Pubmed du 04/10/25
1. Ito H, Tsuji T, Sobue K. Clinical and demographic characteristics of patients with autism spectrum disorder receiving general anesthesia with or without physical restraint: a single-center retrospective study. J Anesth. 2025.
PURPOSE: Perioperative management of patients with autism spectrum disorder (ASD) often requires premedication and physical restraint. This study examined the characteristics of patients with ASD who required special interventions for general anesthesia, particularly physical restraint during induction. METHOD: This retrospective study included patients diagnosed with ASD (autism, pervasive developmental disorder, Rett syndrome, Asperger’s syndrome, or childhood disintegrative disorder) based on established criteria. All patients underwent general anesthesia at a hospital for patients with disabilities between April 2019 and March 2022. Data collected included clinical and demographic characteristics, perioperative management (premedication and anesthetic methods), surgical indications, physical restraint use, and induction time. A comparative analysis was conducted to identify differences in patient characteristics and induction times between physical restraint and no-restraint groups. Induction times were compared using Kaplan-Meier survival curves and log-rank tests. RESULTS: A total of 136 procedures were performed on 102 patients. Median age was 23.3 years (interquartile range: 12.8-35.2), 79% of participants were male, and approximately 40% exhibited self-injurious or aggressive behaviors. Dental procedures were the most common indication for anesthesia. Midazolam and pentobarbital were the most frequently administered premedications. Patients requiring physical restraint were generally larger and more likely to exhibit self-injurious or aggressive behaviors than those who did not. However, induction times were not prolonged in the physical restraint group compared with the no-restraint group. CONCLUSION: The characteristics identified in this study, such as large body size, self-injurious behavior, and aggressive behavior, may inform future research aimed at refining physical restraint use for patients with ASD.
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2. Lin J, Hefford B, Hefford J, Jacombs E, Solayar R, Kang S, Provenzano SCJ, Matta MG. Coronary Embolism From a Sinus Venosus ASD With PAPVD. JACC Case Rep. 2025; 30(30): 105220.
BACKGROUND: Paradoxical embolism (PDE) is a rare, underrecognized cause of acute coronary syndrome, occurring when a thrombus crosses an intracardiac defect into systemic circulation. Sinus venosus atrial septal defects (ASDs), often associated with partial anomalous pulmonary venous drainage, may manifest in adulthood with complications such as PDE. CASE SUMMARY: We describe a 52-year-old man presenting with non-ST elevation myocardial infarction. Coronary angiography showed a distal right coronary occlusion suggestive of embolic infarction. Transthoracic echocardiography with bubbles revealed a right-to-left shunt. Transesophageal echocardiography confirmed a sinus venosus ASD with partial anomalous pulmonary venous drainage. Surgical correction with intra-atrial baffle and ASD closure was successful. DISCUSSION: This case highlights the importance of considering PDE in myocardial infarction in the absence of risk factors. Multimodality imaging was key to diagnosis and guiding treatment. TAKE-HOME MESSAGES: PDE is an underrecognized cause of acute coronary syndrome mechanism. Structural heart defects must be ruled out in coronary embolism or cryptogenic myocardial infarction.
