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PURPOSE: Since 2010, new guidelines for procedural sedation and the Helsinki Declaration on Patient Safety have increased patient safety, comfort, and acceptance considerably. Nevertheless, the administration of sedatives and opioids during sedation procedures may put the patient at risk of hypoxemia. However, data on hypoxemia during procedural sedation are scarce. Here, we studied the incidence and severity of hypoxemia during procedural sedations in our hospital. METHODS: A historical, single-centre cohort study was performed at the University Medical Centre Utrecht (UMCU), a tertiary centre in the Netherlands. Data from procedural sedation in our hospital between 1 January 2011 and 31 December 2018 (3,459 males and 2,534 females; total, 5,993) were extracted from our Anesthesia Information Management System. Hypoxemia was defined as peripheral oxygen saturation < 90% lasting at least two consecutive minutes. The severity of hypoxemia was calculated as area under the curve. The relationship between the severity of hypoxemia and body mass index (BMI), American Society of Anesthesiologists (ASA) Physical Status classification, and duration of the procedure was investigated. The primary outcome was the incidence of hypoxemia. RESULTS: Twenty-nine percent of moderately to deeply sedated patients developed hypoxemia. A high incidence of hypoxemia was found in patients undergoing procedures in the heart catheterization room (54%) and in patients undergoing bronchoscopy procedures (56%). Hypoxemia primarily occurred in longer lasting procedures (> 120 min) and especially in the latter phases of the procedures. There was no relationship between severity of hypoxemia and BMI or ASA Physical Status. CONCLUSIONS: This study showed that a considerable number of patients are at risk of hypoxemia during procedural sedation with a positive correlation shown with increasing duration of medical procedures. Additional prospective research is needed to investigate the clinical consequences of this cumulative hypoxemia.

RéSUMé: OBJECTIF: Depuis 2010, les nouvelles lignes directrices pour la sédation procédurale et la Déclaration d'Helsinki concernant la sécurité des patients ont considérablement augmenté la sécurité, le confort et l'acceptation des patients. L'administration de sédatifs et d'opioïdes pendant les interventions sous sédation peut toutefois mettre le patient à risque d'hypoxémie. Cependant, les données concernant l'hypoxémie pendant une sédation procédurale sont rares. Ici, nous avons étudié l'incidence et la sévérité de l'hypoxémie pendant la sédation procédurale dans notre hôpital. MéTHODE: Une étude de cohorte historique monocentrique a été réalisée au Centre médical universitaire d'Utrecht (UMCU), un centre tertiaire aux Pays-Bas. Les données des sédations procédurales réalisées dans notre hôpital entre le 1er janvier 2011 et le 31 décembre 2018 (3459 hommes et 2534 femmes; au total, 5993 patients) ont été extraites de notre système de gestion de l'information en anesthésie. L'hypoxémie a été définie comme une saturation périphérique en oxygène < 90 % durant au moins deux minutes consécutives. La sévérité de l'hypoxémie a été calculée en tant que surface sous la courbe. Les relations entre la sévérité de l'hypoxémie et l'indice de masse corporelle (IMC), la classification du statut physique selon l'American Society of Anesthesiologists (ASA) et la durée de l'intervention ont été étudiées. Le critère d'évaluation principal était l'incidence d'hypoxémie. RéSULTATS: Vingt-neuf pour cent des patients sous sédation modérée à profonde ont développé une hypoxémie. Une incidence élevée d'hypoxémie a été observée chez les patients subissant des interventions en salle d'hémodynamie (54 %) et chez les patients subissant des bronchoscopies (56 %). L'hypoxémie est principalement survenue lors d'interventions plus longues (> 120 min) et particulièrement dans les phases plus tardives des interventions. Aucune relation n'a été observée entre la sévérité de l'hypoxémie et l'IMC ou le statut physique ASA. CONCLUSION: Cette étude a démontré qu'un nombre considérable de patients sont à risque d'hypoxémie pendant la sédation procédurale, une corrélation positive ayant été démontrée avec une durée prolongée des interventions médicales. D'autres recherches prospectives sont nécessaires pour étudier les conséquences cliniques de cette hypoxémie cumulée.

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BACKGROUND: Severe pulmonary complications occur frequently following transthoracic oesophagectomy. An exaggerated immunological response is probably a main driving factor, and this might be prevented by perioperative administration of a glucocorticoid. OBJECTIVE: To determine the clinical benefits and harms of perioperative glucocorticoid during transthoracic oesophagectomy, using pulmonary complications as the primary outcome. Mortality, anastomotic leakage rate and infection were secondary outcomes. METHODS: A systematic review of interventional trials with a meta-analysis of randomised controlled trials (RCTs). RESULTS: The search retrieved seven RCTs and four interventional nonrandomised studies. In total, 367 patients received perioperative glucocorticoid and 415 patients did not. A meta-analysis of the RCTs showed no significant effect of glucocorticoid. For pulmonary complications, the pooled risk ratio was 0.69 [95% confidence interval (CI) 0.26 to 1.79], for anastomotic leakage 0.61 (95% CI 0.23 to 1.61) and for infections 1.09 (95% CI 0.41 to 2.93). A subgroup analysis of RCTs that used weight-dependent dosing within 30 min preoperatively showed a pooled risk ratio of 0.28 (95% CI 0.10 to 0.77) for pulmonary complications compared with placebo. CONCLUSION: In this meta-analysis, perioperative administration of glucocorticoid did not affect the risk of pulmonary complications after transthoracic oesophagectomy, nor did it cause adverse effects. A subgroup analysis showed that a weight-dependent dose of methylprednisolone 10 to 30 mg kg within 30 min preoperatively might be the most promising dosing regimen for further research.

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BACKGROUND: In the Netherlands, the employment as a "nurse anaesthetist" is comparable to that of a registered nurse anaesthetist in the Scandinavian countries and Poland. However, the Dutch healthcare system employs nurse anaesthetists both with and without nursing backgrounds. This study has investigated whether a nursing background influences the attitudes and perceptions of nurse anaesthetists in the Netherlands. METHODS: A survey was distributed to all nurse anaesthetists working in Dutch hospitals to discover differences in their perceptions of their work context, job satisfaction, and work climate, as well as health and turnover intention. The questionnaire also sought basic information on socio-demographic factors and psychosomatic symptoms. Descriptive statistics, factor analyses and independent T-tests were computed. RESULTS: Overall 923 of a total of 2,000 questionnaires were completed and analysed (response rate of 46%). Independent T-tests showed no significant differences between nurse anaesthetists with and those without nursing backgrounds in all the areas examined. CONCLUSION: Dutch nurse anaesthetists with and without nursing backgrounds reported similar perceptions of and information about their work context, job satisfaction, work climate, psychosomatic symptoms, burnout, sickness absence, general health and turnover intention. Both academic tracks appeared to produce individuals who functioned similarly as professionals.

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Finding ways to retain nurse anesthetists in the profession to meet the increasing demands of the healthcare system is of paramount importance. The present study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. A questionnaire was distributed to Dutch nurse anesthetists to assess their perceptions of their work climates, and their levels of job satisfaction. Multiple regression analyses were performed to obtain the predictive value of work climate for job satisfaction. All of the work climate characteristics had statistically significant correlations to job satisfaction, and explained 20% of the variance in job satisfaction. To achieve a higher level of job satisfaction among nurse anesthetists, it is necessary to improve some essential work climate characteristics, such as: (1) making the nurse anesthetist feel an important part of the organization's mission statement, (2) discussing progress at work, (3) giving recognition for delivered work, (4) encouraging development, and (5) providing sufficient opportunities to learn and to grow.

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BACKGROUND: The retention of nurse anesthetists is of paramount importance, particularly in view of the fact that the health care workforce is shrinking. Although many health care providers find their work satisfying, they often consider leaving their jobs because of the stress. Are there ways to improve this situation? PURPOSE: This study investigated how work environment characteristics and personality dimensions relate to burnout and job satisfaction and ultimately to turnover intention among Dutch nurse anesthetists. METHODOLOGY: An online self-reporting questionnaire survey was performed among Dutch nurse anesthetists. The questionnaire included scales to assess personality dimensions, work climate, work context factors, burnout, job satisfaction, and turnover intention. The research model stated that personality dimensions, work climate, and work context factors, mediated by burnout and job satisfaction, predict turnover intention. Structural equation modeling was used to test the research model. FINDINGS: Nine hundred twenty-three questionnaires were completed (46% response rate). Burnout mediated the relationship between personality dimensions and turnover intention; job satisfaction mediated the relationship of work climate and work context factors to turnover intention. PRACTICE IMPLICATIONS: To retain nursing staff and to maintain adequate staff strength, it is important to improve job satisfaction by creating a positive work climate and work context and to prevent burnout by selecting the most suitable employees through personality assessment.

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Objectives. To investigate which skills and competence are imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and to analyze the underlying levels of evidence. Study Design and methods. Systematic review of literature published between 1993 and March 2009. Selected papers were classified according to their methodological quality and summarized in evidence-based conclusions. Next, conclusions were used to formulate recommendations. Results. Although the safety profiles vary among PS drugs, the possibility of potentially serious adverse events and the predictability of depth and duration of sedation define the imperative skills and competence necessary for a timely recognition and appropriate management. The level of effectiveness is mainly determined by the ability to apply titratable PS, including deep sedation using short-acting anesthetics for invasive procedures and nitrous oxide for minor painful procedures, and the implementation of non-pharmacological techniques. Conclusions. PS related safety and effectiveness are determined by the circumstances and professional skills rather than by specific pharmacologic characteristics. Evidence based recommendations regarding necessary skills and competence should be used to set up training programs and to define which professionals can and cannot be credentialed for PS in children.

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BACKGROUND AND OBJECTIVE: The anaesthesia workforce in Europe is understaffed and may not meet the growing demands of surgery. In many European countries where responsibilities can be identified and a varying degree of task substitution occurs, the anaesthesia service is provided by a team of physician and nonphysician anaesthesia members. This study assesses the availability, as well as the roles and functions, of nonphysician anaesthesia team members in European countries. METHODS: A survey was carried out to examine differences in anaesthesia practices and the strength of the anaesthesia workforce in Europe. A questionnaire, seeking information about perioperative anaesthesia input by nonphysician anaesthesia team members, was sent to all the national representatives of the Union of European Medical Specialists Anaesthesiology section and the International Federation of Nurse Anaesthetists. RESULTS: The responses to the questionnaire revealed that each European country has its own unique type of nonphysician anaesthesia team member and the roles of these vary substantially. Their levels of organisation vary from country to country and whereas nurse anaesthetists are often well organised, circulation nurses are not. CONCLUSION: The present study demonstrated the heterogeneity and variety of anaesthesia practices throughout Europe. Standardisation of the training and practice of European nurse anaesthetists is desirable for patient safety and quality of care if they seek to work in more than one European country. Those countries that anticipate a shortfall in the supply of anaesthesiologists should examine working models from other countries that currently work with fewer physicians and more nurse anaesthetists.

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