Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Review Meta Analysis
Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis.
Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. ⋯ It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations.
-
Observational Study
Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg raising maneuver: a prospective observational study.
Assessing fluid responsiveness is important in the management of patients with hemodynamic instability. Passive leg raising (PLR) is a validated dynamic method to induce a transient increase in cardiac preload and predict fluid responsiveness. Variations in end-tidal carbon dioxide (ETCO2) obtained by capnography correlate closely with variations in cardiac output when alveolar ventilation and carbon dioxide production are kept constant. In this prospective observational study, we tested the hypothesis that variations in ETCO2 induced by a simplified PLR maneuver can track changes in the cardiac index (CI) and thus predict fluid responsiveness. ⋯ Use of a passive leg raising maneuver to induce variation in ETCO2 is a noninvasive and useful method to assess fluid responsiveness in paralyzed cardiac surgery patients receiving mechanical ventilation. Given its high NPV, fluid responsiveness is unlikely if a passive leg raising maneuver induces ΔETCO2 of < 2 mmHg.
-
In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team. ⋯ Hypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes.
-
Letter Randomized Controlled Trial
Dual-route tranexamic acid to reduce blood loss in coronary artery bypass graft surgery: a randomized controlled trial.