Purpose The primary objectives of this historical casecontrol study were to evaluate the incidence of and reasons and risk factors for adult unanticipated admissions in three tertiary care Canadian hospitals following ambulatory surgery. Methods A random sample of 200 patients requiring admission (cases) and 200 patients not requiring admission (controls) was taken from 20,657 ambulatory procedures was identified and compared. The following variables were included: demographics, reason for admission, type of anesthesia, surgical procedure, length of procedure, American Society of Anesthesiologists' (ASA) classification, surgical completion time, pre-anesthesia clinic, medical history, medications (classes), and perioperative complications. Multiple logistic regression analysis was used to assess factors associated with unanticipated admissions. ResultsThe incidence of unanticipated admission following ambulatory surgery was 2.67%. The most common reasons for admission were surgical (40%), anesthetic (20%), and medical (19%). The following factors were found to be associated with an increased risk of unanticipated admission: length of surgery of one to three hours (odds ratio [OR] Author contributions Amanda Whippey, Greg Kostandoff, James Paul, Jinhui Ma, and Lehana Thabane helped design the study and write the manuscript. Amanda Whippey, Greg Kostandoff, and James Paul helped conduct the study. Heung Kan Ma helped in data collection, and Jinhui Ma and Lehana Thabane helped analyze the data. James Paul is the author responsible for archiving the study files. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, Lehana Thabane, and Heung Kan Ma have seen the original study data. Amanda Whippey, Greg Kostandoff, Jinhui Ma, James Paul, and Lehana Thabane reviewed the analysis of the data. 0.08 to 0.33), and dental/ear-nose-throat surgery (OR 0.32; 95% CI 0.13 to 0.83) when compared with general surgery. Other comorbid conditions did not impact unanticipated admission. Conclusion Unanticipated admission after ambulatory surgery occurs mainly due to surgical, anesthetic, and medical complications. Length of surgery more than one hour, high ASA class, advanced age, and increased BMI were all predictors. No specific comorbid illness was associated with an increased likelihood of unanticipated admission. These findings support continued use of the ASA classification as a marker of patient perioperative risk rather than attributing risk to a specific disease process. RésuméObjectif Les objectifs primaires de cette e´tude cas-te´moin historique e´taient d'e´valuer l'incidence ainsi que les raisons et les facteurs de risque des admissions non anticipe´es de patients adultes dans trois hôpitaux canadiens de soins tertiaires apre`s une chirurgie ambulatoire. dentaire / oto-rhino-larynge´e (ORL) (RC 0,32; IC 95 % 0,13 a`0,83) par rapport a`une chirurgie ge´ne´rale. Aucun impact sur les admissions non anticipe´es n'a e´te´observeá vec d'autres comorbidite´s. Conclusion Les admissions non anticipe´es apre`s une chi...

Up to 40% of individuals with unresponsive wakefulness syndrome (UWS) actually might be conscious. Recent attempts to detect covert consciousness in behaviorally unresponsive patients via neurophysiological patterns are limited by the need to compare data from brain-injured patients to healthy controls. In this report, we pilot an alternative within-subject approach by using propofol to perturb the brain state of a patient diagnosed with UWS. An auditory stimulation series was presented to the patient before, during, and after exposure to propofol while high-density electroencephalograph (EEG) was recorded. Baseline analysis revealed residual markers in the continuous EEG and event-related potentials (ERPs) that have been associated with conscious processing. However, these markers were significantly distorted by the patient’s pathology, challenging the interpretation of their functional significance. Upon exposure to propofol, changes in EEG characteristics were similar to what is seen in healthy individuals and ERPs associated with conscious processing disappeared. At the 1-month follow up, the patient had regained consciousness. We offer three alternative explanations for these results: (1) the patient was covertly consciousness, and was anesthetized by propofol administration; (2) the patient was unconscious, and the observed EEG changes were a propofol-specific phenomenon; and (3) the patient was unconscious, but his brain networks responded normally in a way that heralded the possibility of recovery. These alternatives will be tested in a larger study, and raise the intriguing possibility of using a general anesthetic as a probe of brain states in behaviorally unresponsive patients.

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Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.

The findings from this study suggest that the use of any given descriptor conveys slightly different meaning dependent on the context in which it is used. This helps to address some key issues surrounding the application of qualitative markers to performance assessment in medical education.