January - February 2023

Anesthesia Analgesia

Submitted January 2023 by Dr Susan Hale

Read by 292 Journal Watch subscribers

This editorial focuses on the concept of sponsorship in academic medicine as raised in the above study [Basile et al, 2023] and reflects on how effective sponsorship can be promulgated at personal, institutional and professional society levels.

Trainees and early career faculty:
- Recognise the importance of sponsorship in career progression
- Recognise that not all mentors can be sponsors
- Be prepared for spontaneous self-promotion opportunities
- Adhere to terms of sponsorship agreements
- Seek opportunities to sponsor junior colleagues and mentees

Sponsors and potential sponsors:
- Consider sponsorship a fundamental leadership action
- Identify departmental, institutional or professional society needs as opportunities for sponsorship
- Intentionally pair protégés with specific opportunities
- Set clear expectations for sponsorship
- Commit funding to support sponsorship
- Understand that sponsored opportunities may require ongoing support of longitudinal mentorship
- Share successful sponsorship opportunities with colleagues

Professional societies:
- Offer specific opportunities for early career participation in society and conference activities
- Use society platforms to sponsor early career members and to highlight the work of effective mentors and sponsors
- Develop speakers bureaus or other platforms to endorse and facilitate self-promotion by early career members
- Set policies to ensure representation in underrepresented groups in society activities
- Accept self-nominations as an avenue for advancement for members without access to effective sponsors
- Ensure that organisational structures provide opportunities for career advancement

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Anesthesia Analgesia

Submitted January 2023 by Dr Susan Hale

Read by 289 Journal Watch subscribers

Introduction
This study investigated the role of internal and external factors influencing the career pathways of 26 women identified as being in leadership positions in academic anesthesiology in North America. The topic was identified as an important area of research due to ongoing large gaps in the representation of women in leadership in academic medicine and in particular the specialty of anesthesia. In addition, there are few studies investigating the process of leadership emergence and there is a need to focus on women’s experiences in order to provide practical knowledge about gaining leadership positions.

Methods
This is a qualitative study of 26 women in leadership positions in anesthesiology in North America. The participants were identified using a purposive sampling strategy. Eligible participants were considered from the following groups – current and former presidents of national societies, chairs of academic anesthesiology departments and influential contributors to anesthesiology (published authors, American Board of Anesthesia Examiners and hospital executives) and identified using the ASA website, the Association of Academic Anesthesiology Chairs and the ASA Committee of Women in Anesthesiology. 4 participants were known to 1 or more of the authors. Of the participants, 92% identified as White and 8% as Black, 81% were married, 71% had spouses who were working physicians and 81% had children. The method used was constructivist grounded theory (CGT), a process which aims to construct an explanatory theory from systematically obtained data which is then analysed using comparative analysis. The primary source of data was semi-structured interviews with secondary data obtained from curriculum vitae.

Interview transcripts were analysed using CGT methodology with initial coding to identify and label patterns then subsequent focused coding on the following factors: early influences, mentorship, leadership attainment, self-perception, how to succeed and gender bias. A qualitative analysis software program was then used for further analysis which identified central themes. Theoretical coding was then used to develop a cohesive theoretical framework.
Results
The 4 central themes identified were personality traits, leadership preparation, gender-related considerations and leadership. Self-reported personality traits seen as helping to achieve career success included adaptability, hard work, perseverance and ability to overcome failures. Failure and obstacles were commonly reframed as opportunities for growth. Formal leadership courses and professional coaching were seen as vital for the
development of leadership skills as was networking at departmental, hospital and national level. In addition, 77% of participants identified an early career mentor with 65% of those individuals being categorised as high value mentors defined as someone with power or authority.

Regarding gender-related considerations, the majority of participants were of the opinion that there was gender bias in their workplace, an example being gender-related reasons for delayed promotion. Family obligations discussed included maternity leave, role conflict, maintaining work-life balance and maintaining work commitments. Contributions to leadership acquisition included self-promotion or putting oneself forward for consideration of leadership roles, however, sponsorship by a powerful sponsor was seen as the most important pathway to gain a leadership role.

Commentary
Limitations include small numbers (however this is reflective of the issue being investigated), cultural specificity to North America and furthermore to the dominant demographic characteristics of being white, married, married to a physician or having children. The issue of some of the participants being known to the authors was not specifically addressed although researcher bias is mentioned as a limitation in the discussion. Some of the results pertaining to personality traits and gender related considerations are only presented as narratives with examples given of answers to questions and experiences but no data as to the proportion of participants who expressed these views.

However, this is an interesting study in that it uses qualitative methodology to answer questions about perception of intrinsic qualities, personal experiences and external resources that are important for career progression to leadership positions. It provides a useful perspective which adds to the narrative around gender gap inequality in academic anesthesiology leadership and may be helpful for those aspiring to leadership positions.

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Anaesthesia & Intensive Care Medicine

Submitted January 2023 by Dr Oh Ryong (Ryan) Kwen

Read by 315 Journal Watch subscribers

This is a review article that provides a basic understanding of common surgical conditions encountered in neonates and infants. The description of the surgical procedure and perioperative anaesthetic considerations for each case provides a useful framework for each of the pre-, intra- and post-operative phases of the anaesthesia. The physiological impacts of minimally invasive techniques such as laparoscopy or thoracoscopy are also described, as are their implications for anaesthetic management.

Overall, this is an overview article of commonly encountered surgical cases and their anaesthetic implications in neonates and infants. However, the non-exhaustive list of the conditions and their brief descriptions indicate that further reading should be supplemented to enhance the reader’s understanding.

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Anaesthesia & Intensive Care Medicine

Submitted January 2023 by Dr Oh Ryong (Ryan) Kwen

Read by 255 Journal Watch subscribers

This paper is a review article that provides basic description of the normal neonatal cardiovascular physiology as well as several congenital cardiac abnormalities and their presentations. It is very relevant to the paediatric anaesthesia as congenital heart disease represents the most common significant congenital abnormality. The succinct description
of the pathophysiology of several conditions aided by detailed diagrams helps the readers to effectively understand the complicated conditions and its implications in both cardiac and non-cardiac surgeries. However, the brief and introductory nature of this article means this article should be supplemented by further reading for a more detailed understanding and relevant clinical caveats. Overall, this article provides a brief overview of common neonatal
cardiac conditions and their pathophysiology.

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Anaesthesia & Intensive Care Medicine

Submitted January 2023 by Dr Oh Ryong (Ryan) Kwen

Read by 289 Journal Watch subscribers

This is a review article that highlights the physiological and pathological consequences of prematurity in various systems, as well as their subsequent implications in the provision of anaesthesia. Its succinct description of the common pathological processes of the prematurity makes this article very relevant to our daily practice. The author also provides caveats for different phases of the anaesthesia which serves as a useful framework while
planning/delivering anaesthesia to this population. The description of common neonatal surgical emergencies and their clinical presentation provides a glimpse into various systemic pathologies involved during this early phase of life.

The article lacks a method section and does not describe the search, or inclusion and exclusion criteria for the referenced articles. As such, the list included in this article is not exhaustive.

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Anaesthesia & Intensive Care Medicine

Submitted January 2023 by Dr Oh Ryong (Ryan) Kwen

Read by 263 Journal Watch subscribers

This paper appears to be a review article and several articles were referenced to support the authors’ statements. However, no clear description was provided to explain the search methods or inclusion/exclusion criteria for the referenced articles. Therefore, it can be inferred that the list of factors mentioned in this article is not exhaustive, though detailed.

This article demonstrates the increased neonatal perioperative complications compared to the other paediatric and adult populations. It lists various anatomical, physiological and pharmacological characteristics in the neonates that account for these increased complications, as well as measures to minimise them. These include:
• Characteristics of the neonatal airway anatomy
• Neonatal respiratory and cardiovascular physiology
• Blood pressure monitoring and its measurement
• Fluid/temperature homeostasis
• Neonatal pharmacokinetics/pharmacodynamics

Overall, this is a review article that succinctly demonstrates the major differences in neonates to explain their vulnerability and increased perioperative complication. It is highly relevant to the paediatric anaesthetic practice and can be especially useful to provide the basic knowledge of the paediatric anaesthesia.

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Anesthesiology

Submitted January 2023 by Dr Renee Burton

Read by 304 Journal Watch subscribers

A comprehensive overview of anaphylaxis is delivered by this paper. Covering the pathophysiology (triggering mechanisms, diagnosis) and epidemiology. Of particular interest, is a review of agents commonly implicated in peripoperative anaphylaxis. The paper concludes with initial management, proceeding with surgery after a reaction and allergy work up.

A rare complication of anaesthesia, anaphylaxis is explored well in this article and is useful in updating knowledge in this area for the busy anaesthetist.

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British Journal of Anaesthesia

Submitted January 2023 by Dr Renee Burton

Read by 330 Journal Watch subscribers

The authors present extensive review of the current literature relating to providing sedation “needle free” for MRI. The study includes a wide variety of different techniques of providing sedation in children aged 0-8 years sourced from various databases. A total of 67 studies were included spanning 22380 patients.

It becomes clear from reading the paper, that given there are so many differences in sedation techniques, dosing, duration of action and reporting of complication and success rates, that no clear conclusion can be reached as to which needle free method is superior in regards to safety, success rates and acceptability for paediatric patients for MRI. However, as the article concludes when considering such needle free sedation techniques – well organised team and careful patient selection are vital to ensure safety is maintained in such remote environments.

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