Sara Guzman-Reyes

Anticoagulant therapy for venous thromboembolism during pregnancy: a systematic review and a meta-analysis of the literature: a rebuttal.

See also Romualdi E, Dentali F, Rancan E, Squizzato A, Steidl L, Middeldorp S, Ageno W. Anticoagulant therapy for venous thromboembolism during pregnancy: a systematic review and a meta-analysis of the literature. J Thromb Haemost 2013; 11: 270–81 and Romualdi E, Dentali F, Squizzato A, Ageno W. Anticoagulant therapy for venous thromboembolism during pregnancy: a systematic review and a meta-analysis of the literature: a reply to a rebuttal. This issue, pp 788–9.

Thrombelastograph platelet mapping in a patient receiving antiplatelet therapy.

description of using theThrombelastograph (TEG) PlateletMapping (PM) assay(Haemonetics Corp., Braintree, MA) to monitor andguide the antithrombotic management of a complexpatient with great interest. This novel approach willbe useful to physicians caring for patients with thecoagulation abnormalities associated with cirrhosis inaddition to pharmacological anticoagulants. However,it is being increasingly appreciated that pharmacoki-netic/dynamic effects with antiplatelet therapy arerelevant to the interpretation of PM results.

Thrombelastography for perioperative monitoring in patients with von Willebrand disease

the suggestion that practitioners would benefit from using ETT insertion depths of 20 cm in women and 22 cm in men. Sitzwoh et al assessed in 160 patients the sensitivity and specificity of different bedside methods of verifying correct ETT placement [6]. Compared with bilateral auscultation of the lungs and observation, palpation of symmetrical chest movements, observing the cm scale printed on each ETT was the best means of excluding inadvertent endobronchial intubation. Moreover, in their prospective, randomized blinded trial, inserting ETTs according to the 21/23 cm rule would have resulted in inappropriate or critical ETT positioning (as defined by Rigini et al) in one of 5 patients. A general 20/22 cm rule for normal-sized women and men, respectively, appears to be a safer approach. The authors concluded that clinicians should rely more on insertion depth than on auscultation to assess correct ETT insertion, and accept only cautiously ETT insertion depths that differ from 20 cm in women and 22 cm in men.

Dramatic change in cerebral oximetry during liver transplantation

ABSTRACT We report dramatic changes in bilateral cerebral tissue oxygenation in a patient undergoing an orthotopic liver transplant coincident with clamping and subsequent restoration of flow through the inferior vena cava. Although hemodynamic stability was maintained with low-dose vasopressor support, cardiac output was decreased, suggesting preload dependence of the measured cerebral oxygenation. Further investigation is warranted in patients with end-stage liver disease and interruption of venous return.

Reliability of a faculty evaluated scoring system for anesthesiology resident applicants (Original Investigation)

STUDY OBJECTIVE To assess reliability and reproducibility of a recently instituted anesthesiology resident applicant interview scoring system at our own institution. DESIGN Retrospective evaluation of 2 years of interview data with a newly implemented scoring system using randomly assigned interviewing faculty. SETTING Interview scoring evaluations were completed as standard practice in a large academic anesthesiology department. SUBJECTS All anesthesiology resident applicants interviewed over the 2013/14 and 2014/15 seasons by a stable cohort of faculty interviewers. Data collection blinded for both interviewers and interviewees. INTERVENTIONS None for purposes of study - collation of blinded data already used as standard practice during interview process and analysis. MEASUREMENTS None specific to study. MAIN RESULTS Good inter-rater faculty reliability of interview scoring (day-of) and excellent inter-faculty reliability of application review (pre-interview). CONCLUSIONS Development of a department-specific interview scoring system including many elements beyond traditional standardized tests shows good-excellent reliability of faculty scoring of both the interview itself (including non-technical skills) and the application resume.

Importance of patient selection for patient-controlled epidural analgesia (PCEA), as even low-concentration solutions may lead to a very high block

Patient-controlled epidural analgesia (PCEA) is an excellent choice of analgesia technique in labor; however, patient selection for such treatment is important. A 14 year old healthy parturient receiving PCEA had a very high block due to patient noncompliance.