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Anesthesiology, as an occupation, has its own unique sets of challenges, problems, issues, and circumstances, all leading to \"occupational stress,\" which by now should be unequivocally accepted as a well-established fact. It is futile to continue pursuing research questions like, if there \"really\" is stress existing among practicing anesthesiologists/trainees, by conducting questionnaire-based surveys and doing meta-analyses. A significantly high incidence of existence of occupational stress in anesthesiologists is an undisputable and practical reality, which, when longstanding, gets culminated into \"burnout syndrome\" with its disastrous outcomes. Rather than pursuing the often-trodden path of finding the incidence, sources, and other superficial issues, an in-depth study of available literary evidence in relation to burnout has been carried out. Objectifying it as a \"syndrome,\" its etiopathogenesis, pathophysiology inclusive of the prevalent theories of its causality, typology, and progression into various stages of/continuum of the process as an evolving clinical entity have been described. The preventive measures and \"coping strategies\" have been discussed at length in the end. It is the fervent hope and the desire of the authors that this discourse will sensitize all anesthesiologists, especially the younger and upcoming future generation, and help them avoid becoming a prey to this dreadful entity!

Transesophageal echocardiography (TEE) has emerged as a critical imaging technique for anesthesiologists, enabling them to monitor and detect significant cardiothoracic conditions in both cardiac and noncardiac surgical patients throughout the perioperative period. Given the expanding applications of TEE, its integration into the anesthesiology residency curriculum at an early stage is crucial. This ensures that residents have ample time to develop their TEE skills, thereby facilitating meaningful clinical application post-residency. While studies have demonstrated the successful use of simulators and web-based modules in TEE education, there is currently a lack of educational materials that provide a structured curriculum specifically designed to teach the fundamentals of TEE to residents. Furthermore, simulation training in TEE prior to patient exposure may contribute to enhanced patient safety and comfort. By providing residents with the opportunity to practice their TEE skills in a controlled, risk-free environment, simulation training can help to mitigate the potential risks associated with real-world patient care. TEE has become an indispensable tool for anesthesiologists, and its integration into the residency curriculum is essential. The use of simulation-based training, particularly in a virtual reality setting, offers a promising avenue for enhancing TEE education and fostering the development of competent practitioners.

OBJECTIVE: Job burnout among anesthesiologists has been consistently high. This study evaluated the association of calcium and vitamin D supplementation with burnout among Chinese anesthesiologists.
METHODS: A cross-sectional online survey was conducted during April and May 2023. Burnout was evaluated using the Maslach Burnout Inventory, which assesses emotional exhaustion, depersonalization, and low personal accomplishment. Data on calcium and vitamin D supplementations were self-reported. Sociodemographic information and medical history were also assessed. Binary and ordinal logistic regression were used to evaluate the risk of burnout and burnout levels, respectively. The relative excess risk due to interaction and the attributable proportion due to interaction were examined to determine the synergistic effects of calcium and vitamin D supplementations on burnout risk.
RESULTS: Among the 4222 invited anesthesiologists, 3766 submitted eligible questionnaires. Approximately 49.8% met the criteria for general burnout. Among anesthesiologists with burnout, 58.4% experienced emotional exhaustion, 35.8% depersonalization, and 61.2% low personal accomplishment. Anesthesiologists receiving calcium supplementation had a decreased risk of emotional exhaustion (OR = .83, 95% CI = .70-.99). Supplementation of vitamin D with or without calcium was not associated with overall burnout and any of its dimensions. No additive interaction of calcium and vitamin D on burnout was observed.
CONCLUSIONS: Job burnout among anesthesiologists is of concern in China. Burnout is negatively associated with calcium supplementation but not with vitamin D. Further research is warranted to confirm the mechanism and causal relationship.

UNASSIGNED: Penile plication is commonly performed for Peyronie\'s disease under general or spinal anesthesia. Conscious sedation (CS) offers decreased anesthetic risks, cost-effectiveness, and the ability to perform the procedure in outpatient settings with shorter wait times. We sought to compare tolerability of penile plication under deep intravenous sedation (DIS) administered by anesthesiologists and nursing-administered CS (NACS).
UNASSIGNED: Tolerability for penile plication was prospectively evaluated, excluding revision surgeries and those with hourglass or hinge deformities. DIS included midazolam and ketamine with infusion of propofol and remifentanil. NACS consisted of midazolam and fentanyl. Baseline characteristics, procedural information, and patient- and surgeon-reported pain assessments were collected. Patients were administered a standardized tolerability questionnaire on follow-up.
UNASSIGNED: Forty patients were enrolled (23 DIS; 17 NACS) with similar baseline characteristics. Median curvature of the DIS cohort was 55° (interquartile range = 43.75-76.25) and 45° (interquartile range = 45-60) in NACS. There was a 100% success rate with no procedure abortion or conversion to general anesthetic. On follow-up, all patients had functional curvature (<20°), and 100% of patients in the DIS and NACS cohorts reported that they would recommend CS to others. Over 93% of patients in both cohorts would choose CS over general anesthetic in the future, with no differences in perioperative and postoperative pain between groups.
UNASSIGNED: Penile plication with CS, whether administered by an anesthesiologist or nursing, is well tolerated with no differences in pain or complications. This indicates that outpatient penile plication with trained nursing staff administering CS can safely reduce costs, risks, and wait times.

BACKGROUND: The majority of published research suggests that anesthesia handovers during major surgical procedures are associated with unintended harmful consequences. It is still unclear if the number or quality of the transition of care is the main driver of the adverse outcomes. There is even less data if the timing of the anesthesiologist handovers during the critical portion of the anesthetic continuum (induction or emergence versus surgical period) plays a role in patient outcomes. Therefore, we investigated if the anesthesiologist handovers during induction and emergence are associated with adverse patient outcomes.
METHODS: This retrospective investigation included noncardiac surgical procedures occurring between January 1, 2012 and December 31, 2019 that had exactly 1 attending anesthesiologist handover. We categorized transitions of care between attending anesthesiologists as being before incision, between incision and closing, and after closing. Our primary outcome was a composite of 6 categories of surgical complications and in-hospital mortality. We created logistic generalized estimating equation models to estimate the average relative effect odds ratio between each pair of the 3 transition timing groups across the components of the composite outcome. Inverse probability of treatment weights were used to mitigate confounding on a host of baseline variables. We used Bonferroni correction to adjust for multiple comparisons between the transition groups.
RESULTS: In total, we studied 36,937 procedures with exactly 1 attending anesthesiologist handover. Of these records, 4370 had the transition during induction, 24,999 between incision and closure, and 7568 during emergence. No differences were found between the transition periods and the composite outcome. The estimated average relative effect odds ratio (98.3% confidence interval [CI]) across the components of the composite outcome was as follows: (1.0002 [0.81-1.24], P = .99) between the induction and surgical period; (1.10 [0.87-1.40], P = .32) between the induction and emergence periods; and (0.91 [0.79-1.04], P = .08) between the emergence and surgical periods.
CONCLUSIONS: Timing of intraoperative handover among attending anesthesiologists during noncardiac surgery is not associated with adverse patient outcomes.

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Perioperative crisis events refer to unexpected seriously life-threatening when the patient is during or after surgery, and require rapid identification, evaluation, and management by clinical teams to minimize harm. The pediatric anesthesia management during perioperative period is special and challenging for anesthesiologists, requiring professional technical and non-technical skills. The article mainly elaborates on the incidence and risk factors of pediatric anesthesia crisis events during perioperative period and introduces the concept of anesthesia crisis resource management and strategies. The anesthesiologist team needs to adopt a crisis resource management strategy, taking a typical crisis event of malignant hyperthermia as an example, including identification of crisis signs immediately, termination of trigger drugs rapidly, intravenous injection of the special drug dantrolene, physical cooling, and symptomatic support treatment, seeking assistance from other teams actively, recording and feeding back. This study aims to improve the cognitive decision-making ability and teamwork ability of anesthesiologists and their teams, effectively preventing and responding to potential crisis events effectively, and ensuring the safety of pediatric patients during perioperative period.
围手术期危机事件是指在手术期间或手术后发生的、非预料之中的患者生命受到严重威胁的状态，需要临床团队快速识别、评估和管理，最大限度减少对患者的伤害。而围手术期儿科麻醉的管理对于麻醉医师尤其具有特殊性和挑战性，需要麻醉医师具备专业的技术和非技术技能。本文主要阐述围手术期儿科麻醉危机事件的发生率和风险因素，引入麻醉危机资源管理的概念以及处理策略。并以恶性高热典型危机事件为例，介绍了麻醉团队需采取的麻醉危机资源管理策略，包括及时识别危机征兆、迅速终止诱发药物、静注特效药丹曲林钠、物理降温及对症支持治疗、积极寻求其他团队协助、记录和反馈等。以期提高麻醉医师的认知决策能力和团队合作能力，从而有效预防和应对可能发生的潜在危机事件，保障患儿围手术期的安全。.

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Point-of-care ultrasound (POCUS) has been developed as a critical tool for diagnostic patient evaluation and clinical management. Its transcendence into anesthesiology necessitates appropriate and effective educational strategies to assist in the development of anesthesia POCUS learners. Several professional societies, including the American Society of Anesthesiologists (ASA), American Society of Regional Anesthesia (ASRA), and Accreditation Council for Graduate Medical Education (ACGME) for anesthesiology have established minimum training standards for POCUS education for anesthesiologists, residents, and fellows.1,4 The article at hand aims to summarize and provide insight into the various educational modalities utilized in POCUS training, incorporate these strategies in the established \"Indication, Acquisition, Interpretation, and Medical decision-making\" (I-AIM) framework, and include recommendations on the minimum number of POCUS exams to aid in achieving competency. 3.