Anesth. Res., Volume 2, Issue 3 (September 2025) – 3 articles

This case report describes the acute and multidisciplinary management anesthesiologists performed for an intra-operative bronchobiliary fistula during a routine endoscopic retrograde cholangiopancreatography for a patient with intrahepatic cholangiocarcinoma. During the procedure, an unexpected rapid airway deterioration was encountered due to bile infiltration of the right bronchus and anesthesia circuit, necessitating (1) emergent extubation and reintubation with bronchoscopy, (2) extubation and reintubation with double-lumen endotracheal tube with right-bronchial blocker, and (3) transportation of the patient from endoscopy to interventional radiology for biliary drain placement. Overall, this case highlights a rare but serious consideration for patients with intrahepatic cholangiocarcinoma who may present with a bronchobiliary fistula and the steps taken to prevent total airway compromise and ensure rapid patient stabilization through coordination with advanced gastroenterology, interventional pulmonology, and interventional radiology. Full article

Introduction: Propofol is a widely used sedative drug in electrophysiological studies (EPS). However, literature has shown that this drug may interfere with the cardiac conduction system (CCS). Our objective is to evaluate whether propofol interferes with CCS and the inducibility of arrhythmias during EPS. Method: A systematic review and a meta-analysis were performed. The databases were PubMed, Embase, Web of Science, and Scopus. Rayyan software was used to select the studies. Three Mesh terms were used: Propofol, Cardiac arrhythmias, Electrophysiologic Study, and Cardiac. Cohort studies and randomized clinical trials were included. Results: Only one of the six studies showed four cases where it was impossible to induce arrhythmia. We found no significant difference between propofol and the control group in the analyzed variables: cycle length, atrial-His, His-ventricular, corrected sinus node recovery time, atrial effective refractory factor, and ventricular effective refractory period, with low heterogeneity (I² = 0% to a maximum of I² = 8%). A significant difference in favor of the control group was found in the analysis of the atrioventricular node effective refractory period (MD:18.67 {95% CI 4.86 to 32.47} p = 0.008, I² = 44%). Discussion: The meta-analyzed data in this study showed that propofol possibly does not interfere with CCS, making it a safe drug for this type of procedure. Conclusions: However, extra care should be exercised with pediatric patients when the arrhythmia’s mechanism is automatic. More robust studies are still needed in this class. Full article

Background: PP-007 (SANGUINATE^®, PEGylated carboxyhemoglobin, bovine) is under development to treat conditions of ischemia/hypoxia. Hemorrhagic/hypovolemic shock (H/HVS) becomes a life-threatening comorbidity due in part to hypotension and hypoxia. Blood transfusions are indicated, but supply and compatibility issues may limit subject access or when blood is not an option due to religious restriction or concern for clinical complications. PP-007 is universally compatible with an effective hydrodynamic radius and colloidal osmotic pressure facilitating perfusion without promoting extravasation. Methods: A review of previous clinical trials was performed and revealed an Open-Label Phase 1 safety study of acute severe anemia (hemoglobin ≤ 5 g/dL) in adult (≥18 y) patients unable to receive red blood cell transfusion (NCT02754999). Primary outcomes included safety events with secondary efficacy measures of organ function and survival at 1, 14, and 28 days. Additionally, a retrospective review of published, peer-reviewed case reports was performed, evaluating the administration of Sanguinate for Expanded Access in those patient populations where blood was not an option over the past 12 years. Results: A total of 103 subjects were enrolled in the Phase I safety study with significant co-morbidities that most commonly included hypertension (n = 43), acute and chronic kidney disease (n = 38), diabetes mellitus (n = 29), gastrointestinal bleeds (n = 18), and sickle cell disease (n = 13). Enrollment characteristics included decreased hemoglobin and severe anemia (mean baseline hemoglobin of 4.2 g/dL). Treatments included an average of three infusions [range 1–17]. Secondary efficacy measures were mean Hb levels, respiratory support, and vasopressor requirements, all demonstrating clinically relevant improvements. Fourteen additional cases were identified in the literature. Though one patient died due to pre-treatment conditions, all patients but one were discharged home in stable condition. Conclusion: Collectively, these observations are encouraging and provide support for the continued evaluation of PP-007 in advanced clinical trials in severe anemia including H/HVS. The review of published case reports underscored the potential of Sanguinate to reduce early mortality. Adverse effects included transient hypertension, lethargy, dizziness, and troponin elevation. These findings highlight the need for continued research and funding of blood alternatives to improve outcomes when standard blood transfusions are unavailable or contraindicated. Full article