Working conditions during pregnancy: a survey of 3590 European anaesthesiologists and intensivists.

BACKGROUND: Pregnancy adds challenges for healthcare professionals, regardless of gender. We investigated experiences during pregnancy, attitudes towards pregnant colleagues, family planning decisions, and awareness of regulations among European anaesthesiologists and intensivists. METHODS: A cross-sectional online survey was conducted among 3590 anaesthesiologists and intensivists from 47 European countries. The survey, available for 12 weeks, collected data on demographics, working conditions, safety perceptions, and the impact of clinical practice and training demands on family planning. Quantitative data were analysed using descriptive statistics, whereas qualitative data underwent thematic content analysis. RESULTS: Only 41.4% (n=678) of women were satisfied with their working conditions during pregnancy, and only 38.5% (n=602) considered their working environment safe. The proportion of women who changed their clinical practice during pregnancy and who took sick leave to avoid potentially harmful working conditions increased over time (P<0.001 for both). Men had children more often during residency than women (P<0.001). Pregnant colleagues' safety concerns influenced clinical practice, with women and men who had experience with their own and partner's pregnancy being more likely to modify their practices. Work and training demands discouraged plans to have children, particularly among women, leading to consideration of leaving training. Awareness of national regulations was limited, and respondents highlighted a need for better support and flexible working conditions. CONCLUSIONS: Improved support and working environments for pregnant colleagues and ability to express preferred clinical areas for work are needed. Department heads should commit to safety and family friendliness, and men transitioning to parenthood should not be neglected.

Relationships between the qNOX, qCON, burst suppression ratio, and muscle activity index of the CONOX monitor during total intravenous anesthesia: a pilot study.

BACKGROUND: Processed electroencephalographic (EEG) indices can help to navigate general anesthesia. The CONOX (Fresenius Kabi) calculates two indices, the qCON (hypnotic level) and the qNOX (nociception). The CONOX also calculates indices for electromyographic (EMG) activity and EEG burst suppression (BSR). Because all EEG parameters seem to influence each other, our goal was a detailed description of parameter relationships. METHODS: We used qCON, qNOX, EMG, and BSR information from 14 patients receiving propofol anesthesia. We described index relationships with linear models, heat maps, and box plot representations. We also evaluated associations between qCON/qNOX and propofol/remifentanil effect site concentrations (ceP/ceR). RESULTS: qNOX and qCON (qCON = 0.79*qNOX + 5.8; p < 0.001; R2 = 0.84) had a strong linear association. We further confirmed the strong relationship between qCON/qNOX and BSR for qCON/qNOX < 25: qCON=-0.19*BSR + 25.6 (p < 0.001; R2 = 0.72); qNOX=-0.20*BSR + 26.2 (p < 0.001; R2 = 0.72). The relationship between qCON and EMG was strong at higher indices: qCON = 0.55*EMG + 33.0 (p < 0.001; R2 = 0.68). There was no qCON > 80 without EMG > 0. The relationship between ceP and qCON was qCON=-3.8*ceP + 70.6 (p < 0.001; R2 = 0.11). The heat maps also suggest that the qCON and qNOX can at least partially separate the hypnotic and analgetic components of anesthesia. CONCLUSION: We could describe relationships between qCON, qNOX, EMG, BSR, ceP, and ceR, which may help the anaesthesiologist better interpret the information provided. One major finding is the dependence of qCON > 80 on EMG activity. This may limit the possibility of detecting wakefulness in the absence of EMG. Further, qNOX seems generally higher than qCON, but high opioid doses may lead to higher qCON than qNOX indices.

Effect of machine learning models on clinician prediction of postoperative complications: the Perioperative ORACLE randomised clinical trial.

BACKGROUND: Anaesthesiologists might be able to mitigate risk if they know which patients are at greatest risk for postoperative complications. This trial examined the impact of machine learning models on clinician risk assessment. METHODS: This single-centre, prospective, randomised clinical trial enrolled surgical patients aged ≥18 yr. Anaesthesiologists and nurse anaesthetists providing remote telemedicine support reviewed electronic health records with (assisted group) or without (unassisted group) reviewing machine learning predictions. Clinicians predicted the likelihood of postoperative 30-day all-cause mortality and postoperative acute kidney injury (AKI) within 7 days. The primary outcome was area under the receiver operating characteristic curve (AUROC) for clinician predictions of mortality and AKI, comparing AUROCs between assisted and unassisted assessments. RESULTS: We analysed 5071 patients (mean [range] age: 58 [18-100] yr; 52% female) assessed by 89 clinicians. Of these, 98 (2.2%) patients died within 30 days of surgery and 450 (11.1%) patients sustained AKI. Clinician predictions agreed with the models more strongly in the assisted vs unassisted group (weighted kappa 0.75 vs 0.62 for death, mean difference: 0.13 [95% CI 0.10-0.17]; and 0.79 vs 0.54 for AKI, mean difference: 0.25 [95% CI 0.21-0.29]). Clinical prediction of death was similar between the assisted (AUROC 0.793) and unassisted (AUROC 0.780) groups (mean difference: 0.013 [95% CI -0.070 to 0.097]; P=0.76). Prediction of AKI had an AUROC of 0.734 in the assisted group vs 0.688 in the unassisted group (difference 0.046 [95% CI -0.003 to 0.091]; P=0.06). CONCLUSIONS: Clinician performance was not improved by machine learning assistance. Further work is needed to clarify the role of machine learning in real-time perioperative risk stratification. CLINICAL TRIAL REGISTRATION: NCT05042804.

Factors Influencing Medical Students' Choice of Anesthesiology as a Future Specialty in Saudi Arabia.

Background According to the American Society of Anesthesiologists (ASA), anesthesiologists are experts in administering anesthesia, pain management, and critical care medicine. In addition, they provide general perioperative care. Personal interests, career stability, reputation, income, and clinical rotation experience influence medical students' career choices. Studies show that anesthesiology remains one of the least popular specialties among Saudi medical students. Our study aims to determine the preference for anesthesiology among Saudi medical students and the factors influencing their career choice options. Methodology This cross-sectional study was implemented by distributing a self-administered verified survey. Results Our study included 532 medical students, predominantly female (n=344, 64.7%), aged 18-24 years (n=424, 79.7%), and Saudi nationals (n=508, 95.5%). Most were single (n=500, 94%) without children (n=522, 98.1%). A majority were not interested in anesthesiology as a future specialty (n=297, 55.8%), with some uncertainty (n=148, 27.8%) and a smaller interested group (n=87, 16.4%). Controllable lifestyle (n=294, 55.3%) and financial income (n=213, 40%) were critical factors for choosing anesthesiology as a specialty. Interest in another specialty (n=342, 64.3%) and stress (n=286, 53.8%) were significant opposing factors. Academic year significantly affected consideration (p<0.001), with second-year students showing the highest interest (61.8%) and sixth-year the lowest (24.8%). Other factors showed no significant association. Conclusion Our study reveals low interest in anesthesiology among Saudi medical students. A controllable lifestyle and financial income are key attractions. Interest declines significantly by the sixth year due to their interest in other specialties, lifestyle concerns, and stress.

Point-of-Care Ultrasound: A Vital Tool for Anesthesiologists in the Perioperative and Critical Care Settings.

Point-of-care ultrasound (POCUS) is an essential skill in various specialties like anesthesiology, critical care, and emergency medicine. Anesthesiologists utilize POCUS for quick diagnosis and procedural guidance in perioperative and critical care settings. Key applications include vascular ultrasound for challenging venous and arterial catheter placements, gastric ultrasound for aspiration risk assessment, airway ultrasound, diaphragm ultrasound, and lung ultrasound for respiratory assessment. Additional utilities of POCUS can include multi-organ POCUS evaluation for undifferentiated shock or cardiac arrest, ultrasound-guided central neuraxial and peripheral nerve blocks, focused cardiac ultrasound, and novel applications such as venous excess ultrasound. This review highlights these POCUS applications in perioperative and intensive care and summarizes the latest evidence of their accuracy and limitations.

Heart rate deceleration capacity as a marker of perioperative risk: identifying relevant patient phenotypes and surgical procedures.

Loss of regulation of the autonomic nervous system is found in many diseases from the age of 50 to 60 yr and even more so in older patients. The imbalance is usually manifested by an increase in sympathetic tone, long considered to be the most deleterious element in terms of cardiac rhythmic risk, but also by a reduction in the effectiveness of short-term regulation of the baroreflex arc (partial loss of parasympathetic control). Techniques for analysing this autonomic disorder by analysing heart rate regulation are widely available in outpatient clinics and provide interesting indicators of cardiovascular and cerebrovascular risk. Deceleration capacity of cardiac autonomic control has been identified for its prognostic role in high-risk patients and in the general population. Further research is indicated to assess the value of this marker in anaesthetic risk management by targeting procedures with greater risk of intraoperative and postoperative autonomic dysfunction.

Navigating the Perils of Anesthesia: Managing Mediastinal Masses for Tru-Cut Biopsy.

Managing mediastinal masses during anesthesia presents formidable challenges, particularly in pediatric patients undergoing procedures such as tru-cut biopsy. These masses, both benign and malignant, can compress vital structures, leading to life-threatening complications. This article explores the complexities of managing anesthesia in patients with mediastinal masses, emphasizing the importance of meticulous preoperative assessment, understanding the relationship between the mass and surrounding anatomy, and employing lifesaving techniques such as inhalation induction and awake intubation. In the first case, a seven-year-old boy with a large heterogeneous mediastinal mass causing left lung collapse and compression of major vessels underwent a tru-cut biopsy under spontaneous general anesthesia. The procedure was uneventful, and the mass was diagnosed as neuroblastoma. In the second case, a 13-year-old boy with a mediastinal mass causing compression of the trachea and major vessels presented with respiratory distress and was managed with a tru-cut biopsy under local anesthesia with ultrasound guidance. The mass was diagnosed as acute T-cell lymphoblastic lymphoma. In the third case, a 14-year-old girl with a large mediastinal mass causing compression of the pulmonary trunk and major vessels experienced airway compromise during the biopsy, necessitating emergency intubation and repositioning. The mass was diagnosed as Hodgkin lymphoma. Mediastinal masses can cause significant compression of the trachea, bronchi, and major vessels, leading to a range of clinical symptoms. Effective management requires thorough preoperative evaluation, planning for potential airway emergencies, and collaboration with surgical teams. Case reviews highlight the variability of airway dynamics and the necessity of positive pressure ventilation and vigilant postoperative monitoring. Comprehensive pre-procedural assessment, preparedness for airway emergencies, and skilled anesthesia teams are crucial for managing pediatric patients with mediastinal masses. These cases underscore the complexities and emphasize the importance of careful planning and proactive measures to ensure successful outcomes and minimize risks during anesthesia induction and diagnostic procedures.

Regional Anaesthesia, Contemporary Techniques, and Associated Advancements: A Narrative Review.

In particular, the application of regional anaesthesia techniques in existing medicine can be characterized as experiencing regular changes in recent decades. It is useful for obtaining accurate and efficient pain management solutions, from the basic spinal and epidural blocks to the novel ultrasound nerve blocks and constant catheter procedures. These advancements do enhance not only the value of the perioperative period but also the patient's rated optimization as enhancing satisfaction, better precision, and the safety of nerve block placement. The use of ultrasound technology makes it even easier to determine the proper positioning of the needle and to monitor nerve block placement. Moreover, the duration and efficiency of regional anaesthesia are being enhanced by state-of-the-art approaches, which come in the form of liposomal bupivacaine, and better recovery plans and protocols, which shorten recovery time and decrease the number of hospital days. As these methods develop further, more improvements in the safety, efficacy, and applicability of regional anaesthesia in contemporary medicine are anticipated through continued research and innovation.

A matter of life and death: physician gender and patient outcomes after surgery.

Accumulating evidence supports an effect of physician gender (or sex, a surrogate used in many studies) on important patient outcomes such as death, complications, and hospital length of stay. Recent studies suggest that these effects result from the gender diversity of the team rather than individual physician gender. Here, we reflect on the potential mechanisms of an effect of physician gender on patient outcomes.

Examiner workload comparison: three structured oral examination formats for the European diploma in anaesthesiology and intensive care.

The COVID-19 pandemic triggered transformations in academic medicine, rapidly adopting remote teaching and online assessments. Whilst virtual environments show promise in evaluating medical knowledge, their impact on examiner workload is unclear. This study explores examiner's workload during different European Diploma in Anaesthesiology and Intensive Care Part 2 Structured Oral Examinations formats. We hypothesise that online exams result in lower examiner's workload than traditional face-to-face methods. We also investigate workload structure and its correlation with examiner characteristics and marking performance. In 2023, examiner's workload for three examination formats (face-to-face, hybrid, online) using the NASA TLX instrument was prospectively evaluated. The impact of examiner demographics, candidate scoring agreement, and examination scores on workload was analysed. The overall NASA TLX score from 215 workload measurements in 142 examiners was high at 59.61 ± 14.13. The online examination had a statistically higher workload (61.65 ± 12.84) than hybrid but not face-to-face. Primary contributors to workload were mental and temporal demands, and effort. Online exams were associated with elevated frustration. Male examiners and those spending more time on exam preparation experienced a higher workload. Multiple diploma specialties and familiarity with European Diploma in Anaesthesiology and Intensive Care exams were protective against high workload. Perceived workload did not impact marking agreement or examination scores across all formats. Examiners experience high workload. Online exams are not systematically associated with decreased workload, likely due to frustration. Despite workload differences, no impact on examiner's performance or examination scores was found. The hybrid examination mode, combining face-to-face and online, was associated with a minor but statistically significant workload reduction. This hybrid approach may offer a more balanced and efficient examination process while maintaining integrity, cost savings, and increased accessibility for candidates.

Impact of Burnout on Anaesthesiologists.

Professional burnout syndrome (PBS) is an issue affecting individuals and organizations alike, characterized by emotional exhaustion and reduced effectiveness resulting from overwhelming work demands. Root causes include excessive workload, unrealistic expectations, and blurred work-life boundaries, which are often intensified by organizational culture and inadequate support systems. The consequences range from decreased productivity and creativity to high turnover rates and financial strain on organizations. Mitigating PBS requires a comprehensive approach that addresses both individual and organizational levels. Individually, stress management techniques and self-care practices are crucial for building resilience and coping with work-related stressors. Organizations play a vital role in promoting employee well-being by fostering a supportive work environment, promoting work-life balance and providing access to support systems such as counseling and mentorship programs. Leadership is key in creating a culture that values employee health and prioritizes open communication and empathy. Policy interventions can further support efforts to combat PBS by enforcing labor laws that protect employee rights, such as setting limits on working hours and ensuring access to mental health services. Additionally, incentivise organizations to prioritize employee well-being through tax incentives or certification programs can encourage proactive measures against burnout. The aim of this review is to provide a comprehensive exploration of PBS, examining its causes, consequences, and potential mitigation strategies in individuals and organizations, with a focus on anaesthesiology.

The BJA Editorial Fellowship 2024: a barometer for the state of academic anaesthesiology, perioperative, pain, and critical care medicine.

Throughout its 100-yr history, a key ambition of the British Journal of Anaesthesia has been to foster our academic community by addressing the needs of individuals in the early stages of their independent clinical and research careers. Longitudinal mentoring and peer networking are critical for establishing a community of like-minded peers and mentor-advisors required to navigate the challenges of academic medicine. In 2019, the Journal launched an Editorial Fellowship scheme, aimed at comprehensively demystifying the process of peer review, editing, and publishing through guided mentorship and experiential learning.

Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists.

BACKGROUND: Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross-sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care. METHODS: A 20-item multiple-choice-question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3-month period, September-November 2023. RESULTS: The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55-9.67), p < .001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13-2.58), p = .011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi-tasking. Approximately half of respondents expressed that audio podcast-based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills. CONCLUSION: Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer-review processes, and potential sex-differences.

Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care.

BACKGROUND: Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe. METHODS: Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives. RESULTS: Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK. CONCLUSION: This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.

Setting a direction for continuing professional development in anesthesiology: A synthesis of the outcome from an Utstein style meeting.

BACKGROUND: An Utstein style meeting of key stakeholders from the existing collaboration surrounding post-graduate training was arranged to set a direction for continuing professional development (CPD) of anesthesiologists in Denmark. A 2-day meeting was planned to guide discussions about competencies in anesthesiology, facilitate the development of a blueprint for a portfolio-based CPD program and provide examples of how a portfolio can be used in practice. METHODS: The meeting agenda was based on an adaptation of Kern's six-step approach to curriculum development. Twenty-four participants from the university hospitals in Denmark were invited. Prior to the meeting participants were informed of the objectives and the Utstein style process. RESULTS: Participants acknowledged a need for a more structured approach to CPD, preferably within the current organizational set up at the departmental level, and with a portfolio-based, individualized curriculum. It was recognized that CPD should contain an array of possibilities to accommodate needs and wants of both the individual and the department. It was emphasized that, while anesthesiologists are used to give feedback to trainees, many are less familiar in providing the same to peers, and psychological safety was identified as a prerequisite to support a culture where specialists can reflect openly on each other's performance. CONCLUSION: The results provide an insight into the attitudes, opportunities, and challenges of anesthesiologists in relation to continuing professional development in Denmark. Generally, participant suggestions are in line with the shift in medical education toward workplace-based learning, feedback and lifelong learning.

Factors associated with increased risk of postoperative blood transfusion in patients undergoing total hip arthroplasty at an Irish University Hospital.

INTRODUCTION: Approximately 7000 total hip arthroplasty (THA) surgeries occur in Ireland each year. A number of preoperative factors have been identified that increase the risk of postoperative blood transfusion after THA, including anaemia. The ability to identify patients at risk may allow preoperative management strategies to reduce blood transfusions. Data from Irish orthopaedic patients is currently lacking. AIM: To investigate if preoperative anaemia and other factors are associated with postoperative blood transfusions in patients who undergo THA. METHODS: A retrospective cohort study of all patients who underwent THA in 2019 in SIVUH, Cork, using medical chart review. RESULTS: In total, 350 charts met the inclusion criteria, with 291 charts reviewed. 8.9% of the patients who underwent THA had preoperative anaemia. Among these, 19.2% had a postoperative blood transfusion, compared to 1.5% of patients who were not anaemic preoperatively. The odds of receiving a blood transfusion was 15.5 times greater in the preoperative anaemia group compared to the non-anaemic group. Increasing age and higher ASA scores were associated with preoperative anaemia and postoperative blood transfusions. Length of stay was increased by 2.2 days (p < 0.00016) if blood transfusion was required. CONCLUSION: Preoperative anaemia was common in an Irish orthopaedic population undergoing THA. Preoperative anaemia predisposes patients to the greatest increased risk of postoperative blood transfusions. The other factors associated with the need for postoperative transfusion were ASA grade 3 or more and age greater than 65 years. Patients who received postoperative blood transfusions had a significantly increased length of hospital stay.