Relationship between financial well-being and Burnout Syndrome in anesthesiologists

Burnout syndrome and problems in personal financial life can have negative effects on mental health. Given this similarity between the two, the question is whether there is a correlation between financial well-being and the risk of developing the syndrome. In this study a questionnaire was applied to analyze this relationship. The results show that the lower the financial well-being, the higher the risk of Burnout. The prevalence of the syndrome in the sample was 28.6%. Furthermore, age and time in the job market showed a negative correlation with this risk, while the weekly work load showed a positive correlation. Despite not demonstrating causality between the variables, this study presents new data in the literature. Future studies in the area are necessary to aid in the prevention and treatment of Burnout Syndrome.

Therapeutic options for Corona Virus Disease 2019 (COVID-19)

The aim of this review article is to put forth the therapeutic options for coronavirus disease 2019 (COVID-19). There is no specific treatment or therapy recommended for COVID-19 up to now. The therapeutic approaches should be ordered according to the severity of disease. These options can be listed from one to ten such as isolation; oxygen support; respiratory treatment; anticoagulant treatment; anti-inflammatory drugs; hydroxychloroquine and combinations therapies; antiviral drugs; convalescent plasma therapy; mesenchymal stem cells therapy and vaccination. According to the severity and stage of the disease, suitable options are recommended.

Protective ventilation measures improve outcomes during major vascular surgery

Background: In major endovascular and open vascular surgery cases, pulmonary complications remain persistently high and the most prevalent. Despite strong evidence from intensive care unit (ICU) practices demonstrating benefits of ventilation management with low tidal volume and high positive end expiratory pressure (PEEP), no consensus exists regarding protective ventilation use intraoperatively. Methods: A single institute, patient and surgeon blinded, prospective, randomized study design was used. Patients undergoing major vascular surgery (vascular surgery scheduled for >120 minutes and requiring general anesthesia) from 2015-2016 were randomized to pre-defined control (n = 14) or intervention (n =19) intraoperative ventilation arms. As described later, intervention consisted of a combination of low tidal volume, optimized positive end expiratory pressure (PEEP) and low intraoperative FiO2. Primary outcomes included all-cause mortality, myocardial infarction (MI) and reintubation within 7 post-operative days (POD). Secondary outcomes included atelectasis, pulmonary function measures, hospital length of stay and post-operative complications of re-intubation, pneumonia, sespsis, unplanned readmission or return to operating room, and/or mortality. Results: The intervention arm had significantly reduced post-operative atelectasis ((p <0.02) and increased post-operative SpO2 (p< 0.02). The intervention arm also had a significantly lower length of hospital stay (6.9±5.5 vs 3.3±1.8, p < 0.016). This was corroborated by a multivariate regression analysis that showed therapy was independently correlated with decreased length of stay (p<0.007). Conclusion: Our data indicate a combination of low tidal volumes, optimized PEEP and low FiO2 improves outcomes of patients undergoing major vascular surgery. Importantly, our study demonstrates that these study parameters for evaluation of intraoperative ventilation management are feasible in a busy academic center and a larger clinical trial is worthy. Protective intraoperative ventilation measures could have significant effects on vascular surgery outcomes.

Cerebral thromboangiitis associated with Covid-19 infection: a young woman case report

COVID-19 may predispose to both venous and arterial thromboembolic disease due to excessive inflammation, hypoxia, and immobilization. Remarkably, thrombotic complications have hardly been described. We describe a patient with severe pneumonia, COVID-19 correlated, who developed a presumable and rare form of thromboangioiitis with cerebrovascular thrombotic complication and neurological symptoms, in absence of other cardio-vascular risk factor. Significant inflammation is present in our patient, which may explain more dramatic activation of coagulation and arterial endothelium vessels damage. The probable mechanism of this cardiovascular injury may be a direct effect of coronavirus related to Angiotensin-converting enzyme 2 receptor (ACE2-r). The exact mechanisms by which COVID-19 induced hypercoagulability remain incompletely elucidated and more research are necessary.

Use of Fibroquel® (Polymerized type I collagen) in patients with hypoxemic inflammatory pneumonia secondary to COVID-19 in Veracruz, Mexico

Since the beginning of the pandemic, there is currently no specific treatment, however some drugs, after systematic reviews and meta-analysis have been positioned as potential treatments (dexamethasone, tocilizumab, baricitinib), however, other drugs with therapeutic potential are being investigated, such as Polymerized type I collagen (Fibroquel). Material and methods: Adult patients are admitted to the study from December 2020 to January 2021, with prior informed consent, carriers of viral pneumonia confirmed by axial tomography, secondary to infection by Sars Cov2 virus identified by RT-PCR or antigen test, who also present severity data (dyspnea, desaturation -saturation at room air of 92% or less-, persistent fever), as well as inflammation markers (D-dimer 1000ng/ml±100; ferritin> 300mg) and that allow treatment with Polymerized type I collagen (Fibroquel®) at home or in a hospital area. Results: We include data from 35 patients, 19 (54.3%) women and 16 (45.7%) men, with a median age of 51.0 (38.0-76.0) years. The number of patients with a history of previous comorbidities was 34 (97.1%) and 20 (57.1%) had multiple comorbidities (3 or more synchronous comorbidities). The most frequent comorbidities among these patients were obesity in 94.3%, DM2 62.9%, Arterial hypertension 60.0%, COPD 14.3%, heart disease 8.6%, nephropathy 5.7%, in addition to SLE and trisomy 21, both in 2.9% of patients. In the baseline evaluation laboratory, we found that 33 (94.3%) patients had lymphocytopenia and 3 (8.6%) had thrombocytopenia. Median D-Dimer and Ferritin serum levels were 1,200.0 (990.0- 1,800.0) ng/mL and 394.5 (320.0-492.5) ug/L, respectively. The neutrophil-lymphocyte index was calculated, which on average was 10.8 (8.0 - 14.7) and an ABC-GOALSclx index of 14.0 (11.0 - 16.0) was calculated, which translate severe disease and an indication of stay in an intensive care unit. Relation to the pulse oximetry at ambient air in the baseline evaluation, we found that the median O2 saturation was 88.0% (86.0% - 89.0%). The median number of days of evolution from the onset of symptoms to the moment in which treatment with Fibroquel was started was 8.0 (7.0-9.0) days. The pulse oximetry quantified 7 days after the start of treatment had a median of 94.0% (93.0-95.0%); Regarding the measurement of prognostic biomarkers, the median d-dimer and ferritin in serum measured at 7 days of follow-up were 656.0 (497.0 - 697.5) ng/mL and 394.5 (320.0-492.5) ug/L, respectively. Conclusion: Polymerized type I collagen (Fibroquel) is an effective drug in patients with inflammatory and hypoxemic pneumonia secondary to Sars COV 2 infection, favoring clinical improvement and favoring extubation, oxygenation, and inflammation indices, as well as a biosafety profile that ensures its use without restrictions in these patients.

Prognostic factors of intraoperative awakening

A prospective longitudinal cohort study was carried out in patients announced for major elective surgery, with orotracheal general anesthesia, at the “Carlos Manuel de Céspedes de Bayamo Provincial Hospital, from the Cauto region during the period from January 1, 2016 until December 31, 2018; with the objective of identifying the risk factors hypothetically related to the prognosis of intraoperative awakening. The exposed cohort consisted of two patients who experienced intraoperative awakening in the study period, and met the inclusion criteria. The magnitude of the associations was estimated by calculating the relative risks (RR). Age equal to or greater than 65 years, difficult intubation, patients with ASA III and IV physical status, and chronic alcohol ingestion, were the surgical risk factors depending on the patient, associated with the prognosis of awakening. Intraoperative in patients announced for major elective surgery, under general orotracheal anesthesia, although not significantly; while the female sex did not present an association. The time of surgery equal to or greater than four hours, was constituted in the surgical risk factor depending on the surgery, related to the prognosis of appearance of intraoperative awakening in patients announced for major elective surgery, with orotracheal general anesthesia.

Perioperative focused cardiac ultrasound: a brief report

Background: The anesthesiologist's emerging role as a perioperative physician has challenged the field to broaden its scope of practice to meet the demands of the patient undergoing surgery today. This brief report aims to identify the indications, clinical impact on management decisions, and perioperative focused cardiac ultrasound accuracy in patients scheduled for non-cardiac surgery. Methods: A review from the Department of Anesthesia Perioperative Echocardiography database on transthoracic echocardiography was performed, including clinical, demographic, indications, therapeutic impact, and accuracy from February 1, 2017 to October 10, 2019. Results: A total of 220 FoCUS exams were identified. FoCUS was performed in 55% males and 45% females. The average age was 66.5 years, and 68% of patients were designated ASA 3 classification. The majority underwent thoracic procedures with a history of cardiovascular disease for hemodynamic instability in the post-anesthesia care unit (PACU). In this group, 94% had a change in management. New findings in 9 patients resulted in pre-induction management change. FoCUS was also performed intraoperatively to differentiated hemodynamic instability, significantly altering care. Postoperatively, new wall motion abnormalities findings hasten care to the cardiology service. Immediate assessment of hemodynamic instability altered care and postoperative recovery location in a significant number of patients. In all cases, FoCUS was used to guide management in the differential diagnosis of the acute event and to assess treatment response. Conclusion: This review demonstrates that FoCUS is an excellent clinical adjunct in the perioperative period. Diagnostic accuracy and efficiency by pattern recognition helped answer clinically significant questions and guide management. The non-invasive approach of POCUS and its rapid adaptation makes it an exciting area of future research.

Determination and calibration in the airway of the Mallampati, Patil-Aldreti tests, sternomentonian distance, interincisive distance

An analytical, cross-sectional study was carried out in patients undergoing major elective surgery under general orotracheal anesthesia, at the "Carlos Manuel de Céspedes" University Provincial Hospital of Bayamo, in the period from January to December 2018, with the objective of evaluating the effectiveness of predictive tests of difficult intubation: Mallampati, Patil-Aldreti test, sternomentonian distance, and interincisive distance. For the calculation of the sample, the professional statistical program Epidemiological Analysis of Tabulated Data was applied, resulting in 269 patients, who were selected in the anesthesia office and applied the tests, after signing the informed consent. For the information processing, descriptive and inferential statistics were used. According to the Youden index, the interincisive distance was unsurpassed in effectiveness in all the tests performed, following the sternomentonian distance; The Mallampati test was the one with the lowest predictive value. Combinations of tests can increase the diagnostic value compared to the value of each test alone.