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Robotic-assisted laparoscopy with the use of carbon dioxide (CO2) for insufflation is rapidly adopted procedure for gynecological surgery. Insufflation of the abdomen with CO2can potentially cause complications such as hypercarbia, subcutaneous emphysema (SE), pneumothorax, and pneumomediastinum. The incidence of SE ranges from 0.43% to 77%. Numerous potential mechanisms were proposed for the development of these complications. Several authors speculated that the surgical time, surgical ports, age, and peritoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly. We experienced a case who developed delayed massive SE extended to neck and face after robotic ovarian cystectomy, it perhaps due to weaker tissues bonding fascial planes because she was acute weight loss within 1 month. more...

Tramadol is a common anesthetic used to treat cancer pain, including endometrial cancer, but its function in endometrial cancer remains unclear. The purpose of this study was to elucidate the antitumor effects of tramadol on human endometrial cancer cells. Colony formation, BrdU, cell cycle profiles, apoptosis, ROS, and Western blot analyses were used to study the response of endometrial cancer cells to tramadol. JC-1 and seahorse metabolic flux assays were used to detect the effect of tramadol on mitochondria in endometrial cancer cells. Combination index was used to detect the interaction of tramadol with chemotherapy drugs in endometrial cancer cells. In this study, we found that tramadol was able to inhibit proliferation and induce cell cycle arrest, ROS generation, and apoptosis in two types of endometrial cancer cells. In addition, tramadol treatment also induced mitochondrial dysfunction in endometrial cancer cells by causing a loss of mitochondrial membrane potential and a decreased oxygen consumption rate. More importantly, the synergetic effect of tramadol with doxorubicin or cisplatin was further confirmed in endometrial cancer cells by the results of the combination index and apoptosis assay. In summary, our findings indicate that tramadol has an antitumor effect on endometrial cancer cells, which might serve as a potential adjuvant therapy strategy for endometrial cancer. [ABSTRACT FROM AUTHOR] more...

The letter published in the Journal of Medical Sciences discusses an alternative method for managing the intraoperative tear of the cuff inflation line of an endotracheal tube during ophthalmic surgery. The case study presented involves a 77-year-old female patient in Taiwan who experienced a loss of endotracheal cuff pressure during surgery. The authors successfully managed the situation using a self-assembly syringe inflator, avoiding the need to exchange the endotracheal tube and minimizing the risk of complications. The study highlights the importance of thorough preuse checks of endotracheal tubes and offers a potential solution for similar situations, emphasizing the need for continuous monitoring to prevent aspiration and airway injury. [Extracted from the article] more...

Background: Evidences show that sugammadex may facilate extubation after surgery. Applying neuromuscular monitoring in general anesthesia may prevent postoperatrive reintubation. However, routine general anesthesia does not always include neuromuscular monitoring. Therefore, we investigated the relationship between the sugammadex use and postoperative reintubation in the absence of neuromuscular monitoring. Methods: We conducted a retrospective analysis of the incidence of postoperative reintubation in the operating room (OR) or postanesthesia care unit following sugammadex use in the absence of neuromuscular monitoring that involved a large number of patients over 4 years (from January 2017 to August 2020). Postoperative reintubation was applied for patients who had peripheric oxygen saturation <90% despite being given 6 L/min oxygen with a face mask. Patients with perioperative neuromuscular monitoring, renal or hepatic failure, electrolyte imbalance, body mass index over 35, incomplete data, and age under 20 years were excluded. All data from the ORs' database and anesthesia records were analyzed. Results: Of 6582 patients receiving sugammadex, 6313 were included in this study. Two confirmed cases of postoperative reintubation were detected, with an incidence of 0.03% (2 of 6,313). As of the type of surgery, a 34 years old male received elective thoracic surgery, and another 66 years old male received elective urological surgery. No long-term pulmonary sequelae were found. Conclusion: This study suggests that the occurrence of postoperative reintubation following sugammadex (2–4 mg/kg) use is rare even in the absence of neuromuscular monitoring. Further large prospective studies are required to validate the findings of this study. [ABSTRACT FROM AUTHOR] more...