Anesthesiology
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The researchers performed multiple cross-sectional surveys of three years of US anesthesiology trainees, from their first year of clinical anesthesia training to a year after qualification. They surveyed the anesthesiologists for burnout, distress and depression.
Burnout, distress and depression were worryingly common (51%, 32% and 12% of residents), although self-reported availability of workplace resources to manage burnout & depression, and perceived work-life balance were protective, roughly halving odds of each outcome.
Having strong social supports was also associated with lower rates of depression and burnout, although not distress.
Both working more hours each week and having larger student loan debt were associated with depression and distress, although not burnout.
Females, although only making up 37% of respondents, were more likely to suffer from burnout and depression. International medical school graduates were in contrast less likely.
The take-home message...
Burnout, distress and depression are common among anesthesiology trainees and newly qualified anesthesiologists. Workplace support, efforts to maintain work-life balance, maintaining social supports and limiting working hours are modifiable factors that have protective effects.
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Randomized Controlled Trial
Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial.
Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve. ⋯ Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.
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Randomized Controlled Trial
Influence of Reversal of a Partial Neuromuscular Block on the Ventilatory Response to Hypoxia: A Randomized Controlled Trial in Healthy Volunteers.
The ventilatory response to hypoxia is a critical reflex that is impaired by neuromuscular blocking drugs. However, the degree to which this reflex is restored after reversal of blockade is unknown. ⋯ Despite full reversal of partial neuromuscular block at the thumb, impairment of the peripheral chemoreflex may persist at train-of-four ratios greater than 0.9 following reversal with neostigmine and sugammadex or spontaneous recovery of the neuromuscular block.