Development and Patient Satisfaction of a New Telemedicine Service for Pain Management at Massachusetts General Hospital to the Island of Martha's Vineyard.

OBJECTIVE: Patients in remote areas lack access to specialist care and pain management services. In order to provide pain management care to patients remote from our center, we created a telemedicine pain clinic (telepain) at Massachusetts General Hospital (MGH) in Boston, MA to extend services to the Island of Martha's Vineyard. DESIGN: Over 13 months, 238 telepain video clinic evaluations were conducted. A pain physician visited the island 1-2 days per month and performed 121 interventions. Given the novelty of telemedicine clinics, we surveyed patients to gauge satisfaction and identify perceived weaknesses in our approach that could be addressed. Forty-nine consecutive patients answered a 14-question, 5-point balanced Likert-scale survey with 1 (no, definitely not) being most negative and 5 (yes, definitely) being most positive. SETTING: Patients on Martha's Vineyard referred for pain management consultation services via telemedicine. PATIENTS: Forty-nine consecutive patients evaluated via telemedicine. INTERVENTIONS: Likert-scale survey administered. MEASURES: Questions measured patient impressions of video-based visits with their doctor, convenience of the visit, concerns about privacy, and whether they would recommend such a visit, among other items. RESULTS: Mean respondent scores for each question were >4.3 indicating a favorable impression of the telepain clinic experience. Lowest mean scores were found when respondents were asked to compare the care they received by telepain versus an in-person visit, or whether they were able to develop a friendly relationship with the doctor. CONCLUSIONS: The results suggest an overall positive reception of telepain by patients, yet highlight the challenge of building a patient-physician relationship remotely.

Transient Hypoglossal and Lingual Nerve Injury Following the Use of I-gel Supraglottic Airway: A Case Report.

Injury to the hypoglossal and/or lingual nerve is a rare occurrence with the use of a laryngeal mask airway (LMA) or supraglottic airway (SGA) device. There has been one prior report of a lingual and hypoglossal nerve injury with the i-gel™ SGA. We are describing the second reported hypoglossal and lingual transient nerve injury in a male patient while using an i-gel™ SGA. Although excessive cuff pressure has been cited as a possible cause, the i-gel™ does not have a cuff. This report highlights that hypoglossal nerve injury can still occur, even with the use of a cuffless LMA such as the i-gel™ SGA.

Total Spinal Anesthesia Following an Interscalene Block Treated with Intravenous Lipid Emulsion.

Total spinal anesthesia following interscalene block is a rare and life-threatening complication of regional anesthesia. A 56-year-old woman underwent an uncomplicated left shoulder bone spur removal under general anesthesia with an interscalene nerve block at an outpatient surgical center. Subsequently, she developed bilateral mydriasis, paralysis of all extremities, and respiratory arrest. She was intubated and transferred to the emergency department (ED) where she was given intravenous lipid emulsion (ILE) with complete recovery of neurological function. ILE therapy may be considered as a rescue treatment in addition to supportive therapy for total spinal anesthesia.

Methods in drug abuse models: comparison of different models of methamphetamine paradigms.

Methamphetamine (METH) is a widely abused psychomotor stimulant. Investigating the effects of METH use on the brain has been applied in different animal models, including rats, mice, and nonhuman primates. Human abuse of METH occurs in different paradigms ranging from episodes of binge abuse to chronic abuse over years; different animal models have been established to replicate these various patterns of human behavior. In this chapter, we discuss the different models of METH abuse, including the acute model which assesses the immediate effects of METH on the brain and chronic exposure model which simulates the more common long-term use observed in humans; additionally, two other relevant models, escalating dose paradigm and METH self-administration, are examined. In comparing the models, this chapter briefly considers the METH-induced neurotoxic effects associated with each METH administration paradigm and the behavioral changes observed.