A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy.

Regional analgesia, in a variety of forms, has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair. This study compares the efficacy of wound instillation with 0.25% bupivacaine (n = 20), caudal block with 0.25% bupivacaine (n = 35), and a control group (n = 15). Outcome parameters examined include total operating room time, time to extubation, postoperative objective pain scales, and requirement for supplemental analgesics. Patients who received caudal blocks had significantly decreased emergence times (P < .002), exhibited fewer pain-related behaviors postoperatively (P < .0025), and required less narcotic to maintain normal hemodynamics (P < .05). Operating room time was not statistically different between the three groups. The use of perioperative analgesic blocks resulted in quicker awakening, a more comfortable postoperative course, and potentially earlier discharge from same-day surgery.

Selection of anesthesiology residents.

The large numbers of medical graduates seeking residency training in anesthesiology have created a logistical problem for many programs. This difficulty and the recurrent phenomenon of the misplaced physician have prompted a search for better selection criteria and more efficient evaluation systems. The literature does not provide a concise description of the ideal resident candidate, but it does contain several approaches taken by a few individual teaching centers to improve applicant review procedures. Computer-assisted resident candidate selection (CARCS) is a three-phase system of preinterview screening, interview evaluation, and final ranking. Based on faculty criteria, the entire process uses data management technology that provides automatic calculation of selection parameters, sorting on any data field or combination thereof, and maintenance of a concise information profile for each candidate. CARCS allows equitable consideration of all who apply, with significant cost savings to both program and applicants. This paper reviews traditional methods of selecting anesthesiology residents, describes the CARCS system, and previews the future of resident candidate selection.

Analysis of learning style.

Analysis of learning style, a relatively new technique in the field of education, is being used in grade school and college, as well as in graduate and postgraduate training programs. The trend in the health professions to emphasize continuing education has created a need for individual practitioners to understand the principles of self-education. Analysis of learning style is useful in this regard. It also provides a basis for teaching task-specific cognitive skills to those in residency training. In this article we review the conceptual evolution of learning style analysis, especially its use in the health professions, and describe the Kolb Learning Style Inventory (LSI), which we use to study 205 anesthesia personnel.

Learning style analysis in surgical training.

Learning style analysis is being used at many educational levels to individualize the instructional process. The Kolb Learning Style Inventory (LSI) in particular has been employed to determine the learning preferences of medical students and physicians in family practice, internal medicine, and anesthesiology. This investigation was undertaken to discover whether there exists a characteristic learning profile for surgery as a specialty. The Kolb LSI was administered to 39 surgical personnel. Kolb's Converger was the preferred learning style type of the study group (46%). Accommodator (26%) and Assimilator (20%) were next, followed by Diverger (8%). These results suggest that there is an identifiable surgical learning style that can provide a referential basis for teaching and counseling during residency training.

Anesthesia for plastic surgery in the pediatric patient.

The anesthetic management of pediatric patients for plastic surgical procedures requires close cooperation and understanding between the surgeon and anesthesiologist. Success depends upon avoidance of psychological trauma, establishment and maintenance of a secure airway, and adequate access to the vascular system.

Anesthetic management of an intracranial arteriovenous malformation in infancy.

The prevention and control of massive bleeding has always been a problem in neurosurgical procedures, particularly in patients with arteriovenous malformations, intracranial aneurysms, and large vascular tumors. During the past 25 years, new technics have reduced the risk of hemorrhage; however, these have been most suitable for adult patients. Vascular intracranial lesions during infancy present even more complex problems. This is a report of the anesthetic management of a 7-month-old infant with an aneurysm of the v cerebri magna (great vein of Galen). Anesthetic management consisted of (1) halothane-N2O-O2 general endotracheal anesthesia, (2) surface-induced profound hypothermia, and (3) low-flow extracorporeal circulation. Phenothiazine premedication was used with halothane anesthesia to antagonize reflex vasoconstriction during hypothermia, hypothermia and low cardiac output to lessen the possibility of hemorrhage, aneurysmal rupture, and neurologic damage, and surface-induced hypothermia because it provides better core perfusion than central cooling. This technic allowed a successful outcome in an otherwise high-risk procedure.

Anesthesia for intracranial aneurysms.

At the Medical University of South Carolina during the past five years, 62 patients have had intracranial aneurysm surgery, with an overall mortality of 4.8%. Anesthesia was given by me to 14 of these patients. Preoperatively these patients were placed on bedrest, steroid prophylaxis, and sedative and antihypertensive medication to reduce th possibility of recurrent subarrachnoid hemorrhage. Halothane-nitrous oxide-oxygen endotracheal anesthesia with controlled ventilation was used, with careful monitoring of EKG, direct arterial pressure, arterial blood gases, body temperature, and urinary output. Adjuncts for control of bleeding and intracranial pressure were osmotic diuresis, cerebrospinal fluid drainage, minimal head-up tilt, and controlled hypotension using trimethaphan (Arfonad). There were no operative deaths, although one patient died postoperatively. Three patients had neurologic deficitys. These data indicate that controlled hypotension is a safe technic which, when properly used, can reduce the risk of anesthesia for intracranial aneurysm surgery.