Abstract:
BACKGROUND:The clinical utility of focused transthoracic echocardiography (TTE) is increasingly recognized in perioperative medicine. However its use is limited among anesthesiologists because of a lack of training. The most efficient training methods have not been determined. We hypothesized that simulation-based TTE training would be more effective than traditional lecture-based methods for teaching basic TTE skills to the anesthesiology residents. METHODS:In this prospective randomized study, 61 anesthesiology residents (in anesthesia clinical training years 1 to 3) were randomized to either control (n = 30) or simulation groups (n = 31) for TTE training. A standardized pretest was administered before TTE training sessions of 45 minutes each. The first training session used a lecture-based video didactic in the control group or a TTE simulator in the simulation group. Comprehension in both groups was then assessed using a written posttest and by performing a TTE examination on a volunteer subject. TTE examinations were graded on the ability to acquire the correct image, image quality, anatomy identification, and time required to attain proper imaging by 2 blinded experts. A second training session incorporating "hands-on" training with a volunteer subject was conducted in a subset of 21 residents (n = 11 control, n = 10 simulation). The simulation group included additional simulator training. After the second session, another posttest on a volunteer subject was administered. RESULTS:Pretest scores revealed similar preintervention knowledge among residents (56.0% ± 11.9% vs 59.3% ± 11.0%, P = 0.25; control versus simulator group, respectively). The simulation group scored higher on all criteria after the first training session: written posttest (57.9% ± 8.8% vs 68.2% ± 10.1%; P < 0.001), volunteer subject posttest image quality scores (0 to 25 scale) (6.4 ± 3.5 vs 12.4 ± 4.2; P = 0.003), anatomy identification scores (0 to 25 scale) (8.3 ± 6.6 vs 17.8 ± 6.6; P = 0.003), and percentage correct views (50 ± 19 vs 78 ± 21; P < 0.001). After the second session, all scores were again improved in the simulation group: volunteer subject posttest image quality scores (9.6 ± 3.3 vs 15.6 ± 2.8; P = 0.002), anatomy identification scores: (17.6 ± 3.8 vs 22.8 2.4; P = 0.003), and percentage correct views (80 ± 16 vs 96 ± 8; P = 0.007). DISCUSSION:This prospective randomized study demonstrated that anesthesiology residents trained with simulation acquired better skills in TTE image acquisition and anatomy identification on volunteer subjects. The educational benefit of simulation persisted even with introduction of hands-on instruction with volunteer subjects in both groups. The impact of these short-term educational approaches on longer-term retention and actual clinical application warrants further investigation.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Neelankavil J,Howard-Quijano K,Hsieh TC,Ramsingh D,Scovotti JC,Chua JH,Ho JK,Mahajan Adoi
10.1213/ANE.0b013e318265408fsubject
Has Abstractpub_date
2012-11-01 00:00:00pages
1042-51issue
5eissn
0003-2999issn
1526-7598pii
ANE.0b013e318265408fjournal_volume
115pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Lung-protective ventilation (LPV) has been demonstrated to improve clinical outcomes in surgical patients. There are very limited data on the current use of LPV for patients undergoing 1-lung ventilation (1LV) despite evidence that 1LV may be a particularly important setting for its use. In this multicenter ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000002642
更新日期:2018-02-01 00:00:00
abstract::The effect of laparoscopy on cardiac function is controversial. We hypothesized that cardiac dysfunction related to increased afterload could be predominant in patients undergoing elective abdominal aortic repair. To test this hypothesis, we conducted a transesophageal echocardiographic study in 15 patients during lap...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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abstract:UNLABELLED:Adenosine and adenosine analogs induce analgesia in humans and presumed antinociception in animal models when administered both systemically and intrathecally. In the present investigation in rats, we studied the effects of intrathecally administered adenosine analogs, with or without systemic coadministrati...
journal_title:Anesthesia and analgesia
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doi:10.1097/00000539-199709000-00025
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abstract:BACKGROUND:Many of the complications of mechanical ventilation are related to inappropriate endotracheal tube (ETT) cuff pressure. The aim of the current study was to evaluate the effectiveness of automatic cuff pressure closed-loop control in patients under prolonged intubation, where presence of carbon dioxide (CO2) ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1213/ANE.0000000000002358
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abstract:UNLABELLED:The purpose of this study was to determine if rates of telemetry events differ between patients whose monitoring is appropriately "indicated" versus "not indicated" by systematically applying rigorous criteria for appropriateness of electrocardiogram (ECG) telemetry usage. We performed a retrospective cohort...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000081720.49358.53
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abstract:BACKGROUND:Whether intraoperative analgesics have an impact on postoperative cancer recurrence is unknown. Some investigations suggest that the opioids could favor relapse and that regional analgesia and nonsteroidal antiinflammatory drugs could improve cancer prognosis. We retrospectively reviewed our series of breast...
journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
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abstract:BACKGROUND:The inflated costs and documented deleterious effects of excess perioperative transfusion have led to the investigation of targeted coagulation factor replacement strategies. One particular coagulation factor of interest is factor I (fibrinogen). Hypofibrinogenemia is typically tested for using time-consumin...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
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更新日期:2016-09-01 00:00:00
abstract::To improve operating room workflow, an internal transfer pricing system (ITPS) for anesthesia services was introduced in our hospital in 2001. The basic principle of the ITPS is that the department of anesthesia receives reimbursement only for the surgically controlled time, not for anesthesia-controlled time (ACT). A...
journal_title:Anesthesia and analgesia
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doi:10.1213/01.ANE.0000154187.47998.60
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journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000119
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1984-06-01 00:00:00
abstract:UNLABELLED:The purpose of this study was to investigate whether propofol protects rat hepatocyte suspensions against an oxidant attack by a free radical generator 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH). Rat hepatocyte suspensions (2 x 10(6) cells/mL) were prepared using Seglen's collagenase perfusion tec...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199811000-00033
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abstract:BACKGROUND:The blood/gas partition coefficient of a certain volatile anesthetic is of clinical importance because it determines its velocity of uptake into and elimination from the body of a patient and thus its pharmacokinetic behavior. To date, the blood/gas partition coefficients of isoflurane, sevoflurane, and desf...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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abstract:BACKGROUND:Patients with bone marrow failure and severe thrombocytopenia are frequently given prophylactic platelet transfusion before interventions. The clinical effects of such transfusions, however, are poorly defined. We performed a prospective observational study on patients with bone marrow failure scheduled for ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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abstract:UNLABELLED:There has been growing interest in determining the possible immune consequences of opioid administration for the management of postoperative pain. We studied the effects of morphine and tramadol on pain and immune function during the postoperative period in 30 patients undergoing abdominal surgery for uterin...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200006000-00028
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abstract::Dexmedetomidine is frequently used for deep sedation during electrophysiology procedures. We report a case where, presumably, the use of dexmedetomidine resulted in a patient's death. The patient developed unexplained and refractory cardiogenic shock and could not be resuscitated. Autopsy failed to demonstrate any abn...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318172fafc
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000278090.88402.26
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181e668b8
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journal_title:Anesthesia and analgesia
pub_type: 社论
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更新日期:2006-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199411000-00028
更新日期:1994-11-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199812000-00010
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Calmodulin (CaM) activation by Ca(2+), its translocation to the nucleus, and stimulation of phosphorylation of cyclic adenosine monophosphate response element-binding protein (CREB) (P-CREB) are necessary for new gene expression and have been linked to long-term potentiation, a process important in memory fo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181b5a1b8
更新日期:2009-10-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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更新日期:2019-01-01 00:00:00
abstract::The purpose of this study was to examine the effects of dexmedetomidine, an alpha 2-adrenergic agonist, on cerebral blood flow and metabolic rate in dogs anesthetized with 0.64% isoflurane. After intubation and institution of mechanical ventilation, arterial, venous, pulmonary artery, and sagittal sinus catheters were...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199006000-00008
更新日期:1990-06-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
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