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Perioperative medicine (POM) is a new and evolving field of medicine that has rapidly spread across the globe. The speed at which POM has emerged and spread has created a demand for clinicians with knowledge and expertise in POM that has outpaced traditional clinical training programs and the ability of clinicians to be trained in the specialty. The skills and knowledge needed for the practice of POM does not fit any one specialty nor are they traditionally taught in medical school or postgraduate training programs. Many of these skills, e.g., team-based leadership and patient-centered communication skills, are amenable to simulation-based education and training (SBET). The rapid emergence and the unique skills required for the practice of this new specialty have created an opportunity for SBET to fill the demand for POM clinicians.

Background: Sedative agents used during cardiac surgery can influence the patient’s time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. Objective: This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. Methods: This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium. Results: Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.

Neurologic injury in the form of cognitive decline, delirium, and stroke are common phenomena in patients undergoing cardiac surgery and continues to be one of the most common complication after cardiac surgery, in spite of improvements in mortality and and improved surgical and anesthetic techniques. These complications lead to a significant increase in length of stay in the intensive care unit, increased length of hospital admission, and functional impairment, resulting in not only profound negative effects on patients who experience these complications, but also to increased costs of medical care and delivery. We discuss each of these complications in regard to their risks factors, incidence, potential therapeutic modalities, and relevant intraoperative and postoperative considerations.