Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review
Perioperative management of the severely obese patient: a selective pathophysiological review.
Obesity is widespread, yet it is often understood primarily as a disorder of body structure. This article provides anesthesiologists with a synopsis of recent research into the complex pathophysiology of obesity. It emphasizes the importance of this information for the perioperative planning and management of this patient group and for reviewing some of the major perioperative challenges. ⋯ The literature clearly highlights the complexity of severe obesity as a multisystem disease, and anesthesiologists caring for these patients perioperatively must have a sound understanding of the changes in order to offer the highest quality care to these patients.
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Case Reports
Case reports: iatrogenic bronchial rupture following the use of endotracheal tube introducers.
Endotracheal tube introducers are often used in difficult tracheal intubations, but they are rarely deemed responsible for airway injuries. There have been only a few reports of severe complications, such as pharyngeal perforation, mainstem bronchus bleeding, perforation of the tracheal mucosa, and tracheal abrasion associated with hemopneumothorax. Using a computed tomography (CT) scan, we illustrate two cases of non-severe airway injuries related to endotracheal tube introducers. ⋯ These two cases show that airway damage related to endotracheal tube introducers may not be exceptional. It is not unusual to have some blood on an airway management device, and the rate and severity of these lesions are unknown. However, damage to the airway can be avoided by adapting preventive techniques during tracheal intubation.
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Case Reports
Case report: unusual complication during outpatient continuous regional popliteal analgesia.
Continuous regional anesthesia applied as pain therapy at home is clinically established standard practice after upper and lower limb surgery. Persistent motor block at discharge or after continuous infusion of local anesthetics, however, might lead to complications related to the insensate extremity. We report a rare case of a foot fracture due to stumbling after continuous sciatic nerve block at home and discuss the related clinical implications. ⋯ The true incidence of complications related to falls at home associated with lower extremity blockade remains unknown, as symptoms of possible complications may be masked by the effects of the local anesthetic. However, with increasing use of postoperative regional anesthesia, it is mandatory to develop and adhere to clinical care maps, and to elaborate and teach strategies to further enhance patient safety.
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Without a core curriculum for the training and evaluation of Canada's family practice anesthetists, little is known regarding the training process of these physicians. This article offers a description of the variety of cases and procedures experienced by family practice anesthesiology (FPA) residents during their training year based on records in the Resident Logbook. ⋯ Although FPA residents use the Resident Logbook inconsistently, the data obtained offer an initial description of the composition of the FPA training year. We believe that the Resident Logbook offers an excellent tool for furthering the goal of a standardized curriculum and assessment program for FPA training.