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Individuals deeply socialized into professional cultures tend to strongly resist breaking from their professions' core cultural tenets. When these individuals face external pressure (e.g., via new technology or regulation), they typically turn to peers for guidance in such involuntary reinventions of their work. But it is unclear how some professionals may voluntarily break from deeply ingrained views. Through our study of French anesthesiologists who practice hypnosis, we aim to better understand this little-explored phenomenon. Adopting hypnosis, a technique that many anesthesiologists consider subjective and even magical, contradicted a core tenet of their profession: the need to only use techniques validated by rigorous scientific-based research. Drawing on interviews and observations, we analyze how these anesthesiologists were able to change their views and reinvent their work. We find that turning inward to oneself (focusing on their own direct experiences of clients) and turning outward to clients (relying on relations with clients) played critical roles in anesthesiologists' ability to shift their views and adopt hypnosis. Through this process, these anesthesiologists embarked on a voluntary internal transformation, or reboot, whereby they profoundly reassessed their work, onboarded people in adjacent professions to accept their own reinvention, and countered isolation from their peers. Overall, we show a pathway to such reinvention that entails turning inward and outward (rather than to peers), a result that diverges significantly from prior understandings of professionals' transformations. [ABSTRACT FROM AUTHOR]

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare peripheral neurological disorder that manifests with increased sensitivity to pressure. In people with this disorder, the peripheral nerves are unusually sensitive to pressure. Minor trauma or compression causing paralysis in the extremities is a hallmark of this disorder. Ensuring there is no pressure on the extremities is recommended as a preventive measure. We describe for the first time, postoperative vocal cord paralysis in a patient with HNPP due to left recurrent laryngeal nerve palsy. Anesthesiologists and surgeons should be aware of this possible complication in patients with HNPP.

Large, randomised trials are the bedrock of evidence-based medicine, but the resources required to complete such trials greatly limit the number of important clinical questions that can be addressed within a reasonable period of time. Adaptive platform trials can identify effective, ineffective, or harmful treatments faster. These trials have been shown to deliver rapid evidence through the COVID-19 pandemic and are now being adopted across surgery and anaesthesia, with many opportunities for surgeons, anaesthetists, and other perioperative physicians to conduct and collaborate in platform trials. [ABSTRACT FROM AUTHOR]

The article focuses on the anaesthetic perioperative management of patients undergoing pancreatic cancer surgery, emphasizing the complexity of the procedure and the role of anaesthesiologists in improving patient outcomes. Topics discussed include patient risk assessment, the importance of a multidisciplinary approach, and key perioperative strategies such as fluid management, infection prevention, and postoperative care.

Background: Patient safety is important in daily anesthesia practices, and providing deep anesthesia is difficult. Current debates on the optimal anesthetic agents highlight the need for safer alternatives. This study was justified by the need for safer and more effective anesthetic protocols for outpatient hysteroscopic procedures, particularly those conducted outside the operating room. Propofol, while widely used, has significant limitations, including respiratory depression, hemodynamic instability, and delayed recovery when higher doses are required for adequate sedation. The addition of opioids to propofol, though beneficial for analgesia, introduces risks such as hypoxemia and hypotension. These challenges necessitate exploring alternative combinations that balance sedation depth with fewer side effects. Objective: To assess the efficacy and safety of deep sedoanalgesia achieved with dexmedetomidine-propofol versus remifentanil-propofol combinations in daily anesthesia practices. Design: Prospective randomized clinical study. Settings: This study was carried out at Dursun Odabaş Medical Center. Patients: Eighty ASA I–II patients, aged 18–65, scheduled for elective hysteroscopic interventions under sedoanalgesia were included in the study. Main outcome measures: The primary aim of our study was to identify an anesthetic agent combination capable of delivering effective and safe deep sedation, with sedation depth assessed via the Ramsey Sedation Score (RSS) and respiratory safety evaluated through desaturation rates. Secondary endpoints included Visual Analogue Scale (VAS) scores, oxygen saturation (SpO2), patient, surgeon, and anesthesiologist satisfaction scores, hemodynamic parameters, the time to achieve an RSS > 4, the time to reach a Modified Aldrete Score (MAS) > 9, and the requirement for mask ventilation and jaw thrust maneuvers. Interventions: Patients were randomized into two groups (n = 40 each): Group DP (Dexmedetomidine–Propofol): A bolus of 1 mg/kg IV propofol and 1 mcg/kg IV dexmedetomidine over 10 min, followed by a continuous infusion of 0.2–1.4 mcg/kg/hour. Group RP (Remifentanil–Propofol): A bolus of 1 mg/kg IV propofol and 0.25 mcg/kg IV remifentanil, followed by a continuous infusion of 0.025–0.1 mcg/kg/minute. Results: Patients in the DP group exhibited significantly lower VAS scores and desaturation rates (p = 0.003) compared to the RP group. Satisfaction scores (patient, surgeon, anesthesiologist) and integrated pulmonary index (IPI) values were significantly higher in the DP group (p < 0.05). Conclusion: The dexmedetomidine-propofol combination is an effective and safe anesthetic regimen for deep sedation in outpatient hysteroscopic procedures, offering adequate sedation and superior preservation of respiratory function. Additionally, the dexmedetomidine-propofol combination ensures more stable hemodynamics, with a lower incidence of hypoxia, and results in higher satisfaction rates among patients, surgeons, and anesthesiologists. Trial registration: Clinical Trials ID is NCT05674201 Date 2022.12.07. Key points: Dexmedetomidine combined with propofol provides adequate depth of anesthesia and analgesia for hysteroscopic procedures. The combination of dexmedetomidine and propofol affects respiratory function less, and hypoxemia is less common in patients. When nonoperating rooms administer dexmedetomidine, one should be prepared for cardiovascular complications, especially bradycardia. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation (ETI) is a life-saving procedure that must be accurately carried on to guard against complications. Presbyopia leads to difficulty in viewing close objects and may obstacle proper intubation even with the best hands. Purpose: This study supposed that the use of video-laryngoscope (VL) may provide better intubation conditions for presbyopic anesthetists and targets to evaluate the neonates and infants' intubation success rates (ISR) by anesthetists aged ≥ 45 years using the C-MAC VL compared to the standard laryngoscope (SL). Methods: Thirty-one neonates with an age of 18.2 ± 5.2 days and a body weight of 4.5 ± 0.3 kg and 103 infants aged 8.6 ± 1 months and weighing 9.4 ± 1.5 kg were randomly categorized into the SL group that received ETI using the SL and the VL group had intubated using the C-MAC® (Karl Storz, Germany) VL with the standard Miller blade and flexible Stylet (2 mm PORTEX® stylet; Smiths Medical International Ltd., UK) to strengthen the endotracheal tube (ETT) and adjust its curvature as C-shaped. The study outcomes included the frequency of successful intubation and the number of intubation attempts. Results: The ISR was significantly (P < 0.001) higher with significantly (P = 0.0037) lower frequency of using assistance maneuvers with VL. The mean score of the anesthetist's difficulty rating was significantly (P < 0.001) higher with SL (2.7 ± 2) than with VL (1.27 ± 1.27). Times for the full intubation process were significantly (P < 0.001) shorter with VL than SL. The 1st attempt success rate was significantly (P = 0.0195) higher with VL than SL (86.6% vs. 67.2%). The frequency of maneuver-related complications was insignificantly (P = 0.116) reduced with the use of VL (4.5%) than with SL (12%). The ISR showed a negative significant correlation (r=−0.973, P = 0.005) with the anesthetist's age. Conclusion: Neonatal and infantile intubation using VL is feasible and easy to handle by aged anesthetists and allows higher ISR and 1st attempt rate with minimal need for external assistant maneuvers and maneuver-related complications. VL might be more appropriate for the presbyopic pediatric anesthetists than the SL. Limitations: The limitations of the study are the small sample size of anesthetists and the use of one type of VLs. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding the application of lung-protective ventilation strategies during one-lung ventilation (OLV) across mainland China. A nationwide questionnaire survey was conducted to investigate this issue in current clinical practice. Methods: The survey covered various aspects, including respondent demographics, the establishment and maintenance of OLV, intraoperative monitoring standards, and complications associated with OLV. Results: Five hundred forty-three valid responses were collected from all provinces in mainland China. Volume control ventilation mode, 4 to 6 mL per kilogram of predictive body weight, pure oxygen inspiration, and a low-level positive end-expiratory pressure ≤ 5 cm H2O were the most popular ventilation parameters. The most common thresholds of intraoperative respiration monitoring were peripheral oxygen saturation (SpO2) of 90–94%, end-tidal CO2 of 45 to 55 mm Hg, and an airway pressure of 30 to 34 cm H2O. Recruitment maneuvers were traditionally performed by 94% of the respondents. Intraoperative hypoxemia and laryngeal injury were experienced by 75% and 51% of the respondents, respectively. The proportions of anesthesiologists who frequently experienced hypoxemia during OLV were 19%, 24%, and 7% for lung, cardiovascular, and esophageal surgeries, respectively. Up to 32% of respondents were reluctant to perform lung-protective ventilation strategies during OLV. Multiple regression analysis revealed that the volume-control ventilation mode and an SpO2 intervention threshold of < 85% were independent risk factors for hypoxemia during OLV in lung and cardiovascular surgeries. In esophageal surgery, working in a tier 2 hospital and using traditional ventilation strategies were independent risk factors for hypoxemia during OLV. Subgroup analysis revealed no significant difference in intraoperative hypoxemia during OLV between respondents who performed lung-protective ventilation strategies and those who did not. Conclusions: Lung-protective ventilation strategies during OLV have been widely accepted in mainland China and are strongly recommended for esophageal surgery, particularly in tier 2 hospitals. Implementing volume control ventilation mode and early management of oxygen desaturation might prevent hypoxemia during OLV. [ABSTRACT FROM AUTHOR]

Background: As the global population ages, medical professionals are also aging. This study investigates the status of Korean anesthesiologists over the age of 60. Methods: Anesthesiologists aged 60 and older, residing and working in Korea, were invited to participate in this study via e-mail from February to March 2021 and by mail from June to August 2021. The survey consisted of 40 questions covering 10 topics, including health status, residence, work style, and economic status. Depending on the type of question, answers were ranked on a scale of 1, 2, and 3, with the most preferred response being selected. Results: A total of 63 responses were received, resulting in a response rate of 26.5%. Among the respondents, 56 were currently practicing as anesthesiologists and reported satisfaction with their clinical practice and life status. On average, they treated 24 patients per day without experiencing significant discomfort or inconvenience in their roles as senior physicians. Twenty-four respondents acknowledged physical discomfort related to aging, and nine expressed cautions regarding age-related changes. Fifty-two respondents indicated that reeducation for advanced medical practice as anesthesiologists was necessary. Conclusions: Senior anesthesiologists in Korea are primarily working in secondary and tertiary hospitals and are satisfied with their current life status. A comprehensive evaluation of reeducation programs for advanced clinical practice and retirement strategies for senior anesthesiologists is needed to address the growing number of aging physicians in the workforce. [ABSTRACT FROM AUTHOR]

A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel–bougie–endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel–bougie–ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation. We then performed a simulation crossover study using 20 volunteer anaesthetic doctors to compare this modification with the traditional technique. After a standardised pre-recorded video demonstration, participants performed simulated tube insertion using both the standard 'scalpel–bougie–ETT' technique and the SAFE airway device in randomised order. Participants were filmed for accurate timestamping. The primary outcome was time to successful tube insertion while secondary outcomes included number of attempts and ease of insertion. Overall time to cuff inflation was shorter, statistically and practically, with the SAFE airway device compared with the ETT (median 30 vs. 52 seconds, P < 0.001). Twenty-five percent of participants required multiple attempts using the ETT method versus 5% using the SAFE airway device, which was also rated as being easier to use. This study demonstrates that the SAFE airway device was fast, effective, easy to use and acceptable to airway practitioners in a simulated manikin environment. These findings indicate that further studies of the SAFE airway device are warranted. [ABSTRACT FROM AUTHOR]

Junior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist–surgeon seniority might impact patient safety. This was a sequential explanatory, mixed-methods evaluation conducted at a general hospital, comprising a retrospective case-control study followed by semi-structured interviews. In the quantitative phase, the case group included surgical patients who experienced anaesthesia-related adverse events. The control group was randomly selected from surgical patients without adverse events, matched to the case group by surgeon, surgery, and surgery year. The exposure was the differences in work experience between anaesthesiologists and surgeons. For the qualitative phase, participants were recruited from attending anaesthesiologists using a theoretical sampling strategy, and a grounded theory analysis was performed. The quantitative study included 390 patients in the case group and 1560 patients in the control group. After controlling for confounders, we did not find a significant association between differences in anaesthesiologist–surgeon seniority and odds of anaesthesia-related adverse events (adjusted odds ratio 1.00, 95% confidence interval 0.98–1.01, P =0.634). In cases of disagreements among surgeons, anaesthesiologists primarily based clinical decisions on the potential impact on patient safety. Junior anaesthesiologists faced challenges when rejecting surgeons. Nevertheless, they received robust support from anaesthesiology colleagues. The capacity of anaesthesiologists to uphold patient safety was not significantly affected by their seniority levels relative to surgeons. [ABSTRACT FROM AUTHOR]

Background: In medicine, Artificial intelligence has begun to be utilized in nearly every domain, from medical devices to the interpretation of imaging studies. There is still a need for more experience and more studies related to the comprehensive use of AI in medicine. The aim of the present study is to evaluate the ability of AI to make decisions regarding anesthesia methods and to compare the most popular AI programs from this perspective. Methods: The study included orthopedic patients over 18 years of age scheduled for limb surgery within a 1-month period. Patients classified as ASA I-III who were evaluated in the anesthesia clinic during the preoperative period were included in the study. The anesthesia method preferred by the anesthesiologist during the operation and the patient's demographic data, comorbidities, medications, and surgical history were recorded. The obtained patient data were discussed as if presenting a patient scenario using the free versions of the ChatGPT, Copilot, and Gemini applications by a different anesthesiologist who did not perform the operation. Results: Over the course of 1 month, a total of 72 patients were enrolled in the study. It was observed that both the anesthesia specialists and the Gemini application chose spinal anesthesia for the same patient in 68.5% of cases. This rate was higher compared to the other AI applications. For patients taking medication, it was observed that the Gemini application presented choices that were highly compatible (85.7%) with the anesthesiologists' preferences. Conclusion: AI cannot fully master the guidelines and exceptional and specific cases that arrive in the course of medical treatment. Thus, we believe that AI can serve as a valuable assistant rather than replacing doctors. [ABSTRACT FROM AUTHOR]

GABA (γ-aminobutyric acid) receptors are constituents of many inhibitory synapses within the central nervous system. They are formed by 5 subunits out of 19 various subunits: α1–6, β1–3, γ1–3, δ, ε, θ, π, and ρ1–3. Two main subtypes of GABA receptors have been identified, namely GABAA and GABAB. The GABAA receptor (GABAAR) is formed by a variety of combinations of five subunits, although both α and β subunits must be included to produce a GABA-gated ion channel. Other subunits are γ, δ, ε, π, and ϴ. GABAAR has many isoforms, that dictate, among other properties, their differing affinities and conductance. Drugs acting on GABAAR form the cornerstone of anesthesia and sedation practice. Some such GABAAR agonists used in anesthesia practice are propofol, etomidate, methohexital, thiopental, isoflurane, sevoflurane, and desflurane. Ketamine, nitrous oxide, and xenon are not GABAR agonists and instead inhibit glutamate receptors—mainly NMDA receptors. Inspite of its many drawbacks such as pain in injection, quick and uncontrolled conversion from sedation to general anesthesia and dose-related cardiovascular depression, propofol remains the most popular GABAR agonist employed by anesthesia providers. In addition, being formulated in a lipid emulsion, contamination and bacterial growth is possible. Literature is rife with newer propofol formulations, aiming to address many of these drawbacks, and with some degree of success. A nonemulsion propofol formulation has been developed with cyclodextrins, which form inclusion complexes with drugs having lipophilic properties while maintaining aqueous solubility. Inhalational anesthetics are also GABA agonists. The binding sites are primarily located within α+/β− and β+/α− subunit interfaces, with residues in the α+/γ− interface. Isoflurane and sevoflurane might have slightly different binding sites providing unexpected degree of selectivity. Methoxyflurane has made a comeback in Europe for rapid provision of analgesia in the emergency departments. Penthrox (Galen, UK) is the special device designed for its administration. With better understanding of pharmacology of GABAAR agonists, newer sedative agents have been developed, which utilize "soft pharmacology," a term pertaining to agents that are rapidly metabolized into inactive metabolites after producing desired therapeutic effect(s). These newer "soft" GABAAR agonists have many properties of ideal sedative agents, as they can offer well-controlled, titratable activity and ultrashort action. Remimazolam, a modified midazolam and methoxycarbonyl-etomidate (MOC-etomidate), an ultrashort-acting etomidate analog are two such examples. Cyclopropyl methoxycarbonyl metomidate is another second-generation soft etomidate analog that has a greater potency and longer half-life than MOC-etomidate. Additionally, it might not cause adrenal axis suppression. Carboetomidate is another soft analog of etomidate with low affinity for 11β-hydroxylase and is, therefore, unlikely to have clinically significant adrenocortical suppressant effects. Alphaxalone, a GABAAR agonist, is recently formulated in combination with 7-sulfobutylether-β-cyclodextrin (SBECD), which has a low hypersensitivity profile. [ABSTRACT FROM AUTHOR]

Administering anesthesia for the separation of conjoined twins poses distinct challenges for anesthesiologists. The rarity of these surgeries, coupled with the unique anatomical variations in each case, makes every separation procedure a distinct experience. This case report details the anesthetic management and the challenges faced during the separation of thoraco-omphalopagus twins at our tertiary care hospital. [ABSTRACT FROM AUTHOR]

Background: In Japan, the escalating demand for anesthesia services has resulted in a shortage of anesthesiologists, presenting a societal challenge. Urgent measures involve the imperative task shifting to nurses. The perspectives of anesthesiologists on perianesthesia nurses (PANs) and the PAN system significantly influence the collaboration between anesthesiologists and PANs. Methods: Twenty-four anesthesiologists initially approached in writing among a pool of 304, ultimately agreed to participate in interviews. Verbatim transcripts from these interviews were analyzed using the framework method. In this procedure, data analysis was facilitated by MAXQDA software (version 22.7.0) to construct a case-code matrix, enhancing the reliability of our findings. Results: Five themes and fifteen categories related to PAN and its system emerged. Participants provided insights into the diverse social conditions accompanying the implementation of the PAN system. They highly regarded PANs as colleagues, expecting a spectrum of capabilities. Nevertheless, the analysis revealed considerable variation in role expectations across institutions and individuals, with some perspectives being mutually critical. Conflicting opinions emerged on two crucial aspects: assigning anesthesia management conducted by PANs and substituting PANs for anesthesiologists. Multiple suggestions were put forth for enhancing and evolving the PAN system. Conclusion: This qualitative study is the first to reveal that Japanese anesthesiologists hold diverse perspectives on PANs and the system. The approach was well-suited for exploring diverse perspectives, showing significant differences among institutions and individuals. Our data provided crucial insights, including findings suggesting potential barriers to task shifting of anesthesia duties to PANs. [ABSTRACT FROM AUTHOR]

Background: Developing proficiency in ultrasound-guided nerve block (UGNB) demands an intricate understanding of cross-sectional anatomy as well as spatial reasoning, which is a big challenge for beginners. The aim of this pilot study was to evaluate the feasibility of virtual reality (VR)-facilitated anatomy education in the first performance of ultrasound-guided interscalene brachial plexus blockade among novice anesthesiologists. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial. Methods: Twenty-one anesthesia trainees with no prior ultrasonography or nerve block training were included in this study. All participants underwent a training program encompassing theory and hands-on practice. Trainees were randomized into one of two groups: one received VR-assisted anatomy course while the other did not. Subsequently, both groups completed identical practical modules on ultrasound scanning and needle insertion. The primary end point was defined as the evaluation of trainees' performance during their initial ultrasound-guided interscalene brachial plexus block, assessed using both the Global Rating Scale (GRS) and a task-specific Checklist. The secondary end point included the improvement in scores for written multiple-choice questions (MCQs). Results: In evaluating practical ultrasound-guided nerve block skills, the VR group significantly outperformed the control group on the task-specific Checklist (29.23 ± 3.91 vs. 24.85 ± 5.13; P < 0.05), while both groups showed comparable performance on the GRS. Additionally, post-theoretical course MCQ scores increased substantially, with post-test results significantly surpassing pre-test scores in both groups (P < 0.001). However, intergroup analysis indicated no significant difference in score improvements between the VR and control groups (21.82 ± 12.30 vs. 18.33 ± 9.68, P > 0.05). Conclusions: Overall, the findings of this pilot study suggest that immersive virtual reality training in anatomy may contribute to improving the proficiency of ultrasound-guided brachial plexus blocks among novice anesthesiologists. Incorporating VR into future anesthesia technique training programs should be considered. Trial registration: ClinicalTrials.gov identifier: ChiCTR2300067437. Date of Registration Jan 9, 2023. [ABSTRACT FROM AUTHOR]

Background: Overtime work is common in anesthesiologists due to shortage of manpower. Herein, we analyzed if overtime work of anesthesiologists was associated with delirium development in older patients after surgery. Methods: This was a secondary analysis of the database from a randomized trial. Seven hundred older patients (aged ≥ 65 years) who were admitted to the intensive care unit (ICU) after elective noncardiac surgery were enrolled in the underlying trial. Anesthesiologists who worked continuously for more than 8 h by the end of the surgery were marked as “work overtime”. Delirium was assessed with the Confusion Assessment Method for the ICU twice daily during the first 7 postoperative days. The association between overtime work of anesthesiologists and development of postoperative delirium was analyzed with multivariable logistic regression models. Results: All 700 patients (mean age 74.3 years, 39.6% female) were included in this analysis. Anesthesiologists of 281 patients (40.1%) were marked as “work overtime” at the end of surgery. When compared with patients whose anesthesiologists didn’t work overtime, patients whose anesthesiologist worked overtime had a higher incidence of delirium within 7 days (20.3% [57/281] vs. 12.9% [54/419], P = 0.009). After correction for confounding factors, both overtime work (OR 1.87, 95% CI 1.19–2.94, P = 0.007) and prolonged continuous working hours of anesthesiologists (OR 1.08, 95% CI 1.01–1.15, P = 0.020) were associated with an increased risk of postoperative delirium. Conclusions: Overtime work of anesthesiologists was associated with an increased risk of delirium development in older patients admitted to ICU after major noncardiac surgery. Trial registration: The underlying trial was registered with Chinese Clinical Trial Registry (; ChiCTR-TRC-10000802; March 18, 2010). [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI), especially Machine Learning (ML), has developed systems capable of performing tasks that require human intelligence. In anesthesiology and other medical fields, AI applications can improve the precision and efficiency of daily clinical practice, and can also facilitate a personalized approach to patient care, which can lead to improved outcomes and quality of care. ML has been successfully applied in various settings of daily anesthesiology practice, such as predicting acute kidney injury, optimizing anesthetic doses, and managing postoperative nausea and vomiting. The critical evaluation of ML models in healthcare is crucial to assess their validity, safety, and clinical applicability. Evaluation metrics allow an objective statistical assessment of model performance. Tools such as Shapley Values (SHAP) help interpret how individual variables contribute to model predictions. Transparency in reporting is key in maintaining trust in these technologies and to ensure their use follows ethical principles, aiming to reduce safety concerns while also benefiting patients. Understanding evaluation metrics is essential, as they provide detailed information on model performance and their ability to discriminate between individual class rates. This article offers a comprehensive framework in assessing the validity, applicability, and limitations of models, guiding responsible and effective integration of ML technologies into clinical practice. A balance between innovation, patient safety and ethical considerations must be pursued. [ABSTRACT FROM AUTHOR]

We aim to enhance the reporting of complications in surgical operations by establishing a classification for patient complexity. Current comorbidity assessment tools are insufficient due to their reliance on physiological parameters. The proposed patient surgical class category (PSCC) aims to address these limitations and enhance results by incorporating relevant aspects of a patient's surgical history. The new classification system for patient surgical classes was developed via a modified Delphi method across two iterations with urological scenarios. The consensus on the importance of individual classes within PSCC ranged from 72.83% for Class 0 to 87.95% for Class 4A. The survey results show that our proposed grading system is easy, broadly applicable, and useful for categorizing the surgical history of patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). Methods: We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. Results: Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. Conclusions: US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Enhanced recovery after surgery (ERAS) protocols have existed for the past three decades; these protocols may improve patient outcomes and healthcare costs. Yet, ERAS is difficult to implement, and there has been limited focus on processes used to promote ERAS use. Thus, the aim of this study was to identify and describe the barriers and enablers to implementing ERAS.In this qualitative descriptive sub‐study, semi‐structured interviews, guided by the Theoretical Domains Framework, were conducted with surgeons, anaesthetists, and nurses. Interviews were analyzed using inductive and deductive content analysis.Three categories were found, which mapped to 12 domains in the Theoretical Domains Framework. Category 1 ‘realizing the value of ERAS, despite varying levels of exposure and motivation’ showed clinicians' different views and knowledge towards ERAS, with a general belief that ERAS was evidence‐based. Category 2, ‘building momentum for ERAS implementation’ outlined strategies to encourage clinicians to practice ERAS. The final category ‘providing resources for ERAS’ illustrated the tools and up‐front costs needed for ERAS implementation.Motivational strategies are required to inspire individual clinicians to adopt ERAS. Additionally, resources are needed for ERAS to guide practice and support implementation (i.e., staffing and time), underscoring the need for hospital leadership support. [ABSTRACT FROM AUTHOR]

Nitrous oxide (N 2 O) is a potent greenhouse gas that contributes significantly to the healthcare sector's carbon footprint. Pre-utilisation losses of N 2 O are up to 95%. Decommissioning manifolds can reduce these losses. Hospitals in our Greater London research network with at least one active N 2 O manifold were included in the Nitrous Oxide Manifold and Other Reduction of Emissions (NoMoreGas) study. N 2 O utilisation data were collected continuously over 5 days and extrapolated over a year, in addition to collecting procurement records from the preceding financial year. The primary outcome was the discrepancy between clinically utilised N 2 O and the quantity procured by hospitals, referred to as the 'N 2 O gap'. Secondary outcomes included anaesthetists' self-reported utilisation of N 2 O and their opinions on manifold decommissioning. Eighteen of 53 hospitals were included. In total, 6 487 200 L of N 2 O were procured with a median (IQR) of 304 200 (183 600–473 400) L per site. During the 5-day data collection period, sites utilised a median (IQR) of 501 (42–1409) L of N 2 O. Extrapolating over a year resulted in a median (IQR) annual utilisation of 36 573 (3066–102 857) L per site and a total of 1 175 348 L. This represented an estimated 18% of the N 2 O procured, suggesting pre-utilisation losses of 5 311 852 L. Among surveyed anaesthetists, 70% (n =309) reported using N 2 O within the previous year, with one-third (n =97) using it once a week or more. There was widespread support for decommissioning manifolds. Consistent with other reports, the data demonstrate a substantial discrepancy between the quantities of N 2 O procured and utilised clinically, indicative of significant pre-utilisation losses. Our findings support the decommissioning of N 2 O manifolds for environmental and economic benefits. [ABSTRACT FROM AUTHOR]

The use of depth of anesthesia monitoring, such as a processed electroencephalogram (pEEG), can decrease the risk of awareness with recall, yet the current standards for monitoring during the administration of anesthesia do not include the use of brain monitoring for anesthetic depth. This retrospective cohort study describes the frequency of use and explores the characteristics of utilization of pEEG monitoring by anesthesia professionals during the administration of general anesthesia in the adult patient population at a large academic medical center. Descriptive associations with pEEG monitoring were confirmed in both univariate and multivariable analyses with multiple patient, anesthetic, and surgical characteristics. After taking anesthesia provider, patient, anesthetic, and surgical characteristics into consideration, 38.0% of the variability in pEEG use was accounted for. Although these data suggest recommended guidelines are being followed, further analyses should examine explicit relationships and differences in pEEG use. [ABSTRACT FROM AUTHOR]

When our rural trauma center first became certified in 1986, the Emergency Department (ED) was a mix of board-certified Emergency Medicine (EM) and Family Medicine trained physicians each with various degrees of airway experience. Therefore, Anesthesia providers had provided airway management during trauma activations for decades. Recently, our institution saw dramatic growth in the ED which is now staffed by board certified EM physicians and complemented by an EM residency program. This prompted the institution to enact a policy change transitioning airway management during trauma activations from Anesthesiology to EM. The authors hypothesized that this policy change was not associated with a reduced rate of successful first pass intubations in trauma patients. A retrospective analysis was performed of all trauma activations requiring intubation from March 1, 2018, to January 31, 2023. The ED assumed responsibility for airway management March 1, 2021. These patients were then divided into two groups; the pregroup, representing airways managed by Anesthesiology, and the postgroup representing airways managed by EM. The primary outcome was the rate of successful intubation performed on the first pass. Secondary outcomes included periprocedural vital signs and presence of airway management associated complication. The pregroup included 71 patients while the postgroup included 58 patients with full documentation meeting our criteria. We found no difference in the rate of successful first pass intubations between the pregroup and postgroup (85.90% versus 87.9%, P = 0.736). Both groups had 100% intubation success rates on the second pass. There were no significant differences between groups across the majority of secondary outcomes measured. The transition in airway management of the trauma patient from anesthesiology to the ED in a rural Level II trauma center found no difference regarding successful first pass intubations in the trauma bay. [ABSTRACT FROM AUTHOR]

Purpose: Same-day discharge (SDD) is increasingly prevalent following minimally invasive hysterectomy (MIH). However, consensus guidelines for selecting SDD eligibility criteria for MIH remain unexplored. This study aims to identify predictive factors for non-SDD following MIH (registered in PROSPERO CRD42022350373). Methods: PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. All original studies that involve patients who were discharged on the same day are compared with those who were not (not failure to discharge / not intended to discharge). Categorical and continuous variables were reported as risk ratios with 95% confidence intervals and weighted mean differences with 95% CIs, respectively. Heterogeneity among the included studies was assessed using the I2 statistics. We conducted sensitivity analysis to identify the reason(s) for this heterogeneity. Results: Ten studies (59,589 patients) were included, with a mean SDD rate of 20.28%. The predictors of overnight observation included factors such as American Society of Anesthesiologists classification (ASA) > II (P =.02; I2 = 92%), increased estimated blood loss (EBL) (P < 0.00001; I2 = 87%), surgeries starting later in the day (P < 0.00, I2 = 15%), and longer operation times (P =.002; I2 = 96%). In sensitivity and subgroup analyses, uterus weight emerged as a potential factor (P < 0.00; I2 = 50%), while the results concerning ASA, uterine weight, and EBL appeared to be homogeneous. However, the operation time remained heterogeneous. Conclusion: These factors could assist surgeons in the decision-making process regarding the performance of SDD subsequent to MIH procedures for patients. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations. Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories. Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification. [ABSTRACT FROM AUTHOR]

Anesthesiologists are perioperative leaders of patient and health care team safety. The anesthesiologist needs to remain vigilant in the perioperative setting and while caring for patients. The ability to navigate increased noise levels, distractions, and hazards is crucial for maintaining a safe environment. While some noise, such as music, can have benefits, overall noise levels can distract from patient care and have adverse effects on patient care and intraoperative staff. This study provides an overview of noise, distractions, and hazards in the perioperative environment. [ABSTRACT FROM AUTHOR]

In wave 4 of the opioid crisis, which is dominated by illicitly manufactured fentanyl (IMF) and stimulant use, anesthesia personnel could play an important role in the perioperative care of these persons. Knowledge of the extent and lethality of opioid use in the current wave of the opioid crisis could raise awareness of the problem among anesthesia personnel. In the absence of research to guide development of best practice recommendations, knowledge of the historical trends in opioid use, the epidemiology of IMF use, and pragmatic clinically-oriented approaches for identifying persons using IMF could provide a general framework for future research. [ABSTRACT FROM AUTHOR]

Postoperative cognitive recovery is deeply important to patients and perioperative clinicians. Despite decades of data on "postoperative cognitive decline" (POCD), a research diagnosis based on objective cognitive test performance, perspectives on subjective cognitive complaints (SCC) after modern surgery/anesthesia have not been systematically collected or studied despite their recent inclusion in the 2018 redefinition of "postoperative neurocognitive disorder." The authors describe the alignment between SCC anecdotes and the research diagnosis of POCD, contextualizing these findings using recent literature within and outside anesthesiology. This article prepares anesthesiologists to discuss what is, and is not, known about subjective cognitive recovery after surgery/anesthesia. [ABSTRACT FROM AUTHOR]

Background: There is significant variability in airway management training among pulmonary and critical care medicine (PCCM) fellows. Objective: To assess the airway management training of PCCM fellows, specifically evaluating the role of the institutional approach to intubations (anesthesia-predominant primary operators vs. PCCM-predominant) to the overall fellows' educational experience. Methods: We performed a survey of PCCM fellows at 14 institutions to assess the perceptions of airway management training. Summary statistics were used to analyze the Likert scale responses. Based on our hypothesis of a relationship of a fellow's experience to the institutional approach to intubations, we stratified responses based on whether the primary operator for airway management for critically ill patients was generally anesthesiology or PCCM providers. Statistical significance was determined using either t testing (after converting Likert-style responses to continuous variables) or analysis of variance for categorical variables (P < 0.05). Results: Respondents included 132 fellows across 14 PCCM programs (47% response rate), spanning all fellowship years (29% in first year [n = 38], 31% in second year [n = 41], 26% in third/fourth year [n = 34]). Seventy percent (n = 80) of fellows were very or somewhat satisfied with their airway management training. In fellows training where anesthesia providers primarily perform airway management (29% [n = 34]), satisfaction with training was significantly lower, as was the self-assessment of one's airway management skills. The location of airway management experience in anesthesia-predominant programs was mainly the operating room (69% [n = 22]), versus mainly in the intensive care unit for PCCM-predominant programs (94% [n = 77]). The number of completed intubations was lower for fellows in anesthesia-predominant programs (P = 0.02). Conclusion: We found significant differences in fellows' experiences in airway management based on the institutional approach to intubations (anesthesia-predominant primary operators vs. PCCM-predominant). Ongoing focus on strategies to optimize competency-based airway management training is needed, particularly at programs where anesthesia involvement limits the amount of clinical exposure. [ABSTRACT FROM AUTHOR]

Background: Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness. Methods: Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants' confidence in performing cricothyrotomy was conducted during the training session. Results: The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5–103.0 s) to the posttest (median = 59.0 s, IQR = 49.0–69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5–39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0–25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants' confidence levels in performing cricothyrotomy also improved after the curriculum. Conclusion: The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy. [ABSTRACT FROM AUTHOR]

In the face of an ongoing opioid epidemic and an aging population, the utilization of a successful multimodal pain regimen in patients undergoing total knee arthroplasty (TKA) is vital. This study looks to explore the effect of different types of anesthesia in addition to a multimodal pain regimen on post-operative outcomes after undergoing TKA. From January 2016 to December 2022, 783 charts of patients undergoing an elective TKA were reviewed. Patients undergoing primary, isolated, and unilateral TKA procedures were included. Patients were grouped into three study arms: 1) general anesthesia (GA); 2) general anesthesia with a local anesthetic adductor canal block (GA + ACB); 3) spinal anesthesia with local anesthetic adductor canal block (SA + ACB). Patients who received other anesthesia types or received ACB utilizing liposomal bupivacaine were excluded. Of the 420 included patients, 63 patients received GA, 148 GA + ACB, and 209 SA + ACB. Patients in the SA + ACB group had a shorter LOS compared to both the GA + ACB and GA groups (p < 0.01. The SA + ACB group had the lowest daily average OME requirement (p < 0.01). Finally, patients in the SA + ACB group had the lowest average total cost of $11,683.91 (p < 0.01). Spinal anesthesia with adductor canal block is effective in decreasing opioid usage and improving postoperative outcomes after TKA. Surgeons and anesthesiologists should look to utilize this anesthetic option along with a multimodal regimen when deciding how to best manage postoperative pain after TKA procedures. Level III. [ABSTRACT FROM AUTHOR]

Importance: The closed‐loop infusion system can automatically adjust and maintain the depth of anesthesia by using the propofol target‐controlled infusion (TCI) model under the feedback guidance of the bispectral index (BIS). Objective: To evaluate the safety and superiority of closed‐loop TCI of propofol guided by BIS during maintenance of generalized intravenous anesthesia for preschool children. Methods: A total of 120 children aged 1–6 years were enrolled and were divided into a closed‐loop feedback group (Group C) and an open‐loop manual control group (Group O), with 60 participants in each group. For anesthesia maintenance, the propofol infusion rate was adjusted by the injection system under the guidance of BIS in Group C and was manually adjusted by anesthesiologists according to the BIS and clinical experience in Group O, to maintain a BIS level of 50. The time ratio of adequate anesthesia (40 ≤ BIS ≤ 60), light anesthesia (BIS > 60), and deep anesthesia (BIS < 40) were recorded. Results: A total of 119 patients (59 in Group C and 60 in Group O) were enrolled in the study. Group C demonstrated a higher time ratio of adequate anesthesia (P = 0.014) compared to Group O. The time ratio of light anesthesia and the global score was lower in Group C than in Group O (P = 0.010, P = 0.015, respectively). The frequency of adjustment per unit of time was higher in Group C for propofol (P < 0.001), while it was lower for remifentanil (P = 0.010). Interpretation: BIS‐guided closed‐loop infusion of propofol is safe and effective for preschool children. The depth of anesthesia is controlled more accurately and smoothly. [ABSTRACT FROM AUTHOR]

Aims: While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA). Methods: We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm. Results: The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral heads increased both revision and reoperation risks. Conclusion: This is the first study to develop machine-learning models to forecast the risk of PPFF necessitating secondary surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice. Cite this article: Bone Joint Res 2025;14(1):46–57.

Abstract Background In modern healthcare systems, the scope of practice for anesthesiologists is expanding within and beyond the traditional perioperative care continuum. This study was conducted to assess the knowledge and perceptions of perioperative patients of the roles of anesthesiologists as providers of healthcare services in different Palestinian hospitals. The study also assessed associations between the patients' different demographic and clinical variables and their knowledge and perceptions about the roles of anesthesiologists. Method This study was conducted using a cross-sectional design and a questionnaire among perioperative patients admitted for elective surgeries in five major public and private hospitals in the Nablus, Tulkarm, Jenin, and Salfit governorates of the West Bank of Palestine. The data were collected between September 2023 and December 2023. Results Of the 500 patients invited, 411 patients completed the questionnaire, giving a response rate of 82.2%. The overall knowledge score of the patients about the roles of anesthesiologists was 59.4% (18.8%). The majority of the patients lacked awareness about the roles of anesthesiologists outside the operating room. There was a low positive correlation between the self-rated general health and overall knowledge score (Pearson's r = 0.17, p-value

BACKGROUND: Anesthesiologists are experiencing unprecedented levels of workplace stress and staffing shortages. This analysis aims to assess how U.S. attending anesthesiologist burnout changed since the onset of the COVID-19 pandemic and target well-being efforts. METHODS: The authors surveyed the American Society of Anesthesiologists U.S. attending anesthesiologist members in November 2022. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey with additional questions relating to workplace and demographic factors. Burnout was categorized as high risk for burnout (exhibiting emotional exhaustion and/or depersonalization) or burnout syndrome (demonstrating all three burnout dimensions concurrently). The association of burnout with U.S. attending anesthesiologist retention plans was analyzed, and associated factors were identified. RESULTS: Of 24,680 individuals contacted, 2,698 (10.9%) completed the survey, with 67.7% (1,827 of 2,698) at high risk for burnout and 18.9% (510 of 2,698) with burnout syndrome. Most (78.4%, n = 2,115) respondents have experienced recent staffing shortages, and many (36.0%, n = 970) were likely to leave their job within the next 2 yr. Those likely to leave their job in the next 2 yr had higher prevalence of high risk for burnout (78.5% [760 of 970] vs. 55.7% [651 of 1,169], P < 0.001) and burnout syndrome (24.3% [236 of 970] vs. 13.3% [156 of 1,169], P < 0.001) compared to those unlikely to leave. On multivariable analysis, perceived lack of support at work (odds ratio, 9.2; 95% CI, 7.0 to 12.1), and staffing shortages (odds ratio, 1.96; 95% CI, 1.57 to 2.43) were most strongly associated with high risk for burnout. Perceived lack of support at work (odds ratio, 6.3; 95% CI, 3.81 to 10.4) was the factor most strongly associated with burnout syndrome. CONCLUSIONS: Burnout is more prevalent in anesthesiology since early 2020, with workplace factors of perceived support and staffing being the predominant associated variables. Interventions focused on the drivers of burnout are needed to improve well-being among U.S. attending anesthesiologists.

Abstract Background Burnout syndrome is marked by three primary domains: emotional exhaustion, depersonalization, and low personal accomplishment. This study assessed the prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit (ICU) nurses in Palestinian hospitals. In addition, this study also sought to assess associations and identify the factors that can predict higher burnout among anesthesiologists, anesthesia technicians, and ICU nurses. Methods This study was conducted in a cross-sectional design using a questionnaire between October 2023 and December 2023. The questionnaire collected the demographic variables of the healthcare providers, their living conditions, lifestyle, working conditions, job satisfaction, and intention to change the profession. The healthcare providers were included from 12 different hospitals. Burnout syndrome was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP). Results A total of 250 healthcare providers were invited to participate in this study, of those, 212 completed the questionnaire, giving a response rate of 84.8%. Of the healthcare providers, 72 (34.0%) were anesthesiologists, 41 (19.3%) were anesthesia technicians, and 99 (46.7%) were ICU nurses. Of all healthcare providers, 151 (71.2%) reported emotional exhaustion, 125 (59%) reported depersonalization and 145 (68.4%) reported a lack of personal achievement based on the MBI-HSS-MP criteria for burnout. Multiple linear regression showed that higher emotional exhaustion scores could be predicted by the number of working hours per day (p-value = 0.039) and higher depersonalization scores could be predicted by having children (p-value = 0.001). On the other hand, lower personal achievement scores could be predicted by having children (p-value = 0.006), not owning a car (p-value = 0.036), and having more night shifts (p-value = 0.049). Conclusions The findings of this study indicated that burnout syndrome was prevalent among anesthesiologists, anesthesia technicians, and ICU nurses in Palestinian hospitals. Healthcare authorities and professional bodies should consider designing interventions to reduce burnout and improve the psychological well-being of anesthesiologists, anesthesia technicians, and ICU nurses. Further studies are required to identify the most effective interventions for reducing burnout among anesthesiologists, anesthesia technicians, and ICU nurses in Palestine.

Abstract Background Inadequate postoperative analgesia greatly affects the recovery of patients, can poses a substantial health and economic burden. Patient-controlled analgesia is the most commonly used method for postoperative pain relief. However, the situation of inadequate analgesia still exists. Artificial intelligent Patient-controlled analgesia (Ai-PCA) system can make it easier for medical staff to understand the pain level of patients in order to deal with it in time. So far, several studies have investigated anesthesiologists’ knowledge and management of Ai-PCA. Objective This study aimed to assess the degree of anesthesiologists’ knowledge, attitude and their practice (KAP) towards Ai-PCA in east China’s Jiangsu Province. Methods This cross-sectional study was conducted among 396 anesthesiologists working in tertiary hospitals. The data were collected using a pretested, structured and self-administered KAP questionnaire. The data were analyzed using Independent t-test, analysis of variance, Pearson’s correlation and multiple linear regression tests. Results Five hundred twelve questionnaires were collected, 396 anesthesiologists (190 Male, and 206 Female) were included in our study for statistical analysis. The score of knowledge, attitude, practice was 5.49 ((SD = 1.65; range:0–8), 37.45 (SD = 4.46; range:9–45), and 26.41 (SD = 9.61; range:9–45), respectively. Among the participants, 309 (78%) and 264 (66.7%) had good knowledge and positive attitudes toward Ai-PCA, respectively. However, only 81 (20.5%) of the participants exhibited good practice regarding Ai-PCA. Participation in Ai-PCA training showed a significant correlation with knowledge, attitude and practice scores. Besides, age, years of experience and professional titles of anesthesiologists were correlated with knowledge scores. The title of the anesthesiologist was associated with attitude scores. And the marital status of anesthesiologists was correlated with practice scores. Conclusion Our findings revealed the score of practice regarding Ai-PCA are very poor among anesthesiologists in east China’s Jiangsu Province. The utilization of Ai-PCA was found to be impacted by whether the individual had received training. This calls for a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of anesthesiologist on using Ai-PCA and more Ai-PCA training to be included in the daily learning. Trial registration Chinese Clinical Trial Registry ( www.chictr.org.cn ; 27/10/2023; ChiCTR2300077070).

Burnout is increasingly relevant among healthcare professionals. The aim of this study is to describe the prevalence of burnout and other parameters of professional satisfaction among different specialists dedicated to Liver Transplantation (LT) in transplant teams. A working group from the Spanish Society of LT designed a survey with 39 questions evaluating the prevalence of parameters related to professional satisfaction, including burnout. It was distributed among 496 specialists dedicated to liver transplantation in Spanish transplant teams. Responders included surgeons (49%), hepatologists (27%), anesthesiologists (16%), intensivists (4%), and other specialties (4%). Among responders, 78% reported some degree of burnout. Moreover, 46% of responders did not see themselves working in transplantation in 5 years. The rates of burnout and dissatisfaction among anesthesiologists and surgeons were higher than other specialists. The highest levels of dissatisfaction were in economic remuneration and work–life balance. Being younger than 60 years old and non-head of department showed to be risk factors of burnout. In conclusion, the prevalence of burnout among LT physicians in Spain was notably high. Among the various specialties, anesthesiologists and surgeons exhibited the highest dissatisfaction rates. The results of this work may be of interest to healthcare management and planning. [ABSTRACT FROM AUTHOR]