Simulation-based assessment of anesthesiology residents ’ competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC)
AbstractThe specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force. The goals were to develop, implement, and evaluate a set of consensus-driven standardized...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial
AbstractPurposeOne-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofolvs sevoflurane during lung surgery.MethodsThere were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both grou...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Comparison of isoflurane and sevoflurane in cardiac surgery: a randomized non-inferiority comparative effectiveness trial
AbstractPurposeVolatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was non-inferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery.MethodsThis was a pragmatic randomized non-inferiority comp...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Evaluation of failed and high blocks associated with spinal anesthesia for Cesarean delivery following inadequate labour epidural: a retrospective cohort study
AbstractPurposeThe purpose of this retrospective cohort study was to investigate factors associated with failed and high spinal blocks in patients who received spinal anesthesia for Cesarean delivery following a labour epidural that was inadequate for surgical anesthesia.MethodsWe searched our perioperative database for women with a labour epidural who received spinal or combined spinal-epidural anesthesia for Cesarean delivery due to the inadequacy of the existing epidural. The primary outcome was the occurrence of failed spinal blocks, and the secondary outcome was the occurrence of high blocks following spinal administr...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials
AbstractPurposeThe transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption.SourceWe searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of C...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients
AbstractPurposeInhaled milrinone (iMil) has been used for the treatment of pulmonary hypertension (PH) but its efficacy, safety, and prophylactic effects in facilitating separation from cardiopulmonary bypass (CPB) and preventing right ventricular (RV) dysfunction have not yet been evaluated in a clinical trial. The purpose of this study was to investigate if iMil administered before CPB would be superior to placebo in facilitating separation from CPB.MethodsHigh-risk cardiac surgical patients with PH were randomized to receive iMil or placebo after the induction of anesthesia and before CPB. Hemodynamic parameters and RV ...
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Newer isn ’t always better: comparative effectiveness of sevoflurane and isoflurane in cardiac surgery
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Oxford Handbook of Anaesthesia, Fourth Edition
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

An ultrasound-guided ABCDE approach with a sniff test to evaluate diaphragmatic function without acoustic windows
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

“Winding down” guidelines for anesthesiologists: The Ottawa Hospital plan
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Linshom respiratory monitoring device: a novel temperature-based respiratory monitor
ConclusionsRespiratory rates using the LRMD, a novel temperature-based respiratory instrument, were consistent with those using capnometry. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Inhaled milrinone for pulmonary hypertension in high-risk cardiac surgery: silver bullet or just part of a broader  management strategy?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

External carotid compression: a novel technique to improve cerebral perfusion during selective antegrade cerebral perfusion for aortic arch surgery
ConclusionsDirect ultrasound visualization and cautious partial compression of the left carotid artery may address asymmetrical CBF that occurs with SACP during HCA for aortic arch surgery. This strategy may lead to improved symmetry of CBF and corresponding cerebral oximetry measurements during aortic arch surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

In reply: Combined use of flexible bronchoscopy and video laryngoscopy for endotracheal intubation in patients with King laryngeal tube in situ
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Bifid epiglottis in a patient with Pallister-Hall syndrome
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Combined use of flexible bronchoscopy and video laryngoscopy for endotracheal intubation in patients with King laryngeal tube in situ
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 15, 2016 Category: Anesthesiology Source Type: research

Postoperative orthostatic intolerance: a common perioperative problem with few available solutions
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 13, 2016 Category: Anesthesiology Source Type: research

Opioid use after propofol or sevoflurane anesthesia: a randomized trial
ConclusionIntraoperative sevoflurane did not reduce postoperative analgesia. This finding is consistent with the results in most previous reports. This trial was registered at ClinicalTrials.gov: NCT00712517. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 13, 2016 Category: Anesthesiology Source Type: research

REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial
AbstractBackgroundOpioid-sparing pain management is important for Enhanced Recovery After Surgery. Rectus sheath (RS) blocks are emerging as a promising modality for pain relief following midline laparotomy; however, there are limited prospective clinical trials testing their efficacy. The purpose of this randomized-controlled trial is to assess the morphine-sparing effect of local anesthetic (LA) boluses through RS catheters following elective gynecological oncology surgery.MethodAfter patients ’ informed consent, bilateral RS catheters were placed intraoperatively in 74 females (American Society of Anesthesiologist...
Source: Canadian Journal of Anesthesia - September 13, 2016 Category: Anesthesiology Source Type: research

A two-stage review process for randomized controlled trials: the ultimate solution for publication bias?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 12, 2016 Category: Anesthesiology Source Type: research

In reply: A two-stage review process for randomized controlled trials: the ultimate solution for publication bias?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - September 12, 2016 Category: Anesthesiology Source Type: research

Surgical Pain Management: A Complete Guide to Implantable and Interventional Pain Therapies
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 23, 2016 Category: Anesthesiology Source Type: research

Neuroanesthesia and Cerebrospinal Protection
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 22, 2016 Category: Anesthesiology Source Type: research

Difficultintubationapp.com – A difficult airway electronic record
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 17, 2016 Category: Anesthesiology Source Type: research

Complications in Neuroanesthesia
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 15, 2016 Category: Anesthesiology Source Type: research

The Anatomical Foundations of Regional Anesthesia and Acute Pain Medicine
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 14, 2016 Category: Anesthesiology Source Type: research

Guest Reviewers
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 11, 2016 Category: Anesthesiology Source Type: research

Revisiting the consequences of inadequate Canadian physician resource planning: a renewed call to action
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 9, 2016 Category: Anesthesiology Source Type: research

Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study
ConclusionSame-day discharge from hospital is possible in carefully selected patients after both GA and AC for supratentorial tumour surgery. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 9, 2016 Category: Anesthesiology Source Type: research

In reply: Monitoring recovery from neuromuscular block using acceleromyography at the trapezius muscle: problems that must be considered
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 8, 2016 Category: Anesthesiology Source Type: research

Monitoring recovery from neuromuscular block using acceleromyography at the trapezius muscle: problems that must be considered
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 7, 2016 Category: Anesthesiology Source Type: research

Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review
ConclusionPerioperative TTCM is more common than appreciated and should be considered in any hospitalized patient presenting with acute coronary syndrome and/or hemodynamic instability, acute respiratory distress, as well as cardiac arrhythmias and arrest. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making
ConclusionThis study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare professionals the opportunity to identify vulnerable patients in ambulatory surgery, although additional modification and validation are needed. (ClinicalTrials.gov number, NCT01441843). (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Preoperative hemostatic assessment: a new and simple bleeding questionnaire
AbstractPurposeCurrent recommendations for the assessment of the risk of perioperative bleeding limit coagulation testing to patients with a personal and/or family history of bleeding. As no simple preoperative screening questionnaire is currently available, we assessed the performance of a novel screening questionnaire for its ability to detect bleeding disorders.MethodsA dichotomized, seven-point questionnaire named HEMSTOP (Hematoma, hEmorrhage,  Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) was applied to three groups of subjects: patients referred to hemostasis specialists for bleeding symptom...
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis
ConclusionIt remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg raising maneuver: a prospective observational study
AbstractBackgroundAssessing fluid responsiveness is important in the management of patients with hemodynamic instability. Passive leg raising (PLR) is a validated dynamic method to induce a transient increase in cardiac preload and predict fluid responsiveness. Variations in end-tidal carbon dioxide (ETCO2) obtained by capnography correlate closely with variations in cardiac output when alveolar ventilation and carbon dioxide production are kept constant. In this prospective observational study, we tested the hypothesis that variations in ETCO2 induced by a simplified PLR maneuver can track changes in the cardiac inde...
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Hypertensive disorders of pregnancy
ConclusionsHypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Postoperative environmental anesthetic vapour concentrations following removal of the airway device in the operating room versus the postanesthesia care unit
ConclusionsAfter a volatile-based anesthetic, our results suggest that removal of the airway device in the PACUvs in the OR increases the amount of waste anesthetic gas in a patient ’s breathing zone and thus potentially in the PACU nurse’s working zone. (Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Detection of inherited and acquired hemostatic disorders in surgical patients
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Point-of-Care Tests for Severe Hemorrhage - A Manual for Diagnosis and Treatment
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Does your reinforced tube have a Murphy EYE ?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

What mediates postoperative risk in obstructive sleep apnea: airway obstruction, nocturnal hypoxia, or both?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Optimization and outcomes of patients who decline blood transfusion during complex spine surgery: a retrospective cohort study
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

A place that is easier to get into than to get out of!
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

In reply: Deliberately restricted laryngeal view with GlideScope ® video laryngoscope: ramifications for airway research and teaching
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Dr. Charles Leslie MacAdams
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Erratum to: Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Tracheal diverticulum as a cause of subcutaneous emphysema following positive-pressure ventilation
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research

Deliberately restricted laryngeal view with GlideScope ® video laryngoscope: ramifications for airway research and teaching
(Source: Canadian Journal of Anesthesia)
Source: Canadian Journal of Anesthesia - August 5, 2016 Category: Anesthesiology Source Type: research