Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Regional anesthesia has been shown to improve outcomes in several recent studies. The transversus abdominis plane (TAP) block provides anesthesia to the abdominal wall by introducing local anesthetic to the ventral rami of the thoracolumbar nerves. This work quantifies the area of anesthesia obtained after performing the novel thoracolumbar interfascial plane block (analogous to the TAP block but intended for the back) which targets the sensory component of the dorsal rami of the thoracolumbar nerves. ⋯ This report shows that a reproducible area of anesthesia can be obtained by ultrasound-guided injection of local anesthetic in the fascial plane between the multifidus and longissimus muscles of the thoracolumbar spine. The area of anesthesia consistently covered the midline and had a predictable spread. This project was registered with clinicaltrials.gov (NCT02297191).
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Randomized Controlled Trial
Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study.
The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB. ⋯ We conclude that prophylactic intravenous ephedrine administration at the time of CSE during labour was ineffective at reducing the risk for EPFB associated with CSE. Nevertheless, a lower than expected rate of EPFB resulted in the trial being underpowered. This trial was registered at ClinicalTrials.gov, identifier: NCT02062801.
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Randomized Controlled Trial Comparative Study
Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists.
The use of ultrasound (US) for radial arterial catheterization has been reported to result in faster insertion times with fewer complications when compared with traditional direct palpation (DP). We sought to determine if this applies to expert operators and tested the hypothesis that, among cardiac anesthesiologists, US-guided insertion similarly results in faster insertion times as well as fewer re-directs, attempts, and complications. ⋯ Among experienced cardiac anesthesiologists, the use of US to facilitate radial arterial catheterization did not affect insertion times, the number of re-directs, or the number of attempts when compared with DP. Ultrasound use had no significant effects on the rates of success on first attempt, failure, or hematoma formation. This trial was registered at www.clinicaltrials.gov : NCT02118441.
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Observational Study
Noninvasive pulse pressure variation and stroke volume variation to predict fluid responsiveness at multiple thresholds: a prospective observational study.
Pulse pressure variation (PPV) and stroke volume variation (SVV) are dynamic preload variables that can be measured noninvasively to assess fluid responsiveness (FR) in anesthetized patients with mechanical ventilation. Few studies have examined the effectiveness of predicting FR according to the definition of FR, and assessment of inconclusive values of PPV and SVV around the cut-off value (the "grey zone") might improve individual FR prediction. We explored the ability of noninvasive volume clamp derived measurements of PPV and SVV to predict FR using the grey zone approach, and we assessed the influence of multiple thresholds on the predictive ability of the numerical definition of FR. ⋯ Noninvasive PPV and SVV measurements allow an acceptable FR prediction, although the reliability of both variables is dependent on the intended increase in SVI, which improves substantially with concomitant smaller grey zones at higher ↑SVI thresholds.
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Erratum to: Can J Anesth/J Can Anesth 2015 DOI 10.1007/s12630-015-0441-9. In the article entitled: "Real-time ultrasound-guided epidural catheter insertion in obese parturients" published in the November 2015 issue, Can J Anesth 2015; DOI: 10.1007/s12630-015-0441-9, the name of the third author is incorrect and should read: Marc Edouard Gentili. The publisher apologizes most sincerely for this error.