Human dissection for anesthesiology resident training augments anatomical knowledge and clinical skills.

Anatomy is an essential component of clinical anesthesiology. The use of simulated patients and alternative materials, including embalmed human bodies, have become increasingly common during resident physician training due to the deemphasis on anatomical education during undergraduate medical training. In this report, the need for a more extensive review of relevant anatomy for the practice of anesthesiology was addressed by the design, evaluation, and dissemination of a human dissection course for procedural training of anesthesiology residents.

Expert Consensus Statement on the Perioperative Management of Adult Patients Undergoing Head and Neck Surgery and Free Tissue Reconstruction From the Society for Head and Neck Anesthesia.

The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities.

A Tribute to Chad Epps: A Mentor, Educator, Leader, Collaborator, and Friend.

Dr Chad Epps' journey in healthcare simulation touched countless lives in his role as a mentor, educator, leader, collaborator, and friend. Here, we highlight Chad's lasting impact upon which we all stand today.

Reliability of simulation-based assessment for practicing physicians: performance is context-specific.

Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.

Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.

A Prospective Observational Study of Video Laryngoscopy Use in Difficult Airway Management.

Objectives/hypothesis: Video laryngoscopy has grown tremendously in popularity over the last decade for management of the anticipated difficult airway. The use of video laryngoscopy has not been adequately studied in the head and neck pathology patient population, including those with masses, previous head and neck surgery, or radiation.

Study Design: Prospective observational study.

Regional Anesthesia and Acute Pain Management.

Regional anesthesia and acute pain management in otolaryngology uses multimodal techniques for perioperative pain control. Multiple methods for regional anesthesia and acute pain management are discussed, including indications and techniques for decreasing perioperative opioid requirements and enhancing recovery.

Simulation-Based Education and Team Training.

Simulation-based education (SBE) has become pervasive in health care training and medical education, and is even more important in subspecialty training whereby providers such as otolaryngologists and anesthesiologists share overlapping patient concerns because of the proximity of the surgical airway. Both these subspecialties work in a fast-paced environment involving high-stakes situations and life-changing events that necessitate critical thinking and timely action, and have an exceedingly small bandwidth for error. Team training in the form of interprofessional education and learning involving surgeons, anesthesiologists, and nursing is critical for patient safety in the operating room in general, but more so in otolaryngology surgery.

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery.

Background: Functional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery.

Simulated death enhances learner attitudes regarding simulation.

Introduction: Despite the widespread use of simulated death in healthcare education, some view it as a controversial learning tool due to potential psychological harm. Others believe that allowing death during simulation enhances participant learning. Sparse data exist in the literature about learner attitudes towards simulated death.

Anesthetic Management of a Patient With Tracheal Dehiscence Post-Tracheal Resection Surgery.

We present a case of a patient with complete tracheal dehiscence and multiple false passages after recent tracheal resection and anastomosis. Loss of tracheal continuity after disruption of anastomosis with distal stump retraction presents a unique anesthetic challenge given lack of access to the trachea and the need for adequate anesthesia and analgesia for surgical neck dissection. Traditional airway management, including awake fiberoptic intubation, intubation via direct laryngoscopy, needle cricothyrotomy, and awake tracheostomy are not viable options.

Use of pharyngeal packs in functional endoscopic sinus surgery: A randomized controlled trial.

Objective: To determine if pharyngeal packs have an effect on postoperative pain and postoperative nausea and vomiting in functional endoscopic sinus surgery (FESS).

Study Design: Forty-six patients scheduled for routine endoscopic sinus surgery were recruited into this study. The patients were randomly allocated to have or to not have pharyngeal packing prior to surgery.

Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

Background: We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods.

Methods: A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios.

Simulated Mortality-We Can Do More.

High-fidelity simulation (HFS) is a relatively new teaching modality, which is gaining widespread acceptance in medical education. To date, dozens of studies have proven the usefulness of HFS in improving student, resident, and attending physician performance, with similar results in the allied health fields. Although many studies have analyzed the utility of simulation, few have investigated why it works.

A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation.

Background: Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure.

Comparison of expert and novice performance of a simulated transesophageal echocardiography examination.

Introduction: Training in transesophageal echocardiography (TEE) requires a significant commitment of time and resources on behalf of the trainees and the instructors. Training opportunities may be limited in the busy clinical environment. Medical simulation has emerged as a complementary means by which to develop clinical skills.

Simulation-based assessment and retraining for the anesthesiologist seeking reentry to clinical practice: a case series.

Background: Established models for assessment and maintenance of competency in anesthesiology may not be adequate for anesthesiologists wishing to reenter practice. The authors describe a program developed in their institution incorporating simulator-based education, to help determine competency in licensed and previously licensed anesthesiologists before return to practice.

Methods: The authors have used simulation for assessment and retraining at their institution since 2002.

The influence of simulation-based physiology labs taught by anesthesiologists on the attitudes of first-year medical students towards anesthesiology.

Background: The development of medical students' perceptions of different medical specialties is based on many factors and influences their career choices and appreciation of other practitioners' knowledge and skills. The goal of this study was to determine if participation in a series of anesthesiologist-run, simulation-based physiology labs changed first year medical students' perceptions of anesthesiologists.

Methods: One hundred first-year medical students were surveyed at random three months before completion of a simulation-based physiology lab run by anesthesiologists.

Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery.

Background: Endoscopic sinus surgery (ESS) is a common procedure preferably done with an anesthetic technique ensuring effective postoperative analgesia while speeding discharge home. Although anesthesia administered locally in conjunction with vasoconstricting agents is known to minimize intraoperative bleeding, its usefulness in providing postoperative analgesia has not been well characterized. The results supporting the use of regional anesthesia for sinus surgery have also been limited.