The In Vivo Skills Laboratory in Anesthesiology Residency Training.

Background: Anesthesiologists routinely perform high-risk procedures that are associated with permanent disability or death. Critical perioperative events require that the anesthesiologist perform procedures that are only used intermittently. Teaching these procedures is complicated by their infrequency and pressure to maximize operating room efficiency; therefore we created an annual 1-day anesthesiology skills lab as an innovative method of residency education.

Right ventricular remodeling in restrictive ventricular septal defect.

Restrictive ventricular septal defect (rVSD) presents with little/no hemodynamic aberrations despite a patent septal defect. Clinically, these patients are observed with the hope that the defect will functionally close over time without the need for surgical repair and development of heart failure. Without evidence supporting a definitive therapeutic strategy, rVSD patients may have increased risk of a poor outcome.

Cytoskeletal remodeling of desmin is a more accurate measure of cardiac dysfunction than fibrosis or myocyte hypertrophy.

Aims: Fibrosis and myocyte hypertrophy are classical remodeling parameters in heart failure (HF); however, an intriguing possibility is that myocytes undergo intracellular remodeling which decrease compliance, contributing to diastolic dysfunction. The most obvious candidates are cytoskeletal proteins. The cytoskeletal protein desmin reinforces the sarcomeres, enabling force generation.

Left ventricular assist device support induces acute changes in myocardial electrolytes in heart failure.

The regulation of myocardial electrolyte concentrations is critical to proper cardiac function. Myocardial ischemia is associated with deranged ion transport. Left ventricular assist device (LVAD) therapy improves myocyte bioenergetics in chronic heart failure (CHF), which may manifest as electrolyte alterations; however, rapid electrolyte shifts may place critically ill patients at risk for arrhythmias upon initiation of LVAD support.

Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases.

Currently used methods of sedation for fiberoptic intubation such as benzodiazepines, propofol, or opioids have their limitations. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist that has been used clinically for its sympatholytic, analgesic, and sedative properties. We report on 4 patients with particularly difficult airways who underwent successful awake fiberoptic intubation with DEX.

Hemodynamic stability during labor and delivery with continuous epidural infusion.

Context: Epidural anesthesia for labor pain is frequently complicated by maternal hypotension.

Objective: To test whether continuous epidural infusion (CEI) of local anesthetic, without bolus administration, lowers the incidence of hypotension in parturient patients.

Methods: In a single-blind clinical study, subjects were randomly assigned to CEI-only (10 mL/h of 0.

Uvular edema secondary to snoring under deep sedation.

A 57-year-old male with a documented history of obstructive sleep apnea with loud snoring received deep intravenous sedation with midazolam, fentanyl, ketamine, and propofol infusion and a left interscalene brachial plexus nerve block for a left biceps tendon repair. Loud snoring during the case was noted. On the second postoperative day, he was observed to have significant uvular edema.

Partial support with a centrifugal left ventricular assist device reduces myocardial oxygen consumption in chronic, ischemic heart failure.

Background: Left ventricular assist devices (LVAD) are increasingly used for heart failure (CHF); however, the level of optimal support has not been elucidated. We hypothesize that partial LVAD support in an ovine model of microinfarction-induced CHF significantly reduces left ventricular myocardial oxygen consumption (LVVO2).

Methods And Results: Microembolization of the circumflex coronary artery was used to induce CHF in 5 sheep (ejection fraction 28 +/- 2%).

Regional anesthesia techniques for the lower extremity.

This article focuses on regional anesthesia for orthopedic procedures of the lower extremity.

Selective microembolization of the circumflex coronary artery in an ovine model: Dilated, ischemic cardiomyopathy and left ventricular dysfunction.

Background: Ventricular remodeling often occurs after myocardial infarction, yet the natural history remains unpredictable because of the chronicity of the process and therapeutic interventions involved. We induced cardiac dysfunction in an ovine model via selective microembolization of the circumflex coronary artery (LCx) to test the hypothesis that ventricular remodeling progresses following coronary microembolization for up to 24 months. Methods and results Sheep underwent weekly selective microembolization of the LCx until left ventricular ejection fraction stabilized <35% for 2 consecutive weeks.

Neuroprotection is associated with beta-adrenergic receptor antagonists during cardiac surgery: evidence from 2,575 patients.

Objective: To determine the impact of perioperative beta-adrenergic receptor (betaAR) antagonist administration on neurologic complications.

Design: Observational database analysis.

Setting: A clinical investigation at a single tertiary academic medical center.

Anesthesia for foot and ankle surgery.

Regional anesthesia (RA) is the anesthetic of choice for all foot and ankle surgery. Advances in anesthetic equipment and techniques have made peripheral nerve blocks the perfect anesthetic technique for these patients, who should be educated about them in their surgeon's office. The anesthetic alternative of choice is, in the authors' opinion, a neuraxial (i.