Radial artery catheterization using a novel T-type ultrasound probe: a single-center randomized study.

Ultrasound guidance has been reported to facilitate radial artery catheterization compared with the palpation method. However, a recent meta-analysis showed that there was not significant differences in the first attempt success rate between the long-axis in-plane (LA-IP) method and the short-axis out-of-plane method. In 2023, we started using a novel T-type probe. We can recognize the needle first during the radial artery access with the short-axis view and then dose it with the long-axis view using the T-type probe. Therefore, we hypothesized that the T-type probe-guided method might heighten the first attempt success rate in radial artery catheterization, even for non-expert practitioners, compared with the LA-IP technique. One hundred and fifty adult patients, older than 20 years, ASA I to III, were randomly assigned to the T-type probe-guided group (Group T: n = 75) or the LA-IP group (Group L: n = 75). The primary outcome was the first attempt success rate. The first attempt success rate in Group T (49/71, 69%) was significantly higher than that in Group L (31/68, 46%) (p = 0.0062). The present study showed that the T-type probe might facilitate the radial artery catheterization rather than the LA-IP method.

Comparison of Mill Suss™-guided radial artery catheterization with the long-axis in-plane ultrasound-guided method under general anesthesia: a randomized controlled trial.

Continuous arterial blood pressure measurement is an effective perioperative monitoring method in patients with high-risk comorbidities. Recently, ultrasound guidance has been reported to facilitate radial artery catheterization. A new device, Mill Suss™, has also been developed for visualization of the radial artery and superficial veins using near-infrared laser light. In this study, we hypothesized that the Mill Suss-guided method might reduce the time and the number of attempts required for radial artery catheterization under general anesthesia, as compared to the long-axis in-plane ultrasound-guided method. Seventy-two adult patients aged 20-80 years, ASA physical status I or II, were randomly assigned to the Mill Suss-guided group (Group M: n = 36) or ultrasound-guided group (Group U: n = 36). Primary outcomes were the time required for successful radial artery catheterization and the number of cannulation attempts. There were no significant differences in the characteristics of patients between the two groups. The time required for successful radial artery catheterization was significantly shorter in Group M than in Group U. The number of attempts for successful cannulation was not statistically significantly different between the two groups. However, the results might be different among anesthesiologists well experienced in the ultrasound-guided method.

Recovery of postoperative cognitive function in elderly patients after a long duration of desflurane anesthesia: a pilot study.

Postoperative cognitive dysfunction (POCD) increases morbidity and mortality. The mechanisms underlying POCD remain elusive; however, systemic responses induced by anesthesia and surgery might trigger neuroinflammation and POCD. Desflurane is a preferable volatile anesthetic agent for elderly patients because it facilitates shorter recovery from general anesthesia. The aim of this study was to determine whether quality of emergence and cognitive function in elderly patients undergoing a long duration desflurane anesthesia are better than those in the case of sevoflurane anesthesia. Forty-two patients who were older than 65 years of age and scheduled for surgery of more than 4 h in duration were enrolled in this study. Patients were randomly assigned to a desflurane anesthesia group (D group) and sevoflurane anesthesia group (S group). General anesthesia was maintained with 3.5 % desflurane (D group) and 1.0 % sevoflurane (S group). The Mini-Mental State Examination (MMSE) was used for assessing cognitive function 24 h before and after surgery. Postoperative MMSE score in the D group was significantly improved compared to that in the preoperative period. In conclusion, elderly patients undergoing desflurane anesthesia have significantly better quality of emergence and may have better cognitive function than those in elderly patients undergoing sevoflurane anesthesia.

[Anesthetic management of an adult patient with Ebstein's anomaly].

Ebstein's anomaly is a rare congenital heart disease. An adult patient with Ebstein's anomaly was scheduled for Hetzer's procedure (modified tricuspid valve repair). This 36-year-old female had been diagnosed as Ebstein's anomaly and a patent foramen ovale during pregnancy, and Hetzer's repair procedure for tricuspid valve incompetence and closure of the foramen ovale were performed. The surgical techniques were chosen based on preoperative transthoracic echocardiography and intraoperative transesophageal echocardiography. During the operation, maximal attention was paid to prevent hypoxemia and paradoxical embolization. The patient's postoperative course was successful, and she was discharged from the hospital on the 14th postoperative day. Tricuspid valve regurgitation was reduced from IV to I, and New York Heart Association functional class was improved from III to I in the postoperative period. Hetzer's procedure is a useful technique for tricuspid repair of Ebstein's anomaly. Accurate morphological evaluation of the tricuspid valve by preoperative transthoracic and intraoperative transesophageal echocardiography is very important for the surgeon to plan surgery appropriately. Anesthesiologists should understand transesophageal echocardiography for congenital heart disease well.