JA Clinical Reports最新文献

Background: Prehabilitation, which includes nutritional and exercise therapies, is recommended for patients before surgery to improve physical and cognitive functions. This study aimed to identify the awareness, understanding, and issues among surgeons and anesthesiologists regarding the implementation of prehabilitation.

Methods: We conducted a survey on prehabilitation targeting surgeons and anesthesiologists working at a university hospital and two private hospitals. The survey collection period was set for 1 month, commencing on February 5, 2024. Descriptive statistics were employed to summarize the characteristics of the participants.

Results: A total of 254 surgeons and 49 anesthesiologists from three hospitals participated, with a response rate of 61.7%. Regarding the understanding of prehabilitation, 16.7% of anesthesiologists and only 2% of surgeons had a good grasp of its content. When enquired about the necessity of prehabilitation, 100% of anesthesiologists indicated it as necessary or somewhat necessary, whereas 98.7% of surgeons responded similarly. Several barriers to the implementation of prehabilitation were identified, with the most common reason being the busy schedule of outpatient services.

Conclusion: This study highlights that while both surgeons and anesthesiologists recognize the importance of prehabilitation, significant challenges exist in its practical implementation. This underscores the need for simple explanatory tools for patients, the introduction of remote care options, and simple orders to relevant departments, which are essential and require multidisciplinary collaboration.

Background: Mandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a rare autosomal dominant disorder that presents unique challenges for anesthetic management due to its multisystemic manifestations. This report outlines the anesthetic considerations for MDPL patients based on our case experience.

Case presentation: A 15-year-old male with MDPL syndrome underwent testicular extraction under general anesthesia. Insertion of a peripheral venous catheter was challenging due to scleroderma-like skin. Although the facial features of MDPL syndrome suggested a difficult airway, intubation with a McGrath™ Mac video laryngoscope was successful. Despite MDPL syndrome's association with hypertriglyceridemia due to lipodystrophy, this patient's triglyceride levels were normal. Thiamylal and sevoflurane were used without issues such as delayed emergence from anesthesia.

Conclusions: MDPL syndrome requires careful preoperative assessment and tailored anesthetic management due to potential airway challenges arising from its distinctive facial features and the possibility of altered anesthetic pharmacokinetics associated with lipodystrophy.

Background: Nausea and vomiting during awake craniotomy (AC) can increase cerebral pressure and cause asphyxia and aspiration. 5-HT3 receptor antagonists, such as granisetron, are often administered before awakening to prevent nausea during AC. Recently, dexamethasone was reported to prevent nausea and vomiting during AC; however, the efficacy of both drugs in preventing nausea has not yet been investigated.

Methods: We examined the frequency of nausea and vomiting in AC patients (n = 170) treated at our hospital until the end of September 2019. We divided patients as those who received dexamethasone (n = 71) and or granisetron (n = 99) before awakening and examined the frequency of nausea and vomiting after propensity score (PS) matching.

Result: Eighty-two patients were selected after PS matching. The incidence of nausea was significantly lower in the dexamethasone group than in the granisetron group (9.8% vs 41.5%, p = 0.002). In the logistic regression analysis after matching, the incidence of nausea significantly reduced with dexamethasone treatment (odds ratio: 0.12, 95% confidence interval: 0.029-0.499, p = 0.03).

Conclusion: In conclusion, dexamethasone was more effective than granisetron in preventing nausea during AC.

Background: Although subdural hematoma is a rare complication after spinal anesthesia, there have been no reports of an intracranial epidural hematoma after cesarean section with spinal anesthesia.

Case presentation: A 32-year-old nulliparous woman at the 35^th week of a twin pregnancy underwent an emergency cesarean section due to her first contraction. She had no preoperative complications and the spinal anesthesia was uneventful, with 0.5% bupivacaine 12 mg and fentanyl 15 µg from the L3/4 intervertebral space. She complained of headache and nausea 15 min after spinal anesthesia, demonstrating a consciousness disturbance after surgery. Computed tomography 2 h after the cesarean section revealed an intracranial epidural hematoma. She underwent decompressive craniotomy 1 h later.

Conclusion: This case highlights the possible development of an intracranial epidural hematoma in low-risk obstetric patients.

Background: Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking.

Case presentation: A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery.

Conclusions: Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia.

Background: From the standpoint of infection prevention, anesthesiologists need to simultaneously use a surgical mask and an oxygen mask when administering oxygen to patients. However, there is a lack of scientific evidence to justify this method. We aimed to investigate a suitable method of oxygen administration when using a surgical mask in postoperative patients.

Methods: This was a randomized, single-blind, cross-over study involving 42 patients admitted to the ICU. We compared three methods of oxygen administration: nasal cannula under the surgical mask, oxygen mask under the surgical mask, and oxygen mask above the surgical mask, using a cross-over design. The primary endpoint was partial pressure of arterial oxygen (PaO₂). The secondary endpoint was partial pressure of arterial carbon dioxide (PaCO₂).

Results: PaO₂ was higher when the oxygen mask was placed under the surgical mask (median values 197.7 mmHg), the nasal cannula was under the surgical mask (180.6 mmHg), and the oxygen mask was above the surgical mask (143.0 mmHg), in descending order, with significant differences between all groups (P < 0.001). PaCO₂ did not differ between groups.

Conclusions: The current standard method of administering oxygen to postoperative patients using an oxygen mask over a surgical mask results in poor oxygenation. Adopting the method of oxygen administration under the surgical mask via an oxygen mask or nasal cannula should be considered instead.

Background: It is difficult to evaluate adequate dose of heparin for cardiopulmonary bypass (CPB) by activated clotting time (ACT) in a patient receiving both heparin and dabigatran because dabigatran can also prolong ACT. We evaluated the effect of dabigatran by thromboelastography (TEG) to determine adequate heparin dose for CPB.

Case presentation: An 81-year-old woman receiving both heparin and dabigatran was scheduled for an emergency surgical repair of iatrogenic atrial septal perforation. Although ACT was prolonged to 419 s, we performed TEG to distinguish anticoagulation by dabigatran from heparin comparing R in CK and CHK. As the results of TEG indicated residual effect of dabigatran, we reversed dabigatran by idarucizumab and then dosed 200 U/kg of heparin to achieve adequate anticoagulation for CPB by heparin.

Conclusions: TEG could help physicians to determine need for idarucizumab and also an adequate dose of heparin to establish appropriate anticoagulation for CPB.