Operating Room Fires.

Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.

Operating Room Management at the Edge of Order and Chaos.

The operating room (OR) management literature tends to view management problems as having finite solutions and assumes that equilibrium exists in the intricate encounters that occur every day. In this article, we review complexity theory and assess its applicability to the strategic, tactical, and operational issues facing OR managers. By building on complexity theory and its assumptions, we also show that as complex systems, ORs resemble high-reliability organizations more than they resemble ultra-safe organizations.

Observational study of Mallampati changes after prone spinal surgery.

Study Objective: To evaluate airway changes in patients undergoing surgery in the prone position.

Design: Single-arm observational study.

Patients: Patients between 18 to 65 years old, scheduled for prone spinal surgery; 74 patients were enrolled and 54 patients were analyzed.

Cognitive outcome after spinal anesthesia and surgery during infancy.

Background: Observational studies on pediatric anesthesia neurotoxicity have been unable to distinguish long-term effects of general anesthesia (GA) from factors associated with the need for surgery. A recent study on elementary school children who had received a single GA during the first year of life demonstrated an association in otherwise healthy children between the duration of anesthesia and diminished test scores and also revealed a subgroup of children with "very poor academic achievement" (VPAA), scoring below the fifth percentile on standardized testing. Analysis of postoperative cognitive function in a similar cohort of children anesthetized with an alternative to GA may help to begin to separate the effects of anesthesia from other confounders.

The relationship of intravenous midazolam and posttraumatic stress disorder development in burned soldiers.

Background: Midazolam, a short-acting benzodiazepine, is administered preoperatively and intraoperatively for amnesia and anxiolysis. Subsequently, patients often do not recall events which occurred while they were sedated. Recent studies have also reported retrograde facilitation after midazolam exposure.

Pain management in current combat operations.

Pain management in the U.S. Military, particularly in combat, shares many of the same principles found in civilian heath care organizations and institutions.

The effect of propranolol on posttraumatic stress disorder in burned service members.

Posttraumatic stress disorder (PTSD) is reported to affect almost one third of the civilian burn patient population. Predisposing factors for PTSD include experiencing a traumatic event. Of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) soldiers returning home after deployment without injury, 17% reported cognitive symptoms of PTSD.

Novel use of a portable ventilation device with low-flow tracheal insufflation of oxygen in a Swine model.

Introduction: Mechanical ventilation of intubated patients is standard to meet oxygenation and ventilation goals. This can require significant energy and oxygen resources. In military operations and mass casualty disasters, oxygen conserving strategies may be important.

The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism.

Background: The evolution of military medical care to manage polytrauma, critically ill-wounded warriors from the greater war on terrorism has been accompanied by significant changes in the diagnosis, management, and modulation of acute and chronic trauma-related pain. A paradigm shift in pain management includes early treatment of pain at the point of injury and throughout the continuum of care with a combination of standard and novel therapeutic interventions. These concepts are important for all critical care providers because they translate to most critically ill patients, including those resulting from natural disasters.

Total intravenous anesthesia including ketamine versus volatile gas anesthesia for combat-related operative traumatic brain injury.

Background: Traumatic brain injury is a leading cause of death and severe neurologic disability. The effect of anesthesia techniques on neurologic outcomes in traumatic brain injury and potential benefits of total intravenous anesthesia (TIVA) compared with volatile gas anesthesia (VGA), although proposed, has not been well evaluated. The purpose of this study was to compare TIVA versus VGA in patients with combat-related traumatic brain injury.

The correlation between ketamine and posttraumatic stress disorder in burned service members.

Background: Predisposing factors for posttraumatic stress disorder (PTSD) include experiencing a traumatic event, threat of injury or death, and untreated pain. Ketamine, an anesthetic, is used at low doses as part of a multimodal anesthetic regimen. However, since ketamine is associated with psychosomatic effects, there is a concern that ketamine may increase the risk of developing PTSD.

Low-flow transtracheal rescue insufflation of oxygen after profound desaturation.

Background: The objective of this study was to determine whether low-flow transtracheal insufflation of oxygen (TRIO) could rescue an animal from profound desaturation. This temporizing maneuver could be useful during cannot-intubate or -ventilate scenarios by resolving hypoxia without the morbidity associated with more invasive procedures.

Methods: Seven swine for a total of 12 runs were studied.

A comparison of target-controlled infusion versus volatile inhalant anesthesia for heart rate, respiratory rate, and recovery time in a rat model.

We conducted this study to determine whether heart rate, respiratory rate, and recovery time differed significantly between rats receiving target-controlled infusion (TCI) and those under volatile inhalant anesthesia. TCI rats received intravenous propofol at an average effect site concentration of 11.3 microg/ml or propofol plus ketamine (5 mg/ml of propofol) at an average effect site concentration of 8.