RESIDENT IMPLEMENTATION OF THE 2007 ACC/AHA GUIDELINES ON PREOPERATIVE CARDIAC EVALUATION IN NON-CARDIAC SURGERY PATIENTS: IS CLINICAL EXPERIENCE ENOUGH?

Background: Preoperative evaluation of surgical patients is important, as perioperative complications are associated with increased mortality. Specialties including anesthesiology, internal medicine, cardiology, and surgery are involved in the evaluation and management of these patients. This institutional study investigated the residents' knowledge of the 2007 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on perioperative evaluation of patients undergoing non-cardiac surgery.

The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function.

Study Objective: Outpatient continuous interscalene brachial plexus blocks containing bupivacaine or ropivacaine are commonly used to control pain after shoulder surgery. Interscalene blocks cause hemidiaphragmatic paresis. Because ropivacaine preferentially blocks sensory fibers, it may cause less blockade of the phrenic nerve.

Ambulatory continuous interscalene blocks for cancer pain.

Continuous peripheral nerve blocks are used in the management of pain following surgical procedures. They can also be used in patients with cancer-related pain, to improve sleep quality, reduce opioid requirements and their side effects. We describe two cancer patients in whom interscalene brachial plexus catheters were used on an outpatient basis, allowing them to travel, decrease their opioid use, and improve their ability to perform routine activities.

Effective low dosage of mepivacaine in ultrasound-guided axillary nerve block: a double-blinded, randomized clinical trial of efficacy in patients undergoing distal upper extremity surgery.

Study Objective: To evaluate two low-dose volumes (20 mL or 30 mL) of 1.5% mepivacaine solution used for ultrasound-guided axillary blockade for outpatients undergoing distal upper limb surgery.

Design: Prospective, double-blinded randomized study.

Unusual case of contralateral Horner's syndrome following stellate-ganglion block: a case report and review of the literature.

Stellate-ganglion block (SGB) is a commonly performed procedure for the treatment of numerous conditions, including upper-extremity complex regional pain syndromes and arterial insufficiency. The appropriate response to SGB includes ipsilateral Horner's syndrome and temperature elevation of affected extremity. Contralateral and bilateral Horner's syndrome following SGB are rarely seen, with only six prior cases reported.

Special article: mandragora: anesthetic of the ancients.

Initial attempts at surgical anesthesia began many centuries ago, with the plants of antiquity. The mandragora, or mandrake, was used as a sedative and to induce pain relief for surgical procedures. It has been depicted in tablets and friezes since the 16th century before the common era (BCE) and used for its sedative effects by Hannibal (second century BCE) against his enemies.

Gene therapy for chronic neuropathic pain: how does it work and where do we stand today?

Objectives: Chronic neuropathic pain has been an enigma to physicians and researchers for decades. A better understanding of its pathophysiology has given us more insight into its various mechanisms and possible treatment options. We now have an understanding of the role of various ionic channels, biologically active molecules involved in pain, and also the intricate pain pathways where possible interventions might lead to substantial pain relief.

The utility of pre-residency standardized tests for anesthesiology resident selection: the place of United States Medical Licensing Examination scores.

Background: The resident selection process could be improved if United States Medical Licensing Examination (USMLE) scores obtained during residency application were found to predict success on the American Board of Anesthesiology (ABA) written examination (part 1). In this study, we compared USMLE performance during medical school to anesthesiology residency standardized examination performance.

Methods: Sixty-nine anesthesiology residents' USMLE, ABA/American Society of Anesthesiologists (ASA) In-Training Examination, and ABA written board examination (part 1) scores were compared.

Patient survey of continuous interscalene analgesia at home after shoulder surgery.

Background: The use of continuous peripheral nerve blocks at home (CPNBH) has improved patients' perioperative experience. In 30 months, 348 patients were sent home with interscalene CPNBH.

Methods: With the Institutional Review Board (IRB) approval, all patients were surveyed for quality of analgesia and complications.

Anesthesia management of a Jehovah's Witness patient with pheochromocytoma undergoing off pump coronary artery bypass graft surgery--acase report.

Concomitant coronary artery disease (CAD) and pheochromocytoma are rare. Patients with advanced CAD requiring coronary artery bypass graft (CABG) surgery and clinically active pheochromocytoma present a challenge to anesthesiologists. The risk is much higher if the patient is an anemic Jehovah's Witness because these patients refuse to receive blood or blood products, even when faced with a life-threatening hemorrhage.

Succinylcholine and the open eye.

The use of succinylcholine in ocular trauma is controversial because it raises intraocular pressure. This article reviews the advantages and disadvantages of succinylcholine and its alternatives, including regional anesthesia for open globe injuries. Finally, an algorithm is proposed for airway management of patients with penetrating eye injuries, highlighting circumstances where succinylcholine may be the safest muscle relaxant.

Electrocautery-induced fire during adenotonsillectomy: report of two cases.

We describe two cases of flash fires in the oropharynx, secondary to electrocautery during adenotonsillectomies. We believe that in both cases, the leak around the uncuffed endotracheal tubes raised the oxygen concentration in the oropharynx. Cuffed endotracheal tubes provide many advantages, and their use should strongly be considered during adenotonsillectomy in children when electrocautery is to be used.

A Workshop in Physician-Patient Communication for Anesthesiology Trainees.

Background: Although abundant literature demonstrates the importance of effective physician-patient communication, most research and teaching models in this area are based on a primary care setting, and may not apply to procedural specialties. Some research demonstrates that patients perceive their surgeons' and anesthesiologists' communication skills to be less effective than those of primary care specialists. In order to improve the effectiveness of anesthesiology trainee communication skills and simultaneously address the new ACGME general competency requirements pertaining to such skills, faculty from the Departments of Anesthesiology and Internal Medicine collaborated in the development of a workshop tailored to the needs of this group.