Event-specific, simulation-based training resulted in superior performance in scenarios compared with traditional training and simulation-based training in an alternate event.

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Anesthesiology residents who underwent focused training on a simulator that included performance of a general anesthetic for emergency CD exhibited improved performance during a subsequent simulated anesthetic scenario compared with trainees who did not undergo such instruction.

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and nausea, and an inadequate response was defined as the presence of hypotension, nausea, or both.The mean age of the enrolled patients was 34.5 ± 3.8 years and the mean gestational age, 38.4 ± 0.8 weeks. The dose of phenylephrine ranged from 40 to 120 mg. The 120-mg dose was effective in all 15 patients who received it. On the basis of an estimated logistic dose-response curve, the bolus ED95 to produce an effective response was 159 mg (95% confidence interval 122-371 mg). In successful cases, the total phenylephrine dose used from initiation of spinal anesthesia until uterine incision ranged from 120 to 1800 mg. Hypotension occurred in 10 patients, in whom doses of phenylephrine ranged from 40 to 110 mg. The estimated ED95 for preventing hypotension alone was 135 mg (confidence interval 106-257 mg), slightly lower than the dose for preventing both hypotension and nausea. Fourteen patients developed hypertension after phenylephrine doses ranging from 60 to 120 mg. Bradycardia did not occur in any patient. Eleven patients had nausea after phenylephrine doses of 40 to 110 mg and 7 also had hypotension. No patient vomited. Umbilical artery pH values were less than 7.2 in 2 patients, whose phenylephrine doses were 40 and 50 mg, respectively; both had ineffective responses.The ED95 of phenylephrine, as used in this study, is at least 122 mg per bolus dose, higher than that used during the study. Further studies are required to assess the safety of this dose, or doses higher than this, in patients undergoing elective cesarean delivery under spinal anesthesia.E pinephrine-containing local anesthetic solutions are often prepared by anesthesiologists using the ''wash'' technique (the amount of epinephrine added to the resulting solution depends on the amount remaining in the needle/syringe dead space) or a measured technique with an insulin syringe. The wash technique has been reported to be less precise in measuring the volume of epinephrine solution. This study compared the final epinephrine concentrations using the 2 techniques to prepare typical epinephrinecontaining concentrations.Five experienced anesthesiologists prepared syringes for spinal and epidural anesthesia using both techniques. In trials 1 and 3 (spinal and epidural, respectively), epinephrine was drawn up in a 0.5-mL insulin syringe through the attached needle; local anesthetic was drawn into a 5 or 20-mL syringe using a filter straw or needle, which was then removed and the epinephrine solution emptied into the local anesthetic syringe. In trials 2 and 4 (spinal and epidural, respectively), 1 mL epinephrine was aspirated into the local anesthetic syringes through a filter straw or needle; most of the epinephrine was expelled and the local anesthetic solution was drawn into the syringe using the same straw. The target epinephrine concentration for trials 1 and 2 was 100 mg/mL and for trials 3 and 4, 5 mg/mL. Bupivacaine (1.8 mL) was the local anesthetic solution for trials 1 and 2 (syringe volumes 5 mL) and 20 mL lidocaine for trials 3 and 4 (syringe v...