Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
Timing the initiation of renal replacement therapy for acute kidney injury in Canadian intensive care units: a multicentre observational study.
The optimal timing for starting renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is unknown. Defining current practice is necessary to design interventional trials. We describe the current Canadian practice regarding the timing of RRT initiation for AKI. ⋯ Patients admitted to an ICU who were started on RRT generally had advanced AKI, high-grade illness severity, and multiorgan dysfunction. Also, they were started on RRT shortly after hospital presentation. We describe the current state of practice in Canada regarding the initiation of RRT for AKI in critically ill patients, which can inform the designs of future interventional trials.
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Practice guidelines suggest that patients with obstructive sleep apnea (OSA) should be monitored postoperatively to reduce adverse events. This study evaluated outcomes following ambulatory surgery in patients who had previously undergone polysomnography (PSG), and compared unplanned admissions in patients diagnosed with OSA with those in patients without OSA. ⋯ We did not identify a clinically important increased rate of unplanned admission associated with a prior diagnosis of OSA.
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Case Reports
Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation.
Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. ⋯ We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations.