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Outcomes in neuroanesthesia: What matters most?
Conclusions Future endeavours in neuroanesthesia research should advocate prospective randomized trials that focus on long-term neurologic outcomes. These initiatives will require coordination of multiple centres through a clinical trials network. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 23, 2015 Category: Anesthesiology Source Type: research

Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery
Conclusion Perioperative bleeding itself is a complex syndrome that can be classified as an outcome measure. Red blood cell transfusion has limitations when considered as an outcome variable and can be biased by many confounders. Its relationship with clinical outcome remains uncertain. In addition to being potential outcome measures, transfusion rates and the number of allogeneic blood products transfused may also be considered as quality-of-care markers. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 22, 2015 Category: Anesthesiology Source Type: research

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study
Abstract Purpose Desflurane has the lowest solubility of currently available volatile anesthetics and may allow for more rapid emergence and recovery compared with sevoflurane. Nevertheless, after volatile induction with sevoflurane, it has not been determined whether the use of desflurane provides faster emergence and recovery. The present study aimed to elucidate the effects of changing from sevoflurane to desflurane during the early part of anesthesia. Methods Fifty-two patients who were scheduled for vitreous surgery with general anesthesia were enro...
Source: Canadian Journal of Anesthesia - October 20, 2015 Category: Anesthesiology Source Type: research

Mismanagement of obstructive sleep apnea may result in finding these patients dead in bed
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 19, 2015 Category: Anesthesiology Source Type: research

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications
Abstract Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. As a result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients’ perceived quality of care, recovery, and satisfa...
Source: Canadian Journal of Anesthesia - October 16, 2015 Category: Anesthesiology Source Type: research

Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review
Conclusions Complementary and alternative medicine therapies in general may provide a useful adjunct in the management of chronic pain. Nevertheless, many patients are not aware of the risks and benefits of individual therapies. In the perioperative setting, the most concerning CAM therapy is the use of herbs and other supplements that may produce physiologic and metabolic derangements and may interact with prescription medications. Resources exist to aid pain specialists, anesthesiologists, and patients in the evidence-based utilization of CAM therapies. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 14, 2015 Category: Anesthesiology Source Type: research

Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis
Conclusion Uterine repair by exteriorization may reduce blood loss and the associated decrease in hemoglobin, but the difference may not be clinically relevant. There was no statistically significant difference between the two repair techniques for intraoperative nausea, vomiting, or pain. In situ repair may be associated with a faster return of bowel function. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2015 Category: Anesthesiology Source Type: research

Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists
Conclusions Among experienced cardiac anesthesiologists, the use of US to facilitate radial arterial catheterization did not affect insertion times, the number of re-directs, or the number of attempts when compared with DP. Ultrasound use had no significant effects on the rates of success on first attempt, failure, or hematoma formation. This trial was registered at www.clinicaltrials.gov: NCT02118441. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2015 Category: Anesthesiology Source Type: research

Tranexamic acid: When is enough (data) enough?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2015 Category: Anesthesiology Source Type: research

Perioperative Kidney Injury: Principles of Risk Assessment, Diagnosis and Treatment
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2015 Category: Anesthesiology Source Type: research

Erratum to: Real-time ultrasound-guided epidural catheter insertion in obese parturients
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2015 Category: Anesthesiology Source Type: research

A randomized trial comparing axillary block versus targeted intracluster injection supraclavicular block for upper limb surgery
Abstract Purpose This randomized trial aimed to validate a new method for brachial plexus blockade, i.e., targeted intracluster injection supraclavicular block (TII SCB), by comparing it with ultrasound-guided axillary block (AXB). We hypothesized that TII SCB would result in a shorter total anesthesia-related time. Methods Forty patients undergoing upper limb surgery were randomized to ultrasound-guided TII SCB (n = 20) or AXB (n = 20). In the TII SCB group, we deposited 16 mL of lidocaine 1.5% with epinephrine 5 µg·mL−1 into the...
Source: Canadian Journal of Anesthesia - October 2, 2015 Category: Anesthesiology Source Type: research

Antithrombin activity and heparin response in neonates and infants undergoing congenital cardiac surgery: a retrospective cohort study
Abstract Purpose The immature coagulation system during infancy has age-related physiological differences in proteins that contribute to significant variation in heparin responsiveness through alterations in heparin-enhanced thrombin inhibition. The primary aim of this study was to evaluate the relationship between preoperative antithrombin (AT) activity and heparin responsiveness in neonates and infants undergoing congenital cardiac surgery. Methods In this retrospective cohort study, neonates (aged 0-28 days) and infants (aged 29-365 days) undergoing c...
Source: Canadian Journal of Anesthesia - October 2, 2015 Category: Anesthesiology Source Type: research

Preoperative pulse and thermal radiofrequency facilitates prehabilitation and subsequent rehabilitation of a patient scheduled for total knee arthroplasty
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 2, 2015 Category: Anesthesiology Source Type: research

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study
Conclusion The introduction of an education pamphlet significantly improved self-reported proper opioid disposal rates in postoperative patients. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 2, 2015 Category: Anesthesiology Source Type: research

Crisis Management in Anesthesiology, 2nd Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

Comparison of train-of-four count by anesthesia providers versus TOF-Watch ® SX: a prospective cohort study
Conclusion Anesthesia providers report higher values of TOF count compared with the TOF-Watch SX, especially at intermediate levels of neuromuscular blockade. Since the dosing guidelines for the timing and dose of reversal agents are based on the TOF count derived from the TOF-Watch SX, a manually assessed TOF count may lead to inadequate dosing and/or premature administration of reversal agents. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

Effect of absent bilateral radial arteries on the accuracy of continuous real-time noninvasive blood pressure monitoring with the Nexfin™ system
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

Guide d’échographie pratique en anesthésie-réanimation: anesthésie locorégionale
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

Using lung ultrasound in an infant to detect bronchial intubation not previously identified by auscultation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position
Abstract Purpose Positional change can displace an endotracheal tube (ETT) and change the ETT cuff pressure in a tracheally intubated patient. Endotracheal tubes with different cuff shapes may lead to different cuff pressures after positional change. We hypothesized that the intracuff pressure in the TaperGuard™ ETT with a tapered-shaped cuff would be higher than that in the conventional ETT with a cylindrical-shaped cuff after a change from the supine to the lateral flank position. Methods Fifty-eight patients scheduled for open urological...
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

In reply: A view from the middle of the totem pole
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

A view from the middle of the totem pole
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 6, 2015 Category: Anesthesiology Source Type: research

A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery
This study aimed to determine if the incidence of recall was equivalent between light and deep sedation for colonoscopy. Secondary analysis included complications, patient clinical recovery, and post-procedure cognitive impairment. Methods Two hundred patients undergoing elective outpatient colonoscopy were randomized to light (bispectral index [BIS] 70-80) or deep (BIS
Source: Canadian Journal of Anesthesia - September 3, 2015 Category: Anesthesiology Source Type: research

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation
Abstract Purpose Tranexamic acid (TXA) therapy can reduce red blood cell (RBC) transfusion; however, this therapy remains underutilized in many surgical patient populations. We assessed whether implementation of a protocol to facilitate universal administration of TXA in patients undergoing total hip or knee arthroplasty would reduce the incidence of RBC transfusion without increasing adverse clinical outcomes. Methods We implemented a quality of care policy to provide universal administration of intravenous TXA at a dose of 20 mg·kg−1 ...
Source: Canadian Journal of Anesthesia - September 3, 2015 Category: Anesthesiology Source Type: research

Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds: a prospective observational study
Conclusion Noninvasive PPV and SVV measurements allow an acceptable FR prediction, although the reliability of both variables is dependent on the intended increase in SVI, which improves substantially with concomitant smaller grey zones at higher ↑SVI thresholds. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 3, 2015 Category: Anesthesiology Source Type: research

Histological confirmation of needle tip position during ultrasound-guided interscalene block: a randomized comparison between the intraplexus and the periplexus approach
Conclusion Although our study was somewhat underpowered due to a lower than previously reported rate of subepineurial needle tip positioning, our results suggest that there may be an increased likelihood of subepineurial needle tip position with the intraplexus approach. The periplexus technique resulted in no subepineurial spread of ink, suggesting that this approach may be less likely to result in mechanical trauma to nerves from direct needle injury. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 3, 2015 Category: Anesthesiology Source Type: research

Safe and effective positioning of a left-sided double-lumen tube
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 1, 2015 Category: Anesthesiology Source Type: research

A novel airway management technique for nasal surgery following transoral robotic surgery for patients with obstructive sleep apnea
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 29, 2015 Category: Anesthesiology Source Type: research

Optimizing depth of sedation for colonoscopy
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 26, 2015 Category: Anesthesiology Source Type: research

Ultrasound-guided internal jugular vein cannulation: techniques to confirm guidewire location
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 26, 2015 Category: Anesthesiology Source Type: research

In reply: Ultrasound-guided internal jugular vein cannulation: techniques to confirm guidewire location
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 26, 2015 Category: Anesthesiology Source Type: research

Efficacy of palonosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis
Conclusion Palonosetron provides more effective prophylaxis of early PON, late PON, and late POV compared with ondansetron. Future studies are required to investigate the role of palonosetron during 24-72 hr following surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 22, 2015 Category: Anesthesiology Source Type: research

One-year outcome of the sevoflurane in acute myocardial infarction randomized trial
Abstract Background Sevoflurane is an inhalation anesthetic that has cardioprotective effects. There is limited information regarding its use outside of the operating room and its potential protective effect for patients presenting with myocardial infarction. Methods In the Sevoflurane In Acute Myocardial Infarction trial, patients with a first acute ST-elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention were randomized to inhalation of sevoflurane or oxygen (control). From the time of the patient’...
Source: Canadian Journal of Anesthesia - August 22, 2015 Category: Anesthesiology Source Type: research

The “grey zone” or how to avoid the binary constraint of decision-making
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 22, 2015 Category: Anesthesiology Source Type: research

Advances in photoplethysmography: beyond arterial oxygen saturation
Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 19, 2015 Category: Anesthesiology Source Type: research

Perioperative outcomes: Are we asking the right questions?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 19, 2015 Category: Anesthesiology Source Type: research

A foreign body in the nasopharynx: missing tooth mystery solved
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 18, 2015 Category: Anesthesiology Source Type: research

Ethical concerns for anesthesiologists during an Ebola threat
Conclusions Government, public health authorities, and anesthesia departments need to be prepared to respond to an outbreak of Ebola. Anesthesiologists have a skill that is suited to treat the complications of Ebola virus disease, and in case they are called for duty, anesthesiologists should be aware of the ethical concerns of treating a highly contagious communicable disease. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Substance abuse: a national survey of Canadian residency program directors and site chiefs at university-affiliated anesthesia departments
Conclusion The prevalence of substance abuse among Canadian anesthesiologists and the substances abused appear comparable with data from the United States, with residents being the group most often affected. Early recognition and treatment of chemically dependent anesthesiologists remain imperfect. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Perspectives of anesthesia residents training in Canada on fellowship training, research, and future practice location
Conclusion The majority of anesthesia residents training in Canada choose to pursue fellowship training and work at an academic hospital. Approximately one-third of residents have an interest in incorporating research into their future careers. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Mentoring during anesthesia residency training: challenges and opportunities
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

So…why do you want to become an anesthesiologist?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Chestnut’s Obstetric Anesthesia Principles and Practice, Fifth Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial
In this study, the DLT was replaced with either a single-lumen endotracheal tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Methods Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal™ (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed ...
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

The impact of two different inspiratory to expiratory ratios (1:1 and 1:2) on respiratory mechanics and oxygenation during volume-controlled ventilation in robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial
Abstract Background Volume-controlled ventilation with a prolonged inspiratory to expiratory ratio (I:E ratio) has been used to optimize gas exchange and respiratory mechanics in various surgical settings. We hypothesized that, when compared with an I:E ratio of 1:2, a prolonged I:E ratio of 1:1 would improve respiratory mechanics without reducing cardiac output (CO) during pneumoperitoneum and steep Trendelenburg positioning, both of which can impair respiratory function in robot-assisted laparoscopic radical prostatectomy. Furthermore, we evaluated its effect on oxygenation during robot-a...
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

A survey of mentorship among Canadian anesthesiology residents
Conclusions Formal mentorship programs were present in half of anesthesiology training programs. Although 74% of the residents identified a mentor, 42% did not interact regularly with their mentor. The presence of a formal mentorship program was positively associated with mentorship. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Analysis of the number of publications by Canadian anesthesiology departments from 2000-2013
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research

Anesthesiology: Is it a career, a job, or both?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2015 Category: Anesthesiology Source Type: research