This study was conducted to optimize the parameters involved in the electronarcosis of market chicken and turkeys. A prototype constant current stunner designed at the Department of Electrical Engineering of Virginia Polytechnic Institute and State University was used. Broilers were electrically stunned with 8, 29 and 50 mA per bird. Turkeys were electrically stunned with 10, 30 and 50 mA per bird. Three weight classes, controlled by age, were used as treatment levels. Broiler males were grown for 36, 43 and 50 days while females were grown for 37, 44 and 51 days. Turkey hens were grown for 84, 98 and 112 days, while toms were grown for 112, 126 and 140 days. Pre-stun levels of 3, 5 and 8 hours of feed and water withdrawal were used for each weight class and sex. The effect of sex, weight and feed and water withdrawal on stunning efficiency, recovery time, blood splatter, bone breakage, color and pH of the breast meat was determined. The experimental unit for each specie, sex, weight and feed withdrawal class used was a "pen" comprised of 10 birds. A total of 130 birds, by gender and specie are used for each repetition. Two repetitions of all experiments were accomplished. A third repetition was done in turkeys, but this time a cooping time of three hours prior to slaughter was added. All data was statistically analyzed with ANOVA and a Box-Behnken response surface design was used to optimize the current for the different experimental variables. Results indicated a significant (p < 0.0001) gender difference in resistance, recovery time and prevalence of defects in both broilers and turkeys. Optimization of the stunning process parameters was not achieved due to inability of the model to express logistic regression equations at the levels used in this study. / Master of Science

Fentanyl has historically been used to reduce inhalant anesthetic requirements in the dog, with the end goal of reducing detrimental cardiovascular effects seen with their use. While fentanyl has been investigated in this context with the older agent enflurane, this agent is no longer in common use. In the current literature, no studies exist that compare the effects of low and high doses of fentanyl on cardiovascular function in dogs anesthetized with isoflurane. In previous literature, a high dose of fentanyl improved cardiovascular function in enflurane anesthetized dogs only following correction of bradycardia associated with its use. The objective of this study was to evaluate the effect of two doses of fentanyl on isoflurane requirement in the dog, followed by an evaluation of cardiovascular function in the isoflurane-anesthetized dog at equivalent depth of anesthesia. The hypothesis was that fentanyl would reduce inhalant requirements in a dose dependent fashion, and that cardiovascular function would increase with fentanyl administration only following correction of bradycardia. A total of 8 healthy adult male beagle dogs were enrolled in this study, which was performed in a randomized cross-over design. Minimum Alveolar Concentration (MAC) was determined in these dogs via a 30 mA electric stimulation both before and after administration of a low (loading dose 30 µg/kg, continuous rate infusion (CRI) of 0.2 µg/kg/minute) or high (loading dose 90 µg/kg, CRI 0.8 µg/kg/min) dose of fentanyl. A 7-day washout was observed between experimental days. Following MAC determination, in a subsequent anesthetic episode animals were placed at a MAC multiple of 1.3 and cardiovascular and blood gas parameters were evaluated before and after each fentanyl dose in the presence and absence of bradycardia. Fentanyl decreased MAC in a dose-dependent fashion (p < 0.001), with the low dose reducing MAC by about 42% and the high dose by about 77%. MAC reduction, however, did not translate into improvement in cardiovascular function, with a significant reduction in cardiac index and oxygen delivery noted with both doses (p < 0.01) that was not different between treatments. Normal mean arterial pressures were maintained with both treatments despite these effects. Only with the high dose, however, correction of bradycardia caused an increase in both cardiac index and oxygen delivery (p < 0.02) when compared to isoflurane alone. In clinically healthy dogs, administration of a high dose of fentanyl increased cardiac function following correction of bradycardia, but a decrease was observed when bradycardia went uncorrected. Further studies are needed in order to evaluate these effects in clinical patients. / Master of Science

Improving patient safety through reduction of medical errors is a national priority. One of the strategies widely utilized to address this issue is the use of incident reporting systems. The purpose of this study was to describe factors that predict the likelihood that Certified Registered Nurse Anesthetists (CRNAs) will use incident reporting systems, guided by the theory of planned behavior (Ajzen, 1991). A non-experimental, correlational research design was utilized to achieve the study aims. Following IRB approval, a cross-sectional survey was administered electronically to a random sample of practicing CRNAs. Correlational analyses and a standard logistic regression were utilized to determine the relationship between cognitive factors and CRNAs' use of incident reporting systems. Two hundred and eighty-three practicing CRNAs participated in this study. These CRNAs value incident reporting, perceive social pressure to report, and feel in control over reporting, yet had not consistently used existing incident reporting systems in the past 12 months. A CRNA’s attitude toward reporting and the degree to which he or she perceived social pressure to report, were determined to be significant predictors of the likelihood that a CRNA would use an incident reporting system. Social pressure to report was the most important factor in the prediction model. The results of this study revealed that there are missed opportunities for learning from patient safety incidents in anesthesia practice. The information gained in this study has the potential to assist organizations in the design of strategies to promote incident reporting by practicing CRNAs.

Purpose: The purpose of this study was to compare the adverse events that occur with general anesthesia for dental rehabilitation between a hospital setting and dental clinic setting. Methods: A retrospective chart review was performed examining patients who had received dental rehabilitation with general anesthesia at the Virginia Commonwealth University Department of Pediatric Dentistry. Subjects were either treated in the Pediatric Dental Clinic or the Hospital Ambulatory Surgery Center (ASC) from July 2005 to December 2006. Anesthesia records of induction, intubation, maintenance, emergence and recovery were compared between the two settings.Results: There were a total of 422 charts reviewed with n=193 cases in the dental clinic and n=229 cases in the ASC. Patients in the dental clinic setting were slightly older (t = 2.63, df = 420, p-value = 0.0089), and healthier (chi-square = 45.9, df = 2, p-value Conclusion: Overall, the prevalence of adverse events occurring with dental rehabilitation under general anesthesia in the dental clinic setting was lower compared to adverse events in the hospital-based ambulatory surgical setting.

Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve current anesthesia practices that impact patient safety. Educational methodologies used by both clinical and didactic instructors that will improve teaching effectiveness need to be investigated to ensure that patient safety content is being delivered to nurse anesthesia students in a manner consistent with the American Association of Nurse Anesthetists (AANAs) Council on Accreditation's COAs) standards of care. Utilizing a simulated anesthesia crisis situation, this study compared the differences in cognitive imprinting and application to practice between two content delivery methods, the written case study and patient safety vignettes, in nurse anesthesia students. The control group was given a written case study which is considered a traditional method of content delivery. The treatment groups studied vignettes, which are short, realistic, simulated audio-visual videos that demonstrate content to be relayed. The research hypothesis studied the use of anesthesia crisis oriented vignettes as an educational tool to impact memory recall, thus potentially improving application to clinical practice. Hypotheses for the study were: Hypothesis 1 (Hl): Student anesthetists exposed to audio-visual vignettes will exhibit superior clinical performance during simulated apparatus-related crisis events, evidenced by higher group mean demonstration scores, when compared to a matched group exposed to written case studies. Hypothesis 2 (H2): Student anesthetists exposed to audio-visual vignettes will exhibit superior recall of apparatus related material, evidenced by higher group mean post-test scores, when compared to a matched group exposed to written case studies. Using the paired samples t-test and analysis of variance procedure (ANOVA), statistical findings were evaluated for significance. The different teaching methodologies were represented in the abbreviation of the variables studied. Two different crisis oriented events were presented in vignette format, a malfunctioning unidirectional expiratory valve and a malfunctioning suctioning apparatus. Variables that were studied include: clinical performance during the anesthesia machine checkout process by recreating the stuck expiratory valve and malfunctioning suction apparatus scenarios. Statistically, mixed results were obtained. The impact that the stuck expiratory valve vignette had on student recall and clinical performance was found to be insignificant. The impact resulting from exposure to the non-functioning suction apparatus vignette was found to be significant for both student recall and clinical performance. Other recall and clinical performance measures related to the non- functioning suction apparatus were also found to be significant. Conclusions: In this research study, memory and clinical performance were impacted when the anesthesia provider incorporated the correct anesthesia apparatus checkout process and crisis management skills into their practice. This research demonstrated that under the conditions of this study, teaching methodology impacted some areas of clinical performance. Due to the small sample size and because the clinical performance measurements tools were newly designed for this particular study, findings from this study cannot be generalized to any other group or population. However, the findings from this study merit further investigation into the potential use of vignettes as an educational methodology to impact clinical practice and improve patient safety.

Orientador: Newton Nunes / Resumo: Objetivou-se, com este estudo, determinar e comparar a concentração mais efetiva de lidocaína, para tumescência em cadelas, na mastectomia radical unilateral por meio da avaliação de dor no período pós-operatório fazendo uso da Escala de Dor de Glasgow Modificada (EDGM) e dos filamentos de von Frey até 720 minutos pós extubação. Para tal, foram utilizadas 20 cadelas distribuídas aleatoriamente em dois grupos (n=10) de acordo com a concentração de lidocaína na solução tumescente. O grupo G1 recebeu a solução de tumescência com concentração de 0,1% de lidocaína e o grupo G2 recebeu solução com concentração de 0,32% do mesmo fármaco. Para pré-medicação empregou-se a associação de clorpromazina (0,3 mg/Kg) e meperidina (3 mg/Kg), pela via intramuscular. A indução anestésica foi realizada com propofol (5 mg/Kg) e a manutenção com isofluorano. A solução tumescente na dose fixa de 15 mL/Kg foi ministrada no tecido subcutâneo da cadeia mamária, com o auxílio de cânula de Klein. A aferição dos parâmetros no período transanestésico foi padronizada em conformidade com o ato cirúrgico e contempla parâmetros cardiovasculares e respiratórios. A avaliação da dor no período pós-operatório se iniciou imediatamente após a extubação e 30, 60, 120, 240, 480 e 720 minutos após. As cadelas foram submetidas ao uso de terapia antimicrobiana terapêutica, com início no transcirúrgico. Empregou-se ANOVA e teste de Tukey para as variáveis paramétricas e teste de Friedman para as não paramétricas. Foi co... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to determine and compare the most effective concentration of lidocaine, for tumescence in bitches, treated with unilateral radical mastectomy, through the evaluation of pain in the postoperative period using the Modified Glasgow Pain Scale and von Frey Filaments up to 720 minutes after extubation. For this, 20 bitches were randomly distributed into two groups (n = 10). The group G1 received lidocaine tumescent solution at 0,1% and the G2 group received a 0,32% solution of the same drug. The dogs were premedicated with the combination of chlorpromazine (0.3 mg/kg) and meperidine (3 mg/kg). Anesthetic induction was performed with propofol (5 mg/kg) and maintenance with isoflurane. The lidocaine solutions solution at the fixed dose of 15 mL/kg was applied in the subcutaneous tissue of the mammary chain using a Klein's cannula. The observation of the intraoperative parameters were standardized according to the surgical procedure and pain evaluation in the postoperative period started immediately after extubation and at 30, 60, 120, 240, 480 and 720 minutes after this. ANOVA and Tukey's test were used for the parametric variables and Friedman test for the non-parametric data. A p value of 0.05 was considered. There were no significant differences among groups in the physiological parameters studied. In agreement, there was no difference in the pain scores by the von Frey Filaments method and Modified Glasgow Pain Scale in both groups. The conclusion is th... (Complete abstract click electronic access below) / Mestre

INTRODUÇÃO: A cetamina por via regional ou sistêmica melhora a analgesia pós-operatória. A hipótese testada nesse estudo foi a de que o uso profilático da cetamina S(+) por via peridural é melhor que a cetamina S(+) administrada por via venosa durante toda a anestesia, para o controle da dor pós-operatória em crianças submetidas a operações ortopédicas. MÉTODOS: 60 pacientes pediátricos foram aleatoriamente distribuídos em dois grupos de 30 pacientes. Os pacientes do grupo I receberam por via peridural 1 ml.kg-1 de ropivacaína a 0,2%, acrescida de 0,5 mg.kg-1 de cetamina S(+). Os pacientes do grupo II receberam por via peridural a mesma dose de ropivacaína, e antes da incisão cirúrgica receberam por via venosa infusão contínua de cetamina S(+) na dose de 0,2 mg.kg-1.h-1, interrompida ao final da sutura da pele. A mesma técnica anestésica geral complementar foi utilizada para os dois grupos. A dor foi avaliada pela escala Oucher de faces. Também foi avaliado o tempo para a primeira dose do analgésico de resgate e o consumo de morfina nas primeiras 24 h. Os resultados receberam tratamento estatístico pelo teste t de Student, não pareado, para comparação entre os dados demográficos dos grupos, tempo de duração do ato cirúrgico e tempo para recuperação, o teste do Qui quadrado e o teste exato de Fisher para análise de dados não paramétricos, e o teste de análise de variância, para comparar os valores da pressão arterial e da frequência cardíaca. RESULTADOS: Não foram encontradas diferenças estatísticas quanto à intensidade da dor, o tempo para a primeira dose de analgésico de resgate e o consumo de morfina entre os grupos. O valor da frequência cardíaca foi estatisticamente maior no grupo II do que no grupo I. CONCLUSÕES: A intensidade da dor pós-operatória, o tempo para a primeira dose de analgésico de resgate e o consumo de morfina foi semelhante com o uso da cetamina S(+) por via peridural ou sistêmica. A incidência de efeitos adversos foi semelhante com o uso da cetamina por via peridural ou sistêmica, com exceção da frequência cardíaca que foi estatisticamente maior no grupo em que a cetamina S(+) foi empregada em infusão contínua por via venosa. / INTRODUCTION: Ketamine by neuroaxial as well as intravenousroute could improve postoperative analgesia. The hypothesis to be tested here was that the prophylactic epidural use the S(+) ketamine, added to a local anesthetic solution, would improve postoperative pain control after orthopedic surgical procedures in pediatric patients, when compared to intravenous administration. METHODS: 60 pediatric patients were randomly assigned to one of two groups of 30 patients each named I, and II. Before the surgical incision the patients of group I, received by epidural route 1 ml.kg-1 0.2% ropivacaine and 0.5 mg. kg-1 S(+) ketamine. Patients of group II received by epidural route the same ropivacaine dose and 0.2 mg.kg-1h-1 S(+) ketamine IV infusion through all surgical procedure long suspended after the skin suture. The same complement anesthesia technique was provided to all patients. The pain was assessed by Oucher scale, time elicited to first rescue analgesia and 24 h morphine consumption. All data were statistically managed as follow: t test for demographics, surgical procedure duration and time to postoperative recovery; square CHI and Fisher test for nonparametric data and ANOVA for comparing the values of arterial pressure and heart rate. RESULTS: there were no statistical differences on time elicited to the first rescue analgesia, degree of pain complaint or morphine consumption when compared groups I and II. Mild tachycardia was observed for group II with statistical differences when compared to group I (P<0.05). CONCLUSION: the time elicited to the first rescue analgesia, degree of pain complaint and morphine consumption were similar with S(+) ketamine, by epidural and intravenous either. The adverse effects incidence was similar except for the heart rate statistically higher for the group where S(+) ketamine was employed by continuous intravenous route.

Introdução. A morbi-mortalidade durante e após anestesia para aneurismectomia de aorta abdominal é alta, pois esta doença acomete pacientes após a sétima década de vida e que possuem várias doenças concomitantes. Objetivos. Analisar e discutir as condutas anestésicas utilizadas nos períodos pré e intra-operatório no Serviço de Anestesiologia do HCFMRP-USP. Casuística e Método. Foram analisados os prontuários de 104 pacientes submetidos à aneurismectomia de aorta no tocante às condutas utilizadas pelos anestesiologistas para a condução destes casos. Resultados. Apenas um paciente possuía menos de 40 anos de idade, 76,80% estavam na sétima ou oitava década de vida e 88,46% eram do sexo masculino. A hipertensão arterial acometeu 70,19% dos pacientes e 26,92% possuíam coronariopatia. Pacientes com obesidade foram a minoria (26,92%). O ecocardiograma pré-operatório demonstrou que a grande maioria dos pacientes apresentava função ventricular normal. A cirurgia foi realizada em regime de urgência em 7,69% dos casos. A anestesia geral exclusiva foi realizada em 17 pacientes e associada com a peridural em 57 pacientes, com a raquianestesia em 11 e com a raqui-peri combinadas em 19. O tempo cirúrgico variou de 120 a 510 minutos enquanto que o tempo de clampeamento aórtico variou de 30 a 165 minutos. Houve um óbito no período intra-operatório e a causa foi choque hipovolêmico e 10 óbitos até o vigésimo dia pós-operatório. Sessenta e seis pacientes receberam concentrado de papa de hemácias durante o período intra-operatório, mas só em 43,27% desses casos a indicação esteve suportada por exame laboratorial. Oitenta pacientes foram extubados ainda na sala de cirurgia, enquanto que os demais (23) permaneceram intubados no período pós-operatório e 19 necessitaram de suporte ventilatório que teve tempo que variou de 3 a 96 horas com média de 42,31 horas. Apenas quatro pacientes fizeram pós-operatório imediato no Centro de Terapia Intensiva enquanto que os demais permaneceram na Sala de Recuperação Pós-Anestésica. Conclusão. Não existe um protocolo único para a realização de anestesia para aneurismectomia de aorta no HCFMRP-USP e a técnica anestésica utilizada não influenciou o morbi-mortalidade. / Introduction. The morbidity and mortality during and after anesthesia for aneurysmectomy of the abdominal aorta are high since this disease affects patients after the seventh decade of life who have several concomitant diseases. Objectives. To analyze and discuss the anesthetic conducts used during the preoperative and intra-operative periods at the Service of Anesthesiology of HCFMRP-USP. Cases and Method. The medical records of 104 patients submitted to aneurysmectomy of the aorta were analyzed regarding the conducts used by the anesthesiologists for the management of these cases. Results. Only one patient was less than 40 years old, 76.80% were in he seventh or eighth decade of life, and 88.46% were male. Arterial hypertension was present in 70.19% of the patients and 26.92% had coronary artery disease. Obese patients were a minority (26.92%). The preoperative echocardiogram demonstrated that most patients had normal ventricular function. Surgery was performed on an emergency basis in 7.69% of cases. Seventeen patients received exclusive general anesthesia, while general anesthesia was associated with peridural anesthesia in 57, with rachi-anesthesia in 11 and with combined rachi-peridural anesthesia in 19. Surgical time ranged from 120 to 510 minutes and time of aortic clamping ranged from 30 to 165 minutes. One death occurred intra-operatively due to hypovolemic shock and 10 patients died up to the 20th postoperative day. Sixty-six patients received a red blood cell concentrate intra-operatively, but this indication was supported by a laboratory exam in only 43.27% of these cases. Eighty patients were extubated while still in the operating room while the remaining 23 continued to be intubated during the postoperative period and 19 required ventilatory support lasting 3 to 96 hours (mean duration: 42.31 hours). Only four patients spent the immediate postoperative period in the Intensive Care Unit, while the remaining ones stayed in the Post-Anesthesia Recovery Room. Conclusion. There is no single protocol for the application of anesthesia for aneurysmectomy of the aorta at HCFMRP-USP and the anesthetic technique used did not influence morbidity-mortality.

Li, Xiang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 161-184). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.

Although ACC exerted a strong effect on the haemodynamic changes after SA, SA per se did not have much influence on ACC. The incidence and severity of ACC remained unchanged compared with the pre-spinal state. As long as maternal blood pressure were well controlled, the uterine blood flow indices were not affected by ACC. / Although there are many publications on ACC, most publications have considered ACC as a single entity, or reported its effects in terms of just a few end-point measures. The information published so far on ACC remains fragmented. This will be readdressed by taking a multidisciplinary approach with input from the fields of anaesthesia, obstetrics and radiology to non-invasively assess the haemodynamic changes associated with ACC. / Aortocaval compression occurs when parturients lie in the supine position with the gravid uterus compressing the aorta and the inferior vena cava. This interferes with venous return to the heart to reduce cardiac output, resulting in hypotension, uterine hypo-perfusion and fetal acidosis. Under neuraxial anaesthesia when the compensatory mechanisms via the sympathetic nervous outflow are blocked, the effects from ACC are exaggerated and results in maternal and fetal morbidity. / Intermittent IVC compression was responsible for most of the haemodynamic effects, presenting mainly as a reduction in cardiac output. Blood pressure or heart rate changes are poor indicators for IVC compression, and most patients were asymptomatic. Patients who have moderate to severe ACC have a higher incidence of hypotension after SA and consume a higher amount of phenylephrine for maintaining BP. / The research was conducted on non-labouring term parturients presenting for elective Caesarean section under spinal anaesthesia. Measurements were performed to assess the patency of blood vessels and haemodynamic responses to lateral tilts, using ultrasound and non-invasive haemodynamic monitors. / This research has achieved the following: (1) Qualitative measurements of compression of the aorta and IVC with US imaging and Doppler US; (2) Development of a new simple bedside method for detecting ACC using US; (3) Quantitative measurements of physiological responses in the maternal and fetal circulation associated with ACC; (4) Investigation of the effects of spinal anaesthesia per se on ACC. / Lee, Wee Yee Shara. / Adviser: Khaw Kim Sun. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3446. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 234-254). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.