Chapter 13 - Occupational well-being, resilience, burnout, and job satisfaction of surgical teams

Resilience and occupational health of healthcare workers have emerged as central to the sustainable functioning healthcare systems during the COVID-19 pandemic. However, the range of interventions used to address this challenge remains fragmented, resting on variable empirical evidence and highly variable outcomes. Surgical team burnout is a syndrome characterized by emotional exhaustion, depersonalization, depression, and a decreased sense of personal accomplishment caused by work-related stressors. Clinicians are at a unique increased risk for burnout as a result of immense stress throughout their training and careers, long work hours, delayed gratification, challenges with sustaining work and home balance, and challenges associated with patient care and harm prevention. Future endeavors need to provide meaningful solutions, both in providing resources and pathways for perioperative team members who are already burned out and, more importantly, teaching clinicians to respond more effectively to their environment to help mitigate burnout and mortal injury. Specific protocols to reduce burnout among surgical teams from the beginning of their training and throughout their professional careers are needed. This chapter offers a systematic overview and evaluation of the structure, effectiveness, and resources required for implementing a wellness program, and a better understanding of what does and does not work. Feedback from those participating in these programs can provide a significant amount of information and help surgical team members from all disciplines. The development and implementation of effective programs may help clinicians before the problem dramatically affects their lives and directly impacts patient care and outcomes.

Are Non-Contact Thermometers an Option in Anaesthesia? A Narrative Review on Thermometry for Perioperative Medicine.

Measurement of core body temperature-clinical thermometry-provides critical information to anaesthetists during perioperative care. The value of this information is determined by the accuracy of the measurement device used. This accuracy must be maintained despite external influences such as the operating room temperature and the patient's thermoregulatory defence. Presently, perioperative thermometers utilise invasive measurement sites. The public health challenge of the COVID-19 pandemic, however, has highlighted the use of non-invasive, non-contact infrared thermometers. The aim of this article is to review common existing thermometers used in perioperative care, their mechanisms of action, accuracy, and practicality in comparison to infrared non-contact thermometry used for population screening during a pandemic. Evidence currently shows that contact thermometry varies in accuracy and practicality depending on the site of measurements and the method of sterilisation or disposal between uses. Despite the benefits of being a non-invasive and non-contact device, infrared thermometry used for population temperature screening lacks the accuracy required in perioperative medicine. Inaccuracy may be a consequence of uncontrolled external temperatures, the patient's actions prior to measurement, distance between the patient and the thermometer, and the different sites of measurement. A re-evaluation of non-contact thermometry is recommended, requiring new studies in more controlled environments.

2021 Update on airway management from the Anaesthesia Continuing Education Airway Management Special Interest Group.

Airway Management is the key for anaesthetists dealing with patients undergoing diagnostic procedures and surgical interventions. The present coronavirus pandemic underpins even more how important safe airway management is. It also highlights the need to apply stringent precautions to avoid infection and ongoing transmission to patients, anaesthetists and other healthcare workers (HCWs). In light of this extraordinary global situation the aim of this article is to update the reader on the varied aspects of the ever-changing tasks anaesthetists are involved in and highlight the equipment, devices and techniques that have evolved in response to changing technology and unique patient and surgical requirements.

The case for a 3rd generation supraglottic airway device facilitating direct vision placement.

Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, to visualise insertion of the device, enable immediate manoeuvres to optimise SAD position, verify whether correct 1st and 2nd seals are achieved and check whether size selected is appropriate. We do not provide technical details of such a '3rd generation' device, but rather present a theoretical analysis of its desirable properties, which are essential to overcome the remaining limitations of current 1st and 2nd generation devices. We also recommend that this further milestone improvement, i.e. ability to place the SAD accurately under direct vision, be eligible for the moniker '3rd generation'. Blind insertion of SADs should become the exception and we anticipate, as in other domains such as central venous cannulation and nerve block insertions, vision-guided placement becoming the gold standard.