Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

{"title":"Impact of major postoperative complications on employment and earnings after elective hip or knee replacement surgery: a population-based matched cohort study.","authors":"Calvin Diep, Rachael Jaffe, Christopher Witiw, Julian F Daza, Duminda N Wijeysundera, Bheeshma Ravi, Karim S Ladha","doi":"10.1007/s12630-025-02960-0","DOIUrl":"https://doi.org/10.1007/s12630-025-02960-0","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative complications can steer patients away from a typical surgical recovery trajectory and hinder their ability to work and earn income. We aimed to quantify these effects for working-aged adults after elective joint replacement surgery.</p><p><strong>Methods: </strong>We conducted a population-based cohort study of adults aged 30-63 yr having elective hip or knee arthroplasty using the Canadian Hospitalization and Taxation Database from 2004 to 2019. Our primary exposure was a postoperative complication, defined as a composite of adverse medical events, intensive care unit visit, or rehospitalization within thirty days. Our coprimary outcomes were employment and earnings in the second calendar year after surgery. We matched patients with complications 1:1 to those without complications using a propensity score considering demographic, medical, and financial characteristics. We used probit regression to assess employment after surgery and difference-in-difference ordinary least squares regression for the change in earnings from before to after surgery.</p><p><strong>Results: </strong>We included 222,087 adults undergoing an elective hip or knee replacement. In total, 6.3% experienced postoperative complications. In the second year after surgery, 55.1% of patients with complications were working compared with 57.3% of patients without complications (-2.2 percentage points [pp], 95% confidence interval [CI], -3.5 to -1.0). Patients with complications had a CAD 1,782 greater decline in annual earnings from before surgery (95% CI, -2,775 to -789; values inflated to 2023 Canadian dollars) than patients without complications.</p><p><strong>Conclusions: </strong>Postoperative complications resulted in a lower likelihood of employment and lower earnings after elective hip or knee replacement surgery. This may also have broader economic implications.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of major abdominal surgery on the sublingual microcirculation: an observational study.","authors":"Moritz Flick, Gyde P Jannsen, Linda Krause, Jonathan Montomoli, Franziska Pollok, Parisa Moll-Khosrawi, Karim Kouz, Alina Bergholz, Kristen K Thomsen, Matthias P Hilty, Can Ince, Christian Zöllner, Bernd Saugel","doi":"10.1007/s12630-025-02941-3","DOIUrl":"https://doi.org/10.1007/s12630-025-02941-3","url":null,"abstract":"<p><strong>Purpose: </strong>It remains unknown whether the sublingual microcirculation is impaired during noncardiac surgery. We, therefore, aimed to investigate the sublingual microcirculation in patients undergoing major abdominal surgery. Specifically, we sought to test the primary hypothesis that the sublingual microcirculation is persistently impaired during major abdominal surgery.</p><p><strong>Methods: </strong>In this prospective observational study, we assessed the sublingual microcirculation using vital microscopy before induction of general anesthesia, at the time of surgical incision, every 20 min during surgery, and on the first postoperative day in 46 patients undergoing major abdominal surgery. The primary endpoint was the area under a proportion of perfused vessels (PPV) of 92% as a measure of the duration and severity of capillary red blood cell flow impairment.</p><p><strong>Results: </strong>The median [interquartile range (IQR)] intraoperative area under a PPV of 92% was 71%⋅min [2%⋅min-278%⋅min], and the median [IQR] time-weighted average PPV < 92% was 0.3% [0%-0.9%]. Twelve patients (26%) had an area under a PPV of 92% of 0%⋅min, and five patients (11%) had an area under a PPV of 92% of 400%⋅min or higher. The duration of surgery had no clinically important persistent effect on intraoperative PPV or any other sublingual microcirculation variable. The lowest intraoperative PPV was lower than the PPV at incision (estimated difference, -5.3%; 95% confidence interval, -6.3 to -4.4; P < 0.001).</p><p><strong>Conclusions: </strong>The area under a PPV of 92% during elective major abdominal surgery was small, indicative of little impairment of sublingual microcirculation. The duration of surgery had no clinically important effect on sublingual microcirculatory variables.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operative team critical incident debriefing in a community hospital: a mixed methods study.","authors":"Maira Quinanilha, Breanne Aylward, Patrick Feng, Ariane Fielding","doi":"10.1007/s12630-025-02936-0","DOIUrl":"https://doi.org/10.1007/s12630-025-02936-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory total knee arthroplasty in a patient with cold agglutinin disease.","authors":"Shikha Bansal","doi":"10.1007/s12630-025-02961-z","DOIUrl":"https://doi.org/10.1007/s12630-025-02961-z","url":null,"abstract":"<p><strong>Purpose: </strong>Cold agglutinin disease (CAD) is a rare autoimmune disease caused by high titres of cold-reacting autoantibodies that cause red blood cell agglutination and subsequent hemolysis at low temperatures. Trauma, surgery, and infection/inflammation exacerbate CAD. The present report describes the successful perioperative management of a patient with CAD who underwent outpatient total knee arthroplasty (TKA).</p><p><strong>Clinical features: </strong>A 70-yr-old female was diagnosed with CAD in 2016 with symptoms of pain and pallor in her fingertips, numbness and bluish discoloration of her tongue, and shortness of breath. She was treated with folic acid, rituximab, and bendamustine. After remaining symptom-free for 4 yrs and following consultation with hematology, she was scheduled to undergo TKA. She received a spinal anesthetic with chloroprocaine, intravenous sedation, antiemetic prophylaxis, and an adductor canal catheter for continuous perineural analgesia. Warming measures, including a warm (20 °C) operating room, warm intravenous fluids, warm irrigating fluids, warm surgical prepping solution, forced-air warming blankets, and avoidance of a thigh tourniquet, helped prevent hypothermia in the patient. The patient's perioperative course was uneventful, and she was discharged on the same day. She was followed up via a patient monitoring mobile application and advised to monitor herself for signs of CAD relapse. She had no concerns up to three months after surgery.</p><p><strong>Conclusion: </strong>The perioperative management of patients with CAD is challenging, and multidisciplinary collaboration and coordination between the anesthesiologist, surgeon, hematologist, and nurses, as well as adequate intraoperative precautions and postoperative instructions and monitoring, are essential to ensuring safe surgery and optimal patient outcomes.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveying anesthesia care provision and deficiencies among the secondary public sector hospitals of rural Sindh, Pakistan.","authors":"Mustafa A Khan, Samie A Dogar, Sadaf Khan, Sameen Siddiqi, Fauzia A Khan, Asad Latif","doi":"10.1007/s12630-025-02923-5","DOIUrl":"https://doi.org/10.1007/s12630-025-02923-5","url":null,"abstract":"<p><strong>Purpose: </strong>Provision of anesthesia care must go hand in hand with surgical care to equitably widen surgical coverage of underserved populations, especially the rural segments of low- and middle-income countries. The aim of this study was to assess the availability of key items and infrastructure needed for anesthesia care.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey at ten subdistrict or taluqa headquarter (THQ) hospitals and five district headquarter (DHQ) hospitals in six rural districts of the Sindh province of Pakistan using the Anesthesia Facility Assessment Tool. We assessed the domains of infrastructure, workforce, service delivery, conduct of anesthesia, equipment, and medications. We also scored these components and then compared the difference in mean scores.</p><p><strong>Results: </strong>Three hospitals did not meet the minimum bed number required for a secondary hospital. Four hospitals had nonfunctioning operating rooms and conducted procedures elsewhere. Ten had full-time, certified anesthesiologists, while 11 had a postanesthesia care unit. There were only two hospitals with critical care units providing mechanical ventilation, and only one hospital conducting telemetry. Six hospitals did not have a dedicated anesthesia provider present at all times. Thirteen hospitals did not use the World Health Organization preoperative checklist before performing procedures. There were deficiencies in drugs such as hypnotics, opioids, and vasopressors.</p><p><strong>Conclusion: </strong>There are many shortcomings in anesthesia care provision among these rural hospitals. Greater attention and investment are needed to safely conduct anesthesia in this setting.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional anesthesia use as a bridge to the provision of medical assistance in dying.","authors":"Catherine Moores, Duncan Maguire, Vincent P Fruci, Tim T H Jen","doi":"10.1007/s12630-025-02956-w","DOIUrl":"https://doi.org/10.1007/s12630-025-02956-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female representation in the Canadian physician anesthesia workforce: a historical analysis.","authors":"Mitchell Crozier, Jason McVicar, Gianni R Lorello, Miriam Mottiar, C Ruth Wilson, Beverley A Orser","doi":"10.1007/s12630-025-02949-9","DOIUrl":"https://doi.org/10.1007/s12630-025-02949-9","url":null,"abstract":"<p><strong>Purpose: </strong>According to an analysis of data from the Canadian Institutes for Health Information (CIHI) National Physician Database, the proportion of female anesthesia physicians is substantially lower than the proportion of female physicians in the total physician population. The goal of this study was to identify trends in female representation in the major subgroups of anesthesia providers, including specialists certified by the Royal College of Physician and Surgeons of Canada (RCPSC), international medical graduates, and family physician anesthetists (FPAs).</p><p><strong>Methods: </strong>We examined the sex distribution of the existing physician workforce, including anesthesia providers working in urban and rural Canada, using the CIHI National Physician Database (1996-2018). We also examined the sex distribution of physicians entering the workforce using the Canadian Post-MD Education Registry database and calculated descriptive statistics.</p><p><strong>Results: </strong>The proportion of female physicians increased steadily over time in all groups; nevertheless, the numbers of female FPAs and rural anesthesia providers continued to lag relative to all Canadian physicians (9.4%, 9.4%, and 26.7%, respectively, in 1996; 18.7%, 21.1%, and 42.1%, respectively, in 2018). Of the graduates from RCPSC training programs in 1996, 28% were female, whereas by 2018, 33.5% of graduates were female.</p><p><strong>Conclusions: </strong>Female physicians were underrepresented in all subgroups, but the proportions were lowest among FPAs and rural physicians. Given that greater sex diversity in clinical teams is associated with better outcomes, and in light of ongoing workforce shortages, the barriers that prevent female physicians from entering and/or remaining in the anesthesia workforce need to be understood and ameliorated.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged arm block from inadvertent subdural cannulation during a thoracic epidural insertion.","authors":"Soleil S Schutte, Barys V Ihnatsenka, Michael Berentzen, John H Rees","doi":"10.1007/s12630-025-02950-2","DOIUrl":"https://doi.org/10.1007/s12630-025-02950-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound-guided fluid management to prevent hypotension after induction of general anesthesia-a conundrum to conquer!","authors":"Anisha Pauline Paul, Aruna Parameswari, Priadharsan Pavazhakannan, Mahalakshmi Sankar, Jabeena Salim","doi":"10.1007/s12630-025-02954-y","DOIUrl":"https://doi.org/10.1007/s12630-025-02954-y","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns with inflation line position in preformed nasal endotracheal tubes-proximal or distal?","authors":"Banupriya Ravichandrane, Janani Vijayasundaram, Santhosh Arulprakasam, Priya Rudingwa","doi":"10.1007/s12630-025-02953-z","DOIUrl":"https://doi.org/10.1007/s12630-025-02953-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}