A&A practice最新文献

Anesthetic management for thoracic surgery in patients with single-lung physiology is challenging when mechanical ventilation is not possible or limited. Apneic oxygenation maintains oxygenation during apnea, facilitating lung collapse and optimal surgical exposure. We report a 50-year-old man with bilateral lung metastases from osteosarcoma who underwent left lung wedge resection 10 days after right pneumonectomy, using apneic oxygenation instead of conventional one-lung ventilation. This case demonstrates that apneic oxygenation may serve as a safe and effective alternative in selected patients. However, limitations such as hypercapnia and respiratory acidosis require careful patient selection, time constraints, and vigilant intraoperative monitoring.

Positive communication in perioperative medicine improves patient satisfaction, outcomes, and psychological safety. Grounded in the biopsychosocial model, it promotes shared decision-making and trust among patients and clinicians. It helps reduce anxiety and pain, but challenges remain. These include differing perceptions of "positive" communication, the stress of acute care, and limited research due to inconsistent methodologies and outcomes. Clinician well-being is crucial for sustaining positive interactions. Advancing the field requires evidence-based strategies and interdisciplinary collaboration to ensure effective, consistent communication in high-pressure settings and to bridge the gap between research and real-world clinical practice.

Bernard-Soulier syndrome is a rare inherited bleeding disorder caused by a deficiency of the platelet surface glycoprotein Ib-IX-V complex, leading to defective platelet adhesion and increased bleeding risk. Catamenial hemothorax, a rare manifestation of thoracic endometriosis, involves recurrent intrapleural bleeding in synchrony with menstruation. Coexistence of both conditions poses significant challenges to perioperative anesthetic management due to compounded risks of hemorrhage and respiratory complications. We report the successful anesthetic management of a 22-year-old woman with coexisting Bernard-Soulier syndrome and catamenial hemothorax who underwent thoracotomy and pleurodesis, along with a brief review of the relevant literature.

Preoperative optimization clinics enhance surgical outcomes by optimizing patients' health, reducing unnecessary tests, and minimizing cancellations. Artificial intelligence (AI) now promises to further advance these efforts by improving predictive modeling, automating risk assessments, and enabling personalized care strategies. AI models have shown particular strength in predicting postoperative complications, such as cardiovascular events. Tools like natural language processing (NLP) have also improved risk detection for conditions like alcohol misuse. The historical development of preoperative clinics-from Dr. J Alfred Lee's initial concept in 1949 to modern models like Enhanced Recovery After Surgery (ERAS) and Anesthesia Preoperative Evaluation Clinic (APEC)-laid the groundwork for today's integration of electronic health records (EHRs) and decision-support systems, now evolving toward AI-driven care. Machine-learning algorithms have proven superior to traditional models for predicting postoperative anemia, opioid dependence, diabetes complications, and mortality risks, thus offering precise stratification and resource optimization. Specific applications include AI-assisted anemia management, penicillin allergy delabelling, and opioid use prediction after major surgeries. AI also enhances patient education through tools like ChatGPT and improves smoking cessation efforts using conversational AI. NLP has demonstrated better accuracy than standard International Classification of Disease (ICD) codes in identifying risky alcohol use (>2 standard drinks per day before surgery). However, barriers to widespread adoption include data privacy, algorithmic bias, and clinician skepticism. Future studies should focus on validating AI models across diverse populations and integrating AI recommendations within clinical workflows while adhering to evolving regulatory standards. Ultimately, AI's incorporation into preoperative assessments could significantly boost the efficiency and impact of clinic resources, potentially shifting outcomes more favorably by improving the slope of resource utilization versus patient outcome curves. Continued research and refinement are essential for AI to achieve its full potential in perioperative medicine.

We report a case of a 53-year-old male with myasthenia gravis who underwent thymectomy via a full-length median sternotomy. To minimize opioid exposure and enhance postoperative recovery, a bilateral ultrasound-guided superficial parasternal intercostal plane (S-PIP) block was administered using 15 mL of 0.25% bupivacaine on each side before incision. Postoperative analgesia was maintained with paracetamol and dexketoprofen. No systemic opioids were required, and pain scores remained below 4 during the first 24 hours. The patient recovered uneventfully in the postoperative period. This case highlights the utility of S-PIP block as a safe and opioid-sparing technique in high-risk patients undergoing sternotomy.

Anesthetic management of central airway tumors is challenging due to airway obstruction, lack of a definitive airway, and shared airway with surgeon. While a nasogastric tube (NGT) is primarily designed for feeding and administration of medication, it can be an auxiliary device in emergency situations, when airway anatomy poses a significant obstacle to traditional ventilation methods. We describe the use of an NGT as an alternative airway conduit to bypass the tumor and maintain ventilation in a case with a distal tracheal tumor causing complete airway occlusion.

Spinal cord stimulation (SCS) is effective for some pain syndromes, but inappropriate referrals can frustrate patients and misuse resources. This retrospective study reviewed 370 patients referred to a Neuromodulation for Pain Program (NPP) from July 2022 to June 2024. Of these, 241 were deemed appropriate for SCS. The SCS-appropriate group had higher pain intensity, more neuropathic pain, and lower opioid use. Inappropriate referrals were often from family physicians. Key factors associated with inappropriateness included low pain intensity, lack of neuropathic features, and high opioid use. Enhancing referral quality through targeted education may improve care and system efficiency.

The biceps femoris short head (BiFeS) block is a novel, ultrasound-guided, motor-sparing regional anesthesia technique targeting the posterolateral sensory innervation of the knee. We present two unilateral total knee arthroplasty (TKA) cases in which BiFeS was combined with adductor canal block (ACB) under spinal anesthesia. Blocks were administered postoperatively, before the onset of pain. Both patients had low pain scores, preserved quadriceps and ankle motor function, minimal morphine consumption (6 mg and 5 mg), and high Quality of Recovery-15 (QoR-15) scores (140 and 137). BiFeS may be a valuable adjunct to ACB for multimodal analgesia in TKA.

Succinylcholine is widely used in anesthesia for electroconvulsive therapy (ECT). Succinylcholine apnea is a recognized rare complication. A patient's dormant, undiagnosed, genetic pseudocholinesterase deficiency was clinically triggered and unmasked by the combination of long-term rivastigmine therapy and succinylcholine used in ECT, resulting in post-ictal succinylcholine apnea. In subsequent treatments, low-dose rocuronium was successfully used instead. Clinicians providing electroconvulsive therapy should consider potential interactions between cholinesterase-inhibiting drugs and succinylcholine or use alternative neuromuscular blocking drugs.