Burrhole simulation for an intracranial hematoma simulator.

Traumatic head injuries can cause internal bleeding within the brain. The resulting hematoma can elevate intracranial pressure, leading to complications and death if left untreated. A craniotomy may be required when conservative measures are ineffective. To augment conventional surgical training, a Virtual Reality-based intracranial hematoma simulator is being developed. A critical step in performing a craniotomy involves cutting burrholes in the skull. This paper describes volumetric-based haptic and visual algorithms developed to simulate burrhole creation for the simulator. The described algorithms make it possible to simulate several surgical tools typically used for a craniotomy.

Simulation in cardiothoracic and vascular anesthesia education: tool or toy?

The use of simulators in cardiothoracic and vascular anesthesia runs the gamut from standardized patients and part-task trainers to full-scale high-fidelity human patient simulators. The use of simulation to teach medical students, anesthesiology residents, board-certified anesthesiologists with subspecialty interests, hospital administrators, attorneys, and the lay public is still evolving as educational research evaluates the use of simulation and health professional educators struggle to define its role and value. This article provides a general overview of the field and attempts to critically evaluate what is and what is not scientifically determined about simulation and simulators.

Simulation in cardiology and cardiothoracic and vascular surgery.

Cardiologists and cardiac surgeons are rapidly embracing the use of realistic patient simulators and virtual reality devices to allow mastery of complex techniques, planning of complicated procedures, crisis management of infrequently seen diseases and complications, and development of medical team work. Simulation can certainly be used for these purposes in surgical education but provides only the ;;tip of the iceberg'' of the knowledge needed by the competent cardiothoracic, vascular, or general surgeon. Is simulation really the way to learn how to perform actual surgical procedures? This review will describe available surgical simulation technology, and define some of the problems to be solved for validation and general acceptance.

Fast tracking in paediatric cardiac anaesthesia: an update.

A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.