Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy.

BACKGROUND: The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period. METHODS: A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher's exact test, paired t-test, or Wilcoxon singed-rank test. RESULTS: All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes. CONCLUSIONS: The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.

Loss of function of phosphatidylserine synthase causes muscle atrophy in Drosophila.

Maintenance of appropriate muscle mass is crucial for physical activity and metabolism. Aging and various pathological conditions can cause sarcopenia, a condition characterized by muscle mass decline. Although sarcopenia has been actively studied, the mechanisms underlying muscle atrophy are not well understood. Thus, we aimed to investigate the role of Phosphatidylserine synthase (Pss) in muscle development and homeostasis in Drosophila. The results showed that muscle-specific Pss knockdown decreased exercise capacity and produced sarcopenic phenotypes. In addition, it increased the apoptosis rate because of the elevated reactive oxygen species production resulting from mitochondrial dysfunction. Moreover, the autophagy rate increased due to increased FoxO activity caused by reduced Akt activity. Collectively, these findings demonstrate that enhanced apoptosis and autophagy rates resulting from muscle-specific Pss knockdown jointly contribute to sarcopenia development, highlighting the key role of the PSS pathway in muscle health.

Severe refractory hypotension during induction of general anesthesia in patient after 48 hours of azilsartan discontinuation: A case report.

RATIONALE: Angiotensin II receptor blockers (ARBs) are currently considered first-line antihypertensive drugs, effectively inhibiting the renin-angiotensin-aldosterone system. However, ARBs have been associated with intraoperative hypotension during general anesthesia. Although it is recommended to discontinue ARBs for 24 hours before surgery, the optimal duration of discontinuation remains unclear. We present a severe refractory hypotension encountered during general anesthesia despite discontinuing ARBs for 48 hours before anesthesia. PATIENT CONCERNS: A severe refractory hypotension occurred during the induction of general anesthesia for cranioplasty in a 66-year-old male patient (170 cm/75 kg). The patient was taking azilsartan, angiotensin receptor blocker, for hypertension, which was discontinued 48 hours before anesthesia induction. Despite repeated administration of ephedrine and continuous infusion of norepinephrine, hemodynamic instability did not improve. Therefore, the surgery was postponed. DIAGNOSIS: The patient was diagnosed with angiotensin receptor blocker-induced refractory hypotension. INTERVENTIONS: Before the second surgery, the angiotensin receptor blocker was discontinued 96 hours prior to the surgery. Invasive blood pressure monitoring was performed before anesthesia induction, and vasopressin was prepared. General anesthesia was induced using remimazolam and maintained with desflurane. OUTCOMES: The surgery was completed successfully without occurrence of refractory hypotension. LESSONS: Refractory hypotension induced by Angiotensin receptor blockers can still occur even after discontinuing the medication for 48 hours before induction of general anesthesia. Despite withholding the medication, caution should be practiced regarding hypotension during general anesthesia in patient taking ARBs.

Remimazolam sedation with regional anesthesia in difficult airway due to huge thyroid goiter: A case report.

RATIONALE: Remimazolam, a novel benzodiazepine, is known to have less respiratory depression compared to other anesthetic agents, and it also has a reversal agent that can be used in emergency situations. Remimazolam with these characteristics can be usefully utilized in the anesthetic management of patients with difficult airway. PATIENT CONCERNS: A 78-year-old female patient was scheduled proximal humerus fracture surgery. The patient occasionally complained dyspnea and had multiple comorbidities including thyroid goiter, dementia, and delirium. DIAGNOSES: The patient had a large thyroid goiter compressing and deviating the trachea. A short neck with increased circumference was confirmed. A difficult airway was anticipated in the preanesthetic evaluation. INTERVENTIONS: Sedation with remimazolam followed by regional anesthesia was performed for the surgery. OUTCOMES: The surgery was completed without complications. The patient recovered and was discharged on 15th postoperative days. LESSONS: The use of remimazolam for sedation may be an appropriate option in the anesthetic management of patients with difficult airway.

Can remimazolam be safely used in cardiac tamponade?: A case report.

RATIONALE: Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam. PATIENT CONCERNS: An 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion. DIAGNOSES: The patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis. INTERVENTIONS: Decompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia. OUTCOMES: Severe hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours). LESSONS: Remimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.

The association between the risk perceptions of COVID-19, trust in the government, political ideologies, and socio-demographic factors: A year-long cross-sectional study in South Korea.

Risk perception research, targeting the general public, necessitates the study of the multi-faceted aspects of perceived risk through a holistic approach. This study aimed to investigate the association between the two dimensions of risk perception of COVID-19, i.e., risk as a feeling and analysis, trust in the current government, political ideologies, and socio-demographic factors in South Korea. This study used a year-long repeated cross-sectional design, in which a national sample (n = 23,018) participated in 23 consecutive telephone surveys from February 2020 to February 2021. Most factors differed in the magnitude and direction of their relationships with the two dimensions of risk perception. However, trust in the current government, alone, delineated an association in the same direction for both dimensions, i.e., those with a lower level of trust exhibited higher levels of cognitive and affective risk perception. Although these results did not change significantly during the one-year observation period, they are related to the political interpretation of risk. This study revealed that affective and cognitive risk perceptions addressed different dimensions of risk perception. These findings could help governments and health authorities better understand the nature and mechanisms of public risk perception when implementing countermeasures and policies in response to the COVID-19 pandemic and other public health emergencies.

Herpes zoster after COVID-19 vaccination, aspect of pain medicine: a retrospective, single-center study.

BACKGROUND: Herpes zoster (HZ) is one of the most common cutaneous adverse reactionsassociated with the coronavirus disease 2019 (COVID-19) vaccine and has been widely reported. This study aimed to evaluate HZ following COVID-19 vaccination from the viewpointof pain management. METHODS: A retrospective study was conducted on 42 patients with HZ who visited the painclinic between August 2021 and October 2021. Medical records were reviewed to comparepain severity, treatment methods, treatment duration, and incidence rate of postherpeticneuralgia (PHN) in patients who received COVID-19 vaccination within 6 weeks prior to developing symptoms compared with other patients with HZ. RESULTS: Fourteen patients developed HZ within 6 weeks after vaccination and were significantly younger than the other HZ groups. There were no significant differences in the frequency of prodromal pain, location of pain, pain severity, treatment methods, treatmentduration, or incidence of PHN compared with the other HZ groups. CONCLUSIONS: COVID-19 vaccination-related HZ showed clinical features similar to those ofthe other HZ.

Severe pancytopenia and coagulopathy discovered during anesthesia after pre-anesthetic evaluation - A report of two cases.

BACKGROUND: Pre-anesthetic evaluation is an important aspect of perioperative patient management. However, anesthesiologists often encounter challenges during anesthesia due toconditions that are not detected during pre-anesthetic evaluations. CASE: Case 1 involved a 74-year-old female patient scheduled for cranioplasty and meningioma excision. Severe pancytopenia was detected during anesthesia. Cranioplasty was onlyperformed, the surgery was terminated, and drug-induced pancytopenia was diagnosed andtreated. The pre-anesthetic test results were normal, except for anemia. Case 2 involved a71-year-old male patient who discovered large ecchymosis during general anesthesia preparation in the operating room for choledochal cyst surgery. Surgery was canceled to evaluatethe bleeding tendency, and acquired coagulation factor VIII deficiency was diagnosed andtreated. The pre-anesthetic tests were normal, except for prolongation of the activated partial thromboplastin time. CONCLUSIONS: Abrupt hematologic and hemostatic changes may occur during anesthesiaeven though pre-anesthetic evaluation findings are normal.

A Pneumatically Controlled Prosthetic Socket for Transfemoral Amputees.

Amputees typically experience changes in residual limb volume in their daily lives. It causes an uncomfortable fit of the socket by applying high pressure on the sensitive area of the residual limb or by loosening the socket. In this study, we developed a transfemoral prosthetic socket for above-the-knee amputees that ensures a good socket fit by maintaining uniform and constant contact pressure despite volume changes in the residual limb. The socket has two air bladders in the posterior femoral region, and the pneumatic controller is located on the tibia of the prosthesis. The pneumatic system aims to minimize unstable fitting of the socket and improve walking performance by inflating or deflating the air bladder. The developed socket autonomously maintains the air pressure inside the prosthetic socket at a steady-state error of 3 mmHg or less by adjusting the amount of air in the air bladder via closed-loop control. In the clinical trial, amputee participants walked on flat and inclined surfaces. The displacement between the residual limb and socket during the gait cycle was reduced by up to 33.4% after air injection into the socket. The inflatable bladder increased the knee flexion angle on the affected side, resulting in increased stride length and gait velocity. The pneumatic socket provides a stable and comfortable walking experience not only when walking on flat ground but also on slopes.

Assessing the Safety of Total Intravenous Anesthesia with Remimazolam in General Anesthesia for Transcatheter Aortic Valve Implantation of Severe Aortic Valve Stenosis: A Case Series.

Background and Objectives: In patients with severe aortic stenosis (sAS), it is crucial to maintain hemodynamic stability during the induction and maintenance of general anesthesia for transcatheter aortic valve implantation (TAVI). In this study, we assessed the efficacy and safety of remimazolam in maintaining hemodynamic stability during anesthetic induction and maintenance. Cases: TAVI was performed on seven patients with sAS, and remimazolam was administered for total intravenous anesthesia (TIVA) of general anesthesia with induction (3.0 mg/kg/h) and maintenance (1.0 mg/kg/h). All patients underwent TAVI without major hemodynamic concerns and later recovered. Conclusions: Remimazolam can be safely used for induction and maintenance of general anesthesia in patients with sAS when performing TAVI.

Development of a quantitative evaluation tool for Seoul's community-based participatory health program 'building healthy communities'.

Community-based participatory health (CBPH) programs are important for addressing health disparities; however, the limited development of validated scales to measure outcomes may hinder the utilization and upscaling of such programs. Thus, this study aimed to develop a culturally appropriate and valid tool for the quantitative evaluation of a CBPH program and to test theory-driven pathways of associations among participation, social capital, empowerment and health outcomes. This study used a participatory and mixed methods approach. Formative research, including a literature review, survey results over the past 2 years, focus group interviews and participatory evaluation committee meetings, was conducted. Four program components-participation, social capital, empowerment and quality of life (QoL)-were identified and used to construct a validated evaluation tool. A total of 317 participants (89.9% women, mean age = 57.7 ± 11.5 years) responded to the survey. The data were analyzed for internal consistency and factor structure. Structural equation modeling (SEM) was used to test the theoretical pathways of health promotion through the CBPH program. The SEM results showed two significant mediation pathways such that participation in interventions was associated with higher QoL via social capital accumulation and improved empowerment. Our results exemplify a validated scale that can be used to evaluate the intermediate- and long-term outcomes of a CBPH program.

This study aimed to develop a reliable and valid tool for the evaluation of community-based participatory health (CBPH) programs and to test a pathway to explain how participation may be associated with better health. The study used mixed methods, including focus group interviews, analysis of survey data from the past 2 years, participatory evaluation committee meetings and a main survey. Four core program components were identified: participation, social capital, empowerment and quality of life. In total, 317 participants responded to the survey. The results also showed that program participation was associated with a higher quality of life through increased social capital and empowerment. In conclusion, the developed evaluation tool can be used to evaluate the intermediate-and long-term outcomes of a CBPH program.

Predictive Factors for Rheumatoid Arthritis Flare After Switching From Intravenous to Subcutaneous Formulation of Tocilizumab in Real-World Practice.

BACKGROUND: To evaluate the incidence and related factors of rheumatoid arthritis (RA) flares after switching from intravenous tocilizumab (TCZ-IV) to subcutaneous tocilizumab (TCZ-SC) injection in stable RA patients. METHODS: We retrospectively evaluated the medical records of stable RA patients who used TCZ-IV for more than 6 months and switched to TCZ-SC between January 2013 and April 2020. RA flare was defined as an increase of more than 1.2 in the RA disease activity as assessed by the disease activity score in 28 joints. The factors associated with RA flare were evaluated by logistic regression analysis. RESULTS: Among 106 patients treated with TCZ-IV for > 6 months, 37 patients were switched to TCZ-SC after the acquisition of remission or low disease activity. RA flares occurred in 11 (29.7%) of patients who switched TCZ-SC. Results from the multivariable logistic analysis revealed that the dose of TCZ-IV per weight at switching (odds ratio [OR], 20.70; 95% confidence interval [CI], 2.22-192.84; P = 0.008) and methotrexate (MTX) non-use (OR, 8.53; 95% CI, 1.21-60.40; P = 0.032) were associated with the risk of RA flares after switching to TCZ-SC. Interestingly, most patients who switched back to TCZ-IV had their RA activity controlled again. CONCLUSION: MTX non-use and high dose of TCZ-IV per weight were associated with a risk of RA flare after switching to TCZ-SC. RA patients with these factors need to be carefully observed for flare after switching from TCZ-IV to TCZ-SC.

Expression of osteogenic markers after administration of selective estrogen receptor modulators during implant placement in the osteoporotic rat maxilla.

PURPOSE: This study examined the effects of raloxifene during bone formation around the dental implant in the ovariectomy-induced osteoporotic rat maxilla. METHODS: Fifty-four female 10-week-old Sprague-Dawley rats were divided into three groups (n = 18 each); sham-operated (control), ovariectomized (OVX), and ovariectomized and raloxifene-administered (RAL). Eight weeks after ovariectomy, both upper first molars were extracted, and implants were placed 4 weeks post-extraction. The RAL group was given 1 mg/kg of raloxifene per day while the other groups received a vehicle. Six rats in each group were sacrificed at days 4, 7, and 14 and submitted for quantitative reverse transcription polymerase chain reaction and immunohistochemical staining, for evaluation of osteogenic genes expressions. RESULTS: The alkaline phosphatase expression was upregulated in the RAL group compared to the OVX group at day 4. The osteocalcin expression was significantly higher between the RAL group and the OVX group at day 7. Immunohistochemical staining revealed increased expression during the initial bone-forming process and indicated more active bone formation in the RAL group than in the OVX group. CONCLUSION: Raloxifene administration enhanced the osteogenic genes and proteins expression in the bone around the implant. Further studies are required to establish the long-term clinical effects of raloxifene administration.

High prevalence of stress and suicidal ideation in women with temporomandibular disorder: A population-based cross-sectional survey.

Objective: To investigate the association between temporomandibular disorders (TMD) and psychological factors according to gender in a large representative sample.Methods: Participants provided demographic, socio-economic, and behavioral information and responded to questionnaires assessing mental health status regarding perceived stress, mood disturbance, suicidal ideation, and diagnosis of depression. The association between TMD and its risk factors by gender and the association between psychological factors and TMD were statistically analyzed.Results: In men, perceived stress was highly associated with TMD. However, in women, not only perceived stress but suicidal ideation showed significantly high rates of TMD. The suicidal ideation was significantly associated with TMD in women after controlling confounders.Discussion: Current results provide evidence that TMD is associated with stress in both genders and with suicidal ideation, especially in women. This study has important implications for intense screening and evaluation of suicidal ideation among patients with TMD according to gender.

Anaphylaxis to tocilizumab in patients with rheumatic disease.

Background: Anaphylaxis to tocilizumab has been reported anecdotally. Therefore, we evaluated the incidence of anaphylaxis in patients starting tocilizumab. Materials & methods: This retrospective study included patients with rheumatic disease who were administered tocilizumab from 2013 to 2020. The incidence of anaphylaxis was examined during the first 6 months. Results: During follow-up, four of 171 patients developed anaphylaxis within the third course of infusions. The incidence of anaphylaxis to tocilizumab was higher in patients with adult-onset Still's disease (AOSD) than in those with other rheumatic disease (21.4% in AOSD vs 0.7% in rheumatoid arthritis vs 0% in Takayasu arteritis). Conclusions: When we consider tocilizumab treatment, especially in AOSD, we should keep in mind that intensive monitoring for anaphylaxis is necessary.

Lay abstract Anaphylaxis is a life-threatening allergic reaction that can be triggered by food, latex and drugs. Tocilizumab is widely used to treat rheumatic disease, including rheumatoid arthritis (RA), adult-onset Still's disease (AOSD) and Takayasu arteritis (TAK). As case reports of tocilizumab-induced anaphylaxis have previously been reported, we evaluated the incidence of anaphylaxis in patients starting tocilizumab treatment. Over the course of 6 months, four of 171 (21.4% in AOSD vs 0.7% in RA vs 0% in TAK) patients developed anaphylaxis within the third course of infusions. An AOSD patient with anaphylaxis, who presented with active disease status persistently, was successfully treated with tocilizumab again after desensitization. In conclusion, when considering tocilizumab treatment, especially in AOSD patients, we should keep in mind that intensive monitoring for anaphylaxis is necessary.

The effect of interscalene brachial plexus block with propofol sedation on preventing perioperative hypothermia during arthroscopic shoulder surgery.

BACKGROUND: Interscalene brachial plexus block (ISBPB) is commonly used with general anesthesia for postoperative pain management in shoulder surgery. This study investigated the incidence of hypothermia and changes in the body temperature in patients undergoing arthroscopic shoulder surgery under ISBPB with propofol sedation. METHODS: This retrospective study enrolled 220 patients who underwent arthroscopic shoulder surgery. Patients were divided into general anesthesia (n = 34) and ISBPB with propofol sedation (n = 186) groups, and medical records were retrospectively compared. In addition, patients from the ISBPB group were further divided according to age (elderly, [≥ 65 years]; n = 98 vs. young, [< 65 years]; n = 88), and the incidence of hypothermia and changes in the body temperature were compared. RESULTS: Twenty-seven patients (12.3%) experienced perioperative hypothermia (range; 35.3-35.9℃). The incidence of perioperative hypothermia was 29.4% and 9.1% in the general anesthesia and ISBPB groups, respectively, and there was a significant difference between the two groups (P = 0.002). The incidence of perioperative hypothermia according to age in the ISBPB group was 9.2% and 9.1% in the elderly and young groups, respectively, and there was no significant difference between the two groups (P = 0.983). CONCLUSIONS: The incidence of perioperative hypothermia during arthroscopic shoulder surgery under ISBPB with propofol sedation is lower than that under general anesthesia. Furthermore, when using ISBPB with propofol sedation, the incidence of perioperative hypothermia in elderly patients is similar to that in younger patients.

Investigating similarities and differences in health needs according to disability type using the International Classification of Functioning, Disability and Health.

PURPOSE: This study aimed to investigate the health needs of adults with disabilities in South Korea according to disability type using the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS: An exploratory, qualitative approach using content analysis was employed. Five focus groups consisted of six to seven participants with visual impairment (PVI), hearing impairment (PHI), physical impairment (PPI), brain disorder (PBD), and intellectual disability (PID). Linking rules were used to identify how the health needs related to the ICF components of Body Functions, Activity & Participation, and Environmental Factors. RESULTS: The health needs related to the Environmental Factors were the most mentioned and were frequently perceived as causes of poor health conditions related to Activities & Participation and Body Function. According to what participants perceived as main health issues in the Environmental Factors, the five groups were classified into (1) Services, systems, and policies mainly affecting type (PVI and PPI); (2) Support and relationships mainly affecting type (PHI); and (3) Attitude mainly affecting type (PBD and PID). CONCLUSIONS: Government officials and health professionals must tailor development and provision of healthcare for people with disabilities based on health need type.IMPLICATIONS FOR REHABILITATIONFew studies have investigated the health needs of people with disabilities, although many health indicators suggest that they are facing health inequalities in South Korea.The health issues related to the Environmental Factors were often perceived in this study as causes of poor health conditions related to the Activities & Participation and Body Function, indicating the need to preferentially solve the health issues related to the Environmental Factor.According to what people with each of the five types of disabilities perceived as main health issues and what kinds of actions they expected in the Environmental Factors, they could be classified into three health need types.It is recommended that government officials and health professionals develop and provide appropriate supply-side measures of healthcare considering these different demand-side health needs according to disability type.

Comparison of chemical pregnancy rates according to the anesthetic method during ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization: a retrospective study.

BACKGROUND: Oocyte retrieval is the most important procedure in in vitro fertilization (IVF). Various anesthetic methods are used to control a patient's anxiety and pain during IVF; however, there are no recommended anesthetic methods at present. In this study, we retrospectively investigated chemical pregnancy rates according to the anesthetic method used for oocyte retrieval. METHODS: We reviewed records of patients who underwent oocyte retrieval between January 1, 2012 and December 31, 2017. Patients were divided into the spinal anesthesia (SA) and monitored anesthesia care (MAC) groups. The primary outcome was chemical pregnancy rate after IVF. RESULTS: The study included 95 patients. SA was administered in 77 (81%) and MAC in 18 (19%). The overall chemical pregnancy rate was 32.6% (31/95). According to the anesthetic method, the pregnancy rate was 32.5% (25/77) in the SA group and 33.3% (6/18) in the MAC group. There was no statistical difference in the pregnancy rate between the groups (P = 0.575). The procedural time was significantly shorter in the SA group than in the MAC group (P < 0.001). CONCLUSIONS: Chemical pregnancy rates were not significantly different between the SA and MAC groups. However, the procedure duration was shorter in the SA group than in the MAC group.

Herpes zoster in the ophthalmic branch of the trigeminal ganglia obscuring cavernous sinus thrombosis due to Streptococcus constellatus subsp. constellatus - A case report.

BACKGROUND: Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. CASE: We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus subsp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. CONCLUSIONS: CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.

Invisible perforation during an endoscopic procedure of the esophagus under general anesthesia - A case report.

BACKGROUND: Endoscopic procedures of the esophagus are more complicated than those of other regions of the gastrointestinal tract. They have a relatively long procedure time and high risk of complications, such as perforation and bleeding. Perforations that occur during the procedure can accompany pneumoperitoneum and pneumomediastinum through leakage of insufflation air and cause severe ventilatory impairment. CASE: A 58-year-old male patient underwent enucleation of leiomyoma in the esophagus using endoscopy under general anesthesia. Ventilatory impairment occurred 15 min after commencement of the procedure. Subsequently, subcutaneous emphysema and severe abdominal distension were observed. We suggested the possibility of microperforation during the procedure to the endoscopist, and he performed endoscopic clipping around the excision site of leiomyoma. CONCLUSIONS: Providing anesthetic care by anesthesiologists during endoscopic procedures is considered necessary for patient safety. Complications of endoscopic procedures can be detected and managed early without sequelae during anesthetic care.