Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Awake flexible bronchoscope-guided intubation is challenging in patients with extremely limited mouth opening (when there is inadequate space for an oropharyngeal airway), especially when nasal access is unavailable. Alternatives include awake front of neck access, which is an invasive procedure and not suitable for elective surgery. We present a novel technique to facilitate flexible bronchoscope-guided oral intubation in these patients. ⋯ By placing an endotracheal tube with the tip in the pharynx, TTIP can establish a conduit for awake oral flexible bronchoscope-guided intubation in patients with extremely limited mouth opening and unavailable nasal access. This technique requires equipment that is readily available and may help avoid unnecessary awake tracheostomy.
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Our primary objective was to describe consent models used in Canadian-led adult and pediatric intensive care unit (ICU/PICU) randomized controlled trials (RCTs). Our secondary objectives were to determine the consent rate of ICU/PICU RCTs that did and did not use an alternate consent model to describe consent procedures. ⋯ Alternate consent models were used in the minority of Canadian-led ICU/PICU RCTs but have been used more frequently over the last decade. This suggests that Canadian ethics boards and research communities are becoming more accepting of alternate consent models in ICU/PICU trials.
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The objective of this study was to describe the incidence, management, and complications of difficult and failed endotracheal intubation in a general surgical population. ⋯ The incidences of difficult and failed intubations in our study were 2.6 and 0.3 per 1,000 surgeries requiring laryngoscopies, respectively, with a decrease over time. Videolaryngoscopy showed a high success rate as a rescue device.
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Observational Study
Competence of anesthesiology residents following a longitudinal point-of-care ultrasound curriculum.
Point-of-care ultrasound (POCUS) facilitates diagnostic, procedural, and resuscitative applications in anesthesiology. Structured POCUS curricula improve learner satisfaction, test scores, and clinical management, but the learning curve towards competency and retention of skills over time remain unknown. ⋯ Our study shows that anesthesiology residents can achieve competence in rescue echo and lung ultrasound through participation in a structured, longitudinal POCUS curriculum, and outlines the learning curve for progression towards competency.
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The optimal regional technique to control pain after breast cancer surgery remains unclear. We sought to synthesize available data from randomized controlled trials comparing pain-related outcomes following various regional techniques for major oncologic breast surgery. ⋯ PROSPERO (CRD42020198244); registered 19 October 2020.