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Background: Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe., Methods: Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives., Results: Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK., Conclusion: This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: It is essential to understand the strategic importance of intensive care resources in the sustainable organisation of healthcare systems. Our objective has been to identify the intensive and intermediate care beds managed by Anaesthesiology and Resuscitation Services (A-ICU and A-IMCU) in Spain, their human and technical resources, and the changes made to these resources during the COVID-19 pandemic., Material and Methods: Prospective observational study performed between December 2020 and July 2021 to register the number and characteristics of A-ICU and A-IMCU beds in hospitals listed in the catalogue published by the Spanish Ministry of Health., Results: Data were obtained from 313 hospitals (98% of all hospitals with more than 500 beds, 70% of all hospitals with more than 100 beds). One hundred and forty seven of these hospitals had an A-ICU with a total of 1702 beds. This capacity increased to 2107 (124%) during the COVID-19 pandemic. Three hundred and eight hospitals had an A-IMCU with a total of 3470 beds, 52.9% (2089) of which provided long-term care. The hospitals had 1900 ventilators, at a ratio of 1.07 respirators per A-ICU; 1559 anaesthesiologists dedicated more than 40% of their working time to intensive care. The nurse-to-bed ratio in A-ICUs was 2.8., Discussion: A large proportion of fully-equipped ICU and IMCU beds in Spanish hospitals are managed by the anaesthesiology service. A-ICU and A-IMCUs have shown an extraordinary capacity to adapt their resources to meet the increased demand for intensive care during the COVID-19 pandemic., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Cushing syndrome is a metabolic disease caused by chronic exposure to high levels of glucocorticoids. It can present as an endocrine emergency due to a rapid increase in circulating cortisol leading to increased risk of cardiovascular disease and infection. Etomidate rapidly reduces plasma cortisol levels by inhibiting the action of 11β-hidroxilase. We report the case of a patient with severe hypercortisolaemia accompanied by metabolic and psychiatric disorders in whom administration of etomidate reduced preoperative levels of cortisol., (Copyright © 2023 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Aims: In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA., Patients and Methods: Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year., Results: Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm., Conclusions: These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA., (Copyright © 2023 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Cauda equina syndrome (CES) is a rare but possible complication of neuroaxial anesthesia. Damage to the nerve roots may occur due to compression, inflammation, stretching, direct trauma, spinal ischemia or neurotoxicity, usually with lidocaine or bupivacaine. We describe a case of a 33-year-old patient that underwent an uneventful cesarean section with a combined spinal-epidural technique anesthesia, with levobupivacaine. 48 h after the procedure, she presented diminished muscular strength and abolished osteotendinous reflexes in the left lower limb, limited flexion of the right hallux, urinary retention and saddle anesthesia. Imaging exams excluded hematoma, thickening or compression of the cauda equina nerve roots. CES was suspected and treatment was initiated. 9-month follow up revealed diminished osteotendinous reflexes on the left lower limb and perianal hypoesthesia. Despite being unusual, neurological complications require prompt recognition and management to avoid permanent damage., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: Advances in medicine, including anesthesiology and resuscitation, have made natural death increasingly rare. As a consequence, dysthanasia has become usual in a scenario for which there is not rationale. The present study aimed to assess the level of knowledge of Brazilian anesthesiologists on the principles of dysthanasia and orthothanasia. Thence, we studied the management preferences of these professionals, vis-à-vis those practices, as well as how medical school contributed to addressing death-related issues., Method: Quantitative approach, prospective and descriptive cohort that included 150 anesthesiologists, members of the Brazilian Society of Anesthesiology, and who were invited to participate by email. An online questionnaire containing 38 questions was prepared by the authors. The study was approved by the Instructional Research Ethics Committee., Results: Anesthesiologists, although claiming to know dysthanasia and orthothanasia, mostly acquired knowledge outside medical school. If faced with their own end of care, or of a patient or a loved one, they prefer orthothanasia, to die at home, prioritizing dignity. However, the specialists claimed to have already practiced dysthanasia, even when orthothanasia was the choice management, which caused them negative feelings. Almost all respondents stated that they did not have practical training in undergraduate school on how to face end-of-life issues, although they felt capable of identifying it. Most were not aware of Federal Council of Medicine Resolution 1.805/06 that makes practicing orthothanasia feasible. Anesthesiologists' religion or the political-administrative region of residence had no effect on their preferences., Conclusions: Anesthesiologists claim to have knowledge on dysthanasia and orthothanasia, but prefer, in the face of a terminally ill patient, to practice orthothanasia, although dysthanasia is usual, and results in frustration and indignation. The medical school curriculum is unsatisfactory in addressing death-related issues., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the usefulness of premedication with 75 mg pregabalin orally to reduce the degree of preoperative anxiety in patients scheduled for plastic surgery procedures., Method: A controlled randomized double-blind clinical trial that analyzed two groups of patients: 75 mg pregabalin tablet (Pg) against placebo tablet (Pl). Efficacy was assessed using the visual anxiety scale (VAS) with two measurements, the first without medication and the second 70 minutes after the drug was taken., Results: One hundred patients were evaluated, fifty received pregabalin and fifty placebo, baseline VAS score showed an general average of 4.6 ± 1.9 points, significantly higher in the Pg group (Pg 5.2 ± 2.1 points vs 4.1 ± 1.6 points Pl; p = 0.0035). The VAS score after premedication was 3.9 ± 2.1 points, significantly lower in the Pg group (Pg 3.2 ± 1.6 points vs 4.6 ± 2.3 Pl points, p = 0.0006)., Conclusion: Premedication 75 mg pregabalin orally decreases the degree of preoperative anxiety in adult patients scheduled for plastic surgery procedures., (Copyright: © 2020 Permanyer.)

Background and Objectives: Cardiac Magnetic Resonance Imaging (MRI) is a technique used for evaluation of children with congenital heart diseases. General anesthesia ensures immobility, particularly in uncooperative patients. However, chest wall movements can limit good quality scans. Prolonged apnea may be necessary to decrease respiratory motion artefacts, potentially leading to hypoxemia and other adverse events. The use of a high frequency jet ventilator may be a solution avoiding chest wall movements., Case Report: We report four cases of pediatric patients, ASA II, aged between 4 and 15 years-old, scheduled for cardiac MRI. General anesthesia was proposed and parental informed consent was obtained. After general anesthesia was induced, an uncuffed endotracheal tube was inserted. Then, a 7Fr×40 cm catheter was placed through the endotracheal tube. The proximal outlet of the catheter was attached through a connecting tube to a high frequency jet ventilator (Monsoon III®, Acutronic Medical Systems). Good quality MRI images were obtained. At the end of the procedures, we observed increased salivation and increased end-tidal CO 2 (60-70 mmHg), in all patients. The patients were extubated after normocapnia was achieved and neuromuscular blockade reversed. Following appropriate recovery time, the four children were discharged home the same day., Conclusions: This case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Demands for health services have been growing sharply. Consequently, the costs of the institutions for their operational maintenance and investments also increase. The challenge of hospital management is to achieve standards of quality and safety for patients, increasing their productivity and minimizing costs. Lean Six Sigma is a well-structured methodology that aims to eliminate waste and activities that do not add value, focused on reducing process variation, eliminating the causes of the defect, and improving performance. As a result, cost reduction, higher quality, and customer satisfaction are observed., Objectives: To define Lean Six Sigma methodology and search references in the literature on its use in Health and specifically in Anesthesiology., Content: How often the waste of medicines, materials and time (rework), as well as the errors that happen in the day-to-day of the anesthesiologist are reported. Anesthesiologists must know the impact of their professional practice, with the purpose of making more appropriate choices, thus reducing the damage to the environment, improving overall health, and reducing costs with health care. The use of the Lean Six Sigma methodology is suggested to make the anesthesia field more sustainable, improving the processes without prejudice to the patient., Conclusion: Lean Six Sigma methodology is a new business management strategy in the health area. It is perfectly inserted in the current context of quality and safety to the patient; therefore, relevant in the practice of anesthesiology., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014-2015)., (Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Burnout is a chronic condition caused by high levels of stress and anesthesiology is a stressful medical specialty with more vulnerability to burnout. The aim of this study is to review the characteristics and impact of burnout in anesthesiology., Contents: In this review, the stressors and risk factors, manifestations, assessment, complications, management and prevention of burnout as well as the inconsistent research found in the state-of-art are approached., Conclusions: Anesthesiologists are in a high-risk group to develop burnout, with different manifestations and consequences such as suicide or medical errors. Although there is no specific treatment yet, there are a lot of helpful measures to cope this condition. Prevention is considered an important step in order to reduce the prevalence of burnout., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objective: There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District., Method: A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%., Results: Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables., Conclusions: There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Introduction: Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively., Method: Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis., Results: 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR=4.46) followed by heart disease (MR=4.26); hematocrit (MR=4.34); age (RM=4.1) and microcirculation evaluation (MR=4.22). Respondents (82.3%) identified levels of Hb=6g.dL -1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR=2.81) and decided by drugs (MR=2.95) were the least reported., Conclusion: We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject., (Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist., Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine, opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested., Conclusions: The Federal Council of Medicine resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist., Content: The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine (FCM), opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested., Conclusions: The FCM resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Introduction: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created., Objective: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors., Materials and Methods: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors., Results: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were: distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%)., Conclusion: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Introduction: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created., Objective: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors., Materials and Methods: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors., Results: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%)., Conclusion: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Anaesthesiology is a specialty whose specificity of the working process results in high levels of stress as an inevitable condition - a particularly worrying situation in the daily life of these professionals., Objectives: This study, based on data from national and international literature, aims to discuss the basis of the occurrence of mental and behavioural disorders or of psychopathological injuries (psychological distress) related to working activity in anesthesiologists., Method: A literature review was conducted, with papers selected from Medline and Lilacs databases, published between 2000 and 2012 in Portuguese, English and Spanish, and addressing the possible association between occupational hazards of the anaesthesiologist profession and mental health problems and psychic distress. Twenty-six publications were listed., Results: Several aspects of the anesthesiologist's work are important points to better understand the relationship between mental health at work and working organization. Poor temporal structuring of work, conflictuous interpersonal relationships and poor control over the activity itself may be mentioned as illness enhancers., Conclusion: The working organization, when not appropriate, is an important occupational risk factor for the life and mental health of workers, mainly of professionals focused on the care of people. This paper focuses on anesthesiologists, who are constantly exposed to stressful and anxiogenic factors., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties., Methods: Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant., Results: We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management., Conclusions: Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties., Methods: Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant., Results: We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management., Conclusions: Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: burnout syndrome is a result of chronic stress, characterized by emotional exhaustion, depersonalization, and sense of low professional accomplishment. It affects workers under extreme responsibility or those who care for individuals at risk, including anesthesiologists who distanced themselves from the work, patients and colleagues because they feel safer in maintaining indifference., Objective: evaluate the prevalence of burnout syndrome and the intensity of its components and identify the characteristics of those with the syndrome among anesthesiologists in the Federal District., Method: cross-sectional study with 241 anesthesiologists enrolled in the Society of Anesthesiology of the Federal District. A self-administered questionnaire was used, which included the Maslach Burnout Inventory, demographic, professional, and leisure data., Results: of the 134 completed questionnaires (55.8%), there was a predominance of male (65.6%), aged 30-50 years (67.9%). Significant lower levels of job satisfaction (47.7%), depersonalization (28.3%), and emotional exhaustion (23.1%) were found. Burnout syndrome showed a prevalence of 10.4%, occurring mainly in men (64.2%), aged 30-50 years (64.2%), with over ten years of experience (64.2%), working in night shifts (71.4%), sedentary (57.1%), and not taking courses unrelated to medicine (78.5%). Of the participants, 50.7% had at least one of three criteria to develop the syndrome and only 8.2% have a low risk to manifest it., Conclusion: the prevalence of burnout is relevant among anesthesiologists in the Federal District. It is advisable to seek strategies for labor restructuring to reduce stress factors and loss of motivation and increase job satisfaction., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: Understand, through the theory of social representations, the influence exerted by the establishment a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil., Method: Qualitative methodology. The theoretical framework comprised the phenomenology and the Social Representation Theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, five anesthesiologists, two nurses, and five nursing technicians), who work in operating rooms and post-anesthesia care units, all with prior and posterior experience to the establishment of residency., Results: From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, recognition of weaknesses in the perioperative process. It was evident upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed., Conclusion: The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The case is presented of a 71 year-old male, diagnosed with a thymoma. A thoracoscopic thymectomy was performed using the carbon dioxide insufflation technique in the mediastinum. During the procedure, while performing one-lung ventilation, the patient's respiration worsened. The contralateral lung had collapsed, as carbon dioxide was travelling from the mediastinum to the thorax through the opened pleura. Two-lung ventilation was decided upon, which clearly improved oxygenation in the arterial gases and airway pressures. Both pH and pCO2 stabilized. The surgical approach and the carbon dioxide technique were continued because 2-lung ventilation did not affect the surgical procedure. This technique has many serious complications and it should always be performed using 2-lung ventilation., (Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically., Methods: This study reports the performance of medical residents in anesthesiology from the Clinics Hospital - University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree-disagree-not sure-agree-totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis - difficulty index and discrimination power., Results: Residents filled one hundred and seventy three evaluations in the months of December 2011 (n=51), July 2012 (n=66) and December 2012 (n=56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating "totally agree" from "agree" increased the difficulty indices, but did not improve the discrimination power., Conclusions: The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting., (Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background and Objectives: the interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically., Methods: this study reports the performance of medical residents in anesthesiology from the Clinics Hospital - University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree-disagree-not sure-agree-totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis - difficulty index and discrimination power., Results: residents filled one hundred and seventy three evaluations in the months of December 2011 (n=51), July 2012 (n=66) and December 2012 (n=56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating "totally agree" from "agree" increased the difficulty indices, but did not improve the discrimination power., Conclusions: the use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting., (Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To describe the frequency of dose notification of antiinfectives for systemic use in clinical cases published in Revista Española de Anestesiología y Reanimación., Material and Method: Review of individualized clinical cases published in the sections «Clinical case» or «Letter to the Editor» of the above mentioned journal from year 2010 to 2012, and identification of the drugs and their therapeutic regimens cited in such publications, being dose notification the main variable. Drugs have been classified according to the Anatomical Therapeutic Chemical Classification System., Results: One thousand one hundred and thirty-five drugs cited 1,317 times were identified in 167 articles describing the clinical pictures of 182 patients, 73 of the citations (5.6%) regarding to drugs belonging to group J (Antiinfectives for systemic use) which were divided into perioperative prophylaxis (n=15) and active treatment (n=58). Doses were scarcely notified for group J drugs as a whole (27.4%), but especially for active treatment (17.2%) compared to perioperative prophylaxis (66.7%), percentage which was similar to those more classical anesthetic drugs (fentanyl: 86.6%; remifentanil: 70.5%; sevoflurane: 78%; propofol: 79%; rocuronium:79.6%; cisatracurium: 68.4%) or even for antiemetics (ondansetron: 92.3%; dexamethasone: 84.6%)., Conclusions: Quality of case reports could be improved by including dose notification for antiinfective agents., (Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Many congenital and acquired diseases, including trauma, may result in cervical spine instability. Given that airway management is closely related to the movement of the cervical spine, it is important that the anesthesiologist has detailed knowledge of the anatomy, the mechanisms of cervical spine instability, and of the effects that the different airway maneuvers have on the cervical spine. We first review the normal anatomy and biomechanics of the cervical spine in the context of airway management and the concept of cervical spine instability. In the second part, we review the protocols for the management of cervical spine instability in trauma victims and some of the airway management options for these patients., (Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. All rights reserved.)

As different specialists are becoming increasingly involved in the preoperative management of our patients (for two main reasons; Primary Care doctors have to perform minor surgical procedures, and as coordination between Primary Care and In-hospital Care is more and more necessary in order to improve their outcomes), we believe that an update is needed as regards the management of chronic medications in this period. We will try to review the current literature dealing with the recommendations about withdrawing or continuing these drugs., (Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

The experience in airway management permits the anesthesiologist to participate in cases of cervical spine instability in the operating room when the patient is subjected to surgical procedures, or in cases of difficulty to access or keep the airway open in emergencies. This article reviews the epidemiology, definition, etiology, diagnostic criteria, methods of approach to airway management, and current recommendations on handling cervical instability in different scenarios. There is no approach to the airway that ensures complete immobility of the cervical spine, but there are methods that are better adapted to specific contexts; at the end, the reader will be able to identify the virtues and defects of the various options that the anesthesiologists have to address the airway in cases of cervical instability., (Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

The baroreflex, chemoreflex, pulmonary reflexes, Bezold-Jarisch and Bainbridge reflexes and their interaction with local mechanisms, are a demonstration of the richness of cardiovascular responses that occur in human beings. As well as these, the anesthesiologist must contend with other variables that interact by attenuating or accentuating cardiopulmonary reflexes such as, anesthetic drugs, surgical manipulation, and patient positioning. In the present article we review these reflexes and their clinical relevance in anesthesiology., (Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)