The Pediatric Cardiac Anesthesia Handbook

No abstract available

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Academic Anesthesiology Career Development: A Mixed-Methods Evaluation of the Role of Foundation for Anesthesiology Education and Research Funding

BACKGROUND: In 1986, the American Society of Anesthesiologists created the Foundation for Anesthesiology Education and Research (FAER) to fund young anesthesiology investigators toward the goal of helping launch their academic careers. Determining the impact of the FAER grant program has been of importance. METHODS: This mixed-methods study included quantitative data collection through a Research Electronic Data Capture survey and curriculum vitae (CV) submission and qualitative interviews. CVs were abstracted for education history, faculty appointment(s), first and last author peer-reviewed publications, grant funding, and leadership positions. Survey nonrespondents were sent up to 3 reminders. Interview questions elicited details about the experience of submitting a FAER grant. Quantitative data were summarized descriptively, and qualitative data were analyzed with NVivo. RESULTS: Of 830 eligible participants, 38.3% (N = 318) completed surveys, 170 submitted CVs, and 21 participated in interviews. Roughly 85% held an academic appointment. Funded applicants were more likely than unfunded applicants to apply for National Institutes of Health funding (60% vs 35%, respectively; P

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Observation Medicine: Principles and Protocols

No abstract available

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Tranexamic Acid Dosing for Cardiac Surgical Patients With Chronic Renal Dysfunction: A New Dosing Regimen

BACKGROUND: Tranexamic acid (TXA) is a common antifibrinolytic agent used to minimize bleeding in cardiac surgery. Up to 50% cardiac surgical patients have chronic renal dysfunction (CRD). Optimal dosing of TXA in CRD remains poorly investigated. This is important as TXA is renally eliminated with accumulation in CRD. High TXA doses are associated with postoperative seizures. This study measures plasma TXA concentrations in CRD cardiac surgical patients for pharmacokinetic modeling and dose adjustment recommendations. METHODS: This prospective cohort study enrolled 48 patients with stages 1–5 CRD, classified by Kidney Disease Outcome Quality Initiative. Patients were separated into 2 treatment groups. A "low-risk" group underwent simple aortocoronary bypass or single-valve repair/replacement and received a 50 mg/kg TXA bolus. A "high-risk" group underwent redo, aortic, multiple valve or combination surgery and received the Blood Conservation Using Anti-fibrinolytics Trial dosing regimen (loading dose 30 mg/kg, infusion 16 mg/kg/h with 2 mg/kg in pump prime). Primary outcome identified changes in TXA clearance and distribution volume, which provided the rationale for dose adjustment. Descriptive clinical outcomes assessed postoperative seizures, blood loss, ischemic-thrombotic complications, in-hospital mortality, and length of hospital stay. RESULTS: TXA concentrations were elevated and sustained above the therapeutic threshold for approximately 12 hours in high-risk stages 3–5 groups, in accordance to CRD severity. CONCLUSIONS: Using a pharmacokinetic model, we propose a simple new TXA dosing regimen that optimizes maximal antifibrinolysis and avoids excessive drug dosing. Accepted for publication October 26, 2017. Funding: This study was supported by Heart and Stroke Foundation of Canada, Merit Award, Department of Anaesthesia, University of Toronto, and Natural Sciences and Engineering Research Council of Canada. The sponsors aided funding of the study and were not involved in the study conduct, analysis, or data interpretation. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Study Registration: ClinicalTrials.gov, NCT01609686. The study concept was derived by A.J. and M.W. The study was designed by all authors. Tranexamic acid concentration measurement was performed by N.L., N.R.G., T.V., B.B., and J.P. Statistical analysis was conducted by A.J. Pharmacokinetic analysis was conducted by Q.J.Y. and K.S.P. All authors contributed to the study manuscript. Reprints will not be available from the authors. Address correspondence to Angela Jerath, FRCPC, FANZCA, MBBS, BSc, Department of Anaesthesia and Pain Medicine, Toronto General Hospital University Health Network, Toronto, Ontario M5G 2C4, Canada. Address e-mail to Angela.Jerath@uhn.ca. © 2018 International Anesthesia Research Society

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Chinese Anesthesiologists Have High Burnout and Low Job Satisfaction: A Cross-Sectional Survey

BACKGROUND: The Chinese health care system must meet the needs of 19% of the world's population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing–Tianjin–Hebei region focusing on job satisfaction and burnout to determine the incidence and associated factors. METHODS: A large cross-sectional study was performed in the Beijing–Tianjin–Hebei region of China. The anonymous questionnaire was designed to collect and analyze the following information: (1) demographic characteristics and employer information; (2) job satisfaction assessed by Minnesota Satisfaction Questionnaire; (3) burnout assessed by Maslach Burnout Inventory-Human Service Survey; and (4) sleep pattern and physician–patient communication. RESULTS: Surveys were completed and returned from 211 hospitals (response rate 74%) and 2873 anesthesiologists (response rate 70%) during the period of June to August 2015. The overall job satisfaction score of Minnesota Satisfaction Questionnaire was 65.3 ± 11.5. Among the participants, 69% (95% confidence interval [CI], 67%–71%) met the criteria for burnout. The prevalence of high emotional exhaustion, high depersonalization, and low personal accomplishment was 57% (95% CI, 55%–59%), 49% (95% CI, 47%–51%), and 57% (95% CI, 55%–58%), respectively. Using multivariable logistic regression analysis, we found that age, hospital category, working hours per week, caseload per day, frequency of perceived challenging cases, income, and sleep quality were independent variables associated with burnout. Anesthesiologists with a high level of depersonalization tended to engage in shorter preoperative conversations with patients, provide less information about pain or the procedure, and to have less empathy with them. CONCLUSIONS: The anesthesiologists in the Beijing–Tianjin–Hebei region of China expressed a below-average level of job satisfaction, and suffered a significant degree of burnout. Improvement in job satisfaction and burnout might create a positive work climate that could benefit both the quality of patient care and the profession of anesthesiology in China. Accepted for publication November 21, 2017. Funding: This study was sponsored by the Department of Anesthesiology, Peking Union Medical College Hospital. The authors declare no conflicts of interest. H. Li and M. Zuo contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Yuguang Huang, MD, Department of Anesthesiology, Peking Union Medical College Hospital, No 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. Address e-mail to garybeijing@163.com. © 2018 International Anesthesia Research Society

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The Role of Cost-Effectiveness Analysis in Global Anesthesia

No abstract available

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Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa

BACKGROUND: Previously, we studied the relative importance of different institutional interventions that the largest hospital in Iowa could take to grow the anesthesia department's outpatient surgical care. Most (>50%) patients having elective surgery had not previously had surgery at the hospital. Patient perioperative experience was unimportant for influencing total anesthesia workload and numbers of patients. More important was the availability of surgical clinic appointments within several days. These results would be generalizable if the median time from surgery to a patient's next surgical procedure was large (eg, >2 years), among all hospitals in Iowa with outpatient surgery, and without regard to the hospital where the next procedure was performed. METHODS: There were 37,172 surgical cases at hospital outpatient departments of any of the 117 hospitals in Iowa from July 1, 2013, to September 30, 2013. Data extracted about each case included its intraoperative work relative value units. The 37,172 cases were matched to all inpatient and outpatient records for the next 2 years statewide using patient linkage identifiers; from these were determined whether the patient had surgery again within 2 years. Furthermore, the cases' 1820 surgeons were matched to the surgeon's next outpatient or inpatient case, both including and excluding other cases performed on the date of the original case. RESULTS: By patient, the median time to their next surgical case, either outpatient or inpatient, exceeded 2 years, tested with weighting by intraoperative relative value units and repeated when unweighted (both P 2 years for patients versus 1 day for surgeons. Thus, although patients' experiences are an important attribute of quality of care, surgeons' experiences are orders of magnitude more important from the vantage point of marketing and growth of an anesthesia practice. Accepted for publication November 20, 2017. Funding: Departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Dr, 6 JCP, Iowa City, IA 52242. Address e-mail to Franklin-Dexter@UIowa.edu. © 2018 International Anesthesia Research Society

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