Anesthesiology
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The researchers performed multiple cross-sectional surveys of three years of US anesthesiology trainees, from their first year of clinical anesthesia training to a year after qualification. They surveyed the anesthesiologists for burnout, distress and depression.
Burnout, distress and depression were worryingly common (51%, 32% and 12% of residents), although self-reported availability of workplace resources to manage burnout & depression, and perceived work-life balance were protective, roughly halving odds of each outcome.
Having strong social supports was also associated with lower rates of depression and burnout, although not distress.
Both working more hours each week and having larger student loan debt were associated with depression and distress, although not burnout.
Females, although only making up 37% of respondents, were more likely to suffer from burnout and depression. International medical school graduates were in contrast less likely.
The take-home message...
Burnout, distress and depression are common among anesthesiology trainees and newly qualified anesthesiologists. Workplace support, efforts to maintain work-life balance, maintaining social supports and limiting working hours are modifiable factors that have protective effects.
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Postoperative delirium is common, but its long-term consequences remain unclear WHAT THIS ARTICLE TELLS US THAT IS NEW: About a quarter of enrolled patients, averaging 80 yr of age, developed delirium after major elective and urgent major orthopedic surgeryActivities of daily living at 2 to 3 yr and mortality at 3 yr were both worse in patients who experienced delirium BACKGROUND:: Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery. ⋯ Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.
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Pectoralis-II block is a potential alternative to paravertebral blocks to provide regional analgesia for breast cancer surgery WHAT THIS ARTICLE TELLS US THAT IS NEW: This meta-analysis includes 14 randomized trials comparing pectoralis-II block with paravertebral blocks and found that there were no differences in pain scores or opioid consumption between the two groups in patients having surgery for breast cancerPectoralis-II blocks were noninferior to paravertebral blocks in reducing pain intensity and morphine consumption for the first 24 h after surgery and both were superior to systemic analgesia alone BACKGROUND:: Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery. ⋯ We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
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Syntaxin1A is a presynaptic molecule that plays a key role in vesicular neurotransmitter releaseMutations of syntaxin1A result in resistance to both volatile and intravenous anestheticsTruncated syntaxin1A isoforms confer drug resistance in cell culture and nematode models of anesthesia WHAT THIS ARTICLE TELLS US THAT IS NEW: Resistance to isoflurane anesthesia can be produced by transiently expressing truncated syntaxin1A proteins in adult Drosophila fliesElectrophysiologic and behavioral studies in Drosophila show that mutations in syntaxin1A facilitate recovery from isoflurane anesthesiaThese observations suggest that presynaptic mechanisms, via syntaxin1A-mediated regulation of neurotransmitter release, are involved in general anesthesia maintenance and recovery BACKGROUND:: Mutations in the presynaptic protein syntaxin1A modulate general anesthetic effects in vitro and in vivo. Coexpression of a truncated syntaxin1A protein confers resistance to volatile and intravenous anesthetics, suggesting a target mechanism distinct from postsynaptic inhibitory receptor processes. Hypothesizing that recovery from anesthesia may involve a presynaptic component, the authors tested whether syntaxin1A mutations facilitated recovery from isoflurane anesthesia in Drosophila melanogaster. ⋯ The same neomorphic syntaxin1A mutation that confers isoflurane resistance in cell culture and nematodes also produces isoflurane resistance in Drosophila. Resistance in Drosophila is, however, most evident at the level of recovery from anesthesia, suggesting that the syntaxin1A target affects anesthesia maintenance and recovery processes rather than induction. The absence of truncated syntaxin1A from the presynaptic complex suggests that the resistance-promoting effect of this molecule occurs before core complex formation.
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Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve. ⋯ Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.