Effect of active airway warming with a heated-humidified breathing circuit on core body temperature in patients under general anesthesia: a systematic review and meta-analysis with trial sequential analysis.

BACKGROUND: The application of a heated-humidified breathing circuit (HHBC) may reduce respiratory heat loss during mechanical ventilation, but its effect in preventing intraoperative hypothermia is controversial. This study aimed to investigate the effectiveness of HHBC in maintaining the core temperature of patients receiving mechanical ventilation under general anesthesia. METHODS: We searched MEDLINE, Embase, Cochrane library (CENTRAL), and Google Scholar to identify all randomized controlled trials (RCTs) up to February 2022 that compared the intraoperative core temperature in patients with heated humidifier (HH) and other circuit devices. The primary outcome was the intraoperative core temperature at the end of surgery. The weighted mean differences (WMDs) between the groups and their 95% CIs were calculated for each outcome. We performed a trial sequential analysis of the primary outcomes to assess whether our results were conclusive. RESULTS: Eighteen RCTs with 993 patients were included in the analysis. A significantly higher core temperature was observed at the end of surgery in patients with HH than those with no device (WMD = 0.734, 95% CI [0.443, 1.025]) or heat and moisture exchanger (WMD = 0.368, 95% CI [0.118, 0.618]), but with substantial heterogeneity. CONCLUSIONS: Although HHBC did not absolutely prevent hypothermia, this meta-analysis suggests that it can be used as an effective supplemental device to maintain the intraoperative core temperature under general anesthesia. However, considering the substantial heterogeneity and limitations of this study, further well-designed studies are needed to clarify the effectiveness of HHBC.

Repeated endotracheal tube cuff tears during nasotracheal intubation due to nasal cavity orthodontic micro-implant - A case report.

BACKGROUND: Nasotracheal intubation is generally performed for intraoral surgery. CASE: A 34-year-old female patient who underwent orthognathic surgery exhibited repeated endotracheal tube cuff tears during nasotracheal intubation. After intubation, leaks developed, and torn endotracheal cuff was observed in the removed endotracheal tube. Subsequently, re-intubation through the same nasal cavity was performed immediately, but leakage from the torn endotracheal tube cuff was re-observed. A leakage test of the extubated tube revealed air bubbles and leaks near the tube cuff due to the tear. Nasotracheal intubation was performed through the other nasal cavity, and there were no leakage findings or abnormalities. During the course of the surgery, the surgeon noticed that the orthodontic micro-implant deposited in the mid-tube cavity was exposed to the nasal cavity. CONCLUSIONS: We aimed to emphasize caution and discuss the possibility that orthodontic micro-implants that are not confirmed during preoperative evaluation may cause repeated endotracheal tube cuff tears.

Ultrasound-guided treatment of common peroneal neuropathy caused by Baker's cyst: a clinical note - A case report.

BACKGROUND: Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy. CASE: We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait. CONCLUSIONS: In this case, we found the Baker's cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.

Relationship between Surgery under General Anesthesia and the Development of Dementia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the association between exposure to general anesthesia and the development of Alzheimer's disease (AD) and dementia by reviewing and integrating the evidence from epidemiological studies published to date. METHODS: We searched MEDLINE, EMBASE, and Google Scholar to identify all relevant articles up to April 2018 reporting the risk of AD/dementia following exposure to general anesthesia and finally updated in February 2020. We included patients older than 60 or 65 years who had not been diagnosed with dementia or AD before the study period. The overall pooled effect size (ES) was evaluated with a random-effect model. Subgroup analyses were conducted and possibility of publication bias was assessed. RESULTS: A total of 23 studies with 412253 patients were included in our analysis. A statistically significant positive association between exposure to general anesthesia and the occurrence of AD was detected in the overall analysis (pooled ES = 1.11, 95%confidence interval = 1.07-1.15), but with substantial heterogeneity (p χ 2 < 0.001, I 2 = 79.4). Although the overall analysis revealed a significant association, the results of the subgroup analyses were inconsistent, and the possibility of publication bias was detected. CONCLUSION: s. This meta-analysis demonstrated a significant positive association between general anesthesia and AD. However, considering other results, our meta-analysis must be interpreted with caution. Particularly, it should be considered that it was nearly impossible to discriminate the influence of general anesthesia from the effect of surgery itself on the development of AD. Further, large-scale studies devised to reduce the risk of bias are needed to elucidate the evidence of association between general anesthesia and AD. Trial registration. PROSPERO International prospective register of systematic reviews CRD42017073790.

Pharmacological interventions for preventing postoperative nausea and vomiting in adult patients undergoing ambulatory surgery: Protocol for a systematic review and network meta-analysis.

BACKGROUND: We aimed to conduct a systematic review and network meta-analysis (NMA) of published studies to comprehensively compare and rank the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery. METHODS: A systematic and comprehensive search will be performed using the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases, beginning from their inceptions to July and August 2019. Only randomized clinical trials on the efficacy and safety of pharmacologic interventions for preventing nausea and vomiting after ambulatory surgery will be included.The primary endpoints will be the incidences of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) in the following recovery phases: before discharge (recovery phase I and II), after discharge but within 24 hours following surgery, and after discharge, after the initial 24-hour postoperative period.The incidences of delayed post-discharge nausea, post-discharge vomiting, and post-discharge nausea and vomiting, which occur after the initial 24-hour postoperative period, severities of PON, POV, and PONV, use of rescue antiemetics, and the incidence of complete response, as well as safety issues, including complications, such as headache, dizziness, and drowsiness, will be also assessed.We will conduct both pairwise meta-analysis and NMA. We will use surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX). RESULTS: The results of this systematic review and NMA will be published in a peer-reviewed journal. CONCLUSION: This systematic review and NMA will provide comprehensive and convincing evidence summarizing the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery. TRIAL REGISTRATION NUMBER: CRD42018103068.

Myoclonic movement after general anesthesia: A case report and review of the literature.

RATIONALE: Myoclonic movement is a rare side effect after general anesthesia. Since we use various intravenous agents during general anesthesia recently, it is troublesome to find out the exact cause of this neurologic complication. PATIENT CONCERNS: A 31-year-old female patient without any past medical history underwent hip arthroscopic surgery under general anesthesia. DIAGNOSES: Although there was no specific event during the operation, she showed a sudden myoclonic movement confined to left upper extremity in recovery room. INTERVENTIONS: We administered anticonvulsant agents intrvenously, the myoclonus was stopped shortly but recurred over again. As we stopped the patient-controlled analgesia due to nausea, the symptom halted. OUTCOMES: There was no significant abnormality in electroencephalography or brain diffusion magnetic resonance imaging, which was taken after the event. LESSONS: Clinicians should carefully consider the pharmacologic characteristics and neurologic adverse effects of all administered agents when myoclonus occurs after general anesthesia.

Comparison of bolus versus continuous infusion of propofol for procedural sedation: a meta-analysis.

OBJECTIVE: To compare the efficacy and safety of bolus infusion versus continuous infusion for propofol sedation. METHODS: We searched OVID-MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Koreamed, and Kmbase databases to identify all randomized controlled trials that compared bolus infusion with continuous infusion for propofol sedation. We evaluated propofol dose used, procedure, sedation, and recovery time. The incidences of respiratory and cardiovascular complications were also evaluated. RESULTS: A total of 12 studies of 963 patients were included. The required propofol dose was significantly higher in continuous infusion compared with bolus infusion (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.71 to -0.16; I2 = 84%). Sedation time was significantly longer in continuous infusion compared with bolus infusion (mean difference [MD]: -8.58 min; 95% CI: -15.13 to -2.03; I2 = 44%). The recovery time and incidences of desaturation, airway intervention, hypotension, and bradycardia were comparable between bolus and continuous infusion. CONCLUSIONS: Propofol sedation by continuous infusion required a higher dose of propofol compared with bolus infusion, but the recovery time and frequency of complications were similar.