Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study.

Background: Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge.

Improving Tolerance to Snorkel Mask Use as Alternative Personal Protective Equipment.

Snorkel masks have become an option for personal protective equipment (PPE) due to the shortage of air filtration at least 95% of airborne particle (N95) masks as a result of the coronavirus disease 2019 (COVID-19) pandemic. We developed a 3D design of a triheaded adapter that connects a snorkel mask to 3 different National Institute for Occupational Safety and Health (NIOSH)-approved air filtration at least 99% of airborne particles (N99) filters with the aim of improving wearer comfort. We measured the resistance of the new triheaded adapter to be one-third the resistance of the single adapter.

Heart rate response to a caudal block in children anesthetized with sevoflurane after ultrasound confirmation of placement.

Introduction: Previous studies identified decreasing heart rate (HR) as a predictor of successful caudal placement in children using halothane and isoflurane. No changes were found in HR in the one study using sevoflurane. We documented HR changes in children following a caudal block during sevoflurane anesthesia utilizing ultrasound to confirm successful caudal placement.

Focused Transthoracic Cardiac Ultrasound: A Survey of Training Practices.

Objective: The role of focused assessment by transthoracic echocardiography or focused cardiac ultrasound (FoCUS) in the perioperative setting is uncertain and evolving. To the authors' knowledge, there are no studies that evaluate the current teaching practices regarding FoCUS in US anesthesiology residencies. The authors surveyed residents and residency program directors to examine the frequency, type, and variability of instruction regarding training of FoCUS.

Use of ultrasound-guided cryotherapy for the management of chronic pain states.

Study Objective: To report the use of ultrasound for cyroablation of purely sensory nerves for long-term relief of pain because the use of ultrasound enhances accuracy while minimizing injury to surrounding structures.

Design: Case series of three patients with positive long-term outcomes.

Setting: Outpatient Pain Management Clinic associated with a large, university affiliated, tertiary-care community hospital.

Technical communication: inhaled anesthetic agent-vaporizer mismatch: management in settings with limited resources: don't try this at home.

Agent-specific vaporizers minimize opportunities for error and evidence our specialty's commitment to patient safety as a general principle. End-tidal anesthetic gas concentration monitoring is a useful adjunct whenever inhaled anesthetics are used in operating rooms. Due to their expense and required maintenance, end-tidal anesthetic gas monitors are not commonly used in developing nations.

Unwarranted variability in antibiotic prophylaxis for cesarean section delivery: a national survey of anesthesiologists.

Background: Current guidelines from the American College of Obstetricians and Gynecologists recommend antibiotic prophylaxis for cesarean delivery immediately before incision. The purpose of this study was to measure and describe correlates of adherence to these guidelines in a sample of United States anesthesiologists.

Methods: We invited a random sample of the membership of the American Society of Anesthesiologists (n = 10,000) to complete an online survey.

Addition of epinephrine to epidural bupivacaine infusions following initiation of labor analgesia with epidural fentanyl.

Study Objective: To evaluate the analgesic effects of the addition of epinephrine to a bupivacaine epidural infusion in early labor after a fentanyl bolus, following a lidocaine-epinephrine test dose.

Design: Randomized, double-blinded study.

Setting: Labor suite of a tertiary care hospital.

ε-Aminocaproic acid and clinical value in cardiac anesthesia.

Objective: The primary aim was to compare the "clinical value" of tranexamic acid (TXA) with ε-aminocaproic acid (EACA) when used for blood conservation during high-risk cardiac surgery.

Design: Data previously reported by the Blood Conservation Using Antifibrinolytics in a Randomized Trial (BART) study investigators were reanalyzed independently after appropriate statistical adjustment. The authors compared TXA with EACA for important primary and secondary outcomes and applied the "clinical value" equation to this comparison.

Inhaled epoprostenol during one-lung ventilation.

We used inhaled epoprostenol (with intravenous phenylephrine) during one-lung ventilation to improve oxygenation in a patient with severe interstitial lung disease undergoing video-assisted thoracoscopic surgery. The pharmacologic manipulation of pulmonary blood flow remains an underused strategy for the management of hypoxemia during one-lung ventilation.

A surgical site infection cluster: the process and outcome of an investigation--the impact of an alcohol-based surgical antisepsis product and human behavior.

Background: The institution of a process used to successfully execute a perioperative antibiotic administration system is but 1 component of preventing postoperative infections. Continued surveillance of infections is an important part of the process of decreasing postoperative infections. We recently experienced an increase in the number of postoperative infections in our patients.

Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade.

Background And Objective: Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. However, it has not been evaluated when given in conjunction with bupivacaine and clonidine to provide blockade of the brachial plexus at the interscalene level. The purpose of this investigation was to determine whether the addition of dexamethasone to interscalene brachial plexus block would prolong the duration of sensory analgesia in a group of patients undergoing outpatient shoulder arthroscopy.

Determining the accuracy of caudal needle placement in children: a comparison of the swoosh test and ultrasonography.

Background: The aim of the present study was to compare two confirmatory tests - the 'swoosh' test (auscultation during caudal injection) and real time ultrasound imaging (both transverse 2D imaging and color flow Doppler imaging) in pediatric patients receiving a caudal epidural block.

Methods/materials: This was a retrospective observational study of caudal injections administered to 83 pediatric patients (0-11 years) presenting for elective surgery over a 4 month time period. While injecting small aliquots of local anesthetic, a standard stethoscope was placed over the lower lumbar spine to auscultate for the 'swoosh' test.

Hydrocortisone improves somnolence without hypotension in the postpartum period.

Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery.

Ultrasonography and pediatric caudals.

Ultrasound is an important tool for performing pediatric regional blocks, including caudal blocks. We present a case in which the availability of ultrasound allowed us to proceed with a successful caudal block which we otherwise might have abandoned in an infant with difficult anatomy.

Epidural clonidine added to a bupivacaine infusion increases analgesic duration in labor without adverse maternal or fetal effects.

Purpose: Many obstetric patients receiving epidural analgesia are encouraged to ambulate. This current study was designed to determine the potential for maximizing the time to first epidural supplement when adding clonidine to a 0.625 mg.