Indigenous Peoples in Canada are disproportionately burdened with a spectrum of health issues and consistently report lower satisfaction with their health care; nevertheless, little is known about their experiences with critical care and the support received during critical illness. We aimed to describe the current scope of critical-care-specific resources available to Indigenous patients and their families across Alberta to identify gaps and opportunities to implement actionable change to realize more equitable and culturally safe care. We conducted a two-phase environmental scan. Phase 1 entailed searching websites for information to support Indigenous patients, their families, and health care workers. Phase 2 facilitated 21 interviews with intensive care unit (ICU) stakeholders from across Alberta to further describe site-specific resources, services, tools, or initiatives to support Indigenous Peoples. Indigenous partners were engaged through all aspects of the project. Our environmental scan identified a paucity of ICU-specific resources, programs, or policies to support Indigenous patients and families’ navigation with critical care. We identified two national resources aimed at clinicians, rather than patients or families. Interviews with ICU stakeholders confirmed the paucity of Indigenous-specific resources. Stakeholders cited numerous barriers, including inadequate culture training, staff time constraints and burnout, physical space limits, and insufficient personnel, such as Indigenous liaisons and social workers. Multiple gaps exist in the availability of critical-care-focused resources and supports for Indigenous Peoples experiencing critical illness in Alberta, Canada. Addressing these care gaps may improve health equity, access, and the experience for Indigenous patients and families during critical illness and further build trust and strengthen relationships with health care workers.
Purpose We sought to determine the effective initiation volume of ropivacaine 0.1% with sufentanil 0.3 mu g& centerdot;mL(-1) in 90% of patients (EV90) for labour epidural analgesia using the dural puncture epidural (DPE) technique. Methods In this biased-coin up-and-down sequential allocation study of labour analgesia, we included patients with a singleton pregnancy who were nulliparous; who had an American Society of Anesthesiologists Physical Status II-III classification, a numerical rating scale (NRS) pain score > 5, and cervical dilation < 5 cm; and who requested labour analgesia. We used a 25 G Whitacre needle to puncture the dura mater and initiated labour analgesia with epidural ropivacaine 0.1% with sufentanil 0.3 mu g& centerdot;mL(-1), omitting a lidocaine test dose. The initiation volume for the first parturient was 12 mL and was modified for the next parturient per the study design (groups 12, 14, 16, 18, and 20 with an initiation volume of 12, 14, 16, 18, and 20 mL, respectively). We defined effective analgesia as an NRS <= 3 at 20 min and assessed sensory blockade levels, Bromage scores, and maternal or neonatal adverse effects. Results We analyzed data from 40 participants. The estimated EV90 was 18 mL (95% confidence interval [CI], 14 to 18) with isotonic regression. The proportion of patients with the highest sensory block level reaching or exceeding T6 was 0/2 (0%), 0/4 (0%), 2/15 (13%), and 1/19 (5%) in groups 12, 14, 16, and 18, respectively. One patient who received 18 mL experienced hypotension but did not require vasopressor treatment. Conclusions When using the DPE technique to initiate labour analgesia without a lidocaine test dose, the EV90 of ropivacaine 0.1% with sufentanil 0.3 mu g& centerdot;mL(-1) was 18 mL (95% CI, 14 to 18).
Tracheal intubation is a physically and mentally demanding for anesthesiologists because it requires fine motor control, technical precision, rapid decision-making, situational awareness, and error avoidance. While videolaryngoscopes reduce muscle strain in normal airways, their ergonomic impact during difficult airway management remains poorly established. We aimed to compare upper limb muscle activity using dynamic surface electromyography during intubation via direct laryngoscopy (DL) vs videolaryngoscopy (VL) in simulated difficult airway scenarios. We conducted a randomized crossover trial involving 35 experienced anesthesiologists who performed tracheal intubation on a high-fidelity manikin with a normal airway, locked jaw, and rigid neck, respectively, using a Macintosh direct laryngoscope, a C-MAC® videolaryngoscope (C blade), and a King Vision® channeled videolaryngoscope. The primary outcome was upper limb muscle activity, measured by surface electromyography. Secondary outcomes included intubation time, force on upper incisors, first-attempt success rate, and perceived workload (National Aeronautics and Space Administration Task Load Index [NASA-TLX] score). Direct laryngoscopy produced significantly higher brachioradialis muscle activity than C-MAC VL in the simulated normal airway (16 vs 13 µV; median difference [MD], 3 µV; 95
Moderate to severe pain is common after cardiac surgery, especially in the first two postoperative days. Inadequate pain control may prolong intensive care unit (ICU) stay, may increase cost, and contributes to chronic pain. Enhanced Recovery After Cardiac Surgery (ERACS) protocols prioritize multimodal analgesia, including regional anesthesia techniques. In a recent randomized trial with continuous serratus anterior plane (SAP) catheters, we found unexpectedly high pneumothorax rates. To address this, we aimed to design a propensity-score-matched comparison using patients from the same institution to control for institutional practice patterns, surgical techniques, and patient demographics that could confound comparisons with published literature rates from other centres. We conducted a secondary analysis of RCT data with propensity score matching to a historic cohort. We compared the pneumothorax rates in patients receiving continuous SAP catheters in our previous Cardiac-Serratus Anterior Plane (Cardiac-SAP) trial with those in a retrospective institutional database cohort of patients receiving standard care undergoing cardiac surgery via sternotomy. The two groups were propensity score matched in a 1:20 ratio based on age, sex, smoking status, surgery type, and pre-existing respiratory disease. We analyzed univariate comparisons using Fisher’s exact test or the percentile bootstrapping method. We matched 50 patients from the Cardiac-SAP trial to 989 retrospective cohort patients. After matching, the SAP catheter group was associated with a significantly higher risk of pneumothorax (12
