Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Anesthetic and surgical considerations for awake craniotomy (AC) include airway patency, patient comfort, and optimization of real-time brain mapping. The purpose of this study is to report our experience of using dexmedetomidine and scalp blocks, without airway intervention, as a means to facilitate and optimize intraoperative brain mapping and brain tumour resection during AC. ⋯ Dexmedetomidine-based anesthesia and scalp block facilitated AC surgery without any requirement for urgent airway intervention or unplanned conversion to a full general anesthetic. This approach can enable physiologic testing before and during tumour resection facilitating real-time surgical decision-making based on intraoperative brain mapping with patients awake thereby minimizing the risk of neurologic deficit and increasing the opportunity for optimal surgical resection.
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Recommendations for safe medication injection practices to eliminate the risk of patient-to-patient transmission of blood-borne infections have been in place for many years. The purpose of our study was to evaluate the medication administration practices of Canadian anesthesiologists relative to current safe practice guidelines. ⋯ Sharing medication vials between multiple patients is common practice in Canada, with new needles and syringes used for each patient. Unfortunately, a small minority of anesthesiologists continue to reuse needles and/or syringes between patients, and this may pose a significant risk of patient-to-patient infection transmission.