A mobile application to facilitate implementation of programmatic assessment in anaesthesia training.

Background: Programmatic assessment is a concept to support learning through continuously providing information about learner progress to trainees and supervisors. Central to the concept are multiple low-stakes workplace-based assessments and meaningful feedback opportunities. Mobile technology may facilitate frequent and concise workplace-based assessments and trigger meaningful feedback.

Bottom-up feedback to improve clinical teaching: validation of the Swiss System for Evaluation of Teaching Qualities (SwissSETQ).

Aims Of The Study: Clinical teaching is essential in preparing trainees for independent practice. To improve teaching quality, clinical teachers should be provided with meaningful and reliable feedback from trainees (bottom-up feedback) based on up-to-date educational concepts. For this purpose, we designed a web-based instrument, "Swiss System for Evaluation of Teaching Qualities" (SwissSETQ), building on a well-established tool (SETQsmart) and expanding it with current graduate medical education concepts.

How to train thoracic anesthesia for residents and consultants?

Purpose Of Review: The training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied.

Agreement between trainees and supervisors on first-year entrustable professional activities for anaesthesia training.

Background: Entrustable professional activities (EPAs) are commonly developed by senior clinicians and education experts. However, if postgraduate training is conceptualised as an educational alliance, the perspective of trainees should be included. This raises the question as to whether the views of trainees and supervisors on entrustability of specific EPAs differ, which we aimed to explore.

Predictors of blood loss in lung transplant surgery-a single center retrospective cohort analysis.

Background: This retrospective study aims to identify clinical predictors of intraoperative blood loss during lung transplantation. While for other surgical specialties predictors of blood loss have been identified such as previous likewise located surgery, poor preoperative health status of patients, blood coagulation status, and use of extra corporeal circulation, predictors of blood loss during lung transplantation are not yet established.

Methods: A total of 326 lung transplants were performed between January 2000 and February 2014 at a tertiary hospital.

Establishing a non-intubated thoracoscopic surgery programme for bilateral uniportal sympathectomy.

Aim Of The Study: Non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully developed in several centres worldwide. Local anaesthesia techniques and techniques to perform thoracoscopic surgery on a spontaneously breathing lung are the two key elements which must be adopted to establish a NiVATS programme. We established NiVATS by performing bilateral, uniportal sympathectomies, and compared it to classical video-assisted thoracoscopic surgery (VATS) under general anaesthesia with double-lumen intubation.

Established and potential predictors of blood loss during lung transplant surgery.

Lung transplantation is an established therapeutic procedure for end stage lung diseases. Its success may be impaired by perioperative complications. Intraoperative blood loss and the resulting blood transfusion are among the most common complications.

Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey.

Background: There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB.

Methods: An anonymous questionnaire was sent to 299 pulmonologists.

Impact of cytokine release on ventricular function after hepatic reperfusion: a prospective observational echocardiographic study with tissue Doppler imaging.

Background: Postreperfusion syndrome and haemodynamic instability are predictors for poor outcome after liver transplantation. Cytokine release has been claimed to be responsible for postreperfusion syndrome. However, the underlying pathophysiologic mechanism is not clarified.

Continuous elastomeric pump-based ropivacaine wound instillation after open abdominal aortic surgery: how reliable is the technique?

Introduction: We aimed at quantifying the impact of continuous wound infusion with ropivacaine 0.33% on morphine administration and subjective pain relief in patients after open abdominal aortic repair in a double-blind, placebo-controlled study.

Methods: Before closing the abdominal wound, 2 multihole ON-Q® Soaker Catheters™ (I-Flow Corporation, Lake Forest, California, USA) were placed pre-peritoneally in opposite directions.

Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation.

Objective: Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery.

Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program.

Background And Objective: Key factors of Fast Track (FT) programs are fluid restriction and epidural analgesia (EDA). We aimed to challenge the preconception that the combination of fluid restriction and EDA might induce hypotension and renal dysfunction.

Methods: A recent randomized trial (NCT00556790) showed reduced complications after colectomy in FT patients compared with standard care (SC).

A fast-track program reduces complications and length of hospital stay after open colonic surgery.

Background & Aims: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery.

Methods: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care.

The effect of clonidine on perioperative blood coagulation.

Study Objective: To evaluate the influence of perioperative stress protection by clonidine on blood coagulation.

Design: Prospective, randomized, double-blinded, placebo-controlled clinical trial.

Setting: University hospital.

Patterns of changes in arterial PO2 during one-lung ventilation: a comparison between patients with severe pulmonary emphysema and patients with preserved lung function.

Objectives: One-lung ventilation (OLV) during thoracoscopic surgery is associated with a significant decline in arterial PO(2) in patients with severe pulmonary emphysema and patients with preserved lung function. The authors hypothesized that patterns of arterial PO(2) changes are different in these 2 patient groups.

Design: Prospective nonrandomized study.

Accuracy and performance of a modified continuous intravascular blood gas monitoring device during thoracoscopic surgery.

Objective: The only commercially available continuous intravascular blood gas monitoring system for adults, the Paratrend (Diametrics Medical Inc, High Wycombe, UK), was modified by the manufacturer to the Paratrend 7+ (PT7+) in 1999. The aim of this study was to evaluate the modified probe over a wide range of blood gas and pH values during thoracoscopic surgery in a similar setup as done with the previous model.

Design: Prospective methods comparison study.

Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry.

Objective: Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Switzerland, the first lung transplant was performed in November 1992, more than ten years after the first successful procedure world-wide. Thenceforward, a prospective national lung transplant registry was established, principally to enable quality control.

Successful lung volume reduction surgery in a child with severe airflow obstruction and hyperinflation due to constrictive bronchiolitis.

Lung volume reduction surgery (LVRS) may improve pulmonary function in patients with severe emphysema. However, its effects in other types of obstructive lung disease are unknown. To delay the need for lung transplantation, we performed LVRS in a 14-year-old boy with disabling airflow obstruction/hyperinflation secondary to postinfectious bronchiolitis nonresponsive to medical therapy.

Preoperative clonidine blunts hyperadrenergic and hyperdynamic responses to prolonged tourniquet pressure during general anesthesia.

Unlabelled: Although the mechanism of tourniquet-induced hypertension is still unclear, plasma norepinephrine concentrations continuously increase in parallel to arterial blood pressure during tourniquet inflation. Clonidine attenuates hyperadrenergic and hyperdynamic responses. We investigated the effects of clonidine on prolonged tourniquet inflation.