ABSTRACT

How to cite this Editorial: Giacalone M, Cyr S, Hemmerling TM. Influence of Aging on Competence of Physicians: What Do We Actually Know? Int J Periop Ultrasound Appl Technol 2012;1(3):v-vii.

Influence of Aging on Competence of Physicians: What Do We Actually Know?

In a world where human beings become increasingly old, where financial crisis destabilises the very fundamentals of our society, the concept of ‘aging’ undergoes dramatic changes. The boundaries to practice are met by the requirements to provide health care of the highest quality, with increasing age of its practitioners. The idea of practicing way beyond the age of 70 has been a reality in North America for a long time; based on a socio-financial structure with pension funds mostly left to the discretion of the physicians, it is not uncommon but rather normal to see physicians, surgeons or anaesthesiologists, practice medicine beyond the age of 70 or more. In Europe, there is a restriction of working beyond a certain age, however, the limits have been extended and will be even more in the future. Assessment of performance or competence in physicians in general is a difficult task, similar to other professions, e.g. lawyers, artists, craftsmen. For surgeons and anaesthesiologists, performance is always related to execution of some manual skills, e.g. performing surgery or delivering anaesthesia, but also to cognitive skills, managerial skills, inter-human relationships, whether this applies to interaction with other health care providers or patients. It seems that we have just started to research possible means of performance evaluations, with even the basic assessment of age-related performances and competence rather fuzzy.

ABSTRACT

Transoesophageal echocardiography allows the precise assessment of mitral valve pathology. Perioperative assessment of the mitral valve provides valuable support for the cardiac surgical team in planning a repair or replacement of this unique three-dimensional structure. This article will review the echocardiographic methods and views that allow a systematic assessment of the mitral valve apparatus.

Keywords: Transoesophageal echocardiography, Mitral valve, Anaesthesia.

How to cite this article: Lau G, Hebballi R. Transoesophageal Echocardiographic Evaluation of the Mitral Valve. Int J Periop Ultrasound Appl Technol 2012;1(3):89-93.

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

We assessed the effectiveness of a continuous local anaesthesia block of the articular branches of the femoral nerve (ABFN) for the treatment of early postoperative pain in 74 patients undergoing total hip anthroplasty (THA). Postoperative analgesia was provided by patient-controlled analgesia (PCA) in 20 patients (PCA group), or by continuous block of ABFN in addition to PCA in 54 patients (PCA + ABFN group). Combining standard PCA morphine and ABFN block decreased the morphine consumption in the postanaesthesia care unit (PACU) by 56% and reduced the time in the PACU by 31%. Twenty-four hours after surgery, continuous block of the ABFN decreased morphine consumption by 44% and pain scores by 32% at rest and 19% with activities. The addition of a block of the ABFN is an effective method of pain treatment immediately following THA because it provides excellent pain control while enabling early mobilisation without impairing motor function.

Keywords: Hip arthroplasty, Pain, Anaesthesia, Nerve block.

How to cite this article: Tanzer M, Taddei R, Arbeid E, Zaouter C, Hemmerling TM. Block of the Articular Branches of the Femoral Nerve improves Early Pain Control Following Total Hip Arthroplasty. Int J Periop Ultrasound Appl Technol 2012; 1(3):94-98.

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

Review of the literature suggests a decrease in complication rates when using ultrasound guidance in central venous line (CVL) placement. Carotid artery puncture is the most common complication of attempted internal jugular vein catheterisation with an incidence of 2 to 8%. This audit reviewed our local practice in CVL insertion techniques and carotid artery puncture rates for the period May 2008 to May 2009. The findings were reported and a repeat audit was performed for the period of February 2010 to February 2011. The results were interesting.

Keywords: Anaesthesia, Ultrasound, Central venous access.

How to cite this article: Mulvany SA, McConkey C, Allen S. An Audit of Central Venous Line Insertion, the use of Ultrasound Guidance and the Incidence of Carotid Artery Puncture. Int J Periop Ultrasound Appl Technol 2012;1(3):99-101

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

Objectives: Increasingly, ultrasonography is being used to insert perineural catheters. We report the case of a knotted and retained interscalene catheter that required surgical extraction.

Case report: An interscalene catheter was inserted to provide postoperative analgesia in a patient undergoing surgical repair of a proximal humeral fracture. Using ultrasound guidance, the needle tip was advanced in real time next the brachial plexus. Under direct vision, a bolus of local anaesthetic agents was injected and found to surround the plexic roots and trunks. Subsequently, a perineural catheter was inserted blindly past the needle tip. Postoperatively, removal of the catheter (at 24 hours) yielded unexpected resistance. An X-ray of the neck revealed the presence of a knot. The catheter was successfully removed with a surgical incision. The patient suffered no neurological sequelae.

Conclusion: In order to maximise the benefits of ultrasound guidance for perineural catheter insertion, the operator should ensure that all steps (needle insertion, local anaesthetic injection and catheter advancement) be carried out under direct vision.

Keywords: Knot, Perineural catheter, Ultrasonography.

How to cite this article: Duong CY, Tran DQH, Sinha AK. Knotting of a Perineural Catheter Inserted with Ultrasonography. Int J Periop Ultrasound Appl Technol 2012; 1(3):102-104.

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

We present a case report where ultrasonography was used for detection of a misplaced central venous catheter. The position of the catheter tip can be established within less than 1 minute noninvasively using ultrasonography.

Keywords: Ultrasonography, Central venous catheterization.

How to cite this article: Malik S, Verma PK, Chowdhury I, Dubey M. Ultrasonography for Detection of Misplaced Central Venous Catheter: Is Chest X-ray Necessary? Int J Periop Ultrasound Appl Technol 2012;1(3):105-106.

Source of support: Nil

Conflict of interest: None declared

ABSTRACT

Central venous catheters (CVC) are often inserted in critically ill patients. Complications associated with this procedure are more often than reported in literature. Use of ultrasound improves the likelihood of success of CVC, thus decreasing the adverse events. We report a case in which inadvertent injury to the sympathetic fibres occurred during insertion of CVC which led to Horner’s syndrome.

Keywords: Central venous catheter, Complication, Horner’s syndrome.

How to cite this article: Sriramka B, Sahoo NP. Horner’s Syndrome Following Central Venous Catheterisation. Int J Periop Ultrasound Appl Technol 2012;1(3):107-108.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Keywords: Transoesophageal echocardiography, Chiari’ network, Rheumatic heart disease.

How to cite this article: Kiro KL, Tempe D, Dutta D, Garg M. Chiari’s Network: An Unusual but not Uncommon Finding. Int J Periop Ultrasound Appl Technol 2012;1(3):109-110.

Source of support: Nil

Conflict of interest: None declared