Propofol Infusions and Their Role for Patients Undergoing Surgery for Head and Neck Squamous Cell Carcinoma.

PURPOSE: Propofol infusions may improve survival for patients undergoing surgery for various types of cancer. However, propofol has not been shown to improve survival for all cancer types. The purpose of this retrospective study was to investigate whether propofol infusions during surgery for head and neck squamous cell carcinoma (HNSCC) improved survival. METHODS: A retrospective analysis was performed on all patients undergoing surgery for HNSCC with neck dissection at one institution between June 15, 2017, and April 28, 2021. The primary analysis was performed as a cohort study, with one cohort receiving a propofol infusion and the other cohort not receiving a propofol infusion. A second analysis was performed as a case-control study with matching by cancer staging, human papillomavirus (HPV)/p16 status, pathology margin status, surgical duration within 90 minutes, American Society of Anesthesiologists (ASA) status, and Charlson Comorbidity Index (CCI) within a score of 1. Cases included patients who received a propofol infusion, and controls were patients who did not receive a propofol infusion. RESULTS: For the primary analysis, there was no statistically significant difference in age (p=0.650), BMI (p=0.956), sex (p=0.069), and CCI (p=0.351), but there was a statistically significant difference in ASA status (p=0.003). The time exposed to sevoflurane (MAC >0.3) was significantly higher in the no-propofol group (p<0.001). The duration of surgery was significantly longer in the propofol patient group compared to the no-propofol group (p=0.013). The length of hospital stay was roughly two days longer for the propofol group (p=0.029). There was no difference in survival for patients who did not receive propofol versus those who did (p=0.247), even after adjusting for HPV/p16 tumor marker status (p=0.223). When patients were matched in a case-control approach, there were no differences in age (p=0.956), BMI (p=0.828), CCI (p=1.000), or ASA status (p=1.000). The death rate was not significant between the cases and controls (p=0.311). CONCLUSIONS: This data suggests that propofol may not influence survival in patients with HNSCC. Larger studies are necessary to better characterize the effect of propofol infusions on patients with HNSCC.

Refractory Hyperactive Delirium Without Intravenous Access: A Case Report.

Refractory delirium is a complex, often underdiagnosed, and difficult-to-treat phenomenon. It poses significant challenges to healthcare providers, especially in patients without prior intravenous access. In extreme cases, anesthetic management may be needed to treat refractory delirium. Here, we present a unique case of postoperative hyperactive refractory delirium in a patient without intravenous access, ultimately requiring anesthetic management for resolution.

Problems With Magnetic Resonance Imaging-Conditional Anesthesia Machine During Routine Imaging: A Near-Miss Case Report.

Delivering safe anesthesia care in the magnetic resonance imaging (MRI) scanner presents many unique challenges. We present a case report of how an MRI-conditional anesthesia machine malfunctioned after being pulled toward an MRI scanner during routine imaging, not previously reported in the literature. This near-miss event emphasizes the continued need for staff education and vigilance.