Determinants and Practice Variability of Oxygen Administration during Surgery in the United States: A Retrospective Cohort Study.

BACKGROUND: The best approaches to supplemental oxygen administration during surgery remain unclear, which may contribute to variation in practice. This study aimed to assess determinants of oxygen administration and its variability during surgery. METHODS: Using multivariable linear mixed-effects regression, the study measured the associations between intraoperative fraction of inspired oxygen and patient, procedure, medical center, anesthesiologist, and in-room anesthesia provider factors in surgical cases of 120 min or longer in adult patients who received general anesthesia with tracheal intubation and were admitted to the hospital after surgery between January 2016 and January 2019 at 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry. RESULTS: The sample included 367,841 cases (median [25th, 75th] age, 59 [47, 69] yr; 51.1% women; 26.1% treated with nitrous oxide) managed by 3,836 anesthesiologists and 15,381 in-room anesthesia providers. Median (25th, 75th) fraction of inspired oxygen was 0.55 (0.48, 0.61), with 6.9% of cases less than 0.40 and 8.7% greater than 0.90. Numerous patient and procedure factors were statistically associated with increased inspired oxygen, notably advanced American Society of Anesthesiologists classification, heart disease, emergency surgery, and cardiac surgery, but most factors had little clinical significance (less than 1% inspired oxygen change). Overall, patient factors only explained 3.5% (95% CI, 3.5 to 3.5%) of the variability in oxygen administration, and procedure factors 4.4% (95% CI, 4.2 to 4.6%). Anesthesiologist explained 7.7% (95% CI, 7.2 to 8.2%) of the variability in oxygen administration, in-room anesthesia provider 8.1% (95% CI, 7.8 to 8.4%), medical center 23.3% (95% CI, 22.4 to 24.2%), and 53.0% (95% CI, 52.4 to 53.6%) was unexplained. CONCLUSIONS: Among adults undergoing surgery with anesthesia and tracheal intubation, supplemental oxygen administration was variable and appeared arbitrary. Most patient and procedure factors had statistical but minor clinical associations with oxygen administration. Medical center and anesthesia provider explained significantly more variability in oxygen administration than patient or procedure factors.

Association of anaesthesia provider sex with perioperative complications: a two-centre retrospective cohort study.

BACKGROUND: Previous studies suggested that surgeon sex is associated with differential patient outcomes. Whether this also applies to anaesthesia providers is unclear. We hypothesised that female sex of the primary anaesthesia provider is associated with lower risk of perioperative complications. METHODS: The first case for all adult patients undergoing anaesthesia care between 2008 and 2022 at two academic healthcare networks in the USA was included in this retrospective cohort study. The primary exposure was the sex of the anaesthesia provider who spent the most time in the operating theatre during the case. The primary outcome was intraoperative complications, defined as hypotension (mean arterial blood pressure <55 mm Hg for ≥5 cumulative minutes) or hypoxaemia (oxygen saturation <90% for >2 consecutive minutes). The co-primary outcome was 30-day adverse postoperative events (including complications, readmission, and mortality). Analyses were adjusted for a priori defined confounders. RESULTS: Among 364,429 included patients, 57,550 (15.8%) experienced intraoperative complications and 55,168 (15.1%) experienced adverse postoperative events. Care by female compared with male anaesthesia providers was associated with lower risk of intraoperative complications (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.94-0.97, P<0.001), which was magnified among non-trainees (aOR 0.84, 95% CI 0.82-0.87, P-for-interaction<0.001). Anaesthesia provider sex was not associated with the composite of adverse postoperative events (aOR 1.00, 95% CI 0.98-1.02, P=0.88). CONCLUSIONS: Care by a female anaesthesia provider was associated with a lower risk of intraoperative complications, which was magnified among non-trainees. Future studies should investigate underlying mechanisms.

Unravelling the effect of anaesthesia provider sex on patient outcomes: statistical analyses for sound conclusions.

Unravelling the impact of the sex of the anaesthesia provider on the outcomes of patients requires careful statistical analysis and the validity of many assumptions. A recent study in the British Journal of Anaesthesia investigates the effect of anaesthesia provider sex on patient outcomes, using data from two academic healthcare networks in the USA. The authors show that female provider sex was associated with a lower risk of intraoperative complications. They also show that there was no meaningful difference between male and female providers with respect to postoperative outcomes. There have been several recent studies considering the effect of healthcare provider sex on outcomes. We will discuss the interpretation of these results and the validity of the underlying assumptions.

Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis.

BACKGROUND: The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of different ASA risk classes (ASA II [mild risk] and ASA III [severe risk]) on clinical outcomes following hip fracture surgery, including all-cause mortality and postoperative complications. METHODS: A retrospective analysis from 2019 to 2021 across three Jordanian centers was conducted. The study included patients aged 65 and above who underwent hip fracture repair surgeries. Preoperative measures, intraoperative management protocols, and postoperative care were collected. Clinical data were extracted from electronic medical records, including demographics, fracture type, intraoperative data, and postoperative outcomes. RESULTS: The analysis included 1033 patients, with 501 (48.5%) in the mild anesthetic risk group (ASA I-II) and 532 (51.5%) in the severe anesthetic risk group (ASA III-V). The mean age was 73 years, with a higher prevalence of males in the severe risk group. Patients in the severe risk group had more comorbidities, higher ICU admissions (15.23% vs. 6.18%), longer hospital stays (median 7 vs. 6 days), and higher rates of postoperative thromboembolic complications (3.39% vs. 1.39%) compared to the mild risk group. Additionally, the severe risk group showed higher mortality rates both in-hospital mortality (3.38% vs. 1.39%) and all-cause mortality (16.92% vs. 10.36%). Multivariate analysis identified higher ASA score as independent risk factors for increased all-cause mortality (HR = 1.64 95%CI 1.51-2.34) and thromboembolic complications (OR = 2.85 95%CI 1.16-7). Length of hospital stay was significantly associated with higher ASA score (OR = 1.04 95%CI 0.96-1.11). CONCLUSION: The study underscores the significant impact of anesthetic risk on the outcomes of hip fracture surgeries. Patients with higher ASA scores associated with severe systemic diseases may have at increased risk of adverse outcomes.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Brain drain in pediatric anesthesiology: The geographic and demographic distribution of national origin among pediatric anesthesiologists in the United States.

BACKGROUND: American pediatric anesthesiologists have a long history of international volunteerism. However, the US healthcare system also benefits from the contributions of a large number of physicians who come from other nations to work within its borders. Despite this fact, little is known about the contribution of international medical graduates (IMG) to the pediatric anesthesiology subspecialty. AIMS: To characterize the contribution of IMG to the field of pediatric anesthesiology in the United States, and to elucidate the geographic and demographic distribution of their national origins so as to understand the movement of skilled personnel between countries. METHODS: Online physician directories of American children's hospitals were searched, and anesthesiologists were recorded for their national origin of medical education. International graduates were reported as a percentage of the pediatric anesthesiology workforce. Those attending medical colleges catering to American students ("offshore" medical schools) were analyzed separately from other IMGs. The cohort of non-offshore IMGs were analyzed for national and continental origins, and by national level of economic development. RESULTS: Of 1979 anesthesiologists analyzed, 397 attended medical school outside the United States, with 58 being from offshore schools. The remaining 338 represented 17.1% of the total pediatric anesthesiology workforce. They came from 58 countries on six continents. Of those, 65.1% attended medical school in low- and middle-income countries. CONCLUSIONS: International medical graduates, disproportionately from low- and middle-income countries, compose a large proportion of the US Pediatric Anesthesiology workforce. While these clinicians play a vital role in providing care for American children, the potential impacts of skilled physician loss on their nations of origin must also be considered.

The management of paediatric acute pain in Spain in 2021: Results of a national survey among paediatric anaesthesiologists.

OBJECTIVE: To improve knowledge about routine clinical practice in the management of paediatric acute pain in Spain. METHODS: A telematic survey was conducted via the Internet on a representative sample of healthcare professionals involved in the management of paediatric acute pain (specifically anaesthesiologists) in Spain. The survey included 28 questions about their usual clinical practice in the assessment and treatment of acute pain, and also training and organisational aspects in paediatric acute pain. RESULTS: The survey was completed during March 2021 by 150 specialists in anaesthesiology. The respondents widely experienced in the management of acute paediatric pain (mean years of experience: 14.3: SD: 7.8), essentially in acute postoperative pain (97% of cases). Although 80% routinely used validated paediatric acute pain assessment scales, only 2.6% used specific scales adapted for patients with cognitive impairment. Most of the respondents routinely used analgesic drugs such as paracetamol (99%) or metamizole (92%), but only 84% complemented these drugs with a loco-regional blocking technique or other non-steroidal anti-inflammatory drugs (62%). Furthermore, only 62.7% acknowledged having received specific training in paediatric acute pain, only 45% followed hospital institutional protocols, and a scant 28% did so through paediatric pain units. CONCLUSIONS: The survey identified important points for improvement in the training and organisation of acute pain management in Spanish paediatric patients.

Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction.

BACKGROUND: This study investigates the potential of ChatGPT-4, developed by OpenAI, in enhancing medical decision-making processes, particularly in preoperative assessments using the American Society of Anesthesiologists (ASA) scoring system. The ASA score, a critical tool in evaluating patients' health status and anesthesia risks before surgery, categorizes patients from I to VI based on their overall health and risk factors. Despite its widespread use, determining accurate ASA scores remains a subjective process that may benefit from AI-supported assessments. This research aims to evaluate ChatGPT-4's capability to predict ASA scores accurately compared to expert anesthesiologists' assessments. METHODS: In this prospective multicentric study, ethical board approval was obtained, and the study was registered with clinicaltrials.gov (NCT06321445). We included 2851 patients from anesthesiology outpatient clinics, spanning neonates to all age groups and genders, with ASA scores between I-IV. Exclusion criteria were set for ASA V and VI scores, emergency operations, and insufficient information for ASA score determination. Data on patients' demographics, health conditions, and ASA scores by anesthesiologists were collected and anonymized. ChatGPT-4 was then tasked with assigning ASA scores based on the standardized patient data. RESULTS: Our results indicate a high level of concordance between ChatGPT-4 predictions and anesthesiologists' evaluations, with Cohen's kappa analysis showing a kappa value of 0.858 (p = 0.000). While the model demonstrated over 90% accuracy in predicting ASA scores I to III, it showed a notable variance in ASA IV scores, suggesting a potential limitation in assessing patients with more complex health conditions. DISCUSSION: The findings suggest that ChatGPT-4 can significantly contribute to the medical field by supporting anesthesiologists in preoperative assessments. This study not only demonstrates ChatGPT-4's efficacy in medical data analysis and decision-making but also opens new avenues for AI applications in healthcare, particularly in enhancing patient safety and optimizing surgical outcomes. Further research is needed to refine AI models for complex case assessments and integrate them seamlessly into clinical workflows.

Modelo dinámico para proyectar la necesidad de recursos humanos en salud: anestesistas en Uruguay / Anesthesiologists in Uruguay: dynamic model to project the need of human resources in healthcare

Objetivo Desarrollar un modelo dinámico para simular la oferta de médicos especialistas y estimar la brecha especto a la demanda/necesidad en anestesiología en el sistema de salud del Uruguay. Métodos Se desarrolló un modelo de simulación dinámico determinístico implementado en el programa libre R. Se analizaron las proyecciones en el período 2011-2050 y se estimó la brecha a partir de la situación de equilibrio o desequilibrio entre oferta y demanda/necesidad. Se evaluó la calidad del modelo comparando los valores simulados con los datos históricos, con indicadores de bondad de ajuste, como la raíz del error cuadrático medio relativo (rRMSE). Se realizó un análisis de sensibilidad con respecto a los cupos de ingreso a la especialidady la tasa de crecimiento de la necesidad de especialistas. Resultados Se proyectó la oferta y demanda de anestesistas para el período considerado. Se obtuvo un rRMSE menor a 0,1, lo que sugiere que el modelo propuesto reproduce adecuadamente la dinámica de la oferta real. Para el período proyectado la situación a mediano y largo plazo es de equilibrio. Conclusión El modelo simulado presenta buen ajuste, por lo que la proyección de la oferta de Recursos Humanos (RR. HH.) representa de forma precisa la disponibilidad futura de la fuerza de trabajo. Además, el modelo representa un insumo de interés para la gestión informada sobre la necesidad de recursos humanos y las políticas de salud, dado que permite evaluar las proyecciones bajo diferentes escenarios.

Objectives The aim of this study is to develop a dynamic model to simulate the supply of specialized physicians in Anesthesiology and estimate the gap with its demand, within Uruguay healthcare system. Methods A deterministic dynamic simulation model was developed and implemented using R software. Projections for the 2011-2050 period were analyzed, and the gap was estimated based on the equilibrium state of supply and demand. The quality of the model was evaluated comparing the simulated data with historical empirical data using goodness of fit indicators, such as the relative root mean square error (rRMSE). Results The demand and supply of anesthesiologists was projected for the period under analysis. A rRMSE<0,1 was obtained, which suggests the proposed model adequately reproduces the real offer dynamics. Based on the defined gap criteria, in the medium and long-term the situation is in equilibrium state. Conclusions The simulated model presents a good fit so that the human resources (HR) supply projection represents in a precise way the future availability of the work-force. Given that the model allows to evaluate the projection dynamics under different management scenarios, the model also represents an input of the utmost interest for management knowledgeable about human resource demands and healthcare policy.

Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo? / Vitamin D levels among anesthesiologists and other physicians

Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.

Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions

OBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.

Correlation between weekly working time and burnout syndrome among anesthesiologists of Maceió-AL / Correlação entre a carga horária semanal de trabalho com a síndrome de burnout entre os médicos anestesiologistas de Maceió-AL

Abstract Background and objective: The current jobs are insufficient to determine the causative agent, as well as to identify characteristic high risk profiles for BS, leaving a clear need for more studies to this end. This study objective was to evaluate the correlation between weekly workload and BS dimensions. Methods: An observational, descriptive, cross-sectional study performed with 43 anesthesiologists from Maceió-AL, with the application of Maslach Burnout Inventory (MBI) forms. Pearson's correlation coefficient r was used for the three dimensions and a 95% confidence interval for the prevalence of burnout syndrome and high scores in all three dimensions. Results: Among the studied physicians, 51.16% were male and the average age was 49.82 ± 12.05 years. For physicians who have been diagnosed with BS through the MBI, the average weekly working time 69.27 ± 22.39 h. The high level of frequency in at least one of the three dimensions was found in 67.44% of physicians, with this percentage being considered diagnostic for burnout syndrome in this population. Conclusion: This study showed no correlation between the weekly working time and the BS dimensions in this population.

Resumo Justificativa e objetivo: Os trabalhos atuais são insuficientes para determinar o agente causal, assim como identificar perfis característicos de alto risco para síndrome de burnout (SB), e deixam evidente a necessidade de mais pesquisas com esse objetivo. O presente estudo teve como objetivo avaliar a correlação entre a carga semanal de trabalho com as dimensões da SB. Métodos: Estudo observacional descritivo e transversal feito com 43 médicos anestesiologistas de Maceió-AL, por meio da aplicação de formulários com o Maslach Burnout Inventory (MBI). Foi usado o teste de correlação R de Pearson para as três dimensões e um intervalo de confiança de 95% para a prevalência da síndrome de burnout e para escores altos nas três dimensões. Resultados: Entre os médicos estudados, 51,16% pertenciam ao gênero masculino com média de 49,82 ± 12,05 anos. Para os médicos que por meio do MBI foram diagnosticados com SB, a média de carga horária semanal de trabalho foi de 69,27 ± 22,39 horas. A frequência de alto nível em pelo menos uma das três dimensões foi encontrada em 67,44% dos médicos, foi considerada essa a porcentagem de diagnóstico para a síndrome de burnout na população estudada. Conclusão: O presente estudo demonstra não haver correlação entre a carga horária semanal de trabalho com as dimensões da SB na população estudada.

Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants / Análise da aplicação de pressão cricoide: residentes em anestesiologia vs. enfermeiros assistentes de anestesia

ABSTRACT BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p = 0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p = 0.03). There were no significant differences in the Cormack-Lehane view between both groups. CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

RESUMO JUSTIFICATIVA E OBJETIVO: Avaliar a capacidade de residentes em anestesiologia em comparação com enfermeiros assistentes de enfermagem para identificar a cartilagem cricoide, aplicar a pressão cricoide adequada e produzir uma vista adequada da entrada da laringe. MÉTODOS: Foram convidados 85 participantes, 42 residentes em anestesiologia e 43 enfermeiros assistentes de enfermagem a responder questionários sobre a quantidade correta de força a ser aplicada na cartilagem cricoide. Os participantes deviam identificar a cartilagem cricoide e aplicar a pressão cricoide em modelos de vias aéreas superiores colocados sobre uma balança de pesagem e a pressão era registada. Posteriormente, aplicaram pressão cricoide em pacientes anestesiados reais após a indução de sequência rápida. Os detalhes sobre a aplicação de pressão cricoide e a classificação de Cormack-Lehane da visibilidade da laringe foram registrados. RESULTADOS: Os residentes em anestesiologia foram significativamente melhores do que os enfermeiros assistentes de enfermagem na identificação da cartilagem cricoide (95,2% vs. 55,8%, p = 0,001). No entanto, o conhecimento de ambos os grupos era precário sobre a quantidade de força necessária para aplicar a pressão cricoide (11,9% vs. 9,3%, respectivamente) e a correta aplicação da pressão cricoide (16,7% vs. 20,9%, respectivamente). A técnica de três dedos foi aplicada por 85,7% dos residentes em anestesiologia e 65,1% dos enfermeiros assistentes de enfermagem (p = 0,03). Não houve diferença significativa entre os dois grupos em relação à classificação de Cormack-Lehane para a visão. CONCLUSÃO: Os residentes em anestesiologia foram melhores do que os enfermeiros assistentes de enfermagem para identificar a cartilagem cricoide, mas ambos os grupos apresentaram um conhecimento igualmente precário sobre a aplicação de pressão cricoide.

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina / Perfil de erros de administração de medicamentos em anestesia entre anestesiologistas catarinenses

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

INTRODUÇÃO: A anestesiologia é a única especialidade médica que prescreve, dilui e administra os fármacos sem conferência de outro profissional. Somando-se a alta frequência de administração de fármacos, cria-se o cenário propício aos erros. OBJETIVO: Verificar a prevalência dos erros de administração de medicamentos durante anestesia, entre anestesiologistas catarinenses, as circunstâncias em que ocorreram e possíveis fatores associados. MATERIAIS E MÉTODOS: Um questionário eletrônico foi enviado a todos os anestesiologistas da Sociedade de Anestesiologia do Estado de Santa Catarina contendo respostas diretas ou de múltipla escolha sobre dados demográficos e perfil da prática anestésica do entrevistado; prevalência de erros, tipo e consequência do erro; e fatores que possivelmente contribuíram para os erros. RESULTADOS: Dos entrevistados, 91,8% afirmaram ter cometido erro de administração, somando total de erros de 274 e média de 4,7 (6,9) erros por entrevistado. O erro mais comum foi substituição (68,4%), seguido por erro de dose (49,1%) e omissão (35%). Apenas 7% dos entrevistados referiram erros de administração no neuroeixo. Quanto às circunstâncias dos erros, ocorreram principalmente no período matutino (32,7%), na manutenção da anestesia (49%), com 47,8% sem danos ao paciente e 1,75% com maior morbidade com dano irreversível e em 87,3% dos casos a identificação imediata. Quanto aos possíveis fatores contribuintes, os mais frequentes foram: distração e fadiga (64,9%) e leitura errada dos rótulos de ampolas ou seringas (54,4%). CONCLUSÃO: A maioria dos anestesiologistas entrevistados cometeu mais de um erro de administração em anestesia, principalmente justificado como distração ou fadiga, de baixa gravidade.

Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists / Pesquisa de curarização residual no pós-operatório, eventos respiratórios agudos e abordagem de anestesiologistas

BACKGROUND AND OBJECTIVES: residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution. METHODS: This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation <90% and 90-93% despite receiving 3 L/min nasal O2, respiratory rate >20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study. RESULTS: The incidence of PORC was 43% (n = 179) for TOFR <0.9, and 15% (n = 61) for TOFR <0.7. The incidence of TOFR <0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR <0.9 was found in 46% (n = 126) of the patients receiving neostigmine. CONCLUSIONS: When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

JUSTIFICATIVA E OBJETIVOS: A paralisia residual após o uso de bloqueadores neuromusculares (BNMs) sem monitoração neuromuscular continua sendo um problema clínico, mesmo quando BNMs são usados. Este estudo pesquisou a curarização residual pós-operatória e os eventos respiratórios críticos em sala de recuperação, bem como a abordagem clínica da CRPO feita pelos anestesiologistas em nossa instituição. MÉTODOS: Este estudo observacional incluiu 415 pacientes que receberam anestesia geral com BNMs de ação intermediária. A manutenção da anestesia foi feita por anestesiologistas não participantes, "cegos" para o estudo. A monitoração neuromuscular foi realizada no momento da chegada à sala de recuperação. Um ERC foi definido como necessidade de suporte ventilatório; saturação periférica de oxigênio <90% e 90-93%, a despeito de receber 3 L/min de O2 via cânula nasal; frequência respiratória >20 bpm; uso de musculatura acessória; dificuldade de engolir ou falar e necessidade de reintubação. A abordagem clínica de nossos anestesiologistas, em relação aos agentes de reversão, foi avaliada usando um miniquestionário de oito perguntas logo após o estudo. RESULTADOS: A incidência de CRPO foi de 43% (n = 179) para a SQE <0 e 15% (n = 61) para a SQE <0,7. A incidência de SQE <0,9 foi significativamente maior em mulheres, pacientes com estado físico ASA III e com anestesia de curta duração (p < 0,05). Além disso, 66% (n = 272) dos 415 pacientes que chegam à sala de recuperação haviam recebido neostigmina. Uma SQE <0,9 foi encontrada em 46% (n = 126) dos pacientes que receberam neostigmina. CONCLUSÃO: Quando a monitoração neuromuscular objetiva de rotina não está disponível, a CRPO continua sendo um problema clínico, a despeito do uso de BNMs. O momento e o antagonismo ideais do bloqueio neuromuscular e a monitoração neuromuscular objetiva de rotina são recomendados para aumentar a segurança do paciente.

Construction of a tool to measure perceptions about the use of the World Health Organization Safe Surgery Checklist Program / Construção de uma ferramenta para medida de percepções sobre o uso do checklist do Programa de Cirurgia Segura da Organização Mundial da Saúde

Abstract Background: The World Health Organization (WHO) has recommended greater attention to patient safety, particularly regarding preventable adverse events. The Safe Surgery Saves Lives (CSSV) program was released recommending the application of a surgical checklist for items on the safety of procedures. The checklist implementation reduced the hospital mortality rate in the first 30 days. In Brazil, we found no studies of anesthesiologists’ adherence to the practice of the checklist. Objective: The main objective was to develop a tool to measure the attitude of anesthesiologists and residents regarding the use of checklist in the perioperative period. Method: This was a cross-sectional study performed during the 59th CBA in BH/MG, whose participants were enrolled physicians who responded to the questionnaire with quantitative epidemiological approach. Results: From the sample of 459 participants who answered the questionnaire, 55% were male, 44.2% under 10 years of practice, and 15.5% with over 30 years of medical school completion. Seven items with 78% reliability coefficient were selected. There was a statistically significant difference between the groups of anesthesiologists who reported using the instrument in less or more than 70% of patients, indicating that the attitude questionnaire discriminates between these two groups of professionals. Conclusions: The seven items questionnaire showed adequate internal consistency and a well-defined factor structure, and can be used as a tool to measure the anesthesiologists’ perceptions about the checklist usefulness and applicability.

Resumo Introdução: A Organização Mundial da Saúde (OMS) tem recomendado uma maior atenção com a segurança do paciente, mais especificamente em relação aos eventos adversos evitáveis. Foi lançado o programa “Cirurgia Segura Salva Vidas (CSSV)”, que recomenda a aplicação da lista de verificação cirúrgica (checklist) para a conferência de itens relacionados à segurança do procedimento. A implantação do checklist reduziu a mortalidade hospitalar nos primeiros 30 dias. No Brasil, não foram identificados estudos sobre adesão dos anestesiologistas à prática do checklist. Objetivo: Desenvolvimento de uma ferramenta para mensuração da atitude dos anestesiologistas e residentes em relação ao uso do checklist no período perioperatório. Método: Estudo transversal feito durante o 59° Congresso Brasileiro de Anestesiologia (CBA), em Belo Horizonte (MG), cujos participantes foram médicos inscritos e que responderam ao questionário com abordagem epidemiológica quantitativa. Resultados: A amostra constou de 459 participantes que responderam ao questionário, 55% do sexo masculino, 44,2% com menos de 10 anos e 15,5% acima de 30 anos de conclusão do curso médico. Foram selecionados sete itens com coeficiente de confiabilidade de 78%. Houve diferença estatisticamente significativa entre os grupos de anestesiologistas que referiram usar o instrumento em menos ou mais de 70% dos pacientes assistidos. Isso indica que o questionário de atitudes discrimina entre esses dois grupos de profissionais. Conclusões: O questionário de sete itens mostrou adequada consistência interna e uma estrutura fatorial bem delimitada. Pode ser usado como ferramenta para medida das percepções de anestesiologistas quanto à utilidade e a aplicabilidade do checklist.

O uso de bloqueadores neuromusculares no Brasil / Neuromuscular blockers in Brazil

JUSTIFICATIVA E OBJETIVOS: Dados estatísticos referentes ao uso de bloqueadores neuromusculares no Brasil são desconhecidos. Este trabalho se propõe a análise estatística desse tópico. MÉTODO: Foram compiladas 831 respostas de um questionário preenchido em parte por anestesiologistas presentes ao 48° Congresso Brasileiro de Anestesiologia em Recife, 2001 e em parte via Internet, por anestesiologistas cujos endereços eletrônicos constam na página da Sociedade Brasileira de Anestesiologia (www.sba.com.br). Foram analisados os seguintes dados: tempo de contato com a especialidade, região onde atuam os anestesiologistas, uso de bloqueadores neuromusculares (BNM) em ordem de preferência, indicações do uso de succinilcolina, uso do monitor da transmissão neuromuscular, critérios para se considerar o paciente descurarizado, uso de neostigmina, forma de administração dos BNM e descrição de complicações observadas. RESULTADOS: A maioria dos anestesiologistas em questão exerce a profissão há mais de 11 anos e o maior número de respostas foi proveniente da região sudeste do Brasil. O BNM mais empregado é o atracúrio, seguido de pancurônio e succinilcolina. A succinilcolina é mais empregada na indução rápida e em crianças (80 por cento e 25 por cento respectivamente). Monitores da transmissão neuromuscular, 53 por cento dos anestesiologistas nunca usam, e como critério de recuperação, 92 por cento consideram o paciente descurarizado mediante sinais clínicos. Em 45 por cento das vezes os profissionais empregam a neostigmina de forma rotineira, e 94 por cento administra os BNM sob forma de bolus. Cerca de 30 por cento registra ter havido complicação decorrente do uso de BNM. As complicações mais apontadas foram o bloqueio prolongado, o broncoespasmo grave e a curarização residual. CONCLUSÕES: O atracúrio é o bloqueador neuromuscular mais empregado no Brasil, há percentual alto de uso da succinilcolina em situações não emergenciais, o uso de monitores da transmissão neuromuscular é raro, e, como um corolário, um percentual significativo de uso de critérios eminentemente clínicos para considerar o paciente descurarizado. Registrou-se que, cerca de 30 por cento dos anestesiologistas teve algum tipo de complicação decorrente do uso desses fármacos.