Postoperative hyperthermia in a patient having cortical brain resection.

When a profound fever occurs in a surgical patient, clinicians usually start thinking about the malignant hyperthermia syndrome. Simple consideration of the clinical situation, the patient's medical history, and a few rapid laboratory assessments are enough to direct appropriate treatment.

A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy.

Regional analgesia, in a variety of forms, has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair. This study compares the efficacy of wound instillation with 0.25% bupivacaine (n = 20), caudal block with 0.25% bupivacaine (n = 35), and a control group (n = 15). Outcome parameters examined include total operating room time, time to extubation, postoperative objective pain scales, and requirement for supplemental analgesics. Patients who received caudal blocks had significantly decreased emergence times (P < .002), exhibited fewer pain-related behaviors postoperatively (P < .0025), and required less narcotic to maintain normal hemodynamics (P < .05). Operating room time was not statistically different between the three groups. The use of perioperative analgesic blocks resulted in quicker awakening, a more comfortable postoperative course, and potentially earlier discharge from same-day surgery.

Selection of anesthesiology residents.

BACKGROUND: CARCS (computer-assisted resident candidate selection) is a database application developed in 1983 at the Department of Anesthesiology of the Medical University of South Carolina to deal with the greatly increased quantity of applicant information. This article relates a representative sample of CARCS data to the process of selecting residents in general. METHOD AND RESULTS: CARCS files were analyzed for 1985-86, 1986-87, 1990-91, and 1991-92, and data for each year were derived as simple averages and percentages for two groups: (1) the entire pool of residency applicants (approximately 200 per year) and (2) the eight residency candidates per year who actually matched with the program through the National Resident Matching Program, Analyses showed that the standardized test scores, grades, and class ranks of the matched candidates were not significantly higher than those of the applicants; however, the matched candidates' scores for letters of reference and for interviews were consistently higher than those for the applicant pool. CONCLUSIONS: The results support the view of medical educators that the traditional academic criteria are not sufficiently predictive of clinical performance or interpersonal skills. Research relating residents' performances to personality, learning style, and other neuropsychological factors may provide needed alternatives to knowledge testing by developing combined cognitive-noncognitive profiles. The anesthesiology clerkship experience is now almost universal among applicants and could be structured to provide pertinent information about potential residents through direct observation as well as behavioral testing.

Stability of midazolam hydrochloride in a flavored, dye-free oral solution.

The stability of injectable midazolam hydrochloride in a solution for oral use was studied at three temperatures over 56 days. A 2.5-mg/mL oral solution was prepared from injectable midazolam hydrochloride and a flavored, dye-free syrup. Samples of solution were stored in amber glass bottles at 7, 20, or 40 degrees C. Duplicate samples were analyzed by high-performance liquid chromatography on days 0, 1, 3, 5, 14, 21, 35, and 56. Samples were also visually inspected on each sampling day. The concentrations of all samples remained greater than 90% of the original concentration and there were no visual signs of microbial growth or changes in color, turbidity, or odor throughout the 56-day period. A 2.5-mg/mL solution of injectable midazolam in syrup was stable for 56 days at 7, 20, or 40 degrees C.