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

{"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":"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":"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}

{"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":"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}