Journal of clinical anesthesia
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Comparative Study
Anesthesiology residents' perception of educational environment: comparison between different years of training.
To assess whether the year of residency in anesthesiology is associated with residents' overall perceptions of the learning environment and to evaluate the association between year of residency and each of the five domains of the Dundee Ready Education Environment Measure (DREEM) survey. ⋯ Resident's perception of the learning environment in the anesthesiology residency program of the Cleveland Clinic is on the positive side, as measured by the DREEM questionnaire. We found no association between the year of training and the DREEM questionnaire overall score. Furthermore, we found no association between year of residency and any of the subscores for the 5 DREEM domains. There is room for improvement, especially in the area of self-perception.
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Case Reports
Intrapleural placement of a thoracic epidural catheter in a patient with spinal stenosis.
Due to the close proximity of the thoracic epidural space and parietal pleura, pleural puncture with intrapleural catheter placement is a potential complication of thoracic epidural anesthesia. The authors present a case of an obese patient with a history of spinal stenosis that underwent thoracotomy. Repeated failed attempts at epidural anesthesia were complicated by intrapleural placement of the catheter. The patient subsequently developed clinical signs of pneumothorax and required urgent thoracostomy.
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Case Reports
Peroperative cardiogenic shock suggesting acute coronary syndrome as initial manifestation of Lyme carditis.
Carditis can complicate Lyme disease in an estimated <5% of cases, and cardiogenic shock and severe cardiac arrhythmias are described with electrocardiographic abnormalities that could be suggestive of coronary manifestations. We report a case of severe persistent biventricular heart failure complicated by cardiac arrhythmias as initial manifestation of a Lyme disease developing peroperatively electrocardiographic abnormalities suggesting acute transmural myocardial infarction.
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Case Reports
Lack of electrical interference between spinal cord stimulators and other implanted electrical pulse devices.
Spinal cord stimulators (SCSs) have been used for decades to treat chronic pain. SCSs are often used to treat patients with chronic back pain caused by failed back surgery syndrome, patients with complex regional pain syndrome, or individuals who are not candidates for surgery. SCSs are a relative contraindication in patients with another electrical pulse device. ⋯ The second case was a nonsurgical candidate with a pacemaker who received an SCS to help with lower back pain due to an occupational injury. The third case was a patient with complex regional pain syndrome and a bladder stimulator with a previous SCS who received a revision to help manage the pain. In all these patients, pain scores significantly improved after the trial.
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Comparative Study
Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider.
To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. ⋯ Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.