ABSTRACT
BACKGROUND AND OBJECTIVE: Fibreoptic intubation is an essential skill in anaesthesiology that is challenging to learn in the clinical setting. The goal of this study was to evaluate 'virtual fibreoptic intubation' (VFI) software as an adjunct to the traditional fibreoptic intubation teaching. METHODS: After informed consent, 42 undergraduate medical students were randomized into two groups. The 'control group' was taught conventionally by an expert bronchoscopist with a 1 h lecture. In addition to the didactic lecture by the expert, the 'VFI group' was given the VFI CD-ROM, and students self-trained with the software until they felt competent performing a virtual fibreoptic bronchoscopy on the normal patient models. Students were evaluated 2 weeks later on their first orotracheal fibreoptic intubation of an airway manikin. The primary endpoint was success, as evaluated by a staff anaesthesiologist blinded to the group of teaching. Fibreoptic intubation ability was the secondary endpoint. RESULTS: The fibreoptic intubation success rate was significantly higher in the VFI group than in the control group (81 versus 52%, P < 0.05). Among 10 failures in the control group, nine were due to oesophageal intubation as compared with only one out of four in the VFI group. Among four failures in the VFI group, three were because of taking longer than 4 min as compared with only one out of 10 in the control group. The VFI group tended towards better ability in the procedural skills of fibreoptic intubation than the control group. CONCLUSION: Self-training in fibreoptic intubation with the VFI software may improve the acquisition of fibreoptic intubation skills.
Subject(s)
Anesthesiology/education , Anesthesiology/methods , Fiber Optic Technology , Intubation, Intratracheal/methods , Audiovisual Aids , Clinical Competence , Computer Simulation , Education, Medical, Undergraduate , Female , Humans , Male , Software , TeachingABSTRACT
The porphyrias are a group of inherited or acquired enzymatic defects of heme biosynthesis. Each type of porphyria has a characteristic pattern of overproduction and accumulation of heme precursors based on the location of dysfunctional enzyme in the heme synthetic pathway. Variegate porphyria, one of the acute hepatic porphyrias, is characterized by a partial reduction in protoporphyrinogen oxidase, the seventh enzyme of the heme biosynthetic pathway. A case of liver transplantation is described with a recovery from a variegate porphyria. Acute porphyria is commonly worsened by a wide variety of medications. We describe a step-by-step perioperative management protocol.
