Anaesthetic Management for A Patient Presenting for Caesarean Delivery with A giant Thymoma - A Case Report

Presentation of a thymoma during pregnancy means that safe delivery becomes more challenging. We present a 33-year-old pregnant woman who was diagnosed with a large thymoma causing marked compression of the tracheobronchial tree and right atrium. After various multidisciplinary meetings she presented for elective caesarean section delivery at 31 weeks of gestation. A combined spinal-epidural anaesthesia was performed, along with colloid pre-and co-loading, and vasopressor support. The delivery was uneventful. The possibility of catastrophic complications was foreseen. Therefore, all requirements for the possibility of airway or haemodynamic collapse were planned carefully, including the possibility of emergent cardiopulmonary bypass.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.

Anesthesia for penetrating injury of the oropharynx in a child: a case report

BackgroundPenetrating injury of the oropharynx occurs frequently in children, however, anesthetic management is seldom described in such cases.Case presentationA 2-year old child came to the emergency room with a toothbrush impacted in the gingivobuccal sulcus making airway management difficult. We used a simple yet unique approach to secure the airway safely given the lack of pediatric size fibreoptic and videolaryngoscopes in our emergency operation theatre. The patient was kept in Pediatric ICU and watched for any complications and discharged on the 4th postoperative day.ConclusionsThus, ingenious non-invasive techniques to secure the airway can prevent the patient from undergoing surgical tracheostomy.

Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine.

Perioperative care delivery is a patient-centered, multidisciplinary process. It relies heavily on synchronized teamwork from a well-coordinated team. Perioperative physicians-surgeons and anesthesiologists-face enormous challenges in surgical care delivery due to changing work environments, post-COVID consequences, shift work disorder, value conflict, escalating demands, regulatory complexity, and financial uncertainties. Physician burnout in this working environment has become increasingly prevalent. It is not only harmful to physicians' health and well-being, but it also affects the quality and safety of patient care. Additionally, the economic costs associated with physician burnout are untenable due to the high turnover rate, high recruitment expenses, and potential early permanent exit from medical practice. In this deteriorating environment of unbalanced physician supply/demand, recognizing, managing, and preventing physician burnout may help preserve the system's most valuable asset and contribute to higher quality and safety of patient care. Leaders in government agencies, health care systems, and organizations must work together to re-engineer the health care system for better physicians and patient care.

Association Between the Community Prevalence of COVID-19 and Daily Unscheduled Absences of Anesthesiologists, Nurse Anesthetists, and Residents in an Academic Anesthesia Department.

Introduction An "unscheduled absence" refers to an occurrence when an employee does not appear for work and the absence was not approved in advance by an authorized supervisor. Daily unscheduled absences need to be forecasted when doing staff scheduling to maintain an acceptable risk of being unable to run all anesthetizing locations and operating rooms planned. The number of extra personnel to be scheduled needs to be at least twice as large as the mean number absent. In an earlier historical cohort study, we found that our department's modeled risks of being unavailable unexpectedly differed among types of anesthesia practitioners (e.g., anesthesiologists and nurse anesthetists) and among weekdays (i.e., Mondays, Fridays, and workdays adjacent to holidays versus other weekdays). In the current study, with two extra years of data, we examined the effect of the coronavirus COVID-19 pandemic on the frequency of unscheduled absences. Methods There were 50 four-week periods studied at a large teaching hospital in the United States, from August 30, 2018 to June 29, 2022. The sample size of 120,687 person-assignment days (i.e., a person assigned to work on a given day) included 322 anesthesia practitioners (86 anesthesiologists, 88 certified registered nurse anesthetists, 99 resident and fellow physicians, and 49 student nurse anesthetists). The community prevalence of COVID­19 was estimated using the percentage positive among asymptomatic patients tested before surgery and other interventional procedures at the hospital. Results Each 1% increase in the prevalence of COVID-19 among asymptomatic patients was associated with a 1.131 increase in the odds of unscheduled absence (P < 0.0001, 99% confidence interval 1.086 to 1.178). Using an alternative model with prevalence categories, unscheduled absences were substantively more common when the COVID-19 prevalence exceeded 2.50%, P [Formula: see text] 0.0002. For example, there was a 1% unscheduled absence rate among anesthesiologists working Mondays and Fridays early in the pandemic when the prevalence of COVID-19 among asymptomatic patients was 1.3%. At a 1% unscheduled absence rate, 67 would be the minimum scheduled to maintain a <5.0% risk for being unable to run all 65 anesthetizing locations. In contrast, there was a 3% unscheduled absence rate among nurse anesthetists working Mondays and Fridays during the Omicron variant surge when the prevalence was 4.5%. At a 3% unscheduled absence rate, 70 would be the minimum scheduled to maintain the same risk of not being able to run 65 rooms. Conclusions Increases in the prevalence of COVID-19 asymptomatic tests were associated with more unscheduled absences, with no detected threshold. This quantitative understanding of the impact of communicable diseases on the workforce potentially has broad generalizability to other fields and infectious diseases.

The Impact of the COVID-19 Surge Response on Motivation Among Anesthesiology Residents and Fellows: A discussion of findings from semi-structured interviews at Montefiore Medical Center and educational takeaways.

Background: The American Board of Medical Specialties definition of medical professionalism cites the need to acquire, maintain, and advance a value system serving the patients' and public's interests above self-interests.4 Medical professionalism is a one of the core physician competencies assessed by both the ACGME training program evaluation and the ABA certification process. However, a growing concern for the decline of professionalism and altruism in medicine resulted in increased publications on the matter, citing various potential sources for the issue. Methods: All residents and fellows (Focus Group 1) of the Anesthesiology Department of Montefiore Medical Center in Bronx, NY were invited to participate in a semi-structured interview via Zoom, held on two separate dates. A separate invitation was sent to the faculty of the department (Focus Group 2), held on one date. During the interview, guiding questions were provided by the 4 interviews to facilitate discussion. The interviewers, all members of the anesthesia faculty, took notes as the interviews progressed. The notes were reviewed for common themes as well as supporting and contradicting quotations. Results: A total of 23 residents and fellows and a total of 25 faculty members within the Anesthesiology department at Montefiore Medical Center were interviewed. Amongst the findings, common discussions concerned motivating and demotivating factors contributing to the professionalism and altruism exhibited by the residents and fellows when caring for critical COVID-19 patients during the height of the pandemic. It was widely regarded that patient improvement, community and team support, as well as intrinsic desire to help greatly motivated the team while continuous patient deterioration, uncertainty in staffing and treatment, and concerns for personal and family safety were sources of discouragement. Overall, faculty perceived an increased demonstration of altruism amongst residents and fellows. The statements made by the residents and fellows during their interviews supported this observation. Conclusions: The actions of the Montefiore Anesthesiology residents and fellows demonstrated that altruism and professionalism were readily available amongst physicians. Increased levels of empathy and responsibility contributed to a demonstration of professionalism that challenges previous views of a perceived decline of these attributes in the medical field. The findings of this study stress the importance of creating a curriculum and exercise that stress empathy-based care and altruism in order to improve resident satisfaction and decrease feelings of burnout. Additionally, curriculum additions to facilitate professionalism are proposed.

Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs During the COVID-19 Pandemic: Quantitative Survey.

BACKGROUND: Social media may be an effective tool in residency recruitment, given its ability to engage a broad audience; however, there are limited data regarding the influence of social media on applicants' evaluation of anesthesiology residency programs. OBJECTIVE: This study evaluates the influence of social media on applicants' perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the use of social media by applicant demographic characteristics (eg, race, ethnicity, gender, and age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. METHODS: All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding subinternship rotation completion, social media resource use and impact (eg, "residency-based social media accounts positively impacted my opinion of the program"), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. RESULTS: The survey was emailed to 1091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate=58.6%). Nearly 65% of applicants reported an inability to complete 2 or more planned subinternships due to COVID-19 restrictions (n=361, 55.9%), with 25% of applicants reporting inability to do any visiting student rotations (n=167). Official program websites (91.5%), Doximity (47.6%), Instagram (38.5%), and Twitter (19.4%) were reported as the most used resources by applicants. The majority of applicants (n=385, 67.3%) agreed that social media was an effective means to inform applicants, and 57.5% (n=328) of them indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach α=.838). There was a positive and statistically significant relationship such that male applicants (standardized ß=.151; P=.002) and older applicants (ß=.159; P<.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicants' race and ethnicity were not associated with the social media scale (ß=-.089; P=.08). CONCLUSIONS: Social media was an effective means to inform applicants, and generally positively impacted applicants' perception of programs. Thus, residency programs should consider investing time and resources toward building a social media presence to improve resident recruitment.

Impact of the COVID-19 pandemic on antimicrobial resistance.

Objectives: The COVID-19 pandemic has had a major impact on the healthcare system, which has been forced to manage large num-bers of patients, including those with respiratory insufficiency and in need of oxygen therapy. Due to concerns about bacterial co-in-fection, antibiotic therapy was administered to many patients. The aim of the present study was to compare antimicrobial resistance in intensive care patients in the pre-pandemic and pandemic periods. Material(s) and Method(s): Patients hospitalized at the Department of Anesthesiology, Resuscitation and Intensive Care Medicine of the University Hospital Olomouc in the pre-COVID-19 period (2018-2019) and during the pandemic (2020-2021) were enrolled in the stu-dy. Clinical samples from the lower respiratory tract were routinely collected twice a week, with one strain of a given species first isolated from each patient being included in the study. Result(s): While several bacterial species (Escherichia coli, Proteus mirabilis and Haemophilus influenzae) were found to occur less fre-quently, an increased occurrence was documented for Enterococcus faecium, Serratia marcescens and Klebsiella variicola. Overall, ho-wever, it can be concluded that there was no major change in the frequency of bacterial pathogens isolated from the lower respiratory tract during the COVID-19 period. Similarly, with only a few exceptions, antimicrobial resistance did not change significantly. More significant increases in resistance to piperacillin/tazobactam, cefotaxime, ciprofloxacin and gentamicin have been demonstrated for Serratia marcescens. However, a decrease in the resistance of Pseudomonas aeruginosa and Burkholderia cepacia complex to mero-penem was also observed. Conclusion(s): There was no significant change in the frequency of bacterial pathogens and their resistance to antibiotics during the COVID-19 pandemic. However, there was an increase or decrease in the percentage of some species and in their resistance.Copyright © 2022, Trios spol. s.r.o.. All rights reserved.

The use of ilioinguinal and iliohypogastric nerve block anesthesia in inguinal bladder hernia repair

Aim: There are data showing that the use of minimally invasive anesthesia methods (local anesthesia, nerve blocks) as an alternative to traditional anesthesia methods used in inguinal hernia repair surgery is safe and effective. During the COVID-19 pandemic, which affected the whole world, we aimed to evaluate the use of minimally invasive anesthesia methods in patients with inguinal bladder hernia, as well as their perioperative and postoperative results in our pilot study.Material and Methods: We evaluated the perioperative and postoperative data of five patients with inguinal bladder hernia, who underwent surgery with local anesthesia and ilioinguinal/iliohypogastric nerve blockade, four of which were performed during the COVID-19 pandemic.Results: It is possible to perform inguinal bladder hernia surgery with local anesthesia and ilioinguinal/iliohypogastric nerve block, including in secondary cases. Better hemodynamic stabilization in the intraoperative period reduces the need for narcotic analgesics by providing effective analgesia in the postoperative period, as well as reducing the risk of contamination in airway control.Discussions: Performing inguinal bladder hernia surgery using local anesthesia and ilioinguinal/iliohypogastric nerve block provides reliable and effective analgesia during the perioperative and postoperative periods.

SASA 2023 Congress

The proceedings contain 34 papers. The topics discussed include: comparison of intra-arterial blood pressures versus two noninvasive measuring systems: a cross-sectional analytic study employing Bland-Altman and error grid analyses;prevalence of vitamin D deficiency amongst anesthesia providers at the Universitas Academic Hospital;chemical and physical stability of an admixture of anesthetic drugs;postoperative pulmonary complications in adult surgical patients in low- and middle-income countries: a systematic review and meta-analysis;the prevalence of SARS-CoV-2 infection in an academic department of anesthesiology;evaluation of the use of a 3D printed video laryngoscope for tracheal intubation in a manikin;the prevalence of caregiver anxiety in theatre at universitas academic hospital;the spectrum of disease and short-term outcomes of obstetric patients with cardiac disease at a tertiary hospital in South Africa;and almost 30% reduction in carbon footprint using volatile anesthesia - a quality improvement project introducing low-flow anesthesia in a regional hospital.

Year 2022 in review - Anesthesiology in obstetrics.

The article highlights and discusses several current topics that have been published in the field of anaesthesiology in obstetrics in the Czech Republic and abroad last year. It summarizes the influence of the COVID-19 pandemic on anesthesiological praxis in obstetrics. It also presents new developments in systemic and neuraxial obstetric analgesia, Caesarean Section anesthesia, and emergencies in the peripartum period.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Impact of COVID-19 pandemic on anesthesia resident's training program in Cairo University Hospital

Background: The purpose of this study was to evaluate the impact of COVID-19 pandemic on the training process of anesthesia residents in Cairo University Hospital regarding technical skills, operative, and critical care experience. Method(s): This cross-sectional survey study included two groups of anesthesia residents according to the time of their residency in relation to the pandemic (before-pandemic group [N = 44] and during-pandemic group [N = 42]). The participants were asked to fill out a questionnaire regarding their training. The questionnaire included technical skills experience (regional anesthesia, vascular access, and advanced airway techniques, soft tissue ultrasound), operative and critical care experience, and duration of intensive care unit (ICU) rotation. The quality of training was graded as adequate, moderate, or deficient training according to the number of performed procedure/managed cases. Comparisons of continuous data were done using the Mann-Whitney test, and qualitative categorical was analyzed using the chi-square test. Result(s): All the participants completed the questionnaire. The training in the during-pandemic group was lesser than that in the before-pandemic group for most of the technical skills except for soft tissue ultrasound which was more in the during-pandemic group. The operative experience was less in the during-pandemic group than that in the before-pandemic group. On the other hand, the ICU experience was more in the during-pandemic group than that in the before-pandemic group. Conclusion(s): The COVID-19 pandemic disrupted the training program of anesthesiology residents with regard to elective procedures and produced over-training in critical care subspeciality.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Year 2022 in review - Paediatric anesthesia and intensive care.

From the Evidence-based medicine (EBM) point-of-view, the year 2022 due to the slowly subsiding world SARS-CoV-2 pan-demic, brought the whole complex of articles, publications, and guidelines once again. The aim of the article Year 2022 in pediatric anesthesia and intensive care is to highlight the important publications that should not be missed due to their impact on daily clinical practice.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

The prevalence of SARS-CoV-2 infection in an academic department of anaesthesiology

Background: Anaesthetists are frontline workers who perform aerosol-generating procedures (AGPs) in enclosed environments, which exposes them to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and increases their risk of contracting SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19). This study describes the prevalence of SARS-CoV-2 infection in the academic department of anaesthesiology of the University of the Witwatersrand prior to vaccination. Method(s): A cross-sectional, contextual, descriptive research design, using an anonymous electronic questionnaire, was followed in the study. Consecutive and convenience sampling methods were used. A p-value of < 0.05 was considered statistically significant. Result(s): A total of 147 participants met the inclusion criteria. There were 90 (61.22%) females and 57 (38.78%) males. The mean age was 35.26 years for the 36 participants who tested positive (26.47%) for SARS-CoV-2. Hospital admission was required by 2.78% of participants with COVID-19. Male participants had a higher prevalence of having SARS-CoV-2 infection (p = 0.045). There were no statistically significant associations between SARS-CoV-2 infection and pregnancy (p = 0.09), asthma (p = 0.11), autoimmune disease (p = 0.77), obesity (p = 0.9), diabetes (p = 0.96), hypertension (p = 0.9) and smoking (p = 0.69). Commonly reported COVID-19-like symptoms included fatigue (68.33%), headaches (61.67%) and myalgia (58.33%). Of the participants with a positive SARS-CoV-2 test, 38.46% had reported travelling within 14 days of testing positive (p < 0.001). Community exposure to a person with SARS-CoV-2 was associated with participants contracting SARS-CoV-2 infection (p = 0.001). Conclusion(s): AGPs are not a significant risk factor for anaesthetists in the context of work or community transmission of the virus. There was a statistically significant predisposition for contracting SARS-CoV-2 infection among males, participants who travelled and participants who had community exposure to a SARS-CoV-2 infected person.

Abdominal Organ Transplantation: Noteworthy Literature in 2022.

This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship.

Introduction: The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible. Methods: We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum. Results: Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning. Discussion: We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

Erratum: How to adapt anesthetic human resources to health emergencies such as the COVID-19 outbreak: Replacing a pre-anesthetic consultation with a questionnaire in a university obstetric unit.

[This corrects the article DOI: 10.3389/fmed.2022.770199.].

Telemedicine for Preanesthesia Consultations During the First COVID-19 Lockdown.

Introduction: In an effort to avoid travel and interpersonal contact, the COVID-19 health crisis was an opportunity to offer preanesthesia teleconsultation (TCs) to patients scheduled for surgery. Materials and Methods: We studied the technical feasibility and patient experiences of these TCs using a 4-point Likert scale questionnaire. Results: Eighty-six patients out of 139 responded. Technical difficulties (no connection, picture, or sound) occurred in 24% of cases. The patient's experience was considered very positive both in terms of feelings and understanding instructions: 4 (4-4). No deprogramming was required. Conclusion: TCs were approved by patients despite technical problems. Further studies are required to ensure that this type of consultation is not inferior to face-to-face consultations. NCT04920604.

Increasing suicide awareness in nurse anesthesiology

Purpose: This Doctor of Nursing Practice (DNP) project aims to increase suicide and gatekeeper awareness among the University of Arizona nurse anesthesiology program clinical site coordinators through an educational presentation. Community-based gatekeeper training is one of the most widely used suicide prevention strategies, educating laypersons on how to recognize, approach, and support a person at risk of suicide.Background: Anesthesia providers have a greater risk of suicide than any other healthcare specialty, with certified registered nurse anesthetists (CRNAs) and resident registered nurse anesthetists (RRNAs) being significantly impacted. For example, 41.7% of RRNAs have reported symptoms of depression, and 21.2% reported suicidal ideation during their anesthesia education.Methods: This educational intervention quality improvement (QI) project aims to increase suicide awareness among the nurse anesthesiology clinical coordinators of the University of Arizona. The volunteer participants will be sent a previously recorded educational session and an accompanying PowerPoint via email. After viewing the educational session, participants will access the link embedded in the email to direct them to an anonymous retrospective pretest assessment survey. Results: Nine clinical coordinators participated in this QI project. A statistically significant improvement was seen overall and across all three survey subscales based on the Gatekeeper Behavior Scale. Also, all participants had found the educational intervention to be useful.Conclusions: Nurse anesthesiology clinical coordinator gatekeeper training effectively provides knowledge about RRNA suicide risks and warning signs, increases suicide prevention skills, and improves self-efficacy. The relevance of this topic continues to emerge with the untoward effects of COVID-19 and the addition of the practice doctorate in nurse anesthesiology education. (PsycInfo Database Record (c) 2022 APA, all rights reserved)