Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Review Retracted Publication
Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence.
Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included. The principles and options for volume replacement were reviewed exclusively in trauma patients and studies from the literature focusing on this problem were analyzed. ⋯ The choice of fluid therapy in trauma patients engenders the most controversy and an examination of the body of literature on this subject results in confusion. It is imperative to continue the search for substances that are effective in avoiding the development of post-trauma multi-organ dysfunction syndrome without detrimental side-effects.
-
To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). ⋯ PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.
-
Review
Massive transfusion and coagulopathy: pathophysiology and implications for clinical management.
To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. ⋯ Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.
-
The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed. ⋯ The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided.
-
The prevalence of recreational drug abuse among young women, including in pregnancy, has increased markedly over the past two decades. Cocaine remains the drug commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anesthetic management of pregnant patients with a history of cocaine abuse. ⋯ In the absence of uniform anesthetic guidelines for pregnant patients with a history of cocaine abuse the decision regarding the administration of peripartum analgesia or anesthesia should be individualized and conducted on a case-by-case basis. This article will attempt to heighten the awareness of cocaine use and abuse in pregnancy and review the perioperative anesthetic management of these high-risk parturients.