The impact of perioperative catastrophes on anesthesiologists: results of a national survey.

BACKGROUND: Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. Very little, however, is known about the emotional impact of these events and their effects on both immediate and long-term ability to provide care. In this study, we examined the incidence of perioperative catastrophes and the impact of these outcomes on American anesthesiologists. METHODS: We sent a self-administered postal survey to 1200 randomly selected members of the American Society of Anesthesiologists. Participants were sent an advance letter, up to 2 copies of the survey, up to 2 reminder postcards, and a small cash incentive. Six hundred fifty-nine physicians (56%) completed the survey. RESULTS: Eighty-four percent of respondents had been involved in at least one unanticipated death or serious injury of a perioperative patient over the course of his/her career. Queried about the emotional impact of a "most memorable" perioperative catastrophe, >70% experienced guilt, anxiety, and reliving of the event with 88% requiring time to recover emotionally from the event and 19% acknowledging having never fully recovered. Twelve percent considered a career change. Sixty-seven percent of respondents believed that their ability to provide patient care was compromised in the first 4 hours subsequent to the event, but only 7% were given time off. CONCLUSION: A perioperative catastrophe may have a profound and lasting emotional impact on the anesthesiologist involved and may affect his or her ability to provide patient care in the aftermath of such events.

"Second" Primary Cardiac Sarcoma in a Patient With Ewing Sarcoma. Always Expect The Unexpected.

A high suspicion for relapsed metastatic disease must arise when an intracardiac mass is detected in a patient with a recent history of Ewing sarcoma. Nevertheless, the scenario may eventually turn out to be much more complex than expected, and the possibility that the intracardiac tumor may instead be a "second" primary sarcoma, although extremely rare, should also be considered. We describe the first case of concomitant diagnosis of Ewing sarcoma and low-grade myxoid spindle cell sarcoma in the same young patient.

Systemic lidocaine decreases the Bispectral Index in the presence of midazolam, but not its absence.

STUDY OBJECTIVE: To evaluate the effects of intravenous (IV) lidocaine on the Bispectral Index (BIS) in the presence or absence of midazolam. DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical study. SETTING: Operating room of a university hospital. PATIENTS: 96 ASA physical status 1, 2, and 3 patients undergoing general anesthesia. INTERVENTIONS: Patients were assigned to one of 6 treatment groups to receive IV midazolam (0.03 mg/kg) or placebo, followed 5 minutes later by one of three IV preinduction doses of lidocaine: 0.5, 1.0, or 1.5 mg/kg. MEASUREMENTS: BIS values were recorded before administration of lidocaine and at 30-second intervals afterwards for three minutes. The primary endpoint was the average BIS level recorded. MAIN RESULTS: Baseline BIS values were lower in the midazolam group (94 ± 4 vs. 90 ± 7, P < 0.001). There was no significant decrease in BIS values in the placebo group for any of the three lidocaine doses. However, in the midazolam groups, significant decreases in BIS levels versus baseline values were measured. CONCLUSION: IV lidocaine decreases BIS in the presence of midazolam, suggesting that the effect of lidocaine on BIS is not direct, but rather results from modulation by midazolam.