Challenges of acute pain management in older patients.

Adequate management of acute pain in the older population is crucial. However, it is inherently complex because of multiple physiological changes that significantly impact both the pharmacokinetics and pharmacodynamics of medications. Current guidelines promote paracetamol as the first-line analgesic for acute pain in older adults, whereas opioids are advised cautiously for moderate to severe acute pain. However, opioids come with a significant array of side effects, which can be more pronounced in older individuals. Ketamine administered via intranasal (IN) and nebulised inhalation in the emergency department for managing acute pain in older patients shows promising potential for improving pain management and reducing opioid reliance Kampan, Thong-on, Sri-on (2024, Age Ageing, 53, afad255). Nebulised ketamine appears superior in terms of adverse event incidence. However, the adoption of IN or nebulised ketamine in older adult acute pain management remains unclear because of the lack of definitive conclusions and clear guidelines. Nevertheless, these modalities can be valuable options for patients where opioid analgesics are contraindicated or when intravenous morphine titration is impractical or contraindicated. Here, we review these concepts, the latest evidence and propose avenues for research.

A cross-sectional survey to explore the prevalence and causes of occupational burnout syndrome among perioperative nurses in Saudi Arabia.

Aim: To detect the level of burnout and its most significant causes among perioperative nurses. Design: A descriptive quantitative cross-sectional survey design. Methods: Data on burnout and its most significant causes were collected by surveying 39 perioperative nurses in a regional hospital in Saudi Arabia using the Maslach Burnout Inventory and a self-developed questionnaire. Descriptive statistics were used to perform statistical analysis. Results: Burnout was detected in 5% of respondents. A high level of emotional exhaustion was detected in 87.2%. Similarly, a high level of depersonalization was detected in 56.4%, while 15.4% of nurses showed a low sense of personal accomplishment. Several factors were identified as the causes of burnout such as high workload, staff shortage, poor teamwork, insufficient salary and occupational hazards. However, lack of departmental support and undesirable supervision in the workplace seem to be the main causes of burnout.

The prevalence and the most significant sources of occupational burnout syndrome amongst anesthetic technicians in Saudi Arabia: A cross-sectional survey.

AIMS: To detect the prevalence and the most significant sources of occupational burnout syndrome among anesthetic technicians in Saudi Arabia and draw recommendations that can reduce the level of this syndrome. SETTINGS AND DESIGN: A cross-sectional descriptive survey was conducted in a central hospital in Saudi Arabia. METHODS: Maslach Burnout Inventory and a self-created questionnaire was utilized to survey seventeen anesthesia technicians in order to capture the prevalence and most significant sources of burnout. STATISTICAL ANALYSIS USED: Descriptive statistics were utilized to conduct the statistical analysis. RESULTS: Occupational burnout syndrome has been found in 29%. A level of emotional exhaustion was critically high in 41.2%. Likewise, a level of depersonalization was extremely high in 58.8%, while 76.5% of anesthetic technicians lacked personal accomplishments. There are several sources perceived by anesthetic technicians as the most significant sources of their occupational burnout syndrome. These sources include staff shortage, high workload, occupational hazards, and poor teamwork. However, the limited career pathway of anesthesia technicians seems to be the main predictor. CONCLUSIONS: A critically high prevalence of occupational burnout syndrome was found among anesthetic technicians, which is the highest among all studies reviewed worldwide. Several recommendations have been made which require urgent implementation into practice in order to protected practitioners' wellbeing and decrease their rate of turnover. These recommendations include implementing physician-led team-based care, provision of training and resources, fostering equity in a workplace and provision of hazard pay.