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.

Incidence of perioperative hypotension in patients undergoing transurethral resection of bladder tumor after oral 5-aminolevulinic acid administration: a retrospective multicenter cohort study.

PURPOSE: Tumors can be visualized using 5-Aminolevulinic acid hydrochloride (5-ALA) during transurethral resection of bladder tumors (TURBT). Hypotension is an adverse effect of 5-ALA; however, its incidence and morbidity rates are unknown. This study aimed to describe the incidence of perioperative hypotension and identify risk factors for hypotension among patients after 5-ALA administration in TURBT. METHODS: This retrospective multicenter cohort study was conducted at three general hospitals in Japan. Adult patients who underwent elective TURBT after 5-ALA administration between April 2018 and August 2020 were included. The primary outcome was the incidence of perioperative hypotension (mean blood pressure < 65 mmHg). The secondary outcomes were the use of vasoactive agents and adverse events, including urgent intensive care unit (ICU) admission. Multivariate logistic regression analysis was performed to investigate risk factors of the incidence of intraoperative hypotension. RESULTS: The median age of 261 patients was 73 years. General anesthesia was induced in 252 patients. The intraoperative hypotension was observed in 246 (94.3%) patients. Three patients (1.1%) were urgently admitted to the ICU for continued vasoactive agent use after surgery. All three patients had renal dysfunction. Multivariate logistic regression analysis revealed that general anesthesia was significantly associated with intraoperative hypotension (adjusted odds ratio, 17.94; 95% confidence interval, 3.21-100.81). CONCLUSION: The incidence of hypotension in patients undergoing TURBT after 5-ALA administration was 94.3%. The incidence of urgent ICU admission with prolonged hypotension was 1.1% in all patients with renal dysfunction. General anesthesia was significantly associated with intraoperative hypotension.

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.

[Perioperative management of a patient with primary adrenal insufficiency who underwent general anesthesia twice].

Perioperative corticosteroid supplementation is generally applied in patients with primary adrenal insufficiency or treated with long-term corticosteroid. Currently, appropriate dose and timing of corticosteroid were revised. A 77-year-old woman with primary adrenal insufficiency underwent transurethral resection of bladder tumor (operation 1) and mastectomy (operation 2). In both operations, we supplied stress dose of hydrocortisone on the operative day (100 mg x day(-1) of hydrocortisone for operation 1 or 300 mg x day(-1) of hydrocortisone for operation 2) and decreased gradually in one day (operation 1) or in three days (operation 2), respectively. No remarkable symptoms of adrenal deficiency and side effects of corticosteroid during perioperative period were observed. According to current recommendation, the dose of corticosteroid we used could be smaller. Perioperative management of adrenal insufficiency is still controversial, and further investigation is necessary.

[Anesthetic management with total intravenous anesthesia for intraoperative wake-up test in pediatric scoliosis surgery].

A 12-year-old girl with severe scoliosis underwent an operative procedure for correction of her spine deformity. Spinal cord injury is one of the most feared complications of scoliosis surgery. Therefore, it is necessary to detect spinal injury as early as possible. Intraoperative wake-up test is used to monitor spinal cord function during surgery. We used an intraoperative wake-up test with the concept of target-controlled infusion and total intravenous anesthesia (propofol and remifentanil). The use of Bispectral Index monitoring as a measure of depth of anesthesia enabled the patient to awake rapidly and consequently we did an immediate evaluation of muscle strength of lower extremities.

[Pulmonary edema due to laryngospasm immediately after extubation].

We describe a case of negative pressure pulmonary edema (NPPE) followed by laryngospasm occurred immediately after extubation. A 56-year-old man with a tumor at the site of ureteroneocystostomy underwent left ureterectomy and partial resection of the neobladder under general anesthesia. The tracheal intubation was difficult with glade 3 of Cormack classification. Anesthesia was maintained with sevoflurane, nitrous oxide, and oxygen. After fully awake extubation, the upper airway obstruction due to laryngospasm was observed. A nasal airway was inserted, but face mask ventilation was impossible. Ventilation became possible with SpO2 of around 40%, and spontaneous respiration appeared. The patient was nasally intubated with a fiberoptic bronchoscope. Furosemide was administered in ICU and mechanical ventilation with 5cmH2O PEEP was started. Seventeen hours later, the pulmonary edema disappeared and he was successfully extubated without any complications. It was warned that laryngospasm would occur even after the full emergence, leading to NPPE.

[Anesthetic management of tracheobronchial stent insertion and extracorporeal lung assist (ECLA)].

We experienced eight cases of general anesthesia for tracheobronchial stent insertion. All stents were Ultraflex stent (Boston Scientific, Tokyo), and they were inserted guided by bronchofiberscopy under general anesthesia. Anesthesia was induced with patients under spontaneous breathing, and we inserted a tracheal tube or a laryngeal mask airway. Anesthesia was maintained with propofol and sevoflurane. In four cases with severe tracheobronchial stenosis, we used venovenous extracorporeal lung assist (ECLA) before general anesthesia induction. Oxygenation during stent insertion was well-maintained in all patients. We must evaluate the severity of tracheobronchial stenosis preoperatively. In high risk cases anticipated of airway obstruction, ECLA should be used for safe anesthetic management.