Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Jun 2015
Myocardial injury and protection related to cardiopulmonary bypass.
During cardiac surgery with cardiopulmonary bypass, the heart is isolated from the circulation. This inevitably induces myocardial ischemia. ⋯ Over the years, several strategies have been developed that aim to attenuate and/or modulate the extent of this ischemia-reperfusion injury related to the episode of cardiopulmonary bypass. This article reviews the pathophysiology of myocardial injury related to cardiopulmonary bypass and summarizes potential therapeutic strategies that may modulate the extent of this myocardial injury.
-
Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewBasic concepts for crew resource management and non-technical skills.
In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems.
-
Best Pract Res Clin Anaesthesiol · Mar 2015
ReviewBriefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.
In this article, we review the debriefing literature and point to the dilemma that although debriefings especially intend to enhance team (rather than individual) learning, it is particularly this team setting that poses risks for debriefing effectiveness (e.g., preference-consistent information sharing, lack of psychological safety inhibiting structured information sharing, ineffective debriefing models). These risks can be managed with a mindful approach with respect to content (e.g., specific learning objectives), structure (e.g., reactions phase, analysis phase, summary phase), attitude (e.g., honesty, curiosity, holding the trainee in positive regard) and setting (e.g., briefings to provide orientation and establish psychological safety). We point to the potential of integrating systemic methods such as circular questions into debriefings, discuss the empirical evidence for debriefing effectiveness and highlight the importance of faculty development.
-
Simulation has become a significant training tool in the operating room (OR). It can be used in both simple task training and complex scenarios. The challenge for simulation in the OR is how to translate that which is learned, and perceived to beneficial, into behavioral change and improved patient outcomes. Simulation in the developing world is progressing, but is still hampered by a shortage of material, personnel funding.