Viji Kurup

Anesthesia 2.0: internet-based information resources and Web 2.0 applications in anesthesia education.

Purpose of review Informatics is a broad field encompassing artificial intelligence, cognitive science, computer science, information science, and social science. The goal of this review is to illustrate how Web 2.0 information technologies could be used to improve anesthesia education. Recent findings Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education of housestaff. These technologies include microblogging, blogs, really simple syndication (RSS) feeds, podcasts, wikis, and social bookmarking and networking. ‘Anesthesia 2.0’ reflects our expectation that these technologies will foster innovation and interactivity in anesthesia-related web resources which embraces the principles of openness, sharing, and interconnectedness that represent the Web 2.0 movement. Although several recent studies have shown benefits of implementing these systems into medical education, much more investigation is needed. Summary Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold great promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed. Thoughtful research to maximize implementation of these technologies should be a priority for development by academic anesthesiology departments. Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

Sedation after spinal anesthesia in elderly patients: a preliminary observational study with the PSA-4000

PurposeNeuraxial blockade is known to have a sedative effect, decreasing the need for inhalational and iv anesthetic agents. The purpose of the present study was to quantify the sedative effect of spinal anesthesia and to determine the time of maximum sedation.MethodsThis is an observational study in which 20 unsedated patients were scheduled to undergo urologic and orthopedic surgeries under spinal anesthesia. Patients with pre-existing neurological conditions or receiving psychotropic medications were excluded from the study. All received 1.5 mL (11.25 mg) of hyperbaric bupivacaine 0.75% intrathecally. No sedative or narcotic was administered intravenously or intrathecally. The Patient State Analyzer, (PSA-4000) was used to monitor sedation along with Observer’s Assessment of Alertness and Sedation (OAA/S) scores every five minutes. Differences in patient state index (PSI) and OAA/S scores are expressed as median and range and were evaluated by Wilcoxon’s signed rank test for non-parametric data; P < 0.05 was considered significant. PSI, OAA/S and time at lowest score are expressed as median(range).ResultsPSI scores decreased from baseline 99 (96–99) to 78 (56–87) at 35(14.5–54) min into the spinal anesthetic (P < 0.05). OAA/S scores decreased from baseline 5 to 4 (range 3–5) at the time of the lowest PSI scores (P < 0.05).ConclusionsIn this elderly patient population, spinal anesthesia induced changes in the processed electroencephalogram with reduction in PSI and OAA/S scores. The reduction in afferent input to the reticular activating system could possibly explain the sedation that has been observed and the reduction in the PSA scores.RésuméObjectifL’effet sédatif du bloc neuraxial est connu pour diminuer les besoins d’anesthésiques iv et par inhalation. Nous avons voulu quantifier l’effet sédatif de la rachianesthésie et déterminer le temps nécessaire pour atteindre la sédation maximale.MéthodeL’étude observationnelle porte sur 20 patients sans sédation qui doivent subir une intervention sous rachianesthésie en chirurgie urologique ou orthopédique. Sont exclus ceux qui ont des pathologies neurologiques préexistantes ou un traitement psychotrope. Tous reçoivent 1,5 mL (11,25 mg) de bupivacaïne hyperbare à 0,75% par voie intrathécale. Aucun sédatif ou narcotique n’est administré par voie intraveineuse ou intrathécale. Le Patient State Analyzer, (PSA-4000), un analyseur de l’état du patient, est utilisé pour surveiller la sédation au même titre que l’Observer’s Assessment of Alertness and Sedation (OAA/S) scores (évaluation de la vigilance et de la sédation par un observateur) toutes les cinq minutes. Les différences de l’index de l’état du patient (IEP) et les scores de l’OAA/S sont exprimés par la médiane et les valeurs extrêmes et évalués par le test de rang des signes de Wilcoxon pour les données non paramétriques; P < 0,05 est considéré significatif. L’IEP, l’OAA/S et le moment du score le plus bas sont exprimés par la médiane (valeurs extrêmes).RésultatsLes scores de l’IEP ont baissé, par rapport aux données du début, de 99 (96–99) à 78 (56–87) à 35(14,5–54) min avec la rachianesthésie (P < 0,05). Les scores à l’OAA/S ont été plus bas que les données initiales, passant de 5 à 4 (3–5) au moment des scores IEP les plus bas (P < 0,05).ConclusionChez les patients âgés, la rachianesthésie a induit des changements à l’électroencéphalogramme traité et une réduction des scores de l’IEP et de l’OAA/S. La réduction des afférences au système réticulé activateur peut expliquer la sédation observée et la réduction des scores du PSA.

The changing landscape of anesthesia education: is Flipped Classroom the answer?

Purpose of review Educators in the specialty of anesthesiology are facing a number of challenges. A new generation of residents are entering the specialty and they have unique learning styles and expectations. The new duty hour regulations also encroach on the time available to the residents for education. In the last decade, a number of models for teaching and learning have been proposed to tackle these issues. Recent findings Recent research has looked at learning gains and acceptability of online material in medical education as well as specific models that can be implemented to address the challenges. Summary The ‘Flipped Classroom’ model seems to combine the best of both worlds. It allows the learner to assimilate basic information (lower order cognitive skills) from material that is placed online, allowing asynchronous learning. It frees up the teacher to use the face-to-face interaction time in the operating room and classroom for training the student in advanced concepts (higher order cognitive skills). This model allows efficient and effective use of time and technology, but involves the redesign of how in person time between faculty and residents are spent, along with the faculty development to effectively engage this new type of curriculum.

Prolonged elevation of plasma argatroban in a cardiac transplant patient with a suspected history of heparin-induced thrombocytopenia with thrombosis.

BACKGROUND: Direct thrombin inhibitors (DTIs) provide an alternative method of anticoagulation for patients with a history of heparin‐induced thrombocytopenia (HIT) or HIT with thrombosis (HITT) undergoing cardiopulmonary bypass (CPB). In the following report, a 65‐year‐old critically ill patient with a suspected history of HITT was administered argatroban for anticoagulation on bypass during heart transplantation. The patient required massive transfusion support (55 units of red blood cells, 42 units of fresh‐frozen plasma, 40 units of cryoprecipitate, 40 units of platelets, and three doses of recombinant Factor VIIa) for severe intraoperative and postoperative bleeding.

The role of social networking applications in the medical academic environment.

The invention of the World Wide Web by Tim Berners-Lee in 1989 revolutionized the transmission and expression of complex, structured data. After 20 years, the web of 2010 is dramatically changed. With a glut of information available, users must learn to navigate and filter the information. The recently coined ‘‘Web 2.0’’ technologies that allow users to contribute and consume information lead to a greater connection to information and fellow users (Fig. 1). Openness, sharing, and interconnectedness characterize Web 2.0 as a movement. Social networking is an important application of Web 2.0 technology. Social networking sites operate through user-created personal digital profiles. These individualized profiles include identifying information,

The new learners--Millennials!!

It is widely accepted that the learners entering academic institutions across the globe differ significantly in their values and characteristics than those a few decades ago. Researchers generally agree that the uniqueness of this generation arise from the technologic forces that surround this group of individuals. Educational establishments are generally not clear about the impact of technology on learning. Different centers are dealing with the changes in different ways. Some institutions have completely revamped the classroom with laptops for every student and SmartBoards in every room, whereas others have buried their heads in the sand and refuse to acknowledge the pervasive technology in their students’ life, blocking wireless access in classrooms and having students leave technology at the door when they enter the establishment. Many educators have been very vocal about the need to integrate technology into educational methods to meet the changing learner population. As early as the 1980s the drive to integrate computers into medical education was gaining momentum and the disconnect between use of technologic advances in the clinical versus the educational field was emphasized. Although we have embraced technology for their clinical applications, we have not done the same in the field of education. For medical education in particular, there has been a growing chorus of criticism in the United States of both its processes and its substance. The Association of American Medical Colleges (AAMC) in its report identified several major problems, ‘‘the huge amount of factual material students are expected to absorb, little of which is retained in useful form after examinations; an absence of emphasis on essential concepts and principles; the need to teach independent learning and problem-solving skills; a need for better faculty supervision and role-modeling; the

Blended Learning in Anesthesia Education: Current State and Future Model

Purpose of review Educators in anesthesia residency programs across the country are facing a number of challenges as they attempt to integrate blended learning techniques in their curriculum. Compared with the rest of higher education, which has made advances to varying degrees in the adoption of online learning anesthesiology education has been sporadic in the active integration of blended learning. The purpose of this review is to discuss the challenges in anesthesiology education and relevance of the Universal Design for Learning framework in addressing them. Recent findings There is a wide chasm between student demand for online education and the availability of trained faculty to teach. The design of the learning interface is important and will significantly affect the learning experience for the student. Summary This review examines recent literature pertaining to this field, both in the realm of higher education in general and medical education in particular, and proposes the application of a comprehensive learning model that is new to anesthesiology education and relevant to its goals of promoting self-directed learning.

The perioperative librarian: luxury or necessity?

Purpose of review There has been an explosion of medical information in the past decade. Current clinical practice demands that anesthesiologists be aware of current treatments and procedures, along with the latest practice standards and guidelines. The need to be able to rapidly retrieve relevant, accurate clinical information at the point of care is now felt more than ever. This review explores the impact of clinical medical librarians, with particular emphasis on their application in the perioperative setting. Recent findings An increasing number of hospitals are turning to medical librarians to help clinicians improve their information-seeking skills. As a result, the role of medical librarians has expanded dramatically. Most studies evaluating the effectiveness of clinical medical librarian programs support their value in clinical teams, yet the studies rely primarily on descriptive surveys and qualitative data. Summary Anesthesiologists have particular information needs for which the physical library is no longer sufficient. New outcome measures to define the ‘success’ of clinical medical librarian programs need to be formulated, and economic considerations need to be factored into these programs.

Concern for Pain in the Pre‐Operative Period‐ Is the Internet Being Used for Information By Patients?

This study was conducted to provide information regarding prevalence of pain, type of provider managing pain, and use of Internet for information regarding pain, among patients coming for presurgical anesthesia consultation at a major academic institution.

E-patients--revolutionizing the practice of medicine.

The traditional model for the practice of medicine, and doctor-patient relationship that existed for centuries have changed irrevocably, mostly as a result of the advent of the World-wide Web. In the traditional role, the doctor was in the position of power, with information flowing to the patient.