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

{"title":"Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study.","authors":"Ian M Randall, Darren Au, Daniel Sibley, Andrew G Matthew, Maggie Chen, Priya Brahmbhatt, Calvin Mach, Daniel Sellers, Shabbir M H Alibhai, Hance Clarke, Gail Darling, Stuart A McCluskey, Laura McKinney, Karen Ng, Fayez Quereshy, Keyvan Karkouti, Daniel Santa Mina","doi":"10.1007/s12630-024-02861-8","DOIUrl":"10.1007/s12630-024-02861-8","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service.</p><p><strong>Methods: </strong>We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18 yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation.</p><p><strong>Results: </strong>One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71 yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90 days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received.</p><p><strong>Conclusion: </strong>Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"162-172"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592323","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":"Ambulatory pediatric adenotonsillectomy.","authors":"Calvin Lo, Kimmo Murto","doi":"10.1007/s12630-024-02872-5","DOIUrl":"10.1007/s12630-024-02872-5","url":null,"abstract":"<p><strong>Purpose: </strong>This Continuing Professional Development module aims to help the general anesthesiologist recognize common pitfalls in ambulatory pediatric adenotonsillectomy and perform appropriate risk stratification, analgesic management, and disposition planning.</p><p><strong>Principal findings: </strong>Pediatric adenotonsillectomy is a widely performed procedure. An updated approach to preoperative risk assessment of commonly associated comorbidities allows the practitioner to anticipate and plan for adverse events. Risks include obstructive sleep apnea, airway hyperresponsiveness, asthma, recent upper respiratory tract infections, obesity, and young age. Risk-modifying interventions consist of delaying surgery, preoperative bronchodilator therapy, recognizing the limitations of volatile agents, and referral of high-risk patients to specialized pediatric centres. Appropriate selection of intraoperative and postoperative analgesia can optimize patient comfort, avoid readmission, and limit adverse events such as postoperative hemorrhage or respiratory depression.</p><p><strong>Conclusions: </strong>Ambulatory pediatric adenotonsillectomy is a common surgical procedure, performed both in the community as well as tertiary care pediatric centres. To optimize outcomes in this heterogenous patient population, anesthesiologists must risk stratify and anticipate perioperative respiratory adverse events.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"181-207"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840363","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":"Guidelines to the Practice of Anesthesia-Revised Edition 2025.","authors":"Gregory R Dobson, Anthony Chau, Justine Denomme, Samantha Frost, Giuseppe Fuda, Conor Mc Donnell, Robert Milkovich, Andrew D Milne, Kathryn Sparrow, Yamini Subramani, Christopher Young","doi":"10.1007/s12630-024-02906-y","DOIUrl":"10.1007/s12630-024-02906-y","url":null,"abstract":"<p><strong>Overview: </strong>The Guidelines to the Practice of Anesthesia-Revised Edition 2025 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine the publication and distribution of the Guidelines. The Guidelines are subject to revision and updated versions are published annually. The Guidelines supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"15-63"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124231","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 prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study.","authors":"Kenny Kwon Ho Lee, Saima Siddiqui, Gillian Heller, Jonathan Clark, Amanda Johns, Jonathan Penm","doi":"10.1007/s12630-024-02819-w","DOIUrl":"10.1007/s12630-024-02819-w","url":null,"abstract":"<p><strong>Purpose: </strong>The management of pain following cancer-related surgeries involves the use of opioid analgesics. Nevertheless, there is little evidence characterizing the utility and prescription patterns of opioids after these procedures. Our primary aim was to identify patients from three types of cancer surgery who were overprescribed with opioids. The secondary aim was to determine the potential predictors of overprescribing in the same period.</p><p><strong>Methods: </strong>We conducted the study at a single cancer referral hospital. Opioid-naïve patients with breast, gynecologic, or head and neck cancer were studied. Patients were considered opioid-naïve if they had a history of opioid use ≤ 30 mg oral morphine equivalent daily dose for less than seven days in the preceding three months before surgery. We recruited eligible participants by convenience sampling on the wards until at least 102 patients were included in the final analysis. After discharge, we followed up on the participants on day 7 via telephone using a structured proforma including questions to identify the last date and amount of opioid dose taken. The equivalent days of opioid use were calculated by their 24-hr use before discharge and the number of doses prescribed for discharge. Our primary outcome was the prevalence of overprescribing in the three surgical specialties defined as the number of patients taking less than 50% of discharge opioids within the first seven days after discharge. We examined the predictors on incidents of overprescribing using multivariable Poisson regression as the secondary outcome.</p><p><strong>Results: </strong>We recruited 119 patients, and 107 patients were included in the final analysis. There were 59/107 (55%) patients found to be overprescribed with opioids. At discharge, they exhibited lower mean numerical rating scale pain scores, lower mean pain severity scores, higher equivalent days of opioids prescribed, and not used opioids in the last 24 hr before discharge. The incidence of overprescribing was 2.4 times greater for patients prescribed with opioids without 24-hr opioid use (relative risk [RR], 2.38; 95% confidence interval [CI], 1.30 to 4.35; P = 0.005). Similarly, the incidence of overprescribing was 1.7 times greater for patients who had opioids 24 hr before discharge and were supplied with opioids for five equivalent days or more at the time of discharge (RR, 1.67; 95% CI, 1.09 to 2.56; P = 0.02).</p><p><strong>Conclusion: </strong>Our study shows that the majority of recruited patients undergoing breast, gynecologic, or head and neck cancer surgery were overprescribed opioids. Individualized assessments on patients' 24-hr opioid requirements before discharge and supplying for less than five days are important considerations to reduce overprescribing in opioid-naïve patients after cancer surgery.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"132-141"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972338","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":"Anesthetic management of a patient with VACTERL association after failed spinal block for Cesarean delivery.","authors":"Alexandra O MacNeil, Michael Smyth, Simon Ash, Allana Munro","doi":"10.1007/s12630-024-02905-z","DOIUrl":"10.1007/s12630-024-02905-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"214-216"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061590","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 gender gap in academic anesthesiology and critical care medicine: a systematic review.","authors":"Alessandro De Cassai, Francesca Rubulotta, Marko Zdravkovic, Sindi Mustaj, Joana Berger-Estilita","doi":"10.1007/s12630-024-02897-w","DOIUrl":"10.1007/s12630-024-02897-w","url":null,"abstract":"<p><strong>Purpose: </strong>Gender disparities in academia are a growing concern, impacting various disciplines, including health care. We aimed to investigate gender-based differences in academic performance, leadership roles, and academic distinction within anesthesiology and critical care medicine.</p><p><strong>Source: </strong>We conducted electronic searches for relevant articles published in PubMed, CENTRAL, Scopus, Web of Science, Embase, Education Resources Information Center, PsychINFO, and ProQuest from database inception until 23 June 2024. Three researchers conducted blinded assessments using predefined inclusion and exclusion criteria, with discrepancies resolved through discussion. We reported descriptive statistics for quantitative data from the included research articles.</p><p><strong>Principal findings: </strong>Our initial screening identified 37,311 studies, 71 of which met the specified inclusion criteria and were therefore evaluated. Analysis of academic publishing trends revealed a gradual increase in the proportion of women as coauthors, first authors (in anesthesiology, the increase ranged from 7% to 17%, and in critical care medicine the increase was 4%), last authors, and corresponding authors. Despite these improvements, women remain underrepresented on the editorial boards of top journals. Although an increase in the representation of women as abstract presenters at conferences was noted, gender disparities persist in senior authorship roles.</p><p><strong>Conclusion: </strong>Gender disparities are evident in academic leadership positions within anesthesiology and critical care medicine, with few women holding editor-in-chief positions and underrepresentation of women on editorial boards. We observed similar gaps in departmental and scientific society leadership roles. The distribution of awards, prizes, and grants remains skewed, indicating persistent gender imbalances in academic distinction. While progress has been made in certain areas, substantial gaps persist in scholarly publishing, leadership, and academic distinction.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022377524 ); first submitted 20 November 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"75-90"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873619","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":"Intraoperative hypoglycemia among adults with intraoperative glucose measurements: a cross-sectional multicentre retrospective cohort study.","authors":"Matthew J Griffee, Aleda M Leis, Nathan L Pace, Nirav Shah, Sathish S Kumar, Graciela B Mentz, Lori Q Riegger","doi":"10.1007/s12630-024-02816-z","DOIUrl":"10.1007/s12630-024-02816-z","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative hypoglycemia is presumed to be rare, but generalizable multicentre incidence and risk factor data for adult patients are lacking. We used a multicentre registry to characterize adults with intraoperative hypoglycemia and hypothesized that intraoperative insulin administration would be associated with hypoglycemia.</p><p><strong>Methods: </strong>We conducted a cross-sectional retrospective multicentre cohort study. We searched the Multicenter Perioperative Outcomes Group registry to identify adult patients with intraoperative hypoglycemia (glucose < 3.3 mmol·L^-1 [< 60 mg·dL^-1]) from 1 January 2015 to 31 December 2019. We evaluated characteristics of patients with intraoperative glucose measurements and with intraoperative hypoglycemia.</p><p><strong>Results: </strong>Of 516,045 patients with intraoperative glucose measurements, 3,900 (0.76%) had intraoperative hypoglycemia. Diabetes mellitus and chronic kidney disease were more common in the cohort with intraoperative hypoglycemia. The odds of intraoperative hypoglycemia were higher for the youngest age category (18-30 yr) compared with the odds for every age category above 40 yr (odds ratio [OR], 1.57-3.18; P < 0.001), and were higher for underweight or normal weight patients compared with patients with obesity (OR, 1.48-2.53; P < 0.001). Parenteral nutrition was associated with lower odds of hypoglycemia (OR, 0.23; 95% confidence interval [CI], 0.11 to 0.47; P < 0.001). Intraoperative insulin use was not associated with hypoglycemia (OR, 0.996; 95% CI, 0.91 to 1.09; P = 0.93).</p><p><strong>Conclusion: </strong>In this large cross-sectional retrospective multicentre cohort study, intraoperative hypoglycemia was a rare event. Intraoperative insulin use was not associated with hypoglycemia.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"119-131"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977344","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":"Guest Reviewers.","authors":"","doi":"10.1007/s12630-024-02892-1","DOIUrl":"https://doi.org/10.1007/s12630-024-02892-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775099","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":"Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey.","authors":"Yuqi Gu, Marshall Tenenbein, Linda Korz, Jason W Busse, Michelle Chiu","doi":"10.1007/s12630-024-02720-6","DOIUrl":"10.1007/s12630-024-02720-6","url":null,"abstract":"<p><strong>Purpose: </strong>Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs.</p><p><strong>Methods: </strong>We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020. The survey consisted of questions pertaining to the characteristics of the simulation centres, their faculty, learners, curriculum, and assessment processes.</p><p><strong>Results: </strong>All 17 residency training programs participated in the survey and reported large variability in the number and formal training of simulation faculty and in content delivery. Five programs (29%) did not provide faculty recognition for curriculum design and running simulation sessions. Most programs offered one to four simulation sessions per academic year for each year of residency. All programs offered mannequin-based and part-task trainers for teaching technical and nontechnical skills. Fourteen programs (82%) offered interprofessional and interdisciplinary simulation sessions, and ten programs (59%) did not include in situ simulation training. Commonly reported barriers to faculty involvement were lack of protected time (12 programs, 71%), lack of financial compensation (ten programs, 59%), and lack of appreciation for SBME (seven programs, 41%).</p><p><strong>Conclusion: </strong>Large variability exists in the delivery of SBME in Canadian anesthesiology residency simulation programs, in part because of differences in financial/human resources and educational content. Future studies should explore whether training and patient outcomes differ between SBME programs and, if so, whether additional standardization is warranted.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1725-1734"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061385","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":"David Richard Bevan, MA, MB, BChir (Cantab) with Distinction, MRCP (London), FRCA, RCPSC, FRCPC.","authors":"Robert Byrick, Beverley A Orser","doi":"10.1007/s12630-024-02796-0","DOIUrl":"10.1007/s12630-024-02796-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1786-1788"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478054","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}