Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis

Remimazolam has been suggested to improve the maintenance of hemodynamic stability when compared with other agents used for general anesthesia. This study aimed to compare the effects of remimazolam and sevoflurane anesthesia on hemodynamic stability in patients undergoing robotic gastrectomy. We retrospectively reviewed the electronic medical records of 199 patients who underwent robotic gastrectomy with sevoflurane (n = 135) or remimazolam (n = 64) anesthesia from January to November 2021. Propensity scores were used for 1:1 matching between the groups. The primary outcome was the difference in use of intraoperative vasopressors between groups. Secondary outcomes included differences in incidence and dose of vasopressors, as well as intraoperative hemodynamic variables, between groups. Remimazolam anesthesia was associated with a significantly less frequent use of ephedrine (odds ratio (OR): 0.13; 95% confidence interval (CI): 0.05-0.38, p < 0.001), phenylephrine (OR: 0.12; 95% CI: 0.04-0.40, p < 0.001), and any vasopressor (OR: 0.06; 95% CI: 0.02-0.25, p < 0.001) compared with sevoflurane anesthesia. Remimazolam anesthesia enables better maintenance of hemodynamic stability than sevoflurane anesthesia. Thus, remimazolam anesthesia may be beneficial for patients who are expected to experience hypotension due to the combined effects of CO2 pneumoperitoneum and the head-up position utilized during robotic gastrectomy.ope

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.ope

Effects of Deep Neuromuscular Block during Robot-Assisted Transaxillary Thyroidectomy: A Randomized Controlled Trial

The occurrence of significant pain and paresthesia after robot-assisted transaxillary thyroidectomy has been reported, and some patients experience chronic symptoms even three months after surgery. This study scrutinized the effects of deep neuromuscular block during robot-assisted transaxillary thyroidectomy on postoperative pain and sensory changes. In this single-blinded, prospective, randomized, controlled trial, 88 patients who underwent robot-assisted transaxillary thyroidectomy were enrolled and randomly allocated to either the moderate or deep neuromuscular block groups. Study endpoints included postoperative pain, paresthesia, and sensory change after surgery. The linear mixed models for numeric rating scale pain scores in the chest, neck, and axilla all showed significant intergroup differences over time (p = 0.003 in chest; p = 0.001 in neck; p = 0.002 in axilla). In the post hoc analysis with Bonferroni correction, the pain scores of the chest, neck, and axilla were significantly lower in the deep neuromuscular block group on postoperative day one compared to the moderate neuromuscular block group (adjusted p < 0.001 in chest, neck, and axilla). This study demonstrated that deep neuromuscular block could reduce postoperative pain after robot-assisted transaxillary thyroidectomy. However, it could not demonstrate that deep neuromuscular block reduces paresthesia or hypoesthesia after the surgery.ope

Protocol-resistant critical care?

ope

Restricting resident work hours.

ope

Does the type of anesthetic agent affect remifentanil effect-site concentration for preventing endotracheal tube-induced cough during anesthetic emergence? Comparison of propofol, sevoflurane, and desflurane

STUDY OBJECTIVE: To investigate whether the type of anesthetic agent administered affects the antitussive effect of remifentanil. DESIGN: Prospective randomized study. SETTING: Operating room of a university hospital. PATIENTS: 78 ASA physical status 1 and 2 women, aged 20 to 65 years, who were scheduled to undergo a thyroidectomy. INTERVENTIONS: Patients were randomly assigned to three groups to receive anesthesia with propofol (Group P), sevoflurane (Group S), or desflurane (Group D). The main anesthetics were titrated to maintain a target Bispectral Index for hypnosis of 40 to 60. Remifentanil was administered via effect-site target-controlled infusion (TCI). To determine the effective remifentanil effect-site concentration (Ce) to suppress coughing in each group, the up-and-down sequential allocation design was used. MEASUREMENTS: The half maximal effective concentration (EC50) values of remifentanil for preventing coughing in the groups were estimated using isotonic regression and compared among the groups. MAIN RESULTS: The EC50 of remifentanil for cough suppression in Group P [1.60 ng/mL (98.3% CI, 0.92-1.75 ng/mL)] was statistically lower than in Group D [1.96 ng/mL (98.3% CI, 1.81-2.50 ng/mL)]. The EC50 in Group S was 1.75 ng/mL (98.3% CI, 1.39-2.13 ng/mL), which was higher than in Group P and lower than in Group D, but did not differ significantly from either group. CONCLUSIONS: Remifentanil administration for cough suppression during emergence should be customized to the anesthetic agent.ope