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  • ISSN: 2333-6641
    Volume 7, Issue 1
    Research Article
    Ji Young Min, Jeong Rim Lee, Hye Mi Lee, Hyun Il Kim, and Hyo-Jin Byon*
    Objective: An equation to calculate an induction dose of thiopental sodium for pediatric sedation during radiological examination has been proposed based on the results of retrospective regression analysis in a previous study (-8.153 + 0.799 × age [months] + 153.844 × body surface area). The purpose of the present study was to compare the dose of thiopental using this equation and a conventional dosing strategy in children undergoing radiological examinations.
    Methods: A total of 94 children scheduled to undergo elective computed tomography (CT) or magnetic resonance imaging (MRI) were randomly assigned to control and experimental groups. Children in the control group received an initial dose of thiopental sodium, calculated using the equation, while those in the experimental group received an initial dose of 2 mg/kg of thiopental, followed by 1 mg/kg of thiopental sodium until Ramsay sedation score was 4–5. A rescue injection of thiopental sodium 2 mg/kg was administered when the children awakened or moved during the imaging scans.
    Jeffrey Bernstein*, Kim Ohaegbulam, Betty Hua, Jing Song, Yelena Spitzer, Shamantha Reddy, and Singh Nair
    Objective: Our study sought to isolate and assess whether IV acetaminophen in four divided doses over 24 hours decreased pain scores and opioid requirements in patients undergoing cesarean delivery with neuraxial anesthesia.
    Methods: The primary objective of this study was to evaluate the effectiveness of IV acetaminophen in reducing 24-hour opioid requirements. A total of 66 patients undergoing elective cesarean delivery under spinal anesthesia with hyperbaric bupivacaine 12 mg, fentanyl 10 µg, and preservative-free morphine 150 µg were randomized to receive either IV acetaminophen or IV placebo for four consecutive doses in the first 24 hours post-operatively. The need for rescue medication using morphine equivalence, pain scores, patient satisfaction, and side effects was assessed by a blinded researcher in the first 24 and 48 hours post-operatively.
    Results: 165 subjects were approached for the study, 84 subjects agreed but 18 did not fulfill the inclusion criteria. Ultimately, 66 were enrolled. There was no difference in opioid requirements in the acetaminophen vs. placebo group, 44.32 ± 23 mg vs. 47.59 ± 28 mg (p=0.607) morphine equivalence, respectively at 24 hours. There was also no difference at 48 hours, 57.95 ± 20 mg vs. 56.59 ± 22mg morphine equivalence (p= 0.795). Post-operative pain scores, patient satisfaction, and adverse events were similar in both groups as well.
    Conclusion: The results of this study failed to demonstrate any additional benefits of administering multiple doses of IV acetaminophen for treating post-operative pain in patients who have undergone CS surgery and receiving intra-thecal morphine as part of their anesthesia and analgesia.
    Valentina Franco Uribe*, Duvan Andres Velez Rios, Laura Chavarriaga Jimenez, Juan Diego Pulecio, Andres Felipe Prado Reina, Juan Camilo Gomez Salgado, and Mauricio Calderon Marulanda
    Introduction: Though direct laryngoscopy is the method of choice to secure the airway, it has multiple disadvantages. There are different devices to improve the visualization of the airway, but their high cost and need for advanced training limit their use. Borescope would be a cost-effective option with advantages similar to those types of devices.
    Objective: The primary objective was to compare successful intubation at first attempt with and without the use of borescope. The secondary objective was to compare the average total intubation time with and without the use of borescope.
    Materials and methods: Controlled non-randomized pilot study in a simulated environment. Population frame work of 48 medical students who received training on the basic management of the device. A difficult airway was recreated in a simulation laboratory using the Laerdal Airway Management Trainer model and intubation parameters were compared using a conventional laryngoscope under direct vision and through borescope.
    Results: In the group with borescope, 22 out of the 24 participants performed the intubation at the first attempt (91.6%) while in the group without borescope, 15 participants performed the intubation at the first attempt (62.5%) (P: 0.02). No statistically significant difference was found in any other evaluated variable. Conclusion: Borescope could be an effective and economic alternative compared to other devices, since it has similar or better success rates, even for non-expert personnel.
    Peter Martin Hansen*, Jakob Sevelstad, and Nikolaj Preus Hatting
    Crew Resource Management (CRM) was adapted from the aviation industry and has spread to other professions including health-care professionals, with the intent of improving critical decision making, situation awareness and team performance. In an Emergency Medical Dispatch Center (EMDC) in Denmark, a need for CRM skills was identified and it was decided to introduce a tailored CRM course. In order to evaluate the impact of CRM introduction on EMDC performance, a prospective qualitative study was initiated.
    Methods: Prior to the CRM courses, a questionnaire was sent to all personnel assigned. A follow-up questionnaire was sent one month post-course. Three months after completion of the courses, the frequency of complaints and incidents relating to critical decision making and patient safety were recorded. For comparison, the same period the previous year was analyzed retrospectively.
    Results: 44 out of 72 answered both questionnaires (61,11 %). There was no significant change in the respondent’s own perception of 18 predefined CRM topics. The number of patient safety related incidents remained unchanged, however the degree of severity improved (4 vs. 8). The number of complaints to the EMDC regarding untoward communication with patients and health professionals was unaffected.
    Conclusion: Introduction of CRM in the EMDC did not improve situation awareness and team performance. Patient safety related incidents and complaints were unaffected. The severity of unintended incidents improved. Physicians were the most positive group towards CRM, while technicians were the most negative.
    Discussion: A literature review suggests that 10% of all CRM course participants are non-responders. This may reflect the fact that prerequisite level of education is an important factor in acquisition of new information and the ability to change behavior. For high reliability organizations, the pursuit of safety is about making the system as robust as is practicable in the face of its human and operational hazards.
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