Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Stellate (cervicothoracic) ganglion block (SGB) can be associated with serious complications, such as esophageal and vascular injury. The objective of this study was to evaluate the potential for vascular and esophageal injury in healthy subjects by examining the sonoanatomy of the neck relevant to the SGB at the sixth (C6) and seventh (C7) cervical vertebral levels and determining the incidence of blood vessels and esophagi in the simulated path of needle insertion in the conventional and two different ultrasound-guided approaches used to perform a SGB. ⋯ Major blood vessels and the esophagus are in close proximity to needle pathways during the anterior approach to SGB performed with either anatomic landmarking or fluoroscopic guidance. An ultrasound-guided lateral approach at the C6 level may possibly confer a greater margin of safety for performing SGB.
-
Review Meta Analysis Historical Article
Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?
Intraoperative cell salvage (ICS) is used as an alternative to allogeneic blood transfusion in an attempt to avoid or minimize the risks associated with allogeneic blood. Intraoperative cell salvage is generally avoided in surgeries where malignancy is confirmed or suspected due to concern for potential metastasis or cancer recurrence. The application of post-processing methods for ICS is hypothesized to eliminate this potential risk. The purpose of this narrative review is to examine the in vitro experimental evidence as it pertains to the removal of tumour cells from ICS blood and to review the clinical studies where ICS blood has been used in patients with malignancy. ⋯ Transfusion of autologous blood harvested via ICS should be considered a viable option for reduction or avoidance of allogeneic product during many oncologic surgeries and may be a lifesaving option for those patients who refuse allogeneic blood products.
-
Randomized Controlled Trial Comparative Study
Video-laryngoscopy versus direct laryngoscopy in critically ill patients: a pilot randomized trial.
Endotracheal intubation in critically ill patients is associated with a high risk of complications that tend to increase with multiple attempts at laryngoscopy. In this pilot study, we compared direct laryngoscopy (DL) with video-laryngoscopy (VL) with regard to the number of attempts and other clinical parameters during endotracheal intubation of critically ill patients performed by novice providers. ⋯ Video-laryngoscopy resulted in improved glottic visualization compared with DL; however, this did not translate into improved clinical outcomes. The trial was registered on ClinicalTrials.gov number, NCT00911755.
-
Comparative Study
Comparing two anesthesia information management system user interfaces: a usability evaluation.
Anesthesia information management systems (AIMS) have been developed by multiple vendors and are deployed in thousands of operating rooms around the world, yet not much is known about measuring and improving AIMS usability. We developed a methodology for evaluating AIMS usability in a low-fidelity simulated clinical environment and used it to compare an existing user interface with a revised version. We hypothesized that the revised user interface would be more useable. ⋯ The usability of anesthesia information management systems can be evaluated using a low-fidelity simulated clinical environment. User testing of the revised user interface showed improvement in some usability metrics and highlighted areas for further revision. Vendors of AIMS and those who use them should consider adopting methods to evaluate and improve AIMS usability.