Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Quality and patient safety (QPS) activities continue to attract more attention and are deemed an essential component of care provision by all departments of anesthesiology, but examples of the structure and processes to manage QPS matters at the department level in Canada are not well described in the literature. This narrative article highlights the creation, structure, evolution, and experiences of a QPS committee in a Canadian department of anesthesiology and pain medicine. Specific focus and case examples of the QPS committee's use of a hospital-wide incident reporting system to monitor and respond to perioperative QPS matters are provided.
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Observational Study
Risk factors for reintubation after anterior cervical discectomy and fusion surgery: evaluation of three observational data sets.
Postoperative loss of airway requiring reintubation is a rare but potentially catastrophic complication following anterior cervical discectomy and fusion (ACDF). We sought to identify risk factors asscociated with reintubation within one day following ACDF. Attention was focused on patient demographics, comorbidities, and factors potentially linked to soft tissue swelling and hematoma formation that could compromise the upper airway. ⋯ Across three complementary data sets, incidence of reintubation within one day of ACDF was approximately 0.20%. Increased risk of reintubation associated with anticoagulant administration suggests upper airway hematoma as an underlying etiology. Steroid administration and delayed extubation may be useful in patients considered to be at higher risk for reintubation.
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Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. The therapeutic outcome of major cardiac surgery is significantly poorer in patients with cirrhosis compared with patients without cirrhosis. To address this, we aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes. ⋯ Despite having low median model for end-stage liver disease scores, this small series of cirrhotic patients undergoing cardiac surgery had significantly higher mortality rates and required more organ support postoperatively than propensity score-matched non-cirrhotic patients. Impact de la cirrhose chez les patients subissant une chirurgie cardiaque : une étude de cohorte observationnelle et rétrospective.