Current Issue : April - June Volume : 2021 Issue Number : 2 Articles : 5 Articles
Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance. Objective: The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator. Methods: We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure. Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded. Results: The duration of the epidural procedure and of the epidural needle advancement phase (P < 0.05) and the number of epidural attempts (P < 0.001) were reduced after the tutorial. When considering the eye tracking metrics, after the tutorial, the number of visit counts decreased and their duration increased (P < 0.05). The number of epidural needle insertions (additional attempts) showed a significant positive correlation with the visits number (aOR = 2.02 (95% CI = 1.26 - 3.55; P = 0.008)) and a significant negative correlation with the visit duration (aOR = 0.65 (95% CI = 0.39 - 0.99; P = 0.05)). Conclusion: We observed significant changes in gaze behavior associated with increased performance during the epidural technique learning with a simulator in anesthesia trainees who had never previously performed an epidural block. These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation....
Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study. Conclusions: In awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray. Trial registration: ChiCTR1900023151. Date of registration: May 14th, 2019....
The ultrasound-guided axillary block is a block commonly used in upper limb surgery. Several local anaesthetics can be used to obtain an effective block. These include ropivacaine 0.5% and lidocaine 1.5% with adrenaline. Objective: To evaluate lidocaine 1.5% with adrenaline as an alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks. Methodology: This was a 6-month prospective and randomized study (July 15, 2019 to January 15, 2020) conducted in the Department of Anesthesia at Ignace Deen National Hospital in Conakry, Guinea. Results: A total of 38 patients were enrolled: 19 in each group. The mean age was 45.8 ± 16.9 years in the lidocaine with adrenaline group compared to 43.9 ± 20 years in the ropivacaine group. The mean onset time in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The mean duration of axillary block was 233.3 ± 57.5 minutes in the lidocaine group versus 260.4 ± 74 minutes in the ropivacaine group (p = 0.21). The performance was identical in both groups with 89.5% of the effective blocks in the lidocaine group and in the ropivacaine group (p = 1). The cost of consumables for the ropivacaine group was 60 euros compared to 15 euros for the lidocaine group. Conclusion: Lidocaine 1.5% with adrenaline is a good alternative to ropivacaine 0.5% for ultrasound-guided axillary blocks in resource- limited countries....
Background and aim: Despite big leaps of progress in its scope, the practice of anesthesia is still suffering from poor public image, especially in developing countries. Little research investigated the public awareness of anesthesia in the Middle East. This study aimed to examine the perception of the practice of anaesthesia among Jordanian patients. Methods: A standard questionnaire with 29 questions was administered through personal interview to consenting patients. Questions tested patients’ correct knowledge of the identity of anesthetists, their roles and scope of their practice. Awareness was measured using the frequency of correct answers to each survey question. A total awareness score was calculated as the percentage ratio of the number of correct answers to the total number of questions. We classified this score into: Poor< 50%. Moderate 50–75%, and Good > 75% to reflect patient’s overall perception of anesthetists and their roles. Effects of demographic variables on results were also investigated. Appropriate statistical tests were used to summarize and compare results. A total of 513 patients admitted for elective surgery were sequentially approached for enrolment. Results: Five hundred and five patients were enrolled. Most patients identified anesthesia as a separate practice from surgery (86%). The anaesthetist was identified as a physician by only 37% of patients. Equal importance to both anaesthetists and surgeons was assumed by 71.5% of patents. Only 15% of patients showed good level of total knowledge of anaesthetist roles, while 51% scored poorly. Highest awareness was of anaesthetist’s preoperative roles (65.1%). Age was the only demographic factor affecting studied awareness (P = 0.009). Conclusion: Although the importance of anesthetist is well perceived among Jordanian patients, there is still some ignorance in their knowledge of the details of anesthesia practice. Active communication efforts and patient education by anesthetists are needed to improve the public status of the specialty....
Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period....
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