The Use of Standardized Patients to Evaluate Interpersonal and Communication Skills of Anesthesiology Residents: A Pilot Study.

Objective: The study was conducted to explore the feasibility and validity of using standardized patients (SPs) in assessing the interpersonal and communication skills (ICS) of anesthesiology residents.

Methods: A cross-sectional study was conducted to assess the ICS of anesthesiology residents using SPs. Each resident participated in two staged encounters and was graded by the SPs using a modified SEGUE framework.

Simulation of the reversal of neuromuscular block by sequestration of the free molecules of the muscle relaxant.

The study examined in simulations the interaction between a muscle relaxant and an antagonist that binds the free molecules of the relaxant, as experimentally demonstrated for rocuronium and sugammadex. The hypothetical muscle relaxant D and the hypothetical antagonist X were assigned pharmacokinetic properties to define the time course of their concentrations in plasma, and pharmacodynamic properties to define binding of D to either X or the receptors at the motor end plates. D, X, and their complex DX were postulated to diffuse between plasma and the effect compartment.

The relationship between twitch depression and twitch fade during neuromuscular block produced by vecuronium: correlation with the release of acetylcholine.

Background: Train-of-four stimulation pattern following the administration of non-depolarizing neuromuscular blocking drugs reveals fade on successive contractions. Fade is caused by the release of fewer acetylcholine molecules by the fourth (A4) than by the first stimulus (A1). The current study was conducted to define the relationship between the clinically observed fade and the simulated decline in acetylcholine release (A4/A1) that would be necessary to produce it.

Modeling of twitch fade based on slow interaction of nondepolarizing muscle relaxants with the presynaptic receptors.

Nondepolarizing muscle relaxants (MRs) diminish the indirectly evoked single twitch due to their binding to the postsynaptic receptors. Additionally, the MRs produce progressive diminution of successive twitches upon repetitive stimulation (fade). Our study addresses the generation of fade as observed under clinical situation.

Intraoperative identification of both a paradoxical embolism and its probable etiologic site.

We report a case of upper extremity arterial ischemia in a 41-year-old man. Intraoperative transesophageal echocardiography identified a paradoxical embolization that traversed a patent foramen ovale as the probable etiology. The diagnosis of paradoxical embolism with intraoperative identification of the etiologic site of the deep venous thrombosis is a rare event.

Volume of the effect compartment in simulations of neuromuscular block.

Background: The study examines the role of the volume of the effect compartment in simulations of neuromuscular block (NMB) produced by nondepolarizing muscle relaxants.

Methods: The molar amount of the postsynaptic receptors at the motor end plates in muscle was assumed constant; the apparent receptor concentration in the effect compartment is the ratio of this amount and the volume arbitrarily assigned to the effect compartment. The muscle relaxants were postulated to diffuse between the central and the effect compartment and to bind to the postsynaptic receptors.