Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Target-achieved propofol concentration during on-pump cardiac surgery: a pilot dose-finding study.
Propofol concentrations that produce laboratory-based cardioprotective effects are generally greater than those produced under routine anesthesia during cardiac surgery. It is unknown whether experimental cardioprotective propofol concentrations can routinely be achieved during cardiopulmonary bypass (CPB) using continuous infusion. ⋯ An infusion rate of 120 microg x kg(-1) x min(-1) is clinically practical and capable of achieving experimental cardioprotective propofol concentrations at reperfusion.
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Randomized Controlled Trial Comparative Study
Supplemental oxygen does not prevent postoperative nausea and vomiting after gynecological laparoscopy.
Postoperative nausea and vomiting are among the most common and distressing side effects of general anesthesia. Supplemental intraoperative 80% oxygen reduces postoperative nausea and vomiting following open and laparoscopic abdominal surgery. However, this benefit has not been observed in other patient populations. We undertook this study to evaluate the effect of 80% supplemental intraoperative oxygen on the incidence of postoperative nausea and vomiting following ambulatory surgery for laparoscopic tubal ligation. ⋯ This trial of 304 women did not demonstrate that administering intraoperative supplemental 80% oxygen during ambulatory surgery for laparoscopic tubal ligation prevented postoperative nausea or vomiting during the initial postoperative 24 hr compared with women who received routine 30% oxygen.
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Spinal anesthesia can be challenging in patients undergoing total joint arthroplasty because of poorly palpable surface landmarks and age-related changes in the lumbar spine. We hypothesized that pre-procedural ultrasound imaging would be effective in identifying the lumbar intervertebral spaces and would provide an accurate measure of the depth to the intrathecal space. ⋯ Ultrasound imaging of the lumbar spine provides clinically useful information that can facilitate spinal anesthesia in the older orthopedic patient population.
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Editorial Comment
Provision of obstetric anesthesia: throwing down the gauntlet!
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Multicenter Study
Key issues and barriers to obstetrical anesthesia care in Ontario community hospitals with fewer than 2,000 deliveries annually.
Lack of the availability of anesthesia services may be a factor in the closure of maternity services in rural Canada, limiting the capacity for Cesarean delivery and intensifying the urbanization of maternity care. Unlike other professions involved in maternal newborn care, health services research in obstetrical anesthesia is virtually non-existent. This study explored barriers physicians encountered in providing obstetrical anesthesia care in Ontario community hospitals experiencing low volumes (fewer than 2,000) deliveries per annum (PA). Solutions proposed by a mixed focus group of academic and community hospital leaders were also described. ⋯ Physicians in community hospitals face significant barriers in the provision of obstetrical anesthesia care. These are greatest among FP/GP anesthetists and in rural hospitals where physician shortages and lack of supports threaten provision of services in some hospitals. Local context-specific and systems-level solutions are required.