Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery. ⋯ Perioperative management of anticoagulation due to DOACs is a growing concern as the number of patients prescribed these medications increases each year. These patients can be safely optimized for urgent or emergent surgery by giving appropriate consideration to timing, monitoring, and reversal agents.
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Randomized Controlled Trial Comparative Study
Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.
Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. ⋯ Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.
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This two-centre randomized trial compared costoclavicular and paracoracoid ultrasound-guided infraclavicular brachial plexus block in patients undergoing upper limb surgery. We hypothesized that both techniques would result in similar onset times and designed the study as an equivalence trial. ⋯ Costoclavicular and paracoracoid ultrasound-guided infraclavicular blocks resulted in similar onset times. Furthermore, no intergroup differences were found in terms of performance times and success rates. Future dose-finding trials are required to elucidate the minimum effective volume of local anesthetic for costoclavicular infraclavicular blocks. This trial was registered at www.clinicaltrials.in.th (Study ID: TCTR20160525001).