Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2019
Multicenter StudyEvaluation of Job Stress and Burnout Among Anesthesiologists Working in Academic Institutions in 2 Major Cities in Pakistan.
Work stress is an integral part of anesthetic practice and has been a subject of many studies. Persistent stress can lead to burnout. There is limited published literature from lower- and middle-income countries where job stressors may be different from high-income countries. ⋯ In conclusion, a high rate of burnout was identified in anesthesiologists working in 2 major cities in Pakistan. Some new associated factors such as initial choice of specialty and city of work were highlighted. Based on these findings, preventive and coping strategies need to be introduced at institutional and national levels.
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There are occasionally intraoperative circumstances in which reduction of mean arterial pressure (MAP) to levels well below those that occur in nonanesthetized adults is necessary or unavoidable. In these situations, clinicians are inevitably concerned about the limits of the tolerance of the brain for hypotension. ⋯ The principal theses offered by this review are: (1) that the average lower limit of cerebral blood flow autoregulation in normotensive adult humans is not less than a MAP of 70 mm Hg; (2) that there is considerable intersubject variability in both the lower limit of cerebral blood flow autoregulation and the efficiency of cerebral blood flow autoregulation; (3) that there is a substantial blood flow reserve that buffers the normal central nervous system against critical blood flow reduction in the face of hypotension; (4) that there are several common clinical phenomena that have the potential to compromise that buffer, and that should be taken into account in decision making about minimum acceptable MAPs; and (5) that the average threshold for the onset of central nervous system ischemic symptoms is probably a MAP of 40-50 mm Hg at the level of the circle of Willis in a normotensive adult in a vertical posture and 45-55 mm Hg in a supine subject. However, these MAPs should probably only be approached deliberately when the exigencies of the surgical situation absolutely require it.
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Anesthesia and analgesia · Apr 2019
Cardiac Risk of Noncardiac Surgery After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents.
Noncardiac surgery (NCS) following percutaneous coronary intervention (PCI) with stenting is sometimes associated with major adverse cardiac events (MACEs). Second-generation drug-eluting stents (DES) were developed to decrease the incidence of MACE seen with bare metal and first-generation DES. ⋯ The incidence of MACE in patients with second-generation DES undergoing NCS was 5.3% and was highest in the first 180 days following DES implantation. The rate of excessive surgical bleeding was 6.7% with the highest observed rate in those on DAPT. However, differences by the presence or absence of antiplatelet therapy were not significant, and future large observational studies will be necessary to further define bleeding risk with continued DAPT.