Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

Curare's implementation into anesthesia care by Dr. Harold Griffith was facilitated by the availability of medical-grade curare, the demonstration that it could provide safe muscle relaxation in psychiatric patients undergoing "shock therapy," and the foresight of a Squibb scientist who realized its potential in the operating room. Griffith's demonstration that curare safely provided muscle relaxation in surgical patients eliminated the need for dangerously high doses of anesthetic gases. This helped pave the way to "balanced anesthesia," whereby small doses of selectively acting drugs are given to achieve specific ends.Curare's initial reception by anesthesiologists, particularly in the UK, was frosty owing to its lingering reputation as a lethal poison associated with witchcraft. We recently unearthed a scathing review of Griffith's work housed in the Wellcome Collection (London, UK). That review, requested by Sir Robert Macintosh, Oxford University's inaugural Nuffield Professor of Anesthesia, was authored by his colleague, Dr. Stuart L. Cowan. In hindsight, this disparaging assessment is especially fascinating: Why was this review so negative when curare would have such a remarkable positive impact on medicine? In the present Special Article, we present the above British response to curare's introduction to anesthesia and trace curare's remarkable journey through the contributions of explorers, scientists, and clinicians preceding the review to help put it in perspective.

Overview: The Guidelines to the Practice of Anesthesia-Revised Edition 2026 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine the publication and distribution of the Guidelines. The Guidelines are subject to revision and updated versions are published annually. The Guidelines supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

Purpose: Long-term effects of ventilatory strategies/adjunctive therapies received in the intensive care unit on mortality of patients with acute respiratory distress syndrome (ARDS) is uncertain. To explore 180-day mortality in adult patients with ARDS, we conducted a network meta-analysis (NMA) comparing the effects of various prespecified interventions added to lung-protective ventilation (LPV).

Source: We systematically searched six databases on 8 November 2024. Two reviewers independently identified eligible randomized clinical trials with published Kaplan-Meier curves, exploring prespecified interventions combined with LPV and LPV alone. Data were synthesized with NMA of survival curves using Bayesian random effects fractional polynomial models.

Principal findings: Twenty-two trials with 8,653 participants assessed six different interventions added to LPV (open lung strategy, neuromuscular blockade [NMBA], corticosteroids, high-frequency oscillatory ventilation [HFOV], prone positioning, and venovenous extracorporeal membrane oxygenation [VV ECMO]), compared with LPV alone. We did not include inhaled pulmonary vasodilator trials. The primary NMA computed survival probability of each intervention on the basis of survival probability of LPV alone at 180 days (0.52; 95% credible interval, 0.49 to 0.55). Compared with LPV alone, 1) the evidence suggests prone positioning results in a reduction in 180-day mortality; 2) an open lung strategy does not reduce 180-day mortality; 3) VV ECMO, NMBA, and corticosteroids may reduce 180-day mortality (very uncertain); and 4) HFOV may increase 180-day mortality (very uncertain). We extrapolated reported mortalities to 180-day mortality in 16 trials, where there might be discrepancy between raw and extrapolated numbers in event rate.

Conclusions: Prone positioning may improve long-term mortality in patients with ARDS.

Study registration: PROSPERO ( CRD42019131849 ); first submitted 26 April 2019.

Purpose: We sought to evaluate the incidence of severe maternal morbidity (SMM) and intensive care unit (ICU) admissions following Cesarean hysterectomy for placenta accreta spectrum (PAS) and to assess factors associated with those outcomes.

Methods: We conducted a historical cohort study to identify patients with PAS who had Cesarean hysterectomy in the USA using delivery hospitalizations in the Premier Inc. database (Charlotte, NC, USA) from 1 October 2015 to 30 June 2021. We collected information about the 21 SMM events as defined by the Centers for Disease Control and Prevention. Since hysterectomy is one of those SMM events, and all patients in our cohort underwent hysterectomy, we assessed SMM events, excluding hysterectomy, using International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnosis codes. We performed mixed-effects logistic regression models with random intercepts for hospitals to assess for factors associated with SMM.

Results: Among 1,972 patients, SMM (excluding hysterectomy) and ICU admission occurred in 54% and 44% of the patients, respectively. The following factors were associated with SMM: placenta percreta compared with accreta (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.09 to 1.95), blood loss anemia (OR, 1.71; 95% CI, 1.26 to 2.33), deficiency anemia (OR, 0.64; 95% CI, 0.43 to 0.96), neuraxial compared with general anesthesia (OR, 0.64; 95% CI, 0.44 to 0.91), admission year (OR, 0.73; 95% CI, 0.68 to 0.80), and hospitals in the Midwest (OR, 0.56, 95% CI, 0.33 to 0.96) and West (OR, 0.47, 95% CI, 0.26 to 0.84) regions of the USA compared with those in the South.

Conclusions: Patients with PAS who underwent Cesarean hysterectomy had a high incidence of SMM and ICU admissions. This finding highlights the need for all centres performing Cesarean deliveries to have plans in place to manage patients with PAS.