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1.
Can J Anaesth ; 67(1): 64-99, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31776895

RESUMO

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2020 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2020 supersedes 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.

2.
Can J Anaesth ; 66(1): 75-108, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30560409

RESUMO

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2019 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2019 supersedes 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.

4.
Can J Anaesth ; 65(1): 76-104, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29243160

RESUMO

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2018 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2018 supersedes 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.


Assuntos
Anestesia/normas , Anestesiologia/normas , Assistência ao Paciente/normas , Anestesia/métodos , Anestesiologistas/organização & administração , Anestesiologistas/normas , Anestesiologia/métodos , Canadá , Fidelidade a Diretrizes , Humanos , Qualidade da Assistência à Saúde
5.
Can J Anaesth ; 64(1): 65-91, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27837405

RESUMO

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2017 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2017 supersedes 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 society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her 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.


Assuntos
Anestesia/normas , Anestesiologia/normas , Anestesiologia/instrumentação , Canadá , Cateterismo Venoso Central , Humanos , Monitorização Intraoperatória , Assistência ao Paciente , Medicação Pré-Anestésica , Cuidados Pré-Operatórios , Ultrassonografia de Intervenção
6.
Can J Anaesth ; 63(1): 86-112, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26576558

RESUMO

OVERVIEW: The Guidelines to the Practice of Anesthesia Revised Edition 2016 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2016 supersedes 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 society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her 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.


Assuntos
Anestesiologia , Guias de Prática Clínica como Assunto , Dor Aguda/terapia , Analgesia Obstétrica , Anestesiologia/educação , Humanos
7.
Asian J Surg ; 38(4): 220-3, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26216259

RESUMO

OBJECTIVE: Brain metastasis occurs in 10-15% of metastatic breast cancer patients and is associated with poor prognosis. This study aims to identify tumor characteristics of primary breast cancer, which are related to brain metastases in Hong Kong Chinese patients. METHODS: A retrospective study of patients with invasive breast cancer receiving treatment in a university hospital from January 2001 to December 2008 was performed. The clinicopathological factors of patients with brain metastases were analyzed and compared with those who had no brain metastasis. Risk factors for brain metastasis were identified by univariate analysis first and then by multivariate analysis. RESULTS: A total of 912 patients with invasive breast cancer were treated during the study period. Of these, 30 patients were found to have distant metastases to brain. Patients with brain metastases had more breast tumors of higher histological grade (Grade III, 78.9% vs. 30.2%; p = 0.001). Their tumors also had a significantly higher rate of negative estrogen receptors (78.9% vs. 30.2%, p = 0.001). On multivariate analysis, only high tumor grading was found to be predictive of developing brain metastasis. CONCLUSION: Chinese breast cancer patients with brain metastasis were more likely to have high-grade tumors and negative estrogen receptor status. A more vigorous surveillance program for the central nervous system should be considered for this group of patients.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias da Mama/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/mortalidade , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Estudos de Casos e Controles , Criança , Feminino , Hong Kong , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Gradação de Tumores , Receptor ErbB-2/metabolismo , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
8.
Hematol Oncol Clin North Am ; 25(2): 425-43, ix-x, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21444039

RESUMO

The management of patients with hematologic disorders in pregnancy involves a multidisciplinary approach involving specialists from hematology, obstetrics, and anesthesiology. Whereas regional anesthesia has led to a decline in maternal morbidity and mortality, the presence of uncorrected coagulopathy or the use of anticoagulant or antithrombotic medications pose a special risk for the rare complication of an epidural hematoma after neuraxial anesthesia. This article briefly reviews the common principles of anesthesia for obstetric patients, provides an obstetric anesthesiologist's perspective on the implications of regional anesthesia in obstetrics, and enhances communication between the specialties.


Assuntos
Anestesia por Condução , Cesárea , Hemorragia/prevenção & controle , Complicações Hematológicas na Gravidez , Trombofilia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Feminino , Humanos , Gravidez , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombofilia/tratamento farmacológico
9.
Ann Surg Oncol ; 18(7): 1884-90, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21225352

RESUMO

BACKGROUND: There is general concern that high-risk patients are more susceptible to the adverse effect of pneumoperitoneum and they are often denied laparoscopic surgery. This study investigated the impact of laparoscopic colorectal cancer resection for patients with high operative risk, which was defined as American Society of Anesthesiologist classes 3 and 4. METHODS: Three hundred thirty-five consecutive high-risk patients who had colorectal cancer resection by open or laparoscopic surgery were included. The patient and tumor characteristics and operative outcomes were recorded prospectively, and comparison was made between the two groups. RESULTS: Compared to open surgery, patients with laparoscopic resection had a shorter hospital stay (8 [6-12] vs. 6 [4-9] days; P < 0.001), less blood loss (200 [100-400] vs. 140 [80-250] mL; P = 0.006), reduced cardiac complication rate (13.2% vs. 3.7%; P = 0.006), overall operative complication rate (36.6% vs. 21.3%; P = 0.006), and a trend toward a lower mortality rate (4.4% vs. 0.9%; P = 0.083). There was no difference in 3-year overall and disease-free survival between two groups. Operative blood loss (P = 0.035; odds ratio = 2.69; 95% confidence interval, 1.00-6.78) and open surgery (P = 0.007; odds ratio = 2.31; 95% confidence interval, 1.26-4.23) were independent factors for occurrence of complication. CONCLUSIONS: Laparoscopic colorectal cancer resection is associated with more favorable short-term results and should be recommended as the preferred treatment option for high-risk patients.


Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Laparoscopia , Complicações Pós-Operatórias , Idoso , Colectomia , Neoplasias Colorretais/patologia , Comorbidade , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
10.
J Orthop Surg (Hong Kong) ; 18(1): 50-4, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20427834

RESUMO

PURPOSE: To compare the costs of femoral head banking versus bone substitutes. METHODS: Records of femoral head banking from 1998 to 2008 were reviewed. The cost of allogenic cancellous bone graft was calculated by estimating the direct expenditure of femoral head procurement, screening tests, and storage, and then divided by the amount of bone harvested. RESULTS: 326 females and 141 males (mean age, 80.3 years) donated 470 femoral heads. Each transplantable femoral head costs US$978. Each gram of transplantable allogenic bone graft costs US$86, compared with US$9 to 26 per gram for commercially available bone substitutes. CONCLUSION: Compared with bone substitutes, femoral head banking in Hong Kong was less economical. Unless allografts yield superior outcomes, harvesting femoral heads for general usage (such as filling bone voids for fresh fractures) is not justified from a financial perspective, especially in banks dedicated to procuring bone from femoral heads only.


Assuntos
Bancos de Ossos/economia , Substitutos Ósseos/economia , Transplante Ósseo/economia , Cabeça do Fêmur/transplante , Hidroxiapatitas/economia , Coleta de Tecidos e Órgãos/economia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Estudos de Coortes , Custos e Análise de Custo , Feminino , Hong Kong , Humanos , Masculino , Estudos Retrospectivos
11.
Clin Transplant ; 24(3): 410-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19807745

RESUMO

We report a case of living donor liver transplantation using a small-for-size graft (SFSG) with graft to estimated standard liver volume of only 28% in a recipient with spontaneous splenorenal shunt and demonstrate the value of intraoperative ultrasonic flowmetry. Despite an SFSG, the graft was underperfused. This was recognized by flowmetry and was rectified by ligation of the splenorenal shunt.


Assuntos
Circulação Hepática/fisiologia , Transplante de Fígado , Fígado/irrigação sanguínea , Veias Renais/cirurgia , Veia Esplênica/cirurgia , Adulto , Feminino , Citometria de Fluxo , Humanos , Ligadura , Doadores Vivos , Masculino , Tamanho do Órgão , Prognóstico , Veias Renais/diagnóstico por imagem , Veia Esplênica/diagnóstico por imagem , Ultrassonografia
12.
Cancer Epidemiol Biomarkers Prev ; 18(7): 1993-9, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19567508

RESUMO

BACKGROUND: In premenopausal women, the sensitivity of screening mammography for detecting breast cancer has been reported to be greater in the follicular phase than in the luteal phase of the menstrual cycle, which may be due to differences in mammographic density. To examine this possible effect, we compared mammographic density in premenopausal women who had mammograms at different phases of the menstrual cycle. METHODS: We recruited premenopausal women ages 40 to 49 years from two mammography units in Toronto, recorded the first day of the last menstrual period (LMP) and measured mammographic density using Cumulus software. We classified the time of the mammography examination as having occurred in one of four intervals, 1 (first week after LMP), 2 (second week after LMP), 3 (third week after LMP) and 4 (>3 weeks after LMP), and compared mammographic density across intervals. RESULTS: Of the 936 women included in the analysis, 620 were examined by film and 316 by digital mammography. There were small and statistically nonsignificant variations in breast dense, nondense area, and percent density over the menstrual cycle in women examined by film mammography. Marginally significant variation in percent density was observed in the digital subset due to significant differences in the amount of nondense tissue over the menstrual cycle. CONCLUSION: Variations in mammographic density over the menstrual cycle were small and nonsignificant for women examined by either film or digital mammography. Thus, timing of mammography in menstrual cycle is unlikely to have a significant influence in breast cancer detection by screening mammography.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Ciclo Menstrual/fisiologia , Adulto , Fatores Etários , Neoplasias da Mama/prevenção & controle , Canadá , Feminino , Fase Folicular , Humanos , Fase Luteal , Programas de Rastreamento , Pessoa de Meia-Idade , Pré-Menopausa , Reprodutibilidade dos Testes , Fatores de Tempo
13.
World J Surg ; 32(12): 2549-53, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18563485

RESUMO

BACKGROUND: Since the introduction of breast-conserving surgery (BCS), it has been increasingly accepted as the standard surgical option for suitable breast cancer patients in Western countries. However, there have been reports suggesting striking ethnic variations in those undergoing BCS. This study aimed to review the rate of BCS in Hong Kong Chinese breast cancer patients and the possible clinicopathologic and psychosocial factors that may have affected the choice of surgery. METHODS: Patients in a university academic surgical center with early-stage breast cancer (stage I/II invasive carcinoma and carcinoma in situ) who underwent definitive surgery from January 2001 to December 2005 were studied. BCS was considered feasible for those with (1) the optimal tumor size for which an acceptable cosmetic outcome can be achieved after surgery, (2) unifocal disease, and (3) no contraindication for postoperative radiotherapy. The proportion of women undergoing BCS or mastectomy were compared. Factors affecting the choice of surgery were correlated. RESULTS: Six hundred eighty female patients with early-stage breast cancer underwent surgery during the study period; 495 (72.8%) mastectomies, 149 (21.9%) BCS, and 36 (5.3%) mastectomies with immediate reconstruction were performed. For those patients who had mastectomies, 54.8% (271/495) had considered BCS as the initial surgical option. Among these, 19.6% (53/271) failed to have BCS performed due to margin involvement or extensive disease, and 80.4% (218/271) declined BCS and opted for mastectomy only. Age, marital status, and educational level were found to be independent significant factors affecting the choice of BCS. CONCLUSION: The rate of BCS in Hong Kong is relatively low compared to that of Western countries. Patients who opted for mastectomies tended to be older, married, and have a lower educational level. Prospective studies on how sociocultural, clinicopathologic, and other factors important in treatment decision-making processes and psychosocial impact of choice of surgery are important so that an ethnic-specific assessment can be made. Suitability and acceptance of BCS by Chinese women should increase with better understanding and education.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Neoplasias da Mama/cirurgia , Carcinoma in Situ/cirurgia , Carcinoma Ductal de Mama/cirurgia , Mastectomia Segmentar , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/etnologia , Neoplasias da Mama/psicologia , Carcinoma in Situ/etnologia , Carcinoma in Situ/psicologia , Carcinoma Ductal de Mama/etnologia , Carcinoma Ductal de Mama/psicologia , Comportamento de Escolha , Estudos de Coortes , Feminino , Hong Kong , Humanos , Mamoplastia , Pessoa de Meia-Idade , Estudos Retrospectivos
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