Limited effect of sugammadex on postoperative pulmonary complications in patients undergoing spine surgery in prone position intraoperatively: A retrospective analysis of matched cohort data.

Postoperative pulmonary complications (PPCs) increase postoperative mortality, hospital stays, and healthcare costs. Whether the use of sugammadex could reduce PPCs remains controversial. This study aimed to determine if sugammadex could more effectively reduce PPCs than acetylcholinesterase inhibitor (AChEi) in patients who had undergone spine surgery, in prone position intraoperatively. From March 2019 to February 2021, adult patients who underwent elective spine surgery were eligible. Primary outcomes were PPCs (including atelectasis on chest radiograph, pneumonia, acute respiratory distress syndrome, and aspiration pneumonitis) and respiratory failure that occurred within 28 days after surgery. Secondary outcomes were length of hospital stay, in-hospital death, and readmission rate within 30 days. Patients were divided into 2 groups (Sugammadex group and AChEi group) and compared by 1:1 propensity score matching. Of a total of 823 patients who underwent spinal surgery, 627 were included. After 1:1 propensity matching, 142 patients were extracted for each group. PPCs occurred in 9 (6.3%) patients in both groups (P = 1.000). Respiratory failure occurred in 7 (4.9%) patients in the Sugammadex group and 5 (3.5%) patients in the AChEi group (P = .77). There was no significant difference in secondary outcomes between the 2 groups. Although there have been some evidences showing that the use of sugammadex can attenuate the development of PPCs, this study did not show positive effects of sugammadex on patients who underwent spine surgery in the prone position.

Comparison between pressure-controlled and manual ventilation during anesthetic induction in patients with expected difficult airway: A prospective randomized controlled trial.

BACKGROUND: Gastric insufflation can cause gastric regurgitation, which may be exacerbated in patients who are expected to have difficult airways. The purpose of this study was to investigate the difference in respiratory parameters and the frequency of gastric insufflation according to the ventilation mode during the anesthestic induction on patients who were predicted to have difficult facemask ventilation. METHODS: A total of eighty patients with expected airway difficulties were included. Patient were allocated to 2 groups (n = 40 each). In the manual ventilation group, ventilation was performed by putting a mask on the patient's face with 1-hand and adjusting the pressure limiting valve to 15 cm H2O. In the pressure-controlled ventilation group, a mask was held in place using 2-handed jaw-thrust maneuver. The pressure-controlled ventilation was applied and peak inspiration pressure was adjusted to achieve a tidal volume of 6 to 8 mL/kg. The primary outcome was the difference of the peak airway pressure between 2 groups every 30 seconds for 120 seconds duration of mask ventilation. We also evaluated respiratory variables including peak airway pressure, End-tidal carbon dioxide and also gastric insufflation using ultrasonography. RESULTS: The pressure-controlled ventilation group demonstrated lower peak airway pressure than the manual ventilation group (P = .005). End-tidal carbon dioxide was higher in the pressure-controlled ventilation group (P = .012). The incidence of gastric insufflation assessed by real-time ultrasonography of the gastric antrum was higher in the manual ventilation group than in the pressure-controlled ventilation group [3 (7.5%) vs 17 (42.5%), risk ratio (95% confidence interval): 0.06 to 0.56, P = .003]. CONCLUSIONS: Pressure-controlled ventilation during facemask ventilation in patients who were expected to have difficult airways showed a lower gastric insufflation rate with low peak airway pressure compared to manual ventilation.

Burst stimulation for refractory angina pectoris - A case report.

BACKGROUND: Refractory angina pectoris (RAP) is a chronic, severe chest pain associated with coronary artery disease that cannot be resolved using optimal medical or surgical approaches. Spinal cord stimulation (SCS) is a suitable treatment option. Conventional waveforms of SCS have shown a potent effect on the tempering of RAP. However, SCS is associated with undesired paresthesia. The new burst SCS waveforms have been reported to have fewer adverse effects. CASE: We reviewed a case in which RAP was successfully treated with burst SCS in a middle-aged male, with a tonic waveform employed for breakthrough pain as needed. CONCLUSIONS: Appropriate use of tonic and burst stimulations according to the symptoms is expected to maximize the effect of relieving chest pain induced by RAP.

Development of pre-procedure virtual simulation for challenging interventional procedures: an experimental study with clinical application.

Background: Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm fluoroscope although it is sometimes difficult for even experienced clinicians to understand the modified three-dimensional anatomy as a two-dimensional X-ray image. To overcome these difficulties, the development of a virtual simulator may be helpful. Therefore, in this study, the authors developed a virtual simulator and presented its clinical application cases. Methods: We developed a computer program to simulate the actual environment of the procedure. Computed tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data were used for the simulations. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, the authors searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified. Results: For the simulations, the CT DICOM data of patients who visited the outpatient clinic was used. When the patients revisited the clinic, images similar to the simulated images were obtained by manipulating the C-arm. Transforaminal epidural injection, which was difficult to perform due to severe spinal deformity, and the challenging procedures of the superior hypogastric plexus block and Gasserian ganglion block, were successfully performed with the help of the simulation. Conclusions: We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.