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

{"title":"Remimazolam in the perioperative setting: an answer in search of an ideal question.","authors":"Kendra L Derry, Duminda N Wijeysundera","doi":"10.1007/s12630-024-02899-8","DOIUrl":"10.1007/s12630-024-02899-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"378-383"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883737","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":"An audit of a multistep quality improvement initiative to enhance patient safety after sugammadex administration to female patients using hormonal contraceptives.","authors":"Andrew D Milne, Gregory R Dobson, David B MacDonald","doi":"10.1007/s12630-025-02917-3","DOIUrl":"10.1007/s12630-025-02917-3","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"508-510"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631091","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":"Comparison of remimazolam and sevoflurane for general anesthesia during transcatheter aortic valve implantation: a randomized trial.","authors":"So Harimochi, Kohei Godai, Mayumi Nakahara, Akira Matsunaga","doi":"10.1007/s12630-024-02900-4","DOIUrl":"10.1007/s12630-024-02900-4","url":null,"abstract":"<p><strong>Purpose: </strong>Safe perioperative management of patients undergoing transcatheter aortic valve implantation (TAVI) is crucial. Remimazolam is a newly developed short-acting benzodiazepine. We hypothesized that combining remimazolam and flumazenil would reduce emergence time compared with sevoflurane in patients undergoing general anesthesia for TAVI.</p><p><strong>Methods: </strong>We conducted a prospective, randomized, parallel-design, open-label, single-centre clinical trial between June 2022 and August 2023 at Kagoshima University Hospital. We allocated patients randomly to either the remimazolam/flumazenil group or the sevoflurane group. Patients in the remimazolam group received iv remimazolam whereas patients in the sevoflurane group received sevoflurane for general anesthesia maintenance. Patients in both groups received a remifentanil infusion throughout the TAVI procedure (0.2 μg·kg^-1·min^-1 iv). Remimazolam and sevoflurane were adjusted to maintain a Bispectral Index™ (Covidien/Medtronic, Minneapolis, MN, USA) of 40-60. In the remimazolam group, flumazenil (0.2 mg iv) was administered immediately after remimazolam discontinuation. The primary outcome was time to extubation. Secondary outcomes included intraoperative variables (hemodynamic variables and vasopressor dose), rate of intra- and postoperative complications, and recovery of muscle strength.</p><p><strong>Results: </strong>Overall, 60 patients were enrolled, and data from 56 were included. The median [interquartile range] time to extubation was significantly shorter in the remimazolam group than in the sevoflurane group (6.5 [5.1-8.1] min vs 14.2 [10.9-15.9] min; difference in medians, -6.9 min; 95% confidence interval, -8.7 to -5.0; P < 0.001). Statistically significant differences were observed in the perfusion index (P = 0.03) and regional cerebral oxygen saturation (P = 0.03) between the groups. No significant differences between the two groups were seen in other secondary outcomes.</p><p><strong>Conclusions: </strong>Compared with sevoflurane, a combination of remimazolam and flumazenil significantly reduced the time to extubation in patients undergoing general anesthesia for TAVI. Therefore, remimazolam may be a suitable choice for general anesthesia in patients undergoing TAVI.</p><p><strong>Study registration: </strong>UMIN.ac.jp ( UMIN000047892 ); first posted 30 May 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"397-408"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883733","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":"Quality comparison of autotransfusion devices in cardiac surgery: a prospective observational cohort study.","authors":"Mark Alm, Margarita Otalora-Esteban, Natasha Bush, Amanda Dranfield, Keyvan Karkouti, Brian Beairsto","doi":"10.1007/s12630-024-02893-0","DOIUrl":"10.1007/s12630-024-02893-0","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to conduct a quality improvement initiative to compare the wash quality and speed of autologous red blood cell (RBC) processing of four autotransfusion devices during cardiac surgery.</p><p><strong>Methods: </strong>Using a prospective observational cohort study approach, we prospectively evaluated four commercially available autologous cell savage devices (autoLog IQ™, Medtronic plc, Minneapolis, MN, USA [135 mL]; Xtra™, LivaNova, plc, Houston, TX, USA [125 mL, 225 mL]; Cell Saver® Elite®+, Haemonetics Corp., Boston, MA, USA [125 mL, 225 mL]; and CATSmart®, Fresenius Kabi AG, Bad Homburg vor der Höhe, Germany) in adult patients undergoing cardiac surgery. Device settings were determined by manufacturer recommendations for optimal wash quality. We collected pre- and postprocessing samples, volumes, and processing times from each device to calculate removal ratios of heparin, potassium, plasma free hemoglobin (PfHb), white blood cells (WBCs), platelets, reinfusion concentrations of heparin and potassium, and red blood cell (RBC) recovery rates.</p><p><strong>Results: </strong>A total of 130 consecutive patients underwent autologous cell salvage, but 15 cases were excluded because of incomplete data. All devices removed > 99% heparin, > 95% potassium, > 94% platelets, and > 85% PfHb from collected shed blood. Comparison of processing sets showed significant differences in median [interquartile range] WBC removal ratios, ranging from 26 [19-33]% to 59 [42-68]%, and median heparin reinfusion concentrations, which ranged from 0.09 [0.08-0.11] to 0.63 [0.55-0.70] U·mL^-1 processed red cells. Median RBC recovery rates also showed significant differences between processing sets, ranging from 8 [8-10] mL RBC·min^-1 to 24 [22-25] mL RBC·min^-1.</p><p><strong>Conclusion: </strong>Wash quality and processing speed differed between autotransfusion devices and processing sets. These findings may have clinical implications when large volumes of shed blood are processed and reinfused.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"417-425"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191492","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":"Environmental responsibility in resource utilization during the practice of regional anesthesia: a Canadian Anesthesiologists' Society Delphi consensus study.","authors":"Vivian H Y Ip, Clifford L Shelton, Forbes McGain, Danielle Eusuf, Deirdre C Kelleher, Galaxy Li, Alan J R Macfarlane, Julien Raft, Kristopher M Schroeder, Thomas Volk, Rakesh V Sondekoppam","doi":"10.1007/s12630-025-02918-2","DOIUrl":"10.1007/s12630-025-02918-2","url":null,"abstract":"<p><strong>Purpose: </strong>Regional anesthesia (RA) is often perceived to be more environmentally sustainable than alternative forms of anesthesia. Nevertheless, the principles of sustainable RA remain ill-defined in the presence of variability of resource utilization within RA practice. Many infection prevention practices are based on low-level evidence, and recommendations vary internationally. We sought to conduct an evidence review and Delphi consensus study to provide guidance on aspects that lack high-quality evidence in RA practice to reconcile responsible resource stewardship and infection prevention in RA.</p><p><strong>Methods: </strong>We conducted a three-round modified Delphi process. After distributing an initial free-text questionnaire to all collaborators, we created structured questions, followed by two rounds of anonymized voting. We defined strong consensus as ≥ 75% agreement and weak consensus as ≥ 50% but < 75% agreement.</p><p><strong>Results: </strong>Forty-six experts agreed to take part in the study and 36 (78%) completed all the voting rounds. Regional anesthesia practice parameters with strong consensus included hand hygiene using alcohol scrub rather than soap and water, sterile gowns being unnecessary for single-injection RA techniques, only minimal equipment in the premade packs, and goal-directed use of sedation and supplemental oxygen.</p><p><strong>Discussion: </strong>We obtained consensus on the safe and environmentally responsible practice of RA for both single-injection and indwelling catheter techniques and identified areas of research focus. While more robust evidence is being generated, clinicians may use these findings as a guide to infection prevention and environmental sustainability in their anesthesia practice.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"436-447"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652096","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":"Development and initial testing of an illness perception questionnaire for substitute decision makers of critically ill patients: a mixed methods study.","authors":"Louise Mui, Brenda Morgan, Michaël Chassé, Jacob Crawshaw, Claudio M Martin","doi":"10.1007/s12630-025-02919-1","DOIUrl":"10.1007/s12630-025-02919-1","url":null,"abstract":"<p><strong>Purpose: </strong>The Brief Illness Perception Questionnaire (Brief-IPQ) is used to quantify a patient's understanding of their condition. In critical care settings, substitute decision makers (SDMs) are tasked with making decisions on behalf of patients, but it can be difficult to evaluate how they perceive the patient's illness. We developed the Illness Perception Questionnaire for Substitute Decision Makers (IPQ-SDM) by adapting the Brief-IPQ and testing it with SDMs of patients in critical care.</p><p><strong>Methods: </strong>In a mixed methods study, we modified the Brief-IPQ for the context of SDMs of critically ill patients using qualitative feedback. We then approached SDMs of critically ill patients three days after intensive care unit (ICU) admission to complete the IPQ-SDM in a prospective observational study. We calculated summary statistics for the individual questions and the total score. We evaluated prespecified associations between individual questions as well as the total score with clinical data that were abstracted from the patient chart.</p><p><strong>Results: </strong>We received 44/50 (88%) complete responses with a mean (standard deviation [SD]) total score of 43 (11). Forty-six percent reported that they did not have any in-person visits due to the restrictions during the COVID-19 pandemic. The correlation of total score with the nine equivalents of nursing manpower score (NEMS) was 0.42 (P = 0.005) but it was not correlated (P = 0.07) with the multiple organ dysfunction score (MODS). The total mean (SD) score was higher (i.e., worse) for patients who died in hospital (48.2 [9.7], n = 13) than for those who were discharged alive (40.5 [10.2], n = 31, P = 0.03). Concern regarding the illness was correlated with MODS (Spearman correlation coefficient [ρ] = 0.39, P = 0.01) and NEMS (ρ = 0.29, P = 0.04).</p><p><strong>Conclusion: </strong>We observed a modest level of correlation of the IPQ-SDM score with clinical measures in the adult ICU setting. Further research is needed before such a tool is broadly implemented.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"473-480"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659800","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":"Oxytocin versus carbetocin at elective Cesarean delivery in parturients with class III obesity: a double-blind randomized controlled noninferiority trial.","authors":"William Turner, Linda Boonstra, Cynthia Maxwell, Kristy Downey, Mrinalini Balki","doi":"10.1007/s12630-024-02891-2","DOIUrl":"10.1007/s12630-024-02891-2","url":null,"abstract":"<p><strong>Purpose: </strong>Class III obesity (body mass index [BMI] ≥ 40 kg·m^-2) is associated with high rates of Cesarean deliveries and postpartum hemorrhage, with increased maternal and fetal morbidity. The doses of oxytocin and carbetocin are two to four times higher at Cesarean delivery in patients with class III obesity. We sought to investigate the efficacy of carbetocin 80 µg iv compared with oxytocin 1 IU iv (plus infusion) at elective Cesarean delivery in parturients with class III obesity. We hypothesized that, with equipotent dosing, carbetocin would be noninferior to oxytocin.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, noninferiority study in nonlabouring, term parturients with BMI ≥ 40 kg·m^-2 undergoing elective Cesarean delivery under neuraxial anesthesia. Patients received either a 1-IU bolus of oxytocin iv followed by an infusion of 4.8 IU·hr^-1 or an 80-µg carbetocin bolus iv followed by a placebo infusion. Uterine tone was determined by palpation by the obstetrician at 3, 5, and 10 min, using a verbal numerical rating score of 0 (boggy) to 10 (firm). The primary outcome was uterine tone at 3 min. Secondary outcomes included uterine tone at 5 and 10 min, blood loss, additional uterotonics, and side effects.</p><p><strong>Results: </strong>Forty-seven participants were included in the analysis. Median tone at 3 min was similar for oxytocin (8; 95% confidence interval [CI], 7 to 8) and carbetocin (8; 95% CI, 8 to 9) (P = 0.06), with no difference at 5 and 10 min. Blood loss, side effects, and the need for additional uterotonics were not significantly different between the study groups.</p><p><strong>Conclusion: </strong>We conclude that carbetocin is noninferior to oxytocin at elective Cesarean delivery in parturients with class III obesity, with the advantage of single bolus dosing without infusion.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT04902729 ); first submitted 21 May 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"426-435"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933932","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":"Suitability of triaged preoperative assessment methods: a survey of anesthesiologists at a Canadian academic medical centre.","authors":"Billy Sun, Anna E H Wyand, Sylvie D Aucoin, Sylvain Gagné, Jane Prud'homme, Daniel I McIsaac","doi":"10.1007/s12630-025-02928-0","DOIUrl":"10.1007/s12630-025-02928-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"517-519"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712211","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 a choice architecture intervention for improvement of sustainability practices in anesthesiology.","authors":"Ying E Lu-Boettcher, Bridget L Muldowney, Mary A Roth, Colin D Boettcher","doi":"10.1007/s12630-025-02934-2","DOIUrl":"10.1007/s12630-025-02934-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"514-516"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659802","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 use of extended reality in anesthesiology education: a scoping review.","authors":"Gianluca Bertolizio, Yu Tong Huang, Marta Garbin, Elena Guadagno, Dan Poenaru","doi":"10.1007/s12630-025-02909-3","DOIUrl":"10.1007/s12630-025-02909-3","url":null,"abstract":"<p><strong>Purpose: </strong>Extended reality, an umbrella term for virtual, augmented, and mixed reality, is increasingly used in health care education as it requires fewer human and logistical resources and offers reduced costs compared with high-fidelity simulations. Nevertheless, the impact of extended reality on education and training in anesthesiology is largely unknown. We aimed to explore the existing extended reality tools and applications in anesthesiology, identify current knowledge gaps, and highlight future research needs in anesthesiology education.</p><p><strong>Methods: </strong>We conducted a scoping review of studies published from January 2010 to December 2023 that focused on extended reality training in anesthesiology and included comparative analyses with other methods. We excluded publications investigating topics unrelated to anesthesiology or not involving interaction with extended reality.</p><p><strong>Results: </strong>After screening 5,419 studies, we included 62 manuscripts in the final analysis. The definitions and uses of extended reality in anesthesiology education were very heterogeneous. Thirty-seven studies compared extended reality with other forms of training. Neuraxial procedures, peripheral blocks, central venous catheters, and bronchoscopy were primarily investigated. Extended reality improved technical skills, knowledge retention, confidence, and student satisfaction. Six studies reported at least one negative result related to learning, sense of realism, and usefulness.</p><p><strong>Conclusion: </strong>The results of this scoping review highlight the increasing interest of extended reality in anesthesiology education. Nevertheless, many studies lack objective outcome measures and relevant comparisons with existing standards. In addition, extended reality needs to be consistently defined in anesthesiology education to derive optimal benefit and impact. Future studies should also focus on defining extended reality's learning objectives and clinical assessments of trainees' performance, which are commonly missing compared with high-fidelity simulation teaching.</p><p><strong>Study registration: </strong>Open Science Framework ( https://doi.org/10.17605/OSF.IO/PDT2F ); first submitted 28 June 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"492-505"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517479","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}