{"title":"Vulnerability to bending and occlusion of distal lumen of the 17G triple-lumen central venous catheter","authors":"Tomohiro Yamamoto","doi":"10.1186/s40981-024-00691-7","DOIUrl":"https://doi.org/10.1186/s40981-024-00691-7","url":null,"abstract":"<p>To the Editor</p><p>The risk of central venous catheter (CVC)-related venous thrombosis [1, 2] should always be kept in mind. It is a critical issue, particularly in pediatric patients with congenital heart diseases, because of the possible impact on subsequent surgical treatment. The risk of CVC-related venous thrombosis is reportedly greater when CVC is larger than one-third the diameter of the target vein [3]. Cardinal Health™ has recently developed a 17-gauge (G) triple-lumen CVC (ARGYLE™ Fukuroi SMAC<sup>TM</sup> Plus), of which the cross-sectional area of lumens and flow rate are comparable to those of a 15G triple-lumen CVC (Fig. 1).</p><figure><figcaption><b data-test=\"figure-caption-text\">Fig. 1</b></figcaption><picture><source srcset=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00691-7/MediaObjects/40981_2024_691_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"380\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00691-7/MediaObjects/40981_2024_691_Fig1_HTML.png\" width=\"685\"/></picture><p>Cross-section of central venous catheters (CVCs). Cross section of the 17-gauge (G) double-lumen (left), 17G triple-lumen (center), and 15G triple-lumen (right) CVCs (ARGYLE™ Fukuroi SMAC™ Plus, Cardinal Health™), side by side with ruler scale for size comparison. Note the semicircular-shaped distal (largest) lumen of the 17G triple-lumen CVC (center) in contrast with the circular-shaped distal lumens of the 17G double-lumen (left) and of the 15G triple-lumen (right) CVCs. The outer diameters of the 17G double-lumen (left), 17G triple-lumen (center), and 15G double-lumen CVC (right) are 1.35 mm, 1.45 mm, and 1.70 mm, respectively</p><span>Full size image</span><svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-chevron-right-small\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></figure><p>The distal lumen is generally thought to be the least susceptible to catheter bending and the least vulnerable to occlusion because it has the largest lumen and is located in the middle of the catheter. However, uncommonly, we have encountered several cases in our hospital wherein the pressure alarm sounded on the syringe pump connected to the distal lumen or no blood backflow was obtained from the distal lumen of the 17G triple-lumen CVC, whereas the other two smaller lumens had no problems. We found that the CVCs were bent at the site just distal to the junction hub (Fig. 2), which was common in all catheter obstruction cases. However, 17G double-lumen CVCs had been used in our hospital without similar problems. The cross-sectional structure of the CVCs is shown in Fig. 1, where the lumens of the 17G triple-lumen CVC have a semicircular or fan-shaped structure. Additionally, the distal lumen, which has a semicircular structure, is the most vulnerable to bending, while","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In-reply to the comment by Poling et al","authors":"Kyosuke Takahashi, Kotaro Sakurai, Izumi Hamaya","doi":"10.1186/s40981-023-00681-1","DOIUrl":"https://doi.org/10.1186/s40981-023-00681-1","url":null,"abstract":"<p>To the editor</p><p>We thank Poling et al. for their interest in our report [1]. They raised the importance of a new disease concept and optimal management according to the diagnosis.</p><p>As they pointed out, the diagnosis of Freeman-Sheldon syndrome (FSS) (What they call Freeman-Burian syndrome [FBS]) is difficult due to similar physical characteristics between FSS/FBS and Sheldon-Hall syndrome. We think our case was not typical of FSS/FBS. Although she had multiple arthrogryposes and prominent nasolabial folds, microstomia was not severe, midface hypoplasia was mild, and tracheal intubation was easy during anesthesia. However, this does not exclude the diagnosis of FSS/FBS.</p><p>The association between distal arthrogryposis and malignant hyperthermia remains uncertain. An observational study that investigated 73 individuals referred with the diagnosis of FSS revealed that 3 out of 10 patients developed malignant hyperthermia when they had surgery [2]. On the other hand, a study reported no association between malignant hyperthermia and distal arthrogryposis [3]. Considering the mixed findings of past studies, it is still safe to avoid inhalation anesthetics because we have many alternative options without them. Hence, our strategy using propofol, opioids, and dexmedetomidine was a reasonable choice for the patient who underwent cardiac surgery. Further studies with large sample sizes are needed to determine the association between malignant hyperthermia and this syndrome. Until this question is resolved, providing malignant-hyperthermia-safe anesthesia for patients with FSS/FBS is warranted.</p><p>Not applicable.</p><dl><dt style=\"min-width:50px;\"><dfn>FBS:</dfn></dt><dd>\u0000<p>Freeman Burian Syndrome</p>\u0000</dd><dt style=\"min-width:50px;\"><dfn>FSS:</dfn></dt><dd>\u0000<p>Freeman Sheldon Syndrome</p>\u0000</dd></dl><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Takahashi K, Sakurai K, Hamaya I. Anesthetic management of a pediatric patient with Freeman-Sheldon syndrome undergoing atrial septal defect closure: a case report. JA Clin Reports Springer, Berlin Heidelberg. 2023;9:9–12. https://doi.org/10.1186/s40981-023-00633-9.</p><p>Article Google Scholar </p></li><li data-counter=\"2.\"><p>Stevenson DA, Carey JC, Palumbos J, Rutherford A, Dolcourt J, Bamshad MJ. Clinical characteristics and natural history of Freeman-Sheldon syndrome. Pediatrics. 2006;117:754–62.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"3.\"><p>Gleich SJ, Tien M, Schroeder DR, Hanson AC, Flick R, Nemergut ME. Anesthetic Outcomes of Children with Arthrogryposis Syndromes: No Evidence of Hyperthermia. Anesth Analg. 2017;124:908–14.</p><p>Article PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>Not applicable.</p><p>Not applicable.</p><h3>Authors and Affiliatio","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Remimazolam in perioperative management of Eisenmenger syndrome: a case report","authors":"Kazuya Hashimoto, Tsuguhiro Matsumoto, Toshiyuki Mizota, Shinichi Kai, Moritoki Egi","doi":"10.1186/s40981-024-00692-6","DOIUrl":"https://doi.org/10.1186/s40981-024-00692-6","url":null,"abstract":"Eisenmenger syndrome (ES) is characterized by severe and irreversible pulmonary hypertension stemming from an uncorrected intracardiac shunt of significant size. The imbalance between systemic and pulmonary artery pressures predisposes patients with ES to the risk of cardiac arrest. Remimazolam has caused less circulatory depression, which may be advantageous for ES. However, no studies reported the use of remimazolam in perioperative ES management. A 45-year-old female patient with ES derived from a ventricular septal defect was scheduled to undergo bilateral adnexectomy for an ovarian tumor. Her oxygen saturation was 80% with 3 L/min oxygen at rest, and her pulmonary and systemic flow ratio was 0.53. She underwent general anesthesia with remimazolam, and intraoperative hemodynamics was stable without hypotension or reduced oxygen saturation. Our successful management of ovarian tumor surgery in a patient with ES using remimazolam reveals its potential effectiveness in perioperative care.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Andexanet alpha-induced heparin resistance treated by nafamostat mesylate in a patient undergoing total aortic arch repair for Stanford type A acute aortic dissection: a case report.","authors":"Yasuhito Suzuki, Mutsuhito Kikura, Shingo Kawashima, Tetsuro Kimura, Yoshiki Nakajima","doi":"10.1186/s40981-024-00690-8","DOIUrl":"10.1186/s40981-024-00690-8","url":null,"abstract":"<p><strong>Background: </strong>Andexanet alfa, an anti-Xa inhibitor antagonist, induces heparin resistance. Here, we report a case of successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesylate.</p><p><strong>Case presentation: </strong>An 84-year-old female, with Stanford type A acute aortic dissection, underwent an emergency surgery for total aortic arch replacement. Andexanet alfa 400 mg was administered preoperatively to antagonize edoxaban, an oral Xa inhibitor. Heparin 300 IU/kg was administered before cardiopulmonary bypass, and the activated clotting time (ACT) was 291 s. The ACT was 361 s after another administration of heparin 200 IU/kg. According to our routine therapy for heparin resistance, an initial dose of nafamostat mesylate 10 mg was administered intravenously, followed by a continuous infusion of 20-30 mg/h. The ACT was prolonged to 500 s, and cardiopulmonary bypass was successfully established thereafter.</p><p><strong>Conclusions: </strong>This case report presents the successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesilate. This report presents the successful management of cardiopulmonary bypass with andexanet alfa-induced heparin resistance using nafamostat mesilate.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570289","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 intraoperative blood salvage and coagulation disorder after cardiopulmonary bypass.","authors":"Masahiro Morinaga, Kenji Yoshitani, Soshiro Ogata, Satsuki Fukushima, Hitoshi Matsuda","doi":"10.1186/s40981-024-00689-1","DOIUrl":"10.1186/s40981-024-00689-1","url":null,"abstract":"<p><strong>Background: </strong>This study investigated whether intraoperative blood salvage was associated with coagulation disorder diagnosed by conventional coagulation tests and thromboelastography (TEG) after cardiopulmonary bypass (CPB).</p><p><strong>Study design and methods: </strong>This was a prospective, observational study. Ninety-two patients who underwent cardiovascular surgery with CPB were enrolled. We evaluated coagulation function in patients with or without cell salvage blood transfusion at the following time points: before CPB, just after protamine administration, and 1 h after protamine administration. We evaluated platelet count, fibrinogen concentration, and TEG parameters. Patients were considered to have coagulation disorder if one or more of the following criteria were present: (1) residual heparin, (2) low platelet count, (3) low fibrinogen level, (4) low clotting factor level, and (5) hyperfibrinolysis.</p><p><strong>Results: </strong>Fifty-three of 92 patients (57.6%) received intraoperative cell salvage. Coagulation disorder was observed in 56 of 92 patients (60.9%) after CPB. There was no significant difference between patients with or without intraoperative blood salvage in terms of the incidence of coagulation disorder (p = 0.542) or the total volume of blood from the drain after CPB (p = 0.437). Intraoperative blood salvage was not associated with coagulation disorder diagnosed by either TEG or conventional coagulation tests (odds ratio 1.329, 95% confidence interval: 0.549-3.213, p = 0.547). There were no significant interactions between patients with or without intraoperative blood salvage regarding coagulation parameters derived from TEG.</p><p><strong>Conclusions: </strong>The incidence of coagulation disorder and the total blood volume from the drain after CPB did not differ significantly between patients with or without intraoperative blood salvage.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10810763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546187","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":"Comment on: anesthetic management of a pediatric patient with Freeman-Sheldon syndrome undergoing atrial septal defect closure: a case report.","authors":"Mikaela I Poling, Craig R Dufresne","doi":"10.1186/s40981-023-00668-y","DOIUrl":"10.1186/s40981-023-00668-y","url":null,"abstract":"","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519137","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 preoperative frailty and surgical Apgar score in abdominal cancer surgery: a secondary analysis of a prospective observational study","authors":"Sayaka Hirai, Mitsuru Ida, Yuki Kinugasa, Masahiko Kawaguchi","doi":"10.1186/s40981-024-00687-3","DOIUrl":"https://doi.org/10.1186/s40981-024-00687-3","url":null,"abstract":"The surgical Apgar score is useful for predicting postoperative morbidity and mortality. However, its applicability in frail patients with minimal hemodynamic variation remains unknown. This study aimed to investigate the association between frailty and surgical Apgar score. This secondary analysis included 210 patients ≥ 65 years of age undergoing elective major abdominal surgery for cancer. Frailty was assessed using the Fried Frailty Phenotype Questionnaire and defined as a total score of ≥ 3. The surgical Apgar score (range, 0−10; including mean blood pressure, heart rate, and blood loss volume) was compared between patients with or without frailty using the Mann–Whitney U test. Postoperative severe complications and length of postoperative stay were compared between patients with surgical Apgar scores ≤ 7 and > 7. Among the included patients, 45 were classified as frail. The median [1st quartile, 3rd quartile] surgical Apgar scores in patients with and without frailty were 7.0 [7.0, 8.0] and 8.0 [7.0, 8.0], respectively (P = 0.03). Patients with surgical Apgar score ≤7 had a higher incidence of serious postoperative complications (P = 0.03) and longer hospital stays (P < 0.001) compared with patients with surgical Apgar score >7. Frail patients have lower SAS, and patients with lower SAS have higher postoperative complication rates and longer hospital stays in patients who underwent cancer surgery.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fragile lip in a patient with macroglossia due to hemodialysis-associated amyloidosis.","authors":"Tohru Shiratori, Masahiro Nishimura, Yusuke Horitani","doi":"10.1186/s40981-024-00686-4","DOIUrl":"10.1186/s40981-024-00686-4","url":null,"abstract":"","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10781912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402881","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}
Tamayo Takahashi, Kana Oue, Eiji Imado, Mitsuru Doi, Yoshitaka Shimizu, Mitsuhiro Yoshida
{"title":"Severe perioperative lactic acidosis in a pediatric patient with glycogen storage disease type Ia: a case report.","authors":"Tamayo Takahashi, Kana Oue, Eiji Imado, Mitsuru Doi, Yoshitaka Shimizu, Mitsuhiro Yoshida","doi":"10.1186/s40981-023-00683-z","DOIUrl":"10.1186/s40981-023-00683-z","url":null,"abstract":"<p><strong>Background: </strong>Glycogen storage disease (GSD) is a group of rare inherited metabolic disorders caused by enzyme deficiencies in glycogen catabolism. GSD type Ia is a congenital deficiency of the enzyme responsible for the final step in glucose production by glycolysis, resulting in impaired carbohydrate metabolism.</p><p><strong>Case presentation: </strong>A 14-year-old boy with GSD type Ia was scheduled for a maxillary cystectomy under general anesthesia. He was taking oral sugars such as uncooked cornstarch regularly to prevent hypoglycemia. Perioperatively, glucose was administered via the peripheral vein for fasting; however, severe lactic acidosis occurred. He also developed hypercapnia because of intraoperative poor ventilation caused by hepatomegaly.</p><p><strong>Conclusions: </strong>We experienced a child with GSD type Ia who developed severe lactic acidosis despite continuous glucose infusion. Further studies are required to determine appropriate perioperative management for patients with GSD, including fasting glucose administration.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10730783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800033","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}