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

{"title":"Metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a scoping review.","authors":"Janny X C Ke, Kathryn Sparrow, Mindy A Smith, Kang Mu Yoo, May-Sann Yee, Louise Y Sun, W Scott Beattie, Edlyn Lim, Matthias Görges","doi":"10.1007/s12630-025-02943-1","DOIUrl":"10.1007/s12630-025-02943-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this scoping review was to consolidate a list of metrics that can be used to measure quality in anesthesiology, perioperative medicine, and acute pain management in Canada.</p><p><strong>Methods: </strong>We included English-language full-text articles involving metrics (including patient-reported outcome and patient-reported experience measures, quality and safety indicators, and practice standards) for adults aged 18 yr and older undergoing inpatient non-cardiac surgery requiring an anesthesiologist. We searched MEDLINE®, Embase, CINAHL, Web of Science™, the Cochrane Database of Systematic Reviews, and grey literature to find articles on the topic from January 2015 to March 2022. In addition, we contacted 64 Canadian hospitals for existing anesthesia quality assurance and improvement metrics; they responded from June to October 2022. Two independent reviewers performed screening and data extraction. We grouped and condensed similar candidate metrics using thematic analysis.</p><p><strong>Results: </strong>We assessed 4,493 publications, of which 63 met the inclusion criteria. We extracted 662 candidate metrics and consolidated them into 94 distinct metrics. Metrics reflected themes of perioperative management (n = 47), safety and standards (n = 23), patient-centredness (n = 11), intraoperative anesthetic care (n = 5), perioperative team leadership (n = 4), and efficiency (n = 4). Metrics spanned all quality-of-care categories (process, outcome, and structure) and perioperative phases but were limited by poor supporting evidence.</p><p><strong>Conclusions: </strong>We consolidated a list of 94 metrics that can be used to evaluate the quality of anesthesia care. Further work will require verification of feasibility and validity prior to adoption, with operationalization of these metrics into practical indicators that are measurable and comparable.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"822-854"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112899","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":"Concerns with inflation line position in preformed nasal endotracheal tubes-proximal or distal?","authors":"Banupriya Ravichandrane, Janani Vijayasundaram, Santhosh Arulprakasam, Priya Rudingwa","doi":"10.1007/s12630-025-02953-z","DOIUrl":"10.1007/s12630-025-02953-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"860-861"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062585","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":"A standardized set of metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a multidisciplinary modified Delphi study.","authors":"Janny X C Ke, Mindy A Smith, Kathryn Sparrow, Nicholas West, May-Sann Yee, Kang Mu Yoo, Louise Y Sun, W Scott Beattie, Matthias Görges","doi":"10.1007/s12630-025-02951-1","DOIUrl":"10.1007/s12630-025-02951-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to develop a consensus list of metrics to measure the quality of care in anesthesia, perioperative care, and acute pain management in Canada.</p><p><strong>Methods: </strong>We sought to conduct a modified Delphi study involving a multidisciplinary panel of perioperative health care professionals (anesthesiologists, surgeons, nurses, internal medicine and family medicine physicians, and hospital administrators), patients, and caregivers. Participants reviewed a candidate list of metrics synthesized from a previous scoping review and performed three rounds of independent iterative scoring and feedback to achieve consensus. In round 3, we asked participants to identify priority metrics to include in a list of core metrics, and we also asked health care professionals to assess the feasibility of implementing each metric.</p><p><strong>Results: </strong>There were 80 participants (49 health care professionals, 22 patients, and 9 caregivers) who completed at least one round of voting, with 56 completing all three rounds. The panel achieved consensus on 87 metrics, of which they deemed 33 to be priority core metrics. The health care professional and patient/caregiver subgroups differed in prioritizing core metrics. Most participants voted airway complications, no residual neuromuscular blockade, difficult airway documentation, complication or critical incident reporting, and complications from pain management the highest priority metrics. Most health care professional participants considered the core metrics to be already measured, currently feasible, or likely feasible by 2025.</p><p><strong>Conclusions: </strong>A multidisciplinary panel developed a list of metrics for measuring the quality of anesthesiology care in Canada. Many metrics require further refinement and validation, and future research is required to guide the measurement techniques and implementation approaches.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"698-720"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112858","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":"Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review.","authors":"Sandra Lee, Nehal Islam, Karim S Ladha, Mark C Bicket, Duminda N Wijeysundera","doi":"10.1007/s12630-025-02925-3","DOIUrl":"10.1007/s12630-025-02925-3","url":null,"abstract":"<p><strong>Purpose: </strong>Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.</p><p><strong>Source: </strong>We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.</p><p><strong>Principal findings: </strong>Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I² = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I² = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I² = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.</p><p><strong>Conclusions: </strong>Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"721-737"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053898","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":"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}