Safety and efficacy of video DLT (VDLT) for lung isolation during the COVID?19 pandemic

One lung ventilation (OLV) with collapse of the ipsilateral lung is a prerequisite for most thoracic surgical procedures. Double?lumen tube (DLT) is still the preferred method to isolate the lungs and fiberoptic bronchoscopy (FOB) is the gold standard for the confirmation of correct placement of the DLT. However, both these procedures are considered as a high?aerosol?generating procedures and are hazardous to the health workers, particularly at this time of the COVID?19 pandemic. We did nine thoracic surgery cases categorized as essential, requiring OLV during the ongoing period of the COVID?19 between April 2020 and May 2020 where we used Full view DLT for lung isolation. We present our case series which shows that the Full view VDLT can minimize or circumvent the use of FOB during OLV, and reduce the time taken to isolate the lungs thus reducing aerosol in the theater. None of the nine patients required FOB for confirmation of initial positioning nor for diagnosis of intraoperative malposition. The time taken to isolate the lungs was significantly less and the surgical positioning was done under real?time monitoring by visualizing the blue cuff distal to carina at all times. The real?time monitoring by the Full view VDLT offers the additional advantage of detecting any malposition even before it results in loss of isolation or desaturation. We conclude that the Full view VDLT is an efficient and safe alternative for lung isolation at this time of the COVID?19 pandemic.

Transfusion related acute lung injury: a case report

Transfusion Related Acute Lung Injury (TRALI) is one of the most serious complications of blood transfusion. All blood components have been implicated and most often those that contain plasma. The diagnosis is based fundamentally on the integration of clinical, radiological and gasometry elements, once the rest of the possible causes of acute lung injury have been ruled out. The differential diagnosis of a patient who develops a sudden pattern of respiratory failure after a transfusion of blood products must include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products, haemolytic transfusion reaction and TRALI. Author presented the clinical case of a 33-year-old female patient with grade III hypovolemic shock due to a ruptured ectopic pregnancy, reanimated with crystalloid solutions, globular packages and fresh frozen plasma. The patient developed TRALI for what was managed with ventilatory and hemodynamic support in ICU.

Tooth injury in anaesthesiology / Lesão dentária na anestesiologia

BACKGROUND AND OBJECTIVES: Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS: In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS: Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.

JUSTIFICATIVA E OBJETIVOS: A lesão dentária é a complicação mais comum da anestesia geral e apresenta importantes consequências físicas, econômicas e médico-legais. O objetivo deste estudo é fazer uma revisão sobre as características da lesão dentária associada a anestesiologia e os métodos de prevenção existentes. CONTEÚDO: Nesta revisão são abordados o momento da anestesia em que a lesão dentária ocorre, os dentes acometidos, o tipo de lesão mais frequente, os fatores de risco estabelecidos, as estratégias de prevenção, os dispositivos de proteção e as implicações médico-legais inerentes à sua ocorrência. CONCLUSÕES: Antes de iniciar qualquer procedimento médico que exija o recurso à laringoscopia clássica é imperativa uma avaliação pré-anestésica minuciosa e detalhada do estado dentário do doente, de forma a identificar os dentes em risco, analisar a presença de fatores associados a dificuldades de intubação e delinear uma estratégia de prevenção que seja adaptada ao risco de lesão dentária de cada doente.

Work-related mental and behaviour disorders in anesthesiologists / Transtornos mentais e do comportamento relacionados ao trabalho em médicos anestesiologistas

BACKGROUND: Anaesthesiology is a specialty whose specificity of the working process results in high levels of stress as an inevitable condition - a particularly worrying situation in the daily life of these professionals. OBJECTIVES: This study, based on data from national and international literature, aims to discuss the basis of the occurrence of mental and behavioural disorders or of psychopathological injuries (psychological distress) related to working activity in anesthesiologists. METHOD: A literature review was conducted, with papers selected from Medline and Lilacs databases, published between 2000 and 2012 in Portuguese, English and Spanish, and addressing the possible association between occupational hazards of the anaesthesiologist profession and mental health problems and psychic distress. Twenty-six publications were listed. RESULTS: Several aspects of the anesthesiologist's work are important points to better understand the relationship between mental health at work and working organization. Poor temporal structuring of work, conflictuous interpersonal relationships and poor control over the activity itself may be mentioned as illness enhancers. CONCLUSION: The working organization, when not appropriate, is an important occupational risk factor for the life and mental health of workers, mainly of professionals focused on the care of people. This paper focuses on anesthesiologists, who are constantly exposed to stressful and anxiogenic factors.

JUSTIFICATIVA: a anestesiologia é uma especialidade cuja especificidade do processo de trabalho torna elevados níveis de estresse uma condição inevitável, situação preocupante no cotidiano desses profissionais. OBJETIVOS: o presente estudo, fundamentado em dados da literatura nacional e internacional, tem o propósito de discutir as bases da ocorrência de transtornos mentais e de comportamento ou agravos psicopatológicos (sofrimento psíquico) relacionados à atividade laboral em médicos anestesiologistas. MÉTODO: fez-se uma revisão de literatura em que foram selecionados artigos científicos nas bases de dados Medline e Lilacs, publicados entre 2000 e 2012, em português, inglês e espanhol, que abordam a possível associação entre riscos ocupacionais da profissão de médico anestesiologista e problemas de saúde mental e sofrimento psíquico. Foram enumeradas 26 publicações. RESULTADOS: vários aspectos do trabalho do médico anestesiologista apresentam-se como pontos importantes para a compreensão das relações entre saúde mental no trabalho e organização do trabalho. Podem ser destacados como adoecedores a má estruturação temporal do trabalho, as relações interpessoais conflituosas e o mau controle sobre a própria atividade. CONCLUSÃO: a organização do trabalho, quando não adequada, é um importante fator de risco ocupacional para a vida e a saúde mental dos trabalhadores, principalmente, dos profissionais voltados para o cuidado de pessoas. O foco presente são os médicos anestesiologistas, constantemente expostos a fatores estressantes e ansiogênicos.

Thinking of cultivating critical care thinking in anaesthesiology teaching / 中华医学教育探索杂志

The global and local,goal and destination,treatment and reinjury are three common critical thinking,which has the vital significance to the teaching of anesthesiology.Through the classroom interpretation of the pathogenesis,we preliminarily cultivate the students' global and local thinking by guiding students to find the primary problem in the global and local and finding out the breakthrough point of disease treatment.Through the case teaching,we promote students to constantly strengthen their goal and destination thinking by guiding students to select target,determine the endpoint,and solve the problem in stages to make the treatment of the critically ill patient which students simulate has good operability.Through adoption of problem based learning,we make students know how to achieve the optimal treatment effect by guiding them to have extensive discussions and have access to information so as to cultivate students' treatment and reinjury thinking and enhance their global and local thinking at the same time.

La calidad en la formación de los recursos humanos en anestesiología y reanimación / Quality in the formation of human resources in Anaesthesiology and Reanimation

Introducción: la calidad es un concepto extraído de la industria y aplicado a la medicina, que ha evolucionado constantemente durante los últimos años. Objetivo: Identificar el nivel de la calidad en la formación de recursos humanos en la especialidad de Anestesiología y Reanimación. Métodos: Con fecha 2 de mayo y hasta el 2 de junio del 2012 se circuló por la lista de Anestesiología una encuesta que sirviera para identificar el estado actual de la calidad de la formación de los recursos humanos en Anestesiología y Reanimación. Se realizó de forma anónima, por medio de preguntas de fácil respuesta dirigidas a residentes de tercero y cuarto año. Resultados: La mayoría de los encuestados (90 %) señalaron que se cumplieron las expectativas en su formación académica como anestesiólogos y que esta estuvo acorde con el nivel científico de sus profesores. Asimismo manifestaron que la calidad de la educación influyó en el trabajo y calificaron su formación de excelente y buena. Otros (10 %) señalaron que las pirámides docentes están incompletas, que no hay nuevas tecnologías para aplicar en la especialidad y calificaron su formación como regular. Conclusiones: Independientemente de los resultados obtenidos en el estudio, los profesores de mayor nivel académico deben trabajar con más exigencia. Se sugiere aplicar un sistema de gestión de la calidad que cumpla con los requisitos establecidos por las Normas ISO 9000:2000, que evalúe de forma frecuente y mantenida la calidad de la formación de recursos humanos.

Background: quality is a concept that has been drawn from industry and applied to Medicine. This concept has evolved in recent years. Objectives: To identify the quality of life in the formation of human resources in the specialty of Anaesthesiology and Reanimation. Methods: from May, 2 to June 2, an inquiry was done by the Anaesthesiology Department in order to identify the current state of quality in the formation of human resources in Anaesthesiology and Reanimation. This survey was carried out anonymously by asking easy questions to the 3rd and 4th year residents. Results:The majority of the respondents (90%) pointed out that their expectations for their academic formation as Anaesthesiologists were fulfilled which was in agreement with the scientific level of their professors. Similarly, they stated that the quality of education influenced in their work and marked their formation as excellent and good. Other respondents (10%) pointed out that the teaching pyramids are incomplete, that there are no new technologies to apply in the specialty and qualified it as regular. Conclusions:It is concluded that, regardless of the results obtained in the study, the professors with the highest academic levels should be more demanding. The implementation of a quality management system that responds to the requirements established by the ISO norms 9000:2000 and evaluates the quality of the formation of human resources in a systematic and maintained form is also suggested.

Conocimiento del desfibrilador automático externo (DEA) por parte de candidatos a instructores en reanimación básica / Trainee basic reanimation instructors' knowledge concerning an automated external defibrillator (DEA)

Antecedentes. El uso apropiado del desfibrilador automático externo (DEA) hace parte del tercer eslabón de la cadena de supervivencia, fundamental para el manejo del paro cardiaco más frecuente en el adulto, la Fibrilación Ventricular (FV). La capacitación en las maniobras básicas de reanimación tiene 3 estaciones de trabajo: la RCP o maniobras de compresiones y ventilaciones, el manejo de la obstrucción de la vía aérea y el manejo del DEA. Objetivo. Evaluar el conocimiento previo que tienen sobre el DEA, los aspirantes a instructores en Reanimación Cardiocerebropulmonar (RCCP) Básico. Material y Métodos. Estudio de corte transversal descriptivo, en asistentes al taller de formación de instructores en RCCP Básico (n=4 residentes de anestesiología y 29 anestesiólogos), durante el Congreso Peruano de Anestesiología (octubre de 2012). En la estación de manejo del DEA se realizó un taller de formación de instructores en RCCP Básico a 4 residentes de anestesiología y 29 anestesiólogos. En la estación del manejo del DEA se realizó una encuesta a partir de 3 interrogantes básicos: ¿para qué sirve?, los factores que interfieren en su funcionamiento y las indicaciones. Resultados. Los 33 asistentes respondieron la encuesta. 17 participantes, respondieron correctamente la primera pregunta. En la segunda pregunta, 14 participantes no propusieron ningún factor; 11 acertaron con un solo factor, 3 con 2 factores y 5 con 3 factores. En la tercera pregunta, 14 contestaron correctamente. Conclusión. Este estudio encontró un desconocimiento al ingreso al taller, de los principios básicos del DEA. Se sugiere continuar con los lineamientos básicos de enseñanza en el manejo del DEA y de renovar la adquisición de estas competencias en un periodo no mayor de 2 años.

Background. The proper use of an automated external defibrillator (AED) forms part of the third link in the chain of survival; it is fundamental in managing ventricular fibrillation (VF the most commonly occurring cardiac arrest in adults). Training in basic resuscitation manoeuvres consists of 3 workstations: cardiopulmonary resuscitation (CPR) or compression and ventilation manoeuvres, airway obstruction management and AED management. Objective. Assessing basic cardiocerebral pulmonary resuscitation (CCPR) trainee instructors' prior knowledge concerning AED. Methods. This was a descriptive crosssectional study regarding trainees attending a basic CCPR workshop which was run by the AED management station during the Peruvian Anaesthesiology Congress held in October 2012 (n = 4 anaesthesiology residents and 29 anaesthesiologists). Three basic questions were asked in a survey of those attending the AED management station: "What is its purpose?", "Which factors interfere with its operation?" and "What are the pertinent indications?" Results. Seventeen of the 33 participants answering the survey answered the first question correctly. Fourteen participants did not propose any factor at all in response to the second question, eleven stated a single factor, three stated 2 factors and five 3 factors. Fourteen answered the third question correctly. Conclusion. The study revealed a lack of knowledge regarding the basic principles of AED on admission to the workshop. It is thus suggested that efforts be made to continue teaching basic guidelines regarding how to manage AED and that acquiring these skills should be renewed in a period not exceeding two years.

Boletim eletrônico de anestesia: a anestesiologia na era digital / Electronic report of anesthesia: the anaesthesiology in the digital age

A sociedade, assim como a Medicina, esteve, nas últimas décadas, questionando condutas e priorizando ações que melhor se adaptassem ao conceito de ser ecologicamente correto. Com isso, renderam-se às facilidades do mundo digital, trazendo à rotina hospitalar, entre tantas outras novidades, prontuários e boletins eletrônicos. O boletim de anestesia é um dos instrumentos de trabalho do anestesiologista, sendo um documento de relevante importância por conter todas as informações relativas ao paciente e acontecimentos ocorridos na sala cirúrgica. Seu uso está fortemente vinculado à defesa do profissional em casos jurídicos, à avaliação das técnicas anestésicas utilizadas, às pesquisas epidemiológicas e ao ensino e aprendizagem de médicos especializados. Atingir a meta de uma documentação clara e completa em cada boletim de anestesia é um desafio, especialmente em situações em que o anestesiologista é responsável pelo cuidado de múltiplos pacientes e seu foco primário de atenção está no cuidado ao paciente e no ensino a médicos especializandos. Frente a esta realidade, a era digital na anestesiologia tem apresentado promissoras soluções...

The society, as well as medicine, has been challenging behaviors and prioritizing actions that would be better adapted to the concept of being environmentally friendly in recent decades, with facilities that haue surrendered to the digital world, bringing to the hospital routine, among many other innovations, electronic records and newsletters. The report of anesthesia is one of the working tools of the anesthesiologist and a document of great significance because it contains ali information relating to patients and events in the operating room. Its use is strongly linked to the defense of professional legal cases, evaluation of anesthetic techniques used, the epidemiological research and teaching and learning of medical trainees. Achieving the goal of a complete and clear documentation of anesthesia in each report is a challenge, especially in situations where the anesthesiologist is responsible for the care of multiple patients and their primary focus of attention is on patient care and education for medical trainees. Faced with this reality, the digital age has made anesthesia promising solutions...

Exploration on the teaching reformation of anesthesiology / 中华医学教育探索杂志

In order to better match the teaching hours of clinical anesthesiology with the teaching content of modem anesthesia, the teachers must take full advantage of various supplementary teaching methods in the limited teaching hours to help enhance the students' enthusiasm in active learning, help the students concentrate on the crucial points and apply their knowledge and ultimately improve the teaching quality.

Three-dimensional case teaching method and its application to anesthesia teaching / 中华医学教育探索杂志

There are many subjects related to anesthesiology and the band between anesthesiology and clinical practicevery is close. So students can not be proficient in anesthesiology by traditional teaching methods. The use of three-dimensional case teaching method in anaesthesiology teaching is a good attemptment. three-dimensional case teaching method integrate case method, multimedia technology and clinical case. It can help medical students analyze and solve clinical problems, improvetheir academic performance and enhance their clinical basic skills.

Bacteriological Profile of Epidural Catheters.

The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterization and before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, the portion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bit just before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and the anaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcus epidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining 23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures from skin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal action of the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tip culture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 cases the cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

Auditoria média en anestesia / Audit medicates in anestesiology

Debido a la difusión de los derechos de los pacientes, el profesional médico se ve afectado por denuncias públicas. Esto lleva al desarrollo de Programas de Auditoria Médica que tiene por objeto la evaluación periódica de la calidad de atención médica a través del expediente clínico. La Auditoria Médica es un mecanismo de perfeccionamiento y educación médica continua, basada en la utilización de normas, protocolos y registros, aplicando acciones correctivas y preventivas, permitiendo tomar resguardo en aspectos técnicos, administrativos, éticos y principalmente médico legales. Engloba aspectos educativos, de control, normativos, investigativos, médico legales, evaluativos, sistemáticos, multidisciplinarios, la gestión de calidad y los aspectos financieros. La Auditoria Médica evalúa el acto médico del anestesiólogo a través de la evaluación de: la visita preanestésica, del manejo transoperatorio, la posanestesia y el alta de recuperación, los acontecimientos adversos y el registro anestésico. Por tanto la responsabilidad del médico anestesiólogo es cada vez mayor y la Auditoria Médica esté dirigida a prevenir el error médico y contribuye a elevar la calidad asistencial en los hospitales.

Due to the diffusion of the rights of the patients, the medical professional meets affected by public denunciations. This leads to the development of Programs of Medical Audit that takes as an object the periodic evaluation of the quality of medical attention across the clinical process. The Medical Audit is a mechanism of development and medical constant education, based on the utilization of procedure, protocols and records, applying corrective and preventive actions(shares), allowing to take security in technical, administrative, ethical aspects and principally medically legal. Doctor includes educational aspects, of control, normative, investigative, legal, evaluative, systematic, multidisciplinary, the management of quality and the financial aspects. The Medical Audit evaluates the medical act of the anesthesiologist across the evaluation of: the visit preanestésic, of the managing transoperatory, the posanestesic and the discharge of recovery, the adverse events and the anesthesic record. Therefore the responsibility of the doctor anesthesiologist is every time major and the Medical Audit is directed to anticipate the medical mistake and helps to raise the welfare quality in the hospitals.

Primary Discussion on Ability Culture of Interns in Anaesthesiological Department / 中华医学教育探索杂志

Objective:to culture excellent bachelor majoring in anesthesiology.Methods:to make teaching plan for practice in anesthesiological department with emphasis on following aspects:culture of emotional intelligence;development of the sense of responsibility for work;training of clinical thought to combine theory and practice and training of basic techniques;formation of good relationship and communication with the others and culture of scientific research ability.Results:All faculties execute the plan carefully,and all the interns graduate with clinical and research ability as expected.Conclusion:It is very important for ability improvement of interns to make and execute available plan,keep strict and careful attitude,train their clinical thought and basic techniques,and emphasis the sense of responsibility for work.

Discussion of our hospital's expansion of services offered by the department of anaesthesiology / 中华医院管理杂志

Expansion of services offered by the department of anaesthesiology in a hospital not only satisfies social needs but also conforms to the hospitals need for survival and development. Hence some hospitals have adopted the following methods to expand the services offered by their department of anaesthesiology: ①improvement of the anaesthesiologists skills; and ②delivery of such additional services as painless childbirth, deep vein tube placement, dressing change and pain easing for patients with extensive burn, fast extrication from drugs, painless endoscopy and treatment of pain. With the improvement of the expertise and the service quality of the department of anaesthesiology, sound social and economic benefits have been obtained.