Asking about pain and pain scores after Caesarean section adversely affects patient reports of their postoperative experiences.

SummaryAnaesthetists have traditionally focused on technological and pharmacological advances when considering the provision of anaesthetic care. Anaesthetists are expected to be able to communicate effectively with peers, patients, their families and others in the medical community; however, few details are provided regarding how this might be achieved. Recent evidence suggests that communication practices should include a consideration of conscious and subconscious processes and responses. This model has potential relevance when learning and teaching how to communicate effectively in the stressful environment of anaesthetic clinical practice, and includes: reflective listening; observing; acceptance; utilisation; and suggestion. Understanding these processes could allow the development of a learnable framework for effective communication when the usual strategies are not working. This concept could also be used to facilitate communicating with surgeons and other colleagues, with potential benefits to patients. Anaesthetists have traditionally focused on advances in technology and pharmacology when considering how they can improve the care they provide to patients. The specialty of anaesthesia clearly encompasses technical fluency; however, beyond competencies such as cannulation or tracheal intubation are unwritten and unvoiced strategies for managing the patient and recognising the limits of safe practice. True mastery involves communicating, anticipating and minimising discomfort, and knowing when to change strategies or techniques [1]. Patients have placed a value on communication and the provision of information regarding their care that is frequently underappreciated by anaesthetists [2]. Until relatively recently, it was a common belief that communication skills were natural talents that could not be taught -one was either endowed with them or not [3]. Anaesthetists tend to practice in a way that adheres closely to the traditional medical model whereby the doctor provides the care while the patient passively accepts it. Less commonly appreciated is that anaesthetists are in the fortunate position of having abundant opportunities to enhance the clinical care they provide through the way they communicate [4]. Good communication is said to improve health outcomes or patient satisfaction and reduce error, misunderstandings, distress and negligence claims [5] [17][18][19].Anaesthetists in many ways are already expert communicators in the majority of situations in which they find themselves. They take a focused history and perform a targeted examination, frequently in extraordinarily stressful situations. They perform invasive procedures during which they communicate in ways that aim to facilitate relaxation and comfort. Anaesthetists also communicate to a wide variety of other colleagues -surgeons,

We investigated the incidence of and risk factors for persistent pain after caesarean delivery. Over a 12-month period, women having caesarean delivery were recruited prospectively at an Australian tertiary referral centre. Demographic, anaesthetic and surgical data were collected and at 24 hour follow-up, women were assessed for immediate postoperative pain and preoperative expectations of pain. Long-term telephone follow-up was conducted at two and 12 months postoperatively. Complete data were obtained from 426 of 469 women initially recruited (90.6%). The incidence of persistent pain at the abdominal wound at two months was 14.6% (n=62) but subsequently reduced to 4.2% (n=18) at 12 months. At two months, 33 patients (7.8%) experienced constant or daily pain. At 12 months, five patients (1.1%) continued to have constant or daily pain which was mild. There was no apparent increase in incidence of persistent pain associated with general versus regional anaesthesia (relative risk [RR] 0.89, 95% confidence interval [CI] 0.49 to 1.6); emergency vs elective procedure (RR 0.65, 95% CI 0.39 to 1.07); higher acute pain scores (RR 1.1, 95% CI 0.69 to 1.75); or history of previous caesarean delivery (RR 0.81, 95% CI 0.50 to 1.33). Persistent pain, usually of a mild nature, is reported by some women two months after their caesarean delivery, but by 12 months less than 1% of women had pain requiring analgesia or affecting mood or sleep. All declined a pain clinic review. Clinicians and patients can be reassured that caesarean delivery is unlikely to lead to severe persistent pain in the long-term.

Spontaneous cerebral spinal fluid leakage is increasingly recognized as a cause of headache due to low intracranial pressure. The site of leakage can be identified with radionuclide cisternography, and anesthesiologists are increasingly requested to provide epidural blood patch for their management. This series of case reports demonstrates some of the issues relating to the management of this condition.

This research illustrates the importance of understanding the potentially functional effects common negative arousal emotions may have on clinical performance, particularly for those with less experience.

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Drug errors amongst anaesthetists are common. Although there has been previous work on the system factors involved with drug error, there has been little research on the sequelae of a drug error from the anaesthetist's perspective. To clarify this issue, we surveyed anaesthetists regarding their most memorable drug error to identify associated factors and personal sequelae regarding their professional practice after the event. An online survey was sent anonymously to 989 Australian and New Zealand College of Anaesthetists (ANZCA) Fellows in March 2016 and the results were collected over the following two months. There were 295 completed surveys (29.8% response). The majority of respondents were male consultants, aged over 45 years. Reported drug errors occurred most frequently during normal working hours, and the most common drugs involved were non-depolarising muscle relaxants. In 34% of the errors, another anaesthetist was present, and their presence was felt to have contributed in 40.7% of these cases. About 20% of respondents reported that they did not receive adequate support after the event. Sleep patterns were affected in 14.4% of respondents, although very few found that the error had affected their capacity to function at work. These findings suggest that memorable drug errors can be significant enough to have adverse sequelae to anaesthetists, even if no patient harm occurs.

This research has broad implications for professions where fixation may impair practice. This research suggests that professional training should teach practitioners to identify their emotions and understand the role of these emotions in fixation.