Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study Clinical Trial
Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study.
Most deaths in intensive care units (ICUs) follow a withdrawal of life support (LS). Evaluation of this process including the related perspectives of grieving family members is integral to improvement of palliation in the ICU. ⋯ Most patients were perceived by family members to die in comfort during a withdrawal of LS. Perceptions of patient comfort and drug use in the hours before death were not associated with the mode or sequence of withdrawal of LS, or the time to death.
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To review the effects of maternal anesthesia and analgesia on the fetus and newborn. ⋯ The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn.
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Comparative Study
Simple changes can improve conduct of end-of-life care in the intensive care unit.
To describe changes to the conduct of withdrawal of life support (WOLS) in two teaching hospital tertiary care medical surgical intensive care units (ICUs) in a single centre over two distinct time periods. ⋯ Simple changes to the process of WOLS can improve conduct of end-of-life care in the ICU.
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Case Reports
Spontaneous recovery from a spinal epidural hematoma with atypical presentation in a nonagenarian.
Spinal epidural hematoma following epidural anesthesia is extraordinarily rare in association with low-dose sc heparin, and the prognosis for neurologic recovery without rapid surgical decompression poor. We report a case of spinal epidural hematoma in a nonagenarian who received low-dose sc unfractionated heparin postoperatively in accordance with standard guidelines, presented with no back pain, and made full neurologic recovery without surgical intervention. ⋯ Complete neurologic recovery from flaccid paralysis following spinal epidural hematoma occurred without surgical decompression in a nonagenarian. Low-dose sc heparin may be a greater risk factor for spinal epidural hematoma than previously assumed, and the absence of back pain does not rule out this diagnosis.