Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The practice of obstetrical anesthesia relies on collaborative effort between anesthesiologists and nurses, but teamwork remains a challenge. We sought to identify a consensus on the perceived barriers to collaborative care between anesthesiologists and perinatal nurses in a Canadian tertiary labour and delivery (L&D) unit. ⋯ Anesthesiologists and nurses at our tertiary L&D unit identified communication as a major barrier to collaborative care. This study also shows the feasibly of using the modified Delphi technique in L&D units seeking to improve collaborative care.
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Approximately 200,000 individuals worldwide are born annually with sickle cell disease (SCD). Regions with the highest rates of SCD include Africa, the Mediterranean, and Asia, where its prevalence is estimated to be 2-6% of the population. An estimated 70,000-100,000 people in the United States have SCD. Due to enhanced newborn screening, a better understanding of this disease, and more aggressive therapy, many sickle cell patients survive into their adult years and present more frequently for surgery. ⋯ Effective management of SCD patients in the perioperative setting requires familiarity with the epidemiology, pathophysiology, clinical manifestations, and treatment of SCD.
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Observational Study
Evaluation of the analgesia nociception index (ANI) in healthy awake volunteers.
Analgesia might be evaluated with simple changes in vital signs, a non-specific and non-sensitive method. Heart rate variability (HRV) correlates with autonomous nervous system activity and can be used to evaluate painful stimuli. Heart rate variability is then transformed into a numeric scale called the analgesia nociception index (ANI), where higher values represent predominant parasympathetic tone, thus low nociception. Under general anesthesia, the ANI decreases following painful stimuli and increases after administration of analgesia, but significant interindividual variability is present. The goal of the present study was to evaluate the ANI as a pain index in healthy awake volunteers. ⋯ These findings provide little evidence to support use of the ANI in awake subjects or in awake patients such as those in the emergency room or in the intensive care unit. Nevertheless, based on an important difference between the expected correlation and the real correlation between the ANI and the NRS scores found in our results, the present study might be underpowered. Studies with a larger sample size would be required to enable firm conclusions about the clinical utility of the ANI in this population of awake volunteers as well as in awake patients. This study was registered with ClinicalTrials.gov (NCT02589093).