Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The current methods (work based assessments and logbooks) used to assess procedural competency and performance have well-documented deficiencies. Cumulative sum analysis (cusum), a statistical method that generates performance graphs over time, is an alternative tool that is not currently widely used. The purpose of this review is to investigate its current role in anesthetic procedural skills training and performance. ⋯ Cusum can be used to assess procedural competency, but several problems need to be overcome before it can become a universally accepted method. It is ideally placed to be used as a quality control tool for a trained individual and could also be used to assess the impact of new training methods or equipment on performance.
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The use of internal iliac artery balloons for prevention of hemorrhage in cases of placenta accreta is increasing. Most described complications of this technique are maternal and thromboembolic in nature. Complications related to vascular rupture are rare, their presentation is not well described, and the resultant neonatal consequences are infrequently reported. ⋯ In addition to the known maternal risks, fetal risks must be considered when planning the placement of endovascular iliac balloons during pregnancy. We recommend continuous monitoring of maternal and fetal status when performing the procedure. Contraction-like pain during placement should raise the suspicion of arterial disruption.
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We report on two patients with ocular myasthenia gravis who received rocuronium, followed later by sugammadex to reverse neuromuscular blockade. Recovery was monitored simultaneously at the adductor pollicis muscle (APM) and the corrugator supercilii muscle (CSM). ⋯ After rocuronium-induced paralysis in both patients with ocular myasthenia, spontaneous recovery and sugammadex-assisted recovery were slower at the CSM than at the APM. In patients without the disorder, CSM recovery is faster than APM recovery. Thus, in ocular myasthenia gravis, neuromuscular recovery at the APM may not reflect recovery of all muscles.
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We present the case of a parturient diagnosed with primary ciliary dyskinesia with secondary bronchiectasis who developed significant hypoxemia following administration of intravenous oxytocin during Cesarean delivery under spinal anesthesia. This case suggests that oxytocin can affect pulmonary vascular tone and interfere with the protective effects of hypoxic vasoconstriction. ⋯ The vasodilatory effects of intravenous oxytocin on the pulmonary vasculature may worsen shunting and interfere with hypoxic pulmonary vasoconstriction, producing clinically significant hypoxemia in patients with comorbid lung disease. Oxytocin should be used with caution in patients with compromised lung function.
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Letter Randomized Controlled Trial Comparative Study
The catheter-over-needle assembly offers greater stability and less leakage compared with the traditional counterpart in continuous interscalene nerve blocks: a randomized patient-blinded study.