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Quintão VC, Concha M, Argüello LAS, Cavallieri S, Cortinez LI, de Sousa GS, Clemente MMM, Carlos RV, Rodríguez JM, Gutiérrez K, Jablonka DH, García-Marcinkiewicz AG. Pediatric anesthesiology in Brazil, Chile, and Mexico. Paediatr Anaesth 2024. [PMID: 38619275 DOI: 10.1111/pan.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. OBJECTIVE Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. DESCRIPTIONS AND CONCLUSIONS Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.
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Affiliation(s)
- Vinícius Caldeira Quintão
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Concha
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Silvana Cavallieri
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Anesthesiology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis I Cortinez
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Soares de Sousa
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Serviços Médicos de Anestesia, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Ricardo Vieira Carlos
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Karla Gutiérrez
- Department of Pediatric Anesthesia, Instituto Mexicano del Seguro Social La Raza, Hospital Medica Sur, Mexico City, Mexico
| | - Denis H Jablonka
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Annery G García-Marcinkiewicz
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fitzsimons MG, de Sousa GS, Galstyan A, Quintão VC, Simões CM. Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review. Braz J Anesthesiol 2023; 73:810-818. [PMID: 37517585 PMCID: PMC10625155 DOI: 10.1016/j.bjane.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.
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Affiliation(s)
- Michael G Fitzsimons
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, USA
| | - Gabriel Soares de Sousa
- Hospital Sírio-Libanês, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil
| | - Arpine Galstyan
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, USA
| | - Vinícius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil.
| | - Cláudia Marquez Simões
- Hospital Sírio-Libanês, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Hospital das Clínicas (HC), Instituto do Câncer do Estado de São Paulo ICESP, São Paulo, SP, Brazil
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Sousa GSD, Fitzsimons MG, Mueller A, Quintão VC, Simões CM. Drug abuse amongst anesthetists in Brazil: a national survey. Braz J Anesthesiol 2021; 71:326-332. [PMID: 33845097 PMCID: PMC9373323 DOI: 10.1016/j.bjane.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of Substance Use Disorders (SUD) and acceptance of drug testing among anesthetists in Brazil has not been determined. Methods An internet-based survey was performed to investigate the prevalence of SUD among anesthetists in Brazil, to explore the attitudes of anesthetists regarding whether SUD jeopardizes the health of an impaired provider or their patient, and to determine the provider’s perspective regarding acceptance and effectiveness of drug testing to reduce SUD. The questionnaire was distributed via social media. REDCap was utilized to capture data. A sample size of 350 to achieve a confidence level of 95% and confidence interval of 5 was estimated. Study report was based on STROBE and CHERRIES statements. Results The survey was returned from 1,295 individuals. Most individuals knew an anesthesia provider with a SUD (82.07%), while 23% admitted personal use. The most common identified substances of abuse were opioids (67.05%). Very few respondents worked in a setting that performs drug testing (n = 17, 1.33%). Most individuals believed that drug testing could improve personal safety (82.83%) or the safety of patients (85.41%). Individuals with a personal history of SUD were less likely to believe in the effectiveness of drug testing to reduce one’s own risk (74.92% vs. 85.18%, p < 0.0001) or improve the safety of patients (76.27% vs. 88.13%, p < 0.001). Conclusions SUDs are common among anesthetists in Brazil. Drug testing would be accepted as a viable means to reduce the incidence although a larger study should be performed to investigate the logistical feasibility.
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Affiliation(s)
| | - Michael Gerald Fitzsimons
- Massachusetts General Hospital, Harvard Medical School, Department of Anaesthesia, Critical Care and Pain Medicine, Boston, USA
| | - Ariel Mueller
- Massachusetts General Hospital, Harvard Medical School, Department of Anaesthesia, Critical Care and Pain Medicine, Boston, USA
| | - Vinicius Caldeira Quintão
- Hospital Sirio-Libanes, Serviços Médicos de Anestesia Ltda, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Disciplina de Anestesiologia, São Paulo, SP, Brazil
| | - Cláudia Marquez Simões
- Hospital Sirio-Libanes, Serviços Médicos de Anestesia Ltda, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), Instituto do Câncer do Estado de São Paulo, Disciplina de Anestesiologia, São Paulo, SP, Brazil
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