Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Recombinant activated factor VII (rFVIIa) is a pro-hemostatic drug that is approved for treatment of bleeding in hemophilia patients, but it is frequently used off-label in non-hemophiliacs. The purpose of this study was to determine if the off-label use of rFVIIa is expanding and whether this poses a net harm to patients. ⋯ The off-label use of rFVIIa in Canada remains stable. Since severity of bleeding is prognostically important, the benefits of rapidly gaining control of bleeding that is non-responsive to conventional therapies may at times warrant the use of potent hemostatic drugs with established risk profiles, such as rFVIIa.
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Observational Study
Low-fidelity simulation improves mastery of the aseptic technique for labour epidurals: an observational study.
The objective of this study was to determine the impact of a low-fidelity simulation model on mastering the sterile technique during placement of epidural catheters. ⋯ This study describes a comprehensive teaching model for mastering the sterile technique during epidural catheter placement. It suggests that low-fidelity simulation improves the learning process when used in addition to conventional teaching.
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Epidural/spinal opioids are increasingly used to relieve parturients' pain in labour. Some studies indicate that opioids can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. This meta-analysis aimed to clarify the effects of opioids in labour analgesia on neonates. ⋯ The common doses of fentanyl and sufentanil used with an epidural/spinal technique in labour analgesia are safe for neonates up to 24 hr after delivery. In future studies, more attention should be paid to the long-term side effects in neonates.
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Historical Article
From the Journal archives: Masseter muscle rigidity: a dose-related drug effect or an early manifestation of a rare potentially fatal pharmacogenetic disorder.
Plumley MH, Bevan JC, Saddler JM, Donati F, Bevan DR. Dose-related effects of succinylcholine on the adductor pollicis and masseter muscles in children. Can J Anaesth 1990; 37: 15-20.