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1.
JMIR Res Protoc ; 11(6): e37084, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35687418

RESUMO

BACKGROUND: Malignant hyperthermia (MH) is a rare life-threatening anesthetic emergency. With respect to the high fatality rate, difficulty in early recognition, and the lack of disease-specific drug (ie, dantrolene) in China, more effort is needed to strengthen early diagnosis and effective treatment of MH emergencies. Nowadays, mobile health (mHealth) apps are changing the way of medical practice; they can serve as an accessible tool to help anesthesiologists deal with MH crises. However, no related mHealth-based emergency system is available currently. OBJECTIVE: The aim of this study is to outline the protocol for the development of a WeChat applet used to design a National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China, as well as the protocol for the evaluation of the user experience and perception of the system. METHODS: The system adopts the client-server architecture, with a custom user interface operating as clients and the back-end system operating as the server. The client-side software was developed using uni-app technology with Vue.js-based framework, which consists of 6 modules: Quick Diagnosis, Dantrolene Mobilization, Instruction on Dantrolene Use, MH Treatment, Recovery Period Treatment, and DNA Test and Biopsy. The back-end system was developed based on the Spring framework. The system will be evaluated by administrating a modified user version of the Mobile App Rating Scale. Pilot testing will be conducted in Sichuan Province, China, and a subsequent evaluation on a national scale is planned. RESULTS: The theoretical framework design of this system was completed in August 2021. The development of the system was completed in February 2022, and the refinement is currently ongoing. Pilot testing after the implementation of the system in Sichuan Province is planned to take 2 months, and the subsequent evaluation on a national scale is planned to take 2 months. CONCLUSIONS: We have described a novel approach using the WeChat applet to develop the MH-NRES. Findings from the usability testing process in the current study may lead to refinements and is expected to suggest that this system is both feasible and welcomed by anesthesiologists. Depending on the availability of research funding, this system will be extended nationally across China. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37084.

3.
Wien Med Wochenschr ; 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35759051

RESUMO

BACKGROUND: Adenotonsillectomy is the most commonly performed surgery in the pediatric population. Hemorrhage after adenotonsillectomy, which can occur at any time postoperatively, is one of the most serious complications. OBJECTIVE: To determine the frequency of hemorrhage in children after adenotonsillectomy and to compare postoperative hemorrhage with regard to age and sex. METHODS: A cross-sectional longitudinal study was conducted at the Ear, Nose, and Throat Clinic, University Clinical Center Tuzla, and included all children of both sexes, aged 3 to 15 years, who underwent adenotonsillectomy during a 1.5-year period. RESULTS: A total of 201 children aged 3-15 years underwent adenotonsillectomy, 113 males and 88 females, which corresponds to a ratio of 1.28: 1. Adenotonsillectomy was performed in 147 (73.1%) patients and adenoidectomy in 54 (27%). In the overall sample, there were 19 (9.5%) subjects with postoperative hemorrhage. Primary hemorrhage occurred in 9 subjects (47%) and secondary hemorrhage in 10 subjects (53%). Significantly more female subjects had postoperative hemorrhage. In the group of subjects with hemorrhage, the mean age (standard deviation) was 8.45 (3.3) years. Tonsillar lodges are common sites of hemorrhage. CONCLUSION: The frequency and causes of hemorrhage after adenotonsillectomy in our study are partially comparable to the world data.

4.
Cureus ; 14(5): e24924, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35706730

RESUMO

Pneumothorax is a known complication following breast surgery but is likely underappreciated by anesthesiologists. Iatrogenic pneumothorax can be caused by needle injury during local anesthetic injection, surgical damage to the intercostal fascia or pleura, or pulmonary injury from mechanical ventilation. We present two cases of pneumothorax following bilateral mastectomy with bilateral pectoral blocks and immediate breast reconstruction. Both cases occurred at a freestanding ambulatory surgery center in patients with no history of lung disease. One patient was found to have bilateral pneumothoraxes after complaining of shortness of breath and chest pain in the post-operative care unit. The second patient was asymptomatic but found to have a right-sided pneumothorax on a chest X-ray (CXR) that was ordered to rule-out left-sided pneumothorax due to concern of intraoperative breach of the left chest wall. Both patients were treated with chest tubes, transferred to a nearby hospital, and discharged several days later. Anesthesiologists must be aware of this potentially life-threatening complication and consider pneumothorax in the differential diagnosis of perioperative hypoxemia, shortness of breath, chest pain, and hemodynamic collapse in patients undergoing breast surgery. Though traditionally diagnosed via radiograph, pneumothorax can be rapidly diagnosed with ultrasound. Tension pneumothorax should be decompressed immediately with a needle. A clinically significant, non-tension pneumothorax is treated with chest tube placement. Equipment necessary to treat pneumothorax should be available for emergency treatment in facilities wherever breast surgery is performed.

5.
J Educ Perioper Med ; 24(1): E681, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707013

RESUMO

Background: Residency recruitment requires significant resources for both applicants and residency programs. Virtual interviews offer a way to reduce the time and costs required during the residency interview process. This prospective study investigated how virtual interviews affected scoring of anesthesiology residency applicants and whether this effect differed from in-person interview historical controls. Methods: Between November 2020 and January 2021, recruitment members at the University of Chicago scored applicants before their interview based upon written application materials alone (preinterview score). Applicants received a second score after their virtual interview (postinterview score). Recruitment members were queried regarding the most important factor affecting the preinterview score as well as the effect of certain specified applicant interview characteristics on the postinterview score. Previously published historical controls were used for comparison to in-person recruitment the year prior from the same institution. Results: Eight hundred and sixteen virtual interviews involving 272 applicants and 19 faculty members were conducted. The postinterview score was higher than the preinterview score (4.06 versus 3.98, P value of <.0001). The change in scores after virtual interviews did not differ from that after in-person interviews conducted the previous year (P = .378). The effect of each characteristic on score change due to the interview did not differ between in-person and virtual interviews (all P values >.05). The factor identified by faculty as the most important in the preinterview score was academic achievements (64%), and faculty identified the most important interview characteristic to be personality (72%). Conclusions: Virtual interviews led to a significant change in scoring of residency applicants, and the magnitude of this change was similar compared with in-person interviews. Further studies should elaborate on the effect of virtual recruitment on residency programs and applicants.

6.
J Educ Perioper Med ; 24(1): E683, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707018

RESUMO

Background: The shift to virtual interviews during the COVID-19 pandemic has elevated the vital role of Accreditation Council for Graduate Medical Education residency program websites in conveying information to applicants. The purpose of our study was to assess the recruitment, education, and diversity and inclusion content on websites for anesthesiology residency programs. Second, we aimed to test the hypothesis that the content scores of websites are higher in programs with more National Institutes of Health funding, in programs that are university-based versus community-based, and in larger programs, as measured by number of residents. Methods: Two independent reviewers evaluated the websites of the 159 anesthesiology residency programs accredited by the Accreditation Council for Graduate Medical Education for the presence (yes/no) of 12 recruitment, 6 education, and 8 diversity and inclusion criteria. Multiple linear regression was used to determine which program factors were most associated with total website content score. Results: Anesthesiology residency program websites contained a mean of 12.9 (SD = 3.4; range, 3-21) of the 26 study-defined criteria. The most common recruitment, education, and diversity and inclusion criteria were, respectively, program description, rotation information, and community demographics. Controlling for program factors, a university-based affiliation (P = .016) was associated with higher website content scores. Conclusions: There is large variation in the recruitment, education, and diversity and inclusion content on anesthesiology residency program websites nationally. Since program websites averaged only half of criteria, this may provide an impetus for programs to modify their websites, which may inform applicant decisions about which programs align with their training and career goals.

7.
J Educ Perioper Med ; 24(1): E682, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707019

RESUMO

Background: Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge. Methods: An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship. A secondary analysis of anonymous deidentified answers was completed. Results: Fellows averaged 64%, 74%, and 79% correct responses on the orientation, 4-month, and 8-month exams, respectively. An analysis of the orientation exam revealed that the most commonly incorrect answers stemmed from topics including lower extremity nerve blocks, truncal blocks, and neuraxial anesthesia. The 4-month exam showed overall marked improvement; however, truncal blocks remained the most missed topic. Topics with 100% correct response rates in all examinations were local anesthetic pharmacology and systemic opioids. Conclusions: The results of this study indicate that a large portion of learning occurs during the first 4 months of the fellowship and slows thereafter. Using this simple form of fellowship evaluation, changes to an educational didactic curriculum can be implemented to reach medical knowledge goals more effectively and efficiently as required by the Accreditation Council for Graduate Medical Education.

8.
Cureus ; 14(5): e25280, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35755517

RESUMO

Background Managers of an anesthesia department sought an estimation of how often each anesthesiologist can give lunch breaks and morning breaks to nurse anesthetists to plan staff scheduling. When an anesthesiologist supervising the nurse anesthetists can give a break, it would be preferred because fewer extra nurse anesthetists would be scheduled to facilitate breaks. Methodology Our methodological development used retrospective cohort data from the three surgical suites of a single anesthesia department. Surgical times were estimated using three years of data from October 2016 through September 2019, with 95,146 cases. Comparison was made with the next year from October 2019 through September 2020, with 30,987 cases. The 5% lower prediction bounds for surgical time were estimated based on two-parameter, log-normal distributions. The times when two and three sequential rooms had overlapping lower prediction limits were calculated. Sequential rooms were used because that was how anesthesiologists' assignments were made at the studied department, when feasible given constraints. Percentages of cases were reported with 15 minutes available starting sometime between 9:00 and 10:30 and 30 minutes starting sometime between 11:15 and 12:45, times characteristic for the studied department. At the studied university's facilities, the nurse anesthetists were independent practitioners (e.g., an anesthesiologist supervising two nurse anesthetists each with a long case could give a break to one of the two rooms). Results The percentage of days for which an anesthesiologist could give a lunch break (11:15-12:45) was close to the percentage of cases when an anesthesiologist could give the same-length break anytime throughout the workday. In other words, the length of the break was important, not the time of the day of the break. The absolute percentages also depended on how many rooms the anesthesiologist supervised, the duration of cases, and facility. For example, among anesthesiologists at the adult surgical suite supervising three nurse anesthetists, a lunch break could be given by the anesthesiologist on at most one-third of the days without affecting workflow. Conclusions Our results show that the feasibility of an anesthesiologist clinically supervising one, two, or three rooms to give lunch breaks to the nurse anesthetists in the rooms depends principally on how many rooms are supervised, the duration of the break, and the facility's percentage of cases with surgical times longer than that duration. The specific numerical results will differ among departments. Our methodology would be useful to other departments where anesthesiologists are clinically supervising independent practitioners, sometimes during cases long enough for a break, and there is anesthesiologist backup help. Such departments can use our methodology to plan their staff scheduling for additional nurse anesthetists to give the remaining breaks.

9.
Ann Transl Med ; 10(10): 577, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35722375

RESUMO

Background: Extubation is the process of removing tracheal tubes so that patients maintain oxygenation while they start to breathe spontaneously. However, hypoxemia after extubation is an important issue for critical care doctors and is associated with patients' oxygenation, circulation, recovery, and incidence of postoperative complications. Accuracy and specificity of most related conventional models remain unsatisfactory. We conducted a predictive analysis based on a supervised machine-learning algorithm for the precise prediction of hypoxemia after extubation in intensive care units (ICUs). Methods: Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database for patients over age 18 who underwent mechanical ventilation in the ICU. The primary outcome was hypoxemia after extubation, and it was defined as a partial pressure of oxygen <60 mmHg after extubation. Variables and individuals with missing values greater than 20% were excluded, and the remaining missing values were filled in using multiple imputation. The dataset was split into a training set (80%) and final test set (20%). All related clinical and laboratory variables were extracted, and logistics stepwise regression was performed to screen out the key features. Six different advanced machine-learning models, including logistics regression (LOG), random forest (RF), K-nearest neighbors (KNN), support-vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM), were introduced for modelling. The best performance model in the first cross-validated dataset was further fine-tuned, and the final performance was assessed using the final test set. Results: A total of 14,777 patients were included in the study, and 1,864 of the patients' experienced hypoxemia after extubation. After training, the RF and LightGBM models were the strongest initial performers, and the area under the curve (AUC) using RF was 0.780 [95% confidence interval (CI), 0.755-0.805] and using LightGBM was 0.779 (95% CI, 0.752-0.806). The final AUC using RF was 0.792 (95% CI, 0.771-0.814) and using LightGBM was 0.792 (95% CI, 0.770-0.815). Conclusions: Our machine learning models have considerable potential for predicting hypoxemia after extubation, which help to reduce ICU morbidity and mortality.

10.
J Clin Med ; 11(12)2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35743397

RESUMO

It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL-1 increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm-1, 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = -0.034, p = 0.36), Consensus PPV (r = -0.014, p = 0.72) or Consensus PPV Small (r = -0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.

11.
Front Med (Lausanne) ; 9: 770199, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35665325

RESUMO

To manage referrals to the pre-anesthetic consultation during the COVID-19 pandemic, a screening questionnaire was created and sent to parturients with anesthetic risk during the pre-anesthetic consultation. This innovative approach enabled the redistribution of medical anesthetic resources in units that were heavily affected by the pandemic.

12.
Anesthesiol Clin ; 40(2): 235-243, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35659397

RESUMO

There are several work-related barriers to breastfeeding among physician mothers including: lack of appropriate place for breastmilk expression, unpredictable and inflexible schedules, and lack of time to breastfeed or express milk. In a survey of physician mothers, those who were in surgical and procedural subspecialties, including anesthesiology, reported a lack of lactation facilities in close proximity to the operating room as a barrier to breastfeeding. Unlike other physicians and clinicians in different health care environments, anesthesiology is unique in that there is often no built-in time for breaks or a predictable end time to the operating room schedule. A break system is typically established, within an institution, for meal break relief for trainees, Certified Registered Nurse Anesthetist, and Anesthesia Assistants. This system for breaks may not be sufficient to accommodate the frequency or length required for lactation sessions. In addition, these break systems do not typically provide relief for supervising anesthesiologists for meals or lactation sessions. A study of physician mothers across specialties identified anesthesiologists as significantly more likely than women of other medical specialties to self-report maternal discrimination. The study defined maternal discrimination as discrimination based on pregnancy, maternity leave, or breastfeeding. As a workforce and specialty, we must support our breastfeeding anesthesiologists and facilitate lactation needs on return to the workplace.


Assuntos
Anestesiologia , Aleitamento Materno , Feminino , Humanos , Lactação , Mães , Gravidez , Local de Trabalho
13.
Anesthesiol Clin ; 40(2): 257-274, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35659399

RESUMO

Addressing resident wellness is an important topic given the high risk for burnout and depression in resident physicians compared with the general U.S. population. This article provides an overview of various approaches to help conceptualize and intervene on resident wellness, based on the 9-strategies framework to improve wellness laid out by Shanafelt and colleagues. This article outlines the most relevant literature in each strategy followed by the authors' experience within their anesthesiology residency program.


Assuntos
Anestesiologia , Esgotamento Profissional , Internato e Residência , Esgotamento Profissional/prevenção & controle , Educação de Pós-Graduação em Medicina , Humanos
14.
Pediatric Health Med Ther ; 13: 155-163, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35548373

RESUMO

Background: Various criteria exist for defining difficult intravenous access (DIVA) in infants and children. The current study evaluated the factors associated with DIVA in a prospective cohort of over 1000 infants and children presenting for anesthetic care. Methods: This was a prospective, observational study of patients aged 0 to 18 years undergoing elective surgical or radiologic procedures under general anesthesia. Prior to the initial attempt at peripheral intravenous (PIV) cannulation, the anticipated difficulty of PIV catheter placement was determined by the provider using a visual analogue scale (VAS) from 1 to 10. The number of attempts was recorded as well as the time required to achieve PIV access. DIVA was defined as requiring three or more attempts. After successful cannulation, the actual difficulty of the PIV placement was assessed by the provider and recorded using the same VAS. Patient characteristics, including age, race, body mass index (BMI), American Society of Anesthesiologists (ASA) physical classification, and history of difficult PIV placement, were evaluated as covariates. Results: In our cohort of 1002 pediatric patients, 78% of patients were successfully cannulated in a single attempt and 91% of patients were successfully cannulated in two or fewer attempts. Factors associated with requiring three or more PIV attempts included younger age (OR 8.73; 95% CI: 3.38, 22.6 for age <1 year and OR 4.93; 95% CI: 2.05, 11.8 for age 1-3 years), higher ASA physical classification (OR 1.95; 95% CI: 1.10, 3.46 for ASA II), and prior history of difficult PIV placement (OR 3.46; 95% CI: 1.70, 7.08). BMI, racial category or gender were not independent predictors of DIVA. Conclusion: We found that approximately 9% of patients required three or more attempts at IV placement in the operating room. Patients that required multiple PIV attempts were more likely to be younger, have a higher ASA classification or a history of difficult PIV placement.

15.
Cureus ; 14(4): e24428, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35637797

RESUMO

This case report highlights some of the anesthetic challenges of an airway foreign body removal. We present a case report of foreign body removal in a 50-year-old male with an oxtail bone lodged between the vocal cords. We used face mask general anesthesia with sevoflurane.

16.
Ann Med Surg (Lond) ; 77: 103616, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35638059

RESUMO

Background: Spinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort. Objective: To assess the type, management, and related factors of failure of spinal anesthesia at cesarean section. Methods: Multicenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff. Result: Of 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47-6.90), patient position (AOR = 14.43,95%CL, 2.65-78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69-15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90-13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12-3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33-5.53) were found to be statistically significant associated with failed spinal anesthesia. Conclusion and recommendation: Experience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines.

17.
Front Med (Lausanne) ; 9: 834334, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35602485

RESUMO

Introduction: During awake craniotomy, effective use of local anesthetics, such as ropivacaine, is critical. Blood concentrations of ropivacaine after repeated administration over a short period during awake craniotomy have not been studied. Materials and Methods: In this prospective cohort study, we evaluated serum concentrations of ropivacaine 15 min after each administration during awake craniotomy at Nagoya University Hospital between April 5, 2018 and August 31, 2019 to determine the safe dose. A total of 30 patients scheduled to undergo elective awake craniotomy were included. Patients were injected with 0.375% ropivacaine before the awake phase at the following points: scalp block (T1), headpin area (T2), skin incision area (T3), temporal muscle (T4), and dura mater (T5). Arterial blood samples were collected 15 min after ropivacaine administration. In addition to the blood concentrations of ropivacaine, complications during the awake phase were evaluated as secondary endpoints. Results: The mean total dose of ropivacaine was 5.01 ± 0.68 mg/kg (maximum total dose: 6.30 mg/kg). The mean interval from T1 to T5 was 128.0 ± 17.7 min. The maximum serum concentration did not exceed the toxicity threshold of 4.3 µg/mL in any patient (mean serum concentration: T1, 1.23 ± 0.36 µg/mL; T5, 0.82 ± 0.26 µg/mL). No addiction symptoms were observed during awakening in any case. Conclusion: Our results show that, in cases of awake craniotomy with repeated anesthetic administration, a total dose of up to 5.0 mg/kg is safe, without addiction symptoms. Relatively large amounts of ropivacaine can be safely injected during awake craniotomy.

18.
Acad Pediatr ; 2022 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-35623550

RESUMO

OBJECTIVES: Combined pediatrics-anesthesiology programs uniquely prepare residents to care for critically ill children, but trainees in these combined programs face challenges as residents within two specialties. Social belonging predicts motivation and achievement and protects against burnout. The objective of our study was to evaluate sense of belonging and self-identified professional identity of current combined pediatrics-anesthesiology residents. METHODS: All current residents in combined pediatrics-anesthesiology programs were invited to participate in an anonymous survey assessing sense of belonging and professional identity. Open-ended responses were qualitatively analyzed using an inductive coding process and thematic analysis. Likert questions were analyzed using paired t-tests. RESULTS: 32/36 residents completed the survey (89% response rate). 92% of respondents had a lower sense of belonging in pediatrics than anesthesiology (3.32 vs 3.94) and more self-identified as anesthesiologists than pediatricians. Thematic analysis yielded five themes: (1) the team-based nature of pediatrics results in strong initial bonds, but feelings of isolation as training pathways diverge; (2) the individual nature of anesthesiology results in less social interaction within daily work, but easier transitions in and out of anesthesiology; (3) divergent training timelines result in feeling left behind socially and academically; (4) residents identify different professional and personal characteristics of pediatricians and anesthesiologists that impact their sense of belonging; and (5) the structure of the combined program results in experiences unique to combined residents. CONCLUSIONS: Most residents in combined pediatrics-anesthesiology programs had a higher sense of belonging and self-identification in anesthesiology than pediatrics. Program structure and autonomy had significant impacts.

19.
Semin Cardiothorac Vasc Anesth ; 26(2): 140-153, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35608409

RESUMO

This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.


Assuntos
COVID-19 , Transplante de Rim , Transplante de Órgãos , Transplante de Pâncreas , Anestesiologistas , Humanos
20.
Cureus ; 14(4): e24075, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35573580

RESUMO

Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy. Methods An 83-item web-based survey was developed. An introductory email was sent to 505 physicians and child-life specialists with expertise in pediatric anesthesia and/or affiliated with pediatric radiation oncology departments. Results The response rate was 128/505 (25%) and included specialists from Africa (5, 4%), Asia (18, 14%), Australia/Oceania (5, 4%), Europe (45, 35%), North America (50, 39%), and South America (5, 4%). The 128 respondents included 91 anesthesiologists (71%), 20 physicians who were not anesthesiologists (16%), 14 child life/social education specialists (11%), one radiotherapist, one pediatric radiation nurse, and one non-specified medical professional (all = 2%). Of the 128 respondents, 95 (74%) used anesthesia or sedation to facilitate repetitive cranial or craniospinal radiotherapy. Overall, total intravenous anesthesia without intubation was preferred by 67 of 95 (71%) specialists during one or more forms of radiotherapy. During photon-based radiotherapy, total intravenous anesthesia without intubation was the preferred anesthetic method with the patient in the supine (57/84, 68%) and prone positions (25/40, 63%). Propofol was the most used anesthetic agent for both supine (73/84, 87%) and prone positions (38/40, 95%). For proton radiotherapy, total intravenous anesthesia without intubation was the most preferred anesthetic method for the supine (32/42, 76%) and prone treatment positions (11/18, 61%), and propofol was the most used anesthetic (supine: 40/43, 93%; prone: 16/18, 89%). Conclusions In this survey of 95 specialists responsible for anesthesia or sedation of children undergoing repetitive cranial or craniospinal radiotherapy, propofol-based total intravenous anesthesia without intubation was the preferred anesthetic technique.

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