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

{"title":"Surveying anesthesia care provision and deficiencies among the secondary public sector hospitals of rural Sindh, Pakistan.","authors":"Mustafa A Khan, Samie A Dogar, Sadaf Khan, Sameen Siddiqi, Fauzia A Khan, Asad Latif","doi":"10.1007/s12630-025-02923-5","DOIUrl":"10.1007/s12630-025-02923-5","url":null,"abstract":"<p><strong>Purpose: </strong>Provision of anesthesia care must go hand in hand with surgical care to equitably widen surgical coverage of underserved populations, especially the rural segments of low- and middle-income countries. The aim of this study was to assess the availability of key items and infrastructure needed for anesthesia care.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey at ten subdistrict or taluqa headquarter (THQ) hospitals and five district headquarter (DHQ) hospitals in six rural districts of the Sindh province of Pakistan using the Anesthesia Facility Assessment Tool. We assessed the domains of infrastructure, workforce, service delivery, conduct of anesthesia, equipment, and medications. We also scored these components and then compared the difference in mean scores.</p><p><strong>Results: </strong>Three hospitals did not meet the minimum bed number required for a secondary hospital. Four hospitals had nonfunctioning operating rooms and conducted procedures elsewhere. Ten had full-time, certified anesthesiologists, while 11 had a postanesthesia care unit. There were only two hospitals with critical care units providing mechanical ventilation, and only one hospital conducting telemetry. Six hospitals did not have a dedicated anesthesia provider present at all times. Thirteen hospitals did not use the World Health Organization preoperative checklist before performing procedures. There were deficiencies in drugs such as hypnotics, opioids, and vasopressors.</p><p><strong>Conclusion: </strong>There are many shortcomings in anesthesia care provision among these rural hospitals. Greater attention and investment are needed to safely conduct anesthesia in this setting.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"811-821"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063002","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 the head-elevated position on cervical spine motion during videolaryngoscopic intubation with manual in-line stabilization: a randomized controlled trial.","authors":"Woo-Young Jo, Chan-Ho Hong, Kyung Won Shin, Hyongmin Oh, Hee-Pyoung Park","doi":"10.1007/s12630-025-02946-y","DOIUrl":"10.1007/s12630-025-02946-y","url":null,"abstract":"<p><strong>Purpose: </strong>The head-elevated position during videolaryngoscopic intubation enables better visualization of the glottis than the head-flat position. We hypothesized that the head-elevated position would result in less cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial in which we assigned patients undergoing coil embolization for unruptured cerebral aneurysms into the head-elevated (N = 55) or head-flat (N = 54) groups. Manual in-line stabilization was applied to simulate cervical spine immobilization during Macintosh-type videolaryngoscopic intubation. To measure the cervical spine angle, two lateral cervical spine radiographs using the capture method were taken, one before and one during intubation, respectively. The primary outcome was cervical spine motion during intubation (cervical spine angle during intubation - cervical spine angle before intubation) at the occiput-C1 segment. We investigated cervical spine motion at the C1-C2 and C2-C5 segments; intubation performance, such as the success rate at the first attempt, intubation time, and frequency of external laryngeal maneuver; and intubation-associated airway complications (airway bleeding, injury, sore throat, and hoarseness).</p><p><strong>Results: </strong>There was significantly less cervical spine motion at the occiput-C1 segment in the head-elevated group than the head-flat group (mean [standard deviation], 8.6° [5.6°] vs 11.4° [5.7°]; mean difference [95% confidence interval], -2.9° [-5.0 to -0.7]; P = 0.009). Cervical spine motion at the C1-C2 and C2-C5 segments, intubation performance, and intubation-associated airway complications did not significantly differ between the groups.</p><p><strong>Conclusions: </strong>The head-elevated position during Macintosh-type videolaryngoscopic intubation with manual in-line stabilization resulted in less upper cervical spine motion than the head-flat position.</p><p><strong>Study registration: </strong>CRIS.nih.go.kr ( KCT0008669 ); date of registration (approved), 1 August 2023.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"748-757"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055008","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 arm block from inadvertent subdural cannulation during a thoracic epidural insertion.","authors":"Soleil S Schutte, Barys V Ihnatsenka, Michael Berentzen, John H Rees","doi":"10.1007/s12630-025-02950-2","DOIUrl":"10.1007/s12630-025-02950-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"862-864"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007915","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":"Operative team critical incident debriefing in a community hospital: a mixed methods study.","authors":"Maira Quinanilha, Breanne Aylward, Patrick Feng, Ariane Fielding","doi":"10.1007/s12630-025-02936-0","DOIUrl":"10.1007/s12630-025-02936-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"857-859"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053375","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":"Simple act, complex effects: how ascribing identities leads to structural violence in health care.","authors":"Gianni R Lorello, Sasha K Shillcutt, Brett Schrewe","doi":"10.1007/s12630-025-02945-z","DOIUrl":"10.1007/s12630-025-02945-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"694-697"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053893","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":"Local nitroglycerin to facilitate radial arterial catheterization in adults: a systematic review and meta-analysis.","authors":"Uday Rao, Timothy Phillips, Shripada Rao","doi":"10.1007/s12630-025-02931-5","DOIUrl":"10.1007/s12630-025-02931-5","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to investigate the efficacy and safety of local nitroglycerin (NTG) application in facilitating radial artery cannulation in adults.</p><p><strong>Methods: </strong>In February 2024, we searched PubMed®, Embase, EMCARE, and the Cochrane Library. Local NTG could have been subcutaneous injection or topical application. We sought to conduct a meta-analysis using Hartung-Knapp adjustment of the DerSimonian-Laird random effects model.</p><p><strong>Results: </strong>We included 15 randomized controlled trials (RCTs) (n = 2,370), of which 4 (n = 423) evaluated topical NTG, whereas 11 (n = 1,947) used subcutaneous infiltration. All 4 trials evaluating topical NTG and 9/11 evaluating subcutaneous NTG used ultrasound to facilitate radial artery cannulation, whereas this was unclear in 2/11 trials evaluating subcutaneous NTG. The majority of studies had an unclear risk of bias (ROB). All 15 studies reported NTG to be beneficial. The meta-analysis found that subcutaneous NTG was associated with increased rates of first-attempt success (risk ratio [RR], 1.61; 95% confidence interval [CI], 1.23 to 2.10; five studies; 516 patients) and decreased risk of radial artery spasm (RR, 0.43; 95% CI, 0.24 to 0.77; seven studies; 1,519 patients). Topical NTG was associated with increased rates of first-attempt success (RR, 2.45; 95% CI, 1.39 to 4.34; one study; 92 patients) but resulted in little or no difference to the incidence of radial artery spasm (RR, 0.67; 95% CI, 0.20 to 2.25; three RCTs; 275 patients). The overall certainty of evidence was low.</p><p><strong>Conclusions: </strong>Topical or subcutaneous NTG has the potential to facilitate radial artery access and decrease local complications. Given that the certainty of evidence was low, additional RCTs are needed.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022342158 ); first submitted 29 June 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"567-578"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665131","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":"Estimating sample means and standard deviations from the log-normal distribution using medians and quartiles: evaluating reporting requirements for primary and secondary endpoints of meta-analyses in anesthesiology.","authors":"Pei-Fu Chen, Franklin Dexter","doi":"10.1007/s12630-025-02922-6","DOIUrl":"https://doi.org/10.1007/s12630-025-02922-6","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical trials often report medians and quartiles due to skewed data distributions. We sought to evaluate the methods currently used in meta-analyses in anesthesiology to estimate means and standard deviations (SDs) from medians and quartiles.</p><p><strong>Methods: </strong>We simulated sample sizes (n = 15, 27, 51) and coefficients of variation (CV = 0.15, 0.3, 0.5), representative scenarios in anesthesiology studies, generating data that have a log-normal distribution with zero log-scale means. We calculated generalized confidence intervals for the ratios of means and ratios of SDs using means and SDs estimated from three quartiles in time scale, using Luo et al.'s and Wan et al.'s methods, McGrath et al.'s quantile estimation and Box-Cox transformation, and Cai et al.'s maximum likelihood estimation method.</p><p><strong>Results: </strong>The method by Luo et al. and Wan et al. produced 95% confidence intervals for the ratio of means with coverage ranging from 92.4% to 93.6%, and for SDs from 79.2 to 89.6. McGrath et al.'s quantile estimation method yielded coverage for mean ratios between 88.5% and 91.5% and SDs between 78.0 and 82.7. McGrath et al.'s Box-Cox transformation method showed coverage for mean ratios from 86.6% to 94.4% and SDs from 67.1 to 83.1. The maximum likelihood estimation method by Cai et al. for nonnormal distributions showed coverage for mean ratios from 78.9% to 86.4% and SDs from 67.6 to 78.0.</p><p><strong>Conclusions: </strong>All evaluated methods of estimating means and standard deviations from quartiles of log-normal distributed data result in confidence interval coverages below the expected 95%. Because these methods are widely used in meta-analyses of anesthesiology data, P values reported as < 0.05 cannot be trusted. Anesthesiology journals and investigators should revise reporting requirements for continuous skewed variables. We advise reporting the quartiles, mean, and SD, or the quartiles and including the raw data for the relevant variables as supplemental content. This holistic approach could improve the reliability of statistical inferences in meta-analyses of anesthesiology research, particularly when skewed distributions are involved.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":"72 4","pages":"633-643"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043111","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":"When our intuition lets us down-something believed to be beneficial may actually be harmful.","authors":"Virendra K Arya, Philip M Jones","doi":"10.1007/s12630-025-02929-z","DOIUrl":"10.1007/s12630-025-02929-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"525-528"},"PeriodicalIF":3.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677441","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":"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}