Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Point-of-care ultrasound (POCUS) is becoming an integral part of anesthesia practice throughout the world. Despite the growing interest in POCUS among trainees and faculty, POCUS training is variable among universities across Canada. This suggests a need for curriculum development and standardization. ⋯ Availability of trained staff anesthesiologists remains a major limitation to curricula implementation in most centres. A National Curriculum should be modeled on the Competency By Design Approach, in line with the CanMEDS 2015 roles, and start with a focus on basic POCUS modalities and applications. Guidance for the training and certification of POCUS among practicing anesthesiologists is lacking.
-
Understanding cardiovascular physiology should help clinicians to understand the purpose of fluid and drug management during the perioperative period. The purpose of this narrative review is to describe the pivotal role of the venous circulation in goal-directed hemodynamic and fluid therapy. ⋯ The physiologic basis of goal-directed hemodynamic therapy is complex and not necessarily reflected in the information received from hemodynamic monitors. Understanding the physiologic basis of such therapy is a logical step towards its optimal use.
-
Randomized Controlled Trial Multicenter Study Comparative Study
A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.
Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. ⋯ In obese women undergoing Cesarean delivery with spinal anesthesia, prophylactic phenylephrine infusion was associated with less intraoperative nausea, less need for rescue antiemetics, and reduced early postoperative vomiting.