JA Clinical Reports最新文献

Introduction: To investigate the association between the presence of both anxiety and depression and the quality of recovery after caesarean delivery.

Methods: This secondary analysis of a prospective observational study included 137 patients aged ≥ 18 years who underwent elective and urgent caesarean delivery under spinal anesthesia and completed the Obstetric Quality of Recovery-11 scale at least once postoperatively. Before caesarean delivery, patients were screened for anxiety and depression using the Hospital Anxiety and Depression Scale. A total score of ≥ 8 in each subscale was considered positive screening. Postpartum quality of recovery was assessed using the Obstetric Quality of Recovery-11 at three time points, with a higher score indicating better recovery.

Results: Among the eligible patients, 17.5% (24/137) screened positive for both anxiety and depression. No significant difference was found in the Obstetric Quality of Recovery-11 score 24 h after caesarean delivery (p = 0.13, Cohen's d = 0.33), but differences were observed on postoperative day 3 (p = 0.004, Cohen's d = 0.67) and postoperative day 5 (p = 0.01, Cohen's d = 0.58). In the multiple regression analysis, after adjusting for prominent clinical factors, the presence of both anxiety and depression was associated with the Obstetric Quality of Recovery-11 score on postoperative day 3 (p = 0.01) and postoperative day 5 (p = 0.01), but not 24 h after delivery (p = 0.19).

Conclusions: Positive Hospital Anxiety and Depression Scale screening for both anxiety and depression was associated with a poor quality of recovery, measured using the Obstetric Quality of Recovery-11 scores on PODs 3 and 5.

Background: Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, including low molecular weight heparins (LMWHs) like dalteparin. While LMWHs reduces the risk of HIT compared to unfractionated heparin, vigilance remains essential.

Case presentation: An 82-year-old male with chronic kidney disease (CKD) developed HIT during hemodialysis anticoagulation with dalteparin, resulting in a platelet count of 17,000/µL and positive HIT antibodies. Dalteparin was replaced with nafamostat mesilate. Following confirmed HIT antibody seronegativity, elective aortic valve replacement was performed under cardiopulmonary bypass using heparin. Postoperative dialysis was managed using nafamostat mesilate, preventing HIT recurrence. His platelet count recovered after dalteparin replacement, and no recurrence of HIT was observed.

Conclusions: Even LMWHs, such as dalteparin, pose a HIT risk, necessitating vigilant monitoring. Confirming HIT antibody seronegativity and appropriately timing surgery are critical for patients with a history of HIT. Proper postoperative follow-up and alternative anticoagulation strategies can prevent HIT recurrence.

Background: We report a case of tetanus developed after inguinal hernia repair without traumatic wounds, which was difficult to be diagnosed under sedation with mechanical ventilation for pneumonia and anaphylactic shock.

Case presentation: The 67-year-old Japanese male underwent inguinal hernia repair with ileal resection. On postoperative day (POD) 9, he was admitted to the ICU due to dyspnea and worsening oxygenation. Immediately after tazobactam piperacillin was administered as empiric treatment for aspiration pneumonia, anaphylaxis developed, requiring tracheal intubation and continuous intravenous adrenaline. On POD 10, sedative titration increased his extremities' muscle rigidity; weaning from mechanical ventilation was difficult, while he could communicate. On POD 15, tetanus was diagnosed based on the physical examination findings prior to ICU admission.

Conclusion: Tetanus should be considered when patients show abnormal hypertension and no impaired consciousness during muscle rigidity, even in the absence of obvious trauma.

Background: Video laryngoscopes generally increase the success rate of tracheal intubation and clinical outcome compared to traditional direct laryngoscopes. However, there is a concern that their effectiveness can be compromised in bright outdoor environments. The impact of polarized sunglasses on the visibility of a video laryngoscope in a high-illumination environment simulating outdoor conditions was assessed. Additionally, the effect of screen smudges on screen visibility was examined.

Methods: A high-illumination environment was created using artificial light equivalent to daylight outdoors. Twenty-four anesthesiologists participated in this study. A commercially available laryngoscope was utilized to evaluate the visibility of the monitor screen and visualize the larynx. The experiment involved a fixed order sequence, including viewing with the naked eye, wearing sunglasses, cleaning the screen without wearing sunglasses, and cleaning the screen while wearing sunglasses, to evaluate visibility with each intervention. A visual analog scale (VAS) (0-100 mm) was used to evaluate the visibility of the larynx displayed on the screen.

Results: Polarized sunglasses significantly enhanced visibility, with a median VAS score of 12 compared to 5 (P = 0.004). Moreover, cleaning the monitor screen significantly improved visibility more than wearing sunglasses alone, with a median VAS score of 38 compared to 12 (P = 0.002). Additionally, wearing sunglasses after cleaning the monitor screen provided even better visibility compared to only cleaning the screen, with a median VAS score of 57 compared to 38 (P = 0.002).

Conclusions: Based on these findings, it is suggested that when using a video laryngoscope outdoors in sunny conditions, the first step to address impaired visibility should be to clean the screen. Wearing sunglasses, if possible, can also be effective in improving visibility.

Background: To our knowledge, no previous case report explicitly shows that urethral catheter misplacement in the vagina cannot be ruled out even if urinary outflow is observed during catheterization.

Case presentation: A 70-year-old female underwent urethral catheterization during induction of general anesthesia for hemiarthroplasty using a bipolar hip prosthesis. Although the urethral meatus could not be visualized, urinary outflow was observed. However, drainage subsequently stopped, and the catheter was eventually found to have been misplaced in the vagina. Detection of the catheter misplacement was delayed because of the assumption that no urinary outflow occurs when the catheter is misplaced in the vagina.

Conclusion: Even if urinary outflow is observed during female urethral catheterization, catheter misplacement in the vagina cannot be ruled out; therefore, catheter misplacement in the vagina must be verified in patients for whom the urethral meatus cannot be identified for catheter insertion or when drainage stops.

Background: Negative-pressure pulmonary edema (NPPE) often develops with upper airway obstruction, and is uncommon in secured airways, for example, after tracheostomy. Herein, we report two cases of NPPE post-tracheostomy.

Case presentation: Case 1: A 69-year-old man underwent prophylactic tracheotomy for possible airway obstruction secondary to glottic carcinoma. Two hours after awakening from general anesthesia, he had difficulty expectorating and developed NPPE due to airway secretions obstructing the tracheostomy tube. Case 2: An 11-year-old boy was admitted to the intensive care unit for continuous hemodiafiltration on a ventilator under sedation. On the 76th day, the day after the tracheostomy was performed, the patient developed patient-ventilator asynchrony due to sedative withdrawal syndrome. The postulated primary mechanism was functional airway obstruction due to patient-ventilator asynchrony.

Conclusion: These cases highlight the need to consider NPPE, even in patients with an airway secured with a tracheostomy.

Background: Guidelines on airway management in neonates and infants recommend using a stylet when a videolaryngoscope is used, but it is not clear if the use of a stylet facilitates tracheal intubation and which shape of the stylet is suitable in neonates.

Methods: As a preliminary simulation study of a randomized controlled cross-over design, 25 anesthesiologists (3 specialists, 11 senior residents, and 11 junior residents) used a McGrath® MAC videolaryngoscope (Covidien, Medtronic, Tokyo, Japan) blade 1 for tracheal intubation (of a 3.5-mm ID Shiley™ tube with a cuff), with one of four differently shaped stylets (C-shaped, J-shaped, hockey stick-shaped and double C-shaped) or without a stylet in a manikin of a neonate, and compared intubation times.

Results: Compared with intubation time without the use of a stylet, intubation time was significantly longer with the use of the J-shaped stylet (P = 0.007; median (95% CI) difference: 2 (1 to 2) s) or with the hockey stick-shaped stylet (P = 0.0002; median (95% CI) difference: 9 (9 to 10) s). In contrast, intubation time was similar between no stylet and the C-shaped stylet (P = 0.90; median (95% CI) difference: 0 (0 to 0) s) or between no stylet and the double C-shaped style (P = 0.60; median (95% CI) difference: 0 (0 to 0) s).

Conclusions: In conclusion, while time to tracheal intubation would be similar with and without the use of a stylet, the shape of the stylet would affect intubation time in neonates.

Background: Transurethral surgery is often accompanied by postoperative urinary tract infection. Although early detection and adequate treatment of bacteremia are required to prevent sepsis, it is usually undetectable during surgery. We report two cases with remarkable hypertension and tachycardia during transurethral surgery in which bacteremia was diagnosed by an intraoperative blood test.

Case presentation: An 80-year-old man (Case 1) underwent transurethral holmium laser prostate enucleation under spinal anesthesia, and an 88-year-old woman (Case 2) underwent transurethral resection of bladder tumor under general anesthesia. Altered consciousness (Case 1) and postoperative delirium (Case 2) were noted, in addition to remarkable intraoperative hypertension and tachycardia. We administered broad-spectrum antibiotics for possible bacteremia in both cases. The patients' hemodynamics positively recovered the following day. Intraoperative blood samples revealed gram-negative bacillus.

Conclusions: Hypertension, tachycardia, and altered consciousness may suggest the onset of symptomatic bacteremia during transurethral surgery, and adequate treatment is required to prevent sepsis.