Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load

Bilotta, Fredrico; Titi, Luca; Lanni, F.; Stazi, Elisabetta; Rosa, Giovanni

doi:10.1016/j.jclinane.2013.01.012

Cited by 20 publications

(10 citation statements)

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“…They recommend limiting the local anaesthetic volume for auriculotemporal nerve block to 3 ml, and staying above the level of the tragus. [ 41 ] The specific learning rate to apply adequate RSNB is about ten procedures [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

et al. 2016

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BackgroundAwake craniotomy (AC) renders an expanded role in functional neurosurgery. Yet, evidence for optimal anaesthesia management remains limited. We aimed to summarise the latest clinical evidence of AC anaesthesia management and explore the relationship of AC failures on the used anaesthesia techniques.MethodsTwo authors performed independently a systematic search of English articles in PubMed and EMBASE database 1/2007-12/2015. Search included randomised controlled trials (RCTs), observational trials, and case reports (n>4 cases), which reported anaesthetic approach for AC and at least one of our pre-specified outcomes: intraoperative seizures, hypoxia, arterial hypertension, nausea and vomiting, neurological dysfunction, conversion into general anaesthesia and failure of AC. Random effects meta-analysis was used to estimate event rates for four outcomes. Relationship with anaesthesia technique was explored using logistic meta-regression, calculating the odds ratios (OR) and 95% confidence intervals [95%CI].ResultsWe have included forty-seven studies. Eighteen reported asleep-awake-asleep technique (SAS), twenty-seven monitored anaesthesia care (MAC), one reported both and one used the awake-awake-awake technique (AAA). Proportions of AC failures, intraoperative seizures, new neurological dysfunction and conversion into general anaesthesia (GA) were 2% [95%CI:1–3], 8% [95%CI:6–11], 17% [95%CI:12–23] and 2% [95%CI:2–3], respectively. Meta-regression of SAS and MAC technique did not reveal any relevant differences between outcomes explained by the technique, except for conversion into GA. Estimated OR comparing SAS to MAC for AC failures was 0.98 [95%CI:0.36–2.69], 1.01 [95%CI:0.52–1.88] for seizures, 1.66 [95%CI:1.35–3.70] for new neurological dysfunction and 2.17 [95%CI:1.22–3.85] for conversion into GA. The latter result has to be interpreted cautiously. It is based on one retrospective high-risk of bias study and significance was abolished in a sensitivity analysis of only prospectively conducted studies.ConclusionSAS and MAC techniques were feasible and safe, whereas data for AAA technique are limited. Large RCTs are required to prove superiority of one anaesthetic regime for AC.

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Section: Discussionmentioning

confidence: 99%

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

et al. 2016

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“…Furthermore, everything has to be done without compromising the neurophysiological and neuropsychological testing. Confidence in all the main aspects of the procedure is achieved by residents after about 30 procedures [22].…”

Section: Role Of Anesthesiamentioning

confidence: 99%

Awake craniotomy for brain tumor: indications, technique and benefits

Dziedzic

Bernstein

2014

Expert Review of Neurotherapeutics

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Increasing interest in the quality of life of patients after treatment of brain tumors has led to the exploration of methods that can improve intraoperative assessment of neurological status to avoid neurological deficits. The only method that can provide assessment of all eloquent areas of cerebral cortex and white matter is brain mapping during awake craniotomy. This method helps ensure that the quality of life and the neuro-oncological result of treatment are not compromised. Apart from the medical aspects of awake surgery, its economic issues are also favorable. Here, we review the main aspects of awake brain tumor surgery. Neurosurgical, neuropsychological, neurophysiological and anesthetic issues are briefly discussed.

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“…Quite recently, a form for laparoscopic hysterectomy [20] was published, but unfortunately this form was not available at the time our study was ongoing. The VAS score is typically used to assess pain or anxiety among patients, but it can be also used for other purposes, e.g., among residents for assessing their own management in a special kind of anesthesia [21], and in assessing the overall quality of patient sign-out from the emergency department [22]. For trainees' surgical skills, the VAS score has been used to evaluate suturing and knot tying skills [23], showing the VAS score and the OSATS for global rating skills 'good' for educational purposes with interrater reliability (IRR) 0.71 in a group where assessors were trained to the use of scales.…”

Section: Discussionmentioning

confidence: 99%

Simulator training and residents’ first laparoscopic hysterectomy: a randomized controlled trial

2019

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Background Hysterectomy rates are decreasing in many countries, and virtual reality simulators bring new opportunities into residents' surgical education. The objective of this study was to evaluate the effect of training in laparoscopic hysterectomy module with virtual reality simulator on surgical outcomes among residents performing their first laparoscopic hysterectomy. Methods This randomized study was carried out at the Department of Obstetrics and Gynecology in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty residents and randomly signed half of them to train ten times with the laparoscopic hysterectomy module on a virtual reality simulator, while the rest represented the control group. Their first laparoscopic hysterectomy was video recorded and assessed later by using the Objective Structured Assessment of Technical Skills (OSATS) forms and Visual Analog Scale (VAS). The scores and surgical outcomes were compared between the groups. Results The mean OSATS score for the Global Rating Scale (GRS) was 17.0 (SD 3.1) in the intervention group and 11.2 (SD 2.4) in the control group (p = 0.002). The mean procedure-specific OSATS score was 20.0 (SD 3.3) and 16.0 (SD 2.8) (p = 0.012), and the mean VAS score was 55.0 (SD 14.8) and 29.9 (SD 14.9) (p = 0.001). Operative time was 144 min in the intervention group and 165 min in the control group, but the difference did not reach statistical significance (p = 0.205). There were no differences between the groups in blood loss or direct complications. Conclusion Residents training with a virtual reality simulator prior to the first laparoscopic hysterectomy seem to perform better in the actual live operation. Thus, a virtual reality simulator hysterectomy module could be considered as a part of laparoscopic training curriculum. Keywords Surgical education · Resident education · Virtual reality simulator · OSATS · VASAlthough the number of live operations in residents' training has diminished [1], technology offers new solutions for surgical training in the form of lap trainers and virtual reality simulators [2][3][4][5]. With these training tools, it is possible to acquire fundamental laparoscopic skills [2], and they may be used as a part of the procedural training curriculum [6], as well. Though procedural skills have been proven to be transferred into the operating room after virtual reality simulator modules in laparoscopic cholecystectomy [7], in laparoscopic salpingectomy [8], and in cataract surgery [9], no data exists on the effect of virtual reality simulators on advanced major surgical procedures [10].Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load

Cited by 20 publications

References 47 publications

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

Anaesthesia Management for Awake Craniotomy: Systematic Review and Meta-Analysis

Awake craniotomy for brain tumor: indications, technique and benefits

Simulator training and residents’ first laparoscopic hysterectomy: a randomized controlled trial

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