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ABSTRACT BACKGROUND AND OBJECTIVES: Chronic postoperative pain (CPP) can be defined as pain that continues for two or more months after surgery, after ruling out other causes. In Brazil, there is a lack of reliable data regarding the incidence of acute and chronic postoperative pain, as well as its impact on patients. The aim of this study was to evaluate the knowledge of anesthesiologists and surgeons regarding the management of CPP. METHODS: This cross-sectional observational study was conducted using an online questionnaire distributed to a non-probabilistic convenience sample of anesthesiologists and surgeons. The questionnaire, administered through Google Forms™, consisted of 22 questions covering sociodemographic information, self-assessment of knowledge, therapeutic management of postoperative pain, and the perceived need for further training. Chi-square test or Fisher's Exact test was used to analyze the data. RESULTS: The main sociodemographic findings indicate a gender difference (p=0.03) among surgeons. Of 109 participants, most did not have expertise or specialization in pain management (p=0.02) and obtained knowledge about pain and analgesia only after undergraduate courses (p=0.013). Surgeons provided more incorrect answers about the definition of acute pain (p<0.001) and chronic pain (p=0.003) than anesthesiologists. Most participants claim to remember at least two risk factors for the development of chronic pain in surgical patients (p=0.001). Participants did not recommend the use of antidepressants (p=0.024) or antiepileptics (p=0.013) for the treatment of acute pain. Anesthesiologists considered strong opioids adequate to control acute pain (p<0.001). In relation to chronic pain, 70.7% of surgeons and 89.7% of anesthesiologists believed that antiepileptic drugs could be effective in managing this type of pain (p=0.018). Longer training time was related to less study of pain during undergraduate education (p=0.041). CONCLUSION: Surgeons and anesthesiologists showed substantial deficits in knowledge about postoperative pain. It is necessary to reassess the inclusion of the pain subject in medical curricula, and a more practical approach to the topic could greatly benefit future professionals working in this field.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória crônica (DPC) pode ser definida como uma dor que persiste por dois ou mais meses após a cirurgia, após a exclusão de outras causas. No Brasil, faltam dados confiáveis sobre a incidência de dor pós-operatória aguda e crônica, bem como seu impacto nos pacientes. O objetivo deste estudo foi avaliar o conhecimento de anestesiologistas e cirurgiões sobre o manejo da DPC. MÉTODOS: Este estudo observacional transversal foi realizado por meio de um questionário online distribuído a uma amostra não probabilística de conveniência de anestesiologistas e cirurgiões. O questionário, administrado por meio do Google Forms™, consistia em 22 questões abrangendo informações sociodemográficas, autoavaliação do conhecimento, manejo terapêutico da dor pós-operatória e percepção da necessidade de treinamento adicional. O teste Qui-quadrado ou o Exato de Fisher foi utilizado para analisar os dados. RESULTADOS: Os principais achados sociodemográficos indicaram diferença de sexo (p=0,03) entre os cirurgiões. Dos 109 participantes, a maioria não possuía expertise ou especialização no manejo da dor (p=0,02) e obtiveram conhecimento sobre dor e analgesia somente após a graduação (p=0,013). Os cirurgiões forneceram mais respostas incorretas sobre a definição de dor aguda (p<0,001) e dor crônica (p=0,003) do que os anestesiologistas. A maioria dos participantes afirmou se lembrar de ao menos dois fatores de risco para o desenvolvimento de dor crônica em pacientes cirúrgicos (p=0,001). Os participantes não recomendaram o uso de antidepressivos (p=0,024) ou antiepilépticos (p=0,013) para o tratamento da dor aguda. Os anestesiologistas consideraram os opioides fortes adequados para o controle da dor aguda (p<0,001). Em relação à dor crônica, 70,7% dos cirurgiões e 89,7% dos anestesiologistas acreditam que os fármacos antiepilépticos podem ser eficazes no controle desse tipo de dor (p=0,018). O maior tempo de formação foi relacionado a um menor estudo da dor durante a graduação (p=0,041). CONCLUSÃO: Cirurgiões e anestesiologistas mostraram déficits substanciais no conhecimento sobre dor pós-operatória. É preciso reavaliar a inclusão do tema da dor nos currículos médicos, e uma abordagem mais prática do tema pode beneficiar muito os futuros profissionais que atuam nessa área.
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Context: Cardiac anesthesiologists play a key role during the conduct of cardiopulmonary bypass (CPB). There are variations in the practice of CPB among extracorporeal technologists in India. Aims: The aim of this survey is to gather information on variations during the conduct of CPB in India. Settings and Design: This was an online conducted survey by Indian College of Cardiac Anaesthesia, which is the research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. Subjects and Methods: Senior consultants heading cardiac anesthesia departments in both teaching and nonteaching centers (performing at least 15 cases a month) were contacted using an online questionnaire fielded using SurveyMonkey™ software. There were 33 questions focusing on institute information, perfusion practices, blood conservation on CPB; monitoring and anesthesia practices. Results: The response rate was 74.2% (187/252). Fifty-one (26%) centers were teaching centers; 18% centers performed more than 1000 cases annually. Crystalloid solution was the most common priming solution used. Twenty-three percent centers used corticosteroids routinely; methylprednisone was the most commonly used agent. The cardioplegia solution used by most responders was the one available commercially containing high potassium St. Thomas solution (55%), followed by Del Nido cardioplegia (33%). Majority of the responders used nasopharyngeal site to monitor intraoperative patient temperature. Antifibrinolytics were commonly used only in patients who were at high risk for bleeding by 51% of responders, while yet, another 39% used them routinely, and 11% never did. About 59% of the centers insist on only fresh blood (<7 days old) when blood transfusion was indicated. The facility to use vaporizer on CPB was available in 62% of the centers. All the teaching centers or high volume centers in India had access to transesophageal echocardiography probe and echo machine, with 51% using them routinely and 38% using them at least sometimes. Conclusions: There is a wide heterogeneity in CPB management protocols among various Indian cardiac surgery centers. The survey suggests that adherence to evidence-based and internationally accepted practices appears to be more prevalent in centers that have ongoing teaching programs and/or have high volumes, strengthening the need to devise guidelines by appropriate body to help bring in uniformity in CPB management to ensure patient safety and high quality of clinical care for best outcomes.
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The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA),a nonprofit organization representing anesthesiologists in 150 countries,and the World Health Organization (WHO).The recommendations have been approved by WHO and the membership of WFSA.These Standards are applicable to all anesthesia providers throughout the world.They are intended to provide guidance and assistance to anesthesia providers,their professional organizations,hospital and facility administrators,and governments for maintaining and improving the quality and safety of anesthesia care.The Standards cover professional aspects;facilities and equipment;medications and intravenous fluids;monitoring;and the conduct of anesthesia.HIGHLY RECOMMENDED standards,the functional equivalent of mandatory standards,include (amongst other things):the continuous presence of a trained and vigilant anesthesia provider;continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter;intermittent monitoring of blood pressure;confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection;the use of the WHO Safe Surgery Checklist;and a system for transfer of care at the end of an anesthetic.The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards,preferably exceeding the standards outlined in this document.
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Background: Subarachnoid block is commonest anaesthetic technique used for most gynaecological surgeries. Local anaesthetic agents have traditionally been used for this, but with the discovery of opioid receptors in spinal cord in substantia gelatinosa. Possibility of synergism between opioids & local anaesthetics co-administered intrathecally has been explored for various lower abdominal surgeries. Aims & Objective: To study was to compare effect of intrathecal bupivacaine with bupivacaine, fentanyl mixture to assess safety and efficacy, peri –operative hemodynamic stability postoperative pain relief in major gynecological surgeries. Materials and Methods: 60 female patients with American society of anaesthesiologists (ASA) grade I OR II were divided in two groups after matching. Group BF received inj. Bupivacaine 15 mg (0.5%) 3 ml + inj. Fentanyl 25 mcg, (50 mcg/ml), 0.5 ml and Group B: (inj. Bupivacaine 15 mg (0.5%) 3 ml + Normal Saline (0.5 ml), total volume was 3.5 ml in each group. Spinal anaesthesia was given with conventional technique. Results: Duration of sensory block and effective analgesia was prolonged while there was no change in duration of motor block with intrathecally bupivacaine with fentanyl as compared to inj. Bupivacaine alone. Conclusion: Intrathecal Fentanyl as an adjuvant to bupivacaine improves quality of block with longer duration of sensory block & prolongs duration of effective analgesia.