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Objectives: Endotracheal/general anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural (non-general) anesthesia have been increasingly employed for lumbar decompressions (LD) and lumbar fusion recently. The objective of this study was to investigate the outcomes of general and non-general anesthesia in patients undergoing posterior lumbar fusion (PLF) and LD using a national registry., Patients and Methods: ACS-NSQIP database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011-2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of stay (LOS). Three-to-one propensity-score matching and conditional logistic regression were used to adjust for potential bias., Results: A total of 60,222 patients who underwent LD were identified; 59,876 (99.4%) received general anesthesia and 342 (0.6%) were given non-general anesthesia. On multivariable conditional regression, type of anesthesia was found to have no significant effect on any of the outcomes analyzed (Readmission: OR:0.90, p = 0.79; Any Complication:OR:0.75, p = 0.75; LOS:Coef.:0.18, p = 0.35). A total of 31,419 patients who underwent PLF were identified; 31,377(99.9%) were given general anesthesia and 42(0.1%) were given non-general anesthesia. Anesthesia type had no significant effect on any of the outcomes analyzed (Readmission: OR:0.78, p = 0.83;Any Complication: OR:0.50, p = 0.40; LOS: Coef.:0.17, p = 0.68)., Conclusion: Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS and complications compared to general anesthesia in patients undergoing LD or PLF. While the choice of anesthesia type remains a matter of preference, our results show that non-general anesthesia may be practiced safely and is associated with equivalent outcomes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Study Objective: The objective of this study was to design and implement a preclinical elective (termed selective) in anesthesiology, critical care, and perioperative medicine and to report survey results assessing the impact of the selective on first- and second-year medical students' understanding of basic concepts, comfort with procedural skills, and interest in the specialty., Design: Preinvention and postintervention survey evaluation was used as the design of this study., Setting: The study was conducted at Mayo Medical School and Mayo Clinic., Participants: The participants in this study are first- and second-year medical students., Interventions: A 1-week introductory anesthesiology curriculum was developed to include didactic sessions, shadowing experiences, lunch and dinner panels, mentorship and networking opportunities, and procedural workshops in airway management, ultrasound, and vascular access techniques., Measurements: Preselective and postselective surveys using a 10-point scale (1, strongly disagree; 10, strongly agree) were administered 1 week before and after the selective., Main Results: A total of 8 students participated in the selective, with a 100% survey response rate. Students reported significant increases for all survey questions regarding basic concepts and skills. The largest increases were reported in comfort with airway management skills, understanding of the perioperative surgical home model, and vascular access skills. All participants indicated a higher likelihood of pursuing anesthesiology as a career and attributed their increased interest in anesthesiology to the selective., Conclusions: This new selective was successful in giving first- and second-year medical students a comprehensive overview of anesthesiology and increasing medical student interest in the specialty. The success of this selective leads to promising belief that similar peer-designed educational experiences can be developed at other medical schools to improve education and interest in this area of medicine., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Objective: To assess patients' knowledge of the role of the anesthesiologist and to identify information patients desire during the preoperative visit., Design: Self-administered structured survey evaluation., Setting: Preoperative Evaluation Clinic at Mayo Clinic, Rochester, Minnesota., Patients: 502 adult surgical patients scheduled for elective surgery., Measurements: A survey was designed and administered to patients in the preoperative clinic to assess their knowledge of the job descriptions and roles of anesthesiologists. The survey also included questions about information that patients desire before anesthesia and surgery., Main Results: The survey was distributed to 502 patients, 500 of whom (99%) completed the survey. Seventy-four percent (346/466) of respondents were educated at or above the college level. The majority (377/460; 82%) of patients in this study had adequate or high health literacy levels. Four hundred sixteen of 486 (86%) respondents knew that an anesthesiologist was a doctor specializing in anesthesia. However, the roles of anesthesiologists throughout the hospital system were not well known. Ninety-six of 475 (20%) patients knew that anesthesiologists may work in pain management clinics, 80 of 470 (17%) patients knew that anesthesiologists may work in intensive care units, but only 59 of 472 (13%) patients knew that anesthesiologists may transfuse blood during surgery if needed., Conclusion: Despite the high level of education and health literacy in this group of patients, many were uninformed about the roles of anesthesiologists. Patients expressed interest in receiving a broad range of information during the preoperative visit. An educational booklet was the preferred method to provide this information., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Study Objective: To re-evaluate factors responsible for selecting a career in anesthesiology and for selecting an anesthesiology training program. The perceptions of anesthesiology residents about employment opportunities and future job security were also re-examined. Novel data on the impact of duty hour restrictions on residency training were obtained., Design: Survey instrument., Setting: Academic medical center., Subjects: 63 residents enrolled in the anesthesiology residency at Mayo Clinic in Rochester, MN (clinical base year and clinical anesthesia years 1-3) during the 2010-11 academic year. All responses were anonymous., Measurements: Current study data were compared to data from two similar studies published by the authors (1995-96 and 2000-01) using an f-exact test. A P-value ≤ 0.05 was considered significant., Main Results: 55 of 63 (87%) residents responded to the survey. The most frequently cited reasons for selecting a career in anesthesiology were: anesthesiology is a "hands-on" specialty (49%), critical care medicine is included in the scope of training/practice (33%), anesthesiology provides opportunities to perform invasive procedures (31%), and the work is immediately gratifying (31%). When current data were compared with data from the 1995-96 survey, respondents reported significant decreases in interest in physiology/pharmacology (42% vs 21%; P = 0.03), opportunities to conduct research (13% vs 2%; P = 0.05) and opportunities to train in pain medicine (13% vs 0%; P = 0.01) as reasons for selecting anesthesiology. When current data were compared with data from the 2000-2001 survey, respondents reported a significant increase in critical care medicine (7% vs 33%, P = 0.01), significant decreases in time off (36% vs 11%; P = 0.01) and work time mostly devoted to patient care (20% vs 2%; P = 0.01) as factors in selecting anesthesiology as a career. Nearly all (94%) respondents reported a high level of satisfaction with their specialty choice and would choose anesthesiology again if currently graduating medical school. When current data were compared with those from the 2000-2001 survey, a significant increase in respondents who anticipated difficulty securing employment (0% vs 14%; P = 0.01) was noted. However, anticipation of difficulty in securing employment remained significantly lower than what was reported on the 1995-96 survey (54% vs 14%; P = 0.01). Thirty-eight percent of residents reported that implementation of duty hour restrictions had a positive impact on resident education, and 43% of residents reported that duty hour restrictions improved their quality of life. However, most respondents (69%) did not support further duty hour restrictions, and many (43%) expected to work longer hours after graduation., Conclusions: Residents in this study remain highly satisfied with anesthesiology as a career choice and with their training program. However, a resurgence of concern about employment after program completion and about future job security is apparent. The impact of critical care medicine training has significantly increased as a factor in selecting anesthesiology as a career, and the impact of training in pain medicine has significantly decreased. Although work hour restrictions were viewed as having a positive impact on training and well-being by 48% of residents, a majority of respondents in this study (76%) disagreed with further duty hour restrictions., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Study Objective: To review national data on anesthesiology critical care medicine (ACCM) fellowship program enrollment and to describe a program that successfully recruited ACCM fellows and faculty at a single academic medical center., Design: An incentive program known as the Mayo Clinic Scholar program, designed to recruit ACCM fellows and faculty, was reviewed. Interviews were conducted to assess the impact of the Mayo Clinic Scholar program., Setting: Academic health center., Measurements: ACCM fellowship program enrollment data were compared with similar data for critical care medicine fellowship programs in internal medicine, pulmonary medicine, pediatrics, and surgery.The results of a program to recruit ACCM fellows and faculty were reviewed., Main Results: Only 89 of 147 (60.5%) ACCM fellowship positions available nationally were filled during the 2010-2011 academic year, and only 89 of the 896 (9.9%) critical care medicine fellows anticipated to graduate in 2011 were in ACCM programs. The Mayo Clinic ACCM fellowship enrolled 28 fellows from January 1, 2000 through July 1, 2010 (range 0-6 per yr). Ten of the 28 (35.7%) were United States medical graduates (USMGs) and 6 of the 10 (60.0%) USMGs who were graduates of the Mayo Clinic residency were appointed as Mayo Clinic Scholars. All 6 Mayo Clinic Scholars were retained as ACCM faculty. Only two of the 6 (33.3%) Mayo Clinic Scholars would have completed ACCM training without a Mayo Clinic Scholar appointment. All recommend ACCM training to others and plan to continue to practice ACCM., Conclusions: The Mayo Clinic Scholar program effectively recruited ACCM fellows and faculty in a single institution. Incentive-based programs should be considered to support the involvement of anesthesiologists in perioperative medicine., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The roles and responsibilities of anesthesiology core program directors have evolved, in part because the Anesthesiology Residency Review Committee of the Accreditation Council for Graduate Medical Education no longer requires that the department chair also serve in this role. We reviewed several core anesthesiology program director academic and demographic characteristics including age, academic rank, gender, duration of service, board certification and re-certification status, and whether the program director also serves as department chair. Anesthesiology core residency program directors range in age from 33 to 74 years, with a median of 52 years. Thirty-seven (28%) program directors are women. The majority (67%) have senior academic rank (professor or associate professor). The median appointment duration is 3.7 years. The core residency program director currently also serves as department chair in 24 of the 131 (18.3%) programs., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The McGRATH Video Laryngoscope Series 5 is an example of indirect laryngoscopic equipment. Experience using this device to safely intubate the trachea of awake and asleep patients with known or anticipated difficult airways is presented., ((c) 2010 Elsevier Inc. All rights reserved.)

Background: Significant changes in perioperative red blood cell (RBC) transfusion practice during the past two decades have been reported but similar data are not available for patients undergoing abdominal aortic aneurysm (AAA) surgery., Methods: Adult patients who had undergone primary, elective, open AAA repair were stratified into one of two transfusion-related groups: early practice (1980-1982) or late practice (2003-2006). RBC transfusion and hemoglobin concentration (Hb) were analyzed as a continuous variable and compared between groups with use of the rank sum test. Perioperative complications were compared between groups with Fisher's exact test. Data were age adjusted, and analyses were corrected for multiple comparisons., Results: Compared with the early practice group, patients in the late practice group had significantly lower intraoperative (mean 10 +/- 1.4 vs. 11.5 +/- 1.5 g/dL), postoperative (11.9 +/- 1.4 vs. 13.4 +/- 1.5 g/dL), and discharge Hbs (mean 10.8 +/- 1.2 vs. 12.5 +/- 1.5 g/dL) (p < 0.0001 for each variable). Patients in the late practice group were significantly less likely to receive intraoperative allogenic transfusions (46% vs. 99%, p < 0.0001). Additionally, significantly fewer total allogenic units of RBCs per patient were transfused in the late practice group (mean 1.7 vs. 4.3, p < 0.0001). Intraoperative autotransfusions were used in 97% of the late practice patients but in none of the early practice patients (p < 0.0001). In the late practice group, 119 patients (40%) experienced a major perioperative morbidity or mortality event compared with 106 patients (35%) in the early practice group (p = 0.27)., Conclusion: In this retrospective analysis, we observed significantly lower perioperative Hb, fewer allogenic RBC transfusions, and more autotransfusions in open AAA repairs done in 2003-2006 versus those done in 1980-1982. Additionally, late transfusion practice patients were older and had more comorbid diseases. Despite these observations, no significant differences in perioperative morbidity or mortality were observed between groups., (Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

Posterior reversible encephalopathy syndrome refers to a neuroradiologic disorder in which seizure activity (multiple seizures are more common than single events) is commonly the initial presenting symptom. We describe a case of posterior reversible encephalopathy syndrome in a previously healthy parturient who presented to the labor and delivery suite with generalized tonic-clonic seizures. Prompt recognition and treatment of this potentially catastrophic disease may avert injury to the patient and neonate.

Providing anesthesia care for patients who have recently undergone intracoronary drug-eluting stent placement presents unique clinical challenges. It is currently recommended that these patients remain on antiplatelet therapy until reendothelialization of the vessel has occurred (ie, 3-6 months, depending on the eluting medication) to prevent stent restenosis. In the setting of urgent or emergent surgery, it may not be possible to wait until a full course of antiplatelet therapy has been completed. We report an unusual case of postoperative acute coronary syndrome in a gentleman who underwent intracoronary stenting 7 weeks before nonelective revision hip arthroplasty. To our knowledge, this is the first case in the anesthesia literature to report postoperative cardiac morbidity after recent drug-eluting stent deployment.

Successful management strategies for pulmonary thromboembolism-primarily published as case reports-include a spectrum ranging from medical treatment with cardiovascular support and anticoagulation to more invasive interventions such as pulmonary embolectomy. We present a case of massive intraoperative pulmonary embolism that was managed with emergent pulmonary embolectomy. Unlike previously reported cases, this aggressive management strategy was unsuccessful, due in part perhaps to lack of discernible clot during embolectomy.

We report a case in which kinking of the Lasertubus resulted in near-total occlusion of the endotracheal tube, which in turn precluded adequate ventilation. Although the reporting of kinked endotracheal tubes is not uncommon in the anesthesia literature, our case is unique with respect to the physical mechanism responsible for tube deformation.

We present an unusual case in which a pediatric patient sustained iatrogenic pulmonary contusion resulting in severe hemoptysis. Aside from being a rare complication of pediatric extracorporeal shock wave lithotripsy, our case is unique in regard to the timing and apparent severity of hemoptysis.

Study Objective: To reexamine, in a follow-up to our first study, those factors responsible for house staff (i.e., residents and clinical fellows) selecting anesthesiology as a career and a specific training program, as well as house staff satisfaction with various educational aspects of our training program, and their perceptions of the future for graduating anesthesiology trainees., Design: Survey questionnaire of 77 house staff at the Mayo Clinic during the 2000 to 2001 academic year., Setting: Academic medical center., Measurements: A cross-sectional analysis was conducted using a questionnaire to survey 77 house staff enrolled in the anesthesiology training program at Mayo Clinic, Rochester, MN during the 2000 to 01 academic year. All responses were anonymous. Data were compared between time epochs using an f-exact test. A p-value

Use of single-dose and continuous interscalene brachial plexus block (ISB) are gaining widespread popularity. When compared with general anesthesia, ISB has been reported to provide superior postoperative analgesia with fewer side effects, and it is associated with greater patient satisfaction. Anatomical landmarks are readily identifiable, which contributes to the ease of performing this block. In the future, we anticipate increased use of continuous interscalene catheters or injection of biodegradable local anesthetic impregnated microspheres to provide prolonged perioperative outpatient analgesia., (Copyright 2002 by Elsevier Science Inc.)