Anesthesia progress最新文献

{"title":"Perioperative Analgesia Using an Indwelling Catheter to Deliver an Inferior Alveolar Nerve Block: A Case Report.","authors":"Yuki Kojima, Kazuma Asano, Takeshi Murouchi, Kazuya Hirabayashi","doi":"10.2344/anpr-70-02-11","DOIUrl":"10.2344/anpr-70-02-11","url":null,"abstract":"<p><p>A 74-year-old male was diagnosed with osteomyelitis of the left mandible requiring marginal mandibulectomy under general anesthesia. However, the patient's pulmonary function tests demonstrated findings consistent with severe chronic obstructive pulmonary disease, classified as stage III. The consulting pulmonologist explained the increased risk of respiratory complications associated with general anesthesia and advised against its use. Therefore, we opted to perform the surgery under moderate sedation using 0.2% ropivacaine administered via bilateral ultrasound-guided inferior alveolar nerve blocks (UGIANBs) and an indwelling catheter with a pump for continuous perioperative local anesthesia and prolonged postoperative analgesia. This approach delivered excellent local anesthetic effects without any need for rescue medications or complications. Use of UGIANBs along with an indwelling catheter and pump may provide adequate local anesthesia and postoperative analgesia in patients with contraindications for general anesthesia.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"128-133"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242876","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":"Pronounced QT Prolongation During General Anesthesia in a Child with Left Ventricular Noncompaction Cardiomyopathy: A Case Report.","authors":"Mika Nishikawa, Kazumi Takaishi, Marina Takata, Osamu Sasajima, Shigeki Joseph Luke Fujiwara, Satoru Eguchi, Shinji Kawahito","doi":"10.2344/anpr-70-02-12","DOIUrl":"10.2344/anpr-70-02-12","url":null,"abstract":"<p><p>We report the case of an 8-year-old boy with left ventricular noncompaction cardiomyopathy (LVNC) and QT prolongation who experienced further prolongation of the QTc during general anesthesia for extraction of a maxillary mesiodens. Pronounced prolongation of the QTc was observed after induction of general anesthesia with thiamylal and during emergence. No notable fluctuations in blood pressure, heart rate, and estimated continuous cardiac output were observed. We considered it likely that the QT prolongation was triggered by thiamylal and increased sympathetic nervous system activity. During general anesthesia for children with LVNC and QT prolongation, it is necessary to monitor intraoperative hemodynamic fluctuations and prepare for the possible occurrence of arrhythmias.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"137-139"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242878","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":"Suspected Accidental Infiltration of Rocuronium During General Anesthesia Induction: A Case Report.","authors":"Yuya Sakurai, Makiko Shibuya, Ryuichi Okiji, Yuri Hase, Takayuki Hojo, Yukifumi Kimura, Toshiaki Fujisawa","doi":"10.2344/anpr-70-02-01","DOIUrl":"10.2344/anpr-70-02-01","url":null,"abstract":"<p><p>There are few reports on rocuronium infiltration under general anesthesia. We report a case of suspected accidental rocuronium infiltration during anesthesia induction. A 25-year-old woman with autism spectrum disorder, intellectual disability, and epilepsy was scheduled for the extraction of 4 impacted third molars under general anesthesia. After induction with sevoflurane, an intravenous (IV) line was established in the left cephalic vein. Rocuronium was administered; however, subcutaneous swelling at the IV site was observed immediately. Spontaneous ventilations were maintained until additional rocuronium was administered via a new IV line. After heat pack application, the swelling disappeared 60 minutes after infiltration, and no tissue damage was observed. A strategy was developed to continue neuromuscular monitoring until recovery occurred. Acceleromyography was used, and the train-of-4 ratios at 99, 130, and 140 minutes after infiltration were 0.79, 0.91, and 1.0, respectively. Sugammadex was administered to prevent neuromuscular blockade recurrence. The patient was extubated once adequate return of muscle function and consciousness were observed. No neuromuscular block prolongation or recurrence were observed postoperatively. When rocuronium infiltration is suspected, it is important to eliminate swelling at the infiltration site and determine a management strategy based on neuromuscular monitoring.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"116-119"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242880","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 Review of Current Oral Sedation Agents for Pediatric Dentistry","authors":"Regina A. E. Dowdy, Sarah Forgy, Oussama Hefnawi, Tiffany A. Neimar","doi":"10.2344/anpr-268717","DOIUrl":"https://doi.org/10.2344/anpr-268717","url":null,"abstract":"The administration of oral sedatives for minimal and moderate sedation is common practice for pediatric dentistry. Being up to date with contemporary medications and dosing recommendations is imperative for patient safety. Historic medications such as chloral hydrate have become obsolete with the introduction of benzodiazepines and other newer medications such as alpha-2 adrenergic agonists. Oral opioids are useful for analgesia and mild sedation but may result in significant respiratory depression when combined with other central nervous system depressants and, if left untreated, hypoxemia. Antihistamines can provide minimal sedation but may have other added benefits such as antiemetic and antisialagogue effects. This review will discuss relevant pharmacologic aspects, including onset, duration of action, metabolism, and adverse reactions, for several common agents used for minimal and moderate oral sedation to assist practitioners in determining ideal medications or combinations that fit the needs of the pediatric patient and dental procedure contingent upon the provider’s level of training.","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735439","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":"Positional Change Used to Manage Postextubation Respiratory Failure in a Child With Cerebral Palsy.","authors":"Jun Hirokawa, Kouichi Hidaka, Mitsuyo Kanemaru, Takashi Hitosugi, Yu Oshima, Takeshi Yokoyama","doi":"10.2344/anpr-70-02-08","DOIUrl":"10.2344/anpr-70-02-08","url":null,"abstract":"<p><p>Dental treatment for patients with cerebral palsy (CP) is often performed under general anesthesia due to involuntary movements that can render dental treatment difficult. Since CP is often accompanied by spasticity, care must be taken when positioning patients during general anesthesia. We report the management of a 14-year-old girl with CP and epilepsy undergoing general anesthesia for dental treatment who experienced respiratory failure due to acute thoracoabdominal muscle hypertonia after extubation. She had a history of cardiac arrest due to respiratory failure caused by acute muscle hypertonia and successful resuscitation. General anesthesia was induced after careful positioning of the patient to prevent spastic muscle stretching, and the dental treatment was completed without complications. However, upon awakening after extubation, the patient developed respiratory failure due to acute muscle hypertonia. The patient was resedated and repositioned from a supine to a sitting position, and her symptoms improved. There was no recurrence of muscle hypertonia, and she recovered fully without complications. In this case, respiratory failure associated with acute muscle hypertonia was successfully managed by position change after initial treatment with positive-pressure ventilation and propofol. It is important to be prepared for the possibility of respiratory failure associated with acute muscle hypertonia and its countermeasures when providing general anesthesia for patients with CP.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"124-127"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242877","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":"Visit Las Vegas for the 2024 ADSA/IFDAS Meeting.","authors":"Kyle J Kramer","doi":"10.2344/anpr-70-03-XX","DOIUrl":"10.2344/anpr-70-03-XX","url":null,"abstract":"","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"109"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242905","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":"Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study.","authors":"Alexandra Woo, John Nusstein, Melissa Drum, Sara Fowler, Al Reader, Ai Ni","doi":"10.2344/anpr-70-03-01","DOIUrl":"10.2344/anpr-70-03-01","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this prospective, randomized crossover study was to compare the peak incidence of success, onset, and incidence over time of pulpal anesthesia in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine.</p><p><strong>Methods: </strong>A total of 118 adults received 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine via buccal infiltration of the maxillary first molar at 2 separate appointments. Electric pulp testing (EPT) of the maxillary first molar was performed over 68 minutes.</p><p><strong>Results: </strong>There was no significant difference in the peak incidence of anesthetic success (85% and 92%, respectively) in the maxillary first molar between 1.8 mL and 3.6 mL. The difference in onset times (4.5 min for 1.8 mL vs 4.4 min for 3.6 mL) was not statistically significant. However, the 3.6-mL volume did produce a significantly higher incidence of pulpal anesthesia from minutes 48 to 68 compared with the 1.8-mL volume.</p><p><strong>Conclusion: </strong>There was no significant difference in peak incidence or onset of pulpal anesthesia in the maxillary first molar between 1.8 mL and 3.6 mL of articaine with epinephrine. The incidence of pulpal anesthesia was significantly higher with 3.6 mL of articaine at 48 minutes and beyond, but neither volume provided complete pulpal anesthesia for all subjects that lasted at least 60 minutes.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"110-115"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242879","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 Case Report of Burning Mouth Syndrome with Dry Mouth Managed by Kampo Medicine.","authors":"Ichiro Okayasu, Mizuki Tachi, Erika Suzue, Nanae Ito, Yu Ozaki, Gaku Mishima, Shinji Kurata, Takao Ayuse","doi":"10.2344/anpr-70-02-10","DOIUrl":"10.2344/anpr-70-02-10","url":null,"abstract":"<p><p>The patient was a 56-year-old woman who complained of chronic pain involving her tongue. We diagnosed her with burning mouth syndrome (BMS) based on exclusion of any local factors or systemic conditions. The patient not only had tongue pain but also had other signs and symptoms like scalloped tongue, dry mouth, and headache. To manage these additional issues, we used Goreisan, an herbal Kampo medicine, as a complementary alternative medicine (CAM) approach along with cognitive behavioral therapy (CBT). The patient's BMS was successfully managed with the combination of CAM and CBT, which may suggest that the pathophysiology for BMS might be nociplastic pain rather than purely nociceptive or neuropathic.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"134-136"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242873","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":"Dental Treatment Under General Anesthesia With Nasal Intubation in a Patient With Selective Immunoglobulin A Deficiency.","authors":"Yuho Sakuma, Mika Ogawa, Chie Nakagawa, Kodai Momota, Emi Kaji, Kingo Matsumura, Saori Morinaga, Kentaro Nogami, Mizuko Ikeda","doi":"10.2344/anpr-70-02-13","DOIUrl":"10.2344/anpr-70-02-13","url":null,"abstract":"<p><p>Immunoglobulin A (IgA) deficiency is one of the most common immune disorders characterized by increased susceptibility to infections, especially involving the respiratory tract and mucosal surfaces of the mouth, gingiva, and nasal sinus. Because dental surgery and general anesthesia may pose an increased risk for systemic infections, management of IgA-deficient patients requires caution during dental procedures and intubated general anesthesia. We report a 5-year-old female patient with IgA deficiency who underwent extraction of 18 deciduous teeth under general anesthesia. Antibiotic prophylaxis and antiseptic mouthwash were used perioperatively to reduce bacteremia risks. Nasotracheal intubation was carefully performed after applying topical disinfectants and epinephrine-containing gauze packing into the nasal cavity to minimize trauma. The patient was carefully monitored overnight in the hospital and discharged without any signs or symptoms of infection the next day. Dental anesthesia providers must be aware of the potential implications for safe practice when managing patients with IgA deficiency.</p>","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"140-141"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242875","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 Review of Current Literature of Interest to the Office-Based Anesthesiologist.","authors":"Mark A Saxen","doi":"10.2344/anpr-70-03-154","DOIUrl":"10.2344/anpr-70-03-154","url":null,"abstract":"When muscle relaxants are used to facilitate intubation, a significant amount of residual neuromuscular blockade remains when reversal drugs are not administered; however, routine reversal is not a universal practice. While most anesthesiologists routinely reverse neuromuscular blockade if muscular weakness is suspected at the time of extubation, others caution against the routine use of anticholinesterase reversal agents, which have been associated with impaired upper airway and breathing function with increased risk of adverse postoperative respiratory events. Neostigmine has neuromuscular blocking properties when given in the absence of neuromuscular blockade and can induce paradoxical reduction in the train-of-four ratio (TOF ratio). This study tested the hypothesis that TOF ratios in patients receiving neostigmine at the time of postanesthesia care unit admission would not be less than TOF ratios in patients randomly assigned to receive a saline placebo. The authors also tested the hypothesis that the incidence of postextubation adverse respiratory symptoms and muscle weakness would not be increased in the neostigmine group. One hundred twenty patients undergoing general anesthesia received a small dose of rocuronium to facilitate intubation. Ninety patients achieved a TOF ratio of 0.9 to 1.0 and received either neostigmine or saline. Patients were subsequently monitored for muscle strength and postextubation respiratory adverse events. No significant difference in these parameters was noted between the 2 groups, leading the authors to conclude that administration of neostigmine at neuromuscular recovery was not associated with clinical evidence of anticholinesterase-induced muscle weakness. Comment: This study is accompanied by an editorial (Brull SJ, Naguib M. How to catch unicorns (and other fairytales). Anesthesiology. 2018;128:1–3) that discusses long-standing beliefs and misconceptions about the relative risk and benefits of administering muscle relaxants. The editors praise the study by Murphy et al for debunking 4 common myths. First, the study shows no evidence that neostigmine, at a dose of 40 lg/ kg, induces signs or symptoms of neuromuscular weakness, contradicting previous reports. Second, it challenges the belief that clinical assessment alone (eg, 5second head lift) is sufficient to assess adequate muscle recovery and underscores the need for quantitative neuromuscular assessment (TOF ratio). The study also challenged the widely held belief that neuromuscular recovery can be subjectively assessed by watching or feeling the response to TOF stimulation. Finally, the ‘‘time elapsed’’ principle of reversal is debunked. This principle stated that reversal was not necessary if the duration since the last dose of neuromuscular blocking agent was greater than 1 or 2 elimination half-lives, noting that 21% of patients failed to recover to a TOF ratio of 0.9 in 163 minutes after a single dose of 0.3 mg/ kg rocuronium. The editorial prov","PeriodicalId":94296,"journal":{"name":"Anesthesia progress","volume":"70 3","pages":"154-155"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242874","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}