Avner Sidi - Academia.edu (original) (raw)
Papers by Avner Sidi
Austin journal of anesthesia and analgesia, Feb 25, 2020
Our goal was to develop and validate a realistic assessment technique (using simulation), that wi... more Our goal was to develop and validate a realistic assessment technique (using simulation), that will allow to assess Cognitive and Technical skills and performance of Anesthesiology residents. To achieve all these integrated goals we built a 3 phase plan. The first phase in our investigation was to assess the construct validity (= progression of scores within progressing levels of training) of the simulationbased OSCE (=Objective Structured Clinical Examination) summative assessment tools developed and established by the Israeli Board Examination, and its potential generalizability to an American training program for formative or summative assessment. The exam related to 1 st phase of our investigation was administered 66 times to 50 different residents. In the second phase we evaluated the deficiencies in cognitive performance according to error rates and performance grades within and across different clinical domains, and between PGY (= post graduate year of training) levels-in 47 residents tested 80 times. In the last phase, where our primary aim was to detect changes in "higherorder" deficiencies, comparing 2 successive academic years-35 PGY-3 &-4 residents were tested 50 times. The pass rate in the 1st phase was significantly higher for PGY3 and PGY4 residents compared to PGY2 residents in the OR; this rate was also significantly higher for PGY4 residents compared to PGY2 residents when all three clinical domains were combined (11/22=0.50 vs. 2/23=0.09). The cognitive success rate by PGY4 residents in the 2 nd phase was 0.5-0.68, and significantly lower than the non-cognitive success rate for Resuscitation and Trauma. In the 3 rd phase we found a change in mean error rates across years. In all 3 clinical domains, the cognitive success rate was higher (range, 0.74-1.00) than the previous year's value (range, 0.39-0.87). The reduction in error rates is primarily due to decreases in non-technical errors, predominantly in resuscitation & trauma. Conclusions: In its 1st phase, our study demonstrated the "generalizability", sharing of scenarios. In the 2 nd phase our main findings revealed that PGY-3 &-4 residents' error rates were higher for the cognitive items as compared to the non-cognitive ones in each domain tested. In the final phase we demonstrated that not only simulation is effective at identifying these errors, but also that simulation may be a valuable way to teach and combat these errors.
Cahiers d'anesthésiologie, 1984
13 malades ont recu 10-20 ml de sang autologue en injection peridurale. 92% de resultats excellen... more 13 malades ont recu 10-20 ml de sang autologue en injection peridurale. 92% de resultats excellents apres colmatage sanguin peridural. 97,6% de succes dans la litterature
PubMed, Oct 1, 1987
The effects of fluorescein, methylene blue, and indocyanine green on hemodynamic variables and on... more The effects of fluorescein, methylene blue, and indocyanine green on hemodynamic variables and on pulse oximetry and co-oximetry measurements of arterial hemoglobin oxygen saturation (SaO2) and oxyhemoglobin percentage (% HbO2) were evaluated in 16 anesthetized dogs in vitro by co-oximetry (% HbO2) and in vivo by pulse oximetry (SaO2). The light absorbance (optical density) in plasma (range 500 to 800 nm) was measured by a spectrophotometer. Fluorescein did not affect oximetry measurements, plasma light absorbance in the range measured, or hemodynamic variables. Methylene blue caused dose-dependent decreases in measurements made with both forms of oximetry for up to 30 minutes, the decrease being greater and longer lasting with pulse oximetry (P less than 0.05). Hemodynamic measurements in 5 dogs showed that methylene blue (1 to 5 mg/kg) increased arterial pressure transiently, after which cardiac output, stroke index, and left ventricular stroke work index decreased and left ventricular end-diastolic pressure and systemic and pulmonary vascular resistances increased (P less than 0.05 with 5 mg/kg). Methemoglobin concentration measured by co-oximetry increased significantly (to 19.9 +/- 1.4%, P less than 0.05) 1 minute after 5 mg/kg of methylene blue was injected. Methylene blue had a dose- and time-dependent effect on plasma light absorbance, and this effect peaked in the 660- to 670-nm range. The data do not distinguish the relative contributions of physiology (hemodynamic change), chemistry (methemoglobin production), and physics (optical properties) to the decrease in pulse oximetry and co-oximetry measurements that follows injection of methylene blue. Indocyanine green affected neither hemodynamic variables nor co-oximetry readings but decreased pulse oximetry readings for up to 10 minutes dose dependently.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesiology, Sep 1, 1986
Anesthesiology, Sep 1, 1986
Anesthesia & Analgesia, Sep 1, 1992
We hypothesized that either through local myocardial or systemic effects, adenosine could be used... more We hypothesized that either through local myocardial or systemic effects, adenosine could be used to control hypotension during ischemia. Therefore, we compared the effects of systemic with intracoronary infusion of adenosine on myocardial hemodynamics and metabolism during ischemia in 27 dogs. Left anterior descending artery (LADa) flow was measured and the LADa constricted by a micrometer to restrict resting flow by 50%, 75%, and 100%. Adenosine was infused either systemically (n = 9), to maintain mean aortic pressure at 5C-60 mm Hg, or directly into the LADa (n = 9), to create maximal coronary hyperperfusion; no adenosine was infused in the control group (n = 9). With systemic adenosine, during each constriction aortic pressure, left ventricular first derivative (LV dPIdt), and heart rate
Cahiers d'anesthésiologie
Israel journal of medical sciences, 1984
Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty... more Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.
Canadian journal of anaesthesia = Journal canadien d'anesthésie, 1990
Anaesthesia, 1982
Some centres use paravertebral blocks (17%) or local anaesthetic thoracic epidural blocks (32%) i... more Some centres use paravertebral blocks (17%) or local anaesthetic thoracic epidural blocks (32%) in relatively small numbers of patients. Nineteen units (46%) use epidural opiates, predominantly via a thoracic route, and 10 centres (24%) use intrathecal opiates for postoperative analgesia. The extent of use of intrathecal and epidural opiates. however, may have changed since this survey was carried out as possible hazards of these methods have become more apparent.*
Barbiturates have been used for several Years to reduce intracranial pressure (ICP) (Shapiro et a... more Barbiturates have been used for several Years to reduce intracranial pressure (ICP) (Shapiro et al. 1974, Marshall et al. 1977, Marshall et al. 1979, Rockoff et al. 1979). Yet, this method of treatment has not been universally accepted (Miller 1979) because of the drawbacks associated with its administration. These include the loss of the capaCity to follow clinically the neurological progress of the disease, the variable degree of cardiovascular depression, and the costly, sophisticated intensive-care facility which must be available for patients receiving high-dose barbiturates if they are to be looked after safely. Despite these disadvantages, however, we have used thiopentone sodium (TS) since 1978 to lower raised ICP secondary to brain edema both after severe head injury (HI) and elective craniotomy (EC), whenever the usual measures (i.e. surgical evacuation of hematoma, dexamethasone, loop and osmotic diuretics, CSF drainage and alveolar hyperventilation to a PaCO2 of 25–30 torr) fail to control it. Intracranial hypertension that leads to transtentorial herniation may be the sole, most significant cause of death after severe HI (Miller et al. 1977, Papo et al. 1980, Miller et al. 1981), and must therefore, in our view, be controlled by all available means, whenever possible. In this report we present our experiences with the use of TS for reducing raised ICP after both HI and EC.
The Journal of cardiovascular surgery
We present three patients with successful surgical repair of abdominal aortic aneurysms with sign... more We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.
PubMed, Mar 1, 1987
We present three patients with successful surgical repair of abdominal aortic aneurysms with sign... more We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.
Austin journal of anesthesia and analgesia, Feb 25, 2020
Our goal was to develop and validate a realistic assessment technique (using simulation), that wi... more Our goal was to develop and validate a realistic assessment technique (using simulation), that will allow to assess Cognitive and Technical skills and performance of Anesthesiology residents. To achieve all these integrated goals we built a 3 phase plan. The first phase in our investigation was to assess the construct validity (= progression of scores within progressing levels of training) of the simulationbased OSCE (=Objective Structured Clinical Examination) summative assessment tools developed and established by the Israeli Board Examination, and its potential generalizability to an American training program for formative or summative assessment. The exam related to 1 st phase of our investigation was administered 66 times to 50 different residents. In the second phase we evaluated the deficiencies in cognitive performance according to error rates and performance grades within and across different clinical domains, and between PGY (= post graduate year of training) levels-in 47 residents tested 80 times. In the last phase, where our primary aim was to detect changes in "higherorder" deficiencies, comparing 2 successive academic years-35 PGY-3 &-4 residents were tested 50 times. The pass rate in the 1st phase was significantly higher for PGY3 and PGY4 residents compared to PGY2 residents in the OR; this rate was also significantly higher for PGY4 residents compared to PGY2 residents when all three clinical domains were combined (11/22=0.50 vs. 2/23=0.09). The cognitive success rate by PGY4 residents in the 2 nd phase was 0.5-0.68, and significantly lower than the non-cognitive success rate for Resuscitation and Trauma. In the 3 rd phase we found a change in mean error rates across years. In all 3 clinical domains, the cognitive success rate was higher (range, 0.74-1.00) than the previous year's value (range, 0.39-0.87). The reduction in error rates is primarily due to decreases in non-technical errors, predominantly in resuscitation & trauma. Conclusions: In its 1st phase, our study demonstrated the "generalizability", sharing of scenarios. In the 2 nd phase our main findings revealed that PGY-3 &-4 residents' error rates were higher for the cognitive items as compared to the non-cognitive ones in each domain tested. In the final phase we demonstrated that not only simulation is effective at identifying these errors, but also that simulation may be a valuable way to teach and combat these errors.
Cahiers d'anesthésiologie, 1984
13 malades ont recu 10-20 ml de sang autologue en injection peridurale. 92% de resultats excellen... more 13 malades ont recu 10-20 ml de sang autologue en injection peridurale. 92% de resultats excellents apres colmatage sanguin peridural. 97,6% de succes dans la litterature
PubMed, Oct 1, 1987
The effects of fluorescein, methylene blue, and indocyanine green on hemodynamic variables and on... more The effects of fluorescein, methylene blue, and indocyanine green on hemodynamic variables and on pulse oximetry and co-oximetry measurements of arterial hemoglobin oxygen saturation (SaO2) and oxyhemoglobin percentage (% HbO2) were evaluated in 16 anesthetized dogs in vitro by co-oximetry (% HbO2) and in vivo by pulse oximetry (SaO2). The light absorbance (optical density) in plasma (range 500 to 800 nm) was measured by a spectrophotometer. Fluorescein did not affect oximetry measurements, plasma light absorbance in the range measured, or hemodynamic variables. Methylene blue caused dose-dependent decreases in measurements made with both forms of oximetry for up to 30 minutes, the decrease being greater and longer lasting with pulse oximetry (P less than 0.05). Hemodynamic measurements in 5 dogs showed that methylene blue (1 to 5 mg/kg) increased arterial pressure transiently, after which cardiac output, stroke index, and left ventricular stroke work index decreased and left ventricular end-diastolic pressure and systemic and pulmonary vascular resistances increased (P less than 0.05 with 5 mg/kg). Methemoglobin concentration measured by co-oximetry increased significantly (to 19.9 +/- 1.4%, P less than 0.05) 1 minute after 5 mg/kg of methylene blue was injected. Methylene blue had a dose- and time-dependent effect on plasma light absorbance, and this effect peaked in the 660- to 670-nm range. The data do not distinguish the relative contributions of physiology (hemodynamic change), chemistry (methemoglobin production), and physics (optical properties) to the decrease in pulse oximetry and co-oximetry measurements that follows injection of methylene blue. Indocyanine green affected neither hemodynamic variables nor co-oximetry readings but decreased pulse oximetry readings for up to 10 minutes dose dependently.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesiology, Sep 1, 1986
Anesthesiology, Sep 1, 1986
Anesthesia & Analgesia, Sep 1, 1992
We hypothesized that either through local myocardial or systemic effects, adenosine could be used... more We hypothesized that either through local myocardial or systemic effects, adenosine could be used to control hypotension during ischemia. Therefore, we compared the effects of systemic with intracoronary infusion of adenosine on myocardial hemodynamics and metabolism during ischemia in 27 dogs. Left anterior descending artery (LADa) flow was measured and the LADa constricted by a micrometer to restrict resting flow by 50%, 75%, and 100%. Adenosine was infused either systemically (n = 9), to maintain mean aortic pressure at 5C-60 mm Hg, or directly into the LADa (n = 9), to create maximal coronary hyperperfusion; no adenosine was infused in the control group (n = 9). With systemic adenosine, during each constriction aortic pressure, left ventricular first derivative (LV dPIdt), and heart rate
Cahiers d'anesthésiologie
Israel journal of medical sciences, 1984
Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty... more Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.
Canadian journal of anaesthesia = Journal canadien d'anesthésie, 1990
Anaesthesia, 1982
Some centres use paravertebral blocks (17%) or local anaesthetic thoracic epidural blocks (32%) i... more Some centres use paravertebral blocks (17%) or local anaesthetic thoracic epidural blocks (32%) in relatively small numbers of patients. Nineteen units (46%) use epidural opiates, predominantly via a thoracic route, and 10 centres (24%) use intrathecal opiates for postoperative analgesia. The extent of use of intrathecal and epidural opiates. however, may have changed since this survey was carried out as possible hazards of these methods have become more apparent.*
Barbiturates have been used for several Years to reduce intracranial pressure (ICP) (Shapiro et a... more Barbiturates have been used for several Years to reduce intracranial pressure (ICP) (Shapiro et al. 1974, Marshall et al. 1977, Marshall et al. 1979, Rockoff et al. 1979). Yet, this method of treatment has not been universally accepted (Miller 1979) because of the drawbacks associated with its administration. These include the loss of the capaCity to follow clinically the neurological progress of the disease, the variable degree of cardiovascular depression, and the costly, sophisticated intensive-care facility which must be available for patients receiving high-dose barbiturates if they are to be looked after safely. Despite these disadvantages, however, we have used thiopentone sodium (TS) since 1978 to lower raised ICP secondary to brain edema both after severe head injury (HI) and elective craniotomy (EC), whenever the usual measures (i.e. surgical evacuation of hematoma, dexamethasone, loop and osmotic diuretics, CSF drainage and alveolar hyperventilation to a PaCO2 of 25–30 torr) fail to control it. Intracranial hypertension that leads to transtentorial herniation may be the sole, most significant cause of death after severe HI (Miller et al. 1977, Papo et al. 1980, Miller et al. 1981), and must therefore, in our view, be controlled by all available means, whenever possible. In this report we present our experiences with the use of TS for reducing raised ICP after both HI and EC.
The Journal of cardiovascular surgery
We present three patients with successful surgical repair of abdominal aortic aneurysms with sign... more We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.
PubMed, Mar 1, 1987
We present three patients with successful surgical repair of abdominal aortic aneurysms with sign... more We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.