Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study
Utility of prepuncture ultrasound for localization of the thoracic epidural space.
Ultrasound has been shown to facilitate accurate identification of the intervertebral level and to predict skin-to-epidural depth in the lumbar epidural space with reliable precision. We hypothesized that we could accurately predict the skin-to-epidural depth and the intervertebral level in the thoracic spine with the use of ultrasound. ⋯ Ultrasound-based measurements of skin-to-epidural depth show acceptable agreement with the actual depth observed during epidural catheterization; however, the limits of agreement are wide, which restricts the predictive value of ultrasound-based measurements. Further study is required to delineate the role of ultrasound in thoracic epidural catheterizations.
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In this article, we describe a critical event which occurred in a simulation centre, and we also review possible safety issues for participants and staff involved in medical simulation training. ⋯ Simulation in healthcare is a valuable educational tool to train for a variety of clinical encounters in a safe environment without harming a patient. Due to technological progress and the use of authentic equipment recreating near real environments, simulation training has become exceedingly realistic. The Society for Simulation in Healthcare (SSH) has published revised accreditation standards for simulation centres which incorporate training safety sub-criteria to address and manage. By highlighting recommendations of other high-risk industries on this issue, SSH proposes a possible approach to enhance safety in medical simulation.
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In various medical and surgical specialties, it is essential to acquire fibreoptic upper airway endoscopy skills for successful endotracheal intubation, especially when faced with a difficult airway. The aim of our study was to evaluate the learning curves of residents performing fibreoptic upper airway endoscopy in the simulation environment. ⋯ There is a large variation in the learning curves of residents performing fibreoptic upper airway endoscopy. The training for fibreoptic airway endoscopy should be tailored to the needs of each individual.
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Case Reports
Sequential bilateral upper extremity intravenous regional anesthesia with chloroprocaine.
This case report describes the novel use of sequential bilateral upper extremity intravenous regional anesthesia with 2-chloroprocaine for bilateral endoscopic carpal tunnel decompression. ⋯ Bilateral sequential intravenous regional anesthesia with 2-chloroprocaine is effective for upper extremity surgery of short duration. Recommendations to minimize the risk of local anesthetic toxicity are reviewed.