Canadian journal of anaesthesia = Journal canadien d'anesthésie
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In this narrative review, we aim to provide the pathophysiology and diagnostic criteria of the piriformis syndrome (PS), an underdiagnosed cause of buttock and leg pain that can be difficult to treat. Based on existing evidence, frequencies of clinical features are estimated in patients reported to have PS. In view of the increasing popularity of ultrasound for intervention, the ultrasound-guided technique in the treatment of PS is described in detail. ⋯ Piriformis syndrome continues to be a controversial diagnosis for sciatic pain. Electrophysiological testing and nerve blocks play important roles when the diagnosis is uncertain. Injection of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes. An ultrasound-guided injection technique offers improved accuracy in locating the piriformis muscle. Optimizing the therapeutic approach requires an interdisciplinary evaluation of treatment.
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Malignant hyperthermia (MH) is a potentially lethal disorder of skeletal muscle triggered by anesthetic agents. A histomorphological examination of diseased muscle may provide insight into MH pathophysiology, but it is not a routine part of standard-of-care practice for the identification of MH-susceptibility. In this study, we investigated muscle histomorphology in a large cohort of MH-susceptible (MHS) patients and examined its relationship to genotype and phenotype. ⋯ Despite the inability of the histomorphological examination to identify consistent features in MHS patients, histology may serve as a potential adjunct to CHCT and aid in the identification of other myopathies. Nevertheless, the specifics of its utility ought to be assessed in other studies and by way of formal cost-effectiveness analysis.
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Previous studies discussing the risk of medical misconduct amongst anesthesiologists differ in their conclusions. In Canada, there is a paucity of data regarding demographic information, disciplinary findings, and penalties received by anesthesiologists. The aim of this study was to identify potential characteristics for discipline within the specialty of anesthesiology by ascertaining disciplinary findings and types of penalties received by anesthesiologists and comparing these with cases of disciplinary action against other Canadian physicians. ⋯ Anesthesiologists in Canada have been subject to low rates of disciplinary action. Specifically, there have been low rates of sexual misconduct and unprofessional behaviour. Interventions to reduce disciplinary findings in anesthesiology could be directed toward bolstering education relating to standard of care issues, prescribing practices, and fraudulent behaviour.