Transesophageal echocardiography can be a useful monitor during noncardiac surgery, in patients with comorbidities and/or undergoing procedures associated with substantial hemodynamic changes. The goal of this study was to investigate if transesophageal-echocardiography-related knowledge could be acquired during anesthesia residency.After institutional review board approval, a prospective observational study was performed in two anesthesiology residency programs. After a 41-week didactic transesophageal-echocardiography-education curriculum residents' exam scores were compared to baseline. The educators' examination was validated against the National Board of Echocardiography's Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography.After the 41-week course, clinical anesthesia (CA)-3 exam scores increased 12% compared to baseline (P = .03), CA-2 scores increased 29% (P = .007), and CA-1 scores increased 25% (P = .002). Pearson correlation coefficient between the educators' exam score and the special competence exam percentile rank was 0.69 (P = .006). Pearson correlation coefficient between the educators' exam score and the special competence exam scaled score was 0.71 (P = .0045).The 41-week course resulted in significant increases in exam scores in all 3 CA-classes. While didactic knowledge can be learned by anesthesiology residents during training, it requires significant time and effort. It is important to educate residents in echocardiography, to prepare them for board examinations and to care for the increasingly older and sicker patient population. Further work needs to be done to determine optimal methods to provide such education.
Hypertension (HTN) is the most common medical diagnosis. It results in end-organ damage in the vasculature, heart, brain, kidneys, and eyes. It is associated with more cardiovascular disease (CVD) deaths than any other modifiable disease, accounting for an estimated 50% of deaths from coronary artery disease and stroke in one large study. It is responsible for the deaths of approximately nine million people annually worldwide, is present in more than 60% of people 60 years of age and older, and is controlled in under 20% of patients globally. Since most patients are asymptomatic, and associated complications are serious, HTN has been labeled the silent killer. The silent nature of the disease is especially concerning as later onset of treatment is associated with cardiac and renal pathophysiologic changes and a higher risk of CVD, compared with the normal population, even among treated hypertensives who achieve the same blood pressure (BP) values as the normal population.Although generally managed by primary care providers such as internists, family practitioners, and nurse practitioners, severe perioperative HTN may result in excess surgical bleeding, myocardial ischemia and/or infarction, congestive heart failure (CHF) and acute pulmonary edema (APE). Therefore, it is vital that anesthesiologists, nurses, and all healthcare professionals who manage patients in preparation for surgery, and during the perioperative period, are knowledgeable regarding the care of patients with HTN.
Bacteraemia secondary to orotracheal intubation has been reported to occur in 0-5.3% of patients. Bacteraemia detection is dependent upon several factors including the volume of blood per culture and the number of cultures. Prior studies used small volumes of blood and one or two cultures, and may therefore have underestimated the incidence of bacteraemia. Sixty-two adult patients who underwent direct laryngoscopy and endotracheal intubation were studied. Baseline blood cultures were sterile in all patients. After intubation, four blood cultures were obtained in ten minutes, with 10 ml being evenly divided between aerobic and anaerobic media. Two patients (3.2%) became bacteraemic. This is a lower incidence than occurs in association with other procedures for which The American Heart Association does not recommend administration of prophylactic antibiotics. Therefore, prophylactic antibiotics are not recommended prior to direct laryngoscopy. However, when a prophylactic antibiotic is administered prior to surgery, it would be best to administer the antibiotic prior to direct laryngoscopy and intubation.
Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge.
