Manual jet ventilation to rescue a patient with pinhole tracheal stenosis: A case report

Background: Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. Case: A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established. Conclusion: Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.

Prevalence survey of clinical help-seeking of anesthesiologists in public hospitals / 中华麻醉学杂志

Objective:To investigate the current situation of clinical help-seeking of anesthesiologists and analyze the influencing factors of help-seeking behaviors in order to provide a basis for improving the help-seeking ability of anesthesiologists.Methods:The anesthesiologists in 35 public hospitals in Hubei province were investigated using a self-designed questionnaire, and the demographic differences and influencing factors related to help-seeking were analyzed.Results:The score for the help-seeking attitude questionnaire of anesthesiologists was (3.6±0.4). The score for the help-seeking needs sub-questionnaire of anesthesiologists was (2.7±0.6), and the score for the help-seeking behavior sub-questionnaire was (3.0±0.4). The item with the highest score was " special patients or patient emergency needs help", and the item with the lowest score was " self injury potential needs help". There was a statistically significant difference in the scores for the help-seeking needs sub-questionnaire for anesthesiologists of different ages and working years ( P<0.05), and there was no statistically significant difference in the scores for the help-seeking attitude questionnaire and help-seeking behavior sub-questionnaire for anesthesiologists of different genders, ages, professional titles, working years, personnel types, and whether they obtained a doctor′s license ( P>0.05). The percentage of anesthesiologists who believed that " they did not ask for help timely or without asking for help" was 35.4%, and the percentage of anesthesiologists who believed that " colleagues did not ask for help timely or without asking for help" was 50.7%. Among the reasons why the need for help did not translate into help-seeking behavior, the percentage of anesthesiologists who believed that " doctors think they can solve" was the highest (74.0%). Conclusions:Anesthesiologists in public hospitals have a positive attitude towards seeking-help and can better translate the need for help into behaviors. The main reasons for delay in seeking-help or non-seeking-help are inaccurate assessment of their own ability and inability to grasp the opportunity of seeking-help, and targeted training should be carried out to improve the doctors′ help-seeking ability.

Contradicción anestesiológica en una gestante con adenoma pleomórfico y alergia a los anestésicos locales / Anesthesiological contradiction in a pregnant woman with pleomorphic adenoma and allergy to local anesthetics

Introducción: El adenoma del paladar blando es frecuente en mujeres, aunado a los cambios fisiológicos que suceden durante el embarazo, es de presumir que la gestante puede presentar una vía aérea difícil. Objetivo: Describir el abordaje de la vía aérea en una gestante con adenoma del paladar blando. Presentación del caso: Se trata de una gestante de 20 años de edad con antecedentes patológicos personales de asma bronquial, alergia a los anestésicos locales, que presenta un adenoma en el paladar blando que impide ver la estructura de la orofaringe, Mallampatti IV, anunciada para procedimiento quirúrgico de urgencia para realizarle cesárea segmentaria anterior. Conclusiones: La embarazada presenta mayor incidencia de vía aérea difícil comparado con la población general, debido a los cambios fisiológicos que presenta en este periodo, si a ello se le adiciona la presencia de un tumor oro faríngeo que imposibilita la manipulación de la vía aérea, la evaluación preoperatoria y trazar una estrategia multidisciplinaria, constituyen los pilares para evitar complicaciones potencialmente fatales(AU)

Introduction: Adenoma of soft palate is frequent in women, together with the physiological changes that occur during pregnancy. The pregnant woman is to be presumed to have a difficult airway. Objective: To describe the airway managment in a pregnant woman with adenoma of soft palate. Case presentation: This is a 20-year-old pregnant woman (Mallampati IV) with a personal pathological history of bronchial asthma and allergy to local anesthetics, who presents an adenoma of soft palate that avoids seeing the oropharynx structure, announced for emergency surgical procedure for an anterior segmental cesarean section. Conclusions: The pregnant woman has a higher incidence of difficult airway compared to the general population, due to the physiological changes that she presents in this period. If, apart from this situation, the presence is considered of an oropharyngeal tumor that makes it impossible to manipulate the airway, preoperative assessment and tracing a multidisciplinary strategy are the pillars to avoid potentially fatal complications(AU)

A survey and analysis of hospital staff and patients′ awareness about anesthesiologists′ work / 中华麻醉学杂志

Objective:To investigate and analyze the hospital staff and patients, awareness about anesthesiologists′ work.Methods:A questionnaire survey was conducted among the hospital staff in the non-anesthesiology departments and non-operating room and the patients undergoing elective surgery at the same time in tertiary hospitals.Logistic regression was used to analyze the factors affecting the level of awareness of the respondents.Results:Sixty point three percent of the respondents had a low level of awareness about the anesthesiologists′ work.Compared with the patients, the physicians ( OR=2.866, 95%CI: 1.405-5.848) had higher level of awareness.There was no significant difference in the levels of awareness among the nurses ( OR=1.633, 95%CI: 0.815-3.273), medical technicians ( OR=1.359, 95%CI: 0.630-2.935), administrative staff ( OR=1.470, 95%CI: 0.651-3.317) and the patients.The respondents, aged 36-50 yr ( OR=1.848, 95%CI: 1.224-2.792), with master′s degree ( OR=2.068, 95%CI: 1.090-3.925) and bachelor′ s degree ( OR=3.624, 95%CI: 1.701-7.723), had higher level of awareness, and the respondents without history of anesthesia and surgery ( OR=0.574, 95%CI: 0.380-0.867) and without medicine-related education background ( OR=0.354, 95%CI: 0.145-0.865) had lower level of awareness. Conclusion:There is insufficient awareness about anesthesiologists′ work among hospital staff and patients.Hospital staff are generally better than patients in terms of the level of awareness, but there are differences among different job categories.There is no significant difference in the level of awareness among nurses, medical technicians, administrative staff and patients.The respondents who are middle-aged, with higher education level, with history of anesthesia and surgery and with medicine-related education background, have higher level of awareness.

Importancia del anestesiólogo en la prevención del dolor crónico / Importance of the anesthesiologist in the prevention of chronic pain

The development of chronic pain after surgery or persistent postoperative pain is a significant public health problem that affects between 10%-56% of patients undergoing surgical intervention. It produces great restrictions of mobility, limitation of daily activities, dependence on opioids, anxiety, depression, a great alteration of the quality of life and important legal and medical-economic consequences. There is a very close correlation between acute postoperative pain, and persistent postoperative pain. For this reason, pain must be treated effectively in its acute phase to reduce the incidence of chronic pain after surgery. There are risk factors that predispose to its appearance and that must be known by the anesthesiologist. In an individualized and meticulous pre-anesthetic consultation, these risk factors can be detected, as well as the presence of surgical procedures related to chronic pain, with the purpose of the therapeutic approach of the first ones if necessary, and a good planning of the anesthetic and analgesic technique, which reduces the participation of the second, in the chronicity of acute pain. The role of the anesthesiologist in the pre-anesthetic consultation is essential for the planning of preventive and multimodal analgesia that, together with other resources, should reduce the incidence of persistent postoperative pain.

El desarrollo del dolor crónico después de la cirugía o dolor posoperatorio persistente, es un problema de salud pública significativo que afecta entre el 10%-56% de los pacientes sometidos a una intervención quirúrgica. Produce grandes restricciones de la movilidad, limitación de las actividades de vida diaria, dependencia a los opioides, ansiedad, depresión, una gran alteración de la calidad de vida e importantes consecuencias legales y médico-económicas. Hay una correlación muy estrecha entre el dolor agudo posoperatorio, y el dolor posoperatorio persistente. Por esa razón, el dolor debe ser tratado de manera eficaz en su fase aguda para disminuir la incidencia del dolor crónico posterior a la cirugía. Existen factores de riesgo que predisponen a su aparición y que deben ser conocidos por el anestesiólogo. En una consulta pre-anestésica individualizada y minuciosa, se podrán detectar estos factores de riesgo, como también la presencia de procedimientos quirúrgicos relacionados con el dolor crónico, con la finalidad del abordaje terapéutico de los primeros de ser necesario, y una buena planificación de la técnica anestésica y analgésica, que disminuya la participación de los segundos, en la cronicidad del dolor agudo. El rol del anestesiólogo en la consulta pre-anestésica, es fundamental para la planificación de la analgesia preventiva y multimodal que junto a otros recursos deberían disminuir la incidencia del dolor postoperatorio persistente.

Update on biological risk for anesthetists taking care of patients affected by SARS-CoV2, COVID19 / Actualizacion de los riesgos biologicos para anestesiologos en la atencion de pacientes afectados por SARS-CoV-2, COVID-19

Abstract Biological risks are currently of great interest and concern due to the coronavirus disease 19 (COVID-19) pandemic. In this setting, the exposure of anesthetists and healthcare personnel to patients infected with severe acute respiratory syndrome-CoV-2 causing COVID-19 in their professional practice makes an update in the knowledge of the subject essential. The aim is prevention and protection during procedures entailing a higher risk, as is the case of the so-called aerosol generators (by inhalation of droplets). Therefore, we recommend extreme standard precautions focused on hand washing and barrier protection through the use of personal protective equipment in accordance with comprehen sive prevention and protection protocols for anesthetists, patients, and operating rooms.

Resumen En la actualidad, los riesgos biológicos han tomado un gran interés y preocupación debido a la pandemia por COVID-19. En ese escenario, la exposición en su ejercicio profesional de los anestesiólogos y personal sanitario a pacientes infectados con SARS-CoV-2 causante de la COVID-19 hace imprescindible una actualización en el conocimiento del tema apuntando a la prevención y protecciones durante procedimientos que revisten mayor riesgo, como los denominados generadores de aerosoles (por inhalación de gotas). Por lo tanto, se recomienda extremar las precauciones estándar enfocadas al lavado de manos y protecciones de barrera equipo de protección personal (EPP) siguiendo protocolos de prevención y protección integral del anestesiólogo, del paciente y del quirófano. Dados los rápidos cambios en la evidencia disponible en esta patología emergente, muchas de las recomendaciones aquí pre sentadas serán sujeto de modificaciones o ajustes futuros.

A Rare Case Report on the Role of Anaesthetist in Management of Homicidal Cut Throat Injury

Homicidal cut-throat injuries are potentially life threateningbecause of the many vital structures that course through thisarea. Management of homicidal cut-throat injuries requires amulti-disciplinary approach. The role of an anesthesiologist ininstituting an airway using an endotracheal intubation ortracheostomy before wound exploration and repair oftransected tissues, is challenging, as, such injuries are most ofthe time associated with distortion of the normal anatomy ofthe airway. Anaesthesiologist is pivotal in securing a definitiveairway in such cases thereby facilitating the wound explorationand surgical repair. We present a patient who was the victimof a homicidal cut-throat injury.

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study / Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Abstract Background and objectives: Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. Methods: Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. Results: Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. Conclusion: The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Resumo Justificativa e objetivos: O controle inadequado da pressão dos balonetes dos tubos traqueais pode resultar em complicações. A técnica objetiva com uso de manômetro é a recomendada para manutenção de valores seguros de pressão (20-30 cm H2O). Mas como ese instrumento é pouco disponível, os anestesiologistas recorrem a técnicas subjetivas. O objetivo deste estudo foi avaliar a adequação da técnica subjetiva para obtenção das pressões dos balonetes e o nível de experiência com uso do manômetro entre médicos especialistas e residentes de anestesiologia de um Hospital Universitário. Método: Estudo observacional prospectivo, com participantes que realizaram intubação traqueal e técnica subjetiva para insuflação dos balonetes. Pacientes com via aérea difícil, anormalidades anatômicas de laringe e traqueia, risco de broncoaspiração e os casos de emergência não foram incluídos. Até 60 minutos após a intubação, um investigador registrava a pressão do balonete utilizando um manômetro aneroide (AMBU®) conectado ao balonete guia do tubo. Resultados: Quarenta e sete anestesiologistas foram incluídos no estudo - 24 residentes e 23 especialistas. As pressões (cm H2O) média (DP) e mediana (IQR) encontradas foram, respectivamente, 52,5 (27,1) e 50 (30-70). Da amostra, 83% estavam fora da faixa adequada de pressão, sem diferença entre especialistas e residentes. O nível de experiência com a técnica objetiva também foi semelhante entre os grupos. Correção da pressão foi realizada em 76,6% dos casos. Conclusões: A técnica subjetiva para insuflar os balonetes dos tubos traqueais resultou em alta prevalência de pressões inadequadas, sem diferença no desempenho entre especialistas e residentes.

Coronavirus y anestesia: Consideraciones en torno a la solidaridad / Anesthesia and coronavirus: Solidarity issues

COVID-19 coronavirus infection has led us to reflect on the role of the enormous responsibility that the individual plays within his community for the free enjoyment and enjoyment of life on this planet that belongs to everyone, and the natural cooperation that it must exist between countries to build trust and progress. The WHO declared it a pandemic, and the repercussions of a health and economic emergency have dramatically altered social relations and daily life. The health system has been overwhelmed in high-income countries like Spain and Italy, creating a panorama that ranges from bewilderment to panic. In all the hospitals of the 180 countries that are experiencing this pandemic, the service has been provided with heroism, regardless of the current public health crisis, due to the mercantilist models and the privatization of the system. The high risk of general contagion has not mattered either, there is that large contingent of health workers firm and determined to serve, and anesthesiologists are not far behind. Still, we must be aware that the community needs us, that we must be well informed, and we must take care of ourselves with all the biosecurity measures that this challenge demands. The purpose of this article is to draw attention to these topics, highlighting that the importance of humanity depends on their behavior, their solidarity, and social responsibility.

La infección por el coronavirus COVID-19 nos ha puesto a reflexionar en torno al papel de enorme responsabilidad que juega el individuo dentro de su comunidad para el libre disfrute y goce de la vida en este planeta que es de todos, y la cooperación natural que debe existir entre los países para generar confianza y progreso. La OMS la declaró una pandemia y las repercusiones de emergencia sanitaria y económica han alterado de forma dramática las relaciones sociales y la cotidianeidad. El sistema de salud ha sido desbordado en países de altos ingresos como España e Italia, sembrando un panorama que va desde el desconcierto hasta el pánico. En todos los hospitales de los 180 países que cursan con esta pandemia, el servicio se ha venido prestando con heroísmo, sin importar la crisis de salud pública existente, a causa de los modelos mercantilistas y de privatización del sistema. No ha importado tampoco el alto riesgo de contagio general, allí está ese gran contingente de trabajadores de salud firme y decidido a servir, y los anestesiólogos no nos quedamos atrás, pero tenemos que ser conscientes que la comunidad nos necesita, que debemos estar bien informados y debemos cuidarnos con todas las medidas de bioseguridad que exige este reto. El propósito de este artículo es, llamar la atención sobre estos tópicos, destacando que la trascendencia de la humanidad depende de su comportamiento, de su solidaridad y de su responsabilidad social.

Efectividad de la indometacina vs analgésico habitual en el tratamiento del dolor posthisterectomía / Effectiveness of using indomethacin vs usual analgesic in the management of postoperative pain in hysterectomy

Resumen: OBJETIVO: Determinar la efectividad de la indometacina, por vía rectal, en el tratamiento del dolor posthisterectomía versus paracetamol o metamizol administrados por vía intravenosa. MATERIALES Y MÉTODOS: Estudio experimental, comparativo y prospectivo llevado a cabo en el Hospital Central del Estado de Chihuahua entre noviembre y diciembre de 2019. Criterios de inclusión: pacientes histerectomizadas, con expediente clínico completo y de cualquier edad. Criterios de exclusión: pacientes con alteraciones en el umbral del dolor, inconsistencias en el expediente, histerectomía total no ginecológica. Criterios de eliminación: pacientes con limitantes en la información que no permitieron relacionar la variable dependiente con la independiente. El seguimiento del dolor referido se efectuó con la escala análoga del dolor y valoraciones a las 12 y 24 horas posteriores a la cirugía. RESULTADOS: Se reunieron 141 pacientes, que se dividieron en tres grupos. Grupo 1: metamizol intravenoso e indometacina por vía rectal (n = 24). Grupo 2: paracetamol intravenoso e indometacina por vía rectal (n = 19). Grupo 3: paracetamol y metamizol intravenosos (n = 98). La mayoría de las pacientes de los grupos 1 y 2 reportaron, a las 24 h, una escala visual análoga menor de 3 vs las del grupo 3. Diez de 98 pacientes requirieron tratamiento en el servicio de Anestesiología. CONCLUSIÓN: La administración de indometacina por vía rectal a pacientes histerectomizadas demostró menor dolor que con metamizol y paracetamol, y evolución clínica y alta hospitalaria más temprana.

Abstract: OBJECTIVE: To determine the effectiveness of indomethacin in the treatment of post-hysterectomy pain versus paracetamol or metamizole administered intravenously. MATERIALS AND METHODS: Experimental, comparative and prospective study at the Central Hospital of the State of Chihuahua, period November to December 2019, patients undergoing hysterectomy with complete clinical record, any age. Patients with alterations in the pain threshold, inconsistencies in the file, total non-gynecological hysterectomy were excluded, patients with information limitations were eliminated, which did not allow to relate the dependent variable, with the independent one. RESULTS: 141 patients were collected, which were divided into three groups. Group 1: intravenous metamizole and indomethacin rectally (n = 24). Group 2: intravenous paracetamol and indomethacin rectally (n = 19). Group 3: intravenous paracetamol and metamizole (n = 98). Most of the patients in groups 1 and 2 reported, at 24 hours, a visual analog scale of less than 3 vs those of group 3. Ten of 98 patients required treatment in the Anesthesiology service. CONCLUSION: The administration of indomethacin rectally in postoperative patients of hysterectomy has been shown to reduce pain more effectively than conventional analgesics such as metamizole and paracetamol, relating to clinical evolution and early hospital discharge.

Seguridad de la sedación con propofol administrado por gastroenterólogos en endoscopia digestiva / Safety of propofol sedation administered by gastroenterologists in digestive endoscopy

Resumen Objetivo: tradicionalmente, la sedación con propofol ha estado a cargo de especialistas en anestesiología; sin embargo, una extensa cantidad de información publicada ha demostrado que la sedación con propofol administrado por no anestesiólogos, es segura y eficaz. El estudio se realizó con el objetivo de evaluar la seguridad en la administración de propofol por gastroenterólogos, para la realización de procedimientos en endoscopia digestiva. Métodos: se hizo un estudio retrospectivo en el cual se revisaron los expedientes de 1135 pacientes sometidos a endoscopias digestivas diagnósticas y terapéuticas, en el período comprendido entre enero de 2016 y marzo de 2017. Los pacientes se organizaron por su: edad, género, clasificación de riesgo de la Sociedad Americana de Anestesiólogos, indicación para la endoscopia, y dosis utilizada de propofol. Se registraron los efectos adversos asociados al uso de Propofol, tales como: episodios de hipoxemia transitoria, complicaciones cardiopulmonares serias y muerte. Resultados: se incluyeron los datos de 1135 pacientes (56 % fueron mujeres) que se practicaron endoscopia digestiva bajo sedación con propofol administrado por gastroenterólogos, en un período de 14 meses. La dosis promedio utilizada de propofol fue de 154 +/- 66 mg. Según la clasificación de riesgo de la Sociedad Americana de Anestesiólogos, el 84 % de los pacientes corresponde a las clasificaciones I y II, un 14,8 % a pacientes con clasificación de riesgo III y un 1,1 %, riesgo IV. Los estudios efectuados fueron mayoritariamente gastroscopias (52,6 %) y según la indicación, el 79,6 % corresponde a estudios diagnósticos, seguido de un 12,1% para los sangrados digestivos altos de emergencia. En cuanto a las complicaciones documentadas, se identificaron 70 episodios de hipoxemia que corresponden a un 6,2 % de las sedaciones realizadas. (IC 95%, 4,7-7,6). Solamente un 3,7 % de los pacientes presentó un episodio de hipoxemia por debajo del 80 %. Todos los episodios de hipoxemia, excepto uno, resolvieron con maniobras simples, como la elevación del mentón. Durante el estudio no se presentaron complicaciones cardiopulmonares serias o muertes. Se identificaron, como factores de riesgo para la aparición de hipoxemia, una clasificación de riesgo de la Sociedad Americana de Anestesiólogos mayor a 3, y la realización del estudio endoscópico para dilatación esofágica o colocación de gastrostomía percutánea. Conclusiones: el uso de sedación con propofol administrado por no anestesiólogos en el estudio, no evidenció incremento en la aparición de complicaciones cardiopulmonares serias, ni en los episodios de hipoxemia.

Abstract Aim: Traditionally, sedation with propofol has been approved exclusively for use by anethesiologists, however, an extensive amount of published information has shown that sedation with propofol administered by non-anesthesiologists is safe and effective. The present study was conducted with the objective of evaluating the safety in the administration of propofol by gastroenterologists for the performance of procedures in digestive endoscopy. Methods: A retrospective study was conducted in which the records of 1135 patients who underwent digestive and therapeutic digestive endoscopies were reviewed in the period between January 2016 and March 2017. The patients were classified by age, gender, risk classification of the American Society of Anesthesiologists (ASA), indication for endoscopy, and dose of propofol. The adverse effects associated with the use of propofol were recorded, such as episodes of transient hypoxemia, serious cardiopulmonary complications and death. Results: We included data from 1135 patients (56% were women) who underwent gastrointestinal endoscopy under sedation with propofol administered by gastroenterologist in a period of 14 months. The average dose used for propofol was 154 +/- 66 mg of propofol. According to the American Society of Anesthesiologists risk classification, 84% of the patients correspond to risk I and II, 14.8% to risk level III and 1.1% to risk level IV. The study carried out the most were gastroscopies (52.6%) and according to the indication, 79.6% corresponded to diagnostic studies, followed by 12.1% for upper gastrointestinal bleeding. Regarding the documented complications,70 episodes of hypoxemia were identified, corresponding to 6.2% of the sedations performed. (95% CI, 4.7-7.6). Only 3.7% of patients had an episode of hypoxemia below 80%. All episodes of hypoxemia, except one, resolved with simple maneuvers such as chin elevation. There were no serious cardiopulmonary complications or deaths during the study. We identified as risk factors for the appearance of hypoxemia a risk classification of the American Society of Anesthesiologists greater than 3 and performance of the endoscopic study for esophageal dilation or percutaneous gastrostomy placement. Conclusions: The use of sedation with propofol administered by non-anesthesiologists in the present study did not show an increase in the appearance of serious cardiopulmonary complications, or in episodes of hypoxemia.

The utilization spectrum of cardiac output monitoring devices among anesthesiology programs across Veterans Health Administration in the United States

Background: Electronic monitoring of physiologic variables has gained widespread support over the past decade for critical patients in the intensive care setting. Specifically, anesthesiologists have increased the emphasis and practice of hemodynamic control through monitoring cardiac output (CO). However, these physicians are presented with several options in terms of how they wish to study the trend of this physiologic parameter. Materials and Methods: A survey was distributed to 250 general and subspecialty-trained anesthesiologists. A series of questions were presented in terms of preference of patient monitoring methods requiring yes or no answers. Anesthesiologists were asked about subspecialty training, years since residency graduation, and preferences toward specific hemodynamic monitoring tools. Nonparametric statistical analysis and Chi-squared tests were used to analyze both normal and nonnormally distributed data. Results: CO monitoring devices were implemented by 106 out of 133 anesthesiologists, with 98 of these physicians utilizing CO monitoring for fluid and vasopressors response. Of the physicians implementing a monitoring device, 48 out of 107 physicians preferred pulmonary artery catheter, while pulse contour analysis was preferred by 17 anesthesiologists. An echocardiography unit was available to the department for 90 anesthesiologists, and 77 anesthesiologists were trained to use this technology for monitoring cardiac function. Conclusion: Many anesthesiologists have placed emphasis on the importance of CO monitoring within the intensive care setting. However, physicians are still faced with multiple options in terms of how they wish to specifically monitor this hemodynamic variable. Factors that influence such decisions include the time of physician's residency training along with patient and clinical case characteristics.

Impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists / 中华医学教育探索杂志

Objective To explore the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists in Heilongjiang Province.Methods Questionnaire survey was used for data collection.Descriptive statistics,Pearson correlation analysis and multivariate linear hierarchy regression analysis were performed to analyze the impact of work-family conflict on job satisfaction and turnover intention of anesthesiologists.Results The average value of work-family conflict among anesthesiologists was (2.99 ± 0.57).The finding indicated that work-family conflict of anesthesiologists had a significant negative effect on job satisfaction (β=-0.248,P＜0.01) and a positive effect on turnover intention (β=0.329,P＜0.01).Conclusion Anesthesiologists' work-family conflict is above the middle level in Heilongjiang Province.The work-family conflict of anesthesiologists can reduce job satisfaction and increase turnover intention.

Reflexiones acerca del rol de enfermería especializado en anestesia en uruguay / Reflections about the nursing role specialized in anesthesia in uruguay / Reflexões sobre o papel de enfermagem especializado na anestesia no uruguai

RESUMEN Los ayudantes de anestesia (nombre utilizado en Uruguay para denominar al enfermero técnico en anestesia) son pilar importante en la administración de anestesia segura y de buena calidad al cumplir un rol de asistente del médico anestesiólogo. El objetivo de este trabajo es investigar la situación (roles, entrenamiento académico y responsabilidades) de los enfermeros que realizan tareas de Ayudante de Anestesia en Uruguay. Materiales y métodos: Se realiza recolección de datos mediante una búsqueda bibliográfica no sistemática, una encuesta a enfermeros del área de block quirúrgico en ocho instituciones públicas y privadas del país y una encuesta semidirigida a la Cap. (M) Karina Rando, Ex Profesora Adjunta de la Catedra de Anestesiología (UDELAR) y Jefa de los Servicios de Anestesiología del Hospital Central de las Fuerzas Armadas y del Instituto Nacional de Ortopedia y Traumatología. Resultados: De los datos recolectados podemos afirmar que en Uruguay la educación y entrenamiento del enfermero especializado en anestesiología no es adecuada. No existe educación formal ni tecnicatura especializada y la educación informal se da de manera heterogénea en las diferentes instituciones. Enfermería no especializada es quien cumple mayoritariamente el rol de Ayudante de Anestesia y la educación es incidental e informal, habitualmente impartida por Licenciados/as de Block Quirúrgico o médicos Anestesiólogos. Conclusiones: Si bien hay roles definidos en América Latina para los Ayudantes de Anestesia, no hay en Uruguay una educación acorde a las exigencias requeridas en dichos roles.

SUMMARY Anaesthesia assistants (the name used in Uruguay to name the technical nurse in anesthesia) are an important pillar in the administration of safe and good quality anesthesia when performing an assistant role of the anesthesiologist. The objective of this study is to investigate the situation (roles, academic training and responsibilities) of nurses performing anesthesia assistant tasks in Uruguay. Materials and methods: Data collection was done through a non-systematic bibliographic search, a survey of nurses from the surgical block area in eight public and private institutions in the country, and a semi-directed survey of Cap. (M) Karina Rando, Former Assistant Professor of the Chair of Anesthesiology (UDELAR) and Head of the Anesthesiology Services of the Central Hospital of the Armed Forces and the National Institute of Orthopedics and Traumatology. Results: From the data collected we can affirm that in Uruguay the education and training of the nurse specialized in anesthesiology is not adequate. There is no formal education or specialized technicature and informal education occurs in a heterogeneous way in different institutions. Non-specialized nursing is the one who mostly fulfills the role of anesthesia assistant and education is incidental and informal, usually taught by Surgical Block Graduates or anesthesiologists. Conclusions: Although there are defined roles in Latin America for Anesthesia Assistants, there is no education in Uruguay according to the requirements required in these roles.

RESUMO Assistentes de anestesia (nome usado no Uruguai para nomear a enfermeira anestesia técnica) são pilar importante na administração de anestesia segura e de boa qualidade para desempenhar um papel de assistente anestesista. O objetivo deste trabalho é investigar a situação (papéis, formação acadêmica e responsabilidades) dos enfermeiros que realizam tarefas de anestesia assistencial no Uruguai. Materiais e métodos: A coleta de dados foi realizada por meio de busca bibliográfica não sistemática, levantamento de enfermeiros da área do bloco cirúrgico em oito instituições públicas e privadas do país e levantamento semidirigido do Chap. (M) Karina Rando, Ex Professor Associado do Departamento de Anestesiologia (UDELAR) e Chefe do Hospital Central Serviços Anestesiologia das Forças Armadas e do Instituto Nacional de Ortopedia e Traumatologia. Resultados: A partir dos dados coletados podemos afirmar que no Uruguai a formação e capacitação do enfermeiro especializado em anestesiologia não é adequada. Não há educação formal ou técnica especializada e a educação informal é dada de maneira heterogênea em diferentes instituições. Enfermeira não especializada é aquela que mais desempenha o papel de anestesia assistente e a educação é incidental e informal, geralmente ministrada por graduados em anestesiologistas ou cirurgiões de bloco. Conclusões: Embora existam papéis definidos na América Latina para os Assistentes de Anestesia, não há educação no Uruguai de acordo com os requisitos exigidos nesses papéis.

Efficacy and safety of smoking cessation intervention by anesthesiologists / 临床麻醉学杂志

Objective To assess the efficacy and safety of smoking intervention by anesthesiol-ogists in surgical patients.Methods A total of 182 male patients,aged 18-79 years,ASA grade Ⅰ-Ⅲ,scheduled for elective noncardiovascular and nonthoracic surgery,were assessed preoperatively. Patients were randomized to either the control group or the intervention group,n =91 each.The con-trol group did not receive specific smoking cessation intervention.The intervention group received brief counseling by the anesthesiologist,leaflets on smoking cessation,including pictorial health warning labels,smoking cessation clinic’s smokers’hot line and WeChat public number.Anesthesia methods,operation time,treatment time in PACU,the rate of smoking cessation at 30 days postop-eratively,perioperative complications and smoking status at 30 days postoperatively were recorded. Results One hundred and sixty-six patients were included in the analysis finally.There was no signif-icant difference between two groups in 30 days of follow-up postoperatively.Self-reported smoking re-duction in the postoperative 30 days the intervention group was significantly lower than that in the control group (36.9% vs.22.0%,P <0.05).For smokers,there was a relationship between the lev-el of eCO and the smoking cessation rate,it was 83.3% in the intervention group and 40.0% in the control group (P <0.05).There was no significant difference of overall rate of combined intraopera-tive and immediate postoperative complications between two groups.Conclusion Smoking cessation intervention launched by anesthesiologists promotes 30 days of abstinence postoperatively.

Simulation‑based transthoracic echocardiography: “An anesthesiologist’s perspective”.

With the growing requirement of echocardiography in the perioperative management, the anesthesiologists need to be well trained in transthoracic echocardiography (TTE). Lack of formal, structured teaching program precludes the same. The present article reviews the expanding domain of TTE, simulation‑based TTE training, the advancements, current limitations, and the importance of simulation‑based training for the anesthesiologists.

Síndrome de Burnout en residentes y especialistas de anestesiología / Burnout syndrome in residents and anesthesiologists

El síndrome de Burnout (SB) constituye un tipo de estrés laboral que se observa en profesionales de la salud que mantienen contacto directo y constante con otras personas. El objetivo del estudio fue determinarla prevalencia del síndrome de Burnout en residentes y médicos especialistas del servicio de anestesiología de la Ciudad Hospitalaria “Dr. Enrique Tejera”, periodo enero-julio 2015; distribuirlos según edad, cargo, centro de trabajo, años laborales; determinar su situación emocional según el agotamiento emocional, despersonalización y realización personal; además, diagnosticar el nivel de estrés laboral de los mismos. Se realizó una investigación de tipo descriptivo, con diseño de campo y transversal, cuya muestra estuvo constituida por la totalidad de la población, 64 médicos entre especialistas y residentes, previa firma de un consentimiento informado. Se utilizó el cuestionario de Maslach Burnout Inventory, para indagar la presencia del SB. Los resultados arrojaron la presencia de SB en un 64,1% de los médicos encuestados, siendo mayor en los residentes 73,3%, hubo predominio del género femenino 62,5%; en lo referente a cansancio emocional 34,4%, despersonalización 39,1% y falta de realización personal 81,2%. Se concluyó que el SB es prevalente en las tres cuartas partes de los médicos, que además tenían 32 años o menos, seis de cada diez eran mujeres y poco más de la mitad eran médicos residentes, demostrándose la necesidad de mejorar las condiciones de trabajo del servicio de anestesiología.

Burnout syndrome (BS) is a kind of occupational stress that is observed in health professionals who maintain direct and constant contact with others. The aim of the study wasdetermine the prevalence of Burnout syndrome in residents and medical service specialists of anesthesiology at the City Hospital “Dr. Enrique Tejera”, period January-July 2015; distribuit them according to age, office, workplace, working years; also the emotional situation as emotional exhaustion, depersonalization and personal accomplishment was determined, besides the level of work stress of them was diagnosed. It was made a descriptive, with field design and transversal research, whose sample consisted of the entire population, 64 medical specialists and residents, after signing an informed consent. The Maslach Burnout Inventory questionnaire was used to investigate the presence of BS. The results showed the presence of BS in 64.1% of the surveyed physicians, being higher in residents with 73.3%, there was predominance of female 62.5%; in terms of emotional exhaustion 34.4 %, depersonalization 39.1% and lack of personal fulfillment 81.2%. It was concluded that BS is prevalent in the three quarters of doctors, who also had 32 years or less, six out of ten were women and just over half were resident physicians, demonstrating the need for better working conditions of anesthesiology service.

Prevalence of carotid artery stenosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting for coronary artery disease: Role of anesthesiologist in preoperative assessment and intraoperative management.

Objective(s): This study aimed to determine the prevalence of carotid artery stenosis (CAS) due to atherosclerosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting (CABG) for coronary artery disease (CAD). It contemplated a greater role for the cardiac anesthesiologist in the perioperative management of such patients with either previously undiagnosed carotid artery disease or towards re-assessment of severity of CAS. Design: Prospective, observational clinical study. Setting: Operation room of a cardiac surgery centre of a tertiary teaching hospital. Participants: A hundred adult patients with New York Heart Association (NYHA) classification I to III presenting electively for CABG. Interventions: All patients included in this study were subjected to ultrasonic examination by means of acarotid doppler scan to access for presence of CAS just prior to induction of general anesthesia. Measurements and Main Results: Based on parameters measured using carotid doppler, the presence of CAS was defined using standard criteria. The prevalence of CAS was found to be as high as 38% amongst the patients included in our study. The risk factors for CAS were identified to be advanced age, history of smoking, diabetes mellitus, dyslipidaemia and presence of a carotid bruit. Conclusion: This study points towards the relatively wide prevalence of carotid artery disease in neurologically asymptomatic patients undergoing CABG for CAD in the elective setting. It highlights the need to routinely incorporate carotid ultrasonography in the armamentarium of the cardiac anesthesiologist as standard of care for all patients presenting for CABG.

Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea

BACKGROUND/AIMS: This study sought to characterize the current sedation practices of Korean endoscopists in real-world settings. METHODS: All active members of the Korean Society of Gastrointestinal Endoscopy were invited to complete an anonymous 35-item questionnaire. RESULTS: The overall response rate was 22.7% (1,332/5,860). Propofol-based sedation was the dominant method used in both elective esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard sedation in both examinations (all p<0.001). The use of propofol was supervised exclusively by endoscopists (98.6%). Endoscopists practicing in nonacademic settings, gastroenterologists, or endoscopists with <10 years of endoscopic practice were more likely to use propofol than were their counterparts (all p<0.001). In total, 27.3% of all respondents performed sedation practices without having undergone sedation training, and 27.4% did so without any formal sedation protocols. The choice of propofol as the dominant sedation method was the only significant predictor of endoscopist experience with serious sedation-related adverse events (odds ratio, 1.854; 95% confidence interval, 1.414 to 2.432). CONCLUSIONS: Endoscopist-directed propofol administration is the predominant sedation method used in Korea. This survey strongly suggests that there is much room for quality improvement regarding sedation training and patient vigilance in endoscopist-directed sedation.

Current supply and future workforce projections of anesthesiologists for safe anesthetic care of the Korean population

BACKGROUND: Recently, current or potential shortage and regional imbalance of anesthesiologists have become controversial issues due to political reasons. Thus, we examined the occurrence of current shortage of anesthesiologists in non-capital areas and forecasted the supply of anesthesiologists in the target period between 2020 and 2025. METHODS: In November 2015, membership data including the type of anesthesia service, age, and regional distribution of the Korean Society of Anesthesiologists (accounting for 73.7% of all anesthesiologists) was renewed. Excepting unidentified members (n = 231), previous data from the 2007 survey were used for analysis. Future workforce projections were determined by adding the number of new anesthesiologists minus the predicted number of anesthesiologists who will retire or die in the targeted period. RESULTS: In 2015, the cumulative number of anesthesiologists was 4,826. The available anesthesiologists in our country numbered 4,515. Of these, 2,675 anesthesiologists (59.2%) have provided surgical anesthesia services with centralization of the capital region (58.1%). The number of the available anesthesiologists in our country were expected to be 4,585 and 5,478 in 2020 and 2025, respectively. CONCLUSIONS: The regional distribution of anesthesia services reported by the Health Insurance Report indicated a current centralization of anesthesiologists in the capital region, as a result of anesthesia demand concentration in this area. The age composition of current anesthesiologists as well as the numeric trends of trainees acquiring professional license indicated a stable supply of anesthesiologists over the next 10 years.