No abstract available.
Humans ; Hyperglycemia* ; Peritoneal Dialysis*

Since the implementation of the model for end-stage liver disease (MELD) scoring system in 2002, the liver transplantation (LT) society has observed a substantial increase in the number of recipients with renal dysfunction. Intraoperative renal replacement therapy (ioRRT) has emerged as one of the solutions available to manage high-MELD score recipients; however, its usefulness has not yet been proven. To date, we have experienced five cases of simultaneous liver and kidney transplantation (SLKT). Recipients of SLKT tend to have a lower pre-transplant kidney function and the longer operation time mandates a larger amount of fluid than LT alone. Hence, anesthetic care is more prone to be challenged by hyperkalemia, metabolic acidosis, and volume overload, making ioRRT a theoretically valuable intervention. However, in all five cases, recipients were managed without ioRRT, resulting in excellent graft and patient survival. As such, in this case series, we discuss current issues about ioRRT and SLKT.
Acidosis ; Humans ; Hyperkalemia ; Kidney Transplantation* ; Kidney* ; Liver Diseases ; Liver Transplantation ; Liver* ; Renal Replacement Therapy* ; Transplants

A patient with pulmonary alveolar proteinosis underwent whole lung lavage of the right lung. Lavage of the left lung was not immediately possible because of severe hypoxemia. Three days later, after correction of hypoxemia, we re-attempted the left lung lavage. However, the patient had severe hypoxemia (SpO₂< 80%) within a few minutes of performing right one lung ventilation (OLV). On bronchoscopic examination, proper tube location was confirmed. Bronchodilator nebulization and steroid injection were attempted with no effect. While searching for the cause of the hypoxemia, we found that the breath sound from the right lung had become very weak and distant compared with that from initial auscultation. Right pneumothorax was diagnosed on chest X-ray and a chest tube was inserted. After confirming pneumothorax resolution, we re-tried right OLV and were able to proceed with the left lung lavage without signs of aggravating air leak, loss of tidal volume, or severe hypoxemia.
Anoxia ; Auscultation ; Bronchoalveolar Lavage ; Chest Tubes ; Humans ; Lung ; One-Lung Ventilation ; Pneumothorax* ; Pulmonary Alveolar Proteinosis ; Therapeutic Irrigation* ; Thorax ; Tidal Volume

BACKGROUND: There have been few recent reports on the methodological quality of meta-analysis, despite the enormous number of studies using meta-analytic techniques in the field of anesthesia. The purpose of this study was to evaluate the quality of meta-analyses and systematic reviews according to the Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the anesthesia literature. METHODS: A search was conducted to identify all meta-analyses ever been published in the British Journal of Anaesthesia (BJA), Anaesthesia, and Korean Journal of Anesthesiology (KJA) between Jan. 01, 2004 and Nov. 31, 2016. We aimed to apply the AMSTAR and PRISMA checklists to all published meta-analyses. RESULTS: We identified 121 meta-analyses in the anesthesia literature from January 2004 through the end of November 2016 (BJA; 75, Anaesthesia; 43, KJA; 3). The number of studies published and percentage of ‘Yes’ responses for meta-analysis articles published after the year 2010 was significantly increased compared to that of studies published before the year 2009 (P = 0.014 for Anaesthesia). In the anesthesia literature as a whole, participation of statisticians as authors statistically improved average scores of PRISMA items (P = 0.004) especially in the BJA (P = 0.003). CONCLUSIONS: Even though there is little variability in the reporting and methodology of meta-analysis in the anesthesia literature, significant quality improvement in the reporting was observed in the Anaesthesia by applying the PRISMA checklist. Participation of a statistician as an author improved the reporting quality of the meta-analysis.
Anesthesia* ; Anesthesiology ; Checklist* ; Quality Improvement

BACKGROUND: Virtual reality (VR) distraction is a nonpharmacological method to prevent acute pain that has not yet been thoroughly explored for anesthesiology. We present our experience using VR distraction to decrease routine intravenous sedation for patients undergoing preoperative perineural catheter insertion. METHODS: This 1-month quality improvement project involved all elective unilateral primary total knee arthroplasty patients who received a preoperative adductor canal catheter. Clinical data were analyzed retrospectively. For the first half of the month, all patients received usual care; intravenous sedation was administered at the discretion of the regional anesthesiologist. For the second half of the month, patients were offered VR distraction with intravenous sedation upon request. The primary outcome was fentanyl dosage; other outcomes included midazolam dosage, procedure-related pain, procedural time, and blood pressure changes. RESULTS: Seven patients received usual care and seven used VR. In the VR group, 1/7 received intravenous sedation versus 6/7 who received usual care (P = 0.029). The fentanyl dose was lower (median [10th–90th percentiles]) in the VR group (0 [0–20] µg) versus the non-VR group (50 [30–100] µg; P = 0.008). Midazolam use was lower in the VR group (0 [0–0] mg) than in the non-VR group (1 [0–1] mg; P = 0.024). Procedure-related pain was lower in the VR group (1 [1–4] NRS) versus the non-VR group (3 [2–6] NRS; P = 0.032). There was no difference in other outcomes. CONCLUSIONS: VR distraction may provide an effective nonpharmacological alternative to intravenous sedation for the ultrasound-guided placement of certain perineural catheters.
Acute Pain ; Analgesics, Opioid ; Anesthesia, Conduction ; Anesthesiology ; Arthroplasty, Replacement, Knee ; Blood Pressure ; Catheters* ; Fentanyl ; Humans ; Methods ; Midazolam ; Quality Improvement ; Retrospective Studies* ; Ultrasonography

BACKGROUND: Gabapentin and pregabalin are antiepileptic drugs that are also used for chronic pain treatment. This study evaluated the effects of pregabalin and gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 108 candidates for elective laparoscopic cholecystectomy were randomly assigned to gabapentin (n = 36), pregabalin (n = 36), and placebo (n = 36) groups. Patients received 800 mg of gabapentin or 150 mg of pregabalin orally one hour before surgery. Postoperative analgesia was administered by pethidine via patient-controlled analgesia. The amount of opioid consumed, number of nausea events, vomiting, and pain scores at 2, 6, 12, and 24 hours after surgery were recorded. RESULTS: The gabapentin and pregabalin groups had significantly lower pain intensity than the placebo group, and pain intensity in the pregabalin group decreased more compared to the gabapentin group. The mean amount of pethidine consumption in the placebo group was significantly higher than in the gabapentin and pregabalin groups. CONCLUSIONS: A single dose of gabapentin or pregabalin decreased postoperative pain and nausea, as well as vomiting and opioid consumption after laparoscopic cholecystectomy. Moreover, the findings revealed that pregabalin was superior to gabapentin for reducing postoperative pain.
Analgesia ; Analgesia, Patient-Controlled ; Anticonvulsants ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Chronic Pain ; Humans ; Meperidine ; Nausea ; Pain, Postoperative* ; Pregabalin* ; Vomiting

BACKGROUND: Dexmedetomidine is a highly selective central α₂-agonist used as a sedative in pediatric intensive care unit (PICU). However, little is known about the relationship between dexmedetomidine dose and its plasma concentration during long-term infusion. We have previously demonstrated that the sedative plasma dexmedetomidine concentration is moderately correlated with the administered dose in adults (r = 0.653, P = 0.001). We hypothesized that there would be a similar relationship between the sedative dexmedetomidine concentration and administered dose in infants. METHODS: All patients admitted to the PICU at Nagoya City University Hospital, Japan, between November 2012 and March 2013 were eligible for inclusion in the study. Plasma dexmedetomidine concentration was measured by ultra-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS: We measured the plasma dexmedetomidine concentration in 203 samples from 45 patients. Of these, 96 samples collected from 27 patients < 2 years old were included in this study. All patients received dexmedetomidine at 0.12–1.40 µg/kg/h. The median administration duration was 87.6 hours (range: 6–540 hours). Plasma dexmedetomidine concentration ranged from 0.07 to 3.17 ng/ml. Plasma dexmedetomidine concentration was not correlated with the administered dose (r = 0.273, P = 0.007). The approximate linear equation was y = 0.690x + 0.423. CONCLUSIONS: In infants, plasma dexmedetomidine concentration did not exhibit any correlation with administered dose, which is not a reliable means of obtaining optimal plasma concentration.
Adult ; Chromatography, Liquid ; Cohort Studies* ; Critical Illness* ; Dexmedetomidine* ; Humans ; Infant* ; Intensive Care Units ; Japan ; Plasma* ; Prospective Studies* ; Tandem Mass Spectrometry

BACKGROUND: This study aimed to retrospectively evaluate the use of sugammadex in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS: Data were obtained from medical record review of patients who underwent VATS lobectomy from January 2013 to November 2014. Fifty patients were divided into two groups: the sugammadex group (group S, n = 19) was administered sugammadex 2 mg/kg, while the pyridostigmine group (group P, n = 31) received pyridostigmine 20 mg with glycopyrrolate 0.2 mg or atropine 0.5 mg. The primary endpoint measure was the overall incidence of postoperative pulmonary complications including prolonged air leak, pneumonia, and atelectasis. The secondary endpoint measures were the length of postoperative hospital stay and duration of chest tube insertion. RESULTS: The overall incidence of postoperative pulmonary complications in patients in group S was significantly lower compared with that of group P (5 [26.3%] vs. 17 [54.8%]; P = 0.049). Also, the durations of chest tube insertion (5.0 [4.0–7.0] vs. 7.0 [6.0–8.0] days; P = 0.014) and postoperative hospital stay (8.0 [8.0–10.0] vs. 10.0 [9.0–11.0] days; P = 0.019) were shorter in group S compared with group P. Administration of sugammadex was associated reduced with postoperative pulmonary complications (OR: 0.22; 95% CI: 0.05–0.87; P = 0.031). CONCLUSIONS: The use of sugammadex, compared with pyridostigmine, showed a significantly reduced overall incidence of postoperative pulmonary complications and decreased duration of chest tube use and postoperative hospital stay in patients undergoing VATS lobectomy, suggesting that sugammadex might be helpful in improving clinical outcomes in such patients.
Atropine ; Chest Tubes ; Glycopyrrolate ; Humans ; Incidence ; Length of Stay ; Lung Neoplasms* ; Lung* ; Medical Records ; Pneumonia ; Pulmonary Atelectasis ; Pyridostigmine Bromide ; Retrospective Studies ; Thoracic Surgery, Video-Assisted

BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Epinephrine ; Female ; Fentanyl ; Hypotension ; Incidence ; Labor Pain ; Lidocaine ; Nausea ; Pregnancy ; Prospective Studies* ; Shivering ; Vomiting

Tracheobronchial rupture is considered to be a life-threatening condition and most commonly occurs after blunt trauma to the neck or chest. However, single- and double-lumen endotracheal tubes can cause serious airway injury. The recognition of this complication and a knowledge of the possible contributory factors is critical, because failure to do so could result in lethal events. We report the case of a 63-year-old male patient who developed pneumomediastinum three days after routine orotracheal intubation.
Humans ; Intubation ; Intubation, Intratracheal* ; Male ; Mediastinal Emphysema* ; Middle Aged ; Neck ; Rupture ; Subcutaneous Emphysema ; Thorax