ABSTRACT
Simulation practice is known to be effective in anesthesiology education. In our simulation practice of general anesthesia for open cholecystectomy at the Tohoku University simulation center, we projected a surgical video onto a mannequin's abdomen. In this observational study, we investigated whether video-linked simulation practice improved students' performance. We retrospectively compared the general anesthesia simulation practice scores of fifth-year medical students in a video-linked or conventional group. In the simulation practice, we evaluated the performance of each group in three sections: perioperative analgesia, intraoperative bleeding, and arrhythmia caused by abdominal irrigation. The primary endpoint was the total score of the simulation practice. The secondary endpoints were their scores on each section. We also investigated the amount of bleeding that caused an initial action and the amount of bleeding when they began to transfuse. The video group had significantly higher total scores than the conventional group (7.5 [5-10] vs. 5.5 [4-8], p = 0.00956). For the perioperative analgesia and arrhythmia sections, students in the video group responded appropriately to surgical pain. In the intraoperative bleeding section, students in both groups scored similarly. The amount of bleeding that caused initial action was significantly lower in the video group (200 mL [200-300]) than in the conventional group (400 mL [200-500]) (p = 0.00056).Simulation practice with surgical video projection improved student performance. By projecting surgical videos, students could practice in a more realistic environment similar to an actual case.
Subject(s)
Manikins , Humans , Anesthesiology/education , Perioperative Care/education , Video Recording , Students, Medical , Simulation Training/methods , Male , Female , Anesthesia/methodsABSTRACT
BACKGROUND AND AIMS: Thyromental height (TMH) has been reported to be useful for prediction of difficult visualisation of the larynx (DVL), defined as Cormack--Lehane (C&L) grade III or IV. The aim of this study was to compare the diagnostic accuracy of the TMH test for DVL with that of other clinically used tests in Japanese patients. METHODS: Six hundred and nine surgical patients undergoing endotracheal intubation under general anaesthesia were enrolled in this prospective observational study. TMH, thyromental distance (TMD), and Samsoon and Young's modified Mallampati (MMT) tests were performed in all patients. The C&L grades for the laryngoscopic view with and without external backward, upward, rightward pressure (BURP) were determined by designated airway assessors. The cutoff value for the TMH test was calculated using receiver-operating characteristic (ROC) curve analysis. The sensitivity, specificity, positive predictive value, accuracy, positive likelihood ratio, and area under the ROC curve (AUROC) for each predictive test were calculated and compared. RESULTS: ROC curve analysis indicated that 54 mm is the optimal cutoff value for the TMH test. However, both this value and the conventional cutoff value of 50 mm, which has been reported as having good diagnostic accuracy in the literature, had poor diagnostic accuracy. The AUROC for the TMH test was 0.631 without BURP and 0.592 with BURP; these values were not superior to those for the TMD test or MMT. CONCLUSION: The TMH test is not a good predictor of DVL in Japanese patients.
ABSTRACT
We tested the hypothesis that the environmental noise generated by a forced-air warming system reduces the monitoring accuracy of acoustic respiration rate (RRa). Noise levels were adjusted to 45-55, 56-65, 66-75, and 76-85 dB. Healthy participants breathed at set respiration rates (RRset) of 6, 12, and 30/min. Under each noise level at each RRset, the respiration rates by manual counting (RRm) and RRa were recorded. Any appearance of the alarm display on the RRa monitor was also recorded. Each RRm of all participants agreed with each RRset at each noise level. At 45-55 dB noise, the RRa of 13, 17, and 17 participants agreed with RRset of 6, 12, and 30/min, respectively. The RRa of 14, 17, and 16 participants at 56-65 dB noise, agreed with RRset of 6, 12, and 30/min, respectively. At 66-75 dB noise, the RRa of 9, 15, and 16 participants agreed with RRset of 6, 12, and 30/min, respectively. The RRa of one, nine, and nine participants at 76-85 dB noise agreed with RRset of 6, 12, and 30/min, respectively, which was significantly less than the other noise levels (P < 0.05). Overall, 72.9% of alarm displays highlighted incorrect values of RRa. In a noisy situation involving the operation of a forced-air warming system, the acoustic respiration monitoring should be used carefully especially in patients with a low respiration rate.
