A & A case reports
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Sevoflurane vaporizers (GE Tec 7) were difficult to fill with "slow flow" and a need to "burp." Evaluation of the bottle of sevoflurane (AbbVie Ultane) demonstrated a contaminant. Four of the facilities' 13 sevoflurane vaporizers had the contaminant. ⋯ Gas chromatography revealed the production of multiple metabolites of sevoflurane, including primarily urea and 1,3,5-triazine-2,4,6(1H,3H,5H)-trione (83% and 9.6% of volatiles) in addition to multiple other organic molecules. Sevoflurane contains water that can accumulate in vaporizers allowing bacterial growth.
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The safety of anesthesia was dramatically improved by the introduction of pulse oximetry. This technology was rapidly adopted by anesthesiologists and made a standard of practice in many countries. ⋯ The Lifebox Foundation was formed to determine how a suitable oximeter could be made available to anesthesia providers in these countries. Almost 11,000 oximeters have been delivered in 90 countries, with education courses completed in over 50 countries.
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Tracheal surgery requires continued innovation to manage the anesthetic during an open airway phase. A common approach is apneic oxygenation with continuous oxygen flow, but the lack of effective ventilation causes hypercapnia, with respiratory acidosis. We used extracorporeal carbon dioxide removal for intraoperative decapneization during apneic oxygenation in a 64-year-old woman who was scheduled for tracheal surgery because of tracheal stenosis caused by long-term intubation. Our findings demonstrate that even after 40 minutes of total apnea, using an EZ-blocker for oxygenation and external decapneization, hemodynamic and gas exchange variables never demonstrated any dangerous alterations.
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Given the evolution of competency-based education and evidence supporting the benefits of incorporating simulation into anesthesiology residency training, simulation will likely play an important role in the training and assessment of anesthesiology residents. Currently, there are little data available regarding the current status of simulation-based curricula across US residency programs. In this study, we assessed simulation-based training and assessment in US anesthesiology programs using a survey designed to elicit information regarding the type, frequency, and content of the simulation courses offered at the 132 Accreditation Council of Graduate Medical Education-certified anesthesiology training programs. ⋯ The results from this survey highlight that there are currently large variations in simulation-based training and assessment among training programs. It also confirms that many program directors feel that standardizing some components of simulation-based education and assessment would be beneficial. Given the positive impact simulation has on skill retention and operating room preparedness, it may be worthwhile to consider developing a standard curriculum.