Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. ⋯ Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.
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Hypoxic pulmonary vasoconstriction (HPV) is a fundamental physiological process whereby ventilation/perfusion matching is optimized through the constriction of the pulmonary circulation supplying poorly ventilated lung units. In their 1981 paper in the Journal, Noble, Kay, and Fisher used a series of animal experiments to show that alveolar carbon dioxide (CO2) plays a critical role in the regulation of hypoxic pulmonary vasoconstriction. At physiological concentrations, CO2 potentiates the HPV response, and the absence of alveolar CO2 blunts HPV. The enhancement of HPV by CO2 resulted in reduced perfusion of specific hypoxic lung regions, thereby improving systemic oxygenation in lung-ventilated dogs.
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Addiction to alcohol and illicit drugs occurs in approximately 10% of the Canadian population and thus likely affects numerous perioperative patients. Provision of perioperative analgesia to these patients is challenging for physiological and behavioural reasons. Seven electronic databases were searched to identify papers addressing the perioperative management of analgesia in addicted patients. ⋯ Perioperative analgesic management of addicted patients remains poorly understood. Most clinical trials specifically exclude addicted patients. Suggestions for management are provided.