A national survey into desirable personality traits in anaesthesia trainees in a developing country

OBJECTIVE: To explore personality traits considered to be important in selection of trainees by consultant anaesthetists in a developing country. METHODS: A questionnaire listing 28 traits was sent to 125 consultant anaesthetists. The raters were asked to mark each trait on a scale of 1 to 10, with one being least desirable and 10 as most desirable. Listing of five most desirable and one least desirable trait was also required. RESULTS: The response rate was 79%. The most desirable trait was identified as reliability by 40%, followed by honesty 17%, functionality under stress 9%, punctuality 7%, and discipline 4%. The least desirable trait was considered as resourcefulness (21%), sense of humour (20%), unassuming mannerism (15%), high self esteem (11%), inquisitive (5%) and expedious (5%). CONCLUSION: Some traits have been identified as more desirable than others for trainees in our country. We plan to assess these in structured behavioural interviews in our residency programme

Anaesthetic management of patient with Ellis Van Creveld syndrome

A known case of Ellis-Van Creveld Syndrome was scheduled for emergency repair of obstructed paraumblical hernia. We describe the anaesthetic management of the case with special reference to the classic physical and physiological manifestations of this syndrome present in our patient

Post-dural puncture posterior reversible encephalopathy syndrome

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there was complete resolution of neurological symptoms. We highlight the importance of high index of suspicion of this reversible encephalopathy in obstetric cases with intentional or inadvertent dural puncture, with headache similar to post-dural punctural headache, and the essential role of neuroradiology in confirmation of the diagnosis, as placement of an epidural blood patch would be highly detrimental in these cases

Using participatory research methods to explore residents’ perception of workplace stressors during residency training

Introduction: The culture of the learning environment is a major determinant of behaviours developed by residency trainees. This study explores anaesthesia residents perceptions of workplace stressors which affect behaviour and work performance adversely during the training period. Methods: We used two complementary qualitative participatory research methods based on focus group discussions and semi-structured interviews, with volunteers from each year of residency. The discussions were held in complete privacy and recorded on a digital voice recorder. Report of each discussion was shared with all participants to ensure credibility through member checking. Results: The stressors identified by anaesthesia residents which impaired work performance and generated stress were related to multiple supervisors, conflicting attitudes of different supervisors, workload and unsupportive organizational culture outside the parent department. Conclusion: Tensions due to lack of tolerance for divergent practices, diverse faculty, lack of constructive feedback and respect are the major stressors identified by residents which affect behaviour adversely. This information is a valuable resource for evaluation of workplace culture as perceived by the trainees, and planning self-development programs for faculty members and medicals resident

Audit of postoperative nausea and vomiting in paediatric day case surgery

OBJECTIVE: To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009. METHODS: All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay in discharge, or unplanned admission due to PONV were documented. Data was analyzed on SPSS 14. RESULTS: Out of 163 patients only one patient (0.6%) had an episode of vomiting in the recovery room and two patients (1.2 %) had vomiting in the step down unit. There was no delay in discharge or unplanned admission due to PONV in paediatric day cases during the period of our audit. CONCLUSION: The incidence of postoperative vomiting in paediatric day cases at our day care unit does not justify polymodal prophylaxis as a protocol for PONV

Paraneoplastic syndrome of renal cell carcinoma

We report a case of renal cell carcinoma who presented with the classic triad of flank pain, hematuria and fever as well as progressively developed multisystem disease, including a massive anteroseptal myocardial infarction. This was diagnosed as paraneoplastic syndrome of renal cell carcinoma and the decision to proceed with nephrectomy was taken after 3 weeks of acute myocardial infarction, despite predicted high cardiac risk under general anaesthesia; following removal of tumour, all symptoms and signs regressed. He has remained well till the time of last follow-up 4 months later

Anticipated vs. experienced pain at site of spinal needle insertion in patients undergoing elective lower segment caesarean section: Perspective from resource-limited region

Background: Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient\u27s expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS). Method: The cross-sectional study was conducted in a labour room suite of a tertiary care hospital. Results: A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain (P value \u3c 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate (coefficient: 2.59; 95% CI: 1.49 to 3.68; P value \u3c 0.001) and multivariable analyses (coefficient: 2.51; 95% CI: 1.36 to 3.67; P value \u3c 0.001). Thus, anxiety was associated with statistically significant higher anticipated pain. Conclusion: In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSC

Evaluation of cardiology consultations sought from the anaesthesia clinic

Objective: To evaluate the criteria for cardiology referrals and to assess the perioperative relevance of the cardiology advice given in patients evaluated for non-cardiac surgery.Design: Single center, observational study.PLACE AND DURATION OF STUDY: Outpatient Anaesthesia Clinic at The Aga Khan University Hospital (AKUH), between January 2001- August 2001 and February 2002- August 2002.MATERIALS AND Methods: A review of case files of 70 patients, scheduled for non-cardiac surgery, who were referred for cardiology consultations from the anaesthesia clinic at AKUH during the study period. The clinical criteria for seeking cardiology advice, the cardiology advice given, its influence on patient management, as well as number of adverse cardiac events in the perioperative period were documented.Results: A history of hypertension, ischemic heart disease, and ECG abnormalities were the major criteria for seeking opinion on cardiac status. Cardiology advice frequently resulted in the ordering of extensive cardiac investigations. Among the patients identified for further tests by the cardiologists, 75% had no evidence of ischemic heart disease or myocardial dysfunction; none of them were monitored invasively intraoperatively or had adverse cardiac events in the perioperative period requiring intensive care or prolonged hospital stay.CONCLUSION: No definite criteria or pattern for referrals was identified. Most of the referrals did not fall within the AHA guidelines. Cardiology advice given had very little influence on the perioperative management