Effects of Preoperative Sublingual Misoprostol on Uterine Tone during Isoflurane Anesthesia for Cesarean Section

SummaryBackground and objectivesMisoprostol would reduce the uterine bleeding after cesarean delivery without harmful effects on either mother or baby. We aimed to evaluate the effects of preoperative misoprostol on maternal blood loss, uterine tone, and the need for additional oxytocin after cesarean delivery under isoflurane anesthesia.MethodsAfter ethical approval, 366 patients scheduled for elective cesarean delivery were randomly allocated to receive either sublingual misoprostol 400μg (n=179) or placebo tablet (n=187) after intubation. Anesthesia was maintained with 0.5–0.7 MAC isoflurane with nitrous oxide. All patients received intravenous infusion of 10IU of oxytocin after placental delivery. Perioperative estimated blood loss, uterine tone, need for supplementary oxytocin, hematocrit, Apgar scores at 1 and 5 min and adverse effects were recorded.ResultsAfter induction, patients receiving sublingual misoprostol had significant less perioperative estimated blood loss (202±383.1 vs. 708±204.3mL, p<0.001), need for oxytocin (p<0.001), higher hematocrit levels (p<0.001) and uterine tone (p<0.02). The incidence of shivering was higher in the misoprostol group (p=0.04). There were no differences between the two groups as regarding Apgar scores, nausea and vomiting, gastrointestinal disturbances and pyrexia.ConclusionPreoperative administration of sublingual misoprostol 400μg is safe and effective in attenuating the maternal bleeding and uterine atony from isoflurane anesthesia for cesarean delivery

Challenges in the Cardiothoracic and Vascular Anesthesia Fellowship Program Since the Coronavirus Disease 2019 (COVID-19) Pandemic: An Electronic Survey on Potential Solutions

OBJECTIVE: We explored the current practice of fellowship training in cardiothoracic and vascular anesthesia and surveyed the acceptability of potential solutions to mitigate the interrupted fellowship training during the severe acute respiratory syndrome coronavirus disease (COVID-19) pandemic. DESIGN: A prospective electronic questionnaire-based survey. SETTING: The survey was initiated by the Education Committee of the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) PARTICIPANTS: EACTAIC fellows, EACTAIC and non-EACTAIC subscribers to the EACTAIC newsletter and EACTAIC followers on different social media platforms. INTERVENTIONS: After obtaining the consent of participants, we assessed the peri-operative management of COVID-19 patients, infrastructural aspects of the workplace, local routines for preoperative testing, the perceived availability of personal protective equipment (PPE) and the impact of COVID-19 on fellowship training. In addition participants rated suggested solutions by the investigators to cope with the interruption of fellowship training using a traffic light signal scale. MEASUREMENTS AND MAIN RESULTS: We collected 193 responses from 54 countries. 82.4% of respondents reported cancelling or postponing elective cases during the first wave. Of the respondents, 89.7% had provided care for COVID-19 patients, 75.1% reported staff in their center being reassigned to work in the Intensive Care Unit (ICU), and 45% perceived a shortage of PPE at their centers. Most respondents reported the termination of local educational activities (79.6%) and fellowship assessments (51.5%) because of the pandemic (although 84% of them reported having time to participate in online teaching), and 83% reported a definitive psychological impact. More than 90% of the respondents chose green and/or yellow traffic lights to rate the importance of the suggested solutions to cope with the interrupted fellowship training during the pandemic. CONCLUSIONS: The COVID-19 pandemic led to the cancellation of elective cases, deployment of anesthesiologists to intensive care units, involvement of anesthesiologists in perioperative care for COVID-19 patients, and interruption of educational activities and trainees’ assessments. There is some consensus on suggested solutions for mitigation of the interruption in fellowship training

European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum:First Edition

International audiencePediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers

European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition.

International audienceThis document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale. The new regulations include the following: (1) more flexibility in the fellows` rotation, as long as the total number of days, rotations, and cases are completed during the training year; (2) recommendation for strict compliance with national working-time guidelines; (3) no extension of fellowship training to compensate for annual and/or sick leave, unless the required minimum number of cases and rotations are not reached; (4) interruption of fellowship training for >12 months is allowed for personal or medical reasons; (5) introduction of a checklist for quantitative assessment of standard clinical skills; (6) recommendations for a uniform structure of exit interviews; (7) possibility of a 1-month training rotation in a postanesthesia care unit instead of an intensive care unit; and (8) provided all other requirements have been met, the allowance of progression from the basic training year to the advanced fellowship training year without first passing the transesophageal echocardiography examination

Can the similarity index predict the causes of retractions in high-impact anesthesia journals? A bibliometric analysis

Background: The overall similarity index (OSI) and highest similarity scores (HSSs) from a single source might help to predict the potential reasons for the retraction from the anesthesia journals. Methods: Retracted publications, from five highest impact anesthesia journals, were retrieved from the MEDLINE and journal archives and analyzed using a plagiarism detection software (iThenticate) and manually verified for citation characteristics, OSI, HSS, and the presence, extent, and location of the duplicate text. The validity of the OSI including and excluding quotations and references and the HSS in predicting the potential reasons for retraction were tested using the receiver operating characteristic curves. Results: Of the total 138 retracted original and corresponding articles identified, 131 articles were analyzed. Most of them had the HSS more than 40% arising from a single source. Extensive degree of plagiarism (OSI score >35%) was identified through the main text of all analyzed retracted articles. The areas under the curves indicate that the OSI including and excluding quotations and bibliography and the HSS had reasonable ability to predict plagiarism and fabrication with a perfect sensitivity rate and low specificity but were weaker at distinguishing ethical misconduct or inconsistent or erroneous contents. Conclusions: The study highlights the presence of significant plagiarism in the retracted anesthesia publications irrespective to the reasons for retraction. The high OSI and the HSS could be useful tools to identify the potential manuscripts with high risks for plagiarism and fabrication

Impact of regional analgesia techniques on the long-term clinical outcomes following thoracic surgery

Continuous monitoring of clinical outcomes after thoracotomy is very important to improve medical services and to reduce complications. The use of regional analgesia techniques for thoracotomy offers several advantages in the perioperative period including effective pain control, reduced opioid consumption and associated side effects, enhanced recovery, and improved patient satisfaction. Postthoracotomy complications, such as chronic postthoracotomy pain syndrome, postthoracotomy ipsilateral shoulder pain, pulmonary complications, recurrence, and unplanned admission to the intensive care unit are frequent and may be associated with poor outcomes and mortality. The role of regional techniques to reduce the incidence of these complications is questionable. This narrative review aims to investigate the impact of regional analgesia on the long-term clinical outcomes after thoracotomy

Enhanced recovery after surgery: comes out to the Sun

Abstract ERAS programs aim to reduce the length of hospital stays and lower costs, and minimize the risk of postoperative complications and readmissions while enhancing the overall patient experience. BMC Anesthesiology has initiated a new collection on ERAS, urging investigators to conduct large-scale, high-quality studies that address the existing knowledge gap

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

Background: This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents (NMB) in 2012. Methods: We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine "first choice" use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring (NMT), type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium. Results: A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation (39% and 35%, respectively). From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB. Conclusions: We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC (>20%) and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines