Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Labour epidural analgesia (LEA) is an evolving field. Various neuraxial techniques and dosing regimens are available to the modern obstetric anesthesia provider, allowing for significant practice variability. To begin a search for consensus on optimal care, we sought to query fellowship training practices for LEA. ⋯ Despite significant variability in LEA practice, some clear patterns emerged in our survey, including preference for opioid-containing CSE and maintenance with PIEB, PCEA, and dilute epidural solutions.
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Unfractionated heparin continues to be one of the main agents used for thromboprophylaxis in obstetrics, which can complicate the placement of neuraxial anesthetics. In this study, we explored the relationship between a point-of-care coagulation test (thromboelastometry) and plasma heparin concentrations in vitro. ⋯ The point-of-care IH CT ratio may be useful in identifying the presence of little to no heparin activity. Further research is needed to determine if this ratio can predict heparin activity in vivo.
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International practice guidelines make different recommendations for postoperative troponin testing to detect perioperative myocardial infarction and myocardial injury after noncardiac surgery. To gain insights into current testing patterns, we evaluated predictors of routine troponin testing after three commonly performed major noncardiac surgeries. ⋯ Troponin testing varied substantially across hospitals for selected major noncardiac surgery procedures even after accounting for differences in patient-level cardiac risk factors. Our observations lend support to a more standardized approach for troponin testing after noncardiac surgery.
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The purpose of this Continuing Professional Development module is to provide information pertaining to anesthetic considerations and management of endovascular thrombectomy (EVT) for patients with acute ischemic stroke. ⋯ Timely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is effective communication with the multidisciplinary team.
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To report on an unusual case of ketamine-precipitated syndrome of inappropriate antidiuretic hormone secretion (SIADH) in an individual managed by an outpatient pain specialty team. ⋯ This case is of clinical importance for providers using ketamine in the field of pain management as the effect of this medication reaction can be profound. Clinicians should develop an awareness that ketamine can potentiate adverse effects such as SIADH and they should monitor, detect, and manage as appropriate.