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      Benefits and Pitfalls of Cadavers as Learning Tool for Ultrasound-guided Regional Anesthesia

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          Abstract

          Ultrasound-guided regional anesthesia (UGRA), like other basic skills, should be learnt in a simulation laboratory before performing on the patient. Cadavers provide an ideal tool for learning sonoanatomy and skills required for performing UGRA. On the basis of preservation technique used, the cadavers can be formalin embalmed cadavers, Thiel cadavers (soft cadavers), and fresh frozen cadavers. We compared three types of cadavers for performing ultrasound-guided upper and lower limb blocks. We observed that fresh frozen and Thiel cadavers were less smelling and had more realistic appearance as compared to formalin embalmed cadavers. It was seen that Thiel cadavers were more flexible and hence, rotation of neck, shoulder and knee was easier. Although images seen in most cadavers were comparable with live subjects but, Thiel cadavers provided more realistic model.

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          Most cited references 27

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          Simulation-based training in anaesthesiology: a systematic review and meta-analysis.

          Simulation has long been integrated in anaesthesiology training, yet a comprehensive review of its effectiveness is presently lacking. Using meta-analysis and critical narrative analysis, we synthesized the evidence for the effectiveness of simulation-based anaesthesiology training. We searched MEDLINE, ERIC, and SCOPUS through May 2011 and included studies using simulation to train health professional learners. Data were abstracted independently and in duplicate. We included 77 studies (6066 participants). Compared with no intervention (52 studies), simulation was associated with moderate to large pooled effect sizes (ESs) for all outcomes (ES range 0.60-1.05) except for patient effects (ES -0.39). Compared with non-simulation instruction (11 studies), simulation was associated with moderate effects for satisfaction and skills (ES 0.39 and 0.42, respectively), large effect for behaviours (1.77), and small effects for time, knowledge, and patient effects (-0.18 to 0.23). In 17 studies comparing alternative simulation interventions, training in non-technical skills (e.g. communication) and medical management compared with training in medical management alone was associated with negligible effects for knowledge and skills (four studies, ES range 0.14-0.15). Debriefing using multiple vs single information sources was associated with negligible effects for time and skills (three studies, ES range -0.07 to 0.09). Our critical analysis showed inconsistency in measurement of non-technical skills and consistency in the (ineffective) design of debriefing. Simulation in anaesthesiology appears to be more effective than no intervention (except for patient outcomes) and non-inferior to non-simulation instruction. Few studies have clarified the key instructional designs for simulation-based anaesthesiology training.
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            Human body preservation - old and new techniques.

             Erich Brenner (2014)
            This review deals with the art of (anatomical) embalming. The first part contains a brief historical review of the history of embalming, starting with ancient cultures such as the Egyptians and the lesser known Chinchorro culture, then going down the centuries and describing the anatomical techniques developed over the last two centuries. The second part deals in detail with the chemicals used for embalming purposes. The third part deals with several approaches to evaluating embalming methods, their suitability for biomechanical testing, antimicrobial properties, histological appearance, and usability. The fourth and final part analyze the European Biocidal Products Directive (98/8/EC) in the light of embalming. © 2014 Anatomical Society.
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              The American Society of Regional Anesthesia and Pain Medicine and the European Society Of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia.

              Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA.This document specifically defines the following:In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.
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                Author and article information

                Journal
                Anesth Essays Res
                Anesth Essays Res
                AER
                Anesthesia, Essays and Researches
                Medknow Publications & Media Pvt Ltd (India )
                0259-1162
                2229-7685
                Jan-Mar 2017
                : 11
                : 1
                : 3-6
                Affiliations
                Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Forensic Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
                [2 ]Department of Anesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
                [3 ]Department of Neurosugery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Address for correspondence: Dr. Chhavi Sawhney, Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, F 49, Ansari Nagar (West), New Delhi - 110 029, India. E-mail: drchhavisawhney@ 123456gmail.com
                Article
                AER-11-3
                10.4103/0259-1162.186607
                5341665
                28298747
                Copyright: © 2017 Anesthesia: Essays and Researches

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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