Search PubMed⌕ Search

Biomedical subjects

W Bosseau Murray

Publications and source records attributed to W Bosseau Murray.

7 recordsLinked to original sources
PubMed2006

Dantrolene reconstitution: can warmed diluent make a difference?

STUDY OBJECTIVE: To evaluate the drug constitution of dantrolene by comparing reconstitution with diluent at ambient and warmed temperatures, so as to determine whether differences in reconstitution time might provide clinical or therapeutic advantages. DESIGN: Randomized study. SETTING: University-affiliated medical center. MEASUREMENTS AND MAIN RESULTS: We reconstituted 10 vials of dantrolene, 5 with room-temperature diluent (sterile water) and 5 with diluent warmed to approximately 41 degrees C. Injection of diluent (10 seconds) was followed by 5 seconds of observation and recurring 15-second cycles (10 seconds of moderate manual agitation followed by 5 seconds of observation) until full reconstitution. In a second series of reconstitutions, warmed diluent injection was immediately followed by predetermined lengths of moderate manual agitation, and reconstitution status was noted at the end of each trial. Time to full reconstitution was based on a series of predetermined objective criteria. In experiment 1, with ambient-temperature diluent (22.0 degrees C -23.1 degrees C), reconstitution occurred in 90 to 130 seconds; whereas warmed diluent (40.7 degrees C-41.3 degrees C) reconstitution occurred in less than 30 seconds (P<0.004). In experiment 2, with warmed diluent (40.9 degrees C), full reconstitution occurred after 10 seconds of injection and 18 seconds of moderate manual agitation. CONCLUSION: The use of prewarmed diluent to 41 degrees C significantly reduces dantrolene reconstitution time. Further studies should evaluate the efficacy of dantrolene reconstituted with warmed diluent.

Dantrolene↗
PubMed2006

Complications of regional anesthesia.

PURPOSE OF REVIEW: The use of regional anesthesia, either alone or as an adjunct to general anesthesia, is at an all-time high. Demonstrated benefits include reduced side effects, more efficient use of facilities and enhanced patient satisfaction with the improved postoperative pain relief. New advances in equipment, techniques and medications have been incorporated over the past 10 years, and especially over the last 2 years. As the number of practitioners and procedures increase, the number of complications may rise as well. RECENT FINDINGS: The specific issues of nerve damage, treatment of local anesthetic toxicity with lipid solutions and prevention of wrong-sided procedures are examined with special reference to recent publications. SUMMARY: Specific needle shapes, appropriate pharmacologic resuscitation from intravascular injection of local anesthetics and institutional procedures to positively identify patients and the correct block location are all part of a strategy to minimize the occurrence of adverse outcomes and to mitigate the consequences of those adverse events when they do occur. More importantly, these are changes that can be instituted immediately with minimal expense to the institution and great benefit to the patient.

Anesthesia, Conduction↗
PubMed2005

Implementation of a Web- and simulation-based curriculum to ease the transition from medical school to surgical internship.

BACKGROUND: Starting a surgical internship is a stressful experience. We developed a web and simulation-based curriculum to ease this transition. METHODS: We created an educational website containing a curriculum of commonly encountered on call situations. After match day in 2003, we contacted all of our new surgical interns. We performed a confidence assessment using a Likert-scale questionnaire, and the trainees were given access to the curriculum. In June 2003, we performed human patient simulator sessions. The participants were asked to provide feedback regarding the simulator experience. During the first week of residency, they were again asked to answer the confidence questionnaire. RESULTS: Sixteen residents (94%) used the web curriculum, and 17 (100%) participated in the simulations. Eleven (65%) filled out both questionnaires. The confidence score improved from 5.4 to 6.7 (P < .0001). CONCLUSIONS: A web and simulation-based curriculum for incoming house staff is feasible. Studies are underway to validate this novel method and to expand its use for surgical education.

Adult↗
PubMed2005

Detecting unidirectional valve incompetence by the modified pressure decline method.

The 1993 Food and Drug Administration anesthesia apparatus checkout recommendation provides guidance for a standardized circle system checkout but, we believe, inadequately tests unidirectional valve (UDV) function. We developed the modified pressure decline method (MPDM) for checking UDVs. The test involves pressurizing reservoir bags downstream of the UDVs to check for competency. Thirty-six UDVs in 18 anesthesia circle systems were evaluated using the MPDM. One Draeger (Draeger Medical Inc., Telford, PA) and one Ohmeda (Datex-Ohmeda Inc., Madison, WI) machine were then retested using incompetent valve discs. One incompetent UDV (3%) was identified of the 36 valves tested in 18 anesthesia machines. The MPDM detected the valve leak (Draeger 0.6 L/min flow leak; Ohmeda 0.9 L/min flow leak) when the incompetent valve discs were intentionally introduced into each type of machine. MPDM provides a quick and effective way of identifying incompetent UDVs.

Air Pressure↗
PubMed2002

Learning about new anesthetics using a model driven, full human simulator.

OBJECTIVE: New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. METHODS: Patients and clinical settings in which remifentanil might provide clinical advantages over existing anesthetics were identified. A simulator curriculum was developed to demonstrate the use of remifentanil in the sample cases. The simulation was designed to highlight the clinical advantages and potential side effects of remifentanil. A screen displaying the concentrations of remifentanil in plasma and in the hypothetical effector site was developed. A simulator was modified (addition of an infusion pump and a pharmacokinetic screen display) and transported to several cities in the U.S.A. An instructor guided small groups of anesthesiologists and anesthetists through a structured program that enabled participants to observe drug effects in simulated patients. RESULTS: There were 836 participants in the remifentanil program, which was offered in 58 cities in the U.S.A. Surveys were completed by 574 anesthesiologists. There was a significant difference in comfort level for using remifentanil after the session compared to before (Chi-square, p < 0.001.) The statement: "Clinical simulation experience is a means to learn about new agents like remifentanil" was rated as "excellent" by 81% and as "good" by 19% of participants. No participant found the experience to be "not useful." CONCLUSIONS: Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.

Anesthesiology↗
PubMed2002

Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study.

BACKGROUND: Anesthesia simulators can generate reproducible, standardized clinical scenarios for instruction and evaluation purposes. Valid and reliable simulated scenarios and grading systems must be developed to use simulation for evaluation of anesthesia residents. METHODS: After obtaining Human Subjects approval at each of the 10 participating institutions, 99 anesthesia residents consented to be videotaped during their management of four simulated scenarios on MedSim or METI mannequin-based anesthesia simulators. Using two different grading forms, two evaluators at each department independently reviewed the videotapes of the subjects from their institution to score the residents' performance. A third evaluator, at an outside institution, reviewed the videotape again. Statistical analysis was performed for construct- and criterion-related validity, internal consistency, interrater reliability, and intersimulator reliability. A single evaluator reviewed all videotapes a fourth time to determine the frequency of certain management errors. RESULTS: Even advanced anesthesia residents nearing completion of their training made numerous management errors; however, construct-related validity of mannequin-based simulator assessment was supported by an overall improvement in simulator scores from CB and CA-1 to CA-2 and CA-3 levels of training. Subjects rated the simulator scenarios as realistic (3.47 out of possible 4), further supporting construct-related validity. Criterion-related validity was supported by moderate correlation of simulator scores with departmental faculty evaluations (0.37-0.41, P < 0.01), ABA written in-training scores (0.44-0.49, < 0.01), and departmental mock oral board scores (0.44-0.47, P < 0.01). Reliability of the simulator assessment was demonstrated by very good internal consistency (alpha = 0.71-0.76) and excellent interrater reliability (correlation = 0.94-0.96; P < 0.01; kappa = 0.81-0.90). There was no significant difference in METI versus MedSim scores for residents in the same year of training. CONCLUSIONS: Numerous management errors were identified in this study of anesthesia residents from 10 institutions. Further attention to these problems may benefit residency training since advanced residents continued to make these errors. Evaluation of anesthesia residents using mannequin-based simulators shows promise, adding a new dimension to current assessment methods. Further improvements are necessary in the simulation scenarios and grading criteria before mannequin-based simulation is used for accreditation purposes.

Anaphylaxis↗