Supervision finalThe January issue of Anesthesia & Analgesia has just posted.

Dr. Steven Shafer, editor-in-chief, Anesthesia & Analgesia:

In 2008 Filho proposed an instrument for measuring faculty supervision. In this issue of Anesthesia & Analgesia De Oliveira Jr. and colleagues (Reliability and Validity of Assessing Subspecialty Level of Faculty Anesthesiologists’ Supervision of Anesthesiology Residents) validated this instrument in a national sample of anesthesia residents for evaluation of both anesthesia departments and specific rotations. Residents’ evaluations of overall supervision tended to be worse than for individual faculty members (Anesthesia Residents’ Global (Departmental) Evaluation of Faculty Anesthesiologists’ Supervision Can Be Less Than Their Average Evaluations of Individual Anesthesiologists). As Getúlio R. de Oliveira Filho, the instrument’s author, notes in his accompanying editorial (Departmental Evaluations by Residents: Widening the Scope of the Faculty Supervision Evaluation) “the metrics … can help prospective applicants avoid programs with poor supervision, and presumably poor teaching, and direct their attention to training programs with the best supervision.”

In a study of whether intraoperative awareness resulted in posttraumatic stress disorder (PTSD), Whitlock and colleagues (Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials) found PTSD in 8.7% of patients with intraoperative awareness and (surprisingly) 7.6% of patients without awareness. Risk factors for postoperative PTSD other than awareness included poor social support, prior PTSD symptoms, prior mental health treatment, dissociation related to surgery, and perceiving that one’s life was threatened during surgery.

In an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database, Suresh and colleagues (Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database) found zero incidences of temporary or permanent sequelae. However, about one-quarter of children received higher than recommended doses of local anesthetic.

Naveen Nathan, MD, Cover Editor and Illustrator:

Many in the lay public may not appreciate the significant gravity of receiving an anesthetic. To their credit, the soft-spoken overtones of our preoperative anxiety-reducing consolation do undermine the austerity of our practice; inasmuch as the amount of leg-room in coach becomes the primary focus of one’s experience when flying. Never mind the fact that we’re suspended at 25,000 feet in a metal tube! The irony of our field is that we impose something intrinsically dangerous upon our patients. Because of this we have refined the practice of anesthesiology to the point where it looks deceptively easy. How does one adequately supervise the conduct of inherently perilous interventions? At what point is it safe to dismantle the training wheels and allow our learners to assume the burden of risk? The cover captures the all-too-familiar and ephemeral moment when fear turns to trust, a metaphoric hand-off of responsibility from mentor to apprentice.