Experiential learning in simulated parapharyngeal abscess in breathing cadavers.

PURPOSE: Education in airway management is a fundamental component of anesthesiology training programs. There has been a shift towards the use of simulation models of higher fidelity for education in airway management. The goal of this study was to create a novel cadaveric model of a simulated parapharyngeal abscess with features of a difficult airway such as distorted anatomy and narrow airway passages presenting as stridor. The model was further assessed for its suitability for enhanced experiential learning in the management of difficult airways. METHODS: Cadaver heads were modified surgically to simulate parapharyngeal abscess. Airtight torso of the cadaver was connected to an Oxylog ventilator to simulate respiratory movements-the opening and closing of air channels with breaths in a patient with parapharyngeal abscess. Advanced airway workshop facilitators conducted directed one-to-one learning, and provided feedback to participants. A paper-based feedback was obtained from 72 participants on their confidence level, and the realism, attractiveness, beneficial, and difficulty levels of the simulated cadaveric models. RESULTS: The modified cadavers were reliable in simulating difficult airways. The majority of participants (91%) reported an increase in confidence level for management of the difficult airway after the experience with the modified cadavers and found the models realistic (93%), attractive (92%), beneficial (93%), and difficult (85%). CONCLUSIONS: Surgical modifications of cadavers to simulate difficult airways such as parapharyngeal abscess with edema and stridor can be incorporated into advanced airway management courses to enhance experiential learning in airway management by awake fibreoptic intubation, and promote patient safety.

Bilateral bispectral index monitoring to detect cerebral hypoperfusion during carotid endarterectomy under general anesthesia.

The bilateral use of bispectral index (BIS) monitoring in a 68-year-old male who underwent right carotid endarterectomy (CEA) under general anesthesia (GA) is described. During three episodes of right internal carotid artery cross-clamping intraoperatively, the right BIS value rose relative to the left within 1 min of clamping, followed by a return to baseline within 1-2 min of clamp release. Since unilateral BIS values can decrease or increase in response to cross-clamping, a significant difference in left and right BIS values may provide a simple and easily available method to detect cerebral hypoperfusion during CEA under GA.