Canadian Journal of Anesthesia最新文献

{"title":"Laparoscopic cholecystectomy in a patient with Fontan circulation","authors":"Rattanaporn Tankul, Becky Rodrigues, Laura V. Duggan","doi":"10.1007/s12630-024-02833-y","DOIUrl":"https://doi.org/10.1007/s12630-024-02833-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Fontan circulation is created when a baby is born with only one functioning cardiac ventricle. A series of surgeries are performed to allow the ventricle to provide oxygenated blood to the systemic circulation and to create passive flow of venous blood to the pulmonary circulation via a conduit. Laparoscopic surgery poses several hemodynamic challenges to a patient with Fontan physiology attributable to carbon dioxide insufflation, positive pressure ventilation, and reverse Trendelenburg positioning.</p><h3 data-test=\"abstract-sub-heading\">Clinical features</h3><p>A 39-yr-old male with a Fontan physiology was referred to our tertiary care centre because of repeated bouts of cholecystitis requiring a percutaneous drain and now elective laparoscopic cholecystectomy. Because of repeated cardiac surgeries, the patient also had complete heart block and was pacemaker dependent. We placed an arterial catheter prior to induction of general anesthesia with tracheal intubation. Transesophageal echocardiography allowed for real-time intraoperative assessment of venous blood flow through the patient’s extracardiac diversion system throughout the surgery. This information was used to guide management and determine circulation tolerance during the various stages of laparoscopy. Inhaled milrinone resulted in the shunt fraction returning to the patient’s baseline. Intraperitoneal pressure was kept below 10 mm Hg, and systemic blood pressure was supported with a low-dose norepinephrine infusion.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Intraoperative transesophageal echocardiography is a useful monitoring device during laparoscopic surgery when a patient has Fontan circulation. Knowing how to administer inhaled milrinone is a useful skill to decrease the shunt fraction through a patient’s conduit, increasing pulmonary blood flow while avoiding hypotension.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ineffectiveness of a point-of-care waste anesthetic gas recovery system.","authors":"Stephan Williams,Gabriel Paquin-Lanthier","doi":"10.1007/s12630-024-02842-x","DOIUrl":"https://doi.org/10.1007/s12630-024-02842-x","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Charcot–Marie–Tooth disease and peripheral nerve blocks: a retrospective cohort study of 25 patients","authors":"Sara Amaral, Salim Zerriny, Walid Alrayashi","doi":"10.1007/s12630-024-02832-z","DOIUrl":"https://doi.org/10.1007/s12630-024-02832-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Charcot–Marie–Tooth (CMT) disease is an inherited neurologic disorder characterized by progressive peripheral neuropathies. The use of peripheral nerve blocks (PNB) in patients with CMT disease has been controversial because of concerns about exacerbating existing neurologic impairments and the “double hit” hypothesis. We aimed to assess the use of PNB in pediatric patients with CMT disease undergoing orthopedic surgery to address the limited data available in the literature on this topic.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this retrospective cohort study, we included all pediatric patients with CMT disease scheduled for orthopedic surgery receiving PNB at our centre. All of the patients had preoperative neurologic exams and received one or more ultrasound-guided regional anesthesia techniques. Data extracted included details of anesthesia technique, surgical procedure, opioid consumption, and pain scores during the first three postoperative days. We also reviewed any complications such as neurologic deficits and local anesthetic toxicity. We used descriptive statistics to summarize the findings.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We included 25 patients, 14 of whom (56%) presented with pre-existing neurologic deficits, primarily in the lower extremities. Postoperative assessments revealed no new neurologic impairments in 24/25 (96%) patients, with only one patient experiencing a nerve injury possibly related to the surgical procedure. Opioid consumption was low in the postanesthesia care unit and on the day of surgery. No additional complications were noted in the first 72 hr after surgery.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Despite concerns, PNB showed favourable outcomes in a pediatric cohort with CMT disease, with low opioid consumption and pain scores and minimal complications during follow-up. These findings match previous reports of adult patients with CMT disease and suggest that the benefits of PNB may outweigh the perceived risks in pediatric patients with CMT disease.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution and formalization of anesthesia assistant roles across Canada","authors":"Homer Yang, Judith Littleford, Beverley A. Orser, Marco Zaccagnini, Hamed Umedaly, Monica Olsen, Mateen Raazi, Kenneth LeDez, J. Adam Law, Mitch Giffin, Jason Foerster, Brandon D’Souza, Irfaan Ali, Derek Dillane, Chris Christodoulou, Natalie Buu, Rob Bryan","doi":"10.1007/s12630-024-02812-3","DOIUrl":"https://doi.org/10.1007/s12630-024-02812-3","url":null,"abstract":"&lt;h3 data-test=\"abstract-sub-heading\"&gt;Purpose&lt;/h3&gt;&lt;p&gt;The purpose of this Special Article is to document the evolution of the anesthesia assistant (AA) profession in Canada and summarize AA practice at Canadian institutions as it exists today, five decades after Quebec and 15 years after most other provinces formalized AA practice.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Source&lt;/h3&gt;&lt;p&gt;Through the Management Committee of the Association of Canadian University Departments of Anesthesia (ACUDA), we conducted a purposeful sampling of all ACUDA chairs or their delegates. We requested the following data: history of AAs becoming a reality in their particular province or region; potential recruitment pools; training programs and curricula; pathway to credentialing; funding, pay, retention, recruitment, and status of union representation; and metrics.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Principal findings&lt;/h3&gt;&lt;p&gt;Data were provided by 19 institutions in 8 provinces: Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Given the different health care governance structures across the provinces, AA roles vary in terms of its associated technical, clinical, and educational responsibilities. The role of AAs in supporting anesthesia care through equipment maintenance and assistance with airway management, resuscitation, and administration of regional anesthesia seems to be well established, as is their role in providing brief intraoperative relief for anesthesiologists during a stable period of anesthesia. Anesthesia assistant duties continue to evolve, becoming more aligned with the specific institution and less dependent on the supervising anesthesiologist. Apart from the initial metrics collected during the Ontario ACT implementation pilot projects, we are not aware of any formal metrics, current or ongoing, being collected across Canada, related to either patient safety events or perioperative efficiency.&lt;/p&gt;&lt;h3 data-test=\"abstract-sub-heading\"&gt;Conclusions&lt;/h3&gt;&lt;p&gt;This compilation of pan-Canadian AA data shows diverse models of practice and highlights the value to patients and the health care system as a whole of incorporating these allied professionals into the anesthesia care team (ACT). The present findings allow us to offer suggestions for consideration during discussions of retention, recruitment, program expansion, and cross-country collection of metrics and other data. We conclude by making six recommendations: 1. recognize that implementation of ACTs is a key element in solving the challenge of an increasing surgical backlog; 2. develop, or facilitate the development of, metrics and increase data-sharing nationally to enable health care authorities to better understand the importance of AAs in patient safety and perioperative efficiency; 3. develop and implement funding strategies to lower the barriers to AA training such as hospital-sponsored positions, ongoing salary support, and return-of","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of halothane is still important in some parts of the world.","authors":"Adrian W Gelb,Eric Vreede","doi":"10.1007/s12630-024-02836-9","DOIUrl":"https://doi.org/10.1007/s12630-024-02836-9","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call to action-anesthesia assistants in Canada.","authors":"Lucie Filteau,Roanne Preston,Katherine M Seligman","doi":"10.1007/s12630-024-02813-2","DOIUrl":"https://doi.org/10.1007/s12630-024-02813-2","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of postintensive care syndrome in a prospective cohort of survivors of COVID-19 critical illness: a 12-month follow-up study","authors":"Sol Fernández-Gonzalo, Guillem Navarra-Ventura, Gemma Gomà, Marta Godoy-González, Laia Oliveras, Natalia Ridao Sais, Cristina Espinal, Cristina Fortià, Candelaria De Haro, Ana Ochagavía, Merce Jodar, Carles Forné, Verónica Santos-Pulpon, Leonardo Sarlabous, Neus Bacardit, Carles Subirà, Rafael Fernández, Diego Palao, Oriol Roca, Lluís Blanch, Josefina López-Aguilar","doi":"10.1007/s12630-024-02811-4","DOIUrl":"https://doi.org/10.1007/s12630-024-02811-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Studies integrating an exhaustive longitudinal long-term follow-up of postintensive care syndrome (PICS) in critically ill COVID-19 survivors are scarce. We aimed to 1) describe PICS-related sequelae over a 12-month period after intensive care unit (ICU) discharge, 2) identify relevant demographic and clinical factors related to PICS, and 3) explore how PICS-related sequelae may influence health-related quality of life (HRQoL) in critically ill COVID-19 survivors.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a prospective cohort study in adult critically ill survivors of SARS-CoV-2 infection that did or did not need invasive mechanical ventilation (IMV) during the COVID-19 pandemic in Spain (March 2020 to January 2021). We performed a telemedicine follow-up of PICS-related sequelae (physical/functional, cognitive, and mental health) and HRQoL with five data collection points. We retrospectively collected demographic and clinical data. We used multivariable mixed-effects models for data analysis.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We included 142 study participants in the final analysis, with a median [interquartile range] age of 61 [53–68] yr; 35% were female and 59% needed IMV. Fatigue/dyspnea, pain, impaired muscle function, psychiatric symptomatology and reduced physical HRQoL were prominent sequelae early after ICU discharge. Over the 12-month follow-up, functionality and fatigue/dyspnea improved progressively, while pain remained stable. We observed slight fluctuations in anxiety symptoms and perception of cognitive deficit, whereas posttraumatic stress disorder (PTSD) and depressive symptoms improved, with a mild rebound at the end of the follow-up. Female sex, younger age, and the need for IMV were risk factors for PICS, while having higher cognitive reserve was a potential protective factor. Physical HRQoL scores showed a general improvement over time, whereas mental HRQoL remained stable. Shorter ICU stay, better functionality, and lower scores for fatigue/dyspnea and pain were associated with better physical HRQoL, while lower scores for anxiety, depression, and PTSD were associated with better mental HRQoL.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Postintensive care syndrome was common in COVID-19 critical illness survivors and persisted in a significant proportion of patients one year after ICU discharge, impacting HRQoL. The presence of risk factors for PICS may identify patients who are more likely to develop the condition and who would benefit from more specific and closer follow-up after ICU admission.</p><h3 data-test=\"abstract-sub-heading\">Study registration</h3><p>ClinicalTrials.gov (NCT04422444); first submitted 9 June 2020.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The connection between Dr. Harold Griffith and Richard Gill: new insights into the history of curare use in anesthesia from previously unknown correspondence","authors":"Noha Elsherbini, Steven B. Backman","doi":"10.1007/s12630-024-02750-0","DOIUrl":"https://doi.org/10.1007/s12630-024-02750-0","url":null,"abstract":"<p>Dr. Harold R. Griffith and Richard C. Gill figure prominently in curare’s storied history. In 1938, Gill returned from an Amazon expedition with over 11 kg of curare. After scientists at E. R. Squibb &amp; Sons identified a plant source (<i>Chondrodendron tomentosum</i>) and isolated a stable extract of uniform potency (marketed as Intocostrin), Griffith administered it in the operating room in 1942, showing its advantages and safety. In this article, we report correspondence between Griffith and Gill, heretofore not appreciated, after finding a letter from Gill to Griffith affixed to the inside back cover of a book contained in a private library.</p><p>Following the serendipitous discovery of this previously unknown letter, we interrogated archived correspondence and material associated with Griffith and Gill in the Osler Library History of Medicine (McGill University, Montreal, QC, Canada), Arthur E. Guedel Memorial Anesthesia Center (University of California, San Francisco, CA, USA), the Wood Library Museum of Anesthesiology (Schaumburg, IL, USA), the Anaesthesia Heritage Centre (London, UK), and the Wellcome Collection (London, UK). Further, we searched for information on the historical background of curare via Google, Ovid MEDLINE, Adam Matthew Explorer, Project MUSE, and Latin American History databases.</p><p>We found seven letters. The first is a letter to Gill dated 2 June 1943 (Wood Library) and an earlier draft dated 2 June 1943 (Osler Library). In this letter, Griffith praises Gill’s success in procuring curare and informs him of its usefulness in anesthesia. The second letter is a letter from Gill to Griffith dated 10 July 1943 (found affixed to a book that was donated to the Osler Library). In this letter, Gill congratulates Griffith and claims he foresaw curare’s use in the operating room and predicts its routine use to produce muscle relaxation during surgery. The third letter is a letter to Griffith dated 17 April 1945 (Osler Library). In this correspondence, Gill disputes Squibb’s claim that curare derives solely from <i>C. tomentosum</i> and asks Griffith to retract published statements on this point. The fourth letter is a letter to Gill dated 25 April 1945 (Osler Library), in which Griffith declines to retract and emphasizes that Gill receive credit for making curare available to medicine. The fifth letter is a letter to Griffith dated 24 May 1945 (Osler Library), in which Gill accepts Griffith’s retraction decision and indicates negotiations with another drug company. The sixth letter is a letter to Griffith dated 11 July 1945 (Osler Library), in which Gill requests anesthesia morbidity and mortality data and continues to remonstrate against Squibb’s claim of curare’s botanical source. The seventh and final letter is to Gill and dated 21 July 1945 (Osler Library). In this letter, Griffith indicates the lack of morbidity and mortality information, mentions a new Squibb curare product, and cites data suggesting curare may e","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology","authors":"Glenio B. Mizubuti, Sarah Maxwell, Sergiy Shatenko, Heather Braund, Rachel Phelan, Anthony M.-H. Ho, Nancy Dalgarno, Hailey Hobbs, Adam Szulewski, Faizal Haji, Ramiro Arellano","doi":"10.1007/s12630-024-02746-w","DOIUrl":"https://doi.org/10.1007/s12630-024-02746-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (<i>n</i> = 25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada’s National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with &lt; 50% agreement, revised those with 50–79% agreement based upon feedback provided, and maintained unrevised those items with ≥ 80% agreement.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140613948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of different routes of acetaminophen administration for postoperative pain in children: a systematic review and network meta-analysis","authors":"Danilo Osorio, Diana Maldonado, Koen Rijs, Caroline van der Marel, Markus Klimek, Jose A. Calvache","doi":"10.1007/s12630-024-02760-y","DOIUrl":"https://doi.org/10.1007/s12630-024-02760-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30 days and 17 yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous <i>vs</i> rectal routes of administration of acetaminophen (difference in means, −0.28; 95% confidence interval [CI], −0.62 to 0.06; very low certainty of the evidence) and intravenous <i>vs</i> oral acetaminophen (difference in means, −0.60; 95% CI, −1.20 to 0.01; low certainty of the evidence). For the comparison of oral <i>vs</i> rectal routes, we found evidence favouring the oral route (difference in means, −0.88; 95% CI, −1.44 to −0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question.</p><h3 data-test=\"abstract-sub-heading\">Study registration</h3><p>PROSPERO (CRD42021286495); first submitted 19 November 2021.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140614057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}