Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery
AbstractPurposeIn this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery.Principal findingsTranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (
Source: Canadian Journal of Anesthesia - May 15, 2021 Category: Anesthesiology Source Type: research

Correction to: A survey assessing the need for spinal chloroprocaine to provide subarachnoid neuraxial anesthesia for short-duration surgeries in Canada
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 13, 2021 Category: Anesthesiology Source Type: research

Preoperative analgesic instruction and prescription reduces early home pain after outpatient surgery: a randomized controlled trial
AbstractBackgroundHome pain remains the most common complication in outpatient surgery. Optimal management requires good information and early availability of analgesics. The main objective of this randomized controlled trial was to compare the effects of pre-vs postoperative analgesic instruction and prescription on postoperative home pain.MethodsPatients were randomized into an anesthesia consultation group (AC group) and a standard postoperative group (POP group). The AC group and the POP group received analgesic prescription and instruction during the anesthesia consultation and after surgery, respectively. The primary...
Source: Canadian Journal of Anesthesia - May 12, 2021 Category: Anesthesiology Source Type: research

In reply: Comments on: Mechanisms of action of the erector spinae plane (ESP) block: a narrative review (Letters #1 and #2)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 12, 2021 Category: Anesthesiology Source Type: research

Comments on: Mechanisms of action of the erector spinae plane (ESP) block: a narrative review (Letter #1)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 12, 2021 Category: Anesthesiology Source Type: research

A retrospective evaluation of the failure rate of continuous infraclavicular nerve blockade in the ambulatory setting
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 11, 2021 Category: Anesthesiology Source Type: research

Tranexamic acid for primary elective off-pump coronary artery bypass grafting surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 11, 2021 Category: Anesthesiology Source Type: research

The impact of a barrier enclosure on time to tracheal intubation: a randomized controlled trial
AbstractPurposeNovel devices such as the barrier enclosure were developed in hopes of improving provider safety by limiting SARS-CoV-2 transmission during tracheal intubation. Nevertheless, concerns arose regarding a lack of rigorous efficacy and safety data for these devices. We conducted a randomized controlled trial to evaluate the impact of the barrier enclosure on time to tracheal intubation.MethodAfter Research Ethics Board approval, elective surgical patients with normal airway predictors were randomly allocated 1:1 to tracheal intubation with or without a barrier enclosure. The primary outcome was time to tracheal ...
Source: Canadian Journal of Anesthesia - May 10, 2021 Category: Anesthesiology Source Type: research

Increasing the reproducibility of research will reduce the problem of apophenia (and more)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 7, 2021 Category: Anesthesiology Source Type: research

Apophenia and anesthesia: how we sometimes change our practice prematurely
AbstractHuman beings are predisposed to identifying false patterns in statistical noise, a likely survival advantage during our evolutionary development. Moreover, humans seem to prefer “positive” results over “negative” ones. These two cognitive features lay a framework for premature adoption of falsely positive studies. Added to this predisposition is the tendency of journals to “overbid” for exciting or newsworthy manuscripts, incentives in both the academic and publ ishing industries that value change over truth and scientific rigour, and a growing dependence on complex statistical t...
Source: Canadian Journal of Anesthesia - May 7, 2021 Category: Anesthesiology Source Type: research

A proof-of-concept assessment in healthy volunteers of stimulated skin wrinkling to determine the presence or absence of digital nerve blockade
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

Near-complete glottic obstruction from a loose glottic cancer mass
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

Effect of intraoperative hypovolemic phlebotomy on transfusion and clinical outcomes in patients undergoing hepatectomy: a retrospective cohort study
ConclusionsThe use of IOHP during hepatectomy was associated with less RBCs transfused on the same day of surgery. Trials comparing IOHP with other techniques to reduce blood loss and transfusion are needed in liver surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

Flow is not perfusion, and perfusion is not function: ancillary testing for the diagnosis of brain death
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

Transesophageal lung ultrasound in the intensive care unit
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

Health technology assessment: ownership through shared responsibility and accountability —sugammadex as an example
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 4, 2021 Category: Anesthesiology Source Type: research

The use of the Fluid IV Alert monitor to decrease the incidence of undetected empty intravenous bags in dimmed operating rooms
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 3, 2021 Category: Anesthesiology Source Type: research

The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review
ConclusionPersistent peripheral eosinopenia is a marker of bacterial sepsis and is independently associated with poor outcomes. Bronchoalveolar lavage eosinophil counts are low in early-phase ARDS, but increase in late-phase ARDS, while elevated markers of eosinophil activity correlate with ARDS severity. Further studies understanding the mechanisms leading to eosinopenia in sepsis and increased eosinophil activity in ARDS are needed. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 10, 2021 Category: Anesthesiology Source Type: research

The state of adoption of anesthesia information management systems in Canadian academic anesthesia departments: a survey
ConclusionsA majority of Canadian academic anesthesia departments are still using paper records, but this trend is expected to reverse in the next five years as more departments install an AIMS. Health informatics expertise is lacking in most of the departments, with a minority planning to support the training of future anesthesia informaticians. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 10, 2021 Category: Anesthesiology Source Type: research

False negative electrical epidural stimulation test due to the excessive impedance of a saline bridge
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 10, 2021 Category: Anesthesiology Source Type: research

Augmenting conventional regional nerve block with peripheral neuromodulation using a perineural stimulating catheter
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 10, 2021 Category: Anesthesiology Source Type: research

Correction to: The impact of unilateral diaphragmatic paralysis on sleepdisordered breathing: a scoping review
A correction to this paper has been published: https://doi.org/10.1007/s12630-021-01981-9 (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 7, 2021 Category: Anesthesiology Source Type: research

Flow sensor fault during induction
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - April 2, 2021 Category: Anesthesiology Source Type: research

Non-ventilated lung deflation during one-lung ventilation with a double-lumen endotracheal tube: a randomized-controlled trial of occluding the non-ventilated endobronchial lumen before pleural opening
AbstractPurposeLung deflation during one-lung ventilation (OLV) is thought to be faster using a double-lumen endotracheal tube (DL-ETT) than with a bronchial blocker, especially when the non-ventilated lumen is opened to allow egress of air from the operative lung. Nevertheless, ambient air can also be entrained into the non-ventilated lumen before pleural opening and subsequently delay deflation. We therefore hypothesized that occluding the non-ventilated DL-ETT lumen during OLV before pleural opening would prevent air entrainment and consequently enhance operative lung deflation during video-assisted thoracoscopic surger...
Source: Canadian Journal of Anesthesia - April 2, 2021 Category: Anesthesiology Source Type: research

Can self-reported cognitive difficulties predict postoperative delirium?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 4, 2021 Category: Anesthesiology Source Type: research

Intubation and extubation of patients with a heat and moisture exchanger attached to the endotracheal tube in patients with COVID-19
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 2, 2021 Category: Anesthesiology Source Type: research

Manuel d ’hémodynamique appliquée en anesthésie réanimation et médecine péri-opératoire
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 2, 2021 Category: Anesthesiology Source Type: research

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