Quality of Sleep among Portuguese Anaesthesiologists: A Cross-Sectional Study.

INTRODUCTION: Sleeping is essential to maintain proper relationships with others, keep alertness, and execute responsibilities, among many other functions. In the medical profession, there are several studies linking sleep deprivation with a decrease in responsiveness, cognition and attention. With this study we intended to characterize the sleep pattern of Portuguese anaesthesiologists and identify independent factors associated with sleep quality in this population. MATERIAL AND METHODS: An observational, cross-sectional study of senior and resident anesthesiologists working in Portugal was carried out through an online questionnaire. Individuals working exclusively in intensive care units, emergency departments or with previously diagnosed sleep disorders were excluded. Socio-demographic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Perceived Stress Scale were applied. Statistical significance was assessed using the Mann-Whitney test and the chi-square test. A multivariable analysis was performed to examine the association between the Pittsburgh Sleep Quality Index and certain variables. RESULTS: Among 256 respondents, 46.1% reported "poor" quality of sleep (Pittsburgh Sleep Quality Index > 5). Within these individuals, 77.1% slept less than 7 hours per night (p < 0.001). Excessive daytime sleepiness (Epworth Sleepiness Scale > 10) was present in 41.0% of the sample, and the median Perceived Stress Scale score was 17.0. The independent factors associated with worse quality ofsleep were the number of working hours/week (OR 1.03, 95% CI 1,01 to 1,06), perceived stress (OR 1.18, 95% CI 1.11 to 1.26), taking sleep medication (OR 14.72, 95% CI 5.55 to 39.08), and sleep hours/night (OR 0.25, 95% CI 0.15 to 0.42). DISCUSSION: This fraction of Portuguese anaesthesiologists presented a poorer quality of sleep, with excessive daytime somnolence, perceived stress and higher sedative use compared to previously studied populations. CONCLUSION: Our study characterizes sleep patterns and identifies potential risk factors linked to sleep disturbances in a sample of Portuguese anaesthesiologists. Government and institutional policies can endorse sleep hygiene practices and habits, promoting healthier working environments.

Introdução: O sono é essencial para executar tarefas, manter o estado de alerta, executar tarefas, entre outras funções. Diversos estudos na área médica relacionam a privação de sono com a redução da capacidade de resposta, cognição e nível de atenção. Os objetivos deste estudo foram a caracterização do padrão de sono dos anestesiologistas Portugueses e identificação de fatores de risco independentes para pior qualidade de sono. Material e Métodos: Efetuámos um estudo observacional e transversal em anestesiologistas e internos de formação específica em Anestesiologia a trabalhar em Portugal. Foram excluídos profissionais que trabalham exclusivamente em unidades de cuidados intensivos, serviços de urgência ou com patologias do sono previamente diagnosticadas. Foram colhidos dados sócio-demográficos e aplicadas as escalas de Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) e Perceived Stress Scale (PSS). A significância estatística foi analisada recorrendo aos testes de Mann-Whitney e qui-quadrado. A associação entre o Pittsburgh Sleep Quality Index e demais variáveis foi testada através de uma regressão logística. Resultados: Dos 256 casos admitidos, 46,1% apresentaram "má" qualidade de sono (Pittsburgh Sleep Quality Index > 5). Nestes, 77,1% dormiram menos de 7 horas por noite (p < 0,001). A sonolência diurna excessiva (Epworth Sleepiness Scale > 10) surgiu em 41,0% da amostra e a mediana da Perceived Stress Scale foi 17,0. Os fatores de risco independentes para "má" qualidade de sono foram: número de horas de trabalho semanais (OR 1,03, IC 95% 1,01 a 1,06), stress percecionado (OR 1,18, IC 95% 1,11 a 1,26), toma de medicamentos para dormir (OR 14,72, IC 95% 5,55 a 39,08) e número de horas dormidas por noite (OR 0,25, IC 95% 0,15 a 0,42). Discussão: A nossa amostra de anestesiologistas Portugueses apresentou pior qualidade de sono, com sonolência diurna excessiva, stress percecionado e uso de sedativos superiores a outras populações previamente estudadas. Conclusão: O presente estudo caracteriza o padrão de sono e identifica potenciais factores de risco relacionados com distúrbios do sono, numa amostra de Anestesiologistas Portugueses. Políticas de saúde governamentais e institucionais poderão ser orientadas para a promoção da higiene do sono, levando a ambientes de trabalho mais saudáveis.

Severe bradycardia and asystole associated with sugammadex: case report / Bradicardia grave e assistolia associadas ao sugamadex: relato de caso

Abstract Background and objectives: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. Case report: A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200 mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. Conclusions: Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution.

Resumo Justificativa e objetivos: O sugamadex é uma gama ciclodextrina modificada, o primeiro agente seletivo para reversão do bloqueio neuromuscular induzido pelos relaxantes musculares não despolarizantes do tipo esteroide, com maior afinidade para o rocurônio. Neste artigo apresentamos um caso de bradicardia grave e assistolia após administração de sugamadex. Relato do caso: Doente do sexo masculino, 54 anos, ASA II, com antecedentes pessoais de hipertensão, dislipidemia e obesidade, submetido à herniorrafia umbilical em regime de urgência sob anestesia geral balanceada. O relaxamento muscular intraoperatório foi mantido com rocurônio. No fim da cirurgia o doente mantinha bloqueio neuromuscular com duas respostas no TOF, pelo que foi administrado sugamadex 200 mg. Cerca de trinta segundos após a sua administração, o doente desenvolveu bradicardia acentuada (FC 30 bpm) seguida de período de assistolia. Conclusões: A bradicardia e a assistolia documentadas foram atribuídas à administração do sugamadex. Este caso evidencia que, apesar de rara, a parada cardíaca é um efeito adverso possível desse fármaco e que o conhecimento dessa situação pode ser determinante para a evolução do doente.

[Severe bradycardia and asystole associated with sugammadex: case report]. / Bradicardia grave e assistolia associadas ao sugamadex: relato de caso.

BACKGROUND AND OBJECTIVES: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. CASE REPORT: A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. CONCLUSIONS: Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution.

Contrast induced acute kidney injury in endovascular surgery.

INTRODUCTION: Endovascular interventions are associated with renal impairment possibly due to intraoperative contrast use. The goal of this study was to determine the incidence, risk factors and pharmacological prevention strategies for contrast-induced acute kidney injury in patients undergoing vascular surgery. Another aim was finding a threshold dose of contrast as a predictor of contrast-induced acute kidney injury. METHODS: Contrast-induced acute kidney injury was studied in patients submitted to vascular surgery procedures requiring intravascular contrast over a one year period (n=180). Clinical and outcome data were collected from medical records. Pearson chi-square test and Fisher's exact test were used for categorical variables. Student's t test was used for continuous variables. RESULTS: The incidence of contrast-induced acute kidney injury was 10% [95%CI 6.42-15.25]. Contrast volumes over 175ml were associated with an 8-fold increase in the risk of contrast-induced acute kidney injury [95%CI 2.60-24.26; p<0.001]. The administration of N-acetylcysteine reduced the possibility of acute kidney injury occurrence in 28.20% [95%CI 9.50 - 83.50; p=0.022]. CONCLUSION: Patients that developed contrast-induced acute kidney injury were exposed to higher contrast volumes. This study suggests 175 ml of contrast volume as a cut-off value for the development of contrast-induced acute kidney injury. N-acetylcysteine had a protective effect in these patients submitted to endovascular surgery.

Introdução: Os procedimentos endovasculares estão frequentemente associadas a lesão renal que se deverá provavelmente à utilização de contraste intravascular durante o intra-operatório. O presente estudo teve como objectivo principal a determinação da incidência, fatores de risco e medidas farmacológicas aplicáveis na prevenção de lesão renal aguda em doentes submetidos a procedimentos endovasculares com utilização de contraste. Pretendeu-se ainda determinar o cut-off volume de contraste intravascular preditor de lesão renal aguda neste contexto. Métodos: A lesão renal aguda associada à utilização de contraste foi estudada retrospetivamente durante o período de 1 ano em doentes submetidos a cirurgia vascular com utilização de contraste intravascular (n=180). A colheita de dados foi realizada através da consulta dos registos clínicos peri-operatórios. A análise estatística foi realizada com o teste Qui-quadrado de Pearson e teste exato de Fisher para variáveis categóricas. Utilizou-se o teste t de Student para variáveis contínuas. Resultados: A incidência de lesão renal aguda associada ao contraste foi de 10% [IC95% 6,42-15,25]. A administração de um volume de contraste acima dos 175ml associou-se a um aumento de 8 vezes do risco de lesão renal aguda associada ao contraste [IC95% 2,60-24,26; p<0,001]. A administração de N-acetilcisteína reduziu a probabilidade de lesão renal aguda associada ao contraste em 28,20% [IC95% 9,50-83,50; p=0,022]. Conclusão: Os doentes que desenvolveram lesão renal aguda associada ao contraste foram expostos a volumes superiores do mesmo. Este estudo sugere o volume de 175ml de contraste administrado como cut-off para o desenvolvimento de lesão renal aguda associada ao contraste intravascular. A administração de N-acetilcisteína teve um efeito nefroprotector neste grupo de doentes submetidos a cirurgia endovascular.

Postoperative delirium after vascular surgery.

OBJECTIVES: The objectives of this study were to determine the incidence of Postoperative Delirium and to identify specific perioperative risk factors in patients undergoing Vascular Surgery. Other goals were to study its impact in hospital length of stay and to create an algorithm to deal with patients under suspicion of Postoperative Delirium. MATERIAL AND METHODS: A total of 56 consecutive vascular surgery patients were prospectively evaluated. Exclusion criteria were age less than 18, dementia, abnormal level of consciousness, psychiatric disorder and visual or hearing impairment. Mini Mental State Examination were applied during pre-anesthetic visit. In patients with clinical indicators of delirium the Confusion Assessment Method was applied. Patients were assessed during 5 days after surgery. RESULTS: The overall incidence of delirium was 12,5%, developped mostly by the second to fifth postoperative day. Patients with delirium presented moderate to severe pain. Patients who received combined general and regional anesthesia didn't develop delirium. The median hospital length of stay was 21 in patients with delirium and 7 days in patients without (p 0.001). CONCLUSIONS: The overall incidence of postoperative delirium was lower than previously reported. The incidence of delirium was higher in ICU patients and pain was associated with postoperative delirium suggesting the opportunity to control postoperative factores. The development of delirium in the second and fifth day indicated the need for early and more prolonged preventive and diagnosing measures. Clinical and costly considerations of prolonged hospital stay shown in this cohort warrant strong debate strategies to be applied.