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

{"title":"Blood pressure management during cardiac surgery: a survey of Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons.","authors":"Karen Zhao, Renée Fournier, Kevin Kennedy, Hilary P Grocott, Emilie Belley-Côté, Matthew Cameron, Richard P Whitlock, C Scott Brudney, Allison M Janda, Eric Jacobsohn, C David Mazer, François Lamontagne, Christie Smith, Gordon Guyatt, Jessica Spence","doi":"10.1007/s12630-025-02971-x","DOIUrl":"https://doi.org/10.1007/s12630-025-02971-x","url":null,"abstract":"<p><strong>Purpose: </strong>Clinicians presume a relationship between the management of blood pressure during cardiac surgery and postoperative morbidity and mortality. With limited evidence to inform practice, we surveyed Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons. We sought to solicit information to inform a trial evaluating the blood pressure management approach on outcomes after cardiac surgery.</p><p><strong>Methods: </strong>We iteratively developed a survey assessing the lowest and highest blood pressures respondents would target, the narrowest feasible blood pressure range to achieve, the range of blood pressure observed in clinical practice, and factors influencing targeted blood pressure before, during, and after cardiopulmonary bypass (CPB). We contacted leads from every Canadian hospital providing cardiac surgery to distribute the survey via a computerized link. We used a modified Dillman approach to optimize response rate. Responses were analyzed descriptively.</p><p><strong>Results: </strong>Of 819 clinicians surveyed, 532 (65%) responded. Respondents' lowest pooled mean arterial pressure (MAP) target, presented as mean (standard deviation [SD]), was 59 (6) mm Hg before CPB, 55 (7) mm Hg during CPB, and 60 (5) mm Hg after CPB. Respondents' highest pooled MAP target, presented as mean (SD), was 92 (10) mm Hg before CPB, 84 (7) mm Hg during CPB, and 75 (6) mm Hg after CPB. The narrowest feasible MAP range, presented as mean (SD), all respondents believed could be achieved was 19 (7) mm Hg before CPB, 16 (7) mm Hg during CPB, and 20 (7) mm Hg after CPB.</p><p><strong>Conclusions: </strong>The responses to our survey support the clinical acceptability of a trial examining blood pressure target thresholds at the extreme ends of the range recommended by existing guidelines and the feasibility of maintaining blood pressure within a narrow target range.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267963","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":"Blood pressure management in cardiac surgery: how low can you go?","authors":"Vanja Ristovic, Louise Y Sun","doi":"10.1007/s12630-025-02972-w","DOIUrl":"https://doi.org/10.1007/s12630-025-02972-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267964","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":"Umbilical analgesic concentrations after labour analgesia with programmed intermittent epidural bolus: a prospective observational study.","authors":"Arisa Ijuin, Masaki Sato, Nagayoshi Umehara, Shoichiro Amari, Jumpei Saito, Mayuko Abe, Wataru Matsunaga, Yoko Yamashita, Yasuyuki Suzuki, Kenichi Masui","doi":"10.1007/s12630-025-02975-7","DOIUrl":"https://doi.org/10.1007/s12630-025-02975-7","url":null,"abstract":"<p><strong>Purpose: </strong>The umbilical analgesic concentrations after using programmed intermittent epidural bolus (PIEB) and patient-controlled epidural analgesia (PCEA) without continuous infusion are unknown. We aimed to characterize umbilical ropivacaine and fentanyl concentrations and examine their influence on neonatal conditions at delivery.</p><p><strong>Methods: </strong>We prospectively studied 50 parturients with singleton pregnancies who received combined spinal-epidural analgesia using PIEB (7 mL every 45 min) and PCEA (7 mL per bolus; lockout interval: 15 min) with 0.08% ropivacaine and 2 μg·mL^-1 fentanyl, with clinician-administered boluses as necessary. We evaluated the umbilical venous analgesic concentrations and neonatal characteristics.</p><p><strong>Results: </strong>The median [interquartile range (IQR)] hourly ropivacaine and fentanyl doses were 13 [11-15] mg·hr^-1 and 39 [30-50] µg·hr^-1, respectively. The ropivacaine and fentanyl concentrations were 77 [56-98] ng·mL^-1 and 0.125 [0.125-0.20] ng·mL^-1 at delivery, respectively. The umbilical analgesic concentrations were correlated with the labour duration and total dose. In parturients given clinician-administered boluses within 1 hr before delivery, the ropivacaine and fentanyl concentrations were similar to those without (81 [54-104] vs 77 [54-96] ng·mL^-1 and 0.20 [0.125-0.20] vs 0.125 [0.05-0.20] ng·mL^-1, respectively). The umbilical arterial pH was > 7.2 and the Apgar score at 5 min was ≥ 8 for all neonates. No neonates exhibited systemic local anesthetic toxicity. Respiratory support was required for 14 neonates.</p><p><strong>Conclusions: </strong>Umbilical analgesic concentrations at delivery were low after labour analgesia using a regimen of PIEB with PCEA for up to 19 hr. An intermittent bolus dosing regimen may contribute to a decrease in umbilical analgesic concentrations.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267965","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":"Critical Care Canada Forum 2024 Abstracts.","authors":"","doi":"10.1007/s12630-025-02967-7","DOIUrl":"https://doi.org/10.1007/s12630-025-02967-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259451","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":"Dexmedetomidine and acute kidney injury in patients with sepsis: a retrospective cohort study.","authors":"Papawadee Chaengsuthiworawat, Tharin Thampongsa, Thanyalak Thamjamrassri, Chawika Pisitsak","doi":"10.1007/s12630-025-02977-5","DOIUrl":"https://doi.org/10.1007/s12630-025-02977-5","url":null,"abstract":"<p><strong>Purpose: </strong>Acute kidney injury (AKI) is a common complication of sepsis. AKI is associated with increased morbidity and mortality. Studies show that dexmedetomidine has a protective effect against AKI. We sought to evaluate the association between dexmedetomidine administration and AKI in patients with sepsis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 331 adult patients with sepsis. We divided patients into two groups: patients who received an infusion of dexmedetomidine of ≥ 0.2 µg·kg^-1·hr^-1 for > 6 hr within 72 hr of sepsis diagnosis (the dexmedetomidine group; N = 73) and patients who did not receive a dexmedetomidine infusion (the nondexmedetomidine group; N = 258). The primary outcome was the incidence of AKI within seven days, defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We analyzed our results using multivariable logistic regression models including 1) the entire cohort (331 patients) or 2) a 1:1 propensity-score-matched cohort (73 patients per group).</p><p><strong>Results: </strong>Acute kidney injury was diagnosed in 190/331 (57.4%) patients. The incidence of AKI was not different between the dexmedetomidine group and the nondexmedetomidine group in both the entire cohort (54.8% vs 58.1%; P = 0.61) and the propensity-matched cohort (54.7% vs 63.0%; P = 0.31). Additionally, there were no significant differences between groups in the incidence of renal replacement therapy (10.9% vs 13.6%; P = 0.61) and 30-day mortality (32.8% vs 24.6%; P = 0.27). We observed a statistically significant interaction between patient age > 65 yr and reduced odds of developing AKI in patients who received dexmedetomidine (adjusted odds ratio, 0.25; 95% confidence interval, 0.07 to 0.90; P = 0.03).</p><p><strong>Conclusions: </strong>While there was no association between dexmedetomidine administration and AKI in our overall cohort of patients with sepsis, we observed reduced odds of developing AKI in older patients (aged > 65 yr) who received dexmedetomidine. Further research is needed to confirm that dexmedetomidine has a protective effect against AKI in this patient population.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259452","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":"Large language models in perioperative medicine-applications and future prospects: a narrative review.","authors":"Arnaud Romeo Mbadjeu Hondjeu, Zi Ying Zhao, Luka Newton, Anass Ajenkar, Emily Hladkowicz, Karim Ladha, Duminda N Wijeysundera, Daniel I McIsaac","doi":"10.1007/s12630-025-02980-w","DOIUrl":"https://doi.org/10.1007/s12630-025-02980-w","url":null,"abstract":"<p><strong>Purpose: </strong>Large language models (LLMs) are a subset of artificial intelligence (AI) and linguistics designed to help computers understand and analyze human language. Clinical applications of LLMs have recently been recognised for their potential enhanced analytic capacity. Availability and performance of LLMs are expected to increase substantially over time with a significant impact on patient care and health care provider workflow. Despite increasing recognition of LLMs, insights on the utilities, associated benefits and limitations are scarce among perioperative clinicians. In this narrative review, we delve into the functionalities and prospects of existing LLMs and their clinical application in perioperative medicine. Furthermore, we summarize challenges and constraints that must be addressed to fully realize the potential of LLMs.</p><p><strong>Source: </strong>We searched MEDLINE, Google Scholar, and PubMed® databases for articles referencing LLMs in perioperative care.</p><p><strong>Principal findings: </strong>We found that in the perioperative setting (from surgical diagnosis to discharge postoperatively), LLMs have the potential to improve the efficiency and accuracy of health care delivery by extracting and summarizing clinical data, making recommendations on the basis of these findings, as well as addressing patient queries. Moreover, LLMs can be used for clinical decision-making support, surveillance tools, predictive modelling, and enhancement of medical research and education.</p><p><strong>Conclusions: </strong>The integration of LLMs into perioperative medicine presents a significant opportunity to enhance patient care, clinical decision-making, and operational efficiency. These models can streamline processes, provide personalized patient education, and offer robust decision support. Nevertheless, their clinical implementation requires addressing several key challenges, including managing hallucinations, ensuring data security, and mitigating inherent biases. If these challenges are met, LLMs can revolutionize perioperative practice, improving both patient outcomes and clinician workflow.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259453","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":"Anesthesia management for pediatric intestinal transplantation-a single-centre case series of eleven patients.","authors":"Melody Long, Asad Siddiqui, Yaron Avitzur, Dimitri Parra, Blayne Sayed, Anand Ghanekar, Mark Cattral, Naiyi Sun","doi":"10.1007/s12630-025-02976-6","DOIUrl":"https://doi.org/10.1007/s12630-025-02976-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric intestinal transplantation is the main treatment modality for children with intestinal failure who develop severe complications including intestinal failure-associated liver disease, progressive loss of central venous access, and repeated admissions requiring critical care management. We aimed to describe the perioperative management of patients undergoing intestinal transplantation at a tertiary children's hospital between 2012 and 2023, identifying challenges and potential solutions.</p><p><strong>Methods: </strong>We retrospectively reviewed the anesthetic management of 11 children who underwent intestinal transplantation between January 2012 and August 2023. Information collected included preoperative characteristics, intraoperative management, and postoperative outcomes.</p><p><strong>Results: </strong>The predominant diagnosis of intestinal failure was gastroschisis (5/11, 45%), while progressive liver disease (6/11, 55%) was the main indication for transplantation. In our cohort, five patients underwent isolated intestinal transplantation, four underwent multivisceral transplantation, and two had liver and intestine transplantation. Five patients had postreperfusion syndrome, while eight (73%) patients were hypothermic (temperature [T] < 35 °C). Ten patients required at least one vasopressor/inotrope intraoperatively, with the first-line agent being norepinephrine. Three patients were extubated in the operating room; they had a median intensive care unit stay of three days. To date, the 1-year patient and graft survival rates were 91% (10/11).</p><p><strong>Conclusions: </strong>With careful preoperative planning, judicious fluid management, and anticipation of potential hemodynamic instability, including postreperfusion syndrome, our data show that pediatric intestinal transplantation can be performed safely, with improved long-term outcomes compared with previous reports.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250977","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":"Enhancing needle visualization during ultrasound-guided procedures by attaching a mirror to the transducer.","authors":"Masatoshi Tomonari, Akiko Tomonari","doi":"10.1007/s12630-025-02985-5","DOIUrl":"https://doi.org/10.1007/s12630-025-02985-5","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250978","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":"Postoperative vision loss and visual disturbances in a Canadian provincial administrative data repository.","authors":"Michael T Paillé, Frank Stockl, Thomas C Mutter","doi":"10.1007/s12630-025-02974-8","DOIUrl":"https://doi.org/10.1007/s12630-025-02974-8","url":null,"abstract":"<p><strong>Purpose: </strong>Population-based, health administrative database analyses of postoperative vision loss (POVL) have primarily examined International Classification of Diseases (ICD) diagnosis codes for ischemic optic neuropathy (ION) and retinal artery occlusion (RAO) after cardiac and spine surgery. Other nonspecific diagnosis codes describing significant vision loss have been mostly overlooked. We sought to investigate their contribution to the broader epidemiology of POVL after a variety of surgical procedures.</p><p><strong>Methods: </strong>Using administrative data from Manitoba, Canada, we identified hospital admissions where patients underwent spine, cardiac, and other common inpatient and ambulatory surgeries between 1987 and 2017. To avoid misclassifying pre-existing vision loss as POVL, we excluded admissions where patients had ICD diagnosis codes suggestive of pre-existing vision loss in at least 5 years of preoperative data. Postoperative vision loss outcomes included specific diagnosis codes, such as RAO and ION, and nonspecific diagnosis codes for blindness, visual disturbances, and visual field defects.</p><p><strong>Results: </strong>We excluded 158,730 admissions for suspected pre-existing vision loss, including 345 admissions with POVL diagnosis codes. We included 170 POVL cases in 596,241 admissions. Nonspecific diagnosis codes accounted for 140 (82%) cases and were associated with risk factors previously reported for ION, RAO, and cortical blindness. Overall, 24 (14%) cases were RAOs, and privacy restrictions precluded analysis of the remaining 6 (4%) cases. The incidence of RAO and nonspecific diagnosis codes was highest after cardiac and spine surgery. Still, other types of surgery accounted for 87 (62%) of the nonspecific diagnosis code cases and 11 (46%) of the RAO cases.</p><p><strong>Conclusion: </strong>In surgical patients without a history of vision loss, new diagnosis codes for blindness, visual field defects, and visual disturbances other than ION and RAO may represent an important but overlooked aspect of POVL epidemiology.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250979","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":"Comparison of out-of-hospital mortality following injury in Canadian provinces and territories: a historical cohort study.","authors":"Alexandra Lapierre, Audace Nkeshimana, Natalie Yanchar, Barbara Haas, David C Evans, Markus Ziesman, Amanda W McFarlan, Éric Mercier, Jacynthe Lampron, Bourke Tillmann, Lynne Moore","doi":"10.1007/s12630-025-02964-w","DOIUrl":"https://doi.org/10.1007/s12630-025-02964-w","url":null,"abstract":"<p><strong>Purpose: </strong>Trauma systems encompass injury prevention, prehospital care, acute care, rehabilitation, and community integration. The proportion of out-of-hospital injury deaths may indicate the effectiveness of trauma systems, particularly in prevention and prehospital care. In the absence of Canadian data, we aimed to estimate this proportion nationally and by province and analyze variations by age, sex, and year.</p><p><strong>Methods: </strong>We conducted a historical cohort study to analyze aggregate data on hospital discharges and mortality statistics covering injury-related deaths in Canadian provinces and territories from 2017 to 2020. We included deaths from all Canadian provinces and territories except Quebec, for which data on in-hospital deaths were unavailable. We calculated the proportions of out-of-hospital deaths with 95% confidence intervals. We used robust Poisson models to assess provincial variation, adjusting for age, sex, and year for Ontario, Alberta, and British Columbia (the volumes were too low in the other provinces). We conducted subgroup analyses for age group, sex, year, and injury mechanism.</p><p><strong>Results: </strong>Canada recorded 64,725 injury-related deaths between 2017 and 2020 (32.3% ≥ age 65 yr; 34.5% female), with 48% occurring outside of hospitals globally and 80% in < 65-yr-olds. Proportions of out-of-hospital deaths ranged from 30% in the Atlantic provinces to 58% in Saskatchewan. After adjusting for age, sex, and year, Alberta had a 13% higher risk of out-of-hospital mortality than Ontario (reference standard), while British Columbia had a 26% lower risk. Subgroup analyses revealed variations across age groups, sex, and years.</p><p><strong>Conclusions: </strong>Half of all injury deaths in Canada between 2017 and 2020 occured outside of hospitals. This proportion varied by province, possibly suggesting differences in the development and maturity of provincial trauma systems. Future studies should strive to identify modifiable determinants of these interprovincial variations to inform public health strategies.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236066","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}