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1. MECHANISMS OF INJURY

Author

J. Hugh Devitt and Doreen A. Yee

Subjects
medicine.medical_specialty, Resuscitation, Isolation (health care), Perioperative management, business.industry, medicine.disease, Occult, Anesthesiology and Pain Medicine, Blunt, Trauma management, medicine, Intensive care medicine, business, Penetrating trauma
Abstract

Most practicing anesthesiologists are involved in the care of multisystem injured patients at some time in their careers; others specialize in trauma management. In addition to providing anesthesia for trauma patients requiring surgery, anesthetic training and skills naturally lend themselves to the ongoing monitoring, resuscitation, and critical care that these challenging patients require. An understanding of the mechanisms of injury and the resultant patterns of injury is essential for the management of every traumatized patient. This knowledge allows clinicians to formulate perioperative management plans that optimize safety for patients and to anticipate complications that may arise later from missed or occult injuries. As an integral part of the team caring for these complex patients, it is unacceptable for anesthesiologists to merely provide intraoperative anesthetic care in isolation. This article discusses those mechanisms of injury in commonly seen types of blunt and penetrating trauma and reviews the patterns of injury resulting from them.

Published
1999
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2. Abstracts

Author

Cristina Hurtado, John Bradley, Andrew R. Burns, Keyvan Karkouti, Rob Anderson, Simon D. Abrahamson, C. David Mazer, O. R. Hung, L. Comeau, Joseph A. Fisher, Janet Tessler, Joshua Rucker, Alix Mathicu, Sara Murray-Foster, Chou Tz-Chong, Li Chi-Yuan, Takako Tsuda, Akihiko Tabuchi, Hiroshi Sasano, Masanobu Kiriyama, Akinori Okada, Junichiro Hayano, Akinori Takeuchi, Hirotada Katsuya, Claude P. Tousignant, Elizabeth Ling, Ramiro Arellano, N. Dowd, J. Karski, D. Cheng, J. Carroll-Munro, D. K. Rose, C. O. Mazer, M. M. Cohen, D. Wigglesworth, William P. S. McKay, Robert J. Teskey, Julio Militzer, Guy Kember, Travis Blanchet, Peter H. Gregson, Steven R. Howells, James A. Robblee, Terrance W. Breen, Laura Dierenfield, Tacie McNeil, Donna J. Nicholson, Stephen E. Kowalski, G. Andrew Hamilton, Michael P. Meyers, Carl Serrette, Peter C. Duke, Ingrid Custeau, Rend Martin, Sonia Larabée, Martine Pirlet, Madeleine Pilote, Jean-Pierre Tetrault, Ban C. H. Tsui, Sunil Gupta, Brendan Finucane, Mitchell J. Weisbrod, Vincent W. S. Chan, Z. Kaszas, C. Dragomir, M. R. Cohen, M. Gandhi, A. S. Clanachan, B. A. Finegan, Lisa Isaac, William M. Splinter, L. A. Hall, H. M. Gould, E. J. Rhine, Lyne Bergeron, Michel Girard, Pierre Drolet, Hong Hanh Le Truong, Carl Boucher, Daniel Vézina, Martin R. Lessard, Marie Gourdeau, Claude A. Trépanier, Theresa Yang, Alison Macarthur, P. Chouinard, F. Fugère, M. Ruel, Pekka Tarkkila, Marja Silvasti, Marjatta Tuominen, Nils Svartling, Per H. Rosenberg, David M. Bond, John F. Rudan, Michael A. Adams, Brian K. Tsang, Wanda Keahey, Lucia Gagliese, Marla Jackson, Paul Ritvo, Adarose Wowk, Alan N. Sandler, Joel Katz, J. G. Laffey, J. F. Boylan, Neal H. Badner, Wendy E. Komar, R. A. Cherry, S. M. Spadafora, R. J. Butler, Fiona McHardy, Joanne Fortier, Frances Chung, Scott Marshall, Ananthan Krishnathas, Jean Wong, Ewan Ritchie, Andrew Meikle, Nicole Avery, Janet van Vlymen, Joel L. Parlow, David Sinclair, Gabor Mezei, Fengling Jin, Andrew Norris, Tharini Ganeshram, Bernard A. MacLeod, Aliréza Azmudéh, Luigi G. Franciosi, Craig R. Ries, Stephan K. W. Schwarz, William PS McKay, Benjamin W. S. McKay, Pascal Meuret, Vincent Bonhomme, Gilles Plourde, Pierre Fiset, Stevens B. Backman, Alex Vesely, Leeor Sommer, Joel Greenwald, Elana Lavine, Steve Iscoe, George Volgyesi, Ludwik Fedorko, Joseph Fisher, Emilio B. Lobato, Cheri A. Sulek, Laurie K. Davies, Peter F. Gearen, François Bellemare, François Donati, Jacques Couture, Hwan S. Joo, Sunil Kapoor, Shahriar Shayan, Kenneth M. LeDez, Jim Au, John H. Tucker, Edwin B. Redmond, V. Gadag, Catherine Penney, Gregory M. T. Hare, Timothy D. G. Lee, Gregory M. Hirsch, Fan Yang, Eric Troncy, Gilbert Blaise, Yoshiyuki Naito, Shoji Arisawa, Masahiro Ide, Susumu Nakano, Kazuo Yamazaki, Takae Kawamura, Noriko Nara, Reiji Wakusawa, Katsuya Inada, Robert J. Hudson, Karanbir Singh, Gary A. Harding, Blair T. Henderson, Ian R. Thomson, Christopher G. Wherrett, Donald R. Miller, Alan A. Giachino, Michelle A. Turek, Kelly Rody, H. Vaghadia, V. Chan, S. Ganapathy, A. Lui, J. McKenna, K. Zimmer, William D. Regan, Ross G. Davidson, Krista Nevin, Sergio Escobedo, E. Mitmaker, M. J. Tessler, K. Kardash, S. J. Kleiman, M. Rossignol, L. Kahn, F. Baxter, A. Dauphin, C. Goldsmith, P. Jackson, J. McChesney, J. Miller, L. Takeuchi, E. Young, Kristine Klubien, Edith Bandi, Franco Carli, Kathleen Dattilo, Doris Tong, Mohit Bhandari, Louise Mazza, Linda Wykes, L. Z. Sommer, J. Rucker, A. Veseley, E. Levene, Y. Greenwald, G. Volgyesi, L. Fedorko, S. Iscoe, J. A. Fisher, Guo-Feng Tian, Andrew J. Baker, F. X. Reinders, A. J. Baker, R. J. Moulton, J. I. M. Brown, L. Schlichter, Laurence Van Tulder, Stéphane Carignan, Julie Prénovault, Jean-Paul Collet, Stan Shapiro, Jean-Gilles Guimond, Louis Blait, Thierry Ducruet, Martin Francœur, Marc Charbonneau, Guy Cousineau, Daniel R. Wong, Michele McCall, Fergus Walsh, Regina Kurian, Mary Keith, Michael J. Sole, Kursheed N. Jeejeebhoy, E. Whitten, P. H. Norman, J. A. Aucar, L. A. Coveler, Rodney M. Solgonick, Y. Bastien, Bruce Mazer, Koji Lihara, Beverley A. Orser, Michael Tymianski, Brendan T. Finucane, Nuzhat Zaman, Ibrahim Kashkari, Soheir Tawfik, Yun K. Tarn, Peter D. Slinger, Karen McRae, Timothy Winton, Alan N. Sandier, J. E. Zamora, Mary Jane Salpeter, Donglin Bai, John F. MacDonald, Kelly Mayson, Ed Gofton, Keith Chambers, Susan E. Belo, J. Colin Kay, Sean R. R. Hall, Louie Wang, Brian Milne, Chris Loomis, Zhi He, Wichai Wougchanapai, Ing K. Ho, John H. Eichhorn, Tangeng Ma, Wichai Wongchanapai, John H. Eicnhorn, Damian B. Murphy, M. B. Murphy, Steven B. Backman, Reuben D. Stein, Brian Collier, Canio Polosa, Chi-Yuan Li, Tz-Chong Chou, Jia-Yi Wang, John Fuller, Ronald Butler, Salvatore Spadafora, Neil Donen, Laurence Brownell, Sandy Shysh, Keith Carter, Chris Eagle, Isabella Devito, Stephen Halpern, J. Hugh Devitt, Doreen A. Yee, John L. deLacy, Donald C. Oxorn, Gary F. Morris, Raymond W. Yip, M. G. Gregoret-Quinn, R. F. Seal, LJ. Smith, A. B. Jones, C. Tang, B. J. Gallant, L. A. Nadwidny, Gerald V. Goresky, Tara Cowtan, Hilary S. Bridge, Carolyne J. Montgomery, Ross A. Kennedy, Pamela M. Merrick, M. Yamashita, K. Wada, Sylvie LeMay, Jean-François Hardy, Pamela Morgan, Steven Halpern, Jana Evers, P. Ronaldson, F. Dexter, Desmond Writer, Holly Muir, Romesh Shukla, Rob Nunn, John Scovil, Jeremy Pridham, Ola Rosaeg, Allan Sandier, Patricia Morley-Foster, Simon Lucy, Lesley-Ann Crone, Karen Zimmer, Deborah J. Wilson, Robert Heid, M. Joanne Douglas, Dan W. Rurak, Anna Fabrizi, Chantal T. Crochetière, Louise Roy, Edith Villeneuve, Louise Lortie, Sandra Katsiris, Barbara Leighton, Donna Wilson, Jean Kronberg, Leszek Swica, Janet Midgley, Robert Nunn, Bruce Smith, Michael E. Rooney, David C. Campbell, Celina M. Riben, Ray W. Yip, Jo MacDonell, and Tracey Levine

Subjects
Sevoflurane, Anesthesiology and Pain Medicine, Morphine, Total Knee Arthroplasty, Pulmonary Capillary Wedge Pressure, Ropivacaine, General Medicine, Article
Published
1998

4. Changing Anesthesiologists' Practice Patterns

Author

Doreen A. Yee, Marsha M. Cohen, and D. Keith Rose

Subjects
medicine.medical_specialty, Practice patterns, business.industry, Nausea, medicine.drug_class, Ethics committee, Anesthesiology and Pain Medicine, Anesthesia, Emergency medicine, Vomiting, Medicine, Antiemetic, Premedication, medicine.symptom, business, Droperidol, Postoperative nausea and vomiting, medicine.drug
Abstract

Background Because the ultimate purpose of new medical knowledge is to achieve improved health outcomes, physicians need to possess and use this knowledge in their practice. The authors introduced enhanced education and individualized feedback to reduce postoperative nausea and vomiting (PONV). The primary objective was to increase anesthesiologists' use of preventive measures to reduce PONV, and the secondary objective was to determine whether patient outcomes were improved. Methods After obtaining hospital ethics committee approval, the effect of education and feedback on anesthesiologist performance and the rate of PONV in major surgery elective inpatients during a 2-yr period was assessed. After baseline data collection (6 months), anesthesiologists at the study hospital received enhanced education (8 months) and individualized feedback (10 months). Parallel data collection was performed at a control hospital at which practice was continued as usual. The education promoted preventive measures (antiemetic premedication, nasogastric tubes, droperidol, metoclopramide). Individualized feedback provided the number of patients receiving promoted measures and the rate of PONV. The mean percentage of anesthesiologists' patients receiving at least one promoted measure and the rate of PONV were compared with baseline levels. Results At the study hospital, there was a significant increase in the mean percentage of the anesthesiologists' female patients receiving a preventive measure as well as a significant increase in the use of droperidol > or = 1 mg (P < 0.05) for all patients. The use of other promoted measures was unaffected. Absolute rates of PONV were unaffected at the study hospital until the post-feedback period (decrease of 8.8% between baseline and post-feedback (P = 0.015)). Conclusion It was demonstrated that enhanced education and individualized feedback can change anesthesiologists' practice patterns. The actual benefit to patients from use of preventive measures was limited when used in the everyday clinical situation. Therefore, only modest decreases in PONV were achieved, despite the use of preventive measures.

Published
1996
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5. Abstracts

Author

C. A. Botero, C. E. Smith, C. Holbrook, A. C. Pinchak, David Johnson, Dorothy Thomson, Taras Mycyk, M. Burbridge, Irvin Mayers, nR. W. M. Wahba, F. Belque, S. J. Kleiman, Steven Parker, Peter Cox, Helen Holtby, Lawrence Roy, Marc A. St-Amand, John M. Murkin, Donna Baird, Donal B. Downey, Alan H. Menkis, Fan Yang, Éric Troncy, Martin Francœur, Marc Charbonneau, Patrick Vinay, Gilbert Blaise, William M. Splinter, David J. Roberts, Elliot J. Rhine, Helen B. MacNeill, Craig W. Reid, William PS McKay, Miklavs Erjavec, Benjamin W. S. McKay, Peter H. Gregson, Travis Blanchet, Guy Kember, Josée Lavoie, Daniel Vischoff, Louise Cyrenne, Edith Villeneuve, Pierre Williot, A. K. Raghupathy, R. Haug, B. Punjabi, F. Ditzig, Howard Melnik, Michael J. Tessler, L. Jill Krasner, David M. Corda, Kal Solanki, A. Joseph Layon, T. James Gallagher, Daniel P. Stoltzfus, Shannon L. Rabuka, Carol A. Moote, Robert J. B. Chen, Doreen A. Yee, Ellen Harrington, Beverley A. Orser, D. Mitch Giffin, Kenneth W. Gow, P. Terry Phang, Keith R. Walley, C. Brian Warriner, Matthew H. Cohen, Andrew J. Klahsen, Deirdre O’Reilly, John McBride, Margaret Ballantyne, Blair D. Goranson, Scott Lang, William N. Dust, Jeff McKerrell, Guy Martin, René Martin, Daniel Martin, Philippe Valet, Jean-Pierre Tétrault, Caroline Dagenais, Martine Pirlet, Dominique Dansereau, Pedro D’Orléans-Justes, Agnès Jankowska, Yves Veillette, Angela L. Mathieson, Howard Intrater, Lionel Cruickshank, P. C. Duke, B. Y. Ong, Vincent Woo, Donna Schimnowski, Sharon Trosky, Linda Dalton, Ibrahim Zabani, Colin R. Chilvers, Himat Vaghadia, Pamela M. Merrick, Ibrahim Kashkari, Hossam Al-Oufi, D. Jolly, B. T. Finucane, Wolfgang Weyland, Ulrich Fritz, Heike Landmann, Ingrid Schumacher, Michael English, Dietrich Kettler, Catherine M. Duffy, Pirjo H. Manninen, Frances Chung, Shanthini Sundar, Emilio B. Lobato, Orlando Florete, Glenn B. Paige, Thierry Daloze, Daniel A. Chartrand, Denis St-Laurent, Gordon S. Fox, Murray L. Rice, D. John Doyle, George A. Volgyesi, Joseph A. Fisher, Arthur Slutsky, Igor Salazkin, Karen A. Brown, Pradeep Kulkarni, Bibiana Cujec, Randy McCuaig, Tom Hurst, David Antecol, François Bellemare, Jacques Couture, Manon Marchand, Peter McNeil, Orlando Hung, Lily M. Ho-Tai, J. Hugh Devitt, Alva G. Noel, Michael P. O’Donnell, Robert J. Greenhow, Frank W. Cervenko, Brian Milne, Mark D. Peterson, Ian R. Thomson, Robert J. Hudson, Morley Rosenbloom, Michael Moon, Jitender Sareen, H. Locke Bingham, Steven B. Backman, Reuben D. Stein, C. Polosa, Michael Tessler, Salvatore M. Spadafora, John G. Fuller, Lisa Kim, Keyvan Karkouti, D. Keith Rose, Lorraine E. Ferris, DK Rose, MM Cohen, F. E. Ralley, B. DeVarennes, M. Robitaille, Norman Searle, Raymond Martineau, Peter Conzen, A. Al-Hasani, Tom Ebert, Michael Muzi, Jean-François Hardy, Sylvain Bélisle, André Couturier, Danielle Robitaille, Micheline Roy, Lyne Gagnon, Elisabeth J. Avraamides, P. J. Dryden, J. P. O’Connor, W. R. E. Jamieson, I. Reid, D. Ansley, H. Sadeghi, L. H. Burr, A. I. Munro, P. M. Merrick, Mark Benaroia, Andrew Baker, C. David Mazer, Lee Errett, Luc Frenette, Jerry Cox, Donna Kerns, Steve Pearce, David Mark, Paul McDonagh, Lulz DeLlma, Howard Nathan, Jean-Yves Dupuls, J.Earl Wynands, G. C. Moudgil, J. G. Johnson, G. M. Moudgil, Richard I. Hall, Connie MacLaren, M. J. Ali, M. Ballantyne, D. Norris, Stephen D. Beed, Eugene A. Menard, Leon P. Noel, Gary G. Bonn, William Clarke, H. Marion Gould, Leslie E. Hall, Philippe Bernard, Juan Bass, Ramona A. Kearney, Cheryl A. Mack, Lucy M. Entwistle, Joan C. Bevan, Andrew J. Macnab, Guy Veall, Colin Marsland, Craig R. Ries, Shahnaz K. Hamid, Ian R. Selby, Nancy Sikich, Elizabeth Hsu, Patricia McCarthy, Ching-Yue Yang, Wun-Chin Wu, Jiunn-Jye Huang, Shyu-Yin Chen, Hsiang-Ning Luk, Chok-Yung Chai, Gina K. Lafreniere, Donald G. Brunet, Joel L. Parlow, Hossam El-Beheiry, Aviv Ouanounou, Mary Morris, Peter Carlen, Pamela J. Morgan, Roger Chapados, Marlene Gauthier, John W. D. Knox, Jacques LeLorier, Roddy Lin, Keith Rose, Bernadette Garvey, Robert McBrobm, L. C. McAdam, J. F. MacDonald, B. A. Orser, Georgios koutsoukos, Susan Belo, Christopher A. Chin, Brendan O’Hare, Jerrold Lerman, Junko Endo, Arthur E. Schwartz, Oktavijan Minanov, J. Gilbert Stone, David C. Adams, Aqeel A. Sandhu, Mark E. Pearson, William L. Young, Robert E. Michler, Ernest Cutz, Matt M. Kurrek, Marsha M. Cohen, Kevin Fish, Pamela Fish, Patricia Murphy, Donald Fung, Alva Noel, John-Paul Szalai, Ari Robicsek, Joshua Rucker, Joshua Kruger, Mark Slutsky, Leeor Sommer, Jeff Silverman, Jodi Dickstein, Viren Naik, Douglas J. Hemphill, Regina Kurian, Khursheed N. Jeejeebhoy, Osama A. Alahdal, N. H. Badner, W. E. Komar, R. Bhandari, R. Craen, D. Cuillerier, W. B. Dobkowski, M. H. Smith, A. N. Vannelli, R. B. Bourne, C. H. Rorabeck, J. A. Doyle, Antoinette Corvo, Richard M. Wahba, Nathalie Scheffer, John Y. C. Tsang, Brad A. Brush, N. Q. N’Guyen, C. Orain, S. Tougui, G. Lavenac, D. Milon, Ewan D. Ritchie, Doris Tong, Andrew Norris, Anthony Miniaci, Santhira D. Vairavanathan, Timothy FitzPatrick, Mark Stafford-Smith, Ken Kardash, Toula Trihas, Simcha J. Kleiman, Michel Rossignol, Dominique Bérard, Brent Martel, J. P. Tétrault, Peter G. Lunt, Dennis W. Coombs, Stephen Halpern, Elizabeth A. Peter, Patricia Janssen, Jill Mahy, M. Joanne Douglas, Caroline S. Grange, Timothy J. Adams, Louis Wadsworth, Holly Muir, Romesh Shukla, Desmond Writer, Richard McLaren, Robert Liston, Don Paetkau, Bill Y. Ong, Ron Segstro, Judy Littleford, Cristina Hurtado, Ananthan Krishnathas, Marcelo Lannes, Joanne Fortier, Jun Su, Rubini Jeganathan, and Suzanne Vaillancourt

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1996
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6. Airway management for intra-oral surgery--airway first!

Author

Doreen A. Yee and Naveen Eipe

Subjects
medicine.medical_specialty, Mouth, business.industry, Pain medicine, medicine.medical_treatment, Oral Surgical Procedures, Respiratory System, General Medicine, Anesthesia, General, medicine.disease, Surgery, Anesthesiology and Pain Medicine, Dermoid cyst, Intra oral, Anesthesiology, Anesthesia, Preoperative Care, medicine, Humans, Airway management, Airway, business, Difficult airway, Ultrasonography
Published
2007

7. Development of a computerized database for the study of anaesthesia care

Author

D. Keith Rose, Doreen A. Yee, Marsha M. Cohen, and Daniel F. Wigglesworth

Subjects
medicine.medical_specialty, Databases, Factual, Teaching hospital, Pacu, Anesthesiology, Chart review, Computer software, medicine, Humans, Computerized databases, Ontario, Data collection, biology, business.industry, Computers, Medical record, General Medicine, biology.organism_classification, Anesthesiology and Pain Medicine, Anesthesia, Costs and Cost Analysis, Hospital Information Systems, business, Anesthesia Department, Hospital, Software
Abstract

To record, tabulate and report problems associated with anaesthesia, we have developedan information collection system and computer software to follow all patients attended by an anaesthetist at a teaching hospital in Canada. For the last 15 mo, data for 17,000 patients have been collected and the system is ongoing. Data collection is from three sources: carbonless copies of the handwritten Operating Room (OR) and Post Anaesthetic Care Unit (PACU) records, other hospital databases, and postoperative visits. Adverse events (observations which differ from specific physiological variables, or require an intervention and do not normally occur during the routine conduct of anaesthesia), are defined directly on each OR and PA CU record. These events are recorded when they occur by the attending anaesthetist or the PACU nurse. All data are verified by a research nurse and an anaesthetist. Computer software, developed from DBase IV, is used to track 95 individual items on preoperative status and anaesthetic technique and another possible 1,450 selections for drugs, physicians, airways, surgical procedures and events for each patient. Data are analyzed with SAS software and reports generated to link the casemix and process with outcome. Comparison of data entered into the computer programme to a retrospective chart review revealed discrepancies of less than 0.5%. Collection, verification and computer entry takes five minutes per patient and the on-going cost is estimated at $4 per patient record. Analysis of the information collected in this database has been useful for research of adverse outcome following anaesthesia, resident expertise profiles, and the administrative management of an anaesthesia department.

Published
1992

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