JA Clinical Reports最新文献

{"title":"Incidence and risk factors of intubation-related vocal cord paralysis after unilateral thyroidectomy.","authors":"Takumi Harata, Ryosuke Yamamoto, Takashi Fujiwara, Kazuyoshi Ishida","doi":"10.1186/s40981-025-00842-4","DOIUrl":"10.1186/s40981-025-00842-4","url":null,"abstract":"<p><strong>Background: </strong>Vocal cord paralysis (VCP) is a recognized complication of endotracheal intubation, but its true incidence may be underestimated because many asymptomatic cases remain undetected. Previous studies have focused primarily on VCP affecting the surgical side after unilateral thyroidectomy, whereas the non-surgical side has received less attention. The present study determines the incidence and risk factors of intubation-induced VCP on the non-surgical side in patients undergoing hemithyroidectomy.</p><p><strong>Results: </strong>This retrospective cohort included 339 patients who underwent hemithyroidectomy at a single institution between 2010 and 2018. All patients underwent routine pre- and postoperative laryngeal examinations using flexible endoscopy. The incidence of intubation-induced VCP on the non-surgical side was 2.4% (8/339). Patients who developed VCP had significantly lower body weight and body mass index than those without VCP, suggesting that underweight individuals may be more vulnerable. Most cases were transient, resolving within two months of surgery. No significant associations were identified between age, duration of surgery, endotracheal tube size, or intubation method. All cases of intubation-related VCP occurred in patients anesthetized with total intravenous anesthesia. However, this finding should be interpreted with caution because the retrospective design precludes establishing causality and potential confounders.</p><p><strong>Conclusions: </strong>Intubation-induced VCP was observed more frequently than previously reported, particularly among underweight patients. Routine perioperative laryngeal assessment enables detection of asymptomatic cases and may help clarify risk factors. Careful preoperative evaluation and vigilant intraoperative management remain essential to reduce the risk of this underrecognized complication.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"11"},"PeriodicalIF":1.2,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846343","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 Platypnea-orthodeoxia syndrome in a young patient with residual atrial septal defect following congenital heart surgery.","authors":"Yoshifumi Naito, Misao Yoshikawa, Michiyo Yamano, Takeshi Nakamura, Fumimasa Amaya","doi":"10.1186/s40981-025-00844-2","DOIUrl":"10.1186/s40981-025-00844-2","url":null,"abstract":"<p><strong>Background: </strong>Platypnea-orthodeoxia syndrome (POS) is a rare condition causing dyspnea and hypoxemia that worsen in the upright position and improve when supine. While often reported in elderly patients, POS in young adults, particularly due to residual atrial septal defects (ASD) after congenital heart surgery, is uncommon.</p><p><strong>Case presentation: </strong>We present a 24-year-old woman with POS caused by a residual ASD following congenital heart surgery. Agitated saline contrast transthoracic echocardiography confirmed marked right-to-left shunting exacerbated by positional change and Valsalva maneuver. Anesthetic management focused on minimizing shunt flow by maintaining systemic vascular resistance, avoiding hypoxia, hypercarbia, and acidosis, and carefully adjusting ventilation parameters. Transesophageal echocardiography was utilized for shunt evaluation and device placement. Additionally, continuous cerebral oximetry was monitored for possible ischemic changes associated with paradoxical embolisms. The patient underwent successful percutaneous ASD closure without complications.</p><p><strong>Conclusion: </strong>This rare case of young-onset POS highlights the importance of understanding the dynamic shunt physiology and vigilant intraoperative monitoring to ensure patient safety.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"10"},"PeriodicalIF":1.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819245","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":"Impact of a PACU bypass protocol on time from surgery completion to ward transfer and safety in patients undergoing spinal anesthesia: a retrospective cohort study.","authors":"Emi Suda, Yukie Murooka, Tadanao Hiroki, Takashi Suto, Shigeru Saito","doi":"10.1186/s40981-025-00831-7","DOIUrl":"10.1186/s40981-025-00831-7","url":null,"abstract":"<p><p>INTRODUCTION: Enhancing operating room (OR) efficiency and patient flow remains a persistent challenge in Japan. While post-anesthesia care units (PACU) are widely recognized as useful and have been routinely established in large hospitals, their implementation in small- and medium-sized hospitals remains limited owing to the costs of staffing and facility expansion. Safety concerns regarding direct ward transfer after surgery have also been raised. Therefore, intermediate PACU operational models feasible in smaller hospitals are needed. This study evaluated the effect of implementing a PACU bypass protocol on postoperative efficiency and patient safety. METHODS: We retrospectively analyzed patients who underwent elective urological surgery under spinal anesthesia between June 2022 and October 2024. The PACU bypass protocol, implemented in 2023, enables eligible patients to be transferred directly from the OR to the ward when predefined criteria, including stable vital signs, anesthetic level at or below T4, and absence of postoperative symptoms, are met. The primary outcome was the duration from surgical completion to discharge from the PACU. RESULTS: In total, 675 patients were included (214 in 2022, 225 in 2023, and 236 in 2024). The mean PACU stay will significantly decrease from 34 min in 2022 to 19 min in 2023 and 20 min in 2024 (p < 0.05). Two minor adverse events were reported in 2023, and none in 2024. CONCLUSIONS: Implementing the PACU bypass protocol significantly reduced the PACU stay without compromising patient safety, thereby enhancing perioperative efficiency. Continued protocol adherence and staff training are essential for sustained improvement. </p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"68"},"PeriodicalIF":1.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793862","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":"Capnogram plateau micro‑oscillations preceding end‑tidal CO₂ decline as an early cue to venous air embolism during supratentorial craniotomy: a case report.","authors":"Ayumu Matsumoto, Noriko Takeno, Michiyoshi Sanuki","doi":"10.1186/s40981-025-00841-5","DOIUrl":"10.1186/s40981-025-00841-5","url":null,"abstract":"<p><p>BACKGROUND: Venous air embolism (VAE) is a potentially fatal complication of craniotomy. When a TEE is not used, attention to waveform-level changes during conventional monitoring is crucial. CASE PRESENTATION: A woman in her 70 s underwent supratentorial tumor resection in the supine position with a slight head-up tilt. Approximately 1 h after the craniotomy, gradual decreases in SpO2 (98% → 96%), systolic blood pressure (105 → 90 mmHg), and EtCO2 (37 → 30 mmHg) were observed. New micro-oscillations appeared on the capnogram plateau, followed by an EtCO2 decrease to 22 mm Hg. VAE was suspected. Treatment, including field flooding, head-down positioning, as well as FiO2, dobutamine, and rapid fluid supplementation, stabilized her and allowed the uneventful completion of surgery. Arterial blood gas levels improved concurrently with EtCO2 recovery. CONCLUSIONS: Careful scrutiny of capnogram morphology, not only numeric EtCO2, can expedite the suspicion and timely management of VAE when advanced monitoring is unavailable. </p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"9"},"PeriodicalIF":1.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723335","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":"Perioperative anaphylaxis due to intravenous tranexamic acid following cutaneous exposure.","authors":"Yasuhiro Amano, Takahiro Tamura, Yuko Konishi, Yui Somura, Koichi Akiyama","doi":"10.1186/s40981-025-00840-6","DOIUrl":"10.1186/s40981-025-00840-6","url":null,"abstract":"<p><p>BACKGROUND: Tranexamic acid (TXA) is widely used to prevent surgical bleeding; further, it has been recently applied in cosmetic dermatology. TXA-induced anaphylaxis is very rare; however, most reported cases occur upon initial administration. CASE PRESENTATION: This case report describes a 41-year-old man with atopic dermatitis who developed TXA-induced anaphylaxis during induction of general anesthesia for spinal surgery. Intradermal testing using TXA yielded reproducible positive reactions, while other tested drugs yielded negative results. His medical history revealed repeated episodes of dermatitis 1 year prior after applying a topical skin-lightening cream containing TXA. This suggested that prior percutaneous exposure may have contributed to sensitization. CONCLUSIONS: Our findings suggest a possible relationship between prior topical exposure to TXA and perioperative anaphylaxis. Although TXA-induced anaphylaxis is extremely rare, the increasing use of TXA in both surgical and cosmetic contexts may increase opportunities for exposure. Therefore, clinicians should be aware of this potential risk. </p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"8"},"PeriodicalIF":1.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12799862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714340","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":"Bridging via extracorporeal cardiopulmonary resuscitation for hemodynamic collapse in a patient with metastatic lung cancer: a case report.","authors":"Takayuki Hasegawa, Shoe Kobiyama, Ryosuke Sasaki, Tatsusmi Yakushiji, Keisuke Yoshida, Takahiro Hakozaki, Satoki Inoue","doi":"10.1186/s40981-025-00839-z","DOIUrl":"10.1186/s40981-025-00839-z","url":null,"abstract":"<p><strong>Background: </strong>Due to the highly invasive nature of veno-arterial extracorporeal membrane oxygenation (VA-ECMO), advanced malignancy is considered a relative contraindication. We here report a patient with hemodynamic collapse secondary to metastatic lung cancer in whom bridging via VA-ECMO was successful.</p><p><strong>Case presentation: </strong>A 35-year-old man with metastatic non-small cell lung cancer harboring a deletion in exon 19 of epidermal growth factor receptor developed acute right ventricular failure and hemodynamic collapse due to pulmonary tumor thrombotic microangiopathy. Because treatment with the targeted agent osimertinib had already been initiated and a rapid response was anticipated, VA-ECMO was instituted as a bridge to its therapeutic effect. The patient's hemodynamics stabilized within 7 days, permitting VA-ECMO decannulation. At the time of writing, the patient is continuing to undergo regular outpatient follow-up.</p><p><strong>Conclusions: </strong>In carefully selected oncology patients with highly treatment-sensitive disease, short-term VA-ECMO may be an effective bridge to systemic therapy.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"7"},"PeriodicalIF":1.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677359","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 between a remimazolam-propofol combination for maintenance of anesthesia and extubation time: a propensity score analysis.","authors":"Takayuki Katsuragawa, Soichiro Mimuro, Hiroki Anezaki, Yuji Suzuki, Tsunehisa Sato, Yoshitaka Aoki, Masakazu Yamaguchi, Yoshiki Nakajima","doi":"10.1186/s40981-025-00836-2","DOIUrl":"10.1186/s40981-025-00836-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effect of combined administration of remimazolam and propofol on extubation time during anesthesia maintenance.</p><p><strong>Methods: </strong>This retrospective study was conducted at Hamamatsu University Hospital, enrolling adult patients who underwent non-cardiac surgery between September 2020 and October 2024. Eligible patients underwent invasive arterial pressure monitoring and anesthesia maintenance with remimazolam alone (RB group), propofol alone (PROP group), or a combination of both (RB + PROP group). Extubation time was defined as the interval between the cessation of sedative administration and tracheal extubation. Propensity score matching was performed after adjusting for age, sex, body mass index, American Society of Anesthesiologists Physical Status, preoperative comorbidities, type of surgery, combined with epidural anesthesia, scheduled or emergency surgery, operation time, and blood loss. The primary endpoint was the extubation time, while the secondary endpoints included the severity of hypotension, assessed by the time-weighted average area under the threshold, and the incidence of postoperative nausea and vomiting.</p><p><strong>Results: </strong>The study included 165, 403, and 178 patients in the RB, PROP, and RB + PROP groups, respectively. After propensity score matching, 75 matched cohorts were analyzed. Among the three groups, significant differences were found in terms of extubation time and hypotension (p < 0.001 and p = 0.04, respectively), whereas the incidence of postoperative nausea and vomiting did not significantly differ (p = 0.23). In multiple comparisons, the RB group (9.0 min) and the RB + PROP group (9.0 min) had significantly shorter extubation times than the PROP group (13.0 min) (each p < 0.001). Time-weighted average area under the threshold was significantly lower in the RB group (0.74 mmHg) than in the PROP group (2.03 mmHg) (p = 0.03).</p><p><strong>Conclusion: </strong>Extubation time with combined remimazolam and propofol was comparable to that with remimazolam alone, and both were shorter than that with propofol alone.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"5"},"PeriodicalIF":1.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668337","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":"Spinal anesthesia in a patient with hereditary dysfibrinogenemia who underwent emergency cesarean delivery: a case report.","authors":"Sae Ono, Yuki Hosokawa, Mizue Kamiyama, Eriko Ohsugi, Michiko Gotanda, Yuka Yamashita, Rie Kato","doi":"10.1186/s40981-025-00810-y","DOIUrl":"10.1186/s40981-025-00810-y","url":null,"abstract":"<p><strong>Background: </strong>Dysfibrinogenemia causes abnormal fibrinogen production, leading to thrombotic or bleeding complications, which are relative contraindications for neuraxial anesthesia. Neuraxial anesthesia is recommended for cesarean delivery to reduce maternal and neonatal morbidity.</p><p><strong>Case presentation: </strong>We report a 39-year-old gravida 2, para 0 woman with dysfibrinogenemia who safely underwent spinal anesthesia, as assessed using thromboelastography, for an urgent cesarean delivery.</p><p><strong>Conclusions: </strong>Thromboelastography can aid the anesthesia team in evaluating the risks versus benefits of neuraxial anesthesia in patients with hereditary dysfibrinogenemia.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"67"},"PeriodicalIF":1.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653984","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":"Early detection and management of mesenteric traction syndrome using the hypotension prediction index: a case report.","authors":"Rui Yajima, Takayuki Sugai, Kei Inoue, Takashi Ouchi, Toshiya Koitabashi","doi":"10.1186/s40981-025-00838-0","DOIUrl":"10.1186/s40981-025-00838-0","url":null,"abstract":"<p><p>Mesenteric traction syndrome (MTS) is a transient circulatory disturbance characterized by sudden hypotension, tachycardia, and facial flushing following mesenteric manipulation during abdominal surgery. Early recognition is essential; however, conventional monitoring often detects these events only after hemodynamic deterioration. We report a 68-year-old man who underwent distal pancreatectomy and splenectomy under combined general and thoracic epidural anesthesia. Sixteen minutes after the start of surgery, the hypotension prediction index (HPI)-an artificial intelligence-based monitoring system-abruptly increased to > 85 despite stable vital signs. The systemic vascular resistance index decreased, suggesting early vasodilatory change. Prompt intravenous phenylephrine boluses were administered, and rapid colloid infusions were initiated to minimize hypotension. Recognition of facial flushing subsequently confirmed the diagnosis of MTS, and intravenous flurbiprofen stabilized the circulation. This case suggests that HPI monitoring may assist in the early identification of vasodilatory changes associated with MTS and support timely intervention before severe hypotension develops.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"3"},"PeriodicalIF":1.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12775253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653987","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":"Efficacy of 10% lidocaine gel for injection site pain associated with treprostinil in the treatment of pulmonary hypertension: a report of four cases.","authors":"Shuji Kawamoto, Mariko Miyao, Kotaro Sakurai, Karin Kato, Makiko Ikeura, Akiko Hirotsu, Hideyuki Kinoshita, Moritoki Egi","doi":"10.1186/s40981-025-00834-4","DOIUrl":"10.1186/s40981-025-00834-4","url":null,"abstract":"<p><p>BACKGROUND: Treprostinil, a prostacyclin analogue, is an effective treatment for pulmonary arterial hypertension (PAH). However, continuous subcutaneous infusion is often complicated by severe injection site pain, which can limit continuation of therapy. CASE PRESENTATION: We report four PAH patients who developed severe injection site pain during subcutaneous treprostinil therapy in the lower abdomen. A hospital-compounded 10% lidocaine gel was applied around the infusion site. Pain was markedly reduced in all cases, with visual analog scale scores improving from 75 to 100/100 to 0–20/100. In two patients, tramadol could be reduced or discontinued, and all patients were able to continue treprostinil therapy without pain-related limitation or treatment interruption. No systemic adverse effects were observed, although one patient experienced mild local skin irritation. CONCLUSIONS: Topical 10% lidocaine gel provided rapid and effective relief of injection site pain associated with subcutaneous treprostinil, facilitating continuation of therapy without pain-related interruption in patients with PAH. </p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":" ","pages":"2"},"PeriodicalIF":1.2,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12770123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633641","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}