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Aquino NJ, Reece-Nguyen TL, Sanchez KJ, Roque RA, Tollinche LE. Perioperative Considerations for Transgender and Gender-Diverse Patients. Anesthesiol Clin 2025; 43:99-126. [PMID: 39890325 DOI: 10.1016/j.anclin.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Due to changes in the cultural, political, and social landscape regarding gender identity, transgender patients often encounter significant levels of transphobia and discrimination within health care environments. As this population grows, anesthesiology professionals are increasingly likely to care for transgender and gender-diverse patients undergoing both gender-affirming and non-gender-affirming procedures. The aim of this review is to equip anesthesiology professionals with a culturally sensitive and evidence-based framework for effectively managing transgender and gender-diverse patients throughout the preoperative, intraoperative, and postoperative phases.
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Affiliation(s)
- Nelson J Aquino
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Travis L Reece-Nguyen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, 453 Quarry Road, Mail Code: 5663, Palo Alto, CA 94304, USA
| | - Kyle J Sanchez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Remigio A Roque
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code - UH2, Portland, OR 97239, USA
| | - Luis E Tollinche
- Department of Anesthesiology and Pain Medicine, The MetroHealth System, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA; Case Comprehensive Cancer Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, Cleveland, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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2
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Kanjia MK, Jooste EH, Illig M, Neifeld Capps J, Eisner C, Fan SZ, Lenarczyk J, Wojdacz R. Optimizing the anesthetic care of patients with aromatic l-amino acid decarboxylase deficiency. Paediatr Anaesth 2025; 35:99-106. [PMID: 39435566 PMCID: PMC11701947 DOI: 10.1111/pan.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/23/2024] [Accepted: 10/07/2024] [Indexed: 10/23/2024]
Abstract
Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, including motor and autonomic dysfunction, hypotonia, and developmental delay, often before the age of one. Until recently, treatment options were limited to symptom control, but the recent approval of the first gene therapy for AADC deficiency in Europe and the UK has provided an alternative to treating symptoms for this disease. Eladocagene exuparvovec is a one-time gene therapy, administered bilaterally to the putamen by magnetic resonance imaging-guided stereotactic neurosurgery. While administration of the gene therapy itself is minimally invasive, the anesthetic management of patients with AADC deficiency is challenging due to the absence of sympathetic regulation secondary to the lack of adrenergic neurotransmitters. Optimal anesthetic management requires an understanding of the complex and heterogeneous nature of the disease. Hemodynamic instability, temperature dysregulation, and hypoglycemia are of primary concern, but there are also challenges regarding intravenous access and airway management. A thorough preoperative assessment is essential and should be guided by the patient's history. Advanced planning is necessary regarding the timing of the procedure schedule and operative plan; meticulous preparation, simulation for the operating room, as well as communication with all perioperative staff members, are crucial. Intraoperatively, utmost care must be taken to protect the skin, maintain body temperature, and to prepare for inotropic and/or glycemic support as needed. Postoperative intensive care management is necessary for consideration of postoperative extubation and provision of supportive care. With careful planning, preparation, and vigilance, patients with AADC deficiency can safely undergo anesthesia.
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Affiliation(s)
- Megha K. Kanjia
- Texas Children's HospitalHoustonTexasUSA
- Baylor College of MedicineHoustonTexasUSA
| | | | | | | | | | | | - Jerzy Lenarczyk
- University Center for Women's and Newborn HealthWarsawPoland
| | - Rafał Wojdacz
- University Center for Women's and Newborn HealthWarsawPoland
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3
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Marrone F, Failli S, Fabbri F, Paventi S, Lepre L, Virno V, Pullano C. Erector Spinae Plane Block Together With Inter-Transverse Process Block for Open Gastrectomy: Case Report. A A Pract 2025; 19:e01918. [PMID: 39898544 DOI: 10.1213/xaa.0000000000001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Fascial plane blocks of the posterior thoracic wall (erector spinae plane [ESP] and intertransverse plane [ITP]) may offer advantages for high-risk patients requiring open abdominal surgery in whom thoracic epidural analgesia (TEA) combined with general anesthesia (GA) may be relatively contraindicated. As a primary anesthesia method, ESP/ITP (paravertebral by proxy) blocks proved effective in a case of open gastrectomy by avoiding airway intervention, mechanical ventilation, and effectively managing visceral pain. This article highlights the use of ESP/ITP blocks in a high-risk patient for whom GA and TEA posed substantial risks, with the patient who experienced favorable perioperative outcomes.
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Affiliation(s)
- Francesco Marrone
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Simone Failli
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Fabio Fabbri
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Saverio Paventi
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Luca Lepre
- Department of Surgery, Santo Spirito Hospital, Rome, Italy
| | - Vincenzo Virno
- Department of Surgery, Santo Spirito Hospital, Rome, Italy
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4
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Marrone F, Fusco P, Paventi S, Tomei M, Pullano C. The Sacral Multifidus Plane Block for Analgesia After Coccygectomy: Case Report. A A Pract 2025; 19:e01919. [PMID: 39898552 DOI: 10.1213/xaa.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Coccygodynia results from traumatic, nontraumatic, or idiopathic causes. Chronic cases resistant to conservative treatments may necessitate surgery. This case report highlights the innovative use of sacral multifidus plane block (S-MPB) for multimodal pain management after a coccygectomy performed under spinal anesthesia. The patient, suffering from chronic coccygodynia due to exostosis, underwent surgical removal of the coccyx and associated fistula. S-MPB was chosen for its simplicity, efficacy, and safety, providing postoperative analgesia without complications. This approach suggests that S-MPB is a promising addition to the pain management arsenal for coccygectomy, warranting further investigation to optimize its application and outcomes.
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Affiliation(s)
- Francesco Marrone
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care, SS Filippo and Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Saverio Paventi
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
| | - Marco Tomei
- From the Department of Anesthesia, Santo Spirito Hospital, Rome, Italy
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5
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Liotiri D, Diamantis A, Zacharoulis D. Comparing Analgesic Efficacies of Combined Fascial Plane Blocks for Postoperative Pain Following Laparoscopic Cholecystectomy. Clin J Pain 2025; 41:e1260. [PMID: 39773875 DOI: 10.1097/ajp.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Affiliation(s)
| | - Alexandros Diamantis
- Department of Hepatobiliary and Pancreas Surgery, IASO Thessalias General Hospital
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6
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Weaver JMJ, Patey SJ. Systemic anti-cancer therapy and anaesthesia: a narrative review. Anaesthesia 2025; 80 Suppl 2:12-24. [PMID: 39776428 DOI: 10.1111/anae.16522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Cancer research has revolutionised the treatment, quality of life and life expectancy of people living with cancer. Systemic anti-cancer treatments have expanded to involve not only cytotoxic drugs, but targeted drugs and immunotherapy. Although highly effective in many patients, these drugs can cause serious and sometimes life-threatening adverse reactions. As part of their treatment, many patients living with cancer will be offered both systemic anti-cancer therapy and surgery, and many patients will undergo recurrent episodes of both with the aims of cure, palliation or prolongation of life expectancy. It is important for anaesthetists to understand the effects of systemic anti-cancer therapy on their patients. METHODS An electronic literature search using was conducted in May 2024 for peer-reviewed articles in English. An initial search of the terms 'anaesthesia' and 'chemotherapy' revealed that existing review literature was tailored towards the neoadjuvant setting and prompted this review to include the complications of targeted therapies, emergency care and intra-operative administration of systemic anti-cancer therapy to reflect this evolving field. A narrative approach was taken to discuss common regimens and their complications. RESULTS The review encompasses a wide range of sub-topics including pharmacology; physiology; peri-operative medicine; specialist surgery; adverse events; and safety. Data from multicentre trials that form the basis of current treatment regimens and practice were prioritised during the selection process. Smaller studies, case series and case reports were included to illustrate the rarer but clinically significant adverse effects of specific therapies. CONCLUSIONS It is important for anaesthetists to have a comprehensive understanding of the effects of systemic anti-cancer therapies, including cytotoxic and immunotherapies. There are many potential toxicities and complications associated with these treatments, particularly in the context of emergency surgery and the administration of cytotoxic drugs within the operating theatre environment.
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Kojima T, Nakahari H, Ikeda M, Kurimoto M. Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study. J Anesth 2025; 39:93-100. [PMID: 39616586 PMCID: PMC11782304 DOI: 10.1007/s00540-024-03436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 11/20/2024] [Indexed: 01/31/2025]
Abstract
PURPOSE The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants. METHODS This pilot interventional study included 10 consecutive infants requiring motor-evoked potentials between January 2023 and March 2024. The motor-evoked potential amplitudes in the upper and lower extremities were recorded twice when general anesthesia was maintained using (1) propofol-based total intravenous anesthesia and (2) 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane + propofol-based total intravenous anesthesia. RESULTS The motor-evoked potential amplitude in the right upper extremity was not significantly different after the addition of a small dose of sevoflurane [192 (75.3-398) μV, 121 (57.7-304) μV, P = 0.19]. All the motor-evoked potential amplitudes in the right lower extremity (quadriceps femoris, anterior tibialis, and gastrocnemius muscles) were significantly attenuated by adding a small dose of sevoflurane (median [interquartile range]: 47.9 [35.4-200] μV, 25.2 [12.4-55.3] μV, P = 0.014; 74.2 [51.9-232] μV, 31.2 [2.7-64] μV, P = 0.0039; 29.8 [20-194] μV, 9.9 [3.8-92.4] μV, P = 0.0039, respectively). Similar results were observed in the left lower extremities. CONCLUSION Adding even 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.
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Affiliation(s)
- Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan.
- Division of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hirofumi Nakahari
- Department of Anesthesia, St. Luke's International Hospital, Tokyo, Japan
| | - Makoto Ikeda
- Department of Clinical Engineering, Aichi Children's Health and Medical Center, Obu, Japan
| | - Michihiro Kurimoto
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Japan
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Goldenberg RM, Gilbert JD, Houlden RL, Khan TS, Makhija S, Mazer CD, Trinacty J, Verma S. Perioperative and periprocedural management of GLP-1 receptor-based agonists and SGLT2 inhibitors: narrative review and the STOP-GAP and STOP DKA-2 algorithms. Curr Med Res Opin 2025:1-17. [PMID: 39871617 DOI: 10.1080/03007995.2025.2458538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/15/2025] [Accepted: 01/20/2025] [Indexed: 01/29/2025]
Abstract
The GLP-1 receptor-based agonists (GLP-1RAs) and SGLT2 inhibitors (SGLT2i) are major twenty first century breakthroughs in diabetes and obesity medicine but there are important safety considerations regarding the perioperative and periprocedural management of individuals who are treated with these agents. GLP-1RAs have been linked to an increased risk of retained gastric contents and pulmonary aspiration while SGLT2i can be associated with diabetic ketoacidosis. This manuscript provides a narrative review of the available evidence for perioperative and periprocedural risks in people prescribed GLP-1RAs and SGLT2i. The authors provide expert opinion-driven recommendations and algorithms on how to safely manage GLP-1RAs and SGLT2i under perioperative/periprocedural settings.
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Affiliation(s)
| | - Jeremy D Gilbert
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Robyn L Houlden
- Division of Endocrinology and Metabolism, Queen's University, Kingston, Canada
| | - Tayyab S Khan
- Division of Endocrinology and Metabolism, St. Joseph's Healthcare Centre, London, Canada
- Department of Medicine, Western University, London, Canada
| | | | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Jill Trinacty
- LMC Diabetes & Endocrinology, Ottawa, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Canada
- Bruyère Continuing Care, Ottawa, Canada
| | - Subodh Verma
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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9
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Weber M, Goss W, Hoffer C, Ogunsulire J, Schafer F. Rhabdomyolysis of Infectious Etiology with Creatine Kinase Above One Million: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2025; 26:e946364. [PMID: 39885682 PMCID: PMC11791690 DOI: 10.12659/ajcr.946364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/20/2024] [Accepted: 11/25/2024] [Indexed: 02/01/2025]
Abstract
BACKGROUND Rhabdomyolysis occurs commonly in hospitalized patients due to many etiologies. It is characterized by elevated creatine kinase, weakness, and myalgias, with severe forms causing electrolyte imbalances. However, many of these patients have a mild disease course with no symptoms. Those with more severe disease often have associated acute kidney injury. When acute kidney injury occurs solely due to rhabdomyolysis, it is unlikely to cause the patient to require renal replacement therapy. Regardless of how common this disease is, little research has been done to determine prognosticating factors for renal recovery in the patients who do require renal replacement therapy. CASE REPORT We present the case a young patient who developed severe kidney damage from rhabdomyolysis, requiring renal replacement, and who had renal recovery in a relatively short time. Our patient's maximum creatine kinase was 1 353 105 IU/L. Yet regardless of this severe elevation, his kidneys showed full recovery in under 3 weeks. CONCLUSIONS We present a case of a patient with rhabdomyolysis and CK above one million. In our literature review, we found that exertion and genetic defects were found to cause CK elevations above one hundred thousand, but infection is perhaps the most common cause of such extreme elevations. Regardless of how high CK is, there are no consistent factors reported in the literature correlating with degree of and rate of renal recovery in these patients.
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Affiliation(s)
- Marshall Weber
- Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - William Goss
- Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Colton Hoffer
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joseph Ogunsulire
- Division of Nephrology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ferdinand Schafer
- Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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10
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Rita C, Flavia P, Anna C, Giuseppe G, Salvatore R, Silvia C, Marinella L, Margherita M, Maria M, Simone S, Helga B. Remimazolam for procedural sedation in gastrointestinal endoscopy: real-life, single center observational study. BMC Gastroenterol 2025; 25:41. [PMID: 39881221 PMCID: PMC11776136 DOI: 10.1186/s12876-025-03636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 01/20/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND AND AIM Remimazolam has proved to be a very promising sedative drug in randomized clinical trials for usage in a wide spectrum of patients, including critically ill ones. The purpose of our study was to verify efficacy and safety of remimazolam for procedural sedation during diagnostic and first level operative endoscopy in a real-world setting. METHODS This single centre prospective study evaluated sedation regimen with remimazolam for EGDS and fentanyl and remimazolam for colonoscopy in consecutive ASA 1-3 patients. RESULTS Seventy-one patients underwent 73 procedures (25 EGDS, 48 colonoscopies) with a total amount of 13.2 ± 8.7 mg and 10.2 ± 6.2 mg of remimazolam administered respectively. In 6 EGDS, rescue sedation with propofol was needed. Transient hypotension was frequent (37%) and no cases of hypoxia occurred. One case of suspected allergy (erythema of the trunk) without anaphylaxis was reported. CONCLUSIONS Procedural sedation can be applied with remimazolam without the use of propofol, obtaining effective sedation in colonoscopies while in EGDS remimazolam alone guarantees the result in a percentage of around 70-75% of cases.
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Affiliation(s)
- Conigliaro Rita
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Pigò Flavia
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy.
- Ospedale Civile di Baggiovara, Viale giardini 1355, Modena, Italy.
| | - Caiazzo Anna
- Gastroenterology Unit, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Grande Giuseppe
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Russo Salvatore
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Cocca Silvia
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Lupo Marinella
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Marocchi Margherita
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Marsico Maria
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Sculli Simone
- Anaesthesiology Department, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Bertani Helga
- Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliero Universitaria Modena, Modena, Italy
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McGeary J, Cafferkey A. Two-person verbal check to confirm tracheal intubation: evaluation of practice changes to prevent unrecognised oesophageal intubation. Br J Anaesth 2025:S0007-0912(25)00010-8. [PMID: 39863468 DOI: 10.1016/j.bja.2025.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/03/2025] [Accepted: 01/03/2025] [Indexed: 01/27/2025] Open
Affiliation(s)
- Joseph McGeary
- Department of Anaesthesiology, St James's Hospital, Dublin, Ireland.
| | - Aine Cafferkey
- Department of Anaesthesiology, St James's Hospital, Dublin, Ireland
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Clariot S, Gras S, Goetz L, Boulloud C, Bonheur J, Vayssiere P, D'Hardemare V, Ravelli C, Dorison N, Devys JM. Case Series of Anesthetic Management of Gene Therapy in Children With Aromatic L-Amino Acid Decarboxylase Deficiency. Paediatr Anaesth 2025. [PMID: 39854129 DOI: 10.1111/pan.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/15/2024] [Accepted: 12/17/2024] [Indexed: 01/26/2025]
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare life-threatening inborn error of neurotransmitter biosynthesis. It is characterized by deficient biosynthesis of neurotransmitters dopamine and serotonin, leading to catecholamines deficiency and sympathetic deprivation, while the parasympathetic system remains functional. Since 2012, gene therapy has led to clinical improvements in symptoms and motor function with a severe phenotype. General anesthesia of children with AADC deficiency is challenging. AIM Describe prolonged anesthesia management of children with aromatic L-amino acid decarboxylase deficiency undergoing stereotactically guided gene therapy. METHODS Prospective reporting of epidemiologic and anesthetics data of four children consecutively undergoing magnetic resonance-guided direct delivery of an AADC vector for gene therapy under general anesthesia. RESULTS General anesthesia was initiated with sevoflurane and ketamine and rocuronium was the neuromuscular blocking agent of choice throughout the procedures. Intraoperative hemodynamic monitoring included an arterial line. All children required low doses of diluted norepinephrine during the intraoperative period. No dysautomic episodes as well as no episode of severe hypotension and no severe hypoglycemia were reported throughout the procedures. Vasopressor support was discontinued for all children at the end of the procedures. Moreover, no peroperative and postoperative effects secondary to AADC vector injection were noted. CONCLUSION Using an anesthetic plan based on atropine, ketamine, sevoflurane, and a titrated infusion of norepinephrine, prolonged anesthesia appeared to be safe and reproductible in this population.
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Affiliation(s)
- Simon Clariot
- Department of Anaesthesiology, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Séverine Gras
- Department of Anaesthesiology, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Laurent Goetz
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Christophe Boulloud
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Julie Bonheur
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Pia Vayssiere
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Vincent D'Hardemare
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
| | - Claudia Ravelli
- Department of Pediatric Neurology, Trousseau Hospital, Paris, France
| | - Nathalie Dorison
- DYSPA Unit, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurosurgery, Adolphe de Rothschild Foundation Hospital, Paris, France
- Department of Pediatric Neurology, Trousseau Hospital, Paris, France
| | - Jean-Michel Devys
- Department of Anaesthesiology, Adolphe de Rothschild Foundation Hospital, Paris, France
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13
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Abbott L, Main M, Wolfe A, Rohwer A, Baranello G, Munot P, Manzur A, Muntoni F, Scoto M. Spinal presentations in children with type 1 spinal muscular atrophy on nusinersen treatment across the SMA-REACH UK network: a retrospective national observational study. BMJ Open 2025; 15:e082240. [PMID: 39842910 PMCID: PMC11784377 DOI: 10.1136/bmjopen-2023-082240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/04/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Prior to the introduction of disease-modifying treatments (DMTs), children with type 1 spinal muscular atrophy (SMA) typically did not survive beyond the age of 2 years; management was mainly palliative. Novel therapies have made this a treatable condition, resulting in increased life expectancy and more time spent upright. Survival and improved function mean spinal asymmetry is a new complication with limited data on its prevalence and severity and no current guidelines on management and treatment. This study aimed to evaluate the spinal presentation and management of type 1 SMA children on nusinersen across the SMA-REACH UK network. METHODS Spinal presentation and management of 80 children (age range 4 months-14 years, median 4 years 2 months) with type 1 SMA on nusinersen across the SMA-REACH UK network were reviewed through retrospective data analysis. RESULTS There were 60 type 1 children who developed a spinal asymmetry, of which 40 had kyphosis and 50 used a supportive thoraco-lumbar-sacral orthosis (TLSO). TLSOs were predominantly a one-piece jacket with abdominal hole, advised to be worn when upright during the day. Reduced neck range of movement was found in 33, 1 of these had plagiocephaly and 5 had torticollis. Of those with reduced neck range of movement, 26 (79%) had spinal asymmetry. Spinal surgery was performed in 7. CONCLUSIONS Our study confirms high prevalence of spinal asymmetry in this cohort, requiring long-term management planning. It provides information on presentation and treatment options, facilitating development of guidelines for these new complications observed in children surviving longer with DMTs.
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Affiliation(s)
| | - Marion Main
- UCL GOS Institute of Child Health, London, UK
| | - Amy Wolfe
- UCL GOS Institute of Child Health, London, UK
| | | | | | - Pinki Munot
- UCL GOS Institute of Child Health, London, UK
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14
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Stilo F, Strumia A, Catanese V, Montelione N, Tomaselli E, Pascarella G, Costa F, Ciolli A, Longo F, Mattei A, Schiavoni L, Ruggiero A, Codispoti FA, Paolini J, Agrò FE, Spinelli F, Carassiti M, Cataldo R. Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study. J Clin Med 2025; 14:601. [PMID: 39860607 PMCID: PMC11766136 DOI: 10.3390/jcm14020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/13/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.
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Affiliation(s)
- Francesco Stilo
- Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (F.S.); (N.M.); (F.A.C.); (F.S.)
- Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (A.C.); (J.P.)
| | - Alessandro Strumia
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Vincenzo Catanese
- Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (F.S.); (N.M.); (F.A.C.); (F.S.)
| | - Nunzio Montelione
- Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (F.S.); (N.M.); (F.A.C.); (F.S.)
- Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (A.C.); (J.P.)
| | - Eleonora Tomaselli
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Giuseppe Pascarella
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Fabio Costa
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Ciolli
- Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (A.C.); (J.P.)
| | - Ferdinando Longo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Alessia Mattei
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Lorenzo Schiavoni
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Ruggiero
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy;
| | - Francesco Alberto Codispoti
- Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (F.S.); (N.M.); (F.A.C.); (F.S.)
| | - Julia Paolini
- Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (A.C.); (J.P.)
| | - Felice Eugenio Agrò
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy;
| | - Francesco Spinelli
- Vascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (F.S.); (N.M.); (F.A.C.); (F.S.)
- Research Unit of Vascular Surgery, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy; (A.C.); (J.P.)
| | - Massimiliano Carassiti
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy;
| | - Rita Cataldo
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy; (A.S.); (E.T.); (G.P.); (F.C.); (F.L.); (A.M.); (L.S.); (F.E.A.); (M.C.); (R.C.)
- Research Unit of Anaesthesia and Intensive Care, Department of Medicine, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy;
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Rissardo JP, Fornari Caprara AL, Bhal N, Repudi R, Zlatin L, Walker IM. Drug-Induced Myoclonus: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:131. [PMID: 39859113 PMCID: PMC11767161 DOI: 10.3390/medicina61010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 01/06/2025] [Accepted: 01/13/2025] [Indexed: 01/27/2025]
Abstract
Background and Objectives: Myoclonus is already associated with a wide variety of drugs and systemic conditions. As new components are discovered, more drugs are suspected of causing this disabling abnormal involuntary movement. This systematic review aims to assess the medications associated with drug-induced myoclonus (DIM). Materials and Methods: Two reviewers assessed the PubMed database using the search term "myoclonus", without language restriction, for articles published between 1955 and 2024. The medications found were divided into classes and sub-classes, and the subclasses were graded according to their level of evidence. Results: From 12,097 results, 1115 were found to be DIM. The subclasses of medications with level A evidence were intravenous anesthetics (etomidate), cephalosporins (ceftazidime, cefepime), fluoroquinolones (ciprofloxacin), selective serotonin reuptake inhibitors (citalopram, escitalopram, paroxetine, sertraline), tricyclic antidepressant (amitriptyline), glutamate antagonist (amantadine), atypical antipsychotics (clozapine, quetiapine), antiseizure medications (carbamazepine, oxcarbazepine, phenytoin, gabapentin, pregabalin, valproate), pure opioid agonist (fentanyl, morphine), bismuth salts, and mood stabilizers (lithium). The single medication with the highest number of reports was etomidate. Drug-induced asterixis is associated with a specific list of medications. The neurotransmitters likely involved in DIM are serotonin, dopamine, gamma-aminobutyric acid (GABA), and glutamate. Conclusions: DIM may be reversible with management that can include drug discontinuation, dose adjustment, and the prescription of a medication used to treat idiopathic myoclonus. Based on the main clinical constellation of symptoms and pathophysiological mechanisms found in this study, DIM can be categorized into three types: type 1 (serotonin syndrome), type 2 (non-serotonin syndrome), and type 3 (unknown).
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Affiliation(s)
- Jamir Pitton Rissardo
- Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA; (A.L.F.C.); (I.M.W.)
| | | | - Nidhi Bhal
- Medicine Department, Jehangir Hospital, Pune 411001, India;
| | - Rishikulya Repudi
- Medicine Department, Apollo Institute of Medical Sciences and Research, Hyderabad 500072, India;
| | - Lea Zlatin
- Neuroscience Department, Ohio State University, Columbus, OH 43210, USA;
| | - Ian M. Walker
- Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA; (A.L.F.C.); (I.M.W.)
- Neurology Department, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
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Qiao W, Liu L, Zhang X, Liu K, Wang L. Heavy gravity combined with light gravity local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in maternal women: a prospective cohort study. BMC Anesthesiol 2025; 25:22. [PMID: 39794686 PMCID: PMC11721320 DOI: 10.1186/s12871-025-02895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 01/06/2025] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Subarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice. METHODS This prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events. RESULTS Data from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women (P = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased (P < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine (P = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine (P = 0.027). CONCLUSIONS Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women.
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Affiliation(s)
- Wei Qiao
- Department of Anesthesiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Linlin Liu
- Department of Anesthesiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xiaoxiao Zhang
- Department of Anesthesiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Kairui Liu
- Department of Anesthesiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China
| | - Lingzhi Wang
- Department of Anesthesiology, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, Jiangsu, China.
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17
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Pillarisetti L, Agrawal DK. Semaglutide: Double-edged Sword with Risks and Benefits. ARCHIVES OF INTERNAL MEDICINE RESEARCH 2025; 8:1-13. [PMID: 39902055 PMCID: PMC11790292 DOI: 10.26502/aimr.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2025]
Abstract
Type 2 Diabetes Mellitus therapy has evolved over the years to now include a new class of therapeutics, semaglutide. This article reviews the mechanism of action and formulation of semaglutide therapy, potential benefits, contraindications, adverse effects, and drug interactions. Oral and subcutaneous semaglutide therapies have shown effectiveness in improving glycemic control, weight loss, and reducing cardiovascular risks associated with diabetes mellitus. Semaglutide has also shown potential in being used as a therapeutic strategy in Alzheimer's disease due to its anti-neuroinflammatory effects and being used to treat polycystic ovary syndrome. However, semaglutide therapy is also associated with concerning adverse effects like acute pancreatitis, anesthetic risks like pulmonary aspiration or residual gastric content, acute kidney injury, acute gallbladder injury, nonarteritic anterior ischemic optic neuropathy and diabetic retinopathy. Contraindications of semaglutide include history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, and pregnancy. Drug interactions to consider with semaglutide therapy include those also used in diabetes treatment, like metformin, as well as anti-psychotics, due to anti-psychotics associated weight gain. The findings of this article emphasize the need for a cross-disciplinary approach to understand the molecular mechanisms and clinical implications of semaglutide on patients with complex medical histories and treatment regimens. The potential anesthetic risks of semaglutide therapy warrant careful consideratiion with ethical concerns. Further studies can assess if there is a need to modify pre-operative guidelines to account for patient using semaglutide and how delayed gastric emptying and constitpation will affect surgical outcomes and complications. While semaglutide therapy for diabetes mellitus has been established, there is a need for extensive research on repurposing semaglutide in neurodegenerative disease treatment.
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Affiliation(s)
- Lekha Pillarisetti
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California 91766 USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California 91766 USA
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El-Boghdadly K, Dhesi J, Fabb P, Levy N, Lobo DN, McKechnie A, Mustafa O, Newland-Jones P, Patel A, Pournaras DJ, Clare K, Dhatariya K. Elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors: a multidisciplinary consensus statement: A consensus statement from the Association of Anaesthetists, Association of British Clinical Diabetologists, British Obesity and Metabolic Surgery Society, Centre for Perioperative Care, Joint British Diabetes Societies for Inpatient Care, Royal College of Anaesthetists, Society for Obesity and Bariatric Anaesthesia and UK Clinical Pharmacy Association. Anaesthesia 2025. [PMID: 39781571 DOI: 10.1111/anae.16541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2024] [Indexed: 01/12/2025]
Abstract
INTRODUCTION Glucagon-like peptide-1 receptor agonists, dual glucose-dependent insulinotropic peptide receptor agonists and sodium-glucose cotransporter-2 inhibitors are used increasingly in patients receiving peri-operative care. These drugs may be associated with risks of peri-operative pulmonary aspiration or euglycaemic ketoacidosis. We produced a consensus statement for the peri-operative management of adults taking these drugs. METHODS This multidisciplinary consensus statement included surgeons, anaesthetists, physicians, pharmacists and people with lived experience relevant to these guidelines. Following the directed literature review, a three-round modified Delphi process was conducted to generate and ratify recommendations. RESULTS Patients taking glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic peptide receptor agonists should: continue these drugs before surgery; have full risk assessment and stratification; and receive peri-operative techniques that may mitigate risk of pulmonary aspiration before, during and after sedation or general anaesthesia. Patients taking sodium-glucose cotransporter-2 inhibitors should omit them the day before and the day of a procedure. All patients should have risks and mitigation strategies discussed with a shared decision-making approach. DISCUSSION Until more evidence becomes available, this pragmatic, multidisciplinary consensus statement aims to support shared decision-making and improve safety for patients taking glucagon-like peptide-1 receptor agonists, dual glucose-dependent insulinotropic peptide receptor agonists and sodium-glucose cotransporter-2 inhibitors during the peri-operative period.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Jugdeep Dhesi
- King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philippa Fabb
- Department of Anaesthesia, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nicholas Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Suffolk, UK
| | - Dileep N Lobo
- Division of Translational Medical Sciences, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew McKechnie
- Department of Anaesthesia, Lewisham and Greenwich NHS Trust, London, UK
| | - Omar Mustafa
- Department of Diabetes, King's College Hospital, London, UK
| | - Philip Newland-Jones
- Department of Diabetes and Endocrinology, University of Southampton, Southampton, UK
| | - Anil Patel
- Department of Anaesthesia, University College London, London, UK
| | - Dimitri J Pournaras
- Bristol Weight Management and Bariatric Service, North Bristol NHS Trust, Bristol, UK
| | | | - Ketan Dhatariya
- Department of Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- University of East Anglia Medical School, Norwich, UK
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Min S, Yoon S, Han J, Seo JH, Bahk JH. A novel technique of blindly positioning bronchial blockers for one-lung ventilation: a prospective, randomized, crossover study. J Cardiothorac Surg 2025; 20:50. [PMID: 39780264 PMCID: PMC11715086 DOI: 10.1186/s13019-024-03276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 12/25/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Several methods for blindly positioning bronchial blockers (BBs) for one-lung ventilation (OLV) have been proposed. However, these methods do not reliably ensure accurate positioning and proper direction. Here, we developed a clinically applicable two-stage maneuver by modifying a previously reported one-stage maneuver for successful insertion of a BB at the appropriate depth and direction in patients requiring lung isolation where a flexible bronchoscope (FOB) is not applicable. METHODS This prospective, randomized, crossover study was conducted at a tertiary university hospital and included 94 patients requiring OLV for elective thoracic surgery under general anesthesia. The patients underwent the one-stage maneuver followed by the two-stage maneuver and vice versa, and the success rates of the two methods were compared. After tracheal intubation, the deflated rigid-angle BB was inserted into the endotracheal tube (ET) until a pre-marked point indicating that the BB was just protruding from the ET tip. To identify the carinal depth without FOB, the BB balloon was inflated and advanced toward the intended side whilst monitoring abrupt changes in peak inspiratory pressure and expiratory tidal volume to indicate placement at the carina. In one-stage maneuver, the BB balloon was deflated and advanced 3 cm further from the estimated carinal depth. During the two-stage maneuver, the same procedure was performed to determine the carinal depth, and the deflated BB was withdrawn and reinserted to a predetermined depth with its tip directed 90 degree toward the target bronchus. The accuracy of BB positioning for both maneuvers was evaluated by a 4-point scale, with grades 1 and 2 considered acceptable for providing OLV. RESULTS BB placement was more accurate in the two-stage maneuver than in the one-stage maneuver [88.0% (81/92) vs. 73.9% (68/92), relative risk (95% confidence interval [CI]), 0.45 (0.23-0.88), P < 0.001]. This improvement was particularly significant when targeting the left main bronchus [84.8% (39/46) vs. 58.7% (27/46), relative risk (95% CI), 0.36 (0.17-0.79), P < 0.001)]. CONCLUSIONS The novel two-stage maneuver significantly improved the success rate of blindly positioning the BB. TRIAL REGISTRATION This study was registered in ClinicalTrials.gov (NCT02981537) on December 05, 2016.
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Affiliation(s)
- Seihee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110 Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jiwon Han
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110 Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Katz J, Bok SS, Dizdarevic A. The Role of Regional Anesthesia in ICU Pain Management. Curr Pain Headache Rep 2025; 29:21. [PMID: 39777576 DOI: 10.1007/s11916-024-01328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the most recent update and summary on the consideration, benefits and application of regional anesthesia in the ICU setting, as it pertains to the management of perioperative pain. RECENT FINDINGS Regional anesthesia and analgesia have become ubiquitous in the perioperative setting, with numerous indications and benefits. As integral part of the multimodal analgesia approach, various regional blocks have been increasingly utilized in critically ill patients. We focus this review on various regional techniques employed for critically ill patients after cardiac, thoracic, and major abdominal surgery, including neuraxial and novel truncal blocks. Effective pain management in critically ill patients poses many challenges and is extremely important. Regional anesthesia, in combination with other analgesia modalities, while still under-utilized, can help reduce acute perioperative pain, stress response, opioid use and related side effects and expedite recovery and improve clinical outcomes.
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Affiliation(s)
- Jared Katz
- Columbia University Medical Center, New York, NY, USA
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El‐Boghdadly K, Desai N, Jones JB, Elghazali S, Ahmad I, Sneyd JR. Sedation for awake tracheal intubation: A systematic review and network meta-analysis. Anaesthesia 2025; 80:74-84. [PMID: 39468765 PMCID: PMC11617133 DOI: 10.1111/anae.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2024] [Indexed: 10/30/2024]
Abstract
BACKGROUND Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation. METHODS We searched for randomised controlled trials of patients undergoing awake tracheal intubation for any indication and reporting: overall tracheal intubation success rate; tracheal intubation time; incidence of arterial oxygen desaturation; and other related outcomes. We performed a frequentist network meta-analysis for these outcomes if two or more sedation regimens were compared between included trials. We also performed a sensitivity analysis excluding trials with a high risk of bias. RESULTS In total, 48 studies with 2837 patients comparing 33 different regimens were included. Comparing overall awake tracheal intubation success rates (38 studies, 2139 patients), there was no evidence suggesting that any individual sedation regimen was superior. Comparing times to successful tracheal intubation (1745 patients, 24 studies), any sedation strategy was superior to placebo. When we excluded trials with a high risk of bias, we found no evidence of a difference between any interventions for time to successful tracheal intubation. Thirty-one studies (1753 patients) suggested that dexmedetomidine and magnesium sulphate were associated with a reduced risk of arterial oxygen desaturation compared with other interventions, but excluding trials with a high risk of bias suggested no relevant differences between interventions. The quality of evidence for each of our outcomes was low. CONCLUSIONS To maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.
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Affiliation(s)
- Kariem El‐Boghdadly
- Department of AnaesthesiaGuy's and St Thomas' NHS Foundation TrustLondonUK
- King's College LondonLondonUK
| | - Neel Desai
- Department of AnaesthesiaGuy's and St Thomas' NHS Foundation TrustLondonUK
- King's College LondonLondonUK
| | | | | | - Imran Ahmad
- Department of AnaesthesiaGuy's and St Thomas' NHS Foundation TrustLondonUK
- King's College LondonLondonUK
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22
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Bruijstens LA, van Eijk LT, Bruhn J. Comment on 'Remimazolam sedation for awake tracheal intubation'. Anaesth Rep 2025; 13:e12337. [PMID: 39759177 PMCID: PMC11695459 DOI: 10.1002/anr3.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2024] [Indexed: 01/07/2025] Open
Affiliation(s)
- L. A. Bruijstens
- Department of Anaesthesia, Pain and Palliative MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - L. T. van Eijk
- Department of Anaesthesia, Pain and Palliative MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - J. Bruhn
- Department of Anaesthesia, Pain and Palliative MedicineRadboud University Medical CenterNijmegenThe Netherlands
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23
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Bruijstens L, Koch R, Van Der Wal R, Van Eijk L, Bruhn J. Remimazolam for Sedation and Trachospray for Topicalization During Flexible Nasal Intubation in a Spontaneously Breathing Patient. Cureus 2025; 17:e77406. [PMID: 39817266 PMCID: PMC11735163 DOI: 10.7759/cureus.77406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2025] [Indexed: 01/18/2025] Open
Abstract
When a difficult airway is anticipated, awake tracheal intubation can be considered. Usually, low doses of sedatives are administered during this procedure for minimal sedation and anxiolysis, such as midazolam and remifentanil. The newly developed ultra-short-acting benzodiazepine remimazolam has a pharmacokinetic profile that is more suitable for titration during awake tracheal intubation than the long-acting midazolam. It can be titrated to effect while spontaneous breathing is preserved. When desired, cessation of administration will result in emergence from sedation in several minutes, but it can also be antagonized with flumazenil if needed. Here we report a case of a difficult airway in which awake nasal flexible intubation was performed using remimazolam for sedation: background infusion of 0.25 mg/kg/h with an initial bolus of 0.1 mg/kg and later extra boli of 0.04 mg/kg if needed. This was supplemented with a low dose of remifentanil (2 mcg/kg/hr). In addition, topical anesthesia of the upper airway was performed using a specifically designed device called the Trachospray, which nebulizes lidocaine into a fine mist that precipitates in the upper airway of the patient upon inhalation. About 4 ml of lidocaine 4% were inhaled via the Trachospray. An additional 2 ml of lidocaine 2% was sprayed via an epidural catheter advanced through the working channel of the endoscope for further topicalization of the epiglottis, vocal cords, and proximal portion of the trachea. This combination led to adequate anxiolysis and sedation, preservation of spontaneous breathing throughout the procedure, good conditions for successful intubation, and amnesia for the endoscopy and intubation. Further research is needed to establish the superiority of any of these techniques in comparison to other accepted methods.
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Affiliation(s)
- Loes Bruijstens
- Anesthesiology and Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, NLD
| | - Rebecca Koch
- Anesthesiology and Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, NLD
| | - Raymond Van Der Wal
- Anesthesiology and Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, NLD
| | - Lucas Van Eijk
- Anesthesiology and Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, NLD
| | - Jörgen Bruhn
- Anesthesiology and Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, NLD
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24
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Simon NB, Mas D Alessandro NM, Lebak K, Serafin J, Barnett KM. Special Populations in Ambulatory Surgery: Oncologic, Lactating, Transgender and Gender Diverse, and Suicidal Ideation. Int Anesthesiol Clin 2025; 63:32-44. [PMID: 39651666 DOI: 10.1097/aia.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2024]
Affiliation(s)
- Natalie B Simon
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicolas Mario Mas D Alessandro
- Department of Anesthesiology and Pain Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kelly Lebak
- Department of Anesthesiology and Pain Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Joanna Serafin
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kara M Barnett
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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25
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Wakabayashi R, Azuma S, Hayashi S, Ueda Y, Iwakiri M, Asamoto M, Uchida K. Potential role of electroencephalographic monitoring for diagnosis and treatment of local anesthetic systemic toxicity during general anesthesia: a case report. JA Clin Rep 2024; 10:80. [PMID: 39731628 DOI: 10.1186/s40981-024-00763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/20/2024] [Accepted: 12/25/2024] [Indexed: 12/30/2024] Open
Abstract
BACKGROUND Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication. Under general anesthesia, neurological signs are often masked, delaying diagnosis and increasing the risk of sudden cardiovascular collapse. Therefore, early detection methods are critically needed. CASE PRESENTATION A 48-year-old male patient (height: 182 cm, weight: 98 kg) underwent resection of a mediastinal goiter. He received 10 mL of 4% lidocaine for topical airway anesthesia and 20 mL of 1% lidocaine with 1:100,000 epinephrine for chest wall anesthesia. Thirty minutes after airway anesthesia, continuous theta waves appeared on the frontal electroencephalogram (EEG), which were enhanced following chest wall anesthesia. These waves transitioned into a repeating pattern and evolved into sharp periodic discharges. After administering 150 mL of 20% lipid emulsion, the EEG normalized. CONCLUSIONS This case highlights that EEG monitoring during general anesthesia may facilitate the early detection of LAST and provide real-time feedback on treatment efficacy.
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Affiliation(s)
- Ryo Wakabayashi
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Seiichi Azuma
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Saori Hayashi
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuji Ueda
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaki Iwakiri
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaaki Asamoto
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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26
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Monikha P, Jagadish PP, Verma A. Extraction of impacted fish bone from the hypopharynx of an infant using video-laryngoscope. BMJ Case Rep 2024; 17:e263301. [PMID: 39730169 DOI: 10.1136/bcr-2024-263301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2024] Open
Affiliation(s)
- Potturu Monikha
- Paediatric Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
| | | | - Ajay Verma
- Paediatric Surgery, All India Institute of Medical Sciences New Delhi, Delhi, India
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27
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Martín Serrano P, Ferraz Pérez A, Medina Hernández C, Prieto Hidalgo V. Erector spinae plane block for obstetric analgesia in a patient with factor XI deficiency: a case report. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:101632. [PMID: 39708971 DOI: 10.1016/j.redare.2024.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2024]
Abstract
Factor XI (FXI) deficiency is a rare bleeding disorder characterized by a quantitative or qualitative deficiency of FXI. The symptoms are highly variable, and the severity and site of bleeding is unpredictable and does not necessarily correlate with FXI levels. FXI deficiency is classified by phenotype: bleeding or non-bleeding, depending on the clinical manifestations. We present the case of a woman in her twenties diagnosed with FXI with a bleeding phenotype. The patient requested labour analgesia, but the haematology department contraindicated neuraxial techniques, given her history. An ultrasound-guided lumbar erector spinae plane (ESP) block was performed, achieving pain relief after 45 min. ESP block could be an alternative to consider when neuraxial analgesia is contraindicated in labour.
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Affiliation(s)
- P Martín Serrano
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Spain.
| | - A Ferraz Pérez
- Servicio de Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Spain
| | - C Medina Hernández
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Spain
| | - V Prieto Hidalgo
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Spain
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28
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Yi S, Li D, Zhang XL, Duan FY, Gao H, Kong MJ. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study. Open Med (Wars) 2024; 19:20241068. [PMID: 39655050 PMCID: PMC11627071 DOI: 10.1515/med-2024-1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 09/14/2024] [Accepted: 09/25/2024] [Indexed: 12/12/2024] Open
Abstract
Objective The aim of this study was to assess the impact of the external oblique intercostal block (EOIB) on early postoperative pain in patients who underwent laparoscopic cholecystectomy. Methods 120 patients were divided into two groups: the EOIB group (Group E) and the control group (Group C). The assessed variables were mainly intraoperative remifentanil usage, numerical rating scale (NRS) pain scores at 0, 1, 2, 4, 6, 12, and 24 h postoperatively, cumulative fentanyl consumption within 24 h postoperatively and within the first-hour post-anesthesia care unit. Results Remifentanil consumption during surgery was significantly reduced in Group E compared to Group C. Postoperative fentanyl requirements were also lower in Group E at 1 and 24 h after surgery. Furthermore, Group E demonstrated significantly lower NRS scores at 0, 1, 2, 4, and 6 h postoperatively and a reduced need for rescue analgesia compared to Group C. However, at 12 h post-surgery, Group E's NRS scores were slightly higher than Group C's. Conclusion The EOIB is associated with reduced pain within the first 24 postoperative hours following laparoscopic cholecystectomy.
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Affiliation(s)
- Shuai Yi
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Dan Li
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Xin-lei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Fen-yu Duan
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Han Gao
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Ming-jian Kong
- Department of Anesthesiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32 Meijian Road, Xuzhou, 221006, Jiangsu, China
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29
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Diawtipsukon S, Moradokkasem W, Chansriniyom N, Nuntnarumit P. Cesarean section with operation on placental support as an adapted EXIT procedure for fetal thyroid goiter: A case report and literature review. Int J Gynaecol Obstet 2024. [PMID: 39636186 DOI: 10.1002/ijgo.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/11/2024] [Accepted: 11/14/2024] [Indexed: 12/07/2024]
Abstract
The ex-utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero-placental-fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource-limited settings.
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Affiliation(s)
- Sanpon Diawtipsukon
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woraluk Moradokkasem
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nareenun Chansriniyom
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pracha Nuntnarumit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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30
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Fang JY, Yamamoto T, Yamamoto S. Propofol-Induced Fasciculations in a Patient With Obstructive Sleep Apnea: A Case Report. Cureus 2024; 16:e75559. [PMID: 39803114 PMCID: PMC11723773 DOI: 10.7759/cureus.75559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 12/11/2024] [Indexed: 01/16/2025] Open
Abstract
We report a case of a 39-year-old male patient who developed propofol-induced fasciculations during the induction of general anesthesia. The patient had a history of moderate obstructive sleep apnea and was intolerant to continuous positive airway pressure therapy. He subsequently underwent the insertion of a hypoglossal nerve stimulator as a viable surgical intervention. The patient had a drug-induced sleep endoscopy that showed a 100% obstruction at the velum and the oropharynx, mainly in the anteroposterior and lateral directions. The patient experienced a smooth induction and emergence from general anesthesia, except for a brief episode of myoclonus-like movement in the bilateral upper extremities after propofol administration. The patient recovered well and reported an improvement in his sleep quality and daytime symptoms.
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Affiliation(s)
- Jaden Y Fang
- Anesthesiology, University of Texas Medical Branch, Galveston, USA
| | - Tomohiro Yamamoto
- Department of Medicine, Gunma University School of Medicine, Maebashi, JPN
| | - Satoshi Yamamoto
- Anesthesiology, University of Texas Medical Branch, Galveston, USA
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31
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VanderWielen BA, Brian Beam W. Perioperative Considerations for Patients on GLP1 Agonists. Adv Anesth 2024; 42:1-26. [PMID: 39443044 DOI: 10.1016/j.aan.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
GlP-1 receptor agonists are a class of medications that are becoming increasingly popular. Large trials have shown that their use provides reliable weight loss in obese patients and improved glycemic control in diabetic patients. Its use also has broader implications for overall metabolic health and has been shown to improve cardiovascular outcomes in high-risk populations. Glucagon-like peptide 1 receptors cause multiple effects in the body through stimulation of receptors expressed in a broad range of tissues including the pancreas, liver, gastrointestinal tract, kidneys, heart, endothelium, muscle, and brain. For the anesthesia professionals the effects of these medications on gastric emptying is important.
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