METHODS: Healthy human volunteers (n = 30) underwent progressive LBNP in 5-minute intervals. Standard vital signs, along with stroke volume (SV), total peripheral resistance, functional capillary density, SmO(2), HbT, and pHm were measured continuously throughout the study.

RESULTS AND DISCUSSION: SmO(2) and SV significantly decreased during the first level of central hypovolemia (-15 mm Hg LBNP), whereas vital signs were later indicators of impending cardiovascular collapse. SmO(2) declined with SV and inversely with total peripheral resistance throughout LBNP. HbT was correlated with declining functional capillary density, suggesting vasoconstriction as a cause for decreased SmO(2) and subsequently decreased pHm.

CLINICAL TRANSLATION: The monitor has been miniaturized to a 58-g solid-state sensor that is currently being evaluated on patients with dengue hemorrhagic fever. Early results demonstrate significant decreases in SmO(2) similar to those observed with progressive reductions in central blood volume. As such, this technology has the potential to (1) provide a monitoring capability for both nontraumatic and traumatic hemorrhage and (2) help combat medics triage casualties and monitor patients during lengthy transport from combat areas.

History of Anesthesia [HOA] may be taught through lectures, small group discussions, or by one-on-one teaching. HOA competes for scarce time in a busy didactic schedule and for coverage in mainstream medical journals devoted to anesthesiology. These efforts are hampered by the fact that HOA does not have any direct impact on the delivery of modern anesthesia, and the fact that these topics do not appear in written or oral board examinations.

We describe three additional modalities to teach HOA to anesthesia residents that have been successfully employed by the Department of Anesthesiology at the University of Massachusetts: 1) Tours; 2) Historical Narratives and Novels; and 3) Movies and Video Clips.

Conclusions:

It is difficult to impart information using lectures due to time constraints and a very busy didactic schedule in residency programs. HOA related material does not get adequate coverage in standard textbooks of anesthesiology. We describe successful use of three modalities of imparting interesting information in an informal setting. Such efforts provide a unique experience during residency training. From preliminary reports we are confident that details from such tours, novels and movies remain imprinted in their memory for many years, perhaps permanently. These individuals are likely to remain advocates of history, and may choose to devote a part of their academic career towards exploration of HOA.

The patient arrived in the PACU on a backboard and with a cervical collar in place directly from the ER. The review of the patient’s chart revealed that he had a history of hypertension, PE / DVT on coumadin, hypothyroidism, NIDDM, bipolar disorder and cervical spine ankylosing spondylitis of his neck. On physical exam the patient was sleepy, but arousable and unable to move his lower extremities, with loss of bladder and bowel control. There was one 20 G IV in place. The airway exam revealed Mallampati Class 4. The patient was hemodynamically unstable with BP ~80/~40 mm HG; HR ~70’s/min; SpO2 ~86-88%. Resuscitation commenced immediately. The patient was started on face mask @ 10 l/m O2. One liter of normal saline was administered with minimal effect. A phenylephrine infusion was started. The blood pressure improved to SBP of 120’s mm Hg. The O2 saturation increased to 95%. A methylprednisone drip (30mg/kg iv bolus) was started for treatment of his spinal cord injury.

For additional IV access, another 20G IV was placed. Two units of FFP were given to normalize the INR of 2.4. After multiple attempts, a right radial arterial catheter was successfully placed. A right internal jugular (RIJ) central venous catheter was inserted under ultrasound guidance

Materials and Methods: We consulted staff at Connecticut Historical Society (CHS) and at Hartford Medical Society to help identify sites and artifacts in Hartford that honor Horace Wells. Thereafter, we visited and studied each of these sites.

Results: In 1847, Wells wrote a pamphlet titled ‘History of the Discovery of the Application of Nitrous Oxide Gas, Ether and Other Vapors to Surgical Operations.’ (Fig. 1). In 1907, the Spanish Dental Society honored Wells by awarding the city of Hartford a silver coat of arms. (Fig. 2) After Wells’ tragic death in 1848, his friend and dental colleague, John Riggs, prepared a death mask. (Fig. 3). The original mask was used by T. H. Bartlett in 1874 to sculpt a bronze statue of Horace Wells that was erected in Bushnell Park1 (Fig. 4). Wells’ office was located on Main Street, Hartford, and a plaque has been inserted onto the modern structure that stands in its place currently (Fig. 5). Horace and Elizabeth Wells were buried initially at Hartford’s Old North Cemetery. However, in 1908, Charles T. Wells (Horace’s only son) disinterred his parents’ remains from Old North Cemetery and reinterred them at Cedar Hill Cemetery. He also commissioned sculptor Louis Potter to create a fitting memorial consisting of a large granite grave marker with a bronze plaque on the front surface, and two angel figures on either end depicting the glory of his father’s discovery.2 (Fig. 6) Charles’ efforts to recognize his father’s discovery also led him to order from Louis C. Tiffany, a stain glass window (Fig. 7) that adorns Center Congregational Church. The Chapel at Trinity College has a pew dedicated to Horace Wells (Fig. 8).3 American artist Charles Noel Flagg (1848-1916) painted a portrait of Horace Wells, and this is part of the collection at Wadsworth Atheneum Museum of Art (Fig. 9).3,4

Conclusions: The city of Hartford, Connecticut celebrates Horace Wells’ achievements with many historical monuments, gifts, books and paraphernalia; thereby remembering his role in the discovery of the anesthetic effects of nitrous oxide. His work was recognized not only in the United States, but also in Europe.3

CONCLUSION: Prolonged CPR can result in favorable patient outcomes if done promptly and effectively, utilizing all available resources including intra-arrest PCI and ECMO.

Methods: Nationwide Inpatient Sample data for each year between 1998 and 2007 were accessed. Entries were included if they underwent a surgical procedure and had a diagnosis of RI/ARDS following surgery. Patients fulfilling entry criteria were divided into those with and without obesity. In-hospital mortality was the primary outcome. A logistic regression model was fitted to elucidate if obesity was associated with increased odds for the outcome while controlling for age, gender, admission and procedure type, and comorbidity burden.

Results: We identified 9 149 030 admissions that underwent the included surgical procedures between 1998 and 2007. Of those, 5.48% had a diagnosis of obesity. The incidence of RI/ARDS was 1.82% among obese and 2.01% among nonobese patients. Obese patients whose postoperative course was complicated by RI/ARDS had a significantly lower incidence of the need for mechanical ventilation (50% vs 55%). In-hospital mortality was significantly lower compared to nonobese patients (5.45% vs 18.72%). For those patients with RI/ARDS requiring intubation, the in-hospital mortality rate was 11% for obese and 25% for nonobese patients. In the multivariate regression analysis, obesity was associated with a 69% reduction in the odds of in-hospital mortality in postoperative patients with RI/ARDS.

Conclusion: In our analysis, obesity was associated with a decreased incidence and adjusted odds for in-hospital mortality after surgery. Our results support the emerging concept of the "obesity paradox."

METHODS AND RESULTS: In 20 healthy volunteers, systemic oxygen delivery and oxygen consumption, skeletal muscle oxygenation and oral mucosa perfusion were measured over increasing levels of LBNP to the point of hemodynamic decompensation. With sequential reductions in central blood volume, progressive reductions in oxygen delivery and tissue oxygenation and perfusion parameters were noted, while no changes were observed in systemic oxygen uptake or markers of anaerobic metabolism in the blood (e.g., lactate, base excess). While blood pressure decreased and heart rate increased during LBNP, these changes occurred later than the reductions in tissue oxygenation and perfusion.

CONCLUSIONS: These findings indicate that LBNP induces changes in oxygen transport consistent with the compensatory phase of hemorrhage, but that a frank state of shock (delivery-dependent oxygen consumption) does not occur. LBNP may therefore serve as a model to better understand a variety of compensatory physiological changes that occur during the pre-shock phase of hemorrhage in conscious humans. As such, LBNP may be a useful platform from which to develop and test new monitoring capabilities for identifying the need for intervention during the early phases of hemorrhage to prevent a patient's progression to overt shock.

DESIGN: Survey instrument.

SETTING: University-affiliated hospital.

MEASUREMENTS: In addition to information related to the identity of the respondent and institution, we inquired about the presence of faculty members with an interest in the history of anesthesia (HOA), the inclusion of HOA-related lectures in the didactic curriculum, whether the program would consider inviting an outside lecturer for a session devoted to HOA, the inclusion of HOA-related tours, and whether the program would allow residents an elective rotation of one to three months devoted to a research project related to HOA.

MAIN RESULTS: On the basis of responses from 46 of 132 residency programs (35%), 54% of programs had at least one faculty member with an interest in HOA, and 45% of programs included lectures related to HOA in their didactic curriculum. An encouraging finding was that 83% of programs (without such didactic sessions) were willing to invite visiting professors to deliver lectures on HOA. The vast majority (91%) did not conduct tours related to HOA, while 74% indicated a willingness to allow residents interested in HOA to devote one to three months to undertake such projects.

CONCLUSIONS: The low rate of interest in HOA among faculty members, and the lower rate of inclusion of lectures related to HOA during residency training, suggests that substantial barriers exist within the academic community towards a wider acceptance of the importance of HOA. Two positive indicators were the willingness to invite outside speakers and the receptivity to allowing residents to devote one to three months to projects related to HOA.