... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jen... more ... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jenny Lam-McCulloch, Doreen Yee. ... Patients with laryngeal fracture, airway burn, or head and neck injury are likely to require a secure airway to prevent upper airway obstruction. ...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2015
Care of the severely injured trauma patient requires integrated care provided by a high-functioni... more Care of the severely injured trauma patient requires integrated care provided by a high-functioning trauma team. Anesthesiologists, with their attendant skill sets in airway management, resuscitation, and vascular access, are uniquely positioned to be essential members, if not leaders, of this team. These skills sets frequently need to be ''modified or adapted'' to the trauma population, which is a very heterogeneous group. Corey S. Scher, the editor of this book, attempts to provide the necessary information to achieve this end. One strong point of this multi-author textbook, which is not captured in the ''trauma chapter'' of most major anesthesia textbooks, is the valuable detailed coverage of most of the spectrum of trauma care that our specialty will encounter. A major weakness, however, is the lack of meticulous editing. For example, there are numerous typographical errors in more than half of the chapters, ranging from spelling errors and incorrect wording to incomplete sentences. This can become increasingly annoying while reading through the subject matter. Some chapters, e.g., the first chapter, deliver a good summary or overview of trauma care, while others state specific considerations for special situations. In addition, other chapters discuss controversial areas and newer ideas which have resulted in changes in practice by some practitioners. The second chapter, which deals with airway management, is well written and comprehensive and includes references to special trauma airway situations as well as the role of newer airway equipment.
Most practicing anesthesiologists are involved in the care of multisystem injured patients at som... more Most practicing anesthesiologists are involved in the care of multisystem injured patients at some time in their careers; others specialize in trauma management. In addition to providing anesthesia for trauma patients requiring surgery, anesthetic training and skills naturally lend themselves to the ongoing monitoring, resuscitation, and critical care that these challenging patients require. An understanding of the mechanisms of injury and the resultant patterns of injury is essential for the management of every traumatized patient. This knowledge allows clinicians to formulate perioperative management plans that optimize safety for patients and to anticipate complications that may arise later from missed or occult injuries. As an integral part of the team caring for these complex patients, it is unacceptable for anesthesiologists to merely provide intraoperative anesthetic care in isolation. This article discusses those mechanisms of injury in commonly seen types of blunt and penet...
Canadian journal of anaesthesia = Journal canadien d'anesthesie, Jan 25, 2015
We conducted this study to determine the preferences of anesthesia residents training in Canada f... more We conducted this study to determine the preferences of anesthesia residents training in Canada for fellowship training, research, and future practice location and to identify the factors that influence those preferences. Using a cross-sectional study design, a survey was sent to all anesthesia residents enrolled at an accredited Canadian anesthesiology residency program (N = 629). Data were collected on demographics and preferences for fellowship training, research, and future practice location. A multivariable logistic regression model was used to determine significant associations. Two hundred forty-four residents (39%) responded to the survey. Seventy percent of residents intended to pursue fellowship training. The top three fellowships they favoured were regional anesthesia, intensive care, and cardiac anesthesia. Male sex was positively associated with the decision to pursue fellowship training, whereas having an additional graduate degree was negatively associated with this c...
ABSTRACT Comment: This 2.5-year long study attempts to change physician practice patterns by usin... more ABSTRACT Comment: This 2.5-year long study attempts to change physician practice patterns by using active measures such as "enhanced education" and "individualized feedback" to implement the use of five different preventive measures for postoperative nausea and vomiting (PONV). Although the authors felt that all of the chosen methods were effective and easy to use, the insertion of a nasogastric tube involved leaving this in during the postoperative period. Many patients would find a nasogastric tube much more objectionable than an episode of PONV and opt for the latter. Premedication with an anti-emetic such as promethazine seems reasonable and not unpleasant, but the sedative effects may persist, possibly delaying emergence from anesthesia. Droperidol (in greater than 1 mg doses) was the only method for prevention of PONV that increased during the study period. This was probably because of the familiarity anesthesiologists have with this drug as a rescue medication in the postanesthesia care unit for vomiting patients. Antiserotonin drugs such as ondansetron were not considered an option because of cost but probably would have been readily used if available owing to the low incidence of side-effects and high rate of success. An incidental finding from this study relates to the difference in treatment received between male and female patients. Female patients are at higher risk of nausea and vomiting with anesthesia, yet only 67% of the women received prophylaxis for PONV before the study, whereas 75% of the men were treated with antiemetic strategies at the onset of the investigation. By the end of data collection, 79% of the females and 77% of the males were receiving preventative measures for PONV. The inequality at the beginning of the study may reflect the trend recently discovered in medicine of poorer treatment for female patients in general.
Results: One hundred and four patients were identified as TAI in the study period (incidence of 0... more Results: One hundred and four patients were identified as TAI in the study period (incidence of 0.4% for blunt and 4.5% for penetrating trauma). Sixty-eighty patients were victims of penetrating trauma (ISS: 24 AE 10; mortality: 16%). Thirty-six patients were blunt trauma victims (ISS: 33 AE 16; mortality: 36%). Overall, 65% of the patients received a definitive airway (DA) in the pre-hospital setting or at the initial hospital assessment. Alternative techniques for obtaining DA including wound tracheal tube, surgical airway and intubation under fiberoptic bronchoscopy were used in 30% of the patients. Among 24 deaths, 10 were considered primarily due to the airway injury. Twelve patients presented with thoracic TAI with nine deaths in this subgroup. Conclusions: Overall, the incidence of TAI is low. Blunt trauma TAI is less common, and these patients have a different clinical presentation, higher ISS and mortality than the penetrating TAI group. Early assessment of airways is crucial and DA was required in 2/3 of the patients with TAI. Lower airway injuries have higher mortality than upper airway injuries. Even though most patients died as a result of other injuries, causative factors of death included difficulty in obtaining DA and ventilation/oxygenation problems. #
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2001
GENERAL ANESTHESIA 139 Purpose: The objectives of this study were to determine: 1) if anesthesiol... more GENERAL ANESTHESIA 139 Purpose: The objectives of this study were to determine: 1) if anesthesiologists had experienced a medication error and 2) to identify causal factors. The perceived value of a Canadian reporting agency for medication errors and improved standards for labels on drug ampoules was also investigated.
Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, phy... more Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, physicians need to possess and use this knowledge in their practice. The authors introduced enhanced education and individualized feedback to reduce postoperative nausea and vomiting (PONV). The primary objective was to increase anesthesiologists' use of preventive measures to reduce PONV, and the secondary objective was to determine whether patient outcomes were improved. After obtaining hospital ethics committee approval, the effect of education and feedback on anesthesiologist performance and the rate of PONV in major surgery elective inpatients during a 2-yr period was assessed. After baseline data collection (6 months), anesthesiologists at the study hospital received enhanced education (8 months) and individualized feedback (10 months). Parallel data collection was performed at a control hospital at which practice was continued as usual. The education promoted preventive measures (antiemetic premedication, nasogastric tubes, droperidol, metoclopramide). Individualized feedback provided the number of patients receiving promoted measures and the rate of PONV. The mean percentage of anesthesiologists' patients receiving at least one promoted measure and the rate of PONV were compared with baseline levels. At the study hospital, there was a significant increase in the mean percentage of the anesthesiologists' female patients receiving a preventive measure as well as a significant increase in the use of droperidol > or = 1 mg (P < 0.05) for all patients. The use of other promoted measures was unaffected. Absolute rates of PONV were unaffected at the study hospital until the post-feedback period (decrease of 8.8% between baseline and post-feedback (P = 0.015)). It was demonstrated that enhanced education and individualized feedback can change anesthesiologists' practice patterns. The actual benefit to patients from use of preventive measures was limited when used in the everyday clinical situation. Therefore, only modest decreases in PONV were achieved, despite the use of preventive measures.
... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jen... more ... Anita Sarmah Corresponding Author Contact Information , E-mail The Corresponding Author , Jenny Lam-McCulloch, Doreen Yee. ... Patients with laryngeal fracture, airway burn, or head and neck injury are likely to require a secure airway to prevent upper airway obstruction. ...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2015
Care of the severely injured trauma patient requires integrated care provided by a high-functioni... more Care of the severely injured trauma patient requires integrated care provided by a high-functioning trauma team. Anesthesiologists, with their attendant skill sets in airway management, resuscitation, and vascular access, are uniquely positioned to be essential members, if not leaders, of this team. These skills sets frequently need to be ''modified or adapted'' to the trauma population, which is a very heterogeneous group. Corey S. Scher, the editor of this book, attempts to provide the necessary information to achieve this end. One strong point of this multi-author textbook, which is not captured in the ''trauma chapter'' of most major anesthesia textbooks, is the valuable detailed coverage of most of the spectrum of trauma care that our specialty will encounter. A major weakness, however, is the lack of meticulous editing. For example, there are numerous typographical errors in more than half of the chapters, ranging from spelling errors and incorrect wording to incomplete sentences. This can become increasingly annoying while reading through the subject matter. Some chapters, e.g., the first chapter, deliver a good summary or overview of trauma care, while others state specific considerations for special situations. In addition, other chapters discuss controversial areas and newer ideas which have resulted in changes in practice by some practitioners. The second chapter, which deals with airway management, is well written and comprehensive and includes references to special trauma airway situations as well as the role of newer airway equipment.
Most practicing anesthesiologists are involved in the care of multisystem injured patients at som... more Most practicing anesthesiologists are involved in the care of multisystem injured patients at some time in their careers; others specialize in trauma management. In addition to providing anesthesia for trauma patients requiring surgery, anesthetic training and skills naturally lend themselves to the ongoing monitoring, resuscitation, and critical care that these challenging patients require. An understanding of the mechanisms of injury and the resultant patterns of injury is essential for the management of every traumatized patient. This knowledge allows clinicians to formulate perioperative management plans that optimize safety for patients and to anticipate complications that may arise later from missed or occult injuries. As an integral part of the team caring for these complex patients, it is unacceptable for anesthesiologists to merely provide intraoperative anesthetic care in isolation. This article discusses those mechanisms of injury in commonly seen types of blunt and penet...
Canadian journal of anaesthesia = Journal canadien d'anesthesie, Jan 25, 2015
We conducted this study to determine the preferences of anesthesia residents training in Canada f... more We conducted this study to determine the preferences of anesthesia residents training in Canada for fellowship training, research, and future practice location and to identify the factors that influence those preferences. Using a cross-sectional study design, a survey was sent to all anesthesia residents enrolled at an accredited Canadian anesthesiology residency program (N = 629). Data were collected on demographics and preferences for fellowship training, research, and future practice location. A multivariable logistic regression model was used to determine significant associations. Two hundred forty-four residents (39%) responded to the survey. Seventy percent of residents intended to pursue fellowship training. The top three fellowships they favoured were regional anesthesia, intensive care, and cardiac anesthesia. Male sex was positively associated with the decision to pursue fellowship training, whereas having an additional graduate degree was negatively associated with this c...
ABSTRACT Comment: This 2.5-year long study attempts to change physician practice patterns by usin... more ABSTRACT Comment: This 2.5-year long study attempts to change physician practice patterns by using active measures such as "enhanced education" and "individualized feedback" to implement the use of five different preventive measures for postoperative nausea and vomiting (PONV). Although the authors felt that all of the chosen methods were effective and easy to use, the insertion of a nasogastric tube involved leaving this in during the postoperative period. Many patients would find a nasogastric tube much more objectionable than an episode of PONV and opt for the latter. Premedication with an anti-emetic such as promethazine seems reasonable and not unpleasant, but the sedative effects may persist, possibly delaying emergence from anesthesia. Droperidol (in greater than 1 mg doses) was the only method for prevention of PONV that increased during the study period. This was probably because of the familiarity anesthesiologists have with this drug as a rescue medication in the postanesthesia care unit for vomiting patients. Antiserotonin drugs such as ondansetron were not considered an option because of cost but probably would have been readily used if available owing to the low incidence of side-effects and high rate of success. An incidental finding from this study relates to the difference in treatment received between male and female patients. Female patients are at higher risk of nausea and vomiting with anesthesia, yet only 67% of the women received prophylaxis for PONV before the study, whereas 75% of the men were treated with antiemetic strategies at the onset of the investigation. By the end of data collection, 79% of the females and 77% of the males were receiving preventative measures for PONV. The inequality at the beginning of the study may reflect the trend recently discovered in medicine of poorer treatment for female patients in general.
Results: One hundred and four patients were identified as TAI in the study period (incidence of 0... more Results: One hundred and four patients were identified as TAI in the study period (incidence of 0.4% for blunt and 4.5% for penetrating trauma). Sixty-eighty patients were victims of penetrating trauma (ISS: 24 AE 10; mortality: 16%). Thirty-six patients were blunt trauma victims (ISS: 33 AE 16; mortality: 36%). Overall, 65% of the patients received a definitive airway (DA) in the pre-hospital setting or at the initial hospital assessment. Alternative techniques for obtaining DA including wound tracheal tube, surgical airway and intubation under fiberoptic bronchoscopy were used in 30% of the patients. Among 24 deaths, 10 were considered primarily due to the airway injury. Twelve patients presented with thoracic TAI with nine deaths in this subgroup. Conclusions: Overall, the incidence of TAI is low. Blunt trauma TAI is less common, and these patients have a different clinical presentation, higher ISS and mortality than the penetrating TAI group. Early assessment of airways is crucial and DA was required in 2/3 of the patients with TAI. Lower airway injuries have higher mortality than upper airway injuries. Even though most patients died as a result of other injuries, causative factors of death included difficulty in obtaining DA and ventilation/oxygenation problems. #
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2001
GENERAL ANESTHESIA 139 Purpose: The objectives of this study were to determine: 1) if anesthesiol... more GENERAL ANESTHESIA 139 Purpose: The objectives of this study were to determine: 1) if anesthesiologists had experienced a medication error and 2) to identify causal factors. The perceived value of a Canadian reporting agency for medication errors and improved standards for labels on drug ampoules was also investigated.
Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, phy... more Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, physicians need to possess and use this knowledge in their practice. The authors introduced enhanced education and individualized feedback to reduce postoperative nausea and vomiting (PONV). The primary objective was to increase anesthesiologists' use of preventive measures to reduce PONV, and the secondary objective was to determine whether patient outcomes were improved. After obtaining hospital ethics committee approval, the effect of education and feedback on anesthesiologist performance and the rate of PONV in major surgery elective inpatients during a 2-yr period was assessed. After baseline data collection (6 months), anesthesiologists at the study hospital received enhanced education (8 months) and individualized feedback (10 months). Parallel data collection was performed at a control hospital at which practice was continued as usual. The education promoted preventive measures (antiemetic premedication, nasogastric tubes, droperidol, metoclopramide). Individualized feedback provided the number of patients receiving promoted measures and the rate of PONV. The mean percentage of anesthesiologists' patients receiving at least one promoted measure and the rate of PONV were compared with baseline levels. At the study hospital, there was a significant increase in the mean percentage of the anesthesiologists' female patients receiving a preventive measure as well as a significant increase in the use of droperidol > or = 1 mg (P < 0.05) for all patients. The use of other promoted measures was unaffected. Absolute rates of PONV were unaffected at the study hospital until the post-feedback period (decrease of 8.8% between baseline and post-feedback (P = 0.015)). It was demonstrated that enhanced education and individualized feedback can change anesthesiologists' practice patterns. The actual benefit to patients from use of preventive measures was limited when used in the everyday clinical situation. Therefore, only modest decreases in PONV were achieved, despite the use of preventive measures.
Uploads
Papers by Doreen Yee