Physician Anesthesiologists Research Articles

Dental sedation permit requirements for physician anesthesiologists in the United States and the European Union: a review

Purpose of review This review addresses the dental sedation permit requirements for physician anesthesiologists in the United States and the European Union (EU). The regulatory landscape for office-based anesthesia, including dental settings, is often described as the ‘Wild West’ of patient safety, making it crucial to outline the similarities and differences in dental anesthesia regulations and offer practical guidelines for regulators. Recent findings There is virtually no literature that addresses the issue of dental sedation permits for physicians. By summarizing the variation in language and terminology from state to state, this review highlights the inconsistencies and gaps in dental regulations. The review also highlights the limited specific guidance on the permit process for physicians administering dental anesthesia. Summary By comparing dental anesthesia regulations and guidelines across all U.S. states and the EU, the review aims to offer practical guidelines for regulators to institute an oversight process that is fair to physician anesthesiologists and does not impede their ability to practice in the dental office setting. This framework for credentialing and permitting physicians in dental office-based anesthesia settings is informed by existing safety recommendations and best practices.

Revisiting the effects of state anesthesia policy interventions: A comprehensive look at certified registered nurse anesthetist service provision in U.S. hospitals from 2010 to 2021.

Rural hospitals in the United States often rely on nonphysician providers such as advanced practice nurses to care for their patients. One important role that is served by advanced practice nurses is that of anesthesia provider (certified registered nurse anesthetist or CRNA). In 2001, Centers for Medicare & Medicaid Services (CMS) passed an opt-out law affording state governors the right to loosen physician supervision requirements on CRNAs in their respective states, thus potentially improving access in targeted areas. Since then, 24 states have adopted these opt-out provisions. We aim to understand the extent to which the CMS opt-out law has resulted in increased CRNA service provision in hospitals, especially in rural areas. The study used a longitudinal design. We compiled 2010-2021 American Hospital Association data, which includes 4,464 unique U.S. hospitals observed an average of 8 times annually (35,863 total hospital-year observations). We model CRNA services provision at the hospital level using longitudinal mixed effects generalized linear models that incorporate state, county, and hospital control variables. Using descriptive statistics and mixed effects generalized linear models, we discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals. Notably, opt-out provisions do not improve access in rural counties. However, in supplemental analysis, we discover some of the conditions under which the likelihood of CRNA service provision is influenced. Hospitals often utilize CRNAs to staff their hospitals. However, many hospitals use both CRNAs and physician anesthesiologists; this can be a potential source of contention and confusion, given the lack of uniformity in thescope of practice policies. We offer some suggestions with regard to the effects of state interventions into the field, and how they might impact this dispute. Lastly, policymakers should consider additional measures to address rural access limitations, as the opt-out policy does not seem to be working as intended.

Influence of Factors on Career Intentions: A Cross-Sectional Study of Female Medical Students Pursuing Anesthesia Careers in Saudi Arabia

Background: The decision to pursue a medical career is influenced by a multitude of factors, including gender, family background, and socioeconomic status. Despite the multifaceted role of anaesthesia in critical care and disaster response, physician anesthesiologists remain underrepresented in Saudi Arabia and other developing countries, posing challenges to healthcare systems. This study explores the factors influencing career intentions among female medical students in Saudi Arabia regarding pursuing a career in anaesthesia. Aim: This study aims to identify factors influencing the career choice of anesthesia among female undergraduates, exploring associations with other sociodemographic variables. Methodology: A cross sectional study was done by using comprehensive questionnaire-based approach employed to gather data on demographic profiles, experiences during anaesthesia rotations, postgraduate training preferences, and perceptions of the field. Logistic regression analysis was applied to investigate associations between demographic variables and attitudes towards anaesthesia as a career choice. Results: Varied age distribution (9.9%-54.5%), predominantly Saudi nationals (90.4%), and diverse parental occupations, mainly in healthcare, including medicine (6.8%-47.7%), were observed in the study. Regression analysis identifies non-Saudi nationality as associated with a positive attitude (Odds Ratio = 4.9247, p = 0.050), while increasing undergraduate years correlate with decreased positive attitudes. Factors linked to negative attitudes include older age (>27) (Coefficient = 1.2668, p = 0.248), and non-Saudi nationality with higher log odds (Odds Ratio = 5.0054, p = 0.130). Key influencers include financial considerations, perceptions of respect and patient care, mentorship, and misconceptions. Attitudes towards anaesthesia evolved with advancing education years. Conclusion: This study sheds light on the nuanced factors shaping career intentions within the anaesthesia field among female medical students in Saudi Arabia. By understanding these influences, healthcare institutions and policymakers can develop tailored strategies to attract and retain talent, addressing the underrepresentation of physician anesthesiologists and promoting anaesthesia as a rewarding career path. Our study emphasizes the pivotal role of cultural context, clinical experiences, and tailored support mechanisms in shaping the career intentions of Saudi Arabian female medical students towards anaesthesia.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Increasing access to pediatric surgical care: Assessing district hospital readiness in rural Rwanda.

Safe and quality surgery is crucial for child health. In Rwanda, district hospitals serve as primary entry points for pediatric patients needing surgical care. This paper reports on the organizational readiness and facility capacity to provide pediatric surgery in three district hospitals in rural Rwanda. We administered the Children's Surgical Assessment Tool (CSAT), adapted for a Rwandan district hospital, to assess facility readiness across 5 domains (infrastructure, workforce, service delivery, financing, and training) at three Partners in Health supported district hospitals (Kirehe, Rwinkwavu, and Butaro District Hospitals). We used the Safe Surgery Organizational Readiness Tool (SSORT) to measure perceived individual and team readiness to implement surgical quality improvement interventions across 14 domains. None of the facilities had a dedicated pediatric surgeon, and the most common barriers to pediatric surgery were lack of surgeon (68%), lack of physician anesthesiologists (19%), and inadequate infrastructure (17%). There were gaps in operating and recovery room infrastructure, and information management for pediatric outpatients and referrals. In SSORT interviews (n=47), the highest barriers to increasing pediatric surgery capacity were facility capacity (mean score=2.6 out of 5), psychological safety (median score=3.0 out of 5), and resistance to change (mean score=1.5 out of 5 with 5=no resistance). This study highlights challenges in providing safe and high-quality surgical care to pediatric patients in three rural district hospitals in Rwanda. It underscores the need for targeted interventions to address facility and organizational barriers prior to implementing interventions to expand pediatric surgical capacity.

Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.

Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.

Artificial Intelligence in Anesthetic Care: A Survey of Physician Anesthesiologists.

This study explored physician anesthesiologists' knowledge, exposure, and perceptions of artificial intelligence (AI) and their associations with attitudes and expectations regarding its use in clinical practice. The findings highlight the importance of understanding anesthesiologists' perspectives for the successful integration of AI into anesthesiology, as AI has the potential to revolutionize the field. A cross-sectional survey of 27,056 US physician anesthesiologists was conducted to assess their knowledge, perceptions, and expectations regarding the use of AI in clinical practice. The primary outcome measured was attitude toward the use of AI in clinical practice, with scores of 4 or 5 on a 5-point Likert scale indicating positive attitudes. The anticipated impact of AI on various aspects of professional work was measured using a 3-point Likert scale. Logistic regression was used to explore the relationship between participant responses and attitudes toward the use of AI in clinical practice. A 2021 survey of 27,056 US physician anesthesiologists received 1086 responses (4% response rate). Most respondents were male (71%), active clinicians (93%) under 45 (34%). A majority of anesthesiologists (61%) had some knowledge of AI and 48% had a positive attitude toward using AI in clinical practice. While most respondents believed that AI can improve health care efficiency (79%), timeliness (75%), and effectiveness (69%), they are concerned that its integration in anesthesiology could lead to a decreased demand for anesthesiologists (45%) and decreased earnings (45%). Within a decade, respondents expected AI would outperform them in predicting adverse perioperative events (83%), formulating pain management plans (67%), and conducting airway exams (45%). The absence of algorithmic transparency (60%), an ambiguous environment regarding malpractice (47%), and the possibility of medical errors (47%) were cited as significant barriers to the use of AI in clinical practice. Respondents indicated that their motivation to use AI in clinical practice stemmed from its potential to enhance patient outcomes (81%), lower health care expenditures (54%), reduce bias (55%), and boost productivity (53%). Variables associated with positive attitudes toward AI use in clinical practice included male gender (odds ratio [OR], 1.7; P < .001), 20+ years of experience (OR, 1.8; P < .01), higher AI knowledge (OR, 2.3; P = .01), and greater AI openness (OR, 10.6; P < .01). Anxiety about future earnings was associated with negative attitudes toward AI use in clinical practice (OR, 0.54; P < .01). Understanding anesthesiologists' perspectives on AI is essential for the effective integration of AI into anesthesiology, as AI has the potential to revolutionize the field.

Operational outcomes of propofol sedation versus fentanyl, midazolam and diphenhydramine sedation for endoscopies and colonoscopies at an academic medical center.

On July 1st, 2021, the University of Colorado Hospital (UCH) implemented new sedation protocols in the luminal gastrointestinal (GI) suite. GI proceduralist supervised, Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS) sedation was transitioned to Monitored Anesthesia Care with propofol under physician anesthesiologist supervision (MAC). To determine if there are statistically significant reductions in Sedation-Start to Scope-In time (SSSI) when using Monitored Anesthesia Care with propofol (MAC) versus Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS). Secondary objectives were to determine if statistically significant improvements to other operational times, quality measures, and satisfaction metrics were present. This study was a retrospective analysis of a natural experiment resultant of a change from NAS to MAC sedation protocols. Outcomes for NAS protocols from 1/1/21-6/30/21 were compared to outcomes of MAC protocols from the dates 8/1/21-10/31/21. Results were analyzed using Quasi-Poisson regression analysis and stratified based on upper GI, lower GI, and combined procedures. Patient demographic data including age, biological sex, comorbidities, and BMI, were adjusted for in the analysis. ASA matching was not performed as nursing sedation does not use ASA classifications. Pre-anesthesia co-morbidities were assessed via evaluation of a strict set of comorbidities abstracted from the electronic medical record. Perioperative operational outcomes include Sedation Start to Scope-In (SSSI), In-Room to Scope-In Time (IRSI), Scope Out to Out of Room (SOOR), Total Case Length (TCL), and Post Anesthesia Care Unit Length of Stay (PACU LOS). Quality outcomes include PACU Administered Medications (PAM), and Clinician Satisfaction Scores (CSS). A total of 5,582 gastrointestinal (GI) endoscopic cases (upper, lower, and combined endoscopies) were observed. Statistically significant decreases in SSSI of 2.5, 2.1, and 2.2 minutes for upper, lower, and dual GI procedures were observed when using MAC protocols. A statistically significant increase in satisfaction scores of 47.0 and 19.6 points were observed for nurses and proceduralists, respectively, when using MAC. MAC protocols for endoscopic GI procedures at UCH led to statistically significant decreases in the time required to complete procedures thus increasing operational efficiency.

The Physician Anesthesia Workforce in Canada From 1996 to 2018: A Longitudinal Analysis of Health Administrative Data.

A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Machine Learning Algorithm to Perform the American Society of Anesthesiologists Physical Status Classification.

The American Society of Anesthesiologists (ASA) Physical Status (PS) Classification System defines perioperative patient scores ranging from 1 to 6 (healthy to brain dead, respectively).The scoring is performed and used by physician anesthesiologists and providers to classify surgical patients based on co-morbidities and various clinical characteristics. There is potentially a variability in scoring stemming from individual biases.The biases impact the prediction of operating times, length of stay in the hospital, anesthetic management, and billing.This study's purpose was to develop an automated system to achieve reproducible scoring. A machine learning (ML) model was trained on already assigned ASA PS scores of 12,064 patients. The ML algorithm was automatically selected by Wolfram Mathematica (Wolfram Research, Champaign, IL) and tested with retrospective records not used in training. Manual scoring was performed by the anesthesiologist as part of the standard preoperative evaluation.Intraclass correlation coefficient (ICC) in R (version 4.2.2; R Development Core Team, Vienna, Austria) was calculated to assess the consistency of scoring. An ML model was trained on the data corresponding to 12,064 patients. Logistic regression was chosen automatically, with an accuracy of 70.3±1.0% against the training dataset. The accuracy against 1,999 patients (the test dataset) was 69.6±1.0%. The ICC for the comparison between ML and the anesthesiologists' ASA PS scores was greater than 0.4 ("fair to good"). We have shown the feasibility of applying ML to assess the ASA PS score within an oncology patient population. Though our accuracy was not very good, we feel that, as more data are mined, a valid foundation for refinement to ML will emerge.

Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education

Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.

Physician Anesthesiologists Week 2023 – Join Us in Advocating for the Specialty and Protecting Physician-Led Anesthesia Care

Physician Anesthesiologists Week 2023 – Join Us in Advocating for the Specialty and Protecting Physician-Led Anesthesia Care

Anesthesia in Low-Resourced Settings. Near Misses and Lessons Learned

Physician training requires the highest intelligence quotient of all professions to assimilate the vast amounts of complex knowledge required. The most critical decision-making medical specialty is anesthesiology, which requires much art of practicing medicine. That art is acquired via experience from years of medical practice.Clinical experience can also be gleaned from studying these 90 case reports in Brock-Utne’s book, Anesthesia in Low-Resourced Settings. These cases are from third-world countries, but any of these situations could also occur in American Ivy League University hospitals.Limited hospital night staff can be overwhelmed by a sudden influx of gunshot trauma cases and force one to care for emergency patients outside one’s regular working expertise. Another time one could be working remote from the hospital’s fully equipped main operating room complex in a small-case specialty single operating room. Then a crisis arises needing additional drugs and devices taking 20 min to be transported to that remote venue. Innovative temporary medical measures will be required. Power failures can occur without backup electricity. Suction systems can fail. Gas delivery can fail. An anesthesia machine can fail. A device may develop a problem not foreseen by its designers. Low-resourced settings can occur in a flash moment anywhere in the world, even in rich countries.This book’s cases challenge anesthesiologists’ training, intellect, and resourcefulness. This book is rich in wisdom. Before doing “mission medical work,” all anesthesiologists should read this book. There is a summarizing list of pearls of wisdom in the book. Reading that list may save one patient’s life in your career. I read the book in 2 days. Reading this book should be mandatory for anesthesia trainees nearing graduation. Anesthesiologists at any career point will read lessons echoing some anesthesia mishap they have experienced and wish they had read this book earlier in their careers.The deficient resources can be:This is the most valuable case in the book.A 29-yr-old woman fell off a moving train. When she arrived at a midsize Somali hospital, she was hypotensive, in pain, and tachycardic. She had fractures of the T10 vertebra, right humerus, the pelvis, and five right-side ribs with a right-side hemopneumothorax. A large-bore right subclavian multi-lumen access cordis venous cannula and an intercostal chest drain were immediately inserted. The pleural cavity drained 1,500 ml of blood. Additional peripheral venous access catheters were inserted.The anesthesiologist administered 4 units of blood. The blood pressure improved, but the centralized venous pressure measured via the subclavian cannula stayed at zero. Intercostal blood continued to drain and worried the thoracic surgeon, who urgently wanted to operate to stop the bleeding. The international normalized ratio (INR) test for clotting, of a sample withdrawn for the right-subclavian vein cannula, measured 2.3 (N = less than 1.1 when not on warfarin).The anesthesiologist worried about the darkness of the ongoing draining chest blood and the inexplicable high INR test result. The thoracotomy found no active bleeding source. A repeat INR test sample drawn from the femoral vein revealed a normal INR test of 1.1. The right subclavian cannula was intrapleural, and the persistent draining dark blood was subclavian catheter transfused blood. The first INR test had been done on the trauma intrapleural blood.A patient underwent general anesthesia with intubation using a wire-reinforced flexible endotracheal tube. On awakening, the patient bit firmly on the tube and occluded it, bending the reinforcing wire. After the biting relaxed, the tube was still entirely blocked from the crimping of the reinforcing wire. The patient’s chest started to heave as he struggled to breathe past the sustained endotracheal tube obstruction.Fully deflate the endotracheal tube cuff. That frees up about 40% of the cross-sectional area of the trachea for the patient to breathe past the outside of the endotracheal tube.Soon this patient woke up and was safely extubated. The problem is preventable by initially placing a bite-block or a Guedel airway in the mouth beside the endotracheal tube.After reading this book, many will recall many forgotten pearls of wisdom. Dr. Brock-Utne is a rare and superbly trained physician anesthesiologist who has worked extensively in third-world circumstances. He is an Emeritus full clinical professor from Stanford University in California. He is the epitome of a clinically expert scientist. His book is recommended to read.

Using behavioural science to explore impact and implementation of obstetric anaesthesia training in Tanzania, Nepal and Bangladesh: a qualitative evaluation study with obstetric anaesthesia providers

Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists’ practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants’ clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations.

Japanese Dental Society of Anesthesiology Celebrates 50 Years.

The Japanese Dental Society of Anesthesiology (JDSA), with ∼2600 members, celebrated its 50th anniversary with a special banquet after its annual scientific session at the Imperial Hotel Tokyo on Sunday, October 30th, hosted by JDSA President, Professor Takehiko Iijima. Professor Emeritus Yuzuro Kaneko gave the celebration address titled “The History of Japanese Dental Anesthesiology.”Dental anesthesiology in Japan began with physician anesthesiologists who saw the need to train dentists to provide anesthesia for dental and oral & maxillofacial surgery. Professor Yasuya Kubota, a physician who later trained as a dentist, opened the first dental anesthesiology department in Japan at Tokyo Medical and Dental University in 1967. Gradually, virtually every dental school opened their own separate department in the 1970s and 1980s, and these departments began dental anesthesiology residency programs. To manage patients who required hospital admission following surgery, dedicated dental hospitals run jointly by dental anesthesiology and oral & maxillofacial surgery emerged with some facilities having dedicated intensive care units for patients requiring intubation following surgery, such as for head and neck cancer surgery and, as was common in the past, orthognathic surgery. Dental anesthesiology was recognized as one of only 5 dental specialties by the Japanese federal government in 2006.The Japanese Board of Dental Anesthesiology (JBDA) was formed to assess competence in anesthesia care in 1977. With time, 2 examinations were developed – Board Certification (1336 dentists) and Specialist Certification (339 dentists). The examination for JDBA board certified dentists occurs after 2 years of dental anesthesiology residency and allows these dentists to provide conscious sedation (as it is referred to in Japan), including the use of propofol to achieve this level of sedation, in private dental offices. Specialist Certification allows for general anesthesia to be administered in dental offices and generally requires an additional 3 years of training. Oral & maxillofacial surgeons may also provide conscious sedation after their residencies. Unlike in the US, conscious sedation guidelines recommend that the sedation dentist does not participate in the surgical procedure. Deep sedation and general anesthesia may only be provided by dentist anesthesiologists dedicated to anesthesia provision as is the case in all other parts of the world other than North America.At the 50th Anniversary Celebration, congratulations were offered by the presidents of the Japanese Society of Dental Sciences, the Japanese Dental Association, the Japanese Society of Anesthesiology, and various elected officials representing several agencies of government. Greetings and congratulations from the ASDA and the ADSA were made by Dr. Steven Ganzberg, who also lectured at the annual scientific session.We applaud the outstanding research and high level of clinical activity by dental anesthesiology in Japan. We in the US are all proud to have Japanese dental anesthesiologists as our colleagues. We wish the JDSA continued success as we celebrate 50 years of dedication to the art and science of dental anesthesiology with them.Respectfully submitted,

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Creating Future Physician Anesthesiologist Advocates – The California Society of Anesthesiologists Model

Creating Future Physician Anesthesiologist Advocates – The California Society of Anesthesiologists Model

Women of the First Anesthesia Journal.

This special article briefly discusses the role of women as the new journal Current Researches in Anesthesia and Analgesia (now Anesthesia & Analgesia [A&A]) began in 1922. It was a time of a few women physicians, and they were usually isolated from the world of mainstream medicine and its predominantly male practitioners The journal's founders, Frank McMechan and his wife Laurette of Cincinnati, were committed to developing an organization for everyone, and women physicians were welcomed early on. Three women physicians even served as the presidents of various anesthesia organizations early in the formation of the present national organization. This acceptance of women was to change as medical education and practice evolved to embrace scientific medicine, after the Flexner Report of 1910 documented the deficiencies of American medicine. Mrs McMechan made the most important contributions by a woman because she cared totally for Dr McMechan, after he experienced disabling and very severe arthritis. He became dependent on his wife for most activities, including the simple act of eating. He could not function without her; she kept him going physically for another 27 years after the onset of his very debilitating illness. After her husband's death in 1939, Mrs McMechan served an executive function, keeping the organization going and maintaining production of the journal. This article also briefly discusses the life of the first woman physician to publish an article in A&A, Frances Edith Haines, MD, of Chicago. Haines published several articles in the journal; the first was in 1922, in the second journal issue. She was the president of the Mid-Western Association of Anesthetists, an affiliated organization, in 1926. She also served in World War I as a contract physician anesthetist for the US Army; she was the first woman contract surgeon to go overseas, to Limoges, France. Her adventure-filled and bold life changed as she aged and developed financial problems. She tried, but failed, to get financial help from the government and the military for her war service, and she died in 1966. These women are examples of women physicians involved with the journal, as it began in 1922. As the number of women physicians has increased recently, some past problems, such as difficulty with getting admitted to medical schools, for example, have improved. However, there are still many issues for women in medicine, including in our specialty.

Enhancing Residency Recruitment Processes to Facilitate a Diverse Work Force in Anesthesiology

Committee News| May 2022 Enhancing Residency Recruitment Processes to Facilitate a Diverse Work Force in Anesthesiology Sujatha Ramachandran, MBBS, MACM; Sujatha Ramachandran, MBBS, MACM Search for other works by this author on: This Site PubMed Google Scholar Camille Fontaine, MD; Camille Fontaine, MD Search for other works by this author on: This Site PubMed Google Scholar Tracey Straker, MD, MS, MPH, CBA, FASA Tracey Straker, MD, MS, MPH, CBA, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor May 2022, Vol. 86, 36–37. https://doi.org/10.1097/01.ASM.0000830860.56287.f1 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Sujatha Ramachandran, Camille Fontaine, Tracey Straker; Enhancing Residency Recruitment Processes to Facilitate a Diverse Work Force in Anesthesiology. ASA Monitor 2022; 86:36–37 doi: https://doi.org/10.1097/01.ASM.0000830860.56287.f1 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: internship and residency, mentors, workforce Building a diverse workforce of physician anesthesiologists should be paramount for hospitals and health care systems. More inclusive preoperative staff would better reflect current demographics nationwide, help address health care disparities, encourage minority patient participation in decision-making, improve patient outcomes and satisfaction, and foster greater innovation in medicine (JAMA Intern Med 2014;174:289-91; Proc Natl Acad Sci U S A 2020;117:9284-91). Despite these indisputable advantages of physician workforce diversity, the percentage of people identifying as belonging to racial/ethnic minority groups in medicine has continued to remain below that of the general U.S. population (JAMA Netw Open 2019;2:e1910490; N Engl J Med 2019;380:803-5). In anesthesiology, the percentage of under-represented minority (URM) physicians is around 11%. Medical schools are documenting upward trends in Black and brown female graduates (asamonitor.pub/3tLSg8M; JAMA Intern Med 2015;175:1706-8). As per the Association of American Medical Colleges (AAMC), between 1986... You do not currently have access to this content.

ASA Promotes Patient Safety at 2021 NCSL Legislative Summit

State Beat| February 2022 ASA Promotes Patient Safety at 2021 NCSL Legislative Summit Jason Hansen, MS, JD Jason Hansen, MS, JD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2022, Vol. 86, 29. https://doi.org/10.1097/01.ASM.0000820420.71787.6b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Jason Hansen; ASA Promotes Patient Safety at 2021 NCSL Legislative Summit. ASA Monitor 2022; 86:29 doi: https://doi.org/10.1097/01.ASM.0000820420.71787.6b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search In early November 2021, ASA State Affairs represented the society at the National Conference of State Legislatures (NCSL) 46th annual Legislative Summit in Tampa, Florida. For more than 15 years, ASA has participated as an exhibitor at this important gathering of state lawmakers. Jay Epstein, MD, FASA, Chair of the ASA Task Force on State Advocacy, joined State Affairs staff in interacting with state legislators and legislative staff at the exhibit booth. ASA represented physician anesthesiologists as part of a larger joint physician booth called “Physicians Advocating for Patients.” This booth included representatives of the American Academy of Anesthesiologist Assistants, American Society for Dermatologic Surgery, American Academy of Dermatology, American College of Surgeons, and the Federation of State Medical Boards. NCSL has become one of the largest bipartisan organizations of state lawmakers in the country. It serves state lawmakers and legislative staff throughout the U.S. with policy research and... You do not currently have access to this content.