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

{"title":"Perceptions of health care providers involved in organ donation or transplantation on cardiac donation after death by circulatory criteria: a qualitative study.","authors":"Kimia Honarmand, Ian Ball, Maureen O Meade, Aimee Sarti, Danielle LeBlanc, John Basmaji, Emilie P Belley-Côté, Michaël Chassé, Frédérick D'Aragon, Gordon Guyatt, Bram Rochwerg, Sam D Shemie, Robert Sibbald, Marat Slessarev, Mathew J Weiss, Jeanna Parsons Leigh","doi":"10.1007/s12630-025-02979-3","DOIUrl":"https://doi.org/10.1007/s12630-025-02979-3","url":null,"abstract":"<p><strong>Purpose: </strong>Cardiac donation after death determination by circulatory criteria (DCC) can be performed using either 1) direct procurement and perfusion of ex situ organs or 2) normothermic regional perfusion (NRP). Nevertheless, there are concerns regarding the acceptability and ethics of these procedures, particularly NRP in which the blood supply to the brain is surgically interrupted and circulation in the thorax and abdomen is restored prior to heart retrieval. We aimed to understand the perspectives on cardiac donation following DCC of Canadian clinicians who are involved in donation and transplantation.</p><p><strong>Methods: </strong>We performed a qualitative descriptive study of 75 clinicians to better understand the perspectives of physicians on cardiac DCC. We purposively sampled clinicians who care for organ donors (N = 51) and those who care for transplant recipients (N = 24) in Canada. We performed thematic analysis to generate themes describing participants' perspectives about cardiac DCC and its implementation in Canada.</p><p><strong>Results: </strong>We found that the broad support and interest to implement cardiac DCC among the cohort of clinicians interviewed was tempered by their anticipation that other clinicians, donor families, and the public would be less supportive. Donor clinicians were particularly concerned about potential erosion in public trust in the organ donation system as a whole. Participants identified opportunities to address anticipated challenges, including strategies for education and communication around cardiac DCC, staged/gradual introduction of cardiac DCC, and the option for stakeholders (clinicians, donor families, potential transplant recipients) to opt out of participation in cardiac DCC.</p><p><strong>Conclusions: </strong>In this qualitative study of clinicians involved in organ donation or transplantation across Canada, we found broad support for cardiac DCC. Nevertheless, we observed several challenges with the implementation of cardiac DCC, particularly concerns of nonsupport by other stakeholders. Participants also identified opportunities to address anticipated barriers.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546331","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 diagnostic accuracy of point-of-care ultrasound in shock: a systematic review and meta-analysis.","authors":"John Basmaji, J Elaine Tang, Robert Arntfield, Karishma Desai, Ian M Ball, Kyle Fiorini, Marat Slessarev, Kimia Honarmand, Phil Jones, Vincent Lau, Kimberley Lewis, Nicolas Orozco, Maureen Meade, Brian Park, Ross Prager, Bram Rochwerg, Lehana Thabane, Michelle Y S Wong, Gordon Guyatt","doi":"10.1007/s12630-025-02997-1","DOIUrl":"https://doi.org/10.1007/s12630-025-02997-1","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to conduct a systematic review to determine the diagnostic test accuracy of point-of-care ultrasound (POCUS) for the specific etiologies and subtypes of shock.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and the grey literature for prospective studies in adult populations with shock. We collected data on study design, patient characteristics, operator characteristics, POCUS protocol, and true and false positives and negatives, and assessed the risk of bias.</p><p><strong>Results: </strong>We found 18 eligible studies with a total of N = 2,088 patients. The pooled sensitivity and specificity of POCUS for determining shock subtype were 90% (95% confidence interval [CI], 81 to 95) and 95% (95% CI, 90 to 97) for hypovolemic shock, 95% (95% CI, 84 to 98) and 98% (95% CI, 97 to 99) for cardiogenic shock, 78% (95% CI, 69 to 85) and 97% (95% CI, 94 to 99) for distributive shock, 94% (95% CI, 85 to 97) and 99% (95% CI, 98 to 100) for obstructive shock, and 85% (95% CI, 77 to 91) and 98% (95% CI, 91 to 100) for mixed shock (all low to moderate quality evidence). The pooled sensitivity and specificity of POCUS for determining specific shock etiologies were 78% (95% CI, 18 to 98) and 96% (95% CI, 87 to 99) for sepsis, 92% (95% CI, 71 to 98) and 99% (95% CI, 83 to 100) for pulmonary embolism, and 100% (95% CI, 69 to 100) and 100% (95% CI, 98 to 100) for cardiac tamponade. The quality of the evidence ranged from very low to moderate.</p><p><strong>Conclusions: </strong>On the basis of very low to moderate quality evidence, POCUS may perform better at ruling in shock subtypes and specific shock etiologies than ruling them out. Point-of-care ultrasound is a promising tool for the diagnosis of shock.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42020160001 ); first submitted 1 December 2019.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555966","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":"Failure of neuraxial anesthesia for postpartum tubal ligation: a single-centre retrospective cohort study.","authors":"Megan Foster, Kelsey Hudson, Jessica C Ehrig, Emily E Sharpe, Michael P Hofkamp","doi":"10.1007/s12630-025-03004-3","DOIUrl":"https://doi.org/10.1007/s12630-025-03004-3","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to identify the neuraxial anesthesia failure rate of de novo single-injection spinal and combined spinal-epidural anesthesia for postpartum tubal ligation at our hospital along with variables associated with neuraxial anesthesia failure.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study of patients who underwent a postpartum tubal ligation with de novo single-injection spinal or combined spinal-epidural anesthesia from 1 January 2020 to 31 December 2022 at Baylor Scott & White Medical Center-Temple (Temple, TX, USA). We defined neuraxial anesthesia failure as conversion to general anesthesia involving the use of an endotracheal tube or supraglottic airway, administration of intravenous propofol at doses > 10 mg, intravenous fentanyl > 100 µg, or the use of inhaled nitrous oxide.</p><p><strong>Results: </strong>During the study period, 243 patients underwent postpartum tubal ligation with single-injection spinal or combined spinal-epidural anesthesia, and 28 (11.5%) had neuraxial anesthesia failure. Using a multivariate logistic regression designed to predict neuraxial anesthesia failure using variables of interest, we found that a 5-min increase in time from spinal anesthesia placement to skin incision was associated with neuraxial anesthetic failure (adjusted odds ratio [aOR], 3.10; 95% confidence interval [CI], 2.01 to 4.79; P < 0.001) along with a 5-min increase in time from skin incision to wound closure (aOR 1.35; 95% CI, 1.10 to 1.66; P = 0.004) CONCLUSION: Patients who underwent postpartum tubal ligation under single-injection spinal or combined spinal epidural anesthesia had a neuraxial failure rate of 11.5%. Time from spinal placement to skin incision and time from skin incision to wound closure were independently associated with neuraxial anesthesia failure.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546330","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":"(An)othering patient experience: (re)humanizing perioperative care.","authors":"Joseph Farag Alla, Laura Hawryluck, Gianni R Lorello","doi":"10.1007/s12630-025-03008-z","DOIUrl":"https://doi.org/10.1007/s12630-025-03008-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546328","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":"Challenging dogma with intention: reflections on day-to-day anesthesia practices from a patient perspective.","authors":"Sarah M McIsaac","doi":"10.1007/s12630-025-03007-0","DOIUrl":"https://doi.org/10.1007/s12630-025-03007-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546329","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":"Prognostic value of perioperative changes in serum primary metabolites in patients after major surgery under general anesthesia: an exploratory secondary analysis of the TAPIR trial.","authors":"Nadine Krieg, Philipp Baumbach, Iuliana-Andreea Ceanga, Anne Standke, Markus H Gräler, Ralf A Claus, Julia Y Nicklas, Martin S Winkler, Bernd Saugel, Sina M Coldewey","doi":"10.1007/s12630-025-02984-6","DOIUrl":"https://doi.org/10.1007/s12630-025-02984-6","url":null,"abstract":"<p><strong>Purpose: </strong>Major surgery under general anesthesia substantially alters physiologic homeostasis. Nevertheless, the intricate effects on the metabolome are poorly studied. Metabolic fingerprints may allow the identification of patients at risk for unfavourable outcomes.</p><p><strong>Methods: </strong>We conducted a secondary, exploratory, targeted metabolomic analysis of 177 high-risk patients undergoing major abdominal surgery under general anesthesia enrolled in the Targeting preoperatively Assessed Personal cardiac Index in major abdominal suRgery patients (TAPIR) randomized controlled trial. We analyzed primary serum metabolites using liquid chromatography coupled with triple quadrupole mass spectrometry before surgery (on preoperative day 0) and on postoperative day 3 (POD3). Our primary aim was to investigate postoperative alterations in primary serum metabolites. Secondary objectives included analyses in different subgroups, including patients with postoperative complications (composite of complication, delirium, acute kidney injury, and infection) up to day 30. We applied regression analyses and calculated false discovery rate-adjusted P values to address multiplicity.</p><p><strong>Results: </strong>Of the 37 metabolites analyzed, 20 were different on POD3 after comparison with before surgery (lower: 4-hydroxyproline, alanine, asparagine, citrulline, cystine, dimethylglycine, glutamine, glutamic acid, glycine, guanosine, histidine, niacinamide, serine, uric acid, and xanthine; higher: isoleucine, leucine, methionine, methionine sulfoxide, pyruvic acid; adjusted P values < 0.05). We found no statistically significant preoperative differences between patients with and without postoperative complications (all adjusted P values ≥ 0.05). Postoperatively, patients with (vs without) delirium within thirty days after surgery (n = 13/177) showed lower levels of alanine, asparagine, citrulline, cystine, glutamine, glutamic acid, serine, threonine, and tyrosine after adjusting for preoperative metabolite levels.</p><p><strong>Conclusion: </strong>Major abdominal surgery under general anesthesia was associated with complex changes in primary metabolites. We identified alterations in certain metabolites that were associated with postoperative delirium. Future research may establish metabolic patterns allowing the identification of patients at risk for unfavourable postoperative outcomes.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531306","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":"Implementation of a quality improvement project at National University Hospital Singapore to mitigate the environmental impact of nitrous oxide.","authors":"Rachel G Law, Wen Jun Koh, Pei Kee Poh, Nay Myo Htet, Su Wei Bryan Ng, Eugene Hern Choon Liu, King Sin Ang","doi":"10.1007/s12630-025-03003-4","DOIUrl":"https://doi.org/10.1007/s12630-025-03003-4","url":null,"abstract":"<p><strong>Purpose: </strong>Nitrous oxide (N₂O) is an ozone-depleting greenhouse gas that lingers in the atmosphere for over a hundred years. Much of the climate impact of medical N₂O is due to systemic central pipeline losses even before it reaches the patients. Health care systems around the world are changing the way it is supplied to decrease wastage to a minimum.</p><p><strong>Methods: </strong>We conducted a quality improvement project at National University Hospital Singapore with the aim to deactivate the central N₂O piped supply system, substituting it with a portable supply system within the operating room (OR) complex. At the preintervention phase, we gathered N₂O monthly procurement data and evaluated our system and clinical practices. Following this, we carried out three sequential Plan-Do-Study-Act cycles: the first to raise awareness and understanding of N₂O's significant leaks and climate impact, the second to disconnect central piped supply from the anesthesia machines, and the third to fully cease the central piped supply system and transition to using portable cylinder supply in ORs.</p><p><strong>Results: </strong>We achieved a 96% reduction in N₂O systemic consumption (as estimated using monthly procurement data) and a 66% reduction in the number of general anesthesia cases using N₂O (as captured by snapshot audits). The project will enable annual carbon savings of 307 tonnes of carbon dioxide equivalents (CO₂e) and annual financial savings of CAD 7,620.</p><p><strong>Conclusions: </strong>This quality improvement project shows that substantial reduction in N₂O systemic consumption in an OR complex is possible through changing the N₂O supply from a central piped supply system to small cylinders directly mounted on anesthesia machines. Next steps would include shifting institutional clinical practice towards using alternatives to N₂O, thereby withdrawing N₂O altogether. This project can be replicated at other centres to collectively reduce the greenhouse gas effect of N₂O in clinical care.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531305","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":"From garbage to green in the operating room: an anesthesiology resident-led soft plastics recycling quality improvement project.","authors":"Karim Narsingani, Claire Moura, Simrin Dhillon, Shelley Tweedle, Susan M Lee","doi":"10.1007/s12630-025-02994-4","DOIUrl":"https://doi.org/10.1007/s12630-025-02994-4","url":null,"abstract":"<p><strong>Purpose: </strong>Anesthesia contributes up to 25% of operating room (OR) waste. We sought to conduct a quality improvement project to initiate soft plastic recycling, aiming to recycle 1,000 g per day of soft plastic.</p><p><strong>Methods: </strong>In this single-centre, anesthesiology resident-led quality improvement initiative in British Columbia, Canada, we started a soft plastics recycling collection program in a single operating room (OR) and expanded it to 12 ORs through a series of Plan-Do-Study-Act cycles. The outcome measure was the daily weight of soft plastics recycled. We tracked the number of mistakes as a balancing measure. We collected data eight months after the conclusion of the project to assess sustained changes. We visualized data with Shewhart control charts.</p><p><strong>Results: </strong>One OR resulted in a mean (standard deviation [SD]) of 194 (157) g of soft plastics collected daily. Once we expanded to all ORs, a mean (SD) of 1,524 (708) g of waste was collected daily. A mean (SD) of 1,284 (613) g was recycled daily during the eight-month follow-up. There was a median [interquartile range (IQR)] of 0 [0-2] mistakes per day with only one OR, which increased to a median [IQR] of 2 [1-4] mistakes per day upon expansion, and remained low at eight months, with a median [IQR] of 1 [0-3] mistake per day. E-mail reminders and signage improved the error rate.</p><p><strong>Conclusions: </strong>We successfully introduced and sustained a soft plastics collection program in our centre's OR suite with the aim to stream it for recycling. Monitoring and education were helpful in growing the program and reducing errors.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512867","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":"Effects of anesthesia modality on plasma proteomics and biomarkers of inflammation and vascular injury: an exploratory analysis.","authors":"Nathan Wiebe, Victor Spicer, David Sontag, Ying Lao, Dustin Erickson, Andrew J Halayko, Thomas Murooka, Abdelilah S Gounni, Frederick A Zeiler, Rene P Zahedi, Duane Funk, Asher A Mendelson","doi":"10.1007/s12630-025-02999-z","DOIUrl":"https://doi.org/10.1007/s12630-025-02999-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509590","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":"Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units.","authors":"Aimee J Sarti, Stephanie Sutherland, Maureen Meade, Matthew J Weiss, Sonny Dhanani, Ken M Lotherington, Angele Landriault, Brandi Vanderspank-Wright, Sabira Valiani, Sean Keenan, Andreas H Kramer, Stephen Beed, Joanne Brennan, Pierre Cardinal, Michaël Chassé, Peter Nickerson, Sam D Shemie","doi":"10.1007/s12630-025-02978-4","DOIUrl":"https://doi.org/10.1007/s12630-025-02978-4","url":null,"abstract":"<p><strong>Purpose: </strong>Donation after death determination by circulatory criteria (DCC) is an option currently available for imminently dying patients who do not meet neurologic criteria for death. When organ donation is not successful following withdrawal of life-sustaining measures (WLSM), family members may experience additional feelings of loss and bereavement. In this study, we sought to explore the lived experiences of family members who consented to donation after DCC, including families whose loved ones proceeded to donation and those for whom donation was not possible.</p><p><strong>Methods: </strong>We conducted a qualitative study using semi-structured interviews with family members whose loved ones agreed to donation after DCC and underwent WLSM in Canadian intensive care units. We recruited participants from all Canadian provinces with an organ donation organization (n = 10) and analyzed themes using a modified grounded theory approach.</p><p><strong>Results: </strong>Interviews with 79 family members of 78 potential donors with DCC revealed nine main themes as important in the context of WLSM in DCC: 1) early and repetitive communication, 2) predicting time of death (after WLSM), 3) invitation to witness WLSM, 4) family agency in donation after DCC (e.g., wishing they had been able to take some action and/or exert more control), 5) environment, 6) support, 7) honouring donor/meaning making, 8) guilt, and 9) triple loss (i.e., death, unsuccessful donation, and loss for recipients).</p><p><strong>Conclusion: </strong>In this qualitative study, we identified a range of experiences among family members in the context of WLSM in DCC. Among those, we found family involvement in the WLSM and the DCC process to be very important. Family member perspectives on organ donation are essential to guide practices that can support consistent, high-quality family-centred care in this context.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509591","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}