Distraction by using an iPad during immunizations reduces the parent's perception of their child's pain and distress. This type of distraction tool can also improve the parent's satisfaction with the pain control provided for their child while receiving their vaccines.
Characteristics of good anaesthesia teachersPurpose: The Department of Anaesthesia undertook a qualitative study to a) reveal the characteristics of teachers who had been identified as "good," and b) explore the levels of epistemological development (defined as conceptualization of knowledge) that are evidenced. Changes in medical education curricula have focused attention on the ways in which medical teaching staff conceptualize the learning/teaching interactions and their ability to alter or modify their teaching styles. Teachers are often assessed or informally recognized as Ugoocl teachers," but there are few indicators to guide what is meant by the label in anaesthesia.Methods: Teachers who had consistently received overall ratings of 4+ on a 5 point rating scale over a five year period were selected to be interviewed, Data were analyzed a) noting key teaching charactenstics and patterns of teaching and b) within the framework of adult development theories, Results: Good teachers in Anaesthesia all identified six characteristics necessary for good teaching. They were characterised by their "inquiry" approach to teaching, their complexity of thought and their functioning at higher relativistic/Commitment levels of epistemological development. Conclusion: Teaching in anaesthesia is depicted by the need to address multiple aspects of thinking and action.
ABSTRACT:Techniques used to monitor the function of the seventh and eighth cranial nerves during acoustic neuroma and other posterior fossa surgery are reviewed. The auditory brainstem response (ABR), electrocochleogram (ECochG) and direct recording from the auditory nerve (CNAP) were compared. The best technique is the ECochG, although in many cases, the CNAP should be used as a back-up technique. The CNAP is especially useful for the identification of the auditory nerve. Both can provide real-time feedback on the physiological integrity of the auditory nerve. The ABR may be helpful in monitoring brainstem function. For some procedures, optimal monitoring requires the combined recording of all three techniques.Monopolar constant-voltage intracranial stimulation of the facial nerve is helpful for the identification and preservation of the facial nerve. Audio monitoring of spontaneous electromyographic activity provides real-time feedback on the effect of surgical manipulation of the nerve. Monitoring of ephaptic transmission in the facial nerve during microvascular decompression for hemifacial spasm aids in the identification of the offending vessel.
The question of whether or not to reverse heparin following carotid endarterectomy is a topic of debate. The potential reduction of the risk of thrombosis at the endarterectomy site with non‐reversal has to be measured against a potential increase in the risk of wound haematoma. This study prospectively followed activated clotting time (ACT) of 42 consecutive patients undergoing carotid endarterectomy. A standard heparin dose of 100 units/kg was used, and heparin reversal was employed only if the wound appeared excessively haemorrhagic at the procedure's completion. Heparin was reversed in 11 patients. Following heparin administration, ACT increased to a mean 2.72 ± 0.09 times baseline (range 1.84–4.07), and fell with time, until at 3 h after heparin administration mean ACT in the non‐reversed patients was 1.48 ± 0.03 times baseline (range 1.1–2.03). There was one postoperative neurological event (2%), a contralateral hemisphere stroke. No patient developed a frank wound haematoma requiring evacuation, although three patients (7% of the total study group, 9% of patients not receiving heparin reversal) developed neck swelling and symptoms of airway compromise, and were intubated. Measurements of ACT suggest that a heparin dose of 100 units/kg achieves an adequate anticoagulant level in the operative and early postoperative phase, when thrombosis is most likely to occur, and is not associated with an increased risk of wound haematoma. If heparin is to be selectively reversed in patients felt to be at high risk of postoperative haematoma, the decision should be based on an objective measurement such as ACT, and not the surgeon's impression of wound haemostasis.
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