Definitive surgical trauma care live porcine session: a technique for training in trauma surgery.

BACKGROUND: A new Definitive Surgical Trauma Care course was developed to educate surgeons in operative management of injuries. The course consists of an interactive CD-ROM and a live porcine animal laboratory. METHOD: A five-hour session was conducted. Penetrating injuries to stomach, bowel, diaphragm, spleen, pancreas, kidney, ureter, inferior vena cava, liver, and heart were created by the senior surgeon and managed by the junior surgeon. Participants rated their expertise in 26 maneuvers pre- and post-lab. The evaluation scale used was: no prior experience; able to perform skill with assistance; proficient at procedure; able to teach procedure to another surgeon. RESULTS: In 26 procedures, a maximum score of 78 was possible. There was an increase from pre- to post-session scores of 22.6 for PGY-4 residents (n = 3); 23.3 for PGY-5 residents (n = 4); 11.25 for fellows (n = 4); and 0 for attendings (n = 4). CONCLUSION: The operative animal session had the greatest educational benefit among surgeons without formal training in trauma surgery. By exposing them to a range of trauma-induced surgical conditions, the DSTC course develops their operative repertoire and should increase their effectiveness in managing trauma patients.

The effects of programmed ventricular stimulation on plasma procainamide levels: an experimental model.

To evaluate the effects of programmed ventricular stimulation on resultant plasma concentrations of intravenously administered procainamide, drug dosing was performed with and without ventricular stimulation on two separate days (48 hours apart) in 12 dogs (13 dosing trials) at > or = 14 days after myocardial infarction (mean: 62 days). During infarct surgery, three bipolar electrodes were plunged into left ventricular epicardium, externalized, and later used for ventricular stimulation. On the first study day, procainamide was dosed to achieve two sequential plateau plasma levels (I and II), with a 20-minute equilibrium period at each plateau before ventricular stimulation. Plasma procainamide concentrations were measured before initiation of ventricular stimulation and at the completion of ventricular stimulation for each sequential plateau level. Stimulation involved delivery of one, two, and three extrastimuli at three paced cycle lengths at three left ventricular sites before procainamide dosing and at each of the two procainamide plateau levels. Three dogs were excluded from analysis due to induction of lethal ventricular arrhythmias. No ventricular arrhythmias were induced in the remaining nine animals. On the second study day, procainamide was dosed identically, but no ventricular stimulation was performed. Intravenous drug administration and collection of plasma concentration samples were performed with +/- 1 minute on both study days. Mean plasma procainamide concentrations at the end of ventricular stimulation at dosage Levels I & II were 10% and 12% greater (P < 0.02 and P < 0.005, respectively) than plasma concentrations measured at comparable times on the study day when no ventricular stimulation was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic stability of bipolar epicardial plunge electrodes in dogs.

We constructed and surgically implanted 114 chronic bipolar epicardial plunge electrodes for programmed left ventricular stimulation in closed chest dogs; 88 electrodes could be analyzed in animals surviving infarct surgery. Electrode plunges were constructed of silver wire, with conduction strands of silver-plated copper wire, in medical grade silicone tubing. Electrodes were implanted epicardially through left thoracotomy and secured with prolene. Wires exited the fifth intercostal space and were tunneled subcutaneously and secured at the dorsal aspect of the neck. Baseline thresholds (mA) were recorded at a paced cycle length of 300 ms and pulse duration of 1 ms. At least 5 days after implantation, under light Nembutal sedation, thresholds were reassessed before programmed stimulation. Each lead was tested repeatedly over 5-177 (mean 28) days. The number of leads decreased with time due to animal attrition from ventricular arrhythmias. Mean pacing threshold at implantation was 0.25 mA. Mean and median threshold values reached plateau after 1 week and showed little change thereafter for the duration of the study. More than 50% of the leads maintained thresholds less than 1.5 mA through the entire study. In animals that survived, 86% of the electrodes remained useful for the duration of the protocol. These data support the use of this electrode system as effective and reliable for chronic electrophysiologic studies in dogs.