Evaluation of psychological impact of COVID-19 on anesthesiology residents in the United States.

The aim of our study was to evaluate the impact of COVID-19 on the mental health of in-training anesthesiology residents in the United States. A link containing validated survey tools including the Depression-Anxiety-Stress-Scale (DASS-21), the Abbreviated Maslach Burnout Inventory (aMBI), and the Brief Resilient Coping Scale (BRCS) along with questions related to work environment, and additional personal factors were emailed to 159 Anesthesiology residency programs across the US. 143 responses were received of which 111 were complete. The prevalence of depression, anxiety, stress and burnout was 42%, 24%, 31% and 71% respectively. Emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment were experienced by 80%, 53%, and 65% of respondents, respectively. The BRCS scale showed 33% of respondents with low, 44% with moderate and 22% with high coping scales. Logistic regression analyses indicated those with a prior mental health diagnosis were 3 times more likely to have a non-normal DASS depression score, 4 times more likely to have a non-normal DASS anxiety score, and 11.74 times more prone to emotional exhaustion. Increased work hours and higher training levels were associated with increased levels of stress. In our survey, prior mental health illness, gender and increased work hours were the main drivers of increased risk.

The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit-A Multicenter Prospective Observational Study.

INTRODUCTION: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. METHODS: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. CONCLUSIONS: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.

Real-time echocardiographic guidance for confirming septal placement of right ventricular leads: A pilot study.

INTRODUCTION: Accuracy of fluoroscopy in predicting septal placement of the right ventricular (RV) leads is poor. This pilot study evaluated the feasibility and impact of real-time transthoracic echocardiogram (TTE) during RV lead placement. METHOD: Consecutive patients undergoing transvenous RV lead placement and had a point of care ultrasound team available for TTE guidance were included in the study. TTE was performed to confirm or refute the septal position of RV lead initially positioned using fluoroscopy; leads were repositioned until a septal position was confirmed on TTE. The primary outcome measured was whether the use of TTE resulted in lead repositioning. RESULT: Among the 26 patients included in the study, real-time TTE during RV lead placement resulted in reposition of the lead to a septal position in 38.5% of patients. CONCLUSION: Use of real-time TTE guidance during fluoroscopic RV lead placement is feasible and can aid in confirming a septal position.

Anesthetic Management of Awake Craniotomy for Resection of the Language and Motor Cortex Vascular Malformations.

BACKGROUND: Although the safety and feasibility of awake craniotomy are well established for epilepsy and brain tumor surgery, its application for resection of vascular lesions, including arteriovenous malformations (AVMs) and cavernomas, is still limited. Apart from the usual challenges of awake craniotomy, vascular lesions pose several additional problems. Our goal is to determine the safety and practicality of awake craniotomy in patients with cerebral vascular malformations located near the eloquent areas, using a refined anesthetic protocol. METHODS: A retrospective case series was performed on 7 patients who underwent awake craniotomy for resection of AVMs or cavernomas located in the eloquent language and motor areas. Our protocol consisted of achieving deep sedation, without a definitive airway, using a combination of propofol, dexmedetomidine, and remifentanil/fentanyl during scalp block placement and surgical exposure, then transitioning to a wakeful state during the resection. RESULTS: Six patients had intracranial AVMs, and 1 patient had a cavernoma. Six patients had complete resection; however, 1 patient underwent repeat awake craniotomy for residual AVM nidus. The patients tolerated the resection under continuous awake neurologic and neurophysiologic testing without significant perioperative complications or the need to convert to general anesthesia with a definitive airway. CONCLUSIONS: Awake craniotomy for excision of intracranial vascular malformations located near the eloquent areas, in carefully selected patients, can facilitate resection by allowing close neuromonitoring and direct functional assessment. A balanced combination of sedative and analgesic medications can provide both adequate sedation and rapid wakeup, facilitating the necessary patient interaction and tolerance of the procedure.

Substance use, aggression perpetration, and victimization: temporal co-occurrence in college males and females.

Many studies have documented associations of substance use with aggression perpetration and aggression victimization; however, little is known about the co-occurrence of these problem behaviors within the same day in college students. The present study investigated whether substance use and aggression increase the likelihood of each other and whether attitudes justifying aggression strengthen those associations. College student participants (N = 378, 32% males) self-selected into an online study in which they reported on 2 days of alcohol/drug use and on aggression perpetration and victimization (including physical, psychological and electronic aggression, and sexual coercion) with friends and dating partners. Using regression to test for nonequivalence of predictor and outcome variables, we found bidirectional effects for males only. Males' substance use was associated with an increased likelihood on the same day of aggression perpetration and of aggression victimization; males' aggression perpetration and aggression victimization were associated with an increased likelihood of substance use on the same day. Females did not show significant contingencies between substance use and aggression in either direction. Males' attitudes justifying male-to-female aggression were associated with their aggression perpetration and victimization and their justification of female-to-male aggression strengthened the link between substance use and aggression perpetration. With interpersonal aggression and substance use being significant problems on college campuses, many colleges offer separate preventive intervention programs aimed at these public health challenges; this study suggests possible benefits of an integrated approach that addresses connections between alcohol/drug use and aggression.

College students' electronic victimization in friendships and dating relationships: anticipated distress and associations with risky behaviors.

This study investigated college students' reports of electronic victimization in friendships and dating relationships. We examined 22 items representing four categories of electronic victimization: hostility, humiliation, exclusion, and intrusiveness. Nearly all participants (92%) reported some electronic victimization in the past year, with males reporting more victimization and females anticipating more distress. Both females and males anticipated more distress from electronic victimization in dating relationships than friendships. More actual experience with electronic victimization related to lower anticipated distress. Electronic victimization was associated with females' alcohol use, even after controlling for other victimization experiences. Discussion focuses on the contextualized nature of electronic victimization, and on the importance of understanding what makes electronic victimization highly distressing for some individuals.

Earthquakes and Children: The Role of Psychologists with Families and Communities.

The 2008 Sichuan Province earthquake and 2005 Pakistan earthquake are examples of natural disasters that took an unimaginable toll on children. In such disaster management contexts, family members as well as health care and school personnel are the first-line responders and are natural sources of continued social support as children recover. Although psychologists have increasingly sophisticated understandings of post-disaster reactions and strategies for helping children and adolescents cope with trauma, models for responding to mass catastrophes are limited, particularly in geographically remote communities and in regions where mental health services are stigmatizing. With children's well-being subsequent to earthquakes inextricably linked to family and community, psychologists can make important contributions in three spheres: (a) coordinating and activating collaborations within children's existing social contexts to develop post-earthquake interventions; (b) designing prevention and preparedness programs focused on the emotional needs of children in earthquake-prone communities; and (c) conducting research on interventions and recovery with particular attention to developmental stage, socio-cultural-economic contexts, and the similarities versus differences across various types of disasters.