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

{"title":"Finding meaning in measurement: time to make the national conversation around quality of care in anesthesiology louder.","authors":"Maha Al Mandhari, Tariq Esmail, Justyna Bartoszko","doi":"10.1007/s12630-025-02944-0","DOIUrl":"10.1007/s12630-025-02944-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"683-693"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112865","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":"Effects of breathing circuit insulation on inspired gas conditioning and water vapour condensation: an in vitro study.","authors":"Thi Nguyen-Minh, Christian Hönemann, Alexander Zarbock, Marie-Luise Rübsam","doi":"10.1007/s12630-025-02959-7","DOIUrl":"10.1007/s12630-025-02959-7","url":null,"abstract":"<p><strong>Purpose: </strong>During general anesthesia, physiologic conditioning of inspired gases is bypassed. Mechanical ventilation with dry and cold gas from the central gas supply may lead to dehydration of the mucus membranes, cilia dysfunction, retention of secretions, and atelectasis. The use of metabolic fresh gas flow improves the conditioning of inspiratory gases but increases water vapour condensation within the breathing system. We sought to investigate the effects of breathing circuit insulation on the conditioning of inspired gases and the condensation of water vapour.</p><p><strong>Methods: </strong>In this in vitro study, we used a mechanical nonheated, nonhumidified lung model with carbon dioxide (CO₂) insufflation. We tested foam, cotton, and polyester insulation (FOI, COI, and PEI) against control (noninsulated regular tubing). We measured temperature, absolute humidity (AH), and water vapour condensation after 120 min. We performed 8 measurements per group (total N = 32) and adjusted P values and confidence intervals (CIs) for multiple testing using Bonferroni-Holm adjustment.</p><p><strong>Results: </strong>Regarding mean AH, FOI performed better than control. The mean (standard deviation [SD]) differences in AH between control and insulation were -0.63 (0.52) g·m^-3 H₂O for PEI (adjusted 95% CI, -1.42 to 0.17; P = 0.26), -0.63 (0.74) g·m^-3 H₂O for COI (adjusted 95% CI, -1.42 to 0.17; P = 0.26), and -1.13 (0.35) g·m^-3 H₂O for FOI (adjusted 95% CI, -1.92 to -0.33; P < 0.001). The mean temperature was higher in insulated circuits. The mean (SD) difference compared to control was 0.42 (0.28) °C for PEI (adjusted 95% CI, 0.05 to 0.79; P = 0.002), 0.62 (0.26) °C for COI (adjusted 95% CI, 0.25 to 0.99; P < 0.001), and -1.07 (0.14) °C for FOI (adjusted 95% CI, 0.70 to 1.44; P < 0.001). Condensation of water vapour was lower in insulated breathing circuits compared with control.</p><p><strong>Conclusion: </strong>Foam-based insulation was the most effective form of insulation of the breathing circuit to increase temperature and AH of inspired gases and to reduce water vapour condensation. Overall, the results of this in vitro study support the principle of breathing circuit insulation as a method for inspired gas conditioning during the use of metabolic flow anesthesia.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"780-790"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121527","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":"Unusual but effective \"nasotracheal\" intubation.","authors":"Vincent Legros, Adrien Cornillon, Benjamin Brochet, Pierre-Antoine Seube","doi":"10.1007/s12630-025-02927-1","DOIUrl":"10.1007/s12630-025-02927-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"855-856"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626892","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: Point-of-care ultrasound-guided fluid management to prevent hypotension after induction of general anesthesia-a conundrum to conquer!","authors":"Elad Dana, Cristian Arzola, James S Khan","doi":"10.1007/s12630-025-02955-x","DOIUrl":"10.1007/s12630-025-02955-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"867-868"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047059","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":"Impact of major postoperative complications on employment and earnings after elective hip or knee replacement surgery: a population-based matched cohort study.","authors":"Calvin Diep, Rachael Jaffe, Christopher Witiw, Julian F Daza, Duminda N Wijeysundera, Bheeshma Ravi, Karim S Ladha","doi":"10.1007/s12630-025-02960-0","DOIUrl":"10.1007/s12630-025-02960-0","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative complications can steer patients away from a typical surgical recovery trajectory and hinder their ability to work and earn income. We aimed to quantify these effects for working-aged adults after elective joint replacement surgery.</p><p><strong>Methods: </strong>We conducted a population-based cohort study of adults aged 30-63 yr having elective hip or knee arthroplasty using the Canadian Hospitalization and Taxation Database from 2004 to 2019. Our primary exposure was a postoperative complication, defined as a composite of adverse medical events, intensive care unit visit, or rehospitalization within thirty days. Our coprimary outcomes were employment and earnings in the second calendar year after surgery. We matched patients with complications 1:1 to those without complications using a propensity score considering demographic, medical, and financial characteristics. We used probit regression to assess employment after surgery and difference-in-difference ordinary least squares regression for the change in earnings from before to after surgery.</p><p><strong>Results: </strong>We included 222,087 adults undergoing an elective hip or knee replacement. In total, 6.3% experienced postoperative complications. In the second year after surgery, 55.1% of patients with complications were working compared with 57.3% of patients without complications (-2.2 percentage points [pp], 95% confidence interval [CI], -3.5 to -1.0). Patients with complications had a CAD 1,782 greater decline in annual earnings from before surgery (95% CI, -2,775 to -789; values inflated to 2023 Canadian dollars) than patients without complications.</p><p><strong>Conclusions: </strong>Postoperative complications resulted in a lower likelihood of employment and lower earnings after elective hip or knee replacement surgery. This may also have broader economic implications.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"738-747"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058685","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":"Critical Care Canada Forum 2024 Abstracts.","authors":"","doi":"10.1007/s12630-025-02967-7","DOIUrl":"10.1007/s12630-025-02967-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1-226"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259451","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":"First-pass success rate and predictive factors for stylet use in videolaryngoscopic intubations with a Macintosh blade: a prospective observational study.","authors":"Seung Eun Song, Ji-Yoon Jung, Chul-Woo Jung, Jung Yeon Park, Won Ho Kim, Hyun-Kyu Yoon","doi":"10.1007/s12630-025-02952-0","DOIUrl":"10.1007/s12630-025-02952-0","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the first-pass success rate of videolaryngoscopic intubations without a stylet using a Macintosh blade and to identify predictive factors for successful intubation.</p><p><strong>Methods: </strong>We conducted a prospective observational study of 224 adult patients scheduled for elective videolaryngoscopic intubations using a Macintosh blade. We excluded patients who had cervical spine issues, airway disease, anticipated difficult intubation, or a body mass index > 35 kg·m^-2, or who required rapid sequence induction. We initially attempted intubations without a stylet, with laryngeal manipulation on the second attempt if needed, and a stylet added after two failures. We evaluated the first-pass success rate and identified predictive factors using multivariable logistic regression, incorporating demographic, conventional, and ultrasonographic airway parameters. We performed ultrasound examination after induction of general anesthesia. We developed and evaluated a prediction model using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>The first-pass success rate was 80% (180/224), increasing to 96% (215/224) after laryngeal manipulation on the second attempt. Nine patients (4%) required a stylet. Longer sternomental distance (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.01 to 1.53; P = 0.04) and increased thyromental height (OR, 1.14; 95% confidence interval [CI], 1.07 to 1.21; P < 0.001) were associated with first-pass success without a stylet. Limited (OR, 0.39; 95% CI, 0.16 to 1.00; P = 0.049) or severely limited (OR, 0.05; 95% CI, 0.01 to 0.19; P < 0.001) cervical spine movement negatively affected success.</p><p><strong>Conclusions: </strong>Routine stylet preparation for elective videolaryngoscopic intubations with a Macintosh blade may not be necessary, as only a small percentage of patients required it.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"758-767"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062889","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":"The effect of major abdominal surgery on the sublingual microcirculation: an observational study.","authors":"Moritz Flick, Gyde P Jannsen, Linda Krause, Jonathan Montomoli, Franziska Pollok, Parisa Moll-Khosrawi, Karim Kouz, Alina Bergholz, Kristen K Thomsen, Matthias P Hilty, Can Ince, Christian Zöllner, Bernd Saugel","doi":"10.1007/s12630-025-02941-3","DOIUrl":"10.1007/s12630-025-02941-3","url":null,"abstract":"<p><strong>Purpose: </strong>It remains unknown whether the sublingual microcirculation is impaired during noncardiac surgery. We, therefore, aimed to investigate the sublingual microcirculation in patients undergoing major abdominal surgery. Specifically, we sought to test the primary hypothesis that the sublingual microcirculation is persistently impaired during major abdominal surgery.</p><p><strong>Methods: </strong>In this prospective observational study, we assessed the sublingual microcirculation using vital microscopy before induction of general anesthesia, at the time of surgical incision, every 20 min during surgery, and on the first postoperative day in 46 patients undergoing major abdominal surgery. The primary endpoint was the area under a proportion of perfused vessels (PPV) of 92% as a measure of the duration and severity of capillary red blood cell flow impairment.</p><p><strong>Results: </strong>The median [interquartile range (IQR)] intraoperative area under a PPV of 92% was 71%⋅min [2%⋅min-278%⋅min], and the median [IQR] time-weighted average PPV < 92% was 0.3% [0%-0.9%]. Twelve patients (26%) had an area under a PPV of 92% of 0%⋅min, and five patients (11%) had an area under a PPV of 92% of 400%⋅min or higher. The duration of surgery had no clinically important persistent effect on intraoperative PPV or any other sublingual microcirculation variable. The lowest intraoperative PPV was lower than the PPV at incision (estimated difference, -5.3%; 95% confidence interval, -6.3 to -4.4; P < 0.001).</p><p><strong>Conclusions: </strong>The area under a PPV of 92% during elective major abdominal surgery was small, indicative of little impairment of sublingual microcirculation. The duration of surgery had no clinically important effect on sublingual microcirculatory variables.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"768-779"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997331","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":"Correction to: Effects of intraoperative hyperoxia on cerebral blood flow and dynamic cerebral autoregulation.","authors":"Rokus E C van den Dool, Lariza Batelaan, Denise P Veelo, Jimmy Schenk, Markus W Hollmann, Alexander P J Vlaar, Nicolaas H Sperna Weiland, Rogier V Immink","doi":"10.1007/s12630-025-02948-w","DOIUrl":"10.1007/s12630-025-02948-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"869"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019968","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":"Female representation in the Canadian physician anesthesia workforce: a historical analysis.","authors":"Mitchell Crozier, Jason McVicar, Gianni R Lorello, Miriam Mottiar, C Ruth Wilson, Beverley A Orser","doi":"10.1007/s12630-025-02949-9","DOIUrl":"10.1007/s12630-025-02949-9","url":null,"abstract":"<p><strong>Purpose: </strong>According to an analysis of data from the Canadian Institutes for Health Information (CIHI) National Physician Database, the proportion of female anesthesia physicians is substantially lower than the proportion of female physicians in the total physician population. The goal of this study was to identify trends in female representation in the major subgroups of anesthesia providers, including specialists certified by the Royal College of Physician and Surgeons of Canada (RCPSC), international medical graduates, and family physician anesthetists (FPAs).</p><p><strong>Methods: </strong>We examined the sex distribution of the existing physician workforce, including anesthesia providers working in urban and rural Canada, using the CIHI National Physician Database (1996-2018). We also examined the sex distribution of physicians entering the workforce using the Canadian Post-MD Education Registry database and calculated descriptive statistics.</p><p><strong>Results: </strong>The proportion of female physicians increased steadily over time in all groups; nevertheless, the numbers of female FPAs and rural anesthesia providers continued to lag relative to all Canadian physicians (9.4%, 9.4%, and 26.7%, respectively, in 1996; 18.7%, 21.1%, and 42.1%, respectively, in 2018). Of the graduates from RCPSC training programs in 1996, 28% were female, whereas by 2018, 33.5% of graduates were female.</p><p><strong>Conclusions: </strong>Female physicians were underrepresented in all subgroups, but the proportions were lowest among FPAs and rural physicians. Given that greater sex diversity in clinical teams is associated with better outcomes, and in light of ongoing workforce shortages, the barriers that prevent female physicians from entering and/or remaining in the anesthesia workforce need to be understood and ameliorated.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"791-800"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041478","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}