Purpose Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. Clinical features We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient. Conclusion We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations. RésuméObjectif La spondylarthrite ankylosante (SpA) est une maladie chronique e´volutive affectant plusieurs syste`mes. Les patients souffrant de SpA posent une se´rie de de´fis spe´cifiques lie´s à l'anesthe´sie et les proble`mes d'une parturiente souffrant de SpA ne´cessitent une approche encore plus e´labore´e. Nous de´crivons notre expe´rience avec une parturiente atteinte de SpA avance´e et proposons une nouvelle explication pour l'incidence e´leve´e d'e´checs de la pe´ridurale dans cette population de patientes. Caractéristiques cliniques Nous pre´sentons le cas d'une parturiente de 36 ans, primipare, ayant des ante´ce´dents de SpA se´ve`re et des voies ae´riennes difficiles. Le plan the´rapeutique initial consistait a`utiliser une pe´ridurale continue pour l'analge´sie au cours du travail. Malgre´la mise en place re´ussie de deux cathe´ters pe´riduraux par voie lombaire, une diffusion rostrale approprie´e de l'anesthe´sie locale pour atte´nuer sa douleur n'a jamais e´teó btenue par voie pe´ridurale. En conse´quence, une
Background Increasing evidence suggests that sustainable delivery of interprofessional education (IPE) has the potential to lead to interprofessional collaborative practice (IPCP), which in turn has the potential to lead to enhanced healthcare systems and improved patient-centered care health outcomes. To enhance IPE in Canada, the Accreditation of Interprofessional Health Education (AIPHE) project initiated collaborative efforts among accrediting organizations of six health professions to embed IPE language into their respective accreditation standards. To further understand the impact of the AIPHE project, this study evaluated the accountability of the IPE language currently embedded in Canadian health professions’ accreditation standards documents and examined whether such language spanned the five accreditation standards domains identified in the AIPHE project. Methods We conducted a comparative content analysis to identify and examine IPE language within the “accountable” statements in the current accreditation standards for 11 Canadian health professions that met our eligibility criteria. Results and discussion A total of 77 IPE-relevant accountable statements were identified across 13 accreditation standards documents for the 11 health professions. The chiropractic, pharmacy, and physiotherapy documents represented nearly 50% (38/77) of all accountable statements. The accountable statements for pharmacy, dentistry, dietetics, and nursing (registered) spanned across three-to-four accreditation standards domains. The remaining nine professions’ statements referred mostly to “Students” and “Educational program.” Furthermore, the majority of accreditation standards documents failed to provide a definition of IPE, and those that did, were inconsistent across health professions. Conclusions It was encouraging to see frequent reference to IPE within the accreditation standards of the health professions involved in this study. The qualitative findings, however, suggest that the emphasis of these accountable statements is mainly on the students and educational program, potentially compromising the sustainability and development, implementation, and evaluation of this frequently misunderstood pedagogical approach. The findings and exemplary IPE-relevant accountable statements identified in this paper should be of interest to all relevant stakeholders including those countries, where IPE accreditation is still emerging, as a means to accelerate and strengthen achieving desired educational and health outcomes.
Optimal pain management, better parental information about risks of postoperative behavior disturbances, and program integrating parent and child preparation should improve quality of care and global satisfaction in the fast-track recovery process.
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