Human papillomavirus (HPV) remains the most common sexually transmitted infection with a lifetime incidence of over 75%. Based on US data from the Centers for Disease Control and Prevention (CDC), 64% of invasive HPV-associated cancers are attributable to HPV 16 or 18 (65% for females; 63% males) and may be prevented by vaccination with either the quadrivalent or nonavalent HPV vaccine. Public HPV vaccination programs are now the norm for women aged 9-45 years and men aged 9-26 years in Canada. Yet, only recently have guidelines begun to consider vaccination of men older than 26 years of age. There now exist compelling reasons to recommend vaccination against HPV amongst males >26 years of age. Recognizing that the risks posed by HPV infection persist beyond 26 years of age, that the vaccination of men aged 26-45 years with HPV vaccine confers immunogenicity at levels demonstrably efficacious against HPV-related diseases, and that the Food and Drug Administration recently expanded the HPV vaccination to include older men, it is argued that HPV vaccination in men older than 26 years of age should be routinely recommended.
(Can J Anesth/J Can Anesth. 2019;66:762–771)
Neuraxial anesthesia is preferable for cesarean deliveries (CDs), as it allows mothers to be awake and avoids the associated risks of general anesthesia. However, an estimated 53% of patients under neuraxial anesthesia suffer from shivering. Uncontrolled shivering intervenes with vital sign monitoring, causes physiological stress, and affects a patient’s satisfaction and comfort. The most common pharmacological treatment for shivering is meperidine (a synthetic opioid). However, as this drug becomes increasingly scarce in North American hospitals, an effective alternative agent is desired. Dexmedetomidine is an alternative treatment for shivering and can alleviate shivering while avoiding side effects associated with opioids. The aim of this study was to test whether a single bolus of 30 μg intravenous (IV) dexmedetomidine, administered 5 minutes after childbirth, could reduce shivering during CD under neuraxial anesthesia.
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