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

{"title":"In reply: Point-of-care ultrasound-guided fluid management to prevent hypotension after induction of general anesthesia-a conundrum to conquer!","authors":"Elad Dana, Cristian Arzola, James S Khan","doi":"10.1007/s12630-025-02955-x","DOIUrl":"https://doi.org/10.1007/s12630-025-02955-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047059","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":"First-pass success rate and predictive factors for stylet use in videolaryngoscopic intubations with a Macintosh blade: a prospective observational study.","authors":"Seung Eun Song, Ji-Yoon Jung, Chul-Woo Jung, Jung Yeon Park, Won Ho Kim, Hyun-Kyu Yoon","doi":"10.1007/s12630-025-02952-0","DOIUrl":"https://doi.org/10.1007/s12630-025-02952-0","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the first-pass success rate of videolaryngoscopic intubations without a stylet using a Macintosh blade and to identify predictive factors for successful intubation.</p><p><strong>Methods: </strong>We conducted a prospective observational study of 224 adult patients scheduled for elective videolaryngoscopic intubations using a Macintosh blade. We excluded patients who had cervical spine issues, airway disease, anticipated difficult intubation, or a body mass index > 35 kg·m^-2, or who required rapid sequence induction. We initially attempted intubations without a stylet, with laryngeal manipulation on the second attempt if needed, and a stylet added after two failures. We evaluated the first-pass success rate and identified predictive factors using multivariable logistic regression, incorporating demographic, conventional, and ultrasonographic airway parameters. We performed ultrasound examination after induction of general anesthesia. We developed and evaluated a prediction model using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>The first-pass success rate was 80% (180/224), increasing to 96% (215/224) after laryngeal manipulation on the second attempt. Nine patients (4%) required a stylet. Longer sternomental distance (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.01 to 1.53; P = 0.04) and increased thyromental height (OR, 1.14; 95% confidence interval [CI], 1.07 to 1.21; P < 0.001) were associated with first-pass success without a stylet. Limited (OR, 0.39; 95% CI, 0.16 to 1.00; P = 0.049) or severely limited (OR, 0.05; 95% CI, 0.01 to 0.19; P < 0.001) cervical spine movement negatively affected success.</p><p><strong>Conclusions: </strong>Routine stylet preparation for elective videolaryngoscopic intubations with a Macintosh blade may not be necessary, as only a small percentage of patients required it.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062889","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 to: Effects of intraoperative hyperoxia on cerebral blood flow and dynamic cerebral autoregulation.","authors":"Rokus E C van den Dool, Lariza Batelaan, Denise P Veelo, Jimmy Schenk, Markus W Hollmann, Alexander P J Vlaar, Nicolaas H Sperna Weiland, Rogier V Immink","doi":"10.1007/s12630-025-02948-w","DOIUrl":"https://doi.org/10.1007/s12630-025-02948-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019968","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":"Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review.","authors":"Sandra Lee, Nehal Islam, Karim S Ladha, Mark C Bicket, Duminda N Wijeysundera","doi":"10.1007/s12630-025-02925-3","DOIUrl":"https://doi.org/10.1007/s12630-025-02925-3","url":null,"abstract":"<p><strong>Purpose: </strong>Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.</p><p><strong>Source: </strong>We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.</p><p><strong>Principal findings: </strong>Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I² = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I² = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I² = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.</p><p><strong>Conclusions: </strong>Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053898","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 cross-sectional study of diversity in regional anesthesia and acute pain medicine fellowships.","authors":"Uchenna O Umeh, Mandip S Kalsi, Maya Tailor, Haoyan Zhong, Shivani Mehta, Niyant Jain, Poonam Pai, Bridget Pulos, Rodney Gabriel, Raymond S Joseph, Justas Lauzadis, Mary J Hargett, Meg A Rosenblatt","doi":"10.1007/s12630-025-02947-x","DOIUrl":"https://doi.org/10.1007/s12630-025-02947-x","url":null,"abstract":"<p><strong>Purpose: </strong>The number of underrepresented in medicine (URiM) physicians is disproportionately low compared with the general population. Patient-physician racial concordance may increase patient satisfaction and therapeutic adherence. In this study, we evaluated diversity within 2023-2024 regional anesthesia and acute pain medicine (RA/APM) fellowship programs and discuss methods to increase diversity and inclusion.</p><p><strong>Methods: </strong>The Hospital for Special Surgery Institutional Review Board (IRB no. 2023-1862) approved this cross-sectional survey study. We distributed a questionnaire to RA/APM fellowship directors (FDs) on 2 October 2023 and present responses as counts and percentages or medians and interquartile ranges.</p><p><strong>Results: </strong>We sent questionnaires to 84 FDs with 44 responses (52%)-39 from the USA and five from Canada. Overall, 4/44 (9%) FDs identified as URiM. Many FDs reported no URiM (57%) or lesbian, gay, bisexual, transgender, queer, intersex, asexual, or other (LGBTQIA +) fellows (50%). We observed no differences regarding gender identity, with 46% cisgender female FDs and 46% female fellows reported. While 35 (80%) FDs considered themselves successful at having a diverse program, 27 (61%) reported no outreach programs targeted to underrepresented groups. Thirty-two (73%) programs reported Accreditation Council for Graduate Medical Education accreditation and 33 (75%) reported participation in the 2023 San Francisco Residency and Fellowship Match.</p><p><strong>Conclusions: </strong>Organizational diversity offers several advantages; however, there is a discrepancy between the diversity of RA/APM FDs and fellows compared with the general US and Canadian population. Methods to further increase URiM representation at the trainee and FD levels should be further explored.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011493","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":"Simple act, complex effects: how ascribing identities leads to structural violence in health care.","authors":"Gianni R Lorello, Sasha K Shillcutt, Brett Schrewe","doi":"10.1007/s12630-025-02945-z","DOIUrl":"https://doi.org/10.1007/s12630-025-02945-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053893","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 the head-elevated position on cervical spine motion during videolaryngoscopic intubation with manual in-line stabilization: a randomized controlled trial.","authors":"Woo-Young Jo, Chan-Ho Hong, Kyung Won Shin, Hyongmin Oh, Hee-Pyoung Park","doi":"10.1007/s12630-025-02946-y","DOIUrl":"https://doi.org/10.1007/s12630-025-02946-y","url":null,"abstract":"<p><strong>Purpose: </strong>The head-elevated position during videolaryngoscopic intubation enables better visualization of the glottis than the head-flat position. We hypothesized that the head-elevated position would result in less cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial in which we assigned patients undergoing coil embolization for unruptured cerebral aneurysms into the head-elevated (N = 55) or head-flat (N = 54) groups. Manual in-line stabilization was applied to simulate cervical spine immobilization during Macintosh-type videolaryngoscopic intubation. To measure the cervical spine angle, two lateral cervical spine radiographs using the capture method were taken, one before and one during intubation, respectively. The primary outcome was cervical spine motion during intubation (cervical spine angle during intubation - cervical spine angle before intubation) at the occiput-C1 segment. We investigated cervical spine motion at the C1-C2 and C2-C5 segments; intubation performance, such as the success rate at the first attempt, intubation time, and frequency of external laryngeal maneuver; and intubation-associated airway complications (airway bleeding, injury, sore throat, and hoarseness).</p><p><strong>Results: </strong>There was significantly less cervical spine motion at the occiput-C1 segment in the head-elevated group than the head-flat group (mean [standard deviation], 8.6° [5.6°] vs 11.4° [5.7°]; mean difference [95% confidence interval], -2.9° [-5.0 to -0.7]; P = 0.009). Cervical spine motion at the C1-C2 and C2-C5 segments, intubation performance, and intubation-associated airway complications did not significantly differ between the groups.</p><p><strong>Conclusions: </strong>The head-elevated position during Macintosh-type videolaryngoscopic intubation with manual in-line stabilization resulted in less upper cervical spine motion than the head-flat position.</p><p><strong>Study registration: </strong>CRIS.nih.go.kr ( KCT0008669 ); date of registration (approved), 1 August 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055008","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 nitroglycerin to facilitate radial arterial catheterization in adults: a systematic review and meta-analysis.","authors":"Uday Rao, Timothy Phillips, Shripada Rao","doi":"10.1007/s12630-025-02931-5","DOIUrl":"10.1007/s12630-025-02931-5","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to investigate the efficacy and safety of local nitroglycerin (NTG) application in facilitating radial artery cannulation in adults.</p><p><strong>Methods: </strong>In February 2024, we searched PubMed®, Embase, EMCARE, and the Cochrane Library. Local NTG could have been subcutaneous injection or topical application. We sought to conduct a meta-analysis using Hartung-Knapp adjustment of the DerSimonian-Laird random effects model.</p><p><strong>Results: </strong>We included 15 randomized controlled trials (RCTs) (n = 2,370), of which 4 (n = 423) evaluated topical NTG, whereas 11 (n = 1,947) used subcutaneous infiltration. All 4 trials evaluating topical NTG and 9/11 evaluating subcutaneous NTG used ultrasound to facilitate radial artery cannulation, whereas this was unclear in 2/11 trials evaluating subcutaneous NTG. The majority of studies had an unclear risk of bias (ROB). All 15 studies reported NTG to be beneficial. The meta-analysis found that subcutaneous NTG was associated with increased rates of first-attempt success (risk ratio [RR], 1.61; 95% confidence interval [CI], 1.23 to 2.10; five studies; 516 patients) and decreased risk of radial artery spasm (RR, 0.43; 95% CI, 0.24 to 0.77; seven studies; 1,519 patients). Topical NTG was associated with increased rates of first-attempt success (RR, 2.45; 95% CI, 1.39 to 4.34; one study; 92 patients) but resulted in little or no difference to the incidence of radial artery spasm (RR, 0.67; 95% CI, 0.20 to 2.25; three RCTs; 275 patients). The overall certainty of evidence was low.</p><p><strong>Conclusions: </strong>Topical or subcutaneous NTG has the potential to facilitate radial artery access and decrease local complications. Given that the certainty of evidence was low, additional RCTs are needed.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022342158 ); first submitted 29 June 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"567-578"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665131","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":"Estimating sample means and standard deviations from the log-normal distribution using medians and quartiles: evaluating reporting requirements for primary and secondary endpoints of meta-analyses in anesthesiology.","authors":"Pei-Fu Chen, Franklin Dexter","doi":"10.1007/s12630-025-02922-6","DOIUrl":"https://doi.org/10.1007/s12630-025-02922-6","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical trials often report medians and quartiles due to skewed data distributions. We sought to evaluate the methods currently used in meta-analyses in anesthesiology to estimate means and standard deviations (SDs) from medians and quartiles.</p><p><strong>Methods: </strong>We simulated sample sizes (n = 15, 27, 51) and coefficients of variation (CV = 0.15, 0.3, 0.5), representative scenarios in anesthesiology studies, generating data that have a log-normal distribution with zero log-scale means. We calculated generalized confidence intervals for the ratios of means and ratios of SDs using means and SDs estimated from three quartiles in time scale, using Luo et al.'s and Wan et al.'s methods, McGrath et al.'s quantile estimation and Box-Cox transformation, and Cai et al.'s maximum likelihood estimation method.</p><p><strong>Results: </strong>The method by Luo et al. and Wan et al. produced 95% confidence intervals for the ratio of means with coverage ranging from 92.4% to 93.6%, and for SDs from 79.2 to 89.6. McGrath et al.'s quantile estimation method yielded coverage for mean ratios between 88.5% and 91.5% and SDs between 78.0 and 82.7. McGrath et al.'s Box-Cox transformation method showed coverage for mean ratios from 86.6% to 94.4% and SDs from 67.1 to 83.1. The maximum likelihood estimation method by Cai et al. for nonnormal distributions showed coverage for mean ratios from 78.9% to 86.4% and SDs from 67.6 to 78.0.</p><p><strong>Conclusions: </strong>All evaluated methods of estimating means and standard deviations from quartiles of log-normal distributed data result in confidence interval coverages below the expected 95%. Because these methods are widely used in meta-analyses of anesthesiology data, P values reported as < 0.05 cannot be trusted. Anesthesiology journals and investigators should revise reporting requirements for continuous skewed variables. We advise reporting the quartiles, mean, and SD, or the quartiles and including the raw data for the relevant variables as supplemental content. This holistic approach could improve the reliability of statistical inferences in meta-analyses of anesthesiology research, particularly when skewed distributions are involved.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"633-643"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043111","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":"When our intuition lets us down-something believed to be beneficial may actually be harmful.","authors":"Virendra K Arya, Philip M Jones","doi":"10.1007/s12630-025-02929-z","DOIUrl":"10.1007/s12630-025-02929-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"525-528"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677441","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}