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The 90% effective dose of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia in parturients with super obesity: an up-down sequential allocation study
No full textPURPOSE: To determine the 90% effective dose (ED) of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia (CSE) in parturients with super obesity (body mass index [BMI] ≥ 50 kg·m). METHODS: We enrolled parturients with BMI ≥ 50 kg·m with term, singleton vertex pregnancies undergoing elective Cesarean delivery under CSE. An independent statistician generated the 0.75% hyperbaric bupivacaine dosing regimen in increments of 0.75 mg using a biased-coin up-down sequential allocation technique. This was combined with 15 μg fentanyl, 150 μg morphine, and normal saline to a volume of 2.05 mL. The initial and maximum doses were 9.75 mg and 12 mg, respectively. Participants, clinical team, and outcome assessors were blinded to the dose. The primary outcome was block success, defined as T6 block to pinprick within ten minutes and no intraoperative analgesic supplementation within 90 min of spinal injection. We determined the ED using logistic regression. RESULTS: We enrolled 45 parturients and included 42 in the analysis. All doses achieved a T6 level within ten minutes, and the primary outcome occurred in 0/1 (0%) of the 9.75-mg doses, 2/3 (67%) of the 10.5-mg doses, 21/27 (78%) of the 11.25-mg doses, and 11/11 (100%) of the 12-mg doses. The ED of hyperbaric bupivacaine was 11.56 mg (95% confidence interval, 11.16 to 11.99). Four parturients (9.5%) had sensory level higher than T2, but none was symptomatic or required general anesthesia. CONCLUSION: The estimated ED of hyperbaric bupivacaine with fentanyl and morphine in parturients with super obesity undergoing Cesarean delivery under CSE was approximately 11.5 mg. STUDY REGISTRATION: ClinicalTrials.gov (NCT03781388); first submitted 18 December 2018
Novel technique for ultrasound-guided needle tracking: An inexpensive reusable phantom model utilising a closed electrical circuit
No full textPURPOSE: Purpose:There are a variety of commercially made ultrasound training phantoms available for educational purposes. A new concept in phantoms is presented that utilises a low-cost method to create a reusable phantom. METHODS: A closed electric circuit was combined with insulating material to create a novel phantom that can be used to practise needle tracking under ultrasound guidance on repeated occasions. A tricolour light-emitting diode (LED) illuminates when the needle (under ultrasound gudiance) contacts one of three metal objects embedded in the phatom material. CONCLUSION: This prototype model provides a simple solution for trianing ultrasound needle guidance is particularly geared towards programmes with a high volume of users. This protoype provides a starting point for a new concept in educational phantom trainers
Building a Program; The Coronary Artery Anomaly Program: From Mere Coincidence to an Opportunity, to Success
No full textPresented by Ziyad Binsalamah, MD, M.Sc. FRCS (C), FACS
Date of Presentation: April 25th, 2024
CME available for 1 year after presentation
Please complete an evaluation in CloudCME to claim credit for this presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1042/thumbnail.jp
June 12th, 2024: Severe Cutaneous Adverse Reactions (SCARs): A Practical Approach to SCAR Management for the Internist
No full textZoom Passcode: 1n7t%&7ghttps://knowledgeconnection.mainehealth.org/medicine_gr/1027/thumbnail.jp
January 10th, 2024: STEMI Care Update
No full textZoom Passcode: 8zqu.E8Ghttps://knowledgeconnection.mainehealth.org/medicine_gr/1013/thumbnail.jp
Improving Nurse-Provider Communication
Get PDFBackground: Ineffective communication among healthcare staff has been shown to cause an increase in errors and decrease in patient satisfaction.https://knowledgeconnection.mainehealth.org/nurseresidency/1013/thumbnail.jp
Nurse Mentorship and Retention
Get PDFBackground: Every year hospitals experience staff turnover. Implementation of a mentorship program apart from someone who is a preceptor, could help with staff retention and staff satisfaction.https://knowledgeconnection.mainehealth.org/nurseresidency/1008/thumbnail.jp
Statewide Needs Assessment of Neonatal Readiness at Delivery Hospitals in Maine
Get PDFBackground
• Neonatal mortality is higher in hospitals with low birth rates
• More than two-thirds of hospitals deliver less than one neonate per day in Maine
• Identification of neonatal preparedness is lacking and will assist in prioritization of education and outreach initiatives to delivery hospitals
• Our objective was to engage stakeholders to understand current neonatal readiness at delivery hospitals across the state and identify barriers to and helpful resources for improving neonatal care deliveryhttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2024/1013/thumbnail.jp
Comparing Two Ways to Treat Serious Worry among Older Adults from Underserved, Racial or Ethnic Minority Communities
Get PDFCompared with other older adults, those with serious worry are more likely to have poor physical health, and often have depression, sleep problems, and trouble thinking clearly.https://knowledgeconnection.mainehealth.org/reach/1008/thumbnail.jp
Comparing Universal versus Targeted School Screenings for Depression among Teens
Get PDFThe US Preventive Services Task Force endorses universal adolescent major depressive disorder (MDD) screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.https://knowledgeconnection.mainehealth.org/reach/1006/thumbnail.jp