Anaesthesia reports最新文献

{"title":"Anaesthetic management of colorectal surgery in a patient with chronic pericardial effusion","authors":"E. Ahmad,&nbsp;H. S. Liu,&nbsp;A. Miller","doi":"10.1002/anr3.70031","DOIUrl":"https://doi.org/10.1002/anr3.70031","url":null,"abstract":"<div>\u0000 \u0000 <p>Chronic pericardial effusions are a peri-operative challenge as anaesthesia and surgery can precipitate haemodynamic compromise. Guidance for managing patients requiring time-sensitive non-cardiac surgery in this setting is limited. We report the case of a 43-year-old woman with a moderate chronic, asymptomatic pericardial effusion scheduled for robotic anterior resection of rectal cancer. The principal challenge was balancing the need for time-sensitive oncological surgery against the risk of haemodynamic compromise in the context of suboptimal pre-operative cardiology assessment. Surgery proceeded after multidisciplinary discussion, with pre-emptive vasopressor support and intra-operative transoesophageal echocardiography monitoring to guide management. The peri-operative course was stable, and the patient was discharged on postoperative day 4. Two months later, she required pericardial window formation for a persistent effusion which had become symptomatic. This case illustrates that non-cardiac surgery in chronic, asymptomatic pericardial effusion can be performed safely when guided by physiological reasoning, real-time echocardiography and multidisciplinary planning.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146307","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":"Spontaneous knot formation between nasogastric tube and temperature probe in the oesophagus","authors":"D. Lindsay,&nbsp;M. Welstand-Patel,&nbsp;N. Kalra","doi":"10.1002/anr3.70030","DOIUrl":"https://doi.org/10.1002/anr3.70030","url":null,"abstract":"<p>We report a case of spontaneous intra-operative granny knot formation between a large bore nasogastric tube (NGT) and an oro-oesophageal temperature probe within the oesophagus [<span>1</span>]. Whilst entanglement between NGT and other devices has been reported; true knot formation is rare.</p><p>A 67 year-old man presented with a sigmoid volvulus and abdominal compartment syndrome and was listed for exploratory laparotomy. After previous failed attempts in the emergency department, a 16 Fr NGT was inserted by ICU staff. However, it was observed that the NGT was not draining anything passively or on suctioning. Upon attempting to replace the NGT, resistance was encountered along with associated movement of the temperature probe.</p><p>Re-advancement of the NGT and withdrawal of the temperature probe allowed the knot to be visualised and undone (Figures 1 and 2). While cutting the NGT and extracting the knot en bloc would have been an option, releasing the knot and extracting the devices intact reduced the risk of soft tissue trauma from the cut end.</p><p>The granny knot is related to the surgeon's knot and reef knot commonly used in surgical suturing techniques. It can be used as a binding knot, such as in a simple suture encircling opposed edges of a wound, or as a bend to join the ends of two lengths. However, the latter is insecure as it may capsize under tension unless externally stabilised, leading it to become undone [<span>2</span>]. In this instance, we believe it may have been stabilised in a bend configuration by the surrounding tissues of the oesophagus.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146306","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":"Effect of intravenous lidocaine on nociception level-directed management in robot-assisted laparoscopic radical prostatectomy: protocol for a single-centre, factorial-randomised controlled trial (VALINOR study)","authors":"H. Matsuura,&nbsp;N. Tanaka,&nbsp;Y. Sasaki,&nbsp;T. Kotani,&nbsp;Y. Yamamoto,&nbsp;M. Ida,&nbsp;M. Kawaguchi","doi":"10.1002/anr3.70027","DOIUrl":"10.1002/anr3.70027","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate the efficacy of intra-operative lidocaine administration combined with nociception level-guided opioid management and to compare two minimum remifentanil infusion rate limits (0.11 vs. 0.05 μg.kg&lt;sup&gt;−&lt;/sup&gt;¹.min&lt;sup&gt;−&lt;/sup&gt;¹) during robot-assisted radical prostatectomy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Single-centre, double-blinded, two-by-two factorial randomised controlled trial.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Operating theatres at Nara Medical University Hospital, Nara, Japan.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eighty-four adult patients scheduled for elective robot-assisted radical prostatectomy were participated in the study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Interventions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Participants will be randomised into four groups (lidocaine/0.11, lidocaine/0.05, placebo/0.11 and placebo/0.05). All groups will receive nociception level-guided intra-operative opioid management.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Measurements&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The primary outcome is the numerical rating scale score during movement 2 hours after surgery. Secondary outcomes include plasma concentrations of peri-operative inflammatory biomarkers (interleukin-6, cortisol and C-reactive protein), intra-operative remifentanil consumption, Quality of Recovery-15 scores (pre-operative and postoperative days 1 and 2), postoperative numerical rating scale scores up to postoperative day 7, peri-operative fentanyl consumption and the presence of prolonged postoperative pain at 3 months.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Hypothesis&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Lidocaine will decrease intra-operative remifentanil requirements and early postoperative pain without increasing the inflammatory biomarker levels and the minimum remifentanil infusion rate limit will not significantly impact clinical outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This trial will evaluate the effects of intra-operative lidocaine administration and minimum remifentanil infusion rate limit based on nociception level-guided opioid management in patients undergoing robot-assisted radical prostatectomy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial Registration&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Japan Registry of Clinical Trials, jRCTs052240226 (registered on 26","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102032","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":"Implementation of a maternity hospital rotational thromboelastometry (ROTEM®) guided transfusion strategy: a quality improvement study*","authors":"H. Tawfik,&nbsp;L. Pentony,&nbsp;R. M. O'Donovan,&nbsp;S. R. Mir,&nbsp;M. Tahir,&nbsp;T. Drew","doi":"10.1002/anr3.70028","DOIUrl":"10.1002/anr3.70028","url":null,"abstract":"<p>A rotational thromboelastometry (ROTEM^®) guided transfusion strategy for obstetrics was implemented at our institution in September 2022. The aim of the strategy was to facilitate timely, targeted administration of coagulation products based on viscoelastic haemostatic testing, thereby reducing unnecessary transfusions. To improve compliance with the ROTEM^® strategy, an electronic decision tool was developed and integrated into a smartphone application, supported by departmental education and training. We subsequently analysed data on 944 women who experienced postpartum haemorrhage ≥ 1500 ml over a 5-year period, comparing 1 year of data after the formal introduction of the ROTEM^®-guided transfusion strategy (post-ROTEM^®) with the previous 4 years, when a conventional transfusion strategy was in place based on standard laboratory tests (pre-ROTEM^®). Following implementation, the annual use of fibrinogen concentrate, Octaplas^® (Octapharma Pharmazeutika GmbH, Vienna, Austria) and platelets to treat PPH ≥ 1500 ml decreased by 46%, 72% and 79%, respectively, yielding a cost saving of €51,738. Compliance with evidence-based fibrinogen transfusion triggers improved significantly (84% vs. 23%) and empirical product use was eliminated. There was no statistically significant difference in the proportion of women who progressed to severe haemorrhage (≥ 2000 ml) between groups: 97/238 (40%) in the post-ROTEM^® group vs. 312/706 (44%) in the pre-ROTEM group (p = 0.35). This quality improvement initiative demonstrated that embedding a ROTEM^®-guided transfusion strategy into clinical workflows, supported by a decision tool and staff training, can enhance adherence to evidence-based practice, reduce unnecessary coagulation product use and generate substantial cost savings, without adversely affecting clinical outcomes. These findings may inform institutions seeking to optimise transfusion strategies in obstetric haemorrhage through structured implementation approaches.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101944","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":"Delayed hypertensive crisis after intracavernosal phenylephrine for penile plication","authors":"J. C. Davis,&nbsp;J. C. Krakowski","doi":"10.1002/anr3.70026","DOIUrl":"10.1002/anr3.70026","url":null,"abstract":"<div>\u0000 \u0000 <p>Intracavernosal phenylephrine injection is commonly used during penile plication for Peyronie's disease due to its desirable vasoconstrictive effect in achieving detumescence. Although systemic absorption of medications following intracavernosal administration may occur, high-dose intracavernosal phenylephrine has been reported to be safe and effective in treating priapism with a rare incidence of morbidity or significant haemodynamic changes. We describe a 68-year-old man who underwent ambulatory penile plication with intra-operative intracavernosal phenylephrine injection, which led to hypertensive emergency 90 min postoperatively. This case highlights the potential for delayed-onset haemodynamic changes following intra-operative intracavernosal phenylephrine injection and the need for judicious monitoring postoperatively.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935156","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":"Confirmation of tracheal tube placement with a flexible bronchoscope when the capnograph trace is absent due to bronchospasm","authors":"J. Robinson,&nbsp;S. Goellner,&nbsp;P. Hart","doi":"10.1002/anr3.70025","DOIUrl":"10.1002/anr3.70025","url":null,"abstract":"<div>\u0000 \u0000 <p>Detection of sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation in current practice. However, this may be impossible in rare clinical situations. International guidelines include flexible bronchoscopy as an alternative method of confirming tracheal intubation when capnography is inconclusive and tube removal is considered dangerous. We present the case of a patient with severe bronchospasm who aspirated gastric contents at induction of anaesthesia for ventilatory support for respiratory failure. Following apparent tracheal intubation, ventilation appeared impossible and no capnography trace could be obtained. Tracheal intubation was confirmed using flexible bronchoscopy, and the patient subsequently recovered following a period of extracorporeal membrane oxygenation. This case illustrates the value of flexible bronchoscopy in the unusual situation when ventilation is so compromised that capnography is unobtainable.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910378","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":"Comment on ‘Postoperative bilateral visual loss after a single dose of tranexamic acid’","authors":"K. Sonawane,&nbsp;T. Mistry","doi":"10.1002/anr3.70024","DOIUrl":"10.1002/anr3.70024","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910377","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":"Heart failure-related elevation of carbohydrate antigen 125 identified by pre-operative cardiopulmonary exercise testing","authors":"R. G. Davies,&nbsp;F. Fiorini,&nbsp;D. M. Bailey","doi":"10.1002/anr3.70023","DOIUrl":"10.1002/anr3.70023","url":null,"abstract":"<p>Heart failure is a major peri-operative risk factor associated with significant postoperative morbidity and mortality. Traditional biomarkers used in heart failure management include natriuretic peptides. Carbohydrate antigen 125 biomarker is well known to be elevated in ovarian cancer but can also be elevated in heart failure, particularly right-sided heart failure and heart failure with preserved ejection fraction. We report the management of a 71-year-old woman with a presumed diagnosis of ovarian cancer based on imaging and an elevated carbohydrate antigen 125, who underwent cardiopulmonary exercise testing as part of the pre-operative assessment. Exercise testing, despite being sub-maximal, identified significant but asymptomatic heart failure. Surgery was deferred and cardiology-led optimisation resulted in normalisation of her carbohydrate antigen biomarker, refuting her ovarian cancer diagnosis and avoidance of a major intra-abdominal surgery. This case highlights the role of biomarkers, such as carbohydrate antigen 125, in heart failure treatment and the use of exercise testing in heart failure diagnosis and management. Cardiopulmonary exercise testing facilitated the identification of hidden comorbidities leading to better pre-operative risk stratification, optimisation and collaborative decision making.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910379","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":"Connector blood leakage suggesting pulmonary artery catheter damage","authors":"T. Ishii,&nbsp;H. Miyoshi,&nbsp;H. Sato,&nbsp;H. Yokomi,&nbsp;T. Takasaki,&nbsp;S. Takahashi,&nbsp;Y. M. Tsutsumi","doi":"10.1002/anr3.70022","DOIUrl":"10.1002/anr3.70022","url":null,"abstract":"<p>Catheter entrapment is a rare complication of pulmonary artery catheter (PAC) insertion [<span>1, 2</span>].</p><p>A 57-year-old man underwent ascending aortic replacement. A PAC was inserted via the right internal jugular vein without difficulty under continuous transoesophageal echocardiographic guidance, which confirmed its appropriate placement in the right pulmonary artery. As this was his second cardiac surgery, dense adhesions were present. During adhesiolysis, an injury occurred at the base of the pulmonary artery, which was successfully repaired using felt-reinforced sutures.</p><p>Fresh blood was observed around the optical module connector upon arrival to the intensive care unit, though the significance of this was unknown (Fig. 1A). Pulmonary artery pressures, mixed venous oxygen saturation and cardiac output measurements were unaffected and clinically appropriate.</p><p>On postoperative day 1, PAC removal was attempted but resistance was encountered after withdrawing approximately 5 cm. Fluoroscopy revealed that the catheter tip was fixed. During resternotomy, we found the PAC had been inadvertently sutured to the pulmonary artery. The catheter was carefully released and removed with cardiac bypass support. Examination revealed suture punctures through the optical module lumen, resulting in blood leakage without affecting monitored values (Fig. 1B and C). The patient recovered without further complications.</p><p>Blood leakage from the optical module connector may indicate catheter damage or entrapment, even in the absence of abnormal monitoring data, and should prompt further evaluation.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681425","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":"Postoperative bilateral visual loss after a single dose of tranexamic acid","authors":"B. Chevalley,&nbsp;M. Betello,&nbsp;E. Blavakis,&nbsp;A. Malclès,&nbsp;J. Maillard","doi":"10.1002/anr3.70020","DOIUrl":"10.1002/anr3.70020","url":null,"abstract":"<p>A 32-year-old woman presented with transient visual loss following the intra-operative administration of a single intravenous dose of tranexamic acid during urgent cholecystectomy. Apart from obesity, the patient had no notable medical history or pre-existing ocular conditions. Immediately after surgery, the patient reported sudden onset blindness. Ophthalmological and radiologic assessments did not reveal any detectable macrovascular or organic ophthalmic lesions. The patient's vision gradually improved spontaneously, with the resolution of the dyschromatopsia on the first postoperative day and complete recovery by the second postoperative day. This case highlights the importance of prompt investigation of acute visual impairment postoperatively and identifying potential causative agents, such as tranexamic acid.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589604","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}