Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Fatal awake malignant hyperthermia episodes in a family with malignant hyperthermia susceptibility: a case series.
The present report of two fatal awake malignant hyperthermia (MH) episodes in an MH susceptible (MHS) family is intended to raise awareness among medical personnel and MHS individuals to the possibility of life-threatening non-anesthesia-triggered MH episodes and to provide a strong incentive for development of effective preventive measures. ⋯ Life-threatening awake MH episodes may develop in some MHS individuals in the absence of anesthetic triggers. Potential triggers can be physical exertion in combination with a febrile illness. Malignant hyperthermia susceptible patients are recommended to be vaccinated against flu and restrict physical activities when febrile, wear an MH alert bracelet, and inform medical personnel of their MH history. Oral dantrolene is suggested to be available to MHS patients for administration with the early signs of awake MH.
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In the article entitled: "Carfentanil: a narrative review of its pharmacology and public health concerns" published online and in the April 2019 issue of the Journal, Can J Anesth 2019; DOI: https://doi.org/10.1007/s12630-019-01294-y , the Figure showed the wrong structures for remifentanil and carfentanil. This is now corrected in the accompanying revised figure and legend.
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Acute kidney injury (AKI) is defined as an abrupt decrease in kidney function, with the most severe form requiring some method of renal replacement therapy (RRT). The use of RRT is required in 5-10% of critically ill patients who develop severe AKI. ⋯ Continuous renal replacement therapy may be run in different modes of increasing complexity depending on a given patient's clinical needs. Regional citrate anticoagulation is recommended as the therapy of choice for the majority of critically ill patients requiring CRRT.
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Cerebral oximetry is a monitoring tool used in the perioperative care of cardiac surgery patients to ensure adequate cerebral perfusion and oxygenation. When combined with somatic oximetry, the differential diagnosis of cerebral desaturation can be better identified and managed more specifically, as somatic oximetry serves as a global or localized perfusion monitor (depending on its regional position). The use of processed electroencephalography (pEEG) in cardiac surgery could further guide the management of desaturation episodes, as reductions in pEEG activity without a change in the anesthetic agent level indicate potential cerebral ischemia. Continuous integration of multiple monitoring modalities are thus desirable to assess organ perfusion and organ function. ⋯ Integrating combinations of different monitoring modalities such as cerebral and somatic oximetry with pEEG can help the diagnosis and treatment of organ malperfusion and related dysfunction.