JA Clinical Reports最新文献

Background: Camptocormia, a postural deformity seen in Parkinson's disease (PD), complicates general anesthesia, especially airway management, owing to severe spinal flexion in advanced stages.

Case presentation: We report the anesthetic management of a 76-year-old man with PD who developed severe long-seated forward flexion with the face buried between the knees, from camptocormia and multiple spinal surgeries. Removal of the exposed spinal implants was necessary, and general anesthesia was planned. Anesthesia was administered in the right lateral position from induction to awakening. Video laryngoscopy enabled successful intubation, and remimazolam with flumazenil ensured good recovery without complications.

Conclusions: This case demonstrates the feasibility of managing the airway and administering anesthesia in the right lateral position in patients with PD with severe long-seated forward flexion. Video-laryngoscopy and remimazolam with flumazenil offer advantages in such cases, although further studies are required to validate their broader applications.

Background: Management of acute aortic dissection (AAD) caused by retrograde perfusion through the femoral artery during minimally invasive cardiac surgery (MICS) remains controversial. We present a case of AAD occurring during the late cardiopulmonary bypass (CPB) phase, which was successfully managed by vascular graft replacement, without altering the blood supply route.

Case presentation: A 63-year-old man was scheduled for totally endoscopic aortic valve replacement. CPB was initiated through the right femoral artery and venous cannulation. Approximately 120 min after the initiation of CPB, mean arterial pressure and bilateral cerebral regional oxygen saturation temporarily decreased. Transesophageal echocardiography revealed type A AAD. Cerebral perfusion was preserved, allowing us to proceed to deep hypothermic circulatory arrest and successfully perform ascending aortic replacement without altering the blood supply route.

Conclusions: In MICS, continuous monitoring is crucial as AAD can occur at any point during CPB, and early detection enables successful outcomes.

Background: Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by increased pulmonary vascular resistance (PVR) during PE.

Case presentation: A 66-year-old man with pulmonary hypertension (PH) and glomerulonephritis was admitted with dyspnea. He had discontinued sildenafil prior to admission. Alveolar hemorrhage associated with AAV was suspected, and PE was performed. Soon after, he developed circulatory failure and hyperlactatemia. Echocardiography revealed right ventricular dilation, suggesting increased PVR. Inhaled nitric oxide (iNO) was administered, rapidly improving hyperlactatemia and oxygenation. The shock observed during PE was attributed to multiple factors, including the potential removal of sildenafil, which may have led to an increase in PVR.

Conclusions: The shock was attributable to acute right heart failure caused by an exacerbation of PH, possibly due to sildenafil removal via PE, although other contributing factors could not be excluded.

Background: Simultaneous cardiac and non-cardiac surgeries can be beneficial for patients, but there are still few reports on this approach.

Case presentation: A 90-year-old woman was diagnosed with a femoral trochanteric fracture and severe aortic stenosis. A heart team conference decided to perform transcatheter aortic valve implantation (TAVI) and femoral osteosynthesis under general anesthesia on the same day. A preoperative simulation was conducted to review the surgical procedure and confirm the arrangement of the operating table and instruments. Preoperative management was carried out with attention to the risk of myocardial ischemia caused by bleeding or pain from the fracture. Transfemoral TAVI was completed without trouble, and after the patient was moved to the traction table, osteosynthesis was started. Back-up pacing with a temporary pacemaker was activated for atrioventricular block and bradycardia. After completing the surgery, the patient recovered from anesthesia, and extubation was performed after confirming the absence of paralysis. The patient had no noticeable postoperative complications and successfully underwent rehabilitation.

Conclusions: Through meticulous preparation and perioperative management, we were able to perform TAVI and femoral osteosynthesis simultaneously, achieving a favorable outcome.

Background: Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia that induces blood coagulation and hemolysis upon exposure to cold temperatures. Strict temperature control is essential to mitigate these effects, especially during surgical procedures where hypothermia is possible.

Case presentation: A 57-year-old male, 165 cm and 72 kg, diagnosed with CAD, underwent cerebral vascular anastomosis. Intraoperatively, mean arterial pressure was maintained at or above 65 mmHg with phenylephrine administration, while body temperature was rigorously controlled between 36.5 °C and 37.5 °C using forced-air warming blankets and heated intravenous infusions. Despite these measures, thrombotic occlusion occurred, necessitating surgical thrombus removal, intravenous heparin administration, and irrigation of the surgical field with warmed saline followed by re-anastomosis. The anastomosis remained patent without recurrence of thrombus formation thereafter.

Conclusion: Preventing hypothermia is extremely important in the anesthesia management of CAD patients. However, careful attention must also be paid to temperature regulation in the surgical field.

Background: Bilateral trigeminal neuralgia secondary to multiple sclerosis is an extremely rare condition. When Gasserian ganglion block is performed, it is necessary to achieve reliable long-term analgesic effects while avoiding treatment-related complications.

Case presentation: A 49-year-old male with multiple sclerosis exhibited persistent dull pain and paroxysmal electric shock-like pain in his bilateral maxillary molars and mandible. He was diagnosed with trigeminal neuralgia due to multiple sclerosis. Due to severe side effects, it was difficult to achieve adequate pain control with medication alone. By performing low-temperature radiofrequency thermocoagulation and pulsed radiofrequency of the Gasserian ganglion while monitoring masseter muscle contraction, a satisfactory and rapid analgesic effect was obtained without masticatory atonia.

Conclusions: To the best of our knowledge, this is the first case of bilateral trigeminal neuralgia due to multiple sclerosis in which low-temperature radiofrequency thermocoagulation combined with pulsed radiofrequency was successfully performed for pain relief without masticatory atonia.

Background: Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication. Under general anesthesia, neurological signs are often masked, delaying diagnosis and increasing the risk of sudden cardiovascular collapse. Therefore, early detection methods are critically needed.

Case presentation: A 48-year-old male patient (height: 182 cm, weight: 98 kg) underwent resection of a mediastinal goiter. He received 10 mL of 4% lidocaine for topical airway anesthesia and 20 mL of 1% lidocaine with 1:100,000 epinephrine for chest wall anesthesia. Thirty minutes after airway anesthesia, continuous theta waves appeared on the frontal electroencephalogram (EEG), which were enhanced following chest wall anesthesia. These waves transitioned into a repeating pattern and evolved into sharp periodic discharges. After administering 150 mL of 20% lipid emulsion, the EEG normalized.

Conclusions: This case highlights that EEG monitoring during general anesthesia may facilitate the early detection of LAST and provide real-time feedback on treatment efficacy.