Substance abuse in anaesthetists.

PURPOSE OF REVIEW: Anaesthesiologists have a significantly higher frequency of substance abuse by a factor of nearly 3 when compared with other physicians. This is still a current problem that must be reviewed. RECENT FINDINGS: Many hypotheses have been formulated to explain why anaesthesiologists appear to be more susceptible to substance abuse than other medical professionals (genetic differences in sensitivity to opioids, stress, the association between chemical dependence and other psychopathology or the second-hand exposure hypothesis). Environmental exposure and sensitization may be an important risk factor in physician addiction. There is a long debate about returning to work for an anaesthetist who has been depending on opioid drugs, and recent debates are discussed. Institutional efforts have been made in many countries and physician health programmes have been developed. SUMMARY: As drug abuse among anaesthesiologists has continued, new studies have been conducted to know the theories about susceptibility. Written substance abuse policies and controls must be taken in place and in all countries.

Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.

OBJECTIVE: Despite the use of thoracic epidural analgesia, a constant severe ache occurs in the ipsilateral shoulder of almost 75% of patients after thoracotomy. The aim of this prospective-randomized study was to investigate the effect of phrenic nerve infiltration (PNI) compared with suprascapular nerve block (SNB) on ipsilateral shoulder pain after thoracic surgery. METHODS: After Local Research Ethics Committee approval, written informed consent was obtained from 90 adult patients undergoing thoracotomy for pulmonary resection. Patients were excluded if they had preexisting shoulder pain, were unable to understand the visual analog scale (VAS) scoring system or due to failure of epidural analgesia. The phrenic group (PNI) received 10 ml of 2% lidocaine infiltrated into the periphrenic fat pad, 1-2 cm close to the diaphragm, just before chest closure. The suprascapular group (SNB) received 10 ml of 0.5% plain bupivacaine injected into the suprascapular fossa once the surgery was finished. A blinded observer to the study group assessed the patient's shoulder and thoracotomy pain, using the VAS score and a five-point observer verbal rating score (OVRS), at 0.5, 1, 2, 3, 4, 5, 6, 12, 48, and 72 h after surgery and at discharge. The time and dose of any administered analgesic medication were recorded. RESULTS: Finally, 74 patients were included (37 per group). Sixteen patients were excluded (unable to understand scoring system, failure of the epidural technique, and lost data). There were no significant differences in age, gender, body mass index, type/duration of operation, and pain scores at rest, between the two groups. Shoulder pain intensity was significantly lower in the PNI group compared with the SNB group (median value of VAS area under the curve for the PNI group: 8.1 (0-70.9)cm vs 114.3 (43.8-193.8)cm for the SNB group; p < 0.001). There were no significant differences between the two groups according to postoperative thoracotomy pain. CONCLUSIONS: Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal-diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve.

[Anesthesia in thoracic surgery in Catalonia: results of a survey carried out in 2003]. / Actividad anestésica en cirugía torácica en Cataluña. Resultados de una encuesta realizada durante 2003.

OBJECTIVE: To determine the anesthetic, surgical, and postoperative characteristics of patients who underwent thoracic surgery in Catalonia, Spain, in 2003. MATERIAL AND METHODS: A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. All hospitals performing thoracic surgery in Catalonia took part. Data were collected on patient characteristics, anesthetic techniques, procedures, analgesia, and postoperative care. RESULTS: Data on 171 anesthetic procedures in thoracic surgery were collected from 27 hospitals; these procedures represented 0.7% of the total anesthetic workload. Extrapolation from the collected data indicated that 4458 anesthetic procedures were performed in thoracic surgery in 2003 (95% confidence interval, 3624-4823 procedures). Of these procedures, 75.4% were performed in public hospitals and 24.6% in private hospitals. The median age of patients was 55 years (10th-90th percentiles, 22.4-73 years) and 63.9% were men. Surgical procedures were scheduled in 92.8% of the cases. The most common interventions were lung and bronchial surgery other than resection (36.8%), lung and/or bronchial resection (24.6%), and thoracoscopy and mediastinoscopy (20.5%). The median duration of pneumonectomies and lobectomies was 180 minutes (10th-90th percentiles, 90-221 minutes). General anesthesia was the most commonly used procedure (74.3%). Postoperative recovery took place in a conventional recovery room in 54.4% of cases, in a postanesthetic intensive care unit in 33.3% of cases, and in an intensive care unit in 12.3% of cases. CONCLUSIONS: This survey provided information on anesthesia in thoracic surgery, which represented 0.7% of all anesthesia procedures in an area with a population of 7 million.

[Selective lobar blockade using an arndt endobronchial blocker in 2 patients with respiratory compromise who underwent lung resection]. / Bloqueo lobular selectivo mediante el bloqueador bronquial de Arndt en 2 pacientes con compromiso respiratorio sometidos a resección pulmonar.

Selective lobar blockade is an alternative to one-lung ventilation in thoracic surgery. We present 2 cases of lung resection with severe respiratory compromise. The first patient had previously undergone a left lower lobectomy and 2 atypical resections in the left and right upper lobes and was scheduled for a right lower lobectomy. The second patient presented chronic obstructive pulmonary disease with forced vital capacity of 1200 mL (26% of predicted value) and forced expiratory volume in 1 second of 820 mL (25% of predicted value) and was scheduled for an atypical resection of the left upper lobe with pleural abrasion. Selective lobar blockade was achieved in both cases using an Arndt endobronchial blocker. Ventilation during the operation was sufficient. Surgery was uneventful in both cases and lobar collapse was satisfactory.