ABSTRACT
Telemedicine is a modality which utilizes technology to provide and support health care across large distances. It has redefined the practices of medicine in many specialties and continues to be a boon for clinicians on many frontiers. Its role in the branch of anesthesia remains largely unexplored but has shown to be beneficial in all the three phases: pre-operative, intra-operative, and post-operative. Now time has come that anesthesiologists across the globe reassess their strategies and utilize the telemedicine facilities in the field of anesthesia.Copyright © 2021 EDP Sciences. All rights reserved.
ABSTRACT
In the context of the COVID-19 pandemic, the burden on healthcare professionals at all levels has increased significantly, especially those who are at the forefront of the fight for patients' lives. Physicians directly caring for COVID-19 patients are exposed to excessive stress and significant biological and psychosocial risk. Objective. To identify the features of the mental state of doctors of various specialties during the COVID-19 pandemic. Material and methods. The study included 85 doctors of the Arkhangelsk region: 41 anesthesiologists/intensive care physicians (mean age 32.4+/-5.0 years) and 44 general practitioners (mean age 38.9+/-4.2 years). The study was conducted during the third wave of the COVID-19 pandemic (from May to June 2021). We used the following study methods: questionnaire, psychological testing (K. Maslach and S. Jackson Burnout Inventory (MBI), Beck's Depression Inventory, Perceived Stress Scale, World Health Organisation-Five Well-Being Index), mathematical and statistical processing of empirical data. Results and discussion. Analysis of the results showed that about half of the surveyed general practitioners and only 3 (7.3%) of the anesthesiologists/intensive care physicians had a history of COVID-19, having contracted it while performing professional duties. Manifestations of maladaptation, such as low professional competence, lack of soft skills, aggressiveness, introversion, risktaking, recklessness, and family problems, are more pronounced in anesthesiologists/intensive care physicians. They were more likely to have negative emotions and feelings, were less satisfied with themselves and life in general, and had a lower well-being index than general practitioners. General practitioners overestimated their professional burnout severity and more often complained about their state of health. Correlation analysis of the examination results for anesthesiologists/intensive care physicians allowed us to identify direct relationships between the level of perceived stress, overstrain and depression, low mood, difficulties in relationships with relatives and colleagues, dissatisfaction with various aspects of life, inverse relationships between the level of perceived stress and the well-being index. In general practitioners, direct relationships were established between perceived stress and overexertion, and inverse relationships were established between the level of perceived stress, the well-being index, and the reduction of personal achievements. Conclusion. The COVID-19 pandemic negatively impacts anesthesiologists/intensive care physicians more than general practitioners, causing negative emotions and maladaptation. In primary care physicians, the pandemic increases mobilization processes to address emerging professional challenges. Therefore, special attention should be paid to psychological support for anesthesiologists/intensive care physicians.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
In the context of the COVID-19 pandemic, the burden on healthcare professionals at all levels has increased significantly, especially those who are at the forefront of the fight for patients' lives. Physicians directly caring for COVID-19 patients are exposed to excessive stress and significant biological and psychosocial risk. Objective. To identify the features of the mental state of doctors of various specialties during the COVID-19 pandemic. Material and methods. The study included 85 doctors of the Arkhangelsk region: 41 anesthesiologists/intensive care physicians (mean age 32.4+/-5.0 years) and 44 general practitioners (mean age 38.9+/-4.2 years). The study was conducted during the third wave of the COVID-19 pandemic (from May to June 2021). We used the following study methods: questionnaire, psychological testing (K. Maslach and S. Jackson Burnout Inventory (MBI), Beck's Depression Inventory, Perceived Stress Scale, World Health Organisation-Five Well-Being Index), mathematical and statistical processing of empirical data. Results and discussion. Analysis of the results showed that about half of the surveyed general practitioners and only 3 (7.3%) of the anesthesiologists/intensive care physicians had a history of COVID-19, having contracted it while performing professional duties. Manifestations of maladaptation, such as low professional competence, lack of soft skills, aggressiveness, introversion, risktaking, recklessness, and family problems, are more pronounced in anesthesiologists/intensive care physicians. They were more likely to have negative emotions and feelings, were less satisfied with themselves and life in general, and had a lower well-being index than general practitioners. General practitioners overestimated their professional burnout severity and more often complained about their state of health. Correlation analysis of the examination results for anesthesiologists/intensive care physicians allowed us to identify direct relationships between the level of perceived stress, overstrain and depression, low mood, difficulties in relationships with relatives and colleagues, dissatisfaction with various aspects of life, inverse relationships between the level of perceived stress and the well-being index. In general practitioners, direct relationships were established between perceived stress and overexertion, and inverse relationships were established between the level of perceived stress, the well-being index, and the reduction of personal achievements. Conclusion. The COVID-19 pandemic negatively impacts anesthesiologists/intensive care physicians more than general practitioners, causing negative emotions and maladaptation. In primary care physicians, the pandemic increases mobilization processes to address emerging professional challenges. Therefore, special attention should be paid to psychological support for anesthesiologists/intensive care physicians.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesiologists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.
ABSTRACT
Introduction: Aim of the study was to analyse the structure of patients referred for dental treatment in general anaesthesia (GA) and to analyse the triage outcomes. Material(s) and Method(s): Retrospective chart analysis of patients referred between January 1st 2018 and July 7th 2022 was performed. Following data were registered: age, sex, diagnosis/ reason for referral for GA, indication for dental treatment in GA, trisage outcome and waiting time for the GA procedure. Result(s): Charts of 193 referred in the aforementioned period were analysed. Most common reason for the referral was autism (65/33.7%), cerebral paralysis (29/15%) and mental retardation (27/14%). Indication for dental treatment in GA was found in 156(80.8%) patients while in 37(19.2%) patients no indication for dental treatment in GA was found. Out of the 156 patients who were indicated for dental treatment in GA, 98(62.8%) patients were managed through day-care surgery and 8(5.2%) patients were admitted to hospital. Twenty patients (12.8%) were still waiting for their GA appointment in the time of analysis, 29(18.6%) were lost to follow up and in one (0.6%) patient the anaesthesiologist recommended ambulatory treatment due to increased risk. Out of the 37 patients in whom no indication for the treatment in GA was found, 13(35.2%) had no caries, 16/ (43.2%) were referred to paediatric dentist and 8(21.6%) were managed on the initial exam. Median time of waiting for the procedure was 120(10-365) days. Before the COVID- 19 pandemics median waiting time was 90(15-300) days, and after the COVID-19 pandemics median waiting time was 135(10-365) days. Conclusion(s): In the majority of the patients referred for dental treatment in GA, indication for the procedure was established. Majority of the referred patients can be managed through a day-care surgery. COVID-19 pandemics is probably one of the reasons for the increased GA procedure waiting time.
ABSTRACT
Introduction: The COVID-19 pandemic is one of the most stressful events in recent times. Medical professionals, including anesthesiologists-reanimatologists, suffered the main blow in this difficult and stressful environment. Aim(s): This study aimed at identifying the features of anesthesiologists-reanimatologists' emotional states in different COVID-19 pandemic periods. Method(s): The study was conducted through an anonymous questionnaire among anesthesiologists-reanimatologists in two periods. In the First stage - which was carried out in May 2020 (during the first COVID-19 pandemic wave) - 58 anesthesiologists-reanimatologists in the Arkhangelsk region took part. During the Second segment - which took place in October 2020 (in the second COVID-19 pandemic wave) - 43 anesthesiologistsreanimatologists were examined. Repeated questioning was carried out among the same participants. Result(s): In October 2020, compared to May, the number of doctors who noted a high intensity of professional activity increased. Regardless of the study period, one-third of the subjects experienced constant pronounced anxiety. Anesthesiologists-reanimatologists, whose professional activity was directly related to the patients in COVID-19 care, noted a poorer emotional state more frequently in October, accompanied by anxiety, depressed mood, irritability and a high burnout level, which may indicate a depletion of internal resources in this group. Conclusion(s): The study results showed that for anesthesiologists-reanimatologists, a further depletion of emotional resources accompanied the second pandemic wave. The anesthesiologists-reanimatologists' emotional state was mediated by a number of social and gender factors, as well as specific labor organization features.Copyright © 2022 The Authors. Published by Semmelweis University, Institute of Mental Health, Budapest.
ABSTRACT
The COVID-19 pandemic is ongoing as of September 2022. Since January 2020 when the first case was reported in Japan, the medical community faced a variety of problems both domestically and internationally. It is meaningful to review the impact of COVID-19 from an anesthesiologist's perspective to clarify our policy for future infectious disease outbreaks. In this year's Journal of Anesthesia (JA) symposium, five experts who were deeply involved in the COVID-19 response reviewed the past 2.5 years and made recommendations for potential future pandemics. Anesthesiologists are specialists in airway management and their role in intubating patients with COVID-19 has received much attention. However, they have also played an important backup role in intensive care as critical care physicians and must be more involved in critical care in regular (non-pandemic) times to properly fulfill this role. It is especially important for the Japan Society of Anesthesiologists and JA to quickly disseminate accurate information on unknown infectious diseases to the medical community and wider society. Therefore, it is important to promptly publish papers that are quality-assured through peer review.
ABSTRACT
Background: Since the beginning of the COVID-19 pandemic in April 2020 the supply with blood products was largely stable and the demand for red blood cell concentrates (RBCC) could be covered. From June 2021, a blatant undersupply of RBCC occurred and rescheduling elective interventions depending on the patient's blood group was required. A well-considered restrictive blood bank management approach for RBCC provision became imperative and the analysis of its effects is presented here. Method(s): Data was analyzed to show the influence of the COVID-19 pandemic on the RBCC distribution management in the blood bank. Therefore, RBCC cross-matches, delivery, return and transfusions of RBCC were analyzed, so the crossmatch-to-transfusion ratio (CTR: ratio of cross-matched to transfused RBCC) as an efficiency marker could be calculated. In consideration of the CTR the consequences of minimizing the number of RBCC provided for elective surgeries in direct consultation with clinical decision makers on blood bank management efficiency were statistically described in the context of inpatient admissions and operations. Result(s): The availability on demand and consumption of RBCC were stable from April 2020 to May 2021 (mean value per month, fig. 1). However, the significant drop in RBCC supply from June 2021 was intercepted by a change of the RBCC management strategy as the number of transfusions remained unchanged (fig. 1): for elective operations the amount of RBCC provided was drastically reduced (from 48% to 23%). As a result, the overall CTR decreased from 3.0 on annual average (January 2019 to June 2021) to 1.7 from July 2021 to December 2021 (fig. 2). The number of operations was stable on a monthly average, as well as the inpatient admissions per month from 2019 to 2021 (2512) were only interrupted temporarily in April 2020 (1689). Conclusion(s): Regarding constant inpatient admissions and performed surgeries, the amount of transfused RBCC was stable. With drastically decreasing the number of RBCC provided for elective interventions a more efficient blood bank management led to a uncompromised patient care and even the target CTR of 1.7 in the surgical field (Gombotz, Patient Blood Management, Anesthesiologist 2013, 62:519-527) could be reached. Therefore, we consider this proceeding worth maintaining for the future. (Figure Presented).
ABSTRACT
Background: Anesthesiologists play a crucial role in every disaster event, including biological disasters by COVID-19. This medical specialty should be prepared for a surge in patients due to a pandemic. The present study aims to evaluate the preparedness of anesthesiologists in facing the surge in the number of COVID-19 patients at the beginning of the pandemic in Indonesia. Methods: This is a descriptive cross-sectional study using an online survey to Anesthesiologists in Indonesia, with snowballing sampling method. A distribution frequency was used to describe the univariate analysis results of the variables. Pearson correlation was used to test the correlation between perceived resource adequacy/availability and perceived preparedness to face the surge. Results: A total of 141 anesthesiologists participated in our online survey; 47% of responders said they do not have enough staff, while 53% said that their staff did not have sufficient knowledge of handling the critical COVID-19 patients. They also reported limited resources, especially the limited isolation space and N95 masks. The correlation analysis indicated a strong and significant relationship between limited resources and the preparedness of anesthesiologists. Conclusion: At the beginning of the pandemic, Indonesian Anesthesiologists felt that they still had very limited resources, leading to unpreparedness to deal with the surge in the number of COVID-19 patients with critical conditions.
ABSTRACT
Background: COVID-19 has become the largest medical challenge worldwide, affecting the physical and mental well-being of physicians. The aim of this study was to explore the well-being of physicians during the second wave of the COVID-19 outbreak in a Belgian tertiary hospital, with special attention to anaesthesiologists. They were confronted with overcrowded intensive care units, were mentally challenged during several months by an overwhelming workload. Method(s): All physicians of the Antwerp University Hospital (UZA) were invited to participate through an online anonymous questionnaire to objectively evaluate their well-being during the second wave of the COVID-19 outbreak in Belgium. Mental well-being was evaluated by the validated Warwick-Edinburgh Mental Well-being Scale (WEMWBS) summing 14 equally weighted questions (scoring range 1 to 5) about mental well-being. Demographic data such as age, gender, function, COVID exposure was collected. Result(s): Ninety physicians, 42 residents and 48 staff members, completed the questionnaire with an average WEMWBS of 50.6+/-8.0. Participating residents were deployed more on COVID-19 departments compared to participating staff members (p=0.02) and reported a higher workload (p=0.001). Residents scored significantly lower on the WEMBWS compared to staff members (48.1+/-8.2 vs. 52.8+/-7.3, p=0.01). Also, 15 female anaesthesiologists scored significantly lower in the WEMWBS compared to their 12 male colleagues (p=0.03). Conclusion(s): During the second wave of the COVID-19 outbreak in Belgium, residents reported a significantly higher workload due to COVID-19 and reported a significantly lower well-being compared to staff members. Copyright © 2022 ARSMB-KVBMG. All rights reserved.
ABSTRACT
Introduction: In the COVID-19 pandemic situation the burden that has fallen on the shoulders of resuscitation anesthesiologists has become really great. These specialists experience emotional and psychical stress that has led to the high risk of formation of the emotional burnout syndrome in the pre-COVID period. Objective(s): A comparative analysis of the formation of a complete syndrome of emotional burnout in 2020-2021 in resuscitation anesthesiologists with varied years of professional activity. Method(s): Sixty-two resuscitation anesthesiologists volunteered to take part in the study: 47 males and 15 females. The main method of study was V. Boiko's method of "Diagnosis of level of emotional burnout". Result(s): The results have shown that, during the said period, the number of doctors with complete syndrome of emotional burnout has significantly increased, that is, all three phases: stress, resistance and exhaustion had formed. The period of study has clearly shown two groups of male doctors: with period of work of 20 or more years, and with period of work of less than 5 years. The said symptoms cause a feeling of physical and psychological overburdens, stress at work and at home, conflicts with management personnel, colleagues and patients. Conclusion(s): The atypical COVID-19 pneumonia pandemic has laid significant stress on the psychic and physical health of resuscitation anesthesiologists. The high level of psychological strain, accumulation of negative emotions, and the feeling of helplessness led to medical errors and delays in important tactical decisions.
ABSTRACT
Introduction: Pre-Operative Assessment (PoA) is an integral part of surgery. It is essential for pre-operative investigations including bloods and COVID-19 swabbing. There was concern within The Breast-Unit that patients may be having unnecessary blood-tests as part of their PoA. This was likely due to PoA not having one unified resource to refer to. Guidance suggests PoA uses The patient's American Association of Anaesthesiologist's (ASA) grade, type of Surgery they are undergoing and additional conditions for determining pre-operative investigations. Method(s): This QIp consistedof 2 cycles. During cycle-1 data was audited against national guidance to see which blood tests were performed unnecessarily. After developing a universal-guidance poster and teaching sessions, a second cycle was performed. Cycle-2 assessed whether there was a reduction in unnecessary blood tests being performed. Result(s): During cycle-1, 216 pre-operative blood tests were undertaken. of these only 99 were required. Therefore 54% of The tests were unnecessary. This equates to 690.77 over 2-months and if extrapolated 4144.62 spent, unnecessarily per-year. This represents a significant cost to The Trust and puts needless pressure onto The laboratory. During cycle-2, after our intervention, there were 57 fewer tests and 40 fewer, incorrect blood tests. Our intervention therefore resulted in a 183.46 saving, which over a year equates to 1110.76 saved. Conclusion(s): The potential benefits of improving PoA include financial savings, patient autonomy, increased appointment availability and reduced pressure on The laboratory. In these unprecedented times, trying to tackle The COVID-19 backlog;we advise all departments to ensure that clear guidance exists.
ABSTRACT
BACKGROUND: During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19-related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19-related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). OBJECTIVE: In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. METHODS: Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. RESULTS: A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01). CONCLUSIONS: Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff.
ABSTRACT
Anesthesiologists receive extensive training in the area of perioperative care and the specialized skills required to maintain life during surgery and complex procedures. Integrated into almost every facet of contemporary medicine, they interact with patients at multiple stages of their health care journeys. While traditionally thought of as the doctors best equipped to save lives, they may also be some of the best doctors to help navigate the chapters at the end of life. Successfully navigating end-of-life care, particularly in the COVID-19 era, is a complicated task. Competing ethical principles of autonomy and nonmaleficence may often be encountered as sophisticated medical technologies offer the promise of extending life longer than ever before seen. From encouraging patients to actively engage in advance care planning, normalizing the conversations around the end of life, employing our skills to relieve pain and suffering associated with dying, and using our empathy and communication skills to also care for the families of dying patients, there are many ways for the anesthesiologist to elevate the care provided at the end of life. The aim of this article is to review the existing literature on the role of the anesthesiologist in end-of-life care, as well as to encourage future development of our specialty in this area.
Subject(s)
Advance Care Planning , COVID-19 , Terminal Care , Humans , Anesthesiologists , Terminal Care/methods , DeathABSTRACT
SESSION TITLE: Close Critical Care Calls SESSION TYPE: Case Reports PRESENTED ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: COVID-19 has resulted in many patients presenting in severe hypoxemic respiratory failure without the ability to achieve adequate oxygenation despite non-invasive positive pressure ventilation prior to attempting endotracheal intubation. Recently, the American Academy of Anesthesiology (AAOA) released an updated 2022 guideline addressing difficult airway management. Though evidence is limited, the use of a combination maneuvers with a supraglottic airway and lighted stylet yielded a greater than 75% intubation success rate after failed direct laryngoscopy [1]. The following case emphasizes a novel definitive airway rescue option for an anatomically and physiologically difficult airway, complicated by an inability to ventilate and oxygenate in the setting of severe hypoxemic respiratory failure. CASE PRESENTATION: The patient is a 58 year old, morbidly obese (BMI-58) female with severe COVID-19 pneumonia and severe refractory hypoxemia on Bi-Level non-invasive ventilation (inspiratory pressure 20, expiratory pressure 15, 100% fraction inspired oxygen) complicated by an acute complete opacification of the left hemi-thorax and right pneumothorax with oxygen saturation (SpO2) of 80%. Rapid sequence induction was attempted, however failed despite multiple maneuvers. Due to continued deterioration of the patient's oxygenation, a laryngeal mask airway (LMA) was placed with improvement of the patient's oxygen saturation. A single-use disposable bronchoscope was then placed through the LMA with successful navigation through the vocal cords and direct visualization of the tip within the right main-stem bronchus. Using trauma shears, the handle of the bronchoscope was cut away from the insertion tube. The LMA was then retracted (Fig. 1) and forceps were utilized to maintain position of the insertion tube (Fig. 2) during this maneuver. The video laryngoscope blade was then reinserted into the oropharynx for visualization of the insertion tube coursing through the vocal cords. Using the insertion tube from the single-use bronchoscope as a stylet, intubation was successfully accomplished by inserting a 7.5mm ETT over the insertion tube under direct visualization with the video laryngoscope (Fig. 3). DISCUSSION: Single use bronchoscope devices have been successfully used for planned awake intubations [2] as well as confirmation of endotracheal tube placement [3] after emergent intubation. The novel technique described above can be a useful measure to facilitate intubation under direct visualization in complicated airway scenarios without the need for a surgical airway. CONCLUSIONS: This technique offers a number of advantages to include direct visualization of the airway, navigational capability of bronchoscopy and confirmation of placement with video laryngoscopy. The combination of these techniques can be considered as an alternative prior to pursuing an invasive surgical option. Reference #1: Jeffrey L. Apfelbaum, Carin A. Hagberg, Richard T. Connis, Basem B. Abdelmalak, Madhulika Agarkar, Richard P. Dutton, John E. Fiadjoe, Robert Greif, P. Allan Klock, David Mercier, Sheila N. Myatra, Ellen P. O'Sullivan, William H. Rosenblatt, Massimiliano Sorbello, Avery Tung;2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31–81 doi: https://doi.org/10.1097/ALN.0000000000004002 Reference #2: Kristensen MS, Fredensborg BB. The disposable Ambu aScope vs. a conventional flexible videoscope for awake intubation – a randomised study. Acta Anaesthesiol Scand. 2013 Aug;57(7):888-95. doi: 10.1111/aas.12094. Epub 2013 Mar 15. PMID: 23495767 Reference #3: Mitra A, Gave A, Coolahan K, Nguyen T. Confirmation of endotracheal tube placement using disposable fiberoptic bronchoscopy in the emergent setting. World J Emerg Med. 2019;10(4):210-214. doi: 10.5847/wjem.j.1920-8642.2019.04.003. PMID: 31534594;PMCID: PMC6732169 DISCLOSURES: No relevant r lationships by John Levasseur No relevant relationships by Lauren Sattler No relevant relationships by Tyson Sjulin
ABSTRACT
Introduction: COVID-19 has become the largest medical challenge of the last 50 years, affecting the whole world. Well-being can be scaled through the validated Warwick-Edinburgh Mental Well-being Scale (WEMWBS), mean score 50,7/70 general population sample.1 Objective: The aim of this study was to evaluate the wellbeing of physicians, during the second wave of the COVID-19 outbreak in a Belgian tertiary hospital, with special attention to anaesthesiologists who have been confronted with overcrowded intensive care units during several months challenging their physical and mental well-being. Methods: All physicians in a tertiary Belgian hospital were invited to participate by e-mail during the second COVIDoutbreak by an online anonymous questionnaire. All included persons gave their informed consent. The demographics collected were age, gender, function, COVID contact, workload and the WEMWBS score, summing 14 equally weighted questions (1 to 5) about mental well-being. SPPS, version 26.0, was used. Results: 42 residents and 48 staff members completed the online survey with average WEMWBS 50.6±8.0. Participating residents worked significantly more on a COVID-19 department than participating specialists (p=0.02). These residents noticed that their workload was higher (p=0.001) and scored lower on the WEMBWS (48.1±8.2) compared to staff members (52.8±7.3), (p=0.01). Male anaesthesiologists scored significant higher in the WEMWBS compared to their female colleagues (p=0.03). Conclusion: Physicians with a higher workload due to COVID reported a significantly lower well-being than those with a low workload. This small study showed a significant difference between the well-being of specialists and resident doctors. One out of five doctors experienced negative feelings. Attention should be paid on the prevention and treatment of well-being among healthcare workers, especially female anaesthesiologists.
ABSTRACT
Problem: Clinicians treating postprocedure acute pain after third molar removal face a twofold challenge: attenuating pain levels while simultaneously limiting leftover opioid doses. Strategies for achieving the dual goals range from “letting patients decide,” which can lead to leftover doses and misuse, or “letting clinicians decide,” only prescribing opioids for those predicted to experience severe discomfort, which risks under-managing acute pain. A hybrid strategy relies on joint decision-making between the patient and clinician. The hypothesis for this IRB-approved prospective study was that a hybrid-strategy would be successful in moderating acute pain and reducing leftover opioid doses. Methods and Materials: This study included patients who met the American Society of Anesthesiologists, risk classification I or II, ages 18 to 35 years, with at least 2 mandibular third molars removed. Patients being treated for opioid addiction/abuse were excluded. All enrolled subject patients were consented and treated with a multimodal analgesic protocol consisting of intraoperative IV preventive antibiotics, dexamethasone, ketorolac, ondansetron, local anesthetics including liposomal bupivacaine and postoperative cold therapy, and scheduled ibuprofen. Patients were given 2 prescriptions (Rx), each for 4 doses of Hydrocodone/APAP 5/325, to be taken as needed for pain;1 Rx could be filled on the day of surgery, the second on any subsequent day. Opioid Rx data were retrieved from patient records and North Carolina Controlled Substances Reporting System. Pain scores and opioid-use data for each postsurgery day (PSD) were derived from a 14-day diary recorded by subjects. For the patients in this series, the goal was median pain levels ranked 1 or 2 on a 7-point scale, meaning no pain and minimal pain by postoperative day (POD) 3. Descriptive statistics were used for analyses. Results: Data were analyzed from 96 eligible patients treated consecutively from 2018 to 22, with a 15-month hiatus from COVID-19. Fifty-two patients (54%) did not fill an opioid prescription. Twenty-seven patients (28%) filled 1 opioid prescription and 17 patients (18%) filled 2 of the prescriptions. The patients who filled 1 prescription had 72 leftover doses (67% of possible doses), and the patients who filled 2 prescriptions had 50 leftover doses (74% of possible doses). Median worst pain levels reached 1 to 2 out of 7 on POD 4;median average pain on POD 3. Conclusions: The hybrid strategy reduced the number of opioid doses in circulation without compromising the patient's postoperative pain level. Decreasing the number of leftover opioid doses is an important step toward addressing opioid addiction and overdose. References: 1 Magraw CBL, Pham M, Neal T, Kendell B, Reside G, Phillips C, White RP Jr: A multimodal analgesic protocol may reduce opioid use after third molar surgery: A pilot study. Oral Surg Oral Med Oral Path Oral Radiol 126:214, 2018. 2 Pham M, Magraw C, Neal T, Kendell B, Reside G, Phillips C, White R: A Multi-modal Analgesic Protocol reduced opioid use/misuse after 3rd Molar Surgery: An Exploratory Study. Submitted Oral Surg Oral Med Oral Path Oral Radiol March 2019 3 Pham M, Magraw C, Neal T, Kendell B, Reside G, Phillips C, White R: A Multimodal Analgesic Protocol reduced acute pain levels after 3rd molar surgery. In preparation JOMS 4 White RP Jr, Shugars DA, Shafer DM, Laskin DM, Buckley MJ, Phillips C: Recovery after third molar surgery: clinical and health-related quality of life outcomes. J Oral and Maxillofacial Surgery 61:535, 2003. 5 American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116:248, 2012 6-Savarese JJ, Tabler NG Jr: Multimodal analgesia as an alternative to the risks of opioid monotherapy in surgical pain management. J Health Care Risk Manag 37:24, 2017