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Background@#We investigated the effects of sevoflurane exposure on the expression of matrix metalloproteinase (MMP), expression and ablation of natural killer group 2, member D (NKG2D) ligands (UL16-binding proteins 1–3 and major histocompatibility complex class I chain-related molecules A/B), and natural killer (NK) cell-mediated cytotoxicity in breast cancer cells. @*Methods@#Three human breast cancer cell lines (MCF-7, MDA-MB-453, and HCC-70) were incubated with 0 (control), 600 (S6), or 1200 μM (S12) sevoflurane for 4 h. The gene expression of NKG2D ligands and their protein expression on cancer cell surfaces were measured using multiplex polymerase chain reaction (PCR) and flow cytometry, respectively. Protein expression of MMP-1 and -2 and the concentration of soluble NKG2D ligands were analyzed using western blotting and enzyme-linked immunosorbent assays, respectively. @*Results@#Sevoflurane downregulated the mRNA and protein expression of the NKG2D ligand in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells but did not affect the expression of MMP-1 or -2 or the concentration of soluble NKG2D ligands in the MCF-7, MDA-MB-453, and HCC-70 cells. Sevoflurane attenuated NK cell-mediated cancer cell lysis in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells (P = 0.040, P = 0.040, and P = 0.040, respectively). @*Conclusions@#Our results demonstrate that sevoflurane exposure attenuates NK cell-mediated cytotoxicity in breast cancer cells in a dose-dependent manner. This could be attributed to a sevoflurane-induced decrease in the transcription of NKG2D ligands rather than sevoflurane-induced changes in MMP expression and their proteolytic activity.
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Background@#Pyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anesthetic method.Case: A 24-month-old child with a PDHC deficiency presented to the emergency room with respiratory failure, mental decline, systemic cyanosis, and lactic acidosis. During hospitalization period, the patient presented with pneumothorax, pneumoperitoneum, and multiple air pockets in the heart. Two surgeries were performed under general anesthesia using an inhalational anesthetic agent. The patient was discharged with home ventilation. @*Conclusions@#Anesthesiologists should be wary of multiple factors when administering anesthesia to patients with PDHC deficiency, including airway abnormalities, acid-base imbalance, intraoperative fluid management, selection of appropriate anesthetics, and monitoring of lactic acid levels.
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Background@#Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. @*Methods@#This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. @*Results@#Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. @*Conclusions@#Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.
ABSTRACT
Dental implants should be placed at ideal sites for implant-supported restorations. For a patient with insufficient residual ridge, mouth preparation including surgical intervention can be indicated to establish a soft and hard tissue environment favorable for a definitive prosthesis. Prosthodontic design based on computer-guided surgery and computer-aided design-computer-aided manufacturing (CAD-CAM) provides a visual blueprint allowing a clinician to assess the necessity of such a surgical intervention beforehand. In this case, a definitive restoration was planned and made via a CAD-CAM system according to the patient’s oral status before treatment, simulated surgical interventions and serial provisional restorations. Based on the planning, a guided template was made and the implants were installed with bone augmentation using the template. Customized abutments, the first and the second provisional restorations were designed and fabricated by CAD-CAM. The definitive restorations were digitally made following the shape of the second provisional prostheses, which were confirmed in the patient’s mouth. The patient was satisfied with the masticatory, phonetic and aesthetic functions of these definitive prostheses.
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The congenital long QT syndrome (LQTS) is an inherited cardiac disorder characterized by increased QT intervals and a tendency to experience ventricular tachycardia, which can cause fainting, heart failure, or sudden death. A 4-year-old female patient undergoing velopharyngeal correction surgery under general anesthesia suddenly developed Torsades de pointes. Although the patient spontaneously resolved to sinus rhythm without treatment, subsequent QT prolongation persisted. Here, we report a case of concealed LQTS with a literature review.
ABSTRACT
Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB − postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483–8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.
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Cognitive changes in patients after anesthesia and surgery have been recognized for over 100 years. Research on postoperative cognitive changes accelerated in the 1980s and the term postoperative cognitive dysfunction emerged, which was used until recently. Postoperative cognitive dysfunction has been used in research to describe an objectively measurable decline in cognitive function using neuropsychological tests. This dysfunction had significant heterogeneity in the type, number of tests, timing of tests, and the criteria for change. Therefore, a recent article recommended a new nomenclature for perioperative neurocognitive disorders including neurocognitive disorder, postoperative delirium, delayed neurocognitive recovery, and postoperative neurocognitive disorder. Since old age and baseline cognitive impairment are important risk factors for these perioperative neurocognitive disorders, routine preoperative cognitive assessment in all elderly patients is recommended. A preventive strategy is important, since effective modality for the treatment of perioperative neurocognitive disorders is not yet known. Intraoperative monitoring of age-adjusted end-tidal minimal alveolar concentration fraction, electroencephalography-based anesthetic management, and perioperative non-pharmacological methods are recommended for effective prevention.
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The Chiari network is an embryonic remnant of the sinus venosus valve, which is characterized by a fenestrated, netlike structure in the right atrium and has the potential to be misdiagnosed as another right atrial pathology. Additionally, the Chiari network has been frequently reported to entrap intracardiac devices during surgical procedures. In this case report, we present two patients with a Chiari network confirmed by three-dimensional transesophageal echocardiography, which assisted in preventing device entrapment during intracardiac procedures.
ABSTRACT
The Chiari network is an embryonic remnant of the sinus venosus valve, which is characterized by a fenestrated, netlike structure in the right atrium and has the potential to be misdiagnosed as another right atrial pathology. Additionally, the Chiari network has been frequently reported to entrap intracardiac devices during surgical procedures. In this case report, we present two patients with a Chiari network confirmed by three-dimensional transesophageal echocardiography, which assisted in preventing device entrapment during intracardiac procedures.
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Despite its widespread use, complication of incentive spirometry has been rarely reported. We report a case of pharyngeal reperforation following incentive spirometry. A 75-year-old female, had a history of long-term steroid use, entered the intensive care unit for maintenance of mechanical ventilation following surgical repair of a pharyngeal perforation. After ventilator weaning, incentive spirometry was implemented on postoperative day 4. Immediately after incentive spirometry use, patient's neck began to swell, and subcutaneous emphysema was palpated. Pharyngeal reperforation was suspected on neck computed tomography, and emergency surgery was performed. Surgery revealed a 3-cm long rupture from the hypopharynx to the esophagus. The causes were thought to be delayed wound healing due to long-term steroid use and a sudden increase in pharyngeal pressure due to incentive spirometry. In conclusion, particular attention should be paid when using incentive spirometry after head and neck surgery in patients with a history of long-term steroid use.