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

{"title":"Postdural puncture headache in obstetrics.","authors":"Wesley Edwards, Lorraine Chow, Valerie Zaphiratos","doi":"10.1007/s12630-025-03013-2","DOIUrl":"10.1007/s12630-025-03013-2","url":null,"abstract":"<p><strong>Purpose: </strong>In this Continuing Professional Development module, we review the literature on postdural puncture headache (PDPH) in obstetrics. The pathophysiology, risk factors, diagnosis, and outcomes are discussed. We explore the evidence for prevention and treatment options of PDPH in obstetric patients and the importance of the anesthesiologist's role in caring for these patients.</p><p><strong>Principal findings: </strong>A PDPH is any headache that develops after a dural puncture and is not better accounted for by another diagnosis. Risk factors for PDPH include young age and female sex, which, along with the high rate of neuraxial anesthesia use in the obstetric population, predispose these patients to this complication. A spinal anesthesia technique using a small-gauge pencil-point needle with an experienced operator decreases the risk of PDPH. Individuals with PDPH have an increased risk of major neurologic complications, such as subdural hematoma, cerebral venous sinus thrombosis, and bacterial meningitis. No pharmacological modalities have shown a benefit in preventing or treating PDPH. Epidural blood patch remains the most effective treatment for PDPH and should not be delayed in obstetric patients with severe symptoms.</p><p><strong>Conclusions: </strong>Postpartum individuals cope with recovering from birth in addition to the demands of caring for a newborn. Often, the addition of a PDPH is incapacitating. Epidural blood patch should not be delayed in patients with early and severe symptoms. All individuals who experience PDPH should be assessed, receive appropriate treatment, and be reviewed by a member of the anesthesia team until symptoms have resolved, with appropriate follow-up instructions before discharge.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1163-1178"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692583","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 neuraxial anesthesia for postpartum tubal ligation: a single-centre retrospective cohort study.","authors":"Megan Foster, Kelsey Hudson, Jessica C Ehrig, Emily E Sharpe, Michael P Hofkamp","doi":"10.1007/s12630-025-03004-3","DOIUrl":"https://doi.org/10.1007/s12630-025-03004-3","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to identify the neuraxial anesthesia failure rate of de novo single-injection spinal and combined spinal-epidural anesthesia for postpartum tubal ligation at our hospital along with variables associated with neuraxial anesthesia failure.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study of patients who underwent a postpartum tubal ligation with de novo single-injection spinal or combined spinal-epidural anesthesia from 1 January 2020 to 31 December 2022 at Baylor Scott & White Medical Center-Temple (Temple, TX, USA). We defined neuraxial anesthesia failure as conversion to general anesthesia involving the use of an endotracheal tube or supraglottic airway, administration of intravenous propofol at doses > 10 mg, intravenous fentanyl > 100 µg, or the use of inhaled nitrous oxide.</p><p><strong>Results: </strong>During the study period, 243 patients underwent postpartum tubal ligation with single-injection spinal or combined spinal-epidural anesthesia, and 28 (11.5%) had neuraxial anesthesia failure. Using a multivariate logistic regression designed to predict neuraxial anesthesia failure using variables of interest, we found that a 5-min increase in time from spinal anesthesia placement to skin incision was associated with neuraxial anesthetic failure (adjusted odds ratio [aOR], 3.10; 95% confidence interval [CI], 2.01 to 4.79; P < 0.001) along with a 5-min increase in time from skin incision to wound closure (aOR 1.35; 95% CI, 1.10 to 1.66; P = 0.004) CONCLUSION: Patients who underwent postpartum tubal ligation under single-injection spinal or combined spinal epidural anesthesia had a neuraxial failure rate of 11.5%. Time from spinal placement to skin incision and time from skin incision to wound closure were independently associated with neuraxial anesthesia failure.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546330","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 effect of intravenous dexamethasone on rebound pain after wrist and hand surgery under supraclavicular brachial plexus blockade: a randomized placebo-controlled trial.","authors":"RyungA Kang, Yu Jeong Bang, Jae Woo Shim, Soo Joo Choi, So Myung Kong, Tae Soo Hahm, Jungchan Park, Woo Seog Sim, Justin Sangwook Ko","doi":"10.1007/s12630-025-02992-6","DOIUrl":"10.1007/s12630-025-02992-6","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to evaluate the efficacy of intravenous dexamethasone in reducing rebound pain post-orthopedic wrist and hand surgery, administered prior to supraclavicular brachial plexus blockade.</p><p><strong>Methods: </strong>We conducted a randomized placebo-controlled trial on 56 patients scheduled for elective wrist and hand surgery under supraclavicular brachial plexus blockade. We randomized participants into either a control group, receiving 0.9% of intravenous saline, or a dexamethasone group, receiving 0.11 mg·kg^-1 of intravenous dexamethasone. The primary outcome was the difference in pain scores before vs after block resolution. Secondary outcomes included the incidence of rebound pain, pain scores, cumulative opioid consumption, patient satisfaction with postoperative analgesia, and block-related complications in the first 24 hr postoperatively.</p><p><strong>Results: </strong>The mean (standard deviation [SD]) pain score difference was significantly larger in the control group (7.3 [1.9]) compared with the dexamethasone group (4.7 [2.1]), with a mean difference between groups of 2.6 (95% confidence interval, 1.5 to 3.7; P < 0.001). The incidence of rebound pain was also significantly higher in the control group (79% vs 32%; P < 0.001). The cumulative opioid consumption in 24 hr was greater in the control group than in the dexamethasone group (median [interquartile range (IQR)], 72 [54-97] mg vs 25 [14-60] mg; P < 0.001). We found no significant differences in postoperative complications.</p><p><strong>Conclusions: </strong>Preoperative administration of 0.11 mg·kg^-1 intravenous dexamethasone significantly reduced rebound pain within 24 hr after wrist and hand surgery under supraclavicular brachial plexus blockade. The results of our trial support the use of intravenous dexamethasone as an effective method for managing postoperative pain for wrist and hand surgery under supraclavicular brachial plexus blockade.</p><p><strong>Study registration: </strong>www.CRIS.nih.go.kr ( KCT0007208 ); first submitted 5 April 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1079-1089"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337291","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":"CAS 2025 Annual Meeting Abstract Book.","authors":"","doi":"10.1007/s12630-025-03044-9","DOIUrl":"10.1007/s12630-025-03044-9","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"227-459"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876976","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: The evolution and formalization of anesthesia assistant roles across Canada.","authors":"Homer Yang, Judith Littleford, Beverley A Orser, Hamed Umedaly, Monica Olsen, Mateen Raazi, Kenneth LeDez, J Adam Law, Mitch Giffin, Brandon D'Souza, Derek Dillane, Chris Christodoulou, Natalie Buu, Rob Bryan","doi":"10.1007/s12630-025-02989-1","DOIUrl":"10.1007/s12630-025-02989-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1185-1186"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310896","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":"Functional outcomes among the survivors of veno-venous extracorporeal membrane oxygenation during the COVID-19 pandemic: a historical cohort study.","authors":"Eunicia Ursu, Ana Mikolić, Bobo Tong, Noah D Silverberg, Nishtha Parag, Denise Foster, Mypinder S Sekhon, William Panenka, Sonny Thiara, Donald E G Griesdale","doi":"10.1007/s12630-025-02965-9","DOIUrl":"10.1007/s12630-025-02965-9","url":null,"abstract":"<p><strong>Purpose: </strong>Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in patients with respiratory failure. The goal of this study was to characterize postdischarge psychological and functional outcomes of this patient population.</p><p><strong>Methods: </strong>We conducted a historical cohort study of survivors who required VV-ECMO during the COVID-19 pandemic. Using telephone interviews, we assessed the following domains: disability (using the World Health Organization Disability Schedule [WHODAS 2.0] and modified Rankin Scale [mRS]), health-related quality of life (using the European Quality of Life 5 Dimensions 5 Level tool), cognition (using the telephone Montreal Cognitive Assessment tool), depression (using the Patient Health Questionnaire-9), and posttraumatic stress disorder symptoms (using the Impact of Event Scale-6). We used descriptive statistics to analyze our results.</p><p><strong>Results: </strong>Twenty-six participants with a median [interquartile range (IQR)] age of 47 [42-59] yr and 6 (23%) of whom were female were evaluated at a median [IQR] of 22 [17-23] months after ECMO separation. Twenty-two (85%) had a diagnosis of COVID-19. The median [IQR] WHODAS 2.0 score was 26 [15-30] with the highest degree of disability in the mobility and participation domains. Of the 24 participants who were employed full-time, 12 (50%) were able to work in the same capacity. Of the 25 respondents who were living independently at baseline, 22 (88%) maintained complete independence for their activities of daily living (mRS < 3), one (4%) described persistent functional limitations (mRS = 3), and two (8%) required constant care (mRS = 4 or 5). Thirteen (52%) and nine (38%) reported at least moderate pain or anxiety, respectively. Ten (40%) and seven (28%) participants screened positive for symptoms of depression or posttraumatic stress disorder, respectively.</p><p><strong>Conclusions: </strong>Patients who required VV-ECMO experienced significant functional disability, pain, cognitive challenges, mental health problems, and lower quality of life approximately two years after discharge.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1140-1149"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183161","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: The evolution and formalization of anesthesia assistant roles across Canada.","authors":"Allana Munro, Claire Ward, Melissa A Berry, Andrew D Milne","doi":"10.1007/s12630-025-02988-2","DOIUrl":"10.1007/s12630-025-02988-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1183-1184"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310895","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":"Short-term use of nonsteroidal anti-inflammatory drugs immediately after cardiac surgery.","authors":"Anthony M-H Ho, Rachel Phelan, Ramiro Arellano, Glenio B Mizubuti","doi":"10.1007/s12630-025-02981-9","DOIUrl":"10.1007/s12630-025-02981-9","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1031-1040"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487247","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: Channelled versus nonchannelled Macintosh videolaryngoscope blades in patients with a cervical collar: a randomized controlled noninferiority trial.","authors":"Atsushi Kobayashi, Shingo Kawashima, Tetsuro Kimura, Hiroyuki Kinoshita","doi":"10.1007/s12630-025-02969-5","DOIUrl":"10.1007/s12630-025-02969-5","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1179-1180"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175980","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":"Safety of nonselective nonsteroidal anti-inflammatory drugs in cardiac surgery: a historical cohort study.","authors":"Tyson Miao, Lik Hang N Lee, Terri Sun, Megan Patapoff, Erica Wang","doi":"10.1007/s12630-025-02983-7","DOIUrl":"10.1007/s12630-025-02983-7","url":null,"abstract":"<p><strong>Purpose: </strong>Pain management after cardiac surgery is imperative, as inadequate analgesia can increase the risk of myocardial ischemia, thromboembolism, and pulmonary complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of multimodal analgesia, but their use in the postoperative cardiac surgery population is controversial owing to concerns of acute kidney injury (AKI), thrombotic events, and bleeding. We aimed to evaluate the rate of AKI, major adverse cardiovascular events (MACE), and major bleeding in patients receiving NSAIDs early after cardiac surgery.</p><p><strong>Methods: </strong>We conducted a single-centre historical cohort study, which included adult patients who underwent cardiac surgery with sternotomy or thoracotomy between 1 October 2020 and 30 September 2022 and received nonselective NSAIDs postoperatively. The primary outcome was the proportion of patients who developed AKI, MACE, or major bleeding within 7 days of the NSAID exposure during their hospitalization. We used machine learning to identify risk factors associated with adverse events. We assessed pain reduction by analyzing differences in pain scores, opioid use, and supplemental oxygen requirements.</p><p><strong>Results: </strong>We included 431 patients in this study. After NSAID administration, 12% experienced AKI, 1% had MACE, and 3% developed major bleeding. Risk factors for AKI included older age; shorter height; a history of stroke; low preoperative estimated glomerular filtration rate (eGFR) and hemoglobin level; high preoperative platelet count, international normalized ratio, and blood urea nitrogen level; and reduced eGFR and platelet count before NSAID exposure.</p><p><strong>Conclusion: </strong>In patients who received nonselective NSAIDs early after cardiac surgery, the rate of AKI was lower than reported in literature, likely due to selection bias. Baseline renal function emerged as the most important factor, with low preoperative eGFR being the strongest predictor of AKI following NSAID administration.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1056-1065"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487246","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}