Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees.
The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence of burnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology. ⋯ Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.
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Anesthesia and analgesia · Jul 2013
Case ReportsCase report: inadvertent intrathecal placement of a pulmonary artery catheter introducer.
We present a case of unintended intrathecal cannulation by a pulmonary artery catheter introducer in a patient scheduled for coronary surgery. This complication was likely due to multiple attempts of placing the guidewire. Switching to the straight tip of the guidewire may have created a false route, facilitating entrance in the subarachnoid space. ⋯ A lumbar epidural blood patch alleviated all complaints. One month later the patient underwent surgery successfully. We hypothesize that ultrasound imaging may have prevented this complication.
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Anesthesia and analgesia · Jul 2013
Research, education, and nonclinical service productivity of new junior anesthesia faculty during a 2-year faculty development program.
As a specialty, anesthesiology has relatively low research productivity. Prior studies indicate that junior faculty development programs favorably affect academic performance. We therefore initiated a junior faculty development program and hypothesized that most (>50%) new junior faculty would take <50 nonclinical days to achieve a primary program goal (e.g., investigation or publication), and <5 nonclinical days to achieve a secondary program goal (e.g., teaching or nonclinical service). ⋯ Even with structured developmental support, most new junior anesthesia faculty needed >50 nonclinical days to achieve a primary (traditional academic) goal and >5 nonclinical days to achieve a secondary goal. Currently, most new anesthesia faculty are not productive in traditional academic activities (research). They are more productive in activities related to clinical care, education, and patient care systems management.
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Anesthesia and analgesia · Jul 2013
Technical communication: the effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices.
A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. ⋯ Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10-7.00 ppm, n = 9) to 0 ppm (IQR = 0-0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental "high-volumes" suctions (high-volume evacuators producing approximately 12 m(3)/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.
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Anesthesia and analgesia · Jul 2013
Case ReportsCase report: anterior mediastinal central line malposition.
Central venous catheter (CVC) placement is a routine procedure in the management of critically ill patients. It is important to ensure correct positioning of the catheter tip just above the junction of the superior vena cava and the right atrium, to reduce associated complications and to optimize catheter function. The incidence of catheter misplacement is approximately 3%-4% for both subclavian and internal jugular vein access procedures. CVC placement in the right subclavian vein is associated with a higher risk of malposition.(1) We report an unexpected secondary malposition of a right subclavian CVC in the anterior mediastinum, with resultant vena caval perforation in a patient admitted to the neuro-critical care unit after undergoing a craniotomy procedure.