Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study

Introduction. The aim of the study was to assess changes of regional ventilation distribution at the level of the 3rd intercostal space in the lungs of morbidly obese patients as a result of general anaesthesia and laparoscopic surgery as well as the relation of these changes to lung mechanics. We also wanted to determine if positive end-expiratory pressure of 10 cm H2O prevents the expected atelectasis in the morbidly obese patients during general anaesthesia. Materials and Methods. 49 patients completed the examination and were randomized to 2 groups: ventilated without positive end-expiratory pressure (PEEP 0) and with PEEP of 10 cm H2O (PEEP 10) preceded by a recruitment maneuver with peak inspiratory pressure of 40 cm H2O. Impedance Ratio (IR) was utilized to examine ventilation distribution changes as a result of anaesthesia, pneumoperitoneum, and change of body position. We also analyzed intraoperative respiratory mechanics and pulse oximetry values. Results. In both groups general anaesthesia caused a ventilation shift towards the nondependent lungs which was not further intensified after pneumoperitoneum. Reverse Trendelenburg position promoted homogeneous ventilation distribution. Respiratory system compliance was reduced after insufflation and improved after exsufflation of pneumoperitoneum. There were no statistically significant differences in ventilation distribution between the examined groups. Respiratory system compliance, plateau pressure, and pulse oximetry values were higher in PEEP 10. Conclusions. Changes of ventilation distribution in the obese do occur at cranial lung regions. During pneumoperitoneum alterations of ventilation distribution may not follow the direction of the changes of lung mechanics. In the obese patients PEEP level of 10 cm H2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis induced by general anaesthesia

Life Satisfaction and Work-Related Satisfaction among Anesthesiologists in Poland

The aim of the study was to assess the level of life and job satisfaction of Polish anesthesiologists and to explore the impact of extrinsic-hygiene and intrinsic-motivating determinants. Materials and Methods. A cross-sectional questionnaire study was conducted among consultant anesthesiologists in Lodz region. The questionnaire concerned patient care, burden, income, personal rewards, professional relations, job satisfaction in general, and life satisfaction. Respondents were asked to rate their level of satisfaction for each item on a seven-point Likert scale (1: extremely dissatisfied; 7: extremely satisfied). Results. 86.03% of anesthesiologists were satisfied with their economic status, 77.94% found their health status satisfactory, and 52.21% viewed their personal future optimistically. In general, 71.32% of anesthesiologists were satisfied with their current job situation. Among the less satisfying job aspects were work-related stress (2.49; SD = 1.23), administrative burden (2.85; SD = 1.47), workload (3.63; SD = 1.56), and leisure time (3.09; SD = 1.44). Conclusions. Considerable work-related stress leads to job dissatisfaction among anesthesiologists. There is an association between job satisfaction and health status, social life, and economic status. Working for long hours by anesthesiologists results in a high risk of burnout