Flávia Serebrenic Jungerman

Anesthetic drug abuse by anesthesiologists

BACKGROUND AND OBJECTIVES Physicians has a slightly higher rate of psychoactive substance use when compared to the population in general. Anesthesiology is one of the most affected medicine specialties, especially due to overwork and easier access to drugs. This paper aims to carry out a literature review on the topic. Therefore, research was conducted by searching topic-related keywords on papers from the last 30 years available on MEDLINE. CONTENT Despite the fact that alcohol abuse is the most common among anesthesiologists, the abuse of anesthetic agents causes more concern, due to its high dependence potential and consequences, which are often fatal. The most widely used drugs are opioids (fentanyl and sufentanil), propofol and inhalational anesthetics. Young professionals are the most affected. Among the consequences of drug abuse are workplace absence and even death. The return to operating rooms seems to increase the risk of relapse. In Europe and in the USA there are specialized treatment programs for the middle class, as well as preventive measures, such as strict control of drugs and identification of professionals at high risk of abuse. In Brazil, Anesthesiology is the second medicine specialty with most drug addicts, but the topic has not been much studied and there are few specialized programs in the field. CONCLUSIONS Substance abuse by anesthesiologists is an issue that needs to be discussed further, especially due to the possibility of severe consequences for professionals and patients.

Post-therapy group for pathological gamblers: improvement beyond symptoms

In 2006, we devised a psychoeducational program to enable PG to finish the basic program, called Post-Therapy group (PTG). Its goals were to promote quality of life and to keep gambling abstinence. Patients were divided in pilot groups of at most eight participants. Secrecy was underscored and only patients who had finished the basic program would be allowed to participate. Sessions happened on a weekly basis, starting with a brief talk followed by a debate with the patients. Therapists followed scripts for each session (Table 1). No specific sequence of sessions or minimal attendance was required, but we strongly suggested that the patients should attend at least once each type of session. The therapists recorded the sessions on sheets containing a table with the following columns: session date and theme, patients’ names, any gambling in the past week, and the patients’ contributions to the debate. A content analysis of these records with a special focus on reports of gambling and selfimprovement was performed. 3 During two years 24 patients attended the PTG program. Three patients dropped out after the second meeting and two after the fourth meeting. The remainder 19 concluded the nine themes. Seventeen patients were still regular attendees after two years; five have kept absolute abstinence from betting (29.4%). The other 12 gambled occasionally, but never met full criteria for pathological gambling again. Regular PTG attendees reported improvement beyond major symptoms of PG. They mentioned development in their communication, friendships, work, family relationships, leisure activities, and sleep quality, besides more satisfaction with theirselves.

Abuso de fármacos anestésicos pelos anestesiologistas

JUSTIFICATIVA Y OBJETIVOS: El uso de sustancias psicoactivas es un poco mas alto en la clase medica si lo comparamos con la poblacion en general. Entre las especialidades medicas, la Anestesiologia es una de las mas afectadas, principalmente por el exceso de trabajo y la mayor facilidad en el acceso a los farmacos. El objetivo de este articulo, es revisar la literatura sobre el asunto. Para eso, se realizo una investigacion con las palabras clave relacionadas con el asunto en el MEDLINE, con los articulos de los ultimos 30 anos. CONTENIDO: A pesar de que la droga de la que mas se abusa entre los anestesiologos sea el alcohol, el abuso de los agentes anestesicos es lo mas preocupante, debido al alto potencial de dependencia como tambien a sus consecuencias, muchas veces letales. Los mas usados son los opioides (fentanil y sulfentanil), el propofol y los anestesicos inhalatorios. Los profesionales mas jovenes son los mas afectados. Las consecuencias del uso van desde el alejamiento del local de trabajo hasta la muerte. El regreso al quirofano parece llevar a un alto riesgo de recaida. Programas de tratamiento especializado para la clase medica han sido propuestos en USA y en Europa, como tambien algunas medidas preventivas, como la rigidez en el control de los farmacos y la identificacion de los profesionales que tienen un mayor riesgo de abusar de las sustancias. En Brasil, los anestesiologos son la segunda especialidad que mas consume sustancias, sin embargo, el asunto es poco estudiado y hay una falta de programas especializados en esa area. CONCLUSIONES: El abuso de sustancias entre los anestesiologos es un asunto que necesita mas atencion, principalmente debido a las graves consecuencias que ese consumo puede acarrear, tanto para el profesional, como para los pacientes.