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Biomedical subjects

M A Olympio

Publications and source records attributed to M A Olympio.

14 recordsLinked to original sources
PubMed2003

Failure of simulation training to change residents' management of oesophageal intubation.

BACKGROUND: There are few scientific reports documenting the effects of simulation training on learning. Issues of scientific validity challenge investigators who measure such outcomes. We perceived a failure of residents to change their technical management of oesophageal intubation after simulation training and sought clarification of this observation. METHODS: Twenty-one residents were randomly exposed to two deliberate oesophageal intubation scenarios, first as a junior assistant (JS group) or as a senior managing resident (SS group), and secondly as a senior managing resident. After the first episode, residents were given an explanation and demonstration of the suggested technical management strategy, including: (i) confirmation of oesophageal intubation with a second direct laryngoscopy; and (ii) concurrent insertion of a second tube into the trachea. After the second episode, we retrospectively sought to confirm improvement in technical management within the SS group by measuring videotaped performances. Questionnaires were sent to the residents before and after reporting their performance results. RESULTS: There were 14 SS and seven JS subjects. Within SS, there was no improvement in "confirmation of oesophageal intubation with direct laryngoscopy" (8/14 vs 9/14) or any improvement in "concurrent insertion of a second ETT (tracheal) tube" (1/14 vs 2/14). Questionnaire responses offered considerable insight into these negative results. CONCLUSIONS: This failure to change may have been secondary to a lack of criterion validity, lack of repetition or a long duration between episodes. The expectations for management were not regarded as being advantageous in simulation, but they were successfully adopted in actual clinical emergencies.

Anesthesiology↗
PubMed2000

Emergence from anesthesia in the prone versus supine position in patients undergoing lumbar surgery.

BACKGROUND: Conventional supine emergence in patients undergoing prone lumbar surgery frequently results in tachycardia, hypertension, coughing, and loss of monitoring as the patient is rolled supine. The prone position might facilitate a smoother emergence because the patient is not disturbed. No data describe this technique. METHODS: Fifty patients were anesthetized with fentanyl, nitrous oxide, isoflurane, and rocuronium. By the conclusion of surgery, all patients achieved spontaneous ventilation and full reversal of neuromuscular blockade in the prone position, as the volatile anesthetic level was reduced. Baseline heart rate and mean arterial pressure were recorded. Patients were then randomized at time 0 to the supine (n = 24) or prone (n = 21) position as 100% oxygen was administered. Patients in the supine position were then rolled over, while those in the prone position remained undisturbed. Heart rate, mean arterial pressure, and coughs were recorded until extubation. Tracheas were extubated on eye opening or purposeful behavior. RESULTS: When compared with the supine group, prone patients had significantly less increase in heart rate (P = 0.0003, maximum increase 9.3 vs. 25 beats/min), less increase in mean arterial pressure (P = 0.0063, maximum increase 4.8 vs. 19 mmHg), less coughing (P = 0.0004, 7.0 vs. 23 coughs), and fewer monitor disconnections (P < 0.0001). Time to extubation from time 0 was similar (4.0 vs. 3.7 min, prone vs. supine). No one required airway rescue. There was no significant difference in need for restraint (three prone, four supine). CONCLUSIONS: Prone emergence and extubation is associated with less hemodynamic stimulation, less coughing, and less disruption of monitors, without specifically observed adverse effects, when compared with conventional supine techniques.

Androstanols↗
PubMed2000

Electromyography monitoring for percutaneous placement of iliosacral screws.

OBJECTIVE: To report our experience with the use of continuous electromyography (EMG) for placement of iliosacral screws. DATA SOURCES: Concurrently acquired data as well as patient charts, intraoperative EMG records, x-rays, and pelvic computed tomography (CT) scans. DESIGN: The monitored group of twenty-nine patients was studied prospectively. The control group consisted of twenty-two patients studied retrospectively. SETTING: Level One trauma center. METHODS: Continuous electromyograms were recorded for twenty-nine patients and compared with those from a group of twenty-two antecedent patients who were not monitored. The primary parameter of interest of this study was the presence or absence of neurologic change after iliosacral screw placement. This information was obtained prospectively in the study group and by retrospective review in the historical control. RESULTS: Four patients in the control group had postoperative and/or sensory motor changes prompting a postoperative CT scan; in each of these patients, a misdirected screw was identified and subsequently removed in a second procedure. There were no neurologic changes subsequent to placement in the twenty-nine patients who were monitored (7.5 percent versus 0 percent; p = 0.029, Fisher's exact test). All monitored patients had postoperative CT scans and showed the screw in a safe position with no significant violations of the S1 tunnel. CONCLUSION: Continuous EMG monitoring during iliosacral screw placement may be a useful neuroprotective tool.

Adolescent↗
PubMed1996

Instructional review improves performance of anesthesia apparatus checkout procedures.

Checkout recommendations for anesthesia apparatus are promoted as a means of improving patient safety. We sought to determine residents' performance of institutional checkout procedures and the degree of their improvement after instructional video review. Twenty-nine residents performing a list of pre-use checkout procedures were videotaped (VT1) prior to randomization into a Control or Test group. The Control group had a second videotaping (VT2), whereas the Test group received instructional review of VT1 prior to VT2. Control and Test subjects then had instructional review of all tapes. A blinded investigator scored all tapes without interacting with any subject. Control and Test video scores were compared at VT1 and VT2 using analysis of variance. Differences were sought between the clinical anesthesia (CA) 1-, 2-, and 3-yr residents. Percent "perfect," "partial," or "no" completion of each criterion was calculated to determine performance and improvement. A low-performance rate of 69% (20.6/30) occurred in VT1, significantly improving to 81% (24.2/30) in the Test group after intervention (P < 0.0021) with significant reductions in criteria that were totally missed. Anesthesia apparatus checkout procedures are improved after intensive training sessions, although high rates of completion are not achieved. This performance deficit may have implications for the ability of physicians to detect anesthesia machine faults.

Anesthesia↗
PubMed1996

The importance of the postoperative anesthetic visit: do repeated visits improve patient satisfaction or physician recognition?

This study evaluates whether repeated postoperative visits by the anesthesiologist improve patient ability to recall the anesthesiologist's name and the patient's perception of and satisfaction with anesthesia services. In a randomized, prospective trial, 144 patients with an anticipated postoperative length of stay of at least three days were enrolled in three groups: Group A patients (n = 48) had one postoperative visit, Group B (n = 48) had two postoperative visits, and Group C (n = 48) had three postoperative visits. All postoperative visits were performed by the attending anesthesiologist on consecutive postoperative days. Patients were contacted two days after their last postoperative visit to complete a study questionnaire. Patients were able to recall the anesthesiologist's name significantly less frequently than the surgeon's name, and there was no difference in name recall among groups. Recall was not affected by patient age, sex, or ASA physical status; the mode of contact (telephone versus personal visit); the anesthesiologist's gender; the presence of preoperative medication; or the identity of the preoperative evaluator. Patients could identify the anesthesiologist's gender approximately 85% of the time, regardless of group, and were more likely to identify female anesthesiologists (P = 0.026, odds ratio 3.3). Patient evaluation of hospital, surgical, and anesthesia care was favorable in all groups and did not vary with group. Increasing the number of postoperative visits does not improve patient name recognition of the anesthesiologist or increase patient satisfaction with or perception of anesthesia services.

Age Factors↗
PubMed1994

Venous air embolism after craniotomy closure: tension pneumocephalus implicated.

The authors present a case of venous air embolism occurring immediately upon skin closure after craniotomy in the prone position. This 5-year-old patient had a third ventricle tumor resected with bipolar cautery via a frontal trans-collosal approach into the lateral ventricle and through the foramen of Monroe. Doppler monitoring was utilized during the case since the patient's head was extended upwards in 10 degrees reverse Trendelenburg position. No air was detected during the operation. The ventricles were filled with saline presumably displacing air, prior to dural closure. However, with an increase in nitrous oxide from 55 to 68% prior to skin closure, venous air embolism was subsequently detected by Doppler and confirmed by end-tidal/arterial pCO2 gradient. The authors speculate that tension pneumocephalus caused the venous air embolism and describe the probable route of entry into the venous system.

Child, Preschool↗
PubMed1991

Hypertonic/hyperoncotic fluid resuscitation after hemorrhagic shock in dogs.

We compared canine systemic and cerebral hemodynamics after resuscitation from hemorrhagic shock with 4 mL/kg (a volume approximating 12% of shed blood volume) of 7.2% saline (HS; 1233 mEq/L sodium), 20% hydroxyethyl starch (HES) in 0.8% saline, or a combination fluid consisting of 20% hydroxyethyl starch in 7.2% saline (HS/HES). Eighteen endotracheally intubated mongrel dogs (18-24 kg) were ventilated to maintain normocarbia with 0.5% halothane in nitrous oxide and oxygen (60:40). After a 30-min period of hemorrhagic shock (mean arterial blood pressure = 40 mm Hg), extending from time T0 to T30, animals received one of three randomly assigned intravenous resuscitation fluids: HS, HES, or HS/HES. Data were collected at baseline, at the beginning and end of the shock period (T0 and T30), immediately after fluid infusion (T35), and at 60-min intervals for 2 h (T95, T155). After resuscitation, mean arterial blood pressure and cardiac output increased similarly in all groups, but failed to return to baseline. Intracranial pressure decreased during shock and increased slightly, immediately after resuscitation in all groups. During shock, cerebral blood flow (cerebral venous outflow method) declined in all groups. After resuscitation, cerebral blood flow increased, exceeding baseline in the HS and HS/HES groups but remaining low in the HES group (P less than 0.05 HS vs HES at T35). We conclude that small-volume resuscitation (4 mL/kg) with HS, HS/HES, or HES does not effectively restore or sustain systemic hemodynamics in hemorrhaged dogs. In dogs without intracranial pathology, the effects on cerebral hemodynamics are also comparable, except for transiently greater cerebral blood flow in the HS group in comparison with the HES group.

Animals↗
PubMed1989

Thromboxane A2 receptor antagonist SQ29548 does not improve canine postischemic cerebral hypoperfusion.

The thromboxane receptor antagonist SQ29548 was administered to mongrel dogs after an 11-min period of global cerebral ischemia to test the hypothesis that it would improve delayed postischemic cerebral hypoperfusion (PIH) during concurrent elevations in cerebral venous thromboxane B2 (TxB2), the stable metabolite of thromboxane A2 (TxA2). Immediately following an 11-min period of aortic root cross-clamping, six dogs received 0.2 mg/kg of SQ29548 intravenously followed by continuous infusion of 0.2 mg/kg/h (TRA group) and six received a saline placebo (control). Over the next 120 min, cerebral venous outflow was measured from the confluence of the sagittal and lateral sinuses, while arterial and cerebral venous samples were obtained for measurement of TxB2. Delayed postischemic cerebral hypoperfusion, confirmed in the control group (p < 0.05) (16 +/- 2.7 vs. 32 +/- 2.4 ml/min baseline), was nearly identical in the TRA group (14 +/- 0.9 vs. 30 +/- 2.5 ml/min baseline). Cerebral venous TxB2 levels rose dramatically in both groups after ischemia (3670 +/- 440 vs. 1100 +/- 350 pg/ml baseline, control and 2720 +/- 170 vs. 580 +/- 100 pg/ml baseline, TRA group) (p < 0.05). There were no significant group mean differences in any of the other hemodynamic data except mean arterial pressure (MAP) at T120 and Hgb at baseline. We conclude that postischemic intravenous administration of the thromboxane receptor-specific antagonist SQ29548 fails to improve delayed postischemic cerebral hypoperfusion and does not alter cerebral venous TxB2 release in this canine model of global cerebral ischemia.

Journal Article↗
PubMed1980

Isolation of a domain of the plasma membrane in Chinese hamster ovary cells which contains iodinatable, acidic glycoproteins of high molecular weight.

A light vesicle fraction, apparently derived from the plasma membrane, was obtained following breakage of Chinese hamster ovary (CHO) cells by means of a fluid pump disrupting device. The final preparation was enriched approx. 40-fold over the homogenate in K+,Na+-stimulated ATPase and phosphodiesterase I, but only approx. 10-fold in 125I specific radioactivity after lactoperoxidase-catalyzed iodination. This preparation was compared with another plasma membrane fraction purified as large sheets via a two-phase centrifugation procedure. Two-dimensional polyacrylamide gel electrophoresis followed by Coomassie blue staining indicated that both fractions were fairly similar in polypeptide composition, although a few consistent differences were evident. However, staining of glycoproteins by the periodic acid-Schiff technique or by overlaying with 125I-labeled concanavalin A showed that the vesicle fraction was highly enriched in groups of high molecular weight, acidic glycoproteins which stain only weakly with Coomassie blue. These glycoproteins also bound 125I-labeled ricin I agglutinin and wheat germ agglutinin. They appear to be the major receptors for wheat germ agglutinin on the CHO cell surface. After surface labeling of cells by the 125I-lactoperoxidase technique, the membrane sheet fraction contained a large number of iodinated polypeptides, whereas labeling in the vesicle fraction was restricted almost entirely to the high molecular weight, acidic glycoproteins. It is proposed that the vesicle fraction constitutes a specific domain of the cell surface which is coated on its exterior by this group of glycoproteins. These components probably mask underlying proteins of the plasma membrane from external labeling.

Animals↗
PubMedDate not supplied

Postanesthetic delirium: historical perspectives.

Postanesthetic delirium is a type of postoperative emotional response occurring immediately after emergence from general anesthesia. Associated with excitement and confusion, the alternative terms emergence delirium or postanesthetic excitement are frequently used. Historically, the more encompassing term postoperative psychosis is used interchangeably but more frequently refers to those conditions occurring after a lucid interval of 24 to 48 hours. Either phenomenon may arise from a variety of disturbances, with drug reactions, hypoxemia, or reaction to pain being common, or it may arise from psychological causes. Reported is a case of postanesthetic delirium in a healthy young man. An historical overview of this potentially harmful condition, with specific recommendations for diagnosis and treatment, also is presented.

Adult↗