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The results of this study show that psychological distress and burnout have a high prevalence in residents and consultant anaesthesiologists and that both are strongly related to personality traits, especially the trait of neuroticism. This suggests that strategies to address the problem of burnout would do well to focus on competence in coping skills and staying resilient. Personality traits could be taken into consideration during the selection of residents. In future longitudinal studies the question of how personal and situational factors interact in the development of burnout should be addressed.

We determined the forces on the maxillary incisors during routine laryngoscopy in 65 adult patients. The forces were measured by a strain gauge based sensor positioned between the handle and the blade of the laryngoscope. The mean maximal force acting on the maxillary incisors was 49 N . In patients without maxillary incisors, the force acting on the gums was signiJcantly lower at 21 N (p < 0.001). These results suggest that, despite traditional advice to the contrary, a levering movement of the laryngoscope, using the maxillary incisors (or gums) as a fulcrum, is common practice. Biomechanical analysis revealed that, although levering is not the preferred movement, it is an eficient way of bringing the glottis into view. These results may have implications for future laryngoscope design. Key wordsEquipment; laryngoscope.The Macintosh laryngoscope has proved itself over half a century and is still one of the most popular laryngoscopes [I]. Even in experienced hands, however, complications can occur, notably damage to the maxillary incisors (MI) [2,3]; damage to teeth is reported to be the most common single reason for complaints against anaesthetists [4]. Because such damage is the result of contact between the laryngoscope blade and the teeth, the design and manipulation of the blade has a major influence on the risk of this type of morbidity [S]. Until now, this aspect of laryngoscopy has been based on subjective and empirical criteria; detailed evaluation of the laryngoscopy technique has not been possible [6]. To assist the rational development and use of laryngoscopes, an understanding of the forces involved is essential. This, in turn, is o d y possible through study of a biomechanical model followed by objective measurements. Although we realise that our knowledge of the biomechanics of laryngoscopy is limited, the current methods are inadequate for quantifying the forces generated during laryngoscopy in clinical practice.In recent years, various sensors have been described for the measurement of forces applied to the tongue during laryngoscopy [7,9]. Clearly, accurate quantification of other forces present offers the possibility of better laryngoscope design, technique and testing. At present the contact between the laryngoscope blade and the teeth can only be assessed by direct observation. It is said that, to minimise the pressure on the teeth, the blade of the laryngoscope should be lifted upward and forward along the axis of the handle and rotation should be avoided [3, lo]. However, the biomechanical basis of these recommendations is poor. Measurement of the forces acting on the teeth is essential to identify the cause and prevention of damage.In this paper we present a new technique for the measurement of forces on the maxillary incisors during laryngoscopy. This is based on a modification of a strain gauge sensor described previously [8]. The aim of this study was to quantify these forces and, if possible, improve our understanding of the mechanics of laryngoscopy.

The relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many diflculties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation cause3 uncomplicated procedures. more cardiovascular changes than laryngoscopy in routine

Strategies to alleviate stress and hence the development of burnout should not only be directed at adapting occupational or organizational factors but also at equipping anesthesiologists with psychological tools to deal with occupational stress. Furthermore, personality traits that predispose for development of burnout could be taken into consideration in resident selection procedures.