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

{"title":"Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.","authors":"Karel Huard, Olivier Lachance, Mélissa Parent, Patrick Tawil, Elena Saade, Ali Hammoud, Etienne J Couture, Yoan Lamarche, Stéphanie Jarry, Alexander Calderone, Pierre Robillard, Sylvie Levesque, William Beaubien-Souligny, André Y Denault","doi":"10.1007/s12630-025-02911-9","DOIUrl":"https://doi.org/10.1007/s12630-025-02911-9","url":null,"abstract":"<p><strong>Purpose: </strong>Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (T_POD).</p><p><strong>Results: </strong>Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of T_POD (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and T_POD remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation.</p><p><strong>Conclusions: </strong>Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544680","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 use of extended reality in anesthesiology education: a scoping review.","authors":"Gianluca Bertolizio, Yu Tong Huang, Marta Garbin, Elena Guadagno, Dan Poenaru","doi":"10.1007/s12630-025-02909-3","DOIUrl":"https://doi.org/10.1007/s12630-025-02909-3","url":null,"abstract":"<p><strong>Purpose: </strong>Extended reality, an umbrella term for virtual, augmented, and mixed reality, is increasingly used in health care education as it requires fewer human and logistical resources and offers reduced costs compared with high-fidelity simulations. Nevertheless, the impact of extended reality on education and training in anesthesiology is largely unknown. We aimed to explore the existing extended reality tools and applications in anesthesiology, identify current knowledge gaps, and highlight future research needs in anesthesiology education.</p><p><strong>Methods: </strong>We conducted a scoping review of studies published from January 2010 to December 2023 that focused on extended reality training in anesthesiology and included comparative analyses with other methods. We excluded publications investigating topics unrelated to anesthesiology or not involving interaction with extended reality.</p><p><strong>Results: </strong>After screening 5,419 studies, we included 62 manuscripts in the final analysis. The definitions and uses of extended reality in anesthesiology education were very heterogeneous. Thirty-seven studies compared extended reality with other forms of training. Neuraxial procedures, peripheral blocks, central venous catheters, and bronchoscopy were primarily investigated. Extended reality improved technical skills, knowledge retention, confidence, and student satisfaction. Six studies reported at least one negative result related to learning, sense of realism, and usefulness.</p><p><strong>Conclusion: </strong>The results of this scoping review highlight the increasing interest of extended reality in anesthesiology education. Nevertheless, many studies lack objective outcome measures and relevant comparisons with existing standards. In addition, extended reality needs to be consistently defined in anesthesiology education to derive optimal benefit and impact. Future studies should also focus on defining extended reality's learning objectives and clinical assessments of trainees' performance, which are commonly missing compared with high-fidelity simulation teaching.</p><p><strong>Study registration: </strong>Open Science Framework ( https://doi.org/10.17605/OSF.IO/PDT2F ); first submitted 28 June 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517479","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":"Emergence delirium in pediatric anesthesia: the urgent need for evidence-based guidelines.","authors":"Jonathan J Gamble","doi":"10.1007/s12630-024-02888-x","DOIUrl":"https://doi.org/10.1007/s12630-024-02888-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517496","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":"Risk factors for pediatric emergence delirium: a systematic review.","authors":"Kazuyoshi Aoyama, Machiko Furuta, Lieven Ameye, Maria-Alexandra Petre, Marina Englesakis, Mehwish Rana, Nan Gai, Arie Peliowski, Bibek Saha","doi":"10.1007/s12630-024-02889-w","DOIUrl":"https://doi.org/10.1007/s12630-024-02889-w","url":null,"abstract":"<p><strong>Purpose: </strong>Emergence delirium (ED) impacts approximately 25% of pediatric patients undergoing general anesthesia and is associated with with concerning consequences, including injury to patients and health care personnel. Risk prediction models with good usability for pediatric ED are lacking. We aimed to identify published risk factors in this systematic review.</p><p><strong>Methods: </strong>We conducted a systematic literature search of prospective observational studies and clinical trials through eight major databases from inception to 11 January 2023. We included prospective studies published in English that examined the pediatric population (< 18 yr old) undergoing general anesthesia for any surgical or imaging procedure, that measured the risk factor(s) for ED preoperatively/intraoperatively, and that reported the incidence of ED. We excluded studies investigating therapeutic or prophylactic interventions of ED. We assessed the quality of eligible articles according to a modified version of the Scottish Intercollegiate Guidelines Network quality checklists and rated them as high, acceptable, or low quality. Risk factors discovered were qualitatively evaluated and synthesized with the following levels of evidence: strong evidence, moderate evidence, inconclusive evidence, or lack of evidence.</p><p><strong>Results: </strong>Thirty-one studies, comprising a total of 6,068 patients, met the inclusion criteria. The median incidence of ED was 32%. Twelve studies were rated as high quality, 15 as acceptable quality, and the remaining four as low quality. Younger age and agitated/excited induction behaviour with strong evidence, followed by sevoflurane with moderate evidence, were identified as risk factors for pediatric ED. Quantitative synthesis was not feasible as there were no more than two studies that explored the same risk factor with the same cut-off.</p><p><strong>Conclusion: </strong>Although quantitative analyses were not feasible, the current systematic review qualitatively identified three risk factors for pediatric ED with robust evidence.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42020192221 ); first submitted 18 June 2020.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517477","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":"Pain profiles and opioid consumption following joint replacement surgery: a prospective observational cohort study.","authors":"Rachel Chin, Sarah Tierney, Sanjho Srikandarajah, Yasmine Hoydonckx, Abeer Alomari, Danielle Alvares, Vincent Chan, Anuj Bhatia","doi":"10.1007/s12630-025-02910-w","DOIUrl":"10.1007/s12630-025-02910-w","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to analyze postoperative discharge opioid prescription, consumption, and pain over three months following total hip arthroplasty (THA) and total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>We conducted a prospective observational study in patients undergoing THA and TKA at two centres in Toronto, ON, Canada. We contacted study participants at two, six, and 12 weeks after discharge to collect data on analgesic satisfaction, pain relief, time point of stopping opioids, quantity of unconsumed opioid pills, quality of pain, and mental health. We also evaluated patient factors that may have contributed to a higher opioid consumption or dissatisfaction with the analgesic prescription at six weeks.</p><p><strong>Results: </strong>The median [interquartile range] opioid pill count prescribed at the time of discharge for the 443 participants was 60 [50-80]. At 12 weeks after surgery, 33.9% of participants had more than one-third of their prescribed quantity remaining. Three-quarters of the cohort indicated that pain relief after arthroplasty was appropriate at all postoperative follow-ups. The incidence of neuropathic pain reduced from 24.1% before TKA or THA to 4.3% at 12 weeks after arthroplasty. Female sex (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.08 to 2.95; P = 0.03), a history of preoperative opioid use (OR, 2.46; 95% CI, 1.25 to 5.1; P = 0.01), and TKA vs THA (OR, 2.46; 95% CI, 1.47 to 4.17; P = 0.001) were associated with higher opioid consumption at six weeks after arthroplasty.</p><p><strong>Conclusion: </strong>A discharge prescription of 60 opioid pills may be excessive for patients undergoing THA or TKA. Identifying patients with risk factors for higher postoperative opioid consumption may result in more appropriate analgesic regimens.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470089","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":"Using the Theoretical Domains Framework to identify barriers and facilitators to peripheral nerve block use in older adult patients with a hip fracture: a national survey.","authors":"Yuqi Gu, Daniel I McIsaac, Emily Hladkowicz, Keely Barnes, Sylvain Boet, Colin McCartney, Reva Ramlogan","doi":"10.1007/s12630-025-02912-8","DOIUrl":"10.1007/s12630-025-02912-8","url":null,"abstract":"<p><strong>Purpose: </strong>Peripheral nerve blocks (PNBs) in older adult patients with a hip fracture improve morbidity and mortality, reduce health care costs, and improve quality of care. Despite the benefits, PNB use rates remain low. We aimed to use the Theoretical Domains Framework to investigate the barriers and facilitators to PNB use in patients with a hip fracture from the perspective of Canadian anesthesiologists.</p><p><strong>Methods: </strong>We created an online survey that collected both quantitative and qualitative responses. After research ethics board approval, the survey was distributed among all Canadian Anesthesiologists' Society (CAS) members. We present five-point Likert responses as medians and interquartile ranges [IQRs], conducted thematic analysis on the narrative feedback, and performed cluster analysis to explore patterns associated with survey responses.</p><p><strong>Results: </strong>We obtained responses from 256/2,498 (10.2%) CAS members. Of these respondents, 215 (84%) performed PNBs for patients with a hip fracture. The median [IQR] five-point Likert responses showed that participants felt confident placing a PNB (4 [4-5]) and agreed they possessed adequate knowledge and skills for PNB placement (4 [4-5]). Participants' responses showed lower ratings with greater variability for availability of adequate time (3 [3-4]), collaboration with the perioperative team (4 [2-4]), and adequate resources (4 [3-5]). Barriers to PNB use identified through thematic analysis included time pressure as well as inadequate human resources, training opportunities, and multidisciplinary collaboration with other health care professionals. Facilitators included more education, dedicated resources, and clinical care pathways.</p><p><strong>Conclusion: </strong>Our results identified several barriers and facilitators related to physical resources, operational support, and educational factors that may inform future interventions to increase PNB use in older patients with a hip fracture. The results of this study may not be generalizable to all Canadian practice settings because of a low response rate and high proportion of respondents who performed PNBs at their local institution.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425807","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":"Quality comparison of autotransfusion devices in cardiac surgery: a prospective observational cohort study.","authors":"Mark Alm, Margarita Otalora-Esteban, Natasha Bush, Amanda Dranfield, Keyvan Karkouti, Brian Beairsto","doi":"10.1007/s12630-024-02893-0","DOIUrl":"https://doi.org/10.1007/s12630-024-02893-0","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to conduct a quality improvement initiative to compare the wash quality and speed of autologous red blood cell (RBC) processing of four autotransfusion devices during cardiac surgery.</p><p><strong>Methods: </strong>Using a prospective observational cohort study approach, we prospectively evaluated four commercially available autologous cell savage devices (autoLog IQ™, Medtronic plc, Minneapolis, MN, USA [135 mL]; Xtra™, LivaNova, plc, Houston, TX, USA [125 mL, 225 mL]; Cell Saver® Elite®+, Haemonetics Corp., Boston, MA, USA [125 mL, 225 mL]; and CATSmart®, Fresenius Kabi AG, Bad Homburg vor der Höhe, Germany) in adult patients undergoing cardiac surgery. Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.</p><p><strong>Results: </strong>A total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL^-1 processed red cells. Median RBC recovery rates also showed significant differences between processing sets, ranging from 8 [8-10] mL RBC·min^-1 to 24 [22-25] mL RBC·min^-1.</p><p><strong>Conclusion: </strong>Wash quality and processing speed differed between autotransfusion devices and processing sets. These findings may have clinical implications when large volumes of shed blood are processed and reinfused.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191492","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":"Accuracy of tactile bougie use in infrequent intubators: a cadaveric airway study.","authors":"Adam Parks, Megi Nallbani, Judah Goldstein, Cory A Munroe, Janel Swain, Sebastien Hebert, Brett Barro, George Kovacs","doi":"10.1007/s12630-025-02908-4","DOIUrl":"https://doi.org/10.1007/s12630-025-02908-4","url":null,"abstract":"<p><strong>Purpose: </strong>When difficulty with laryngoscopy is encountered, confirmation of endotracheal access can be confirmed using the tactile feedback (i.e., tracheal clicks) of a tracheal tube introducer (bougie). There is anecdotal evidence that a bougie placed in the esophagus may have a unique, tactile \"boggy\" resistance. In this study, we aimed to elucidate the sensitivity and specificity of clicks and boggy resistance for infrequent airway providers in cadaveric airways.</p><p><strong>Methods: </strong>We conducted a prospective observational study using descriptive statistics to examine the diagnostic accuracy of clicks and boggy resistance for bougies placed in cadaveric airways. We recruited prehospital providers from within Atlantic Canada who then underwent a brief formal training protocol. Cadavers were equipped with a static laryngoscope and bougie (placed either in the trachea or esophagus). Each participant, blinded to bougie placement, was then tested on two separate cadavers and asked whether they felt clicks and/or boggy resistance.</p><p><strong>Results: </strong>Thirty-seven paramedics participated in the study (32 advanced care paramedics, five critical care paramedics) and were randomized to perform 74 bougie assessments on cadaveric airways. For tracheal clicks, we calculated an overall sensitivity of 86% (95% confidence interval [CI], 75 to 98) and an overall specificity of 81% (95% CI, 68 to 94). Sensitivity for the esophageal boggy resistance test was 78% (95% CI, 65 to 92) while specificity was 86% (95% CI, 75 to 98).</p><p><strong>Conclusion: </strong>Following a brief training session, prehospital providers who intubate infrequently seemed to show a relatively high degree of accuracy using tracheal clicks and esophageal boggy resistance to confirm bougie placement in cadaveric airways.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191491","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":"\"All models are wrong; some are useful:\" gastric ultrasound in anesthesia practice.","authors":"Laura Girón-Arango, Vincent Chan, Anahi Perlas","doi":"10.1007/s12630-024-02886-z","DOIUrl":"10.1007/s12630-024-02886-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"226-229"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840361","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":"In reply: Comment on: The evolution and formalization of anesthesia assistant roles across Canada.","authors":"Homer Yang, Judith Littleford, Beverley A Orser, Marco Zaccagnini, Hamed Umedaly, Monica Olsen, Mateen Raazi, Kenneth LeDez, J Adam Law, Mitch Giffin, Jason Foerster, Brandon D'Souza, Irfaan Ali, Derek Dillane, Chris Christodoulou, Natalie Buu, Rob Bryan","doi":"10.1007/s12630-025-02914-6","DOIUrl":"10.1007/s12630-025-02914-6","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"371-372"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257417","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}