point pain thresholds. Only mild to moderate adverse effects were reported. Duloxetine 60 mg/day and 120 mg/day has proven to be beneficial in the treatment of FMS symptoms. As true for other antidepressants further studies are needed to assess the long-term efficacy and safety of duloxetine as an additional pharmacological treatment option in FMS.Keywords: fibromyalgia syndrome, duloxetine, antidepressant, review, SNRI

  14. Management of pediatric tonsillectomy pain: a review of the literature

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    Hansen J

    2016-05-01

    Full Text Available Jennifer Hansen, Ravi D Shah, Hubert A Benzon Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: Tonsillectomy is associated with significant pain and postoperative pain control is often unsatisfactory. We discuss the various strategies that have been investigated to control pain following tonsillectomy. Codeine is a weak analgesic frequently used in children for the treatment of mild-to-moderate pain, however, due to adverse events related to its metabolism, it has been contraindicated for postoperative pain in children since 2013. Intravenous morphine is frequently used for moderate-to-severe pain in children, however, its active metabolite can lead to respiratory depressant and other undesirable side effects. Hydromorphone is a commonly used alternative that has been studied infrequently. Alternatives to narcotic pain strategies have also been studied. Nonsteroidal anti-inflammatory drugs (NSAIDs are effective as analgesics, yet many practitioners avoid their use given the concern for postoperative bleeding. Intraoperative acetaminophen has been shown to improve postoperative pain and decrease recovery room time. Dexamethasone has been shown to improve postoperative pain, vomiting, and decrease airway swelling, and seems to be effective for use during tonsillectomy surgery. Ketamine has been shown to decrease analgesic requirements without adverse affects of hallucinations. Direct injection of local anesthetic into the tonsillar bed has been shown to be effective in improving pain control, however, there is concern that local anesthetic could be erroneously injected into the carotid artery and lead to devastating consequences. Optimal pain control regimens following pediatric tonsillectomy continue to be a challenge for both anesthesiologists and otorhinolaryngologists. Opioids are the most commonly used but are

  15. Conditioned pain modulation is minimally influenced by cognitive evaluation or imagery of the conditioning stimulus

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    Bernaba M

    2014-11-01

    Full Text Available Mario Bernaba, Kevin A Johnson, Jiang-Ti Kong, Sean MackeyStanford Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USAPurpose: Conditioned pain modulation (CPM is an experimental approach for probing endogenous analgesia by which one painful stimulus (the conditioning stimulus may inhibit the perceived pain of a subsequent stimulus (the test stimulus. Animal studies suggest that CPM is mediated by a spino–bulbo–spinal loop using objective measures such as neuronal firing. In humans, pain ratings are often used as the end point. Because pain self-reports are subject to cognitive influences, we tested whether cognitive factors would impact on CPM results in healthy humans.Methods: We conducted a within-subject, crossover study of healthy adults to determine the extent to which CPM is affected by 1 threatening and reassuring evaluation and 2 imagery alone of a cold conditioning stimulus. We used a heat stimulus individualized to 5/10 on a visual analog scale as the testing stimulus and computed the magnitude of CPM by subtracting the postconditioning rating from the baseline pain rating of the heat stimulus.Results: We found that although evaluation can increase the pain rating of the conditioning stimulus, it did not significantly alter the magnitude of CPM. We also found that imagery of cold pain alone did not result in statistically significant CPM effect.Conclusion: Our results suggest that CPM is primarily dependent on sensory input, and that the cortical processes of evaluation and imagery have little impact on CPM. These findings lend support for CPM as a useful tool for probing endogenous analgesia through subcortical mechanisms.Keywords: conditioned pain modulation, endogenous analgesia, evaluation, imagery, cold presser test, CHEPS, contact heat-evoked potential stimulator

  16. Dietary methyl content regulates opioid responses in mice

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    Liang DY

    2013-03-01

    Full Text Available De-Yong Liang,1,2 Yuan Sun,1,2 J David Clark1,2 1Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, 2Stanford University School of Medicine, Stanford, CA, USA Background: Large interindividual differences in clinical responses to opioids and the variable susceptibility to abuse of this class of drugs make their use problematic. We lack a full understanding of the factors responsible for these differences. Dietary factors including methyl donor content have been noted to alter multiple physiological and behavioral characteristics of laboratory animals. The purpose of this research was to determine the effects of dietary methyl donor content on opioid responses in mice. Methods: Groups of male C57BL/6J mice were treated with high and low methyl donor diets either in the perinatal period or after weaning. Analgesic responses to morphine, as well as tolerance, opioid-induced hyperalgesia, and physical dependence were assessed. Results: Mice fed high and low methyl donor diets showed equal weight gain over the course of the experiments. Exposure to a high methyl donor diet in the perinatal period enhanced physical dependence. Dietary methyl donor content also altered analgesic responses to low doses of morphine when the dietary treatments were given to the mice after weaning. Opioid-induced hyperalgesia was unaltered by dietary methyl donor content. Conclusion: High and low methyl donor diet treatment has selective effects on opioid responses depending on the timing of exposure. These findings suggest that examination of DNA methylation patterns in specific brain regions linked to opioid analgesia and dependence may provide specific explanations for dietary effects on opioid responses. Keywords: opioid, methylation, tolerance, hyperalgesia, dependence

  17. Mapping of Primary Instructional Methods and Teaching Techniques for Regularly Scheduled, Formal Teaching Sessions in an Anesthesia Residency Program.

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    Vested Madsen, Matias; Macario, Alex; Yamamoto, Satoshi; Tanaka, Pedro

    2016-06-01

    In this study, we examined the regularly scheduled, formal teaching sessions in a single anesthesiology residency program to (1) map the most common primary instructional methods, (2) map the use of 10 known teaching techniques, and (3) assess if residents scored sessions that incorporated active learning as higher quality than sessions with little or no verbal interaction between teacher and learner. A modified Delphi process was used to identify useful teaching techniques. A representative sample of each of the formal teaching session types was mapped, and residents anonymously completed a 5-question written survey rating the session. The most common primary instructional methods were computer slides-based classroom lectures (66%), workshops (15%), simulations (5%), and journal club (5%). The number of teaching techniques used per formal teaching session averaged 5.31 (SD, 1.92; median, 5; range, 0-9). Clinical applicability (85%) and attention grabbers (85%) were the 2 most common teaching techniques. Thirty-eight percent of the sessions defined learning objectives, and one-third of sessions engaged in active learning. The overall survey response rate equaled 42%, and passive sessions had a mean score of 8.44 (range, 5-10; median, 9; SD, 1.2) compared with a mean score of 8.63 (range, 5-10; median, 9; SD, 1.1) for active sessions (P = 0.63). Slides-based classroom lectures were the most common instructional method, and faculty used an average of 5 known teaching techniques per formal teaching session. The overall education scores of the sessions as rated by the residents were high.

  18. An analysis of risk factors and adverse events in ambulatory surgery

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    Kent C

    2014-06-01

    Full Text Available Christopher Kent, Julia Metzner, Laurent BollagDepartment of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USAAbstract: Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more

  19. Management of comorbidities in ambulatory anesthesia: a review

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    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  20. Surgery of malignant pancreatic tumors; Chirurgie maligner Pankreastumoren

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    Loos, M.; Friess, H.; Kleeff, J. [Klinikum rechts der Isar, Technische Universitaet Muenchen (Germany). Chirurgische Klinik und Poliklinik

    2009-02-15

    Ductal adenocarcinoma is the most common malignant tumor of the pancreas. Despite great efforts in basic and clinical pancreatic cancer research, the prognosis remains poor with an overall 5-year survival rate of less than 5%. Complete surgical resection represents the only curative treatment option and 5-year survival rates of 20-25% can be achieved following curative resection and adjuvant chemotherapy. Although pancreatic surgery is considered one of the most technically demanding and challenging procedures, there has been constant progress in surgical techniques and advances in perioperative care with a modern interdisciplinary approach including anesthesiology, oncology, radiology and nursing. This has reduced morbidity and especially mortality rates in high-volume centers. Among extended resection procedures multivisceral and venous resections are technically feasible and should be considered if a complete tumor resection can be achieved. Multimodal regimens have shown promising results, however, only adjuvant chemotherapy is supported by solid evidence from randomized controlled trials. (orig.) [German] Das duktale Adenokarzinom ist der haeufigste maligne Pankreastumor. Trotz intensiver Anstrengungen auf dem Gebiet der Pankreasforschung konnte die Gesamtprognose in den vergangenen Jahren nicht entscheidend verbessert werden. Die einzige potenziell kurative Therapie ist die chirurgische Resektion. In Kombination mit einer adjuvanten Chemotherapie liegen die 5-Jahres-Ueberlebensraten aktuell bei 20-25%. Dank kontinuierlicher Weiterentwicklung der chirurgischen Operationstechnik und Verbesserungen der perioperativen Versorgung der Patienten mit einer engen interdisziplinaeren Zusammenarbeit (Chirurgie, Anaesthesie, Onkologie, Radiologie und Pflege) konnten die perioperative Morbiditaets- und Mortalitaetsraten in den vergangenen Jahren deutlich gesenkt werden. Unter den erweiterten Resektionsverfahren sind Venen- oder multiviszerale Resektionen technisch sicher

  1. Safety of rapid intravenous of infusion acetaminophen.

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    Needleman, Steven M

    2013-07-01

    Intravenous acetaminophen, Ofirmev®, is approved for management of mild to moderate pain, management of moderate to severe pain with adjunctive opioids, and reduction of fever. The product is supplied as a 100 mL glass vial. As stated in the prescribing information, it is recommended to be infused over 15 minutes. This recommendation is related to the formulation propacetamol, the prodrug to acetaminophen, approved in Europe, which caused pain on infusion, and data from the clinical development of acetaminophen. The objective of this retrospective chart review study was to show the lack of side effects of rapidly infusing intravenous acetaminophen. Charts of American Society of Anesthesiology (ASA) Class I-III ambulatory surgical patients who received only acetaminophen in the preoperative setting were reviewed for any infusion-related side effects. Using standard binomial proportion analyses and employing SAS/JMP software, all vital signs were analyzed for statistically significant changes between pre- and postinfusion values. One hundred charts were reviewed. Only one patient had pain on infusion, which lasted 10 seconds. No reported side effects or erythema was seen at the injection site. No infusions had to be slowed or discontinued. The median infusion time was 3:41 minutes. Of the vital signs monitored, only the systolic (P < 0.0001) and diastolic (P < 0.0099) blood pressures had statistically significant changes from pre- to postinfusion; however, they were of no clinical relevance. Acetaminophen can be administered as a rapid infusion with no significant infusion-related side effects or complications. PMID:23814378

  2. EVALUATION OF PULMONARY ASPIRATION AND SELLICK’S MANEUVER IN EMERGENCY LAPAROTOMIES

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    Rajesh

    2015-12-01

    Full Text Available BACKGROUND Sellick’s maneuver is used for the prevention of pulmonary aspiration in emergency situation. To evaluate the efficacy of Sellick’s maneuver controlled trials were not done up till now because of ethical and legal issue. On the background of recent updates, we have planned to evaluate the emergency laparotomy and obstetric cases of last four and a half years for the risk of pulmonary. AIMS AND OBJECTIVES To evaluate the incidence rate of pulmonary aspiration, the morbidity and mortality of pulmonary aspiration and to discuss the efficacy of Sellick’s maneuver. MATERIAL AND METHODS Cases selected are from the period January 2011 to June 2015. Total 807 cases were for evaluation. After permission of record section of our hospital case sheets are evaluated. Where ever required the concerned assistant professor of anesthesiology was interviewed. OBSERVATIONS The incidence of pulmonary aspiration is 1:807. This patient did not need intensive pulmonary management. There is no mortality because of pulmonary aspiration. Two cases of vomiting immediately after extubation are observed, but there was nothing to suggest for pulmonary aspiration. CONCLUSION There are chances of regurgitation even with all preventive measures are applied. The incidence rate is 1:807 in emergency surgical procedures under general anesthesia. Out of three main groups, i.e. obstetric group, pediatric group and adult patients of emergency laparotomy group no group can be labeled as more high risk group for risk of aspiration. There is no mortality because of regurgitation. The training of assistant is crucial to prevent the incidence of aspiration. We are of opinion that Sellick’s maneuver will remain beneficial during induction of general anesthesia to prevent pulmonary aspiration.

  3. A retrospective study on persistent pain after childbirth in the Netherlands

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    Bijl RC

    2016-01-01

    Full Text Available Rianne C Bijl,1,2 Liv M Freeman,2 Philomeen TM Weijenborg,3 Johanna M Middeldorp,2 Albert Dahan,1 Eveline LA van Dorp1 1Department of Anesthesiology, 2Department of Obstetrics, 3Department of Gynecology, Leiden University Medical Center, Leiden, The NetherlandsAbstract: Reported prevalence rates of persistent postpartum pain (PPP range from less than 1% to almost 20%. The aim of this study was to examine the prevalence of PPP in a Dutch cohort and to evaluate a possible causal role for specific risk factors on the development of chronic pain after childbirth. A questionnaire was sent to 960 postpartum women approximately 2 years after delivery. Primary outcome was pain that arose from childbirth at follow-up, and secondary outcomes included quality of life (QoL and Hospital Anxiety and Depression Scale scores. Tested risk factors included mode of labor analgesia, history of negative effect, history of chronic pain, delivery route, parity, and ethnicity. A total of 495 (51.6% women participated. At a mean time of 2.3 postpartum years, 7.3% of women reported any pain and 6.1% reported significant pain related to the delivery. Compared to spontaneous delivery, cesarean delivery provided protection against persistent pain (odds ratio, 0.12; 95% CI, 0.01–0.63, P<0.05. None of the other risk factors, including remifentanil use for labor pain, were of influence on the prevalence of persistent pain. Women with PPP experienced greater negative effects and had lower QoL scores compared to women without pain. In this cohort of Dutch patients, PPP is a serious problem with a great impact on the physical and mental health of women. Keywords: chronic pain after childbirth, chronic pain, partus, labor analgesia, remifentanil, epidural analgesia, risk factors

  4. Investigating the Effects of Adding Fentanyl to Bupivacaine in Spinal Anesthesia of Opium-addicted Patients

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    H Satari

    2014-10-01

    Full Text Available Introduction: Spinal anesthesia in opium-addicted patients can be associated with many complications. Hence, this study aimed to investigate sensory and motor block characteristics, duration of postoperative analgesia, hemodynamic and side effects by adding Fentanyl to bupivacaine in spinal Anesthesia of opium-addicted patients. Methods: In a double-blind randomized clinical trial, 60 American society of Anesthesiology (ASA class I and II opium-addicted patients under spinal anesthesia in lower abdominal and lower limb operations were randomly classified into two groups of spinal anesthesia with bupivacaine and bupivacaine-fentanyl. Clinical symptoms, side effects, the duration of sensory and motor block, initiation of analgesia requirement and sensory block were assessed. Results: The study results indicated no significant difference between bupivacaine and bupivacaine-fentanyl groups in regard with demographic, side effects, blood pressure and heart rate, though a significant difference was observed in respiratory rate 5min, 10min, 45min, 75min and 90 min after block. Duration of sensory (100.33 to 138.83 and motor block (93.43 to 107.66 and , initiation of analgesia requirement (165.33 to 187.76 was significantly longer in bupivacaine-fentanyl, though initiation of sensory block (8.83 to 4.93 was significantly longer in bupivacaine. Conclusion: Addition of fentanyl to bupivacaine in spinal anesthesia increases the duration of sensory and motor block and initiation of analgesia requirement in opium-addicted patients and also decreases initiation of sensory block in these patients.

  5. Our results in surgical treatment of laryngotracheal stenosis, ten years experience

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    Jović Rajko M.

    2006-01-01

    Full Text Available Introduction. There are numerous techniques for the treatment of laryngotracheal stenosis. The aim of this paper was to present surgical techniques and results of treatment of laryngeal and laryngotracheal stenosis in a ten-year period by retrospective analysis. Material and methods. Medical records of 34 patients (17 male and 17 female surgically treated for laryngeal or laryngotracheal stenosis between 1995 and 2004 were analyzed. 19 (55.9% patients had previous surgical procedures, whereas fifteen patients (44.1 % were diagnosed and treated for the first time. Results. 5 patients had a glottic-subglottic stenosis, 11 patients had a subglottic stenosis, 16 patients had subglottic-tracheal stenosis and 2 patients had a glottic-subglottic-tracheal stenosis. 21 patients had normal vocal cord motion, 8 patients showed unilateral vocal cord fixation, and 5 had bilateral vocal cord fixation. Laryngotracheoplasty with anterior-posterior costal cartilage graft was performed in 24 patients, while single stage segmental laryngotracheal resection of the stenotic part was performed in 8 patients. One patient was operated in direct laryngomicroscopy and one with dilatation of the stenotic segment with T tube insertion. The most common complication was the development of granulation due to use of the Montgomery T-tube which was removed in direct laryngomicroscopy. Except for one patient, 33(97% patients were decannulated. There was no perioperative mortality. Conclusion. Although laiyngotracheoplasty with anterior-posterior costal cartilage graft placement cannot be used in all cases of laryngotracheal stenosis, it was the method of choice in previously operated patients with segmental resection of the stenotic segment. This method requires use of Montgomery T-tube or anesthesiological tube, which is very hard to keep clean. Better recovery, short hospitalization and excellent results were obtained with the cricotracheal segmental resection. .

  6. Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy.

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    Milstein, Dan M J; Ince, Can; Gisbertz, Suzanne S; Boateng, Kofi B; Geerts, Bart F; Hollmann, Markus W; van Berge Henegouwen, Mark I; Veelo, Denise P

    2016-06-01

    Gastric tube reconstruction (GTR) is a high-risk surgical procedure with substantial perioperative morbidity. Compromised arterial blood supply and venous congestion are believed to be the main etiologic factors associated with early and late anastomotic complications. Identifying low blood perfusion areas may provide information on the risks of future anastomotic leakage and could be essential for improving surgical techniques. The aim of this study was to generate a method for gastric microvascular perfusion analysis using laser speckle contrast imaging (LSCI) and to test the hypothesis that LSCI is able to identify ischemic regions on GTRs.Patients requiring elective laparoscopy-assisted GTR participated in this single-center observational investigation. A method for intraoperative evaluation of blood perfusion and postoperative analysis was generated and validated for reproducibility. Laser speckle measurements were performed at 3 different time pointes, baseline (devascularized) stomach (T0), after GTR (T1), and GTR at 20° reverse Trendelenburg (T2).Blood perfusion analysis inter-rater reliability was high, with intraclass correlation coefficients for each time point approximating 1 (P generalized significant decrease in mean blood perfusion was observed across all GTR regions of interest during 20° reverse Trendelenburg (P < 0.05).It was feasible to implement LSCI intraoperatively to produce blood perfusion assessments on intact and reconstructed whole stomachs. The analytical design presented in this study resulted in good reproducibility of gastric perfusion measurements between different investigators. LSCI provides spatial and temporal information on the location of adequate tissue perfusion and may thus be an important aid in optimizing surgical and anesthesiological procedures for strategically selecting anastomotic site in patients undergoing esophagectomy with GTR. PMID:27336874

  7. Molecular epidemiology of Candida species isolated from urine at an intensive care unit.

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    Ergon, M C; Gülay, Z

    2005-03-01

    Candida spp. has been the leading microorganism isolated from the urine specimens of patients hospitalized at the Anesthesiology and Reanimation intensive care unit (ICU) of Dokuz Eylul University Hospital, Izmir, since 1998. This study was undertaken to investigate the clonal relationship of Candida urine isolates in order to find the mode of spread among the patients. Epidemiological surveillance of 38 Candida albicans, 15 Candida tropicalis and 12 Candida glabrata recovered from the urine specimens of patients who were hospitalized in the ICU between June 11, 2000 and October 15, 2001 was carried out by antifungal susceptibility testing and randomly amplified polymorphic DNA (RAPD) analysis. Two short primers [Cnd3 (5'-CCAGATGCAC-3') and Cnd4 (5'-ACGGTACACT-3')] were used for RAPD. None of the isolates had high minimal inhibitory concentration (MIC) values (>1 microg ml(-1)) against amphotericin B with MIC50 values of 0.5 microg ml(-1), 0.5 microg ml(-1) and 0.125 microg ml(-1) for C. albicans, C. tropicalis and C. glabrata isolates, respectively. However, three C. glabrata isolates were resistant and one C. albicans and five C. glabrata isolates were dose-dependent susceptible (D-DS) to fluconazole. Among C. albicans isolates 19 and 20 patterns were detected with primers Cnd3 and Cnd4, respectively. When primers Cnd3 and Cnd4 were evaluated together, three and four genotypes were identified for C. tropicalis and C. glabrata isolates, respectively. Our results suggest that the source of C. albicans isolates was mostly endogenous. It is difficult to interpret the mode of spread of C. tropicalis and C. glabrata urine isolates as we obtained insufficient banding patterns for these species.

  8. Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial

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    Sathitkarnmanee T

    2014-08-01

    Full Text Available Thepakorn Sathitkarnmanee,1 Sirirat Tribuddharat,1 Kanlayarat Noiphitak,2 Sunchai Theerapongpakdee,1 Sasiwimon Pongjanyakul,1 Yuwadee Huntula,1 Maneerat Thananun1 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 2Chulabhorn Hospital, Bangkok, Thailand Purpose: To assess the efficacy of a transdermal fentanyl patch (TFP (50 µg/hour applied 10–12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA. Materials and methods: We enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic® 50 µg/hour or placebo patch applied with a self-adhesive to the anterior chest wall 10–12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours. Results: Morphine consumption at 24 and 48 hours in the TFP group versus the placebo group was 15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001. Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression. Conclusion: TFP (50 µg/hour applied 10–12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery. Keywords: analgesia, total knee arthroplasty, fentanyl, matrix transdermal delivery system, patient-controlled analgesia

  9. Knowledge Toward Cancer Pain and the Use of Opioid Analgesics Among Medical Students in their Integrated Clinical Clerkship

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    Maria Fidelis C. Manalo

    2008-01-01

    Full Text Available Introduction: Among the focal issues of barriers to pain management include the physicians’ lack of knowledge about cancer pain and negative attitudes towards opioids. Many physicians and educators attribute this, at least in part, to limited exposure to pain and palliative care education during medical school.Aim: The researcher investigated the medical students’ knowledge about cancer pain and the use of opioid analgesics.Methods: The subjects were a sample of 50 students of the University of the Philippines College of Medicine in their integrated clinical clerkship year. Descriptive statistics (frequencies, means, standard deviation, rating scales were used to determine mean knowledge score and level of confidence with opioid use. The study also identified specific areas where students exhibited good or poor knowledge of opioids.Results: Approximately sixty-nine (69% of the study respondents mentioned that pain management was given to them during their Anesthesiology lectures while a few recalled that they had these lectures during their Family Medicine rotation in Supportive, Palliative and Hospice Care. More than a third (35% of the respondents admitted to not being confident with morphine use at present. The top three reasons cited as limitations in choice of opioids for cancer pain include fear of addiction, lack of adequate knowledge and experience and fear of side effects and complications. Out of a maximum of 13 correct answers, the mean knowledge score of the medical students was 6.6 ± 2.9. Less than 16% of the respondents had adequate knowledge on cancer pain and opioid use.Conclusions: The results show that basic knowledge of the role of opioids in cancer pain management among medical students in their integrated clinical clerkship year at the University of the Philippines is poor. The findings imply a need to look into making revisions in the medical curriculum to include a training program that will enable all students to

  10. Prevalence of burnout syndrome among anesthesiologists in the Federal District

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    Edno Magalhães

    2015-04-01

    Full Text Available BACKGROUND: Burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and a sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference. OBJECTIVE: To evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District. METHOD: A cross-sectional study was carried out with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data. RESULTS: Of the 134 completed questionnaires (55.8%, there was a predominance of male (65.6%, aged 30-50 years (67.9%. Significant lower levels of job satisfaction (47.7%, depersonalization (28.3%, and emotional exhaustion (23.1% were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%, aged 30-50 years (64.2%, with over 10 years of experience (64.2%, working in night shifts (71.4%, sedentary (57.1%, and not taking courses unrelated to medicine (78.5%. Of the participants, 50.7% had at least one of the three criteria to develop the syndrome and only 8.2% have a low risk to manifest it. CONCLUSION: The prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction.

  11. Pain and efficacy of local anesthetics for central venous access

    Directory of Open Access Journals (Sweden)

    William C Culp Jr

    2008-11-01

    Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

  12. Difficulties and challenges associated with literature searches in operating room management, complete with recommendations.

    Science.gov (United States)

    Wachtel, Ruth E; Dexter, Franklin

    2013-12-01

    The purpose of this article is to teach operating room managers, financial analysts, and those with a limited knowledge of search engines, including PubMed, how to locate articles they need in the areas of operating room and anesthesia group management. Many physicians are unaware of current literature in their field and evidence-based practices. The most common source of information is colleagues. Many people making management decisions do not read published scientific articles. Databases such as PubMed are available to search for such articles. Other databases, such as citation indices and Google Scholar, can be used to uncover additional articles. Nevertheless, most people who do not know how to use these databases are reluctant to utilize help resources when they do not know how to accomplish a task. Most people are especially reluctant to use on-line help files. Help files and search databases are often difficult to use because they have been designed for users already familiar with the field. The help files and databases have specialized vocabularies unique to the application. MeSH terms in PubMed are not useful alternatives for operating room management, an important limitation, because MeSH is the default when search terms are entered in PubMed. Librarians or those trained in informatics can be valuable assets for searching unusual databases, but they must possess the domain knowledge relative to the subject they are searching. The search methods we review are especially important when the subject area (e.g., anesthesia group management) is so specific that only 1 or 2 articles address the topic of interest. The materials are presented broadly enough that the reader can extrapolate the findings to other areas of clinical and management issues in anesthesiology. PMID:24257396

  13. Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

    Science.gov (United States)

    Kakoma, Jean Baptiste

    2016-01-01

    The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.

  14. Proinflammatory cytokines and DHEA-S in women with fibromyalgia: impact of psychological distress and menopausal status

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-12-01

    Full Text Available John A Sturgeon,1 Beth D Darnall,1 Heather L Zwickey,2 Lisa J Wood,3 Douglas A Hanes,2 David T Zava,4 Sean C Mackey1 1Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA, USA; 2Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA; 3MGH Institute of Health Professions, Boston, MA, USA; 4ZRT Laboratories, Beaverton, OR, USA Abstract: Though fibromyalgia is not traditionally considered an inflammatory disorder, evidence for elevated inflammatory processes has been noted in this disorder in multiple studies. Support for inflammatory markers in fibromyalgia has been somewhat equivocal to date, potentially due to inattention to salient patient characteristics that may affect inflammation, such as psychiatric distress and aging milestones like menopause. The current study examined the relationships between proinflammatory cytokines and hormone levels, pain intensity, and psychological distress in a sample of 34 premenopausal and postmenopausal women with fibromyalgia. Our results indicated significant relationships between interleukin-8 and ratings of pain catastrophizing (r=0.555, P<0.05, pain anxiety (r=0.559, P<0.05, and depression (r=0.551, P<0.05 for postmenopausal women but not premenopausal women (r<0.20 in all cases. Consistent with previous studies, ratios of interleukin-6 to interleukin-10 were significantly lower in individuals with greater levels of depressive symptoms (r=−0.239, P<0.05. Contrary to previous research, however, dehydroepiandrosterone sulfate did not correlate with pain intensity or psychological or biological variables. The results of the current study highlight the importance of psychological functioning and milestones of aging in the examination of inflammatory processes in fibromyalgia. Keywords: fibromyalgia, cytokines, psychological distress, inflammation

  15. Assessment of current undergraduate anesthesia course in a Saudi University

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    Tarek Shams

    2013-01-01

    Full Text Available Background: The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations (OSCEs, in conjunction with portfolio and multiple-choice questions (MCQ. The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5 th year medical students in our university, as well as study the influence of gender on student performance in anesthesia. Methods: We examined the performance of 154, 5 th year medical students through OSCE, portfolios, and MCQ. Results: The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one (P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam. In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark. Conclusions: This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel.

  16. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    International Nuclear Information System (INIS)

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing

  17. Beautiful small: Misleading large randomized controlled trials? The example of colloids for volume resuscitation

    Directory of Open Access Journals (Sweden)

    Christian J Wiedermann

    2015-01-01

    Full Text Available In anesthesia and intensive care, treatment benefits that were claimed on the basis of small or modest-sized trials have repeatedly failed to be confirmed in large randomized controlled trials. A well-designed small trial in a homogeneous patient population with high event rates could yield conclusive results; however, patient populations in anesthesia and intensive care are typically heterogeneous because of comorbidities. The size of the anticipated effects of therapeutic interventions is generally low in relation to relevant endpoints. For regulatory purposes, trials are required to demonstrate efficacy in clinically important endpoints, and therefore must be large because clinically important study endpoints such as death, sepsis, or pneumonia are dichotomous and infrequently occur. The rarer endpoint events occur in the study population; that is, the lower the signal-to-noise ratio, the larger the trials must be to prevent random events from being overemphasized. In addition to trial design, sample size determination on the basis of event rates, clinically meaningful risk ratio reductions and actual patient numbers studied are among the most important characteristics when interpreting study results. Trial size is a critical determinant of generalizability of study results to larger or general patient populations. Typical characteristics of small single-center studies responsible for their known fragility include low variability of outcome measures for surrogate parameters and selective publication and reporting. For anesthesiology and intensive care medicine, findings in volume resuscitation research on intravenous infusion of colloids exemplify this, since both the safety of albumin infusion and the adverse effects of the artificial colloid hydroxyethyl starch have been confirmed only in large-sized trials.

  18. Sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery

    Science.gov (United States)

    Ersoy, Ayşın; Kara, Deniz; Ervatan, Zekeriya; Çakırgöz, Mensure; Kıran, Özlem

    2015-01-01

    Objectives: To compare midazolam and propofol sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery with bispectral index monitoring. Methods: This prospective and randomized study was completed in the Department of Anesthesiology, Okmeydani Training and Research Hospital, Istanbul, Turkey between February 2013 and December 2014. Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun. In Group II, 1 mg/kg bolus propofol was given within 10 minutes, and then 1-3 mg/kg/hr infusion was begun. The systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, peripheral oxygen saturation values, respiratory rate, and Wilson’s 5-stage sedation score were recorded at 15-minute intervals. At the end of the operation, the recovery time and surgeon satisfaction were recorded. Results: The recovery times for patients in Group I were found to be longer than in Group II (p<0.05). The respiration rate in patients in Group I at the start of surgery, 15th minute of surgery, and after surgery were lower than in Group II (p<0.05). Conclusion: We conclude that propofol is more reliable in terms of hemodynamic stability than midazolam, as it causes less respiratory depression and faster recovery in the propofol group. PMID:26446330

  19. Paraplegia after intercostal neurolysis with phenol

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    Gollapalli L

    2014-11-01

    Full Text Available Lakshman Gollapalli, Rudramanaidu Muppuri Department of Anesthesiology and Pain Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA Abstract: In patients with advanced stages of cancer, severe pain is commonly encountered and is very difficult to treat. It affects the quality of life of the patient and the families involved. Pain can be managed using analgesics and adjuvant therapy. However, studies have shown that at least 10%–15% of patients fail to control pain adequately and will experience severe pain. We discuss the case of a 66-year-old female with metastatic adenoid cystic carcinoma of the left submandibular gland and developed paraplegia following intercostal neurolysis with phenol. After a successful diagnostic T6 to T12 intercostal nerve block, the patient was scheduled for an intercostal neurolytic block. We injected 2 mL of 10% aqueous phenol at each level on the left from the T6 to T12 ribs. One hour after the procedure, the patient developed bilateral lower extremity weakness with difficulty moving. A physical examination showed the absence of sensation to pinpricks and vibration from T10 to S5 and an absence of anal sphincter tone and sensation. Magnetic resonance images of the thoracic and lumbar spine showed leptomeningeal metastatic disease and myelitis. We postulate that the paraplegia could be from phenol diffusing along either the spinal nerves or the paravertebral venous plexus into the subarachnoid space. This case report points to the risks involved with phenol neurolysis close to the spine, and we propose alternative methods to minimize neurological complications. Keywords: intercostal neurolysis, pain, phenol, paraplegia 

  20. Use of dexmedetomidine in intratracheal intubation with fiberoptic bronchoscope in thyroid surgeries under general anesthesia%右旋美托咪定在纤维支气管镜引导气管插管全麻甲状腺手术的应用

    Institute of Scientific and Technical Information of China (English)

    查鹏; 冯鲲鹏; 马艳辉; 张瑛; 李艳英; 刘广宇; 薛纪秀; 王天龙

    2015-01-01

    目的:研究右旋美托咪定(dexmedetomidine,Dex)对全麻甲状腺手术患者接受纤维支气管镜(fiberoptic bronchoscope,FOB)引导经口气管插管的影响.方法:拟行经口气管插管全麻甲状腺手术患者80例,美国麻醉医师协会(American Society of Anesthesiology,ASA)Ⅰ~Ⅲ级,年龄29 ~ 71岁,随机分为两组(n=40):Dex组(D组)及安慰剂组(P组).诱导前两组患者分别以Dex(1μg· kg-1,4μg·mL-1)和等量生理盐水泵入15 min,随后常规麻醉诱导,以FOB行经口气管插管,记录入室后5 min(基础值)、麻醉诱导前、气管插管前、气管插管即刻及气管插管后1,2,3,5,10 min的血压、心率和脑电双频指数(bispectral idex,BIS).观察患者气管插管的血流动力学变化及相关并发症.结果:与P组患者相比,麻醉诱导和气管插管期间,D组患者血流动力学平稳(P<0.05),并发症发生率低(但P >0.05).结论:麻醉诱导前输注Dex,可以减轻FOB引导气管插管血液动力学反应并减少其相关并发症.

  1. Assessment of the resident’s promotion exam: One step to validity of competency measurement in Arak University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Z Anbari

    2013-03-01

    Full Text Available Introduction: Designing a tool for measuring of residents’competency with attention to their main role in education and practice of university. This study aims to assess the residents’ promotion tests of clinical departments at Arak University of Medicals Sciences. Methods: This cross- sectional study that was undertook in 2010 at Arak University of Medical Sciences. Seven hundred and fifty multiple choice questions related to resident promotion tests in surgery, internal medicine, pediatrics, gynecology and anesthesiology was compared. Questionnaire of each department contained 150 questions.   These questions were evaluated in the following domains: structure, Blum taxonomy, discrimination and difficulty index of questions and compliance to the core curriculums. Data gathering tool were: Millmen standard check list for evaluating questions’ structure and check list for evaluating Blum taxonomy and core curriculum and OMR system for evaluating discrimination and difficulty index. The validity and reliability of tools was confirmed and data were analyzed using by ANOVA and X2 tests. Results: Results showed gynecology department had structural problem (4.5±4.2 compared with other departments. Internal medicine department had the highest Blum domain (40% application and 47% comprehension, surgery department had the highest learning aims (90.7% and was assessed as the most suitable questions from difficulty index (67.3% and discrimination index (73.5%. There was significant difference between structural problem, core curriculum and rate of standard questions in various clinical departments (P=0.001. Conclusion: This study confirmed the necessity of test assessment in universities, to form effective educational workshops, control of questions before exams and incentives for clinical departments to design standard questions. Development of electronic question analysis system is recommended.

  2. Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments.

    Science.gov (United States)

    Alexandre, A; Corò, L; Paradiso, R; Dall'aglio, R; Alexandre, A M; Fraschini, F; Spaggiari, P G

    2011-01-01

    Research in spine surgery has proposed new soft and less invasive techniques. These are the results of our experience with oxygen-ozone therapy, which we could experiment within the Italian National Health System over 3 years. A total of 1,920 patients were admitted on the basis of unselected enrolment because of lumbosciatic pain. Patients were divided into three groups: (A) Patients with degenerative disc disease and arthropathy: 509 (26.5%), (B) Patients with failed back surgery syndrome (FBSS): 1,027 (53.489%), and (C) Patients with pure herniated lumbar disc: 384 (20%). The rationale of the treatment for all these different pathologies we have taken into consideration is the biochemical mechanism by which they can engender pain and dysfunction. Treatment for group A: paravertebral injection and phleboclysis (two cycles of 6 sessions, one each 3 days) +endoscopic neurolysis. Treatment for group B: paravertebral injection and phleboclysis (two cycles of 6 sessions, one each 3 days) + endoscopic neurolysis with intradiscal procedure (named percutaneous peridurodiscolysis). Treatment for group C: paravertebral injection (two cycles of 6 sessions, one each 3 days) + percutaneous discolysis.The perceived quality of result for this minimally invasive procedure makes oxygen-ozone therapy an interesting weapon in the hands of doctors. Furthermore, if the technique loses its clinical effectiveness, it can be repeated without harm for the patient, and costs for the health organization are notably very low, above all if compared to surgical procedures.We underline the need that this treatment should be performed in protected structures, in operative rooms, under anesthesiologic control, and in the hands of specialists. PMID:21107949

  3. Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country

    Science.gov (United States)

    Kakoma, Jean Baptiste

    2016-01-01

    The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that. PMID:27303587

  4. Clinical evaluation of sivelestat for acute lung injury/acute respiratory distress syndrome following surgery for abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Tsuboko Y

    2012-10-01

    Full Text Available Yoshiaki Tsuboko,1 Shinhiro Takeda,1,2 Seiji Mii,1 Keiko Nakazato,1 Keiji Tanaka,2 Eiji Uchida,3 Atsuhiro Sakamoto11Department of Anesthesiology, Nippon Medical School, 2Intensive Care Unit and Cardiac Care Unit, Nippon Medical School Hospital, 3Department of Surgery, Nippon Medical School, Tokyo, JapanBackground: The efficacy of sivelestat in the treatment of acute lung injury/acute respiratory distress syndrome (ALI/ARDS has not been established. In part, this is due to the wide variety of factors involved in the etiology of ALI/ARDS. In this study, we examined the efficacy of sivelestat in patients with ALI/ARDS associated with abdominal sepsis.Methods: The subjects were 49 patients with ALI/ARDS after surgery for abdominal sepsis. The efficacy of sivelestat was retrospectively assessed in two treatment groups, ie, a sivelestat group (n = 34 and a non-sivelestat group (n = 15.Results: The sivelestat group showed significant improvements in oxygenation, thrombocytopenia, and multiple organ dysfunction score. The number of ventilator days (6.6 ± 6.1 versus 11.1 ± 8.4 days; P = 0.034 and length of stay in the intensive care unit (8.5 ± 6.2 versus 13.3 ± 9.5 days; P = 0.036 were significantly lower in the sivelestat group. The hospital mortality rate decreased by half in the sivelestat group, but was not significantly different between the two groups.Conclusion: Administration of sivelestat to patients with ALI/ARDS following surgery for abdominal sepsis resulted in early improvements of oxygenation and multiple organ dysfunction score, early ventilator weaning, and early discharge from the intensive care unit.Keywords: sivelestat, acute lung injury, acute respiratory distress syndrome, abdominal sepsis

  5. PROspective Multicenter Imaging Study for Evaluation of Chest Pain: Rationale and Design of the PROMISE Trial

    Science.gov (United States)

    Douglas, Pamela S.; Hoffmann, Udo; Lee, Kerry L.; Mark, Daniel B.; Al-Khalidi, Hussein R.; Anstrom, Kevin; Dolor, Rowena J.; Kosinski, Andrzej; Krucoff, Mitchell W.; Mudrick, Daniel W.; Patel, Manesh R.; Picard, Michael H.; Udelson, James E.; Velazquez, Eric J.; Cooper, Lawton

    2014-01-01

    Background Suspected coronary artery disease (CAD) is one of the most common, potentially life threatening diagnostic problems clinicians encounter. However, no large outcome-based randomized trials have been performed to guide the selection of diagnostic strategies for these patients. Methods The PROMISE study is a prospective, randomized trial comparing the effectiveness of two initial diagnostic strategies in patients with symptoms suspicious for CAD. Patients are randomized to either: 1) functional testing (exercise electrocardiogram, stress nuclear imaging, or stress echocardiogram); or 2) anatomic testing with >=64 slice multidetector coronary computed tomographic angiography. Tests are interpreted locally in real time by subspecialty certified physicians and all subsequent care decisions are made by the clinical care team. Sites are provided results of central core lab quality and completeness assessment. All subjects are followed for ≥1 year. The primary end-point is the time to occurrence of the composite of death, myocardial infarction, major procedural complications (stroke, major bleeding, anaphylaxis and renal failure) or hospitalization for unstable angina. Results Over 10,000 symptomatic subjects were randomized in 3.2 years at 193 US and Canadian cardiology, radiology, primary care, urgent care and anesthesiology sites. Conclusion Multi-specialty community practice enrollment into a large pragmatic trial of diagnostic testing strategies is both feasible and efficient. PROMISE will compare the clinical effectiveness of an initial strategy of functional testing against an initial strategy of anatomic testing in symptomatic patients with suspected CAD. Quality of life, resource use, cost effectiveness and radiation exposure will be assessed. Clinical trials.gov identifier NCT01174550 PMID:24890527

  6. Beautiful small: Misleading large randomized controlled trials? The example of colloids for volume resuscitation.

    Science.gov (United States)

    Wiedermann, Christian J; Wiedermann, Wolfgang

    2015-01-01

    In anesthesia and intensive care, treatment benefits that were claimed on the basis of small or modest-sized trials have repeatedly failed to be confirmed in large randomized controlled trials. A well-designed small trial in a homogeneous patient population with high event rates could yield conclusive results; however, patient populations in anesthesia and intensive care are typically heterogeneous because of comorbidities. The size of the anticipated effects of therapeutic interventions is generally low in relation to relevant endpoints. For regulatory purposes, trials are required to demonstrate efficacy in clinically important endpoints, and therefore must be large because clinically important study endpoints such as death, sepsis, or pneumonia are dichotomous and infrequently occur. The rarer endpoint events occur in the study population; that is, the lower the signal-to-noise ratio, the larger the trials must be to prevent random events from being overemphasized. In addition to trial design, sample size determination on the basis of event rates, clinically meaningful risk ratio reductions and actual patient numbers studied are among the most important characteristics when interpreting study results. Trial size is a critical determinant of generalizability of study results to larger or general patient populations. Typical characteristics of small single-center studies responsible for their known fragility include low variability of outcome measures for surrogate parameters and selective publication and reporting. For anesthesiology and intensive care medicine, findings in volume resuscitation research on intravenous infusion of colloids exemplify this, since both the safety of albumin infusion and the adverse effects of the artificial colloid hydroxyethyl starch have been confirmed only in large-sized trials. PMID:26330723

  7. MO-F-16A-06: Implementation of a Radiation Exposure Monitoring System for Surveillance of Multi-Modality Radiation Dose Data

    International Nuclear Information System (INIS)

    Purpose: We have implemented a commercially available Radiation Exposure Monitoring System (REMS) to enhance the processes of radiation dose data collection, analysis and alerting developed over the past decade at our sites of practice. REMS allows for consolidation of multiple radiation dose information sources and quicker alerting than previously developed processes. Methods: Thirty-nine x-ray producing imaging modalities were interfaced with the REMS: thirteen computed tomography scanners, sixteen angiography/interventional systems, nine digital radiography systems and one mammography system. A number of methodologies were used to provide dose data to the REMS: Modality Performed Procedure Step (MPPS) messages, DICOM Radiation Dose Structured Reports (RDSR), and DICOM header information. Once interfaced, the dosimetry information from each device underwent validation (first 15–20 exams) before release for viewing by end-users: physicians, medical physicists, technologists and administrators. Results: Before REMS, our diagnostic physics group pulled dosimetry data from seven disparate databases throughout the radiology, radiation oncology, cardiology, electrophysiology, anesthesiology/pain management and vascular surgery departments at two major medical centers and four associated outpatient clinics. With the REMS implementation, we now have one authoritative source of dose information for alerting, longitudinal analysis, dashboard/graphics generation and benchmarking. REMS provides immediate automatic dose alerts utilizing thresholds calculated through daily statistical analysis. This has streamlined our Closing the Loop process for estimated skin exposures in excess of our institutional specific substantial radiation dose level which relied on technologist notification of the diagnostic physics group and daily report from the radiology information system (RIS). REMS also automatically calculates the CT size-specific dose estimate (SSDE) as well as provides

  8. The mesenterially perfused rat small intestine: A versatile approach for pharmacological testings.

    Science.gov (United States)

    Schreiber, Dominik; Klotz, Markus; Laures, Kerstin; Clasohm, Jasmin; Bischof, Michael; Schäfer, Karl-Herbert

    2014-05-01

    Pharmaceutical compounds enter the body via several major natural gateways; i.e. the lung, the skin and the gastrointestinal tract. Drug application during surgical operations can lead to severe impairment of gastrointestinal motility, which can contribute to a paralytic ileus. Here we investigated an ex vivo perfused small intestine model that allows us to ascertain the influence of pharmaceuticals upon the gut. Corresponding segments from the proximal jejunum of adult rats were used. Their mesenteric arteries and veins were cannulated and the jejunal segment excised. The individual segments were placed in a custom designed perfusion chamber and perfusion performed through the intestinal lumen as well as the mesenteric superior artery. Three test drugs, which are commonly used in anesthesiology; i.e. pentobarbital, propofol and ketamine were administered via the blood vessels. Their effects upon gastrointestinal motility patterns were evaluated by optical measurements. Longitudinal and pendular movements were distinguishable and separately analyzed. Pharmacological effects of the individual substances could be investigated. Propofol (50-200 μg/ml) was found to decrease intestinal motility, especially longitudinal movements in a dose dependent manner. Pentobarbital decreased intestinal motility only at high concentrations, above 2.5 mg/ml. A dose of 2.5 mg/ml lead to an increase in longitudinal- and pendular movements in comparison to control, while ketamine (2.5-10 mg/ml) did not alter intestinal motility at all. Histological examination of the perfused segments revealed only minor changes in tissue morphology after perfusion. The perfusion approach shown here allows for the identification of compounds which interfere with gut motility in a highly sophisticated way. It is suitable for characterization of drug and dose specific changes in motility patterns and can be used in drug development and preclinical studies.

  9. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

    Directory of Open Access Journals (Sweden)

    Mohanad Shukry

    2010-03-01

    Full Text Available Mohanad Shukry, Jeffrey A MillerUniversity of Oklahoma Health Sciences Center, Department of Anesthesiology, Children’s Hospital of Oklahoma, Oklahoma City, OK, USAAbstract: Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC, airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg-1, and infusion dose ranged from 0.2 to 10 μg kg-1 h-1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.Keywords: dexmedetomidine, sedation, nonintubated patients

  10. Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age

    Directory of Open Access Journals (Sweden)

    Töz E

    2015-06-01

    Full Text Available Emrah Töz, Aykut Özcan, Nesin Apaydin, İbrahim Uyar, Betül Kocakaya, Gülin Okay Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey Objectives: We performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older.Methods: We searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale–Pelvic Floor Disorders form, the Satisfaction Decision Scale–Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form.Results: Fifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8–44 months. There were four cases (7% of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication. Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T® polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse.Conclusion: Constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision

  11. Diversity of United States medical students by region compared to US census data

    Directory of Open Access Journals (Sweden)

    Smith MM

    2015-05-01

    Full Text Available Mark M Smith,1 Steven H Rose,1 Darrell R Schroeder,2 Timothy R Long1 1Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA; 2Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA Purpose: Increasing the diversity of the United States (US physician workforce to better represent the general population has received considerable attention. The purpose of this study was to compare medical student race data to that of the US general population. We hypothesized that race demographics of medical school matriculants would reflect that of the general population. Patients and methods: Published race data from the United States Census Bureau (USCB 2010 census and the 2011 Association of American Medical Colleges (AAMC allopathic medical school application and enrollment by race and ethnicity survey were analyzed and compared. Race data of enrolled medical students was compared to race data of the general population within geographic regions and subregions. Additionally, race data of medical school applicants and matriculants were compared to race data of the overall general population. Results: Race distribution within US medical schools was significantly different than race distribution for the overall, regional, and subregional populations of the US (P<0.001. Additionally, the overall race distribution of medical school applicants differed significantly to the race distribution of the general population (P<0.001. Conclusion: This study demonstrated that race demographics of US medical school applicants and matriculants are significantly different from that of the general population, and may be resultant of societal quandaries present early in formal education. Initiatives targeting underrepresented minorities at an early stage to enhance health care career interest and provide academic support and mentorship will be required to address the racial disparity that exists in US

  12. Evaluation of prostaglandin D2 as a CSF leak marker: implications in safe epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Kondabolu S

    2011-07-01

    Full Text Available Sirish Kondabolu, Rishimani Adsumelli, Joy Schabel, Peter Glass, Srinivas PentyalaDepartment of Anesthesiology, School of Medicine, Stony Brook Medical Center, Stony Brook, New York, USABackground: It is accepted that there is a severe risk of dural puncture in epidural anesthesia. Of major concern to anesthesiologists is unintentional spinal block. Reliable identification of cerebrospinal fluid (CSF from the aspirate is crucial for safe epidural anesthesia. The aim of this study was to determine whether prostaglandin D2 could be clinically used as a marker for the detection of CSF traces.Methods: After obtaining Institutional Review Board approval and patient consent, CSF was obtained from patients undergoing spinal anesthesia, and blood, urine, and saliva were obtained from normal subjects and analyzed for prostaglandin D2 (PGD. CSF (n=5 samples were diluted with local anesthetic (bupivacaine, normal saline and blood in the ratios of 1:5 and 1:10. PGD levels in the CSF samples were analyzed with a PGD-Methoxime (MOX EIA Kit (Cayman Chemicals, MI. This assay is based on the conversion of PGD to a stable derivative, which is analyzed with antiserum specific for PGD-MOX. Results: Different concentrations of pure PGD-MOX conjugate were analyzed by EIA and a standard curve was derived. PGD levels in CSF and CSF with diluents were determined and the values were extrapolated onto the standard curve. Our results show a well-defined correlation for the presence of PGD both in straight CSF samples and in diluted CSF (dilution factor of 1:5 and 1:10. Conclusion: Prostaglandin D2 was reliably identified in CSF by enzyme-linked immunosorbent assay when diluted with local anesthetic, saline, and serum, and can be used as a marker to identify the presence of CSF in epidural aspirates.Keywords: epidural, cerebrospinal fluid, leak, marker, prostaglandin D2

  13. Cardiopulmonary function and laparoscopic cholecystectomy.

    Science.gov (United States)

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  14. Up-regulation of brain-derived neurotrophic factor in the dorsal root ganglion of the rat bone cancer pain model

    Directory of Open Access Journals (Sweden)

    Tomotsuka N

    2014-07-01

    Full Text Available Naoto Tomotsuka,1 Ryuji Kaku,1 Norihiko Obata,1 Yoshikazu Matsuoka,1 Hirotaka Kanzaki,2 Arata Taniguchi,1 Noriko Muto,1 Hiroki Omiya,1 Yoshitaro Itano,1 Tadasu Sato,3 Hiroyuki Ichikawa,3 Satoshi Mizobuchi,1 Hiroshi Morimatsu1 1Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 2Department of Pharmacy, Okayama University Hospital, Okayama, Japan; 3Department of Oral and Craniofacial Anatomy, Tohoku University Graduate School of Dentistry, Sendai, Japan Abstract: Metastatic bone cancer causes severe pain, but current treatments often provide insufficient pain relief. One of the reasons is that mechanisms underlying bone cancer pain are not solved completely. Our previous studies have shown that brain-derived neurotrophic factor (BDNF, known as a member of the neurotrophic family, is an important molecule in the pathological pain state in some pain models. We hypothesized that expression changes of BDNF may be one of the factors related to bone cancer pain; in this study, we investigated changes of BDNF expression in dorsal root ganglia in a rat bone cancer pain model. As we expected, BDNF mRNA (messenger ribonucleic acid and protein were significantly increased in L3 dorsal root ganglia after intra-tibial inoculation of MRMT-1 rat breast cancer cells. Among the eleven splice-variants of BDNF mRNA, exon 1–9 variant increased predominantly. Interestingly, the up-regulation of BDNF is localized in small neurons (mostly nociceptive neurons but not in medium or large neurons (non-nociceptive neurons. Further, expression of nerve growth factor (NGF, which is known as a specific promoter of BDNF exon 1–9 variant, was significantly increased in tibial bone marrow. Our findings suggest that BDNF is a key molecule in bone cancer pain, and NGF-BDNF cascade possibly develops bone cancer pain. Keywords: BDNF, bone cancer pain, chronic pain, nerve growth

  15. Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety?

    Directory of Open Access Journals (Sweden)

    Kissin I

    2013-07-01

    Full Text Available Igor Kissin Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Background: For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1 there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2 the main problem associated with the safety of such treatment – assessment of the risk of addiction – has been neglected. Methods: Scientometric analysis of the articles representing clinical research in this area was performed to assess (1 the quality of presented evidence (type of study; and (2 the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1 editorials; (2 articles in the top specialty journals; and (3 articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles. Results: Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16 were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles. Conclusion: There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the

  16. Propofol-controlled infusion technique in assessing the safe dosage for sedation during epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    Yingmin Cai; Pengbin Liu; Jinxin Song; Rongliang Xue

    2006-01-01

    BACKGROUND:Epidural anesthesia requires a convenient and accurate method to determine the plasma concentration of the given subsidiary drug.The target-controlled infusion(TCI)technique,controlling infusion pump by computer,has been used.Intravenous jnjection of propofol was given for the purpose of measunng plasma concentrations and to observe the effects of different target concentrations on the memory,consciousness,hemodynamics and blood gases of patients,in order to find a safe dosage for sedation in epidural anesthesia.OBJECTIVE:To observe the influence of different target concentrations on the memory,consciousness,hemodynamics and blood gases of patients accepted epiduml anesthesia.DESIGN:A randomized and controlled study.SETTING:Department of Anesthesiology,the Second Affiliated Hospital,Medical College of Xi'an Jiao Tong University.PARTICIPANTS:The expenment was conducted in the Department of Anesthesiology,the Second Affiliated Hospital,Medical College of Xi'an Jiao Tong University from June 2005 to June 2006.Fifty patients underwent surgery for lower abdomen and lower limbs were selected,including 30 males and 20 females,30-60 years old with an average of(46±6)years,weighling(65.8±8.5)kg,and American Society of Anesthesiology(ASA)gradling of Ⅰ-Ⅱ.All the patients were informed and agreed with the items for detection.METHODS:All the patients were given diazepam(10 mg)and atropine(0.5 mg)intramusculady 30 minutes before surgery.They were placed supinely and given oxygen inhalation,their blood pressure,heart rate and blood oxygen saturation were determined,then an epidural puncture was made in the left lateral decubitus position with hands crossed over knees.The patients were in a horizontal position and a radial artery puncture was done,after the epidural cathetar was positioned into epidural space.Blood of radial artery was drawn to get a blood gas,a linked HP multi-functional monitor was used to monitor blood pressure(radial artery

  17. Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Nader Nouri-Majalan

    2009-05-01

    Full Text Available Nader Nouri-Majalan1, Ehsan Fotouhi Ardakani2, Khalil Forouzannia3, Hosein Moshtaghian41Department of Nephrology, 3Department of Cardiovascular Surgery, 4Department of Anesthesiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Ali bin Abu Taleb Medical College, Yazd Azad University, Yazd, IranBackground: Acute renal failure is a common complication of cardiac surgery, with oxidants found to play an important role in renal injury. We therefore assessed whether the supplemental antioxidant vitamin E and the inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction after coronary artery bypass graft (CABG surgery.Methods: Of 60 patients with glomerular filtration rate (GFR < 60 mL/min scheduled to undergo CABG surgery, 30 were randomized to treatment with vitamin E and allopurinol for 3–5 days before surgery and 30 to no treatment. Serum creatinine levels and potassium and creatinine clearances were measured preoperatively and daily until day 5 after surgery. Results: The patients consisted of 31 males and 29 females, with a mean age of 63 ± 9 years. After surgery, there were no significant differences in mean serum creatinine (1.2 ± 0.33 vs 1.2 ± 0.4 mg/dL; p = 0.43 concentrations, or creatinine clearance (52 ± 12.8 vs 52 ± 12.8 mL/min; p = 0.9. The frequency of acute renal failure did not differ in treatment group compared with control (16% vs 13%; p = 0.5. Length of stay in the intensive care unit (ICU was significantly longer in the control than in the treated group (3.9 ± 1.5 vs 2.6 ± 0.7 days; p < 0.001.Conclusion: Prophylactic treatment with vitamin E and allopurinol had no renoprotective effects in patients with pre-existing renal failure undergoing CABG surgery. Treatment with these agents, however, reduces the duration of ICU stay.Keywords: antioxidants, coronary artery bypass, prevention and control, renal function

  18. Factors that increase external pressure to the fibular head region, but not medial region, during use of a knee-crutch/leg-holder system in the lithotomy position

    Directory of Open Access Journals (Sweden)

    Mizuno J

    2015-02-01

    Full Text Available Ju Mizuno,1 Toru Takahashi2 1Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Faculty of Medicine, Juntendo University, Tokyo, Japan; 2Faculty of Health and Welfare Science, Okayama Prefectural University, Soja, Japan Background: Paralysis of the common peroneal nerve is one of the relatively common nerve injuries related to the lithotomy position with the use of a knee-crutch/leg-holder system. Several risk factors have been implicated in lithotomy position-related common peroneal nerve paralysis during operation.Materials and methods: In the present study, 21 young healthy volunteers participated in the investigation of the causes of the paralysis of the common peroneal nerve in the lithotomy position using a knee-crutch/leg-holder; Knee Crutch. We assessed the external pressure applied to the fibular head and medial regions using the Big-Mat pressure-distribution measurement system. Relationships between the peak contact pressure and physical characteristics, such as sex, height, weight, body mass index (BMI, and fibular head circumference, were analyzed.Results: The peak contact pressure to the fibular head region was greater for males than for females. For all subjects, significant positive correlations were observed between the peak contact pressure to the fibular head region and weight, BMI, or fibular head circumference. However, there was no significant difference between the peak contact pressure to the fibular head region and height for any subjects. Moreover, there was no sex-related difference in the peak contact pressure to the fibular medial region, and no significant differences between the peak contact pressure to the fibular medial region and height, weight, BMI, or fibular head circumference.Conclusion: External pressure to the fibular head region is greater for males than for females using a knee-crutch/leg-holder system in the lithotomy position. In addition, the external pressure

  19. History of anesthesia in Germany.

    Science.gov (United States)

    Wawersik, J

    1991-01-01

    1928. After the Second World War, the field of anesthesia in Germany rapidly regained international standards. The journal Der Anaesthesist was founded in 1952, and the German Society for Anesthesiology and Intensive Medicine was established in 1953. PMID:1878238

  20. MicroRNA-125a-5p modulates human cervical carcinoma proliferation and migration by targeting ABL2

    Directory of Open Access Journals (Sweden)

    Qin X

    2015-12-01

    Full Text Available Xian Qin,1 Yajun Wan,1 Saiying Wang,2 Min Xue1 1Department of Obstetrics and Gynecology, 2Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China Background: In this study, we intended to understand the regulatory mechanisms of microRNA-125a-5p (miR-125a-5p in human cervical carcinoma.Methods: The gene expressions of miR-125a-5p in seven cervical carcinoma cell lines and 12 human cervical carcinoma samples were evaluated by quantitative real-time reverse transcription polymerase chain reaction. Ca-Ski and HeLa cells were transduced with lentivirus carrying miR-125a-5p mimics, and the effects of lentivirus-induced miR-125a-5p upregulation on cervical carcinoma proliferation and migration were examined by 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide and transwell assays, respectively. In additional, HeLa cells were inoculated into null mice to evaluate the effect of miR-125a-5p upregulation on in vivo cervical carcinoma growth. The direct regulation of miR-125a-5p on its target gene, ABL proto-oncogene 2 (ABL2, in cervical carcinoma was evaluated by quantitative real-time reverse transcription polymerase chain reaction, Western blotting and luciferase reporter assays, respectively. ABL2 was then downregulated by small interfering RNA to examine its effect on cervical carcinoma proliferation and migration.Results: miR-125a-5p was downregulated in both cervical carcinoma cell lines and human cervical carcinomas. In Ca-Ski and HeLa cells, lentivirus-mediated miR-125a-5p upregulation inhibited cancer proliferation and migration in vitro and cervical carcinoma transplantation in vivo. ABL2 was shown to be directly targeted by miR-125a-5p. In cervical carcinoma, ABL2 gene and protein levels were both downregulated by miR-125a-5p. Small interfering RNA-mediated ABL2 downregulation also had tumor-suppressive effects on cervical carcinoma proliferation and migration