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

{"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}

{"title":"Fluid responsiveness and hypotension in patients undergoing propofol-based sedation for colonoscopy following bowel preparation: a prospective cohort study.","authors":"Megan L Allen, Michael Kluger, Frank Schneider, Kaylee Jordan, John Xie, Kate Leslie","doi":"10.1007/s12630-025-02939-x","DOIUrl":"https://doi.org/10.1007/s12630-025-02939-x","url":null,"abstract":"<p><strong>Purpose: </strong>Fasting and bowel preparation may deplete intravascular volume in patients undergoing colonoscopy. Nevertheless, rigorous demonstration of volume depletion and assessment of clinical consequences is lacking. We designed this study to explore the relationship between intravascular volume status and intraprocedural hypotension and to compare transthoracic echocardiography (TTE) and the ClearSight™ (Edwards Lifesciences, Irvine, CA, USA) noninvasive cardiac output monitor to measure intravascular volume status.</p><p><strong>Methods: </strong>We recruited adult patients undergoing elective colonoscopy following bowel preparation at the Royal Melbourne Hospital. We assessed the volume status preprocedure by taking TTE and ClearSight measurements in patients in the semirecumbent position and following passive leg raising. Patients received propofol-based sedation, and significant intraprocedural hypotension was defined as a mean arterial pressure (MAP) < 60 mm Hg. The primary outcome was the occurrence of intravascular volume depletion as assessed by a positive result in a passive leg raise test on TTE (a 15% increase in the subaortic velocity time integral).</p><p><strong>Results: </strong>Ninety-nine patients completed the study. The primary outcome was recorded in 29 of the 90 patients with adequate TTE images (32%; 95% confidence interval, 23 to 43). There was inadequate agreement between average TTE and ClearSight measurements of stroke volume at baseline or after passive leg raising. More patients experienced significant intraprocedural hypotension in the fluid-responsive group (48%) than in the normovolemic group (21%).</p><p><strong>Conclusion: </strong>Patients undergoing elective colonoscopy after bowel preparation were often fluid responsive. These patients were more likely to have significant intraprocedural hypotension than patients who were volume replete. Transthoracic echocardiography assessment of volume status cannot be readily replaced by ClearSight monitoring.</p><p><strong>Study registration: </strong>ANZCTR.org.au ( ACTRN12616000614493 ); first registered 11 May 2016.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"529-539"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041479","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":"Impact of intraoperative desmopressin on postoperative urine output in adult cadaveric kidney transplantation: a single-centre retrospective cohort study.","authors":"Samhati Mondal, Catherine Wasylyshyn, Roumen Vesselinov, Miranda Gibbons, Chandrasekhar Bhati, Stephanie E Jones, Peter Rock, Megan G Anders","doi":"10.1007/s12630-025-02930-6","DOIUrl":"10.1007/s12630-025-02930-6","url":null,"abstract":"<p><strong>Purpose: </strong>Desmopressin, a synthetic analogue of vasopressin, is used to prevent uremic bleeding in patients undergoing kidney transplantation but can cause oliguria. Graft function assessment is crucial after kidney transplantation. Urine output (UOP) is the simplest, most feasible, and most cost-effective perioperative monitoring tool to assess graft function in kidney transplantation. No study, to our knowledge, has yet assessed this association in the setting of cadaveric adult kidney transplantation.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre cohort study to evaluate the impact of desmopressin on UOP in the immediate postoperative period after kidney transplantation at a tertiary care academic hospital in Baltimore, MD, USA. We included a total of 938 adults who received a cadaveric kidney transplant from January 2016 to December 2022 in the study after reviewing selection criteria. As the primary outcome, we compared immediate postoperative UOP (mL·kg^-1) between recipients of desmopressin and nonrecipients of desmopressin. The secondary outcomes of the study were UOP at 12 and 24 hr postoperatively, estimated blood loss (EBL), and postoperative hemoglobin.</p><p><strong>Results: </strong>Three hundred and fifty-nine (38%) patients received desmopressin intraoperatively. Using multivariable linear regression, desmopressin use was associated with 0.6 mL·kg^-1 lower UOP, representing an average 19% reduction in UOP from a mean UOP of 3.1 mL·kg^-1 in the operating room after adjusting for confounders. A similar reduction in 12- and 24-hr postoperative UOP was also noted (3 mL·kg^-1 and 6 mL·kg^-1, respectively), while desmopressin was associated with a slightly higher EBL. We also observed a dilutional reduction in postoperative hemoglobin.</p><p><strong>Conclusions: </strong>Intraoperative desmopressin in adult cadaveric kidney transplant recipients was associated with reduced urine output in the postoperative period without any significant hemostatic benefit.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"540-549"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677440","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 postoperative oxygenation in children receiving sugammadex versus neostigmine for reversal of neuromuscular blockade: a retrospective cohort study.","authors":"Stephania Paredes, Sascha Ott, Julian Rössler, Busra T Cekmecelioglu, Carlos Trombetta, Yufei Li, Alparslan Turan, Kurt Ruetzler, Surendrasingh Chhabada","doi":"10.1007/s12630-024-02904-0","DOIUrl":"10.1007/s12630-024-02904-0","url":null,"abstract":"<p><strong>Purpose: </strong>Residual neuromuscular blockade can impair postoperative respiratory mechanics, promoting hypoxemia and pulmonary complications. Sugammadex, with its unique mechanism of action, may offer a more effective reversal of neuromuscular blockade and respiratory function than neostigmine. We sought to test the primary hypothesis that children undergoing noncardiac surgery exhibit better initial recovery oxygenation when administered sugammadex than those administered neostigmine. Furthermore, we aimed to investigate if children administered sugammadex experience fewer in-hospital pulmonary complications.</p><p><strong>Methods: </strong>In a retrospective cohort study, we analyzed data from children aged 2-17 yr who underwent noncardiac surgery with general anesthesia and received neostigmine or sugammadex between January 2017 and April 2023 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative oxygenation defined by the mean SpO₂/F_IO₂ ratio during the initial hour in the postanesthesia care unit. The secondary outcome was a composite of postoperative pulmonary complications during the hospital stay.</p><p><strong>Results: </strong>Among 3,523 cases, 430 (12.5%) involved sugammadex and 3,081 (87.5%) involved neostigmine. The median [interquartile range] of the mean SpO₂/F_IO₂ ratio during the first postoperative hour was 403 [356-464] in the sugammadex group and 408 [357-462] in the neostigmine group, resulting in an estimated difference in means of -6.2 (95% confidence interval, -12.8 to 0.41; P = 0.07) after inverse probability of treatment weighting. Overall, 22/1,916 (1.1%) inpatients experienced postoperative pulmonary complications; 2.0% of patients given sugammadex and 1.0% of patients administered neostigmine developed postoperative pulmonary complications (P = 0.19).</p><p><strong>Conclusion: </strong>In this retrospective cohort study, postoperative oxygenation was similar in children after reversal of neuromuscular blockade with sugammadex versus neostigmine.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"591-602"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069812","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}