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

{"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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","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":"Development of a patient-oriented transfer tool for transition from the intensive care unit to the ward: a mixed methods study.","authors":"Jariya Sereeyotin, Hayley Robinson, Michael E Detsky, Christine Soong, Erin Kennedy, Catherine Eta-Ndu, Lisa Burry, Sumesh Shah, Sangeeta Mehta","doi":"10.1007/s12630-024-02890-3","DOIUrl":"https://doi.org/10.1007/s12630-024-02890-3","url":null,"abstract":"<p><strong>Purpose: </strong>The use of patient/family-centred written summaries to supplement verbal information may be useful to improve knowledge and reduce anxiety related to patient transfer from the intensive care unit (ICU) to a hospital ward. We aimed to identify essential elements to include in an ICU-specific patient-oriented discharge summary tool (PODS-ICU).</p><p><strong>Methods: </strong>We conducted a mixed methods study. Participants were ICU patients who were transitioning to a hospital ward and clinicians. We used a validated questionnaire to measure the relocation stress of patients, and standardized questions to qualitatively explore patients' needs during the transition, as well as perspectives of clinician stakeholders. Inductive thematic analysis was used for the qualitative analysis.</p><p><strong>Results: </strong>We recruited 22 participants, including ten patients and 12 clinician stakeholders. Of ten patients, 50-100% reported positive experiences during the transition and 10-30% reported negative experiences. From all participants' perspectives, we identified the following essential elements for the PODS-ICU: the reason for transition, a summary of the ICU course, a clinical update, destination ward details, medication reconciliation, a future care plan, and the planned follow-up by the ICU outreach team. Family presence and earlier notification of an upcoming transfer were identified as support needs to help patients prepare mentally and reduce transfer anxiety. Moreover, using positive communication with patients when providing transfer details and using the brief standardized transfer tool were recommended to improve transition care.</p><p><strong>Conclusions: </strong>We identified informational gaps in patient and family knowledge at the time of transfer from the ICU to a ward, which informed essential elements for the PODS-ICU. The PODS-ICU may reduce transfer anxiety and improve care during the transition from the ICU.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928796","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":"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":"https://doi.org/10.1007/s12630-024-02899-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-23","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-23","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":"An analysis of women's authorship in five leading anesthesiology journals.","authors":"Sören Verleysen, Sander Janssens, Annemie Bauters, Stefan De Hert, Annelies Moerman","doi":"10.1007/s12630-024-02895-y","DOIUrl":"https://doi.org/10.1007/s12630-024-02895-y","url":null,"abstract":"<p><strong>Purpose: </strong>Over the last decade, there has been an increasing interest in gender equity. The present study explored the gender gap in five leading anesthesiology journals worldwide, covering the period from 1980 to 2020.</p><p><strong>Methods: </strong>We included all articles published in Anaesthesia, the British Journal of Anaesthesia, Anesthesiology, Anesthesia & Analgesia, and the Canadian Journal of Anesthesia in the years 1980, 1990, 2000, 2010, and 2020, analyzing trends in women's authorship. We explored its association with variables including study type, subspecialty, continent of the corresponding author, number of authors, and gender of coauthors.</p><p><strong>Results: </strong>There was a significant increase in women's authorship across all positions (first, second, and last) over the years (P < 0.001). Despite this progress, a substantial gender disparity remains evident. Women's authorship positions were notably associated with the type of study, the subspecialty, and the continent of the corresponding author. There was a strong positive correlation (0.82) between the total number of authors and women's first authorship position, whereas the correlation was negative (-0.54) for women's last authorship position. Furthermore, women's first and last authorship, as well as first and second authorship, were strongly associated, with odds ratios of 2.13 and 1.99, respectively.</p><p><strong>Conclusion: </strong>The trajectory of women's authorship in anesthesiology shows an upward trend, yet women continue to be underrepresented in the field. Particularly noteworthy is the finding that, when a woman is either the first or last author, there is a notable increase in the probability of having a woman as the second or first author, respectively. Understanding these dynamics is crucial for fostering inclusivity and diversity within the discipline.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873617","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":"Addressing gender disparities in academic anesthesiology through structural change.","authors":"Alana M Flexman, Louise Y Sun, Gianni R Lorello","doi":"10.1007/s12630-024-02896-x","DOIUrl":"https://doi.org/10.1007/s12630-024-02896-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873615","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 gender gap in academic anesthesiology and critical care medicine: a systematic review.","authors":"Alessandro De Cassai, Francesca Rubulotta, Marko Zdravkovic, Sindi Mustaj, Joana Berger-Estilita","doi":"10.1007/s12630-024-02897-w","DOIUrl":"https://doi.org/10.1007/s12630-024-02897-w","url":null,"abstract":"<p><strong>Purpose: </strong>Gender disparities in academia are a growing concern, impacting various disciplines, including health care. We aimed to investigate gender-based differences in academic performance, leadership roles, and academic distinction within anesthesiology and critical care medicine.</p><p><strong>Source: </strong>We conducted electronic searches for relevant articles published in PubMed, CENTRAL, Scopus, Web of Science, Embase, Education Resources Information Center, PsychINFO, and ProQuest from database inception until 23 June 2024. Three researchers conducted blinded assessments using predefined inclusion and exclusion criteria, with discrepancies resolved through discussion. We reported descriptive statistics for quantitative data from the included research articles.</p><p><strong>Principal findings: </strong>Our initial screening identified 37,311 studies, 71 of which met the specified inclusion criteria and were therefore evaluated. Analysis of academic publishing trends revealed a gradual increase in the proportion of women as coauthors, first authors (in anesthesiology, the increase ranged from 7% to 17%, and in critical care medicine the increase was 4%), last authors, and corresponding authors. Despite these improvements, women remain underrepresented on the editorial boards of top journals. Although an increase in the representation of women as abstract presenters at conferences was noted, gender disparities persist in senior authorship roles.</p><p><strong>Conclusion: </strong>Gender disparities are evident in academic leadership positions within anesthesiology and critical care medicine, with few women holding editor-in-chief positions and underrepresentation of women on editorial boards. We observed similar gaps in departmental and scientific society leadership roles. The distribution of awards, prizes, and grants remains skewed, indicating persistent gender imbalances in academic distinction. While progress has been made in certain areas, substantial gaps persist in scholarly publishing, leadership, and academic distinction.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022377524 ); first submitted 20 November 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873619","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 burden of COVID-19 care in community and academic intensive care units in Ontario, Canada: a retrospective cohort study.","authors":"Daniel Pestana, Divya Joshi, Erick Duan, Robert Fowler, Jennifer Tsang, Alexandra Binnie","doi":"10.1007/s12630-024-02894-z","DOIUrl":"https://doi.org/10.1007/s12630-024-02894-z","url":null,"abstract":"<p><strong>Purpose: </strong>During the COVID-19 pandemic, neighbourhoods with high material deprivation and high proportions of racialized Canadians were disproportionately affected by COVID-19. Many of these neighbourhoods were served by community hospitals. We sought to compare the burden of COVID-19 care in community and academic intensive care units (ICUs) in Ontario, Canada.</p><p><strong>Methods: </strong>We included all adult patients admitted to Ontario ICUs with COVID-19 between 1 March 2020 and 31 July 2021 in a retrospective cohort study. We compared patient volumes, demographics, interventions, and outcomes between community hospital corporations (CHCs) and academic hospital corporations (AHCs).</p><p><strong>Results: </strong>During the first three waves of the pandemic, 9,651 adult ICU admissions for COVID-19 were reported across 72 hospital corporations in Ontario: 6,902 (71.5%) in CHCs and 2,749 (28.5%) in AHCs. Days of ICU care per baseline ICU bed were highest in large CHCs (> 10 baseline ICU beds) relative to AHCs and small CHCs (median [interquartile range], 73.7 [53.8-110.6] vs 42.2 [32.7-71.8] vs 21.4 [7.2-40.3]; Kruskal-Wallis test, P < 0.001). Among direct ICU admissions, CHC patients had greater severity of illness whereas among transfer ICU admissions, AHC patients were more severely ill. In a multivariable logistic regression model, mortality was similar among patients with index admission to a CHC or AHC; however, patients with index admission to an AHC were more likely to receive extracorporeal membrane oxygenation (adjusted odds ratio, 6.16; 95% confidence interval, 4.72 to 8.11).</p><p><strong>Conclusion: </strong>During the pandemic, Ontario's large CHCs provided significantly more days of ICU COVID-19 care per baseline ICU bed compared with AHCs and small CHCs. Equipping large CHCs to handle ICU surges during future emerging disease outbreaks should be a priority for pandemic preparedness.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848550","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":"\"All models are wrong; some are useful:\" gastric ultrasound in anesthesia practice.","authors":"Laura Girón-Arango, Vincent Chan, Anahi Perlas","doi":"10.1007/s12630-024-02886-z","DOIUrl":"https://doi.org/10.1007/s12630-024-02886-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840361","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":"Hydroxocobalamin treatment for refractory hypotension and shock: a case series.","authors":"Liran Shechtman, Varinder Kaur Randhawa, Jutamas Saoraya, Marcela Amaral, Romina Marchesano, Laura Tsang, Sharon Yamashita, Neill K J Adhikari, Damon C Scales, Robert Fowler","doi":"10.1007/s12630-024-02881-4","DOIUrl":"https://doi.org/10.1007/s12630-024-02881-4","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840372","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}