Rafael Ortega

Rafael Ortega
Boston University | BU · Department of Anesthesiology

MD

About

119
Publications
36,748
Reads
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1,281
Citations
Citations since 2017
25 Research Items
898 Citations
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Introduction
I am currently working on the second edition of the multimedia-rich textbook Clinical Anesthesia Fundamentals. Our multimedia laboratory remains busy producing peer-reviewed educational videos, including our latest project on diagnosing brain death. The patient safety book “Ok to Proceed”, a just released innovative educational tool, will offer ample opportunities to engage in educational research to test the efficiency and effectiveness of various teaching approaches on patient safety.

Publications

Publications (119)
Article
Supplemental oxygen is an important therapy for a broad range of clinical conditions. Oxygen can be administered through low-flow and high-flow devices that deliver a range of gas mixtures, with or without temperature and humidity control. It is important for clinicians to understand the functions and properties of the various devices used in oxyge...
Article
Background: Physical and Social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic has forced residency programs to increasingly rely on video conferencing and online resources [1]. Objective: In the current pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and...
Preprint
BACKGROUND Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. OBJECTIVE In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineat...
Article
Racial tensions continue to ignite social unrest in the United States. Structural racism is increasingly recognized as a public health issue. It is therefore necessary to continue addressing the interaction of race and medicine, including anesthesiology. While many may overlook the impact that racial discrimination has had on the development of ane...
Article
Full-text available
Background: Acute respiratory failure from COVID-19 pneumonia is a major cause of death after SARS-CoV-2 infection. We investigated whether PaO2/FiO2, oxygenation index (OI), SpO2/FiO2, and oxygen saturation index (OSI), commonly used to assess the severity of acute respiratory distress syndrome (ARDS), can predict mortality in mechanically ventil...
Article
Intranasal naloxone is used to treat patients with respiratory and central nervous system depression that is known or suspected to be caused by an opioid overdose. This video demonstrates the administration of intranasal naloxone.
Article
When PPE is properly worn, removed, and discarded, it is effective in protecting both the person who wears it and those with whom that person comes into contact.
Article
For millennia, mankind has sought a means of altering consciousness, often aided by naturally occurring elements. Psychotropic substances have been an integral part of spiritual, medicinal, and recreational aspects of life. The origin of anesthesiology stems directly from the use of recreational drugs; early inhaled anesthetics were first used as a...
Book
A hybrid book blending printed text and multimedia addressing a variety of topics on patient safety.
Article
Monitoring the neuromuscular function
Article
Monitoring neuromuscular function is recommended whenever neuromuscular blocking agents are used. Clinical or subjective assessment is unreliable. Routine monitoring, performed with objective measurement techniques, provides additional safety with minimal risk to patients and helps to avoid potentially lifethreatening complications.
Article
The purpose of the residency interview is to determine the extent to which a well-qualified applicant is a good fit with a residency program. However, questions asked during residency interviews tend to be standard and repetitive, and they may not elicit information that best differentiates one applicant from another. The iCAT (interactive Candidat...
Article
Pressure transducers are important in the care of critically ill patients and are used during a variety of specialized procedures. Clinicians should be familiar with indications for their use, understand how they work, and be aware of the associated complications. When pressure transducers are used properly, they are a safe and valuable tool.
Article
Full-text available
Background: The 'flipped classroom' instructional strategy has gained much momentum in educational discourse, yet no single educational offering exists in postgraduate medical education (PME) to systematically replace the lecture element of didactic sessions. This article describes the design and implementation of Clinical Anesthesia Fundamentals,...
Article
Blood transfusion is often performed by health care workers. This video demonstrates a commonly used method for the nonemergency transfusion of red cells in an awake, competent adult.
Chapter
The role of neuromuscular blocking agents (NMBA) in the critically ill continues to evolve. Several drug types are available for use, but nondepolarizing agents are by far the most commonly used in the ICU. Severe respiratory failure requiring mechanical ventilatory support is the most common indication for induced muscle relaxation. Peripheral ner...
Article
Residency programs sometimes struggle with documenting interactions between faculty and trainees, including educational interventions. One approach we find useful is to ask residents to summarize a conversation with a member of the faculty via a confidential e-mail. Faculty may then reply, reinforcing or expanding concepts, or clarifying misinterpr...
Book
From the popular and highly respected Clinical Anesthesia family of titles comes a new resource that clearly and simply explains the core concepts of anesthesiology that you need to know. From physiology and pharmacology to anatomy and system-based anesthesia, it uses full-color graphics, easy-to-read tables, and clear, concise text to convey the e...
Article
Full-text available
PPE is available to minimize the potential harm from exposure to pathogens such as the Ebola virus. When PPE is worn, removed, and discarded properly, it is effective in protecting the person wearing it and the patients and health care workers with whom that person comes into contact.
Article
Full-text available
The uses of electrocardiographic (ECG) monitoring have evolved from the tracking of heart rate and basic rhythm to the detection of complex arrhythmias, myocardial ischemia, and changes in the QT interval. ECG is an inexpensive, reproducible, noninvasive technique that can be invaluable when it is performed correctly.(1-4) The accompanying video fo...
Article
Full-text available
Endotracheal extubation should be performed without causing trauma, while maintaining adequate oxygenation and ventilation. The equipment needed to provide suction, ventilation, and reintubation should be readily available. If extubation is judged to be unsafe, the procedure should be postponed and the patient reevaluated. Most complications relate...
Article
An anesthesiologist must remain vigilant of the patient's clinical status, incorporating many independent physiological measurements. Oxygen saturation and heart rate are represented by continuous audible tones generated by the pulse oximeter, a mandated monitoring device. Other important clinical parameters-notably blood pressure-lack any audible...
Article
Endotracheal extubation should be performed without causing trauma, while maintaining adequate oxygenation and ventilation. The equipment needed to provide suction, ventilation, and reintubation should be readily available. If extubation is judged to be unsafe, the procedure should be postponed and the patient reevaluated. Most complications relate...
Book
Clinical Anesthesia, Seventh Edition, covers the full spectrum of clinical options, providing insightful coverage of pharmacology, physiology, co-existing diseases, and surgical procedures. This classic book is unmatched for its clarity and depth of coverage. Traditionally available as a printed textbook, now it comes with a completely revamped dig...
Article
Patients with pulmonary hypertension are some of the most challenging for an anesthesiologist to manage. Pulmonary hypertension in patients undergoing surgical procedures is associated with high morbidity and mortality due to right ventricular failure, arrhythmias and ischemia leading to hemodynamic instability, and intra- and postoperative hypoxia...
Article
Capnography, the graphic display of the exhaled and inhaled carbon dioxide concentration plotted against time, is used to monitor ventilation. This video reviews the principles of capnography and explains how to interpret the information it provides.
Article
Full-text available
Music permeates the medical literature regarding disease therapy. However, there are only few articles concerning music as a tool for development of cultural competency and interpersonal relations. We share our experience of forming a musical act of students and faculty at a medical school. We believe that this group has encouraged medical humanism...
Article
Full-text available
Internal jugular vein cannulation is performed to establish central venous access for a variety of purposes, such as monitoring of central venous pressure, inserting pulmonary-artery catheters, administering intravenous therapeutic agents and nutrition, performing hemodialysis, and placing cardiac pacemakers. The increased use of ultrasonography to...
Chapter
Neuromuscular blocking agents have, perhaps, the most fascinating history among the drugs used in anesthesiology and intensive care. For centuries, South American aborigines had used curare to hunt animals before Claude Bernard showed in 1850 that these drugs act peripherally, blocking conduction where motor nerves meet the muscle.1 These historica...
Article
We report a case of complete paraplegia after general anesthesia for a right tympanomastoidectomy without any apparent predisposing factors related to the surgical procedure or the anesthetic. The case raises the possibility that the combination of neck rotation and relative hypotension may precipitate paraplegia in patients with preexisting spinal...
Article
Full-text available
The placement of intravenous cannulas can be a difficult task, especially when treating a hypovolaemic or critically ill patient. Often the physician is faced with the problem of being unable to locate a suitable vein or, even more frustrating, finding a vein but not being able to insert the cannula. The author summarises the general principles of...
Article
Numerous monuments in Massachusetts, Connecticut, and Georgia commemorate the original demonstrators of inhalation anesthesia for surgery using sulfuric ether, as well as the controversy surrounding these individuals. The Ether Controversy is a historical event brought about by individual desire and fueled through collective support. It is interest...
Article
Full-text available
Female urethral catheterization is indicated for both therapeutic and diagnostic purposes. It permits effective bladder drainage in patients with acute or chronic urinary retention. A urinary catheter may be used to instill medication for local intravesical therapy or for irrigation to remove blood and clots from the urinary bladder. Urethral cathe...
Article
Full-text available
Indications Providing positive-pressure ventilation with a face mask and a bag-valve device can be a lifesaving maneuver. Although seemingly simple, the technique requires an understanding of the airway anatomy, the equipment, and the indications. Face-mask ventilation is used in patients who have respiratory failure but are still breathing spontan...
Article
Patients with heparin-induced thrombocytopenia II (HIT II) need an alternative nonheparin-based method of anticoagulation for cardiopulmonary bypass (CPB) to prevent thrombosis and thrombosis related complications. Bivalirudin was used during CPB and deep hypothermic circulatory arrest (DHCA) for resection of multiple right atrial masses in a patie...
Article
Team-based learning is a relatively new educational approach in which learning occurs in three phases. Team-based learning is so named because in the third and final phase, students are organized into teams to participate in a classroom team-based learning session. In the Department of Anesthesiology at Boston University Medical Center, a multi-pur...
Article
Computerized multimedia teaching methods, including web-based learning, have become popular because the learner controls the content, the time, and place of learning. The purpose of this article is to describe specifically how a clinical department is using Microsoft Producer to convert PowerPoint presentations into Internet-ready multimedia lectur...
Article
Leroy D Vandam, MD was a remarkable man--an intricate amalgamation of an artist, scientist, and physician. He was a bastion of medical historical knowledge. Dr Vandam became a most influential anesthesiologist, some say, a giant. He was an example of someone who, with resolve, overcame adversity. His artwork is displayed in countless places, and se...
Article
Multimedia applications have been developed to explain many aspects of anesthesiology, including anesthesia machines, cardiopulmonary bypass systems, airway management, anesthetic pharmacology, regional anesthesia, and more recently, the history of the specialty. This article describes how computer-assisted instruction and multimedia have made it p...
Article
A 66-year-old man (t65 cm, 71 kg) had a 10-year history of mitral valve disease with minimal symptoms. Over the last year, he developed increased shortness of breath and fatigue with physical activity; in the last several months, he was unable to climb a flight of stairs without dyspnea. He underwent a cardiac catheterization, which showed a mildly...
Article
Cardiac anesthesia is a complex field requiring extensive training and experience. Multimedia can be used effectively to teach new, complex, and rapidly developing anesthetic and surgical techniques. Minimally invasive Port-Access cardiac surgery is an area in which the computer can be used for educational purposes. As cardiac anesthesiologists bec...
Article
Full-text available
Ethnicity has been shown to be an important determinant of behavior during illness, particularly when a painful condition is present. Studies have shown that pain may be undertreated among different ethnic groups of patients. Whereas individual variations in the reaction to pain occur, available data do not support racial and/or ethnic differences...
Article
To measure the effect of inserting a transesophageal echocardiography (TEE) probe on the pacing threshold of a previously inserted transesophageal pacing stethoscope, and to examine whether an indwelling pacing stethoscope influences the feasibility and image quality of a TEE examination. Prospective, open study using each patient as his/her own co...

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