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Biomedical subjects

G L Zeitlin

Publications and source records attributed to G L Zeitlin.

11 recordsLinked to original sources

Age and anesthetic practice: a regional perspective.

STUDY OBJECTIVE: To obtain information about practitioners' behaviors, perceptions, and perspectives concerning issues related to advancing age and anesthetic practice. DESIGN: Questionnaire survey mailed to 1,208 active and retired American Society of Anesthesiologists (ASA) members in Northern New England. Topics included hours worked, practice policies, stress level of activities, observed in colleagues and personally perceived errors and problems associated with performance, and plans, preparation, and reasons for retirement. SETTING: Practicing respondents worked in academic, community, or federal hospitals, and in ambulatory surgical facilities. MEASUREMENTS AND MAIN RESULTS: For descriptive analysis, counts and frequency distributions were calculated for each question. Statistical methods were used to test differences across age groups and to identify sources of differences. Approximately 40% of respondents in each age group worked an average work week of 50 to 59 hours. Respondents aged 40 to 49 years worked the longest work weeks and duty periods and were more concerned about liability issues than other age groups. Respondents age 60+ tended to work shorter average and maximum work weeks, although 5% of them continued to work 70- to 79-hour weeks. There was no statistically significant difference in hours worked among men and women. Approximately 20% to 30% of respondents relieved older colleagues of late night or call duties, and asked them to restrict or to stop practice out of concern for patient safety. Night call was equally stressful for all age groups. Economic uncertainty, production pressure, and interpersonal relations were more stressful for younger respondents. In preparation for retirement, shifting away from complex cases and phased reduction in clinical activity were increasingly prevalent with each advancing age group. Important reasons for retirement included attitude changes, physical limitations, and declining health. CONCLUSIONS: Despite modest age-associated trends, chronological age per se is not a strong correlate of an individual's practice pattern, behaviors, or perceptions about performance.

Adult↗

Quality assurance programmes and patient safety in anaesthesia.

Formal Quality Assurance programmes have been widely promoted and applied in anaesthesia departments in the United States of America. The rationale of three well-known programmes is examined. Although they may be of use as a method of examining one's own practice, there is little objective evidence to support the idea of measuring an anaesthesiologist's competence. There is also a danger that licensing authorities will misuse such spurious information.

Anesthesia↗

Accumulation of carbon dioxide during eye surgery.

During cataract surgery, both the surgeon and the anesthesiologist need access to the patient's face. At our institution we achieved a working compromise by using an oxygen insufflating hoop, which allowed the surgeon access to the eye and a sterile field. The patient's airway was kept free by the hoop, and the patient breathed a high inspired oxygen fraction. We measured the partial pressure of carbon dioxide (PCO2) of the gas mixture under the surgeon's drapes because they form a semiclosed breathing system for the patient. Accumulation of CO2 occurred in all patients (mean +/- SD, 6.1 +/- 3.1 mmHg), but an oxygen flow of 10 L/min through the hoop prevented an additional rise of CO2 levels during the operation. Reducing the oxygen flow below 10 L/min led to increased retention of CO2 under the drapes. Paper drapes are permeable to CO2, but plastic drapes are impermeable. We did not measure the arterial partial pressure of CO2, and so we do not know whether CO2 accumulation was accompanied by respiratory acidosis.

Carbon Dioxide↗

Possible decrease in mortality associated with anaesthesia. A comparison of two time periods in Massachusetts, USA. Closed Claims Study Committee.

This paper compares mortality associated with anaesthesia in Massachusetts USA, during two periods of time separated by 13 years. The denominators in the calculation of the mortality rates are not precisely comparable but there appears to be approximately a thirteenfold decrease in the death rate after general anaesthesia and a tenfold decrease after spinal anaesthesia.

Anesthesia↗