junko nakahira

As most studies investigating patient satisfaction with anesthesia have some bias, previous results may underrepresent the true level of dissatisfaction with anesthesia.

This study aimed to identify factors associated with patient satisfaction with anesthesia.

Data from patients aged 20 years who had previous surgery and were scheduled for additional surgery were obtained retrospectively through preoperative interviews conducted. Informed consent for anesthesia was obtained by an anesthesiologist prior to the additional surgery. The patients were assigned to one of four anesthesia satisfaction levels, then were categorized into two groups; a high satisfaction group and a low satisfaction group. After comparing parameters between the two groups, logistic regression analysis was performed to identify factors  that were negatively associated with satisfaction with anesthesia.

Of 478 patients interviewed subjects, 469 patients were analyzed. Five individuals were excluded because they were unable to provide informed consent, and four subjects were excluded because they were aged < 10 years at the time of their previous surgery. Age < 65 years, previous surgery for malignancy, female sex, estimated operation duration < 3 hours, and American Society of Anesthesiologists Physical Status score 1 or 2 were included in a logistic regression analysis. Age < 65 years, previous surgery for malignancy, and female sex were predictive of poor patient satisfaction with anesthesia. Reasons for poor satisfaction with anesthesia included postoperative shivering and chills, fear of surgery, ineffective spinal anesthesia, and postoperative surgery-related pain. Of the patients awaiting surgery for malignancy, 57.3% had previous surgery for malignancy.

Age < 65 years, previous surgery for malignancy, and female sex were negatively associated with patient satisfaction with anesthesia. These factors should be considered when preparing patients for future procedures to improve postoperative patient satisfaction.

In this study, we investigated the causes of high respiratory resistance that is observed after general anesthesia. We focused on respiratory resistance at 5 Hz (R5), which were measured preoperatively and postoperatively.
Our prospective observational study enrolled 68 patients who underwent transurethral resection of bladder tumors from April to October 2015. Respiratory impedance was measured the day before surgery and immediately after general anesthesia. Participants were divided into 2 groups: Group L (postoperative R5 values Significant parameters were height, inhalation of desflurane, endotracheal suctioning, and preoperative R5 value. Logistic regression showed that endotracheal suctioning and a higher preoperative R5 level increased postoperative respiratory resistance (> 4 cmH2O/L/sec).
The endotracheal suctioning at the end of anesthesia influenced respiratory resistance more than use of the endotracheal tube and desflurane.

The forced oscillation technique (FOT) is a non-invasive means of measuring respiratory resistance and reactance. We tested our hypothesis that endotracheal intubation would cause more substantial preoperative increases in FOT parameters than a supraglottic airway device (SGD)..
Forty patients requiring general anesthesia and mechanical ventilation for transurethral bladder tumor resection underwent spirometry the day before surgery. Forced oscillation was measured using a MostGraph-01 device the day before surgery and immediately after removal of the airway adjunct. Changes in respiratory resistance and reactance were compared between those intubated and those who used SGD..
The trachea was intubated in 23 patients and SGD was used in the remaining 17 patients. Both airway adjuncts caused significant increases in preoperative respiratory resistance and reactance; however, the magnitude of the changes was significantly greater in the intubated patients..
The SGD appears to cause less pulmonary injury than tracheal intubation. Further study is needed to illuminate the influence of mechanical ventilation, and longer-term consequences and clinical significance of the changes we found in this study. Spontaneous ventilation through an SGD may be preferable in patients with severe respiratory disease..

Pressure and waveform at the catheter tip are continuously monitored during catheterization of pulmonary artery to ensure accurate catheter placement. We present a case in which pulmonary venous blood was unexpectedly collected from the pulmonary artery catheter despite pulmonary artery pressure and waveform detection at the catheter tip, and describe the measures taken to correct the catheter placement..
A 74-year-old male underwent mitral valve plasty for cardiac failure caused by mitral valve regurgitation. Preoperative transthoracic echocardiography showed no septal shunt. The pulmonary artery was catheterized through a sheath introducer in the right jugular vein, and the balloon was inflated after insertion of a 15-cm catheter. The catheter was advanced until a pulmonary artery waveform was detected and the pulmonary artery wedge pressure was 21 mmHg at end-expiration. The balloon was deflated and the catheter tip was pulled back 3 cm. Pulmonary artery waveforms and appropriate a and v waves were detected, and transesophageal echocardiography confirmed the location of the catheter tip in the right pulmonary artery. The first collected blood sample had an oxygen partial pressure of 358.8 mmHg, carbon dioxide partial pressure of 20.1 mmHg, and oxygen saturation of 99%, indicating pulmonary venous blood. The pulmonary artery catheter was pulled back 5 cm, but a second blood sample showed the same results. The catheter was pulled back a further 6 cm while the location of the catheter tip was monitored on X-ray fluoroscopy. Blood gas testing through the catheter tip showed oxygen saturation of 84.4 % and oxygen partial pressure of 41.6 mmHg. Surgery was performed uneventfully. Postoperative chest radiographs showed proper placement of the pulmonary artery catheter, but radiographs on postoperative day 1 showed over-insertion, although the insertion length was unchanged. The catheter was removed. The patient was discharged 2 months postoperatively..
Our case highlights the fact that the tip of the pulmonary artery catheter can easily advance into a peripheral branch of the pulmonary artery and cause pulmonary venous blood to be sampled instead of pulmonary arterial blood. A variety of monitoring techniques are needed to confirm accurate catheter placement..