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Improving Clinical Performance of an Interprofessional Emergency Medical Team through a One-day Crisis Resource Management Training

medicine. Curr Opin Anesthesiol. 2013;26:699-706. 4. Rall M, Gaba D- Human Performance and Patient Safety. In Miller, RD (ed): Miller’s Anesthesia. Philadelphia: Elsevier Churchill Livingstone. 2005, pp. 3021-72. 5. Gaba D, Howard S, Fish K. Simulation-based training in anesthesia crisis resource management (ACRM): a decade of experience. Simul Gaming. 2001;32:175-93. 6. Morey JC, Simon R, Jay GD, et al. Error Reduction and Performance Improvement in the Emergency Department through Formal Teamwork Training: Evaluation Results of the MedTeams Project

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Pupillary dilation reflex and pupillary pain index evaluation during general anaesthesia: a pilot study

Abstract

Background. Pupillary response by pupillary dilatation reflex (PDR) is a robust reflex, even measurable during general anaesthesia. However, the ability of infrared pupillometry to detect PDR differences obtained by intraoperative opioid administration in anaesthesized patients remains largely unknown. We analyzed the performance of automated infrared pupillometry in detecting differences in pupillary dilatation reflex response by a inbuilt standardized nociceptive stimulation program in patients under general anesthesia with a standardized propofol/fentanyl scheme. Methods. In this single center, interventional cohort study 38 patients (24-74 years) were enrolled. Patients were anesthetized with propofol until loss of consciousness. Two dynamic pupil measurements were performed in each patient (before opioid administration and after opioid steady state). Automated infrared pupillometry was used to determine PDR during nociceptive stimulations (10-60 mA) applied by a inbuilt pupillary pain index protocol (PPI) to the skin area innervated by the median nerve. Increasing stimulations by protocol are device specific and automatically performed until pupil dilation of > 13%. Pupil characteristics, blood pressure, heart rate values were collected. Results. After opioid administration, patients needed a higher stimulation intensity (45.26 mA vs 30.79 mA, p = 0.00001). PPI score showed a reduction after analgesic treatment (5.21 vs 7.68, p = 0.000001), resulting in a 32.16% score reduction. Conclusions. PDR via automated increased tetanic stimulation may reflect opioid effect under general anaesthesia. Further research is required to detect possible confounding factors such as medication interaction and optimization of individualized opioid dosage.

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Tracheal intubation with channeled vs. non-channeled videolaryngoscope blades

Abstract

Study objective. Videolaryngoscopes can be fitted either with channeled or non-channeled blades, which may result in a different performance and success of tracheal intubation. We investigated the characteristics of the two different blade types of the commercially available KingVisionTMvideolaryngoscope. Design. A prospective, randomized, single center investigation study in a urological operation unit of a tertiary hospital. Subjects and Methods. Forty adult patients undergoing elective urological surgery in general anaesthesia with tracheal intubation were randomly allocated into group 1 (channeled videolaryngoscopy, n = 20) and group 2 (non-channeled videolaryngoscopy, n = 20). We measured the times from laryngoscope insertion to recognize the glottis and to conclude tracheal intubation. The number of laryngoscopy/intubation attempts and the degree of visual glottis exposure on a visual analog scale from 0 (glottis not visible) to 10 (glottis fully visible) was assessed. The lowest SpO2value during airway management was recorded. Results. There was no statistically significant difference in biometric data between the 2 groups. The time from the laryngoscope insertion to glottis recognition with the non-channeled blades was 5 (4-8) s as compared to the channeled ones with 11 (7-14) s (median and range; p = 0.01). Intubation duration was shorter with the channeled blades 17 (12-27) s vs. 29 (25-51) s (median and range; p < 0.001). Number of laryngoscopy/intubation attempts, grades for glottis visibility, intubation difficulty were not different. The lowest SpO2was 98% in both groups. Conclusions. Videolaryngoscopic glottis recognition time was longer and the total time to secure the airway was shorter with the channeled blades.

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Advantages of the New Tao Mask for Bag Mask Ventilation: a randomized crossover trial

, Cho KH, Choi YH, Yoon SY, Choi YH. Can you deliver accurate tidal volume by manual resuscitator? Emerg Med J 2008; 25: 632-634. doi: 10.1136/emj.2007.053678 12. Na JU, Han SK, Choi PC, Cho JH, Shin DH. Influence of face mask design on bag-valve-mask ventilation performance: a randomized simulation study. Acta Anaesthesiol Scand 2013; 57: 1186-1192. doi: 10.1111/aas.12169 13. Hess D, Spahr C. An evaluation of volumes delivered by selected adult disposable resuscitators: the effects of hand size, number of hands used, and use of

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Awake videolaryngoscope – guided intubation – well worth adding to your skill-mix

review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia 2008; 63: 745-760. doi: 10.1111/j.1365-2044.2008.05489.x 23. Ray DC, Billington C, Kearns PK, Kirkbride R, Mackintosh K, Reeve CS, et al. A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study. Anaesthesia 2009; 64: 1207-1210. doi: 10.1111/j.1365-2044.2009.06061.x 24. Cortellazzi P, Caldiroli D, Byrne A, Sommariva A, Orena EF, Tramacere I. Defining and developoing expertise in tracheal intubation using a

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Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study

factors of patients with solid tumors admitted to an ICU. Am J Hosp Palliat Care. 2008;25(3):240-3. 8. Namendys-Silva SA, Texcocano-Becerra J, Herrera-Gómez A. Application of the Sequential Organ Failure Assessment (SOFA) score to patients with cancer admitted to the intensive care unit. Am J Hosp Palliat Care. 2009;26(5):341-6. 9. Soares M, Fontes F, Dantas J, et al. Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Crit Care. 2004;8(4):R194-203. 10

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Anaesthesia and Intensive Care Residents’ Perception of Simulation Training in Four Romanian Centres

. Can J Anaesth. 2010;57(2):134-42. 11. Blum RH, Boulet JR, Cooper JB, Muret-Wagstaff SL; Harvard Assessment of Anesthesia Resident Performance Research Group: Simulation-based assessment to identify critical gaps in safe anaesthesia resident performance. Anesthesiology. 2014;120(1):129-4. 12. Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R: Does training on an anaesthesia simulator lead to improvement in performance? Br J Anaesth. 1994;73:293-7. 13. Savoldelli GL, Naik VN, Hamstra SJ, Morgan PJ: Barriers to use of simulation

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Simulation-based Training as Perceived by Young Anesthesiology and Intensive Care Residents

R eferences 1. O’Sullivan O, Iohom G, O’Donnell BD, Shorten GD. The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting – a pilot study. BMC Anesthesiol. 2014;14:110. 2. Gerlach H, Toussaint S. Between prediction, education, and quality control: simulation models in critical care, Crit Care. 2007, 11:146. doi:10.1186/cc5950. 3. Price JW, Price JR, Pratt DD, Collins JB, McDonald J. High fidelity simulation in anesthesiology training: a survey of Canadian

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Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

. Congenital heart disease in the newborn requiring early intervention. Korean J Pediatr. 2011;54:183–91. doi: 10.3345/kjp.2011.54.5.183 5. Olney RS, Ailes EC, Sontag MK. Detection of critical congenital heart defects: Review of contributions from prenatal and newborn screening. Semin Perinatol. 2015;39:230-7. doi: 10.1053/j.semperi.2015.03.007. 6. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an antepartum obstetric ultrasound examination. J Ultrasound Med. 2003;22:1116–25. 7. AIUM practice guideline for the

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Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

. Axelsson L, Bergenfeldt M, Ohlsson K. Studies of the release and turnover of a human neutrophil lipocalin. Scand J Clin Lab Invest. 1995; 55(7):577-88 15. Cai L, Rubin J, Han W et al. The origin of multiple molecular forms in urine of HNL/NGAL. Clin J Am Soc Nephrol. 2010; 5(12):2229-35. 16. Cai L, Borowiec J, Xu S, Han W, Venge P. Assays of urine levels of HNL/NGAL in patients undergoing cardiac surgery and the impact of antibody configuration on their clinical performances. Clin Chim Acta. 2009; 403:121. 17. Glassford NJ, Schneider AG, Xu S, et al

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