Canadian Journal of Anesthesia最新文献

{"title":"Beliefs of physician directors on the management of devastating brain injuries at the Canadian emergency department and intensive care unit interface: a national site-level survey","authors":"Piotr Wtorek, Matthew J. Weiss, Jeffrey M. Singh, Carmen Hrymak, Alecs Chochinov, Brian Grunau, Bojan Paunovic, Sam D. Shemie, Jehan Lalani, Bailey Piggott, James Stempien, Patrick Archambault, Parisa Seleseh, Rob Fowler, Murdoch Leeies","doi":"10.1007/s12630-024-02749-7","DOIUrl":"https://doi.org/10.1007/s12630-024-02749-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, <i>n</i> = 78), but 63% of these (<i>n</i> = 62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, <i>n</i> = 48) and believed that an ICU stay is required to improve confidence (99%, <i>n</i> = 97). Most (96%, <i>n</i> = 94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140597495","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":"Postoperative thrombotic events following major surgery in patients with a history of COVID-19: a retrospective cohort analysis of commercially insured beneficiaries in the USA","authors":"","doi":"10.1007/s12630-023-02639-4","DOIUrl":"https://doi.org/10.1007/s12630-023-02639-4","url":null,"abstract":"<h3>Abstract</h3> <span> <h3>Purpose</h3> <p>We sought to evaluate the synergistic risk of postoperative thrombosis in patients with a history of COVID-19 who undergo major surgery. Major surgery and SARS-CoV-2 infection are independently associated with an increased risk of thrombosis, but the magnitude of additional risk beyond surgery conferred by a COVID-19 history on the development of perioperative thrombotic events has not been clearly elucidated in the literature.</p> </span> <span> <h3>Methods</h3> <p>We conducted a retrospective cohort study among commercially insured adults in the USA from March 2020 to June 2021 using the Optum Labs Data Warehouse (OLDW), a longitudinal, real-world data asset containing deidentified administrative claims and electronic health records. We compared patients with prior COVID-19 who underwent surgery with control individuals who underwent surgery without a COVID-19 history and with control individuals who did not undergo surgery with and without a COVID-19 history. We assessed the interaction of surgery and previous COVID-19 on perioperative thrombotic events (venous thromboembolism and major adverse cardiovascular events) within 90 days using multivariable logistic regression and interaction analysis.</p> </span> <span> <h3>Results</h3> <p>Two million and two-hundred thousand eligible patients were identified from the OLDW. Patients in the surgical cohorts were older and more medically complex than nonsurgical population controls. After adjusting for confounders, only surgical exposure—not COVID-19 history—remained associated with perioperative thrombotic events (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 3.81 to 4.36). The multiplicative interaction term (aOR, 1.25; 95% CI, 0.96 to 1.61) and the synergy index (0.76; 95% CI, 0.56 to 1.04) suggest minimal effect modification of prior COVID-19 on surgery with regards to overall thrombotic risk.</p> </span> <span> <h3>Conclusions</h3> <p>We found no evidence of synergistic thrombotic risk from previous COVID-19 in patients who underwent selected major surgery relative to the baseline thrombotic risk from surgery alone.</p> </span>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684091","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":"Hip fracture analgesia: how far ahead are we?","authors":"Reva Ramlogan, Vishal Uppal","doi":"10.1007/s12630-023-02664-3","DOIUrl":"https://doi.org/10.1007/s12630-023-02664-3","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138684020","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":"Improving the quality and quantity of narrative feedback to anesthesiology residents: a program evaluation study","authors":"Eugene Choo, Henry Bi, Mary Ellen Walker, Jennifer O’Brien","doi":"10.1007/s12630-023-02680-3","DOIUrl":"https://doi.org/10.1007/s12630-023-02680-3","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629779","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":"Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care","authors":"Marjorie Hammond, Vivian Law, Keelia Quinn de Launay, Jeanette Cooper, Elikem Togo, Kyle Silveira, David MacKinnon, Nick Lo, Sarah E. Ward, Stephen K. W. Chan, Sharon E. Straus, Christine Fahim, Camilla L. Wong","doi":"10.1007/s12630-023-02665-2","DOIUrl":"https://doi.org/10.1007/s12630-023-02665-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% <i>vs</i> 65%) and a decrease in the median time to administration (1.63 <i>vs</i> 0.81 days).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.</p>","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138629591","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":"Breech presentation: RCT of IV remifentalanil for ECV attempt","authors":"A. Macarthur, S. Gagnon, J. Kingdom, L. Tureanu, J. Dasan, K. Downey","doi":"10.1007/BF03023229","DOIUrl":"https://doi.org/10.1007/BF03023229","url":null,"abstract":"","PeriodicalId":9472,"journal":{"name":"Canadian Journal of Anesthesia","volume":"40 1","pages":"A191"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84986674","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}