D 1 at the end of surgery provides the best quality of emergence from general anesthesia including the control of cough, agitation, hypertension, tachycardia, and shivering. D 0.5 also controls emergence phenomena but is less effective in controlling cough. The 3 doses do not delay extubation. However, they cause dose-dependent hypotension.

BackgroundBreaking bad news (BBN) to patients and their relatives is a complex and stressful task. The ideal structure, training methods and assessment instruments best used to teach and assess BBN for anesthesiology residents remain unclear. The purpose of this study is to evaluate the effectiveness of an education intervention for BBN based on immersive experiences with a high fidelity simulator and role-play with standardized patients (SPs). A secondary purpose is to gather validity evidence to support the use of a GRIEV_ING instrument to assess BBN skills.MethodsThe communication skills for BBN of 16 residents were assessed via videotaped SP encounters at baseline and immediately post-intervention. Residents’ perceptions about their ability and comfort for BBN were collected using pre and post workshop surveys.ResultsPosttest scores were significantly higher than the pretest scores for the GRIEV_ING checklist, as well as on the communication global rating. The GRIEV_ING checklist had acceptable inter-rater and internal-consistency reliabilities. Performance was not related to years of training, or previous BBN experience.ConclusionAnesthesiology residents’ communication skills when BBN in relation to a critical incident may be improved with educational interventions based on immersive experiences with a high fidelity simulator and role-play with SPs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0374-7) contains supplementary material, which is available to authorized users.

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Haloperidol is at worst 13% and 8% less effective than ondansetron by per-protocol analysis and by intention-to-treat analysis, respectively. Thus, it is noninferior to ondansetron for the early treatment of established PONV, but is associated with sedation.

Introduction: Dual-mobility cups (DMC) are currently used in patients having risk factors of instability. Most of the studies report the use of DMC in patients having a single high-risk variable. The aim of the study was to analyse a continuous series of patients treated with primary total hip arthroplasty (THA) and DMC with different high risk for dislocation. Methods: This is a retrospective study analysing the outcomes of primary THA with DMC in patients at high-risk of dislocation. The sample consisted of 215 patients having 1 of 3 aetiologies or risk factors: (1) young subjects (<55 years); (2) osteonecrosis of the femoral head (ONFH); and (3) femoral neck fracture (FNF). Results: With a mean follow-up duration of 70 ± 24.7 months, the findings showed the following: 2 patients had dislocated their hip following motor vehicle accidents; 1 patient had a traumatic femoral peri-prosthetic fracture; and 1 patient had an acute infection. No intra-prosthetic dislocation or aseptic loosening were encountered. No radiolucent lines were observed on the acetabular side. The mean modified Hip Harris Score was 96.6 ± 7.4%. Out of 186 patients, 170 (90.1%) would label their operated hip as a “forgotten hip”. 78 out of the 84 patients (92.8%) who used to practice oriental sitting and/or ablution for prayers were able to return to their usual daily activities of extreme hip position and 74 out of the 84 patients (88%) described their operated hip as “a forgotten hip”. No correlation was found between any of the studied variables. Discussion: The findings of this series of patients at high risk of dislocation showed excellent clinical and radiological results with very few complications. The use of DMC seems to counteract the impact of some aetiologies/risk factors that could lead to higher instability. Most patients practising extreme hip positions resumed their usual practices.

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Background: The aim of this study is to compare the intraoperative opioid free anesthesia approach to the conventional opioid based anesthesia in patients undergoing multilevel spinal fusion surgery, and its impact on postoperative pain, opioid consumption, and related side effects. Methods: Forty-eight patients undergoing elective major spine surgery were randomly allocated to two groups. The Opioid-Free Anesthesia (OFA) group received dexmedetomidine 0.5mcg/kg/hr and lidocaine 1mg/kg/hr as continuous intravenous (IV) infusion for 10 minutes before anesthesia induction, followed by dexmedetomidine 0.3 mcg/kg/hr and lidocaine 1.5mg/kg/hr as continuous IV infusion intraoperatively. The Opioid-Based Anesthesia (OBA) group received fentanyl 2mcg/kg during anesthesia induction and remifentanil 0.2-0.3 mcg/kg/min continuous IV infusion intraoperatively. All patients received ketamine 0.15mg/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg for anesthesia induction and ketamine 0.15 mg/kg/hr with sevoflurane for anesthesia maintenance. All patients received a Patient Controlled Analgesia (PCA) device set to deliver IV morphine ready for use directly after discharge from the Post Anesthesia Care Unit (PACU) for 48 hours after surgery. Postoperative pain was measured using Verbal Analogue Scale (VAS). Opioid side effects were documented when present. Results: The OFA group required less morphine consumption in the first 24 hours post-surgery (17.28 ± 12.25 mg versus 27.96 ± 19.75 mg, p < 0.05). The incidence of nausea and vomiting was significantly lower in the OFA group. There was no significant difference in the hemodynamic changes intraoperatively among the two groups. However, more patients in the OFA group required antihypertensive medications compared to patients in the OBA group (p< 0.05). In the PACU, OFA patients had a significantly longer stay than OBA patients (114.1± 49.33 min versus 89.96 ± 30.71 min, p<0.05), yet there was no significant difference in the morphine consumption. Conclusion: OFA can be an alternative to OBA in patients undergoing multilevel spine fusion surgery. OFA use resulted in reduced need for analgesics for the first 24 hours and less postoperative nausea and vomiting. Trial registration: The study was conducted after receiving approval from local Institutional Review Board, Lebanese American University, Institutional Review Board (LAU IRB) (LAUMCRH.HB1.11/01/2018): and was registered with ClinicalTrials.gov (registration number: NCT03417193) and posted on 31/01/2018.