Corey S. Scher

Measuring determinants of career satisfaction of anesthesiologists: validation of a survey instrument ☆,☆☆

STUDY OBJECTIVE To measure the parameter of job satisfaction among anesthesiologists. DESIGN Survey instrument. SETTING Academic anesthesiology departments in the United States. SUBJECTS 320 anesthesiologists who attended the annual meeting of the ASA in 2009 (95% response rate). MEASUREMENTS AND MAIN RESULTS The anonymous 50-item survey collected information on 26 independent demographic variables and 24 dependent ranked variables of career satisfaction among practicing anesthesiologists. Mean survey scores were calculated for each demographic variable and tested for statistically significant differences by analysis of variance. Questions within each domain that were internally consistent with each other within domains were identified by Cronbachs alpha ≥ 0.7. P-values ≤ 0.05 were considered statistically significant. Cronbachs alpha analysis showed strong internal consistency for 10 dependent outcome questions in the practice factor-related domain (α = 0.72), 6 dependent outcome questions in the peer factor-related domain (α = 0.71), and 8 dependent outcome questions in the personal factor-related domain (α = 0.81). Although age was not a variable, full-time status, early satisfaction within the first 5 years of practice, working with respected peers, and personal choice factors were all significantly associated with anesthesiologist job satisfaction. CONCLUSIONS Improvements in factors related to job satisfaction among anesthesiologists may lead to higher early and current career satisfaction.

How Much Evaluation of the Airway Is Essential Prior to Anesthesia

With the availability of advanced airway management devices and algorithms, airway assessment for difficult laryngoscopy and intubation may be considered less important by some clinicians. Inability of any airway assessment test to provide absolute prediction of difficulty further decreases the importance of airway evaluation. However, proper evaluation of the airway aids in planning the appropriate technique to be used and thus reduce the likelihood of complications such as aspiration, airway obstruction and airway trauma during airway intervention.

Malignant Hyperthermia: “It Certainly Is” Versus “It Certainly Is Not!”

The first case of the day in room 12 is a 4-year-old boy who is scheduled for a bilateral inguinal hernia repair. Three days before the procedure, the child had presented to pre-surgical testing for evaluation. Pertinent history includes birth at 31-week gestation, and predictably, the common morbidities of a premature infant, including lack of lung surfactant requiring a week of intubation and ventilation, apnea of prematurity, bronchopulmonary dysplasia (BPD), hyperbilirubinemia, a grade 2 intraventricular hemorrhage, and 2 seizures. Luckily, all of these problems have resolved. The child did receive an ill-defined anesthetic for a peripherally inserted central catheter (PICC) line during his initial hospitalization in the neonatal intensive care unit (NICU). The Mandarin-speaking father reported that the child needed 3 days of postoperative mechanical ventilation due to lung problems related to prematurity. He did not recall any other problems.

Should a Trainee Be Allowed to Return to Anesthesiology After Narcotic Diversion and Presumed Addiction

Strong rumors quickly solidified when a resident who was suspected of diverting narcotics was caught in the men’s locker room by his co-residents, injecting a drug in a “hep lock” intravenous line that was placed in his left saphenous vein. The resident confessed that he was injecting fentanyl and begged the residents not to “rat him out.” Although the residents agreed to his face, 2 went to the Chair’s office to report this issue immediately. The Chair grabbed a senior attending to serve as a witness in confronting the resident. Apparently, the Chair had experience with this ongoing issue. I was also asked to witness the event. Although I had been a program director for many years in the Deep South, this issue had never come up before in my career.

Managing the Noncompliant HIV-Positive Mother: A PRO/CON Debate

It was another busy night at the hospital when around 10 p.m., a disheveled, unkempt young woman walked in from the rain. While the patient was oriented to name and place, and was able to tell us that she was pregnant, she also remained confused, somewhat somnolent, and altered, making me question the reliability of her medical history.

Would You Recommend Accepting a “Donation After Cardiac Death” Liver?

At 3 in the morning, the telephone rings 5 times before it is picked up by the anesthesiologist.

Should Recent Clinical Trials Change Perioperative Management in Patients with Cardiac Risk Factors

A 75-year-old man with a known history of an ischemic cardiomyopathy presents for resection of a presumed malignant liver tumor. He had 2 cardiac stents placed in the last year and a half. His medications include spironolactone, lisinopril, pioglitazone, and atorvastatin. He also takes 81 mg aspirin per day. A recent cardiac catheterization showed that his stents were wide open and there was evidence of diffuse, cardiac arterial disease not amenable to stenting or surgery. His ejection fraction is 32 %, and there is diastolic dysfunction on his echocardiogram.

Just Say NO to Nitrous

A 65-year-old man is having an open prostatectomy. His ejection fraction is 30 % due to previous myocardial infarctions. He has multiple coronary artery stents for his extensive coronary artery disease. In addition he is in rate-controlled atrial fibrillation treated with metoprolol and flecainamide. The patient is advised to have a neuraxial anesthetic but he declines. The risks and benefits of a general anesthetic are explained to the patient, and it is decided to give a small dose of sevoflurane with the addition of nitrous oxide and fentanyl to pick up the “slack.” The case is discussed in morning conference, and the majority of providers do not agree with the use of nitrous oxide.

Are There Concerns with Using Droperidol for Sedation for an Awake Fiberoptic Intubation

A 60-year-old patient with a history of squamous cell carcinoma on the floor of his mouth presents for esophageal dilation, which is needed after his radiation, chemotherapy, and surgery. The tumor was completely resected, and he has a flap to his face and neck to cover an extensive wound. Of late, he has had a problem of eating solid food as a result of a narrowed esophageal lumen. It is hoped that the dilation will allow him to eat and maintain his current weight. From the airway examination and history, it is obvious that an awake fiberoptic intubation is the safest course of action. Due to what appears to be a treacherous airway, a second attending anesthesiologist is asked to join the resident and assigned anesthesiologist.

A Small Bowel Transplant for a Patient with Scleroderma: Once Again on the Slippery Slope Both Clinically and Ethically

A 55-year-old gentleman with a 30-year history of diffuse scleroderma presents for a small bowel transplant. His rapidly progressive autoimmune disease includes his entire gastrointestinal tract, liver, lungs, skin, and joints. He is brought to the holding area, and the chart includes the following preoperative assessment by organ system.