JA Clinical Reports最新文献

Background: Vocal cord paralysis (VCP) is a recognized complication of endotracheal intubation, but its true incidence may be underestimated because many asymptomatic cases remain undetected. Previous studies have focused primarily on VCP affecting the surgical side after unilateral thyroidectomy, whereas the non-surgical side has received less attention. The present study determines the incidence and risk factors of intubation-induced VCP on the non-surgical side in patients undergoing hemithyroidectomy.

Results: This retrospective cohort included 339 patients who underwent hemithyroidectomy at a single institution between 2010 and 2018. All patients underwent routine pre- and postoperative laryngeal examinations using flexible endoscopy. The incidence of intubation-induced VCP on the non-surgical side was 2.4% (8/339). Patients who developed VCP had significantly lower body weight and body mass index than those without VCP, suggesting that underweight individuals may be more vulnerable. Most cases were transient, resolving within two months of surgery. No significant associations were identified between age, duration of surgery, endotracheal tube size, or intubation method. All cases of intubation-related VCP occurred in patients anesthetized with total intravenous anesthesia. However, this finding should be interpreted with caution because the retrospective design precludes establishing causality and potential confounders.

Conclusions: Intubation-induced VCP was observed more frequently than previously reported, particularly among underweight patients. Routine perioperative laryngeal assessment enables detection of asymptomatic cases and may help clarify risk factors. Careful preoperative evaluation and vigilant intraoperative management remain essential to reduce the risk of this underrecognized complication.

Background: Platypnea-orthodeoxia syndrome (POS) is a rare condition causing dyspnea and hypoxemia that worsen in the upright position and improve when supine. While often reported in elderly patients, POS in young adults, particularly due to residual atrial septal defects (ASD) after congenital heart surgery, is uncommon.

Case presentation: We present a 24-year-old woman with POS caused by a residual ASD following congenital heart surgery. Agitated saline contrast transthoracic echocardiography confirmed marked right-to-left shunting exacerbated by positional change and Valsalva maneuver. Anesthetic management focused on minimizing shunt flow by maintaining systemic vascular resistance, avoiding hypoxia, hypercarbia, and acidosis, and carefully adjusting ventilation parameters. Transesophageal echocardiography was utilized for shunt evaluation and device placement. Additionally, continuous cerebral oximetry was monitored for possible ischemic changes associated with paradoxical embolisms. The patient underwent successful percutaneous ASD closure without complications.

Conclusion: This rare case of young-onset POS highlights the importance of understanding the dynamic shunt physiology and vigilant intraoperative monitoring to ensure patient safety.

Background: Due to the highly invasive nature of veno-arterial extracorporeal membrane oxygenation (VA-ECMO), advanced malignancy is considered a relative contraindication. We here report a patient with hemodynamic collapse secondary to metastatic lung cancer in whom bridging via VA-ECMO was successful.

Case presentation: A 35-year-old man with metastatic non-small cell lung cancer harboring a deletion in exon 19 of epidermal growth factor receptor developed acute right ventricular failure and hemodynamic collapse due to pulmonary tumor thrombotic microangiopathy. Because treatment with the targeted agent osimertinib had already been initiated and a rapid response was anticipated, VA-ECMO was instituted as a bridge to its therapeutic effect. The patient's hemodynamics stabilized within 7 days, permitting VA-ECMO decannulation. At the time of writing, the patient is continuing to undergo regular outpatient follow-up.

Conclusions: In carefully selected oncology patients with highly treatment-sensitive disease, short-term VA-ECMO may be an effective bridge to systemic therapy.

Background: This study aimed to evaluate the effect of combined administration of remimazolam and propofol on extubation time during anesthesia maintenance.

Methods: This retrospective study was conducted at Hamamatsu University Hospital, enrolling adult patients who underwent non-cardiac surgery between September 2020 and October 2024. Eligible patients underwent invasive arterial pressure monitoring and anesthesia maintenance with remimazolam alone (RB group), propofol alone (PROP group), or a combination of both (RB + PROP group). Extubation time was defined as the interval between the cessation of sedative administration and tracheal extubation. Propensity score matching was performed after adjusting for age, sex, body mass index, American Society of Anesthesiologists Physical Status, preoperative comorbidities, type of surgery, combined with epidural anesthesia, scheduled or emergency surgery, operation time, and blood loss. The primary endpoint was the extubation time, while the secondary endpoints included the severity of hypotension, assessed by the time-weighted average area under the threshold, and the incidence of postoperative nausea and vomiting.

Results: The study included 165, 403, and 178 patients in the RB, PROP, and RB + PROP groups, respectively. After propensity score matching, 75 matched cohorts were analyzed. Among the three groups, significant differences were found in terms of extubation time and hypotension (p < 0.001 and p = 0.04, respectively), whereas the incidence of postoperative nausea and vomiting did not significantly differ (p = 0.23). In multiple comparisons, the RB group (9.0 min) and the RB + PROP group (9.0 min) had significantly shorter extubation times than the PROP group (13.0 min) (each p < 0.001). Time-weighted average area under the threshold was significantly lower in the RB group (0.74 mmHg) than in the PROP group (2.03 mmHg) (p = 0.03).

Conclusion: Extubation time with combined remimazolam and propofol was comparable to that with remimazolam alone, and both were shorter than that with propofol alone.

Background: Dysfibrinogenemia causes abnormal fibrinogen production, leading to thrombotic or bleeding complications, which are relative contraindications for neuraxial anesthesia. Neuraxial anesthesia is recommended for cesarean delivery to reduce maternal and neonatal morbidity.

Case presentation: We report a 39-year-old gravida 2, para 0 woman with dysfibrinogenemia who safely underwent spinal anesthesia, as assessed using thromboelastography, for an urgent cesarean delivery.

Conclusions: Thromboelastography can aid the anesthesia team in evaluating the risks versus benefits of neuraxial anesthesia in patients with hereditary dysfibrinogenemia.