Impact of the SARS-CoV-2 pandemic on Colombian anesthesiologists: Survey study / Impacto de la pandemia por SARS-CoV-2 en anestesiólogos colombianos. Estudio de encuesta

Abstract Introduction: The practice of anesthesiology during the COVlD-i9/SARS-CoV-2 pandemic has had a psychological impact, and has been associated with ethical dilemmas, work overload, and occupational risk. Objective: To understand different problems affecting anesthesiologists, in particular with regards to professional ethics in the decision-making process, increased personal workload, and the potential risk in terms of their own safety and health, as a consequence of working during the COVlD-19 pandemic. Methods: Observational, descriptive, cross-sectional study. A survey was administered to anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), to enquire about work hours, occupational safety, prevention standards and strategies, and ethical aspects involved in decision making during the COVID-19 pandemic. Results: 218 anesthesiologist participated in the survey. Most of the respondents felt that there was not a significant increase in their workload, except for those in critical care (42.5 %; n = 17). Most of the participants believe that leisure time is not enough. 55.96 % (n = 122) of the participants said they felt moderately safe with the biosecurity measures, but with a higher risk of contagion versus other practitioners, with 72.9 % (n = 159) responding that they used their own money to buy personal protection equipment (PPE). There was also evidence that one fourth of the respondents has faced ethical dilemmas during the resuscitation of SARS-CoV-2 - infected patients. Conclusions: The information gathered is a preliminary approach to the situation arising in Colombia as a result of the pandemic; it is clear that anesthesiologists perceive higher associated lack of safety due to different factors such as higher risk of infection, shortage of PPEs and burnout, inter alia. Hence we believe that it is fundamental to acknowledge the work of all anesthesiologists and understand the impact that the pandemic has had on this group of professionals.

Resumen Introducción: El ejercicio de la anestesiología durante la pandemia por COVID-i9/SARS-CoV-2 ha tenido un impacto psicológico y ha estado asociado a dilemas éticos, aumento en la sobrecarga y riesgo laboral. Objetivo: Comprender distintos problemas en los que se han visto envueltos los médicos anestesiólogos, en especial los relacionados con su ética profesional en el proceso de tomar decisiones, el aumento en la carga personal y el posible riesgo de su seguridad y salud como consecuencia de su labor durante la pandemia por COVID-19. Métodos: Estudio observacional, descriptivo, de corte transversal. Por medio de una encuesta, aplicada a anestesiólogos afiliados a la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), se indagó acerca de jornadas laborales, seguridad laboral, normas y estrategias de prevención, y aspectos éticos vinculados con la toma de decisiones durante la pandemia por COVID-19. Resultados: Participaron 218 anestesiólogos. La mayoría de los encuestados consideró que no hubo aumento significativo en su carga laboral, excepto aquellos que ejercen en cuidado crítico (42,5 %; n = 17). La mayoría de los participantes consideran que el tiempo de descanso no es suficiente. Un 55,96 % (n = 122) de los participantes, refieren sentirse moderadamente seguros con las medidas de bioseguridad, pero con un mayor riesgo de contagio frente a otros profesionales, con un 72,9 % (n = 159) y manifestaron haber invertido de sus propios recursos para la adquisición de elementos de protección personal (EPP). Así mismo, se evidenció que una cuarta parte de los entrevistados se ha enfrentado a dilemas éticos durante la reanimación de pacientes infectados por SARS-CoV-2. Conclusiones: La información obtenida hace un acercamiento inicial a la problemática generada en Colombia por la pandemia, donde es evidente que los anestesiólogos perciben una mayor inseguridad asociada, debido a diversos factores como mayor riesgo de infección, insuficiencia de EPP y burnout, entre otros. Por ende, creemos que es fundamental reconocer el trabajo de todos los anestesiólogos, y comprender el impacto que la pandemia ha tenido en estos profesionales.

Suicide in Colombian anesthesiologists. National survey study / Suicidio en anestesiólogos colombianos. Estudio de encuesta nacional

Abstract Introduction The risk of suicide among anesthesiologists seems to be higher than in other areas of specialization, probably because of the significant stress associated with this specialty, easy access to strong medications and the profound knowledge about the use of these drugs. There is a poor knowledge about the impact of suicide on anesthesiologists in Colombia and the resources available to deal with this situation are limited. Objective This survey is intended to indirectly identify the frequency of suicide among the Colombian anesthesiologists and the experiences associated with the suicide of a colleague. Methods Observational, cross-sectional study based on a survey administered to all the anesthesiologists members of the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), at a national scale. Results 403 anesthesiologists completed the survey. Eighty (19.8 %) of the respondents said they were aware of the death of at least one colleague that committed suicide. Most of them are male anesthesiologists or intensivists, and the age group with the highest rate of reports is between 25 - 29 years old in males. The primary causal mechanism was opioid overdose (58.5 %). Conclusions In an indirect characterization of suicide among Colombian anesthesiologists, 99 suicide reports were identified corresponding to 80 anesthesiologists. Suicide is preventable and the worksite should provide the support mechanisms required to identify occupational stress, drug dependence, depression and suicide.

Resumen Introducción: El riesgo de suicidio entre anestesiólogos parece ser mayor que el que se presenta en otras especialidades, posiblemente debido al elevado estrés asociado con la especialidad, al fácil acceso a medicamentos potentes y al conocimiento íntimo de cómo usarlos. En Colombia poco se sabe sobre el impacto del suicidio de un colega en un departamento de anestesia y los recursos disponibles para afrontar esta situación. Objetivo: Con esta encuesta se buscó identificar de manera indirecta la frecuencia de suicidio entre anestesiólogos colombianos y las experiencias relacionadas con el suicidio de un colega. Métodos: Estudio observacional de corte transversal de tipo encuesta aplicada a todos los anestesiólogos afiliados a la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) a escala nacional. Resultados: Se obtuvo respuesta de 403 anestesiólogos. Ochenta (19,8 %) participantes indicaron tener conocimiento de la muerte por suicidio de al menos un colega. La mayoría corresponden a anestesiólogos o intensivistas de sexo masculino, y el grupo etario con mayor número de reportes es el de 25 a 29 años para el sexo masculino. El principal mecanismo causal identificado fue la intoxicación por opioides (58,5 %). Conclusiones: En una caracterización indirecta del suicidio en anestesiólogos colombianos se encontraron 99 informes de suicidio reportados por 80 anestesiólogos. El suicidio es prevenible, en los sitios de trabajo deben existir los mecanismos de apoyo para la identificación del estrés laboral, la farmacodependencia, la depresión y el suicidio.

Primary total hip arthroplasty in elderly patients over 85 years old: risks, complications and medium-long term results. / Artroplastia total primaria de cadera en pacientes mayores de 85 años: riesgos, complicaciones y resultados a medio-largo plazo.

INTRODUCTION: The elderly population candidate for total hip arthroplasty (THA) is increasing exponentially in developed countries, due to the high prevalence of osteoarthritis (OA). The objective is to identify the overall survival in patients over 85 years with primary OA who underwent THA. MATERIAL AND METHODS: Retrospective observational study in patients over 85 years with primary hip OA undergoing THA between 2012 and 2019. Demographic, clinical, comorbidity, complications, functionality and pain variables were collected. A descriptive analysis was performed, survival was estimated with the Kaplan-Meier method and the differences in pain and functionality before and after surgery with the McNemar-Bowker test. RESULTS: We included 66 patients, 40 women and 26 men with a mean age of 87.22 years, of whom 15 had high comorbidity (Charlson>2). Only 14 patients presented complications in the postoperative period, the most frequent was confusional syndrome (5); and the most serious was a death (1), with a median hospital stay of 8 days. Two cases of dislocation were detected over a mean follow-up of 3.61 years, without requiring revision surgery. Improvement of pain was evident after surgery (p<.0001). The median overall survival is 6.77 years, with no difference in survival adjusted by the Charlson index (p=.75) or by ASA anaesthetic group (p=.23). CONCLUSIONS: With good patient selection, THA is a good option for patients over 85 years of age with functional limitations or pain due to OA.

A 10 años de la emergencia sanitaria anestésico-quirúrgica en Uruguay. Comparación de los resultados de la oferta actual con la proyectada en 2011 / 10 years after the anesthetic-surgical health emergency in Uruguay. Comparison of the results of the current offer with that projected in 2011 / 10 anos após a emergência de saúde anestésico-cirúrgica no Uruguai. Comparação dos resultados da oferta atual com a projetada para 2011

Resumen: Introducción: durante el 2011 se propuso un modelo de simulación para valorar la oferta, la relación demanda/necesidades y las tendencias en el tiempo de anestesiólogos y establecer escenarios posibles. Objetivo: comparar la oferta actual de anestesiólogos con la proyectada por el modelo de simulación en el año 2011. Material y métodos: se realizó una actualización a partir de las bases de datos disponibles. Se registró número de anestesiólogos titulados y no titulados, su distribución demográfica y se comparó con los escenarios propuestos en un estudio anterior. Resultados: la tasa de médicos con competencias en anestesiología fue de 14,2/100.000 habitantes y la de anestesiólogos titulados 12/100.000. La distribución de edad presentó una mediana de 54 años, el 90% central se encontraba entre 36 y 75 años. El 57% correspondió a mujeres. 21,8 anestesistas/100.000 habitantes corresponden a Montevideo y área metropolitana contra 7/100.000 en el resto del país. Hubo un incremento promedio del 50% en el número de plazas para la formación, un aumento de solicitudes de reválida (11 en el período estudiado) y un incremento del 17,5% de la producción quirúrgica en el subsector público. Conclusiones: el número de anestesiólogos disponibles en el año 2020 sugirió que la proyección realizada en dos de los escenarios propuestos en investigación anterior reprodujeron adecuadamente la oferta real. Se observó un crecimiento de la participación de mujeres, mayor porcentaje en franjas etarias menores, centralización de los recursos humanos en Montevideo y una edad de retiro mayor. La principal limitación sigue siendo contar con información oportuna y de calidad. Es fundamental la utilización de metodologías rigurosas y de aplicaión sistemática para que quienes planifican puedan tomar decisiones informadas.

Summary: Introduction: during 2011 a simulation method was proposed to assess the needs and trends over time of anesthesiologists and establish possible scenarios. Objective: compare the current situation with the projections formulated in 2011 by the simulation method to evaluate anesthesiologists' supply and demand. Material and methods: an update of the available databases was revised. The number and demographic distribution of the anesthesiologist workforce were recorded and compared with the proposed scenarios. Results: the number of physicians with anesthesiology skills was 14.2/100.000, and wholly trained anesthesiologists were 12/100.000. The age distribution presented a median of 54 years, the central 90% were between 36 and 75 years old. 57% of the anesthesiologist are females. 21.8 workforce in anesthesiology/100.000 corresponds to Montevideo and the metropolitan area, against 7/100.000 in the rest of the country. There was an average increase of 50% in the number of positions for training, an increase in revalidation applications, and a rise of 17.5% in a surgical procedure in the public subsector. Conclusions: the prediction of the number of anesthesiologists and their characteristics for 2020 coincided with two of the proposed scenarios. We verify a growth in female participation, a higher percentage in younger age groups, centralization of human resources in Montevideo and higher retirement age. The main limitation was access to reliable information.

Resumo: Introdução: durante 2011, foi proposto um modelo de simulação para avaliar a oferta, demanda / necessidades, tendências ao longo do tempo dos anestesiologistas e estabelecer possíveis cenários. Objetivo: comparar a oferta atual de anestesiologistas com a projetada pelo modelo de simulação em 2011. Material e métodos: foi feita uma atualização das bases de dados disponíveis. O número de anestesiologistas licenciados e não certificados e sua distribuição demográfica foram registrados e comparados com os cenários propostos em um estudo anterior. Resultados: a taxa de médicos com habilidades em anestesiologia foi de 14,2/100.000 habitantes e a de anestesiologistas licenciados de 12/100.000. A distribuição de idade apresentou mediana de 54 anos, os centrais 90% estavam entre 36 e 75 anos. 57% correspondiam a mulheres. 21,8 anestesistas / 100.000 habitantes correspondem a Montevidéu e região metropolitana contra 7 / 100.000 no resto do país. Houve um aumento médio de 50% no número de vagas para treinamentos, um aumento nas solicitações de revalidação (11 no período estudado) e um aumento de 17,5% na produção cirúrgica no subsetor público. Conclusões: o número de anestesiologistas disponíveis em 2020 sugeria que a projeção feita em dos cenários propostos em pesquisas anteriores reproduzia adequadamente a oferta real. Houve crescimento da participação feminina, maior percentual nas faixas etárias mais jovens, centralização dos recursos humanos em Montevidéu e maior idade de aposentadoria. A principal limitação continua sendo a disponibilidade de informaçao oportuna e de qualidade. O uso de metodologias rigorosas e sistematicamente aplicadas é essencial para que aqueles que planejam possam tomar decisões informadas.

Visión de las especialidades de anestesia y cirugía en cuba a través de apuntes históricos / Vision of the specialties of anesthesia and surgery in Cuba through historical notes

RESUMEN Introducción: los programas de formación y superación de los profesionales de las Ciencias Médicas se encuentran enfrascados en una revisión profunda, donde el principal aporte de este trabajo está en reconocer las etapas de estos procesos en las especialidades de Anestesia y Reanimación y Cirugía General imbricadas una con la otra. Objetivo: describir las tendencias históricas de las especialidades de Anestesia y Reanimación unida a Cirugía General en el proceso de formación y superación de estos profesionales en la evaluación preoperatoria del paciente quirúrgico. Métodos: se realiza revisión documental y sistemática de fuentes teóricas y empíricas de artículos con carácter histórico, para la reconstrucción del pasado de manera objetiva a través de la recolección, evaluación, verificación y síntesis de las evidencias existentes que hacían referencia al tema en cuestión, como la formación y superación de estos especialistas. Conclusiones: la cirugía en Cuba ha tenido un progreso mantenido a lo largo de la historia, cuya magnitud ha sido consecuente con el grado de desarrollo de la sociedad y de las limitaciones externas e internas, donde la formación de los cirujanos generales en Cuba comienza a partir del siglo XVII. El nacimiento de la anestesia como ciencia fue el fruto y el esfuerzo de cirujanos que no querían que sus pacientes sufrieran del dolor durante la intervención quirúrgica.

ABSTRACT Introduction: the training and upgrading programs for professionals in the medical sciences are currently undergoing a thorough review, where the main contribution of this work is to recognize the stages of these processes in the specialties of Anesthesia and Resuscitation together with General Surgery, which are intertwined with each other. Objective: to describe the historical trends of the specialties of Anesthesia and Resuscitation together with General Surgery in the process of training and upgrading of these professionals in the preoperative assessment of the surgical patient. Methods: to carry out a documentary and systematic review of theoretical and empirical sources of historical articles for the reconstruction of the past in an objective manner through the collection, assessment, verification and synthesis of existing evidence that would reference the subject in question, such as the training and upgrading syllabuses of these specialists. Conclusions: surgery in Cuba has had a maintained progress throughout history, whose magnitude has been consistent with the degree of development of the society and the external and internal limitations, where the training of general surgeons in Cuba begins from the 17th century. The origin of anesthesia as a science was the fruit and efforts of surgeons who did not want their patients to suffer from pain during the surgery.

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.

Patient safety climate in operating rooms at Colombian hospitals: differences by profession and type of contract / Clima de seguridad del paciente en unidades quirúrgicas de hospitales colombianos: diferencias por profesión y tipo de contratación

Abstract Introduction: The safety climate (SC) measurement in the hospitals, is essential for the development of a patient safety policy (PSP). Information about SC in the operating rooms is scarce. Objective: To measure the dimensions of SC in Colombian Operating Rooms according to characteristics of surgical staff. Methods: Cross-sectional study. The Hospital Survey on Patient Safety and an additional module for operating rooms were administered to healthcare workers in 6 high-complexity hospitals in the Metropolitan Area of Medellín (Colombia). The positive responses percentage for each dimension was measured. Differences by profession and type of contract were analyzed. Results: A total of442 participants were included. The workers in the operating rooms perceive a weak SC in terms of non-punitive response to error and workload (49.4% and 59.3% positive responses, respectively). Differences were found between physicians and nurses with lower scores in nursing for dimensions related to patient care. Anesthesiologists present low scores in events reporting. There are also differences by the type of work contract. Conclusion: Despite the PSP, the perception of a punitive culture to error, with a high workload. Recognizing differences between the groups within the surgical units helps to focus interventions strengthening the patient safety.

Resumen Introducción: La medición del clima de seguridad (CS) en las instituciones de salud es parte fundamental del desarrollo de una política de seguridad del paciente (PSP). Existe poca información acerca de la medición de clima de seguridad en las unidades quirúrgicas. Objetivo: Medir las dimensiones del CS en las unidades quirúrgicas de seis instituciones de salud colombianas según las características del personal. Métodos: Estudio de corte transversal. El cuestionario sobre seguridad del paciente en los hospitales (HSOPS) más la adición de un módulo para unidades quirúrgicas se aplicó al personal de seis hospitales de III nivel de Medellín (Colombia). Se midió el porcentaje de respuestas positivas para cada dimensión del CS. Se analizaron las diferencias por profesión y tipo de contratación. Resultados: Se incluyeron 442 participantes. El personal de las unidades quirúrgicas percibe un CS débil en respuesta no punitiva al error y carga de trabajo (49,4 % y 59,3 % de respuestas positivas respectivamente). Se encontraron diferencias entre personal médico y de enfermería con puntajes más bajos de percepción de CS en enfermería para aquellas dimensiones relacionadas con cuidado del paciente. Los anestesiólogos presentan puntajes bajos en el reporte de eventos. Existen además diferencias según el tipo de contrato de trabajo. Conclusiones: A pesar de la implementación de políticas de seguridad del paciente, persiste la percepción de una cultura punitiva frente al error, con una carga de trabajo elevado. El reconocimiento de las diferencias entre los grupos en las unidades quirúrgicas permitirá focalizar intervenciones que fortalezcan la seguridad del paciente.

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.

La preparación del residente de Anestesiología y Reanimación para la atención al paciente en shock / The Anesthesiology and Reanimation interns' preparation for the attention to the patient in shock

RESUMEN Fundamento: la preparación del residente en Anestesiología y Reanimación para la atención al paciente en shock es una exigencia curricular. Objetivo: diseñar una vía para potenciar la preparación del residente en Anestesiología y Reanimación para la atención médica integral al paciente en shock. Métodos: se realizó un estudio prospectivo y transversal en el Hospital Dr. Agostinho Neto de Guantánamo durante el curso 2017-2018. Se sistematizaron los referentes teóricos esenciales que sustentaron la definición operacional y la estructuración didáctica del proceso de preparación de este residente. Resultados: se definió y operacionalizó la variable preparación del residente en Anestesiología y Reanimación para la atención médica integral al paciente en shock y se identificaron tres momentos de este proceso: Se implementó un sistema de talleres docentes y de tareas docentes que guían el trabajo metodológico de los profesores para este propósito, que posibilitó que el 83,3 % de los residentes mejorara su preparación para la atención médica integral al paciente en shock. El 100 % de los profesores manifestó conformidad con la propuesta de modelación. Conclusión: se hizo una modelación didáctica del proceso de preparación del residente para esta finalidad, que concebirla puede tributar a una transformación cualitativamente superior del proceso de formación de este profesional, y a la profesionalización pedagógica del profesor.

ABSTRACT Background: the preparation of the intern in Anesthesiology and Reanimation for the attention to the patient in shock is a curricular demand. Objective: to design a way to encourage the preparation of the intern in Anesthesiology and Reanimation for the integral medical care to the patient in shock. Methods: a prospective and traverse study was carried out in the hospital Dr. Agostinho Neto of Guantánamo during the academic year 2017-2018. The relating theoretical essentials that sustained the operational definition and the didactic structuring of the process of this intern's preparationwere systematized. Results: the variable preparation of the intern in Anesthesiology and Reanimation for the integral medical care to the patient in shock was defined and operationalized, and three moments of this process were identified: A system of educational workshops was implemented and of educational tasks that guide the methodological work of the professors for this purpose that facilitated that 83.3% of the interns improved their preparation for the integral medical care to the patient in shock. 100.0% of the professors manifested conformity with the model proposal. Conclusion: a didactic model of the process of preparation of the intern was made for this purpose, while conceiving it can contribute to a transformation qualitatively superior of the process of this professional's formation, and to the professor's pedagogic professionalization.

Vía aérea pediátrica. ¿Tan difícil como dicen? / Pediatric airway: as difficult as they say?

Abstract This article is addressed to those anesthetists who are occasionally faced with pediatric patients, and the anxiety and stress created by the fear of failure in the management of the airway. It aims to present specific concepts for approaching the airway safely. The article describes the importance of adequate airway management in pediatrics; relevant differences with respect to adults; the details of the new classification of the pediatric airway proposed since 2012; and important aspects of the existing airway management algorithms. Considerations that may become a source of failure in securing the airway are pointed out, thoughts about each topic are presented, and conclusions are provided.

Resumen El presente artículo está dirigido a aquellos anestesiólogos que ocasionalmente se enfrentan a pacientes pediátricos generán doles ansiedad y estrés, por el temor a fallar en el manejo de la vía aérea. Tiene como objetivo precisar conceptos para abordar la VA de manera segura. Se describe la importancia del manejo adecuado de la vía aérea en pediatría, las diferencias importantes respecto al adulto, se detalla la nueva clasificación de la vía aérea pediátrica propuesta desde el año 2012, se recopilan puntos importantes de los algoritmos existentes para manejar la vía aérea y se puntualizan aspectos que originan fallas al asegurar la vía aérea. Se hace una reflexión de cada tópico para terminar en las conclusiones.

Prospective analysis of the complications, efficacy, and satisfaction level on the sedation performed by anaesthetists in gastrointestinal endoscopy. / Análisis prospectivo de las complicaciones, eficacia y grado de satisfacción en la sedación realizada por anestesiólogos en endoscopia digestiva.

OBJECTIVE: To describe the anaesthesia/sedation complications during gastrointestinal endoscopy, as well as comparing scheduled procedures versus urgent procedures. METHODS: A protocol was developed to define the anaesthesia/sedation in gastrointestinal endoscopy, where the anaesthetist should always be present. These include ASA 3 and 4 patients, complex tests such as polypectomies, endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound, deep sedation, or patients with probable difficult airway management. An analysis was made of the safety based on the complications recorded from the data directly collected automatically from the monitors, both during the sedation and in the recovery unit. An analysis was also performed on the risk factors associated with cardiorespiratory complications, the effectiveness based on the completed tests and the overall level of satisfaction through an interview using a satisfaction scale. RESULTS: The study included a total of 3746 patients over a 7 year-period. The incidence of major complications was low, especially haemodynamic and respiratory complications. An incidence of hypoxaemia of 3% was found in scheduled endoscopy versus 5.7% in urgent endoscopy (P<.05). The rate of hypotension was also low, with significant differences between scheduled and urgent endoscopy (6.4% vs. 18.8%, P<.001). In present study, no test had to be suspended due to poor patient tolerance, and the satisfaction was high in more than 99% of cases. CONCLUSION: The participation of the anaesthetist in sedation for gastrointestinal endoscopy has shown excellent results in this study, in terms of safety and efficacy, mainly in the most serious patients and complex tests, as well as a high level of satisfaction.

Niveles de contaminación acústica y sus efectos en médicos residentes de anestesiología / Noise pollution levels and its effects on resident physicians of anesthesiology

Determinar niveles de ruido mediante técnicas de sonometría, que resultan propicios parala contaminación acústica en el ambiente quirúrgico de los servicios de Sala de Operaciones de Adultos, Sala de Operaciones de la Emergencia de Adultos, Sala de Operaciones de Pediatría, Sala de Operaciones de Ginecología y Sala de Labor y Partos del Hospital Roosevelt, durante abril ­ mayo de 2017. Material y método: Estudio descriptivo transversal realizado en quirófanos del Hospital Roosevelt donde se utilizó la tercera estrategia de la NTG ­ ISO 9612 para determinar exposición al ruido ocupacional con la participación de 26 médicos residentes de anestesiología a quienes se les aplicó diversos test para identificar efectos cognitivos, trastornos del sueño y de la conducta relacionados a niveles altos de ruido. Resultados: Existe una media energética del sonido en quirófanos de entre 69.8 y 95.4 decibelios. El departamento quirúrgico con más ruido es Labor y Partos con 95.4 decibelios, el tipo de procedimiento con mayor contaminación acústica es la cirugía abdominal. El 53.85% de médicos presenta resultado anormal en pruebas cognitivas, 61.54% posee dificultad media para dormir. No existe evidencia de trastornos conductuales. Conclusiones: Los niveles de ruido en quirófanos sobrepasan al doble de lo recomendado por OMS provocando efectos cognitivos y trastornos del sueño en residentes de anestesiología. El horario fijo de labores es la jornada con mayor polución sonora en quirófanos. La fuente con mayor emisión de ruido dentro del área quirúrgica es el sistema de aspiración (AU)

Purpose: To determine noise levels using sonometric techniques, which are conducive to acoustic contamination in the surgical environment of the Adult Operating Room, Adult Emergency Operating Room, Pediatric Operating Room, Operating Room of Gynecology and Labor and Delivery Room of the Hospital Roosevelt in Guatemala, during the months of April and May, 2017. Population and methods: A cross - sectional descriptive study performed in operating rooms of the Hospital Roosevelt where the third strategy of NTG - ISO 9612 was used to determine exposure to occupational noise with the participation of 26 resident physicians of anesthesiology who were given different tests to identify cognitive effects, sleep disorders and behavior related to high noise levels. Results: There is an energetic mean of the sound in operating rooms between 69.8 and 95.4 decibels. The surgical department with the most noise is Labor and Delivery Room with 95.4 decibels, the procedure with the highest noise emission is abdominal surgery. 53.85% of physicians present abnormal results in cognitive tests, 61.54% have medium difficulty sleeping. There is no evidence of behavioral disorders. Conclusion: Noise levels in operating rooms are more than twice that recommended by whom, causing cognitive effects and sleep disorders in residents of anesthesiology. The fixed work schedule is the day with the greatest sound pollution in operating theaters. The source with the highest noise emission within the surgical area is the aspiration system (AU)

Monitorización de indicadores nacionales de atención quirúrgica en el sistema sanitario peruano / Monitoring of national surgical care indicators in the Peruvian health system

Abstract Surgical care is an integral component of healthcare services in all countries, and its quality is evaluated through monitoring of national indicators of safe surgical and anaesthesia care. In Peru, monitoring is only partial because of the lack of data regarding some of the indicators. However, there is a need for comprehensive monitoring in order to gain knowledge of the progress towards the healthcare goals proposed by the World Health Organisation and The Lancet Commission Global Surgery.

Resumen La atención quirúrgica es un componente integral de los sistemas sanitarios en todos los países, y la valoración de su calidad se realiza a través de la monitorización de indicadores nacionales de atención segura quirúrgica y anestésica. En Perú, esta monitorización se realiza de forma parcial, pues no hay información respecto a algunos indicadores. Sin embargo, debería ser integral para conocer el progreso de los objetivos sanitarios propuestos por la Organización Mundial de la Salud y la Comisión Lancet sobre Cirugía Global.

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.

El nuevo especialista en anestesia y cirugía cardiovascular que queremos formar / The new specialist in anesthesiology and cardiovascular surgery we want to train

Doctor Echeverri: En referencia al artículo del Dr. Juan Carlos Giraldo1 publicado en la Revista Colombiana de Cardiología (abril de 2014), titulado Anestesia cardiovascular: ¿Cardiología en salas de Cirugía? me gustaría darle mis felicitaciones al autor por el interesante enfoque que plantea en la formación de los nuevos anestesiólogos cardiovasculares. La descripción de la evolución del arte y la ciencia a la que se refiere el artículo lleva a los estudiosos a buscar la verdad de cada uno de los postulados esbozados por el autor, contribuyendo con ello al engrandecimiento de esta área de la Medicina. Me parece que cada época trae cambios en los conceptos y visiones en los que se cimienta el ejercicio de la profesión médica, y estos cambios hacen parte del progreso de esta ciencia. Me identifico con la exposición del autor con relación a los cambios que han ocurrido en el área de la anestesia cardiovascular, y además estoy convencido de que sin ellos el quehacer del anestesiólogo y del cirujano cardiovascular sería diferente y el paciente no tendría los beneficios que tiene en la actualidad. También estoy de acuerdo con su visión futura sobre las salas de cirugía y su entorno de trabajo.

Perfil clínico e demográfico de anestesiologistas usuários de álcool e outras drogas atendidos em um serviço pioneiro no Brasil / Clinical and demographic profile of anesthesiologists using alcohol and other drugs under treatment in a pioneering program in Brazil / Perfil clínico y demográfico de los anestesiólogos usuarios de alcohol y otras drogas atendidos en un servicio pionero en Brasil

JUSTIFICATIVA E OBJETIVOS: Anestesiologistas são os mais representados em serviços de atendimento a médicos com transtornos por uso de substâncias psicoativas. O objetivo deste trabalho é apresentar um estudo descritivo sobre o perfil clínico e sociodemográfico de uma amostra de anestesiologistas dependentes químicos atendidos em um serviço de referência, bem como elencar comorbidades psiquiátricas, drogas frequentemente utilizadas e repercussões psicossociais e profissionais do consumo. MÉTODO: Realizou-se estudo transversal, prospectivo, tendo sido aplicadas entrevistas estruturadas para diagnóstico de transtornos mentais e transtornos por uso de substâncias psicoativas, com base na Classificação Internacional de Doenças - Versão 10 - e questionário sócio-ocupacional, aplicados por dois pesquisadores treinados. RESULTADOS: Cinquenta e sete anestesiologistas foram entrevistados, em sua maioria do sexo masculino (77,2%), idade média de 36,1 anos (DP = 8,5). Observou-se uma alta prevalência de uso de opioides (59,6%), benzodiazepínicos (35,1%) e álcool (35,1%). Usuários de opioides procuraram tratamento mais precocemente comparado aos não usuários desta substância e, geralmente, sob influência da pressão de colegas ou do conselho regional de medicina. O uso de drogas como automedicação foi elevado dentro deste subgrupo. CONCLUSÕES: Anestesiologistas podem apresentar um perfil distinto de risco de uso de opioides. O padrão de início de consumo, associado aos anos de residência médica ou aos primeiros anos da prática médica, reforça a hipótese de dependência de opioides como problema ocupacional entre anestesiologistas.

BACKGROUND AND OBJECTIVES: Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD: A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS: Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD = 8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS: Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.

JUSTIFICATIVA Y OBJETIVOS: Los anestesiólogos son los más representados en los servicios de atención a médicos con trastornos por el uso de sustancias psicoactivas. El objetivo de este trabajo, es presentar un estudio descriptivo sobre el perfil clínico y socio-demográfico de una muestra de anestesiólogos dependientes químicos, atendidos en un servicio de referencia, como también discriminar las comorbilidades psiquiátricas, las drogas a menudo utilizadas y las repercusiones psicosociales y profesionales del consumo. MÉTODO: Se hizo un estudio transversal, prospectivo, y se aplicaron entrevistas estructuradas para el diagnóstico de los trastornos mentales y de los trastornos por el uso de sustancias psicoactivas, con base en la Clasificación Internacional de Enfermedades (Versión 10) y cuestionario socio-ocupacional, aplicados por dos investigadores entrenados para tal función. RESULTADOS: Cincuenta y siete anestesiólogos fueron entrevistados, en su mayoría del sexo masculino (77,2%), edad promedio de 36,1 años (DE = 8,5). Se observó una alta prevalencia del uso de opioides (59,6%), benzodiazepínicos (35,1%) y alcohol (35,1%). Los usuarios de opioides buscaron tratamiento más rápidamente si los comparamos con los no usuarios de esa sustancia y generalmente, bajo la influencia de la presión de colegas o del Órgano Regional de Medicina. El uso de drogas como automedicación fue elevado dentro de este subgrupo. CONCLUSIONES: Los anestesiólogos pueden presentar un perfil distinto de riesgo de uso de opioides. El estándar de inicio de consumo, asociado a los años de residencia o a los primeros años de la práctica médica, refuerza la hipótesis de dependencia de opioides como el problema ocupacional entre los anestesiólogos.

Abuso de fármacos anestésicos pelos anestesiologistas / Anesthetic drug abuse by anesthesiologists / Abuso de fármacos anestésicos por parte de los anestesiólogos

JUSTIFICATIVA E OBJETIVOS: O uso de substâncias psicoativas é um pouco mais alto na classe médica comparado à população geral. Dentre as especialidades médicas, a Anestesiologia é uma das mais atingidas, principalmente por excesso de trabalho e maior acesso aos fármacos. O objetivo deste artigo é revisar a literatura sobre o assunto. Para isso, realizou-se uma pesquisa com as palavras-chaves relacionadas ao assunto no MEDLINE, com artigos dos últimos 30 anos. CONTEÚDO: Apesar da droga de maior abuso entre os anestesiologistas ser o álcool, o abuso de agentes anestésicos é o mais preocupante, devido ao alto potencial de dependência, bem como às suas consequências, muitas vezes letais. Os mais usados são os opioides (fentanil e sufentanil), o propofol e os anestésicos inalatórios. Os profissionais mais jovens são os mais afetados. As consequências do uso vão desde afastamento do local de trabalho até morte. A volta à sala de cirurgia parece levar a alto risco de recaída. Programas de tratamento especializado para a classe médica são propostos nos EUA e na Europa, bem como medidas preventivas, como rigidez no controle de fármacos e identificação dos profissionais sob maior risco de abuso. No Brasil, os anestesiologistas são a segunda especialidade que mais consomem substâncias, porém o assunto é pouco estudado e há uma carência de programas especializados na área. CONCLUSÕES: O abuso de substâncias entre os anestesiologistas é um assunto que necessita maior atenção, principalmente devido às consequências graves que este consumo pode acarretar tanto para o profissional como para os pacientes.

BACKGROUND AND OBJECTIVES: Physicians has a slightly higher rate of psychoactive substance use when compared to the population in general. Anesthesiology is one of the most affected medicine specialties, especially due to overwork and easier access to drugs. This paper aims to carry out a literature review on the topic. Therefore, research was conducted by searching topic-related keywords on papers from the last 30 years available on MEDLINE. CONTENT: Despite the fact that alcohol abuse is the most common among anesthesiologists, the abuse of anesthetic agents causes more concern, due to its high dependence potential and consequences, which are often fatal. The most widely used drugs are opioids (fentanyl and sufentanil), propofol and inhalational anesthetics. Young professionals are the most affected. Among the consequences of drug abuse are workplace absence and even death. The return to operating rooms seems to increase the risk of relapse. In Europe and in the USA there are specialized treatment programs for the middle class, as well as preventive measures, such as strict control of drugs and identification of professionals at high risk of abuse. In Brazil, Anesthesiology is the second medicine specialty with most drug addicts, but the topic has not been much studied and there are few specialized programs in the field. CONCLUSIONS: Substance abuse by anesthesiologists is an issue that needs to be discussed further, especially due to the possibility of severe consequences for professionals and patients.

JUSTIFICATIVA Y OBJETIVOS: El uso de sustancias psicoactivas es un poco más alto en la clase médica si lo comparamos con la población en general. Entre las especialidades médicas, la Anestesiología es una de las más afectadas, principalmente por el exceso de trabajo y la mayor facilidad en el acceso a los fármacos. El objetivo de este artículo, es revisar la literatura sobre el asunto. Para eso, se realizó una investigación con las palabras clave relacionadas con el asunto en el MEDLINE, con los artículos de los últimos 30 años. CONTENIDO: A pesar de que la droga de la que más se abusa entre los anestesiólogos sea el alcohol, el abuso de los agentes anestésicos es lo más preocupante, debido al alto potencial de dependencia como también a sus consecuencias, muchas veces letales. Los más usados son los opioides (fentanil y sulfentanil), el propofol y los anestésicos inhalatorios. Los profesionales más jóvenes son los más afectados. Las consecuencias del uso van desde el alejamiento del local de trabajo hasta la muerte. El regreso al quirófano parece llevar a un alto riesgo de recaída. Programas de tratamiento especializado para la clase médica han sido propuestos en USA y en Europa, como también algunas medidas preventivas, como la rigidez en el control de los fármacos y la identificación de los profesionales que tienen un mayor riesgo de abusar de las sustancias. En Brasil, los anestesiólogos son la segunda especialidad que más consume sustancias, sin embargo, el asunto es poco estudiado y hay una falta de programas especializados en esa área. CONCLUSIONES: El abuso de sustancias entre los anestesiólogos es un asunto que necesita más atención, principalmente debido a las graves consecuencias que ése consumo puede acarrear, tanto para el profesional, como para los pacientes.

Avaliação do nível de estresse do anestesiologista da cooperativa de anestesiologia de Sergipe / Assessment of the stress level of anesthesiologists of the Sergipe anesthesiologists cooperative / Evaluación del nivel de estrés del anestesiólogo de la cooperativa de anestesiología de Sergipe

JUSTIFICATIVA E OBJETIVOS: Avaliar o impacto que o estresse gera na saúde ocupacional dos anestesiologistas de Sergipe e propor soluções para melhorar as condições de trabalho, qualidade do serviço realizado e qualidade de vida. MÉTODO: Aplicaram-se o questionário WHOQOL-BREF, a definição do tamanho da amostra pelo método de Barbetta e as comparações entre grupos pelos testes t Student e Análise de Variância, considerando-se significativos valores de p < 5 por cento. RESULTADOS: A pesquisa apresentou que a carga horária média semanal de trabalho é de 61,33 horas. Na análise subjetiva sobre a qualidade de vida, 53,1 por cento dos entrevistados apresentam avaliação negativa ou não estabelecida. No item "lazer", 61,2 por cento responderam que tem pouca ou nenhuma oportunidade, demonstrando consonância com a avaliação de satisfação pessoal e de trabalho. A faixa etária entre 41 e 52 anos foi a que apresentou escores melhores. Não houve diferença significativa com relação a gênero e dias de trabalho semanais. O domínio geral apresentou escores inferiores ao dos demais em todas as variáveis analisadas. CONCLUSÕES: A carga horária excessiva contribui para uma autoavaliação negativa sobre qualidade de vida, além de dificultar o acesso a lazer. A implementação de política de qualidade nas instituições de trabalho, bem como uma reavaliação pessoal em busca de inovação, reciclagem profissional, alternativas de lazer e motivação, são fatores que poderão contribuir para a melhora da qualidade de vida e de trabalho desses profissionais.

BACKGROUND AND OBJECTIVE: To assess the impact caused by stress on occupational health of anesthesiologists in Sergipe and to propose solutions to improve work conditions, quality of the service provided, and quality of life. METHODS: WHOQOL-BREF questionnaire was applied; the sample size was determined by the Barbetta method; and Student t test and Analysis of Variance were used for intergroup comparisons, considering significant a p < 5 percent. RESULTS: This study demonstrated that the mean weekly working hours is 61.33 hours. In the subjective analysis of quality of life, 53.1 percent of the respondents had a negative or non-established evaluation. On the item "leisure activities", 61.2 percent answered they have very few opportunities or none at all, demonstrating agreement with personal satisfaction and working assessment. The age group of 41 to 52 years old had the best scores. A significant difference regarding gender and number of working days/week was not observed. The general domain had lower scores than the others in all variables analyzed. CONCLUSIONS: Excessive working load contributed to a negative self-evaluation on quality of life, besides hindering access to leisure activities. The implementation of a quality policy in work institutions, as well as a personal reevaluation in search of innovation, professional recycling, leisure alternatives, and motivation are factors that can contribute to improve the quality of life and work of these professionals.

JUSTIFICATIVA Y OBJETIVOS: Evaluar el impacto que el estrés genera en la salud ocupacional de los anestesiólogos de Sergipe, y proponer soluciones para la mejoría de las condiciones de trabajo, calidad del servicio realizado y calidad de vida. MÉTODO: Se aplicó el cuestionario WHOQOL-BREF, la definición del tamaño de la muestra por el método de Barbetta, y las comparaciones entre grupos por los test t Student y Análisis de Varianza. Se consideraron significativos los valores de p < 5 por ciento. RESULTADOS: La investigación demostró que la carga horaria promedio semanal de trabajo es de 61,33 horas. En el análisis subjetivo sobre la calidad de vida, un 53,1 por ciento de los entrevistados obtuvieron una evaluación negativa o esa evaluación no se estableció. En el aspecto del ocio, un 61,2 por ciento respondieron que tienen poca o ninguna oportunidad, demostrando estar a tono con la evaluación de la satisfacción personal y de trabajo. El rango etario entre 41 y 52 años fue el que presentó mejores puntuaciones. No hubo diferencia significativa con relación al género y a los días de trabajo semanales. El dominio general presentó puntuaciones inferiores a los demás en todas las variables analizadas. CONCLUSIONES: La carga horaria excesiva aportó una autoevaluación negativa sobre la calidad de vida, además de dificultar el acceso al ocio. La implementación de una política de calidad en las instituciones de trabajo, como también una nueva evaluación personal buscando la innovación, el reciclaje profesional, las alternativas de ocio, y la motivación, son factores que podrán aportar una mejoría de la calidad de vida y de trabajo de esos profesionales.

Prevalencia del Síndrome de Agotamiento Profesional en médicos anestesiólogos de la ciudad de Mexicali / Prevalence of Burnout Syndrome among anesthesiologists in Mexicali

Objetivo: Obtener la prevalencia del Síndrome de Agotamiento Profesional en los médicos anestesiólogos de la ciudad de Mexicali, B.C. México. Material y Métodos: Se realizó un estudio poblacional, transversal y descriptivo, mediante cuestionario autoadministrado de Maslach a 92 médicos anestesiólogos de la ciudad de Mexicali, B.C., durante los meses de octubre del 2001 a febrero del 2002. Análisis estadístico: Chi cuadrada para las variables categóricas. Resultados: Se encuestaron a 22 mujeres y 67 hombres ( n = 89 ) obteniendo prevalencia de 44% con síndrome de agotamiento profesional, de los cuales 17% presentó alto grado de agotamiento emocional, 10% presentó alto grado de despersonalización y el 12.3% presentó baja realización personal. Conclusiones: De lo reportado por otros autores hay diferencias con nuestro estudio, posiblemente por corresponder a otras especialidades. Sugerimos estudios similares en otras ciudades del país para obtener prevalencia en este grupo de médicos especialistas.

Objective: To determine the prevalence of Burnout syndrome among anesthesiologists in Mexicali, Mexico. Study design: We carried out a descriptive, cross sectional study. Burnout syndrome was measured using the Maslach Burnout Inventory Human Services Survey (MBIHSS). We administered the inventory to 92 anesthesiologists between October 2001 and February 2002. Statistical analysis included Chi square tests for categorical variables. Results: 89 questionnaires were returned, 22 females and 67 males. Burnout prevalence was 44% divided as follows: 17% reported high emotional exhaustion, 12.3% reported symptoms compatible with depersonalization, and 10% experienced a sense of low personal accomplishment. Conclusions: Our study differs slightly from the literature, although this may be attributed to the medical specialty we chose to survey. We suggest similar studies be carried out in other cities in Mexico to be able to have comparison groups.

Factores de riesgo organizacionales asociados al síndrome de Burnout en médicos anestesiólogos

resumen está disponible en el texto completo

Abstract: Introduction Burnout Syndrome is considered by the WHO as a worker's risk, that causes mental and physical deterioration (headaches, gastrointestinal illness, high blood pressure, muscular tension and chronic fatigue). This is a result of chronic stress and of the workplace environment, which today is cold, hostile, demanding, both economically and psychologically. People are becoming cynical, with negative feelings toward their patients and their professional roll; they feel emotional exhaustion. This occurs frequently in health workers who deal with people who are dependent. What is the cause of this syndrome that is damaging the community of the workers? It is due to many facts, such as organizations where there is work overload (workload is a dimension of organizational life, this means productivity. In their scramble for increased productivity, organizations push people beyond what they can sustain, making work more intense, demanding more time and becoming more complex; this is the major risk factor, in which is shown an uncorrelation between the people and their work); lack of control (of the capacity to set priorities in their own work, to select and to make decisions regarding resources that are central in the professional roll; politics of the organization that interfere with this capacity, reduce individual autonomy an involvement with work); lack of reward (lack of community harmony, lack of fairness and also value conflict); breakdown of community (the loss of harmony in the community is made evident by greater conflicts among people, less mutual support and respect, and a growing sense of isolation); absence of fairness (trust, openness and respect, are all three, elements of fairness essential to maintain a person's engagement with work. Their absence contributes directly to burnout); conflicting valúes (this occurs when there is no correlation between the sources of workplace and the personal values, in some cases work overload makes people work with no ethics, causing them conflict with their own values). This syndrome has three dimensions: Exhaustion. When people experience exhaustion, they feel overextresed, both emotionally and physically; they feel drained, unable to recover, they don't sleep enough, and lack of energy needed to face new projects. Exhaustion is the first reaction to the stress of job demands or major change. Cynicism. They take a distant attitude toward work and the people on the job. They minimise their involvement at work and even give up their ideals. In some way, this is a form of protecting themselves from exhaustion and disappointment, persons feel it's safer to be indifferent, especially when the future is uncertain. Such a negative attitude can seriously damage a person's well-being and capacity to work. Ineffectiveness. Persons feel a growing sense of inadequacy, every project seems overwhelming, they think everybody conspires against them, and whatever they do, seems to be trivial. They lose confidence in themselves, and at the same time, others lose confidence in them. They become vulnerable to family strangements, and to abandon social activities, they tend to remain alone. By this time they can incur in drug abuse, become mentaly insane, and in extreme cases, comit suicide. The measurement instrument for the diagnosis of Burnout Syndrome is Maslach Burnout Inventory, which allows to sample large populations under this condition; it was developed by Maslach in 1976, and a large number of studies have been developed by this time. Chronic stress could have important effects on the quality of family relationships and have a negative influence in anesthesiology performance as well. Because of this important problem that affects physical condition of illness, mental health and performance and quality of medical services, and also because there are no studies in the anesthesiologist environment, we performed this study to asses burnout among anesthesiologist in the city of Mexicali, Baja California. The object of this study was to determine and evaluate the organizational factors associated to burnout, because anesthesiologist performs at surgery rooms, where they have to manage chronic and sustained stress; moreover they get involved with patients, and are exposed to organizational factors. Burnout may affect mental health, and thus, the performance of the anesthesiologist practice, fact that even may put in serious risk the life of patients. Material and methods Control and cases study was performed, universe included all anesthesiologist in Mexicali City (n=92), excluding thoses that are not active in anesthesiologist practice, and who refused to respond the surveys. Cases group was constituted by anesthesiologists with burnout syndrome and control group was constitute by anesthesiologists without burnout. Sampling was obtained by Cochran's formula obtaining n=28 for each group. Independent variables were vicious organizational factors (work overload, lack of control, lack of reward, breakdown of community, absence of fairness, conflicting values). Dependent variable was Burnout Syndrome. Valídate instruments use were Maslach's Inventory for diagnosis of Burnout and a general sociodemographic inventory, for risk factors. Statistic analysis performed were descriptive analysis, proportion tests for two populations, Odds ratios, and Chi2, at the same time Logistic regression was performed, the statistic program use was BMDP and Epi Info 6. Results First of all, we estimated the prevalence of burnout, excluding three anesthesiologists that refused to answer the inventory test, of 89 persons analyzed we obtained 37 cases, that gives us a prevalance of 44%. The group case was constituted by 23 males and five females, control group by 19 males and 9 females (p>0.05). Mean age of case group was 43.7 years; control group 45.8 years. Civil state for cases group was 85.7% married, 7.1% divorced, 3.5% single, 3.5% not married couple, for control group 71.4% married, 14.3% single, 7.1% widows and 7.1% not married couple; working time for case group range from 24 years to two years, mean age 13.5 years, control group range from 28 years to two years, mean age 16.4 years. For no organizational factors, being married or divorced was a risk for burnout with OR 5.20, having children's was a risk for burnout with OR 33.2, and having more years at work was also significant for developing burnout with OR 1.17. For organizational factors, the two variables for risk for burnout were work overload with p = 0.003, and conflicting values with p = 0.034, the other factors were no significant. Discussion The most important findings of the present study, were that work overload is a factor risk for burnout, this agrees with literature reports, where it is said that work overload is the factor that most affects health workers. In relation to conflicting values it also agrees with Maslach's studies, where the author says that this occurs where there is no correlation between work demand and moral values. In most cases, work overload can lead people to act with no ethics in their work, this creating conflicts with their moral values. In this study conflicting values result in being an protecting factor, considering Maslach's publishing, this is a form that health workers assume to try to protect themselves against exhaustion and deception, thus adopting the form of cynicism. The sieges we can find in this study is the honesty in the answers of the persons, besides this is assume by the inventory, this exist. Another siege is the sample size, but this was affront by an statistic manner. It is so important to continue with new investigation lines, because as long as a medical doctor has good mental and physical health, he will be apt to give qualified attention to patients. At the same time is important that organizations recognize this health problem, so they can provide psychiatric intervention for those medical doctors who are affected by this syndrome, and try also to reestructure their organization in order to avoid this problems.