Journal of clinical anesthesia
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The Accreditation Council for Graduate Medical Education requires medical training programs to monitor, track, and formally document a fellow's performance. If deficiencies are found, programs are expected to prepare and implement an effective plan of action for improvement and to ensure that graduates acquire the personal and professional attributes of an independent physician. We revised our evaluation policy and instituted a remediation protocol in 2008. ⋯ All fellows who participated in this program completed their subspecialty training in pediatric anesthesia, and all eligible fellows have successfully achieved their subspecialty board certification. Our approach has the advantage of multimodality, time-based daily evaluations, and group discussions in the context of a Clinical Competency Committee. Utilization of an IRP as a metric for progress has features similar to effective cognitive behavioral therapy contracts and has ensured that our graduates are held to clearly delineated and specified skills and behaviors that allow them to work independently in the field of pediatric anesthesiology.
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Randomized Controlled Trial Comparative Study
Effect of Boussignac continuous positive airway pressure ventilation on Pao2 and Pao2/Fio2 ratio immediately after extubation in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial.
Pathophysiological changes after laparoscopic Roux-en-Y gastric bypass may increase the risk of pulmonary complications in morbidly obese patients. The purpose of the study was to assess the impact of immediate postextubation use of Boussignac continuous positive airway pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The hypothesis is that the use of CPAP may improve oxygenation in the postoperative period when compared to Venturi mask. ⋯ Application of Boussignac CPAP for 2 hours after extubation improved oxygenation but did not improve forced expiratory volume at 1 second and forced vital capacity.
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Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs). ⋯ Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder.
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Randomized Controlled Trial Comparative Study
Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation.
The aim of this study was to evaluate the analgesic efficacy and safety of pectoralis-serratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain. ⋯ Pectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block.
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Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. ⋯ Neuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates.