Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Failure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. ⋯ We provide a structured approach to managing bleeding in the airway that accounts for the source of bleeding and the estimated risk of failure to intubate using direct laryngoscopy or to achieve a front-of-neck access for surgical airway rescue. In situations where these techniques are predicted to be successful, the recommended approach is to identify the cricothyroid membrane (in preparation for rescue cricothyroidotomy), followed by rapid sequence induction. In situations where traditional management of the airway is likely to fail, we recommend an awake approach with one of the aforementioned techniques.
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Review
Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review.
Restrictive fluid management strategies have been proposed to reduce complications in liver transplant recipients. We conducted a systematic review to evaluate the effects of restrictive perioperative fluid management strategies, compared with liberal ones, on postoperative outcomes in adult liver transplant recipients. Our primary outcome was acute kidney injury (AKI). Our secondary outcomes were bleeding, mortality, and other postoperative complications. ⋯ Based on low or very low levels of evidence, we did not find any association between restrictive fluid management strategies and AKI, but we observed possible protective effects of intraoperative restrictive fluid management strategies on other outcomes.
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Quality and patient safety (QPS) activities continue to attract more attention and are deemed an essential component of care provision by all departments of anesthesiology, but examples of the structure and processes to manage QPS matters at the department level in Canada are not well described in the literature. This narrative article highlights the creation, structure, evolution, and experiences of a QPS committee in a Canadian department of anesthesiology and pain medicine. Specific focus and case examples of the QPS committee's use of a hospital-wide incident reporting system to monitor and respond to perioperative QPS matters are provided.