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

{"title":"Electronic health record interventions to reduce postoperative pregabalin prescribing: a quality improvement initiative.","authors":"Sarah Tierney, Ahmed Abbas, Kiran Mysore, Christopher Pysyk, Ian Zunder, Michael Verret, Durotolu Adeleke, Daniel I McIsaac","doi":"10.1007/s12630-025-03045-8","DOIUrl":"https://doi.org/10.1007/s12630-025-03045-8","url":null,"abstract":"<p><strong>Purpose: </strong>Perioperative gabapentinoids may not provide meaningful analgesia and can have significant adverse events. Our objective was to estimate the association of two electronic health record (EHR) interventions with pregabalin prescribing by the acute pain service (APS) at a multi-site academic health sciences network.</p><p><strong>Methods: </strong>We conducted a quality improvement initiative using a retrospective observational cohort and a quasi-experimental interrupted time series design. Following a baseline period (19 January 2021-19 January 2022), we introduced a Best Practice Advisory that warned of pregabalin's risks for sedation or respiratory depression. On 19 June 2022, pregabalin was removed as a standard checkbox in the APS orders. The primary outcome was the proportion of patients receiving pregabalin during their APS admission. The balancing measure was the highest postoperative day one pain score. Analysis used segmented regression in an interrupted time series design to estimate the immediate (level) change, trend (slope), and total counterfactual differences, controlling for the preintervention trend.</p><p><strong>Results: </strong>We included 10,667 patients (5,559 preintervention, 2,271 postintervention 1, and 2,837 postintervention 2). Preintervention, 1,284 APS admissions had a pregabalin order (23.1%) compared with 379 (16.7%) after intervention 1 and 490 (17.3%) after intervention 2. Our interrupted time series analysis did not identify significant immediate, trend, or total counterfactual differences associated with the interventions (intervention 1, total counterfactual P = 0.76; intervention 2, total counterfactual P = 0.11). Only the preintervention trend (-0.2% per week, 95% confidence interval, -0.5 to -0.1) was significantly different (P < 0.001). No changes in pain intensity scores occurred despite decreased pregabalin use over time.</p><p><strong>Conclusion: </strong>We did not identify a significant association of EHR interventions with pregabalin prescribing. Nevertheless, a continued downtrend in pregabalin prescribing was not associated with worsening acute pain.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194010","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":"Revisiting perioperative beta blockade: for what it's worth.","authors":"W Scott Beattie","doi":"10.1007/s12630-025-03026-x","DOIUrl":"https://doi.org/10.1007/s12630-025-03026-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139527","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":"Association of preoperative beta-blocker interruption on postoperative morbidity and mortality: a historical cohort study.","authors":"Suzanne Flier, J Andrew McClure, Britney Le, Philip M Jones, Kelly Vogt, Marko Mrkobrada, Blayne Welk, Luc Dubois","doi":"10.1007/s12630-025-03027-w","DOIUrl":"https://doi.org/10.1007/s12630-025-03027-w","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate the impact that patient-initiated beta-blocker interruption on the morning of surgery has on postoperative adverse outcomes.</p><p><strong>Methods: </strong>We conducted a historical cohort study of consecutive patients undergoing elective surgical procedures at two hospitals belonging to a single academic institution from 2014 to 2018 in the Canadian province of Ontario. We used electronic medical records to identify the initial cohort and collect patient information, including medication interruption. These data were linked to administrative data holdings, which we used to capture study outcomes, including 30-day and 90-day mortality and a composite outcome representing several adverse events. We used logistic regression to evaluate between-group differences in study outcomes and included a covariate representing propensity for beta-blocker interruption.</p><p><strong>Results: </strong>The final cohort included 4,971 patients, 22.2% of whom experienced a preoperative beta-blocker interruption. As compared with patients who continued their medication, those with a beta-blocker interruption had significantly decreased odds of 30-day mortality (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.18 to 1.00; P = 0.049) and 90-day mortality (OR, 0.51; 95% CI, 0.28 to 0.90; P = 0.02) in adjusted analyses. Following adjustment, beta-blocker interruption was not significantly associated with any of the secondary outcomes.</p><p><strong>Conclusions: </strong>Results from this study suggest that preoperative acute beta-blocker interruption is significantly associated with decreased 30-day and 90-day postoperative all-cause mortality. These data challenge the long-held assumption that patients on beta-blockers should continue these medications during the perioperative period and indicate that a proper controlled trial is needed to assess the impact of withholding beta-blockers prior to major surgery.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139579","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 addition of interpectoral and pectoserratus fascial plane blocks to paravertebral blocks for analgesia after total mastectomy and immediate breast reconstruction: a pilot feasibility randomized controlled trial.","authors":"Hannah Wells, Krisha Malik, Penelope M A Brasher, Esta Bovill, Nancy Van Laeken, Rebecca Warburton, Christopher Prabhakar, Xi Lisa Li, Kathryn V Isaac","doi":"10.1007/s12630-025-03030-1","DOIUrl":"https://doi.org/10.1007/s12630-025-03030-1","url":null,"abstract":"<p><strong>Purpose: </strong>Postmastectomy breast reconstruction (BR) may be associated with significant postoperative pain. Use of regional anesthetic blocks has been identified as a potentially beneficial technique to reduce perioperative pain. We sought to conduct a pilot feasibility trial to evaluate the addition of interpectoral and pectoserratus blocks to thoracic paravertebral blocks (TPVBs).</p><p><strong>Methods: </strong>We conducted a pilot feasibility randomized controlled trial (RCT) at the Providence Breast Centre (Mount Saint Joseph's Hospital, Vancouver, BC, Canada), between 7 May 2021 and 17 March 2023. Adult female patients undergoing BR using tissue expanders or implants were randomized (1:1) to receive TPVB + interpectoral and pectoserratus blocks (intervention) or TPVB + saline (control). Feasibility outcomes related to recruitment, retention, block administration, and safety. We also measured numerical rating scale (NRS) pain scores 24 hr postoperatively and assessed whether the lower bound of the 80% confidence interval (CI) for the between-group difference in mean scores was > 0.</p><p><strong>Results: </strong>Of 83 eligible patients, 30 (36%) were randomized. Average recruitment was 1.3 patients per month; all blocks were successfully administered, and there were no complications associated with the blocks. Retention to the end of follow-up (six months) was 90%. Mean (standard deviation) self-reported NRS pain scores at 24 hr postoperatively were 3.0 (1.9) and 3.5 (1.9) in the control and intervention groups, respectively (difference in means, -0.5; 80% confidence interval, -1.4 to 0.5).</p><p><strong>Conclusion: </strong>This RCT showed the feasibility and safety of the intervention with a high retention to the end of follow-up. Nevertheless, we did not meet our prespecified recruitment target, and the results did not provide evidence of potential effectiveness of the intervention to sufficiently support the conduct of a definitive efficacy RCT.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT04860843 ); first posted 27 April 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126664","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":"Opportunities and threats to communication and relationships with patients and patients' loved ones along an intensive care unit journey: a qualitative journey mapping study.","authors":"Salima Suleman, Jennifer M O'Brien, Cari McIlduff, Brittany Benson, Nicole Labine, Sahar Khan, Tiffanie Tse, Joann Kawchuk, Puneet Kapur, Candace Abramyk, Eileen Reimche, Talha Gondal, Sabira Valiani","doi":"10.1007/s12630-025-03037-8","DOIUrl":"https://doi.org/10.1007/s12630-025-03037-8","url":null,"abstract":"<p><strong>Purpose: </strong>When a patient requires critical care, the patient and their loved ones embark on a complex and challenging journey through the intensive care unit (ICU). Communication and the development of trusting relationships is an important part of the journey, especially within the paradigm of patient- and family-centred care (PFCC). We sought to expand our understanding of opportunities and threats to communication, trust, and relationship-building throughout the ICU journey from the perspectives of patients, their loved ones, and ICU health care providers.</p><p><strong>Methods: </strong>We conducted semistructured journey-mapping interviews with 18 participants, including ICU health care providers (n = 10), patients (n = 4), and their loved ones (n = 4). In collaboration with 2 patient partners, we used directed content analysis to identify and understand opportunities and threats.</p><p><strong>Results: </strong>Using the building blocks of the ICU journey, we identified opportunities and threats that could enhance or disrupt relationships, trust, and communication. Opportunities included actions that the ICU team can take to enhance the journey (e.g., providing predictable, consistent, timely, clear, concise, and digestible information to patients and/or loved ones). Threats included factors inherent to the ICU experience (e.g., patients being unable to communicate, the physical and psychological ICU environment), systemic factors (e.g., limited health human resources), and ineffective communication and/or inaction on the part of the ICU team (e.g., limited consideration for patient and loved ones' decisions, goals, privacy, and/or autonomy).</p><p><strong>Conclusions: </strong>Opportunities provide actionable steps that can be taken to enhance PFCC, while threats include inaction and factors inherent to the ICU that are more difficult to mitigate.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088383","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":"Local anesthetic dosing for fascial plane blocks to avoid systemic toxicity: a narrative review.","authors":"Jonathan G Bailey, Garrett Barry, Thomas Volk","doi":"10.1007/s12630-025-03034-x","DOIUrl":"https://doi.org/10.1007/s12630-025-03034-x","url":null,"abstract":"<p><strong>Purpose: </strong>Owing in part to the development and popularization of fascial plane blocks (FPBs), high-volume injection of local anesthetic (LA) is becoming more commonplace. Fascial plane blocks typically use high LA volumes to maximize spread, often pushing towards the maximum recommended dosing. This narrative review summarizes the pharmacokinetic literature for several of the most common FPBs.</p><p><strong>Methods: </strong>We searched PubMed®, Embase, the Cochrane Library, and Google Scholar using the following search terms: (plasma concentration, pharmacokinetics, toxicity, local anesthetic systemic toxicity [LAST]) AND (erector spinae plane, serratus anterior plane, parasternal intercostal plane, quadratus lumborum, transversus abdominis plane, fascia iliaca, pericapsular nerve group), as well as FPB acronyms.</p><p><strong>Results: </strong>Typical LA dosing in studies used concentrations of ropivacaine 0.25-0.5%, levobupivacaine 0.125-0.25%, and bupivacaine 0.25% at volumes of 20-40 mL. While numerous studies found average LA plasma concentrations well below the established thresholds, several patients crossed the toxic threshold. Patients with LA plasma concentrations above toxic thresholds often did not experience LAST symptoms; nevertheless, there are several reports of mild neurologic symptoms and even seizures.</p><p><strong>Conclusions: </strong>Diligent care should be taken to avoid LAST in FPBs. We recommend the calculation of weight-based doses, aspiration before injection, incremental dosing, close monitoring, and ultrasound observation of injectate when administering high volumes. Clinicians should consider adding low-dose epinephrine to FPBs. The LA concentration should decrease with increasing volume to ensure that the total dose of LA remains below maximum dosing recommendations. Clinicians should use extra caution in those blocks and with patients at a higher risk for LAST.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071073","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":"Anticipated difficult airway management and multidisciplinary approach to a patient with a high-risk pregnancy.","authors":"Caelie Stewart, Barry Thorneloe, Ciaran McDonnell, Michelle Mozel","doi":"10.1007/s12630-025-03041-y","DOIUrl":"https://doi.org/10.1007/s12630-025-03041-y","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070697","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":"Use of Ringer's lactate for arterial line maintenance.","authors":"Gregory L Silverman","doi":"10.1007/s12630-025-03042-x","DOIUrl":"https://doi.org/10.1007/s12630-025-03042-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857135","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":"Minimum effective dose of carbetocin for preventing uterine atony during Cesarean delivery in patients with and without preeclampsia: a biased sequential allocation study.","authors":"Asha Tyagi, Thamburu Sasi, Chanchal Nigam, Rajesh S Rautela, Rajeev K Malhotra, Amita Suneja","doi":"10.1007/s12630-025-03005-2","DOIUrl":"10.1007/s12630-025-03005-2","url":null,"abstract":"<p><strong>Purpose: </strong>The aggregate data for successful use of carbetocin in patients at high risk of postpartum hemorrhage is fairly large. Nevertheless, there are scant data evaluating carbetocin in patients with preeclampsia and no established optimal dose. Therefore, we aimed to determine the minimum effective dose (the dose effective in 90% of the studied population [ED₉₀]) of carbetocin to prevent intraoperative uterine atony in patients with preeclampsia undergoing Cesarean delivery.</p><p><strong>Methods: </strong>We based this nonrandomized triple-blinded dose finding study on biased coin sequential allocation design. We enrolled all consenting nonlabouring parturients aged > 18 yr with singleton pregnancy posted for Cesarean delivery under spinal anesthesia (with and without preeclampsia). Doses of carbetocin included 10 μg, 20 μg, 40 μg, 60 μg, 80 μg, 100 μg, or 120 μg, with 20 μg for the first patient of either group and then successively decided by response to the bolus in the previous patient in the respective group. After a \"failed\" dose of carbetocin bolus, the subsequent patient in that group received the next highest dose. In the case of a \"successful\" dose, we decreased it to the lower dose with a probability of 1/9; otherwise, it remained unchanged. The determinant of a successful dose was satisfactory uterine tone at 2 min after carbetocin, along with no need for any additional uterotonic intraoperatively.</p><p><strong>Results: </strong>The ED₉₀ of carbetocin for patients with and without preeclampsia was 96 µg (95% confidence interval [CI], 59 to 114) vs 68 µg (95% CI, 46 to 76).</p><p><strong>Conclusion: </strong>The dose requirement of carbetocin to prevent intraoperative uterine atony in patients with preeclampsia is 1.5 times greater than in those without the disease.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1305-1313"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621276","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":"10.1007/s12630-025-02999-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1331-1333"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","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}