Search

Anesthesia management of fetal pulmonary valvuloplasty (FPV) is difficult, requiring careful consideration of both the mother and the fetus. Few reports have been published on specific anesthesia implementation and intraoperative management. We report the case of a pregnant woman who was treated with FPV under combined spinal epidural anesthesia (CSEA) with dexmedetomidine in the second trimester of pregnancy. Meanwhile, the application of fetal anesthesia through the umbilical vein was optimal. During the operation, the vital signs of the pregnant woman were stable with no complications and the fetal bradycardia was corrected by intracardiac injection of epinephrine. Four months postoperatively, a boy was born alive by full-term transvaginal delivery. CSEA may be a suitable anesthesia method for FPV surgery. Nevertheless, maternal hemodynamic stability maintenance, effective fetal anesthesia, and timely fetal resuscitation were necessary.

Objective To investigate the effectiveness and safety of intravenous remifentanil patient-controlled intravenous analgesia (PCIA) regimen during the active and latency period of the first labor and its influence on plasma prostaglandin E2 (PGE2) in parturients. Methods A total of 60 full-term parturients with a single fetus giving birth vaginally in our center from January 2021 to February 2022 were enrolled in this study. The patients who were willing to receive remifentanil intravenous controlled analgesia formed group R (n=30), and those who refused analgesia formed group C (n=30). Group R received PCA of remifentanil (continuous background infusion of 0.03 μg/kg·min and bolus doses of 0.3 μg/kg with 2 min lockout period in latent phase; continuous background infusion of 0.05 μg/kg·min and bolus doses of 0.4 μg/kg with 2 min lockout period in active phase). Maternal pain score, sedation efficacy, satisfaction, and maternal and fetal adverse reactions were recorded. Neonatal Apgar score and the results of umbilical arterial blood gas analysis were recorded. The levels of PGE2 in R group were determined before and after analgesia. Results Compared to Group C, the mean NRS pain score and the lowest pain score of Group R in latent and active phases were significantly lower (P < 0.05). The overall sedation score and satisfaction score of Group R were obviously higher when compared with Group C (P < 0.05). The incidences of dizziness and drowsiness were statistically higher in the Group R (P < 0.05). No differences were seen in the neonatal Apgar score and the results of umbilical arterial blood gas analysis between the 2 groups (P>0.05). The serum PGE2 levels had no obvious change in Group R before and after analgesia (P>0.05). Conclusion According to the different intensities of labor pain in latent and active phase, appropriate adjustment of remifentanil intravenous controlled analgesia regimen can obviously mitigate maternal labor pain, without obvious maternal and fetal adverse reactions, and has no influence on maternal PGE2 levels.

Background: Postoperative nausea and vomiting are common complications after surgery, and female patients are more likely to experience these adverse events. The goal of this study was to explore the relationship between the CHRM3 rs2165870 polymorphism and postoperative vomiting incidence in female patients who underwent laparoscopic surgery. Methods: Two hundred female patients who underwent elective laparoscopic surgery with subsequent patient-controlled intravenous analgesia using dexmedetomidine and sufentanil were prospectively enrolled. The CHRM3 rs2165870 and KCNB2 rs349358 polymorphisms were genotyped using MassARRAY SNP typing technology. Demographic data and preoperative laboratory results of all patients were recorded. Postoperative analgesia-related information, incidence of postoperative nausea and vomiting, and other adverse events were followed up and recorded for analysis. Results: No significant differences were observed in any of the demographic characteristics of these patients among the different genotype carriers (P>0.05). The percentages of patients with each genotype of CHRM3 were 67% (GG), 28.5% (GA) and 4.5% (AA). We found that the AA or A allele of the CHRM3 rs2165870 polymorphism elevated the risk of postoperative vomiting (AA versus GG; OR, 6.94; 95% CI, 1.49–32.46; P = 0.014; A versus G; OR, 2.52; 95% CI, 1.22–5.19; P = 0.012). The percentages of patients with each genotype of KCNB2 were 84.5% (TT), 15.5% (CT) and 0% (CC). There were no significant differences in the postoperative nausea or vomiting rate across the KCNB2 rs349358 polymorphisms (P>0.05). Conclusion: The CHRM3 rs2165870 polymorphism is associated with the occurrence of postoperative vomiting in female patients who have undergone laparoscopic surgery. The AA genotype or A allele of the CHRM3 rs2165870 polymorphism elevates the risk of postoperative vomiting. Trial registration: www.chictr.org.cn, registration number: ChiCTR2200062425. [ABSTRACT FROM AUTHOR]

Cutaneous squamous cell carcinoma is usually treated with surgery; however, locoregionally advanced cutaneous squamous cell carcinoma can be difficult to resect. Although recent guidelines from Western countries recommend using anti–programmed cell death protein 1 (PD‐1) antibodies, including cemiplimab and pembrolizumab, there are no approved anti–PD‐1 antibodies for locoregional cutaneous squamous cell carcinoma in Asian countries. S‐1 is an oral drug with a low incidence of severe toxicity that can be used for head and neck cancers, including head and neck locoregional cutaneous squamous cell carcinoma, in Japan. We retrospectively evaluated patients with head and neck locoregional cutaneous squamous cell carcinoma treated with S‐1 at two Japanese institutions (2008–2022). The initial dosage was determined by the body surface area (<1.25 m2: 80 mg/day, 1.25–1.5 m2: 100 mg/day, ≥1.5 m2: 120 mg/day) for 28 consecutive days. The outcome measures were objective response rate (ORR), progression‐free survival (PFS), and overall survival (OS). Fourteen patients were included. The ORR was 78%, and the complete response (CR) rate was 64.3%. The median PFS and OS were not reached (NR) (95% confidence interval [CI], 5.9 months–NR) and NR (95% CI, 13.8 months–NR), respectively. The 12‐month PFS and OS rates were 51% and 85%, respectively. Six of the nine patients who achieved CR showed no recurrence during the follow‐up period (median follow‐up, 24.7 months). After CR, three patients experienced recurrence. Among these, two resumed S‐1 treatment and subsequently underwent salvage surgery, resulting in a sustained absence of recurrence. One patient developed lung metastasis and died, although S‐1 therapy was resumed. Only one patient (7.1%) developed grade 3 anemia. S‐1 showed favorable efficacy and low toxicity in patients with head and neck locoregionally advanced cutaneous squamous cell carcinoma. S‐1 may be a good alternative to the anti–PD‐1 antibody for treating head and neck locoregionally advanced squamous cell carcinoma. [ABSTRACT FROM AUTHOR]