Anesthesiology Research and Practice最新文献

{"title":"Maternal Satisfaction and Its Associated Factors towards Spinal Anesthesia for Caesarean Section: A Cross-Sectional Study in Two Eritrean Hospitals.","authors":"Idris Mohammed Idris,&nbsp;Ghidey Gebreyohanns Weldegiorgis,&nbsp;Eyasu Habte Tesfamariam","doi":"10.1155/2020/5025309","DOIUrl":"https://doi.org/10.1155/2020/5025309","url":null,"abstract":"<p><strong>Objective: </strong>Satisfaction of mothers during caesarean section is an important indicator for measuring quality of obstetric anesthesia. This study aimed to determine mothers' level of satisfaction and the predicting factors of dissatisfaction towards spinal anesthesia during caesarean section.</p><p><strong>Methods: </strong>Cross-sectional study design was utilized in Orotta Maternity Hospital (OMH) and Sembel Hospital from December 2017 to February 2018, in Asmara, Eritrea. Satisfaction of the mothers was measured using a pretested questionnaire. Bivariate and multivariate logistic regression were utilized to identify predictors of dissatisfaction using SPSS (Version 22.0).</p><p><strong>Results: </strong>Involvement of mothers in the choice of anesthesia (3.3%) and explanation about the stay at operating theater (10%) were the two least reported items. As per the subscale analysis, the lowest satisfaction was observed for the preoperative assessment (16.7%). Overall, 87.9% of the mothers were satisfied with the spinal anesthetic service. Hospital at which anesthesia was administered (<i>p</i> < 0.001), marital status (<i>p</i> < 0.001), and intraoperative pain (<i>p</i> < 0.001) were significant predictors of dissatisfaction towards spinal anesthesia. Moreover, the rate of refusal to have spinal anesthesia in the future was 12.5%.</p><p><strong>Conclusion: </strong>Though overall satisfaction can be considered as fair, preoperative assessment is considerably low. Hence, explaining the benefits and risks of the anesthetic techniques as well as considering patient's opinion is very important while deciding the type of anesthesia.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"5025309"},"PeriodicalIF":1.4,"publicationDate":"2020-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5025309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37809214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dying in the Intensive Care Unit (ICU): A Retrospective Descriptive Analysis of Deaths in the ICU in a Communal Tertiary Hospital in Germany.","authors":"Esma Ay, Markus A Weigand, Rainer Röhrig, Marco Gruss","doi":"10.1155/2020/2356019","DOIUrl":"10.1155/2020/2356019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Modern intensive care methods led to an increased survival of critically ill patients over the last decades. But an unreflected application of modern intensive care measures might lead to prolonged treatment for incurable diseases, and an inadaequate or too aggressive therapy can prolong the dying process of patients. In this study, we analysed end-of-life decisions regarding withholding and withdrawal of intensive care measures in a German intensive care unit (ICU) of a communal tertiary hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patient datasets of all adult patients dying in an ICU or an intermediate care unit (IMC) in a tertiary communal hospital (Klinikum Hanau, Germany) between 01.01.2011 and 31.12.2012 were analysed for withholding and withdrawal of intensive care measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the two-year period, 1317 adult patients died in Klinikum Hanau. Of these, 489 (37%) died either in an ICU/IMC unit. The majority of those deceased patients (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (&lt;i&gt;n&lt;/i&gt; = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;About one-third of pat","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"2356019"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37752980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Intoxicated Trauma Patients at an Increased Risk for Intraoperative Anesthetic Complications? A Retrospective Study.","authors":"Brian D Wolf,&nbsp;Swapna Munnangi,&nbsp;Raymond Pesso,&nbsp;Charles McCahery,&nbsp;Madhu Oad","doi":"10.1155/2020/2157295","DOIUrl":"https://doi.org/10.1155/2020/2157295","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to correlate intraoperative anesthetic complications of trauma patients with their respective urine toxicology results.</p><p><strong>Methods: </strong>This retrospective, single-center cohort study at a Level 1 trauma center included patients with the following criteria: (1) trauma admission between January 1, 2010, and December 31, 2016, (2) required surgical intervention, (3) are age 18 and older, and (4) urine toxicology screening was completed. Anesthetic records were evaluated for intraoperative complications.</p><p><strong>Results: </strong>The final analysis included 847 patients. The mean anesthesia time, American Society of Anesthesiologists physical status classification scores, change in body temperature, anesthetic complication rate, and mortality were not significantly different between urine toxicology positive and negative patients. Of note, a significantly lower proportion of the urine toxicology positive patients were extubated postoperatively in comparison to urine toxicology negative patients (57.32% vs 63.83%).</p><p><strong>Conclusions: </strong>Trauma patients who presented with a positive urine toxicology screening are not at an increased risk for intraoperative anesthetic complications compared to those with a negative urine toxicology screening. However, our results indicated that the need for postoperative mechanical ventilation increased in the acutely intoxicated trauma patients when compared to those without preinjury intoxication.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"2157295"},"PeriodicalIF":1.4,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2157295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37752978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine Pharmacokinetics in Neonates with Hypoxic-Ischemic Encephalopathy Receiving Hypothermia.","authors":"Ryan M McAdams,&nbsp;Daniel Pak,&nbsp;Bojan Lalovic,&nbsp;Brian Phillips,&nbsp;Danny D Shen","doi":"10.1155/2020/2582965","DOIUrl":"https://doi.org/10.1155/2020/2582965","url":null,"abstract":"<p><p>Dexmedetomidine is a promising sedative and analgesic for newborns with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Pharmacokinetics and safety of dexmedetomidine were evaluated in a phase I, single-center, open-label study to inform future trial strategies. We recruited 7 neonates ≥36 weeks' gestational age diagnosed with moderate-to-severe HIE, who received a continuous dexmedetomidine infusion during TH and the 6 h rewarming period. Time course of plasma dexmedetomidine concentration was characterized by serial blood sampling during and after the 64.8 ± 6.9 hours of infusion. Noncompartmental analysis yielded descriptive pharmacokinetic estimates: plasma clearance of 0.760 ± 0.155 L/h/kg, steady-state distribution volume of 5.22 ± 2.62 L/kg, and mean residence time of 6.84 ± 3.20 h. Naive pooled and population analyses according to a one-compartment model provided similar estimates of clearance and distribution volume. Overall, clearance was either comparable or lower, distribution volume was larger, and mean residence time or elimination half-life was longer in cooled newborns with HIE compared to corresponding estimates previously reported for uncooled (normothermic) newborns without HIE at comparable gestational and postmenstrual ages. As a result, plasma concentrations in cooled newborns with HIE rose more slowly in the initial hours of infusion compared to predicted concentration-time profiles based on reported pharmacokinetic parameters in normothermic newborns without HIE, while similar steady-state levels were achieved. No acute adverse events were associated with dexmedetomidine treatment. While dexmedetomidine appeared safe for neonates with HIE during TH at infusion doses up to 0.4 <i>μ</i>g/kg/h, a loading dose strategy may be needed to overcome the initial lag in rise of plasma dexmedetomidine concentration.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"2582965"},"PeriodicalIF":1.4,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2582965","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37726060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia.","authors":"S Nardi-Hiebl, L H J Eberhart, M Gehling, T Koch, T Schlesinger, P Kranke","doi":"10.1155/2020/9201967","DOIUrl":"10.1155/2020/9201967","url":null,"abstract":"<p><p>This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"9201967"},"PeriodicalIF":1.4,"publicationDate":"2020-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9201967","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Perioperative Music Listening on Patient Satisfaction, Anxiety, and Depression: A Quasiexperimental Study.","authors":"Daryl Jian An Tan,&nbsp;Breanna A Polascik,&nbsp;Hwei Min Kee,&nbsp;Amanda Chia Hui Lee,&nbsp;Rehena Sultana,&nbsp;Melanie Kwan,&nbsp;Karthik Raghunathan,&nbsp;Charles M Belden,&nbsp;Ban Leong Sng","doi":"10.1155/2020/3761398","DOIUrl":"https://doi.org/10.1155/2020/3761398","url":null,"abstract":"<p><strong>Background: </strong>The effect of perioperative music listening has been proven to relieve preoperative anxiety and depression, while improving patient satisfaction. However, music listening has not been extensively studied in Singapore. Therefore, the primary aim of our study is to investigate the patient satisfaction towards perioperative music listening in the local setting. The secondary aim is to investigate the effect of perioperative music listening in reducing patient surgery-related anxiety and depression.</p><p><strong>Methods: </strong>After obtaining ethics board approval, we conducted a quasiexperimental study on a cohort of female patients who were undergoing elective minor gynaecological surgeries. Apple iPod Touch™ devices containing playlists of selected music genres and noise-cancelling earphones were given to patients to listen during the preoperative and postoperative periods. Hospital Anxiety and Depression Scale (HADS), EQ-5D-3L questionnaire, music listening preferences, and patient satisfaction surveys were administered. Wilcoxon signed-rank and McNemar's tests for paired data were used for analysis.</p><p><strong>Results: </strong>83 patients were analysed with 97.6% of patients in the preoperative period and 98.8% of patients in the postoperative period were satisfied with music listening. The median (IQR [range]) score for preintervention HADS anxiety was 7.0 (6.0 [0-17]), significantly higher than that in postintervention at 2.0 (4.0 [0-12]) (<i>P</i> < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (<i>P</i> < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (.</p><p><strong>Conclusion: </strong>Perioperative music listening improved patient satisfaction and can reduce patient anxiety and depression. We hope to further investigate on how wider implementation of perioperative music listening could improve patient care.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"3761398"},"PeriodicalIF":1.4,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3761398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37670150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Associated Factors of Laryngospasm among Pediatric Patients Who Underwent Surgery under General Anesthesia, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: A Cross-Sectional Study.","authors":"Wubie Birlie Chekol,&nbsp;Debas Yaregal Melesse","doi":"10.1155/2020/3706106","DOIUrl":"https://doi.org/10.1155/2020/3706106","url":null,"abstract":"<p><strong>Introduction: </strong>Laryngospasm is a glottis closure due to reflex constriction of the laryngeal muscles. It can occur at any phase of the anesthetic. Different studies have been done previously with various results and indicative values which initiated us to do this research. This study aimed to assess the incidence and associated factors of laryngospasm among pediatric patients who underwent surgery under general anesthesia (GA).</p><p><strong>Methods: </strong>Institution-based, cross-sectional study was conducted on pediatric patients from February to August, 2019, in University of Gondar Comprehensive Specialized Hospital (UOGCSH). Data were entered and analyzed with SPSS version 20. Variables with <i>P</i> value less than <0.2 in bivariate analysis were fitted into the multivariable logistic regression analysis to identify factors associated with laryngospasm. Both crude and adjusted odds ratio with 95% CI were calculated to show strength of association. In multivariable analysis, <i>P</i> value of <0.05 was considered as statistically significant.</p><p><strong>Results: </strong>The incidence of laryngospasm among pediatric patients who underwent surgery under GA was 57 (18.4%). Of this, 34 (59.6%), 12 (21.1%), and 11 (19.3%) happened during emergence, maintenance, and induction phases of GA, respectively. In multivariable analysis, airway anomalies (AOR: 14.64, 95% CI: 1.71, 125.04), secretion (AOR: 2.45, 95% CI: 1.19, 5.06), attempts of airway devices (AOR: 2.47, 95% CI: 1.16, 5.22), upper respiratory tract infection (AOR: 2.91, 95% CI: 1.008, 8.41), and inadequate depth of anesthesia (AOR: 7.92, 95% CI: 2.7, 23.22) were significantly associated with incidence of laryngospasm.</p><p><strong>Conclusions: </strong>Laryngospasm can occur at any phase of the anesthetic. At UOGCSH, the overall rate of laryngospasm was 18.4%, with the vast majority of episodes occurring on emergence. Inadequate depth of anesthesia, URTI, airway anomalies, multiple attempts of airway devices, and oropharyngeal secretion were predictors of laryngospasm. So, added vigilance is needed in patients with URTI, airway anomalies, or those who require multiple attempts at airway device insertion. Prompt clearing of airway secretions and adequate depth of anesthesia may help to prevent laryngospasm. Since the majority of our patients received an IV induction, endotracheal intubation, and maintenance with halothane, caution must be taken in extrapolating these results to other patient populations.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"3706106"},"PeriodicalIF":1.4,"publicationDate":"2020-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3706106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37939348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Needle Extension through the Ligamentum Flavum Using the Standard versus the CompuFlo®-Assisted Loss of Resistance to Saline Technique: A Simulation Study.","authors":"E Capogna,&nbsp;A Coccoluto,&nbsp;M Velardo","doi":"10.1155/2020/9651627","DOIUrl":"https://doi.org/10.1155/2020/9651627","url":null,"abstract":"<p><strong>Background: </strong>The CompuFlo® epidural system has been recently introduced and validated as an objective and sensible tool to detect the epidural space. We aimed to verify whether the high sensitivity of the instrument may help the anesthesiologist to identify the epidural space very early, limiting the extension of the Tuohy needle into the epidural space.</p><p><strong>Methods: </strong>In this prospective, simulation study, we evaluated the Tuohy needle extension through a simulated ligamentum flavum during the epidural procedure performed by 52 expert anesthesiologists by using the CompuFlo® epidural instrument or their standard loss of resistance to saline technique (LORT).</p><p><strong>Results: </strong>The mean (SD) needle extension length was 3.90 (3.71) mm in the standard technique group and 0.68 (0.46) mm in the CompuFlo® group (<i>P</i> < 000001). The extremely reduced variability of the data in the CompuFlo® group (<i>F</i> test 0.01) made the results obtained with this instrument highly predictable.</p><p><strong>Conclusions: </strong>Puncturing high-resistance material that simulated the ligamentum flavum, the use of CompuFlo® has determined the arrest of the needle more precociously when compared with the traditional LORT.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2020 ","pages":"9651627"},"PeriodicalIF":1.4,"publicationDate":"2020-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9651627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37923572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Success and Challenge When Returning to Clinical Practice: A Case Series in Anesthesiologist Re-Entry.","authors":"Michael S Green,&nbsp;Usama Iqbal,&nbsp;Christopher R Hoffman,&nbsp;Parmis Green,&nbsp;Nielufar Varjavand","doi":"10.1155/2019/3531968","DOIUrl":"https://doi.org/10.1155/2019/3531968","url":null,"abstract":"<p><strong>Introduction: </strong>Anesthesiologists returning to clinical practice pose unique challenges for licensing and credentialing boards. Few institutions provide re-education. We describe the physician refresher/re-entry program at our College of Medicine.</p><p><strong>Methods: </strong>We launched the physician re-entry program in 2006. This individualized program re-educates physicians who left clinical practice for any reason and are seeking to return. We report results achieved for 12 anesthesiologists who successfully completed the course between August 2012 and February 2018.</p><p><strong>Results: </strong>Seven men and five women left their practices for various reasons, which included relocation, family or medical reasons, substance use, and burnout. None left practice for medical negligence. Range away from clinical activity was 0-10 years. Five had active licenses. Seven were US graduates and five were international. Nine of 12 achieved their goals. Of the 3 others, 1 did not pursue her goal, another did not obtain a residency, and the other just finished the program. Seven out of 9 (78%) achieved their goal within 1 year of course completion.</p><p><strong>Discussion: </strong>Despite our small sample size, our experience to successfully return inactive physicians to the workforce adds to the scant literature and experience in refreshing inactive physicians. Our trainees return to practice serving communities across the country and are now a pivotal part of the anesthesiology workforce. Thus, this program not only services individual physicians, but the whole community affected by their absence.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2019 ","pages":"3531968"},"PeriodicalIF":1.4,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/3531968","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37538347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Five-Year Data Report of Long-Term Central Venous Catheters Focusing on Early Complications.","authors":"Harald Lenz, Kirsti Myre, Tomas Draegni, Elizabeth Dorph","doi":"10.1155/2019/6769506","DOIUrl":"10.1155/2019/6769506","url":null,"abstract":"<p><strong>Background: </strong>Long-term venous access has become the standard practice for the administration of chemotherapy, fluid therapy, antibiotics, and parenteral nutrition. The most commonly used methods are percutaneous puncture of the subclavian and internal jugular veins using the Seldinger technique or surgical cutdown of the cephalic vein.</p><p><strong>Methods: </strong>This study is based on a quality registry including all long-term central venous catheter insertion procedures performed in patients >18 years at our department during a five-year period. The following data were registered: demographic data, main diagnosis and indications for the procedure, preoperative blood samples, type of catheter, the venous access used, and the procedure time. In addition, procedural and early postoperative complications were registered: unsuccessful procedures, malpositioned catheters, pneumothorax, hematoma complications, infections, nerve injuries, and wound ruptures. The Seldinger technique using anatomical landmarks at the left subclavian vein was the preferred access. Fluoroscopy was not used.</p><p><strong>Results: </strong>One thousand one hundred and one procedures were performed. In eight (0.7%) cases, the insertion of a catheter was not possible, 23 (2.1%) catheters were incorrectly positioned, twelve (1.1%) patients developed pneumothorax, nine (0.8%) developed hematoma, and three (0.27%) developed infection postoperatively. One (0.1%) patient suffered nerve injury, which totally recovered. No wound ruptures were observed.</p><p><strong>Conclusions: </strong>We have a high success rate of first-attempt insertions compared with other published data, as well as an acceptable and low rate of pneumothorax, hematoma, and infections. However, the number of malpositioned catheters was relatively high. This could probably have been avoided with routine use of fluoroscopy during the procedure.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2019 ","pages":"6769506"},"PeriodicalIF":1.6,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37498769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}