Anesthesiologists Research Articles

Results of a survey of anesthesiologists and resuscitation specialists: possible prediction and diagnosis of cardiac complications after non-cardiac surgery

Relevance. A critical task of modern anesthesiology and resuscitation is the prediction and diagnosis of cardiac complications after non-cardiac surgeries. There are clinical guidelines for reducing the incidence of such complications; however, in practice, routine implementation of the full-risk stratification algorithm is not always performed. Objective. To assess the possibility of predicting and diagnosing cardiac complications after non-cardiac surgeries in medical organizations of constituent entities of the Russian Federation with a population of less than 1 million people. Materials and methods. An anonymous online survey of anesthesiologists and resuscitators of one of the constituent entities of the Russian Federation was developed using Yandex Forms.Results. We processed 62 completed questionnaires. Cardiac complications during the postoperative period are registered by 33 (53.2 %) respondents. Cardiac risk indices were used by 10 (16.1 %) physicians and load tests (treadmill, bicycle ergometry) by 9 (14.5 %). Routine ECG monitoring after surgery was performed by 27 (43.5 %) respondents. Cardiac-specific troponin determination is available to 60 (96.8 %) physicians; however, only 6 (9.7 %) respondents measured it routinely before surgery and 4 (6.5 %) respondents measured it after surgery. Natriuretic peptide or its prohormone determination is available to 19 (30.6 %) physicians; however, only 3 (4.8 %) prescribe it before surgery and 0 after surgery. The possibility of performing echocardiography before and after surgery was noted by 54 (87.1 %) respondents. Only 9 (14.5 %) respondents reported that their hospital could perform coronary angiography.Conclusions. The results of this survey revealed that many cardiac complications could have been missed because of insufficient preoperative prognosis and postoperative diagnostic data.

Digitalization of anesthesiology and resuscitation services: multicenter questionnaire study

OBJECTIVE: To substantiate recommendations for the implementation of the concept and technologies of digitalization of the anesthesiology and resuscitation (A&R) service in multidisciplinary hospitals to solve the problem of ensuring the safety of patients and medical personnel. MATERIALS AND METHODS: The study presents data on the implementation of information technology in the practice of the A&R service based on information received from 235 anesthesiology and resuscitation specialists working in leadership positions in various categories of healthcare institutions. Method of collecting information: experts independently completed the online version of the questionnaire. Sampling principle: intentional. Survey period: April 12, 2023 — August 4, 2023. RESULTS: In 87 % of hospitals the medical information system (MIS) of the A&R service is part of the hospital’s MIS. Only in 23 % of hospitals all workstations of the anesthesiologist-resuscitator are connected to the MIS. Logging into a personal electronic workplace using access rights on any of the hospital’s personal computers was confirmed by 87 % of respondents. Hospitals in which anesthesiology and resuscitation equipment are not integrated into the MIS account for 89 %. In the case of branches with a local A&R information system, equipment in 44 % of similar branches is connected to it. Only in 51 % of hospitals the A&R receives data from the laboratory information system, the integration rates with the radiological information system are even lower and amount to only 34 %. The study revealed a significant problem with the introduction of clinical recommendations, drug reference books, as well as prevention and manipulation protocols, various requirements and, in particular, scales/indices for assessing the condition of patients into the MIS. CONCLUSIONS: For the full functioning of the MIS, organizational solutions are needed that are aimed at implementing the tasks, primary and future. The development and application of modern MIS in anesthesiology and resuscitation will contribute to the further development of the specialty and ensure patient safety and adequate quality of medical care. It is necessary to unify the requirements for MIS developers according to the main components in the functionality.

Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician–gynecologists

Objective While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN). Methods A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models. Results The survey was distributed to 556 anesthesiology and 662 obstetrics–gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician–gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001). Conclusions ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

Certified Registered Nurse Anaesthetists’ and Critical Care Registered Nurses’ perception of knowledge/power in teamwork with Anaesthesiologists in Sweden: a mixed-method study

Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists’ (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES.Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23.Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR.Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes.

Needs Assessment of Essential Anatomy: A Perspective from Anesthesiology, Emergency Medicine, ObGyn and Orthopedics Resident

IntroductionCurricular development begins with identifying a problem, followed by a needs assessment of curricular components. Changes in pedagogical approaches and reductions in curricular time for gross anatomy have been identified as problems in undergraduate medical education. The objective of this study was to conduct a needs assessment of the most essential anatomy for residents in Anesthesiology (AN), Emergency Medicine (EM), Ob/Gyn (OB), and Orthopedics (OR) at Beaumont Health in Royal Oak, MI (the teaching hospital for Oakland Univ. William Beaumont School of Medicine).MethodsResidents completed a survey to assess the clinical importance of 907 anatomical structures for the back, upper limb (UL), lower limb (LL), thorax (Thx), abdomen (Abd), pelvis and perineum (P&amp;P), and head and neck (H&amp;N) on a 1‐4 Likert‐scale (1=not important; 4=essential). Kruskal‐Wallis analyses with a Bonferroni correction (p&lt;0.007) were used to assess differences of top‐level items for each region between residency groups. The 3 and 4 rating response frequencies for each structure formed a basis for classifications of importance: structures rated 3 or 4 by ≥75.0% were essential, 50.0‐74.9% more important, 25.0‐49.9% less important, 0.0‐24.9% not important.ResultsFifty‐five residents (AN, N=6; EM, N=l5; OB, N=13; OR, N=21) completed the survey. Ratings by OR residents were significantly higher for the limbs than AN, ER, and OB, and higher for the back than EM and OB. Ratings by OB residents were significantly higher for P&amp;P than by AN and ER residents. No ratings differences were found for Thx, Abd, or H&amp;N. Classifications of essential and more important for all structures across body regions were: AN, 71.8%; EM, 64.5%, OB: 52.0%, OR: 99.9%. Individual regions with ≥70% of structures essential or more important were: AN (Back, Thx, Abd, H&amp;N), EM (UL, Thx, H&amp;N), OB (Abd, P&amp;P), OR (all regions). Regions with ≥20% of structures as not important were: AN (UL, P&amp;P), EM (Back), OB (UL). With few exceptions, the following were classified as essential or more important: surface anatomy, meninges, heart, great vessels, respiratory tract, thoracic skeleton, peritoneum, diaphragm, abdominal veins, skull, cervical fascial spaces, cranial nerves, thyroid and parathyroid glands, and the lumbar and brachial plexuses.ConclusionsThis study conducted a needs assessment of anatomy curricular content solely from the perspective of selected non‐primary care residents at a single clinical site. Significant differences in ratings were found between residents for body regions in which residents would be expected to focus their clinical (surgical) activity (notably, OR and OB).SignificanceThis data provides insight into the importance that non‐primary care residents placed on specific anatomical structures. The authors suggest that the classifications of importance for specific anatomy by these residents were informed by their clinical perspective, and can serve as a guide for curricular development in the context of reduced contact hours, new pedagogies, and vertical integration.

Impostorism and anxiety contribute to burnout among resident physicians

Purpose Physician burnout is an issue that has come to the forefront in the past decade. While many factors contribute to burnout the impact of impostorism and self-doubt has largely been ignored. We investigated the relationship of anxiety and impostorism to burnout in postgraduate medical learners. Materials and methods Postgraduate learners in four diverse training programs: Family Medicine (FM), Paediatric Medicine (PM), Anesthesiology (AN), and General Surgery (GS) were surveyed to identify the incidence of impostorism (IP), anxiety, and burnout. IP, anxiety, and burnout were evaluated using the Clance Impostor Phenomenon Scale (CIPS), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the General Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Burnout was defined as meeting burnout criteria on all three domains. Relationships between IP, anxiety, and burnout were explored. Results Two hundred and sixty-nine residents responded to the survey (response rate 18.8%). Respondents were distributed evenly between specialties (FM = 24.9%, PM = 33.1%, AN = 20.4%, GS = 21.6%). IP was identified in 62.7% of all participants. The average score on the CIPS was 66.4 (SD = 14.4), corresponding to ‘frequent feelings of impostorism.’ Female learners were at higher risk for IP (RR = 1.27, 95% CI: 1.03–1.57). Burnout, as defined by meeting burnout criteria on all three subscales, was detected in 23.3% of respondents. Significant differences were seen in burnout between specialties (p = 0.02). GS residents were more likely to experience burnout (31.7%) than PM and AN residents (26.7 and 10.0%, respectively, p = 0.02). IP was an independent risk factor for both anxiety (RR = 3.64, 95% CI:1.96–6.76) and burnout (RR = 1.82, 95% CI: 1.07–3.08). Conclusions Impostorism is commonly experienced by resident learners independent of specialty and contributes to learner anxiety and burnout. Supervisors and Program Directors must be aware of the prevalence of IP and the impact on burnout. Initiatives to mitigate IP may improve resident learner wellness and decrease burnout in postgraduate learners.

Серцева недостатність із точки зору анестезіолога

Пацієнти кардіологічного профілю все частіше стають об’єктом опіки з боку анестезіологів як пацієнти відділень інтенсивної терапії і як пацієнти, які потребують знеболювання. У зв’язку з цим анестезіологи потребують підвищення рівня знань про хронічну серцеву недостатність та клінічні аспекти, що супроводжують пацієнтів при стаціонарному лікуванні. Сучасна концепція фармакотерапії серцевої недостатності полягає в первинній профілактиці дисфункції лівого шлуночка. Адекватний контроль як гіпертензії, так і гіперхолестеринемії було схвалено як цільову точку фармакопрофілактики. Терапію інгібіторами ангіотензинперетворюючого ферменту і бета-адреноблокаторами слід починати за наявності діабету, стійкої гіпертензії або гіперхолестеринемії в пацієнтів, які перебувають у групі підвищеного кардіоваскулярного ризику, незважаючи на нормальну скорочувальну функцію міокарда, для запобігання ускладненням. Подано перелік схвалених анестезіологічних заходів та дій у пацієнтів, які потребують знеболювання в операційній. Зроблено висновок про те, що знання стратегії щодо фармакотерапії та корекції серцевої недостатності має важливе значення в періопераційному періоді.

Філософські проблеми сучасної анестезіології

У статті розглянуто нагальні філософські проблеми анестезіології. У сучасній анестезіо­логії важливим є своєчасне вирішення як клінічних, так й інших, зокрема філософських, проблем. Серед останніх виділяють вузькоспецифічні, психологічні, морально-етичні, світоглядні, онтологічні та гносеологічні проблеми, при вирішенні яких важливо використовувати філософські методи пізнання — діалектику, системний підхід, синергетику. Анестезіологія як інтегративний напрямок постнекласичної медицини та науки спрямована на збереження особистості пацієнта в його духовній, душевній та тілесній єдності. Вирішення філософських проблем сучасної анестезіології є надзвичайно актуальним і відповідає вимогам часу.

Отдельные моменты из истории украинской анестезиологии: взгляд из прошлого и настоящего в будущее

.

Вибрані матеріали науково-практичної конференції «Молодіжна анестезіологічна конференція — Тріщинські читання» (16–19 жовтня 2019 року, м. Київ, Україна)

No abstract

Проблемы медицинской этики с позиции анестезиолога

В статье рассмотрены этические проблемы, которые возникают в медицине и с которыми сталкиваются анестезиологи. Освещены подходы как в практической деятельности, так и при клинических исследованиях. Среди прочего приведен критический подход к оценке этичности клинических исследований с позиций известного американского анестезиолога Генри Бичера.

Rewarding Best Practice: Tracking the Impact of Incentives in Anesthesiology.

Rewarding Best Practice: Tracking the Impact of Incentives in Anesthesiology.

Colombian anesthesiology at a crossroad?

Colombian anesthesiology at a crossroad?

Anesthesiology in the News

Anesthesiology in the News

This Month in Anesthesiology

This Month in Anesthesiology

Mark Your Calendar and Plan to Attend a Live ANESTHESIOLOGY® 2021 in San Diego

Mark Your Calendar and Plan to Attend a Live ANESTHESIOLOGY® 2021 in San Diego

This Month in Anesthesiology

This Month in Anesthesiology

Fallen from Grace, Ephedrine Finds Haven in Anesthesiology

Fallen from Grace, Ephedrine Finds Haven in Anesthesiology

ANESTHESIOLOGY® 2021 Call for PBLDs

ANESTHESIOLOGY® 2021 Call for PBLDs

Anesthesiology in the News

Anesthesiology in the News