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Yahav-Shafir D, Orkin D, Zahavi G, Epstein I, Nadler M, Berkenstadt H. Patient-Reported Quality of Recovery after Sedation for Endoscopy in the Elderly. Gerontology 2024; 70:455-460. [PMID: 38316110 PMCID: PMC11078320 DOI: 10.1159/000536647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Although sedation is critical in minimizing discomforts in patients, conflicting data regarding the safety of sedation among the elderly population exist. This prospective study aimed to compare the quality of recovery (QoR) from gastrointestinal endoscopy performed under sedation between elderly and younger patients. METHODS We included 177 patients aged 40-64 (group 1, n = 66), 65-79 (group 2, n = 76), and ≥80 (group 3, n = 35) years. QoR was assessed 1 day after the procedure using the quality of recovery 15 (QoR-15) questionnaire, which is a 15-item questionnaire with scores ranging from 0 to 150. Patient demographic, procedural, and sedation data were collected, and neurocognitive function was assessed before and a day after sedation. RESULTS Groups 1 and 3 differed according to the Mini-Cog test and 3-word memory test performed before the procedure (p < 0.001). QoR-15 scores between groups were not different (139 ± 19 group 1, 141 ± 17 group 2, and 147 ± 26 group 3; p > 0.05). Patients in groups 3 and 2 were administered lower doses of propofol and midazolam than those in group 1. The incidence of oxygen desaturation (SaO2 <90% for >30 s) was lower in groups 1 and 2 than in group 3 (p = 0.01). CONCLUSIONS As indicated by the QoR-15 questionnaire, the QoR from sedation was not significantly different between the study groups.
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Affiliation(s)
- Dana Yahav-Shafir
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Dina Orkin
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Guy Zahavi
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Inna Epstein
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Moshe Nadler
- Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Haim Berkenstadt
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
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Zabida A, Zahavi G, Bartoszko J, Otálora-Esteban M, Weinstein J, Frogel J, Miller L, Sivan E, Orkin D, Dolgoker I, Berkenstadt H. Improving blood product management in placenta accreta patients with severe bleeding: institutional experience. Int J Obstet Anesth 2023; 56:103904. [PMID: 37364347 DOI: 10.1016/j.ijoa.2023.103904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. METHODS A retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. RESULTS A total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. CONCLUSION Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.
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Affiliation(s)
- A Zabida
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.
| | - G Zahavi
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Bartoszko
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
| | - M Otálora-Esteban
- Department of Anesthesiology, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Weinstein
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Frogel
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - L Miller
- Blood Bank, Sheba Medical Centre, Tel-Hashomer, Israel
| | - E Sivan
- Josef Buchman Gynecology and Maternity Centre, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - D Orkin
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - I Dolgoker
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - H Berkenstadt
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
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Eidelman Pozin I, Zabida A, Friedman Z, Ivry M, Friedman M, Zahavi G, Yahav Shafir DD, Orkin D, Berkenstadt H. Simulation training results in performance retention for the management of airway fires: A prospective observational study. Anaesth Intensive Care 2023; 51:114-119. [PMID: 36688353 DOI: 10.1177/0310057x221113591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Given the severity of the consequences of operating room fires, it is recommended that every anaesthesiologist master fire safety protocols and periodically participate in operating room fire drills. The aim of the present study was to evaluate skill retention one year after an airway fire training programme. Anaesthesiology residents were evaluated using an airway fire simulation-based scenario one year after an educational programme that included a one-h long problem-based learning session, a simulation-based airway fire drill with debriefing, and a formal group discussion. The same simulation scenario was used for both the initial training and the one-year assessment. Thirty-eight anaesthesiology residents participated as pairs in the initial training programme. Of these, 36 participated in the evaluation a year later. Performance after one year was better than performance during the initial simulation. Time to removal of tracheal tube was 7.0 (4.0-12.8) s (median (interquartile range)) at the one-year assessment compared with 22.0 (18.5-52.5) s at the time of initial training (P < 0.001). Performance improvement was also demonstrated by a higher incidence of performance of crucial action items (cessation of airway gases, removal of sponges and pouring of saline), as well as shorter duration of time necessary to perform these tasks. After controlling the fire, the time to re-establish ventilation by bag-mask ventilation or intubation was shorter at one year: 18.0 (11.0-29.0 ) s, compared with initial training 54.0 s (36.2-69.8) s (P = 0.001). We conclude that skills are effectively retained for a year after an airway fire management training session.
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Affiliation(s)
- Inna Eidelman Pozin
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Zabida
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Zeev Friedman
- Department of Anaesthesia, Sinai Health System, University of Toronto, Toronto, Canada
| | - Michal Ivry
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Maria Friedman
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Guy Zahavi
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dana D Yahav Shafir
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dina Orkin
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Berkenstadt
- Department of Anaesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pozin IE, Zabida A, Nadler M, Zahavi G, Orkin D, Berkenstadt H. Respiratory complications during recovery from gastrointestinal endoscopies performed by gastroenterologists under moderate sedation. Clin Endosc 2023; 56:188-193. [PMID: 36624087 PMCID: PMC10073847 DOI: 10.5946/ce.2022.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/18/2022] [Indexed: 01/11/2023] Open
Abstract
Background/Aims Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications. Methods In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation. Results Pulse oximetry oxygen saturation (SpO2) <90% for <60 seconds occurred in 82 patients (12.5%) and in 11 patients (1.7%), SpO2 of <90% for >60 seconds occurred in 79 patients (12.0%) and in 11 patients (1.7%), and SpO2 <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008-3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649-5.080), hypertension (OR, 1.289; 95% CI, 0.472-3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950-6.095) increased the occurrence of desaturation during recovery. Conclusions We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully.
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Affiliation(s)
- Inna Eidelman Pozin
- Department of Anesthesiology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Amir Zabida
- Department of Anesthesiology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Moshe Nadler
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Zahavi
- Department of Anesthesiology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Dina Orkin
- Department of Anesthesiology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel.,Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Haim Berkenstadt
- Department of Anesthesiology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel.,Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
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5
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Yahav-Shafir D, Kaplan N, Ledot S, Frogel J, Beinart R, Nof E, Zurrof E, Jamal T, Berkenstadt H, Kogan A. APPLICATION OF “FAST-TRACK” PATHWAY FOR VENTRICULAR TACHYCARDIA CATHETER ABLATION. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Many YA, Berkenstadt H, Henkin Y. The safety and efficacy of a nurse-led sedation service using Chloral Hydrate for auditory brainstem response testing. J Pediatr Nurs 2022; 63:e143-e148. [PMID: 34620532 DOI: 10.1016/j.pedn.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a growing number of pediatric procedures requiring sedation outside the operating room. Among these are auditory brainstem response (ABR) tests, the gold standard for objective hearing evaluation in infants and toddlers. Recently, a nurse-led pediatric sedation service based on a structured protocol has been developed for ABR testing. OBJECTIVES To retrospectively analyze the safety and efficacy of the pediatric nurse-led sedation protocol (PNLSP) in a tertiary medical center using Chloral Hydrate (CH) in children undergoing ABR testing. METHODS Data from medical charts of children who underwent sedation for ABR testing between January 2014 and December 2017, were retrieved. Analysis of sedation success/failure rates, sleep induction time (SIT), sleep duration time (SDT), and adverse events (AE), was performed. FINDINGS 1348 children with a mean age of 13.4 months (range 3-42 months), classified by the American Society of Anesthesiologists Physical Status Classification System (ASA score) 1-3, were included in the analysis. All children received a fixed dose of 75 mg / kg CH orally or rectally. Sedation success rate was 98.7% and enabled completion of ABR testing. Failure to sedate was evident in 17 children (1.3%), all classified as ASA score 1-2. Median SIT and SDT were 25 and 100 min, respectively. Mild AE occurred in 9 children (0.67%), none of which required further intervention. CONCLUSIONS Findings support the use of a structured PNLSP using CH as safe and efficient. The suggested protocol is an effective alternative for general anesthesia (GA) for ABR testing in healthy young children.
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Affiliation(s)
- Yael Alfandary Many
- The Edmond and Lily Safra children's Hospital, Departments of Anesthesiology, Sheba Medical Center, Tel Hashomer, Derech Sheba 2, Ramat Gan, 5262000, Israel.
| | - Haim Berkenstadt
- Departments of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Henkin
- Hearing, Speech & Language Center, Sheba Medical Center, Tel Hashomer, Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
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7
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Shilo N, Haviv-Yadid Y, Kogan A, Pessach I, Sharon A, Nave L, Raphael R, Abbo N, Shuki R, Kassif-Lerner R, Mouallem M, Mayan H, Berkenstadt H. [ETHICAL CHALLENGES IN TREATING CRITICAL CORONAVIRUS PATIENTS: EXPERIENCE FROM THE SHEBA MEDICAL CENTER ON THE FIRST COVID-19 PANDEMIC OUTBREAK]. Harefuah 2021; 160:710-716. [PMID: 34817134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
As the coronavirus pandemic emerged in late 2019, a task force was founded in the Sheba Medical Center and began preparing for the arrival of the pandemic to Israel. Several wards were put in charge of isolated COVID-19 patients. A new intensive care unit was formed for the most critical COVID-19 patients, requiring mechanical ventilation and multi-organ treatment. The Corona ICU began operating in March 2020, with a multi-disciplinary team, gathered from ICU units, an internal medicine ward, an anesthesiology department, social workers and psychologists. Simultaneously, the routine medical center functions in non-corona sections were maintained, as much as possible. The coronavirus pandemic entails challenges of many aspects: an unfamiliar pathogen causing an unknown illness, a necessity for social distancing, ambiguity regarding the risk factors for contamination and illness severity, and medical crews put at risk. Consequently, the pandemic involves ethical, social, economic and moral aspects, affecting the medical crew members and system, the patients and their families, and our society as a whole. In this article we review our joint experience in the Sheba Medical Center Corona ICU, of the medical, ethical and moral dilemmas that emerged from the first COVID-19 wave.
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Affiliation(s)
- Noya Shilo
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Haviv-Yadid
- Intensive Care Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Alexander Kogan
- Cardiac Surgery Intensive Care Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Itay Pessach
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Amir Sharon
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Lior Nave
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Roy Raphael
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nira Abbo
- Social Work Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Roza Shuki
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Reut Kassif-Lerner
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Meir Mouallem
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Haim Mayan
- Internal Medicine Department E, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Haim Berkenstadt
- Anesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israe Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
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8
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Kuperstein R, Raibman-Spector S, Canetti M, Wasserstrum Y, Yahav-Shafir D, Berkenstadt H, Vatury O, Hay I, Feinberg MS, Guetta V, Fefer P. Influence of anesthesia on hemodynamic assessment of mitral stenosis severity. Cardiol J 2021; 29:245-251. [PMID: 34708864 PMCID: PMC9007475 DOI: 10.5603/cj.a2021.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The treatment of choice for severe rheumatic mitral stenosis (MS) is balloon mitral valvuloplasty (BMV). Assessment of MS severity is usually performed by echocardiography. Before performing BMV, invasive hemodynamic assessment is also performed. The effect of anesthesia on the invasive assessment of MS severity has not been studied. The purpose of the present study was to assess changes in invasive hemodynamic measurement of MS severity before and after induction of general anesthesia. METHODS The medical files of 22 patients who underwent BMV between 2014 and 2020 were reviewed. Medical history, laboratory, echocardiographic and invasive measurements were collected. Anesthesia induction was performed with etomidate or propofol. Pre-procedural echocardiographic measurements of valve area using pressure half time, and continuity correlated well with invasive measurements using the Gorlin formula. RESULTS After induction of anesthesia the mean mitral valve gradient dropped by 2.4 mmHg (p = 0.153) and calculated mitral valve area (MVA) increased by 0.2 cm² (p = 0.011). A wide variability in individual response was observed. While a drop in gradient was noted in 14 patients, it increased in 7. Gorlin derived MVA rose in most patients but dropped in 4. Assuming a calculated MVA of 1.5 cm² and below to define clinically significant MS, 4 patients with pre-induction MVA of 1.5 cm² or below had calculated MVA above 1.5 cm² after induction. CONCLUSIONS The impact of general anesthesia on the hemodynamic assessment of MS is heterogeneous and may lead to misclassification of MS severity.
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Affiliation(s)
- Rafael Kuperstein
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel. .,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Shir Raibman-Spector
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Michal Canetti
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Yishay Wasserstrum
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dana Yahav-Shafir
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Haim Berkenstadt
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ori Vatury
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ilan Hay
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Micha S Feinberg
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Victor Guetta
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Paul Fefer
- Sheba Medical Center, Tel-Hashomer, 52621 Ramat-Gan, Israel.,Sackler Faculty of Meducine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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9
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Weinstein J, Shinfeld A, Simchen M, Cahan T, Frogel J, Arad M, Berkenstadt H, Kuperstein R. Anesthesia in Parturients Presenting with Marfan Syndrome. Isr Med Assoc J 2021; 23:437-440. [PMID: 34251127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pregnant women with Marfan syndrome (MS) have a high risk of aortic dissection around delivery and their optimal management requires a multi-disciplinary approach, including proper cardio-obstetric care and adequate pain management during labor, which may be difficult due to the high prevalence of dural ectasia (DE) in these patients. OBJECTIVES To evaluate the multidisciplinary management of MS patients during labor. METHODS Nineteen pregnant women (31 pregnancies) with MS were followed by a multi-disciplinary team (cardiologist, obstetrician, anesthesiologist) prior to delivery. RESULTS Two patients had kyphoscoliosis; none had previous spine surgery nor complaints compatible with DE. In eight pregnancies (7 patients), aortic root diameter (ARd) before pregnancy was 40 to 46 mm. In this high-risk group, one patient underwent elective termination, two underwent an urgent cesarean section (CS) under general anesthesia, and five had elective CS; two under general anesthesia (GA), and three under spinal anesthesia. In 23 pregnancies (12 patients), ARd was < 40 mm. In this non-high-risk group three pregnancies (1 patient) were electively terminated. Of the remaining 20 deliveries (11 patients), 14 were vaginal deliveries, 9 with epidural analgesia and 5 without. Six patients had a CS; four under GA and two2 under spinal anesthesia. There were no epidural placement failures and no failed responses. There were 2 cases of aortic dissection, unrelated to the anesthetic management. CONCLUSIONS The optimal anesthetic strategy during labor in MS patients should be decided by a multi-disciplinary team. Anesthetic complications due to DE were not encountered during neuraxial block.
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Affiliation(s)
- Jacob Weinstein
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amichai Shinfeld
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Simchen
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Cahan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Berkenstadt
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Ioscovich A, Guasch E, Brogly N, Shatalin D, Manrique-Muñoz S, Sánchez Royo ME, Zimro S, Ginosar Y, Lages N, Weinstein J, Berkenstadt H, Greenberger C, Lazutkin A, Izakson A, Ioscovich D, Orbach-Zinger S, Weiniger CF. Peripartum anesthetic management of women with SARS-CoV-2 infection in eight medical centers across three European countries: prospective cohort observation study. J Matern Fetal Neonatal Med 2021; 35:7756-7763. [PMID: 34107853 DOI: 10.1080/14767058.2021.1937105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Several reports of obstetric anesthesia management have been published since the onset of the COVID-19 pandemic. We aimed to collect high-quality broad and detailed data from different university medical centers in several European Society of Anesthesiologist countries. METHODS This prospective observational survey was performed in eight medical centers in Spain, Israel and Portugal from 1st April to 31st July 2020. Institutional review board approval was received at each participating center. Inclusion criteria: all women with a positive test for COVID-19. Retrieved data included maternal, delivery, anesthetic, postpartum details, and neonatal outcomes. Descriptive data are presented, and outcomes were compared for women with versus without respiratory signs and symptoms. RESULTS Women with respiratory symptoms (20/12.1%) had significantly higher mean (standard deviation) temperature (37.2 °C (0.8) versus 36.8 °C (0.6)), were older (34.1 (6.7) years versus 30.5 (6.6)) and had higher body mass index kg m-2 - (29.5 (7.5) versus 28.2 (5.1)). Women with respiratory symptoms delivered at a significantly earlier gestational age (50% < 37 weeks) with a 65% cesarean delivery rate (versus 22.1% in the group without respiratory symptoms) and 5-fold increased rate of emergency cesarean delivery, 30% performed under general anesthesia. A higher rate of intrauterine fetal death (3%) was observed than expected from the literature (0.2-0.3%) in developed countries. There was no evidence of viral vertical transmission. CONCLUSION Well-functioning neuraxial analgesia should be available to manage laboring women with respiratory symptoms, as there is a higher frequency of emergency cesarean delivery. We report a higher rate of undiagnosed parturient and intrauterine fetal death.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Emilia Guasch
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Nicolas Brogly
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Sabastine Zimro
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yehuda Ginosar
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Neusa Lages
- Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jacob Weinstein
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Haim Berkenstadt
- The Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | | | - Sharon Orbach-Zinger
- Beilinson Hospital, Petah Tikvah, Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Leshem E, Klein Y, Haviv Y, Berkenstadt H, Pessach IM. Enhancing intensive care capacity: COVID-19 experience from a Tertiary Center in Israel. Intensive Care Med 2020; 46:1640-1641. [PMID: 32451582 PMCID: PMC7246287 DOI: 10.1007/s00134-020-06097-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Eyal Leshem
- Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Klein
- Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Haviv
- Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Berkenstadt
- Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai M Pessach
- Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Integrated Critical Care Program, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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Frogel J, Kogan A, Augoustides JG, Berkenstadt H, Feduska E, Steyn J, Dwarakanath S, Nir EA, Stohl S. The Value of Cerebral Oximetry Monitoring in Cardiac Surgery: Challenges and Solutions in Adult and Pediatric Practice. J Cardiothorac Vasc Anesth 2019; 33:1778-1784. [DOI: 10.1053/j.jvca.2018.08.206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 02/04/2023]
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13
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Goldenshluger M, Zippel D, Ben-Yaacov A, Dux J, Yalon T, Zendel A, Rayman S, Mor E, Berkenstadt H, Fogel-Grinvald H, Ventorrero M, Nissan A. Core Body Temperature but Not Intraabdominal Pressure Predicts Postoperative Complications Following Closed-System Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Administration. Ann Surg Oncol 2017; 25:660-666. [DOI: 10.1245/s10434-017-6279-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 12/14/2022]
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14
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Kerpel A, Ben-Menachem E, Mandelbaum T, Hofstetter E, Preisman S, Berkenstadt H. Evaluation of Miniature Dynamic Light Scattering Technology for the Assessment of Hemodynamic Status During Graded Hemorrhage and Retransfusion in Pigs. Mil Med 2017; 182:e2056-e2060. [PMID: 29087881 DOI: 10.7205/milmed-d-17-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hemorrhagic shock with occult hypoperfusion is a key challenge to prehospital staff during triage and transfer of patients, especially during mass casualty incidents. Recent advances in Dynamic Light Scattering (DLS), and miniaturization of this technology, has resulted in noninvasive sensors capable of continuously monitoring tissue perfusion. This study evaluated the ability of miniature DLS (mDLS) sensors to assess hemodynamic status in a porcine model of hemorrhage. METHODS Following ethics committee approval, anesthetized and ventilated pigs underwent graded hemorrhage and then retransfusion. Standard vital signs were monitored in conjunction with a thermodilution cardiac output (CO), central venous pressure (CVP), and arterial blood gases. The mDLS sensor was attached to each animal's leg and all monitoring measurements were taken 5 minutes after completion of each period of hemorrhage and retransfusion to allow equilibration. RESULTS All measured parameters changed during bleeding and retransfusion. During bleeding; p value were 0.011 for heart rate, 0.07 for CVP, <0.001 for both mean arterial pressure, and mDLS. During retransfusion; p values were 0.023 for heart rate, 0.008 for CVP, and <0.001 for both mean arterial pressure and mDLS. Pearson correlation between changes in mDLS and CO demonstrated r value of 0.917 during hemorrhage and 0.965 during retransfusion. Changes in hemoglobin were not statistically significant during bleeding (p = 0.331) but were during retransfusion (p = 0.0001). Changes of bicarbonate, base excess, and lactate were found to be statistically significant during both phases of the experiment (p = 0.001). CONCLUSIONS In an animal model of hemorrhagic shock, the mDLS sensor strongly correlates with traditional measures of CO. This initial assessment supports further investigation of this technology in human studies.
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Affiliation(s)
- Asaf Kerpel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 5265601
| | - Erez Ben-Menachem
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 5265601
| | - Tal Mandelbaum
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 5265601
| | | | - Sergei Preisman
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 5265601
| | - Haim Berkenstadt
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel 5265601
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15
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Ivry M, Goitein D, Welly W, Berkenstadt H. Melatonin premedication improves quality of recovery following bariatric surgery – a double blind placebo controlled prospective study. Surg Obes Relat Dis 2017; 13:502-506. [DOI: 10.1016/j.soard.2016.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
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Keidan I, Ben-Menachem E, Tzadok M, Ben-Zeev B, Berkenstadt H. Electroencephalography for children with autistic spectrum disorder: a sedation protocol. Paediatr Anaesth 2015; 25:200-5. [PMID: 25145661 DOI: 10.1111/pan.12510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To report the effectiveness and efficiency of a predetermined sedation protocol for providing sedation for electroencephalograph (EEG) studies in children with autism. METHODS Sleep EEG has been advocated for the majority of children with autism spectrum disorder. In most cases, sedation is required to allow adequate studies. Most sedation drugs have negative effects on the EEG pattern. The sedation protocol we adopted included chloral hydrate, dexmedetomidine, and ketamine and was evaluated prospectively for 2 years. RESULTS One hundred and eighty-three children with autistic spectrum disorder were sedated with the described drug protocol that was efficient, provided adequate EEG readings, and was not associated with serious adverse events. CONCLUSIONS Our protocol kept costs to a minimum but provided appropriate escalation in care when required.
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Affiliation(s)
- Ilan Keidan
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Israel; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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18
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Glauber V, Berkenstadt H. Carnitine palmitoyltransferase 2 deficiency, malignant hyperthermia and anesthesia. BMC Anesthesiol 2014. [PMCID: PMC4139680 DOI: 10.1186/1471-2253-14-s1-a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Ben-Menachem E, Gargi Y, Berkenstadt H, Keidan I, Sidi A, Wignanaski T. Percussion pacing as management of nonresponsive asystole during pediatric strabismus surgery. J Clin Anesth 2014; 26:332-4. [DOI: 10.1016/j.jclinane.2014.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 01/23/2014] [Accepted: 01/29/2014] [Indexed: 01/09/2023]
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20
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Keidan I, Sidi A, Ben-Menachem E, Tene Y, Berkenstadt H. Inconsistency between simultaneous blood pressure measurements in the arm, forearm, and leg in anesthetized children. J Clin Anesth 2014; 26:52-7. [PMID: 24444992 DOI: 10.1016/j.jclinane.2013.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 09/29/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine the accuracy and precision of simultaneous noninvasive blood pressure (NIBP) measurement in the arm, forearm, and ankle in anesthetized children. DESIGN Prospective, randomized study. SETTING University medical center. PATIENTS 101 ASA physical status 1 and 2 children (aged 1-8 yrs) scheduled for elective surgery with general anesthesia. MEASUREMENTS Simultaneous NIBP measurements were recorded at the arm, forearm, and ankle at 5-minute intervals. MAIN RESULTS The systolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 63% and 29% of measurements, and within the ± 20% range in 85% and 67% of measurements, respectively. The diastolic blood pressure difference between the arm-forearm or the arm-ankle was within the ± 10% range in 42% and 44% and within the ± 20% range in 67% and 74% of measurements, respectively. In patients in whom the initial three NIBP measurements were within the ± 20% range between the forearm and arm, 86% of the subsequent measurements were also within that limit. CONCLUSIONS Forearm and ankle NIBP measurements are unreliable and inconsistent with NIBP measured in the arm of anesthetized children. These alternative BP measurement sites are not reliable in accuracy (comparison with reference "gold" standard) and precision (reproducibility).
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Affiliation(s)
- Ilan Keidan
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel); Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL 32610-0254, USA
| | - Avner Sidi
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL 32610-0254, USA.
| | - Erez Ben-Menachem
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel)
| | - Yael Tene
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel)
| | - Haim Berkenstadt
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer,Israel (affiliated with Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel)
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21
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Kogan A, Preisman S, Berkenstadt H, Segal E, Kassif Y, Sternik L, Orlov B, Shalom E, Levin S, Malachy A, Lavee J, Raanani E. Evaluation of the Impact of a Quality Improvement Program and Intensivist-Directed ICU Team on Mortality After Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:1194-200. [DOI: 10.1053/j.jvca.2013.02.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Indexed: 11/11/2022]
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22
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Harnof S, Hadani M, Ziv A, Berkenstadt H. Simulation-based interpersonal communication skills training for neurosurgical residents. Isr Med Assoc J 2013; 15:489-492. [PMID: 24340839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. OBJECTIVES To assess the first national simulation-based communication skills training for neurosurgical residents. METHODS Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. RESULTS All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. CONCLUSIONS Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.
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Affiliation(s)
- Sagi Harnof
- Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Moshe Hadani
- Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Amitai Ziv
- lsrael Center for Medical Simulation, Sheba Medical Center, Tel Hashomer, Israel
| | - Haim Berkenstadt
- Anesthesiology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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23
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Berkenstadt H, Perlson D, Shalomson O, Tuval A, Haviv-Yadid Y, Ziv A. [Simulation-based intervention to improve anesthesiology residents communication with families of critically ill patients--preliminary prospective evaluation]. Harefuah 2013; 152:453-499. [PMID: 24167928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. AIMS The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. METHODS Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. RESULTS Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). CONCLUSIONS This preliminary study demonstrates the value of communication skills training in the intensive care environment.
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Affiliation(s)
- Haim Berkenstadt
- Department of Anesthesiology and Intensive Care, Sheba Medical Center.
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Abstract
Simulation-based medical education (SBME) offers a safe and "mistake-forgiving" environment to teach and train medical professionals. The diverse range of medical-simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. Further research is needed to better learn the role of simulation-based learning in trauma management and education.
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Affiliation(s)
- Haim Berkenstadt
- The Israel Center for Medical Simulation (MSR), Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
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Berkenstadt H, Ben-Menachem E, Dach R, Ezri T, Ziv A, Rubin O, Keidan I. Deficits in the Provision of Cardiopulmonary Resuscitation During Simulated Obstetric Crises. Anesth Analg 2012; 115:1122-6. [DOI: 10.1213/ane.0b013e3182691977] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Keidan I, Ben-Menachem E, White SE, Berkenstadt H. Intravenous Sodium Bicarbonate Verifies Intravenous Position of Catheters in Ventilated Children. Anesth Analg 2012; 115:909-12. [DOI: 10.1213/ane.0b013e318258023b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Buchholz V, Berkenstadt H, Goitein D, Dickman R, Bernstine H, Rubin M. Gastric emptying is not prolonged in obese patients. Surg Obes Relat Dis 2012; 9:714-7. [PMID: 22571886 DOI: 10.1016/j.soard.2012.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/25/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Obesity is associated with a poor anesthetic risk, in part because of the greater aspiration rates. A greater gastric residue and lower stomach pH have been implicated. The relationship of obesity to gastric emptying is ill-defined. with contradicting reports stating shorter, similar, and longer times compared with nonobese subjects. The aim of the present study was to compare gastric emptying in obese and nonobese subjects at a university hospital. METHODS A total of 19 obese (body mass index [BMI] >40 kg/m(2)) and 20 nonobese (BMI <30 kg/m(2)) subjects underwent a standardized scintigraphic gastric emptying study. The participants consumed a standard semisolid, technetium-99m-labeled meal. Images were acquired immediately and 1, 2, and 4 hours after meal completion. The interval to evacuate one half of the counts measured at meal completion) and retention (the percentage of counts in stomach at each measurement point) were recorded. RESULTS The mean age and BMI was 35 years and 45 kg/m(2) in the obese and 44 years and 26 kg/m(2) in the nonobese group, respectively. No differences were found between the 2 groups regarding gastric emptying. Regression analysis showed no statistical association between the BMI and gastric emptying, including multivariate analysis, considering BMI, age, and gender. CONCLUSION A scintigraphy test of a labeled meal was used to evaluate gastric emptying in obese and nonobese subjects. In accordance with other published data, no significant difference was found between the 2 groups. The anesthetic risks in the obese should be attributed to factors other than delayed gastric emptying (i.e., anatomic variation, increased rates of hiatal hernia and reflux).
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Affiliation(s)
- Vered Buchholz
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Kogan A, Preisman S, Bar A, Sternik L, Lavee J, Malachy A, Spiegelstein D, Berkenstadt H, Raanani E. The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery. J Anesth 2011; 26:174-8. [DOI: 10.1007/s00540-011-1287-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 10/31/2011] [Indexed: 11/30/2022]
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29
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Keidan I, Ben-Menachem E, Barzilai A, Nur I, Berkenstadt H. Intravenous Sodium Bicarbonate Verifies Intravenous Position of Catheters in Ventilated Patients. Anesth Analg 2011; 113:279-81. [DOI: 10.1213/ane.0b013e3182222ed0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Ben-Menachem E, Ezri T, Ziv A, Sidi A, Brill S, Berkenstadt H. Objective Structured Clinical Examination–Based Assessment of Regional Anesthesia Skills. Anesth Analg 2011; 112:242-5. [DOI: 10.1213/ane.0b013e3181fc3e42] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shapiro R, Barsuk D, Segev L, Shimon-Paluch S, Berkenstadt H, Zippel DB, Papa MZ. Pre-operative cardiac workup after anthracycline-based neoadjuvant chemotherapy. Is it really necessary? Ann R Coll Surg Engl 2010; 93:127-9. [PMID: 21092416 DOI: 10.1308/003588411x12851639107836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In patients receiving pre-operative anthracyclines for locally advanced breast cancer, early cardiotoxicity is a well-recognised complication that may interfere with surgery. The aim of this study was to assess the safety of breast surgery after neoadjuvant treatment with Doxorubicin. PATIENTS AND METHODS A retrospective study of breast cancer patients treated with Doxorubicin as part of their neoadjuvant protocol. All patients were subsequently operated in our institution. Intra-operative and postoperative haemodynamic, cardiac or respiratory events were collected. RESULTS A total of 83 patients were included. All patients had a normal left ventricular ejection fraction before starting on chemotherapy. Doxorubicin was given in conjunction with Cyclophosphamide and Paclitaxel. The cumulative dose of Doxorubicin was 240 mg/m(2). All patients completed their chemotherapy less than a year before surgery and were clinically asymptomatic. Of the patients, 2.3% displayed a significant reduction in cardiac function to meet cardiotoxicity criteria, although not clinically apparent. No complications occurred intra-operatively or postoperatively. CONCLUSIONS Breast surgery can be safely performed after breast neoadjuvant chemotherapy with Doxorubicin. The risk of early cardiotoxicity does not mandate a cardiac function assessment after completion of treatment. Work-up should be individualised according to the anthracycline regimen, patient's cardiac risk factors and functional status before surgery.
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Affiliation(s)
- Ron Shapiro
- Department of Surgical Oncology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Perel A, Berkenstadt H, Yusim Y, Ezri T. The rotated mask hold. J Clin Anesth 2009; 21:617-8. [DOI: 10.1016/j.jclinane.2009.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 03/04/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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Friedman Z, Qin J, Berkenstadt H, Katznelson R. The Confusion Assessment Method-A Tool for Delirium Detection by the Acute Pain Service. Pain Pract 2008; 8:413-6. [DOI: 10.1111/j.1533-2500.2008.00230.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Keidan I, Gravenstein D, Berkenstadt H, Ziv A, Shavit I, Sidi A. Supplemental oxygen compromises the use of pulse oximetry for detection of apnea and hypoventilation during sedation in simulated pediatric patients. Pediatrics 2008; 122:293-8. [PMID: 18676546 DOI: 10.1542/peds.2007-2385] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The goal was to assess the time to recognition of apnea in a simulated pediatric sedation scenario, with and without supplemental oxygen. METHODS A pediatric human patient simulator mannequin was used to simulate apnea in a 6-year-old patient who received sedation for resetting of a fractured leg. Thirty pediatricians participating in a credentialing course for sedation were randomly assigned to 2 groups. Those in group 1 (N = 15) used supplemental oxygen, and those in group 2 (N = 15) did not use supplemental oxygen. A third group (N = 10), consisting of anesthesiology residents (postgraduate years 2 and 3 equivalent), performed the scenario with oxygen supplementation, to ensure validity and reliability of the simulation. The time interval from simulated apnea to bag-mask ventilation was recorded. Oxygen saturation and Paco(2) values were recorded. All recorded variables and measurements were compared between the groups. RESULTS The time interval for bag-mask ventilation to occur in group 1 (oxygen supplementation) was significantly longer than that in group 2 (without oxygen supplementation) (173 +/- 130 and 83 +/- 42 seconds, respectively). The time interval for bag-mask ventilation to occur was shorter in group 3 (anesthesiology residents) (24 +/- 6 seconds). Paco(2) reached a higher level in group 1 (75 +/- 26 mmHg), compared with groups 2 and 3 (48 +/- 10 and 42 +/- 3 mmHg, respectively). There was no significant difference between the groups in oxygen saturation values at the time of clinical detection of apnea (93 +/- 5%, 88 +/- 5%, and 94 +/- 7%, respectively). CONCLUSIONS Hypoventilation and apnea are detected more quickly when patients undergoing sedation breathe only air. Supplemental oxygen not only does not prevent oxygen desaturation but also delays the recognition of apnea.
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Affiliation(s)
- Ilan Keidan
- Department of Anesthesia and Intensive Care, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Berkenstadt H, Haviv Y, Tuval A, Shemesh Y, Megrill A, Perry A, Rubin O, Ziv A. Improving Handoff Communications in Critical Care*: Utilizing Simulation-Based Training Toward Process Improvement in Managing Patient Risk. Chest 2008. [DOI: 10.1378/chest.07-0914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Einav S, Matot I, Berkenstadt H, Bromiker R, Weiniger C. A survey of labour ward clinicians’ knowledge of maternal cardiac arrest and resuscitation. Int J Obstet Anesth 2008; 17:238-42. [DOI: 10.1016/j.ijoa.2008.01.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2008] [Indexed: 10/22/2022]
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Shenkman Z, Berkenstadt H. [Peri-operative stress response and peri-operative analgesia in children]. Harefuah 2008; 147:543-572. [PMID: 18693633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Peri-operative surgical stress (SS) is characterized by increased secretion of pituitary hormones and sympathetic activation and is correlated with changed blood levels of stress hormones and metabolites. Adverse effects of perioperative stress include mortality and morbidity and a negative nitrogen balance. Although peri-operative analgesia and stress response-free period are commonly considered as synonyms, pain seems not to be the only factor determining the hormonal-metabolic response to surgery. Other factors playing a role in the creation of SS in newborns include blood loss, site of surgery, superficial and visceral trauma, surgery duration, hypothermia, infection, prematurity and factors related to cardiac surgery. Potent semi-synthetic opioids attenuate the SS better than morphine. However, supplementation of general anesthesia (GA) with local anesthetics either by way of regional or local anesthesia seems to decrease SS more effectively than GA with IV opioids. Hemodynamic monitoring may not suffice for SS or analgesia quality estimation. The most accessible laboratory measure for the monitoring of the stress response for non-cardiac surgery and pre-bypass phase of cardiac surgery may be blood glucose. Blood glucose increases with stress and when analgesia is inadequate; it is easily measured and treated almost immediately once an excessive response is identified. This individualized approach and real-time feedback may be far better than using either excessive opioid doses (hoping to ablate stress response) or minimal opioid dosages.
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Affiliation(s)
- Ze'ev Shenkman
- Department of Day Care Surgery and Anesthesia C, Sheba Medical Center, Tel Hashomer, Israel.
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Abstract
Laparoscopic basic skills' training relies mainly on costly video trainers. The aim of this study was to evaluate a simple, low-cost devise for laparoscopic training. In all, 32 participants with varying levels of skill were recruited. A Simulab LapTrainer (Simulab, Seattle, Washington), using a simple plastic box, a webcam, and a Universal Serial Bus 2 card, was used together with standard operating tools. Participants performed 3 tasks (rope passing, peg transfer, and intracorporeal knot tying), which were video recorded and blindly assessed by 2 experts using error scores, checklists, and time. Statistical analysis included nonparametric tests and Cronbach α for inter-rater reliability. A P <.05 was deemed significant. Highly significant differences were noted between groups in all tasks and for all parameters ( P = .001). Inter-rater reliability was 0.88. Simulator ratings were good: 63%, excellent: 28%, and only 9% rated it as average. The Simulab LapTrainer provides a valid alternative for skills training. Its simplicity, portability, and relatively low cost make it an attractive surgical training tool.
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Affiliation(s)
- Avner B. Dayan
- Department of General Surgery and Transplantation Sheba Medical Centre, Tel Hashomer, Israel
| | - Amitai Ziv
- Israel Centre for Medical Simulation, Sheba Medical Centre
| | | | - Yaron Munz
- Israel Centre for Medical Simulation, Sheba Medical Centre, , Department of General Surgery and Transplantation Sheba Medical Centre, Tel Hashomer, Israel
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Abstract
Assessment and evaluation are integral parts of any educational and training process, and students at all levels of training respond by studying more seriously for the parts of the course or training that are assessed. To promote and enhance effective learning successfully, simulation and other teaching methods should be both formative and summative, because the ultimate goal is to ensure professional competence. This article describes a model of medical competence, and focuses on the use of medical simulation in assessment and evaluation of different levels of clinical competence using examples from experience.
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Affiliation(s)
- Amitai Ziv
- The Israel Center for Medical Simulation (MSR), Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel.
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Grossman R, Ram Z, Perel A, Yusim Y, Zaslansky R, Berkenstadt H. Control of postoperative pain after awake craniotomy with local intradermal analgesia and metamizol. Isr Med Assoc J 2007; 9:380-2. [PMID: 17591378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Pain following brain surgery is a significant problem. Infiltration of the scalp with local intradermal anesthetics was suggested for postoperative pain control but was assessed only in the first hour postoperatively. OBJECTIVES To evaluate wound infiltration with a single dose of metamizol (dipyrone) for postoperative pain control in patients undergoing awake craniotomy. METHODS This open, prospective, non-randomized observational study, conducted in anesthesiology and neurosurgical departments of a teaching hospital, included 40 patients undergoing awake craniotomy for the removal of brain tumor. Intraoperative anesthesia included wound infiltration with lidocaine and bupivacaine, conscious sedation using remifentanil and propofol, and a single dose of metamizol (dipyrone) for postoperative pain control. Outcome was assessed by the Numerical Pain Scale on arrival at the postoperative care unit, and 2, 4 and 12 hours after the end of surgery. RESULTS On arrival at the postoperative care unit, patients reported NPS scores of 1.2 +/- 1.1 in a scale of 0-10 (mean +/- SD) (median = 1, range 0-4). The scores were 0.8 +/-0.9, 0.9 +/- 0.9 and 1 +/- 0.9 at 2 hours, 4 hours and 12 hours after the end of surgery, respectively. Based on patients' complaints and NPS lower than 3, 27 patients did not require any supplementary analgesia during the first 12 postoperative hours, 11 patients required a single dose of oral metamizol or intramuscular diclofenac, one patient was given 2 mg of intravenous morphine, and one patient required two separate doses of metamizol. CONCLUSIONS Although the clinical setup prevents the use of placebo local analgesia as a control group, the results suggest the possible role of local intradermal infiltration of the scalp combined with a single dose of metamizol to control postoperative pain in patients undergoing craniotomy.
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Affiliation(s)
- Rachel Grossman
- Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Israel
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Berkenstadt H, Erez D, Munz Y, Simon D, Ziv A. Training and assessment of trauma management: the role of simulation-based medical education. Anesthesiol Clin 2007; 25:65-74, viii-ix. [PMID: 17400156 DOI: 10.1016/j.atc.2006.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Simulation-based medical education (SBME) offers a safe and "mistake-forgiving" environment to teach and train medical professionals. The diverse range of medical simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. In this article, the authors describe the possible roles of simulated patients, skills trainers, computerized patient simulators, and web-based teaching in trauma training, and describe some practical aspects of using simulation for trauma training.
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Affiliation(s)
- Haim Berkenstadt
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
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Berkenstadt H, Ziv A, Ezri T, Rubin O, Sidi A. Formative Role of Simulation-based Objective Structured Clinical Examination (OSCE) National Board Examination in Anesthesiology. Simul Healthc 2007. [DOI: 10.1097/01266021-200700210-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berkenstadt H, Munz Y, Trodler G, Blumenfeld A, Rubin O, Ziv A. Evaluation of the Trauma-Man® Simulator for Training in Chest Drain Insertion. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s00068-006-6159-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ziv A, Erez D, Munz Y, Vardi A, Barsuk D, Levine I, Benita S, Rubin O, Berkenstadt H. The Israel Center for Medical Simulation: a paradigm for cultural change in medical education. Acad Med 2006; 81:1091-7. [PMID: 17122476 DOI: 10.1097/01.acm.0000246756.55626.1b] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.
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Affiliation(s)
- Amitai Ziv
- Chaim Sheba Medical Center, Israel Center for Medical Simulation, Tel Hashomer, Israel.
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Yusim Y, Perel A, Berkenstadt H, Attia M, Knoller N, Sidi A. The use of recombinant factor VIIa (NovoSeven) for treatment of active or impending bleeding in brain injury: broadening the indications. J Clin Anesth 2006; 18:545-51. [PMID: 17126787 DOI: 10.1016/j.jclinane.2006.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 02/14/2006] [Accepted: 02/14/2006] [Indexed: 11/16/2022]
Abstract
We report three patients with severe traumatic brain injury, both open and closed, who were treated with recombinant activated factor VII. This treatment was given in a desperate, last-ditch effort to save the life of patient 1, as a preventive or early treatment of a developing hematoma in patient 2, and as treatment of a threatening hematoma in patient 3. One of the three patients survived. During the past few years we have broadened the indications for recombinant activated factor VII and started using it as a preventive measure rather than as a "last line of defense." However, the potential complications of disseminated intravascular coagulation and thrombotic events, as well as the cost-effectiveness in view of the available evidence-based medicine, should be considered.
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Affiliation(s)
- Yakov Yusim
- Department of Anesthesiology, Sheba Medical Center, Tel-Hashomer 52621, Israel
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Berkenstadt H, Yusim Y, Katznelson R, Ziv A, Livingstone D, Perel A. A novel point-of-care information system reduces anaesthesiologists' errors while managing case scenarios. Eur J Anaesthesiol 2006; 23:239-50. [PMID: 16430796 DOI: 10.1017/s0265021505002255] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2005] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The On-Line Electronic Help (OLEH) is a point-of-care information system for anaesthesia providers prepared by the European Society of Anaesthesiologists. In this preliminary study the effect of the OLEH availability on the incidence of knowledge-based errors during the management of case scenarios and participants' subjective evaluation of the OLEH were evaluated. METHODS After a short training session, 48 anaesthesiologists (24 junior residents, 12 senior residents and 12 board-certified) were presented randomly with six computer screen-based case scenarios with, and six without, the option of using the OLEH. Two reviewers evaluated the answers independently according to preconfigured guidelines. RESULTS The availability of the OLEH was associated with higher scores in 11 of the 12 scenarios, and with a decrease in the incidence of critical errors in 10 scenarios. Time to task completion was increased in one scenario only when the OLEH was used. The degree of professional experience was associated with better scores in five of the scenarios and with a reduced occurrence of critical errors in three scenarios. Forty-two out of 48 participants stated that finding information in the OLEH software was easy and that the system was helpful in managing the scenarios. CONCLUSIONS This preliminary study demonstrates the potential value of the OLEH in decreasing the number of knowledge-based errors made by anaesthesiologists. According to the encouraging results, the OLEH system is currently under evaluation using full-scale simulation scenarios in an operating room environment.
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Affiliation(s)
- H Berkenstadt
- Department of Anaesthesiology and Intensive Care, Tel Aviv University, Tel Hashomer, Israel.
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Berkenstadt H, Ziv A, Gafni N, Sidi A. The validation process of incorporating simulation-based accreditation into the anesthesiology Israeli national board exams. Isr Med Assoc J 2006; 8:728-33. [PMID: 17125130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The Israeli Board of Anesthesiology Examination Committee added a simulation-based Objective Structured Clinical Evaluation component to the board examination process. This addition was made in order to evaluate medical competence and considers certain domains that contribute to professionalism. This unique and new process needed to be validated. OBJECTIVES To validate and evaluate the reliability and realism of incorporating simulation-based OSCE into the Israeli Board Examination in Anesthesia. METHODS Validation was performed before the exam regarding Content Validity using the modified Delphi technique by members of the Task Force of the Israeli Board Examination Committee in Anesthesiology. RESULTS The examination has been administered six times in the past 3 years to a total of 145 examinees. The pass rate ranged from 62% (trauma) to 91% (regional anesthesia). The mean inter-rater correlations for the total score (all items), for the Critical checklist items score, and for the Global (General) rating were 0.89, 0.86 and 0.76, respectively. The inter-correlations between the five OSCE stations scores were significant (P< 0.01) only between Trauma & Ventilation for the Total score (r = 0.32, n=63), and between Resuscitation & Regional and OR-crisis for the Global score (r = 0.42 and 0.27, n=64 and 104, respectively). The correlation between the OSCE examination score and the success rate at each of the eight different clinical domains of the oral board examination did not reach statistical significance. Most participants (70-90%) found the difficulty level of the examination stations reasonable to very easy. All major errors, which were identified in the initial two exam periods, disappeared later in the next two exam periods. CONCLUSIONS The exam has gradually progressed from being an optional part of the oral board examination to a prerequisite component of this test. Other anesthesiology programs or medical professions can adopt the model described here.
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Affiliation(s)
- Haim Berkenstadt
- Israel Board Examination Committee in Anesthesiology, Scientific Council, Israel Medical Association, Ramat Gan, Israel
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Ezri T, Weisenberg M, Sessler DI, Berkenstadt H, Elias S, Szmuk P, Serour F, Evron S. Correct depth of insertion of right internal jugular central venous catheters based on external landmarks: avoiding the right atrium. J Cardiothorac Vasc Anesth 2006; 21:497-501. [PMID: 17678774 DOI: 10.1053/j.jvca.2006.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Radiographically, a central venous catheter (CVC) tip should lie at the level of the right tracheobronchial angle. Precalculation of length of CVC insertion may avoid unnecessary catheter malposition. The purpose of this study was to assess the accuracy of a method of CVC positioning, based on external topographic landmarks. DESIGN A prospective, randomized study. SETTING University-affiliated hospital, single institution. PARTICIPANTS Patients scheduled for surgery. INTERVENTIONS Patients were allocated for insertion of the catheter through the right internal jugular vein to either a fixed, predetermined, 15-cm length (n = 50) or to a depth calculated topographically (n = 50) by drawing a line from the level of the thyroid notch to the sternal manubrium. The catheter was repositioned if its tip was situated >5 cm above the carina or >1 cm below it. The distance from the catheter tip to the carina was measured. The main study endpoint was the need for catheter repositioning. MEASUREMENTS AND MAIN RESULTS Two percent of patients required repositioning in the topographic group compared with 78% in the 15-cm length group (p < 0.001). No patient in the topographic group and 10 patients (20%) in the 15-cm group had the catheter placed in the right atrium (p < 0.05). The mean distance from the CVC tip to the carina was 2.9 +/- 1.4 cm above the carina in the topographic group and 1.9 +/- 1.1 cm below the carina in the 15-cm length group (p < 0.001). No patient had a too proximally placed catheter. Insertion lengths in the topographic group ranged between 9 and 12.5 cm. CONCLUSIONS It is recommended to use the topographic approach in deciding CVC depth with right internal jugular CVC placement.
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Affiliation(s)
- Tiberiu Ezri
- Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel
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