Purpose Unanticipated perioperative death (UPD) is a significant event for the anesthesiologist that has not been widely studied. An anonymous questionnaire was used to obtain information about the frequency of UPD, anesthesiologists' most significant UPD, and their opinions regarding UPD. Methods A questionnaire was mailed to all anesthesiologists who were registered with the College of Physicians and Surgeons of Alberta in 2005 (n = 285). Results The study achieved a 63% response rate. Sixtyfour percent of respondents had been in practice for more than ten years, and 53% of respondents had experienced at least one UPD. After the UPD, 46% of the respondents performed further elective cases the same day, although 62% of them indicated that this was not advisable. Personal consequences were reported. Twenty-five percent felt they were being blamed for the event, and 10% thought about the UPD on a daily basis for more than a year afterwards. Mortality and morbidity reviews were common, and disciplinary consequences occurred infrequently. Sixty-four percent of anesthesiologists' most significant UPDs were elective cases. The etiology of death was thought to be anesthesia-related in only 11% of the UPDs. Although most respondents agreed that supportive and educational activities in the aftermath were advisable, such activities occurred in a minority of cases. Conclusions Alberta anesthesiologists are likely to experience UPD during their careers, and the experience can be associated with important personal consequences. Support for the anesthesiologist is inconsistent, and many continued to perform elective cases immediately following UPD. These conditions were not supported by the majority of respondents. RésuméObjectif Le de´ce`s pe´riope´ratoire inattendu (DPI) est un e´ve´nement significatif pour l'anesthe´siologiste et qui n'a que peu e´te´e´tudie´. Un questionnaire anonyme a e´te´utilise´afin de re´colter des informations concernant la fre´quence des DPI, le DPI le plus important pour les anesthe´siologistes, et leurs opinions concernant les DPI. Méthode Un questionnaire a e´te´envoye´a`tous les anesthe´siologistes inscrits aupre`s du Colle`ge des me´decins et chirurgiens de l'Alberta en 2005 (n = 285). Résultats L'e´tude a eu un taux de re´ponse de 63 %. Soixante-quatre pour cent des re´pondants pratiquaient l'anesthe´siologie depuis plus de dix ans, et 53 % des re´pondants avaient ve´cu au moins un DPI. Apre`s le DPI, 46 % des re´pondants ont travaille´sur d'autres cas non urgents le meˆme jour, bien que 62 % aient indique´que cela n'e´tait pas recommande´. Des conse´quences sur le plan personnel ont e´te´rapporte´es. Vingt-cinq pour cent des re´pondants ont ressenti qu'on les blaˆmait pour le de´ce`s, et Work to be attributed to:

UD FRCPCPurpose: Prediction of difficult tracheal intubation is not always reliable and management with flbreoptic intubation is not always successful. We describe two cases in which blind intubation through the intubating laryngeal mask airway (ILMA FasTrach TM) succeeded after tibreoptic intubation failed. Clinical features: The first patient, a 50 yr old man, was scheduled for elective craniotomy for intracerebral tumour. Difficulty with intubation was not anticipated. Manual ventilation was easily performed following induction of general anesthesia, but direct laryngoscopy revealed only the tip of the epiglottis. Intubation attempts with a styletted 8.0 mm endotracheal tube and with the fibreoptic bronchoscope were unsuccessful. A # 5 FasTrach TM was inserted through which a flexible armored cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. The second patient, a 43 yr old man, presented with limited mouth opening, swelling of the right submandibular gland that extended into the retropharynx and tracheal deviation to the left. He was scheduled for urgent tracheostomy. Attempted awake tibreoptic orotracheal intubation under topical anesthesia showed gross swelling of the pharyngeal tissues and only fleeting views of the vocal cords. A # 4 FasTrach TM was easily inserted, a clear airway obtained and a cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. Conclusion: The FasTrach may facilitate blind tracheal intubation when fibreoptic intubation is unsuccessful.Objectif: La prediction d'une difficult~ ~ rintubation endotrach~ale n'est pas toujours sore, et I'intubation fibroscopique n'est pas toujours r~ussie. Nous d&rivons deux cas o0 I'intubation ~ I'aveugle au travers du masque laryng~ (ML FasTrach) a ~t~ couronn& de succ& ~ la suite de I'&hec de rintubation fibroscopique. ]~_A~ments dlniques : Le premier patient, un homme de 50 ans, devait subir une craniotomie ~lective pour une tumeur c&~brale. Des difficult& d'intubation n'fitaient pas pr~vues. La ventilation manuelle &ait facile apr~s I'induction de I'anesth&ie g~n&ale, mais la laryngoscopie directe n'a r~v~l~ que la pointe de I'~piglotte. Eintubation tent& avec un tube endotrach~al de 8,0 mm muni d'un stylet et avec le fibroscope bronchique n'a pas r~ussi. On a ins&~ un FasTrach n ~ 5 au travers duquel on a pass~ dans la trach&, au premier essai, un tube flexible de silicone arm~ avec ballonnet de 8,0 mm. Le second patient, un homme de 43 ans, pr&entait une ouverture limit& de la bouche, une enflure des glandes sous-maxillaires droites qui s'&endait dans le r&ropharynx, et une d~viation de la trach& vers la gauche. II a ~t~ admis pour une trach~otomie d'urgence. I'intubation vigile tent& avec le tibroscope orotrach~al sous anesth&ie locale a montr~ un gonflement des tissus pharyngiens et n'a permis que d'entrevoir les cordes vocales. Un FasTrach n ~ 4 a ~t~ facilement ins&~, permettant de d~gager les voles a&iennes et de passer dans la trach~e, au premier essai, un tube de silicone ~ ballonnet de 8,0 mm. Concl...

Background: In this brief report, we describe two ways in which we assessed the Scholar CanMEDS role using a method to measure residents’ ability to complete a critical appraisal.  These were incorporated into a modified OSCE format where two stations consisted of 1) critically appraising an article and 2) critiquing an abstract.Method: Residents were invited to participate in the CanMEDS In-Training Exam (CITE) through the Office of Postgraduate Medical Education. Mean scores for the two Scholar stations were calculated using the number of correct responses out of 10. The global score represented the examiner’s overall impression of the resident’s knowledge and effort.  Correlations between scores are also presented between the two Scholar stations and a paired sample t-test comparing the global mean scores of the two stations was also performed.Results: Sixty-three of the 64 residents registered to complete the CanMEDS In-Training Exam including the two Scholar stations.  There were no significant differences between the global scores of the Scholar stations showing that the overall knowledge and effort of the residents was similar across both stations (3.8 vs. 3.5, p = 0.13).  The correlation between the total mean scores of both stations (inter-station reliability) was also non-significant (r = 0.05, p = 0.67).  No significant differences between senior residents and junior residents were detected or between internal medicine residents and non-internal medicine residents.Conclusion: Further testing of these stations is needed and other novel ways of assessing the Scholar role competencies should also be investigated.

Interpleural regional analgesia for postoperative pain relief is simple, safe and effective. 1-2 Pneumothorax is the most common complication.l-3Following an elective cholecystectomy in a 29-yr-old healthy human but before extubation of the trachea, the patient was turned to the left side, and an interpleural catheter was placed using the saline infusion technique. 4 General anaesthesia was then discontinued, 20 ml of 0.5% bupivicaine with epinephrine (51~g.ml -l) were injected and the patient had good pain relief. Nine hours later, when a top-up dose was needed, aspiration of the catheter yielded about 9 ml of hazy, red-tinged fluid. This was sent for examination and the top-up dose was withheld. Overnight the patient received meperidine and promethazine for pain relief. Re-aspiration of the catheter the next day produced no aspirate and interpleural analgesia was continued for a further 48 hr uneventfully using plain bupivicaine.Examination of the aspirated fluid showed an RBC count of 60,660. ixl -l and WBC count of 360.1~1-1 (differential leucocyte count from concentrated centrifuge was neutrophils 50%, lymphocytes 13%, monocytes 31%, eosinophils 3% and bands 3%).The mechanism of this effusion is unclear. It could have been a reactionary pleural effusion to the catheter or to sodium metabisulphite and anhydrous citric acid which are added as antioxidants when epinephrine is added to bupivicaine. Subsequent use of plain bupivicaine produced no such effusion. Although no direct cause and effect relationship could be established from this case report, yet it highlights the need for vigilance.

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