Martin J.L. Bucx

Psychological distress, burnout and personality traits in Dutch anaesthesiologists: A survey.

BACKGROUND The practice of anaesthesia comes with stress. If the demands of a stressful job exceed the resources of an individual, that person may develop burnout. Burnout poses a threat to the mental and physical health of the anaesthesiologist and therefore also to patient safety. OBJECTIVES Individual differences in stress appraisal (perceived demands) are an important factor in the risk of developing burnout. To explore this possible relationship, we assessed the prevalence of psychological distress and burnout in the Dutch anaesthesiologist population and investigated the influence of personality traits. DESIGN Survey study. SETTING Data were collected in the Netherlands from July 2012 until December 2012. PARTICIPANTS We sent electronic surveys to all 1955 practising resident and consultant members of the Dutch Anaesthesia Society. Of these, 655 (33.5%) were returned and could be used for analysis. MAIN OUTCOME MEASURES Psychological distress, burnout and general personality traits were assessed using validated Dutch versions of the General Health Questionnaire (cut-off point ≥2), the Maslach Burnout Inventory and the Big Five Inventory. Sociodemographic variables and personality traits were entered into regression models as predictors for burnout and psychological distress. RESULTS Respectively, psychological distress and burnout were prevalent in 39.4 and 18% of all respondents. The prevalence of burnout was significantly different in resident and consultant anaesthesiologists: 11.3% vs. 19.8% (&khgr;2 5.4; Pu200a<u200a0.02). The most important personality trait influencing psychological distress and burnout was neuroticism: adjusted odds ratio 6.22 (95% confidence interval 4.35 to 8.90) and 6.40 (95% confidence interval 3.98 to 10.3), respectively. CONCLUSION The results of this study show that psychological distress and burnout have a high prevalence in residents and consultant anaesthesiologists and that both are strongly related to personality traits, especially the trait of neuroticism. This suggests that strategies to address the problem of burnout would do well to focus on competence in coping skills and staying resilient. Personality traits could be taken into consideration during the selection of residents. In future longitudinal studies the question of how personal and situational factors interact in the development of burnout should be addressed.

Preoperative use of anxiolytic-sedative agents; are we on the right track?

STUDY OBJECTIVEnAlthough anxiolytic-sedative agents are used preoperatively since the advent of anesthesia, many aspects of this treatment, including the intended effects among which anxiolysis, effectiveness, and optimal agents, remain unclear. The objective of this study was to provide insight into the preoperative use of anxiolytic-sedative agents in the Netherlands and to relate the administration of these agents to the anxiolytic-sedative state of patients.nnnDESIGNnQuestionnaire study.nnnSETTINGnUniversity, general, and specialized hospitals in the Netherlands.nnnPATIENTSnOne anesthesiologist in each hospital was asked for details about premedication in all elective procedures, except cardiothoracic surgery, in normal weighted adults in good to fair clinical condition.nnnINTERVENTIONSnNone.nnnMEASUREMENTSnEstimated percentage of patients receiving anxiolytic-sedative premedication, type, dose, route of administration and timing of these agents, and anxiolytic state of patients when arriving at the holding area.nnnMAIN RESULTSnAll 8 university hospitals, 69 of 82 general hospitals and 2 of 3 specialized hospitals participated in this study (response rate, 84.9%). The estimated percentage of patients that received anxiolytic-sedative agents was 46.8% for in-patients and 30.4% for day care patients (P<.0001), with large between-hospital variation. Midazolam (62.7%), oxazepam (20.2%), and temazepam (7.8%) were most frequently used and were virtually always orally administered 1 hour preoperatively. There was no relationship between use of anxiolytic-sedative agents and reduction of perceived anxiety (r=-0.09, P=.46 and r=-0.01, P=.91 for clinical and day care patients, respectively).nnnCONCLUSIONSnAnxiolytic-sedative agents are used preoperatively in a substantial number of patients in the Netherlands, and the pharmacokinetic characteristics of many agents are not optimal of their intended use. In addition, we found no relationship with reduced anxiety. This study stresses the need for clear guidelines on preoperative use of anxiolytic-sedative agents.

A simple intervention to reduce the anesthetic pharmacy budget; the effect of price list stickers placed on vaporizers

STUDY OBJECTIVEnThe study objective is to investigate the effects of a simple price list sticker placed on vaporizers on anesthetic use and costs. The price list only showed the cost per hour of the annually most expensive drugs, which had a low-cost alternative.nnnDESIGNnThe design is a prospective database study with historical controls.nnnSETTINGnThe setting is at operating rooms.nnnPATIENTSnAll patients are undergoing a surgical procedure under anesthesia in both study periods, except cardiothoracic and day care patients.nnnINTERVENTIONSnThe intervention is application of a price list sticker on the vaporizers.nnnMEASUREMENTSnMonthly cost and amount of anesthetic agents used during the 9 months before and after the intervention.nnnMAIN RESULTSnAfter application of the price stickers, the use of both the annually most expensive agents and the anesthetic budget decreased substantially. Most notable was a decrease of 28% in the use of sevoflurane.nnnCONCLUSIONSnPrice sticker on vaporizers may be an effective, simple, and cheap method to reduce anesthetic costs.

A left bevelled tube is easier inserted from the right side

Recently, Boku et al [1] demonstrated that a nasal endotracheal tube is best introduced via the right nostril.Mizutani andUno [2] subsequently commented that this can be explained by the left-sided bevel which allows for an easy introduction into the glottis and that this is “easily understood intuitively”. Unfortunately, they did not explain the mechanics involved. However, these were elaborated in a publication about differences between left-handed and right-handed laryngoscopy [3]. In short, during routine (left-handed) laryngoscopy, the endotracheal tube is introduced from the right side. To allow for an easy introduction of the endotracheal tube into the glottis, the tip of a standard endotracheal tube is adapted for this situation; it has a bevel on the left side to create a relatively sharp tip, allowing easy introduction into the glottis. In addition, the left-sided bevel results in minimal obstruction of the view on the glottis. When during routine laryngoscopy the (left-bevelled) endotracheal tube is introduced from the left side—for instance via the left nostril, the special shape of a standard tube results in mechanical disadvantages; the tip of the tube with respect to the glottic opening is than blunt and obstructs the view on the glottic opening. Combining this with the often rather poor view on the left side of the pharynx as created by a (left-handed) laryngoscope, the increased duration of this procedure via the left nostril is sufficiently explained.

Reducing the cost of anaesthesia

[3], a contributory factor in our incidents was the potential for the net-sided pressure bag (type 1, above) to obscure the labelling and contents of the infusate. Clear pressure infusor cuffs (type 2) should have been the chosen option in our response, but we found a significant issue with both types listed: neither cuff is manufactured to fit the Viaflo fluid bags we use as standard (Baxter, Deerfield, IL, USA), resulting in herniation of the bag or cuff failure. Unfortunately, this only became evident when these infusor cuffs were introduced into practice. We opted for clear-sided pressure infusor cuffs (type 3). These are of low cost, re-usable (unless soiled) and provide an unhindered view of the labelling and contents of the entire infusate, albeit on one side only. They also seem to be manufactured to fit all available types of fluid bag. In conclusion, we insist that all fluid pressurising devices should at least have a fully transparent front panel [4] and must be checked for the compatibility with the fluid bags used.