A clinical tool to predict adverse behaviour in children at the induction of anesthesia.

PURPOSE: To develop and validate a parent questionnaire to aid in predicting which children are likely to exhibit significant adverse behaviour at anesthetic induction. METHODS: Parents of 209 children, ages two to 13 yr, completed a brief questionnaire prior (13 items) to their child's anesthetic induction for surgery. The questionnaire included content drawn from both the literature and clinical experience. Results from the questionnaire were compared with the Induction Compliance Checklist (ICC), a validated tool to measure adverse behaviour at induction. Analyses assessing the correlation between each of the items and the total questionnaire score and between each item and the ICC score resulted in three items being removed from the questionnaire because they provided no predictive power. The association between the resulting ten-item parent questionnaire and the ICC was re-assessed using correlation. Hierarchical regression was used to evaluate the added value of our tool compared with the modified Yale Preoperative Anxiety Scale (mYPAS) in the prediction of ICC scores. RESULTS: The Cronbach's alpha reliability coefficient for the ten-item parent questionnaire was 0.73. The Pearson product-moment correlation between the ten-item questionnaire and the ICC was 0.34 (P < 0.001) for all children and 0.38 (P < 0.001) for children not preoperatively sedated. Values represent medium effect sizes for the new questionnaire's predictive power. The parent questionnaire provided added value relative to the mYPAS in terms of correlation with the ICC. CONCLUSION: Adverse behaviour at anesthesia induction is significantly predicted by our new parent questionnaire. Further refinement may improve predictive power beyond the observed medium effect size.

Evaluation of Canadian family practice anesthesia training programs: can the Resident Logbook help?

PURPOSE: Without a core curriculum for the training and evaluation of Canada's family practice anesthetists, little is known regarding the training process of these physicians. This article offers a description of the variety of cases and procedures experienced by family practice anesthesiology (FPA) residents during their training year based on records in the Resident Logbook. METHODS: Data were extracted from the Resident Logbook, an online program wherein FPA residents across Canada record their daily activities. Data were extracted for four residents from 2009/2010 and four from 2010/2011 who had recorded the largest number of patient encounters for the academic year. Medians were calculated for cases and procedures relevant to the practice of a family practice anesthetist. RESULTS: Residents in FPA use the Resident Logbook inconsistently. The trainees we selected entered a median of 1,418 encounters for 2009/2010 and 1,074 for 2010/2011. Residents appear to have most of their clinical encounters with cases and procedures relevant to FPA. There is still a need, though, to improve areas previously cited as requiring augmentation, such as trauma management and peripheral nerve blocks. CONCLUSIONS: Although FPA residents use the Resident Logbook inconsistently, the data obtained offer an initial description of the composition of the FPA training year. We believe that the Resident Logbook offers an excellent tool for furthering the goal of a standardized curriculum and assessment program for FPA training.

Residents' and program directors' attitudes toward research during anesthesiology training: a Canadian perspective.

We assessed the attitudes of residents and program directors (PD) toward research training in Canadian anesthesiology residency programs. Questionnaires were sent to all 476 anesthesiology residents in Canada and a modified questionnaire was sent to the PD of each of the 16 anesthesiology programs between November 2003 and April 2004. There was a 60% response rate to the resident questionnaire and 95% from the PDs. Eighty-one percent of programs have mandatory research activity, although only 41% of residents think research should be mandatory. A majority of residents were recently involved in a research project. There was a discrepancy between PDs' and residents' views about the availability of some resources to facilitate research. Residents regard the time needed to learn clinical anesthesia, schedule conflicts, inadequate faculty support, and a lack of protected research time as the top barriers to undertaking a research project. PDs do not consider schedule conflicts or a lack of time as important barriers for resident research. Seventy-five percent of residents would prefer to do another academic activity, such as learning transesophageal echocardiography or taking postgraduate programs in education, rather than completing a research project during their residency.

Anesthetic management of a patient with asymptomatic ventricular tachycardia.

There are many causes of ventricular arrhythmias in pediatric patients, even those with structurally normal hearts. However, in young patients with 'normal' hearts, sustained ventricular arrhythmias are relatively rare. The primary concern of the physician is to identify which patients have benign ventricular arrhythmia patterns and which are at risk for sudden cardiac death. Even in asymptomatic patients, the choice of anesthetic agents may be important to minimize precipitation of episodes of tachyarrhythmias. This clinical report describes the anesthetic considerations for an asymptomatic child with a history of sustained premature ventricular contractions, ventricular tachycardia, and bigeminy. This child had chronic serous otitis media requiring repeat tympanostomy and tube replacement. This case report outlines the initial cancellation of anesthesia because of sustained arrhythmias, and subsequent conduct of the anesthesia for the case, as well as the considerations in the selection of the drugs when a child presents with significant ventricular arrhythmia.

A demand-based assessment of the Canadian anesthesia workforce - 2002 through 2007.

PURPOSE: The number of anesthesia providers required by the Canadian health care system remains controversial. Questions persist regarding both the adequacy of the current supply and what the future demand will be. The purpose of this study was to quantify the number and adequacy of anesthesia providers in 2002, and predict the same for the year 2007. METHODS: All licensed health care facilities potentially employing anesthetic services were identified. On February 1(st), 2002 a questionnaire was mailed to each institution. On April 1(st), a second mailing was sent to non-responders. Those facilities that did not respond to either mailing were contacted by telephone. RESULTS: Responses were obtained from 831 of 891 (93%) health care facilities. Four hundred and twenty-six of the facilities employed anesthetic services. There were 1,610 operating rooms (ORs) in use daily, and 2,134 full-time equivalent (FTE) anesthesia providers were available to the institutions surveyed. Respondents identified an immediate need for 228 additional FTEs. Hospitals with less than five ORs or five FTEs reported higher vacancy rates than hospitals with greater than five ORs or five FTEs (P < 0.0001). Ontario (n = 85) and Quebec (n = 69) had the largest absolute deficits of FTEs and significantly greater odds of vacancies than western provinces (Ontario OR = 1.84, Quebec OR = 2.50). The projected need for 2007 was an additional 560 FTEs. CONCLUSION: This is the first study to survey a national census of "consumers" of anesthetic services: Canadian health care facilities. The results indicate substantial current and worsening future shortages of anesthesia providers in Canada.