Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
A pilot randomized-controlled trial evaluating the erector spinae plane block in thoracic and breast surgery.
This pilot study evaluated the feasibility of investigating the effect of the erector spinae plane (ESP) block on the patient-centred outcomes of quality of recovery-15 (QoR-15), and brief pain inventory (BPI) in thoracic and breast surgery patients. ⋯ In this pilot study, the target recruitment rate was not met, but catheter retention and patient attrition rates were both satisfactory. A definitive trial with QoR-15 as the primary outcome would require 300 study participants.
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Randomized Controlled Trial
Intravenous dextrose versus ondansetron for prevention of postoperative vomiting in children: a randomized non-inferiority trial.
Postoperative vomiting (POV) in children is frequent. Dextrose-containing intravenous fluids in the perioperative period have shown improvement of POV in adults. Similar studies have not been done in children. ⋯ These results do not support the use of intravenous dextrose as a satisfactory alternative to ondansetron to prevent POV in ambulatory pediatric dental surgery patients.
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There is a paucity of evidence evaluating whether intensive care unit (ICU) discharge occupancy is associated with clinical outcomes. It is unknown whether increased discharge occupancy leads to greater afterhours discharges and downstream consequences. We explore the association between ICU discharge occupancy and afterhours discharges, 72-hr readmission, and 30-day mortality. ⋯ Greater ICU discharge occupancy was associated with a significant increase in afterhours discharges. Nevertheless, neither discharge occupancy nor afterhours discharge were associated with 72-hr readmission or 30-day mortality.
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Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. ⋯ Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.
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Transcatheter aortic valve implantation (TAVI) has become a widely used technique for treating aortic stenosis. Subclavian access may be warranted in the presence of poor vasculature that precludes femoral access. Conscious sedation is increasingly being adopted with some evidence suggesting better outcomes compared with those of general anesthesia. We describe the use of two regional anesthetic techniques to facilitate subclavian access for TAVI. ⋯ The interscalene catheter in situ allowed for low-dose local anesthetic titration without further jeopardizing the pulmonary function throughout the procedure. Unlike other interfascial plane blocks, combined low-dose superficial cervical plexus and interscalene brachial plexus blocks offer surgical anesthesia and limb immobility, thus providing optimal condition for subclavian TAVI to be performed with minimal sedation.