Effectiveness of a simulator in training anesthesiology residents. 1969.

The educational potential of a computer-controlled patient simulator was tested by the University of Southern California School of Medicine. The results of the experiment suggest unequivocally that there is a twofold advantage to the use of such a simulator in training anesthesiology residents in the skill of endotracheal intubation: (a) residents achieve proficiency levels in a smaller number of elapsed days of training, thus effecting a saving of time in the training of personnel, and (b) residents achieve a proficiency level in a smaller number of trials in the operating room, thus posing significantly less threat to patient safety. The small number of subjects in the study and the large within-group variability were responsible for a lack of statistical significance in 4 of 6 of the analyses performed; however, all differences were substantial and in the hypothesized direction. Thus, despite the narrowly circumscribed tasks to be learned by the experimental subjects, the findings suggest that the use of simulation devices should be considered in planning for future education and training not only in medicine but in other health care professions as well.

Cyclopropane. 1963.

Special precautions are stressed for cyclopropane, not because they are uniquely required for this drug, but because failure to observe them is apt to result in the more rapid occurrence of disaster for the patient. Strict attention to every minute detail is absolutely essential for good, safe cyclopropane anesthesia. Most important of all is adequate ventilation. Practically, this means assisting or controlling the ventilation at all times. Constant monitoring of the precordial heart tones is also mandatory. The blood pressure must be checked frequently, especially when the level of anesthesia is being deepened. In addition to all the required antiexplosion precautions required in operating rooms, we also recommend the use of a wet towel grounding as an added precaution. The anesthesiologist should further protect himself and the patient by keeping everything around the head of the table at the same electrical potential by frequently touching the various items. He should maintain constant contact with the patient whenever possible. The anesthesiologist should train himself to take these precautions automatically, so that they will not be omitted during trying circumstances. Our experience has been that residents trained to administer good, safe cyclopropane anesthesia according to the principles enunciated usually are much more attentive to details with other techniques. Constant observation of the patient and the progress of the surgery is also necessary, if good cyclopropane anesthesia is to result. Finally, there are some guiding principles that I believe are essential for the conduct of good, safe cyclopropane anesthesia. 1. Be thoroughly familiar with the pharmacological actions of the drug. 2. Maintain a healthy respect for the potency of the drug, but no fear. 3. Be especially sure to maintain adequate ventilation through a patent airway. 4. Remember the drug is explosive. 5. Be eternally vigilant to the minute details of the conduct of the anesthesia. 6. This drug is for the real "pro," not the amateur. It is to be handled with the finesse of the violinist, not with the banging of the cymbal player. 7. Answer for yourself the question, "If this drug is so frequently selected for the very poor risk patient, wouldn't it be equally good or better for the healthy patient?".