Hasil untuk "Anesthesiology"

Dandan Luo, Manman Luo, Zhaojun Qiu et al.

ObjectiveTo develop a multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components based on the distraction model, evaluate its efficacy in alleviating preoperative anxiety in preschool children, and provide an evidence-based non-pharmacological intervention strategy for the clinical management of preoperative anxiety in this population.MethodsThe multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components program was constructed via literature review, the Delphi method, and a pre-experiment. A total of 128 preschool children undergoing elective surgery at the Affiliated Hospital of Zunyi Medical University from November 2024 to July 2025 were randomly assigned to either a control group (receiving routine nursing care) or an experimental group (receiving routine nursing care combined with multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components). The Simplified Modified Yale Preoperative Anxiety Scale (m-YPAS-SF), Modified Behavioral Pain Scale (MBPS), Induction Compliance Checklist (ICC), and electrocardiographic monitoring were utilized to assess anxiety levels, anesthetic procedural pain, anesthesia compliance, and heart rate at three time points: pre-intervention (T0), post-intervention (T1), and during anesthesia induction (T2).ResultsNo statistically significant differences were observed in general characteristics (gender, age, surgical approach, preference for culturally familiar cartoon images) between the two groups (P > 0.05). At T1 and T2, the experimental group exhibited significantly lower anxiety scores than the control group (P < 0.05). During anesthesia induction, the experimental group had a lower MBPS score and a superior ICC score compared with the control group (P < 0.05). Additionally, the experimental group demonstrated significantly lower heart rates at T1 and T2 than the control group (P < 0.05).ConclusionThe multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components effectively mitigates preoperative anxiety, reduces anesthetic procedural pain, and improves anesthesia compliance in preschool children in this single-center study, which suggests its potential clinical applicability and warrants further validation for wider promotion.

Wei Liu, Yi Yu, Yi He et al.

Abstract Background Lidocaine is a traditional local anesthetic, which has been reported to trigger apoptosis through the mitochondrial pathway, independent of death receptor signaling. Cuproptosis is a copper triggered mitochondrial cell death mode. In this study, we explored the biological effects of lidocaine on cuproptosis in Hep-2 cells and studied the relevant mechanisms. Methods quantitative RT-PCR was used to measure the expression level of long noncoding RNA (IncRNA) DNMBP-AS1. DNMBP-AS1 siRNA (si-DNMBP-AS1) were transfected into Hep-2 cells to verify the roles of DNMBP-AS1 in cuproptosis. 24 h treatment with 20 nM elesclomol and 2 µM CuCl2 was performed to promote the occurrence of Cuproptosis. Cell proliferation, migration and apoptosis assays ware utilized to analyze biological effect of lidocaine and DNMBP-AS1 on Hep-2 cells. Active caspase-3 were also determined after treatment. Results DNMBP-AS1 was significantly upregulated during cuproptosis in Hep-2 cells. The si-DNMBP-AS1 significantly increased the cell viability with nonactivated caspase-3, promoted the cell migration and suppress the cuproptosis. Lidocaine was cytotoxic to the Hep-2 cells in a dose- and time-dependent manner. Exposure to 10 µM of lidocaine for 24 h did not reduce the viability or activated the caspase-3, but significantly increased the expression of DNMBP-AS1, and promote the cuproptosis. Anymore, si-DNMBP-AS1 reversed the pro-cuproptosis function of lidocaine. Conclusions lidocaine was cytotoxic to Hep-2 cells in a time- and dose-dependent manner, promoted the cuproptosis through up-regulating DNMBP-AS1. The results of this study offered initial optimism that lidocaine could be used in an adjuvant or neoadjuvant fashion in cancer treatment.

Medeni Arpa, Bayram Şen, Leyla Kazancıoğlu et al.

Abstract Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has posed a significant global public health challenge, with long-term sequelae such as post-COVID-19 syndrome continuing to burden health systems. Tobacco use, a major preventable cause of morbidity and mortality, impairs the immune response and exacerbates respiratory diseases, including COVID-19. Passive smoking, an important but often overlooked public health problem, exposes non-smokers to harmful health risks and may contribute to worse outcomes in respiratory disease. This study aims to investigate the relationship between smoking exposure, including passive smoking, and the severity of COVID-19 using urinary cotinine levels to provide objective insights into a critical public health issue. This prospective observational study was conducted over six months in 2021 in the ICU of a tertiary care hospital. Forty-two patients were divided into four groups based on smoking and COVID-19 status: non-smoker/non-COVID-19, smoker/non-COVID-19, non-smoker/COVID-19, and smoker/COVID-19. COVID-19 diagnosis was confirmed by RT-PCR and/or imaging. Data collected included demographic information, clinical scores [APACHE II, mSOFA, GCS], respiratory function [stPaO2/FiO2 ratio], arterial blood gas parameters and routine laboratory findings. Urinary cotinine levels were measured by ELISA and normalised to spot urine creatinine levels to ensure accuracy. Urine cotinine levels were highest in the smoker/COVID-19 group and significantly higher than in the smoker/non-COVID-19 and non-smoker/COVID-19 groups (p = 0.010 and p = 0.002, respectively). Surprisingly, non-smoker/non-COVID-19 patients also had elevated cotinine levels, suggesting exposure to passive smoking. The stPaO2/FiO2 ratio was significantly lower in smoker/COVID-19 patients (p < 0.001), indicating impaired lung function. This study highlights the detrimental effects of smoking exposure, including passive smoking, on the severity of COVID-19. Elevated cotinine levels in non-smokers/non-COVID-19 patients emphasize the widespread public health impact of passive smoking and highlight the need for stronger policies and interventions to minimize tobacco exposure. Addressing both active and passive smoking is critical to improving public health outcomes and reducing the burden of respiratory diseases such as COVID-19. Further research is essential to validate these findings and to inform evidence-based public health strategies.

Johanna K. R. von Mackensen, Ahmed El Shazly, Felix Schoenrath et al.

Riad Abdel Jalil, Ali Dabous, Almu’atasim Khamees et al.

Abstract Background Lung cancer is the second most diagnosed cancer and the leading cause of cancer deaths worldwide. Surgical lung resection is the best treatment modality in the early stages of lung cancer as well as in some locally advanced cases. Postoperative air leak is one of the most common complications after pulmonary resection with incidence ranging between 20 and 33%. The majority of air leaks seal, within 5 days after surgery, on their own by conservative management. However, at least 5% of patients still have prolonged air coming out from the residual lung at discharge. This report describes the management of a thin lady with right lung cancer who underwent a right lower lobectomy and then suffered from a delayed air leak 7 weeks after surgery and required extensive thoracic and general surgery collaboration. Case presentation A 72-year-old heavy smoker female patient diagnosed with stage I lung cancer underwent right robotic-assisted thoracoscopic surgery converted to thoracotomy because of a fused fissure, right lower lobectomy, and mediastinal lymphadenectomy presented with delayed air leak 49 days after surgery. VATS decortication and mechanical pleurodesis were done 2 weeks after unsuccessful conservative treatment. Still, the lung failed to expand four weeks later so the patient was sent to surgery; she is underweight (BMI of 18) with not many options for a big flap to fill the chest cavity empty space. Accordingly; the decision was to use multiple pedicle flaps; omentum, intercostal muscle, and serratus anterior muscle to cover the bronchopleural fistulas and fill the pleural space in addition to mechanical and chemical pleurodesis. Full expansion of the lung was obtained. The patient was discharged on Post-Operative day 5 without remnant pneumothorax. Conclusions Air leaks After lobectomy usually presents directly postoperatively; various management options are available ranging from conservative and minimally invasive to major operative treatment. We presented what we believe was unusual delayed bronchopleural fistula post-lobectomy in a thin lady which demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care till treated and complete recovery.

Masoud Janipour, Shahin Bastaninejad, Alireza mohebbi et al.

Abstract Background Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. Methods Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. Results Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. Conclusion In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.

Yu Chen, Ziyou Liu, Jun Fang et al.

Rabie Soliman, Abdelbadee Yacoub, Assem A M Elbiaa

Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy. Methods: The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level. Results: The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 (P < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 (P < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups (P = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group (P = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group (P = 0.005, P = 0.012, P = 0.033, respectively). Conclusion: Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.

Rashmi Soori, Aanchal Dixit, Prabhat Tewari et al.

Hemolytic anemia and right ventricular outflow tract obstruction following device closure of ruptured sinus of Valsalva have seldom been reported in isolated case reports, and exact incidence is not known. A gentleman presented with severe delayed hemolytic anemia following the use of cocoon duct occluder for ruptured sinus of Valsalva. Right ventricular outflow tract obstruction of unclear etiology was also reported on transthoracic echocardiography, necessitating retrieval of the device and surgical closure of the defect. Intraoperative transesophageal echocardiography (TEE) showed right ventricular outflow obstruction by the cocoon device itself with a normal pulmonary valve. In this report, we emphasize that improper device selection for closure of ruptured sinus of Valsalva aneurysm, may lead to delayed leaks across the device, which can gradually progress causing hemolytic anemia and high gradient across the right ventricular outflow tract. Intraoperative TEE helped to delineate the cause of right ventricular outflow tract obstruction.

Jing Jin, Fuquan Fang, Wei Gao et al.

The vascular endothelial glycocalyx is a dense, bush-like structure that is synthesized and secreted by endothelial cells and evenly distributed on the surface of vascular endothelial cells. The blood-brain barrier (BBB) is mainly composed of pericytes endothelial cells, glycocalyx, basement membranes, and astrocytes. The glycocalyx in the BBB plays an indispensable role in many important physiological functions, including vascular permeability, inflammation, blood coagulation, and the synthesis of nitric oxide. Damage to the fragile glycocalyx can lead to increased permeability of the BBB, tissue edema, glial cell activation, up-regulation of inflammatory chemokines expression, and ultimately brain tissue damage, leading to increased mortality. This article reviews the important role that glycocalyx plays in the physiological function of the BBB. The review may provide some basis for the research direction of neurological diseases and a theoretical basis for the diagnosis and treatment of neurological diseases.

Xin Xu, En Zhou, Jun Zheng et al.

BackgroundN6-methyladenosine (m6A) RNA modification plays a critical role in gastric cancer (GC). However, the relationship between the m6A “eraser”, FTO, and ALKBH5, and the prognosis of GC still remains unclear. This study aimed to evaluate the effect of FTO and ALKBH5 on the prognosis of patients and their potential roles in GC.Materials and MethodsA total of 738 GC samples with clinical information obtained from two independent datasets were included and divided into training set and testing set. Differential expression analysis of the m6A “eraser” related genes was performed. The LASSO Cox regression model was constructed to analyze the m6A “eraser” related risk genes. The univariate and multivariate Cox regression model were employed to identify the independent prognostic factors. Kaplan-Meier method was used for survival analysis. A nomogram model was then carried out to predict the prognosis of GC patients. Additionally, GO and KEGG analyses were conducted to identify the potential role of the m6A “eraser” related genes in GC. The relative proportion of 22 different genotypes in immune infiltrating cells was calculated by CIBERSORT algorithm.ResultsIn total, nine m6A “eraser” related risk genes and risk scores were obtained and calculated. Patients in high-risk group demonstrated significantly worse prognosis than those in low-risk group. Age, stage, and risk score were considered as independent prognostic factors. The nomogram model constructed accurately predicted the 3-year and 5-year overall survival (OS) of patients. Furthermore, m6A “eraser” might play a functional role in GC. The expression of m6A “eraser” leads to changes in tumor immune microenvironment.ConclusionsFTO and ALKBH5 showed association with the prognosis of GC. The m6A “eraser” related genes, which is considered as a reliable prognostic and predictive tool, assists in predicting the OS in GC patients.

Danny D. Bui, Shyamal R. Asher

Succinylcholine is a commonly used medication in all aspects of anesthetic care, and there are a number of known side effects and complications associated with its use. However, when succinylcholine is used emergently, anesthesia providers must remain vigilant to undiagnosed conditions that pose additional risks to patients. We report the use of succinylcholine to treat acute, refractory laryngospasm after extubation leading to prolonged neuromuscular paralysis. There are unique challenges presented by this case including the risk of anesthesia awareness with recall due to the cognitive biases that prevent the clinical diagnosis of pseudocholinesterase deficiency.

Iryna Kozlovska, Yurii Kozlovskiy, Inna Timokhina et al.

The main idea of this research was to determine the effectiveness of holding the unilateral spinal anesthesia in comparison with total, positive and negative effects of these manipulations. In Ukrainian medical practice, the technique of spinal anesthesia for analgesia of surgical interventions on the abdominal cavity and lower extremities has been introduced for a long time. One of the main methods is unilateral spinal anesthesia. The study compared: the effectiveness of anesthesia, the duration of anesthesia, the volume of infusion therapy during surgery and the reaction of the cardiovascular system to the manipulations.

Jun Zhou, Jun Zhou, Rui Yang et al.

The serine/threonine kinase phosphatase and tensin homolog (PTEN)-induced putative kinase 1(PINK1) controls mitochondrial quality and plays a vital role in the pathogenesis of early-onset Parkinson's disease. However, whether PINK1 has functions in innate antiviral immunity is largely unknown. Here, we report that viral infection down regulates PINK1 expression in macrophages. PINK1 knockdown results in decreased cytokine production and attenuated IRF3 and NF-κB activation upon viral infection. PINK1 promotes the retinoic-acid-inducible gene I (RIG-I)-like receptors (RLR)-triggered immune responses in a kinase domain-dependent manner. Furthermore, PINK1 associates with TRAF3 via the kinase domain and inhibits Parkin-mediated TRAF3 K48-linked proteasomal degradation. In addition, PINK1 interacts with Yes-associated protein 1 (YAP1) upon viral infection and impairs YAP1/IRF3 complex formation. Collectively, our results demonstrate that PINK1 positively regulates RIG-I triggered innate immune responses by inhibiting TRAF3 degradation and relieving YAP-mediated inhibition of the cellular antiviral response.

Harshil J Gandhi, Lopa H Trivedi, Deepshikha C Tripathi et al.

Background and Aims: Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine. Material and Methods: Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any. Results: The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance. Conclusion: CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.

Etienne Gayat, Alain Cariou, Nicolas Deye et al.

Abstract Background Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. Methods FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). Results Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73–4.65), p < 0.001). Conclusions The FROG-ICU study identified, at the time of ICU discharge, potentially actionable clinical and biological factors associated with poor long-term outcome after ICU discharge. Those factors may guide discharge planning and directed interventions. Trial registration ClinicalTrials.gov NCT01367093 . Registered on 6 June 2011.

Liyong Zhang, Wei Xiong, Yuming Peng et al.

Abstract Background Ventilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia. However, there is no study on the effect of a lung-protective ventilation strategy in patients undergoing neurosurgery. Methods This is a single-center, randomized, parallel-group controlled trial which will be carried out at Beijing Tiantan Hospital, Capital Medical University. Three hundred and thirty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective-ventilation strategy group. In the control group, tidal volume (VT) will be set at 10–12 ml/kg of predicted body weight but PEEP and recruitment maneuvers will not be used. In the protective group, VT will be set at 6–8 ml/kg of predicted body weight, PEEP at 6–8 cmH2O, and a recruitment maneuver will be used intermittently. The primary outcome is pulmonary complications within 7 days postoperatively. Secondary outcomes include intraoperative brain relaxation, the postoperative complications within 30 days and the cost analysis. Discussion This study aims to determine if the protective, pulmonary-ventilation strategy decreases the incidence of PPCs in patients undergoing neurosurgical anesthesia. If our results are positive, the study will indicate whether the protective, pulmonary-ventilation strategy is efficiently and safely used in neurosurgical patients undergoing the craniotomy. Trial registration ClinicalTrials.gov, ID: NCT02386683. Registered on 18 October 2014.

Hedwig Schroeck, Angela K. Lyden, Wendy L. Benedict et al.

Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units. Univariate and adjusted analyses were performed to identify factors independently associated with abnormal postoperative temperatures. Results. 2,350 cases were included. 82% were normothermic postoperatively, while hypothermia and hyperthermia each occurred in 9% of cases. During the study period, hypothermia decreased from 24% to 2% (p<0.0001) while hyperthermia remained unchanged (13% in 2006, 8% in 2014, p=0.357). Factors independently associated with hypothermia were higher ASA status (p=0.02), lack of intraoperative convective warming (p<0.001) and procedure date before 2010 (p<0.001). Independent associations for postoperative hyperthermia included lower body weight (p=0.01) and procedure date before 2010 (p<0.001). Conclusions. We report an increase in postoperative normothermia rates in critically ill infants from 2006 until 2014. Careful monitoring to avoid overcorrection and hyperthermia is recommended.

Dong Guk Cha, Kyo Sang Kim, Ji Seon Jeong et al.

BackgroundThe aim of this randomized, double-blind, placebo-controlled study was to evaluate dose effects of ephedrine pretreatment on the onset time and intubating conditions after cisatracurium administration.MethodsA total of 140 adult patients were randomized into 4 groups to receive either 30 µg/kg ephedrine (Group 30, n = 35), 70 µg/kg ephedrine (Group 70, n = 35), 110 µg/kg ephedrine (Group 110, n = 35), 3 ml normal saline (Group C, n = 35) as pretreatment given 30 s before anesthetic induction. Neuromuscular block was achieved with 0.15 mg/kg cisatracurium, evaluated accelomyographically with train-of-four stimulation. An anesthesiologist blinded to patient grouping assessed the intubating conditions 1.5 min after cisatracurium administration.ResultsAn onset time of 70 s was obtained in the ephedrine groups (Group 30: 155.4 ± 44.7 s, Group 70: 152.6 ± 40.3 s, Group 110: 151.2 ± 51.6 s) compared to Group C (224.6 ± 56.9 s) after 0.15 mg/kg of cisatracurium (P < 0.001). Ephedrine doses of either 70 or 110 µg/kg for pretreatment significantly improved intubating conditions (P < 0.05). Systolic and diastolic blood pressure and heart rate at 1 min after tracheal intubation were significantly increased than other times in all groups (P < 0.001), with no differences among the groups. However, 5 patients in Group 110 experienced marked hypertension (systolic/diastolic blood pressure: > 200/100 mmHg) 1 min after tracheal intubation with no patients in other groups.ConclusionsWe conclude that pre-treatment with ephedrine 70 µg/kg improved intubating conditions 1.5 min after cisatracurium administration and facilitated the onset of neuromuscular block (70 s) without adverse hemodynamic effects.

Ishizaka Toru, Satoh Hisashi, Iwasaki Hiroto et al.

<p>Abstract</p> <p>Background</p> <p>Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction.</p> <p>Methods</p> <p>The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest.</p> <p>Results</p> <p>Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days.</p> <p>Conclusions</p> <p>The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.</p>