RESUMO
BACKGROUND: Novel methods for teaching are needed to enhance the efficiency of academic anesthesia departments as well as provide approaches to learning that are aligned with current trends and advances in technology. METHODS: A video was produced that taught the key elements of anesthesia machine checkout and room set up. Novice learners were randomly assigned to receive either the new video format or traditional lecture-based format for this topic during their regularly scheduled lecture series. Primary outcome was the difference in written examination score before and after teaching between the two groups. Secondary outcome was the satisfaction score of the trainees in the two groups. RESULTS: Forty-two students assigned to the video group and 36 students assigned to the lecture group completed the study. Students in each group similar interest in anesthesia, pre-test scores, post-test scores, and final exam scores. The median posttest to pretest difference was greater in the video groups (3.5 (3.0-5.0) vs 2.5 (2.0-3.0), for video and lecture groups respectively, p 0.002). Despite improved test scores, students reported higher satisfaction the traditional, lecture-based format (22.0 (18.0-24.0) vs 24.0 (20.0-28.0), for video and lecture groups respectively, p <0.004). CONCLUSIONS: Higher pre-test to post-test improvements were observed among students in the video-based teaching group, however students rated traditional, live lectures higher than newer video-based teaching.
RESUMO
BACKGROUND AND PURPOSE: Although multiple series of helium insufflation-assisted laparoscopic surgery are reported, we encountered difficulty at many levels when arranging a laparoscopic nephrectomy with helium insufflation. We present our experience with attempting to use helium gas as an insufflant and our successful use of argon gas as an adjunct to CO(2) insufflation with a case report as illustration. MATERIALS AND METHODS: The patient is a 66-year-old man with a progressively enlarging 3.1-cm right renal mass. His history is significant for severe chronic obstructive pulmonary disease, necessitating home oxygen and frequent cycles of steroids. In line with the patient's desire for a minimally invasive procedure, we scheduled a laparoscopic nephrectomy with helium gas. Helium tanks need specialized adapters (yoke) to connect to laparoscopic insufflators; once the yoke was located, we were informed that helium is not approved by the Food and Drug Administration for use as an insufflant and we could not proceed with its use without a full hospital institutional review board review. We elected to use low-pressure CO(2) insufflation augmented by argon gas insufflation via the argon beam coagulator. RESULTS: The patient tolerated the low-pressure CO(2) /argon gas pneumoperitoneum without difficulty. There were no significant changes in the hemodynamic variables throughout the procedure. This patient was extubated at the completion of the procedure, and there were no intraoperative or postoperative complications. CONCLUSIONS: Although numerous reports and case series exist regarding the use of helium as an alternate insufflation agent to CO(2), the logistics of obtaining the correct helium yoke and hospital approval are cumbersome for this rarely indicated agent. A far simpler alternative, with similar physiologic effects, is the use of argon gas as an adjunct to CO(2) insufflation, or in lieu of CO(2) insufflation.
