Impact of Caffeine Ingestion on the Driving Performance of Anesthesiology Residents After 6 Consecutive Overnight Work Shifts.

Background: Residency training in anesthesiology involves care of hospitalized patients and necessitates overnight work, resulting in altered sleep patterns and sleep deprivation. Caffeine consumption is commonly used to improve alertness when fatigued after overnight work, in preparation for the commute home.

Methods: We studied the impact of drinking a caffeinated energy drink (160 mg of caffeine) on driving performance in a high-fidelity, virtual reality driving simulator (Virginia Driving Safety Laboratory using the Driver Guidance System) in anesthesiology resident physicians immediately after 6 consecutive night-float shifts.

Haptoglobin 2-2 Phenotype Is Associated With Increased Acute Kidney Injury After Elective Cardiac Surgery in Patients With Diabetes Mellitus.

Background: Recent studies reported an association between the 2-2 phenotype of haptoglobin (Hp 2-2) and increased cardiorenal morbidity in nonsurgical diabetic patients. Our goal was to determine whether the Hp 2-2 phenotype was associated with acute kidney injury (AKI) after elective cardiac surgery in patients with diabetes mellitus.

Methods And Results: We prospectively enrolled 99 diabetic patients requiring elective cardiac surgery with cardiopulmonary bypass.

Perioperative statin use is associated with decreased incidence of primary graft dysfunction after lung transplantation.

Background: Primary graft dysfunction (PGD) is a major cause of early morbidity and mortality after lung transplantation. Statins reduce the risk of chronic rejection after lung transplantation, but their effects on PGD are unknown. We hypothesized that perioperative statin therapy decreases the risk for PGD after lung transplantation.

Driving Performance of Residents after Six Consecutive Overnight Work Shifts.

Background: Residency training requires work in clinical settings for extended periods of time, resulting in altered sleep patterns, sleep deprivation, and potentially deleterious effects on safe performance of daily activities, including driving a motor vehicle.

Methods: Twenty-nine anesthesiology resident physicians in postgraduate year 2 to 4 drove for 55 min in the Virginia Driving Safety Laboratory using the Driver Guidance System (MBFARR, LLC, USA). Two driving simulator sessions were conducted, one experimental session immediately after the final shift of six consecutive night shifts and one control session at the beginning of a normal day shift (not after call).

Ventricular assist devices and increased blood product utilization for cardiac transplantation.

Background And Aim Of Study: The purpose of this study was to examine whether blood product utilization, one-year cell-mediated rejection rates, and mid-term survival significantly differ for ventricular assist device (VAD patients compared to non-VAD (NVAD) patients following cardiac transplantation.

Methods: From July 2004 to August 2011, 79 patients underwent cardiac transplantation at a single institution. Following exclusion of patients bridged to transplantation with VADs other than the HeartMate II® LVAD (n = 10), patients were stratified by VAD presence at transplantation: VAD patients (n = 35, age: 54.

Use of the intrathoracic pressure regulator to lower intracranial pressure in patients with altered intracranial elastance: a pilot study.

Object: The intrathoracic pressure regulator (ITPR) is a novel noninvasive device designed to increase circulation and blood pressure. By applying negative pressure during the expiratory phase of ventilation it decreases intrathoracic pressure and enhances venous return, which increases cardiac output. It is possible that the ITPR may both decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in brain-injured patients by decreasing cerebral venous blood volume and increasing cardiac output.

Ultrasound-guided common peroneal nerve block at the level of the fibular head.

A common peroneal nerve block at the fibular head is uncommon in clinical practice. The case of a 41 year old, morbidly obese woman requiring right total ankle replacement is presented. Ultrasound-guided common peroneal nerve block was performed at the fibular head after an unsuccessful popliteal approach.

Intraoperative factors and the risk of respiratory complications after pneumonectomy.

Background: The potential effect of intraoperative factors on respiratory complications after pneumonectomy is still unclear.

Methods: We conducted a retrospective cohort study; charts of 129 patients who underwent elective pneumonectomy at the University of Virginia were reviewed. Logistic regression was used to estimate the effect of anesthetic factors on the odds of at least one respiratory complication.

The effect of the intrathoracic pressure regulator on hemodynamics and cardiac output.

The intrathoracic pressure regulator (ITPR) (CirQLator; Advanced Circulatory Systems Inc, Roseville, Minn) is a novel, noninvasive device intended to increase cardiac output and blood pressure in hypovolemic or cardiogenic shock by generating a continuous low-level intrathoracic vacuum in between positive pressure ventilations. Although there are robust data supporting the benefit of the ITPR in multiple animal models of shock, the device has not been used in humans.The goals of this study were to evaluate both the safety and efficacy of the ITPR in humans.

Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial.

Background: The explosion of biomedical information has led to an 'information paradox'-the volume of biomedical information available has made it increasingly difficult to find relevant information when needed. It is thus increasingly critical for physicians to acquire a working knowledge of biomedical informatics.

Aim: To evaluate four search tools commonly used to answer clinical questions, in terms of accuracy, speed, and user confidence.

Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle.

Background: The deep peroneal nerve is 1 of 5 nerves anesthetized when performing an ankle block. Multiple techniques of blocking the deep peroneal nerve have been described, but little evidence exists to delineate the efficacy of any one technique. We hypothesized that ultrasound would increase both the success rate and the quality of a deep peroneal nerve block at the ankle.

Strict glucose control does not affect mortality after aneurysmal subarachnoid hemorrhage.

Background: The effects of both hyperglycemia and hypoglycemia are deleterious to patients with neurologic injury.

Methods: On January 1, 2002, the neurointensive care unit at the University of Virginia Health System initiated a strict glucose control protocol (goal glucose < 120 mg/dl). The authors conducted an impact study to determine the effects of this protocol on patients presenting with aneurysmal subarachnoid hemorrhage.