Journal of clinical anesthesia
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To determine the number of interscalene blocks that are necessary for a resident in anesthesiology to complete so as to achieve autonomous success with that specific block. ⋯ Experience with only 40 unspecified peripheral nerve blocks, as currently required by the Residency Review Committee as of January 2001, may not provide adequate opportunity for an individual to develop expertise in regional anesthesia.
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This essay examines the effects of unexpected pediatric death on anesthesiology house staff, and offers a discussion of normal and abnormal patterns of grieving. The increased incidence of substance abuse and suicide among anesthesiologists is discussed, and the relationship of stress following patient death and appropriate coping skills is explored. A blueprint for managing stress is given based on a military combat stress model, and recommendations for residency training programs are made.
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To determine the necessity for ionized magnesium (iMg) assay by evaluating the effect of abdominal surgery without massive transfusion on total magnesium (Mg) and iMg concentrations. ⋯ During abdominal surgery without massive transfusion, both total and ionized hypomagnesemia occur. Changes in iMg and total serum Mg concentrations are closely correlated. Total serum Mg assay, while overestimating the prevalence of ionized hypomagnesemia, is sufficient to screen for hypomagnesemia.
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Case Reports
Epicardial echocardiography: diagnostic utility for evaluating aortic valve disease during coronary surgery.
Intraoperative epicardial echocardiography is commonly used to evaluate the ascending aorta for atheromatous disease before cannulation and cross clamping. In addition, it may serve as a cardiac imaging technique in patients where placement of a transesophageal echocardiography (TEE) probe is contraindicated, probe advancement is difficult, or a TEE probe is not available. ⋯ However, attempts to place a TEE probe were abandoned due to high resistance on probe insertion. Epicardial echocardiography revealed previously undiagnosed aortic valve disease resulting in replacement of this valve.