Massive venous air embolism
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 15, 2018 Category: Anesthesiology Source Type: research

Point-of-care ultrasound in pediatric anesthesiology and critical care medicine
AbstractUltrasound has increasingly become a clinical asset in the hands of the anesthesiologist and intensivist who cares for children. Though many applications for ultrasound parallel adult modalities, children as always are not simply small adults and benefit from the application of ultrasound to their management in various ways. Body composition and size are important factors that affect ultrasound performance in the child, as are the pathologies that may uniquely afflict children and aspects of procedures unique to this patient population. Ultrasound simplifies vascular access and other procedures by visualizing struc...
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Perioperative transesophageal echocardiography for non-cardiac surgery
ConclusionsPerioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Core point-of-care ultrasound curriculum: What does every anesthesiologist need to know?
AbstractPoint-of-care ultrasound (POCUS) is becoming an integral part of anesthesia practice throughout the world. Despite the growing interest in POCUS among trainees and faculty, POCUS training is variable among universities across Canada. This suggests a need for curriculum development and standardization. International guidelines for Emergency Medicine and Critical Care have common frameworks and may be used as a reference to model anesthesia-specific curricula. The Royal College of Anaesthetists of the United Kingdom currently offers the only nationally approved POCUS curriculum for anesthesia and critical care traine...
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Transthoracic echocardiographic evaluation of the heart and great vessels
ConclusionsThe integration of the echocardiographic information particularly from the heart and great vessels with the case story, physical examination, laboratory data, and other relevant clinical information should become the way of the future, and this will benefit the patients under our care. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Point-of-care ultrasound (POCUS) of the upper airway
The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes. Ultrasonography can differentiate tracheal, esophageal, and endobronchial intubation. Ultrasonography of the neck can accurately localize the cricothyroid membrane for emergency airway access and si...
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Critical care echocardiography: a certification pathway for advanced users
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Basic transesophageal and critical care ultrasound
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

Point-of-care ultrasound: a protean opportunity for perioperative care
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 13, 2018 Category: Anesthesiology Source Type: research

The Williams Airway Intubator
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 12, 2018 Category: Anesthesiology Source Type: research

Wesley Bourne: leader extraordinaire of Canadian anesthesiology
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 12, 2018 Category: Anesthesiology Source Type: research

Prevalence of discordant elevations of state entropy and bispectral index in patients at amnestic sevoflurane concentrations: a historical cohort study
AbstractBackgroundProcessed electroencephalogram (EEG) monitors help assess the hypnotic state during general anesthesia or sedation. Maintaining the bispectral index (BIS) or state entropy (SE) between 40 and 60 has been recommended to mitigate anesthesia awareness. Nonetheless, SEs> 70 were frequently observed at end-tidal sevoflurane concentrations unlikely to allow awareness. We sought to determine the prevalence of elevated discordant measurements during BIS and SE monitoring.MethodsElectronic data collected over 11 months at two academic hospitals were retrospectively reviewed. At the hospital using SE, all cases ...
Source: Canadian Journal of Anesthesia - March 9, 2018 Category: Anesthesiology Source Type: research

Analgesia-related differences among the erector spinae, multifidus cervicis, and inter-semispinal plane blocks
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 5, 2018 Category: Anesthesiology Source Type: research

Bromage motor blockade score – a score that has lasted more than a lifetime
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 5, 2018 Category: Anesthesiology Source Type: research

Challenging Topics in Neuroanesthesia and Neurocritical Care
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - March 1, 2018 Category: Anesthesiology Source Type: research

Characteristics and outcomes of patients who underwent bedside surgical tracheostomy performed in the intensive care unit: a retrospective study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

The Young Investigator Retreat of the Canadian Critical Care Trials Group: mentorship and self-discovery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

Erector spinae plane block for the management of chronic shoulder pain: a case report
ConclusionsThe ESP block may be a promising alternative to other interventional procedures in the management of chronic shoulder pain and deserves further study. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

Survey of medical students ’ knowledge and perceptions of anesthesiology at one Canadian university: pre-clerkship and during clinical clerkship, a cohort study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

Comparing the socioeconomic status of critical care doctors and patients
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

A technique for securing the Aintree Intubation Catheter ™ to a flexible bronchoscope
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

Venous circulation and the invisible hand
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

In reply: Eye taping and chlorhexidine exposure: caution when interpreting scarce evidence
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 14, 2018 Category: Anesthesiology Source Type: research

Body mass index predicts insulin sensitivity during cardiac surgery: a prospective observational study
AbstractPurposeTaking into account the previously described link between body weight and diabetes mellitus (DM) in non-surgical patients, and the understanding that the degree of intraoperative insulin resistance is a predictor of adverse clinical outcomes, we investigated the relationship between body mass index (BMI) and insulin sensitivity during cardiac surgery.MethodsWe prospectively enrolled 400 patients scheduled for elective cardiac surgery and divided them into groups based on the presence or absence of type-2 DM. They were further categorized into four subgroups based on their BMI: group 1- normal weight, BMI 18....
Source: Canadian Journal of Anesthesia - February 12, 2018 Category: Anesthesiology Source Type: research

The curious tale of perioperative precision medicine: a story of hydroxocobalamin and cardiac surgery-associated vasoplegia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 8, 2018 Category: Anesthesiology Source Type: research

The sound of air: point-of-care lung ultrasound in perioperative medicine
ConclusionsBecause of the unique physical properties of the lungs, only a careful and systematic analysis of both artifacts and anatomical images allows accurate interpretation of sonographic findings. Future studies exploring the use of software for automatic interpretation, quantitative methods for the assessment of interstitial syndrome, and continuous monitoring devices may further simplify and expand the use of this technique at the bedside in acute medicine and the perioperative setting. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 6, 2018 Category: Anesthesiology Source Type: research

The agreement between venous and arterial blood gases in critical care and ward patients: is there a need to stratify for shock?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 5, 2018 Category: Anesthesiology Source Type: research

In reply: the agreement between venous and arterial blood gas in critical care and ward patients: is there a need to stratify for shock?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 5, 2018 Category: Anesthesiology Source Type: research

A review of diagnostic accuracy and clinical impact from the focused use of perioperative ultrasound
ConclusionPerioperative point-of-care ultrasound is a useful method for the diagnosis of many important perioperative conditions. The impact of this diagnostic approach on patient outcomes however remains to be determined. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2018 Category: Anesthesiology Source Type: research

Postdural puncture headache at Sylvanus Olympio University Hospital of Lom é in Togo: incidence and risk factors
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - February 2, 2018 Category: Anesthesiology Source Type: research

Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study
ConclusionUltrasound-guided TQL injections consistently cover the thoraco-lumbar innervation relevant to the AIC graft donor site. The injectate spread seen in anatomical dissections correlated with the dermatomal anesthesia clinically. The TQL has the potential to provide reliable analgesia for patients undergoing AIC bone graft harvesting. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis
ConclusionsThe results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Anesthesiologists ’ perception of perioperative stroke risk during non-neurologic and non-cardiac surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Nitrous oxide added at the end of isoflurane anesthesia hastens early recovery without increasing the risk for postoperative nausea and vomiting: a randomized clinical trial
ConclusionsAdding N2O during the last 30 min of an isoflurane-based inhalational anesthetic reduced the time to extubation, eye opening, and orientation. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Greenhouse gases: the choice of volatile anesthetic does matter
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

A modified lightwand-guided approach for placement of a King Laryngeal Tube ™
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in the perioperative setting
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Subcutaneous ketamine for postoperative pain relief in Rwanda: a randomized clinical trial
AbstractPurposePostoperative pain control is often inadequate in low-income countries such as Rwanda, prompting the search for an inexpensive improvement. A randomized controlled trial was conducted to study the use of subcutaneous ketamine for the management of postoperative pain in patients undergoing major surgery in Kigali, Rwanda.MethodsFifty-nine patients undergoing major abdominal, head and neck, plastic, or gynecological surgeries were studied. In addition to standard care, patients received five subcutaneous injections of ketamine 1 mg ·kg−1 (ketamine group,n = 30) or normal saline (placebo group,n = ...
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Perioperative implications of sodium-glucose cotransporter-2 inhibitors: a case series of euglycemic diabetic ketoacidosis in three patients after cardiac surgery
We present three cases of euDKA that occurred following elective coronary artery bypass grafting surgery. The role of the anesthesiologist in the prevention, diagnosis, and management of this complication is also discussed.Clinical featuresThree patients receiving chronic SGLT2i therapy for DM-II (discontinued one to two days preoperatively) underwent cardiac surgery. On the first postoperative day, each exhibited nausea, vomiting, and tachypnea. Although these nonspecific postoperative findings are common, our patients also exhibited anion gap metabolic acidosis (pH 12 mmol ·L−1) with lower than anticipated s...
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

The gas has the last laugh
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 13, 2018 Category: Anesthesiology Source Type: research

Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists
ConclusionsPresently, our specialty requires consensus by expert stakeholders to address issues of competence, certification, development of standards and terminology, and the management of unexpected diagnoses. To promote POCUS competency in our discipline, we support its incorporation into anesthesiology curricula and training programs and the continuing professional development of POCUS-related activities at a national level. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2018 Category: Anesthesiology Source Type: research

Management strategies for unintentional dural puncture: a Canadian experience survey in an academic setting
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2018 Category: Anesthesiology Source Type: research

Impact of ENIGMA trials on nitrous oxide: a survey of Canadian anesthesiologists and residents
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2018 Category: Anesthesiology Source Type: research

Mobile ascending aortic mass presenting as acute myocardial infarction
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 11, 2018 Category: Anesthesiology Source Type: research

Postoperative pain and study design: the type of surgical procedure matters
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 10, 2018 Category: Anesthesiology Source Type: research

Under pressure: an audit of airway device pressures
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 10, 2018 Category: Anesthesiology Source Type: research

In reply: Radial artery spasm treatment by radial, median, or musculocutaneous nerve block? A potential therapeutic dilemma
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 10, 2018 Category: Anesthesiology Source Type: research

Efficacy of ultrasound-guided modified thoracolumbar interfascial plane block for postoperative analgesia after spinal surgery: a randomized-controlled trial
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2018 Category: Anesthesiology Source Type: research

Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial
ConclusionCompared with the intravenous route, perineural dexamethasone prolongs the mean interscalene block duration by a small amount that may or may not be clinically significant, regardless of dose. However, the difference in mean block durations between 8 mg and 4 mg of dexamethasone is highly unlikely to be clinically important, regardless of the administration route.Trial registrationwww.clinicaltrials.gov (NCT02426736). Registered 14 April 2015. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 22, 2017 Category: Anesthesiology Source Type: research

Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 22, 2017 Category: Anesthesiology Source Type: research