Journal of Anesthesia最新文献

We report a rare fatal hyperthermic crisis likely precipitated by drug-induced fever in a muscular, obese patient with chronic high-level spinal cord injury (SCI). Shortly after antibiotic therapy was changed to meropenem, the patient developed severe agitation and hyperthermia exceeding 41 °C, accompanied by autonomic instability. Despite intensive management, including active cooling, intravenous fluids, and vasoactive support, the core temperature remained above 41 °C. Computed tomography revealed a low-density brainstem lesion consistent with infarction. The patient experienced respiratory arrest and died 4 h after admission to the ICU. This case underscores the complex interplay between drug-induced fever, impaired thermoregulation due to SCI, and heat-retentive body composition. This case highlights the risk of rapid and disproportionate temperature elevation in patients with high-level SCI, even in response to relatively minor fever-provoking stimuli, due to impaired thermoregulation. Early recognition and prompt intervention are crucial to prevent fatal hyperthermic crises in this vulnerable population.

Purpose: Acute kidney injury (AKI) is a significant postoperative complication associated with poor long-term outcomes. Dexmedetomidine, a selective α₂-adrenergic agonist with anti-inflammatory properties, may protect the kidney during non-cardiac surgery. This study examined whether intraoperative dexmedetomidine reduces AKI in both high-risk and low-risk patients.

Methods: This was a secondary analysis of a randomized double-blind placebo-controlled trial. Patients aged ≥ 60 years scheduled for elective non-cardiac surgery expected to last ≥ 2 h under general anesthesia were enrolled and classified as low-risk or high-risk using the General Surgery Acute Kidney Injury Risk Index. Participants were randomly allocated to receive intraoperative dexmedetomidine (loading dose 0.6 μg/kg over 10 min before induction, followed by 0.5 μg/kg/h until 1 h before surgery end) or normal saline. The primary endpoint was AKI incidence within 7 postoperative days.

Results: Among high-risk patients, AKI occurred in 12.6% (13/103) of the dexmedetomidine group versus 23.4% (25/107) of controls (RR 0.54, 95% CI 0.29 to 1.00, P = 0.043); after multivariable adjustment, dexmedetomidine remained independently associated with lower AKI risk (OR 0.44, 95% CI 0.20 to 0.98, P = 0.045). In contrast, low-risk patients showed no significant difference with or without dexmedetomidine (7.9% vs 9.6%; RR 0.82, 95% CI 0.44 to 1.55, P = 0.543; adjusted OR 0.65, 95% CI 0.30 to 1.38, P = 0.260). Urological surgery was an independent predictor of AKI across the entire cohort.

Conclusion: Intraoperative dexmedetomidine was associated with lower risk of AKI in high-risk but not in low-risk patients undergoing non-cardiac surgery.

Purpose: The administration of intrathecal morphine frequently induces pruritus as an adverse reaction. Xiaofeng Granules (XF) is a compound preparation improved from the ancient formula "Xiaofeng Powder". It has been proven to relieve skin itching caused by various reasons in clinical practice. The aim of the study was to evaluate the effect of XF on pruritus caused by intrathecal morphine and possible mechanism.

Methods: Male C57BL/6 mice were intrathecally injected with morphine to induce scratching behavior. The effects of XF on intrathecal morphine-induced pruritus and analgesia were evaluated. The number of scratching response was counted within 30 min after morphine injection. The warm-water tail immersion test was conducted to measure the tail flick latency (TFL) within 120 min after morphine injection. The maximum possible effect percentage (%MPE) and area under the curve (AUC) were calculated based on TFL to evaluate the analgesic effect. Western blot was performed to evaluate the phosphorylation levels of NR2B, PKC and CAMK II in the dorsal horn of the lumbar spinal cord of mice.

Results: Compared with control treatment, intrathecal morphine elicited obvious scratching response when providing analgesic effect in a dose dependent manner. Gavage administration of XF can significantly reduce intrathecal morphine-induced scratching behavior without affecting its analgesic efficiency; besides, XF can inhibit the phosphorylation of NR2B, PKC, and CAMK II induced by intrathecal morphine, which can be reversed by intrathecal injection of NMDA.

Conclusions: XF can relieve intrathecal morphine-induced pruritus and may be related to the inhibition of the NR2B/PKC/CAMK II signaling pathway.

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.

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.