This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769.

Anesthesia induction is associated with frequent blood pressure fluctuation such as hypotension and hypertension. If it is possible to precisely predict blood pressure a few minutes ahead, anesthesiologists can proactively give anesthetic management before patients develop hemodynamic problem. The objective of this study is to develop a real-time model for predicting 3-min-ahead blood pressure from the start of anesthesia induction to surgical incision. We used only vital signs and anesthesia-related data obtained during anesthesia-induction phase and designed a bidirectional recurrent neural network followed by fully connected layers. We conducted experiments on our collected data of 102 patients, and obtained mean absolute errors between 8.2 mmHg and 11.1 mmHg and standard deviation between 8.7 mmHg and 12.7 mmHg. The average elapsed time for prediction of a batch of 100 unseen data was about 26.56 milliseconds. We believe that this study shows feasibility of real-time prediction of future blood pressures, and the performance will be improved by collecting more data and finding better model structures.

The occurrence of glycemic disturbances has been described for patients undergoing intermittent hepatic inflow occlusion (IHIO) for tumor removal. However, the glycemic responses to IHIO in living liver donors are unknown. This study investigated the glycemic response to IHIO in these patients and examined the association between this procedure and the occurrence of hyperglycemia (blood glucose > 180 mg/dL). The data from 154 living donors were retrospectively reviewed. The decision to perform IHIO was made on the basis of the extent of bleeding that occurred during parenchymal dissection. One round of IHIO consisted of 15 minutes of clamping and 5 minutes of unclamping the hepatic artery and portal vein. Blood glucose concentrations were measured at predetermined time points, including the start and end of IHIO. Repeated hyperglycemic episodes occurred after unclamping. The mean maximum intraoperative blood glucose concentration was greater in donors who underwent 3 rounds of IHIO versus those who underwent 1 or 2 rounds (169 6 30 versus 149 6 31 mg/dL, P 5 0.005). The incidence of intraoperative hyperglycemia was also greater in donors who underwent 3 rounds of IHIO versus those who underwent 1 or 2 rounds (38.7% versus 7.7%, odds ratio 5 7.1, 95% confidence interval 5 2.5-20.4, P < 0.001). Donors who did not undergo IHIO and those who underwent 1 or 2 rounds of IHIO exhibited similar maximum glucose concentrations and similar incidence rates of hyperglycemia. In conclusion, IHIO induced repeated hyperglycemic responses in living donors, and donors who underwent 3 rounds of IHIO were more likely to experience intraoperative hyperglycemia. These results provide additional information on the risks and benefits of IHIO in living donors. Intermittent hepatic inflow occlusion (IHIO) effectively reduces the amount of blood lost during liver resection and can prevent the need for a blood transfusion. Recent studies have suggested that IHIO-induced ischemic preconditioning can increase the ability of the liver to tolerate ischemia and reperfusion injury by promoting cellular repair/protection mechanisms and improving intrahepatic microcirculation.1 Despite these potential benefits and the widespread use of IHIO during liver surgery, the maneuver has not been extensively adopted in living donor liver transplantation because of a lack of understanding of the effects of repeated hepatic ischemia and reperfusion in these subjects. In particular, the glycemic response of living donors is poorly understood. 2The liver plays a prominent role in maintaining blood glucose levels within a narrow range. Accordingly, patients undergoing liver resection are at high risk for experiencing a glycemic disturbance resulting from surgical injuries and hepatocyte loss. Furthermore, IHIO has been shown to induce repeated hyperglycemia in patients undergoing liver resection to remove tumors. 2Glycemic responses to IHIO in living liver donors have never been assessed, and a better understanding of these responses will help clinicians to und...

Two cases were reported in which severe postoperative laryngeal edema were developed after the operation of diffuse idiopathic skeletal hyperostosis (DISH) of cervical spine. In the first case, sudden airway obstruction was developed in the general ward 6 hour after uneventful decompression surgery for osteophyte. In the second patient, an elective preoperative tracheostomy was performed before surgery but the tube could not be removed for 2 months because of laryngeal edema and decreased vocal cord mobility. It should be emphasized that this airway problem can develop during the postoperative as well as the preoperative period, especially in the case of anterior cervical spine surgery.

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BACKGROUND: Previous research has not evaluated the potential effect of transversus abdominis plane (TAP) block on quality of recovery following laparoscopic cholecystectomy. Therefore, we investigated whether addition of the bilateral subcostal and lateral TAP (bilateral dual TAP [BD-TAP]) blocks to multimodal analgesia would improve the quality of recovery as assessed with the Quality of Recovery-40 (QoR-40). METHODS: Patients age 18 to 60 years who were scheduled to undergo elective laparoscopic cholecystectomy were randomized to the BD-TAP or control group. The BD-TAP group received the BD-TAP block with multimodal analgesia under general anesthesia, using 0.25% ropivacaine, and the control group was treated with the same method, except that they received the sham block using 0.9% normal saline. Both groups had the same multimodal analgesia regimen, consisting of intravenous dexamethasone, propacetamol, ibuprofen, and oxycodone. The primary outcome was the QoR-40 score at 24 hours after surgery. Data were analyzed using the independent t test, Mann-Whitney U test, χ2 test, and Fisher exact test. RESULTS: Thirty-eight patients in each group were recruited. The mean QoR-40 score decreased by 13.6 (95% confidence interval [CI], 8.3–18.8) in the BD-TAP group and 15.6 (95% CI, 6.7–24.5) in the control group. The postoperative QoR-40 score at 24 hours after surgery did not differ between the 2 groups (BD-TAP group, median [interquartile range], 170.5 [152–178]; control group, 161 [148–175]; median difference, 3 [95% CI, −5 to 13]; P = .427). There were no differences between the 2 groups in the pain dimension of the QoR-40: 30.5 (95% CI, 27–33) in the BD-TAP group and 31 (95% CI, 26–32) in the control group; median difference was 0 (95% CI, −2 to 2); P = .77. CONCLUSIONS: Our results indicate that the BD-TAP block does not improve the quality of recovery or analgesic outcomes following laparoscopic cholecystectomy. Our results do not support the routine use of the BD-TAP block for this surgery.

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