Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Combined heart and liver transplantation on cardiopulmonary bypass: report of four cases.
Combined heart and liver transplant is a rare procedure to treat end-stage cardiac and liver disease. First performed during cardiopulmonary bypass and anticoagulation, subsequent concerns about increased bleeding changed the strategy to performing liver implantation following separation from cardiopulmonary bypass. Considering the overall decrease in transfusion requirements during liver transplant and the potential benefits to the transplanted heart to remain on cardiopulmonary bypass during liver implantation, we revised the strategy for combined heart and liver transplant. We report the clinical course of four consecutive patients who underwent this procedure in our institution. ⋯ Combined heart and liver transplant during cardiopulmonary bypass is a viable strategy that may confer benefit to this unique type of patient.
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Unanticipated perioperative death (UPD) is a significant event for the anesthesiologist that has not been widely studied. An anonymous questionnaire was used to obtain information about the frequency of UPD, anesthesiologists' most significant UPD, and their opinions regarding UPD. ⋯ Alberta anesthesiologists are likely to experience UPD during their careers, and the experience can be associated with important personal consequences. Support for the anesthesiologist is inconsistent, and many continued to perform elective cases immediately following UPD. These conditions were not supported by the majority of respondents.
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In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects. Thereafter, the correct passage of the needle towards the epidural space is a blind "feel as you go" method. An aim-and-insert single-operator ultrasound-guided epidural needle placement is described and demonstrated. ⋯ This small study demonstrates the feasibility of the ultrasound-guidance technique. Areas for further development are identified for both ultrasound software and physical design.
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Comparative Study
Allogeneic blood transfusion reduction by risk-based protocol in total joint arthroplasty.
To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood. ⋯ A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT.