Journal of Anesthesia最新文献

Purpose: To investigate the clinical characteristics of management strategies for, and outcomes in patients with preoperative venous thromboembolism (VTE) who underwent surgery in Japan.

Methods: We categorized patients with preoperative VTE into the following three groups: pulmonary embolism (PE), proximal deep vein thrombosis (DVT), and distal DVT. We investigated baseline characteristics, including risk factors; perioperative treatment and prophylaxis, including anticoagulation; and postoperative outcomes, including postoperative VTE recurrence, bleeding, and death.

Results: We divided 13,025 patients into PE (n = 2425, 19%), proximal DVT (n = 1792, 14%), and distal DVT groups (n = 8808, 68%). The PE group had the highest incidence of malignancy; the proximal DVT group had the highest incidence of leg fractures; and the distal DVT group had the lowest incidence of physical immobility. Furthermore, the PE group most frequently received preoperative anticoagulation therapy after VTE diagnosis, whereas the proximal DVT group most frequently received an inferior vena cava filter for intraoperative management. Death within 30 postoperative days was most common in the PE group. In addition, recurrent PE was most frequent in the PE group, whereas major bleeding events were least frequent in distal DVT group.

Conclusions: This study, based on nationwide anesthesiologic database, provides contemporary practice patterns and clinical outcomes in patients with preoperative VTE who underwent surgery in Japan. These findings may provide valuable information for healthcare providers involved in surgery.

In Japan, Ministry of Health, Labour and Welfare statistics show a significant decline in blood donors from 1985 to 2023, especially among young people and high school students, while donations among those aged 50 - 69 increased substantially. The decline has been attributed in part to reduced promotional activities. According to the material in the Japanese Red Cross Society, the production and supply volume of red blood cells (RBCs) and platelet concentrates (PCs) remained stable from 2006 to 2023, whereas the supply of fresh frozen plasma (FFP) has decreased. The 2003 Act on Securing a Stable Supply of Safe Blood Products requires medical physicians to ensure appropriate use of blood products. In cases of massive hemorrhage, however, appropriate use for life-saving transfusion is required. The new 2025 Guideline for the Management of Critical Bleeding introduced recommendations on cryoprecipitate and fibrinogen use, and added guidance on tranexamic acid, calcium supplementation, and sodium bicarbonate. To reduce transfusion in routine clinical practice, autologous transfusion should also be considered. In 2024, the Blood Donation Promotion Committee emphasized the importance of research to develop new products.

Purpose: No definite recommendations exist for anesthetic and obstetric management of pregnant patients with intracranial neurovascular disorders during delivery. This case series describes the management of pregnant patients with intracranial vascular abnormalities during delivery.

Methods: Information was gathered from institutional databases to include pregnant patients evaluated by neurology or neurosurgery at a single institution between January 2000 and August 2025 for any central nervous system vascular abnormality. Patients were included if evaluation by neurology or neurosurgery occurred either before, during pregnancy, or up to six months post-partum.

Results: The study cohort consisted of 26 patients having 31 deliveries. The most common lesions were cavernous malformation (n = 8) and cerebral arteriovenous malformation (n = 8). The remainder had aneurysm (n = 4), dural arteriovenous fistula (n = 2), moyamoya disease (n = 2), venous angioma (n = 1), and carotid dissection (n = 1). Twenty-one deliveries were vaginal and 10 were cesarean delivery (CD). The presence of a neurovascular abnormality was an indication for induction of labor in three individuals and for CD in four deliveries. Neuraxial labor analgesia was used in 14 of the 21 patients who had vaginal delivery. Parturients who underwent CD had spinal anesthesia (n = 8), preexisting labor epidural anesthesia (n = 1), and general anesthesia (n = 1). There were no complications attributed to neuraxial anesthesia.

Conclusions: The presence of central nervous system vascular abnormalities in pregnant patients is rare but poses unique challenges to obstetric and anesthetic management. Neuraxial anesthesia and analgesia can be offered to women with central nervous system vascular abnormalities without abnormal neurologic symptoms.

Purpose: To identify the postoperative mortality in patients requiring home oxygen therapy (HOT).

Methods: This descriptive study used a nationwide hospital-based database constructed by JMDC Inc. (Tokyo, Japan). Patients aged ≥ 18 years requiring HOT who underwent surgery between January 2014 and June 2022 were included. The study outcomes were in-hospital and 30-day postoperative mortality rates and other complications. We established a non-HOT group matched by age, sex, procedure, and surgical urgency for contrast and analyzed mortality in subgroups based on the reason for HOT, surgical department, and urgency.

Results: Among the 3349 patients receiving HOT who underwent surgery, 293 (8.7%) in-hospital mortalities and 213 (6.4%) 30-day mortalities were reported. Postoperative pulmonary complications were observed in 359 (10.7%) patients, and 227 (6.8%) had non-respiratory complications. Furthermore, 123 (3.7%) in-hospital mortalities and 74 (2.2%) 30-day mortalities were also reported in the non-HOT group (3323 patients). The subgroup analysis indicated no significant differences in mortality or complications based on the reason for HOT. Higher mortality rates were reported in gastroenterology (9.3%), dermatology (14.7%), respiratory (11.8%), otolaryngology (36.5%), and neurosurgery (16.3%) departments. In-hospital and 30-day mortalities for emergency surgeries in the HOT group were 17.3 and 13.4%, respectively.

Conclusion: Among patients requiring HOT, in-hospital and 30-day mortalities were 8.7 and 6.4%, respectively. In addition, emergency surgeries may contribute to higher postoperative mortalities. Future research should identify specific mortality risk factors and develop perioperative management strategies to reduce these risks.

Purpose: General anesthesia combined with surgery is thought to suppress the immune system. However, few studies have examined the effects of anesthetics alone on humoral immunity. In this study, we aimed to investigate the effects of the intravenous anesthetic propofol on antibody production after immunization and the underlying mechanisms in mice.

Methods: Mice were immunized with 4-hydroxy-3-nitrophenylacetyl (NP) hapten-conjugated keyhole limpet hemocyanin (NP-KLH), a T cell-dependent antigen, or NP hapten-conjugated Ficoll (NP-Ficoll), a T cell-independent antigen, followed by treatment with propofol, or PBS or intralipid as controls, for five consecutive days. The mice were re-immunized, and antibody production and immune cell subsets were evaluated. The effects of propofol on T cell proliferation and survival were also examined.

Results: NP-specific IgM and IgG1 titers were reduced in propofol-treated NP-KLH-immunized mice compared to those treated with PBS or intralipid, and this reduction was more pronounced in the secondary response than in the primary response. By contrast, propofol treatment did not affect NP-specific antibody titers in NP-Ficoll-immunized mice. In vitro, propofol inhibited IL-2-mediated proliferation and IL-7-dependent survival of CD4⁺ T cells.

Conclusions: Propofol suppresses T cell-dependent antibody production in mice and directly affects T cell proliferation and survival in vitro. These data suggest that anesthetics administered close to the time of vaccination may affect vaccine-specific antibody production.

The optimal sedation/anesthesia technique for magnetic resonance imaging (MRI) scans has not been established. The combination of propofol with dexmedetomidine has been reported, but without systematic dosing data. Our primary aim was to determine the propofol-sparing effect of dexmedetomidine (DEX) when added to propofol for MRI scan sedation/anesthesia utilizing a dose-ranging protocol for four distinct regimens (Propofol-Only, DEX-High, DEX-Low, DEX-Bolus). Our secondary aims were to document adverse events, scan interruptions due to patient movements, and determine recovery time. Seventy-nine patients aged 1-12 years scheduled for MRIs under anesthesia were sequentially enrolled. A 60% reduction in propofol dose required was found in the dexmedetomidine cohorts. There was no difference (p = 0.161) in recovery time between Propofol-Only and DEX-Bolus groups. There were no differences in episodes of hypotension (p = 0.464), bradycardia (p = 0.558), or patient movement (p = 0.273) between the Propofol-Only and dexmedetomidine cohorts. Recovery time was prolonged for DEX-High and DEX-Low groups compared to DEX-Bolus or Propofol-Only. The addition of dexmedetomidine significantly decreased the necessary dose of propofol. Propofol combined with a single bolus of dexmedetomidine (no infusion) provided effective sedation/anesthesia without adverse events or extending recovery time.

Background and purpose: General anesthesia is indicated in emergencies, contraindications, or patient requests. The induction agent to use is an important factor in general anesthesia. We aim to provide an updated systematic review and meta-analysis to compare propofol, ketamine, and thiopental sodium in terms of efficacy and safety profiles in women undergoing cesarean sections under general anesthesia.

Methods: We conducted this systematic review and meta-analysis according to PRISMA guidelines. We searched the following databases (PubMed, Scopus, Cochran Library, and Web of Science) up to 18-8-2024. We used a term for cesarian section, thiopental, ketamine, and propofol.

Results: Thirty-six randomized controlled trials met our criteria and were included in our analysis with a total of 1945 patients. In (Thiopentone vs. Propofol) group, the use of thiopentone was associated with higher umbilical artery PH and longer recovery duration, although the certainty of evidence was low for both outcomes, while in the propofol group, the risk of having neonates with Apgar score less than 7 at one minute was higher, but the certainty of evidence was very low. In (Thiopentone vs. Ketamine) group, patients induced with thiopentone reported accidental awareness during general anesthesia (AAGA) more frequently and their neonates revealed higher umbilical vein PvO₂. Also, Apgar score < 7 at 1 and 5 min were less frequent in the thiopentone group. The certainty of evidence for these outcomes was moderate. In (Propofol vs. Ketamine) group, there were no differences among reported outcomes, and the certainty of evidence was low to very low.

Conclusion: Our findings suggest that propofol and thiopentone appear to be clinically comparable. Ketamine was favored over thiopentone for its lower risk of AAGA, while thiopentone was associated with a lower risk of Apgar scores < 7 at 1 and 5 min. Additional well-designed trials are needed to support our conclusions more firmly.

Purpose: Postoperative pain control following adenotonsillectomy in the pediatric population poses a great challenge to care providers. Multi-modal pain management regimes including NSAIDs such as intraoperative ketorolac usage has been purposed for many years. However, the effectiveness of ketorolac to reduce post-tonsillectomy pain and opioid-related side effects is controversial. The study was to evaluate the opioid-sparing effect of an intraoperative intravenous single dose of ketorolac in children undergoing adenotonsillectomy. We also assessed the effectiveness of perioperative ketorolac on alleviating the common adverse effects of opioid usage.

Methods: With IRB approval, a total of 142 pediatric patients aged between 3 and 12 years undergoing elective adenotonsillectomy were randomized to receive either placebo or 0.5 mg/kg ketorolac intraoperatively with other pain management remaining the same. The primary outcomes were postoperative pain scores and postoperative rescue pain medication usage. Common postoperative anesthesia-related complications such as nausea, vomiting and postoperative rebleeding were assessed.

Results: We found that ketorolac usage decreased the overall postoperative pain scores significantly (Max FLACC score 4.3 ± 2.6 for ketorolac vs. 5.9 ± 3.0 for placebo). However, intraoperative single-dose ketorolac administration did not reduce postoperative rescue opioid usage, nor decrease the rates of postoperative nausea and vomiting. We did not observe significant postoperative bleeding or other complications associated with ketorolac usage.

Conclusions: While intraoperative ketorolac usage reduces the overall postoperative pain score, it does not decrease the postoperative opioid consumption in our current practice regime. Ketorolac may be a good multi-modal pain management adjunct without increased postoperative complications such as rebleeding.