Background: We compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position.Methods: In total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU).Results: The incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups.Conclusions: The upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.

Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 ± 2.5 in general anesthesia and 0.5 ± 2.3 in BPB at 2 h, postoperatively; 6.5 ± 2.4 in general anesthesia and 0.5 ± 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 ± 2.4 in general anesthesia and 1.5 ± 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 ± 2.5 in general anesthesia and 3.4 ± 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 ± 2.5 in general anesthesia and 3.2 ± 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.

Excretion. There are restrictions on the use of sugammadex in patients with severe renal impairment. A paucity of data supports the clinical safety of sugammadex in patients with renal impairment. We analyzed mortality after using sugammadex in patients with end-stage renal disease to establish evidence of safety for sugammadex.Methods: We retrospectively collected the medical records of 2,134 patients with end-stage renal disease who were dependent on hemodialysis and underwent surgery under general anesthesia between January 2018 and December 2019. Propensity score matching was used. The primary outcome was the 30-day mortality rate, and secondary outcomes were the 1-year mortality rate and causes of death.Results: A total of 2,039 patients were included in the study. Sugammadex was administered as a reversal agent for rocuronium in 806 (39.5%) patients; the remaining 1,233 (60.5%) patients did not receive sugammadex. After matching, 1,594 patients were analyzed; 28 (3.5%) of the 797 patients administered sugammadex, and 28 (3.5%) of the 797 patients without sugammadex, died within 30 days after surgery (P > 0.99); 38 (4.8%) of the 797 patients administered sugammadex, and 45 (5.7%) of the 797 patients without sugammadex, died within 1 year after surgery (P = 0.499). No significant differences in the causes of 30-day mortality were observed between the two groups after matching (P = 0.860).Conclusions: In this retrospective study, sugammadex did not increase the 30-day and 1-year mortality rate after surgery in end-stage renal disease patients.

Background: The number of patients with end-stage renal disease (ESRD) who are dependent on hemodialysis is increasing rapidly. As a result, more patients with ESRD need surgery. These patients have a significantly higher risk of postoperative death than those with normal kidney function. Therefore, this study analyzed the causes of postoperative mortality in ESRD patients undergoing surgery under general anesthesia and the risk factors for postoperative mortality.Methods: This retrospective analysis examined the mortality of ESRD patients, 20 to 80 years old, undergoing surgery under general anesthesia. We excluded patients who underwent cardiac, cancer, or emergency surgery or organ transplantation from the analysis. The primary outcome was the cause of postoperative 30-day mortality in ESRD patients. We also assessed the mortality rate and risk factors.Results: There were 2,459 eligible ESRD patients. When patients underwent multiple surgeries during the study period, only the last surgery was considered. In total, 167 patients died during the study period, including 65 within 30 days postoperatively. The cause of death was sepsis in 22 cases (33.8%) and a major cardiac event in 16 (24.6%). Atrial fibrillation, current angina, previous myocardial infarction, asthma, lower hemoglobin and albumin levels, and a larger intraoperative colloid volume were likely to increase mortality. Conclusions: Our study suggests that immunological issues have a significant role in the death of ESRD patients after general anesthesia.

Background: Phase-lag entropy (PLE) based on functional connectivity between different regions of the brain may be superior to conventional depth of anesthesia (DoA) methods for monitoring changes in consciousness. However, few studies have compared the PLE and bispectral index (BIS) methods for monitoring consciousness during clinical anesthesia, such as total intravenous anesthesia (TIVA) or anesthesia via inhalation. Therefore, we evaluated differences between the PLE and BIS methods in clinical anesthesia, including TIVA using propofol and anesthesia with sevoflurane. Methods: The observational trial included 60 patients scheduled for elective surgery under general anesthesia. The BIS and PLE electrodes were placed together on the left temporal-frontal area of all patients. During anesthesia, anesthetic levels were adjusted using the BIS values, which are generally used to monitor the DoA; the level of anesthesia was maintained at between 40 and 60. BIS- and PLE-derived values were recorded continuously. Anesthetic events, the concentration of each anesthetic, and standard monitoring values were recorded. The patients included were divided into 2 groups, the TIVA and sevoflurane groups, with 30 patients in each. For the TIVA group, anesthesia was induced and maintained using propofol and remifentanil target-controlled infusion. For the sevoflurane group, anesthesia was induced using propofol and maintained using sevoflurane and remifentanil. Results: From loss of consciousness until the anesthetic maintenance period, PLE values were higher than BIS values at several time points. During the recovery period, BIS values were higher than PLE values (all P < .001). Spaghetti plots showed that there was more variation among the BIS values than among the PLE values. Conclusions: For monitoring DoA during general anesthesia and surgery, PLE values vary less than BIS values; thus, PLE may be more reliable for monitoring changes in consciousness. However, further studies are needed to evaluate the clinical application of these methods in general anesthesia.