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Use of colour Doppler and M-mode ultrasonography to confirm the location of an epidural catheter - a retrospective case series
ConclusionOur preliminary data suggest the feasibility of using colour Doppler and M-mode ultrasonography to confirm proper epidural catheter placement. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 9, 2017 Category: Anesthesiology Source Type: research

Assessing the accuracy of algorithm-derived cardiorespiratory fitness in surgical patients: a prospective cohort study
AbstractPurposeTo determine if a non-exercise algorithm-derived assessment of cardiorespiratory fitness (CRFA) accurately predicted estimated values obtained using a six-minute walk test (CRF6MWD) and the Duke Activity Status Index (CRFDASI).MethodsFollowing research ethics board approval, an observational cohort study was conducted in selected, consenting patients undergoing elective surgery. Participants completed questionnaires assessing their self-reported exercise capacity. Their height, weight, waist circumference, and vital signs were measured. A six-minute walk test was performed twice with a 45-min rest interval b...
Source: Canadian Journal of Anesthesia - January 8, 2017 Category: Anesthesiology Source Type: research

Muscular body build and male sex are independently associated with malignant hyperthermia susceptibility
This study investigated the association between MHS and muscular body build.MethodsData were obtained from existing reports in the North American Malignant Hyperthermia Registry, including the Report of Muscle Biopsy and Contracture Testing (caffeine-halothane contracture test [CHCT]) as well as Adverse Metabolic or Muscular Reaction to Anesthesia (AMRA) reports. Malignant hyperthermia susceptible individuals were compared with MH negative individuals with regard to body build and reason for testing. Males were also compared with females. Both the CHCT and the AMRA forms were reviewed for comments.ResultsOf the 1,292 indiv...
Source: Canadian Journal of Anesthesia - January 5, 2017 Category: Anesthesiology Source Type: research

The “war on drugs” you did not hear about: the global crisis of access to essential anesthesia medications
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 3, 2017 Category: Anesthesiology Source Type: research

Erratum to: Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 3, 2017 Category: Anesthesiology Source Type: research

Access to controlled medicines for anesthesia and surgical care in low-income countries: a narrative review of international drug control systems and policies
ConclusionImproving the capacity and quality of anesthesia care in low- and middle-income countries requires attention to improving access to controlled medicines. Anesthesiologists and others involved in global health work should collaborate with policymakers and others to improve national and international drug control legislation to ensure that attempts to thwart illicit drug trafficking and use do not compromise availability of controlled medicines. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - January 2, 2017 Category: Anesthesiology Source Type: research

Low dose intravenous dexamethasone (4 mg and 10 mg) significantly prolongs the analgesic duration of single-shot interscalene block after arthroscopic shoulder surgery: a prospective randomized placebo-controlled study
This study evaluated the impact of intravenous dexamethasone (4 mg and 10 mg) on the analgesic duration of single-shot interscalene block after arthroscopic shoulder surgery. We hypothesized that both doses would prolong the analgesic duration compared with placebo.MethodsThis was a prospective double-blind randomized placebo-controlled study in patients undergoing elective arthroscopic shoulder surgery under regional anesthesia with a single-shot interscalene block (0.5% ropivacaine 20 mL). Patients received dexamethasone 4 mg (D4), dexamethasone 10 mg (D10), or a placebo (normal saline [NS]) intravenously at the time of ...
Source: Canadian Journal of Anesthesia - January 2, 2017 Category: Anesthesiology Source Type: research

The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review
ConclusionSixteen of the 19 studies showed that apneic oxygenation prolongs safe apneic time and reduces the incidence of arterial oxygen desaturation. Overall, studies in this review show that apneic oxygenation prolongs the time to oxygen desaturation during tracheal intubation. Nevertheless, the majority of the studies were small in size, and they neither measured nor were adequately powered to detect adverse respiratory events or other serious rare complications. Prolonged apneic oxygenation (with its consequent hypercarbia) can have risks and should be avoided in patients with conditions such as increased intracranial...
Source: Canadian Journal of Anesthesia - January 2, 2017 Category: Anesthesiology Source Type: research

Participation of Canadian anesthesiology departments in undergraduate medical education
ConclusionThe contribution of anesthesiology departments to pre-clerkship has increased over the past fifteen years but remains much less than expected based on proportional faculty size. While the increase is encouraging, the relatively poor engagement is concerning, representing not only a missed opportunity but also a possible threat to the academic standing of the profession. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 28, 2016 Category: Anesthesiology Source Type: research

Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update
ConclusionThe anesthesiologist plays an important role to ensure a safe operating environment for patients with an implanted DBS device. Pertinent issues include identifying the type of device, involving a DBS-trained physician, turning off the device intraoperatively, implementing precautions when using electrosurgical equipment, and checking the device postoperatively. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study
ConclusionsIn this large sample of critically ill medical and surgical patients, the admission SOFA score and hospital lengths of stay were not different between the two groups, but medical patients had longer ICU lengths of stay and higher ICU and hospital mortality than surgical patients. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Transforaminal migration of an epidural catheter
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

The effect of verbal and video feedback on learning direct laryngoscopy among novice laryngoscopists: a randomized pilot study
ConclusionThis pilot study establishes feasibility and provides a sample size estimate for a future RCT. Required modifications to the study protocol include wider hospital involvement and consideration regarding standardization of airway education, teaching, feedback, and patient characteristics. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Con: Pure service delivery is no longer needed in global surgical missions
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Glottic impersonation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Preventing intravenous bag contamination
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 26, 2016 Category: Anesthesiology Source Type: research

Pro: Pure service delivery is still needed in global surgery missions
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 21, 2016 Category: Anesthesiology Source Type: research

Apneic oxygenation: Let ’s all just take a deep breath
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 21, 2016 Category: Anesthesiology Source Type: research

Broadband near-infrared spectroscopy can detect cyanide-induced cytochrome aa 3 inhibition in rats: a proof of concept study
AbstractPurposeClinically available near-infrared spectroscopy (NIRS) devices use two to five wavelengths of light to measure the relative amounts of oxyhemoglobin and deoxyhemoglobin in tissue to determine tissue hemoglobin oxygen saturation (StO2). In addition to StO2, broadband NIRS devices (using hundreds of wavelengths of light) may be able to measure the oxidation state of mitochondrial cytochrome aa3 (Cytox) which reflects the subcellular energetic state. We hypothesize that broadband NIRS devices can measure Cytox independent of changes in hemoglobin saturation.MethodsIn this prospective non-randomized study, 20 ma...
Source: Canadian Journal of Anesthesia - December 21, 2016 Category: Anesthesiology Source Type: research

Simulation as an educational modality in an Anesthesiology Resident Wellness Program
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 21, 2016 Category: Anesthesiology Source Type: research

Non-essential blood tests in the intensive care unit: a prospective observational study
ConclusionsAttending physicians deemed a substantial proportion of the blood tests processed in a tertiary care ICU setting as unnecessary. Furthermore, the non-essential tests incurred substantial additional cost. Further work is required to gain a better understanding of the underlying factors contributing to these wasteful practices. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 19, 2016 Category: Anesthesiology Source Type: research

Chirurgie ambulatoire: aspects organisationnels
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 19, 2016 Category: Anesthesiology Source Type: research

Perioperative Fluid Management
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 11, 2016 Category: Anesthesiology Source Type: research

In reply: Further considerations on competence by design: when opportunity stops knocking
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 8, 2016 Category: Anesthesiology Source Type: research

Further considerations on competence by design: when opportunity stops knocking
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 8, 2016 Category: Anesthesiology Source Type: research

The impaired anesthesiologist: what you should know about substance abuse
ConclusionsDue to the considerable morbidity and mortality associated with the abuse of anesthetic agents as well as the continuous increase in the rate of substance abuse by anesthesia providers, it is essential for anesthesia care providers to become familiar with the presenting signs and symptoms of substance abuse and impairment. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 6, 2016 Category: Anesthesiology Source Type: research

The physician at risk: disruptive behaviour, burnout, addiction, and suicide
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 6, 2016 Category: Anesthesiology Source Type: research

Single-injection interscalene bupivacaine and dexamethasone for same-day discharge total shoulder arthroplasty: a case series
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - December 4, 2016 Category: Anesthesiology Source Type: research

Self-care as a professional imperative: physician burnout, depression, and suicide
ConclusionThe concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 30, 2016 Category: Anesthesiology Source Type: research

Physical and psychological abuse in Canadian operating rooms
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 30, 2016 Category: Anesthesiology Source Type: research

The identification and management of substance use disorders in anesthesiologists
ConclusionThe treatment of substance use disorders in anesthesiologists is effective, and a safe return to practice is possible in a majority of cases. National guidelines are needed to ensure equitable access to high-quality treatment and recovery monitoring for all Canadian physicians. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 28, 2016 Category: Anesthesiology Source Type: research

Axillary-femoral bypass in a high-risk patient: a novel anesthetic approach
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 28, 2016 Category: Anesthesiology Source Type: research

Exchanging a King Laryngeal Tube ™ for an endotracheal tube using a fibreoptic bronchoscope−Aintree catheter combination in a known difficult airway
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 28, 2016 Category: Anesthesiology Source Type: research

Competency by design: when opportunity stops knocking
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 22, 2016 Category: Anesthesiology Source Type: research

Are we at risk of losing the soul of medicine?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 22, 2016 Category: Anesthesiology Source Type: research

In Memoriam: Dr. Beverly Evans-Britt
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 22, 2016 Category: Anesthesiology Source Type: research

Anesthesiology Resident Wellness Program at the University of Saskatchewan: concept and development
ConclusionsAfter identifying the need for a formal ARWP in Canada, we implemented one at the University of Saskatchewan. We found high levels of overall resident satisfaction with the program. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 14, 2016 Category: Anesthesiology Source Type: research

Anesthesiology Resident Wellness Program at the University of Saskatchewan: curriculum content and delivery
AbstractResident and physician health are increasingly recognized by the Royal College of Physicians and Surgeons of Canada and its CanMEDS framework as integral to residency training in Canada. Resident stress, burnout, and depression also have implications for patient care. Although curricula have been advocated to promote resident wellness and resilience, no such published curricula exist to guide programs in addressing these needs. The purpose of this article is to describe the curriculum content and delivery of the Anesthesiology Residency Wellness Program (ARWP) at the University of Saskatchewan. The ARWP curriculum ...
Source: Canadian Journal of Anesthesia - November 13, 2016 Category: Anesthesiology Source Type: research

Guidelines to the Practice of Anesthesia – Revised Edition 2017
OverviewThe Guidelines to the Practice of Anesthesia Revised Edition 2017 (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 2017 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 specific patie...
Source: Canadian Journal of Anesthesia - November 10, 2016 Category: Anesthesiology Source Type: research

The biology of addiction
AbstractIn this narrative review, the neurobiological mechanisms underlying substance abuse and addiction are discussed with a particular emphasis on the mechanisms that promote ongoing use and relapse. Addiction is estimated to affect 10-15% or more of the adult population, including physicians. Genetic predisposition, psychological and environmental risk factors, the timing of exposure to the substance, the type of substance used, and the frequency of use influence the individual ’s susceptibility to addiction. Abused substances act on the brain’s reward system, a neural circuit that produces pleasurable feel...
Source: Canadian Journal of Anesthesia - November 10, 2016 Category: Anesthesiology Source Type: research

Thermal softening of polyvinyl chloride nasotracheal tubes: effect of temperature on tube navigability
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 6, 2016 Category: Anesthesiology Source Type: research

Leukocyte larceny: a cause of pseudohypoxemia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 5, 2016 Category: Anesthesiology Source Type: research

Multifidus cervicis plane block is effective for cervical spine surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 2, 2016 Category: Anesthesiology Source Type: research

Life-threatening lingual artery hemorrhage after cardiac surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - November 1, 2016 Category: Anesthesiology Source Type: research

Button battery ingestion in children: a role for angiography?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 31, 2016 Category: Anesthesiology Source Type: research

Rupture of an infected radial artery false aneurysm
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 31, 2016 Category: Anesthesiology Source Type: research

Emergency ventilation with the Ventrain ® through an airway exchange catheter in a porcine model of complete upper airway obstruction
AbstractPurposeDuring difficult airway management, oxygen insufflation through airway-exchange and intubating catheters (AEC/IC) can lead to life-threatening hyperinflation. Ventrain® was originally designed to facilitate emergency ventilation using active expiration through short, small-bore cannulas. Herein, we studied its efficacy (oxygenation and ventilation) and safety (avoidance of hyperinflation) in a long, small-bore AEC.MethodsIn six anesthetized pigs, the upper airway was obstructed, except for a 100 cm long, 3 mm internal diameter AEC. After apneic desaturation to a peripheral oxygen saturation (SpO2) of
Source: Canadian Journal of Anesthesia - October 27, 2016 Category: Anesthesiology Source Type: research

Point of care diaphragmatic ultrasonography made easy
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 27, 2016 Category: Anesthesiology Source Type: research

Erratum to: Can we create a Canadian Perioperative Anesthesia Clinical Trials Group? We review the first five years and glimpse into the future
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - October 26, 2016 Category: Anesthesiology Source Type: research

Using physiological monitoring data for performance feedback: an initiative using thermoregulation metrics
AbstractBackgroundFeedback of performance data can improve professional practice and outcomes. Vital signs are not routinely used for quality improvement because of their limited access. Intraoperative hypothermia has been associated with deleterious effects, including surgical site infections and bleeding. We speculated that providing feedback could help keep temperature monitoring and management a priority in the anesthesiologist ’s mind, thereby improving perioperative temperature management. We hypothesized that feedback on thermoregulation metrics, without changes in policy, could reduce temperature-monitoring d...
Source: Canadian Journal of Anesthesia - October 25, 2016 Category: Anesthesiology Source Type: research