Anesthetic practice in Haiti after the 2010 earthquake.

On January 12, 2010, a 7.0 M(L) earthquake devastated Haiti, the most impoverished nation in the Western hemisphere with extremely limited health care resources. We traveled to Milot, Haiti situated north of Port-au-Prince, to care for injured patients at Hôpital Sacré Coeur, an undamaged hospital with 74 beds and 2 operating rooms. The massive influx of patients brought by helicopter from the earthquake zone transformed the hospital to >400 beds and 6 operating rooms. As with the 2005 Kashmir and 2008 China earthquake, most victims suffered from extremity injuries, encompassing crush injuries, lacerations, fractures, and amputations with associated dehydration and anemia. Preoperative evaluation was limited by language issues requiring a translator and included basic questions of fasting status, allergies, and coexisting conditions. Goals included adequate depth of anesthesia, while avoiding apnea/airway manipulation. These goals led to frequent use of midazolam and ketamine or regional anesthesia. Although many medications were present under various names and concentrations, the absence of a central gas supply proved troublesome. Postoperative care was limited to an 8-bed postanesthesia care unit/intensive care unit caring for patients with tetanus, diabetic ketoacidosis, pulmonary aspiration, acute renal failure due to crush, extreme anemia, sepsis, and other illnesses. Other important aspects of this journey included the professionalism of the health care personnel who prioritized patient care, adaptation to limited laboratory and radiological services, and provision of living arrangements. Although challenging from many perspectives, the experience was emotionally enriching and recalls the fundamental reasons why we selected medicine and anesthesiology as a profession.

Decyl methacrylate-based microspot optodes.

Optode sensing membranes employing decyl methacrylate cross-linked with 1,6-hexanediol dimethacrylate as the polymer support were fabricated by a direct microspotting method on several surfaces. Photopolymerization was used to attach the microspots to the substrate. Using this method, diameters in the micrometer domain were obtained. Silanized glass, poly(methyl methacrylate) (PMMA), polycarbonate, and poly(dimethylsiloxane) were tested as possible substrates. Both polypropylene tips and the steel tips of drafting pens were used for spotting. It was determined that both silanized glass and PMMA gave working optodes, but the ones on PMMA did not fit the theoretical model. Diameters of 994 +/- 80 and 1279 +/- 85 microm were obtained on silanized glass and PMMA, respectively, using the polypropylene tips for spotting. Different size optodes were fabricated using 0.35- and 0.50-mm steel drafting pen tips. The 0.35-mm tips produced diameters of 895 +/- 26 and 688 +/- 54 microm on silanized glass and PMMA, respectively, and the 0.50-mm tips produced diameters of 1274 +/- 94 microm on silanized glass and 839 +/- 28 microm on PMMA. Thus, the microspot size can be controlled based on the hydrophobicity of the surface and the size of the tip used for spotting. Calibration plots of potassium optode microspots indicated that miniaturization does not alter response characteristics, such as selectivity, response time, and dynamic range, of the optodes.