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Except for exaggerated situations in which aspiration risk seems obvious (or absent), the choice of a rapid sequence induction protocol for general anesthesia is often made under uncertainty, according to the individual assessment of the balance between the aspiration risk on one hand and the anaphylaxis risk induced by short-acting curares on the other hand.
The impact of anxiety and impulsivity on the choice of induction protocols under uncertainty has never been studied before.
In order to investigate this issue, an online anonymous survey has been designed and will be sent to the anesthesiologists of the Bourgogne Franche-Comté and Grand Est regions in France.
The primary objective of this study is to assess the impact of trait-anxiety using the STAI-Y2 form on the decision-making process of anesthesiologists during the choice of an induction protocol for patients at risk of aspiration.
The secondary objectives are to characterize decision-making profiles, to measure the implicit dimension of anxiety using an Implicit association test, to study the impact of impulsivity on decision-making processes under uncertainty using the short version of UPPS-P scale and to study the role of socio-demographic data and professional history in these decisions.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Survey | Other | Online anonymous survey |
| Measure | Description | Time Frame |
|---|---|---|
| State-Trait Anxiety Inventory Form Y2 | Measure of STAI Y2. A score above the threshold of 49 out of 80 will display a trait-anxiety interfering with the decision-making of the anesthesiologists. | at 4 months |
| Measure | Description | Time Frame |
|---|---|---|
| Decision-making profiles | Characterize decision-making profiles using a survey of 10 clinical situations presenting a variable degree of uncertainty, for which a risk score (RS) has been determined by an expert committee. For each situation, the induction protocol must be chosen among a five-choice list gathered in 3 categories : (1) rapid sequence induction (hypnotic + short-acting curare), (2) short protocol (hypnotic + alfentanil or remifentanil) and (3) standard (hypnotic + sufentanil or remifentanil + cisatracurium). Each category has its own score, so that a protocol score (PS) is attributed to the chosen protocol. Finally, a global score (GS) is calculated for each subject by adding the product of RS x PS of the 10 situations. The subjects will be attributed to one of the three profiles according to their global score. |
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Inclusion Criteria:
Exclusion Criteria:
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A first phase will include all anesthesiologists of Bourgogne-Franche-Comté and Grand-Est regions (500 subjects) A second phase will include all anesthesiologists registered in France.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| David FERREIRA, PH | Contact | +33 3 81 66 91 31 | dferreira@chu-besancon.fr | |
| Chloé ZANONI, resident | Contact | +33 6 42 56 14 86 | chloe.zanoni@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| David FERREIRA, PH | Centre Hospitalier Universitaire de Besancon | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU Besançon | Recruiting | Besançon | Doubs | 25000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24212195 | Background | Stiegler MP, Tung A. Cognitive processes in anesthesiology decision making. Anesthesiology. 2014 Jan;120(1):204-17. doi: 10.1097/ALN.0000000000000073. | |
| 12915363 | Background | Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. doi: 10.1097/00001888-200308000-00003. |
| Label | URL |
|---|---|
| Current guidelines from the French Society of Anaesthesia \& Intensive Care Medicine for the airway management in anesthesiology of adults, except for difficult intubation | View source |
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The data will be strictly anonymous.
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| ID | Term |
|---|---|
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D011795 | Surveys and Questionnaires |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
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| at 4 months |
| Implicit measure of anxiety | Measure of the anxiety using the Implicit association test. | at 4 months |
| Impulsivity measure : (negative) Urgency, (lack of) Premeditation, (lack of) Perseverance, Sensation (seeking) - Positive (urgency) scale (UPPS-P scale) | Measure of the impulsivity using the short version of the UPPS-P scale which is the (negative) Urgency, (lack of) Premeditation, (lack of) Perseverance, Sensation (seeking) - Positive (urgency) scale. This scale measures five dimensions of impulsivity. Each dimension will be scored and compared to the mean and standard deviation of the other profiles and to the mean and standard deviation of the general population. A score above the mean of the general population shows a higher tendency to impulsive behaviours in the scored dimension. The higher the scores are, the more impulsive the subjects are. Standard values for each dimension : Dimensions Mean Standard deviation Negative Urgency 9.38 2.73 Positive Urgency 10.84 2.38 Lack of premeditation 7.98 2.15 Lack of perseverance 7.46 2.41 Sensation seeking 10.55 2.72 | at 4 months |
| Socio-demographics and professional history | Collection of socio-demographic data : sex, experience, practice in anaesthesic wards where aspiration risk is frequently encountered (digestive OR, emergency OR, obstetrics), region, practice in a public or private facility, time spent on duty (hours per week), coffee and cigarette consumption at work, history of severe anaphylaxis resulting from a rapid sequence induction, history of aspiration resulting from an induction of general anesthesia, emotional issues of severe anaphylaxis or aspiration. | at 4 months |
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| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |