JA Clinical Reports最新文献

英文中文

Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression 一名无病史的 COVID-19 患者因前外侧乳头肌抽吸导致低流量：中央体外生命支持与左心室心尖减压的病例报告

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-04-10 DOI: 10.1186/s40981-024-00701-8

Tomoaki Miyake, Kimito Minami, Masahiro Kazawa, Naoki Tadokoro, Kohei Tonai, Satsuki Fukushima

Left ventricular (LV) decompression is an essential strategy for improving early survival in patients with refractory cardiogenic shock. Low pump flow in patients on extracorporeal life support (ECLS) with LV apex decompression is a life-threatening issue. However, identifying the underlying causes of low flow can be challenging. A 38-year-old woman with COVID-19-related fulminant myocarditis was treated with central ECLS with LV apex decompression. The pump flow in the intensive care unit (ICU) was intermittently low, and low flow alerts were frequent. The initial evaluation based on pressure monitor waveforms and transthoracic echocardiography failed to identify the underlying cause. Prompt bedside transesophageal echocardiography (TEE) revealed that the anterolateral papillary muscle was suctioned into the vent cannula of the LV apex during systole. The patient underwent a repeat sternal midline incision in the operating room, and the cannula at the LV apex was repositioned. There were no further suction events after the repositioning, and the patient was weaned from ECLS 12 days after admission to the ICU. The patient was discharged in a stable condition and without neurological deficits. TEE is an important diagnostic tool to identify the underlying cause of low flow flow in patients undergoing ECLS with LV apex decompression.

左心室减压是提高难治性心源性休克患者早期存活率的重要策略。使用体外生命支持（ECLS）进行左心室心尖减压的患者泵流量过低是一个威胁生命的问题。然而，确定低流量的根本原因可能具有挑战性。一名患有 COVID-19 相关性暴发性心肌炎的 38 岁女性接受了中心体外生命支持（ECLS）和左心室心尖减压治疗。重症监护室（ICU）的泵流量间歇性偏低，并且经常发出低流量警报。根据压力监测波形和经胸超声心动图进行的初步评估未能找出根本原因。及时的床旁经食道超声心动图（TEE）显示，收缩期前外侧乳头肌被吸入左心室心尖的通气插管。患者在手术室再次接受了胸骨中线切开术，并重新定位了左心室心尖的插管。重新定位后未再发生抽吸事件，患者在入住重症监护室 12 天后脱离了 ECLS。患者出院时病情稳定，无神经功能障碍。TEE 是一种重要的诊断工具，可用于确定接受左心室心尖减压的 ECLS 患者出现低流量的根本原因。

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引用次数: 0

Anesthesia experience in an adult Silver-Russell syndrome: a case report 银-拉塞尔综合征成人患者的麻醉经验：病例报告

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-04-03 DOI: 10.1186/s40981-024-00704-5

Akinobu Hibino, Ayaka Hibino, Yoshinori Kamiya

There are no reports of anesthesia use in adult patients with Silver-Russell syndrome (SRS). Here, we report our experience with anesthesia in an adult patient with SRS complicated by chronic respiratory failure. A 33-year-old woman was clinically diagnosed with SRS. She had severe chronic respiratory failure, complicated by superior mesenteric artery syndrome. Percutaneous gastrostomy was scheduled for nutritional management under epidural anesthesia; however, soon after esophagogastroduodenoscopy was started, she lost consciousness and spontaneous respiration. The patient was urgently intubated and converted to general anesthesia. The end-tidal carbon dioxide tension was > 90 mmHg at intubation. Adult SRS patients with chronic respiratory failure have a risk of CO2 narcosis. SRS also requires preparation for difficult airway management during the perioperative period.

目前还没有关于银-拉塞尔综合征（SRS）成年患者使用麻醉的报道。在此，我们报告了我们对一名因慢性呼吸衰竭而并发 SRS 的成年患者进行麻醉的经验。一名 33 岁的女性被临床诊断为 SRS。她患有严重的慢性呼吸衰竭，并发肠系膜上动脉综合征。在硬膜外麻醉下安排了经皮胃造瘘术进行营养管理；然而，食管胃十二指肠镜检查开始后不久，她就失去了意识和自主呼吸。患者被紧急插管并转为全身麻醉。插管时潮气末二氧化碳浓度大于 90 mmHg。患有慢性呼吸衰竭的成人 SRS 患者有二氧化碳麻醉的风险。SRS 还要求在围手术期做好困难气道管理的准备。

引用次数: 0

A case of accidental intraperitoneal placement of the rectus sheath block catheter via an out-of-plane approach 一例通过平面外方法意外将直肠鞘阻断导管置入腹腔的病例

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-04-03 DOI: 10.1186/s40981-024-00705-4

Ai Ono, Keisuke Yoshida, Rieko Oishi, Satoki Inoue

To the editor,Continuous nerve blocks have become widely used for postoperative analgesia in recent years. Ultrasound-guided catheter insertion is commonly performed using an in-plane or out-of-plane approach [1]. However, it is unclear which approach is more effective. Herein, we report a case in which a catheter for continuous rectus sheath block unexpectedly reached the abdominal cavity, via an out-of-plane approach.A 67-year-old woman underwent bilateral rectus sheath blocks with a catheter-through-needle technique (Hakko Disposable Pain Clinic Set®, Hakko, Japan) after open surgical repair of abdominal aortic aneurysm. On ultrasound, due to the surgical wound, the posterior sheath of the rectus abdominis muscle could not be visualized well in the long-axis view with a linear probe; thus, we placed two catheters (left and right sides) under the short-axis view of the rectus sheath muscle using an out-of-plane approach, while injecting a small amount of drug solution to confirm the tips of needle. When we advanced the needle to the proper location, we observed the spread of local anesthetic (0.25% levobupivacaine, 20 mL per one side) along the rectal sheath. Then, we inserted the catheter, rigidly holding the needle in place so it would not shift from its position. However, the tip of the catheter was not clearly visible on ultrasound, and we did not evaluate the spread of local anesthetics administered through the catheter. On the Postoperative Day 1, routine postoperative computed tomography revealed that the right catheter had strayed into the abdominal cavity (Fig. 1). This catheter was quickly removed, resulting in no complications.<figure><figcaption>Fig. 1</figcaption><picture><source srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png?as=webp" type="image/webp"/><img alt="figure 1" aria-describedby="Fig1" height="422" loading="lazy" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png" width="685"/></picture>A computed tomography scan (transverse view) on Postoperative Day 1. The white arrow in the figure indicates the catheter, which strayed into the abdominal cavityFull size image<svg aria-hidden="true" focusable="false" height="16" role="img" width="16"><use xlink:href="#icon-eds-i-chevron-right-small" xmlns:xlink="http://www.w3.org/1999/xlink"></use></svg></figure>The primary advantage of the in-plane approach is its safety, because the entire needle can be visualized during the procedure. The primary disadvantage is its narrow ultrasound beam width of ≤ 1 mm, which makes the visibility of the needle difficult [2]. Furthermore, the distance from the skin to the target tends to be longer using this approach, possibly resulting in reduced visibility in deeper areas [3]. In contrast,

致编辑：近年来，连续神经阻滞已广泛应用于术后镇痛。超声引导导管插入通常采用平面内或平面外方法[1]。然而，目前还不清楚哪种方法更有效。一位 67 岁的女性在腹主动脉瘤开放性手术修补术后接受了双侧直肠鞘阻滞，使用的导管是穿刺针技术（Hakko Disposable Pain Clinic Set®，日本 Hakko 公司）。在超声波检查中，由于手术伤口，腹直肌后鞘在长轴视图中无法用线性探头观察到，因此我们采用平面外方法，在腹直肌后鞘的短轴视图下放置了两根导管（左右两侧），同时注入少量药液以确认针尖。当我们将针头推进到适当位置时，我们观察到局部麻醉剂（0.25% 左布比卡因，每侧 20 mL）沿着直肠鞘扩散。然后，我们插入导管，用力固定针头，使其不会偏离位置。但是，超声波检查无法清楚地看到导管的顶端，因此我们没有评估通过导管注射的局麻药的扩散情况。术后第 1 天，常规术后计算机断层扫描显示右侧导管误入腹腔（图 1）。图 1A 术后第 1 天的计算机断层扫描（横向视图）。图中白色箭头所指的导管误入腹腔全尺寸图片平面内入路的主要优点是安全，因为在手术过程中可以看到整个针头。其主要缺点是超声波束宽度较窄，≤ 1 毫米，因此很难看到针头[2]。此外，使用这种方法从皮肤到目标的距离往往较长，可能导致较深区域的可视性降低[3]。相比之下，平面外方法的优点是针头的可操作性比平面内方法好[2]。然而，它的缺点是无法看到整个针头，也就是说，只能看到针头的一点，但这一点并不一定是 "真正的 "针尖[4]。此外，本报告中我们为患者使用的针头是一种非回声针头，因此很难识别针尖。因此，使用这种针头的平面外方法的这一缺点可能导致了本病例的结果。此外，经过反思，我们还怀疑（拔针后）对导管针尖位置的评估不足也是导致结果和检测延迟的原因之一。总之，我们认为，在超声引导下插入导管进行连续神经阻滞时，应注意平面外和平面内方法的优缺点，如果超声无法明确确认针头/导管的位置，则不应进行神经阻滞。第 46 章：区域麻醉的周围神经阻滞和超声引导。见：Michael AG, editors.米勒麻醉学》。第 9 版。Griffin J, Nicholls B. Ultrasound in regional anaesthesia.麻醉。2010; 65(Suppl):1-12.Article PubMed Google Scholar Kurdi MS, Agrawal P, Thakkar P, Arora D, Barde SM, Eswaran K. Recent advancements in regional anaesthesia.2023;67:63-70.Article PubMed PubMed Central Google Scholar Neice AE, Forton C. Evaluation of a novel out-of-plane needle guide.J Ultrasound Med.2018;37:543-9.Article PubMed Google Scholar 下载参考文献作者感谢福岛医科大学科学英语编辑科为本稿件所做的工作。

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引用次数: 0

Amino acids to prevent cardiac surgery-associated acute kidney injury: a randomized controlled trial. 预防心脏手术相关急性肾损伤的氨基酸：随机对照试验。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-03-26 DOI: 10.1186/s40981-024-00703-6

Masahiro Kazawa, Daijiro Kabata, Hisako Yoshida, Kimito Minami, Takuma Maeda, Kenji Yoshitani, Hitoshi Matsuda, Ayumi Shintani

Background: This study aimed to examine the preventive effect of amino acids on postoperative acute kidney injury (AKI).

Methods: This was single-center, patient- and assessor-blinded, randomized controlled trial. Patients who underwent aortic surgery with cardiopulmonary bypass were included. The intervention group received 60 g/day of amino acids for up to 3 days. The control group received standard care. The primary outcome was the incidence of AKI. We assessed the effect of amino acids on AKI using a Cox proportional hazards regression model.

Results: Sixty-six patients were randomly assigned to the control or intervention group. One patient in the control group withdrew consent after randomization. The incidence of AKI was 10 patients (30.3%) in the intervention group versus 18 patients (56.2%) in the control group (adjusted hazard ratio, 0.44; 95% confidence interval, 0.20-0.95; P = 0.04).

Conclusions: This trial demonstrated a significant reduction in AKI incidence with amino acid supplementation.

Trial registration: jRCT, jRCTs051210154. Registered 31 December 2021, https://jrct.niph.go.jp/re/reports/detail/69916.

背景：本研究旨在探讨氨基酸对术后急性肾损伤（AKI）的预防作用：本研究旨在探讨氨基酸对术后急性肾损伤（AKI）的预防作用：这是一项单中心、患者和评估者双盲的随机对照试验。研究对象包括接受主动脉手术并进行心肺旁路的患者。干预组每天服用 60 克氨基酸，最长 3 天。对照组接受标准护理。主要结果是 AKI 的发生率。我们使用 Cox 比例危险回归模型评估了氨基酸对 AKI 的影响：66名患者被随机分配到对照组或干预组。对照组中有一名患者在随机分配后撤回同意书。干预组 AKI 发生率为 10 例（30.3%），对照组为 18 例（56.2%）（调整后危险比为 0.44；95% 置信区间为 0.20-0.95；P = 0.04）：该试验表明，补充氨基酸可显著降低AKI发生率。试验注册：jRCT，jRCTs051210154。注册日期：2021 年 12 月 31 日，https://jrct.niph.go.jp/re/reports/detail/69916。

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引用次数: 0

Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report. 一名 1 型 Brugada 综合征患者在七氟醚和瑞芬太尼麻醉期间 ST 段抬高持续缓解：病例报告。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-03-12 DOI: 10.1186/s40981-024-00702-7

Kurumi Saito, Hitoshi Yoshida, Kazuyoshi Hirota

Background: During general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established.

Case presentation: A 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia.

Conclusion: The present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.

背景：在全身麻醉期间，Brugada 综合征患者有可能在 ST 段抬高恶化后发生恶性心律失常，从而导致心脏性猝死。Brugada 综合征患者的安全麻醉管理方案尚未确立：一名 63 岁的男性被诊断为自发性 Brugada 1 型，计划在全身麻醉下使用视频辅助胸腔镜手术进行胸膜活检。我们计划使用七氟醚和瑞芬太尼进行挥发性诱导和维持麻醉。我们监测了ST段形态，观察到ST段抬高在整个全身麻醉过程中持续缓解：本病例可能表明，对 Brugada 综合征患者的安全麻醉管理取决于所使用的麻醉剂能否减轻 ST 段抬高。

引用次数: 0

Successful intraoperative management of laparoscopic hysterectomy in a patient with Eisenmenger syndrome: a case report. 艾森曼格综合征患者腹腔镜子宫切除术的术中成功管理：病例报告。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-03-04 DOI: 10.1186/s40981-024-00700-9

Yuki Maeda, Nami Kakuta, Asuka Kasai, Hiroki Yonezawa, Ryosuke Kawanishi, Katsuya Tanaka

Background: Patients with Eisenmenger syndrome (ES) requiring noncardiac surgery are at a significantly high risk of perioperative morbidity and mortality. However, perioperative management of patients with ES requiring laparoscopic surgery remains unclear.

Case presentation: We describe the case of a patient with ES who underwent laparoscopic hysterectomy under general anesthesia with a peripheral nerve block. The objectives of the perioperative management included the following: (1) maintaining systemic vascular resistance and cardiac output through euvolemia, facilitated by the infusion of noradrenaline, and (2) preventing a reduction in oxygen-carrying capacity and factors that elevate pulmonary vascular resistance, such as pain, hypoxia, and decreased body temperature. Although laparoscopic procedures involved an increased risk in patients with ES, they are less invasive than open surgeries.

Conclusion: This report describes the successful anesthetic management of a patient with ES, ensuring a balance between systemic and pulmonary vascular resistance.

背景：需要进行非心脏手术的艾森曼格综合征（ES）患者围手术期发病率和死亡率风险极高。然而，需要进行腹腔镜手术的艾森曼格综合征患者的围手术期管理仍不明确：我们描述了一名 ES 患者的病例，该患者在周围神经阻滞的全身麻醉下接受了腹腔镜子宫切除术。围手术期管理的目标包括以下几点：(1)通过输注去甲肾上腺素，维持全身血管阻力和心输出量；(2)防止携氧能力下降和导致肺血管阻力升高的因素，如疼痛、缺氧和体温下降。虽然腹腔镜手术会增加 ES 患者的风险，但与开腹手术相比，腹腔镜手术的创伤性更小：本报告描述了对 ES 患者的成功麻醉管理，确保了全身和肺血管阻力之间的平衡。

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引用次数: 0

Combination of high-flow nasal oxygen and ketamine/dexmedetomidine sedation for diagnostic catheterization in a child with pulmonary arterial hypertension: a case report 一名肺动脉高压患儿在诊断性导管插入术中合并使用高流量鼻氧和氯胺酮/右美托咪定镇静剂：病例报告

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-02-22 DOI: 10.1186/s40981-024-00699-z

Kaoru Tsuboi, Misuzu Asai, Toshiki Nakamura, Jun Ninagawa, Hiroshi Ono, Shugo Kasuya

Pulmonary hypertension is associated with significant risk of perioperative life-threatening events. We present a case of a 12-year-old child with severe pulmonary arterial hypertension who successfully underwent diagnostic cardiac catheterization under ketamine and dexmedetomidine sedation with the support of high-flow nasal oxygen. Ketamine and dexmedetomidine are reported to have minimal effect on pulmonary vasculature in children with pulmonary hypertension and can be safely used in this population along with its lack of respiratory depression. Positive pressure generated by high-flow nasal oxygen improves upper airway patency, prevents micro-atelectasis, and is shown to improve the effectiveness of ventilation and oxygenation in patients under sedation breathing spontaneously. The presented strategy may contribute to enhancing the safety and effectiveness of procedural sedation for children with life-threatening pulmonary hypertension.

肺动脉高压与围术期危及生命的重大风险相关。我们介绍了一例患有严重肺动脉高压的 12 岁儿童的病例，该患儿在氯胺酮和右美托咪定镇静剂以及高流量鼻氧的支持下成功接受了诊断性心导管手术。据报道，氯胺酮和右美托咪定对肺动脉高压患儿的肺血管影响极小，而且不会抑制呼吸，可以安全地用于此类人群。高流量鼻氧产生的正压可改善上呼吸道的通畅性，防止微偏转，并可提高镇静患者自主呼吸时的通气和吸氧效果。所提出的策略可能有助于提高危及生命的肺动脉高压患儿手术镇静的安全性和有效性。

引用次数: 0

Left common peroneal nerve palsy caused by cross-legged sitting during epidural labor analgesia: a case report. 硬膜外分娩镇痛时盘腿坐姿导致左腓总神经麻痹：病例报告。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-02-21 DOI: 10.1186/s40981-024-00698-0

Shunya Ogawa, Hirotsugu Kanda, Hiromichi Kurosaki, Tomoyuki Kawamata

Background: Nerve injury in epidural labor analgesia can occur with various potential causes. We report a rare case of left common peroneal nerve palsy after delivery caused by a prolonged period of sitting cross-legged during epidural labor.

Case report: Epidural labor analgesia in a 28-year-old primipara started at 39 weeks of gestation. She sat cross-legged to prompt delivery for approximately 4 h with a break of a few minutes every hour. She had numbness in her left lower limb and difficulty in dorsiflexion of the ankle joint that did not improve until 3 h after delivery. We made a diagnosis of left common peroneal nerve palsy. Most of the symptoms had improved at 2 months postpartum.

Conclusion: Epidural labor analgesia prevented recognition of prolonged peroneal head compression caused by sitting cross-legged. When this position is used to facilitate delivery, it should be released frequently owing to the possibility of a neurologic deficit.

背景：硬膜外分娩镇痛中可能出现神经损伤，其潜在原因多种多样。我们报告了一例罕见的产后左腓总神经麻痹病例，其原因是在硬膜外分娩时长时间盘腿坐着：一名 28 岁的初产妇在妊娠 39 周时开始进行硬膜外分娩镇痛。她盘腿坐了大约 4 小时以促进分娩，每小时休息几分钟。她的左下肢麻木，踝关节外展困难，直到产后 3 小时才有所好转。我们诊断为左腓总神经麻痹。产后2个月时，大部分症状都得到了改善：结论：硬膜外分娩镇痛无法识别盘腿坐导致的长时间腓骨头压迫。当采用这种体位促进分娩时，由于可能出现神经功能缺损，应经常解除这种体位。

引用次数: 0

Anesthesia management for thoracoscopic resection of a huge intrathoracic meningocele: a case report. 胸腔镜下巨大胸膜内瘤切除术的麻醉管理：病例报告。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-02-19 DOI: 10.1186/s40981-024-00697-1

Ryosuke Nakazawa, Kenichi Masui, Takahisa Goto

Background: Diagnosed intrathoracic meningocele is an uncommon complication of neurofibromatosis type 1. We report an anesthesia management for a rare case undergoing thoracoscopic resection of a huge intrathoracic meningocele.

Case presentation: A 51-year-old woman was scheduled for thoracoscopic meningectomy under general anesthesia. We monitored intrathecal pressure during anesthesia to prevent a decrease in intrathecal pressure. During surgery, the intrathecal pressure occasionally increased by around 5 cmH₂O immediately after the insertion of the drainage tube and occasionally decreased by up to 10 cmH₂O during the careful slow aspiration of the cerebrospinal fluid (CSF). The pressure rapidly recovered after the interruption of the procedures. She was discharged on postoperative day 4 without major complications.

Conclusions: The CSF pressure was fluctuated by procedures during thoracoscopic resection of a huge meningocele. A CSF pressure monitoring was useful to detect the sudden change of CSF pressure immediately, which can cause intracranial hemorrhage.

背景：胸腔内脑膜瘤是神经纤维瘤病 1 型的一种罕见并发症。我们报告了一个罕见病例在胸腔镜下切除巨大胸腔内脑膜囊的麻醉处理：一名 51 岁的女性计划在全身麻醉下接受胸腔镜脑膜切除术。我们在麻醉期间监测鞘内压，以防止鞘内压下降。在手术过程中，插入引流管后，鞘内压偶尔会立即升高约 5 cmH2O，在小心缓慢地抽吸脑脊液（CSF）时，鞘内压偶尔会降低达 10 cmH2O。手术中断后，压力迅速恢复。她于术后第 4 天出院，未出现重大并发症：结论：在胸腔镜下切除巨大脑膜囊的手术过程中，脑脊液压力会发生波动。结论：胸腔镜巨大脑膜囊切除术过程中，脑脊液压力会因手术而波动，脑脊液压力监测有助于及时发现可能导致颅内出血的脑脊液压力突然变化。

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引用次数: 0

Stroke volume variation remains accurate in the presence of proximal stenosis. 在存在近端狭窄的情况下，冲程量的变化仍然准确。

IF 0.9 Q3 ANESTHESIOLOGY

JA Clinical Reports

Pub Date : 2024-02-13 DOI: 10.1186/s40981-024-00693-5

Hiroatsu Sakamoto, Atsuhiro Kitaura, Shota Tsukimoto, Yukari Yoshino, Takashi Mino, Haruyuki Yuasa, Yasufumi Nakajima

引用次数: 0

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