Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effect of the use of dexmedetomidine as an adjuvant in peribulbar anesthesia in patients presented for vitreoretinal surgeries

Background: Dexmedetomidine, if used in combination with a local anesthetic mixture in peribulbar anesthesia, may alter the block characteristic. This research aimed to study the influence of adding dexmedetomidine to local anesthetics in the peribulbar block. Methods: Sixty adult patients of both gender presented for vitreoretinal surgeries were enrolled in this prospective double-blinded study. They were randomly distributed into two equal groups. All the patients received peribulbar anesthesia with 10 ml mixture composed of 4 ml of plain bupivacaine 0.5%, 4 ml of lidocaine 2 % containing 50 IU hyaluronidase, and either 2 ml of normal saline (Control group) or 20 μg dexmedetomidine in (Dexmedetomidine group). The onset, the duration, and quality of sensory and motor blockade and the perioperative sedation were recorded. Results: As compared to the control group, dexmedetomidine when added to a local anesthetics in peribulbar block, significantly decreased the onset of anesthesia to 2.40 ± 1.50 min, fastened the onset of the lid akinesia to 2.93 ± 2.07 min and globe akinesia to 2.87 ± 1.96 min, increased the duration of lid akinesia to 137.00 ± 17.94 min and globe akinesia to 166.50 ± 21.34 min, and increased the time of the first request for postoperative analgesia to 185.83 ± 30.80 min (P < .05). Also, it significantly increased the level of patients sedation (P < .05). Conclusion: A small dose of dexmedetomidine added to a local anesthetic mixture in peribulbar block improved the sensory and motor block criteria with increased level of patients sedation

Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study

Background: The use of an adjuvant to local anesthetics in the peribulbar block may improve the block characteristics. This study aimed to evaluate the effect of the addition of either ketamine or fentanyl to local anesthetics in single injection peribulbar block on the quality of the block. Methods: The study included ninety adult patients presented for vitreoretinal surgeries. Patients were randomly allocated into three groups. All patients received peribulbar block with a local anesthetic mixture composed of 4 ml lidocaine 2% containing hyaluronidase, and 5 ml of plain bupivacaine 0.5% with an addition of either 1 ml of normal saline, 30 μg fentanyl, or 25 mg ketamine in Control group, Fentanyl group, and Ketamine group respectively. The measurements included the onset and duration of both anesthesia and akinesia with evaluation of intraocular pressure, postoperative pain score and need of analgesics. Results: As compared to control group, the use of either fentanyl or ketamine as local anesthetic adjuvant significantly fastened the onset of anesthesia (1.67 ± 1.21 min) (1.93 ± 1.36 min), prolonged the duration of lid akinesia (127.50 ± 22.20 min) (127.00 ± 22.19 min), increased the duration of globe akinesia (156.00 ± 28.02 min) (158.00 ± 31.18 min), minimized the time required to start surgery (6.57 ± 1.99 min) (6.57 ± 1.85 min), and increased the time for first request of postoperative analgesia (189.50 ± 34.92 min) (184.67 ± 35.37 min) (P  .05). Conclusion: Fentanyl or ketamine can be used as a local anesthetic adjuvant in the peribulbar block in patients presented for vitreoretinal surgeries as both of them improved the quality of the block without increasing intraocular pressure

The role for pre-operative CT chest scans in suspected COVID-19 patients requiring emergent surgery

Objective: To study the role for preoperative CT chest scans in suspected COVID-19 patients requiring emergent surgery. Design: Retrospective \u2013 observational. Participants: A total of 98 patients admitted for emergency surgery with COVID-19 infection and underwent preoperative CT chest scanning. Main outcome measurements: Incidence of clinical symptoms of COVID-19 infection upon presentation, imaging characteristics in chest CT and semi-quantitative CT severity score. Results: The median age of the study cohorts was 50 years (interquartile range (IQR): 40\u201360 years) and 52/98 (53.1%) were males. The most common symptoms were fever (80.6%) and cough (65.3%). 50/98 had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test prior to CT scan, while 48/98 had positive reverse transcriptase-polymerase chain reaction (RT-PCR) result returned after imaging. The imaging characteristics were bilateral infiltrates on CT of 90/98, with 70/98 of infiltrates located peripherally and 28/98 located peripherally and centrally. The most common disease pattern was ground-glass opacities, observed in 95/98. The median total COVID-19 CT severity score was 7 (IQR: 4\u201314), corresponding to 5\u201325% global lung involvement. Conclusion: Patients with mild symptomatic COVID-19 in this study displayed CT evidence of SARS-CoV-2 infection. Preoperative CT imaging should be considered for identifying suspected active SARS-CoV-2 cases in resource limited environments with high community spread, to aid in resource allocation and personal protective equipment (PPE) rationing

Randomized Controlled Study Comparing Use of Propofol Plus Fentanyl versus Midazolam Plus Fentanyl as Sedation in Diagnostic Endoscopy in Patients with Advanced Liver Disease

Objectives. We aimed to investigate the safety and efficacy of propofol plus fentanyl versus midazolam plus fentanyl as sedative for patients with advanced liver disease presented for gastrointestinal endoscopy. Methods. A total of 100 patients with liver cirrhosis referred for upper endoscopy were enrolled and divided equally in two groups, midazolam plus fentanyl group and propofol plus fentanyl group. All patients were subjected to history taking, estimation of level of sedation, endoscopist rating, and hemodynamic parameters including oxygen saturation, heart rate, mean arterial pressure, incidence of side effect as (bradycardia, hypotension, hypoxia, nausea and vomiting, cough, shivering, or diplopia), time needed for complete recovery, and time needed for discharge. Results. There was no statistical significant difference between the studied groups regarding age, sex, weight, Child–Pugh classification score, type and duration of endoscopic intervention, time needed for complete recovery, or time needed for discharge. Complication rates were similar in both groups except for mean arterial blood pressure which was significantly lower in group of patients receiving propofol and fentanyl (P=0.001). Conclusion. The use of either propofol or midazolam in combination to fentanyl is effective in sedation of patients with advanced liver diseases presented for upper GIT endoscope. The trial is registered with ClinicalTrials.gov Identifier: NCT03063866