BackgroundWith over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice.MethodsSearches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically.ResultsAmong the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1).ConclusionsBy mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0863-x) contains supplementary material, which is available to authorized users.

Can J Neurol Sci. 2016; 43: 329-331 Fenestrations of vertebral and basilar arteries are considered to be rare, congenital malformations observed in angiographic and autopsy studies. They are vascular abnormalities having two different lumens and endothelium layers, sharing either the same or separate adventitia layers. Basilar artery fenestration is an uncommon developmental anomaly occurring in 1% to 5% of autopsy specimens, 1 Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery. Association of a saccular cerebral aneurysm at the fenestration has been well documented. However, dissection of a limb of the vertebral artery fenestration is extremely rare. We describe a case of dissection of the left limb of a left vertebral artery fenestration that initially presented itself as a suspected vertebrobasilar aneurysm. CASE REPORTA 55-year-old man awoke suddenly from sleep with a sudden onset, severe headache behind the left eye lasting approximately ten minutes. The headache was associated with ataxia, diaphoresis, and vomiting. He also recalls an unusual symptom of dysphagia, which lasted approximately ten minutes. All symptoms resolved spontaneously within 15 minutes. He recalls having a similar headache one year ago, which resolved spontaneously. The patient is a single, marine engineer, with a history of hypertension that was managed with olmesartan at the time. He does not drink or smoke and has no significant personal or family history of cardiac or cerebrovascular disease.By the time the patient arrived at the local emergency room, he was asymptomatic. He was evaluated for a possible cardiac cause and was discharged that evening without further investigations secondary to unremarkable findings. After investigating his symptoms on the Internet and becoming concerned he had a cerebral aneurysm, the patient presented to the emergency department at our institution three days later. A lumbar puncture (LP) showed acellular cerebrospinal fluid (CSF) without xanthochromia and a computed tomography (CT) scan of the head without contrast was normal.At this stage, it was appropriate to identify the cause for the patient's dysphagia, which was presumably due to transient ischemia to the lateral medulla (nuclei of cranial nerves IX and X). Thus, the differential diagnosis of a thunderclap headache with associated ataxia, vomiting and dysphagia would include the following:• aneurysm-related subarachnoid hemorrhage (SAH), with vasospasm resulting in focal cerebral ischemia;• reversible cerebral vasoconstriction syndrome (RCVS), with or without associated SAH and focal cerebral ischemia;• artery dissection with focal cerebral ischemia;• occlusive atherosclerotic thromboembolism with focal cerebral ischemia and;• migraine with brainstem aura.Although migraine with brainstem aura can present suddenly and be associated with focal neurological signs and symptoms, dysphagia would be an unusual symptom in relative isolation. Given a negative LP and a CT scan that was...

Distribution of Baetodes huaico extends up to the Province of San Luis (Argentina). This constitutes the southernmost record of this species. Morphologicla characteristics were used for the species recognition.

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