Hasil untuk "Anesthesiology"

Sandeep Dey, Megha Tyagi, Amit Goyal et al.

Conventional electroencephalogram (EEG) has been the most common method to detect and manage seizure episodes. Limitations to its use in the intraoperative period during neurosurgical cases have made detecting intraoperative seizure almost impractical, especially in the presence of a neuromuscular blocking agent. Using an EEG-based monitor like bispectral index (BIS) can add a new dimension to intraoperative neuromonitoring in patients at risk of seizure. Apart from other indices, it also displays the real-time raw EEG waveform, which can be valuable in diagnosing an intraoperative seizure and guide the therapeutic achievement of burst suppression. An increase in the BIS value has also been reported during intraoperative seizures. Here, we present the cases of three patients posted for excision of intracranial space-occupying lesions who developed intraoperative seizures, which were diagnosed and managed with the aid of a BIS monitor. This case series highlights the utility of BIS in detecting and managing intraoperative seizures, apart from its role in depth of anesthesia monitoring.

Yixing Lu, Siyan Liu, Shunzhong Jing et al.

Abstract Perineal incision resulting in post-partum pain and impact on puerperal life was the focus of our study. We recruited postpartum mothers who had undergone vaginal delivery to receive labor analgesia and episiotomy with an epidural injection of 0.5 mg hydromorphone to assess the therapeutic effects of postpartum analgesia. The participants were randomly allocated into two groups: the control group (Group NS) received an epidural injection of an equal amount of saline, while the study group (Group HY) received an epidural injection of 0.5 mg hydromorphone. We collected relevant data from electronic medical records to compare the differences between the two groups. The intervention group demonstrated lower pain scores at 4, 8, 12, 16, and 24 h compared to the control group (p < 0.001). Additionally, a higher number of patients in the control group required pain medication (7 (15.9%) compared to 2 (4.7%)). The time to first analgesia request in group NS was earlier than that in group HY (8.94 ± 1.27 h compared to 16.96 ± 3.38 h). The study group experienced higher rates of vomiting (P = 0.002) and itching (P < 0.001). However, there were no differences between the two groups in terms of urinary retention, dyskinesia, respiratory depression, dizziness, or neonatal feeding. The epidural injection of 0.5 mg hydromorphone proved to be effective in alleviating pain caused by maternal episiotomy and did not negatively affect neonatal feeding. Clinical trial registration: http://www.chictr.org.cn/usercenter.aspx identifier: ChiCTR2200064687.

Hong‐Bin Lin, Pu Hong, Meng‐Yu Yin et al.

Background Cardiac damage induced by ischemic stroke, such as arrhythmia, cardiac dysfunction, and even cardiac arrest, is referred to as cerebral‐cardiac syndrome (CCS). Cardiac macrophages are reported to be closely associated with stroke‐induced cardiac damage. However, the role of macrophage subsets in CCS is still unclear due to their heterogeneity. Sympathetic nerves play a significant role in regulating macrophages in cardiovascular disease. However, the role of macrophage subsets and sympathetic nerves in CCS is still unclear. Methods and Results In this study, a middle cerebral artery occlusion mouse model was used to simulate ischemic stroke. ECG and echocardiography were used to assess cardiac function. We used Cx3cr1GFPCcr2RFP mice and NLRP3‐deficient mice in combination with Smart‐seq2 RNA sequencing to confirm the role of macrophage subsets in CCS. We demonstrated that ischemic stroke‐induced cardiac damage is characterized by severe cardiac dysfunction and robust infiltration of monocyte‐derived macrophages into the heart. Subsequently, we identified that cardiac monocyte‐derived macrophages displayed a proinflammatory profile. We also observed that cardiac dysfunction was rescued in ischemic stroke mice by blocking macrophage infiltration using a CCR2 antagonist and NLRP3‐deficient mice. In addition, a cardiac sympathetic nerve retrograde tracer and a sympathectomy method were used to explore the relationship between sympathetic nerves and cardiac macrophages. We found that cardiac sympathetic nerves are significantly activated after ischemic stroke, which contributes to the infiltration of monocyte‐derived macrophages and subsequent cardiac dysfunction. Conclusions Our findings suggest a potential pathogenesis of CCS involving the cardiac sympathetic nerve–monocyte‐derived macrophage axis.

Yang YF, Liu LL, Huang MJ et al.

Yu-fan Yang,1,2,&ast; Lin-Lin Liu,1,2,&ast; Ming-jie Huang,1,2,&ast; Zheng-min Ma,1,2 Wen-wen Huo,1,2 Ya-juan Zhu,1,2 Hong Liu,3 Ke Peng,1,2 Fu-Hai Ji1,2 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA&ast;These authors contributed equally to this workCorrespondence: Ke Peng; Fu-Hai Ji, Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of China, Email pengke0422@163.com; jifuhaisuda@163.comBackground: Postoperative complications are common after major surgical procedures, leading to increased morbidity and mortality. Regional cerebral oxygen saturation (rScO2) reflects cerebral and global perfusion, and thus it can be used to guide hemodynamic management. We aim to explore the effect of rScO2-guided blood pressure management strategy on postoperative major complications in older adults who undergo major noncardiac surgery.Methods: This randomized controlled clinical trial includes a total of 400 elderly patients receiving major noncardiac surgery and general anesthesia. Patients will be randomized (1:1) to one of two blood pressure management groups: a standard care group (targeting mean arterial pressure > 65 mmHg or within 20% of baseline value), and a rScO2-guided group (absolute value of rScO2 > 60% or decrease in rScO2 < 10% of baseline). The primary outcome is the composite outcome of major complications (including infectious, respiratory, neurologic, cardiovascular, renal, thromboembolic gastrointestinal, and surgical complications) and deaths within the first 7 days after surgery. Secondary outcomes include the individual components of the primary outcome by day 7 after surgery and 30-day mortality. Data will be analyzed in the modified intention-to-treat population.Discussion: This study will provide evidence for improving postoperative outcomes using the rScO2-guided blood pressure management among older adults who undergo major noncardiac surgery.Trial Registration: Chinese Clinical Trial Registry (Identifier: ChiCTR2200060816).Plain Language Summary: This is a protocol for a prospective, randomized, controlled clinical trial to evaluate the use of intraoperative individualized regional cerebral oxygen saturation (rScO2) optimization for blood pressure management in older adults undergoing major noncardiac surgery.The primary focus of this trial is the composite outcome of major complications (including infectious, respiratory, neurologic, cardiovascular, renal, thromboembolic gastrointestinal, and surgical complications) and deaths within the first 7 days after surgery. The secondary outcomes are the individual components of the primary outcome by day 7 after surgery and 30-day mortality.The findings of this trial will provide clinical evidence for the rScO2-guided blood pressure management to improve postoperative outcomes in older patients who are scheduled for major noncardiac surgery.Keywords: regional cerebral oxygen saturation, blood pressure management, postoperative major complications, major noncardiac surgery, elderly patients

Heena Chhanwal, Divya Kheskani, Parita Gandhi et al.

Abstract Background Awareness under general anesthesia is an unpleasant phenomenon that usually goes unnoticed and neglected. Numerous incidences of intraoperative awareness are not reported. Reasons for awareness might be the inadequate depth of anesthesia, less effective drugs, lack of proper anesthesia monitoring equipment, and untrained medical staff. The purpose of this study is to evaluate intraoperative awareness during general anesthesia and titrate the amount of anesthetic agents according to BIS values among patients and monitor hemodynamic parameters throughout the surgery. Results The intraoperative awareness reported was 2% in the BIS group and 8% in the non-BIS group. The total propofol consumption in the BIS group was significantly less as compared to the non-BIS group (P value<0.0001). Conclusions The incidence of definite awareness with postoperative recall and propofol consumption was reduced in the BIS group as compared to the non-BIS group.

Sultan M, Beza L, Debebe F et al.

Menbeu Sultan,1 Lemlem Beza,2 Finot Debebe,2 Getaw Worku Hassen,3 Anisha Duvvi,3 Selamawit Tilahun,4 Nura Nasser,5 Sisay Bekele6 1Department of Emergency Medicine and Critical Care, St. Paul’s hospital millennium medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Emergency Medicine, New York Metropolitan Hospital, New York, NY, USA; 4Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 5Department of Anesthesiology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 6Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Menbeu Sultan, Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, Email smenbeu@yahoo.comAbstract: Tracheal masses are rare in occurrence, but could lead to complications depending on the speed of growth, duration and degree of obstruction. Some of the complications are recurrent pneumonia and air trapping resulting in increased intrathoracic pressure. The latter phenomenon can result in obstruction of the venous return and pneumothorax. We are reporting a rare presentation of bilateral pneumothorax (presumed tensioned) in a young patient with a distal obstructive tracheal tumor. In the emergency department (ED) the patient was in respiratory distress and was found to have extensive subcutaneous emphysema of the neck, chest, and abdominal wall with hypotension. Respiratory failure from bilateral tension pneumothorax was suspected and the patient was intubated with simultaneous bilateral thoracostomy. These measures did not improve the patient’s ventilation and oxygenation status. Further fiberoptic investigation revealed a distal tracheal obstructive mass. An emergency surgical intervention was required to remove the tumor. We recommend considering alternative pathologies, such as an obstructive tracheal tumor, in a patient with respiratory distress. They should especially be considered when oxygenation and ventilation are difficult, particularly when endotracheal intubation and/or tube thoracostomy fail to improve the symptoms. A high index of suspicion and a timely multidisciplinary team approach are essential when managing the life-threatening presentation of a patient with a distal tracheal tumor.Keywords: bilateral pneumothorax, tracheal tumor, hypoventilation

Wei Wang, Pengwei Huo, Lei Zhang et al.

Postoperative cognitive dysfunction (POCD) is a common postoperative neurological complication in elderly patients. Circular RNAs (circRNAs) are abundant in the mammalian brain and can probably regulate cognitive function. However, the competitive endogenous RNA (ceRNA) regulatory network in POCD remains illiterate. Transcriptomic signatures in the hippocampus of POCD mice derived from the Gene Expression Omnibus (GEO) dataset GSE190880, GSE95070, and GSE115440 were used to identify the circRNA, miRNA, and mRNA expression profiles of POCD mice compared with controls, respectively. A set of differentially expressed RNAs, including 119 circRNAs, 33 miRNAs, and 49 mRNAs were identified. Transcript validation showed the enhanced expression of circ_0001634, circ_0001345, and circ_0001493. A ceRNA regulatory network composed of three circRNAs, three miRNAs, and six mRNAs was established. The hub mRNAs in the ceRNA network were further found to be involved in the hormone catabolic process and regulation of canonical Wnt signaling pathway, revealing their crucial role in POCD. Finally, three miRNAs and four mRNAs were verified by qRT-PCR. These results based on bioinformatics and PCR array suggest that circ_0001634/miR-490-5p/Rbm47, circ_0001634/miR-490-5p/Sostdc1, circ_0001634/miR-7001-5p/Sostdc1, circ_0001345/miR-7001-5p/Sostdc1, and circ_0001493/miR-7001-5p/Sostdc1 may be novel diagnostic biomarkers and therapeutic targets for POCD.

Koji Hosokawa, Katsuya Tanaka, Kayo Ishihara et al.

Abstract Purpose Early discontinuation of postoperative oxygen support (POS) would partially depend on the innate pulmonary physics. We aimed to examine if the initial driving pressure (dP) at the induction of general anesthesia (GA) predicted POS prolongation. Methods We conducted a single-center retrospective study using the facility's database. Consecutive subjects over 2 years were studied to determine the change in odds ratio (OR) for POS prolongation of different dP classes at GA induction. The dP (cmH2O) was calculated as the ratio of tidal volume (mL) over dynamic Crs (mL/cmH2O) regardless of the respiratory mode. The adjusted OR was calculated using the logistic regression model of multivariate analysis. Moreover, we performed a secondary subgroup analysis of age and the duration of GA. Results We included 5,607 miscellaneous subjects. Old age, high scores of American Society of Anesthesiologist physical status, initial dP, and long GA duration were associated with prolonged POS. The dP at the induction of GA (7.78 [6.48, 9.45] in median [interquartile range]) was categorized into five classes. With the dP group of 6.5–8.3 cmH2O as the reference, high dPs of 10.3–13 cmH2O and ≥ 13 cmH2O were associated with significant prolongation of POS (adjusted OR, 1.62 [1.19, 2.20], p = 0.002 and 1.92 [1.20, 3.05], p = 0.006, respectively). The subgroup analysis revealed that the OR for prolonged POS of high dPs disappeared in the aged and ≥ 6 h anesthesia time subgroup. Conclusions High initial dPs ≥ 10 cmH2O at GA induction predicted longer POS than those of approximately 7 cmH2O. High initial dPs were, however, a secondary factor for prolongation of postoperative hypoxemia in old age and prolonged surgery.

Du J, Deng Y, Qiu Z et al.

Jingyi Du,* Yifan Deng,* Zhuolin Qiu, Guoliang Sun, Yue Guo, Ziqing Hei, Xiang Li Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People&rsquo;s Republic of China*These authors contributed equally to this workCorrespondence: Xiang LiDepartment of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Number 600, Tianhe Road, Guangzhou, 510630, People&rsquo;s Republic of ChinaTel/ Fax +86 20 8525 3132Email lixiang27@mail.sysu.edu.cnPurpose: Cognitive impairment is a complication that most frequently happens in patients with chronic neuropathic pain and has limited effective therapy. The aim of this study was to explore the effects of curcumin on the cognitive deficit in rats with peripheral nerve injury induced-neuropathic pain.Methods: The neuropathic pain rat model was constructed using chronic constriction injury (CCI). The curcumin (60 mg/kg) or vehicle was intraperitoneally administered once a day, beginning at 14th day after surgery and continued for 14 consecutive days. The nociceptive threshold tests were measured by paw mechanical withdraw threshold (PMWT) and paw thermal withdrawal latency (PTWL), while the spatial memory abilities were evaluated by the Morris water maze test. The mean counts of bromodeoxyuridine (Brdu)/neuronal nuclei (NeuN) as well as Brdu/doublecortin (DCX) co-labeled cells were used to evaluate neurogenesis in the dentate gyrus of hippocampus. The ultrastructure of the synapse in hippocampal region was visualized using transmission electron microscopy (TEM).Results: Increased PMWT and PTWL, as well as relieved memory deficits, were found in CCI rats under curcumin administration. Moreover, curcumin treatment increased the number of newly born immature (BrdU/NeuN) and newly generated mature neurons (BrdU/DCX). The TEM examination revealed increased PSD thickness and shorter active zone length as well as narrowed synaptic cleft width in the hippocampal region of CCI rats after curcumin injection.Conclusion: Curcumin can alleviate CCI induced nociceptive behaviors and memory deficit. This effect might be associated with hippocampal neurogenesis and synaptic plasticity improvements, which indicated curcumin as a potential strategy for the cognitive impairment restoration under prolonged neuropathic pain condition.Keywords: curcumin, peripheral nerve injury, cognitive impairment, hippocampus neurogenesis

Gehui Li, Gehui Li, Wanxian Luo et al.

Autophagy dysfunction has been directly linked with the onset and progression of Parkinson’s disease (PD), but the underlying mechanisms are not well understood. High-mobility group A1 (HMGA1), well-known chromatin remodeling proteins, play pivotal roles in diverse biological processes and diseases. Their function in neural cell death in PD, however, have not yet been fully elucidated. Here, we report that HMGA1 is highly induced during dopaminergic cell death in vitro and mice models of PD in vivo. Functional studies using genetic knockdown of endogenous HMGA1 show that HMGA1 signaling inhibition accelerates neural cell death, at least partially through aggravating MPP+-induced autophagic flux reduction resulting from partial block in autophagic flux at the terminal stages, indicating a novel potential neuroprotective role for HMGA1 in dopaminergic neurons death. MicroRNA-103/107 (miR-103/107) family, which is highly expressed in neuron, coordinately ensures proper end-stage autophagy. We further illustrate that MPP+/1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced HMGA1 elevation counterparts the effect of miR-103/107 downregulation by directly binding to their promoters, respectively, sustaining their expression in MPP+-damaged MN9D cells and modulates autophagy through CDK5R1/CDK5 signaling pathway. We also find that HMGA1 is a direct target of miR-103/107 family. Thus, our results suggest that HMGA1 forms a negative feedback loop with miR-103/107-CDK5R1/CDK5 signaling to regulate the MPP+/MPTP-induced autophagy impairment and neural cell death. Collectively, we identify a paradigm for compensatory neuroprotective HMGA1 signaling in dopaminergic neurons that could have important therapeutic implications for PD.

Ralf A. Claus, Markus H. Graeler, Markus H. Graeler et al.

Scientific Background: Sphingolipids are a highly diverse group of lipids with respect to physicochemical properties controlling either structure, distribution, or function, all of them regulating cellular response in health and disease. Mass spectrometry, on the other hand, is an analytical technique characterizing ionized molecules or fragments thereof by mass-to-charge ratios, which has been prosperingly developed for rapid and reliable qualitative and quantitative identification of lipid species. Parallel to best performance of in-depth chromatographical separation of lipid classes, preconditions of precise quantitation of unique molecular species by preprocessing of biological samples have to be fulfilled. As a consequence, “lipid profiles” across model systems and human individuals, esp. complex (clinical) samples, have become eminent over the last couple of years due to sensitivity, specificity, and discriminatory capability. Therefore, it is significance to consider the entire experimental strategy from sample collection and preparation, data acquisition, analysis, and interpretation.Areas Covered: In this review, we outline considerations with clinical (i.e., human) samples with special emphasis on sample handling, specific physicochemical properties, target measurements, and resulting profiling of sphingolipids in biomedicine and translational research to maximize sensitivity and specificity as well as to provide robust and reproducible results. A brief commentary is also provided regarding new insights of “clinical sphingolipidomics” in translational sepsis research.Expert Opinion: The role of mass spectrometry of sphingolipids and related species (“sphingolipidomics”) to investigate cellular and compartment-specific response to stress, e.g., in generalized infection and sepsis, is on the rise and the ability to integrate multiple datasets from diverse classes of biomolecules by mass spectrometry measurements and metabolomics will be crucial to fostering our understanding of human health as well as response to disease and treatment.

Laleh Jalilian, M. Cannesson

As one of the founding fathers of medicine, Hippocrates was prescient in his discernment that patients show differences in the severity of disease symptoms and that some individuals can better cope with their disease compared with others. He believed that it was more important to know the person who has the disease than to tailor the treatment. Hippocrates was one of the earliest physicians to practice precision medicine, where medical decisions and therapies are tailored to the individual patient. In the modern era, precision medicine accounts for individual variability in genes, lifestyle, and environment that may cause patients to manifest disease differently and potentially respond to treatments differently. In the 1990s, scientific and technological advances brought about the genetics revolution, where studies of the human genome suggested that diseasemay have a genetic basis. Since then, advances in genomics and proteomics have provided great insight into the nature and evolution of disease. Simultaneous to the genetics revolution, shifts in health care reform led to the implementation of the 2009 Health Information Technology for Economic and Clinical Health Act, which incentivized the adoption of the electronic health record (EHR). The widespreaddeployment of EHRs led to the accrual ofmassive amounts of digitized clinical data, populated from biospecimens, health care visits, and administrative claims, amongst many others. From its inception as a field of acute caremedicine, anesthesiology directly practiced precision medicine, when the first anesthesiologists administered ether to their patients in unique amounts based on direct observation of clinical effects. Today, clinicians must interpret large amounts of clinical data for critical and timely decisions in the delivery of anesthetic and critical care. As afield, anesthesiology has a history of pioneering patient safety through the use of informatics. The data-rich acute care environment allows anesthesiology to shape the developing field of acute care informatics in a way that may provide advances in patient safety and quality and in reducing health care expenditures. Anesthesiology clinical and research enterprises will require new thinking, training, tools, and a vision for how to utilize and interpret acute care data. This chapter explores how anesthesiology can become the acute care arm of precision medicine by utilizing informatics to address the increasingly complex needs of patients, populations, and organizations.

Marius Keller, Tim Heller, Tobias Lang et al.

Abstract Background Right ventricular (RV) function is an important prognostic indicator. The acute effects of cardiac interventions or cardiac surgery on global and longitudinal RV function are not entirely understood. In this study, acute changes of RV function during mitral valve surgery (MVS), percutaneous mitral valve repair (PMVR) and off-pump coronary artery bypass surgery (OPCAB) were investigated employing 3D echocardiography. Methods Twenty patients scheduled for MVS, 23 patients scheduled for PMVR and 25 patients scheduled for OPCAB were included retrospectively if patients had received 3D transesophageal echocardiography before and immediately after MVS, PMVR or OPCAB, respectively. RV global and longitudinal function was assessed using a 3D multiparameter set consisting of global right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), longitudinal contribution to RVEF (RVEFlong) and free wall longitudinal strain (FWLS). Results Longitudinal RV function was significantly depressed immediately after MVS, as reflected by all parameters (RVEFlong: 20 ± 5% vs. 13 ± 6%, p <  0.001, TAPSE: 13.1 ± 5.1 mm vs. 11.0 ± 3.5 mm, p = 0.04 and FWLS: −20.1 ± 7.1% vs. -15.4 ± 5.1%, p <  0.001, respectively). The global RVEF was slightly impaired, but the difference did not reach significance (37 ± 13% vs. 32 ± 9%, p = 0.15). In the PMVR group, both global and longitudinal RV function parameters were unaltered, whereas the OPCAB group showed a slight reduction of RVEFlong only (18 ± 7% vs. 14 ± 5%, p <  0.01). RVEFlong yielded moderate case-to-case but good overall reproducibility. Conclusions TAPSE, FWLS and RVEFlong reflect the depression of longitudinal compared to global RV function initially after MVS. PMVR alone had no impact, while OPCAB had a slight impact on longitudinal RV function. The prognostic implications of these phenomena remain unclear and require further investigation.

Rupesh Sunkam, Vinayak Seenappa Pujari, Balakrishna Kailasnatha Shenoy et al.

Background: The current bedside predictors of the difficult airway are not perfect. A new test, the acromio-axillo-suprasternal notch index (AASI), has been found to be superior to conventional predictors. In this study, we have compared the accuracy of AASI with upper lip bite test (ULBT) and modified Mallampati (MMP) test to predict difficult laryngoscopy and the time taken to complete each test. Methods: Institutional ethical committee clearance was obtained, and written informed consent was taken from 150 patients posted for elective surgery under general anesthesia with endotracheal intubation. Preoperative airway examination was carried out with AASI, ULBT, and MMP score. AASI ≥0.49, ULBT Class III, and MMP score III/IV were considered as predictive of difficult visualization of larynx (DVL). After the induction of anesthesia, the laryngeal view was recorded according to Cormack–Lehane (CL) grade. Sensitivity, specificity, predictive values, and accuracy were calculated for all the three tests. Results: DVL (CL Grades 3/4) was observed in 18 (12%) patients. AASI was found to have higher specificity (93.2%), positive predictive value (PPV) (55%), and accuracy (89.3%) when compared to MMP and ULBT. MMP was found to have the highest sensitivity (77.8%), and ULBT was found to have least sensitivity (50%). Time taken for AASI was higher (13.01 ± 1.03 s) when compared to ULBT (7.49 ± 1.95 s) and MMP (3.97 ± 0.49 s). Conclusion: We conclude that the MMP is the most sensitive and fastest test to predict DVL when compared to AASI and ULBT. AASI is a better predictor for DVL as it has higher specificity, PPV, accuracy, and odds ratio when compared to standard tests such as MMP and ULBT.

Feroze Mahmood, R. Matyal, N. Skubas et al.

J. Answine, A. Lu, Tal Levy

Marissa G. Vadi, M. Malkin, J. Lenart et al.

Objectives This study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type. Methods The 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants selected face-to-face interviews, 53 applicants selected web-based interviews, and 17 applicants declined to interview. Data regarding applicants' reasons for selecting a particular interview type were gathered using an anonymous online survey after interview completion. Residency program admission rates and survey answers were compared between applicants completing face-to-face versus web-based interviews. Results One hundred twenty-seven (75.1%) applicants completed face-to-face and 42 (24.9%) completed web-based interviews. The admission rate to our residency program was not significantly different between applicants completing face-to-face versus web-based interviews. One hundred eleven applicants completed post-interview surveys. The most common reasons for selecting web-based interviews were conflict of interview dates between programs, travel concerns, or financial limitations. Applicants selected face-to-face interviews due to a desire to interact with current residents, or geographic proximity to the residency program. Conclusions These results suggest that completion of web-based interviews is a viable alternative to completion of face-to-face interviews, and that choice of interview type does not affect the rate of applicant admission to the residency program. Web-based interviews may be of particular interest to applicants applying to a large number of programs, or with financial limitations.

M. Green, R. Tariq, Parmis Green

There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement in patient outcomes are needed to justify the integration of simulation training in resident education but ample number of studies in the past 5 years do show a definite benefit of using simulation in anesthesiology training. This paper gives a brief overview of the history and evolution of use of simulation in anesthesiology and highlights some of the more recent studies that have advanced simulation-based training.

Susan M. Martinelli, Fei Chen, M. McEvoy et al.