Ultrasound-Assisted Combined Spinal-Epidural Anesthesia for Cesarean Delivery in a Parturient With Currarino Triad: A Case Report.

Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. Ultrasound imaging improves accuracy of intervertebral level identification compared to clinical estimation. We present the case of a parturient with Currarino triad and a low conus medullaris undergoing cesarean delivery where preprocedural magnetic resonance imaging and ultrasound imaging allowed for successful combined spinal-epidural anesthesia to be performed. Despite these measures, however, the patient did develop a high spinal and temporary postoperative dizziness.

The Changing Characteristics of Anesthesiology Program Directors.

BACKGROUND: Residency program directors (PD) play a critical role in graduate medical education (GME) programs. We previously published a manuscript that defined the population of programs and program directors of ACGME-accredited anesthesiology residencies and established benchmark data for comparison.1 This study compares characteristics of current anesthesiology programs and PDs with baseline data reported in our previous study. METHODS: Data were gathered through review of ACGME and American Board of Anesthesiology (ABA) websites, medical licensure records, residency program websites, and electronic search engines. Program characteristics assessed included accreditation status, number of approved positions, and previous osteopathic accreditation. PD characteristics assessed included age, academic rank, sex, time since appointment, ABA certification, and simultaneous appointment as department chair. RESULTS: The number of programs increased from 131 to 147 (12.2%) and was mostly (9/13, 68.2%) due to new ACGME-accreditation of preexisting osteopathic programs. PD age, sex, and time since appointment (3.6 years) did not differ between study periods. The number of PDs with senior academic rank and the number who also serve as department chairs decreased significantly. CONCLUSIONS: The number and size of anesthesiology programs increased since our last study. This can be largely explained by ACGME accreditation of osteopathic programs. PD characteristics are similar except for a decrease in the number with senior academic rank and the number who also serve as department chairs. There was no change in the percentage of women PDs between the study periods. The high rate of anesthesiology PD turnover and low median duration of appointment merit further investigation.