Prone cardiopulmonary resuscitation in elderly undergoing posterior spinal fusion with laminectomy.

An 80-year-old male patient presented with 2 weeks history of low back pain undergoing posterior spinal fusion with laminectomy in the prone position. The patient was induced with fentanyl, propofol, and rocuronium, and then he was positioned in the prone position. After 6 h of starting the surgery, the patient started to be hypotension and bradycardia followed by pulseless electrical activity (PEA). Code blue was activated intraoperatively with immediate initiation of cardiopulmonary resuscitation (CPR) in the prone position and multiple epinephrine boluses. Fortunately, the patient had return of spontaneous circulation. After stabilization, he was taken for computed tomography scan which showed massive pulmonary embolization and management was continued in the intensive care unit. CPR in the prone position has shown to be effective for return of spontaneous circulation after PEA.

Preference of cognitive approaches for decision making among anesthesiologists' in Saudi Arabia.

AIMS: The aim of this study was to analyze the thinking processes of anesthesia physicians at in Riyadh, Jeddah, and Dammam cities in Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional study was undertaken in the cities of Riyadh, Jeddah, and Dammam in Saudi Arabia. Using a previously published psychometric tool (the Rational and Experiential Inventory, REI-40), the survey was sent through email and social networks to anesthesia physicians working in the targeted hospitals. An initial survey was sent out, followed by a reminder and a second survey to nonrespondents. Analysis included descriptive statistics and Student's t-tests. RESULTS: Most of the participants (69.2%) were males. At the time of the study, 35% of participants were consultants; 9.6% were associate consultants; 19.2% were registrars, fellows, or staff physicians; and 35.8% were senior residents. Anesthesia physicians' mean "rational" score was 3.22 [standard deviation (SD) =0.49)] and their mean "experiential" score was 3.01 (SD = 0.31). According to Pearson's correlation, the difference of 0.21 between these two scores was not statistically significant (P = 0.35). Male anesthesia physicians tended more toward faster, logical thinking. Consultant anesthesia physicians had faster rational thinking than nonconsultant physicians (P = 0.01). Anesthesia physicians with more than 10 years in practice had faster rational thinking than physicians who had worked for fewer than 10 years (P = 0.001). CONCLUSIONS: This study evaluated anesthesia physicians' general decision-making approaches. Despite the fact that both rational and experiential techniques are used in clinical decision-making, male consultants and physicians with more than 10 years' experience and certified non-Saudi board anesthesiologists prefer rational decision-making style.