Bispectral Index™ variation during living donor liver transplantation in a child with hepatic encephalopathy: a case report.

BACKGROUND: It is unclear whether perioperative Bispectral Index™ (BIS) monitoring in pediatric cases with acute liver failure (ALF) is effective for evaluation of neurological function. We describe a pediatric patient with hepatic encephalopathy (HE) in whom the BIS value increased from low levels to the normal range during liver transplantation (LT). CASE PRESENTATION: Electroencephalography in a 6-year-old comatose girl diagnosed with ALF and HE who was unresponsive to pain and auditory stimuli revealed continuous slow waves, and hence, emergency LT was performed. Intraoperatively, BIS values remained low until reperfusion. However, BIS value variability increased after reperfusion. She was subsequently discharged without any neurological sequelae. CONCLUSIONS: Low BIS values were considered to reflect the severity of HE. It is possible that improvement of the BIS value and waveform was a reflection of graft function. BIS monitoring might be a good indicator of neurological recovery after LT.

Oxygen reserve index (ORi™) contributes to prediction of hypoxemia and patient safety during tracheal stent insertion using rigid bronchoscopy: a case report.

The oxygen reserve index (ORi™) is a new noninvasive and continuous variable, which represents a moderate hyperoxygenation status, with a unitless scale between 0.00 and 1.00. When percutaneous oxygen saturation (SpO2) exceeds 100%, arterial blood oxygen partial pressure cannot be evaluated without performing arterial blood gas analysis. Because of significant air leakage during rigid bronchoscopy, it is difficult to monitor respiration using capnography, which does not measure end-tidal carbon dioxide (ETCO2) accurately. A 66-year-old man (175 cm, 76.8 kg) with a chief complaint of difficulty in breathing was diagnosed with a thyroid tumor. Computed tomography revealed tracheal stenosis due to direct invasion of the thyroid tumor; therefore, tracheal stenting was planned immediately. After supplying 6 L/min oxygen with a face mask and administering 180 mg of propofol intravenously, the supraglottic airway was intubated. General anesthesia (total intravenous anesthesia) through continuous administration of 6-10 mg/kg/h of propofol and intermittent administration of 50 µg of fentanyl (total 200 µg) preserved spontaneous breathing. During tracheal stent insertion, disconnection between the oxygen supply system and rigid bronchoscopy, and tracheal stent expansion, the ORi tended to decrease before SpO2 decreased. Thus, measuring ORi could prevent hypoxemia during tracheal stent insertion using rigid bronchoscopy.

Near-infrared spectroscopy might be a useful tool for predicting the risk of vascular complications after pediatric liver transplants: Two case reports.

In patients that have undergone liver transplants, a postoperative reduction in the blood flow of the liver graft represents a critical complication. We recently encountered an interesting phenomenon; that is, we found that the rSO2 level of the liver graft, as measured by NIRS, drops in patients that subsequently require an emergency liver biopsy. An 8-month-old female and an 8-month-old male underwent living donor liver transplants for biliary atresia. In both cases, a reduction in rSO2 was detected before an emergency liver biopsy was required. As a result of biopsy examinations, both patients were diagnosed with acute graft rejection. NIRS might be useful for graft management during the postoperative period in pediatric patients that undergo liver transplantation. After a liver transplant, a reduction in the rSO2 of the graft might be indicative of the onset of vascular complications.

[A Case of Living Donor Liver Transplantation Complicated by Thrombosis due to a Central Venous Catheter in the Right Internal Jugular Vein].

Central venous catheter-related infection and throm- bosis frequently occur, leading to serious complications in some cases. We encountered a case of thrombosis developing on the sixth day after surgery, in a patient with a PreSep Central Venous Oximetry Catheter™ placed in the internal jugular vein. A 53-year-old woman with a height of 160.8 cm and weight of 52.9 kg, showing normal coagulation test results, was scheduled for living donor liver transplantation under general anesthesia with sevoflurane/remifentanil. The durations of surgery and anesthesia were 6 hours and 56 minutes and 8 hours and 24 minutes, respectively. Although central venous catheter insertion and postop- erative management were appropriately performed, the patient reported chest pain and dyspnea just after the removal of the central venous catheter on the sixth day after surgery, and was diagnosed with thrombosis on CT. This case highlights the importance of selecting appropriate catheters considering perioperative risks and removing them in the early stages.

Optical surgical navigation system causes pulse oximeter malfunction.

An optical surgical navigation system is used as a navigator to facilitate surgical approaches, and pulse oximeters provide valuable information for anesthetic management. However, saw-tooth waves on the monitor of a pulse oximeter and the inability of the pulse oximeter to accurately record the saturation of a percutaneous artery were observed when a surgeon started an optical navigation system. The current case is thought to be the first report of this navigation system interfering with pulse oximetry. The causes of pulse jamming and how to manage an optical navigation system are discussed.

[Comparative study of the KingVision videolaryngoscope and Airwayscope using manikins].

BACKGROUND: KingVision (KV) is a new videolaryngoscope. In this study, we compared the ease of use of the KV with the Airwayscope (AWS) by experienced personnel in a simulated manikin. METHODS: Twenty-eight anesthesiologists participated in this study. We used an advanced patient simulator (AIRSIM) to simulate normal manikin and difficult airway scenarios including cervical spine rigidity and limited mouth opening. We compared the time required for visualization of the glottis (Tv) and tracheal intubation (Ti), and analyzed the percentage of glottic opening (POGO) score and the success rates for tracheal intubation. RESULTS: In normal manikin, the Tv and Ti with the KV were significantly shorter than with the AWS (P < 0.05). The POGO score with the KV was higher than with the AWS (P < 0.05). In difficult airway scenarios including both cervical spine rigidity and limited mouth opening, the Tv and Ti with the KV were shorter than with only the AWS (P < 0.05). There is not much difference between KV and AWS regarding the POGO score in difficult airway. CONCLUSIONS: KV may be a suitable device for routine anesthesia care and difficult airway intubation. Further studies in a clinical setting are necessary to confirm these findings.

Parotid small cell carcinoma presenting with long-term survival after surgery alone: a case report.

INTRODUCTION: Primary involvement of the salivary glands in small cell carcinoma is rare, and has one of the worst prognoses of salivary gland neoplasms. However, it has been reported that some cases have a favorable outcome, although the prognostic factors are still under consideration. Multidisciplinary therapy was usually required to achieve long-term survival. Recently, a resemblance of some small cell carcinomas of the salivary gland to cutaneous Merkel cell carcinoma was suggested; the latter have the potential for spontaneous regression, which is related to a favorable clinical outcome. CASE PRESENTATION: We present a locoregional advanced parotid small cell carcinoma with multiple lymph node metastases in an 87-year-old Asian woman. The tumor was controlled by surgery alone, and nine-year disease-free survival was achieved without any adjunctive therapy. To the best of our knowledge, this is the longest reported follow-up of head and neck small cell carcinoma. CONCLUSION: We believe this to be the first case of small cell carcinoma with involvement of the salivary glands reported in the literature with a good outcome after surgery alone without any adjunctive therapy.