{"title":"Use of vasopressors to manage spinal anesthesia-induced hypotension during cesarean delivery.","authors":"Hee-Sun Park, Woo-Jong Choi","doi":"10.17085/apm.24037","DOIUrl":"10.17085/apm.24037","url":null,"abstract":"<p><p>Cesarean sections are commonly performed under spinal anesthesia, which can lead to hypotension, adversely affecting maternal and fetal outcomes. Hypotension following spinal anesthesia is generally defined as a blood pressure of 80-90% below the baseline value. Various strategies have been implemented to reduce the incidence of spinal anesthesia-induced hypotension. The administration of vasopressors is a crucial method for preventing and treating hypotension. In the past decade, phenylephrine, a primarily alpha-adrenergic agonist, has been the preferred vasopressor for cesarean sections. Recently, norepinephrine, a potent alpha-agonist with modest beta-agonist activity, has gained popularity owing to its advantages over phenylephrine. Vasopressors can be administered via a bolus or continuous infusion. Although administering boluses alone is simpler in a clinical setting, continuous prophylactic infusion initiated immediately after spinal anesthesia is more effective in reducing the incidence of hypotension. Tailoring the infusion dose based on the patient's body weight and adjusting the rate in response to blood pressure changes, in addition to using a prophylactic or rescue bolus, helps reduce blood pressure variability during cesarean sections under spinal anesthesia until neonatal delivery.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 2","pages":"85-93"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jung Eun Kim, Jinse Lee, Giyear Lee, Mi Hwa Chung, Young Ryong Choi, Eun Mi Choi
{"title":"Unintended subdural anesthesia and subdural air bubbles after attempted epidural anesthesia in a patient undergoing cesarean section.","authors":"Jung Eun Kim, Jinse Lee, Giyear Lee, Mi Hwa Chung, Young Ryong Choi, Eun Mi Choi","doi":"10.17085/apm.23105","DOIUrl":"10.17085/apm.23105","url":null,"abstract":"<p><strong>Background: </strong>Unintended subdural anesthesia accompanied by air bubbles compressing the cauda after attempting epidural anesthesia is rare.</p><p><strong>Cases: </strong>A 41-year-old pregnant woman was scheduled to undergo epidural anesthesia for cesarean section. After attempting epidural anesthesia, she experienced prolonged hypotension and recovery time, especially in the right extremity. Through magnetic resonance imaging we found subdural air bubbles compressing the right side of the cauda equina in the L3 region. Thus, we considered unintended subdural anesthesia and performed conservative management with close observation. Her symptoms completely resolved within 24 h.</p><p><strong>Conclusions: </strong>Here, we report a case with various features of subdural anesthesia and subdural air bubbles compressing the cauda.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 2","pages":"150-155"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia and cancer recurrence: a narrative review.","authors":"Hyun Joo Ahn","doi":"10.17085/apm.24041","DOIUrl":"10.17085/apm.24041","url":null,"abstract":"<p><p>Cancer is a leading cause of death worldwide. With the increasingly aging population, the number of emerging cancer cases is expected to increase markedly in the foreseeable future. Surgical resection with adjuvant therapy is the best available option for the potential cure of many solid tumors; thus, approximately 80% of patients with cancer undergo at least one surgical procedure during their disease. Agents used in general anesthesia can modulate cytokine release, transcription factors, and/or oncogenes. This can affect host immunity and the capability of cancer cells to survive and migrate, not only during surgery but for up to several weeks after surgery. However, it remains unknown whether exposure to anesthetic agents affects cancer recurrence or metastasis. This review explores the current literature to explain whether and how the choice of anesthetic and perioperative medication affect cancer surgery outcomes.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 2","pages":"94-108"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eun Ji Park, Ah-Reum Cho, Hyae-Jin Kim, Hyeon-Jeong Lee, Soeun Jeon, Jiseok Baik, Wangseok Do, Christine Kang, Yerin Kang
{"title":"Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study.","authors":"Eun Ji Park, Ah-Reum Cho, Hyae-Jin Kim, Hyeon-Jeong Lee, Soeun Jeon, Jiseok Baik, Wangseok Do, Christine Kang, Yerin Kang","doi":"10.17085/apm.23161","DOIUrl":"10.17085/apm.23161","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia-induced hypotension (SAH) frequently occurs in older patients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomatic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiography within 6 months before surgery revealed grade I LV diastolic dysfunction were recruited. SAH was investigated using the anesthesia records. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed.</p><p><strong>Results: </strong>A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845-0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752-0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%.</p><p><strong>Conclusions: </strong>The preoperative mitral inflow E velocity demonstrated the greatest predictability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identifying patients at high risk of SAH and guiding preventive strategies in the future.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 2","pages":"134-143"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Insun Park, Junkyu Kim, Seung Hyun Chung, Hyo-Seok Na, Sang-Hwan Do
{"title":"Effects of remimazolam combined with remifentanil on quality of recovery after ambulatory hysteroscopic surgery: a prospective, observational study.","authors":"Insun Park, Junkyu Kim, Seung Hyun Chung, Hyo-Seok Na, Sang-Hwan Do","doi":"10.17085/apm.23102","DOIUrl":"10.17085/apm.23102","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam, a new benzodiazepine, is known for its quick onset of effects and recovery time. Recently, it has been licensed for general anesthesia and sedation in Korea and its use is increasing in other countries. However, less is known about its effect on postoperative recovery. We used a patient-reported outcome questionnaire to examine the effect of remimazolam on postoperative recovery.</p><p><strong>Methods: </strong>Patients who underwent hysteroscopy on day surgery basis were administered an induction dose of remimazolam 6 mg/kg/h followed by a maintenance dose of 1-2 mg/kg/h. After surgery, the translated Korean version of 15-item Quality of Recovery scale (QoR-15K) including post-discharge nausea and vomiting (PDNV) and/or pain, was surveyed 24 h after surgery to evaluate patient recovery.</p><p><strong>Results: </strong>Total of 38 patients were enrolled in this prospective, observational study. All patients successfully completed QoR-15K. Only one patient scored low for moderate pain and PDNV. On average, patients scored 9 and above for all QoR-15K items except for moderate pain (8.66 ± 1.68). When QoR-15K items were grouped into dimensions, all dimensions scored an average of 9 or higher on a 10-point scale. In addition, 19 out of 38 patients gave score range of 148 to 150 out of possible 150.</p><p><strong>Conclusions: </strong>Psychometric evaluation based on postoperative QoR-15K among patients receiving remimazolam shows satisfactory patient recovery profiles without significant pain or PDNV. Considering its effectiveness and safety, remimazolam could be one of useful agents for general anesthesia of day surgery in terms of postoperative recovery.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"44-53"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A message from the Editor-in-Chief and Editorial Board, 2023: journal metrics and statistics, and appreciation to reviewers.","authors":"Jun Hyun Kim, Hyun Kang","doi":"10.17085/apm.24008","DOIUrl":"10.17085/apm.24008","url":null,"abstract":"","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10847000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaemoon Lee, Minki Lee, Sookyung Lee, Chung-Sik Oh, Tae-Yop Kim
{"title":"Preoperative evaluation of systolic murmur with point-of-care echocardiography before an elective thoracic surgery - A case report.","authors":"Jaemoon Lee, Minki Lee, Sookyung Lee, Chung-Sik Oh, Tae-Yop Kim","doi":"10.17085/apm.23124","DOIUrl":"10.17085/apm.23124","url":null,"abstract":"<p><strong>Background: </strong>Systolic murmur suggesting the association of aortic valve (AV) stenosis or obstructive pathology in the left ventricular outflow tract (LVOT) usually requires preoperative echocardiographic evaluation for elective surgery.</p><p><strong>Case: </strong>In a 63-year-old female patient undergoing elective thoracic surgery, the systolic murmur was auscultated on the right sternal border of the second intercostal space in the preoperative patient holding area. Point-of-care (POC) transthoracic echocardiography (TTE) demonstrated a systolic jet flow in the LVOT area. The peak systolic velocity of the continuous wave Doppler tracing, aligned to the LVOT and the AV, was approximately 1.5 m/s. The peak/mean pressure gradient was 11/6 mmHg for the AV and 9/5 mmHg for the LVOT. Anesthesia was induced under continuous TTE imaging. Intraoperative transesophageal echocardiography also confirmed the absence of any cardiac pathology.</p><p><strong>Conclusions: </strong>POC echocardiography offered a thorough preoperative evaluation of an unexpectedly identified systolic murmur, avoiding a potential delay in the operation schedule for conventional preoperative echocardiographic evaluation.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"62-67"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10847002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Soiling of non operative lung during one lung ventilation using EZ blocker in a tracheostomised patient.","authors":"Karthik Lakshmikantha, Tanvi M Meshram, Kamlesh Kumari, Darshana Rathod, Ankur Sharma","doi":"10.17085/apm.23141","DOIUrl":"10.17085/apm.23141","url":null,"abstract":"","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"70-71"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuromuscular monitoring of a patient with Charcot-Marie-Tooth disease; which monitoring technique is adequate? - A case report and literature review.","authors":"Seung Un Kim, Seora Kim, Ki Tae Jung","doi":"10.17085/apm.23111","DOIUrl":"10.17085/apm.23111","url":null,"abstract":"<p><strong>Background: </strong>Charcot-Marie-Tooth disease (CMTD) is a hereditary polyneuropathy associated with a life-threatening risk of pulmonary complications.</p><p><strong>Case: </strong>A 61-year-old male with CMTD for 40 years was admitted for the drainage of an abscess in his left ankle. Total intravenous anesthesia was administered, and an electromyography device was attached to the hand for neuromuscular monitoring; however, the response was not measured. Kinemyography and acceleromyography devices were attached to both hands, and responses were obtained. After neuromuscular blockade (NMB) with rocuronium 0.6 mg/kg, the train-of-four (TOF) response on kinemyography was normally measured, but the post-tetanic count on acceleromyography consistently showed 0 during anesthesia. Sugammadex 200 mg was injected to reverse the NMB. After 5 min, the TOF ratios for kinemyography and acceleromyography exceeded 90%. The patient recovered without any complications.</p><p><strong>Conclusions: </strong>For CMTD patients, acceleromyography or kinemyography is superior to electromyography, and sugammadex can be used to reverse NMB successfully.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"54-61"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyung Seo Oh, Yong-Hee Park, Chongwha Baek, Young-Cheol Woo
{"title":"Application of the Bair Hugger™ core body temperature at wrist region with upper body warming blanket: a prospective observational study.","authors":"Kyung Seo Oh, Yong-Hee Park, Chongwha Baek, Young-Cheol Woo","doi":"10.17085/apm.23107","DOIUrl":"10.17085/apm.23107","url":null,"abstract":"<p><strong>Background: </strong>Body temperature monitoring is essential during the perioperative period. However, core body temperature measurement requires invasive device that may cause complications. This study aimed to evaluate the accuracy of non-invasive Bair Hugger™ core body temperature monitoring system (BHTMS) at the wrist compared with esophageal temperature under general anesthesia.</p><p><strong>Methods: </strong>Twenty adult patients of the American Society of Anesthesiologists physical status I or II were enrolled. BHTMS sensor was applied at wrist region. After tracheal intubation, an esophageal probe was inserted. Bair Hugger™ upper body warming blankets were used. Esophageal temperature (Teso) and BHTMS at wrist (Twrist) were recorded every 10 min.</p><p><strong>Results: </strong>Total of 257 pairs of data sets were analyzed: Teso and Twrist had no statistically significant difference (P = 0.103). Median of Teso and Twrist were 36.5°C and 36.4°C. Bland-Altman analysis showed Teso - Twrist of 0.14°C ± 1.44. Subsequently, 99 pairs of 0-40 min data set were analyzed and showed significant difference at 0 and 10 min (P < 0.001) but no significant difference at 20, 30 and 40 min. Bland- Altman plot by times showed difference (Teso - Twrist) of 1.49°C ± 2.00, 0.82°C ± 1.30, 0.29°C ± 1.32, -0.03°C ± 0.84, and -0.12°C ± 0.82 at 0, 10, 20, 30 and 40 min respectively.</p><p><strong>Conclusions: </strong>BHTMS at wrist area under the upper body warming blanket is a potential alternative other than esophageal temperature for monitoring body temperature after 30 min of anesthesia induction.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 1","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}