Search

OBJECTIVE To describe the detailed surgical procedure for open-chest CPR (OC-CPR) through a transdiaphragmatic (TD) approach during planned laparotomy and to evaluate the procedure time and damage to organs. ANIMALS 7 mixed-breed canine cadavers. METHODS The procedure was divided into 3 stages. Durations for each of the 3 stages of the procedure and total time from diaphragmatic incision to the end of Rumel tourniquet application were recorded. Subjective assessment of ease of procedures and postprocedural physical evaluation of thoracoabdominal organs were also performed. RESULTS Mean time from diaphragmatic incision to pericardiotomy was 15.1 seconds (SD, 4.0). Performing 10 cardiac compressions took 12.0 seconds (SD, 1.8). Dissection of the aorta and application of a Rumel tourniquet took 130.4 seconds (SD, 52.2). The mean total time from start of first procedure to end of last procedure was 157.6 seconds (SD, 21.5). The mean length of diaphragmatic incision was 11.5 cm (SD, 2.2). Lung laceration was identified in one dog, and liver laceration was identified in another dog. The mean ease of pericardiotomy was 10, and application of a Rumel tourniquet was 4 (SD, 1.9). There was no instance of abdominal organs moving into the thoracic cavity during the procedure in any of the dogs. CLINICAL RELEVANCE Resuscitation techniques during TD OC-CPR can be performed with acceptable timing and effort, except for aortic Rumel tourniquet application, which was difficult and time consuming. Avoidable damage to thoracoabdominal organs can occur [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the acute strength (failure load and work to failure) of standard incisional gastropexy (SIG) and modified incisional gastropexy (MIG). ANIMALS 37 pig cadavers. PROCEDURES Stomachs and right abdominal walls were harvested from pigs euthanized for reasons unrelated to this study. The tissues were stored in lactated Ringer's solution overnight in a 5 °C cooler. Matching body wall and stomach tissue pairs were randomized and divided into 2 groups, on which either SIG or MIG was performed the following day. The MIG technique was identical to SIG except 2 additional simple interrupted sutures, 1 cranial and 1 caudal to the continuous suture line, were placed full thickness into the stomach to ensure engagement of the submucosa. After gastropexy, the samples underwent biomechanical testing. Information regarding change in position and load was generated by the MTESTQuattro software. Mode of failure was examined after the procedure was complete. RESULTS The MIG had higher failure load and work to failure compared to SIG. All failures were caused by gastric tissue tearing. CLINICAL RELEVANCE The MIG is biomechanically superior to SIG and may provide more security than SIG during healing. However, clinical study is needed to ascertain if there isa difference in gastropexy failure and complications between these 2 techniques. [ABSTRACT FROM AUTHOR]

A retrospective study was performed to evaluate a satisfactory/unsatisfactory (S/U) grading scheme in a didactic surgery laboratory during the first 3 years of implementation (2002-2004) and identify areas for improvement that might be adapted to this course or similar courses. Each instructor graded six students per session by assigning a descriptor of very good (G), acceptable (A), or unacceptable (U) in each of 11 assessment categories. A U in any category in one of the final two laboratories resulted in a failing grade for the course, unless the student performed acceptably in a make-up laboratory. A computerized course evaluation was used to solicit student feedback. Also, the numbers of G, A, and U grades were used to evaluate consistency of grading among instructors, to compare resident and faculty scores, and to track student progress. The return of course evaluations was low, but those available indicated favorable acceptance of S/U grading. There was little difference in assigned grades between faculty and residents, but some individual instructors seemingly graded more strictly than others. Student grades improved as the course progressed each year. No student received a final failing grade; however, two students required the make-up laboratory. Efforts to improve subjective grading should include planned acquisition of student feedback and establishment of more consistency of grading. While objective criteria may not be enough to adequately assess overall performance in didactic surgery laboratories, consistency of subjective evaluation requires adherence to well-defined assessment criteria. (Contains 7 tables and 1 figure.)