Huh H, et al. Korean J Anesthesiol. 2017 Jun;70(3):345-349. https://doi.org/10.4097/kjae.2017.70.3.345

Background: Chlorhexidine and silver sulfadiazine coated central venous catheters (CSS-CVC) may cause loss of antimicrobial efficacy due to friction between the CVC surface and sheer stress caused by the blood flow. Therefore, the aim of this study was to investigate the antibacterial efficacy of CSS-CVC at various flow rates using a bloodstream model. Methods: Each CVC was subjected to various flow rates (0.5, 1, 2, and 4 L/min) and wear-out times (0, 24, 48, 72, 96, and 120 hours), and the optical density (OD) 600 after a Staphylococcus aureus incubation test was used to determine the antibacterial effect of CSS-CVC. Results: In the 0.5 L/min group, there was no significant change in the OD600 value up to 120 hours compared with the baseline OD600 value for CSS-CVC (P > .467). However, the OD600 values of CSS-CVC in the 1 L/min (P < .001) and 2 L/min (P < .001) groups were significantly reduced up to 72 hours, while that in the 4 L/min (p < 0.001) group decreased rapidly up to 48 hours. Conclusion: This study suggests that there is a doubt whether sufficient antibacterial function can be maintained with prolonged duration of catheter placement.

Purpose: Many studies have demonstrated the advantage of maintaining intraoperative deep neuromuscular block (NMB) with sugammadex. This trial is designed to evaluate the impact of muscle relaxation during laparoscopic subtotal gastrectomy on the oncological benefits, particularly in obese patients with gastric cancer. Materials and methods: This is a double-blind, randomized controlled multicenter prospective trial. Patients with clinical stage I–II gastric cancer with a body mass index of 25 and over, who undergo laparoscopic subtotal gastrectomy will be eligible for trial inclusion. The patients will be randomized into a deep NMB group or a moderate NMB group with a 1:1 ratio. A total of 196 patients (98 per group) are required. The primary endpoint is the number of harvested lymph nodes, which is a critical index of the quality of surgery in gastric cancer treatment. The secondary endpoints are surgeon's surgical condition score, patient's sedation score, and surgical outcomes including peak inspiratory pressure, operation time, postoperative pain, and morbidity. Discussion: This is the first study that compares deep NMB with moderate NMB during laparoscopic gastrectomy in obese patients with gastric cancer. We hope to show the oncologic benefits of deep NMB compared with moderate NMB during subtotal gastrectomy. Trial registration number: ClinicalTrials.gov (NCT03196791), date of registration: October 10, 2017.

Primary hyperparathyroidism (PHPT) is the most common cause of pregnancy-related hypercalcemia. PHPT can cause maternal and fetal complications in pregnant women. General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects. Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT. However, the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage. A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy. The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior. Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL, and the parathyroid hormone level was elevated to 157 pg/mL. In a neck ultrasound, it revealed a 0.8 cm × 1.5 cm sized oval, hypoechoic mass in the upper posterior of the left thyroid gland, which was compatible with parathyroid adenoma. Superficial cervical plexus block (SCPB) for parathyroidectomy was performed. After surgery, the obstetrician checked the status of the fetus, and there were no abnormal signs. Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation. Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.