Author: anesthesiaexperts-admin

Sexual Harassment in Academic Anesthesiology: A Survey of Prevalence, Sources, Impact, and Recommendations

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AUTHORS: Hastie, Maya J. MD, EdD et al

Anesthesia & Analgesia January 2025.

BACKGROUND:

A report by the American Association of Medical Colleges (AAMC) showed that academic anesthesiology has the highest prevalence of sexual harassment among specialties for both men and women. We aimed to explore the prevalence, sources, and impact of sexual harassment on anesthesiologists in academic centers in the United States and Canada. We also sought recommendations for its mitigation.

METHODS:

An anonymous online survey instrument was designed based on a previously published report, yielding 39 questions, including demographics and 4 open-ended questions. The survey was sent via email to Association of University Anesthesiologists (AUA) members, who were encouraged to share across academic anesthesiology departments in the United States and Canada.

RESULTS:

A total of 626 responses were received; after exclusion of incomplete and nonfaculty responses, 484 complete survey responses were analyzed. 52.9% of respondents identified as men and 45.9% as women; 3 respondents (0.6%) identified as nonbinary, and 3 respondents (0.6%) preferred not to answer. 43.6% of respondents perceived there is sexual harassment in academic anesthesiology. Significantly more women than men reported presence of sexual harassment in academic medicine (65.3% vs 38.3%, P < .001), in academic anesthesiology (59.5% vs 30.1%, P < .001), and in their place of work (37.8% vs 18.3%, P < .001). 14.5% of men and 43.2% of women had experienced sexual harassment at least once in the past 12 months (P < .001). 43.7% of women reported ever experiencing unwanted physical contact in the workplace compared to 16.8% of men; 74.3% of women reported ever experiencing verbal or nonverbal conduct in the workplace related to gender that caused embarrassment, distress, or offense compared to 24.6% of men (P < .001). 8.2% of men reported feeling their clinical ability doubted, compared to 87.8% of women (P < .001). Experiences of sexual harassment were most consistent with verbal and nonverbal behaviors that convey hostility, objectification, or exclusion of members of one gender. Colleagues from anesthesiology were most likely to be reported as the source of sexual harassment (44.6% of unwanted physical contact, 59% of verbal or nonverbal conduct). The impact was described along 4 themes: emotional, cognitive, behavioral, and professional. Participants made recommendations for eliminating sexual harassment by raising awareness, providing education, establishing reporting, offering support, and ensuring accountability.

CONCLUSIONS:

This survey confirms the high prevalence of sexual harassment in academic anesthesiology. The most common sources are anesthesiology colleagues. The recommendations for leaders and institutions include creating a professional environment free from harassment with support for targets and accountability for instigators.

KEY POINTS

Question: what is the prevalence of sexual harassment in academic anesthesiology, its sources, and impact?

Findings: Women in academic anesthesiology reported experiences of sexual harassment more frequently than men, most commonly manifesting as verbal and nonverbal conduct that conveys hostility, objectification, exclusion, or second-class status about members of one gender. These incidents were most frequently instigated by colleagues in anesthesiology.

Meaning: The high prevalence of sexual harassment in academic anesthesiology results in a wide range of negative impact on targets and could be mitigated by leadership’s adoption of deliberate approaches.

Multi-Institutional Study of Multimodal Analgesia Practice, Pain Trajectories, and Recovery Trends After Spine Fusion for Idiopathic Scoliosis

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AUTHORS: Einhorn, Lisa M. MD et al

Anesthesia & Analgesia January 2025.

BACKGROUND:

Posterior spinal fusion (PSF) surgery for correction of idiopathic scoliosis is associated with chronic postsurgical pain (CPSP). In this multicenter study, we describe perioperative multimodal analgesic (MMA) management and characterize postoperative pain, disability, and quality of life over 12 months after PSF in adolescents and young adults.

METHODS:

Subjects (8–25 years) undergoing PSF were recruited at 6 sites in the United States between 2016 and 2023. Data were collected on pain, opioid consumption (intravenous morphine milligram equivalents (MME)/kg), and use of nonopioid analgesics through postoperative days (POD) 0 and 1. Pain descriptors, functional disability, and quality of life were assessed preoperatively, 2 to 6 and 10 to 12 months after surgery using questionnaires (PainDETECT, Functional Disability Inventory [FDI], and Pediatric Quality of Life Inventory [PedsQL]). Descriptive analyses of analgesic use across and within sites (by preoperative pain and psychological diagnoses), acute postoperative pain and yearly in-hospital analgesic trends are reported. Pain trajectories over 12 months were analyzed using group-based discrete mixture. CPSP (defined as pain score >3/10 beyond 2 months postsurgery), and associated FDI and PedsQL were analyzed.

RESULTS:

In this cohort (343 patients, median [interquartile range {IQR}] 15.2 (13.7–16.6) years, 71.1% female), perioperative use of opioids and nonopioid analgesics significantly varied across sites (P < .001). Preoperatively, gabapentinoids were administered to 48.2% (157/343). Intraoperatively, opioid use included remifentanil (264/337 [78.3%]) and fentanyl (73/337 [21.7%]) infusions, and methadone boluses (159/338 [47%]). Postoperatively, patient-controlled analgesia was commonly used (342/343 [99.9%]). Within sites MMA use did not appear to differ by preoperative pain or psychological comorbidities. Median in-hospital opioid use declined over time (−0.08 [standard error {SE} 0.02] MME/kg/POD 0 to 1 per year, P < .001) while increased use of ketamine (P < .001), methadone (P < .001), dexmedetomidine (P < .001), and regional analgesia (P = .015) was observed. Time spent in moderate-to-severe pain on POD 0 to 1 was ≈33%. CPSP was reported by 24.2% (64/264) with ~17% reporting ongoing neuropathic/likely neuropathic pain. Four postsurgical pain trajectories were identified; 2 (71%) showed resolving pain and 2 (29%) showed persistent mild and moderate-to-severe pain. Although FDI and PedsQL improved over time in both CPSP and non-CPSP groups (P < .001), FDI was higher (P < .001) and PedsQL lower (P = .001) at each time point in the CPSP versus the non-CPSP group.

CONCLUSIONS:

MMA strategies showed site-specific variability and decreasing yearly trends of in-hospital opioid use without changes in acute or chronic pain after PSF. There was a high incidence of persistent pain associated with disability and poor quality of life warrants postoperative surveillance to enable functional recovery.

Preoperative Psychological Factors, Postoperative Pain Scores, and Development of Posttraumatic Stress Disorder Symptoms After Pediatric Anterior Cruciate Ligament Reconstruction

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AUTHORS: Sadacharam, Kesavan MD et al

Anesthesia & Analgesia January 2025.

BACKGROUND:

Acute orthopedic injuries and subsequent surgical repair can be challenging for children and adolescents and result in posttraumatic stress reactions that can be problematic after the acute perioperative period. In a cohort of patients undergoing anterior cruciate ligament reconstruction (ACLR), we investigated the incidence and explored risk factors associated with the development of posttraumatic stress disorder (PTSD) symptoms after surgery.

METHODS:

We analyzed data from a multicenter, prospective, observational registry of pediatric patients undergoing ACLR. Patient data included demographic, psychological assessments, postoperative pain measures, and a posttraumatic stress disorder assessment (Child PTSD Symptom Scale [CPSS]) collected after the operation. An analysis of patients who provided survey data at 6 months was used to determine the incidence of posttraumatic stress reactions and to explore associated risk factors.

RESULTS:

A total of 519 patients were enrolled in a prospective observational study of outcomes after ACLR. A cohort of 226 patients (44%) provided completed data collection and CPSS follow-up surveys at 6 months. We found that 17 of the patients (7.5%) met the criteria for PTSD at 6 months which represents 3.3% of our total study population (17/519). A univariate analysis suggested that a negative (P = .017), excitable (P = .039), or inhibitory (P = .043) temperament compared to a positive temperament, high preoperative scores for anxiety (P = .001) or depression (P = .019) and high pain scores on postoperative day (POD)1 (P = .02) increased the odds of PTSD at 6 months. A multivariable model revealed that patients self-reporting symptoms consistent with clinical anxiety/depression preoperatively and patients with a max pain score ≥7 on POD1 were 29 times (P = .018) and 9.8 times (P = .018) more likely to develop PTSD at 6 months.

CONCLUSIONS:

A portion of patients undergoing ACLR are at risk for the development of symptoms consistent with PTSD. Risk factors include preoperative anxiety or depression and high postoperative pain scores. Interventions designed to address preoperative risk factors and optimization of postoperative pain may represent opportunities to improve outcomes in this patient population.

Discover The Best Anesthesiologist Opportunity in New Mexico

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If you’re an anesthesiologist searching for a balanced lifestyle and rewarding work, you’ll want to check out this opportunity. Our all-anesthesiologist group is seeking a dedicated team member to join our collaborative practice.

Position Highlights:

  • Zero Call for 3 Weeks: Enjoy three weeks of no call duty, followed by one week of call. Even during your call week, there’s no daytime work—just coverage after 7 PM, so you may not work the entire week.
  • Competitive Compensation: Earn a $500,000 annual salary plus a comprehensive benefits package.
  • Work-Life Balance: Enjoy 8 weeks of vacation each year to recharge and relax.
  • Team-Based Approach: Join a cohesive group of 4 full-time anesthesiologists and 1 vacation relief provider, managing 3 operating rooms.

This role provides the perfect mix of professional fulfillment and personal freedom, with a supportive environment and a predictable schedule.

Interested?
Let’s connect! Contact Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com for more details or to apply. Feel free to pass this along to any colleagues who might be interested.

This is a rare opportunity—don’t miss your chance to join a team that values your skills and respects your time!

Join Our New CRNA Team in Riverdale, GA!

Posted on by anesthesiaexperts-admin

We’re excited to announce the formation of a new anesthesia group in Riverdale, GA, located just 10 minutes from the Atlanta Airport. We’re seeking dedicated CRNAs to join our collaborative care team, which will include 4 full-time CRNAs and 2 anesthesiologists managing 4 operating rooms.  This is a 25% independent practice and doing own blocks!

Position Highlights:

  • Case Mix: Bread-and-butter cases – no heads, hearts, trauma, or OB.
  • Call Schedule: Call is from home with only a 10% chance of being called back.
  • Work Environment: Enjoy a supportive and collegial workplace.

This is an excellent opportunity to be part of a close-knit team and establish yourself in a fantastic community near Atlanta.

Interested?
Please reach out to Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com. Feel free to share this opportunity with anyone who might be interested!

We look forward to hearing from you!

Association of Intraoperative Occult Hypoxemia With 30-Day and 1-Year Mortality

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AUTHORS: Stannard, Blaine MD et al

Anesthesia & Analgesia February 2025.

BACKGROUND:

Despite the widespread use of pulse oximetry for intraoperative estimation of arterial oxygen saturation, there is growing evidence that certain patient populations may be vulnerable to inaccurate pulse oximetry measurements and that unrecognized hypoxemia is associated with end-organ damage and adverse outcomes. In this single-center retrospective cohort study, we sought to better elucidate the relationship between intraoperative occult hypoxemia and postoperative mortality among patients undergoing anesthesia and surgery.

METHODS:

Data were collected from our departmental data warehouse for adult patients (≥18 years) undergoing anesthesia between 2008 and 2019 with at least 1 intraoperative arterial blood gas recorded. The number of occult hypoxemic events, defined as arterial oxygen saturation (Sao2) of <88% despite oxygen saturation measured by pulse oximetry (Spo2) >92%, were determined. Mortality data were obtained from the Social Security Death Master File and used to determine 30-day and 1-year postoperative mortality. Propensity score overlap-weighted Firth logistic regression and Cox proportional-hazard modeling were performed to analyze whether at least 1 occult hypoxemic event was predictive of 30-day and 1-year mortality.

RESULTS:

There were 25,234 patients and 62,707 paired readings included in the final analysis. There were 351 patients (1.4%) with at least 1 occult hypoxemic reading. The overall 30-day mortality rate was 3.3% and 1-year mortality rate was 10.2%. In the overlap-weighted models, patients who experienced at least 1 occult hypoxemic event had significantly higher odds of both 30-day mortality (odds ratio [OR] = 2.89, 95% confidence interval [CI], 1.46–5.72, P = .002) and 1-year mortality (hazard ratio [HR] = 1.90, CI, 1.48–2.43, P < .001). There was no significant interaction between occult hypoxemia and self-reported race/ethnicity for predicting mortality.

CONCLUSIONS:

Intraoperative occult hypoxemic events are associated with significantly higher odds of 30-day and 1-year mortality, independent of self-reported race/ethnicity.

Discover The Best Anesthesiologist Opportunity in New Mexico

Posted on by anesthesiaexperts-admin

If you’re an anesthesiologist searching for a balanced lifestyle and rewarding work, you’ll want to check out this opportunity. Our all-anesthesiologist group is seeking a dedicated team member to join our collaborative practice.

Position Highlights:

  • Zero Call for 3 Weeks: Enjoy three weeks of no call duty, followed by one week of call. Even during your call week, there’s no daytime work—just coverage after 7 PM, so you may not work the entire week.
  • Competitive Compensation: Earn a $500,000 annual salary plus a comprehensive benefits package.
  • Work-Life Balance: Enjoy 8 weeks of vacation each year to recharge and relax.
  • Team-Based Approach: Join a cohesive group of 4 full-time anesthesiologists and 1 vacation relief provider, managing 3 operating rooms.

This role provides the perfect mix of professional fulfillment and personal freedom, with a supportive environment and a predictable schedule.

Interested?
Let’s connect! Contact Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com for more details or to apply. Feel free to pass this along to any colleagues who might be interested.

This is a rare opportunity—don’t miss your chance to join a team that values your skills and respects your time!

A New Method for Comprehensive Analysis of Benzodiazepine, Opioid, and Propofol Interactions and Dose Selection Rationales in Gastrointestinal Endoscopy Sedation

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AUTHORS: Liou, Jing-Yang MD, PhD et al

Anesthesia & Analgesia February 2025.

BACKGROUND:

The aim of this study was to explore a new method for determining optimal dosing regimens for combinations of propofol, midazolam, and an opioid to achieve rapid on- and off-set of deep sedation.

METHODS:

We simulated 16 published dosing regimens using a well-validated pharmacodynamic model. The study was divided into 2 parts. First, the regimen that best provided deep sedation and rapid recovery was selected. A deep sedation-time area-under-the-curve (AUC) method was used to compare published dosing regimens; a higher AUC indicated better sedation and faster recovery. Second, subgroup analysis of the best-performing dosing regimen was undertaken better to understand how each drug affected patient recovery.

RESULTS:

The AUC method identified a combination of midazolam 1 mg, alfentanil 500 µg, and propofol target infusion effect-site concentration (Ce) 2 µg mL−1 as the optimal regimen (P < .01). Propofol correlated with high probability of sedation and increased AUC (R2 = 0.53), whereas midazolam had a significant impact on time to return of consciousness (R2 = 0.86). Subgroup analysis indicated that regimens consisting of a fixed dose of alfentanil and either 5 µg mL−1 Ce propofol, or 1 mg midazolam with 3–5 µg mL−1 Ce of propofol, or 2 mg midazolam with 2 µg mL−1 Ce propofol provided adequate sedation and rapid recovery. Midazolam >3 mg greatly prolonged recovery.

CONCLUSIONS:

This study used a clinically relevant method and model simulation to determine suitable sedation regimens for use in gastrointestinal endoscopy. A balanced propofol, midazolam, and an opioid should be used. The AUC method was capable of providing objective assessments for model selection.

Join Our New CRNA Team in Riverdale, GA!

Posted on by anesthesiaexperts-admin

We’re excited to announce the formation of a new anesthesia group in Riverdale, GA, located just 10 minutes from the Atlanta Airport. We’re seeking dedicated CRNAs to join our collaborative care team, which will include 4 full-time CRNAs and 2 anesthesiologists managing 4 operating rooms.  This is a 25% independent practice and doing own blocks!

Position Highlights:

  • Case Mix: Bread-and-butter cases – no heads, hearts, trauma, or OB.
  • Call Schedule: Call is from home with only a 10% chance of being called back.
  • Work Environment: Enjoy a supportive and collegial workplace.

This is an excellent opportunity to be part of a close-knit team and establish yourself in a fantastic community near Atlanta.

Interested?
Please reach out to Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com. Feel free to share this opportunity with anyone who might be interested!

We look forward to hearing from you!

Effect of Low-Dose Ketamine Infusion in the Intensive Care Unit on Postoperative Opioid Consumption and Traumatic Memories After Hospital Discharge

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AUTHORS: Kitisin, Nuanprae MD et al

Anesthesia & Analgesia February 2025.

BACKGROUND:

Low-dose ketamine may have an opioid-sparing effect in critically ill patients but may also predispose them to traumatic memories. We evaluated the effects of low-dose ketamine infusion in the intensive care unit (ICU) on fentanyl consumption and traumatic memories after hospital discharge.

METHODS:

This randomized, double-blind, controlled trial was conducted at a university-based surgical ICU. 118 adult patients who were admitted to the ICU after noncardiac, nonneuro, nontrauma surgery between March 2019 and May 2021 were randomized to receive ketamine 1.5 µg/kg/min (n = 60) or placebo (n = 58). Fentanyl was given to achieve pain control (10-point numerical rating scale pain score [NRS] < 4) and sedation control (Richmond Agitation and Sedation Scale [RASS] level between −2 and 0). A secondary study was conducted by a telephone interview after ICU discharge using the Thai version of the posttraumatic stress disorder (PTSD) questionnaire to evaluate signs and symptoms of PTSD and traumatic memories to the time spent in the ICU.

RESULTS:

24-hour fentanyl consumption was lower in patients who received ketamine compared with placebo (399 µg [95% confidence interval {CI}, 345–454] vs 468 µg [95% CI, 412–523], difference −68 µg; 95% CI, −67 to −69; P = .041); RASS and NRS scores did not differ between the 2 groups. Exploratory effect modification analysis suggested that the opioid-sparing effect of ketamine may be more relevant in patients with intraabdominal surgery (P-for-interaction = 0.012, difference, −177 µg; 95% CI, −204 to −149 µg; P = .001). No acute adverse effects of ketamine were observed. The secondary study included the information from 91 patients from the primary study. Long-term follow-up data was available for 45 patients (23 in the control group, 22 in the ketamine group), and the evaluations were taken 43 ± 8 months after ICU discharge. In this secondary study, ketamine use was associated with a higher incidence of frightening and delusional memories of critical illness and ICU treatment (65% vs 41%, P = .035).

CONCLUSIONS:

Low-dose ketamine is associated with a small but statistically significant reduction (15%) of postoperative opioid consumption in the ICU. Our secondary study revealed that patients who received low-dose ketamine during fentanyl-based postoperative pain therapy in the ICU recalled more frightening and delusional memories after ICU discharge.