{"title":"Intraoperative vascular anastomosis occlusion due to cold agglutinin disease during brain surgery: a case report.","authors":"Kazuma Kitamura, Mayumi Nakanishi, Naokazu Fukuoka, Kumiko Tanabe, Yoshinori Kamiya","doi":"10.1186/s40981-025-00766-z","DOIUrl":"https://doi.org/10.1186/s40981-025-00766-z","url":null,"abstract":"<p><strong>Background: </strong>Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia that induces blood coagulation and hemolysis upon exposure to cold temperatures. Strict temperature control is essential to mitigate these effects, especially during surgical procedures where hypothermia is possible.</p><p><strong>Case presentation: </strong>A 57-year-old male, 165 cm and 72 kg, diagnosed with CAD, underwent cerebral vascular anastomosis. Intraoperatively, mean arterial pressure was maintained at or above 65 mmHg with phenylephrine administration, while body temperature was rigorously controlled between 36.5 °C and 37.5 °C using forced-air warming blankets and heated intravenous infusions. Despite these measures, thrombotic occlusion occurred, necessitating surgical thrombus removal, intravenous heparin administration, and irrigation of the surgical field with warmed saline followed by re-anastomosis. The anastomosis remained patent without recurrence of thrombus formation thereafter.</p><p><strong>Conclusion: </strong>Preventing hypothermia is extremely important in the anesthesia management of CAD patients. However, careful attention must also be paid to temperature regulation in the surgical field.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"2"},"PeriodicalIF":0.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005560","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 combination of low-temperature radiofrequency thermocoagulation and pulsed radiofrequency of the bilateral Gasserian ganglion for bilateral trigeminal neuralgia due to multiple sclerosis: a case report.","authors":"Mihoko Tamura, Masayuki Nakagawa, Yoichiro Abe","doi":"10.1186/s40981-025-00764-1","DOIUrl":"10.1186/s40981-025-00764-1","url":null,"abstract":"<p><strong>Background: </strong>Bilateral trigeminal neuralgia secondary to multiple sclerosis is an extremely rare condition. When Gasserian ganglion block is performed, it is necessary to achieve reliable long-term analgesic effects while avoiding treatment-related complications.</p><p><strong>Case presentation: </strong>A 49-year-old male with multiple sclerosis exhibited persistent dull pain and paroxysmal electric shock-like pain in his bilateral maxillary molars and mandible. He was diagnosed with trigeminal neuralgia due to multiple sclerosis. Due to severe side effects, it was difficult to achieve adequate pain control with medication alone. By performing low-temperature radiofrequency thermocoagulation and pulsed radiofrequency of the Gasserian ganglion while monitoring masseter muscle contraction, a satisfactory and rapid analgesic effect was obtained without masticatory atonia.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the first case of bilateral trigeminal neuralgia due to multiple sclerosis in which low-temperature radiofrequency thermocoagulation combined with pulsed radiofrequency was successfully performed for pain relief without masticatory atonia.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970870","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":"Potential role of electroencephalographic monitoring for diagnosis and treatment of local anesthetic systemic toxicity during general anesthesia: a case report.","authors":"Ryo Wakabayashi, Seiichi Azuma, Saori Hayashi, Yuji Ueda, Masaki Iwakiri, Masaaki Asamoto, Kanji Uchida","doi":"10.1186/s40981-024-00763-8","DOIUrl":"10.1186/s40981-024-00763-8","url":null,"abstract":"<p><strong>Background: </strong>Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication. Under general anesthesia, neurological signs are often masked, delaying diagnosis and increasing the risk of sudden cardiovascular collapse. Therefore, early detection methods are critically needed.</p><p><strong>Case presentation: </strong>A 48-year-old male patient (height: 182 cm, weight: 98 kg) underwent resection of a mediastinal goiter. He received 10 mL of 4% lidocaine for topical airway anesthesia and 20 mL of 1% lidocaine with 1:100,000 epinephrine for chest wall anesthesia. Thirty minutes after airway anesthesia, continuous theta waves appeared on the frontal electroencephalogram (EEG), which were enhanced following chest wall anesthesia. These waves transitioned into a repeating pattern and evolved into sharp periodic discharges. After administering 150 mL of 20% lipid emulsion, the EEG normalized.</p><p><strong>Conclusions: </strong>This case highlights that EEG monitoring during general anesthesia may facilitate the early detection of LAST and provide real-time feedback on treatment efficacy.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"80"},"PeriodicalIF":0.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894296","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 using desflurane and nitrous oxide in a child with non-ketotic hyperglycinemia: a case report.","authors":"Akifumi Mashima, Kenta Furutani, Hiroshi Baba","doi":"10.1186/s40981-024-00762-9","DOIUrl":"10.1186/s40981-024-00762-9","url":null,"abstract":"<p><strong>Background: </strong>Non-ketotic hyperglycinemia (NKH) is a rare autosomal recessive disorder caused by defects in the glycine cleavage system, leading to elevated glycine levels in the central nervous system. NKH manifests in various forms, with the neonatal type being the most severe and often associated with high mortality and significant neurological impairment. This case report highlights the successful uses of desflurane and nitrous oxide for anesthetic management in a patient with NKH.</p><p><strong>Case presentation: </strong>A 6-year-old girl with severe NKH, who had a history of delayed emergence from sevoflurane anesthesia, underwent tracheostomy for recurrent upper airway obstruction and severe obstructive sleep apnea. To address the previous issues with sevoflurane, general anesthesia was induced with propofol and fentanyl and maintained with 4% desflurane and 60% nitrous oxide. The electroencephalogram (EEG) showed near-complete suppression upon induction, which gradually resolved. Following cessation of desflurane and nitrous oxide, the patient exhibited early recovery, with eyes opening 3 min later and spontaneous breathing restored 19 min later. The patient experienced no postoperative complications and was discharged on the 14th postoperative day.</p><p><strong>Conclusion: </strong>This case suggests that desflurane, with its favorable pharmacological profile, may offer a superior alternative to sevoflurane for anesthetic management in NKH patients, particularly those with a history of delayed emergence. The observed EEG suppression may indicate heightened sensitivity to anesthetics in NKH, highlighting the need for tailored anesthetic strategies in this population.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"79"},"PeriodicalIF":0.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893979","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}
Mizuho Matsushita, Yoshikazu Yamaguchi, Honoka Yamashita, Chiyori Yamauchi, Hajime Hayami, Joseph D Tobias, Gaku Inagawa
{"title":"Non-invasive removal of a misplaced and knotted guidewire during ultrasound-guided central venous catheter insertion in a hybrid operating room: a case report.","authors":"Mizuho Matsushita, Yoshikazu Yamaguchi, Honoka Yamashita, Chiyori Yamauchi, Hajime Hayami, Joseph D Tobias, Gaku Inagawa","doi":"10.1186/s40981-024-00761-w","DOIUrl":"10.1186/s40981-024-00761-w","url":null,"abstract":"<p><strong>Background: </strong>The standard of care for placement of a central venous catheter (CVC) includes a real-time ultrasound (US)-guided technique. We describe a rare case in which the guidewire penetrated the posterior wall of the vessel, forming a knot, which precluded simple removal. This occurred despite the procedure being performed under real-time US guidance. The guidewire was eventually removed under fluoroscopic guidance in a hybrid operation room.</p><p><strong>Case presentation: </strong>An 89-year-old male underwent the placement of a CVC in the left internal jugular vein. During the US-guided procedure, the guidewire penetrated the posterior wall of the vessel and formed a knot, which impeded simple removal. This was confirmed by radiologic imaging. Using a short sheath and a push-pull technique, the radiologist was able to untangle the knot to allow for catheter removal. The guidewire was safely removed without vascular injury.</p><p><strong>Conclusions: </strong>A very rare complication of guidewire knotting was observed despite the use of US-guidance during needle and wire placement. The use of US, computed tomography, and fluoroscopy were beneficial for diagnosis, while the hybrid operating room provided the optimal environment for the removal procedure.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"78"},"PeriodicalIF":0.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872017","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":"Hypermagnesemia caused by fecal-mass obstruction in stenotic rectal cancer following preoperative administration of magnesium citrate.","authors":"Yuri Sato, Eiji Hashiba, Yuuma Yamazaki, Koudai Kato, Hirotaka Kinoshita, Satoko Noguchi, Tomoyuki Kudo, Kazuyoshi Hirota","doi":"10.1186/s40981-024-00759-4","DOIUrl":"10.1186/s40981-024-00759-4","url":null,"abstract":"<p><strong>Background: </strong>Hypermagnesemia is a rare complication, leading to fatal cardiovascular and respiratory conditions. We present severe hypermagnesemia developed in a patient with a rectal stenosis after pretreatment with oral magnesium citrate for rectosigmoid surgery.</p><p><strong>Case presentation: </strong>A 78-year-old woman demonstrated consciousness disturbance, muscle weakness, and respiratory depression requiring tracheal intubation after preparation with oral magnesium for rectosigmoid surgery. Endoscopic examination showed a rectal obstruction due to fecal impaction. General condition improved after emergency Hartmann's surgery. Blood test revealed a remarkable increase of serum magnesium level to 17.5 mg/dL when the general condition deteriorated, which would have been responsible for her symptoms. She was discharged from the ICU after extubation on the third postoperative day with a normal magnesium level.</p><p><strong>Conclusions: </strong>Pretreatment with large doses of oral magnesium-containing bowel cleanser may cause severe hypermagnesemia in patients with colorectal stenosis.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"77"},"PeriodicalIF":0.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864100","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":"Successful analgesic treatment with continuous sacral epidural ethanol injection therapy for anal pain caused by multiple metastases of malignant pheochromocytoma.","authors":"Takehito Sato, Shigeru Inoue, Ichiko Asano, Takahiro Ando, Yasuyuki Shibata","doi":"10.1186/s40981-024-00760-x","DOIUrl":"10.1186/s40981-024-00760-x","url":null,"abstract":"<p><strong>Background: </strong>Anal and perineum pain caused by malignant tumor invasion is often difficult to control with opioids. Continuous sacral epidural ethanol injection therapy is less likely to cause bladder and rectal disturbances, making it a suitable treatment option for patients with preserved voiding function.</p><p><strong>Case presentation: </strong>A 45-year-old woman with multiple metastases of malignant pheochromocytoma suffered severe anal pain that worsened, especially when sitting, and was unresponsive to opioid rescue therapy. With her NRS score of 9, a sacral epidural catheter was placed, and a continuous infusion of 2% lidocaine was administered overnight. This is followed by a 1.5mL bolus of ethanol and continuous ethanol administration at 2 mL/h. After administration, her anal pain decreased to approximately NRS 0-1, and she was subsequently discharged.</p><p><strong>Conclusion: </strong>We report successful pain control using continuous sacral epidural ethanol injection therapy in a patient with anal pain due to malignant pheochromocytoma metastasis.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"75"},"PeriodicalIF":0.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846588","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":"Analysis of factors related to anesthetic management affecting acute kidney injury occurring within 72 h after esophagectomy for esophageal cancer: a historical cohort study.","authors":"Seiji Ishikawa, Junko Hirashima, Makiko Hiroyama, Shojiro Ozato, Masayuki Watanabe, Katsuyuki Terajima","doi":"10.1186/s40981-024-00756-7","DOIUrl":"10.1186/s40981-024-00756-7","url":null,"abstract":"<p><strong>Background: </strong>The effects of factors related to anesthetic management, including anesthesia methods and infusion volume, on acute kidney injury (AKI) after esophagectomy have not been thoroughly investigated.</p><p><strong>Methods: </strong>A historical cohort study of patients who underwent esophagectomy between January 2008 and December 2022 was conducted. AKI was defined according to the Kidney Disease Improving Global Outcomes creatinine criteria within 72 h after esophagectomy. Logistic regression was used to model the association between perioperative factors, including factors related to anesthetic management, and postoperative AKI.</p><p><strong>Results: </strong>Of 1005 patients, 48 patients (4.8%) had AKI (40 stage 1 and 8 stage 2). AKI patients were older (67.8 vs. 65.0 years, P = 0.046) and more likely to have hypertension (72.9 vs. 37.9%, P < 0.001), chronic kidney disease (39.6 vs. 14.3%, P < 0.0001), red blood cell (RBC) transfusions (12.5 vs. 3.4%, P = 0.0085), and longer duration of anesthesia (518 vs. 490 min, P = 0.0058) than non-AKI patients. AKI patients were less likely to have epidural anesthesia (72.9 vs. 91.5%, P < 0.001). The distribution of inhaled anesthetics chosen was not significantly different between AKI and non-AKI patients. On multivariable logistic regression analysis, AKI was associated with the Brinkman index (per 100 units, odds ratio (OR) = 1.06), hypertension (OR = 3.39), chronic kidney disease (OR = 2.58), duration of anesthesia (per 10 min, OR = 1.03), epidural anesthesia (OR = 0.35) and RBC transfusion (OR = 3.27).</p><p><strong>Conclusions: </strong>Except for epidural anesthesia, no significant association was found between AKI and factors related to anesthetic management. Epidural anesthesia may protect against early postoperative AKI in patients undergoing esophagectomy.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"74"},"PeriodicalIF":0.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739500","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":"Effective use of a supraglottic airway (i-gel™) during emergence from anesthesia in a patient with multiple giant bullae.","authors":"Hayato Arime, Takashi Asai, Asuka Fujishiro, Tomoyuki Saito","doi":"10.1186/s40981-024-00757-6","DOIUrl":"10.1186/s40981-024-00757-6","url":null,"abstract":"<p><strong>Background: </strong>Anesthetic management of a patient with multiple giant bullae is generally difficult due to an increased risk of respiratory complications, and there is no consensus regarding safe extubation methods. We report a case of an effective use of a supraglottic airway (i-gel™) during emergence from anesthesia in a patient with multiple giant bullae, in whom a double-lumen bronchial tube was being used during anesthesia.</p><p><strong>Case presentation: </strong>A 52-year-old man with multiple giant bullae underwent video-assisted pulmonary resections, while the ventilation was controlled via a double-lumen bronchial tube. After successful thoracoscopic surgery, an i-gel™ was inserted while the double-lumen tube was still in place, and the double-lumen tube was subsequently removed under deep anesthesia. The i-gel™ was removed without complications after the patient had become able to respond to verbal command.</p><p><strong>Conclusion: </strong>We believe that this method would minimize the risk of trauma to the respiratory system during emergence from anesthesia in patients with multiple giant bullae.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"73"},"PeriodicalIF":0.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739502","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}