JA Clinical Reports最新文献

Background: Anaphylaxis caused by intravenous acetaminophen is extremely rare, but a few case reports have identified mannitol, an excipient, as the causative component. Since mannitol is widely present in medications and foods, distinguishing the true antigen is essential to prevent recurrence.

Case presentation: A 67-year-old woman developed anaphylaxis with pulseless electrical activity during ophthalmic surgery after intravenous administration of acetaminophen (Acelio®). Allergy testing revealed positive reactions to both Acelio® and acetaminophen in skin tests and the basophil activation test, while reactions with mannitol were negative. Acetaminophen was confirmed as the causative agent. Hence, the patient was instructed to avoid only acetaminophen.

Conclusions: Accurate identification of the causative component in intravenous acetaminophen formulations is critical. Clarifying whether the reaction is due to the active ingredient or an excipient such as mannitol helps prevent unnecessary drug restrictions and expands future treatment options.

Introduction: Epidural morphine administration following vaginal delivery reduces postpartum pain; however, side effects may occur. We investigated whether a lower dose could achieve pain relief without increasing the incidence and severity of side effects.

Methods: Eighty women treated with combined spinal-epidural analgesia received 0.75 mg epidural morphine (morphine group) or normal saline (normal saline group) after delivery. The primary outcome was the area under the curve (AUC) of the visual analog scale score assessing perineal and contraction pain for 24 h following delivery. Secondary outcomes were time until initial request for additional analgesics, number of analgesic medications, and side effects incidence and severity.

Results: The morphine group did not show lower mean AUCs for postpartum perineal (290, interquartile range [IQR]: 90-580 vs 450, IQR: 265.6-760; P = 0.07) or contraction pain (18.8, IQR: 0-105 vs 156.3, IQR: 11.5-300; P = 0.004). The time until the initial request for additional analgesics was longer in the morphine group (530 min, 95% confidence interval [CI]: 365 to 915 min vs 268 min, 95% CI: 230 to 385 min; P = 0.001). The median (IQR) number of analgesic medications within 24 h were 2 (0.5-3) and 2.5 (2-3) in the morphine and saline groups, respectively (P = 0.007). There were no differences in the incidence of side effects between the groups.

Conclusions: Epidural morphine following vaginal delivery reduces contraction pain but not perineal pain and prolongs the time until initial request for additional analgesia without increasing side effects.

Clinical trials registration number: The University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000039351).

Background: Guidelines recommend prophylactic chest tube placement in patients with traumatic pneumothorax who require positive pressure ventilation to prevent tension pneumothorax. However, chest tube insertion is not without complications, and avoiding it when safely possible is desirable.

Case presentation: A man in his 50 s with a left clavicle fracture and mild left-sided occult pneumothorax on computed tomography was scheduled for surgery under general anesthesia. Conservative management was chosen given the absence of respiratory symptoms and stable imaging. To minimize the risk of pneumothorax progression during positive pressure ventilation, one-lung ventilation was employed to avoid ventilating the affected lung. Surgery proceeded uneventfully, with transient hypoxemia that was managed by increasing FiO₂ to 100%. Postoperative imaging confirmed re-expansion of the left lung and no pneumothorax progression. The patient was discharged in good condition.

Conclusions: General anesthesia was safely managed without prophylactic chest tube placement by employing one-lung ventilation in a patient with occult traumatic pneumothorax.

Background: Posterior reversible encephalopathy syndrome (PRES) often presents with a wide range of neurological symptoms, and atypical manifestations can complicate its diagnosis. We report a rare case of peripartum PRES presenting with profound transient retrograde amnesia and orofacial automatisms, notably in the absence of generalized seizures.

Case presentation: A 29-year-old primigravida developed sustained hypertension during labor. Immediately postpartum, she experienced visual disturbances, followed by altered consciousness and lip-smacking movements. She subsequently developed profound but transient retrograde amnesia, including loss of autobiographical memory. Brain magnetic resonance imaging (MRI) revealed characteristic findings of PRES in the bilateral parieto-occipital lobes, leading to a diagnosis of PRES secondary to preeclampsia.

Discussion: This case highlights that peripartum PRES can present with atypical neurological symptoms, such as transient global amnesia and facial automatisms, even in the absence of typical eclamptic seizures. Such presentations warrant a high index of suspicion and prompt brain MRI to ensure accurate diagnosis and timely intervention.

Background: These case reports focus on successful pain management with ultrasound-guided serratus posterior superior muscle (SPSM) block using 30 mL of 0.25% ropivacaine or physiological saline in three myofascial pain syndrome (MPS) patients presented with cervicoscapular pain.

Case presentation: The SPSM block was administered to three ambulatory patients (cases #1, #2, and #3) who presented with cervicoscapular pain. The SPSM block with 30 mL of 0.25% ropivacaine drastically decreased an NRS score and provided 2-3 weeks of pain relief in cases #1 and #2. On the contrary, the SPSM block with 30 mL of physiological saline also mildly decreased an NRS score and provided 3 weeks of pain relief in cases #1 and #3.

Conclusions: The SPSM block using 30 mL of 0.25% ropivacaine or physiological saline successfully decreased the NRS scores in three MPS patients. These findings suggest that the SPSM block may serve as a useful therapeutic option in MPS patients presenting with cervicoscapular pain.

Background: Aortic valvuloplasty serves as a valve-preserving alternative to aortic valve replacement and offers advantages in younger patients. However, intraoperative complications associated with this technique have rarely been reported.

Case presentation: A 15-year-old male with severe aortic regurgitation due to a congenital bicuspid aortic valve underwent aortic valvuloplasty. During separation from cardiopulmonary bypass, ST-segment elevation was noted on electrocardiography, and transesophageal echocardiography (TEE) revealed regional wall motion abnormalities. Color Doppler imaging revealed absent flow in the left circumflex artery (LCx). The anesthesiology team promptly alerted the surgeons, and LCx occlusion due to suture annuloplasty was suspected. Removal of the implicated suture restored flow and stabilized hemodynamics.

Conclusions: Systematic intraoperative assessment and documentation of coronary flow via TEE are instrumental in diagnosing coronary artery occlusion. Moreover, mutual trust and clear, timely communication between anesthesiologists and surgeons are essential to maintaining surgical safety.

Background: High-quality preoperative patient education is crucial for enhancing comprehension and reducing anxiety. However, anesthesiologists often face time constraints that limit the depth of preoperative consultations. To address this challenge, we implemented a tablet-based preanesthetic explanatory video preview system, allowing patients to view tailored video clips prior to their consultation. This study aimed to evaluate the system's impact on patient acceptance and the workload of anesthesiologists.

Methods: A questionnaire-based survey was conducted at our outpatient clinic between October 27 and November 20, 2023. A total of 121 patients and 20 anesthesiologists participated. Patients completed a three-point scale questionnaire assessing the video's clarity, relevance, and overall satisfaction. Anesthesiologists provided feedback on the efficiency of consultations and workload.

Results: Ninety-five percent of patients found the video "easy to understand," and 96% expressed overall satisfaction. Thirteen out of 14 anesthesiologists reported that the video improved patient understanding and reduced consultation time, with an average time savings of 3.9 ± 3.2 min per patient. None reported an increase in workload.

Conclusions: The preanesthetic video preview system improved patient comprehension and satisfaction while enhancing consultation efficiency. Standardizing preoperative education through video may optimize clinical workflow and reduce the burden on anesthesiologists. Further research is warranted to assess its applicability across diverse patient populations and surgical settings.