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

{"title":"Undetected leak after replacement of carbon dioxide absorbent canister: understanding the collapsed breathing bag scenario.","authors":"R Sripriya, Namburu Jyotsna, Saladi Surya Prakash, Raza Shahbuddin Gouri","doi":"10.1007/s12630-025-02926-2","DOIUrl":"10.1007/s12630-025-02926-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"675-677"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634976","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":"Prolonged opioid use after surgery in children, adolescents, and young adults: a systematic review.","authors":"Naiyi Sun, Apala Roy Chowdhury, Anni Wu, Marina Englesakis, Brittany N Rosenbloom, Benjamin E Steinberg, Jennifer N Stinson, Kazuyoshi Aoyama","doi":"10.1007/s12630-025-02921-7","DOIUrl":"10.1007/s12630-025-02921-7","url":null,"abstract":"<p><strong>Purpose: </strong>Both adult and pediatric studies have shown that patients who receive opioid analgesics for acute postsurgical pain can develop prolonged opioid use after surgery (POUS). We performed a systematic review to synthesize the rates of POUS in children, adolescents, and young adults from existing literature, and to identify associated risk factors.</p><p><strong>Methods: </strong>We searched the databases of MEDLINE, Embase, and CINAHL to identify studies examining the rate of POUS in pediatric and young adult participants. Studies were included if they 1) were prospective or retrospective observational studies investigating the rate of prolonged postoperative opioid use, 2) included patients undergoing any type of surgical procedures, and 3) included pediatric or young adult participants. We assessed the risk of bias in included studies using an adapted version of the Scottish Intercollegiate Guideline Network checklist for cohort studies. Using a best-evidence synthesis, we assessed risk factors based on criteria including the number of studies investigating it, the quality of studies, and the consistency of the association.</p><p><strong>Results: </strong>In this systematic review of 17 studies including 1,576,515 participants, the estimated median reported rate of POUS in children, adolescents, and young adults was 4.5%. Older age, female sex, history of chronic pain, and preoperative opioid use were patient-level risk factors associated with development of POUS.</p><p><strong>Conclusion: </strong>We identified four patient-level predictors of POUS in this systematic review. Clinicians should attempt to identify patients with risk factors preoperatively and devise strategies to mitigate the risk for development of POUS.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022295977 ); first submitted 6 December 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"579-590"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702289","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":"Optimal local anesthetic for spinal anesthesia in patients undergoing ambulatory non-arthroplasty surgery: a systematic review and Bayesian network meta-analysis of randomized controlled trials.","authors":"Narinder P Singh, Naveed T Siddiqui, Jeetinder K Makkar, Ryan Guffey, Preet M Singh","doi":"10.1007/s12630-025-02924-4","DOIUrl":"10.1007/s12630-025-02924-4","url":null,"abstract":"<p><strong>Purpose: </strong>Dosing and types of local anesthetic agents for spinal anesthesia in ambulatory settings vary significantly. We sought to conduct a network meta-analysis to evaluate the effect of the type and dose of local anesthetic on outcomes in patients undergoing ambulatory surgery.</p><p><strong>Methods: </strong>After PROSPERO registration (CRD42023399356), we searched various databases for randomized controlled trials (RCTs) evaluating adult patients undergoing daycare surgery under spinal anesthesia. Most included trials focused on patients undergoing knee arthroscopy, while other covered procedures were perineal, lower abdominal, and limb surgeries. Unfortunately, we could not include trials on arthroplasty surgery owing to the lack of RCTs in this area. We used Confidence in Network Meta-Analysis (CINeMA) to assess the confidence in the estimates, and we used surface under the cumulative ranking curve (SUCRA) to determine the probability rank order. The primary outcome was the time to discharge. Intraoperative effectiveness of anesthetic, sensory, and motor blockade duration; time to first micturition; time to ambulation; and adverse effects such as urinary retention and transient neurologic symptoms (TNS) were the secondary outcomes.</p><p><strong>Results: </strong>Overall, this study included 44 trials comprising 3,299 patients, each comprising 11 distinct agents (2-chloroprocaine, articaine, high-dose bupivacaine, low-dose bupivacaine, lidocaine, high-dose levobupivacaine, low-dose levobupivacaine, mepivacaine, prilocaine, high-dose ropivacaine, and low-dose ropivacaine). Low- to moderate-certainty evidence showed that 2-chloroprocaine, lidocaine, and mepivacaine were superior for discharge readiness, while 2-chloroprocaine ranked highest for other outcomes (sensory and motor block duration, time to first ambulation, and spontaneous voiding).</p><p><strong>Conclusions: </strong>Evidence supports 2-chloroprocaine for short-duration spinal anesthesia in the ambulatory setting.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42023399356 ); first submitted 13 February 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"550-566"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813024","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":"Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.","authors":"Karel Huard, Olivier Lachance, Mélissa Parent, Patrick Tawil, Elena Saade, Ali Hammoud, Etienne J Couture, Yoan Lamarche, Stéphanie Jarry, Alexander Calderone, Pierre Robillard, Sylvie Levesque, William Beaubien-Souligny, André Y Denault","doi":"10.1007/s12630-025-02911-9","DOIUrl":"10.1007/s12630-025-02911-9","url":null,"abstract":"<p><strong>Purpose: </strong>Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (T_POD).</p><p><strong>Results: </strong>Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of T_POD (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and T_POD remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation.</p><p><strong>Conclusions: </strong>Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"615-626"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544680","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: Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using life cycle analysis.","authors":"Mathieu Courchesne, Stephan R Williams, Florian Robin, Maxim Roy","doi":"10.1007/s12630-025-02932-4","DOIUrl":"10.1007/s12630-025-02932-4","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"678-679"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733274","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":"Just a touch of propofol for the colonoscopy: should the anesthesiologist be concerned?","authors":"Ryan Chadha","doi":"10.1007/s12630-025-02940-4","DOIUrl":"https://doi.org/10.1007/s12630-025-02940-4","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"521-524"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043459","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":"Accuracy of tactile bougie use in infrequent intubators: a cadaveric airway study.","authors":"Adam Parks, Megi Nallbani, Judah Goldstein, Cory A Munroe, Janel Swain, Sebastien Hebert, Brett Barro, George Kovacs","doi":"10.1007/s12630-025-02908-4","DOIUrl":"10.1007/s12630-025-02908-4","url":null,"abstract":"<p><strong>Purpose: </strong>When difficulty with laryngoscopy is encountered, confirmation of endotracheal access can be confirmed using the tactile feedback (i.e., tracheal clicks) of a tracheal tube introducer (bougie). There is anecdotal evidence that a bougie placed in the esophagus may have a unique, tactile \"boggy\" resistance. In this study, we aimed to elucidate the sensitivity and specificity of clicks and boggy resistance for infrequent airway providers in cadaveric airways.</p><p><strong>Methods: </strong>We conducted a prospective observational study using descriptive statistics to examine the diagnostic accuracy of clicks and boggy resistance for bougies placed in cadaveric airways. We recruited prehospital providers from within Atlantic Canada who then underwent a brief formal training protocol. Cadavers were equipped with a static laryngoscope and bougie (placed either in the trachea or esophagus). Each participant, blinded to bougie placement, was then tested on two separate cadavers and asked whether they felt clicks and/or boggy resistance.</p><p><strong>Results: </strong>Thirty-seven paramedics participated in the study (32 advanced care paramedics, five critical care paramedics) and were randomized to perform 74 bougie assessments on cadaveric airways. For tracheal clicks, we calculated an overall sensitivity of 86% (95% confidence interval [CI], 75 to 98) and an overall specificity of 81% (95% CI, 68 to 94). Sensitivity for the esophageal boggy resistance test was 78% (95% CI, 65 to 92) while specificity was 86% (95% CI, 75 to 98).</p><p><strong>Conclusion: </strong>Following a brief training session, prehospital providers who intubate infrequently seemed to show a relatively high degree of accuracy using tracheal clicks and esophageal boggy resistance to confirm bougie placement in cadaveric airways.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"627-632"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191491","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: Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using life cycle analysis.","authors":"Lionel Bouvet, Laurent Zieleskiewicz","doi":"10.1007/s12630-025-02933-3","DOIUrl":"10.1007/s12630-025-02933-3","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"680-681"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733275","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":"Perioperative anaphylaxis: an update on pathophysiology, diagnosis, and management.","authors":"Martin Ma, Dallas Duncan, Justyna Bartoszko","doi":"10.1007/s12630-025-02915-5","DOIUrl":"https://doi.org/10.1007/s12630-025-02915-5","url":null,"abstract":"<p><strong>Purpose: </strong>In this Continuing Professional Development module, we provide a framework for the prompt diagnosis and management of perioperative anaphylaxis.</p><p><strong>Principal findings: </strong>Anaphylaxis in the perioperative period can lead to sudden cardiorespiratory compromise. Hypotension, tachycardia, and bronchospasm are the most common presenting signs of anaphylaxis; however, they are nonspecific, making diagnosis challenging. Associated factors that support a diagnosis of anaphylaxis include the timing of symptom onset, a lack of response to first-line vasopressors, evidence of severe hypovolemia, and the appearance of a rash. Treatment should not be delayed in the absence of cutaneous findings, as hemodynamic compromise is often the main presenting feature. Appropriate treatment involves administering epinephrine, resuscitating with fluids, protecting the airway, and removing any triggering agents.</p><p><strong>Conclusions: </strong>Anaphylaxis is a challenge to diagnose and clinically manage in the perioperative period. Provider vigilance, a high index of suspicion, and timely treatment are necessary to ensure the successful resuscitation and safety of the patient.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"649-674"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050974","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":"Percutaneous dilatational tracheostomy in a patient with a large midline aberrant artery.","authors":"Balaji Vaithialingam, Abinash Dutta, Swaroop Gopal","doi":"10.1007/s12630-025-02942-2","DOIUrl":"https://doi.org/10.1007/s12630-025-02942-2","url":null,"abstract":"<p><strong>Purpose: </strong>A midline aberrant artery is an absolute contraindication to percutaneous dilatational tracheostomy (PDT). In this case report, we highlight a number of technical modifications that resulted in a successful PDT in a patient with a large midline aberrant artery.</p><p><strong>Clinical features: </strong>A 72-yr-old woman with a posterior cranial fossa hematoma underwent PDT due to prolonged mechanical ventilation in the neurointensive care unit. On clinical examination, the patient had a huge, pulsatile midline neck mass. Ultrasonography (US) showed an aberrant artery that covered the entire tracheal length and deviated to the right, away from the midline, just below the cricoid cartilage at the level of the first tracheal ring. The patient's family members were counseled, and following provision of informed consent, we planned PDT with technical modifications. After anesthesia induction, we replaced the endotracheal tube with a supraglottic airway device. We performed surface marking with US and chose a higher entry point between the first and second tracheal rings with a left anterolateral approach to the trachea. We made a 1-cm skin incision away from the midline towards the left side to aid with dilatation during the PDT procedure. We punctured the left anterolateral tracheal wall under real-time fibreoptic bronchoscopy and successfully performed PDT using a single-dilatation Ciaglia technique.</p><p><strong>Conclusion: </strong>This report provides an anecdotal description of successful PDT in a patient with a large midline aberrant artery based on the use of US and a number of technical modifications. Nevertheless, PDT should continue to be considered contraindicated in patients with a midline aberrant artery, in whom surgical tracheostomy is the recommended technique.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"644-648"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997610","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}