Traumatic diaphragmatic hernia is a serious complication of blunt trauma to the abdomen or thorax. Although traumatic diaphragmatic hernia is treated with surgical repair, a laparoscopic approach is infrequently employed. Here we present the case of a 66‐year‐old man with a bruise on the left side of his back. CT revealed a left pneumothorax and left rib fractures. He was urgently hospitalized and relieved with conservative treatment. However, on day 4 of hospitalization, an incarcerated diaphragmatic hernia containing the transverse colon was observed on CT. The herniated viscera of the abdominal cavity were reduced laparoscopically, and the hernial orifice was repaired with direct closure. One‐lung ventilation was used to limit the movement of the affected diaphragm, enabling effective laparoscopic suturing. The patient had an uneventful recovery period and was discharged 8 days postoperatively. The absence of diaphragmatic herniation recurrence was confirmed 6 months after surgery.

Purpose. Malignant hyperthermia (MH) is a rare genetic disorder but one of the most severe complications of general anesthesia. The mortality rate of MH has dropped from 70% in the 1960s to 15% because of dantrolene, the only currently accepted specific treatment for MH. In this study, we retrospectively identified the optimal dantrolene administration conditions to reduce MH mortality further. Methods. Our database performed a retrospective analysis of patients with MH clinical grading scale (CGS) grade 5 (very likely) or 6 (almost certain) between 1995 and 2020. We examined whether dantrolene administration affected mortality and compared the clinical variables associated with improved prognosis. Furthermore, a multivariable logistic regression analysis was used to identify specific variables associated with improved prognosis. Results. 128 patients met the inclusion criteria. 115 patients were administered dantrolene; 104 survived, and 11 died. The mortality rate of patients who were not administered dantrolene was 30.8%, which was significantly higher than those of patients who were administered dantrolene ( P = 0.047 ). Among patients administered dantrolene, the interval from the first sign of MH to the start of dantrolene administration was significantly longer in the deceased than in the survivors (100 min vs. 45.0 min, P < 0.001 ), and the temperature at the start of dantrolene administration was also significantly higher in the deceased (41.6°C vs. 39.1°C, P < 0.001 ). There was no significant difference in the rate of increase in temperature between the two, but there was a substantial difference in the maximum temperature ( P < 0.001 ). The multivariable analysis also showed that the patient’s temperature at dantrolene administration and interval from the first MH sign to dantrolene administration was significantly associated with improved prognosis. Conclusions. Dantrolene should be given as rapidly as possible once MH has been diagnosed. Beginning treatment at a more normal body temperature can prevent critical elevations associated with a worse prognosis.

Opioid sensitivity is difficult to predict, and varies among individuals. We previously reported that sympathetic responses to nociceptive stimuli under propofol anesthesia can be predicted by measuring the minimum evoked current of the vascular stiffness value (MECK). We now propose that MECK can also be used in the same capacity for volatile anesthetic. Thirty patients undergoing laparotomy with sevoflurane anesthesia received intravenous remifentanil at a constant concentration of 2 ng/mL followed by tetanic stimulation. The first-order linear regression equation of MECK and the rate of change of systolic blood pressure during the skin incision (ROCBP) under sevoflurane anesthesia were almost the same as those for propofol. We fitted the data in the present study to the prediction equation for ROCBP obtained under propofol anesthesia and performed a Bland-Altman plot analysis. Fixed bias was minimal, at -1.86%, and the precision range at 9.96% was almost the same as 10.17% that from the previous study. No significant proportional errors were observed. These results suggest that MECK can be used as a predictive index for ROCBP under sevoflurane anesthesia. Additionally, the prediction equation for ROCBP under propofol anesthesia can be used for sevoflurane anesthesia without a decrease in predictive performance. Clinical trial registration Registry: University hospital medical information network; Registration number: UMIN000047425; principal investigator name: Noboru Saeki; date of registration: April 8th, 2022.

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