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

{"title":"Persistent dural tear visualized by ultrasound.","authors":"Clémentine Marchandise, Thierry Pirotte, Natalia Magasich-Airola, Elisabeth van der Rest","doi":"10.1007/s12630-026-03117-3","DOIUrl":"https://doi.org/10.1007/s12630-026-03117-3","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857720","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 Sustainable Point-of-Care Ultrasound Education in Anesthesia in a Resource-Limited Setting (SPEARS) training program in India.","authors":"Lucia Lee, Erica Tafuro, Swetha Pakala, Madhavi Julakanti, Pavani Kalyanam, Sanjana Kulkarni, Niharika Thakkar","doi":"10.1007/s12630-026-03110-w","DOIUrl":"https://doi.org/10.1007/s12630-026-03110-w","url":null,"abstract":"<p><strong>Purpose: </strong>The Hospital for Special Surgery (New York, NY, USA) partnered with Osmania General Hospital (OGH) in Telangana, India, to pilot a novel point-of-care ultrasound (POCUS) training program called Sustainable Point-of-Care Ultrasound Education in Anesthesia in a Resource-Limited Setting (SPEARS). In this study, we sought to teach essential POCUS skills that could be integrated into daily practice, evaluate the program's impact, and establish a reproducible framework for anesthesia providers in resource-limited settings.</p><p><strong>Methods: </strong>We conducted a mixed-methods local needs assessment at OGH through direct observations, surveys, and interviews. On the basis of these data, we designed the SPEARS intervention, incorporating online didactics, and training modules followed by a 1-week in-person course. SPEARS was implemented at two time points: in February 2023 (time point 1) and December 2023 (time point 2). Participants were anesthesiology attending physicians and postgraduate residents (N = 26). Data collected at each time point included pre- and post-training knowledge tests, clinical skills assessments, and post-training satisfaction surveys. Participants also maintained logbooks to examine changes in POCUS use over time. The impact of the intervention was analyzed using the Kirkpatrick evaluation model.</p><p><strong>Results: </strong>Repeated measures analysis of variance showed a significant positive within-participant effect on knowledge and clinical skills scores across time points. The mean (standard deviation) 5-point Likert scale satisfaction score was 4.4 (0.8). Logbooks indicated a notable increase in the number of POCUS examinations performed after training.</p><p><strong>Conclusions: </strong>The SPEARS intervention was associated with improved POCUS knowledge, clinical skills, and use among anesthesia providers in a resource-limited setting. These findings suggest that similar blended-learning training initiatives could be adapted and implemented in other resource-limited contexts to build sustainable POCUS capacity.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857757","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":"A national survey of factors leading to health care worker turnover in Canadian intensive care units.","authors":"Sebastian Kilcommons, Jacques Du Toit, Sadie Deschenes, James Mellett, Matthew Douma, Ian Alagadan, Dawn Opgenorth, Nadia Baig, Sean M Bagshaw, Oleksa G Rewa, Kirsten Fiest, Carmel Montgomery, Vincent Lau, Sarah K Andersen","doi":"10.1007/s12630-026-03112-8","DOIUrl":"https://doi.org/10.1007/s12630-026-03112-8","url":null,"abstract":"<p><strong>Purpose: </strong>Intensive care unit (ICU) staff attrition has been exacerbated by the COVID-19 pandemic. We sought to determine what factors have led Canadian health care workers to leave or consider leaving their ICU positions since the onset of the pandemic and to identify targets for intervention.</p><p><strong>Methods: </strong>We designed an electronic survey and distributed it to national and provincial health professional organizations between August and December 2023. The survey was developed by a multidisciplinary team and informed by existing literature, including validated measures of well-being, workplace satisfaction, and moral distress.</p><p><strong>Results: </strong>Of 490 health care workers who responded, most were from Alberta (44%), British Columbia (32%), and Ontario (20%). Represented professions included nurses (68%), respiratory therapists (9%), physicians (5%), and social workers (3%). Half (51%) had left an ICU position since 2020. Among those still employed, 72% thought about leaving at least monthly and 19% daily. For 58%, the COVID-19 pandemic contributed to their decision or desire to leave. The most important factors contributing to intent to leave included excessive workload (69%), inadequate staffing (68%), inadequate work-life balance (64%), decreased professional efficacy (51%), and dissatisfaction with organizational leadership (60%) and culture (53%). Unit-based (54%) and organization-based (20%) interventions were deemed most important to improve retention. Staff with intent to leave had similarly poor workplace satisfaction and well-being compared with staff who had already left.</p><p><strong>Conclusions: </strong>Intent to leave and workplace dissatisfaction remained high among ICU staff following the COVID-19 pandemic. Interventions should target unit- and organization-level factors, including staffing, workload, leadership, and culture.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846773","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":"Perioperative cefazolin prophylaxis in patients with β-lactam allergy: a quality improvement project.","authors":"Tariq Esmail, Mark T McIntyre, David T Wong, Chantelle A Nielson, Indira Gobin, Philip Lui, Natalia Lauzon, Timothy Jackson, Alon Vaisman","doi":"10.1007/s12630-026-03119-1","DOIUrl":"https://doi.org/10.1007/s12630-026-03119-1","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to determine if the rate of cefazolin use for antimicrobial prophylaxis could be increased in elective surgical patients with a reported β-lactam antibiotic allergy with the use of a simplified questionnaire and without of skin testing.</p><p><strong>Methods: </strong>We conducted a quality improvement intervention at University Health Network, Toronto, ON, Canada by adapting a novel allergy assessment tool, the Modified Allergy Clarification for Cefazolin Evidence-based Prescribing Tool (ModACCEPT), which uses history alone to determine the safety of using cefazolin among patients with a self-reported β-lactam antibiotic allergy (SRBA) in the absence of skin testing. Prior to this, we performed knowledge dissemination campaigns to the surgical divisions and anesthesiology to communicate the safety of this approach. We used an interrupted time series analysis to determine the impact of the intervention on the proportion of patients with SRBA receiving cefazolin perioperative prophylaxis.</p><p><strong>Results: </strong>Historic electronic data determined the stable rate of cefazolin administration within the institution at 28% (March 2019) among patients with self-reported β-lactam antibiotic allergy. A recalculation of the baseline confirmed a shift to 62% at the time of project team formation (August 2020). After surgical-program-wide educational efforts and implementation of the ModACCEPT tool, we observed special cause variation, with a new baseline stability at 84% for the primary hospital site. Notably, there was also a small improvement in the rate of cefazolin use, from 20% to 46%, at a second hospital site in the network.</p><p><strong>Conclusions: </strong>Adaptation of a two-question β-lactam antibiotic allergy assessment tool, along with targeted education, was associated with significantly increased rates of cefazolin use for perioperative prophylaxis in patients with a β-lactam antibiotic allergy label.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846288","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":"Glucagon-like peptide-1 receptor agonists and gastric emptying time: a systematic review and meta-analysis of prospective studies.","authors":"Alisia Chen, Karen Zhao, Felicia Ceban, Majid Nabipoor, Marina Englesakis, Frances Chung, Anahi Perlas","doi":"10.1007/s12630-026-03114-6","DOIUrl":"https://doi.org/10.1007/s12630-026-03114-6","url":null,"abstract":"<p><strong>Purpose: </strong>Current management of type 2 diabetes mellitus and obesity increasingly includes treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). In this systematic review and meta-analysis, we sought to characterize the effect of GLP-1 RAs on gastric emptying half-time (T_½).</p><p><strong>Methods: </strong>We conducted a systematic review of prospective studies reporting T_½ with and without GLP-1 RA treatment. Inclusion criteria were 1) patients aged ≥ 18 yr taking a GLP-1 RA for diabetes mellitus and/or weight loss, 2) gastric emptying assessment reported as emptying T_½, and 3) study design that was a randomized controlled trial or a prospective cohort study. We searched the following databases: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, American Psychological Association (APA) PsycInfo®, and CINAHL. We assessed the quality of the studies with the risk of bias assessment tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for nonrandomized trials. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification for assessment of the certainty of the evidence. We performed multilevel random effects meta-analysis to pool standardized mean differences.</p><p><strong>Results: </strong>We included 10 studies (N = 300), one of which reported two independent samples; these were treated as two independent studies for the purpose of meta-analysis. Glucagon-like peptide-1 receptor agonists significantly increased gastric emptying T_½, with a large effect size (standardized mean difference, 2.38; 95% confidence interval [CI], 1.05 to 3.71; P < 0.001) corresponding to a mean prolongation of 74 min (95% CI, 46 to 101). There was a trend towards a more pronounced effect with short-acting GLP-1 RAs, with a standardized mean difference of 3.86 (95% CI, 2.37 to 5.35) corresponding to a prolongation of 116 min (95% CI, 71 to 161) and early treatment phases (< 10 weeks) with a standardized mean difference of 2.72 (95% CI, 1.15 to 4.35) with a mean prolongation of 82 min (95% CI, 35 to 131). Nevertheless, the certainty of the effect size following the GRADE classification was \"very low.\"</p><p><strong>Conclusions: </strong>In this systematic review and meta-analysis, we found that GLP-1 RAs significantly prolonged gastric emptying T_½ by a mean of 74 min, which could have implications for perioperative care. There was a trend towards a more pronounced effect with short-acting (vs long-acting) drugs and in the early treatment phases (< 10 weeks).</p><p><strong>Study registration: </strong>PROSPERO ( CRD42023461665 ); first submitted 8 September 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846767","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":"Immersive virtual reality versus high-fidelity simulation to teach anesthesiology nontechnical skills: a randomized controlled noninferiority trial.","authors":"Gianluca Bertolizio, Natalie Buu, Catherine Paquet, Thomas Engelhardt, Milene Azzam, Danielle S Shafiepour, Marta Garbin, Caroline White, Samuel Wasserman, Yuqi Gu, Simone Crooks, Curtis Nickel, Raman Sohi, Daniel Power, Dan Poenaru","doi":"10.1007/s12630-026-03111-9","DOIUrl":"https://doi.org/10.1007/s12630-026-03111-9","url":null,"abstract":"<p><strong>Purpose: </strong>Virtual reality (VR) may offer training advantages over mannequin-based high-fidelity simulation (HFS), but data are lacking. We sought to investigate whether VR is noninferior to HFS in teaching nontechnical skills to anesthesiology trainees.</p><p><strong>Methods: </strong>We conducted a sequential randomized controlled noninferiority trial to compare two simulation crisis management scenarios in 31 anesthesiology trainees. Scenario #1 was delivered either as a VR or as HFS. After 3 weeks, all participants underwent scenario #2, delivered only as HFS. We set a noninferiority margin of 0.6 for the overall improvement on the Ottawa Global Rating Scale (O-GRS), a crisis resource management scale, in scenario #2 between the two groups. As secondary outcomes, we compared changes in the Anaesthetists' Non-technical Skills (ANTS) scale and the Managing Emergencies in Paediatric Anaesthesia Global Rating Scale (MEPA-GRS) between the two groups. We also evaluated the VR module using the VR Sickness Questionnaire (VRSQ), the System Usability Scale (SUS), the Technology Acceptance Model, and a feedback survey.</p><p><strong>Results: </strong>During scenario #2, VR was noninferior to HFS regarding the overall O-GRS improvement (mean difference [upper bound 97.5% confidence interval], -0.4 [0.5]). Likewise, the VR and HFS groups showed no significant differences in ANTS and MEPA-GRS during scenario #2. In scenario #1, the VR and HFS groups' O-GRS, ANTS, and MEPA-GRS scores were comparable. The VR module reported a low VRSQ score (median [interquartile range (IQR)], 8.3 [4.2-15.8]), high-marginal SUS (median [IQR], 65 [62.5-80.0]), and feedback comparable to HFS.</p><p><strong>Conclusions: </strong>Virtual reality was noninferior to HFS in teaching anesthesiology nontechnical skills, and it was well tolerated and perceived.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05041049 ); first submitted 10 September 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846778","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":"Improving continuity of care for postpartum individuals after discharge: a role for anesthesiologists as perioperative physicians.","authors":"Ruth Liu, Anthony Chau, Ainsley Sutherland, Janny X C Ke","doi":"10.1007/s12630-026-03115-5","DOIUrl":"https://doi.org/10.1007/s12630-026-03115-5","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846326","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 corticosteroids with persistent opioid requirements following total knee arthroplasty: an exploratory population-based cohort study.","authors":"Nasir Hussain, Richard Brull, Ian Gilron, Alan Nguyen, Ryan D'Souza, Tristan Weaver, Anuj Bhatia, Hance Clarke, Ratan Banik, Mahmoud Abdel-Rasoul, Faraj W Abdallah","doi":"10.1007/s12630-026-03118-2","DOIUrl":"https://doi.org/10.1007/s12630-026-03118-2","url":null,"abstract":"<p><strong>Background: </strong>Used to suppress inflammation, preoperative corticosteroid exposure is common among patients undergoing total knee arthroplasty (TKA). New preclinical evidence links corticosteroid exposure to developing chronic pain, which may lead to long-term opioid treatment. We aimed to explore whether there is an association between preoperative corticosteroid exposure and persistent opioid requirements in previously opioid-naïve patients undergoing TKA.</p><p><strong>Methods: </strong>In an exploratory retrospective cohort study, we searched a nationwide USA claims database for patients who were opioid-naïve and underwent primary TKA between January 2010 and October 2022. Our primary objective was to explore the magnitude of any association between preoperative corticosteroid claims (oral/parenteral/intra-articular) and postoperative opioid prescription claims at 3 months using multivariable logistic regression. Our secondary objective was to explore the association at 6 months.</p><p><strong>Results: </strong>The matched cohort included 763,530 patients who were opioid-naïve; of those, 27,510 did and 736,020 did not have preoperative corticosteroid claims within 30 days of TKA. At 3 months, 5,015 patients (18.2%) had corticosteroid and opioid claims, while only 95,230 (12.9%) without corticosteroid claims had opioid claims (P < 0.001). Similarly, at 6 months, 2,425 patients (8.8%) had corticosteroid and opioid claims, while only 49,712 (6.8%) without corticosteroid claims had opioid claims (P < 0.001). The odds ratio (confidence interval [CI]) for opioid claims at 3 and 6 months among patients with corticosteroid claims were 1.34 (95% CI, 1.30 to 1.38; P < 0.001) and 1.20 (97.5% CI, 1.15 to 1.25; P < 0.001), respectively.</p><p><strong>Conclusions: </strong>Our exploratory retrospective cohort study suggests that, after accounting for other potential covariates, patients who were previously opioid-naïve and who were exposed to preoperative corticosteroids may have greater odds (or risk given the low incidence) of persistent opioid claims at 3 and 6 months after TKA. This association may have important clinical implications and requires validation through further observational and randomized studies.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846830","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":"Glucagon-like peptide-1 receptor agonists and periprocedural pulmonary aspiration: where are we now?","authors":"Ion A Hobai","doi":"10.1007/s12630-026-03113-7","DOIUrl":"10.1007/s12630-026-03113-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846786","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":"Comment on: \"Dexmedetomidine in pediatric tonsillectomy: a systematic review with meta-analysis\".","authors":"Eduardo M Pereira, Julio S Curi, Gabriel B Carvalho, Mariana Gaya","doi":"10.1007/s12630-026-03104-8","DOIUrl":"https://doi.org/10.1007/s12630-026-03104-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790411","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}