Effects of conservative treatment of 2-week rigorous bed rest on muscle disuse atrophy in osteoporotic vertebral fracture patients.

Objective: Osteoporotic vertebral fracture (OVF) is conventionally treated with conservative management such as bed rest, but a relatively prolonged bed rest has the potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of rigorous bed rest affects muscle disuse atrophy in OVF patients. Patients and Methods: A total of 54 OVF patients (16 males; 38 females; mean age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by hospitalization with persistent rehabilitation. Cognitive function, swallowing function, grip strength, and lower extremity circumference were evaluated at three-time points (admission, end of bed rest, and discharge). Results: Of the 51 patients who were able to walk independently before the injury, one patient (2.0%) had to use a wheelchair after the injury. During hospitalization, cognitive function decline was observed in 33.3% of patients, but not in patients with Revised Hasegawa's Dementia Scale score ≥25 at admission. Swallowing function decline was observed in one patient, and none of the patients developed aspiration pneumonia during hospitalization. The grip strength significantly improved both at the end of bed rest (P=0.04) and discharge (P=0.02). Although the lower extremity circumference significantly decreased at the end of bed rest (P<0.01), it was recovered afterward. The lower extremity circumference did not significantly differ between the admission and discharge (P=0.17). Conclusion: Our results suggested that conservative treatment of OVF through an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close monitoring for exacerbation should be performed during the hospital stay.

[Enhancing Antitumor Effects Using Hyperthermia(Including Immune Checkpoint Inhibitor)].

Hyperthermia enhances the efficacies of radiotherapy, chemotherapy, immunotherapy, and molecular targeted therapy. In this study, we investigated whether hyperthermia enhanced the efficacy of immune check point inhibitor therapy. The LLC tumor inoculated in mouse was heated and immunostained, which showed increase in PD-L1 staining post-heating. PD-L1 and HLA class I staining increased after heating samples derived from a case of analinvasion of rectalcancer associated with Lynch syndrome.

[Coronary artery spasm during neurosurgical anesthesia].

We experienced a case of coronary artery spasm during neurosurgical anesthesia. A 69-year-old man was scheduled for craniotomy for cerebello-pontine angle meningioma. He had a history of cigarette smoking, but no history or evidence of ischemic heart disease. After the dura mater was opened, marked ST elevation on the ECG monitor followed by ventricular fibrillation was noticed. After successful resuscitation, the surgery was cancelled. Because the coronary angiography, immediately after surgery, demonstrated normal coronary arteries, coronary artery spasm was considered to be the cause of the ECG change. Possible triggering factor in this case was vagal stimulation due to surgical manipulation. Careful anesthetic management is required to prevent intraoperative coronary artery spasm even in patients without a history of ischemic heart disease during neurosurgery.

Anesthetic management of a patient with narcolepsy.

We report the anesthetic management of a narcoleptic patient performed using sevoflurane-remifentanil with bispectral index (BIS) monitoring. A 22-year-old man, who was diagnosed with narcolepsy at the age of 17, requested endoscopic sinus surgery, under general anesthesia, for chronic allergic rhinitis. On the morning of the day of operation, he took his daily dose of modafinil, used to control narcolepsy. Anesthesia was induced by 5% sevoflurane and maintained with sevoflurane and continuous infusion of remifentanil and 60% oxygen in conjunction with BIS monitoring. BIS values were between 47 and 58. Duration of surgery was 150 min. After surgery, the patient emerged from anesthesia within 10 min and was extubated. His recovery was uneventful. We found the use of BIS monitoring for titrating sevoflurane concentration in a narcoleptic patient is useful for preventing not only oversedation but also intraoperative awareness caused by the preoperative medication.

Awareness during anesthesia: the results of a questionnaire survey in Japan.

PURPOSE: We planned a survey to evaluate the current incidence and risk factors of intraoperative awareness. METHODS: A questionnaire survey was conducted via the Internet. The survey was designed to obtain information regarding cases involving intraoperative awareness in 2008. RESULTS: A total of 172 anesthesiologists answered the survey. The total number of reported anesthetic cases was 85,156. Twenty-four cases of definite or possible awareness were reported by 21 anesthesiologists, of which 14 were cases of definite awareness and ten of possible awareness. The incidence of awareness, including possible awareness, was 0.028%. Propofol was used in 21 cases, sevoflurane in two, and a high dose of fentanyl in one. Bispectral index (BIS) monitoring was used in seven cases (29%). Sixteen patients (67%) were <50 years old, six (26%) were men, and 17 (74%) were women. As the type of surgery, three cases (13%) involved gynecological surgeries and seven (30%) involved cervicofacial surgeries. During surgery, the memory at postural change was preserved in two cases. CONCLUSION: The most surprising finding of this study is that total intravenous anesthesia (TIVA) was used in 21 of the 24 (88%) cases of definite and possible awareness. Although the incidence of intraoperative awareness was compatible with the previous studies, meticulous care should be taken when anesthesia is performed by TIVA for high-risk patients. The results of this survey should be verified, as well as further continuous survey and prospective study, because this study was performed by an anonymous questionnaire survey conducted over only 1-year period.