Sudden Severe Bradycardia Induced by Propofol-Succinylcholine in a Healthy Adult Patient: A Case Report.

This case report describes a 27-year-old healthy female patient undergoing bilateral salpingectomy for sterilization who experienced sudden bradycardia following induction with propofol (2, 6 diisopropylphenol) and succinylcholine. Despite lacking prior cardiac issues, the patient's heart rate dropped precipitously, necessitating intervention with glycopyrrolate. This case report highlights the importance of premedication with anticholinergics to prevent bradycardia in similar scenarios, underscoring the need for vigilance and preparedness to manage adverse cardiac events during anesthesia induction, even in patients without evident risk factors.

Comparison of two 3D scanning software to identify facial features: a prospective instrument to predict difficult airway.

Background: Clinical airway assessment has limited predictive ability to anticipate difficult airway. Three-dimensional (3D) technologies have emerged in medicine as valuable tools in different settings including innovation and surgical planning. Three-dimensional facial scanning could add value to clinical measurements and two-dimensional models to assess the airway.

Fetal heart rate changes and labor neuraxial analgesia: a machine learning approach.

Background: Neuraxial labor analgesia has been associated with fetal heart rate changes. Fetal bradycardia is multifactorial, and predicting it poses a significant challenge to clinicians. Machine learning algorithms may assist the clinician to predict fetal bradycardia and identify predictors associated with its presentation.

Effect of table inclination angle on videolaryngoscopy and direct laryngoscopy: Operator's muscle activation and laryngeal exposure analysis.

Background: Optimal vocal cord visualization depends on the patient's anatomical factors, characteristics of the laryngoscope, and the operator's muscle action. This study evaluated the effect of table inclination and three different laryngoscopic methods on procedural variables. The primary aim of this study is to compare differences in laryngoscopic view among clinicians based on the instrument used and table orientation.

Operating room relay strategy for turnover time improvement: a quality improvement project.

Introduction: Operating room (OR) management plays a pivotal role in the healthcare system due to the high cash flow it yields. Enhancing communication in the OR, which is the common root problem for delays, might improve OR efficiency and revenues for healthcare. This study aims to evaluate the impact of an OR relay strategy on turnover time (TOT).

Gender Gap: A Qualitative Study of Women and Leadership Acquisition in Anesthesiology.

Background: The representation of women among leaders in the field of anesthesia continues to trail that of their male counterparts. This qualitative study was conducted to understand the pathway of leadership acquisition among women in the field of anesthesiology.

Methods: Using constructivist grounded theory, we sought to determine whether there were specific internal or external factors that were common to women in leadership in the specialty field of anesthesiology, and specifically, how they obtained leadership positions.

Anxiety in anesthesia providers during coronavirus disease 19 pandemic: Insights into perception of harm a cross-sectional study.

Background: The influence of Coronavirus disease 2019 (COVID-19) pandemic on mental health has been widely studied; however, literature evaluating the mental health effects of the pandemic on small groups of people is scarce. We aim to evaluate the impact of the COVID-19 pandemic on anxiety levels of anesthesiology providers in an academic institution.

Materials And Methods: We conducted a cross-sectional study including one hundred and five participants (Faculty anesthesiologists, anesthesia residents, certified registered and student nurse anesthetists).

Understanding the cycles of COVID-19 incidence: Principal Component Analysis and interaction of biological and socio-economic factors.

The incidence curve of coronavirus disease 19 (COVID-19) shows cyclical patterns over time. We examine the cyclical properties of the incidence curves in various countries and use principal components analysis to shed light on the underlying dynamics that are common to all countries. We find that the cyclical series of 37 countries can be summarized in four principal components which explain over 90% of the variation.

Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report.

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease.

Limiting Outward Flow From the Patient's Airways to the Airway Operator: Head Chamber for Intubation of COVID-19 Patients.

We present the prototype of an adjunct to personal protective equipment (PPE) for intubation of patients with coronavirus disease 2019 (COVID-19). Acknowledging the risk of infection for the airway operator and personnel in the room when tracheal intubation is required for a COVID-19 patient, we designed a chamber that creates a microenvironment around the patient's head that limits the outward flow from a patient's airways to the airway operator with a filtered suction system in order to limit viral spread and lower contamination risk during intubation in non-negative-pressure rooms. The device was successfully tested in a simulation setting.

Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study.

Objective Post-dural puncture headache (PDPH) after an accidental dural puncture is a very common complication of epidural analgesia/anesthesia. We observed the ability of a triple prophylactic method (epidural saline, morphine, and intravenous (IV) cosyntropin) to prevent PDPH and the need for a blood patch.  Methods We retrospectively evaluated the effect of the combination of epidural saline, IV cosyntropin, and epidural morphine in parturients who had an accidental dural puncture with regard to the PDPH rate and the need for an epidural blood patch.

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients.

Objective: To evaluate color flow Doppler flow ultrasound compared to standard clinical techniques, to detect the intravascular position of peripheral intravenous catheters in adult surgical patients.

Methods: A prospective study was conducted in adult (>18 years old) patients scheduled to undergo elective surgery. Peripheral intravenous catheter position was evaluated with standard clinical techniques (free flow of fluid from a hanging bag, easy saline injection, and aspiration of blood), and with color flow Doppler ultrasound proximal to the insertion site to identify intravascular catheter position.

Adaptive optimal target controlled infusion algorithm to prevent hypotension associated with labor epidural: An adaptive dynamic programming approach.

Patients receiving labor epidurals commonly experience arterial hypotension as a complication of neuraxial block. The purpose of this study was to design an adaptive optimal controller for an infusion system to regulate mean arterial pressure. A state-space model relating mean arterial pressure to Norepinephrine (NE) infusion rate was derived for controller design.

Ultrasound your NPO: Effect of body mass index on gastric volume in term pregnant women - Retrospective case series.

Introduction: A common belief has been that obese patients are prone to develop aspiration of gastric contents when general anesthesia is administered. We aimed to determine the correlation between antral cross-sectional area as a surrogate of gastric volume measured by gastric ultrasound, and body mass index (BMI) in term pregnant women scheduled for elective cesarean section.

Methods: A cross-sectional observational study was conducted on forty-two term pregnant patients scheduled for cesarean section.

Intrapartum epidural catheter displacement: Comparison of three dressing methods (Migración de catéter epidural intraparto: Comparación de tres métodos de fijación).

Aim: To compare the effect on epidural catheter migration of three different types of dressing used in labor.

Introduction: Failure of labor epidural is due to multiple factors including catheter migration. Epidural catheter migration has been showed to be related to body mass index and patient position.

Are Anesthesiology Providers Good Guessers? Heart Rate and Oxygen Saturation Estimation in a Simulation Setting.

Background: Anesthesia providers may need to interpret the output of vital sign monitors based on auditory cues, in the context of multitasking in the operating room. This study aims to evaluate the ability of different anesthesia providers to estimate heart rate and oxygen saturation in a simulation setting.

Methods: Sixty anesthesia providers (residents, nurse anesthetics, and anesthesiologists) were studied.

Evaluation of Anesthesiology Residents' Supervision Skills: A Tool to Assess Transition Towards Independent Practice.

Problem Anesthesiologists are often expected to supervise residents, nurse anesthetists, and anesthesiologist assistants in their practice. Development of a supervisory skill set is important during anesthesiology training and has a potential impact on the quality of patient care. During anesthesiology residency training, residents develop different competencies through direct supervision by a staff anesthesiologist.

Association between Blood Viscosity and Cardiovascular Risk Factors in Patients with Arterial Hypertension in a High Altitude Setting.

Background  Blood viscosity is a determinant of vascular resistance, and it is expected to contribute to blood pressure. Arterial hypertension (HTN), in addition to other cardiovascular risk factors, contribute to cardiac morbidity. Our study aimed to establish the association between cardiovascular risk factors including HTN and whole blood viscosity in Ecuadorian patients.

Approach to learning and educational environment: time to rethink measurement tools in postgraduate medical training?

Objectives: To assess the correlation between perception of the learning environment and the approach to learning adopted by anesthesiology residents throughout training in an academic institution in the United States.

Methods: This is a cross-sectional study involving forty-one anesthesiology residents who completed electronic forms of the Revised Two-Factor Study Process Questionnaire to assess learning approaches, and the Dundee Ready Educational Environment Measure questionnaire to assess learning environment. Convenience sampling was used with the current anesthesiology residents.

Multifaceted remediation program: experience of a residency program to rescue residents who failed the American Board of Anesthesiology basic examination.

Problem: Passing the American Board of Anesthesiology (ABA) basic examination is required to progress through anesthesiology training in USA. Failing the test may be related to medical knowledge gaps, presence of negative psychosocial factors, and/or individual approaches to learning. This article describes the experience of development and implementation of a multifaceted remediation program (MRP) in residents who failed the ABA basic test.

Color your epidural: color flow Doppler to confirm labor epidural needle position.

Background: Labor epidural analgesia success depends on precise needle position placement within the epidural space, with reported failure rates to be as high as 32%. In this study, we describe a novel technique employing color Doppler to aid in the confirmation of the correct position of the epidural needle tip.

Methods: Retrospective evaluation of 35 patients who received labor combined spinal-epidural (CSE) with confirmation of epidural needle position with color flow Doppler (CFD) ultrasonography.

Anesthetic and obstetric outcomes in pregnant women undergoing cesarean delivery according to body mass index: Retrospective analysis of a single-center experience.

Aim: To evaluate maternal, neonatal and anesthetic outcomes according to BMI in women undergoing cesarean section.

Background: Increased incidence rates of obesity and morbid obesity have been reported in the United States. Pregnant obese patients are at increased risk of maternal and fetal complications, and obstetric and anesthetic management of these patients is especially challenging.

Water in the human body: An anesthesiologist's perspective on the connection between physicochemical properties of water and physiologic relevance.

The unique structure and multifaceted physicochemical properties of the water molecule, in addition to its universal presence in body compartments, make water a key player in multiple biological processes in human physiology. Since anesthesiologists deal with physiologic processes where water molecules are critical at different levels, and administer medications whose pharmacokinetics and pharmacodynamics depend on interaction with water molecules, we consider that exploration of basic science aspects related to water and its role in physiology and pharmacology is relevant to the practice of anesthesiology. The purpose of this paper is to delineate the physicochemical basis of water that are critical in enabling it to support various homeostatic processes.