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Perioperative catabolism
Conclusions Current anticatabolic therapeutic strategies include glycemic control and perioperative nutrition in combination with optimal pain control and the avoidance of preoperative starvation. All these elements are part of Enhanced Recovery After Surgery (ERAS) programs. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 15, 2015 Category: Anesthesiology Source Type: research

Lumbar plexus block surface landmarks as assessed by computed axial tomography in adult patients with scoliosis: a case series
Conclusions In patients with scoliotic disease of the spine, there is wide variability in the bony surface landmarks. The location of the LP is generally more medial than expected when compared with both modified and traditional landmarks. A review of the imaging studies and the pre-procedural ultrasound assessment of the anatomy should be considered prior to needle puncture. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2015 Category: Anesthesiology Source Type: research

Miller’s Anesthesia, Eighth Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2015 Category: Anesthesiology Source Type: research

Transient Horner’s syndrome following thoracic epidural anesthesia for mastectomy: a prospective observational study
Conclusion The incidence of Horner’s syndrome following thoracic epidural anesthesia and continuous thoracic epidural analgesia for mastectomy was 1.4%. The mechanism was consistent with cephalic spread of the epidural local anesthetic. This trial was registered at: Clinicaltrials.gov, number: NCT02130739. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 6, 2015 Category: Anesthesiology Source Type: research

Lung re-inflation after one-lung ventilation for thoracic surgery: an alternative technique
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 1, 2015 Category: Anesthesiology Source Type: research

The impact of advanced maternal age on peripartum thromboelastographic coagulation profiles: a prospective observational exploratory study
Abstract Purpose Advanced maternal age (AMA) is a known risk factor for pregnancy-related venous thromboembolism. However, it is unclear if underlying differences exist in the maternal coagulation profiles of AMA vs non-AMA women. The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). Methods We compared the peripartum thromboelastographic profiles of healthy AMA women (age> 35 yr) and non-AMA women (age ≤ 35 yr) undergoi...
Source: Canadian Journal of Anesthesia - December 31, 2014 Category: Anesthesiology Source Type: research

Occupational Health: additional support for the aging anesthesiologist
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 31, 2014 Category: Anesthesiology Source Type: research

Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial
Conclusion Hands-on training in cricothyrotomy resulted in fewer major ASA-DAA deviations in a simulated CICO scenario. Training in cricothyrotomy may play an important role in complying with the ASA-DAA in a CICO situation but does not appear to affect non-technical behaviours such as decision-making. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 30, 2014 Category: Anesthesiology Source Type: research

Abstracts
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 30, 2014 Category: Anesthesiology Source Type: research

Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis
Conclusion Transtracheal ultrasound is a useful tool to confirm endotracheal intubation with an acceptable degree of sensitivity and specificity. It can be used in emergency situations as a preliminary test before final confirmation by capnography. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

Controversy between anesthesiologists and obstetricians on the labour ward: the Delphi method is used as a consensus-building technique
Conclusions Both the obstetricians and the anesthesiologists identified several controversial topics that may influence clinical practice on the labour ward. This information could serve as the basis to develop educational programs and strategies to improve communication between the two disciplines. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children
Abstract Purpose Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q™ supraglottic airway than through the i-gel™. Methods Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology t...
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

Sensitivity and specificity of the animal fluency test for predicting postoperative delirium
Abstract Background Preoperative cognitive impairment is a major risk factor for postoperative delirium. We therefore investigated the prognostic significance and feasibility of administering a brief cognitive screen before surgery. Methods Patients > 65 yr of age undergoing hip, knee, or spine surgery were enrolled. A 60-sec cognitive screen, the animal fluency test (AFT), was administered preoperatively. Postoperative delirium was measured using a chart-based tool previously validated using criteria from the Confusion Assessment Metho...
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study
Abstract Purpose Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Anemia and red blood cell (RBC) transfusion have individually been identified as potentially modifiable risk factors, but their interrelationship with AKI has not been clearly defined. The purpose of this study was to explore the interrelationship of preoperative anemia, intraoperative anemia, and RBC transfusion on the day of surgery with AKI in cardiac surgery. Methods This historical cohort study included 16 hospitals, each contributing data on approxi...
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

Complications and Mishaps in Anesthesia. Cases – Analysis – Preventive Strategies
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 24, 2014 Category: Anesthesiology Source Type: research

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial
Abstract Purpose Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia. Methods American Society of Anesthesiologists physical status I-II adults undergoing elective t...
Source: Canadian Journal of Anesthesia - December 19, 2014 Category: Anesthesiology Source Type: research

Perioperative fellowship curricula in anesthesiology: a systematic review
Conclusions There is a paucity of published literature on what perioperative care entails as well as what perioperative fellowship curricula should include. While we suggest certain areas of focus to include, the subspecialty of perioperative medicine would benefit from a cohesive and consensus-based curriculum to which academic fellowships could adhere. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 17, 2014 Category: Anesthesiology Source Type: research

The implications of a tracheal bronchus on one-lung ventilation and fibreoptic bronchoscopy in a patient undergoing thoracic surgery: a case report
Conclusion Careful preoperative assessment of tracheobronchial anatomy is imperative in order to choose an appropriate method of OLV and prevent potential complications. In a type I tracheal bronchus with a narrowed distal trachea, a bronchial blocker may have advantages over the conventional DLT in achieving OLV. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 16, 2014 Category: Anesthesiology Source Type: research

Survey of pre-clerkship medical students’ knowledge and perceptions of anesthesiology at one Canadian university
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 16, 2014 Category: Anesthesiology Source Type: research

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response
Conclusions The implementation of a targeted ERAS program has been shown to modulate perioperative insulin sensitivity, thus improving postoperative outcomes and accelerating the return of baseline function. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 12, 2014 Category: Anesthesiology Source Type: research

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre
Conclusion We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 11, 2014 Category: Anesthesiology Source Type: research

The peripartum anesthesiologist
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 11, 2014 Category: Anesthesiology Source Type: research

Low-dose intrathecal local anesthetic does not increase the threshold current for the epidural stimulation test: a prospective observational trial of neuraxial analgesia in labouring women
Conclusions The intrathecal injection of a low dose of bupivacaine-fentanyl does not affect the MTC if the catheter is placed in the epidural space; however, it does affect the threshold if the catheter is placed intrathecally. We also confirm that the EST can help to determine the position of the epidural catheter prior to injection of the test dose. This trial was registered at ClinicalTrials.gov (NCT00464841). (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 11, 2014 Category: Anesthesiology Source Type: research

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways
Conclusion There are continuing advancements in multimodal analgesic techniques; however, postoperative pain in general continues to be undermanaged. Furthermore, a continuing challenge in multimodal pain research related to ERAS is the difficulty in carrying out randomized trials to determine the relative importance of any one component, including analgesia. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 10, 2014 Category: Anesthesiology Source Type: research

Enhanced Recovery After Surgery (ERAS)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 9, 2014 Category: Anesthesiology Source Type: research

Ambulatory Anesthesiology
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 9, 2014 Category: Anesthesiology Source Type: research

Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial
Abstract Background The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. Methods Patients having breast cancer surgery were randomly assigned to paravertebral analgesia with propofol GA (PPA, n = 187) or sevoflurane GA with perioperative opioid analgesia...
Source: Canadian Journal of Anesthesia - December 6, 2014 Category: Anesthesiology Source Type: research

Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine
Conclusions Pharmacogenomic technologies and strategies provide an opportunity to expand our knowledge in CPSP treatment that may manifest in a personalized approach to diagnosis, prevention, and therapy. Capitalizing on this genomic knowledge will necessitate the analysis of many tens of thousands of study patients. This will require an international coordinated effort to which anesthesiologists and surgeons can contribute substantially. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 4, 2014 Category: Anesthesiology Source Type: research

Perioperative considerations of the patient with malaria
Conclusions Malaria remains one of the most devastating infectious diseases worldwide. Multiple organ systems can be impacted as a consequence of changes in structure and function of parasitized erythrocytes. Safe perioperative management requires a sound knowledge of all these potential system effects. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 4, 2014 Category: Anesthesiology Source Type: research

Cervical spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation: a case report
Conclusion In this case, external cervical spine fixation in flexion resulted in a change to the O-C2 angle, which reduced the oropharyngeal area and predisposed to upper airway obstruction. This highlights the need for anesthesiologists to evaluate the degree of cervical spine flexion in patients with halo devices and to have the surgical team present during airway management in the event of acute airway obstruction. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 3, 2014 Category: Anesthesiology Source Type: research

We should do more to train anesthesia technicians in Africa
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 3, 2014 Category: Anesthesiology Source Type: research

Patient preferences on telemedicine for preanesthesia evaluation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 26, 2014 Category: Anesthesiology Source Type: research

Frailty and perioperative outcomes: a narrative review
Conclusions Patients undergoing surgery who are deemed frail, regardless of the scoring assessment used, have a higher likelihood of experiencing adverse perioperative outcomes. With the lack of a unified definition for frailty, further research is needed to address which assessment method is most predictive of adverse postoperative outcomes. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 25, 2014 Category: Anesthesiology Source Type: research

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