Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2006
Meta AnalysisAvoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin.
Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving children undergoing corrective or palliative cardiac surgery with cardiopulmonary bypass. All studies were assessed for methodological quality, and sources of heterogeneity were examined. ⋯ Most of the studies were of poor methodological quality and predefined transfusion triggers were infrequently used. Overall, aprotinin reduced the proportion of children who received blood transfusion during cardiac surgery with cardiopulmonary bypass. Further high-quality trials with clinically important outcomes may be warranted before aprotinin can be routinely recommended in this population.
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Anesthesia and analgesia · Mar 2006
Comparative StudyIncorporating 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 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.
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Anesthesia and analgesia · Mar 2006
Comparative StudyKetamine attenuates sympathetic activity through mechanisms not mediated by N-methyl-D-aspartate receptors in the isolated spinal cord of neonatal rats.
Ketamine is believed to have sympathomimetic effects, although the central mechanism remains unclear. Using an in vitro splanchnic nerve-spinal cord preparation from neonatal rats, our previous investigations have demonstrated that tonic sympathetic activity is spontaneously generated from the thoracic spinal cord. We designed this study to investigate whether applications of ketamine to the cord would augment sympathetic activity and whether this action was dependent on N-methyl-d-aspartate receptors. ⋯ The 50% inhibitory concentration of ketamine on sympathetic activity was 32 muM. Pretreatment with DL-2-amino-5-phosphonovaleric acid, a selective competitive N-methyl-d-aspartate receptor antagonist, did not alter ketamine-induced depression of sympathetic activity. These results suggest that ketamine reduces sympathetic activity by mechanisms that are independent of N-methyl-d-aspartate receptor activity.
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyUpper airway collapsibility in anesthetized children.
We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. ⋯ Pcrit for sevoflurane ranged from -6.7 to -11.6 (mean +/- sd, -9.8 +/- 1.9) cm H2O. Pcrit for halothane ranged from -8.1 to -33 (mean +/- sd, -19.4 +/- 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.
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Anesthesia and analgesia · Mar 2006
Comparative StudyResidents' and program directors' attitudes toward research during anesthesiology training: a Canadian perspective.
We assessed the attitudes of residents and program directors (PD) toward research training in Canadian anesthesiology residency programs. Questionnaires were sent to all 476 anesthesiology residents in Canada and a modified questionnaire was sent to the PD of each of the 16 anesthesiology programs between November 2003 and April 2004. There was a 60% response rate to the resident questionnaire and 95% from the PDs. ⋯ Residents regard the time needed to learn clinical anesthesia, schedule conflicts, inadequate faculty support, and a lack of protected research time as the top barriers to undertaking a research project. PDs do not consider schedule conflicts or a lack of time as important barriers for resident research. Seventy-five percent of residents would prefer to do another academic activity, such as learning transesophageal echocardiography or taking postgraduate programs in education, rather than completing a research project during their residency.