JA Clinical Reports最新文献

{"title":"Remimazolam-based total intravenous anesthesia in a patient with a confirmed diagnosis of malignant hyperthermia: a case report","authors":"Hiroshi Kondo, Keiko Mukaida, Kurumi Sasai, Yukiko Nao, Ken Hashimoto, Hirotsugu Miyoshi, Rieko Kanzaki, Yasuo M. Tsutsumi","doi":"10.1186/s40981-024-00710-7","DOIUrl":"https://doi.org/10.1186/s40981-024-00710-7","url":null,"abstract":"Malignant hyperthermia (MH) is a rare, life-threatening disorder of calcium homeostasis in skeletal muscle cells that is triggered by volatile anesthetics and succinylcholine, leading to a hypermetabolic reaction. The pathogenic ryanodine receptor 1 (RYR1) gene variant is critical. Patients susceptible to MH should avoid triggering agents, and total intravenous anesthesia (TIVA) is preferred. Remimazolam is safe in patients with suspected MH. We present the first case of remimazolam treatment in a genetically confirmed patient with MH without MH development. A 72-year-old man with a family history of MH underwent remimazolam-based TIVA. After informed consent was obtained, a muscle biopsy and genetic testing were performed. Intraoperatively and postoperatively, the patient exhibited no signs of MH. An enhanced function of the RYR1 channel into releasing calcium was indicated, and the genetic testing revealed a pathogenic variant of RYR1. Remimazolam-based TIVA is safe in patients confirming the diagnosis of MH.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"139 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636356","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":"Anesthetic management in pregnant women with Fontan circulation: a case series","authors":"Ai Fujita, Kazuhiro Shirozu, Midoriko Higashi, Ken Yamaura","doi":"10.1186/s40981-024-00706-3","DOIUrl":"https://doi.org/10.1186/s40981-024-00706-3","url":null,"abstract":"Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation. The mean age at delivery was 28 ± 3 years, and the mean gestational period was 34 weeks and 3 days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C/S) in one, emergency C/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively. For C/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C/S with regional anesthesia at the appropriate time in four patients.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"140 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140630037","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":"Anesthesia management of laparoscopic right colectomy in an older patient with postoperative tetralogy of Fallot with residual anomaly","authors":"Satori Mori, Hisakatsu Ito, Sadamu Sugimoto, Daisuke Hibi, Akiyo Kameyama, Masaaki Kawakami, Tomonori Takazawa","doi":"10.1186/s40981-024-00707-2","DOIUrl":"https://doi.org/10.1186/s40981-024-00707-2","url":null,"abstract":"Diversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited. A 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis. Laparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"20 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576091","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":"Unilateral abnormality of initial motor-evoked potential in the upper limb detected during lumbar spine surgery: a case report","authors":"Sirima Phoowanakulchai, Hironobu Hayashi, Ayako Oi, Yasuhiro Takeshima, Tsunenori Takatani, Masahiko Kawaguchi","doi":"10.1186/s40981-024-00708-1","DOIUrl":"https://doi.org/10.1186/s40981-024-00708-1","url":null,"abstract":"We present a case with abnormal findings of initial motor-evoked potential (MEP) in the left upper limb after prone positioning during lumbar spine surgery. A 71-year-old man with bilateral lower extremity numbness without a history of preexisting motor weakness underwent L3–5 spinal fenestration. Initial MEP monitoring after prone positioning revealed markedly prolonged latency and lower amplitude in the left abductor pollicis brevis (APB). Because the left upper limb somatosensory-evoked potentials had normal values, a position-related impending peripheral nerve injury located between the neck and the forearm was excluded. Postoperative examination revealed that MEP abnormality in the left APB was caused by carpal tunnel syndrome. Abnormal initial MEP from the upper limb was unexpectedly detected after prone positioning during lumbar spine surgery. The condition was caused by preexisting carpal tunnel syndrome.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"123 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576158","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":"Anterolateral papillary muscle suction causing low flow in a COVID-19 patient without medical history: a case report of central extracorporeal life support with left ventricular apex decompression","authors":"Tomoaki Miyake, Kimito Minami, Masahiro Kazawa, Naoki Tadokoro, Kohei Tonai, Satsuki Fukushima","doi":"10.1186/s40981-024-00701-8","DOIUrl":"https://doi.org/10.1186/s40981-024-00701-8","url":null,"abstract":"Left ventricular (LV) decompression is an essential strategy for improving early survival in patients with refractory cardiogenic shock. Low pump flow in patients on extracorporeal life support (ECLS) with LV apex decompression is a life-threatening issue. However, identifying the underlying causes of low flow can be challenging. A 38-year-old woman with COVID-19-related fulminant myocarditis was treated with central ECLS with LV apex decompression. The pump flow in the intensive care unit (ICU) was intermittently low, and low flow alerts were frequent. The initial evaluation based on pressure monitor waveforms and transthoracic echocardiography failed to identify the underlying cause. Prompt bedside transesophageal echocardiography (TEE) revealed that the anterolateral papillary muscle was suctioned into the vent cannula of the LV apex during systole. The patient underwent a repeat sternal midline incision in the operating room, and the cannula at the LV apex was repositioned. There were no further suction events after the repositioning, and the patient was weaned from ECLS 12 days after admission to the ICU. The patient was discharged in a stable condition and without neurological deficits. TEE is an important diagnostic tool to identify the underlying cause of low flow flow in patients undergoing ECLS with LV apex decompression.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"71 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576090","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":"Anesthesia experience in an adult Silver-Russell syndrome: a case report","authors":"Akinobu Hibino, Ayaka Hibino, Yoshinori Kamiya","doi":"10.1186/s40981-024-00704-5","DOIUrl":"https://doi.org/10.1186/s40981-024-00704-5","url":null,"abstract":"There are no reports of anesthesia use in adult patients with Silver-Russell syndrome (SRS). Here, we report our experience with anesthesia in an adult patient with SRS complicated by chronic respiratory failure. A 33-year-old woman was clinically diagnosed with SRS. She had severe chronic respiratory failure, complicated by superior mesenteric artery syndrome. Percutaneous gastrostomy was scheduled for nutritional management under epidural anesthesia; however, soon after esophagogastroduodenoscopy was started, she lost consciousness and spontaneous respiration. The patient was urgently intubated and converted to general anesthesia. The end-tidal carbon dioxide tension was > 90 mmHg at intubation. Adult SRS patients with chronic respiratory failure have a risk of CO2 narcosis. SRS also requires preparation for difficult airway management during the perioperative period.","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"15 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140603255","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":"A case of accidental intraperitoneal placement of the rectus sheath block catheter via an out-of-plane approach","authors":"Ai Ono, Keisuke Yoshida, Rieko Oishi, Satoki Inoue","doi":"10.1186/s40981-024-00705-4","DOIUrl":"https://doi.org/10.1186/s40981-024-00705-4","url":null,"abstract":"<p>To the editor,</p><p>Continuous nerve blocks have become widely used for postoperative analgesia in recent years. Ultrasound-guided catheter insertion is commonly performed using an in-plane or out-of-plane approach [1]. However, it is unclear which approach is more effective. Herein, we report a case in which a catheter for continuous rectus sheath block unexpectedly reached the abdominal cavity, via an out-of-plane approach.</p><p>A 67-year-old woman underwent bilateral rectus sheath blocks with a catheter-through-needle technique (Hakko Disposable Pain Clinic Set®, Hakko, Japan) after open surgical repair of abdominal aortic aneurysm. On ultrasound, due to the surgical wound, the posterior sheath of the rectus abdominis muscle could not be visualized well in the long-axis view with a linear probe; thus, we placed two catheters (left and right sides) under the short-axis view of the rectus sheath muscle using an out-of-plane approach, while injecting a small amount of drug solution to confirm the tips of needle. When we advanced the needle to the proper location, we observed the spread of local anesthetic (0.25% levobupivacaine, 20 mL per one side) along the rectal sheath. Then, we inserted the catheter, rigidly holding the needle in place so it would not shift from its position. However, the tip of the catheter was not clearly visible on ultrasound, and we did not evaluate the spread of local anesthetics administered through the catheter. On the Postoperative Day 1, routine postoperative computed tomography revealed that the right catheter had strayed into the abdominal cavity (Fig. 1). This catheter was quickly removed, resulting in no complications.</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%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png?as=webp\" type=\"image/webp\"/><img alt=\"figure 1\" aria-describedby=\"Fig1\" height=\"422\" loading=\"lazy\" src=\"//media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs40981-024-00705-4/MediaObjects/40981_2024_705_Fig1_HTML.png\" width=\"685\"/></picture><p>A computed tomography scan (transverse view) on Postoperative Day 1. The white arrow in the figure indicates the catheter, which strayed into the abdominal cavity</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 primary advantage of the in-plane approach is its safety, because the entire needle can be visualized during the procedure. The primary disadvantage is its narrow ultrasound beam width of ≤ 1 mm, which makes the visibility of the needle difficult [2]. Furthermore, the distance from the skin to the target tends to be longer using this approach, possibly resulting in reduced visibility in deeper areas [3]. In contrast, ","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"40 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576155","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":"Amino acids to prevent cardiac surgery-associated acute kidney injury: a randomized controlled trial.","authors":"Masahiro Kazawa, Daijiro Kabata, Hisako Yoshida, Kimito Minami, Takuma Maeda, Kenji Yoshitani, Hitoshi Matsuda, Ayumi Shintani","doi":"10.1186/s40981-024-00703-6","DOIUrl":"10.1186/s40981-024-00703-6","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to examine the preventive effect of amino acids on postoperative acute kidney injury (AKI).</p><p><strong>Methods: </strong>This was single-center, patient- and assessor-blinded, randomized controlled trial. Patients who underwent aortic surgery with cardiopulmonary bypass were included. The intervention group received 60 g/day of amino acids for up to 3 days. The control group received standard care. The primary outcome was the incidence of AKI. We assessed the effect of amino acids on AKI using a Cox proportional hazards regression model.</p><p><strong>Results: </strong>Sixty-six patients were randomly assigned to the control or intervention group. One patient in the control group withdrew consent after randomization. The incidence of AKI was 10 patients (30.3%) in the intervention group versus 18 patients (56.2%) in the control group (adjusted hazard ratio, 0.44; 95% confidence interval, 0.20-0.95; P = 0.04).</p><p><strong>Conclusions: </strong>This trial demonstrated a significant reduction in AKI incidence with amino acid supplementation.</p><p><strong>Trial registration: </strong>jRCT, jRCTs051210154. Registered 31 December 2021, https://jrct.niph.go.jp/re/reports/detail/69916.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"19"},"PeriodicalIF":0.9,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10963352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287439","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":"Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report.","authors":"Kurumi Saito, Hitoshi Yoshida, Kazuyoshi Hirota","doi":"10.1186/s40981-024-00702-7","DOIUrl":"10.1186/s40981-024-00702-7","url":null,"abstract":"<p><strong>Background: </strong>During general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established.</p><p><strong>Case presentation: </strong>A 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia.</p><p><strong>Conclusion: </strong>The present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"18"},"PeriodicalIF":0.9,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101607","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 intraoperative management of laparoscopic hysterectomy in a patient with Eisenmenger syndrome: a case report.","authors":"Yuki Maeda, Nami Kakuta, Asuka Kasai, Hiroki Yonezawa, Ryosuke Kawanishi, Katsuya Tanaka","doi":"10.1186/s40981-024-00700-9","DOIUrl":"10.1186/s40981-024-00700-9","url":null,"abstract":"<p><strong>Background: </strong>Patients with Eisenmenger syndrome (ES) requiring noncardiac surgery are at a significantly high risk of perioperative morbidity and mortality. However, perioperative management of patients with ES requiring laparoscopic surgery remains unclear.</p><p><strong>Case presentation: </strong>We describe the case of a patient with ES who underwent laparoscopic hysterectomy under general anesthesia with a peripheral nerve block. The objectives of the perioperative management included the following: (1) maintaining systemic vascular resistance and cardiac output through euvolemia, facilitated by the infusion of noradrenaline, and (2) preventing a reduction in oxygen-carrying capacity and factors that elevate pulmonary vascular resistance, such as pain, hypoxia, and decreased body temperature. Although laparoscopic procedures involved an increased risk in patients with ES, they are less invasive than open surgeries.</p><p><strong>Conclusion: </strong>This report describes the successful anesthetic management of a patient with ES, ensuring a balance between systemic and pulmonary vascular resistance.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"10 1","pages":"17"},"PeriodicalIF":0.9,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10909790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021748","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}