Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review Meta Analysis
Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis.
In labour, neuraxial analgesia is the standard in the provision of pain relief. However, the optimal mode of delivering epidural solution has not been determined, and some parturients may need an alternative to epidural analgesia. We sought to conduct a systematic review and network meta-analysis to compare continuous epidural infusion (CEI), programmed intermittent epidural bolus (PIEB), computer-integrated CEI, computer-integrated PIEB, patient-controlled epidural bolus (PCEA), fentanyl patient-controlled analgesia (PCA), and remifentanil PCA, either alone or in combination. ⋯ PROSPERO (CRD42021254978); registered 27 May 2021.
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We aimed to describe the current literature concerning propofol misuse in medical professionals, specifically relating to the individual demographics of those misusing propofol and the outcomes of propofol misuse. ⋯ Despite knowledge of the pharmacokinetic and pharmacodynamic properties of propofol by those misusing this medication, death was a common outcome reported in the literature. Data related to long-term outcomes including re-entry to clinical practice or success of rehabilitation were limited.
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Multicenter Study
Anesthetic drug shortages in Pakistan: a multicentre nationwide survey.
There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan METHODS: We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists' experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice. ⋯ Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes.
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International partnerships have an important role in capacity building in global health, but frequently involve travel and its associated carbon footprint. The environmental impact of global health partnerships has not previously been quantified. ⋯ Air travel from these CASIEF partnerships resulted in 380.9 tons CO2-e but also enabled 5,601 volunteer days-in-country since 2014. The estimated environmental cost needs to be balanced against the impact of the programs. Regardless, carbon-reduction remains a priority, whether by discouraging premium class travel, organizing longer trips to reduce daily emissions, prioritizing remote support and virtual education, or developing partnerships closer to home.