Does A Low 6-Minute Walk Distance Predict Elevated Postoperative Troponin?

Our study of 100 major vascular and renal transplant patients evaluated the 6-minute walk test (6MWT) as an indicator of perioperative myocardial injury, using troponin as a marker. Using logistic regression and the area under the receiving operator characteristic curve, we compared the 6MWT to the Revised Cardiac Risk Index and metabolic equivalents. Only the 6MWT was associated with elevated postoperative troponins (95% CI, 0.98-0.99). However, the 6MWT area under the receiving operator characteristic curve (0.71 [95% CI, 0.57-0.85]) was not different from the Revised Cardiac Risk Index (P = .23) or metabolic equivalents (P = .14). The 6MWT may have a role in cardiac risk stratification in the perioperative setting.

Transitioning from 1:1 to 1: 2 Supervision in Anesthesia Training: A Descriptive Survey.

BACKGROUND: Advancement from 1:1 to 1:2 (attending to resident) supervision at the beginning of a CA-1 (clinical anesthesia) year can serve as a model for transition to milestone-based curricula. Currently most programs have an individual mixture of training and advancement criteria formed at the discretion of educational leadership. We designed a questionnaire to evaluate degree of variability at programs nationally. METHODS: After obtaining IRB approval, an anonymous survey was sent via Survey Monkey to all Anesthesiology Residency Program Directors with a link for faculty members. The survey remained open for 30 days and two reminders for completion were sent. RESULTS: Among responses from Program Directors, the following competency areas showed most agreement in being absolutely required for advancement: when to call an attending (78%), preoxygenation (60%), room preparation (81%), monitor placement (81%), machine check (77%), and airway assessment (73%). Responses from faculty identified as most important when to call the attending (82%), basic crisis management while waiting for help (64%), monitor placement (77%), machine check (79%), room preparation(77%), and airway assessment (66%). CONCLUSIONS: There are no clear guidelines for transition from 1:1 to 1:2 supervision with wide variability in the design and requirements for the transition. With only modest agreement among and between Residency Program Directors and faculty members at this clearly defined transition, the challenges of implementation of milestones at every level are significant.

Relative performance of the level 1 and ranger pressure infusion devices.

UNLABELLED: Pressure infusion devices are often used to administer fluids in the operating room, but they may rarely be associated with serious venous air embolism. We studied the performance of the Level 1 and the Ranger Pressure Infusor in the laboratory. The Ranger delivered less air and delivered fluid faster than the Level 1 but did not warm fluid or blood as well. Although the Ranger device may be safer in terms of the risk of air embolism, its inferior warming performance shows that the optimal pressure infusion device has yet to be manufactured. IMPLICATIONS: Pressure infusion devices are widely used to treat patients with large-volume blood loss. The use of these devices may subject patients to the risk of venous air embolism. Our study found the new Ranger device to be superior to the widely used Level 1 in air elimination.