BACKGROUND: Simulation-based training is becoming more wide-spread in clinical education because of the increased technology of patient simulators in conjunction with their increased use by many medical centers. Simulation-based training enhances the learning, clinical skills and judgment of the trainees. However, the effect of repetition of simulation-based training has not yet been evaluated. The purpose of this presentation will be to examine whether the number of experiences could have an influence on the interest of the trainee. METHODS: Simulation-based training was designed as an introductory course for new interns and residents. The training course was divided into three sessions: Airway management training, cardiac massage training and advance cardiac life support mega code training. All the trainees were divided into the new interns and residents group. The two group's performances during conducting the three sessions were monitored by video equipment. All the trainees were debriefed and given a post intervention survey to assess their satisfaction with the simulation-based training. RESULTS: A total of 110 trainees completed the survey. On a four point scale, the students rated their stimulation of interest, the usefulness of the knowledge that they learned and if they enjoyed the simulation. There were no significant differences in the effectiveness of the three sessions of simulation-based training among the groups. CONCLUSIONS: Simulation is a powerful tool to get trainees excited about applying the skills they learned in the classroom. Most trainees in both groups agreed that the exercises were a great experience helpful and exciting. We postulate that the repetition of simulation-based training will not decrease the effectiveness of the training.
Airway Management ; Cardiopulmonary Resuscitation ; Clinical Competence ; Exercise ; Heart Massage ; Humans ; Judgment ; Learning

BACKGROUND: In pre-school aged children, the occurrence of emergence delirium (ED) is increased after sevoflurane anesthesia. The purpose of this study was to evaluate if intravenous inducting agents such as propofol, ketamine or thiopental sodium affected the development of ED. METHODS: A total of 62 children between 3 and 6 years of age scheduled for elective tonsillectomy and adenoidectomy were divided into 3 groups in a double-blinded manner. Anesthesia was induced using one of the three drugs intravenously: 5 mg/kg of sodium thiopental, 1 mg/kg of ketamine or 2 mg/kg of propofol. Anesthesia was then maintained with sevoflurane. The development of ED was assessed in the post-anesthetic care unit. RESULTS: The propofol and ketamine group showed a significantly lower pediatric anesthesia emergence agitation (PAEA) score and a lower incidence of ED compared with the thiopental group. CONCLUSIONS: Propofol and ketamine decreased the development of emergence delirium when used as an induction agent.
Adenoidectomy ; Aged ; Anesthesia ; Child ; Delirium ; Dihydroergotamine ; Humans ; Incidence ; Ketamine ; Methyl Ethers ; Propofol ; Sodium ; Thiopental ; Tonsillectomy

Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, is characterized by inability to sweat, insensitivity to pain, recurrent episodes of hyperpyrexia, self-mutilation and mental retardation. Because of lacking autonomic response to painful stimuli, it is difficult to determine adequate depth of anesthesia in patients with CIPA. We report an anesthetic experience for child with CIPA who had undergone an orthopedic operation. Anesthesia was induced by propofol and maintained by Sevoflurane with 50% nitrous oxide and anesthetic depth was monitored by using bispectral index (BIS). Throughout the operation, anesthesia was maintained with low end-tidal Sevoflurane concentrations (<1.5 vol%), BIS was within 28-62 and vital signs were stable. After operation, he did not remember anything about the surgery. The BIS monitor may be a useful tool to guide the adequate depth of anesthesia for the patient with CIPA.
Anesthesia ; Anesthesia, General ; Child ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Indoles ; Intellectual Disability ; Methyl Ethers ; Nitrous Oxide ; Organothiophosphorus Compounds ; Orthopedics ; Propionates ; Propofol ; Sweat ; Vital Signs

Central venous catheterization is of vital importance in the management of critically ill neonates and also premature infants for total parenteral nutrition, hemodynamic monitoring, anesthetic care, transfusion or the administration of a few vasoactive drugs. Various complications of this procedure have been reported, such as arterial puncture, pneumothorax, cardiac tamponade, and catheter related kinking or knotting. Due to narrow safety margins, these complications are more dangerous in extremely premature infants compared to adults. We present a case of left subclavian venous catheterization complicated by U-shaped intravascular catheter kinking in premature infant which was successfully repositioned by insertion of a new guidewire through the previous catheter without secondary skin puncture.
Adult ; Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Critical Illness ; Hemodynamics ; Humans ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature ; Parenteral Nutrition, Total ; Pneumothorax ; Punctures ; Skin

The occurrence of seizure increases 15-30% in women who become pregnant while being treated for epilepsy, due to pharmacological changes in the antiepileptic drugs and, changes in the emotional status and hormones. It is reported that 1-2% of pregnant women experience status epilepticus. When refractory status epilepticus occurs in a pregnant woman, parturition may be an important method of treatment. We report here on a case of a 28 weeks pregnant woman who had epilepsy for 21 years and she had status epilepticus in a refractory status and so she underwent general anesthesia for cesarean section.
Anesthesia, General ; Anticonvulsants ; Cesarean Section ; Epilepsy ; Female ; Humans ; Parturition ; Pregnancy ; Pregnant Women ; Seizures ; Status Epilepticus

BACKGROUND: Hypotension is the most frequent complication associated with spinal anesthesia during cesarean section. Prehydration and/or vasopressor therapy is commonly used for prevention of hypotension in cesarean deliveries. Wrapping of the legs is simple to perform before surgery and was reported be effective for the prevention of post spinal hypotension in a few obstetric units. So we investigated whether wrapping of the legs prevents post spinal hypotension during cesarean section. METHODS: 45 patients were randomly allocated to one of 3 groups (15 in each group): prehydration with 10 ml/kg (group I), prehydration with 10 ml/kg and wrapping of the legs (group II), prehydration with 5 ml/kg and wrapping of the legs (group III). Hypotension was defined as a 20% decrease from initial systolic arterial pressure (SAP) or SAP lower than 90 mmHg and was treated with intravenous ephedrine (4 mg, repeated). Blood pressure was recorded before spinal anesthesia and every min for 10 min and then every 2 min for another 10 min after spinal anesthesia. RESULTS: Group I showed a significant decrease in SAP compared to group II and group III 1 min after spinal anesthesia, but after that, there was no significant difference between the three groups. Group II showed a significant difference in incidence of severe hypotension after spinal anesthesia compared with group I, but there was no difference of the incidence of hypotension between the three groups. CONCLUSIONS: Wrapping of the legs for prevention of post spinal hypotension during elective cesarean section reduces the severity of hypotension.
Anesthesia, Spinal ; Arterial Pressure ; Blood Pressure ; Cesarean Section ; Ephedrine ; Female ; Humans ; Hypotension ; Incidence ; Leg ; Lower Extremity ; Pregnancy

Herpes zoster is viral infection that presents unilateral skin rash or vesicle along the sensory nerve. It is known that pediatric herpes zoster rarely occurs and usually not so severe when it developed, except in immunocompromised children. We report an uncommon case of herpes zoster ophthalmicus in a 9-year-old boy. He presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid. He was treated with oral acyclovir and stellate ganglion block, with complete resolution without sequelae. In addition, we also review the literature on herpes zoster in childhoods.
Acyclovir ; Child ; Exanthema ; Eyelids ; Forehead ; Herpes Zoster ; Herpes Zoster Ophthalmicus ; Humans ; Stellate Ganglion

BACKGROUND: The skin temperature is often decreased during anesthesia because of a cool ambient temperature in the operating room. Contractility of the muscles may be affected by lowering the muscle temperature. This study was designed to verify that efforts to maintain normothermia on the monitored arm can make recovery from deep neuromuscular blockade more reliable. METHODS: A total of 60 patients were enrolled in this study. Each patient was randomly assigned to group 1 (the monitored arm was shielded with a passive warming protector) or group 2 (the monitored arm was was exposed to the ambient operating room temperature). Conventional inhalation anesthesia was induced with propofol and alfentanil, and this was maintained with O2, N2O and isoflurane. The twitch response of the adductor pollicis muscle was recorded. After calibration of the TOF watch(R), 0.6 mg/kg of rocuronium was injected. During anesthesia, the post tetanic count (PTC) was checked every 5 to 6 minutes until the first response to a train-of-four (TOF) stimulations appeared. The ambient operating room temperature, the core temperature and the skin temperature were checked simultaneously. RESULTS: The skin temperature of group 2 was lower than that of group 1 (33.89 +/- 0.81 degreesC and 35.41 +/- 0.45 degreesC, respectively, P < 0.05). When the data was plotted with the equation y=be(-ax), this equation well represented the data of group 1 (R2 = 0.82), but it did not well represent the data of group 2 (R2 = 0.54). CONCLUSIONS: During recovery from deep neuromuscular blockade with using rocuronium, it may be desirable to maintain normothermia at the thenar area for a better recovery time from a given PTC.
Alfentanil ; Androstanols ; Anesthesia ; Anesthesia, Inhalation ; Arm ; Calibration ; Factor IX ; Humans ; Hypothermia ; Isoflurane ; Monitoring, Intraoperative ; Muscles ; Neuromuscular Blockade ; Operating Rooms ; Propofol ; Skin Temperature

The trans-sphenoidal resection of a recurred pituitary tumor was performed in a 42 years old man under general anesthesia with propofol and remifentanil. Neither massive bleeding nor hypotension was observed intraoperatively, but bradycardia was sustained over five hours. The patient did not suffer from hypertriglyceridemia and there was no evidence of drug toxicity or vigorous intervention during the surgery, however hyperamylasemia was observed one day after the surgery. It is presumed that vagal stimulation by propofol and remifentanil infusion might induce bradycardia and abnormal pancreatic enzyme secretion consequently.
Anesthesia, General ; Bradycardia ; Drug Toxicity ; Hemorrhage ; Humans ; Hyperamylasemia ; Hypertriglyceridemia ; Hypotension ; Piperidines ; Pituitary Neoplasms ; Propofol

BACKGROUND: The risk of steroid-induced hyperglycemia is debated, and methylprednisolone is still used during spinal surgery. We have compared the blood glucose level in patients with metabolic syndrome treated with or without methylprednisolone. METHODS: This study was conducted in 68 adult patients who underwent elective spine surgery. Patients were classified into the following groups: methylprednisolone group (n = 39, group M), placebo group (n = 29, group P), group M patients with metabolic syndrome (n = 17, group MM), and group P patients without metabolic syndrome (n = 21, group NMP). Before and after injection of either 125 mg methylprednisolone or a placebo, we consecutively checked the blood glucose level every 30 minutes up to 4 hours. RESULTS: The blood glucose level was significantly increased in group M patients as compared to group P patients. The blood glucose level was more significantly increased in group MM as compared to group NMP patients. The increased blood glucose levels over 4 hours were 50 mg/dl in group MM and 35 mg/dl in group NMP patients. CONCLUSIONS: We recommend that close monitoring of the blood glucose level up to several hours after injection of a steroid should be seriously considered during spine surgery, particularly in patients with metabolic syndrome.
Adult ; Blood Glucose ; Humans ; Hyperglycemia ; Methylprednisolone ; Spine