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

{"title":"Reduction in anesthesia-related nitrous oxide consumption and environmental footprint via a quality improvement initiative at two quaternary hospitals in São Paulo, Brazil.","authors":"Leopoldo Muniz da Silva, Ana Claudia L F de Araújo, Leandro Defácio, Roberta B P Vale, Desiree S Machado, Saullo Q Silveira, Rafael S F Nersessian, Manoel de Souza Neto, Glenio B Mizubuti, Helidea de Oliveira Lima","doi":"10.1007/s12630-025-03002-5","DOIUrl":"10.1007/s12630-025-03002-5","url":null,"abstract":"<p><strong>Purpose: </strong>Climate change is increasingly recognized as an emergency, particularly within the health care sector. Reducing nitrous oxide (N₂O) usage is critical for mitigating anesthesia-related greenhouse gas emissions, a significant environmental threat. We aimed to evaluate the effectiveness of implementing quality improvement (QI) strategies to reduce the carbon footprint in anesthesia practice at two quaternary hospitals in São Paulo, Brazil, São Luiz Anália Franco Hospital and and São Luiz Itaim Hospital. We aimed to lower N₂O use in inhalational anesthesia, targeting a 75% reduction in carbon footprint over 16 weeks.</p><p><strong>Methods: </strong>Through a QI initiative, we restricted N₂O usage to inhalational induction in pediatric anesthesia only. Employing quality and safety tools, we implemented educational strategies to limit N₂O application and minimize waste from the central anesthesia workstation pipeline. We calculated greenhouse gas emissions as carbon dioxide equivalents (CO₂e), monitored adverse events, and tracked sedative agents use both before and after the interventions.</p><p><strong>Results: </strong>From January to August 2024, our project encompassed 30,217 anesthetics over 32 weeks. Among these, 6,806 involved inhalational anesthesia, with 624 (9%) involving N₂O. In adult patients, baseline data over 16 weeks prior to the intervention showed an average N₂O usage rate of 11%, which decreased significantly to 2% postintervention (P < 0.001). In pediatric patients, N₂O usage dropped from 62% to 46% following the intervention (P < 0.001). The emissions per anesthetic using N₂O declined from 132 kg (lower control limit [LCL], 98 kg; upper control limit [UCL], 167 kg) to 23 kg (LCL, 9 kg; UCL, 38 kg) following our interventions.</p><p><strong>Conclusions: </strong>By optimizing N₂O usage through educational and judicious interventions, our QI initiative achieved a 82.5% postintervention reduction in anesthesia-related institutional CO₂e. Moreover, we fostered a significant cultural shift, enhancing accountability for health care initiatives aimed at environmental protection.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1249-1259"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585735","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":"From garbage to green in the operating room: an anesthesiology resident-led soft plastics recycling quality improvement project.","authors":"Karim Narsingani, Claire Moura, Simrin Dhillon, Shelley Tweedle, Susan M Lee","doi":"10.1007/s12630-025-02994-4","DOIUrl":"10.1007/s12630-025-02994-4","url":null,"abstract":"<p><strong>Purpose: </strong>Anesthesia contributes up to 25% of operating room (OR) waste. We sought to conduct a quality improvement project to initiate soft plastic recycling, aiming to recycle 1,000 g per day of soft plastic.</p><p><strong>Methods: </strong>In this single-centre, anesthesiology resident-led quality improvement initiative in British Columbia, Canada, we started a soft plastics recycling collection program in a single operating room (OR) and expanded it to 12 ORs through a series of Plan-Do-Study-Act cycles. The outcome measure was the daily weight of soft plastics recycled. We tracked the number of mistakes as a balancing measure. We collected data eight months after the conclusion of the project to assess sustained changes. We visualized data with Shewhart control charts.</p><p><strong>Results: </strong>One OR resulted in a mean (standard deviation [SD]) of 194 (157) g of soft plastics collected daily. Once we expanded to all ORs, a mean (SD) of 1,524 (708) g of waste was collected daily. A mean (SD) of 1,284 (613) g was recycled daily during the eight-month follow-up. There was a median [interquartile range (IQR)] of 0 [0-2] mistakes per day with only one OR, which increased to a median [IQR] of 2 [1-4] mistakes per day upon expansion, and remained low at eight months, with a median [IQR] of 1 [0-3] mistake per day. E-mail reminders and signage improved the error rate.</p><p><strong>Conclusions: </strong>We successfully introduced and sustained a soft plastics collection program in our centre's OR suite with the aim to stream it for recycling. Monitoring and education were helpful in growing the program and reducing errors.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1240-1248"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512867","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 requirement of neuromuscular monitoring-is any site good enough?","authors":"Christian Lehmann","doi":"10.1007/s12630-025-03028-9","DOIUrl":"https://doi.org/10.1007/s12630-025-03028-9","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765847","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":"Implementation of a quality improvement project at National University Hospital Singapore to mitigate the environmental impact of nitrous oxide.","authors":"Rachel G Law, Wen Jun Koh, Pei Kee Poh, Nay Myo Htet, Su Wei Bryan Ng, Eugene Hern Choon Liu, King Sin Ang","doi":"10.1007/s12630-025-03003-4","DOIUrl":"10.1007/s12630-025-03003-4","url":null,"abstract":"<p><strong>Purpose: </strong>Nitrous oxide (N₂O) is an ozone-depleting greenhouse gas that lingers in the atmosphere for over a hundred years. Much of the climate impact of medical N₂O is due to systemic central pipeline losses even before it reaches the patients. Health care systems around the world are changing the way it is supplied to decrease wastage to a minimum.</p><p><strong>Methods: </strong>We conducted a quality improvement project at National University Hospital Singapore with the aim to deactivate the central N₂O piped supply system, substituting it with a portable supply system within the operating room (OR) complex. At the preintervention phase, we gathered N₂O monthly procurement data and evaluated our system and clinical practices. Following this, we carried out three sequential Plan-Do-Study-Act cycles: the first to raise awareness and understanding of N₂O's significant leaks and climate impact, the second to disconnect central piped supply from the anesthesia machines, and the third to fully cease the central piped supply system and transition to using portable cylinder supply in ORs.</p><p><strong>Results: </strong>We achieved a 96% reduction in N₂O systemic consumption (as estimated using monthly procurement data) and a 66% reduction in the number of general anesthesia cases using N₂O (as captured by snapshot audits). The project will enable annual carbon savings of 307 tonnes of carbon dioxide equivalents (CO₂e) and annual financial savings of CAD 7,620.</p><p><strong>Conclusions: </strong>This quality improvement project shows that substantial reduction in N₂O systemic consumption in an OR complex is possible through changing the N₂O supply from a central piped supply system to small cylinders directly mounted on anesthesia machines. Next steps would include shifting institutional clinical practice towards using alternatives to N₂O, thereby withdrawing N₂O altogether. This project can be replicated at other centres to collectively reduce the greenhouse gas effect of N₂O in clinical care.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1260-1267"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531305","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":"Prospective preference assessment for the Ecstasy for Alleviating Severe Chronic Neuropathic Pain (EASE-Pain) trial.","authors":"Mindy Lu, Victoria Tucci, Nandana Parakh, Sergio M Pereira, Mariela Leda, Gabriella Mattina, Roshni Nayar, Zaaria Thomas, Janneth Pazmino-Canizares, Karim S Ladha, Duminda N Wijeysundera, Paul Ritvo, Daniel I McIsaac, James Khan, Joshua Rosenblat, Sakina J Rizvi, Gabriel Ramsay, Cheryl Pritlove, Akash Goel","doi":"10.1007/s12630-025-03031-0","DOIUrl":"https://doi.org/10.1007/s12630-025-03031-0","url":null,"abstract":"<p><strong>Purpose: </strong>Emerging evidence suggests that 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy may be a promising intervention for chronic pain. We designed the Ecstasy for Alleviating Severe Chronic Neuropathic Pain (EASE-Pain) trial, a randomized controlled trial comparing MDMA with an active placebo (methylphenidate) for pain relief. We sought to conduct a prospective preference assessment (PPA) prior to the trial, with the objectives to 1) assess willingness to participate in the trial, 2) identify participants' motivations and concerns to enhance enrolment and acceptability, and 3) compare demographic and health characteristics between willing and nonwilling participants.</p><p><strong>Methods: </strong>We recruited patients from the St. Michael's Hospital Pain Clinic (Toronto, ON, Canada) from July to August 2024. Each participant completed four PPA phases: 1) a trial description, 2) comprehension assessment, 3) open-ended questions exploring attitudes towards the trial, and 4) a self-administered questionnaire. We analyzed data qualitatively using thematic analysis and quantitatively using t tests and Fisher's exact test.</p><p><strong>Results: </strong>We enrolled 42 patients, with 76% willing and 24% not willing to participate in the EASE-Pain trial. White/European participants were more likely to be willing than not willing to participate (78% vs 40%; P < 0.001). Motivating factors for participation included pain relief (62%) and seeking alternatives to ineffective treatments (26%). Common concerns included side effects (43%), impacts on comorbidities (19%), and the stigma of MDMA (19%).</p><p><strong>Conclusions: </strong>The results of this study indicate a strong willingness among patients with chronic pain to participate in the EASE-Pain trial. Primary concerns included side effects and impacts on comorbidities. In response, protocol modifications, including improved patient education on study drug effects, will be implemented.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765846","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: From Trachlight™ to Trachway®: the evolution of airway visualization.","authors":"Orlando Hung","doi":"10.1007/s12630-025-03015-0","DOIUrl":"10.1007/s12630-025-03015-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1326-1327"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700455","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":"Sexual and gender minoritized persons in organ and tissue donation: a qualitative analysis.","authors":"Murdoch Leeies, Carmen Hrymak, David Collister, Emily Christie, Karen Doucette, Ogai Sherzoi, Tricia Carta, Ken Sutha, Cameron T Whitley, Tzu-Hao Lee, Matthew J Weiss, Sonny Dhanani, Julie Ho","doi":"10.1007/s12630-025-03011-4","DOIUrl":"10.1007/s12630-025-03011-4","url":null,"abstract":"<p><strong>Purpose: </strong>Sexual and gender minoritized persons (SGMs) experience inequities, harms, and gaps in care in organ and tissue donation and transplantation (OTDT) systems. The experiences of SGMs navigating OTDT have not been published from their own perspectives.</p><p><strong>Methods: </strong>We conducted semistructured interviews, transcribed verbatim, and performed a formal qualitative best-fit framework synthesis and inductive thematic analysis with an SGM OTDT patient and caregiver advisory team (N = 12/13) to characterize their self-described experiences.</p><p><strong>Results: </strong>Emergent themes included: 1) stigma, discriminatory criteria, and inertia to change; 2) OTDT patient and community relations; 3) benefits, strength, and resilience of the SGM community; and 4) SGM priorities and opportunities for improvement. Each theme and its respective subthemes are presented with representative quotes.</p><p><strong>Conclusions: </strong>Our novel findings detail the ways that SGMs experience OTDT health care, highlighting the harms of discriminatory donor risk assessment criteria and the need for equitable policy revision. Opportunities to enhance inclusive care include institutional acknowledgement of inequities and transparent communication, target training for health care providers, and intersectional SGM and OTDT caregiver support networks.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1207-1219"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the gift of life: demystifying the organ donation and transplantation pathway in Canada.","authors":"Elaine Tang, Marat Slessarev, Meaghan Wheeler, Janet Taylor, Janice Beitel, Andrew Healey, Stephen D Beed, Prosanto Chaudhury, Dennis Djogovic, George Isac, Andreas Kramer, John Basmaji","doi":"10.1007/s12630-025-03024-z","DOIUrl":"10.1007/s12630-025-03024-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1192-1199"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765845","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":"Prediction of acute kidney injury in the immediate postoperative period following liver resection: a retrospective cohort study.","authors":"Jihad Abou Jamous, Steve Ferreira Guerra, Ziad Haida, Éva Amzallag, Martin Girard, Simon Turcotte, François Martin Carrier","doi":"10.1007/s12630-025-02996-2","DOIUrl":"10.1007/s12630-025-02996-2","url":null,"abstract":"<p><strong>Purpose: </strong>Following liver resection, acute kidney injury (AKI) is a frequent and potentially reversible complication. No predictive model of postoperative AKI following liver resection has assessed the role of oliguria in the postanesthesia care unit (PACU). Our objectives were 1) to estimate the association between PACU oliguria and AKI and to develop and internally validate a predictive model of postoperative AKI using variables available in the PACU and 2) to assess the additive predictive value of PACU urine output.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent elective liver resection. Our primary outcome was the occurence of AKI within seven days after surgery. We used two sets of candidate predictors (17 and 11 variables, respectively) to develop a predictive model for postoperative AKI, including PACU urine output. We first calculated risk ratios (RR) with 95% confidence intervals (CIs) for different definitions of PACU oliguria. We then fitted multivariable logistic regression predictive models with a least absolute shrinkage and selection operator and reported optimism-corrected model performance properties.</p><p><strong>Results: </strong>We included 1,520 patients. Both the incidence of AKI within seven days after surgery and the prevalence of PACU oliguria, defined as a urine output < 0.5 mL·kg^-1·hr^-1, were 11%. PACU oliguria was associated with AKI (RR = 1.74; 95% CI, 1.20 to 2.50). Both predictive models had good discrimination (area under the receiver operating characteristic curves, 0.775 and 0.766, respectively) and excellent calibration. PACU urine output increased models' discrimination.</p><p><strong>Conclusion: </strong>Oliguria in the PACU was associated with AKI within seven days after surgery. We developed predictive models for 7-day AKI following liver resection that had good performance properties.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1268-1279"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638808","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":"Failure of preoperative data to accurately predict which patients undergoing major hepatic surgery will develop postoperative coagulation disturbances: a single-hospital retrospective cohort study.","authors":"Gabriel E Vazquez, Franklin Dexter, Ravina S Vasanwala, Nada A Sadek, Rakesh V Sondekoppam","doi":"10.1007/s12630-025-03032-z","DOIUrl":"https://doi.org/10.1007/s12630-025-03032-z","url":null,"abstract":"<p><strong>Purpose: </strong>Epidural analgesia has been considered a highly effective analgesic modality for hepatobiliary surgeries, particularly within 72 hr postoperatively. Coagulation derangements are possible complications following liver resection that can be concerning in the setting of epidural analgesia given the inherent risk of spinal epidural hematoma. We sought to develop predictive models for postoperative coagulation disturbance (defined as an international normalized ratio > 1.5, a partial thromboplastin time > 40 sec, or a platelet count < 100,000 × 10⁶·L^-1) in patients eligible for epidural analgesia.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients undergoing liver resection at the University of Iowa (Iowa City, IA, USA) between 2011 and 2023. We reviewed records for patient characteristics, operative parameters, preoperative coagulation labs, and postoperative coagulation labs up to seven postoperative days. We used three types of predictive modeling.</p><p><strong>Results: </strong>Among 684 patients, 37 had a length of stay ≤ 72 hr of surgery or preoperative coagulation disturbance. Among the remaining 647 patients, 512 (79%) received a thoracic epidural. The incidence of postoperative coagulation disturbances within 72 hr was 25% (95% confidence interval, 22 to 28), mostly thrombocytopenia (20% of all patients), and was noted on postoperative day 1 for 11% and postoperative day 2 for 22%. The volume of liver resected was greater among patients with postoperative coagulation disturbance (P < 0.001; area under the receiving operating characteristic curve, 0.61). There was no predictive value for coagulation disturbance based on patients' sex, American Society of Anesthesiologists' Physical Status classification, body mass index, weight, age, adjuvant chemotherapy, estimated operative duration, or year of data (all standardized differences < 0.24). Classification tree modeling had a single node (i.e., no useful preoperative prediction). Stepwise backward logistic regression using P < 0.05 for inclusion had just two patients (0.3%) with a predicted probability of postoperative coagulation disturbance < 10% and none < 5%.</p><p><strong>Conclusions: </strong>Coagulation disturbances occur commonly in the context of hepatic surgery. Preoperative data commonly used to qualify a patient to receive epidural analgesia are insufficient to predict which patients are likely to develop postoperative coagulation disturbance. Regardless of the predictive modeling or criterion, the postoperative risk of coagulopathic disturbance will exceed 5% by 72 hr postoperatively. Enhanced recovery protocols recommending early epidural catheter removal need to consider the period of incidence of coagulation disturbance.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755150","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}