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

{"title":"Exploring clinical conundrums in obstetric anesthesia through interactive polls and panel discussion: insights from Canadian obstetric anesthesiology experts.","authors":"Anthony Chau, Roanne Preston, Paul M Wieczorek, Dolores M McKeen, Lorraine Chow, Wesley Edwards, Valerie Zaphiratos","doi":"10.1007/s12630-025-02986-4","DOIUrl":"10.1007/s12630-025-02986-4","url":null,"abstract":"<p><strong>Purpose: </strong>This Special Article aims to synthesize the results of a live audience poll and practice tips from Canadian obstetric anesthesiology experts during a panel session at the Canadian Anesthesiologists' Society 2024 Annual Meeting (Victoria, BC, Canada). We explored six hypothetical case scenarios, each representing a clinically plausible situation that lack a definitive management approach. These scenarios highlight areas where no consensus exists and no single \"correct\" solution has been established.</p><p><strong>Source: </strong>We gathered live poll data about six case scenarios from participants who attended the session and chose to submit a response. The expert panel provided decision analysis of each case.</p><p><strong>Principal findings: </strong>The literature and expert panel suggest that 0.5% isobaric bupivacaine and 0.5% hyperbaric ropivacaine may be appropriate alternatives during shortages of 0.75% hyperbaric bupivacaine. Both combined spinal epidural and standard epidural techniques are effective first choices for rescuing a failed single-shot spinal anesthesia during elective Cesarean delivery. A decision aid may be helpful when converting an epidural for surgical anesthesia. Epidural dexmedetomidine has been used off-label in some centres to enhance the quality of labour analgesia. Nevertheless, owing to limited data in the literature, its routine use for labour analgesia or Cesarean delivery is not currently recommended. In cases of febrile labouring patients, the expert panel advocates initiating antibiotics before epidural placement as a prudent precaution despite the lack of robust contemporary evidence. An obstetric patient with thrombocytopenia may generally undergo neuraxial techniques if the platelet count exceeds 70 × 10<sup>9</sup>·L<sup>-1</sup>. The risks and benefits should be carefully considered when the platelet count is between 50 × 10<sup>9</sup>·L<sup>-1</sup> and 69 × 10<sup>9</sup>·L<sup>-1</sup>, taking into account potential changes in platelet quality due to conditions such as hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. If an accidental dural puncture occurs during an epidural blood patch procedure, a cautious approach would involve abandoning the procedure and reattempting after 24 hr to minimize the risk of blood translocation leading to arachnoiditis. Conversely, a pragmatic approach would involve immediately reattempting the procedure at another level, although there is no consensus on the most appropriate course of action.</p><p><strong>Conclusions: </strong>The range of participant responses highlighted various clinical challenges in obstetric anesthesia where evidence is still limited or inconclusive. Three experts in obstetric anesthesia shared their insights, detailing their decision-making processes and how they would approach each case scenario. They also provided key references, offering valuable take-home messages for anesthesiologists prac","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1047-1055"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318792","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":"Peripartum transverse myelitis with intrathecal catheter placement after unintentional dural puncture.","authors":"Grace Martin, Monica Brundage, Joel Hamstra, Annemaria DeTina, Ibrahim M Nadeem, Kim Wong","doi":"10.1007/s12630-025-03000-7","DOIUrl":"https://doi.org/10.1007/s12630-025-03000-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477989","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":"Association between postoperative body temperature and in-hospital mortality: a nationwide cohort study of 157,028 critically ill patients in Japan.","authors":"Yoshitaka Aoki, Mikio Nakajima, Soichiro Mimuro, Ryo Imai, Takayuki Katsuragawa, Kensuke Kobayashi, Hiromi Kato, Hiroshi Makino, Yoshiki Nakajima","doi":"10.1007/s12630-025-02982-8","DOIUrl":"https://doi.org/10.1007/s12630-025-02982-8","url":null,"abstract":"<p><strong>Purpose: </strong>The association between postoperative body temperature and in-hospital mortality remains unclear. We sought to evaluate this association across all surgical patients and assessed whether it is affected by the indication for surgery (i.e., surgical source control of infection vs other indications).</p><p><strong>Methods: </strong>In a nationwide cohort study, we included critically ill adult patients registered in the Japanese Intensive Care Patient Database who underwent surgery between 2015 and 2021. We evaluated whether the body temperature was associated with in-hospital mortality, and if a differential effect was observed in patients who underwent surgery for source control of infection vs other indications (control group). We categorized the highest body temperatures recorded in the 24 hr after admission following surgery in 0.5-°C intervals and evaluated them using multivariable regression. We conducted a subgroup analysis of patients who underwent surgery for infection control vs other indications. We report the summary estimates using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We examined the association between body temperature category and in-hospital mortality using cubic spline models to assess nonlinear associations.</p><p><strong>Results: </strong>Among 157,028 patients, the overall in-hospital mortality was 2.9%. We observed a U-shaped association of temperature and mortality, with increased mortality at body temperatures < 36.0 °C (OR, 2.15; 95% CI, 1.62 to 2.86) and > 40.0 °C (OR, 1.41; 95% CI, 1.02 to 1.96). We observed the lowest mortality at 37.5-37.9 °C (OR, 0.62; 95% CI, 0.55 to 0.70). Low body temperatures were associated with increased mortality regardless of the presence or absence of infection, while high body temperatures were not associated with increased mortality in patients undergoing surgery for source control of infection.</p><p><strong>Conclusions: </strong>In this large nationwide cohort of critically ill surgical patients in Japan, we observed that low and high postoperative body temperatures were associated with increased in-hospital mortality. Nevertheless, we did not observe the association with high body temperature and increased mortality in the subgroup of patients having undergone surgery for infection control.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310894","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 applications of ChatGPT and other large language models in anesthesiology and critical care: a systematic review.","authors":"Nicolas Daccache, Joe Zako, Louis Morisson, Pascal Laferrière-Langlois","doi":"10.1007/s12630-025-02973-9","DOIUrl":"10.1007/s12630-025-02973-9","url":null,"abstract":"<p><strong>Purpose: </strong>ChatGPT and other large language models (LLMs) have gained immense popularity since their commercial release in 2022, with applications in various sectors including health care. We sought to evaluate their deployment in anesthesiology and critical care in a systematic review. Our aim was to describe the integration of LLMs in the field by showcasing and categorizing their current applications, assessing their performance in patient care, and reviewing application-specific ethical and practical challenges in deployment.</p><p><strong>Methods: </strong>Respecting Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched through PubMed®, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science®, from inception until 1 August 2024. We extracted all papers investigating LLMs in anesthesiology or critical care and reporting results. We segmented the literature into major themes and highlighted key findings and limitations.</p><p><strong>Results: </strong>From 480 retrieved articles, we included 45 papers. The evaluated models (GPT-4, GPT-3.5, Google Bard [now Gemini], LLaMA, and others) showed diverse applications in four segments: intensive care unit, patient education, medical education, and perioperative care. Large language models, especially newer models, are promising in predicting clinical scores, navigating simple clinical scenarios, and managing preoperative anxiety. Their performance remains below the clinician level in predicting outcomes, solving complex clinical scenarios (i.e., airway management), board examinations, and generating patient-directed documents, although newer models performed better than older ones.</p><p><strong>Conclusion: </strong>While LLMs are not yet equipped to fully assist physicians in anesthesiology and critical care, they have significant potential, and their capabilities are rapidly improving. Supervised use for select tasks can streamline patient care. Further trials are warranted as new versions of models become available.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42024567380 ); first submitted 22 July 2024.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"904-922"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310897","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":"Anesthesia management for pediatric intestinal transplantation-a single-centre case series of eleven patients.","authors":"Melody Long, Asad Siddiqui, Yaron Avitzur, Dimitri Parra, Blayne Sayed, Anand Ghanekar, Mark Cattral, Naiyi Sun","doi":"10.1007/s12630-025-02976-6","DOIUrl":"10.1007/s12630-025-02976-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric intestinal transplantation is the main treatment modality for children with intestinal failure who develop severe complications including intestinal failure-associated liver disease, progressive loss of central venous access, and repeated admissions requiring critical care management. We aimed to describe the perioperative management of patients undergoing intestinal transplantation at a tertiary children's hospital between 2012 and 2023, identifying challenges and potential solutions.</p><p><strong>Methods: </strong>We retrospectively reviewed the anesthetic management of 11 children who underwent intestinal transplantation between January 2012 and August 2023. Information collected included preoperative characteristics, intraoperative management, and postoperative outcomes.</p><p><strong>Results: </strong>The predominant diagnosis of intestinal failure was gastroschisis (5/11, 45%), while progressive liver disease (6/11, 55%) was the main indication for transplantation. In our cohort, five patients underwent isolated intestinal transplantation, four underwent multivisceral transplantation, and two had liver and intestine transplantation. Five patients had postreperfusion syndrome, while eight (73%) patients were hypothermic (temperature [T] < 35 °C). Ten patients required at least one vasopressor/inotrope intraoperatively, with the first-line agent being norepinephrine. Three patients were extubated in the operating room; they had a median intensive care unit stay of three days. To date, the 1-year patient and graft survival rates were 91% (10/11).</p><p><strong>Conclusions: </strong>With careful preoperative planning, judicious fluid management, and anticipation of potential hemodynamic instability, including postreperfusion syndrome, our data show that pediatric intestinal transplantation can be performed safely, with improved long-term outcomes compared with previous reports.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"945-953"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250977","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":"Brachial plexus block at the level of the humeral head: a proof-of-concept observational cadaver and clinical study.","authors":"Jean-Pierre Lecoq, Annalinda Ciorra, Marie Renard, Alain Carlier, Pierre Bonnet, Jean-François Fils, Vincent Bonhomme, Emmanuel Guntz","doi":"10.1007/s12630-025-02962-y","DOIUrl":"10.1007/s12630-025-02962-y","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1023-1025"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129526","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":"Regional anesthesia use as a bridge to the provision of medical assistance in dying.","authors":"Catherine Moores, Duncan Maguire, Vincent P Fruci, Tim T H Jen","doi":"10.1007/s12630-025-02956-w","DOIUrl":"10.1007/s12630-025-02956-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1021-1022"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059501","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 magnitude and impact of noise on patient care in a tertiary postanesthesia care unit: an observational study and survey of nursing perspectives.","authors":"Ben T Chen, Wendy H C Song, Anthony Chau, Su-Yin MacDonell","doi":"10.1007/s12630-025-02963-x","DOIUrl":"10.1007/s12630-025-02963-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1026-1027"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112901","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":"Blood pressure management in cardiac surgery: how low can you go?","authors":"Vanja Ristovic, Louise Y Sun","doi":"10.1007/s12630-025-02972-w","DOIUrl":"10.1007/s12630-025-02972-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"877-881"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267964","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":"Postoperative vision loss and visual disturbances in a Canadian provincial administrative data repository.","authors":"Michael T Paillé, Frank Stockl, Thomas C Mutter","doi":"10.1007/s12630-025-02974-8","DOIUrl":"10.1007/s12630-025-02974-8","url":null,"abstract":"<p><strong>Purpose: </strong>Population-based, health administrative database analyses of postoperative vision loss (POVL) have primarily examined International Classification of Diseases (ICD) diagnosis codes for ischemic optic neuropathy (ION) and retinal artery occlusion (RAO) after cardiac and spine surgery. Other nonspecific diagnosis codes describing significant vision loss have been mostly overlooked. We sought to investigate their contribution to the broader epidemiology of POVL after a variety of surgical procedures.</p><p><strong>Methods: </strong>Using administrative data from Manitoba, Canada, we identified hospital admissions where patients underwent spine, cardiac, and other common inpatient and ambulatory surgeries between 1987 and 2017. To avoid misclassifying pre-existing vision loss as POVL, we excluded admissions where patients had ICD diagnosis codes suggestive of pre-existing vision loss in at least 5 years of preoperative data. Postoperative vision loss outcomes included specific diagnosis codes, such as RAO and ION, and nonspecific diagnosis codes for blindness, visual disturbances, and visual field defects.</p><p><strong>Results: </strong>We excluded 158,730 admissions for suspected pre-existing vision loss, including 345 admissions with POVL diagnosis codes. We included 170 POVL cases in 596,241 admissions. Nonspecific diagnosis codes accounted for 140 (82%) cases and were associated with risk factors previously reported for ION, RAO, and cortical blindness. Overall, 24 (14%) cases were RAOs, and privacy restrictions precluded analysis of the remaining 6 (4%) cases. The incidence of RAO and nonspecific diagnosis codes was highest after cardiac and spine surgery. Still, other types of surgery accounted for 87 (62%) of the nonspecific diagnosis code cases and 11 (46%) of the RAO cases.</p><p><strong>Conclusion: </strong>In surgical patients without a history of vision loss, new diagnosis codes for blindness, visual field defects, and visual disturbances other than ION and RAO may represent an important but overlooked aspect of POVL epidemiology.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"923-933"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250979","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}