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Systemic lupus erythematosus associated with development of macrophage activation syndrome and disseminated aspergillosis
ConclusionsFour features of this case merit discussion, including the: 1) infrequent association of SLE with MAS; 2) short interval between SLE diagnosis and critical illness; 3) manifestation of fungal tracheobronchitis with airway obstruction; and 4) lack of response to antifungal treatment while receiving ECMO.
Source: Canadian Journal of Anesthesia - June 22, 2023 Category: Anesthesiology Source Type: research

General anesthesia or conscious sedation for thrombectomy in stroke patients: an updated systematic review and meta-analysis
ConclusionsIn this updated systematic review and meta-analysis, the choice of anesthetic strategy for endovascular treatment of stroke patients did not significantly impact functional outcome as measured with the mRS at three months. Patients managed with general anesthesia may have more frequent successful reperfusion.Trial registrationPROSPERO (CRD42022319368); registered 19 April 2022.
Source: Canadian Journal of Anesthesia - June 2, 2023 Category: Anesthesiology Source Type: research

A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline
AbstractThis 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists ’ Society, the Canadian Neurological Sciences Federatio...
Source: Canadian Journal of Anesthesia - May 2, 2023 Category: Anesthesiology Source Type: research

The impact of hypoalbuminemia on postoperative outcomes after outpatient surgery: a national analysis of the NSQIP database
ConclusionsHypoalbuminemia is associated with major complications and death in outpatient surgery. Since hypoalbuminemia is a potential modifiable intervention, future clinical trials to evaluate the impact of optimizing preoperative albumin levels before outpatient surgery are warranted.
Source: Canadian Journal of Anesthesia - June 27, 2022 Category: Anesthesiology Source Type: research

Anesthetic consideations for endovascular treatment of acute ischemic stroke
ConclusionsTimely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is ef...
Source: Canadian Journal of Anesthesia - April 22, 2022 Category: Anesthesiology Source Type: research

Morbidity and mortality in patients managed with high compared with low blood pressure targets during on-pump cardiac surgery: a systematic review and meta-analysis of randomized controlled trials
ConclusionIndividual trial definitions of high and low blood pressure targets varied, limiting inferences. The effect of high (compared with low) blood pressure targets on other morbidity and mortality after cardiac surgery remains unclear because of limitations with the body of existing evidence. Research to determine the optimal management of blood pressure during cardiac surgery is required.Study registrationPROSPERO (CRD42020177376); registered: 5 July 2020.
Source: Canadian Journal of Anesthesia - February 17, 2022 Category: Anesthesiology Source Type: research

Knowledge and perceptions about perioperative stroke: a cross-sectional survey of patients scheduled for non-neurologic and non-cardiac surgery
ConclusionsPatients at higher risk of stroke frequently underestimate their risk of perioperative stroke. The majority of patients had not discussed perioperative stroke prior to anesthetic consultation.
Source: Canadian Journal of Anesthesia - December 17, 2019 Category: Anesthesiology Source Type: research

Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis
ConclusionAdministration of ESA and iron therapy reduced the risk for RBC transfusion compared with iron therapy alone in patients undergoing cardiac and non-cardiac surgery. Nevertheless, publication bias and heterogeneity reduces the confidence of the finding. Although the analysis was probably under-powered for some outcomes, no difference in the incidence of serious adverse events was observed with ESA and iron compared with iron alone. Further large prospective trials are required to confirm these findings.
Source: Canadian Journal of Anesthesia - May 8, 2019 Category: Anesthesiology Source Type: research

Association between sleep apnea and perioperative outcomes among patients undergoing shoulder arthroscopy
ConclusionSleep apnea is associated with an increased risk of complications and resource utilization in patients undergoing shoulder arthroscopy.
Source: Canadian Journal of Anesthesia - November 9, 2018 Category: Anesthesiology Source Type: research

Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial
ConclusionsGoal-directed fluid therapy did not alter the volume of fluid administered or the incidence of complications. This proof-of-concept trial provides needed data for conducting a larger trial to determine the influence of fluid therapy on the incidence in DGF in deceased donor kidney transplantation.Trial registrationwww.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.
Source: Canadian Journal of Anesthesia - July 11, 2018 Category: Anesthesiology Source Type: research

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