Techniques for blood loss estimation in major non-cardiac surgery: a systematic review and meta-analysis
ConclusionsWe found that significant case-by-case variation exists for all methods of blood loss evaluation and that there is significant disagreement between techniques. Given the importance placed on EBL, particularly for perioperative prognostication models, clinicians should consider the universal adoption of a practical and reproducible method for blood loss evaluation.Trial registrationPROSPERO (CRD42015029439); registered: 18 November 2015.PROSPERO (CRD42015029439); registered: 18 November 2015. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 24, 2020 Category: Anesthesiology Source Type: research

Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres
AbstractPoint-of-care ultrasound (POCUS) uses ultrasound at the bedside to aid decision-making in acute clinical scenarios. The increased use of ultrasound for regional anesthesia and vascular cannulation, together with more anesthesiologists trained in transesophageal echocardiography have contributed to the widespread use of POCUS in perioperative care. Despite the support of international experts, the practice of POCUS in perioperative care is variable as Canadian guidelines for anesthesiologists do not currently exist. Using a Delphi process of online surveys and a face-to-face national Canadian meeting, we developed a...
Source: Canadian Journal of Anesthesia - November 24, 2020 Category: Anesthesiology Source Type: research

Correction to: Requests for somatic support after neurologic death determination: Canadian physician experiences; Demandes de soutien des fonctions vitales apr ès un diagnostic de décès neurologique : les expériences des médecins canadiens
The ESM was updated in the original article to replace an incorrect version that was published with tracked changes notes. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 24, 2020 Category: Anesthesiology Source Type: research

Consensus guidelines for perioperative  point-of-care ultrasound: the devil is in the (implementation) details
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 20, 2020 Category: Anesthesiology Source Type: research

On the stated association between labour epidural analgesia and risk of autism spectrum disorder in offspring
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 20, 2020 Category: Anesthesiology Source Type: research

Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study
ConclusionsPatients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping.Trial registrationwww.ClinicalTrials.gov (NCT03379129); registered 15 December 2017. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study
ConclusionAlthough low molecular weight heparin was used much less frequently than regular heparin, it was associated with a lower incidence of transfusion compared with aspirin and regular heparin. All three anticoagulants were associated with similar incidence of VTE and hematoma. Varying subgroup-specific VTE risks may further inform future studies to identify patients expected to benefit the most from chemical thromboprophylaxis. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

In reply: Sugammadex in end-stage renal disease: too early for a “free-pass”
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

Differences in aerosol flow rates between disposable and reusable atomizers used for airway topicalization: implications for local anesthetic toxicity
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

Intersection of gender, race, and academic rank in anesthesiology
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2020 Category: Anesthesiology Source Type: research

Factors associated with success and failure of patient-controlled oral analgesia after total hip and knee arthroplasty: a historical comparative cohort study
This study evaluated factors related to success or failure of PCOA following total hi p arthroplasty (THA) and total knee arthroplasty (TKA).MethodsWe conducted a retrospective cohort study of all adults who underwent THA and TKA at our institution by extracting data from the proprietary database of our acute pain service. Patient, anesthetic, and surgical variables associated with PCOA failure defined as inadequate analgesia requiring conversion to IV-PCA within 24 hr following THA and TKA were evaluated. Univariable and multivariable logistic regression analyses were performed to identify predictors of PCOA failure.Resul...
Source: Canadian Journal of Anesthesia - November 17, 2020 Category: Anesthesiology Source Type: research

Kanga cloths to smartphones: how should we measure blood loss in the operating room?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 17, 2020 Category: Anesthesiology Source Type: research

Death and brain damage from difficult airway management: a “never event”
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 16, 2020 Category: Anesthesiology Source Type: research

ICU quick drug guide: first edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 16, 2020 Category: Anesthesiology Source Type: research

Sugammadex in end-stage renal disease: too early for a “free-pass”
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 16, 2020 Category: Anesthesiology Source Type: research

Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association
ConclusionsSevere patient harm is common when airway management is the focus of a CMPA medicolegal complaint involving anesthesiologists. Patients were otherwise typically low risk cases presenting for elective surgery. Failure to assess or to change management based on the airway exam or encountered difficulty were the most common errors. Our findings support the continued need for adoption, adherence, and practice of guidelines for anticipated and unanticipated difficult airway management for every patient encounter. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 16, 2020 Category: Anesthesiology Source Type: research

Continuing professional development module
AbstractThe electroencephalogram (EEG) provides a reliable reflection of the brain ’s electrical state, so it can reassure us that the anesthetic agents are actually reaching the patient’s brain, and are having the desired effect. In most patients, the EEG changes somewhat predictably in response to propofol and volatile agents, so a frontal EEG channel can guide avoidance of insufficient and excessive administration of general anesthesia. Persistent alpha-spindles (around 10 Hz) phase-amplitude coupled with slow delta waves (around 1 Hz) are commonly seen during an “appropriate hypnotic state of general ...
Source: Canadian Journal of Anesthesia - November 15, 2020 Category: Anesthesiology Source Type: research

Special Announcement – Guidelines to the Practice of Anesthesia – Revised Edition 2021
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 11, 2020 Category: Anesthesiology Source Type: research

Requests for somatic support after neurologic death determination: Canadian physician experiences
ConclusionsFamily requests for continued somatic support following NDD were encountered by half our sample of Canadian critical care physicians. Mitigation strategies require attention to the multifaceted social contexts surrounding these complex scenarios. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Hydromorphone versus morphine: a historical cohort study to evaluate the quality of postoperative analgesia
ConclusionThis study serves to help guide the decision-making process for selecting either morphine or hydromorphone for acute postoperative analgesia. Overall, we found no significant difference for analgesia or for common opioid-related adverse effects between these two opioids in the postoperative period at the time of discharge from the PACU. Furthermore, according to this data, the equipotency ratio of hydromorphone to morphine is closer to 1:6.5 rather than the commonly employed 1:5 ratio. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Accepting the baton at the Journal : a moment to celebrate success, science, diversity, and future opportunities
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Resident competencies before and after short intensive care unit rotations: a multicentre pilot observational study
ConclusionsA monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents ’ cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Renal microvascular oxygen tension during hyperoxia and acute hemodilution assessed by phosphorescence quenching and excitation with blue and red light
ConclusionThe observed linear relationship between CaO2 and PkO2 shows the biological function of the kidney as a quantitative sensor of anemic hypoxia and hyperoxia. A better understanding of the impact of changes in PkO2 may inform clinical practices to improve renal oxygen delivery and prevent acute kidney injury. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Equity, diversity, and inclusion code of conduct for anesthesiology departments
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Aberrant right subclavian artery and arterioesophageal fistula
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

In reply: The criteria used to justify endotracheal intubation of patients with COVID-19 are worrisome
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

The criteria used to justify endotracheal intubation of patients with COVID-19 are worrisome
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 10, 2020 Category: Anesthesiology Source Type: research

Hypoxemia and prone position in mechanically ventilated Covid-19 patients: a prospective cohort study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 4, 2020 Category: Anesthesiology Source Type: research

Post-intensive care unit clinics in Canada: a national survey
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Re-visiting preoperative SARS-CoV-2 testing using a Bayesian approach
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Calculation of air change rates and post-aerosol pause times for a COVID-19 airway management enclosure
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

The use of continuous perineural catheters and other practices to optimize regional anesthesia in COVID-19 patients
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Estimating the risk of SARS-CoV-2 transmission to pediatric anesthesiologists: a microsimulation model
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

The Association of Faculties of Medicine of Canada electives diversification: a discussion of its implications in anesthesiology
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Professional advocacy and citizenship: a continuing journey that begins during residency
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Outsmarting a pulse oximeter: teaching spectrophotometry with a Foley catheter
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Novel technique for positioning children under general anesthesia for ophthalmic YAG laser capsulotomy using the Hug-U-Vac ® surgical positioning system
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Personal protective equipment during the COVID-19 pandemic (Letter #2)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Performance assessment and clinical experience (PACE) scorecards for anesthesiology residents: a post-implementation physician survey
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Assessing resident member needs at the Canadian Anesthesiologists ’ Society: a national survey
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Developing practice guidelines for anesthesia services in rural Canada: the importance of the family physician perspective
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Positive tracheal SARS-CoV-2 RNA test after three negative SARS-CoV-2 RNA tests in a patient with COVID-19
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Postoperative analgesia with pericapsular nerve group (PENG) block for primary total hip arthroplasty: a retrospective study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Strawman redux: management of end-tidal gases in patients at risk of perioperative neurocognitive disorder
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Sono-anatomy of the paravertebral space in a patient with end-stage renal disease
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 10, 2020 Category: Anesthesiology Source Type: research

Spinal epidural hematoma and abscess after neuraxial anesthesia: a historical cohort study using the Japanese Diagnosis Procedure Combination database
ConclusionsThis analysis identified the incidences of spinal epidural hematoma and/or abscess after neuraxial anesthesia. Additional large-scale studies are warranted to examine the incidences and factors associated with these complications. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 9, 2020 Category: Anesthesiology Source Type: research

Impact of aerosol box on intubation during COVID-19: a simulation study of normal and difficult airways
ConclusionsIn this mannequin-based simulation study, the use of the aerosol box increased the time to intubation in some contexts but not others. Further studies in a clinical setting should be conducted to make appropriate modifications to the aerosol box to fully elicit its efficacy and safety prior to implementation in airway guidelines for managing patients with COVID-19. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 9, 2020 Category: Anesthesiology Source Type: research

Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis
ConclusionIn the absence of long-acting neuraxial opioid after CD, single-dose TAP blocks and WC are effective opioid-sparing strategies. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 9, 2020 Category: Anesthesiology Source Type: research

Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study
AbstractPurposePerioperative complications of patients with idiopathic pulmonary fibrosis (IPF) are not well described. The aim of this study was to identify risk factors associated with adverse postoperative outcomes in IPF patients.MethodsWe performed a single-centre historical cohort study of adult patients with IPF who underwent surgery between 2008 and 2018. We analyzed the prognostic utility of select perioperative factors for postoperative acute exacerbation of IPF (AE-IPF), acute respiratory worsening (ARW), pneumonia, and 30-day and one-year mortality using univariable and multivariable regression analyses. To adj...
Source: Canadian Journal of Anesthesia - October 7, 2020 Category: Anesthesiology Source Type: research