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Use of Intralipid ® in managing refractory hypotension following epidural blockade
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 25, 2014 Category: Anesthesiology Source Type: research

Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation
Conclusion Takotsubo cardiomyopathy following an injection of epinephrine remains a rare but increasingly described occurrence. The severity of the symptoms appears to be patient dependent, but refractory cardiogenic shock may occur and require significant circulatory support. If this situation occurs in a hospital where this necessary equipment is lacking, a mobile ECMO unit appears to be a viable solution to optimize the patient’s chances of survival. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

From the Journal archives : Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

From the Journal archives: Hereditary aspects of malignant hyperthermia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Laryngoscope manipulation by experienced versus novice laryngoscopists
This study compared the angle and grip of the laryngoscope handle by experienced vs novice laryngoscopists to determine whether basic differences could be identified that might aid in teaching the nuances of skillful laryngoscope manipulation. Methods Laryngoscopists were photographed performing tracheal intubation for elective surgical patients (22 experienced laryngoscopists) and an airway trainer mannequin (22 experienced and 21 novice layngoscopists). The photographs were analyzed for laryngoscope handle angle from horizontal, eye-scope distance, and eye-scope angle. Airway t...
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Lifelong lessons I learned from my resident research project
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach
Conclusion The enhanced anatomical knowledge provided by ultrasound-guidance has allowed anesthesiologists to devise new block techniques and refine existing ones. The superior trunk block is an example of this refinement and is intended as an alternative to the conventional interscalene block for anesthesia of the shoulder. Further research is planned to confirm the efficacy and safety of the technique. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Association of anesthesia technique for radical prostatectomy with biochemical recurrence: a retrospective cohort study
Conclusions We did not find an association between anesthesia technique and disease recurrence in men with prostate cancer treated with RP. Anesthesia technique is unlikely to alter disease recurrence following RP independent of surgical and pathological factors. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Three cerebral venous sinus thromboses following inadvertent dural puncture: a case series over an eight-year period
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 23, 2014 Category: Anesthesiology Source Type: research

Lidocaine infusion for continuous interscalene nerve block: Is there evidence for local and systemic benefits?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 20, 2014 Category: Anesthesiology Source Type: research

Special announcement: Guidelines to the Practice of Anesthesia – Revised Edition 2015
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 18, 2014 Category: Anesthesiology Source Type: research

The introduction of a lightweight mini vaporizer and malignant hyperthermia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 15, 2014 Category: Anesthesiology Source Type: research

The limitations of manually entered data in acute care environments
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 15, 2014 Category: Anesthesiology Source Type: research

Prevention of venous thromboembolism in the Enhanced Recovery After Surgery (ERAS) setting: an evidence-based review
Conclusions Venous thromboembolism is a serious but preventable complication of hospitalization, especially among surgical patients. Historically, it has accounted for a high burden of postoperative morbidity and mortality. In the Enhanced Recovery After Surgery era, our aim should be no less ambitious than the eradication of postoperative VTE. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)
Abstract Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical b...
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways?
Conclusion Recovery after surgery is a complex construct. Different outcomes are important at different phases along the recovery trajectory. Measures for quantifying recovery in hospital and after discharge are available. A consensus-based core set of outcomes with input from multiple stakeholders would facilitate research reporting. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Inter-device differences in monitoring for goal-directed fluid therapy
Conclusions The ERAS protocols typically involve a multipronged regimen to facilitate early recovery after surgery. Optimizing perioperative fluid therapy is a key component of these efforts. While no technology is without limitations, the majority of the currently available literature suggests esophageal Doppler and arterial waveform analysis to be the most desirable choices to guide fluid administration. Their performance is dependent, in part, on the interpretation of dynamic changes resulting from intrathoracic pressure fluctuations encountered during mechanical ventilation. Evolving practice patterns, such a...
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Health economics in Enhanced Recovery After Surgery programs
Conclusions In conclusion, ERAS protocols appear to be both clinically efficacious and cost effective across a variety of surgical specialties in the short term. Nevertheless, studies reporting out-of-hospital cost data are lacking. Further research is required to determine how best to evaluate both medium- and long-term costs relating to ERAS pathways while taking quality of life data into account. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

A prospective observational study comparing the ease of use and safety of two neuraxial anesthesia kits on an epidural-spinal training model
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Enhanced Recovery After Surgery (ERAS): good for now, but what about the future?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Spread and adoption of enhanced recovery from elective surgery in the English National Health Service
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Cinching the loop on the Arndt endobronchial blocker during placement for descending aortic aneurysm surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

An improvised pressurization system for arterial lines
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 13, 2014 Category: Anesthesiology Source Type: research

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development
Conclusions Optimal perioperative care of the thoracic patient includes a protective ventilation strategy from intubation to extubation and into the immediate postoperative period. Anesthetic goals include the prevention of perioperative hypoxemia and postoperative ALI. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 12, 2014 Category: Anesthesiology Source Type: research

Ebola virus disease: an update for anesthesiologists and intensivists
Conclusion Anesthesiologists and intensivists may be called upon to manage patients with EVD. It is important that these clinicians have an appreciation for the epidemiology and pathogenesis of this disease and for the proper utilization of PPE when treating these patients. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 6, 2014 Category: Anesthesiology Source Type: research

Ebola and the Journal’s response to “the most severe acute health emergency seen in modern times”
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 6, 2014 Category: Anesthesiology Source Type: research

Unusual difficult airway due to the presence of a large facial foreign body
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 1, 2014 Category: Anesthesiology Source Type: research

Faculty experiences regarding a global partnership for anesthesia postgraduate training: a qualitative study
Conclusions As a new and evolving program, the findings from this study highlight challenges and opportunities for faculty as part of a partnership for postgraduate medical education. Since maintaining an effective faculty is essential to ensure the sustainability of any teaching program, this work may help other similar programs to anticipate and overcome potential challenges. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 31, 2014 Category: Anesthesiology Source Type: research

On the qualities of qualitative research
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 30, 2014 Category: Anesthesiology Source Type: research

Anesthetic considerations and airway management in a professional singer: case report and brief review
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 29, 2014 Category: Anesthesiology Source Type: research

Understanding the physics and fluid dynamics governing ultrasound gel behaviour facilitates its use: the ketchup analogy!
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 29, 2014 Category: Anesthesiology Source Type: research

Use of mobile tablet devices and reduction in time to perioperative transesophageal echocardiography reporting: a historical cohort study
Conclusion Implementation of a MTD system for data entry leads to improved TEE reporting time and reduces TEE reporting delinquency. Further studies are required to determine whether this strategy enhances quality of reporting, optimizes communication between care teams, and improves outcomes without increasing costs. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 28, 2014 Category: Anesthesiology Source Type: research

Postoperative delirium following transcatheter aortic valve implantation: a historical cohort study
Abstract Purpose Transcatheter aortic valve implantation (TAVI) techniques show favourable survival outcomes in high-risk patients, but the incidence of postoperative delirium is unknown. We conducted a historical cohort study to compare postoperative delirium in retrograde transfemoral (TF) versus anterograde transapical (TA) TAVI procedures. We also sought to identify independent predictors of delirium following TAVI. Methods We performed a retrospective chart review on all patients who underwent TF (n = 77) or TA (n = 45) TAVI duri...
Source: Canadian Journal of Anesthesia - October 22, 2014 Category: Anesthesiology Source Type: research

Ultrasound-guided saphenous nerve block – within versus distal to the adductor canal: a proof-of-principle randomized trial
Conclusion In this randomized trial, we found no differences in nerve visibility, block success rate, or onset between the AC and Peri-SBDGA techniques of ultrasound-guided saphenous nerve blockade, although the former technique provided superior vascular landmark visibility. Neither technique produced a sufficiently high success rate to provide reliable surgical anesthesia per se. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 22, 2014 Category: Anesthesiology Source Type: research

Gas leak due to a damaged GE Disposable Multi Absorber Canister used with an EZchange Module following its reinstallation during anesthesia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 18, 2014 Category: Anesthesiology Source Type: research

Guidelines to the Practice of Anesthesia – Revised Edition 2015
Overview The Guidelines to the Practice of Anesthesia Revised Edition 2015 (the guidelines) were prepared by the Canadian Anesthesiologists’ Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2015 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any speci...
Source: Canadian Journal of Anesthesia - October 17, 2014 Category: Anesthesiology Source Type: research

Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis
Conclusion This experience leads us to suggest that, in patients with Morquio A, it may be prudent to avoid the use of epidural anesthesia without very firm indication, to support BP at or near baseline levels in the presence of even moderate spinal stenosis, and to avoid flexion or extension of the spinal column in intraoperative positioning. If the spinal cord/column status is unknown or if the patient is known to have any degree of spinal stenosis, we suggest that the same rigorous BP support practices that are typically applied in other patients with severe spinal stenosis, especially stenosis with myelomalac...
Source: Canadian Journal of Anesthesia - October 17, 2014 Category: Anesthesiology Source Type: research

Malignant hyperthermia and the clinical significance of type-1 ryanodine receptor gene ( RYR1 ) variants: proceedings of the 2013 MHAUS Scientific Conference
This report represents a summary of the proceedings of this conference. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda
Abstract High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, ...
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Patient and caregiver experience following ambulatory surgery: qualitative analysis in a cohort of patients 65 yr and older
Conclusions Patients and caregivers ardently described real challenges during convalescence. Ambulatory care facilities should prepare this specific demographic of patients and caregivers for the post-discharge experience. Paramount for participants was the need for clear communication and a commitment to ongoing support following discharge. The trial on which this analysis was based was registered with Clinical Trials.gov (NCT01382251). (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

A randomized feasibility trial of clonidine to reduce perioperative cardiac risk in patients on chronic beta-blockade: the EPIC study
Conclusion This pilot randomized trial confirmed the feasibility, safety, and tolerability of a full-scale trial of oral and transdermal clonidine for reducing the risk of cardiac complications during non-cardiac surgery. This trial was registered at www.clinicaltrials.gov: NCT00335582. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

From the Journal archives: Apparatus for demand analgesia with parenteral opioids: from leading role to supporting cast
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Reversal of high spinal anesthesia with cerebrospinal lavage after inadvertent intrathecal injection of local anesthetic in an obstetric patient
Conclusion We show that exchange of CSF for normal saline can be used successfully to manage a high spinal in an obstetric patient. Our results suggest that CSF lavage could potentially be an important and helpful adjunct to the conventional supportive management of obstetric patients in the event of inadvertent high or total spinal anesthesia. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Blind nasal intubation: teaching a dying art
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Accuracy of manual entry of drug administration data into an anesthesia information management system
This study examined whether these data are accurate regarding drug name, dose administered, and time of administration, and whether the stage of anesthesia influences data accuracy. Methods Real-time observational data on drug administration during elective operations were compared with computerized information on drug administration entered by anesthesiologists. A trained observer (K.D.) performed the observations. Results Data were collected during 57 operations which included 596 separate occasions of drug administration by 22 anesth...
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Providing quality in anesthesia care in low- and middle-income countries
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Mechanism of stylet-facilitated nasotracheal intubation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Lean-scaled weight can be used to estimate blood volume for obese patients
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

Lung re-inflation after one-lung ventilation for thoracic surgery: importance of clamping the dependent lung
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 11, 2014 Category: Anesthesiology Source Type: research

The temporal relationship between early postoperative delirium and postoperative cognitive dysfunction in older patients: a prospective cohort study
Conclusions Eighty percent of surgical patients experienced some form of cognitive dysfunction the day after surgery, and few recovered by the second day after surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 7, 2014 Category: Anesthesiology Source Type: research