Anesthesia progress最新文献

Objective: This study aimed to determine whether PONV rates differed over time and to identify potential differences in PONV risk factors for oral surgery patients undergoing general inhalational anesthesia (IA) or propofol-based total intravenous anesthesia (TIVA).

Methods: This retrospective cohort study included patients between 16 and 85 years of age and who received intubated general anesthesia with either IA or TIVA for minor oral surgery between January 2021 and July 2022. Primary outcomes were PONV overall (onset at 0-24 hours), early (onset at 0-2 hours), and late (onset at 2-24 hours). Known PONV risk factors as identified from existing literature were included for analysis.

Results: Data were obtained from 188 patients. A total of 41 (21.8%) patients developed overall PONV, 35 patients (18.6%) had early PONV, and 14 patients (7.4%) had late PONV. Any PONV that occurred across 2 periods was categorized in each period. IA compared with TIVA had higher overall PONV (29.6% vs 13.3%; P = .008) and early PONV (25.5% vs 11.1%; P = .034). Female sex and increased Apfel scores were associated with increased overall, early, and late PONV. Per multivariate analysis, females were 2.5 to 6 times higher than males to have overall, early, and late PONV (P < .05), and IA was 3 times higher than TIVA to have overall and early, but not late, PONV (P < .05).

Conclusion: Our results suggested that the method of anesthesia may impact the incidence of overall and early PONV and that female sex and increase Apfel scores correlated with increased PONV through all times.

The analgesic efficacy and safety of liposomal bupivacaine (LB) in third molar extraction was evaluated in this phase 3, double-blind, placebo-controlled study of subjects undergoing bilateral third molar extraction. Subjects were randomized 2: 1 to infiltration with LB (133 mg/10 mL) or placebo, and received opioid rescue medication as needed. Primary efficacy measure was cumulative area under the curve (AUC) of numeric rating scale (NRS) pain severity scores through 48 hours (AUC of NRS0-48) postsurgery. Other measures included AUC of NRS0-24, AUC of NRS0-72, and AUC of NRS0-96, and incidence of adverse events. There were 150 subjects in the primary efficacy population (n = 99 LB, n = 51 placebo) and 89 in the per-protocol population (n = 59 LB, n = 30 placebo). Least-squares mean for AUC of NRS0-48 was 172.3 LB versus 194.7 placebo (P = .227) in the primary efficacy population and 120.8 LB versus 183.3 placebo (P = .023) in the per-protocol population. At all time points, between-group differences in AUC of NRS scores were significant in the per-protocol population (LB lower than placebo, P < .05) but not in the primary efficacy population. The adverse event profile was similar between groups. LB produced significantly lower cumulative pain scores versus placebo at all time points in the per-protocol analysis but not in the primary efficacy analysis because of protocol violations. This study indicates significant improvement in pain scores in the third molar model, but because of extensive protocol violations additional studies are warranted to demonstrate effectiveness.

Objective: Angiogenesis is associated with angiogenic therapy and wound healing processes. It is important for anesthesiologists to understand the effects of perioperative and long-term use of anesthetics on angiogenesis. This study aimed to determine the effects of ketamine on in vitro angiogenesis: the proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF), HUVEC migration, and in vitro capillary tube formation in cocultured HUVEC and NHDF.

Methods: The effects of ketamine at concentrations of 1, 10, and 50 µM on the proliferation of HUVEC and NHDF for 48 hours were determined by using a water-soluble tetrazolium salt reagent. Quantitation of migration for 22 hours was achieved by measuring the fluorescence of migrating HUVEC exposed to ketamine using an angiogenesis system. The effects of ketamine on capillary tube formation with or without vascular endothelial growth factor (VEGF) were investigated in cocultured HUVEC and NHDF incubated for 3 and 10 days.

Results: Ketamine did not show any enhancing or suppressive effects on the in vitro proliferation of HUVEC and NHDF, HUVEC migration, or capillary tube formation in cocultured HUVEC and NHDF for either 3 or 10 days in the presence or absence of VEGF.

Conclusion: Ketamine had no effects on in vitro angiogenesis using cultured HUVEC and NHDF. Ketamine can potentially be used as an anesthetic agent with no influence on angiogenesis.

We describe a case of profound bradyarrhythmia after sugammadex administration during ambulatory anesthesia. The patient was a 21-year-old man with autism spectrum disorder undergoing planned general anesthesia for dental treatment. After treatment completion, sugammadex was administered upon awakening, and sudden bradyarrhythmia appeared immediately. The patient's heart rate decreased to approximately 30 beats/min but quickly recovered to roughly 80 beats/min after the administration of intravenous atropine. Electrocardiography suggested sinoatrial block or sinus arrest. Although the exact mechanism is unknown, severe electrocardiographic changes can occur within a few minutes of sugammadex administration.

Hypomelanosis of Ito (HI), a neurocutaneous syndrome, is characterized by skin depigmentation and skeletal, muscular, central nervous system, cardiac, and renal manifestations. A wide variety of cutaneous manifestations besides depigmentation have been reported. Herein we describe a 23-year-old woman with HI whose extracutaneous symptoms included severe mental and motor impairment, convulsions, and deformity of the orofacial region. She also had severe obesity, asthma, multiple allergies, and skin hypersensitivity. Although no extracutaneous manifestations were problematic during perioperative management of dental procedures under general anesthesia, erythema developed at 3 time points: during induction, during emergence, and in recovery. We speculated that mechanical stimuli to the skin and administration of multiple drugs likely caused histamine release, leading to the 3 episodes of erythema. Because patients with HI often have hypersensitivity reactions in the skin, both cutaneous and extracutaneous manifestations should be considered in the anesthetic management of patients with HI.

Hemangiomas in the head and neck region, especially those that may impact the airway, require special attention perioperatively because of the potential for difficulties with airway management and bleeding control. This case report describes the management of a 31-year-old male with a large hemangioma of the tongue and pharynx undergoing surgical extraction of mandibular third molars under intubated general anesthesia. Despite taking precautions and avoiding traumatizing the hemangioma while securing the airway, massive bleeding occurred during the surgical extractions, which prompted emergent transfer for angiographic embolization and a stay in the intensive care unit until extubation. This case report highlights the additional attention needed for patients with hemangiomas within the oral cavity and upper airway because of the potential for unexpected massive bleeding that can affect airway management and cardiovascular stability.

We present a case of an infant patient with Robin sequence (Pierre Robin sequence; PRS) who underwent general anesthesia for a glossopexy procedure. Pediatric patients with PRS are prone to upper airway obstruction during general anesthesia induction and intubation difficulties due to micrognathia and glossoptosis. In this case, we facilitated mask ventilation by inserting a nasopharyngeal airway before induction and successfully intubated the patient using a 2-person technique that combined the use of a video laryngoscope and a flexible fiber-optic scope. This experience suggests that the use of appropriate devices can help ensure airway patency and enhance visualization and maneuverability during intubation.

Objective: Previous studies have reported that the noise generated by dental equipment can interfere with the auscultation of respiratory sounds during sedation. Therefore, this study aimed to identify whether positing the acoustic sensor on the chest or cervical position would be least susceptible to interference from dental suction device noise, a prominent noise noted during respiratory sound monitoring during dental sedation.

Methods: This prospective cohort study was conducted with 30 students. Sound intensity (dB) and frequency (kHz) levels from the dental suction were recorded from the cervical and chest regions under both oral and nasal breathing conditions and analyzed.

Results: The mean intensity of dental suction sounds was significantly lower in the chest region compared with the cervical region, regardless of the breathing condition (P < .001). Furthermore, in the chest region, the mean sound frequency during oral breathing was significantly lower than that during nasal breathing (P < .01).

Conclusions: Our study suggests that monitoring respiratory sounds in the chest region can significantly reduce interference from noise generated by dental suction devices compared with monitoring at the cervical region.