JA Clinical Reports最新文献

{"title":"High-flow oxygenation therapy for a sedated elderly frail patient with hiccups undergoing transcatheter aortic valve implantation.","authors":"Ryosuke Osawa, Takero Arai, Takashi Asai","doi":"10.1186/s40981-025-00784-x","DOIUrl":"https://doi.org/10.1186/s40981-025-00784-x","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) can be performed under sedation, but body movements may lower the efficacy of the procedure and may increase the risk of complications, such as cardiac tamponade. Additional sedatives and analgesics may be required to prevent body movements; this would increase the risk of upper airway obstruction and of respiratory depression. We report a frail patient with hypoxemia and hiccups, in whom high-flow nasal oxygenation facilitated TAVI by effectively inhibiting body movements and respiratory complications.</p><p><strong>Case presentation: </strong>In an 82-year-old patient with severe aortic stenosis, heart failure, hypoxemia, and hiccups, TAVI was planned under sedation with dexmedetomidine, fentanyl, and ketamine. High-flow nasal oxygenation effectively prevented hiccups and associated body movements, and prevented upper airway obstruction and respiratory depression, during TAVI.</p><p><strong>Conclusions: </strong>High-flow nasal oxygenation therapy is potentially useful during cardiac catheterization procedure under monitored anesthesia care, in elderly frail patients with reduced cardiopulmonary function.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"22"},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008988","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":"Anesthetic management of coronary artery reconstruction in a patient with myocardial ischemia caused by an anomalous origin of the right coronary artery running between the great vessels: a case report.","authors":"Riki Kuzuno, Shuji Kawamoto, Kenichiro Tatsumi, Chikashi Takeda, Moritoki Egi","doi":"10.1186/s40981-025-00786-9","DOIUrl":"https://doi.org/10.1186/s40981-025-00786-9","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery origin anomalies, though often incidentally detected, can lead to sudden death. Comprehensive perioperative management is essential. We report a case of an anomalous right coronary artery (RCA) arising from the left main coronary artery (LMCA) and coursing between the aorta and pulmonary artery, discovered after myocardial infarction, in which intraoperative management ensured successful coronary reconstruction.</p><p><strong>Case presentation: </strong>A 49-year-old woman presented with chest pain and ST segment elevation. Coronary angiography revealed an anomalous RCA demonstrating compressive ischemia by the aorta and pulmonary artery. Preoperatively, blood pressure was stabilized with an isosorbide dinitrate patch. Under cardiopulmonary bypass, the RCA was transected and reanastomosed to its physiological aortic position. Intraoperatively, nicorandil was administered to suppress vascular smooth muscle contraction, while five-lead ECG, transesophageal echocardiography, and operative ultrasound monitoring enabled early detection of ischemia and prevented hypertension. Postoperative ventricular premature contractions resolved by the next day, with uneventful recovery.</p><p><strong>Conclusions: </strong>Targeted pharmacologic blood pressure control and multimodal monitoring are vital for safe perioperative outcomes in anomalous coronary artery origin cases.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"21"},"PeriodicalIF":0.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015728","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":"Evaluation of swallowing function during the perioperative period using fiberoptic endoscopy in a patient with myasthenia gravis: a case report.","authors":"Kunihiro Mitsuzawa, Takashi Ishida, Mariko Ito, Satoshi Tanaka, Mikito Kawamata","doi":"10.1186/s40981-025-00783-y","DOIUrl":"10.1186/s40981-025-00783-y","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia causes postoperative dysphagia, and myasthenia gravis also impairs swallowing function. Thus, managing general anesthesia in patients with myasthenia gravis requires special attention to swallowing function. Fiberoptic endoscopic evaluation of swallowing (FEES) has the potential to provide precise perioperative assessment and management of swallowing in these patients.</p><p><strong>Case presentation: </strong>A 35-year-old woman with myasthenia gravis was scheduled for laparoscopic ileocolic resection. FEES was performed before anesthesia, after extubation, and on postoperative day 1. General anesthesia was performed with endotracheal intubation, and extubation was performed uneventfully. Post-extubation FEES revealed salivary pooling, decreased glottal closure reflex, and redness of right arytenoid, likely caused by the endotracheal intubation and nasogastric tube. However, FEES performed on postoperative day 1 showed improvement of these findings.</p><p><strong>Conclusions: </strong>FEES effectively identified transient swallowing impairments related to intubation and confirmed the absence of dysphagia specific to myasthenia gravis, thereby contributing to safe perioperative care.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"20"},"PeriodicalIF":0.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763451","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":"Association of preoperative anxiety and depression with quality of recovery after caesarean delivery: a prospective observational study.","authors":"Ayu Ishida, Mitsuru Ida, Akane Kinomoto, Yusuke Naito, Masahiko Kawaguchi","doi":"10.1186/s40981-025-00782-z","DOIUrl":"10.1186/s40981-025-00782-z","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate the association between the presence of both anxiety and depression and the quality of recovery after caesarean delivery.</p><p><strong>Methods: </strong>This secondary analysis of a prospective observational study included 137 patients aged ≥ 18 years who underwent elective and urgent caesarean delivery under spinal anesthesia and completed the Obstetric Quality of Recovery-11 scale at least once postoperatively. Before caesarean delivery, patients were screened for anxiety and depression using the Hospital Anxiety and Depression Scale. A total score of ≥ 8 in each subscale was considered positive screening. Postpartum quality of recovery was assessed using the Obstetric Quality of Recovery-11 at three time points, with a higher score indicating better recovery.</p><p><strong>Results: </strong>Among the eligible patients, 17.5% (24/137) screened positive for both anxiety and depression. No significant difference was found in the Obstetric Quality of Recovery-11 score 24 h after caesarean delivery (p = 0.13, Cohen's d = 0.33), but differences were observed on postoperative day 3 (p = 0.004, Cohen's d = 0.67) and postoperative day 5 (p = 0.01, Cohen's d = 0.58). In the multiple regression analysis, after adjusting for prominent clinical factors, the presence of both anxiety and depression was associated with the Obstetric Quality of Recovery-11 score on postoperative day 3 (p = 0.01) and postoperative day 5 (p = 0.01), but not 24 h after delivery (p = 0.19).</p><p><strong>Conclusions: </strong>Positive Hospital Anxiety and Depression Scale screening for both anxiety and depression was associated with a poor quality of recovery, measured using the Obstetric Quality of Recovery-11 scores on PODs 3 and 5.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"19"},"PeriodicalIF":0.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742936","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":"Low molecular weight heparin-induced thrombocytopenia management during hemodialysis and cardiac surgery: a case report and literature review.","authors":"Shuto Takada, Shogo Suzuki, Takahiro Tamura","doi":"10.1186/s40981-025-00781-0","DOIUrl":"10.1186/s40981-025-00781-0","url":null,"abstract":"<p><strong>Background: </strong>Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, including low molecular weight heparins (LMWHs) like dalteparin. While LMWHs reduces the risk of HIT compared to unfractionated heparin, vigilance remains essential.</p><p><strong>Case presentation: </strong>An 82-year-old male with chronic kidney disease (CKD) developed HIT during hemodialysis anticoagulation with dalteparin, resulting in a platelet count of 17,000/µL and positive HIT antibodies. Dalteparin was replaced with nafamostat mesilate. Following confirmed HIT antibody seronegativity, elective aortic valve replacement was performed under cardiopulmonary bypass using heparin. Postoperative dialysis was managed using nafamostat mesilate, preventing HIT recurrence. His platelet count recovered after dalteparin replacement, and no recurrence of HIT was observed.</p><p><strong>Conclusions: </strong>Even LMWHs, such as dalteparin, pose a HIT risk, necessitating vigilant monitoring. Confirming HIT antibody seronegativity and appropriately timing surgery are critical for patients with a history of HIT. Proper postoperative follow-up and alternative anticoagulation strategies can prevent HIT recurrence.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"18"},"PeriodicalIF":0.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735639","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":"Efforts to prevent surgical sponge retention: check X-ray on the big screen.","authors":"Kengo Ito, Shotaro Ishimoto, Chiaki Nemoto, Keisuke Yoshida, Satoki Inoue","doi":"10.1186/s40981-025-00780-1","DOIUrl":"10.1186/s40981-025-00780-1","url":null,"abstract":"","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"17"},"PeriodicalIF":0.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630426","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":"Difficult diagnosis of tetanus in a sedated patient after ileal resection.","authors":"Satoko Noguchi, Junichi Saito, Eiji Hashiba","doi":"10.1186/s40981-025-00779-8","DOIUrl":"10.1186/s40981-025-00779-8","url":null,"abstract":"<p><strong>Background: </strong>We report a case of tetanus developed after inguinal hernia repair without traumatic wounds, which was difficult to be diagnosed under sedation with mechanical ventilation for pneumonia and anaphylactic shock.</p><p><strong>Case presentation: </strong>The 67-year-old Japanese male underwent inguinal hernia repair with ileal resection. On postoperative day (POD) 9, he was admitted to the ICU due to dyspnea and worsening oxygenation. Immediately after tazobactam piperacillin was administered as empiric treatment for aspiration pneumonia, anaphylaxis developed, requiring tracheal intubation and continuous intravenous adrenaline. On POD 10, sedative titration increased his extremities' muscle rigidity; weaning from mechanical ventilation was difficult, while he could communicate. On POD 15, tetanus was diagnosed based on the physical examination findings prior to ICU admission.</p><p><strong>Conclusion: </strong>Tetanus should be considered when patients show abnormal hypertension and no impaired consciousness during muscle rigidity, even in the absence of obvious trauma.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"16"},"PeriodicalIF":0.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582277","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":"Visibility of video laryngoscope in high-illuminance environment simulating outdoor conditions: effects of screen conditions and polarized sunglasses.","authors":"Takayuki Hasegawa, Rieko Oishi, Hidemi Ishido, Ayumi Oishi, Satoki Inoue","doi":"10.1186/s40981-025-00778-9","DOIUrl":"10.1186/s40981-025-00778-9","url":null,"abstract":"<p><strong>Background: </strong>Video laryngoscopes generally increase the success rate of tracheal intubation and clinical outcome compared to traditional direct laryngoscopes. However, there is a concern that their effectiveness can be compromised in bright outdoor environments. The impact of polarized sunglasses on the visibility of a video laryngoscope in a high-illumination environment simulating outdoor conditions was assessed. Additionally, the effect of screen smudges on screen visibility was examined.</p><p><strong>Methods: </strong>A high-illumination environment was created using artificial light equivalent to daylight outdoors. Twenty-four anesthesiologists participated in this study. A commercially available laryngoscope was utilized to evaluate the visibility of the monitor screen and visualize the larynx. The experiment involved a fixed order sequence, including viewing with the naked eye, wearing sunglasses, cleaning the screen without wearing sunglasses, and cleaning the screen while wearing sunglasses, to evaluate visibility with each intervention. A visual analog scale (VAS) (0-100 mm) was used to evaluate the visibility of the larynx displayed on the screen.</p><p><strong>Results: </strong>Polarized sunglasses significantly enhanced visibility, with a median VAS score of 12 compared to 5 (P = 0.004). Moreover, cleaning the monitor screen significantly improved visibility more than wearing sunglasses alone, with a median VAS score of 38 compared to 12 (P = 0.002). Additionally, wearing sunglasses after cleaning the monitor screen provided even better visibility compared to only cleaning the screen, with a median VAS score of 57 compared to 38 (P = 0.002).</p><p><strong>Conclusions: </strong>Based on these findings, it is suggested that when using a video laryngoscope outdoors in sunny conditions, the first step to address impaired visibility should be to clean the screen. Wearing sunglasses, if possible, can also be effective in improving visibility.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"15"},"PeriodicalIF":0.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541885","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":"Delay in detection of urethral catheter misplacement in the vagina of an older adult patient due to urinary outflow during catheterization: a case report.","authors":"Hisashi Shio, Takao Setsu, Tomonobu Takagaki, Hiroshi Adachi, Makoto Kiuchi, Hideyuki Tsubokura","doi":"10.1186/s40981-025-00776-x","DOIUrl":"10.1186/s40981-025-00776-x","url":null,"abstract":"<p><strong>Background: </strong>To our knowledge, no previous case report explicitly shows that urethral catheter misplacement in the vagina cannot be ruled out even if urinary outflow is observed during catheterization.</p><p><strong>Case presentation: </strong>A 70-year-old female underwent urethral catheterization during induction of general anesthesia for hemiarthroplasty using a bipolar hip prosthesis. Although the urethral meatus could not be visualized, urinary outflow was observed. However, drainage subsequently stopped, and the catheter was eventually found to have been misplaced in the vagina. Detection of the catheter misplacement was delayed because of the assumption that no urinary outflow occurs when the catheter is misplaced in the vagina.</p><p><strong>Conclusion: </strong>Even if urinary outflow is observed during female urethral catheterization, catheter misplacement in the vagina cannot be ruled out; therefore, catheter misplacement in the vagina must be verified in patients for whom the urethral meatus cannot be identified for catheter insertion or when drainage stops.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"14"},"PeriodicalIF":0.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523517","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":"Unexpected negative-pressure pulmonary edema after tracheostomy: two case reports.","authors":"Taichi Kotani, Yusuke Naito, Chie Okuda, Shota Sonobe, Junji Egawa, Masahiko Kawaguchi","doi":"10.1186/s40981-025-00777-w","DOIUrl":"10.1186/s40981-025-00777-w","url":null,"abstract":"<p><strong>Background: </strong>Negative-pressure pulmonary edema (NPPE) often develops with upper airway obstruction, and is uncommon in secured airways, for example, after tracheostomy. Herein, we report two cases of NPPE post-tracheostomy.</p><p><strong>Case presentation: </strong>Case 1: A 69-year-old man underwent prophylactic tracheotomy for possible airway obstruction secondary to glottic carcinoma. Two hours after awakening from general anesthesia, he had difficulty expectorating and developed NPPE due to airway secretions obstructing the tracheostomy tube. Case 2: An 11-year-old boy was admitted to the intensive care unit for continuous hemodiafiltration on a ventilator under sedation. On the 76th day, the day after the tracheostomy was performed, the patient developed patient-ventilator asynchrony due to sedative withdrawal syndrome. The postulated primary mechanism was functional airway obstruction due to patient-ventilator asynchrony.</p><p><strong>Conclusion: </strong>These cases highlight the need to consider NPPE, even in patients with an airway secured with a tracheostomy.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"13"},"PeriodicalIF":0.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515671","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}