Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The erector spinae plane (ESP) block is an emerging regional anesthetic technique with significant potential for clinical benefit. Nevertheless, its exact mechanism(s) of action has been much debated. We reviewed the available literature to explore the possible mechanisms of analgesia for the ESP block. ⋯ A systemic effect of local anesthetic is also plausible, but unlikely to be a major contributor to clinical analgesic efficacy. The evidence for significant analgesia due to other proposed mechanisms, such as fascia-mediated analgesia or lymphatic spread, are currently limited and thus remain speculative. Understanding the mechanisms of action could assist clinicians in further investigating and refining ESP block performance, with the ultimate goal of optimizing analgesic efficacy and improving postoperative patient outcomes.
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Present clinical updates, current research findings, and consensus statements relevant to the care of the acute kidney injury (AKI) patient. ⋯ Acute kidney injury continues to affect large numbers of patients receiving surgery or in the intensive care unit, but specific advances in resuscitation techniques, endpoint refinements, epidemiology, biomarkers, and pathology are providing the necessary framework to reduce AKI and associated morbidity.
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Point-of-care ultrasound (POCUS) uses ultrasound at the bedside to aid decision-making in acute clinical scenarios. The increased use of ultrasound for regional anesthesia and vascular cannulation, together with more anesthesiologists trained in transesophageal echocardiography have contributed to the widespread use of POCUS in perioperative care. Despite the support of international experts, the practice of POCUS in perioperative care is variable as Canadian guidelines for anesthesiologists do not currently exist. ⋯ The use of bPOCUS is evolving and will play a significant role in perioperative medicine. This consensus statement aims to define a Canadian national standard on which curricula may be based. It also provides a framework to allow further development of bPOCUS in the perioperative setting.
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Currently, there is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE) in patients undergoing spine surgery. In the absence of large-scale studies, we aimed to use national data to study the association between anticoagulant prophylaxis and VTE in spine surgical patients. Our secondary outcomes were hematoma and blood transfusion. ⋯ Although low molecular weight heparin was used much less frequently than regular heparin, it was associated with a lower incidence of transfusion compared with aspirin and regular heparin. All three anticoagulants were associated with similar incidence of VTE and hematoma. Varying subgroup-specific VTE risks may further inform future studies to identify patients expected to benefit the most from chemical thromboprophylaxis.