Achieving proficiency in rigid bronchoscopy-a study in manikins.

BACKGROUND: Rigid bronchoscopy may be used to relieve acute airway obstruction following induction of anaesthesia and is a recommended option for management of the difficult airway. The ability of anaesthetists to perform rigid bronchoscopy has not been reported. We sought to explore the acquisition of procedural skill in rigid bronchoscopy by anaesthesiologists in a manikin. METHODS: In a prospective interventional study, participants were asked to perform 40 rigid bronchoscopies in a TruCorp AirSim Advance airway manikin, configured to a randomised sequence of easy or difficult laryngoscopic grades to which the participants were blinded. The primary outcome was stabilisation (the attempt after which no further reduction in procedural time occurred). Dental injury and oesophageal intubation were also recorded. Forty anaesthesiologists and 40 unskilled controls (without laryngoscopic skills) participated. RESULTS: In the easy model, stabilisation occurred at attempt 8 in the anaesthesiology group and 10 in the unskilled controls. In the difficult model, stabilisation occurred at attempt 10 in both groups. Dental injury was less common in the anaesthesiology group. The proportion of participants achieving procedural competency did not differ between groups in either the easy (35/40 vs. 30/40) or difficult model (32/40 vs. 25/40). CONCLUSIONS: This study shows that the technical skill of rigid bronchoscopy can be acquired within 10 repetitions in a manikin model. As procedural competence and complication frequency vary with the laryngoscopic grade of the model, both easy and difficult configurations should be used for training. Advanced laryngoscopic skills are not required prior to training in this technique.

Accuracy of emergency room physicians' interpretation of elbow fractures in children.

Elbow fractures in children can be difficult diagnoses for inexperienced physicians to make. The purpose of this prospective study was to determine the accuracy of radiograph interpretation of elbow fractures in children by emergency room (ER) physicians. Thirty fractures were analyzed. The ER physician's radiograph interpretation was compared to the final interpretation by the treating staff pediatric orthopedic surgeon. Accuracy rates were determined for overall agreement and by fracture subtype. Overall accuracy of ER physicians' interpretation was 53% (16/30). This study underscores the importance of educating ER physicians and residents in children's fracture interpretation to optimize patient outcomes. Orthopedists need to be vigilant when taking care of these patients to prevent unnecessary complications.

The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary retention, and mobility following inguinal herniorrhaphy.

This study was conducted to determine the effects of spinal (n = 113) vs epidural (n = 31) anesthetic techniques on 3 common postoperative complications: pain, urinary retention, and mobility for patients undergoing inguinal herniorrhaphy. The study design was a retrospective chart review. Data were collected on 144 subjects who underwent herniorrhaphy between January 1 and December 31, 1999, had an ASA classification of I to III, and were older than 18 years. The local anesthetics used to provide spinal anesthesia were 5% lidocaine, 0.75% bupivacaine, and 1% tetracaine solutions. The anesthetics used to provide epidural anesthesia were a solution of 2% lidocaine with epinephrine or 3% chloroprocaine with epinephrine. Results revealed that pain was not significantly different between the 2 anesthetic groups (P = .65); however, subjects in the epidural anesthesia group were able to ambulate (P = .008) and void (P = .02) sooner than subjects in the spinal anesthesia group. This study demonstrates that epidural anesthesia results in less urinary retention and earlier mobility than spinal anesthesia in men undergoing inguinal herniorrhaphy. Minimizing postoperative complications is essential in order for the nurse anesthetist to provide a satisfactory anesthetic experience. This study's findings suggest that epidural anesthesia optimizes recovery for the patient undergoing inguinal herniorrhaphy.