Hi-Fi simulation: teaching crisis resource management to surgery residents

High-fidelity [HiFi] simulation has shown its effectiveness for teaching crisis resource management [CRM] principles, and our institutional experience in this area is mainly with anesthesiology residents. We recently added to our postgraduate curriculum a new CRM course designed to cater to the specific needs of surgical residents. This short communication describes the experience of the University of Montreal Simulation Centre [Centre d'Apprentissage des Attitudes et Habiletes Cliniques CAAHC] regarding HiFi simulation-based CRM and communication skills teaching for surgical residents. Thirty residents agreed to participate in a simulation course with pre-established scenarios and educational CRM objectives on a voluntary basis. When surveyed immediately after the activity, all residents agreed that the educational objectives were well defined [80% [strongly agree] and 20% [agree]]. The survey also showed that the course was well accepted by all participants [96% [strongly agree] and 4% [agree]]. Further trials with randomized groups and more reliable assessment tools are needed to validate our results. Still, integrating HiFi simulation based CRM learning in the surgical residency curriculum seems like an interesting step

Efficacy of patient controlled epidural analgesia during labor analgesia - a prospective randomized study using 0.1% bupivacaine with fentanyl 2 microg/ml

Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics [LA] and driving block are the major limits of the modalities of maintenance. The purpose of this work was to assess efficiency and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia [PCEA]. 40 monofoetal parturients were randomized in two groups: 0.1% bupivacaine continuous drip associated to fentanyl 2 Ig/mL [CP-group] or same products administrated in PCEA. Evaluation of analgesia, driving and sensory block allows adapting the outputs of drip. Consumption schedule in LA was of 7.5 +/- 2 mL/h in the CP-group and 3.5 +/- 1.5 mL/h in PCEA-group [p < 0.05]. Consumption accumulated by LA is reduced by 35% from the very beginning and 43% a 4-th hour [p < 0.05]. Incidence of the driving block was of 11 cases in CP-group against 4 in PCEA-group per first hour and of 13 cases against 3 per second hour [p < 0.001]. 50% of clinical obstetric interventions were brought together in the CP-group against 5% in the PCEA-group [p = 0.013]. Incidence of side effects is comparable. Besides the perfect analgesia, PCEA offers a psychic independence which explains comfort and maternal satisfaction. Accumulation of LA entails a driving block involved in the change of dynamics of the labor. Incidence of clinical obstetric interventions is the major observation of our study