ABSTRACT
OBJECTIVE: The specific aim of this study was to determine the ability of anesthesiology residents to independently identify a series of anatomic structures in a live model using ultrasound, both before and after a 4-week regional anesthesia rotation that incorporates a standardized ultrasound training curriculum for peripheral nerve blockade. METHODS: Ten CA2 and CA3 anesthesiology residents volunteered to participate in this study. Each resident was subjected to a pre-rotation practical exam, in which he attempted to identify 15 structures at four sites of peripheral nerve blockade, in a test subject. Each resident then received specific training for ultrasound-guided nerve blocks during a 4-week regional anesthesia rotation, and then completed a post-rotation exam. The mean number of structures correctly identified on the exams was compared for significant differences utilizing a paired t-test. RESULTS: Residents were able to identify significantly more anatomic structures on the post-rotation exam as compared with the pre-rotation exam (mean 14.1 vs. 9.9, P<.001), as well as more peripheral nerve targets. The most frequently misidentified structures on the pre-rotation exam were the subclavian vein, the sciatic nerve in the popliteal fossa, and the femur. CONCLUSIONS: Ultrasound-naive anesthesiology residents, who received instruction and experience with ultrasound-guided peripheral nerve blocks on a 4-week regional anesthesia rotation, significantly improved their ability to independently identify relevant anatomic structures with ultrasonography.
Subject(s)
Anesthesia, Conduction/methods , Anesthesiology/education , Internship and Residency , Humans , UltrasonographyABSTRACT
This paper reports a case of simultaneous diaphragmatic and brachial plexus stimulation followed by a successful nerve block using the supraclavicular approach. An explanation for the qualitative differences in phrenic nerve block between interscalene and supraclavicular block is postulated, based on known anatomical variations.
Subject(s)
Nerve Block/adverse effects , Paresthesia/etiology , Phrenic Nerve/abnormalities , Adult , Brachial Plexus , Clavicle , Diaphragm/physiopathology , Humans , Male , Phrenic Nerve/anatomy & histology , Supination , ThumbABSTRACT
Commercial and control solutions of bupivacaine (0(.)75%) and mepivacaine (1(.)5%) were alkalinized with bicarbonate until cloudy at room temperature. The solutions were heated to 37 degrees C for 2(.)5 h. The precipitates were filtered, lyophylized and analysed by fast atom bombardment mass spectrometry. Analysis showed the precipitates to be predominantly the free base of the local anaesthetic. The precipitate of the commercial bupivacaine solution also contained a small amount of the hydrochloride salt. The mepivacaine control crystals contained an unknown at molecular weight 528, which may represent a dimer of the free base and hydrochloride salt.
Subject(s)
Anesthetics, Local/chemistry , Bupivacaine/chemistry , Mepivacaine/chemistry , Chemical Precipitation , Hydrogen-Ion Concentration , Mass Spectrometry , Molecular Weight , Sodium Bicarbonate/chemistryABSTRACT
Medical students, residents, and allied health professionals often have difficulty quantitating ventilation-perfusion mismatch in ill patients. This manuscript quantitates ventilation-perfusion mismatch using the underlying physiological concepts and equations that describe mismatch. In addition, clinical problems with diagrams and worked-out solutions are supplied to help students master these equations as well as their practical limitations.
Subject(s)
Education, Medical/methods , Models, Biological , Physiology/education , Pulmonary Circulation , Ventilation-Perfusion Ratio , Humans , Pneumonia/physiopathology , VeinsABSTRACT
Thrombelastography (TEG), a less commonly available technique used to assess hemostatic function, has recently gained popularity. Analysis of TEG yields qualitative information about platelet function, thromboplastin generation and their interaction with the intrinsic cascade to form a stable clot. Additional information is obtained about fibrinogen and Factor XIII levels as well as the fibrinolytic system. TEG has been shown to be more sensitive and accurate than traditional coagulation tests at both predicting and treating coagulopathies. We report here three cases in which TEG was used to assess hemostatic function in patients at risk for bleeding prior to the induction of regional anesthesia. In all three cases, traditional tests were inadequate to predict the safe practice of regional anesthesia. TEG provided this information and regional anesthesia was successfully employed.
