Impacts of elective surgical cancellations and postponements in Canada
ConclusionResults highlight the multifaceted perceived impacts of surgical cancellations/postponements. These findings suggest there is a need for improvements in reducing elective surgical cancellations and postponements. Results may also inform the development of targeted interventions to improve patients ’ health and quality of life while waiting for surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 24, 2021 Category: Anesthesiology Source Type: research

Aberrant right subclavian artery: an impediment to transesophageal echocardiography
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 24, 2021 Category: Anesthesiology Source Type: research

Are the garment seams a potential source of breach in level-4 personal protective equipment gowns?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 23, 2021 Category: Anesthesiology Source Type: research

COVID-19 encounters reported to the Canadian Anesthesia Incident Reporting System (CAIRS)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 19, 2021 Category: Anesthesiology Source Type: research

R éférentiel d’Anesthésie-réanimation et de médecine péri-opératoire
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

Analgesic duration of interscalene block after outpatient arthroscopic shoulder surgery with intravenous dexamethasone, intravenous dexmedetomidine, or their combination: a randomized-controlled trial
This study compared their relative effectiveness and the benefit of their use in combination.MethodsThis single-centre, double-blinded, parallel three-group superiority trial randomized 198 adult patients undergoing ambulatory arthroscopic shoulder surgery. Patients received preoperative ISB with 30 mL 0.5% bupivacaine and 50 µg dexmedetomidine or 4 mg dexamethasone or both of these agents as intravenous adjuncts. The primary outcome was analgesic block duration. Secondary outcomes included the quality of recovery 15 score (range: 0–150) on day 1 and postoperative neurologic symptoms in the surgical arm.Results...
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

A new hypertonic saline assay for analgesic screening in mice: effects of animal strain, sex, and diurnal phase
AbstractPurposeThere exists a pressing need for the identification of novel analgesics. We recently reported on a new preclinical assay for rapid analgesic screening based on intraplantar (i.pl.) injection of 10% hypertonic saline (HS) in female outbred (CD-1) mice. Herein, we characterized the HS assay ’s performance in inbred (C57BL/6) mice, sensitivity to sex differences, and effects of diurnal rhythm phase.MethodsIn randomized, controlled, blindedin vivo animal experiments, we studied nociceptive responses induced by i.pl. HS in C57BL/6 (vs CD-1) mice of both sexes (n = 240) and determined diurnal rhyth...
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

Intravenous immune globulin in septic shock: a Canadian national survey of critical care medicine and infectious disease specialist physicians
AbstractPurposeThis national survey evaluated the perceived efficacy and safety of intravenous immune globulin (IVIG) in septic shock, self-reported utilization patterns, barriers to use, the population of interest for further trials and willingness to participate in future research of IVIG in septic shock.MethodsWe conducted a cross-sectional survey of critical care and infectious diseases physicians across Canada. We summarized categorical item responses as counts and proportions. We developed a multivariable logistic regression model to identify physician-level predictors of IVIG use in septic shock.ResultsOur survey wa...
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

The COVID-19 match: what Canadian anesthesia programs can do for the virtual match cycles
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

Thoracic epidural analgesia in a lung transplant patient with an activated partial thromboplastin time falsely elevated by C-reactive protein
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 18, 2021 Category: Anesthesiology Source Type: research

Double-lumen endotracheal tubes and bronchial blockers exhibit similar lung collapse physiology during lung isolation
ConclusionsDuring OLV before pleural opening, entrainment of ambient air into the non-ventilated lung occurs when the lumen of the lung isolation device is kept open. This phenomenon is prevented by occluding the lumen of the isolation device before pleural opening, resulting in a progressive build-up of negative pressure in the non-ventilated lung. Future clinical studies are needed to confirm these physiologic results and their impact on lung collapse and operative outcomes.Trial registrationwww.clinicaltrials.gov (NCT02919267); registered 28 September 2016. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 16, 2021 Category: Anesthesiology Source Type: research

Surgical patients and the risk of malnutrition: preoperative screening requires assessment and optimization
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 16, 2021 Category: Anesthesiology Source Type: research

Variation in prophylactic tranexamic acid administration among anesthesiologists and surgeons in orthopedic surgery: a retrospective cohort study
ConclusionWe confirmed the routine use of TXA in primary THA, while observing lower utilization with more variability in hip fracture and spine fusion surgery. Further study is warranted to understand variations in use and the barriers to TXA implementation in a broader population of orthopedic surgical patients at high risk for transfusion. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 16, 2021 Category: Anesthesiology Source Type: research

Sevoflurane-induced hyperglycemia is attenuated by salsalate in obese insulin-resistant mice
AbstractPurposePerioperative hyperglycemia is common and is associated with significant morbidity. Although patient characteristics and surgery influence perioperative glucose metabolism, anesthetics have a significant impact. We hypothesized that mice that were obese and insulin-resistant would experience greater hyperglycemia in response to sevoflurane anesthesia compared with lean controls. We further hypothesized that sevoflurane-induced hyperglycemia would be attenuated by salsalate pre-treatment.MethodsLean and obese male C57BL/6J mice were anesthetized with sevoflurane for 60 min with or without pre-treatment of 62....
Source: Canadian Journal of Anesthesia - February 12, 2021 Category: Anesthesiology Source Type: research

Clinical validation of non-invasive hemoglobin monitoring —a prospective observational study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 12, 2021 Category: Anesthesiology Source Type: research

Family veto in organ donation: the experiences of Organ and Tissue Donation Coordinators in Ontario
ConclusionThis study highlights important considerations about organ donation authorization processes in Ontario. Findings support practice changes towards reducing family veto and further research nationally. Collaborations with key stakeholders are warranted to align healthcare practices, donation policies, and education initiatives towards a shared goal of increasing organ donation. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 11, 2021 Category: Anesthesiology Source Type: research

A modified Tuohy needle tip design for catheter over needle catheterization: in vitro testing
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 11, 2021 Category: Anesthesiology Source Type: research

Much ado about the family veto
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 10, 2021 Category: Anesthesiology Source Type: research

Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study
This study aims to determine the prevalence and risk factors of preoperative malnutrition risk among elderly surgical patients, and its impact on surgical outcomes.MethodsIn this retrospective cohort study of patients ≥ 65 yr old undergoing elective surgery, we recorded demographics, medications, preoperative effort tolerance, Malnutrition Universal Screening Tool (MUST) score, American Society of Anesthesiologists physical status (ASA), Charlson Comorbidity Index (CCI), and Edmonton Frailty Score (EFS). Postop erative complications based on the Clavien–Dindo (CD) classification and hospital length of stay (LOS) w...
Source: Canadian Journal of Anesthesia - February 9, 2021 Category: Anesthesiology Source Type: research

Postoperative hemodynamics after high spinal block with or without intrathecal morphine in cardiac surgical patients: a randomized-controlled trial
This study was designed to study the effect of intrathecal morphine on hemodynamic parameters in cardiac surgery patients.MethodsIn a prospective, double-blind study, 100 adult cardiac surgical patients were randomized to receive either intrathecal 40 mg of 0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group,n = 50) or intrathecal 250 µg of morphine added to 40 mg of 0.5% bupivacaine (intrathecal bupivacaine and morphine [ITBM] group,n = 50). Hemodynamic data, pain scores, rescue analgesic use, spirometry, and vasopressor use were recorded every four hours after surgery for 48 hr. The primary outco...
Source: Canadian Journal of Anesthesia - February 9, 2021 Category: Anesthesiology Source Type: research

Caffeine supplementation as part of enhanced recovery after surgery pathways: a narrative review of the evidence and knowledge gaps
AbstractCaffeine is used daily by 85% of United States adults and caffeine withdrawal is a major cause of perioperative headache. Studies have shown that caffeine supplementation in chronic caffeinators reduces the incidence of perioperative headache. This narrative review discusses the perioperative implications of caffeine withdrawal and outlines the benefits of and strategies of caffeine supplementation in the perioperative period. It is time to “wake up and smell the coffee” on integration of caffeine into established enhanced recovery after surgery protocols as a mechanism to consistently provide periopera...
Source: Canadian Journal of Anesthesia - February 9, 2021 Category: Anesthesiology Source Type: research

The variable impact of the overdose crisis on organ donation among five Canadian provinces: a retrospective study
AbstractBackgroundWhile most overdose deaths in Canada occur in the community, some patients are resuscitated, admitted to intensive care units having sustained severe anoxic brain injury, and have the potential to be organ donors. The purpose of this study was to determine the impact of the overdose crisis on organ donation in selected Canadian provinces.MethodsWe obtained data on the total number of organ donors and those dying because of overdose in five Canadian provinces from 2014 to 2018. We also obtained data for January –June 2019 for four of five provinces (Quebec excepted). We accessed federal and provincia...
Source: Canadian Journal of Anesthesia - February 9, 2021 Category: Anesthesiology Source Type: research

Quantifying and interpreting inequality of surgical site infections among operating rooms
AbstractPurposeThe incidence of surgical site infection differs among operating rooms (ORs). However, cost effectiveness of interventions targeting ORs depends on infection counts. The purpose of this study was to quantify the inequality of infection counts among ORs.MethodsWe performed a single-centre historical cohort study of elective surgical cases spanning a 160-week period from May 2017 to May 2020, identifying cases of infection within 90 days using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used the Gini index to measure inequality of infections among ORs. As...
Source: Canadian Journal of Anesthesia - February 5, 2021 Category: Anesthesiology Source Type: research

Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process
The objectives of this Canadian consensus building process by a multidisciplinary group of Canadian stakeholders were to review current evidence and international DCD heart experience, comparatively evaluate international protocols with existing Canadian medical, legal, and ethical practices, and to discuss implementation barriers. Review of current evidence and international experience of DCD heart donation (DPP and NRP) determined that DCD heart donation could be used to provide opportunities for more heart transplants in Canada, saving additional lives. Although candid discussion identified a number of potential barrier...
Source: Canadian Journal of Anesthesia - February 5, 2021 Category: Anesthesiology Source Type: research

The immunomodulatory effect of ketamine in colorectal cancer surgery: a randomized-controlled trial
ConclusionsIntraoperative low-dose ketamine administration did not convey any favourable impacts on overall postoperative NK cell activity, inflammatory responses, and prognosis in colorectal cancer surgery patients.Trial registrationwww.clinicaltrial.gov (NCT03273231); registered 6 September 2017. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2021 Category: Anesthesiology Source Type: research

Unravelling the unseen metabolic changes in patients with malignant hyperthermia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2021 Category: Anesthesiology Source Type: research

Programmed intermittent epidural bolus for labour analgesia during first stage of labour: a sequential allocation trial to determine the effective interval time between boluses of a fixed volume of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 µg·mL −1
ConclusionThe estimated EI90 for boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 µg·mL−1 was 20 (95% CI, 5.9 to 28.8) min. These results suggest that there is no advantage in using this regimen compared with those reported in the literature using the same dose of bupivacaine in concentrations of 0.0625% and 0.125%.Trial registrationwww.clinicaltrials.gov (NCT03735771); registered 7 November 2018. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2021 Category: Anesthesiology Source Type: research

Femoral and popliteal venous Doppler during prone and supine position in COVID-19 patients: a potential diagnostic tool to detect abnormal right ventricular function
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2021 Category: Anesthesiology Source Type: research

Survey results from The Anesthesia Clerkship Pocket Guide for Medical Students —promoting free open medical education resources in anesthesia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2021 Category: Anesthesiology Source Type: research

Early experience with critically ill patients with COVID-19 in Montreal
ConclusionsCharacteristics and outcomes of critically ill patients with COVID-19 in Montreal were similar to those reported in the existing literature. We found an increased physiologic dead space, supporting the hypothesis that pulmonary vascular injury may be central to COVID-19-induced lung damage. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 26, 2021 Category: Anesthesiology Source Type: research

A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams
ConclusionWe have shown that a highly skilled designated intubation team, following a protocolized, early tracheal intubation model may be beneficial in improving patient and staff safety, and could be considered by other institutions in future pandemic surges. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 26, 2021 Category: Anesthesiology Source Type: research

Lack of evidence that epidural pain relief during labour causes autism spectrum disorder: a position statement of the Canadian Anesthesiologists ’ Society
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 26, 2021 Category: Anesthesiology Source Type: research

Liposomal bupivacaine for prolonging analgesia with TAP blocks —two steps forward, one step back
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 21, 2021 Category: Anesthesiology Source Type: research

Professional fulfillment, burnout, and wellness of anesthesiologists during the COVID-19 pandemic
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 20, 2021 Category: Anesthesiology Source Type: research

Patient-reported outcomes in those consuming medical cannabis: a prospective longitudinal observational study in chronic pain patients
AbstractPurposeWe investigated patients with chronic pain seeking medical cannabis. We assessed their demographics, patterns of cannabis use, and the long-term effectiveness of cannabis on their pain and functional domains.MethodsThis observational study enrolled patients between 8 September 2015 and 31 July 2018 from community-based cannabis clinics in Ontario, Canada. In addition to collecting demographic information, the primary outcomes studied were pain intensity and pain-related interference scores assessed at baseline, three, six, and 12 months. Using validated questionnaires, we also assessed anxiety, depression, q...
Source: Canadian Journal of Anesthesia - January 20, 2021 Category: Anesthesiology Source Type: research

Exploring and reconciling discordance between documented and preferred resuscitation preferences for hospitalized patients: a quality improvement study
ConclusionHospitalized patients may have preferences documented for CPR and ICU interventions contrary to their preferences. Trained nurses can identify inpatients who would benefit from further in-depth resuscitation preference conversations. Once identified, discordance can be reconciled during the index admission. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 15, 2021 Category: Anesthesiology Source Type: research

Anesthesiologists ’ involvement in undergraduate medical education is beneficial to students and the specialty
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 15, 2021 Category: Anesthesiology Source Type: research

Submental approach to intubation for craniomaxillofacial surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2021 Category: Anesthesiology Source Type: research

Association of six-minute walk test distance with postoperative complications in non-cardiac surgery: a secondary analysis of a multicentre prospective cohort study
ConclusionPreoperative 6MWT distance had a modest association with moderate or severe complications after inpatient non-cardiac surgery. Further studies are needed to determine the optimal role of the 6MWT as an objective exercise test for informing preoperative risk stratification. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2021 Category: Anesthesiology Source Type: research

A comparison of methods used to secure pediatric endotracheal tubes using a live human dermal model
ConclusionsThere are significant differences in force required to distract an ETT based on taping methods. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 12, 2021 Category: Anesthesiology Source Type: research

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis
ConclusionsEvidence for the utility of videolaryngoscopy continues to evolve but supports its increased adoption in obstetrics where videolaryngoscopes should be immediately available for use as a first-line device.Trial registrationPROSPERO (CRD42020189521); registered 6 July 2020. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 12, 2021 Category: Anesthesiology Source Type: research

Is high-flow safer than low-flow nasal oxygenation for procedural sedation?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 12, 2021 Category: Anesthesiology Source Type: research

A randomized-controlled trial comparing liposomal bupivacaine, plain bupivacaine, and the mixture of liposomal bupivacaine and plain bupivacaine in transversus abdominus plane block for postoperative analgesia for open abdominal hysterectomies
ConclusionsIn this small study at risk of being under-powered, the mixture of liposomal bupivacaine with plain bupivacaine for TAP block did not improve analgesia compared with either liposomal bupivacaine or plain bupivacaine on their own.Trial registrationwww.clinicaltrials.gov (NCT03250507); registered 5 April 2017. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2021 Category: Anesthesiology Source Type: research

Pupillometry in perioperative medicine: a narrative review
ConclusionsPupillometry is an easy to use non-invasive bedside technique to quantify nociception and monitor opioid effects. It has the potential to personalize pain management in perioperative and intensive care unit environments. Additional studies are needed to further understand the utility of pupillometry in this context. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2021 Category: Anesthesiology Source Type: research

Risks to healthcare workers following tracheal intubation of patients with known or suspected COVID-19 in Canada: data from the intubateCOVID registry
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2021 Category: Anesthesiology Source Type: research

Correction to: An updated introduction to electroencephalogram-based brain monitoring duringintended general anesthesia
This article was updated to correct Heiko A. Kaiser ’s name. It appeared incorrectly as Heiko K. Kaiser. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2021 Category: Anesthesiology Source Type: research

Critical Care Canada Forum 2020 Abstracts
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2021 Category: Anesthesiology Source Type: research

Perioperative mobile application for mothers undergoing Cesarean delivery: a prospective cohort study on patient engagement
ConclusionMost participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs.Trial registrationwww.ClinicalTrials.gov (NCT03746678); registered 5 November 2018. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2021 Category: Anesthesiology Source Type: research

In reply: A safer step-by-step approach for erector spinae plane phenol neurolytic blocks
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2021 Category: Anesthesiology Source Type: research

A safer step-by-step approach for erector spinae plane phenol neurolytic blocks
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 8, 2021 Category: Anesthesiology Source Type: research