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

{"title":"Short-term use of nonsteroidal anti-inflammatory drugs immediately after cardiac surgery.","authors":"Anthony M-H Ho, Rachel Phelan, Ramiro Arellano, Glenio B Mizubuti","doi":"10.1007/s12630-025-02981-9","DOIUrl":"https://doi.org/10.1007/s12630-025-02981-9","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487247","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":"Safety of nonselective nonsteroidal anti-inflammatory drugs in cardiac surgery: a historical cohort study.","authors":"Tyson Miao, Lik Hang N Lee, Terri Sun, Megan Patapoff, Erica Wang","doi":"10.1007/s12630-025-02983-7","DOIUrl":"https://doi.org/10.1007/s12630-025-02983-7","url":null,"abstract":"<p><strong>Purpose: </strong>Pain management after cardiac surgery is imperative, as inadequate analgesia can increase the risk of myocardial ischemia, thromboembolism, and pulmonary complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of multimodal analgesia, but their use in the postoperative cardiac surgery population is controversial owing to concerns of acute kidney injury (AKI), thrombotic events, and bleeding. We aimed to evaluate the rate of AKI, major adverse cardiovascular events (MACE), and major bleeding in patients receiving NSAIDs early after cardiac surgery.</p><p><strong>Methods: </strong>We conducted a single-centre historical cohort study, which included adult patients who underwent cardiac surgery with sternotomy or thoracotomy between 1 October 2020 and 30 September 2022 and received nonselective NSAIDs postoperatively. The primary outcome was the proportion of patients who developed AKI, MACE, or major bleeding within 7 days of the NSAID exposure during their hospitalization. We used machine learning to identify risk factors associated with adverse events. We assessed pain reduction by analyzing differences in pain scores, opioid use, and supplemental oxygen requirements.</p><p><strong>Results: </strong>We included 431 patients in this study. After NSAID administration, 12% experienced AKI, 1% had MACE, and 3% developed major bleeding. Risk factors for AKI included older age; shorter height; a history of stroke; low preoperative estimated glomerular filtration rate (eGFR) and hemoglobin level; high preoperative platelet count, international normalized ratio, and blood urea nitrogen level; and reduced eGFR and platelet count before NSAID exposure.</p><p><strong>Conclusion: </strong>In patients who received nonselective NSAIDs early after cardiac surgery, the rate of AKI was lower than reported in literature, likely due to selection bias. Baseline renal function emerged as the most important factor, with low preoperative eGFR being the strongest predictor of AKI following NSAID administration.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487246","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 preoperative binaural beats on the propofol dose for induction of general anesthesia: a randomized controlled trial.","authors":"Yoon Jung Kim, Hyun Woo Choe, Soo Bin Yoon, Hyeonhoon Lee, Hee-Soo Kim, Jeong-Hwa Seo","doi":"10.1007/s12630-025-02993-5","DOIUrl":"https://doi.org/10.1007/s12630-025-02993-5","url":null,"abstract":"<p><strong>Purpose: </strong>Brainwave entrainment with low-frequency binaural beats has shown sedative-sparing and anxiolytic effects. We sought to investigate whether the preoperative use of binaural beats could reduce the propofol dose for the induction of general anesthesia.</p><p><strong>Methods: </strong>We enrolled patients scheduled for elective surgery under general anesthesia in a randomized controlled trial. In the preoperative waiting area, we randomized patients to hear the binaural beats with frequencies of 432 and 431 Hz in the binaural-beats group (N = 34) or silent sound in the control group (N = 35) for 20 min via stereo headphones. For the induction of general anesthesia, we administered 10 mg of propofol every 15 sec until we observed three clinical signs: the loss of response to verbal commands of \"open your eyes\" (primary outcome), loss of eyelash reflex, and a patient state index of ≤ 50. We collected processed frontal electroencephalography data during the intervention and assessed anxiety scores before and after the intervention.</p><p><strong>Results: </strong>The propofol dose for the loss of response to verbal commands was lower in the binaural-beats group than in the control group (mean [standard deviation], 87 [24] mg vs 105 [32] mg; difference in means, -18 mg; 95% confidence interval, -32 to -5; P = 0.009). There were no significant differences in the delta (P = 0.63), theta (P = 0.28), alpha (P = 0.24), and beta (P = 0.85) bands of the processed frontal electroencephalograms and the anxiety scores (P = 0.50).</p><p><strong>Conclusion: </strong>Binaural beats with a frequency of 1 Hz modestly reduced the propofol dose for the induction of general anesthesia, but we observed no significant differences in the processed frontal electroencephalograms and preoperative anxiety levels.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05431881 ); first submitted 9 June 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499678","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":"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":"https://doi.org/10.1007/s12630-025-03000-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-23","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":"The effect of intravenous dexamethasone on rebound pain after wrist and hand surgery under supraclavicular brachial plexus blockade: a randomized placebo-controlled trial.","authors":"RyungA Kang, Yu Jeong Bang, Jae Woo Shim, Soo Joo Choi, So Myung Kong, Tae Soo Hahm, Jungchan Park, Woo Seog Sim, Justin Sangwook Ko","doi":"10.1007/s12630-025-02992-6","DOIUrl":"10.1007/s12630-025-02992-6","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to evaluate the efficacy of intravenous dexamethasone in reducing rebound pain post-orthopedic wrist and hand surgery, administered prior to supraclavicular brachial plexus blockade.</p><p><strong>Methods: </strong>We conducted a randomized placebo-controlled trial on 56 patients scheduled for elective wrist and hand surgery under supraclavicular brachial plexus blockade. We randomized participants into either a control group, receiving 0.9% of intravenous saline, or a dexamethasone group, receiving 0.11 mg·kg^-1 of intravenous dexamethasone. The primary outcome was the difference in pain scores before vs after block resolution. Secondary outcomes included the incidence of rebound pain, pain scores, cumulative opioid consumption, patient satisfaction with postoperative analgesia, and block-related complications in the first 24 hr postoperatively.</p><p><strong>Results: </strong>The mean (standard deviation [SD]) pain score difference was significantly larger in the control group (7.3 [1.9]) compared with the dexamethasone group (4.7 [2.1]), with a mean difference between groups of 2.6 (95% confidence interval, 1.5 to 3.7; P < 0.001). The incidence of rebound pain was also significantly higher in the control group (79% vs 32%; P < 0.001). The cumulative opioid consumption in 24 hr was greater in the control group than in the dexamethasone group (median [interquartile range (IQR)], 72 [54-97] mg vs 25 [14-60] mg; P < 0.001). We found no significant differences in postoperative complications.</p><p><strong>Conclusions: </strong>Preoperative administration of 0.11 mg·kg^-1 intravenous dexamethasone significantly reduced rebound pain within 24 hr after wrist and hand surgery under supraclavicular brachial plexus blockade. The results of our trial support the use of intravenous dexamethasone as an effective method for managing postoperative pain for wrist and hand surgery under supraclavicular brachial plexus blockade.</p><p><strong>Study registration: </strong>www.CRIS.nih.go.kr ( KCT0007208 ); first submitted 5 April 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337291","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 low Bispectral Index™ values during anesthesia maintenance and one-year mortality in older patients with different comorbidities: a retrospective cohort study.","authors":"Wei Ma, Chengyu Li, Qian Li","doi":"10.1007/s12630-025-02995-3","DOIUrl":"https://doi.org/10.1007/s12630-025-02995-3","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate the correlation between the duration of low Bispectral Index™ (BIS™) values and 1-year mortality in older patients, particularly in those with different comorbidities.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 5,927 older patients (≥ 65 yr of age) who underwent elective noncardiac surgery under general anesthesia with BIS monitoring between February 2015 and February 2022. We used univariable and multivariable Cox proportional hazard models to explore the associations between the cumulative duration of BIS values < 40 and postoperative 1-year mortality. We performed exploratory subgroup and interaction analyses to investigate whether any association with outcome differed in patients with multimorbidity as assessed by the Charlson comorbidity index (CCI).</p><p><strong>Results: </strong>We included 5,927 patients undergoing elective noncardiac surgery, with a mean (standard deviation [SD]) age of 71 (5) yr. Among them, 2,234 (38%) patients with multimorbidity had a CCI ≥ 3, and 3,693 (62%) had CCI < 3. Postoperatively, 588/5,927 (10%) patients died within 1 year. After adjusting for covariates, multivariable Cox proportional hazard analysis showed that the cumulative duration of BIS < 40 was not significantly associated with 1-year mortality (adjusted hazard ratio, 1.07; 95% confidence interval [CI], 0.99 to 1.15; P = 0.08); this association remained stable among patients with multimorbidity (adjusted hazard ratio, 1.06; 95% CI, 0.96 to 1.16).</p><p><strong>Conclusions: </strong>In this retrospective cohort study of 5,927 older patients, the cumulative duration of BIS < 40 was not significantly associated with 1-year mortality, especially in patients with multimorbidity.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318791","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":"Exploring clinical conundrums in obstetric anesthesia through interactive polls and panel discussion: insights from Canadian obstetric anesthesiology experts.","authors":"Anthony Chau, Roanne Preston, Paul M Wieczorek, Dolores M McKeen, Lorraine Chow, Wesley Edwards, Valerie Zaphiratos","doi":"10.1007/s12630-025-02986-4","DOIUrl":"https://doi.org/10.1007/s12630-025-02986-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This Special Article aims to synthesize the results of a live audience poll and practice tips from Canadian obstetric anesthesiology experts during a panel session at the Canadian Anesthesiologists' Society 2024 Annual Meeting (Victoria, BC, Canada). We explored six hypothetical case scenarios, each representing a clinically plausible situation that lack a definitive management approach. These scenarios highlight areas where no consensus exists and no single \"correct\" solution has been established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Source: &lt;/strong&gt;We gathered live poll data about six case scenarios from participants who attended the session and chose to submit a response. The expert panel provided decision analysis of each case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Principal findings: &lt;/strong&gt;The literature and expert panel suggest that 0.5% isobaric bupivacaine and 0.5% hyperbaric ropivacaine may be appropriate alternatives during shortages of 0.75% hyperbaric bupivacaine. Both combined spinal epidural and standard epidural techniques are effective first choices for rescuing a failed single-shot spinal anesthesia during elective Cesarean delivery. A decision aid may be helpful when converting an epidural for surgical anesthesia. Epidural dexmedetomidine has been used off-label in some centres to enhance the quality of labour analgesia. Nevertheless, owing to limited data in the literature, its routine use for labour analgesia or Cesarean delivery is not currently recommended. In cases of febrile labouring patients, the expert panel advocates initiating antibiotics before epidural placement as a prudent precaution despite the lack of robust contemporary evidence. An obstetric patient with thrombocytopenia may generally undergo neuraxial techniques if the platelet count exceeds 70 × 10&lt;sup&gt;9&lt;/sup&gt;·L&lt;sup&gt;-1&lt;/sup&gt;. The risks and benefits should be carefully considered when the platelet count is between 50 × 10&lt;sup&gt;9&lt;/sup&gt;·L&lt;sup&gt;-1&lt;/sup&gt; and 69 × 10&lt;sup&gt;9&lt;/sup&gt;·L&lt;sup&gt;-1&lt;/sup&gt;, taking into account potential changes in platelet quality due to conditions such as hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. If an accidental dural puncture occurs during an epidural blood patch procedure, a cautious approach would involve abandoning the procedure and reattempting after 24 hr to minimize the risk of blood translocation leading to arachnoiditis. Conversely, a pragmatic approach would involve immediately reattempting the procedure at another level, although there is no consensus on the most appropriate course of action.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The range of participant responses highlighted various clinical challenges in obstetric anesthesia where evidence is still limited or inconclusive. Three experts in obstetric anesthesia shared their insights, detailing their decision-making processes and how they would approach each case scenario. They also provided key references, offering valuable take-home messages for anesthesiologists prac","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318792","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 applications of ChatGPT and other large language models in anesthesiology and critical care: a systematic review.","authors":"Nicolas Daccache, Joe Zako, Louis Morisson, Pascal Laferrière-Langlois","doi":"10.1007/s12630-025-02973-9","DOIUrl":"https://doi.org/10.1007/s12630-025-02973-9","url":null,"abstract":"<p><strong>Purpose: </strong>ChatGPT and other large language models (LLMs) have gained immense popularity since their commercial release in 2022, with applications in various sectors including health care. We sought to evaluate their deployment in anesthesiology and critical care in a systematic review. Our aim was to describe the integration of LLMs in the field by showcasing and categorizing their current applications, assessing their performance in patient care, and reviewing application-specific ethical and practical challenges in deployment.</p><p><strong>Methods: </strong>Respecting Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched through PubMed®, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science®, from inception until 1 August 2024. We extracted all papers investigating LLMs in anesthesiology or critical care and reporting results. We segmented the literature into major themes and highlighted key findings and limitations.</p><p><strong>Results: </strong>From 480 retrieved articles, we included 45 papers. The evaluated models (GPT-4, GPT-3.5, Google Bard [now Gemini], LLaMA, and others) showed diverse applications in four segments: intensive care unit, patient education, medical education, and perioperative care. Large language models, especially newer models, are promising in predicting clinical scores, navigating simple clinical scenarios, and managing preoperative anxiety. Their performance remains below the clinician level in predicting outcomes, solving complex clinical scenarios (i.e., airway management), board examinations, and generating patient-directed documents, although newer models performed better than older ones.</p><p><strong>Conclusion: </strong>While LLMs are not yet equipped to fully assist physicians in anesthesiology and critical care, they have significant potential, and their capabilities are rapidly improving. Supervised use for select tasks can streamline patient care. Further trials are warranted as new versions of models become available.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42024567380 ); first submitted 22 July 2024.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310897","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, Hamed Umedaly, Monica Olsen, Mateen Raazi, Kenneth LeDez, J Adam Law, Mitch Giffin, Brandon D'Souza, Derek Dillane, Chris Christodoulou, Natalie Buu, Rob Bryan","doi":"10.1007/s12630-025-02989-1","DOIUrl":"https://doi.org/10.1007/s12630-025-02989-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310896","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: The evolution and formalization of anesthesia assistant roles across Canada.","authors":"Allana Munro, Claire Ward, Melissa A Berry, Andrew D Milne","doi":"10.1007/s12630-025-02988-2","DOIUrl":"https://doi.org/10.1007/s12630-025-02988-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310895","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}