Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery. ⋯ In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients.
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To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. ⋯ An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.
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To provide a narrative review of the physician experience of medical malpractice litigation applied to an anesthesiology case with particular emphasis on the role played by medical expert witnesses. ⋯ The legal process for resolving patient claims against physicians is well delineated and transparent; its operational features are complex and prejudiced by severe outcomes. Bias is pervasive in the analysis of medical occurrences and may result in findings against caregivers which are unfair.
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Review Case Reports
Case report: epidural blood patch in the treatment of abducens palsy after a dural puncture.
To describe a case of iatrogenically induced abducens nerve palsy following a diagnostic lumbar puncture, and to review the evidence for blood patching in the management of sixth cranial nerve palsy after dural puncture. ⋯ Experience from this case as well as other case report evidence suggest that an epidural blood patch performed more than 24 hr after the onset of a sixth cranial nerve palsy consistently fails to relieve diplopia. An epidural blood patch executed within 24 hr from the onset of diplopia could possibly lead to partial improvement and/or earlier resolution of symptoms.
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To review established techniques and to provide an update on new methods for clinical monitoring of neuromuscular function relevant to anesthesia. ⋯ Objective methods should be used to monitor neuromuscular function in clinical anesthesia. Acceleromyography offers the best compromise with respect to ease of use, practicality, versatility, precision and applicability at various muscles. The CS is the optimal muscle to determine the earliest time for intubation, e.g., for rapid sequence induction.