Background: The prone position is used for a variety of procedures and surgeries, and hypotension is a commonly encountered complication. Case: A 75-year-old obese woman with lumbar spinal stenosis underwent posterior lumbar spinal fusion and posterolateral interbody fusion under general anesthesia. Before the surgery, when she was positioned on a Jackson spinal table in the prone position, sudden severe hypotension and hemodynamic collapse developed. The circulatory collapse was refractory to intravascular volume expansion and administration of inotropes and vasopressors. However, the application of external abdominal support immediately restored hemodynamic stability. The patient successfully underwent the surgery using an external abdominal support, and no post-operative complication was noted, including abdominal compartment syndrome. Conclusions: The Jackson spinal table allowed the abdomen to hang freely, providing abdominal decompression while resulting in a severely sagged abdomen. We suspected that the sagging abdomen had pulled the abdominal contents downwards, kinking the inferior vena cava or causing a venous pool in the abdomen, resulting in the obstruction of venous return to the heart.

Background and Objectives: Evidence regarding the prevalence of neuropathic pain in patients with cervical radicular pain is limited. This study aimed to investigate the prevalence of neuropathic pain components in patients with cervical radicular pain using established screening tools and identify the relationship between neuropathic pain components and clinical factors. Materials and Methods: Data from 103 patients (aged ≥ 20 years) with cervical radicular pain who visited our pain clinic were analyzed retrospectively. Demographic characteristics, history of neck surgery, pain intensity using numeric rating score, dominant pain site, duration of symptoms, and neck disability index were assessed. The prevalence of neuropathic pain components was defined according to the Douleur Neuropathique 4 questions and painDETECT questionnaire tools. Patient characteristics were compared using the chi-square test or Fisher’s exact test for categorical variables and the independent t-test or Mann–Whitney U test for continuous variables. The correlation between neck disability index and other variables was analyzed using Pearson’s correlation coefficient. Results: Of the 103 patients, 29 (28.1%) had neuropathic pain components. The neck disability index was significantly higher (p < 0.001) for patients in the neuropathic pain group (23.79 ± 6.35) than that in the non- neuropathic pain group (18.43 ± 7.68). The Douleur Neuropathique 4 questions (r = 0.221, p < 0.025) and painDETECT questionnaire (r = 0.368, p < 0.001) scores positively correlated with the neck disability index score. Conclusions: The prevalence of neuropathic pain components in patients with cervical radicular pain was low. The patients in our study showed a strong correlation between functional deterioration and their neuropathic pain screening score. This study may be useful in understanding the characteristics of cervical radicular pain.

Background: Antihypertensive medications taken before surgery are associated with increased intraoperative hypotension, and patient positioning can further influence hemodynamics during surgery. However, the combined effects of antihypertensive medication use and patient positioning on intraoperative hypotension during spine surgery have not been clearly established. Objectives: This study aimed to investigate the incidence of hypotension in patients undergoing spine surgery according to surgical position, antihypertensive drug use, and patient characteristics through a retrospective analysis of medical records. Methods: This retrospective study analyzed 4,973 patients who had undergone spine surgery. Demographic data, medical history, antihypertensive medication use before surgery, and anesthetic information, including blood pressure during surgery, were collected from electronic medical records (EMRs). The incidence of hypotension according to surgical positioning (supine vs. prone) and antihypertensive medication use was investigated. Results: The incidence of intraoperative hypotension was higher in patients positioned prone (supine: 19.06% vs. prone: 24.91%) and among those taking more antihypertensive medications (no medication: 19.49%; one medication: 25.18%; two or more medications: 32.97%). Logistic regression indicated that patients with a history of hypertension undergoing surgery in the prone position had a significantly greater risk of hypotension [odds ratio (OR) = 1.407] and severe hypotension (OR = 1.940) compared with those with no history of hypertension undergoing surgery in the supine position. Older age, longer anesthesia duration, cervical surgical site, and the use of multiple antihypertensive agents were associated with an increased risk of intraoperative hypotension. In particular, taking two or more antihypertensive drugs (OR = 1.601) and undergoing surgery in the prone position (OR = 1.505) were independent predictors of hypotension and severe hypotension during spine surgery. Conclusions: Preoperative use of two or more antihypertensive medications increases the risk of intraoperative hypotension, and spine surgery in the prone position increases the risk of severe hypotension.

For perioperative hypothermia prevention, a heated, humidified breathing circuit equipped with a fluid-warming unit inside the inspiratory limb has been developed. We report a ventilation difficulty caused by an obstructed heated breathing circuit. Cotton surrounding the hot wire, temperature sensor, and fluid tubing in the distal inspiratory limb was irregularly thicker than that of a normal circuit and nearly blocked the lumen. Despite carrying out routine checks on the anesthesia workstation preoperatively, we failed to make a prediagnosis by omitting the flow test after changing the circuit. This case puts emphasis on a routine flow test with a meticulous examination of the heated breathing circuit before every procedure.

Background and Aims: Ketofol, a combination of ketamine and propofol, is widely used for procedural sedation in monitored anesthesia care (MAC). While it provides analgesia and hemodynamic stability, it may be insufficient for painful procedures. Sufentanil, a potent opioid with rapid onset and moderate duration, may enhance analgesia in ketofol-based MAC. This study aimed to evaluate the efficacy and safety of adding single-dose sufentanil to ketofol in patients undergoing brief ambulatory gynecologic procedures under MAC. Materials and Methods: We retrospectively reviewed patients who received ketofol-based MAC with or without a single dose of sufentanil. Primary outcomes included postoperative pain scores at 0–1 and 1–6 h. Secondary outcomes included surgical condition scores, need for assisted ventilation, and incidence of postoperative nausea and vomiting (PONV). Results: Eighty patients were included (n = 40 per group). The sufentanil group had significantly lower pain scores in the first postoperative hour than did those of the ketofol-only group, with no difference in pain scores at 1–6 h. Surgical conditions were significantly better in the sufentanil group than in the ketofol-only group. However, assisted ventilation was more frequently required in the sufentanil group than in the ketofol-only group. PONV incidence was similar between groups. Conclusion: Adding a single dose of sufentanil to ketofol-based MAC improves early postoperative analgesia and enhances surgical conditions without prolonging the emergence time or increasing the incidence of PONV. However, it significantly increases the need for assisted ventilation, highlighting the importance of respiratory monitoring.