浅谈麻醉学相关手机APP现状及其在麻醉学继续教育中的作用

随着网络和信息化技术的发展,基于手机的移动学习已经成为麻醉学继续教育中不可或缺的组成部分。本文就目前国内智能手机商店麻醉学相关的应用软件（APP）现状进行统计与综述,按照学术论坛、麻醉知识、医学知识、解剖图谱、文献管理、医学英语、药物应用等进行分类及介绍。进一步分析基于手机APP的移动学习在麻醉学继续教育中的平等、便捷、共享等优势,以及依赖性和目的性不强等缺点,为麻醉学科专业人员选择合适的APP并合理地加以利用提供一定的参考。     

非麻醉专业住院医师规范化培训麻醉教学的探讨

住院医师规范化培训是毕业后医学生教育的重要环节,应当重视非麻醉专业规培医师在麻醉科轮转学习。为了提高这类学员麻醉科规培的质量,哈尔滨医科大学附属第三医院麻醉科对于规培医师的麻醉教学进行了探索：制定规范的培训计划,提高调动学员和带教老师的积极性,完善多元化教学模式,制定目的明确的考核,从而提高了这类学员的培训质量。     

中医院临床麻醉学研究生的培养初探

为适应中医院校麻醉学专业研究生的培养目标,教研室对研究生培养方案进行了改革和探索,以期有针对性地培养具备中西医结合为特色的高素质麻醉学专业人才。     

麻醉科进修医生导师制的建立与探讨

根据工作性质和进修医生的特点,北京协和医院麻醉科在进修医生教学中引入导师制。该教学模式增强了带教教师的责任感和进修医生的归属感,通过针对性教学有效提高了进修医生的整体素质,为临床麻醉质量和患者临床安全提供了保障。导师制明确和强化了导师和进修医生之间的关系,是适合麻醉科进修医生培训的有效模式。     

麻醉学住院医师规范化培训学员身心健康状况的调查分析

目的 初步调查武汉地区四家大型教学医院麻醉学住院医师规范化培训学员的身心健康状态,并分析其危险因素。方法 选取武汉市4家大型综合性教学医院麻醉学住院医师规范化培训学员作为研究对象,借助SCL-90症状自评量表（symptom checklist-90,SCL-90）、艾森克人格量表（Eysenck personality questionnaire,EPQ）对麻醉学员展开心理健康和人格状态调查。采用SPSS 22.0进行独立样本t检验或者单因素方差分析及卡方检验。采用Logistic回归对SCL-90结果影响因素进行分析。结果 本次调查共发放问卷328份,有效回收326份（回收率99.39%）,其中68人（20.86%）显示心理状况异常（SCL-90总分大于160）,其中强迫症状、忧郁较高。心理异常学员表现倾向型神经质、倾向型精神质人格特征,且异常人格特征比例比心理正常学员高。单因素分析显示,住培年级、科研压力、月值班次数、人格特征与学员心理异常相关。多因素分析显示,月值班5次以上（B=0.997,P=0.039,OR=2.709,95%CI：1.051~6.986）,科研压力极其严重（B=3.235,P=0.002,OR=25.412,95%CI：3.239~199.363）,情绪不稳定（B=2.015,P<0.001,OR=7.504,95%CI：3.529~15.954）,精神质异常（B=1.640,P<0.001,OR=5.154,95%CI：2.510~10.581）是学员心理异常的危险因素;外向型人格（B=-2.758,P<0.001,OR=0.063,95%CI：0.019~0.215）是学员心理异常的保护因素。结论 武汉地区4家大型教学医院麻醉住培学员心理异常阳性率为20.86%,其可能影响因素与月值班次数、科研压力、工作压力、不同人格特征有关。     

The anesthetic approach to operative delivery of the extremely obese parturient

Extreme obesity (BMI ≥ 40) is thought to complicate approximately 5% of deliveries in the United States. Extreme obesity puts a pregnant woman at an increased risk for cardiovascular disease, including hypertension, coronary artery disease, and congestive heart failure; respiratory disease, including obstructive sleep apnea and asthma; as well as pregnancy-specific diseases including pregnancy-induced hypertension and gestational diabetes. Extreme obesity also puts a parturient at a significantly increased risk of requiring cesarean delivery. For the anesthesiologist, the physiologic changes of obesity combined with the normal physiologic changes of pregnancy can make for a complex and challenging case. This review will focus on the anesthetic approach to the extremely obese parturient undergoing scheduled operative delivery. With proper planning and a detailed understanding of the patient?s comorbidities, a safe and effective anesthetic can be achieved.     

Outpatient sedation for ocular examination

Outpatient sedation of infants, uncooperative children and, rarely, adults provides an opportunity to perform certain ophthalmologic diagnostic procedures such as tonometry, ophthalmoscopy and various electrophysiological studies (e.g., electroretinography and visual evoked response testing) without the expense and usage of an operating room. Many drugs have been recommended and used; all have limitations. The advantages and disadvantages of the more commonly used agents are reviewed. The known effects of these drugs on ocular function are presented.     

Waste gas monitor reduces wasted volatile anesthetic

Objective. The increasing focus on health care costs requires that all physicians evaluate practice behaviors. The primary emphasis in anesthesia has been limiting the use of expensive medications and interventions. Reducing waste is another approach, and volatile anesthetics are an appropriate target in that simple reduction of fresh gas flow (FGF) rates is effective. A monitor that measures and displays the cost of wasted volatile anesthetic was developed and used to determine if real-time display of the cost would result in decreased FGF rates, which, in turn, would decrease wasted anesthetic. Methods. The waste gas monitor (WGM) measures flow rate at the anesthesia machine's scavenger port, integrates this with agent concentration, and displays the calculated cost, real-time, on a portable computer screen. The WGM equipment was attached to the anesthesia machine in the gynecologic surgery operating room (OR) and those cases performed under general endotracheal anesthesia and lasting longer than one hour were eligible for inclusion. First year anesthesiology residents assigned to the study OR as part of a non-specialty rotation, were the subjects of the study. For each resident, after data were collected from at least two eligible baseline cases (Baseline Phase, WGM not visible and resident unaware of its presence), the monitor was introduced and data collection continued for at least three more eligible cases (Visible Phase). Results. Nine residents were initially enrolled, but due to scheduling difficulties only five residents completed the protocol. Data from cases using the WGM demonstrated a 50% decrease (3.58 ± 1.34 l/min vs. 1.78 ± 0.51 l/min (p = 0.009)) in the scavenger flow rates, which resulted in a 48% ($5.28 ± 0.68 vs. $2.72 ± 0.80 (p = 0.002)) decrease in hourly cost of wasted volatile anesthetic. There was no difference between the Baseline and Visible phases with regard to use of nitrous oxide or intravenous anesthetic agents. Conclusions. The WGM decreased wasted volatile anesthetic by encouraging decreased FGF rates.