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.

Estudio multicéntrico sobre el manejo del bloqueo neuromuscular durante la anestesia general en una cohorte de 1.545 pacientes / Neuromuscular block management during general anesthesia in a cohort of 1545 patients: a multicenter study

Introducción: tradicionalmente se ha relacionado el uso de bloqueantes neuromusculares con la posibilidad de aparición de complicaciones respiratorias, aunque establecer este tipo de conclusiones requiere de la elaboración de estudios complejos, con una muestra importante. En este estudio se pretende analizar los datos obtenidos del estudio ARISCAT para ofrecer una visión global del uso de bloqueantes neuromusculares (BNM) y de su reversión en Cataluña. Material y Métodos: de los datos obtenidos en el estudio ARISCAT se han analizado los relacionados con el uso de BNM. Se agruparon a los pacientes en cuatro grupos: NO-BNM si no se había administrado ningún BNM, SC si los pacientes habían recibido únicamente succinilcolina como BNM, BNM-DU si habían recibido una única dosis de BNM no despolarizante y BNM-DR más de una dosis de BNM no despolarizante o administración en perfusión continua. Se analizaron las características demográficas, clínicas y quirúrgicas y las complicaciones intra y postoperatorias en cada uno de los grupos. También se analizaron estas variables en función de si hubo o no reversión. Resultados: de los 2991 pacientes incluidos en el estudio ARISCAT, 1545 fueron sometidos a anestesia general o combinada. De éstos, 1267 (89%) recibieron BNM y en el 54.4% de ellos se realizó reversión con anticolinesterásicos. La distribución de los pacientes fue: NO-BNM (n=103), SC (n=31), BNM-DU (n=527) y BNM DR (n=709). Este último grupo presentó más patología asociada, una duración más prolongada de la cirugía, un mayor número de complicaciones intra y postoperables, y una mayor estancia hospitalaria. La reversión fue significativamente más frecuente en cirugía cardiotorácica y abdominal superior. No se encontraron diferencias en las complicaiones entre ambos grupos. Conclusiones: el uso de bloqueantes neuromusculares no despolarizantes es muy frecuente en Cataluña durante la anestesia general y está asociado a la duración y el tipo de cirugía. El uso de reversión farmacológica de los BNM es relativamente alto en Cataluña respecto a otras zonas geográficas (AU)

BACKGROUND AND OBJECTIVE: Neuromuscular blockers (NMBs) have traditionally been thought to increase the risk of respiratory complications, although drawing conclusions in this respect would require complex studies in large patient samples. The aim of this study was to analyze data from the ARISCAT study to obtain an overall picture of how NMBs are being used and blocks are reversed in Catalonia, Spain. MATERIAL AND METHODS: NMB use as reflected in data from the ARISCAT study was analyzed. Case information from the database was organized into 4 groups: for patients not receiving a NMB (No-NMB), patients whose NMB block was performed with succinylcholine alone (SC), patients who received a single dose of a nondepolarizing NMB (SD-NMB), and patients who received additional doses of a nondepolarizing NMB or a continuous perfusion (AD-NMB). We analyzed patient characteristics, clinical and surgical characteristics, and complications during and after surgery in each of the groups. Variables were also analyzed according to whether the NMB effect had to be reversed. RESULTS: Of the 2991 patients included in the ARISCAT study, 1545 received general or combined anesthesia. Of the 1545 patients, 1267 (89%) received a NMB and the block was reversed with an anticholinesterase agent in 54%. The group distribution was as follows: No-NMB, 103 patients; SC, 31; SD-NMB, 527; and AD-NMB, 709. The highest rate of comorbidity, longest duration of surgery, highest rate of complications during and after surgery, and the longest hospital stays were observed in the last of the 4 groups (AD-NMB). Reversion was required significantly more often after cardiothoracic and upper abdominal surgical procedures; the complication rates after those 2 types of surgery were statistically similar. CONCLUSIONS: Nondepolarizing NMBs are used in combination with general anesthesia often in Catalonia; their use is associated with duration and type of surgery. A reversal drug is administered relatively more often in Catalonia than in other geographic areas (AU)

Comparative study of ropivacaine 0.5% and levobupivacaine 0.33% in axillary brachial plexus block.

BACKGROUND: The aim of this prospective, randomized, double-blind study was to compare the block induced by ropivacaine 0.5% with levobupivacaine 0.33% at the recommended dose range in upper limb surgery. These concentrations have provided equivalent block after epidural analgesia. We hypothesized that the block induced by both local anesthetics at clinical equipotent dose would be similar in axillary block. METHODS: Eighty-six patients received 30 mL of ropivacaine 0.5% (150 mg) or 30 mL of levobupivacaine 0.33% (99 mg) by axillary approach. Sensory and motor blocks were assessed in the 5 main nerve territories of the arm at 2, 5, 10, 15, 20, 25, and 30 mins and every 6 hrs for the first 24 hrs. We used the Student t test and chi test for comparison between groups and an analysis of survival. P < 0.05 was considered statistically significant. RESULTS: Onset of motor block was 9.0 mins (SD, 5.3 mins) for ropivacaine and 12.4 mins (SD, 7.8 mins) for levobupivacaine (P = 0.02). Time to be considered ready for surgery was similar in both groups: ropivacaine, 25.2 mins (SD, 5.1 mins); and levobupivacaine, 25.3 mins (SD, 6.4 mins) (t = -0.09, P = 0.93). Sensory block was 9.2 hrs (SD, 3.1 hrs) for ropivacaine and 11.3 hrs (SD, 4.1 hrs) for levobupivacaine (P = 0.01). CONCLUSIONS: Onset of motor block was significantly faster for ropivacaine than levobupivacaine (P = 0.02), but the time to be ready for surgery was similar with both drugs. Duration of sensory block was prolonged with levobupivacaine (P = 0.01).

Centenarians versus patients within the most frequent age range for hip fractures: transfusion practice.

INTRODUCTION: Descriptive retrospective review to compare transfusion among centenarians operated for a hip fracture with a control group within the "typical" age range for that surgery. METHOD: Fractured centenarians admitted between 2001 and 2006 were compared with a randomly selected control group aged 75-83 years, with the same pathology. Main variables recorded: demographic data; pre- and post-operative status; haemoglobin levels and blood use. A comparative statistical analysis was performed. RESULTS: Both groups were similar: each had 17 patients and a majority of females had a pertrochanteric hip fracture. Although there was a trend towards higher comorbidity rates and transfusion indexes among centenarians, a significant difference could only be found in post-operative and trigger haemoglobin levels, and in the incidence of post-operative complications. CONCLUSION: Despite intuitive beliefs, centenarians had results similar to those of the younger population: only a higher complication rate could be proved. Larger samples and prospective studies might be needed to confirm the trends noted.

[Anesthesia for surgical specialties in Catalonia, Spain, during 2003]. / Anestesias para especialidades quirúrgicas en Cataluña durante el año 2003.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT study was to analyze the characteristics of patients who underwent anesthesia for surgical procedures in Catalonia, Spain, in 2003. PATIENTS AND METHOD: Based on data obtained from the survey undertaken in 131 hospitals, we describe the anesthesia practice associated with surgical specialties, excluding anesthesia performed for obstetric and nonsurgical procedures. Data are provided for all surgical procedures and for each surgical specialty separately. The results are expressed as medians (10th-90th percentile). RESULTS: Surgical anesthesia represented 78.4% of anesthesia practice, corresponding to an estimated 472,857 anesthetic procedures per year. The most common surgical specialties associated with anesthetic procedures were orthopedics and traumatology (23.8%), ophthalmology (20.2%), general and digestive surgery (18.9%), and gynecology (9.7%). The median duration of anesthesia was 60 (25-165) minutes. The physical status of the patients according to the American Society of Anesthesiologists (ASA) classification was as follows: ASA 1, 37.9%; ASA 2, 32.5%; ASA 3, 23.9%; and ASA 4 or higher, 5.7%. The median age of the patients was 52 (21-78) years. Ambulatory procedures accounted for 33.6% of the total, and 9.2% of patients were admitted to postoperative critical care units. The most common procedure was cataract extraction (estimated 76,963 cases) followed by inguinal herniorrhaphy (23,315). Public hospitals performed 74.4% of all anesthetic procedures. Ophthalmology and plastic surgery were the most common procedures requiring anesthesia in private hospitals. CONCLUSIONS: Three out of 4 anesthetic procedures performed in Catalonia in 2003 was for surgery, 1 in 3 of those procedures was ambulatory, and almost 1 in 10 patients required postoperative critical care.

[Anesthesia for diagnostic and nonsurgical procedures in Catalonia, Spain, in 2003]. / Anestesia para exploraciones y procedimientos no quirúrgicos en Cataluña el año 2003.

BACKGROUND AND OBJECTIVE: This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain. PATIENTS AND METHOD: Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution. RESULTS: Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals. CONCLUSIONS: Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned.

Anestesias para especialidades quirúrgicas en Cataluña durante el año 2003 / Anesthesia for surgical specialties in Catalonia, Spain, during 2003

Fundamento y objetivo: Analizar las características de los pacientes que recibieron anestesia para intervenciones quirúrgicas en el año 2003 en Cataluña (España). Pacientes y método: De los datos obtenidos en la encuesta ANESCAT, realizada en 131 hospitales de Cataluña en el año 2003, describimos la actividad anestésica para especialidades quirúrgicas, excluyendo la realizada para obstetricia y procedimientos no quirúrgicos. Se describen los datos globales de todas las anestesias y las realizadas para cada especialidad quirúrgica. Los resultados se expresan en mediana y percentiles del 10-90%. Resultados: La anestesia quirúrgica representó el 78,4% de toda la actividad anestésica, con una estimación anual de 472.857 anestesias. Las especialidades quirúrgicas con mayor frecuencia fueron la cirugía ortopédica y traumatología (23,8%), la oftalmología (20,2%), la cirugía general y digestiva (18,9%) y la ginecología (9,7%). La duración mediana (percentiles 10-90) de las intervenciones quirúrgicas fue de 60 (25-165) min. El estado físico de los pacientes, según la clasificación de la American Society of Anesthesiologists (ASA) fue: ASA 1 el 37,9%, ASA 2 el 32,5%, ASA 3 el 23,9% y ASA 4 o superior el 5,7%. La edad mediana de los pacientes fue de 52 (21-78) años. El 33,6% de estos procedimientos fueron ambulatorios y el 9,2% ingresó en unidades de cuidados críticos postoperatorios. El procedimiento más frecuente fue la cirugía de cataratas (estimación de 76.963 casos), seguida por la herniorrafia inguinal (23.315). Los centros públicos realizaron el 74,4% del total de las anestesias, y la oftalmología y la cirugía plástica fueron las más frecuentes en los centros privados. Conclusiones: Tres de cada 4 anestesias administradas en Cataluña en 2003 fue para procedimientos quirúrgicos, una de cada 3 se realizó en régimen ambulatorio y casi uno de cada 10 pacientes requirió cuidados críticos postoperatorios

Background and objective: The aim of this arm of the ANESCAT study was to analyze the characteristics of patients who underwent anesthesia for surgical procedures in Catalonia, Spain, in 2003. Patients and method: Based on data obtained from the survey undertaken in 131 hospitals, we describe the anesthesia practice associated with surgical specialties, excluding anesthesia performed for obstetric and nonsurgical procedures. Data are provided for all surgical procedures and for each surgical specialty separately. The results are expressed as medians (10th-90th percentile). Results: Surgical anesthesia represented 78.4% of anesthesia practice, corresponding to an estimated 472,857 anesthetic procedures per year. The most common surgical specialties associated with anesthetic procedures were orthopedics and traumatology (23.8%), ophthalmology (20.2%), general and digestive surgery (18.9%), and gynecology (9.7%). The median duration of anesthesia was 60 (25-165) minutes. The physical status of the patients according to the American Society of Anesthesiologists (ASA) classification was as follows: ASA 1, 37.9%; ASA 2, 32.5%; ASA 3, 23.9%; and ASA 4 or higher, 5.7%. The median age of the patients was 52 (21-78) years. Ambulatory procedures accounted for 33.6% of the total, and 9.2% of patients were admitted to postoperative critical care units. The most common procedure was cataract extraction (estimated 76,963 cases) followed by inguinal herniorrhaphy (23,315). Public hospitals performed 74.4% of all anesthetic procedures. Ophthalmology and plastic surgery were the most common procedures requiring anesthesia in private hospitals. Conclusions: Three out of 4 anesthetic procedures performed in Catalonia in 2003 was for surgery, 1 in 3 of those procedures was ambulatory, and almost 1 in 10 patients required postoperative critical care

Anestesia para exploraciones y procedimientos no quirúrgicos en Cataluña el año 2003 / Anesthesia for diagnostic and nonsurgical procedures in Catalonia, Spain, in 2003

Fundamento y objetivo: Conocer y cuantificar el peso de la actividad anestésica no quirúrgica en Cataluña (España) en el año 2003. Pacientes y método: Estudio prospectivo de las anestesias no quirúrgicas realizadas en 131 hospitales catalanes en 14 días del 2003. Se analizaron: características de los pacientes, técnicas anestésicas, procedimientos, duración, tipo de actividad, tipos de centros y distribución geográfica. Resultados: Las anestesias no quirúrgicas representaron el 10,4% del total de anestesias. De estos procedimientos, la endoscopia digestiva representó un 70,4%, el tratamiento electroconvulsivo el 11,7%, la radiología un 11,5% y las cardioversiones un 1,5%. El 73,7% de estos procedimientos se realizaron fuera de quirófano. Hubo un predominio de actividad programada realizada ambulatoriamente bajo sedación o anestesia general. Las endoscopias digestivas más representativas fueron la colonoscopia y la gastroscopia, realizadas mayoritariamente en centros privados. Conclusiones: La anestesia para procedimientos no quirúrgicos, especialmente endoscopias digestivas, fue superior al 10% de todas las anestesias. Estas técnicas tienden a aumentar y es necesario conocer su frecuencia para una correcta planificación y para adelantar las estrategias formativas y organizativas

Background and objective: This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain. Patients and method: Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution. Results: Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals. Conclusions: Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned