Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.
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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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During the coronavirus disease (COVID-19) global pandemic, urgent strategies to alleviate shortages are required. Evaluation of the feasibility, practicality, and value of drug conservation strategies and therapeutic alternatives requires a collaborative approach at the provincial level. The Ontario COVID-19 ICU Drug Task Force was directed to create recommendations suggesting drug conservation strategies and therapeutic alternatives for essential drugs at risk of shortage in the intensive care unit during the COVID-19 pandemic. ⋯ Proposed provincial strategies for drug conservation and therapeutic alternatives may not all be appropriate for every institution. Local implementation will require consultation from end-users and hospital administrators. Competing equipment shortages and available resources should be considered when evaluating the appropriateness of each strategy.
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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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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.