Massive hemorrhage and transfusion in the operating room
ConclusionsMassive hemorrhage is a multidisciplinary challenge that requires immediate response and communication between clinicians, nurses, other healthcare providers, laboratory testing, and blood banks. Basic knowledge and utilization of available products and therapies are inconsistent. A massive transfusion protocol can be used effectively to reduce chaos and ensure that correct treatments and proper dosing occur in a timely manner. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis
ConclusionsIntranasal dexmedetomidine provided more satisfactory sedation at parent separation and reduced the need for rescue analgesics and the incidence of nasal irritation and postoperative nausea and vomiting when compared with other premedication treatments. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Predictive factors of maternal hypothermia during Cesarean delivery: a prospective cohort study
AbstractPurposeAlthough perioperative hypothermia may increase maternal morbidity, active warming is infrequently performed to maintain normothermia during Cesarean delivery (CD). The aim of this prospective observational study was to determine the factors associated with maternal hypothermia in this setting.MethodsWomen scheduled for elective or emergency CD were consecutively included in this study from November 2014 to October 2015. Maternal temperature was measured using an infrared tympanic thermometer on the patient ’s arrival in the operating room, at skin incision, and at the end of skin suture. Maternal hypo...
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Low-dose subcutaneous ketamine for postoperative pain management in Rwanda: a dose-finding study
ConclusionAdding subcutaneous ketamine to standard analgesic measures resulted in decreases in postoperative pain scores without serious side effects. These data can be used to inform a randomized controlled trial to compare subcutaneous ketamine plus standard care with placebo plus standard care for reducing postoperative pain. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Epidural blood patch treatment for headache caused by a ruptured Tarlov cyst
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Contribution of the nasal passage to face mask ventilation: a prospective blinded randomized crossover trial
AbstractBackgroundPrevious studies have shown that the nasal passage plays an important role in manual face mask ventilation, but this has yet to be quantitatively assessed. We conducted a prospective randomized crossover clinical trial to compare the change in pressure-controlled face mask tidal volume with and without nasal airway occlusion.MethodFemale patients undergoing elective surgery under general anesthesia served as study subjects. Patients were randomly assigned to face mask ventilation beginning either with or without nasal passage occlusion (achieved with a swimmer ’s nose clip), followed by removal or a...
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

We must ask relevant questions and answer with meaningful outcomes
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Ketamine: We need to continue to advocate against scheduling
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Precise mathematics yet hazy predictions: Can validated risk indices help improve patient selection for major elective surgery?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Serotonergic medications, herbal supplements, and perioperative serotonin syndrome
ConclusionEven small doses of fentanyl administered to patients taking multiple serotonergic medications and herbal supplements may trigger serotonin syndrome. Prompt reversal of serotonin toxicity in one patient by naloxone illustrates the likely opioid-mediated pathogenesis of serotonin syndrome in this case. It also highlights that taking serotonergic agents concomitantly can produce the compounding effect that causes serotonin syndrome. The delayed presentation of serotonin syndrome in the patient who received a large dose of midazolam suggests that outpatients taking multiple serotonergic drugs who receive benzodiazep...
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Brown ’s Regional Anesthesia Review - 1st Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Tracheal bronchus: an unusual cause of difficult ventilation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Ultrasound-guided radial nerve block to relieve cannulation-induced radial arterial spasm
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 10, 2017 Category: Anesthesiology Source Type: research

Massive pneumopericardium
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 9, 2017 Category: Anesthesiology Source Type: research

Bronchoesophageal fistula
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 7, 2017 Category: Anesthesiology Source Type: research

A primer on nerve agents: what the emergency responder, anesthesiologist, and intensivist needs to know
ConclusionWhile it is unlikely that most medical practitioners will ever encounter nerve agent poisoning, it is critical to be aware of the presenting symptoms and how best to treat patients exposed to these deadly agents. History has shown that rapid medical treatment can easily mean the difference between life and death for a patient in this situation. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 1, 2017 Category: Anesthesiology Source Type: research

The association between the time from oxytocin cessation during labour to Cesarean delivery and postpartum blood loss: a retrospective cohort study
We examined the association between oxytocin recovery interval, i.e., the time from discontinuing oxytocin to Cesarean delivery (CD) for labour arrest, and blood loss.MethodsThis retrospective cohort study included women who underwent CD for labour arrest following oxytocin-augmented labour from July 1, 2013 to July 19, 2015 at our institution. Data were collected on patient demographics, labour and delivery characteristics, oxytocin induction and augmentation, recovery interval, and PPH risk factors. The primary outcome was estimated blood loss (EBL), calculated using the hematocrit variation method.ResultsData on 490 wom...
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Perioperative considerations for patients with sickle cell disease: a narrative review
ConclusionEffective management of SCD patients in the perioperative setting requires familiarity with the epidemiology, pathophysiology, clinical manifestations, and treatment of SCD. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Anesthesia and Perioperative Care for Organ Transplantation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Evaluation of the analgesia nociception index (ANI) in healthy awake volunteers
AbstractBackgroundAnalgesia might be evaluated with simple changes in vital signs, a non-specific and non-sensitive method. Heart rate variability (HRV) correlates with autonomous nervous system activity and can be used to evaluate painful stimuli. Heart rate variability is then transformed into a numeric scale called the analgesia nociception index (ANI), where higher values represent predominant parasympathetic tone, thus low nociception. Under general anesthesia, the ANI decreases following painful stimuli and increases after administration of analgesia, but significant interindividual variability is present. The goal o...
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Continuous ventilation using a modified laparoscopic port and laryngeal mask airway during flexible bronchoscopic intubation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Manual of Pediatric Anesthesia – Seventh Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

In reply: Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Improving trial design in cancer anesthesia (onco-anesthesia) research
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Glottic impersonation, perhaps, but direct visualization remains vital to confirm successful intubation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 11, 2017 Category: Anesthesiology Source Type: research

Obstructing pathology of the upper airway in a post-NAP4 world: time to wake up to its optimal management
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 10, 2017 Category: Anesthesiology Source Type: research

A retrospective assessment of prognostication in 456,685 patients undergoing elective major non-cardiac surgery
AbstractBackgroundThe accuracy of patient prognostication varies extensively in studies of select populations. Prognostication is an important component of patient selection for elective surgery. This retrospective study assessed patient prognostication prior to elective surgery by comparing the observed with the expected number of deaths in such patients.Study designWe used population-based administrative data to identify all adults undergoing one of 13 most common elective major non-cardiac gender-neutral surgeries in Ontario, Canada from 2002 –2014. Survival status within one year of surgery was determined by link...
Source: Canadian Journal of Anesthesia - July 5, 2017 Category: Anesthesiology Source Type: research

Remote solutions for telementoring point-of-care ultrasound echocardiography: The RESOLUTE study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - July 5, 2017 Category: Anesthesiology Source Type: research

Malignant hyperthermia susceptibility in patients with exertional rhabdomyolysis: a retrospective cohort study and updated systematic review
ConclusionFindings from the Canadian patient cohort and the systematic review all signal a potential association between MH susceptibility and ER. The presence of MH-causative mutations and putative deleteriousRYR1 variants in ER patients without a history of adverse anesthetic reactions suggests their possible increased risk for MH. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Effect of magnesium sulfate on oxytocin-induced contractility in human myometrium: an in vitro study
AbstractPurposeThe purpose of this study was to determine the contractile patterns induced by oxytocin in myometrium exposed to magnesium sulfate (MgSO4). We hypothesized that MgSO4 pretreatment would reduce oxytocin-induced myometrial contractions in both oxytocin-na ïve and oxytocin-desensitized myometrium.MethodsIn this prospectivein vitro study, myometrial samples were obtained from 26 women undergoing elective Cesarean deliveries. Samples were divided into six groups. Four groups were apportioned to no pretreatment (control group), oxytocin 10−5 M pretreatment (desensitization group), MgSO4 3.5 mM pretreatm...
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Pediatric tonsillectomy is a resource-intensive procedure: a study of Canadian health administrative data
The objective of this Ontario-based study was to determine the rates and risks of hospital readmission, emergency department (ED) visits, or deaths within 30 days following common pediatric surgeries, with an emphasis on AT.MethodsInpatient and day surgery children who were
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Proc édures anesthésiques liées aux techniques chirurgicales, 2 e édition Procédures anesthésiques liées aux terrains
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Effects of training on resident physician emergency airway management skills
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Mentorship in a Canadian residency program: faculty and resident needs and experiences
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

The electronic medical record in anesthesiology: a standard of quality healthcare and patient safety
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Recurrent non-epileptiform seizure-like phenomena secondary to propofol administration
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Evaluation of two novel techniques for increasing radial artery size: a pilot study utilizing volunteers
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Electronic medical record interventions and recurrent perioperative antibiotic administration: a before-and-after study
AbstractPurposePerioperative antibiotics decrease rates of surgical-site infections. Numerous interventions have improved administration of the first antibiotic dose; however, failures in the administration of subsequent doses frequently occur. We hypothesized that modifications to the electronic medical record (EMR) would improve the administration of the second antibiotic dose and that such improvements would be sustained over time.MethodsThis historical cohort before-and-after study of multipronged alerts in the EMR analyzed 1,348 operations on adult patients. The operations lasted ≥ 240 min, utilized cefazolin as th...
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

All Blood Counts: A Manual for Blood Conservation and Patient Blood Management
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Ultrasonography-guided modified thoracolumbar interfascial plane block: a new approach
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 9, 2017 Category: Anesthesiology Source Type: research

Airway management changes in patients with mucopolysaccharidoses: the role of video laryngoscopy
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 7, 2017 Category: Anesthesiology Source Type: research

Anaesthesia for the Elderly Patient (Second Edition)
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 5, 2017 Category: Anesthesiology Source Type: research

Ultrasound Guided Regional Anesthesia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 2, 2017 Category: Anesthesiology Source Type: research

Expanding the circle of care: Can children find a perioperative surgical home?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 2, 2017 Category: Anesthesiology Source Type: research

Internal jugular vein blood flow in the upright position during external compression and increased central venous pressure: an ultrasound study in healthy volunteers
ConclusionsCompression of the internal jugular veins or an increase in intrathoracic pressure does not reduce venous drainage but actually may increase intracranial venous volume. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 2, 2017 Category: Anesthesiology Source Type: research

Situational awareness: a tacit yet viable concept
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 2, 2017 Category: Anesthesiology Source Type: research

Exploring anesthesiologists ’ understanding of situational awareness: a qualitative study
ConclusionAlthough SA is an essential concept in anesthesiology, its use remains rather tacit, primarily due to the lack of a common operational definition of the term. Faculty development is required to help anesthesiologists teach and assess SA more explicitly in the clinical environment. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - June 1, 2017 Category: Anesthesiology Source Type: research

In reply: Apneic oxygenation: Let ’s all just take a deep breath
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 23, 2017 Category: Anesthesiology Source Type: research

Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery
ConclusionIn patients undergoing cardiac surgery with cardiopulmonary bypass, an early rise in postoperative creatinine is a useful marker for the early identification of AKI patients. This could allow inclusion of such patients in clinical trials of promising therapeutic strategies that need to be initiated soon after the onset of injury. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - May 19, 2017 Category: Anesthesiology Source Type: research