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PubMed2001

Can anesthesiologic strategies for caesarean section influence newborn jaundice? A retrospective and prospective study.

RATIONALE AND OBJECTIVES: Neonatal jaundice is a frequent problem in neonatology and can be influenced by many factors. Our study arose from the clinical observation that among all newborns delivered by caesarean section in our center, some had a more intense physiological jaundice. We began by reviewing clinical anesthesiological case-sheets to ascertain whether this difference was linked to the use of different anesthesiologic strategies. We then performed a prospective study on healthy preterm and term newborns to verify this hypothesis. STUDY DESIGN: We retrospectively considered all healthy term newborns with weight > 2,400 g delivered by caesarean section from January 1998 to May 1999. In the prospective studies we included healthy term and preterm newborns consecutively delivered by caesarean section from May 1999 to December 1999. We excluded preterm newborns with gestational age < 31 weeks and with weight < 1,400 g. RESULTS: Both in retrospective and in prospective studies anesthetic agents employed were isoflurane (A), sevoflurane (B), or bupivacaine (C). The statistical comparison of the three groups in retrospective study confirmed the clinical observation: the total bilirubin levels were significantly higher in the isoflurane group than in the sevoflurane group (p = 0.0000) and bupivacaine group (p = 0.0002). Analysis of data from the prospective study on term newborns confirmed our previous results. In preterm infants total bilirubin is statistically higher in group A starting from 96 h postdelivery. CONCLUSIONS: It is likely that anesthetic technique can be included among factors with possible influence on neonatal jaundice.

Anesthesiology↗
PubMed1991

The development of academic anesthesiology at the Roswell Park Memorial Institute: James O. Elam, MD, and Elwyn S. Brown, MD.

In the early 1950s, Drs. James Elam and Elwyn Brown were recruited to establish the department of anesthesiology at the Roswell Park Memorial Institute. With substantial financial support from both the New York State coffers and the Institute's director, Dr. George Moore, Elam and Brown were able to create a department of anesthesiology renowned for clinical excellence and basic science research. Their work on carbon dioxide elimination led to a redesigning of the soda lime canisters that is still in clinical use. By popularizing mouth-to-mouth rescue breathing, these two anesthesiologists changed the manner in which emergency aid was given and won international acclaim.

Anesthesia Department, Hospital↗
PubMed1993

Work hours of residents in seven anesthesiology training programs.

Medical educators and credentialing organizations recently have called attention to the long hours that some house staff are required to spend in the hospital during training. To determine the average duration of in-hospital work hours of anesthesiology residents, 148 residents at seven, university-affiliated training programs kept daily logs of their activities for one week. Residents in clinical anesthesia years 1, 2, and 3 spent an average of 66, 65, and 64 hours per week, respectively, in the hospital with a range of 43 to 104 hours per week. Although there was not a difference in in-hospital work time among years of training, there was a statistical difference between two of the seven programs studied. The largest portion of the in-hospital time was devoted to patient care activities in the operating room. Residents had time for educational activities, conferences, and reading while in the hospital. The overall work hours of the residents in the anesthesiology training programs included in this survey appeared to be within current guidelines.

Anesthesiology↗
PubMed2006

Incorporating simulation-based objective structured clinical examination into the Israeli National Board Examination in Anesthesiology.

We describe the unique process whereby simulation-based, objective structured clinical evaluation (OSCE) has been incorporated into the Israeli board examination in anesthesiology. Development of the examination included three steps: a) definition of clinical conditions that residents are required to handle competently, b) definition of tasks pertaining to each of the conditions, and c) incorporation of the tasks into hands-on simulation-based examination stations in the OSCE format, including 1) trauma management, 2) resuscitation, 3) crisis management in the operating room, 4) regional anesthesia, and 5) mechanical ventilation. Members of the Israeli Board of Anesthesiology Examination Committee assisted by experts from the Israel Center for Medical Simulation and from Israel's National Institute for Testing and Evaluation were involved in this process and in the development of the assessment tools, orientation of examinees, and preparation of examiners. The examination has been administered 4 times in the past 2 yr to 104 examinees and has gradually progressed from being a minor part of the oral board examination to a prerequisite component of this test. The pass rate ranged from 70% in resuscitation to 91% in regional anesthesia. The mean inter-rater correlations for all the checklist items, for the score based on the critical checklist items only, and for the general rating were 0.89, 0.86, and 0.76, respectively. The overall Kappa coefficients (the inter-rater agreement coefficient) for the total score and the critical checklist items were 0.71 and 0.76, respectively. The correlation between the total score and the general score was 0.76. According to a subjective feedback questionnaire, most (70%-90%) participants found the difficulty level of the examination stations reasonable to very easy and prefer this method of examination to a conventional oral examination. The incorporation of OSCE-driven modalities in the certification of anesthesiologists in Israel is a continuing process of evaluation and assessment.

Anesthesiology↗
PubMed2006

Educating anesthesiology residents to perform percutaneous cricothyrotomy, retrograde intubation, and fiberoptic bronchoscopy using preserved cadavers.

Experience with invasive airway procedures may be difficult to obtain during residency training, and anesthesiologists may therefore be hesitant to use these life-saving techniques. We designed a prospective study to determine whether using embalmed cadavers to teach percutaneous cricothyrotomy (PC), retrograde intubation (RI), and fiberoptic intubation to anesthesiology residents would improve their perceived procedural confidence and ability. After demonstration of these techniques by experienced attending physicians, residents were allowed to practice, with instructor guidance, on the cadavers. Residents completed surveys before and after the workshop about their perceived confidence using these techniques. Eighteen residents attended the lecture workshop and completed surveys. The number of residents who reported that they would use PC increased from 0% to 78% (P <or= 0.001) and those who reported they could correctly perform PC technique increased from 17% to 94% (P <or= 0.001). Likewise, the number of residents who reported they would use RI increased from 6% to 67% (P <or= 0.001) and those who reported they could correctly perform RI technique increased from 28% to 83% (P <or= 0.001). There were no significant changes in residents' confidence with fiberoptic intubation. The results of this study demonstrate an improvement in the confidence of anesthesiology residents in performing PC and RI after training using embalmed cadavers.

Anesthesiology↗
PubMed2006

Trends in gender distribution among anesthesiology residents: do they matter?

BACKGROUND: The number of women graduating from United States medical schools progressively increased during the 26 yr period from 1978 to 2004. This change was associated with shifts in the gender distribution of residents training in Accreditation Council for Graduate Medical Education-accredited residency programs. METHODS: We compared trends in the number and gender distribution of residents enrolled in the 10 specialties with the largest national enrollment of residents. RESULTS: The gender distribution of residents training in different specialty programs varies widely. The percentage of women enrolled in anesthesiology training programs is less than the national average, and the rate of increase is less than that of many other specialties. CONCLUSIONS: The reasons for this distribution are multifactorial. Contributing factors may include limited exposure to women role models (including fewer women with senior academic rank and in leadership positions), gender insensitivity leading to an unprofessional work environment, limited involvement of women anesthesiologists in undergraduate medical education, misperceptions of the physician-patient relationship in anesthesiology, and practice scheduling requirements that are inconsistent and inflexible.

Anesthesiology↗
PubMed1995

Situation awareness in anesthesiology.

Situation awareness has primarily been confined to the aviation field. We believe that situation awareness is an equally important characteristic in the complex, dynamic, and risky field of anesthesiology. We describe three aspects of situations of which the decision maker must remain aware: subtle cues, evolving situations, and special knowledge elements. We provide examples of real or simulated anesthesia situations in which situation awareness is clearly involved in the provision of optimal patient care, and we map the elements of situation awareness onto a cognitive process model of the anesthesiologist. Finally, we consider how situation awareness can be further investigated and taught in this medical domain using anesthesia simulators and analyses of real cases. The study of situation awareness in anesthesiology may provide a good example of the wider application of the concept of situation awareness to nonaerospace environments.

Adult↗
PubMedDate not supplied

A study of the responsibilities of chief residents in anesthesiology with a suggested job description.

We requested information concerning the job description for the chief resident in anesthesiology from 50 different programs. Thirty-two responses were returned, with 9 responses that no such job description existed at their institutions. Eighteen of the remaining 23 respondents had a written job description for the position. Considerable variation existed in the various aspects of the position among institutions. Differences were found in the selection process, administrative duties, number of committee memberships, and educational responsibilities. We present a suggested description of the responsibilities for a chief resident in anesthesiology.

Anesthesia Department, Hospital↗
PubMedDate not supplied

The Gulf War: the experience of a department of anesthesiology in the management of Scud missile casualties.

BACKGROUND: The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. OBJECTIVE: To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. METHODS: On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. RESULTS: There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. CONCLUSION: The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Adult↗
PubMed1999

Organization of a comprehensive anesthesiology oral practice examination program: planning, structure, startup, administration, growth, and evaluation.

STUDY OBJECTIVE: To describe the planning, structure, startup, administration, growth, and evaluation of a comprehensive oral practice examination (OPE) program. SETTING: Midwest U.S. anesthesiology residency training program. MEASUREMENTS AND MAIN RESULTS: Committee planning involved consideration of formal and frequency of administration, timing for best resident and faculty availability, communication, forms design, clerical support, record keeping, and quality monitoring. OPE format was deliberately constructed to resemble that used by the American Board of Anesthesiology (ABA) to enhance resident familiarity with ABA style oral examination. Quality improvement tools consisted of regular examiner and examinee inservice sessions, liaison with ABA associate examiners, and review of examinee exit questionnaires. A set of OPE databases was constructed to facilitate quality monitoring and educational research efforts. A semiannual administration schedule on three to four consecutive Mondays optimally accommodated resident rotations and faculty work schedules. Continued administration of the OPE program required ongoing construction of a pool of guided case-oriented questions, selection of appropriate questions based on examinee training exposure, examination calendar publication, and scheduling of recurring examiner and examinee activities. Important issues that required action by the governing committee were examination timing, conflict with clinical demands, use of OPE results, and procurement of training resources. The OPE program grew from 56 examinations in the first year to 120 exams by year 3. It was perceived positively by the majority of residents. There were 90.2% of exit questionnaires that acknowledged specific learning about oral examination technique, while only 0.3% indicated lack of meaningful information exchange. Fewer than 10% of responses indicated misleading questions or badgering by examiners. Resident preparedness increased with repeat OPE exposure. CONCLUSIONS: A comprehensive mock oral examination program was successfully planned, initiated, and developed. It is well accepted by residents and faculty. Its inception was associated with an increase in resident preparedness. Now in its tenth year of existence it continues to be an asset and essential component of our training program.

Anesthesiology↗
PubMed2000

[Publications derived from free communications at the XX Congress of the Anesthesiology and Resuscitation Spanish Association (Anesthesia 92)].

OBJECTIVES: To analyze the publication in MEDLINE-indexed journals of articles derived from free presentations at the Twentieth Congress of the Spanish Society of Anesthesiology (SEDAR) (Anestesia 92) held in 1992. MATERIAL AND METHODS: Two of the authors independently investigated the publication of research presented at Anestesia 92 in MEDLINE-indexed journals, carrying out a search of authors' names between 1990 and 1998 with no restrictions on language or type of publication. We obtained year of publication and names of journals and extracted the abstracts, then analyzing the number and order of authors, content and time elapsing between the congress and publication. RESULTS: Eighty-four articles (17.1%) were published based on 491 congress presentations, with a mean time to publication of 1.8 years (range -2 to 6). Journals specializing in anesthesiology published 79.8%, and Revista Espanola de Anestesiología y Reanimación published 59.5%. Different authors were listed for published articles and congress presentations in 92.9% and the first author had changed in 35.7%. The content of a published article was similar to that of the congress presentation in 46% and scope was reduced for publication in 35.7%. CONCLUSIONS: Few publications were derived from free presentations at Anestesia 92 and major changes were made in authors and content between congress presentation and publication.

Anesthesiology↗
PubMed2000

Case reports in anesthesiology: their trend through 17 years.

UNLABELLED: The study objective was to delineate the trend of case reports (the simplest of the descriptive forms of study) in the anesthesiological literature by analyzing the frequency of publication, and citation, and especially of the place of citation of a sample of published case reports. It is our opinion that case report in anesthesia is particularly suitable for this specialty rather than for others and is often the first signal of a complication, an adverse event, an anesthetic problem in rare disease and alerts other anesthesiologists to the possibility of unexpected events. METHODS: We analyzed the case reports published on an Anesthesiological journal placed in the middle in term of Impact Factor, from January 1980 to December 1997. Citations of each case report were obtained using computer searches of the Science Citation Index (SCI). For each of these case reports we collected in a custom-designed data base the following data: year of publication, number of authors, number of citations per year, place of citation, type of article quoting the case report, number of self-citations, year of first citation. MAIN RESULTS: We identified 637 case reports and 1946 citations. The number of case reports increased through the years up to a peak in 1994-95 and the same trend was observed for citations and self-citations, the number of authors per case report was < or = 4 in 90.4%; 74.2% of total case reports cited were first cited within two years of publication, while 34.7% were never cited. The type of article quoting the case reports has been, in the majority of cases, an original article. CONCLUSIONS: The analysed case reports and the number of citations can give us information about the importance of a clinical situation at a particular time.

Anesthesiology↗
PubMed2001

[Expected versus real impact factors of publications from Spanish departments of anesthesiology (1991-1996)].

OBJECTIVE: To identify publications by Spanish anesthesiologists in journals indexed by Journal Citation Report from 1991 through 1996; to count the number of citations received and compare the results with the impact factor (IF) of the journals in which they were published. MATERIAL AND METHODS: Articles for which the first author was a member of a Spanish anesthesiology department were searched for in MEDLINE, Science Citation Index and EMBASE. Only publications for which the IF was known were included for analysis. We then counted the number of citations each article received over the two years following publication, recording the source journal in which the citation appeared and country of origin of each citing author. We then calculated the real IF (RIF) of each article, the RIF of all the Spanish articles, and the mean RIF. Also calculated for each article was the expected IF (EIF), based on the IF of the source journal, the overall EIF and the mean EIF. RESULTS: One hundred seventy-two articles were published; 49 of them were letters to the editors. Specialist anesthesiology journals published 72.7%. A total of 186 citations were received. American authors cited the articles more often than did other Spanish authors. Thirty-seven citations (19.9%) were self-citations. Ninety-two articles (53.5%) were never cited. With letters to the editor excluded, the RIF was 85.48 and the global EIF was 213.28; the mean EIF was 1.734 and the RIF was 0.695. Therefore, the rate of citation of the Spanish authors in the period studied was only 40% of the citation rate of the entire population of authors from all countries. The authors of the published articles worked mainly in hospitals in Barcelona, Madrid, La Coruña, Valencia, Cantabria and Murcia. Hospital Germans Trias i Pujol (Badalona, Barcelona) had the largest number of publications and the highest EIF (39.41). Hospital del Mar (Barcelona) had the highest mean RIF and the highest global RIF.A gradual increase in the annual productivity of Spanish scientists can be discerned in a progressive increase in the number of publications as well as their EIF and RIF. CONCLUSIONS: Research by Spanish anesthesiologists is concentrated in only a few hospitals. Although the number of publications is increasing, their international repercussion has still not reached the desired level.

Anesthesia Department, Hospital↗
PubMedDate not supplied

[Significance of anesthesiology and intensive care in the development of reconstructive surgery (as exemplified by the scientific school of the Academician B.V. Petrovskiĭ)].

B. V. Petrovsky, the creator of one of the leading surgical schools, realized, that surgery cannot develop without anesthesiological and resuscitation support. He actively promoted measures which ensured rapid transformation of such branches as anesthesia and postoperative care into independent disciplines. Introduction of neuroleptanalgesia, high-quality artificial ventilation of the lungs, prolonged regional and combined anesthesia, protection of the myocardium and brain, bronchofibroscopy, extracorporeal detoxication, assisted circulation, and computer monitoring allowed the performance of the most sophisticated interventions on the heart, aorta, lungs, esophagus, liver and bile duct, and peripheral vessels. Progress in anesthesiology and reanimatology promoted the development of new trends in reconstructive surgery, such as repair microsurgery, organ transplantation, endovascular and endoscopic surgery.

Anesthesiology↗
PubMed2001

[New study on the history of anesthesiology (8)--Etymological consideration on a Japanese word "Masui"].

The author briefly describes etymology of a Japanese word "Masui" ([symbol: see text]) and discusses why this word has not been correctly understood by lay people as well as Japanese anesthesiologists. The word "Masui" was coined by Seikei Sugita in 1850 when he translated Dutch edition of Schelesinger's monograph on ether anesthesia into Japanese. Therefore the word is not of Chinese origin and has subsequently been exported to China and the countries of Korean peninsula. Although half a century has elapsed since the first Department of Anesthesiology was established at the Tokyo University Faculty of Medicine, social acceptance for our specialty has not adequately and widely been achieved. The author thinks that one of the causes for this inadequate acceptance is that the correct Japanese words of "Masuika-gaku" and "Masuika-i" for Anesthesiology and Anesthesiologists were not coined and the incorrect words as "Masuigaku" and "Masui-i" have been used. Not a small number of Japanese anesthesiologists still employ the words "Masuigaku" and "Masui-i" without any special reasons.

Anesthesiology↗
PubMed2001

[Simulators in anesthesiology].

The work of an anesthesiologist and that of a flight pilot share certain attributes. As pilots use simulators to obtain risk-free practice in recognizing and controlling situations that might lead to disaster, simulation programs are now emerging as a new way to learn and train anesthesiology is being conceived as a new task that integrates scientific knowledge and human factors. Simulators have been introduced into teaching and training programs as a powerful tools that allow anesthesiologists to learn, practice and train in a multitude of situations without putting human life at risk. Experience is limited so far, but acceptance has been high and simulators seem to accelerate the acquisition of skills and knowledge, although their effect on performance in critical situations has not been proven yet. Two types have been applied in anesthesiology: computer screen and mannequin. The usefulness of simulators ranges from training for situations that require the systematic application of protocols and the understanding of new drugs being introduced into clinical practice to the practice of how to use resources for managing anesthetic emergencies. It is still too early to use simulators for certifying and evaluating clinical performance, as further studies are needed to identify the type of events that reflect typical situations and to determine which procedures should be evaluated.

Anesthesiology↗
PubMed2002

[The creation of the first anesthesiology service in Spain (Hospital de la Santa Cruz y San Pablo, Barcelona 1941)].

On the sixtieth anniversary of the founding of the first Spanish anesthesia department, we review factors that led to its creation and its early development. Hospital de la Santa Cruz y San Pablo in Barcelona was the place where the service was established for several reasons. The first was the growing need for anesthesia to be administered by specialized physicians able to handle problems developing during and after surgery. The second was the presence of a prestigious surgeon, Dr. Juan Soler Juliá, who perceived the need, alongside the only physician in Spain who was completely dedicated to anesthesiology, Dr. José Miguel Martínez. Finally, the fact that professional anesthesiology allowed a physician to earn a decent income triggered interest in the specialty among physicians.

Anesthesia Department, Hospital↗
PubMed2003

[New study on the history of anesthesiology--(9) a brief history of "N2O Study Society"].

In Japan nitrous oxide has been manufactured since 1955 at the request of General Headquarters of the Allied Forces. Two years later in 1957, a manufacturer built a small society for the study and popularization of nitrous oxide anesthesia as well as general anesthesia. The society gave more than twenty seminars for this purpose in various cities in a period of 8 years from 1957 until 1965. At the seminars, Prof. Yamamura of Tokyo University and other professors of anesthesiology gave their lectures on basic science of nitrous oxide anesthesia and demonstrated its use for surgical patients. In July 1962, a fatal accident of explosion during ether anesthesia occurred in a hospital in Tokyo, in which a 25-year-old male died due to combustion and explosion triggered by electrical cauterization during surgery of pulmonary empyema. This accident facilitated and accelerated rapid and wide spread of nitrous oxide anesthesia as well as anesthesiology in general in Japan.

Anesthesiology↗