Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report.

Intraoperative wireless interrogation is a useful monitoring method for the leadless pacemaker (LP); however, there are few reports on this technique. A 60-year-old woman underwent cardiac surgery 24 days after Aveir LP implantation. Considering the risk of intraoperative device dislodgment and pacemaker malfunction due to electromagnetic interference, the LP was monitored by wireless interrogation via body-surface electrodes, and no device dislodgement or pacemaker malfunction was observed during surgery. Our findings suggest that wireless interrogation using body-surface electrodes on the chest is a practical and valuable monitoring technique in open-heart surgery, which lends additional safety to anesthetic management.

Acute Exacerbation of Rheumatoid Arthritis-Associated Interstitial Lung Disease After Thoracic Surgery in the Absence of Usual Interstitial Pneumonia Pattern on CT.

The usual interstitial pneumonia (UIP) pattern observed on chest computed tomography (CT) is considered a risk factor for the development of postoperative acute exacerbation in interstitial lung disease (ILD). However, the risk factors for acute exacerbation in patients with rheumatoid arthritis (RA)-associated ILD have not been adequately investigated. We present a case of postoperative acute exacerbation after thoracic surgery in a 73-year-old man with RA-ILD and non-UIP pattern on chest CT. This case report emphasizes that postoperative acute exacerbation can develop even in the absence of a radiological UIP pattern.

Severe and Prolonged Hypotension After Oral 5-Aminolevulinic Acid Administration in a Patient With End-Stage Renal Disease Undergoing Transurethral Resection of a Bladder Tumor: A Case Report.

A 72-year-old man with end-stage renal disease (ESRD) undergoing transurethral resection of a bladder tumor experienced severe and prolonged hypotension after receiving oral 5-aminolevulinic acid (5-ALA). Continuous infusions of norepinephrine and vasopressin ultimately resolved the hypotension over the course of 26 hours. It is uncertain whether 5-ALA is causative or is a contributing factor that influences other factors, such as hypovolemia after hemodialysis and autonomic nerve dysfunction associated with ESRD. Our findings suggest that anesthesiologists should be aware of the possible occurrence of hypotension after administration of 5-ALA, and urologists should consider intravesical 5-ALA administration in patients with ESRD.

[Benefit of Intraoperative Mannitol Use during Endoscopic Surgery for Intracerebral Hemorrhage].

BACKGROUND: Endoscopic hematoma evacuation is an established treatment option for patients with intra- cerebral hemorrhage (ICH). The purpose of this study is to investigate the benefit of mannitol use during en- doscopic hematoma evacuation. METHODS: One hundred patients with ICH treated by endoscopic surgery from June 2009 to November 2014 were retrospectively reviewed. We divided them into mannitol administered group (n=19) and non- administered group (n=81). RESULTS: As for the patient background, surgical time, amount of intraoperative bleeding, residual hema- toma, re-operation and postoperative 30-day mortality, no significant differences were found between the two groups. CONCLUSIONS: There was no clear clinical benefit of intraoperative mannitol use during endoscopic surgery for ICH.

Left ventricular restoration for ischemic cardiomyopathy--comparison of presence and absence of mitral valve procedure.

OBJECTIVE: Association of mitral regurgitation (MR) with ischemic cardiomyopathy (ICM) increases the degree of heart failure and its surgical management remains controversial. The aim of this study was to report the surgical results in patients with or without MR in association with ICM. PATIENTS AND METHODS: Ninety-two patients with ischemic cardiomyopathy (left ventricular [LV] ejection fraction less than 30% with global akinesis) underwent LV restoration. Pre-operative New York Heart Association (NYHA) functional class was either in class-3 or -4 in all patients. MR was moderate to severe in 38 patients (MR-group) and none or mild in 54 patients (noMR-group). Moderate to severe MR was repaired in addition to the complete coronary artery bypass (CABG) and LV restoration. All patients were followed up and echocardiogram was repeated every 6 months after the surgery. RESULTS: The procedure of LV restoration was selected pre- and intra-operative examination and endoventricular circular patch plasty was performed in 76, partial left ventricle resection in three, and septal anterior exclusion in 13. CABG was performed in 85 patients with mean 2.4+/-1.1 grafts in MR-group and 3.2+/-0.4 grafts in noMR-group (P<0.0001). In MR-group mitral valve plasty was performed in 24 and replacement in 14. Undersized (26 or 28 mm) circumferential mitral ring was used in 16 patients for mitral plasty. Emergent operation required in 15 patients (13 in MR-group and two in noMR group) and the hospital mortality was 18.4% in MR-group and 3.7% in no MR-group. Mitral regurgitation recurred in two patients with posterior ring annuloplasty and they underwent valve replacement. The post-operative NYHA functional class improved to class-1 or -2 in 65 patients and cumulative survival in 5 years including emergent and hospital deaths was 60.9% in MR-group and 70.1% in noMR-group. CONCLUSION: In association of MR to ICM, emergent operation required more often and perioperative mortality rate was high. However, the aggressive combined mitral operation in addition to CABG and LV restoration showed the improvement of clinical symptom and quality of life after the surgery.