Junior Anaesthetists Research Articles

Improving compliance with personal protective equipment among anaesthetists through behaviour-changing interventions during the coronavirus disease 2019(COVID-19) pandemic.

Since 2020, the coronavirus disease 2019 (COVID-19) pandemic has seen many changes in our daily infection prevention behaviours so as to reduce healthcare-associated transmission of COVID-19 in patients and healthcare workers. In the early phases of the COVID-19 pandemic of 2020, there was much emphasis on compliant personal protective equipment utilization in the operating theatres (OTs) for COVID-19-positive patients. However, during this period, there was a lack of international validated protocols on the appropriate handling and subsequent storage of personal protective equipment in the context of aerosol-generating procedures in OTs for asymptomatic antigen rapid test (ART)-negative patients. Given the potential for transmission even with a negative ART due to the incubation period, our team developed a checklist of eye protection (e.g. goggles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve the compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital so as to prevent infection transmission and cross-contamination in the OT through education and behaviour-changing interventions. This quality improvement project took place over 19 weeks from June to October 2020 by our team of anaesthetists and nurse clinicians in the non-isolation OT setting. To analyse the problem, we performed a root cause analysis to understand attitudes and beliefs driving their behaviour. The top 80% of cited root causes for non-compliance then guided prioritization of resources for subsequent behaviour-changing interventions. Using the comprehensive infection control checklist, we conducted several plan-do-study-act cycles while implementing this new checklist amongst junior anaesthetists. A total of 227 assessments of junior anaesthetists were made in the care of asymptomatic ART-negative patients. Compliance with correctly handling goggles post-intubation started out as 33.3% in Week 1, which improved to 78.5% by Week 19. Compliance with goggle storage and face shield disposal started out at 13.6% in Week 1 and increased to 78.6% by Week 19. We attributed this improvement to education and behaviour-changing interventions. This quality improvement project focusing on improving compliance with personal protective equipment utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation OTs demonstrated the importance of interventions of education, persuasion, modelling, and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.

Perioperative pain management in thoracic surgery: A survey of practices in Australia and New Zealand.

There are few data on current trends in pain management for thoracic surgery in Australia and New Zealand. Several new regional analgesia techniques have been introduced for these operations in the past few years. Our survey aimed to assess current practice and perceptions towards various modalities of pain management for thoracic surgery among anaesthetists in Australia and New Zealand. A 22-question electronic survey was developed and distributed in 2020 with the assistance of the Australian and New Zealand College of Anaesthetists Cardiac Thoracic Vascular and Perfusion Special Interest Group. The survey focused on four key domains-demographics, general pain management, operative technique, and postoperative approach. Of the 696 invitations, 165 complete responses were obtained, for a response rate of 24%. Most respondents reported a trend away from the historical standard of thoracic epidural analgesia, with a preference towards non-neuraxial regional analgesia techniques. If representative of anaesthetists in Australia and New Zealand more widely, this trend may result in less exposure of junior anaesthetists to the insertion and management of thoracic epidurals, potentially resulting in reduced familiarity and confidence in the technique. Furthermore, it demonstrates a notable reliance on surgically or intraoperatively placed paravertebral catheters as the primary analgesic modality, and suggests the need for future studies assessing the optimal method of catheter insertion and perioperative management. It also gives some insight into the current opinion and practice of the respondents with regard to formalised enhanced recovery after surgery pathways, acute pain services, opioid-free anaesthesia, and current medication selection.

Time to VENT: a weekly, voluntary peer support initiative to improve colleague wellbeing and promote reflective practice

Background: Anaesthesia trainees are particularly susceptible to burnout and depression.1 2 The Association of Anaesthetists of Great Britain and Ireland suggest that wellbeing interventions warrant further research, leading to campaigns such as ‘#CoffeeAndAGas’. A pre-intervention survey showed, within our department, that being on call causes stress that negatively impacts trainees’ wellbeing beyond shifts and there is not always someone who understands their job role to talk to. Trainees do not want to speak to consultants or supervisors about these wellbeing issues but are more willing to speak to colleagues of a similar grade. Therefore, weekly VENT sessions were designed and implemented in our department. Methods: Weekly, voluntary, 30-min VENT sessions were organised for all junior anaesthetists. Ground rules were displayed at the beginning of every session. Core principles included: voluntary engagement, mutual respect, no consultant presence, complete confidentiality, and non-judgmental discussion. The aims were to promote wellbeing through offloading, developing reflective practice, and stimulating culture change. Sessions were structured the same way to promote a comfortable, empathetic, and open environment. The sessions included Vocalising how you really feel, Empathising with colleagues (sharing similar feelings, experiences, and advice), learning a New wellbeing theory or mindfulness technique each session, and finally, Talking about cases and experiences. Anonymous surveys were sent to attendees after four sessions to assess impact and gain feedback. Results: Voluntary attendance was sustained at 95% of all available trainees. Ten (90%) responded to the post session survey. All respondents believed the sessions were helpful for wellbeing and were valuable for learning, with most (80%) seeing value in learning wellbeing theory. All felt the sessions will promote ‘cultural change’ and have a positive impact on overall wellbeing. All respondents believed VENT should be offered by other hospitals and should continue in our hospital. Free text feedback included comments expressing relief and reassurance gained from speaking to more senior trainees, relieving stress, and improving confidence. Trainees also found it helpful to talk through scenarios which aided their own reflection and processing of difficult situations. Conclusion: Junior anaesthetists feel more comfortable speaking to their peers about wellbeing issues than to consultants. The ability to talk to colleagues about things that have happened whilst working is beneficial. Promoting an open environment with a familiar structure exceeded expectations of colleague engagement with most colleagues attending regularly. VENT allows learning from each other’s experiences, and revisiting of personal experiences allows improved reflective practice. VENT is also beneficial in teaching colleagues how to look after their own wellbeing. Overall, regular VENT sessions have had a positive impact on personal wellbeing of our trainees and should become embedded into practice, and be adopted by other hospitals. 1.Looseley A, Wainwright E, Cook TM, et al. Anaesthesia 2019; 74: 1231–92.Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Br J Anaesth 2003; 90: 333–7

P111 Thromboelastography (TEG6s) use and interpretation on labour ward: a survey of current knowledge amongst junior anaesthetists

P111 Thromboelastography (TEG6s) use and interpretation on labour ward: a survey of current knowledge amongst junior anaesthetists

Implications of the current economic crisis on anaesthesia and critical care services in Sri Lanka: observations of a junior anaesthetist

No abstract available

Anaesthetists' knowledge of airborne infections.

Anaesthetists need to be knowledgeable regarding the control of airborne infection to ensure safe practice. The aim of this study was to determine anaesthetists' knowledge regarding airborne infections in the perioperative period in the Department of Anaesthesiology at the University of the Witwatersrand. A cross-sectional research design was followed using an anonymous self-administered questionnaire. Data were collected at academic departmental meetings by convenience sampling. Returning the questionnaire implied consent. A score of 65% was considered adequate knowledge. Of the 150 questionnaires distributed, 137 (91.3%) questionnaires were returned. An overall mean (standard deviation [s.d.]) score of 58.8% (4.252) was achieved, and only 11 (8.1%) of anaesthetists had adequate knowledge. There was no statistically significant association between seniority and passing or failing (p = 0.327). The highest mean (s.d.) score, 67.4% (6.979), was reported in the section pertaining to patients, followed by the section regarding operating theatre staff at 58.1% (11.899) and the lowest mark, 53.5% (5.553), for the environment section. Anaesthetists scored significantly better in the knowledge regarding patients' section than in other sections (p < 0.0005). Knowledge of airborne infections in this study was poor, with only 8.1% achieving a pass, and no difference in knowledge between junior and senior anaesthetists was observed. Considering the ongoing coronavirus disease 2019 (COVID-19) pandemic at the time of the study, this was a surprising finding. Urgent action needs to be taken to ensure the safety of anaesthetists, other operating theatre staff and patients.

Increasing use of an endotracheal intubation safety checklist in the emergency department

Endotracheal intubation (ETI) is a high-risk procedure often performed in the emergency department (ED) in critically unwell patients. The fourth National Audit Project by The Royal College of Anaesthetists found...

Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

BackgroundAn epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation.MethodsThe state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described.ResultsMain surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain.ConclusionsThe key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department

BackgroundVideolaryngoscopy (VL) is increasingly used, but not yet routine practice, for tracheal intubation. Few departments formally trial equipment before adopting it into practice. We describe the decision-making and implementation processes that our department used when introducing universal VL, with the C-MAC© (Karl Storz, Germany), throughout our anaesthesia and intensive care departments. MethodsWe used a structured process to assess the feasibility of a change to universal VL. After departmental training, we undertook a 2 month trial period of mandating VL for all adult in-theatre intubations. Thereafter, VL remained widely available, but not mandated. We regularly surveyed anaesthetists and anaesthetic assistants to evaluate departmental opinion regarding the introduction of universal VL. ResultsBefore the trial period, one-third of anaesthetists judged that universal VL would be of overall benefit to patient safety, team dynamics, and quality of care. Reservations from both junior and senior anaesthetists focused on training concerns. Support for a changeover to VL, amongst both anaesthetists and anaesthetic assistants, increased throughout the trial period. Six months after the 2 month trial, support had grown further and was almost unanimous. Anaesthetists reported significant benefits in clinical performance, teaching, and human factors, especially teamwork and situation awareness. ConclusionsPerforming a formal and prolonged trial of mandatory VL in theatre led to changes in perceptions and departmental consensus. As a result of the trial, the department agreed to the use of C-MAC© videolaryngoscopy as the default intubation technique throughout theatres and intensive care, with removal of standard Macintosh laryngoscopes from routine use.

A national survey of the effects of fatigue on trainees in anaesthesia in the UK.

Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist. There is no official guidance regarding provision of a minimum standard of rest facilities for doctors in the National Health Service, and the way in which rest is achieved by trainee anaesthetists during their on-call shift depends on rota staffing and workload. We conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK. We achieved a response rate of 59% (2231/3772 responses), with data from 100% of NHS trusts. Fatigue remains prevalent among junior anaesthetists, with reports that it has effects on physical health (73.6% [95%CI 71.8-75.5]), psychological wellbeing (71.2% [69.2-73.1]) and personal relationships (67.9% [65.9-70.0]). The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% (55.0-59.1) stating they had experienced an accident or near-miss when travelling home from night shifts. We discuss potential explanations for the results, and present a plan to address the issues raised by this survey, aiming to change the culture around fatigue for the better.

Speak up! Barriers to challenging erroneous decisions of seniors in anaesthesia.

'Speaking up' or the ability to effectively challenge erroneous decisions is essential to preventing harm. This mixed-methods study in two parts explores the concept of 'barriers to challenging seniors' for anaesthetic trainees, and proposes a conceptual framework. Using a fully immersive simulation scenario with unanticipated airway difficulty, we investigated how junior anaesthetists (one to two years of training) challenged a scripted error. We also conducted focus groups with senior trainees (three to seven years of training) and undertook a 'thematic network analysis' of responses. Junior anaesthetic trainees challenged erroneous decisions effectively, but trainees with an additional year of experience challenged more quickly and effectively, combining 'crisp-advocacy-inquiry challenge' with 'non-verbal cues'. Focus group analysis conceptualised a 'barrier network' with three main themes: concerns around relationships; decision-making; and risk/cost-benefit. Emotional maturity is an important protective layer around decisions to challenge. Despite significant multifactorial barriers, systematic training in effective 'speaking up' could improve the confidence and ability of juniors to challenge erroneous decisions.

The rapid sequence spinal for category 1 caesarean section: anaesthetic trainee knowledge and practice.

Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS. The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.

Improving the safety of remote site emergency airway management

Airway management, particularly in non-theatre settings, is an area of anaesthesia and critical care associated with significant risk of morbidity & mortality, as highlighted during the 4th National Audit Project of the Royal College of Anaesthetists (NAP4). A survey of junior anaesthetists at our hospital highlighted a lack of confidence and perceived lack of safety in emergency airway management, especially in non-theatre settings.We developed and implemented a multifaceted airway package designed to improve the safety of remote site airway management. A Rapid Sequence Induction (RSI) checklist was developed; this was combined with new advanced airway equipment and drugs bags. Additionally, new carbon dioxide detector filters were procured in order to comply with NAP4 monitoring recommendations.The RSI checklists were placed in key locations throughout the hospital and the drugs and advanced airway equipment bags were centralised in the Intensive Care Unit (ICU). It was agreed with the senior nursing staff that an appropriately trained ICU nurse would attend all emergency situations with new airway resources upon request. Departmental guidelines were updated to include details of the new resources and the on-call anaesthetist's responsibilities regarding checks and maintenance.Following our intervention trainees reported higher confidence levels regarding remote site emergency airway management. Nine trusts within the Northern Region were surveyed and we found large variations in the provision of remote site airway management resources.Complications in remote site airway management due lack of available appropriate drugs, equipment or trained staff are potentially life threatening and completely avoidable. Utilising the intervention package an anaesthetist would be able to safely plan and prepare for airway management in any setting. They would subsequently have the drugs, equipment, and trained assistance required to manage any difficulties or complications. We suggest that this should be the gold standard of airway resource provision and is in line with NAP4 recommendations.

Do junior anaesthetists face a bleak future?

Many young anaesthetists are worried about the viability of future careers in the NHS and their prospects of becoming consultants. <b>Richard Paul</b> looks at whether this pessimism is justified

Assessment of the Ability of Anaesthetists to Locate the Internal Jugular Vein by the Anatomic Landmark Technique with Ultrasonography: Right or Left, Does it Make any Difference?

To assess senior and junior anaesthetists' ability to locate the right and left jugular vein (IJV) using the anatomic landmark technique. A total of 45 anaesthetists were included in this study. Initially, a questionnaire assessing the experiences of the anaesthetists was completed. The anaesthetists were grouped into two groups, junior and senior. The anaesthetists, who were blind to the screen, were asked to point to the internal jugular vein bilaterally on the neck of a healthy volunteer using an ultrasound probe with the midpoint as an 'imaginary needle'. The success rates for locating the right and left IJV in both junior and senior groups were assessed separately. The success rate for locating the right IJV was 88% (n=26, 23/26) in the senior and 68.4% (n=19, 13/19) in the junior group (p<0.001). The success rate for locating the left IJV was 69% (18/26) in the senior and 78% (15/19) in the junior group (p<0.001), while the difference in success rates for locating the right and left IJV in the senior group was found to be statistically significant (p<0.001). Both use of the anatomic landmark technique and experience increased the success rate. Especially in the less preferred left IJV catheterization, use of the anatomic landmark technique independent of the experience factor could increase the success rate.

Accuracy of ProSeal™ Laryngeal Mask Airway Intracuff Pressure Estimation using Finger Palpation technique – A Prospective, Observational Study

The incidence of pharyngolaryngeal adverse events associated with laryngeal mask airways can be reduced by the use of manometry to limit the laryngeal mask airway intracuff pressures. We conducted a prospective, observational study in 80 patients undergoing general anaesthesia with the ProSeal™ laryngeal mask airway to determine the accuracy of a finger palpation technique compared to actual readings obtained from a hand-held manometer by different anaesthesia personnel. The strength of association of estimated versus actual intracuff pressures, R, for nurse anaesthesia assistants, junior anaesthetists and senior anaesthetists were 0.21 (weak), 0.35 (moderate) and 0.78 (strong) respectively. Subgroup analysis showed that anaesthetists with more than three years of experience were more accurate than those with less than three years of experience. The actual versus estimated intracuff pressures were 4±17 vs 19±27 cmH2O (P value <0.001) respectively. In all groups, the palpation technique tended to underestimate the actual intracuff pressure by a mean of 10.3 cmH2O. Palpation accuracy decreased when actual intracuff pressures were >80 cmH2O. These findings suggest that cuff pressure manometry should be recommended as standard of care with the use of laryngeal mask airways.

Effect of an infection control educational programme on anaesthetists’ attitude and anaesthetic field bacterial contamination

ObjectivesTo evaluate the impact of an infection control educational programme in anaesthetic practice on the clinical performance of the personnel working in anaesthetic field and anaesthetic work place bacterial contamination.MethodsThis study was conducting on 35 personnel involved in 500 operations over two and half months. Their compliance towards handling of anaesthetic equipments, wearing of protective tools and hand hygiene was evaluated using a 13 items check list pre and post delivering of an educational infection control programme (intervention). Of 500 operations 300 were randomly selected for evaluation of bacterial contamination. Two swabs were taken from anaesthetic place before induction of general anaesthesia (T0) and 30 min intraoperative (T1) pre and post intervention. Another swab was taking from anaesthetists’ hands 15 min after induction of anaesthesia (T2).ResultsThe intervention programme influenced positively the attitude of junior anaesthetists and nurses regarding the proper use of protective tools, anaesthetic equipments and hand hygiene. Senior anaesthestists’ compliance with hand hygiene, frequency use of gloves and anaesthetic filter did not change after intervention. But their attitude towards handling of laryngoscope, anaesthetic face mask and catheter for suction improved after intervention. The adherence of housekeepers to hand hygiene, frequency of gloves use and anaesthetic equipments’ disinfection improved significantly after intervention. Ninety-two (63%) swabs were positive for bacteria at T0 before intervention. They reduced to 9 (6.3%) positive swabs after intervention. The number of positive swabs at T1 was 121 (82.9%) before intervention, reduced to 68 (47.2%) after intervention. One hundred and eight (74%) swabs from hands of anaesthetists were positive for bacteria before intervention. They lowered significantly to 55 (38.2%) after intervention. Bacterial cross infection between anaesthetic machine and anaesthetists’ hands existed pre and post intervention. In conclusion, infection control programme enhanced personnel clinical compliance and reduced bacterial contamination in anaesthetic place.

A novel use for the Apple (4th generation) iPod Touch in the operating room

There are many potential uses of video technology in the operating room; however, few have been implemented. Uses include using video for teaching best practice, monitoring team performance, skills training and operating room command and control [1]. We wish to report an innovative use of two iPod Touch™ devices (Apple, Cupertino, CA, USA) in the operating room environment that we believe have the potential to improve patient safety. The latest (4th generation) Apple iPod Touch has two built-in high definition cameras. There is a feature built into the device, called FaceTime™, that allows the devices to be used for live video-conferences. Each party can decide to use either the front-facing or rear-facing cameras, depending on what image they wish to show. The devices do not use a conventional phone signal to carry the FaceTime transmission, rather they use any local WiFi network, which is often present in healthcare facilities. An iPod Touch was mounted on a GorillaPodTM flexible tripod (Joby, San Francisco, CA, USA) using velcro. The tripod was wrapped around a standard intravenous pole mount. The rear-facing camera was pointed to a ‘patient’ monitor (we used a simulated patient to avoid transferring patient data over an unsecured internal network; Fig. 2). A FaceTime connection was established between the two devices. The second device was at a remote location within the same theatre suite (Fig. 3), but could have functioned identically anywhere else in the hospital. The ‘patient’ data were displayed on the second iPod Touch that was secured under a second ‘patient’ monitor. The patient in this case was one of the authors. We found the quality of the video display of the iPod Touch to be acceptable for viewing the vital signs of our simulated patient. There was no perceptible lag, although data transfer rates were not formally measured. The audio quality was also found to be acceptable; a conversation could be held at normal volumes. Our second test involved remote monitoring of a simulated infant undergoing tracheal intubation, and again we found the quality of both video and audio to be acceptable. iPod Touch attached to GorillaPod pointing at the ‘patient monitor’. Second iPod Touch at remote location monitoring the first patient’s vital signs. Remote supervision is routinely practiced in anaesthesia worldwide. In the UK, consultants provide junior anaesthetists with either local or distant supervision. In the USA model, one attending anaesthetist may be supervising multiple theatres, but needs to maintain situational awareness in order to be able to plan multiple operating lists. We have described an effective and relatively cheap method to conduct videoconferences in the theatre environment (iPod Touch $229, Gorillapod $30, Superglue $1.50, ¼ inch nut $0.25 and zero ongoing costs). One of the advantages of this setup is the use of a completely mobile device. The remote iPod Touch can easily be carried from location to location allowing constant situational awareness of the case in progress. As FaceTime includes video and audio, it would be easy to discuss in real time any important changes occurring during a case. Furthermore, the local iPod Touch could easily be redirected to display other pertinent information. Traditional data networks involve more ‘hardwired’ connections with less mobility and often require IT support. They also use more expensive equipment. Although this is not a substitute for an anaesthetist’s presence during a case, such a system could prove beneficial during cases without constant senior presence, thus improving supervision levels, coordination of patient flow and ultimately patient safety. Dr Low is the medical director and founder of iMobileMedic.com Ltd that makes medical software for Apple iPhones and iPods. No other external funding or competing interest declared.

Job Satisfaction, Life Satisfaction and Burnout in French Anaesthetists

The present study aimed to examine the prevalence of burnout, levels of life satisfaction and job satisfaction in anaesthetists in France. A cross-sectional study was conducted among 193 anaesthetists from eight French public hospitals. The results indicated low levels of emotional exhaustion and depersonalization scores, but high levels of reduced accomplishment. The results also revealed differences between subgroups: physician anaesthetists reported higher levels of depersonalization and reduced accomplishment than nurse anaesthetists, female and junior anaesthetists reported higher levels of emotional exhaustion and job dissatisfaction than male and senior anaesthetists. The results and the implications to reduce burnout symptoms in anesthesia teams are discussed.

Obstetric Anaesthesia

Obstetric Anaesthesia Clyburn, P, Collis, R, S Harries and S Davies ( eds ) Oxford University Press : Oxford 2008 , ISBN 978-0-19-920832-6 , 682 pp., Price £42.95 The labour suite and theatres can be a daunting place for both junior and senior anaesthetists. Dealing with the numerous possible clinical scenarios, as well as the labouring mother, anxious family and possibly demanding midwife, can stretch even the most experienced clinicians. This pocket-sized book covers most aspects of obstetric anaesthesia that could be encountered by the anaesthetist. It is written with the practising anaesthetist in mind but the authors are correct in stating that this book would also appeal to a wider audience including nurse anaesthetist, midwives and obstetricians. The layout of this book will be familiar to anyone acquainted with the Oxford Handbook series. There are 22 chapters that are appropriately sub-divided, making information very easy to find. The text is arranged in bullet point form with coloured headings and tables which aids legibility of the relatively small font. The maternal physiology and pathophysiology chapters are fully comprehensive and succinct, making it a useful guide for those preparing for the FRCA examinations. The anaesthetic implications of the pathophysiological conditions are clearly summarised in coloured boxes, making it a quick initial reference for those complicated cases that can be encountered on the labour suite. There is a small section on antenatal issues. The authors state in the preface that they have included this as antenatal identification and preparation of mothers with potential for anaesthetic problems during childbirth is often a neglected area. It may have been useful if they had further expanded this chapter; however, this book is aimed at anaesthetic trainees who rarely have input during the antenatal period. The last two chapters of this book are particularly useful. The ‘controversies in obstetric analgesia’ chapter covers those grey areas that often face the trainee anaesthetist, such as feeding during labour, monitoring and mobilisation with an epidural, and fever and regional anaesthesia. This chapter concisely covers these areas well, providing the reader with the benefits, risks and appropriate management. There is also recommended further reading for those who would like to elaborate. The last chapter is a neatly presented A–Z of rare conditions that can be encountered on the labour ward, providing a quick initial information source with further key references. The conventional chapters on regional anaesthesia, caesarean section, and anaesthesia and analgesia for specific obstetric indications have a breadth of information that is easy to follow and ideal for those new to the speciality or those in need of a recap. The chapter on regional anaesthesia includes diagrams and photographs to complement the text and aid understanding and learning of what is essentially a practical skill. With the widespread availability of internet access in our hospital, one could question the need for such a book. However, having this succinct and easy-to-find volume of information at arm’s length is an essential and irreplaceable resource. We would personally recommend this book, especially for trainees who are new to obstetric anaesthesia.