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Simulation is used in anesthesia training to reinforce didactic learning. The authors hypothesized that knowledge acquisition in the use of transesophageal echocardiography (TEE) could be accomplished better through the use of a simulator than with online or web-based learning. A total of 71 student registered nurse anesthetists were randomly assigned to either web-based or simulator-based TEE training. Using the same rubric, each group was instructed to use 11 views to identify 12 different cardiac structures. In addition, 15 cardiac abnormalities ("pathologies") were identified through either the simulator or a web-based link. The effect of the interventions were measured using a video-based (ExamSoft) assessment to validate improved knowledge of cardiac structures, recognition of ultrasonographic views, and identification of cardiac pathology. Although both groups demonstrated significant improvement, students who trained with the simulator scored higher than the web-based group, 69.4 vs 42.3 (P < .01). Scores were compared using the Mann-Whitney test and 2-tailed t tests. Implementation of TEE training using either modality improved TEE-related knowledge, and both are recommended as a supplement to conventional didactic training. [ABSTRACT FROM AUTHOR]

Anxiety and depression are debilitating, costly psychological disorders that account for $133 billion in direct medical expenses per year in the United States. Finding alternative means of treatment to reduce the personal and financial burden for patients with these disorders, while maintaining patient safety, is vital for overall patient wellness. The purposes of this study were 2-fold: (1) to determine if pure eucalyptol (1,8-cineole) produces anxiolytic and/or antidepressant effects using rat models for anxiety and behavioral despair and (2) to determine the effects of eucalyptol at the benzodiazepine site on the y-aminobutyric acid (GABA) A receptor in the rat central nervous system. Fifty-five male Sprague-Dawley rats were randomly assigned to 1 of 5 groups: vehicle (dimethyl sulfoxide), eucalyptol, midazolam, flumazenil plus eucalyptol, and midazolam plus eucalyptol. Behavioral analyses were conducted on the elevated plus-maze and in the forced swim test. Data were analyzed using a 2-tailed multivariate analysis of variance and a least significant difference post hoc test. Data from the maze suggested eucalyptol may produce anxiolytic effects by acting at the benzodiazepine site on the GABAA receptor while not affecting psychomotor activity. However, no effects on behavioral despair were demonstrated in the Forced Swim test. [ABSTRACT FROM AUTHOR]

The "handoff" phase of patient care is frequently associated with the genesis of adverse events. Patient handoffs in anesthesia care remain poorly studied. By reviewing archived video of anesthesia handoffs taking place in a simulated environment, we aimed to identify latent conditions and their impact on the quality and nature of handoffs occurring during surgical anesthesia care. Four trained coders assessed 58 handoffs occurring in 58 different simulated cases, for the presence or absence of 4 latent conditions: distractions, production pressure, noninteractive communication, and inappropriately timed handoff. Latent hazards frequently jeopardized handoff quality. Distractions and interruptions were conditions observed in 82% of cases; independently these did not appear to degrade handoff quality. The latent condition noninteractive communication was the greatest predictor of poor handoff scores (P < .001). Handoffs were often good or excellent with 0, 1, or 2 latent conditions present, but with 3 or more latent conditions, the quality invariably degraded. When handoff scores were high, the handoffs were always interactive. This is the first study to relate specific latent conditions to handoff quality, providing a foundation for future research, as well as for the education and training of anesthesia providers. [ABSTRACT FROM AUTHOR]

Simulation-based education provides a safe place for student registered nurse anesthetists to practice nontechnical skills before entering the clinical arena. An anesthetist's lack of nontechnical skills contributes to adverse patient outcomes. The purpose of this study was to determine whether an educational intervention on nontechnical skills could improve the performance of nontechnical skills during anesthesia crisis simulation with a group of first-year student registered nurse anesthetists. Thirty-two first-year students volunteered for this quasi-experimental study. Each subject was videotaped and rated as he or she performed 6 simulated crisis scenarios: 3 scenarios before the intervention and 3 after the intervention. Findings revealed that the nontechnical skills mean posttest score was greater than pretest scores: t (df= 31) = 1.99, P= .028. The mean gain in scores for standardized nontechnical skills were significantly greater than those for standardized technical skills: t (df= 30) = 1.81, P = .04. In conclusion, a 3-hour educational intervention on nontechnical skills resulted in significant improvement. Nontechnical skills therefore are not acquired through experience, but rather through instruction. An educational intervention using the Anaesthetists' Non-Technical Skills system is a valuable tool in the measurement of nontechnical skills assessment of first-year student registered nurse anesthetists. [ABSTRACT FROM AUTHOR]

The primary purpose of this investigation was to evaluate postprocedure cognitive function associated with 3 distinct standard sedation regimens used for endoscopic procedures. A secondary aim was to identify complications requiring provider interventions. Subjects scheduled for colonoscopies were approached for enrollment the day of their procedure. A convenience sample of 96 subjects was randomly assigned. Cognitive function was recorded on the day of surgery using the Mini-Mental State Examination (MMSE) and 24 and 48 hours postoperatively using the Telephone Interview of Cognitive Status (TICS). The propofol plus fentanyl group had a mean TICS score of 34.53 at 24 hours compared with 34.96 at 48 hours (P = .017). The midazolam plus fentanyl group had a mean TICS score of 34.76 at 24 hours compared with 36.26 at 48 hours (P = .004). The propofol-alone group had a mean TICS score of 35.09 at 24 hours compared with 35.98 at 48 hours (P = .924). The results of this investigation indicate that the sedation regimen of propofol alone has the least impact on postprocedure cognitive function. Additionally, the number of jaw lift interventions was significantly higher in both groups who received fentanyl. [ABSTRACT FROM AUTHOR]

Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. Thirty patients, with ASA physical status 1 or 2, scheduled for elective open colon surgery were randomly assigned to be ventilated with either PEEP at 10 cm H2O (PEEP, 15 patients) or increased tidal volumes achieved with larger apparatus dead space but with zero end-expiratory pressure (DS group, 15 patients). Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP. [ABSTRACT FROM AUTHOR]

This retrospective study examined whether practice in computer-based tests (CBTs) in student registered nurse anesthetists improved scores on the National Certification Examination (NCE). A group of students with extensive practice in CBTs was compared with a group of students whose tests were administered primarily on paper. Groups were matched on age, grade point average (GPA), and gender (n = 73 each). Higher GPA was associated with higher NCE scores overall. Adjusted for GPA (with analysis of covariance), the mean NCE proficiency score (Φ) in the CBT group was 2.68 (95% confidence interval, 2.54-2. 82), which was higher than the mean score in the paper-based group of 2.36 (95% confidence interval, 2.22-2.50), with an effect size of 0.52. When subgroups were examined, CBT practice improved NCE scores only in those students with graduate GPA less than or equal to 3.50, with an effect size of 1.1. It was concluded that, controlling for GPA, student registered nurse anesthetists at a university with greater exposure to CBTs had higher scores on the NCE than a comparison group with less practice in CBTs. This difference was significant only in students with GPA of 3.50 or less, consistent with a beneficial effect of practice in CBTs. [ABSTRACT FROM AUTHOR]