Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this case report is to describe a patient with a preoperative complex pain syndrome who underwent liver transplantation and was able to reduce his opioid consumption significantly following the initiation of treatment with medical cannabis. ⋯ Reductions in opioid consumption were achieved with the administration of medical cannabis in a patient with acute postoperative pain superimposed on a chronic pain syndrome and receiving high doses of opioids. Concurrent benefits of initiating medical cannabis may include improvements in pain profile and functional status along with reductions in opioid-related side effects. This highlights the potential for medical cannabis as an adjunct medication for weaning patients from opioid use.
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Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. ⋯ Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada.
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Regional anesthesia is enjoying a renaissance due in part to the advent of ultrasound guidance and the development of new techniques such as tissue plane blocks and local infiltration analgesia. The purpose of this Continuing Professional Development module is to provide practitioners with an understanding of the current state of knowledge surrounding local anesthetic systemic toxicity (LAST) in order to help them prevent and manage this complication more effectively. ⋯ Local anesthetic systemic toxicity is a potentially lethal condition with protean manifestations, and anesthesiologists must understand its risks, prevention, and safe management.