Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Canadian residency programs are transitioning from time-based to competency-based medical education (CBME). The anesthesia department at Dalhousie University enrolled its first CBME cohort in 2016, one year prior to national anesthesia rollout. Early implementation allowed a unique opportunity to examine faculty anesthesiologists' experiences with the transition. ⋯ Targeted interventions for faculty uptake should emphasize the trialability and observable results achieved over time. These efforts may have the greatest impact in the early/late majority group.
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In the article entitled "Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials" Can J Anesth 2018; 65: 529-42, we wish to clarify the following items.
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Randomized Controlled Trial Comparative Study
Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized-controlled trial.
Postoperative pulmonary complications may be better reduced by reversal of neuromuscular block with sugammadex than by reversal with neostigmine because the incidence of residual block after sugammadex application is lower and diaphragm function is less impaired than after neostigmine administration. The aim of the study was to compare the effect of reversal of neuromuscular block with sugammadex or neostigmine on lung function after major abdominal surgery. ⋯ We found no differences in pulmonary function in patients reversed with sugammadex or neostigmine in a high-risk population.
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Primary immune thrombocytopenia (ITP) is an autoimmune condition affecting women of childbearing age that is characterized by diminished platelet quantity with preserved function. Although pregnant women with ITP are often denied obstetric neuraxial anesthesia (OBNA) with low platelet counts for fear of neuraxial hematoma, the true magnitude of neuraxial hematoma for ITP parturients is unknown. The aim of this systematic review and meta-analysis was to examine OBNA outcomes in ITP parturients with platelet counts below 100 x 109·L-1. ⋯ Our study highlights continued reluctance to offer OBNA below the commonly quoted 80 x 109·L-1 platelet count, based largely on consensus and theoretical presumption of risk. This further negatively influences the accrual of large-scale data. The evidence of no neuraxial hematoma after OBNA provided herein offers support for considering neuraxial anesthesia at lower platelet count thresholds. Each patient should be afforded individualized discussion of risk and benefit relative to other analgesic measures.
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Randomized Controlled Trial
Peripheral electrical stimulation reduces postoperative hypoxemia in patients at risk for obstructive sleep apnea: a randomized-controlled trial.
Severity of hypoxemic events resulting from obstructive sleep apnea (OSA) is correlated with increased risk of complications and sudden death. We studied the use of a peripheral transcutaneous electrical stimulus (TES) on the magnitude and duration of sleep apnea associated hypoxemia in postoperative patients at high risk for OSA. ⋯ In postoperative surgical patients at risk for OSA, peripheral transcutaneous electrical stimulation applied during apneic episodes decreased the duration and magnitude of hypoxemia.