Journal of Anesthesia最新文献

Purpose: Tissue factor pathway inhibitor (TFPI) is an intrinsic anticoagulant factor, and its plasma concentration is elevated by heparin administration. Because several hours are required to return to normal range after heparin reversal, we investigated the role of TFPI in the inhibition of thrombin generation (TG) in patients undergoing cardiac surgery.

Methods: Blood samples were collected from adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) before, at the end of, and 1 day after surgery. Plasma concentration of TFPI, peak height of the TG assay (peak TG), and whole blood coagulation time by dielectric blood coagulometry using a Russell's viper venom cartridge system were evaluated. Nonparametric correlation was evaluated using Spearman's method, and time-dependent change was analyzed using repeated measures analysis of variance.

Results: The plasma concentration of TFPI was higher (54 [47-60] ng/mL vs. 18 [13-27] ng/mL; P < 0.001) and the peak TG value was lower (98.1 [48.9-148] nM vs. 268 [244-309]; P < 0.001) at the end of surgery than before surgery. Plasma TFPI concentration showed a positive correlation with whole blood coagulation time as measured by dielectric blood coagulometry (Rs = 0.643) and a negative correlation with peak TG (Rs =  - 0.624). Anti-TFPI antibody neutralized reduction in peak TG.

Conclusions: In patients undergoing cardiac surgery using CPB, the increase in plasma TFPI concentration at the end of surgery causes a reduction in TG and impairment of whole blood coagulation via a mechanism that includes inhibition of factor Xa activity.

Malignant hyperthermia (MH) is a rare, life-threatening inherited disorder triggered by volatile inhalational anesthetics and/or the depolarizing muscle relaxant suxamethonium. In susceptible individuals, calcium release from the sarcoplasmic reticulum in the skeletal muscle becomes abnormally accelerated, leading to a hypermetabolic state. Early signs of MH include unexplained hypercarbia (end-tidal carbon dioxide > 55 mm Hg), tachycardia, and muscle rigidity, particularly in the masseter. Rapid increases in core temperature (> 0.5 °C/15 min, with temperatures often exceeding 40 °C) are typical. With progression, respiratory and metabolic acidosis, arrhythmias, cola-colored urine (myoglobinuria), elevated serum potassium, and tented T-waves may develop, potentially leading to cardiac arrest or multiorgan failure. The Japanese Society of Anesthesiologists' guidelines for the management of MH in 2025 (Japanese version) emphasize the importance of early recognition and immediate intervention. The essential steps include discontinuing triggering agents, administering intravenous dantrolene (initially 1-2 mg/kg), aggressive cooling of the body, and managing complications, such as hyperkalemia and acidosis. On the basis of international standards, a higher initial dose of dantrolene is recommended. Preoperative assessment of MH risk should include history taking for anesthetic complications, a family history suggestive of MH susceptibility, signs of congenital myopathies, and careful anesthetic planning using non-triggering agents. Genetic testing and muscle biopsy may aid in the diagnosis but are not definitive in all cases. The Japanese translation of these guidelines has been posted on the following website: https://anesth.or.jp/files/pdf/guideline_akuseikounetsu . pdf.

Purpose: The purpose of this study was to compare the postoperative analgesic outcomes of ultrasound-guided single-shot, ultrasound-guided continuous, or surgeon-performed direct-vision single-shot approaches to paravertebral block (PVB).

Methods: We retrospectively analyzed the data of the adults who underwent video-assisted thoracoscopic surgery (VATS) for lung resection at a university hospital. They were categorized into those who underwent ultrasound-guided single-shot PVB (PVB-US), ultrasound-guided continuous PVB with catheter infusion (PVB-US-Cath), and surgeon-performed intraoperative single-shot PVB under thoracoscopic visualization (PVB-VATS). The primary outcome was the number of rescue analgesic administrations within 24 h of admission to the post-anesthesia care unit (PACU). The secondary outcomes were rescue analgesic use within 24-48 h and pain scores at PACU admission and on the mornings of postoperative days (PODs) 1 and 2.

Results: Of the 489 eligible patients, the data of 385 were included in the final analysis (PVB-US, n = 53; PVB-US-Cath, n = 249; PVB-VATS, n = 83). The median (IQR) numbers of rescue analgesic doses within 24 h for the PVB-US, PVB-US-Cath, and PVB-VATS groups were 1 (1-3), 2 (1-3), and 2 (0-3), respectively (p = 0.6880). Rescue analgesic use during 24-48 h and NRS pain scores at the PACU and on PODs 1 and 2 did not significantly differ between the groups.

Conclusion: This study found no statistically significant differences in the postoperative analgesic outcomes of the ultrasound-guided single-shot, ultrasound-guided continuous, and surgeon-performed direct-vision single-shot PVB techniques for VATS. Given the predominantly mild and short-lived nature of pain after VATS, a technically simple single-shot strategy may offer an optimal balance between efficacy, feasibility, and procedural efficiency.