Introduction Burnout in medical providers is associated with work dissatisfaction, reduction in patient safety, and provider depression. Simulation is a tool effectively used for specific task training but has not been broadly used as a means to combat medical professional stress and enhance wellness. The authors created a medical simulation program targeted at those involved in the social support of medical providers. The hypothesis was that education of non-medical persons involved in social support would translate into an enhanced understanding of the demands among medical providers in anesthesiology. This understanding would thereby open communication pathways within the social support system and contribute to enhanced wellness among providers.MethodsTo assess effectiveness and benefits of the event, survey data were obtained from anesthesia providers and their adult support persons before and after the event. The anesthesia providers were queried on their perception regarding the benefit of the event for their support persons. Support persons were asked questions regarding their understanding of the role of an anesthesia provider.ResultsSixty-three family members and friends (adult=30, child=33) participated in a two-hour simulation event including activities for participants of all ages. Twenty-nine (96.7%) adult participants (age ≥ 14) completed the support person surveys before and/or after the event. The post-event survey results revealed participants’ satisfaction with the event (n=26, 100%). This simulation event also demonstrated an improved understanding of the demands among anesthesia providers by their support persons (seven items, P values range from less than .0001 to .0313). Most anesthesia providers who attended the event enjoyed it a significant amount (n=19, 82.6%). Most providers whose primary work-related support persons attended the event believed that it would be easier to communicate work-related issues (n=12, 85.7%).ConclusionWe outline "The Family Anesthesia Experience Day" as a wellness initiative for anesthesia providers. Our study demonstrated improved understanding of support persons’ knowledge about anesthesia providers’ work-related stress via an immersive two-hour simulation-based learning experience. The event was well-received and may be a useful approach to provide support persons with an opportunity to learn about and better support their beloved anesthesia provider.

Objective: The amount of opioid prescribed following cesarean delivery is commonly in excess of patients’ needs. An additional concern in a breastfeeding mother is neonatal opioid exposure. A maximum daily dose of 30 mg of oxycodone is recommended in breastfeeding women. Inadequate pain control can inhibit breastfeeding and other negative consequences. We aimed to evaluate the effect of reducing the as-needed opioid ordered following cesarean delivery on inpatient opioid consumption and analgesia. Study Design: At our tertiary care institution, our standard as-needed opioid order was reduced from oxycodone 5-10mg every 4 h to oxycodone 5mg every 6 h, in May 2019. Orders for scheduled acetaminophen and non-steroidal anti-inflammatory drugs were unchanged. We compared opioid use and pain scores before (February 2019 – April 2019) and after (May 2019 – July 2019) the order modification. Our primary outcome was the proportion of patients using > 30mg of oxycodone in the 24 h prior to hospital discharge. We further assessed 48-h opioid consumption and patient reported verbal pain scores. Results: There were 559 patients who met inclusion criteria; 241 pre-intervention patients and 318 post-intervention patients. In the pre-intervention group, 14.5% (35/241) used >30 mg oxycodone in the 24 hours before discharge, compared with 5.0% (16/318) after the order set change (RR 0.34, CI (0.19, 0.61); NNT 10.5). There was no change in the proportion of women with one or more pain score > 7 (Pre: 44.4% (107/241), Post 43.1% (137/318), p=0.756) or > 4 and  7 (pre: 36.9% (89/241), post 36.9% (125/318), p=0.567), nor was there a change in mean pain score (mean  SD pre: 2.8  1.6; post: 2.7  1.4, p=0.464). Conclusion: Reducing the amount of opioid ordered after cesarean delivery reduced the proportion of post-cesarean delivery patients exceeding the maximum recommended daily oxycodone dose for breastfeeding women.

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A parturient with unknown thrombotic thrombocytopenic purpura (TTP) received spinal anesthesia for cesarean delivery with subsequent discovery of a platelet count of 7000 × 109/L. Neurologic recovery was normal. Limited data exist to determine the risk of spinal epidural hematoma (SEH) in severely thrombocytopenic patients because they often receive alternate labor analgesia or general anesthesia during cesarean delivery. There is reporting bias in the literature toward cases in which severely thrombocytopenic patients sustain complications after regional anesthesia. It is important to report all cases of neuraxial anesthesia in severely thrombocytopenic patients, including those such as ours, wherein patients recover normally.

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