Asian journal of anesthesiology最新文献

{"title":"StyleTubation Applied for Difficult Airway With Post-Radiation Fibrosis and Halo-Vest Stabilization.","authors":"Yi-Chiao Chen, Alan Shikani, Jason Zhensheng Qu, Hsiang-Ning Luk","doi":"10.6859/aja.202506_63(2).0005","DOIUrl":"10.6859/aja.202506_63(2).0005","url":null,"abstract":"<p><p>Patients with nasopharyngeal cancer and following head/neck radiotherapy often experience a difficult airway during subsequent surgical treatment. Pre-operative airway examination usually reveals certain degrees of radiation-induced fibrosis over the neck, trismus, a higher Mallampati class, and an upper lip bite test grade. Available pre-operative transnasal videoendoscopic and radiological imaging findings might show vulnerable mucous membrane irregularities and anatomical abnormalities over the nasopharynx and larynx, and edematous or distorted epiglottis and vocal cords. Along with aforementioned adverse impacts, the need for mounting devices, such as halo-vest stabilization, would further restrict patients' cervical spines mobility and lead to more difficult endotracheal intubation. Both non-technical and technical skills, and various intubating tools/devices have been discussed in an evidence-based approach. Among them, videolaryngoscopy with/without flexible video-endoscopy is advocated for such difficult airway scenarios. In this short communication, we present our successful experience in applying StyleTubation (video intubating stylet technique) in such a difficult airway scenario (nasopharyngeal carcinoma patient, severe post-radiation fibrosis over the neck, mounted a halo-vest stabilization device, undergoing cervical spine surgery).</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389788","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":"Efficacy of Ketamine for Opioid-Free Anesthesia (OFA) in Patients Undergoing Mastectomy: A Randomized Controlled Trial.","authors":"Aishwarya Ramkrishnan, Nivedhyaa Srinivasaraghavan, Punitha Chockalingam, Kalpana Balakrishnan, Prasanna V Vanmayil","doi":"10.6859/aja.202506_63(2).0004","DOIUrl":"10.6859/aja.202506_63(2).0004","url":null,"abstract":"<p><strong>Background: </strong>Opioid-free anesthesia (OFA) is an emerging practice in cancer care, providing adequate analgesia with reduced side effects. The objective of the study is to evaluate whether ketamine can replace morphine for performing OFA by assessing the acute pain relief achieved and to evaluate its effect on chronic pain.</p><p><strong>Methods: </strong>A total of 182 women undergoing modified radical mastectomy were recruited and randomized into the morphine group and the ketamine group. Participants in the morphine group received 0.05 mg/kg morphine 20 minutes before induction, and those in the ketamine group received 0.40 mg/kg bolus and 1.00 mg/kg/hour ketamine infusion until axillary dissection. The numerical rating pain scale (NRS) at 0, 2, 6, 12, and 24 hours postsurgery was recorded, and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was filled out the next day. The chronic pain score at 3 and 6 months after surgery was noted.</p><p><strong>Results: </strong>The mean NRS at 24 hours was 2.385 ± 0.965 in the ketamine group and 2.240 ± 0.996 in the morphine group (P = 0.336). The APS-POQ-R showed that, on average, patients in the ketamine group and the morphine group experienced moderate to severe pain for and 28.00% and 27.72% of the time in a day, respectively, and rescue analgesia usage was also comparable. The incidence of chronic pain was 28.9% and 21.2% (P = 0.31) at 3 months and 32.1% and 21.2 % (P = 0.19) at 6 months in the ketamine group and the morphine group, respectively, and not statistically significant.</p><p><strong>Conclusion: </strong>The results demonstrated that both ketamine and morphine provided similar levels of acute pain relief during the procedure, with no significant difference in pain outcomes between the two groups. These findings suggest that ketamine may be a viable alternative to morphine in the management of pain during OFA, with similar efficacy in both acute and chronic pain relief.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"63 2","pages":"70-79"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598034","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":"StyleTubation for Omega-Shaped Epiglottis.","authors":"Meng-Wai Cheong, Alan Shikani, Jason Zhensheng Qu, Hsiang-Ning Luk","doi":"10.6859/aja.202506_63(2).0006","DOIUrl":"https://doi.org/10.6859/aja.202506_63(2).0006","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"63 2","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598179","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":"What Corner Pocket? Critical Examination of a Supraclavicular Sonographic View.","authors":"Jackson Harley, Patrick Halliday, Richard K Kim","doi":"10.6859/aja.202503_63(1).0005","DOIUrl":"10.6859/aja.202503_63(1).0005","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"36-37"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484327","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":"Effectiveness of Fascia Iliaca Compartment Blocks for Pain Relief After Hip Arthroplasty Using Ropivacaine and Dexamethasone.","authors":"Quang Minh Pham, Hoang Son Pham, Thanh Hien Nguyen, Huu Tu Nguyen","doi":"10.6859/aja.202503_63(1).0001","DOIUrl":"10.6859/aja.202503_63(1).0001","url":null,"abstract":"<p><strong>Background: </strong>Fascia iliaca compartment block (FICB) is one of the regional blocks used to reduce postoperative pain after total hip arthroplasty (THA). Administration of dexamethasone in the loading dose might lengthen pain-free duration and reduce anesthetic consumption.</p><p><strong>Methods: </strong>Sixty patients undergoing THA with spinal anesthesia and patient-controlled FICB were randomly assigned to receive either 20 mL of 0.25% ropivacaine with 8 mg dexamethasone (Group D, n = 30) or 20 mL of 0.25% ropivacaine alone (Group C, n = 30). Postoperative pain scores, analgesic use, and side effects were assessed over 72 hours.</p><p><strong>Results: </strong>Postoperative visual analogue scale scores did not differ significantly between groups. The time to first bolus was longer in Group D than in Group C (407.10 ± 305.68 vs. 308.63 ± 212.99 minutes; P < 0.05). Total ropivacaine consumption over 72 hours was lower in Group D (210.33 ± 79.64 mg) compared to Group C (288.00 ± 91.32 mg), with a similar reduction in bolus frequency (14.53 ± 7.96 vs. 22.30 ± 9.13). The incidence of adverse events, including quadriceps weakness, local effects, and other side effects, was low and comparable between groups.</p><p><strong>Conclusion: </strong>The addition of dexamethasone to ropivacaine for FICB after THA can significantly provide a longer duration of analgesia with a lower amount of anesthetic.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660090","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":"Impact of Sevoflurane on the Murine Gut Microbiota: Longitudinal Characterization of Diversity Alterations and Dysbiosis Metrics Using Metagenomics.","authors":"Ramadevi Panneerselvam, Monisha Karuppannan, Ganesh Prabhu S C, Elantamilan Durairaj","doi":"10.6859/aja.202503_63(1).0003","DOIUrl":"10.6859/aja.202503_63(1).0003","url":null,"abstract":"<p><strong>Background: </strong>General anesthetics can alter the gut microbiota, but the longitudinal and sex-specific effects of sevoflurane remain unclear. This study examined whether a single exposure to sevoflurane anesthesia induces significant compositional changes in the murine gut microbiome over two weeks, with a secondary focus on sex-specific patterns of alteration.</p><p><strong>Methods: </strong>A controlled animal exposure study was conducted at a tertiary-care academic laboratory animal facility in southern India, approved by an institutional animal ethics committee. Twenty albino mice (6-8 weeks old, ~12 g; both females and males) were randomized to sevoflurane or control groups, subdivided by sex. All animals were housed under standard conditions and completed the study protocol. Experimental animals underwent a single 4-hour exposure to sevoflurane in a controlled chamber; controls experienced identical procedures without sevoflurane. Primary endpoints were gut microbiota alpha and beta diversity (Bray-Curtis distance, Shannon, Simpson indices, richness), phylum- and genus-level differential abundance, and derived Firmicutes: Bacteroidetes and Proteobacteria metrics from serial fecal samples across five time points up to Day 14.</p><p><strong>Results: </strong>Sevoflurane exposure led to significant beta diversity separation between groups at both phylum (P = 0.004) and genus levels (P = 0.034), with additional sex effects (P = 0.035 for genus level); alpha diversity indices were significantly reduced in males (P = 0.0079), but not in females. Phylum-level differential abundance was significant in females but not in males. Group and sex effects were present throughout, and derived dysbiosis metrics varied temporally and by sex Conclusion: A single prolonged exposure to sevoflurane induces significant, durable, and sexually dimorphic shifts in the murine gut microbiome. These findings highlight the importance of considering sex as a biological variable in studies of anesthetic effects on gut health.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"63 1","pages":"20-29"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980415","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":"Systemic Immune-Inflammation Index and Perioperative Risk Scores: A Cross-Sectional Analysis in Elective Surgical Patients.","authors":"Nirupa Ramakumar, Gurjeet Khurana, Priya Ramakrishnan, Arnpriya Pal","doi":"10.6859/aja.202503_63(1).0004","DOIUrl":"10.6859/aja.202503_63(1).0004","url":null,"abstract":"<p><p>The systemic immune-inflammation index (SII) (SII = platelet count × neutrophil count/lymphocyte count) is an emerging inflammatory biomarker. We examined correlations between preoperative SII, medication count as a marker of multimorbidity, and established perioperative risk scores in patients undergoing elective noncardiac surgery. This cross-sectional study included 300 adults undergoing elective surgery. SII was calculated from preoperative blood counts. We assessed correlations between SII and clinical variables using Spearman's rank correlation coefficient, including American Society of Anesthesiologists Physical Status Classification System, Revised Cardiac Risk Index (RCRI), Surgical Outcome Risk Tool (SORT) mortality, and medication count. We investigated polypharmacy (≥ 4 medications) as a multimorbidity indicator. Multivariable regression identified predictors of elevated SII (≥ 754 × 10^9 cells/L). This study examined associations only. Mean age was 63.5 ± 9.6 years, 50.7% male. Median SII was 633 × 10^9/L. SII showed weak correlations with RCRI (ρ = 0.15, P = 0.008) and SORT (ρ = 0.12, P = 0.033). The strongest correlation was with medication count (ρ = 0.77, P < 0.001), reflecting multimorbidity burden. In the analysis, polypharmacy (odds ratio [OR], 6.82; 95% CI, 2.05-22.7), higher SORT mortality (OR, 1.69 per 1% increase), and RCRI (OR, 1.48 per point) predicted elevated SII. This cross-sectional association study found weak correlations between SII and risk scores. The strong association with polypharmacy suggests that both measures capture the multimorbidity burden, raising the question of whether SII offers advantages over counting medications. Prospective studies with actual perioperative outcomes are required before SII can be recommended for clinical risk stratification.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"63 1","pages":"30-35"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980421","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":"Comparison of Single and Double Injection Ultrasound-Guided Supraclavicular Block for Upper Limb Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Rifaldy Nabiel Erisadana, Taufiq Gemawan, Muhamad Rizal Hadi Pratama, Eqiel Navadz Akthar Alami, Achmad Wahib Wahju Winarso, Adelia Handoko","doi":"10.6859/aja.202503_63(1).0002","DOIUrl":"10.6859/aja.202503_63(1).0002","url":null,"abstract":"<p><strong>Background: </strong>The ongoing debate regarding the preferred technique between single-site and double-site injection procedures for supraclavicular block remains unresolved. We conducted this research to evaluate the clinical outcomes of single-site versus double-site injection in patients undergoing upper limb surgery.</p><p><strong>Methods: </strong>A literature search was conducted up to September 2023 to identify randomized controlled trials (RCTs) comparing the single-site injection group (SG) with the double-site injection group (DG) for the supraclavicular block. The analysis was conducted using Review Manager 5.4, employing either a fixed-effects or random-effects model (PROSPERO; no. CRD42023492703).</p><p><strong>Results: </strong>Based on the 10 RCTs included in the quantitative analysis, there were no significant differences in success rates (i.e., the primary outcome), surgical anesthesia, total anesthesia-related time, time to first rescue analgesic, and adverse events. However, significant differences were observed in several secondary outcomes. SG showed advantages in terms of shorter performance time (mean difference [MD], -1.02 minutes [95% confidence interval [CI], -1.79 to -0.25; P = 0.01; I^2 = 91%]) and lower blockade pain scores (MD, -0.30 minutes [95% CI, -0.60 to 0.00; P = 0.05; I^2 = 0%]). Conversely, DG demonstrated superiority in terms of faster block onset time (MD, 5.73 minutes [95% CI, 4.91, 6.54; P < 0.00001; I^2 = 1%]), longer duration of the sensory block (MD, -71.77 minutes [95% CI, -139.50 to -4.03; P = 0.04; I^2 = 98%]), and longer duration of the motor block (MD, -33.13 minutes [95% CI, -39.64 to -26.63; P < 0.00001; I^2 = 0%]).</p><p><strong>Conclusion: </strong>This meta-analysis provides evidence that SG and DG had equivalent success rates. SG revealed favorable outcomes in terms of shorter performance time and lower blockade pain scores. However, DG was considered superior in terms of faster block onset and longer durations of sensory and motor block.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"63 1","pages":"6-19"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980418","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":"Association Between Long- Versus Short-Acting Angiotensin II Receptor Antagonists and Hypotension During Anesthesia Induction: A Retrospective Study.","authors":"Masahiro Kuroki, Hiroto Suzuki, Yu Onodera, Masaki Nakane, Kaneyuki Kawamae","doi":"10.6859/aja.202403_62(1).0004","DOIUrl":"10.6859/aja.202403_62(1).0004","url":null,"abstract":"<p><strong>Background: </strong>The withdrawal or continuation of angiotensin II receptor blockers (ARBs) before surgery continues to be debated. We hypothesized that this is because ARBs with different half-lives have not been studied individually. This retrospective study aimed to clarify whether the degree of hypotension during anesthesia induction differs among ARBs with different half-lives.</p><p><strong>Methods: </strong>We included patients who received general anesthesia with regular oral administration of telmisartan (group T) or valsartan (group V), which have half-lives of approximately 24 and 6 hours, respectively. The frequency of hypotension and vasopressor frequency and dose during anesthesia induction were compared between the two groups. At our hospital, ARBs were withdrawn on the day of surgery in all patients.</p><p><strong>Results: </strong>Groups T and V included 190 and 132 patients, respectively. Patient backgrounds in group V were significantly more strongly associated with the use of calcium channel blockers. No significant differences were observed in the use of other concomitant antihypertensive medications, cardiovascular complications, or renal function. The time during which the mean arterial blood pressure was < 60 mmHg during anesthesia induction was significantly greater in group T than in group V (11 min vs. 7 min, P=0.030). The proportion of patients who used vasopressors was significantly higher in group T than that in group V (74.2% vs. 56.0%, P < 0.001).</p><p><strong>Conclusion: </strong>Patients taking telmisartan showed more hypotensive during the induction of general anesthesia than those taking valsartan, even after withdrawal on the day of surgery.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"28-38"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279822","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":"Adverse Effects of Chemotherapy and the Interaction With Anesthesia: A Narrative Review.","authors":"Marina Ayres Delgado, Paul Holzmann Neto, André Luis Vieira Drumond, Geovana Torres de Souza, André Dos Santos Mendonça, Camila Gomes Dall'Aqua, Bruna Carvalho Oliveira, Bruno Vinícius Castello Branco, Samuel Loureiro Gontijo, David Ribeiro do Nascimento","doi":"10.6859/aja.202403_62(1).0003","DOIUrl":"10.6859/aja.202403_62(1).0003","url":null,"abstract":"<p><p>Many cancer patients have their main tumors surgically removed with the goal of curing them, or as part of palliative care. When a patient receives general anesthesia, the side effects of the administered chemotherapy regimens must be considered, especially those that may have significant repercussions during anesthetic care. The aim of this study is to review the existing literature to identify adverse effects of chemotherapy and known interactions between chemotherapy and anesthetic drugs, analyze the mechanisms underlying these interactions, and discuss relevant clinical implications. This integrative review searched for articles using the search terms: chemotherapy, anesthetic drugs, interaction, adverse effects, and drug combination. Negative perioperative outcomes may be related to the chemotherapy. Regarding the type of oncological surgery, factors such as blood loss, hypothermia, and extended operative time influence the increase in morbimortality. Many anesthetic drugs are related to immunomodulation and interact with chemotherapy, which may get better or worse cancer patients. It is crucial for anesthetists to have a comprehensive understanding of the potential adverse effects of chemotherapy drugs and their interactions with anesthetics.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 1","pages":"21-27"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863026","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}