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":"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":"1397-1405"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528309/pdf/","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":"OA","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":"10.1007/s12630-025-03026-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1341-1353"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","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":"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":"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":"1423-1447"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","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":"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":"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":"1387-1396"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","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":"Richard Chisholm, MD, FRCPC.","authors":"John Chisholm, Michael J Wong","doi":"10.1007/s12630-025-03023-0","DOIUrl":"10.1007/s12630-025-03023-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1460-1461"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure of preoperative data to accurately predict which patients undergoing major hepatic surgery will develop postoperative coagulation disturbances: a single-hospital retrospective cohort study.","authors":"Gabriel E Vazquez, Franklin Dexter, Ravina S Vasanwala, Nada A Sadek, Rakesh V Sondekoppam","doi":"10.1007/s12630-025-03032-z","DOIUrl":"10.1007/s12630-025-03032-z","url":null,"abstract":"<p><strong>Purpose: </strong>Epidural analgesia has been considered a highly effective analgesic modality for hepatobiliary surgeries, particularly within 72 hr postoperatively. Coagulation derangements are possible complications following liver resection that can be concerning in the setting of epidural analgesia given the inherent risk of spinal epidural hematoma. We sought to develop predictive models for postoperative coagulation disturbance (defined as an international normalized ratio > 1.5, a partial thromboplastin time > 40 sec, or a platelet count < 100,000 × 10⁶·L^-1) in patients eligible for epidural analgesia.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients undergoing liver resection at the University of Iowa (Iowa City, IA, USA) between 2011 and 2023. We reviewed records for patient characteristics, operative parameters, preoperative coagulation labs, and postoperative coagulation labs up to seven postoperative days. We used three types of predictive modeling.</p><p><strong>Results: </strong>Among 684 patients, 37 had a length of stay ≤ 72 hr of surgery or preoperative coagulation disturbance. Among the remaining 647 patients, 512 (79%) received a thoracic epidural. The incidence of postoperative coagulation disturbances within 72 hr was 25% (95% confidence interval, 22 to 28), mostly thrombocytopenia (20% of all patients), and was noted on postoperative day 1 for 11% and postoperative day 2 for 22%. The volume of liver resected was greater among patients with postoperative coagulation disturbance (P < 0.001; area under the receiving operating characteristic curve, 0.61). There was no predictive value for coagulation disturbance based on patients' sex, American Society of Anesthesiologists' Physical Status classification, body mass index, weight, age, adjuvant chemotherapy, estimated operative duration, or year of data (all standardized differences < 0.24). Classification tree modeling had a single node (i.e., no useful preoperative prediction). Stepwise backward logistic regression using P < 0.05 for inclusion had just two patients (0.3%) with a predicted probability of postoperative coagulation disturbance < 10% and none < 5%.</p><p><strong>Conclusions: </strong>Coagulation disturbances occur commonly in the context of hepatic surgery. Preoperative data commonly used to qualify a patient to receive epidural analgesia are insufficient to predict which patients are likely to develop postoperative coagulation disturbance. Regardless of the predictive modeling or criterion, the postoperative risk of coagulopathic disturbance will exceed 5% by 72 hr postoperatively. Enhanced recovery protocols recommending early epidural catheter removal need to consider the period of incidence of coagulation disturbance.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1416-1422"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric airway foreign body-a unique simulation scenario for anesthesiology and otolaryngology trainees.","authors":"Arnim Vlatten, Sally J Bird, Tim Brown, Liane Johnson","doi":"10.1007/s12630-025-02990-8","DOIUrl":"10.1007/s12630-025-02990-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1448-1450"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638807","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":"Correction: Association between general anesthesia combined with peripheral nerve blocks versus neuraxial anesthesia without nerve blocks for high-risk isolated distal deep venous thrombosis in patients undergoing knee arthroplasty: a historical cohort study.","authors":"Nanbo Luo, Li Luo, Lei Yang, Zhi Li, Qingmin Yu, Wenling Jian, Wei Sun, Pac-Soo Chen, Qian Chen, Daqing Ma, Qingsheng Xue, Yan Luo, Buwei Yu, Hao Wang, Zhiheng Liu","doi":"10.1007/s12630-025-03012-3","DOIUrl":"10.1007/s12630-025-03012-3","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1462-1463"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripartum transverse myelitis with intrathecal catheter placement after unintentional dural puncture.","authors":"Grace Martin, Monica Brundage, Joel Hamstra, Annemaria DeTina, Ibrahim M Nadeem, Kim Wong","doi":"10.1007/s12630-025-03000-7","DOIUrl":"10.1007/s12630-025-03000-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1451-1453"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477989","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 between postoperative body temperature and in-hospital mortality: a nationwide cohort study of 157,028 critically ill patients in Japan.","authors":"Yoshitaka Aoki, Mikio Nakajima, Soichiro Mimuro, Ryo Imai, Takayuki Katsuragawa, Kensuke Kobayashi, Hiromi Kato, Hiroshi Makino, Yoshiki Nakajima","doi":"10.1007/s12630-025-02982-8","DOIUrl":"10.1007/s12630-025-02982-8","url":null,"abstract":"<p><strong>Purpose: </strong>The association between postoperative body temperature and in-hospital mortality remains unclear. We sought to evaluate this association across all surgical patients and assessed whether it is affected by the indication for surgery (i.e., surgical source control of infection vs other indications).</p><p><strong>Methods: </strong>In a nationwide cohort study, we included critically ill adult patients registered in the Japanese Intensive Care Patient Database who underwent surgery between 2015 and 2021. We evaluated whether the body temperature was associated with in-hospital mortality, and if a differential effect was observed in patients who underwent surgery for source control of infection vs other indications (control group). We categorized the highest body temperatures recorded in the 24 hr after admission following surgery in 0.5-°C intervals and evaluated them using multivariable regression. We conducted a subgroup analysis of patients who underwent surgery for infection control vs other indications. We report the summary estimates using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We examined the association between body temperature category and in-hospital mortality using cubic spline models to assess nonlinear associations.</p><p><strong>Results: </strong>Among 157,028 patients, the overall in-hospital mortality was 2.9%. We observed a U-shaped association of temperature and mortality, with increased mortality at body temperatures < 36.0 °C (OR, 2.15; 95% CI, 1.62 to 2.86) and > 40.0 °C (OR, 1.41; 95% CI, 1.02 to 1.96). We observed the lowest mortality at 37.5-37.9 °C (OR, 0.62; 95% CI, 0.55 to 0.70). Low body temperatures were associated with increased mortality regardless of the presence or absence of infection, while high body temperatures were not associated with increased mortality in patients undergoing surgery for source control of infection.</p><p><strong>Conclusions: </strong>In this large nationwide cohort of critically ill surgical patients in Japan, we observed that low and high postoperative body temperatures were associated with increased in-hospital mortality. Nevertheless, we did not observe the association with high body temperature and increased mortality in the subgroup of patients having undergone surgery for infection control.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1367-1378"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310894","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}