Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This narrative review summarizes the evidence derived from randomized controlled trials pertaining to the treatment of complex regional pain syndrome (CRPS). ⋯ Published RCTs can only provide limited evidence to formulate recommendations for treatment of CRPS. In this review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. Thus, evidence derived from "weaker" trials may be overemphasized. Further well-designed RCTs are warranted.
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This article incorporates the following objectives: to review the current evidence regarding the occurrence and management of difficult airways, to outline the role for alternative technology in the management of the difficult airway, to provide a rationale for structured airway rotations in anesthesia residency training, to discuss the barriers to establishing the rotations, to outline issues that must be considered and resolved to enhance these rotations, and to share the experience we have gained over the last decade of offering an airway rotation in the Department of Anesthesiology at the University of Ottawa. ⋯ Anesthesia training programs must provide residents with the skill sets necessary for safe independent practice in airway management. The changes in the scope and reality of residency training have exposed limitations in the traditional mentoring model of residency training; consequently, many programs have responded by offering sub-specialty rotations. In particular, advanced airway management rotations are being offered increasingly to residents in the Canadian training programs. Considerations and strategies to develop and implement a structured airway management program during anesthesia residency are discussed.
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The purpose of this narrative review is to describe an anatomical approach for residents-in-training and anesthesiologists who are learning techniques of ultrasound-guided regional anesthesia of the neck and upper limb. ⋯ Simple sonographic anatomical patterns can provide a strategy to correctly locate nerves when performing ultrasound-guided cervical and brachial plexus anesthesia.
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Preoxygenation increases oxygen reserves and duration of apnea without desaturation (DAWD), thus it provides valuable additional time to secure the airway. The purpose of this Continuing Professional Development (CPD) module is to examine the various preoxygenation techniques that have been proposed and to assess their effectiveness in healthy adults and in obese, pregnant, and elderly patients. ⋯ Since ventilation and tracheal intubation difficulties are unpredictable, this CPD module recommends that all patients be preoxygenated. The TVB 3 min and the 8 DB 60 sec techniques are suitable for most patients; however, the 4 DB 30 sec is inadequate.
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To review the effects of hereditary hemorrhagic telangiectasia (HHT) in the parturient and the anesthetic management of such patients during pregnancy and delivery. ⋯ An understanding of the presence and potential development of life-threatening AVMs during pregnancy is imperative for anesthesiologists caring for parturients with HHT. Even in the asymptomatic patient, a high index of suspicion should be maintained, screening performed where possible and anesthetic technique adapted accordingly.