A&A practice
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Increasing medical student enrollment creates challenges for clinical course directors to accommodate students and to provide consistency in clinical experiences. We discuss curricular modifications addressing these challenges specific to anesthesiology electives through the creation of 2-week anesthesiology electives to provide scheduling flexibility in the clinical years. We also incorporated curricular enhancements as a consistent didactic framework congruent with the clinical experience. ⋯ More fourth-year students have enrolled in these courses. The annual number of students matching anesthesiology has maintained ≥8% graduating class. Our highest has been 15% in 2020.
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Case Reports
Severe Abdominal Wall Infection After Subcostal Transversus Abdominis Plane Block: A Case Report.
Transversus abdominis plane (TAP) blocks are increasingly used for perioperative analgesia in patients undergoing abdominal surgeries. TAP blocks are easy to perform, reliably effective, and have an excellent safety profile. Nevertheless, we report a patient who underwent an open cholecystectomy and right hemicolectomy where a subcostal TAP block possibly contributed to an unusual abdominal wall abscess that lead to a prolonged and complicated postoperative course.
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Effective communication and conflict management are important skills for anesthesiologists and are designated by the Accreditation Council for Graduate Medical Education (ACGME) as elements of the "interpersonal and communication skill" competency (ACGME Anesthesiology Milestone Project 2020). However, structured conflict management education for anesthesiology residents remains limited. To address this gap, we developed and implemented a conflict management session incorporating didactics and application exercises using role-play and high-fidelity simulation (SIM) for anesthesiology residents (postgraduate years 3 and 4) at a tertiary academic medical institution. These sessions were well-received, and both role-play and SIM appear to help residents learn conflict management skills.
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Anesthetic management of pediatric circumcisions typically involves intravenous access and advanced airway management. We explored the use of a minimally invasive anesthetic protocol for pediatric circumcisions akin to the anesthetic management for bilateral myringotomy and tympanostomy. ⋯ The mean (standard deviation) intraoperative anesthesia time was 41.4 (5.7) minutes, and 1 patient experienced a mild intraoperative complication with emesis at induction. Pediatric circumcisions can be efficiently and safely performed with minimally invasive anesthesia.
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This case presents and discusses a case of unilateral proptosis immediately following intubation in a patient who underwent laparoscopic ventral hernia repair under general anesthesia. The patient developed a right-sided proptosis following intubation when noninvasive blood pressure was measured as 167/111 mm Hg. ⋯ To the best of our knowledge, there is no case report of proptosis secondary to intubation. The aim of this report is to increase the awareness of rare complications caused by intubation, especially ocular complications, and to underline the importance of preoperative evaluation.