Background: Total laparoscopic hysterectomy (TLH) has become a widely accepted alternative to total abdominal hysterectomy (TAH). The aim of this study was to compare the incidence and grade of venous air embolism (VAE) in TLH to those in TAH using transesophageal echocardiography. Methods: Eighty-two American Society of Anesthesiologists physical status I patients scheduled for either TLH or TAH were enrolled. After induction of general anesthesia, a multiplane transesophageal echocardiography probe was inserted. The midesophageal four-chamber or bicaval view was continuously monitored. An independent transesophageal echocardiography-certified anesthesiologist graded VAE. Results: All patients undergoing TLH showed VAE, and 37.5% of patients had VAE grade higher than III. Fifteen percent of patients undergoing TAH showed VAE, and all of them were grade I. No patient in this study showed hemodynamic instability or electrocardiogram changes at the time of VAE occurrence. Most instances of VAE during TLH occurred during transection of the round ligament and dissection of the broad ligament. Conclusion: The incidence of VAE in patients undergoing TLH was 100%. VAE grade in TLH was higher compared to that in TAH, especially during transection of the round ligament and dissection of the broad ligament. Although the hemodynamic instability associated with VAE during TLH was not observed in this study, anesthesiologists must be vigilant for detection of VAE during TLH.

Hocardiography (TEE) during hepatic resection by using either the clamp-crushing method or the CUSA® method. Fifty patients scheduled for hepatic resection were randomly assigned to receive hepatic resection by the clamp-crushing method (CC group) or by CUSA® (CUSA® group). After the induction of anesthesia, the TEE probe was inserted into the patient’s esophagus. An independent anesthesiologist graded VAE shown in the 4-chamber view of TEE. All patients in the CUSA® group showed VAE during hepatic resection and 44% of the patients had air embolism filling more than half the right heart diameter. In CC group, 68% of the patients showed VAE, which filled less than half the right heart diameter. There were no significant differences in hemodynamics and end-tidal CO2 partial pressure between the two groups. In conclusion, hepatic resection by CUSA® increases the incidence and severity of VAE....

Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery. Twenty-nine pediatric patients (1–6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 14) or dexmedetomidine (a bolus dose of 0.5 μg/kg and then an infusion of 0.5 μg/kg/h) (dexmedetomidine group, n = 15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (Scr) was measured before surgery (T0), 10 minutes after anesthesia induction (T1), 5 minutes after cardiopulmonary bypass weaning (T2), 2 hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was defined as an absolute increase in Scr of ≥ 0.3 mg/dL or a percent increase in Scr of ≥50%. The incidence of AKI during the perioperative period was significantly higher in the control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15], P = .042). eGFR was significantly lower in the control group than in the dexmedetomidine group at T2 (72.6 ± 15.1 vs 83.9 ± 13.5, P = .044) and T3 (73.4 ± 15.4 vs 86.7 ± 15.9, P = .03). Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.

Background: Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury. Methods: Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed. Results: There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group. Conclusion: Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.