Training anesthesiologists in out-of-operating room anesthesia.

Purpose Of Review: The purpose of this review is to describe recent developments and current trends in training anesthesiologists in out-of-operating room anesthesia (OORA).

Recent Findings: In the United States, the Accreditation Council for Graduate Medical Education recently updated its training requirements to include a mandatory 2-week rotation in OORA for anesthesiology residents. This likely reflects the continuing expansion of anesthesia services in the out-of-operating room (OOR) environment as well as the increasing complexity of OOR procedures and medical acuity of patients in these settings.

Systematic Postoperative Nausea Prophylaxis Feedback Improves Clinical Performance in Anesthesiology Residents.

Background: Electronic medical records can generate a wealth of information regarding compliance with perioperative clinical guidelines as well as patient outcomes. Utilizing this information to provide resident physicians with measures of their own clinical performance may positively impact residents' clinical performance. We hypothesize that providing residents with objective measures of their individual adherence to evidence based postoperative nausea and vomiting (PONV) management protocols will improve their compliance with standardized treatment methods.

Resident Perceptions and Cost Analysis of a Virtual Patient Application for Anesthesia-Related Critical Incidents.

Background: Since there are limitations on the amount of time residents can spend in full-scale simulation sessions, we introduced a virtual patient application into our anesthesiology program to su pplement mannequin-based simulation sessions. Previous investigations have demonstrated a positive educational effect for virtual patients, but suggest that further research is needed to clarify how to effectively implement virtual patients in medical education. We present a description of the implementation of a virtual patient application in our residency training program, the residents' evaluation of their experience with the application, and a cost analysis of incorporation of the application into the residency program, in order to determine the residents' perceptions of the value and estimate the cost of using virtual patients in anesthesia residency training.

The disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists?

The disclosure of unanticipated outcomes to patients, including medical errors, has received considerable attention of late. The discipline of anesthesiology is a leader in patient safety, and as the doctrine of full disclosure gains momentum, anesthesiologists must become acquainted with these philosophies and practices. Effective disclosure can improve doctor-patient relations, facilitate better understanding of systems, and potentially decrease medical malpractice costs.

Hemodynamic changes in visceral organs following closed head trauma in rats.

Background: Gastrointestinal (GI) tract dysfunction is well documented following head injury. Our study sought to determine whether head injury causes an immediate impairment of the splanchnic circulation which may contribute to later GI sequelae.

Methods: Three groups of eight rats each received either no closed head trauma (CHT) (group 1) or CHT (groups 2 and 3) immediately following baseline measurements at time 0.

Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography.

Patients with refractory seizures may undergo awake craniotomy and cortical resection of the seizure area, using intraoperative functional mapping and electrocorticography (ECoG). We used dexmedetomidine in 6 patients, transitioning successively from the asleep-awake-asleep method, through a combined propofol/dexmedetomidine sedative infusion, to dexmedetomidine as the only sedation. Initial experience with the asleep-awake-asleep method in 2 patients was successful with the replacement of propofol/laryngeal mask anesthesia, 20 to 30 minutes before ECoG testing, by dexmedetomidine infusion, maintained at 0.

Effects of bispectral index monitoring on recovery from surgical anesthesia in 1,580 inpatients from an academic medical center.

Background: The purpose of this study was to determine whether monitoring Bispectral Index (BIS) would affect recovery parameters in patients undergoing inpatient surgery.

Methods: Anesthesia providers (n = 69) were randomly assigned to one of two groups, a BIS or non-BIS control group. A randomized crossover design was used, with reassignment at monthly intervals for 7 months.

Continuous intrathecal meperidine for severe refractory cancer pain: a case report.

The control of severe cancer pain may be problematic despite advances in pain management. Patients with severe intractable pain and/or intractable side effects may require aggressive interventional pain management strategies including the administration of medications by the continuous intrathecal route and/or neurosurgical procedures. Various medications, including opioids, local anesthetics, and alpha-2 agonists may be used intrathecally for the control of cancer pain.