Anesthesia and pain medicine最新文献

Background: Breakage of balloon-less Racz neuroplasty catheters is a rare complication of neuroplasty; however, shearing of balloon catheters during epidural neuroplasty has not been reported.

Case: Herein, we report a case of a broken epidural balloon catheter during neuroplasty. A 76-year-old female underwent percutaneous epidural neuroplasty (PEN) using a Racz catheter, epidural steroid injection, and medial branch block for lumbar spinal stenosis 6 months ago. However, her symptoms did not improve. Subsequently, we performed a PEN using an inflatable balloon catheter. During the procedure, the epidural balloon catheter became trapped, broke, and could not be retrieved. Subsequently, the patient complained of leg pain and numbness. Therefore, surgery was performed to remove the broken catheter, resolving the leg pain and numbness.

Conclusions: This case report supports the surgical removal of broken catheters to avoid the aggravation of symptoms and the development of neurological deficits.

Ultrasound-guided regional anesthesia (UGRA) offers substantial benefits in perioperative pain management; however, it remains underutilized because of technical complexity and training demands. Assistive artificial intelligence (AI) has emerged as a promising solution to support UGRA by enhancing anatomical recognition, procedural accuracy, and user confidence. This narrative review outlines the AI development pipeline for nerve visualization, describes available commercial tools, and summarizes clinical evidence. Although these technologies have the potential to democratize UGRA and reduce interoperator variability, limitations remain, including data bias, narrow anatomical coverage, and lack of outcome-based validation. Future efforts should focus on standardized evaluation, clinician-centered design, and rigorous clinical trials to ensure safe and effective integration of AI into UGRA practice.

Background: Remimazolam is an ultra-short-acting benzodiazepine characterized by rapid onset and recovery with minimal accumulation after continuous infusion. This systematic review and meta-analysis aimed to evaluate whether remimazolam use results in better postoperative recovery as compared to inhalational anesthetics.

Methods: Databases including MEDLINE, EMBASE, CENTRAL, Web of Science, Google Scholar, and Scopus were searched up to August 2024. Randomized controlled trials (RCTs) in adult patients comparing remimazolam with volatile agents were included. The primary outcome was incidence of postoperative nausea and vomiting (PONV) at 24 h. Secondary outcomes included use of rescue antiemetics and analgesics, pain scores, intraoperative hypotension, and other postoperative recovery parameters. Trial sequential analysis (TSA) was performed to validate the robustness of the primary outcome.

Results: Twelve RCTs involving 853 patients were analyzed. Remimazolam significantly reduced the incidence of PONV (relative risk [RR] 0.51; 95% confidence interval [CI] 0.27-0.96; I² = 43%; P = 0.04) and need for rescue antiemetics (RR 0.30; 95% CI 0.10-0.89; I² = 0%; P = 0.03) compared to inhalational agents. No significant differences were found in postoperative pain scores (standardized mean difference -0.17; P = 0.11) or analgesic requirement (RR 0.95; P = 0.82). Remimazolam was associated with a significantly lower incidence of intraoperative hypotension (RR 0.58; P = 0.01). Time to extubation, sedation scores, and post-anesthesia care unit stay were comparable. TSA confirmed that the required information size for the primary outcome was reached, indicating statistical conclusiveness.

Conclusions: Remimazolam use is associated with significantly reduced PONV, rescue antiemetic use, and intraoperative hypotension compared to inhalational agents. TSA confirms the robustness of these findings.

Background: The effects of sugammadex, which reverses neuromuscular blockade, on emergence-related respiratory events in children remain unclear. This study compared the respiratory outcomes of sugammadex and neostigmine in pediatric tonsillectomy.

Methods: Children aged 2 to 6 years undergoing tonsillectomy were randomly assigned to either the sugammadex or neostigmine group. The primary outcome was the occurrence of respiratory adverse events, including oxygen desaturation < 95%, airway obstruction, laryngospasm, bronchospasm, severe coughing, or postoperative stridor. Secondary outcomes included bradycardia, allergic reactions, and emergence delirium.

Results: The study included 172 pediatric patients (n = 86 per group). Neuromuscular blockade reversal was faster in the sugammadex group than in the neostigmine group, achieving a train-of-four ratio of 90% in a median of 1 min vs. 4 min in the neostigmine group (P < 0.001). The time to extubation was comparable between the two groups (median, 8 min; P = 0.679), as was the overall incidence of respiratory adverse events (29.0% vs. 30.2%; relative risk, 0.962; 95% confidence interval [CI], 0.607-1.524; P = 0.858). Emergence delirium occurred in 27.9% of patients overall, but the incidence was higher in the sugammadex group than in the neostigmine group (34.9% vs. 20.9%; relative risk, 1.214; 95% CI, 1.005-1.467; P = 0.044).

Conclusions: Sugammadex provides significantly faster neuromuscular blockade reversal compared to neostigmine but does not shorten the time to extubation or reduce the incidence of emergence-related respiratory adverse events in children undergoing tonsillectomy. Moreover, its use may be associated with an increased risk of emergence delirium.

Cervical facet joints (CFJs) are a frequent source of neck pain, contributing to both localized and referred pain patterns. However, diagnosis remains difficult owing to the nonspecific nature of the clinical findings and limited accuracy of current diagnostic methods. Among available approaches, diagnostic blocks with local anesthetics are considered the most reliable technique for identifying CFJ-mediated pain. Although various treatment strategies are available for managing pain, including pharmacologic, rehabilitative, and surgical approaches, this review focuses on interventional treatment modalities. While these techniques are widely used in clinical settings, they show variable outcomes across studies. The anatomical complexity of the cervical spine and its proximity to critical neurovascular structures demand a high level of anatomical understanding and procedural expertise. This review outlines the key anatomical, technical, and clinical considerations for CFJ interventions. It also summarizes current evidence regarding their diagnostic and therapeutic utility within the context of pain management. Given the limitations in diagnostic certainty and variability in treatment response, interventional procedures should be applied using an anatomically guided and evidence-based approach to optimize patient care.

Opiranserin injection (Unafra®, Vivozon Inc.) is a first-in-class, non-opioid analgesic for the management of moderate-to-severe postoperative pain. The active ingredient, opiranserin (code name: VVZ-149), is a synthetic molecule that simultaneously antagonizes glycine transporter 2 (GlyT2) and serotonin 2A receptors (5-HT2A), both of which play key roles in pain processing. Opiranserin exemplifies the application of ex vivo phenotypic screening combined with a bait-target approach to identify effective multi-target agents that overcome the limitations of conventional single-target analgesics. In this review, we aim to describe the discovery and optimization of opiranserin through efficacy-based screening using a bait-target approach, outline its pharmacological mechanisms of action as a drug with both central and peripheral activity, and summarize published clinical studies demonstrating its successful translation from preclinical efficacy to reductions in postoperative pain and opioid consumption. We also discuss the clinical implications and future research directions to enhance the therapeutic utility of opiranserin injection and maximize patient benefit within the framework of precision analgesia.

Electroencephalography (EEG) reflects thalamocortical activity during anesthesia, but its signatures vary markedly with age. Alpha oscillations emerge in late infancy, peak in childhood, and decline with aging, producing substantial bias in processed EEG (pEEG) indices derived mainly from adult data. This narrative review summarizes age-specific EEG dynamics under γ-aminobutyric acid (GABA)-ergic anesthesia, highlighting developmental and aging trajectories, age effects on pEEG reliability, and associations with postoperative delirium (POD), emergence agitation (EA), and recovery outcomes. In infants and toddlers, immature alpha activity may lead to less reliable or incompletely suppressed index values even during deep anesthesia, whereas in children up to 6-7 years, indices remain variable and poorly correlated with anesthetic concentration. In older adults, alpha attenuation and spectral flattening elevate pEEG values despite EEG suppression, increasing overdose risk. Age-related EEG differences could influence the interpretation of outcome studies. Although results are mixed, meta-analyses suggest that pEEG-guided or lighter anesthesia may modestly reduce POD incidence but not consistently decrease EA in children. EEG features such as reduced alpha power and increased burst suppression are reliable predictors of POD in adults, while pediatric evidence remains limited. Randomized trials on spectrogram- or raw EEG-guided titration have shown variable neurocognitive outcomes and inconsistent anesthetic-sparing effects. Overall, pEEG reliability declines in both young and older patients. Age-adjusted interpretation-incorporating raw EEG and spectrogram analysis-is essential for accurate anesthetic titration and safer neurocognitive outcomes across the lifespan.

Background: Regional anesthetic techniques are becoming increasingly more common for a variety of surgeries. Current literature regarding regional anesthesia for breast surgery also involves sedation or general anesthesia (GA).

Case: A 53 year old female underwent wide local excision breast surgery and sentinel node biopsy under combined thoracic paravertebral block and pectoralis nerve I and II block without concurrent sedation or GA.

Conclusions: This case report demonstrates patient acceptability for completely awake breast surgery with good surgical conditions. This technique could be used for high risk or motivated patients where a GA and its associated complications could be avoided.

Traditionally, anesthesiologists have recommended performing auscultation of breath and heart sounds with a precordial or esophageal stethoscope during anesthesia. The stethoscope is generally considered the most important single device used for monitoring. Unfortunately, many anesthesiologists neglect the perioperative use of a stethoscope, even though it provides a wealth of information about the circulatory system, heart, and lungs. Although point-of-care ultrasound appears to offer greater diagnostic value in some situations, it is premature to dismiss the stethoscope, and its diminished perioperative role should be reconsidered. Recent technological advances have allowed changes in the roles of these modalities to help attending anesthesiologists perform easy assessments using clinically meaningful information from auscultation. The phonocardiopulmogram (PCPG), a real-time visual acoustic monitor, is a rediscovered and renovated technique that allows non-invasive continuous heart-lung function monitoring. However, the novel role of the PCPG as a continuous acoustic monitor, particularly for S1 and S2 heart sounds and their respiratory variations, remains relatively unexplored. This device may convey information about cardiac contractility, cardiac output, and fluid responsiveness. Furthermore, continuous lung sound visualization has potential as a monitoring modality during anesthesia, including during bronchospasm and endobronchial intubation. With its ease of use and intuitive mechanism, the PCPG can be applied during general anesthesia and follow-up in both post-anesthesia and intensive care unit settings, particularly for the detection of acute adverse events during the perioperative period.