Thomas Dent Mütter, M.D. (1811 to 1859): Exemplar of Expertise.

Thomas Dent Mütter, a Philadelphia plastic surgeon in the 1840s, boldly championed anesthesia when few physicians were convinced of its virtues. He was an early advocate of handwashing and hygienic wound care and helped pioneer the concept of postoperative recovery units. A leader in education, Mütter used a highly interactive style of teaching and restructured medical school classes to raise the caliber of clinical training. He supplemented his lectures with a myriad of specimens that he amassed over 24 yr. In 1863, this vast collection would serve as the basis for the Mütter Museum, which remains active today. Mütter exemplified expertise by tirelessly pursuing new knowledge and methods for the benefit of his patients and students.

100 Years of Pediatric Anesthesia With Anesthesia & Analgesia: Growing Together.

As the practice of pediatric anesthesiology grew in the early 20th century, Anesthesia & Analgesia (A&A) became the most important practical resource of pediatric fundamentals for general anesthesiologists. With continued growth in the mid-20th century, focus then shifted to complex cases performed by dedicated pediatric anesthesiologists. To this day, A&A continues to serve as a crucial forum for our subspecialty as it matures. The International Anesthesia Research Society (IARS) also remains pivotal in addressing the crucial questions of modern practice, such as the recent founding of the SmartTots initiative to investigate the potential neurotoxicity of anesthetics in children. While A&A celebrates 100 years of publication, we reflect upon pediatric anesthesiology's evolution and the impact of the IARS and A&A on pediatric anesthesiology's scholarship, clinical practice, and professionalization.

An Anesthesiologist in the Space Race: The Life and Career of Dr. Cloid D. Green.

The space race began in the summer of 1955 when the United States and the Soviet Union pledged to launch artificial satellites. The race culminated in 1969 when the United States landed the first humans on the moon. After completing his training in anesthesiology, Dr. Cloid Green forged his career as one of the physician-scientists who played an integral role by evaluating the effects of space flight on human physiology. Family members of Dr. Green were interviewed and university and society archives, literature and periodicals were reviewed. Dr. Cloid Green received his medical training at the University of Minnesota. He earned his MD in 1946 before moving to South Dakota and working as a general practitioner. A combination of professional curiosity and the military's request for further service led Dr. Green to complete an anesthesia residency at the University of Iowa. After training, he was assigned as the physician in charge of a bomber wing at a base near Austin, Texas, in 1957. Due to his research on the effects of high altitude on pilots, he was recruited to the Brooks Air Force Base. Dr. Green was the ranking medical official overseeing early space flights involving monkeys. After leaving the USAF, Dr. Green practiced anesthesiology at the University of Virginia before moving to Newfoundland, Canada. He became the first chair of Anesthesiology at the Memorial University of Newfoundland in 1969. Dr. Cloid Green's career grew alongside the specialty of anesthesiology in the 1950s. His training in anesthesiology proved to be a versatile and profoundly useful skill set as the specialty became fully recognized. Dr. Green's long and fruitful career is the perfect example of the diverse opportunities afforded by anesthesiology training.

Evaluation of Three-Dimensional Printed Materials for Simulation by Computed Tomography and Ultrasound Imaging.

INTRODUCTION: The use of three-dimensional (3D) printing allows for creation of custom models for clinical care, education, and simulation. Medical imaging, given the significant role it plays in both clinical diagnostics and procedures, remains an important area for such education and simulation. Unfortunately, the materials appropriate for use in simulation involving radiographic or ultrasound imaging remains poorly understood. Therefore, our study was intended to explore the characteristics of readily available 3D printing materials when visualized by computed tomography (CT) and ultrasound. METHODS: Seven 3D printing materials were examined in standard shapes (cube, cylinder, triangular prism) with a selection of printing methods ("open," "whole," and "solid" forms). For CT imaging, these objects were suspended in a gelatin matrix molded to match a standard human CT phantom. For ultrasound imaging, the objects were placed in acrylic forms filled with a gelatin matrix. All images were examined using OsiriX software. RESULTS: Computed tomography imaging revealed marked variation in materials' Hounsfield units as well as patterning and artifact. The Hounsfield unit variations revealed a number of materials suitable for simulation various human tissues. Ultrasound imaging showed echogenicity in all materials, with some variability in shadowing and posterior wall visualization. CONCLUSIONS: We were able to demonstrate the potential utility for 3D printing in the creation of CT and ultrasound simulation models. The similar appearance of materials via ultrasound supports their broad utility for select tissue types, whereas the more variable appearance via CT suggests greater potential for simulating differing tissues but requiring multiple printer technologies to do so.

The influence of neurophysiologic monitoring on the management of pediatric cardiopulmonary bypass.

We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery. While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. A retrospective review of cases from 1 year before the institution of the IONM program was compared with data obtained from cases performed after neurophysiologic monitoring was established as a standard of care for pediatric patients on CPB. This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM. These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.