Journal of clinical anesthesia
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Clinical reasoning by anesthesiology residents in emergency situations where optimal management is uncertain could be improved by setting up a tutored practice exchange group. This study attempted to evaluate the impact of a practice exchange group (PEG), tutored by a senior anesthesiologist, on anesthesiology residents in emergency situations. Changes in clinical reasoning were measured by script concordance tests (SCT). ⋯ Our study strongly suggests that an expert-directed, peer-conducted educational training program may improve the clinical reasoning of anesthesiology residents as measured by SCT.
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Review Case Reports
Bupivacaine drug-induced liver injury: a case series and brief review of the literature.
Bupivacaine is an established and efficacious anesthetic that has become increasingly popular in postoperative pain management. However, there is limited literature regarding the potential for bupivacaine-induced delayed liver toxicity. Describe cholestasis as a potential adverse reaction of bupivacaine infusion into a surgical wound. ⋯ All patients had negative serologic workups for other causes of liver injury. All patients achieved eventual resolution of their liver injury. Bupivacaine-induced liver injury should be on the differential of individuals presenting with jaundice and cholestasis within a month of infusion via a surgically placed catheter of this commonly used anesthetic.
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The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists. We discuss current data, guideline recommendations, and best practice advice on effective management of the direct oral anticoagulants and regional anesthesia, including in specific clinical situations, such as patients undergoing major orthopedic surgery at high risk of a thromboembolic event, or patients with renal impairment at an increased risk of bleeding.
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Comparative Study
Comparative analysis of respiratory muscle strength before and after bariatric surgery using 5 different predictive equations.
Obesity has detrimental effects on general health and respiratory function. This study aimed to evaluate respiratory muscle strength in the morbidly obese population, before and after bariatric surgery, and to compare these estimates with the predictive values using different mathematical equations available. ⋯ Of the 5 mathematical equations studied, that of Enright and colleagues was found best suitable for predicting the MIP in the obese population studied.
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Letter Case Reports Retracted Publication
A successful case of subcutaneous implantable cardioverter-defibrillator implantation performed under the transversus thoracic muscle plane block.