The BUDDYS System: A Unique Peer Support Strategy Among Anaesthesiology Residents During the COVID-19 Pandemic.

OBJECTIVE: The coronavirus disease 2019 pandemic stressed healthcare organizations. Initial efforts focused on supplies with a minimal empha- sis on frontline healthcare workers' wellbeing. Anaesthesiology residents represent vulnerable frontline healthcare workers because airway pro- cedures increase nosocomial infection risks. Peer support can promote healthcare workers' wellbeing during crises; its application to graduate medical trainees is underrepresented in the literature. We implemented a quality improvement project to improve wellbeing among anaesthesiol- ogy residents via a peer support system called BUilding Dynamic Duos for Your Support. METHODS: BUilding Dynamic Duos for Your Support consists of pairing 2 anaesthesiology residents with instructions to support each other in anticipation of a coronavirus disease 2019 case surge. A lecture presentation introduced this system to the residents and described frequent check-ins with another resident. We evaluated the initiative with a survey 2-4 weeks postimplementation. RESULTS: BUilding Dynamic Duos for Your Support began in April 2020 and involved 88 residents. Survey respondents (n = 58) indicated that BUilding Dynamic Duos for Your Support had a positive impact on their wellbeing. BUilding Dynamic Duos for Your Support implementation had no additional costs, requiring minimal resource dedication. CONCLUSIONS: BUilding Dynamic Duos for Your Support promoted wellbeing among anaesthesiology trainees. This quality improvement project highlights the positive impact of a peer support system on anaesthesiology residents' wellbeing with a potential broader application to graduate medical education.

Airway Management During Cardiopulmonary Resuscitation.

Purpose of the review: This review summarizes the updated literature on airway management during cardiopulmonary resuscitation (CPR). It provides guidance for clinicians to carefully incorporate the most recent recommendations related to airway management, oxygenation, and ventilation both during CPR and after return of spontaneous circulation. Recent Findings: The American Heart Association and the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care provide updated recommendations related to airway management during CPR, which focus on advanced airway strategies in out-of-the hospital cardiac arrest and in-hospital cardiac arrest. There is no evidence that any single advanced airway technique is superior to the other in terms of survival and neurological outcomes. There is controversy as to whether early advanced airway management could lead to favorable outcome. Summary: Advanced airway strategies and alternatives to airway management (including passive oxygenation) can be utilized in different settings while minimizing interruption in chest compressions.

Perioperative and Anesthetic Considerations for Patients with Degenerative Spine Disease.

The demand for spine surgery has dramatically increased over the last 2 decades. As the population ages and surgical and anesthetic techniques advance, the perioperative care of spine surgery patients poses challenges to anesthesiologists. Perioperative outcomes in terms of a decrease in complication rates and total health care expenditures have directed perioperative care to focus on enhanced recovery after surgery protocols, which many institutions have adopted. The role of anesthesiologists in the care of patients undergoing spine surgery is expanding beyond intraoperative care; consequently, a multidisciplinary approach is the best direction for optimal patient care.

Transcranial Motor Evoked Potential Monitoring in a Patient With a Deep Brain Stimulator: A Case Report.

SUMMARY: A major complication of surgical scoliosis correction is permanent injury of the spinal cord. Intraoperative neuromonitoring continually evaluates spinal cord function through monitoring sensory and corticospinal motor tracts. There is no literature or manufacturer recommendation on whether transcranial motor evoked potential (tcMEP) monitoring can be performed safely in the presence of a deep brain stimulator (DBS) system. A 17-year-old adolescent boy with severe neuromuscular scoliosis presented for a posterior spinal fusion. The patient suffered from generalized dystonia treated with a DBS terminating in the left and right globus pallidus internus. The competing goals of monitoring motor function during the spinal fusion and preserving the integrity of the DBS system were discussed preoperatively. The DBS system was deactivated for the duration of surgery, and tcMEPs were used sparingly at the lowest suitable stimulation voltage. Intraoperative management focused on facilitating neurophysiologic monitoring through a total intravenous anesthetic of propofol, methadone, and remifentanil. The tcMEPS remained unchanged throughout the operation and the patient emerged able to move his lower extremities to command. Postoperatively, the DBS system was turned back on and showed retained settings, normal functioning, and unchanged impedance of the DBS leads. Neither the patient nor his parents reported any subjective changes in the symptoms of dystonia. The authors conclude that monitoring tcMEPs in the presence of a DBS implant may be done safely, when the clinical circumstances suggest that the added information gained from tcMEPs outweighs the theoretical risk to the DBS system and the course of the medical condition treated by the DBS.