Several complications have been described following pulmonary artery (PA) catheterization, including thrombus formation, balloon rupture, intracardiac knotting of a catheter and pulmonary artery injuries. 1,2 Ventricular arrhythmias are the most common complication associated with PA catheterization. 1,2 Although catheterinduced persistent ventricular tachycardia and ventricular fibrillation have been reported, 3-s this is the first report describing asystolic cardiac arrest occurring during removal of a PA catheter.Case report A 70-yr-old, 52-kg man was scheduled for elective hepatectomy because of hepatic carcinoma. His medical history was unremarkable except for papillotomy for common bile duct stones two years previously. Preoperative assessment, including physical examination, electrolytes, and blood count, was normal. A 12-lead ECG revealed regular sinus rhythm with a heart rate (HR) of 70 beats, min -1 and no conduction disturbance was recognized Upon arrival in the operating room, continuous ECG (lead II), arterial blood pressure (AP), and arterial oxygen saturation monitoring were started. An epidural catheter was inserted from the Tn_12 interspace and 12 ml lidocaine 1.5% with 1:200,000 epinephrine was injected, resulting in a sensory block from T4 to L 3 followed by slowing of HR from 90 beats-min -l to 70 beats .min -1 after 15 min. Ten milliliters of the same local anaesthetic solution were added every hour during the operation. General anaesthesia was induced with thiamylal iv and maintained with isoflurane and nitrous oxide in oxygen. Vecuronium provided neuromuscular relaxation. A 8.0-French catheter introducer was inserted into the right intemal jugular vein and a 7.0-French thermodilution flow-directed PA catheter (Baxter Healthcare Corp., Irvine, CA), which was not heparincoated, was placed through the introducer while monitoring the pressure wave without complications. No haemodynamic problems were encountered throughout the operation. Pulmonary capillary wedge pressure was maintained between 13 and 17 mmHg throughout the operation.The operation was concluded after six hours, at which CAN J ANAESTH 1996 /43:9 /pp 972--4

Expectations for treatment have a favorable effect on the subsequent course of pain and behavior in patients. It is not known whether receiving hydrodissection while patients view their ultrasound image with doctors (visual feedback) is associated with positive treatment expectations. This was an exploratory, prospective, observational clinical trial. We explored the possibility that visual feedback immediately after ultrasound-guided hydrodissection increases the expectations for treatment, which could be one of the related factors for pain reduction. Treatment expectations were set as mediators of pain using path analysis. The primary endpoint was the numerical rating scale to assess expectations for treatment immediately after hydrodissection, between with and without the visual feedback. During 2019 and 2020, 136 outpatients received ultrasound-guided hydrodissection for myofascial pain syndrome. Of these, 65 (47.8%) patients received visual feedback during ultrasound-guided hydrodissection. Compared with the non-visual feedback group, the visual feedback group had higher expectations for treatment immediately after hydrodissection, and their expectations were maintained at day 14 of treatment (p < 0.001). A numerical rating scale (NRS) to assess expectations for treatment was similar before hydrodissection and immediately after hydrodissection was 8.4 (standard deviations, 1.6) in the visual feedback and 5.9 (standard deviations, 2.6) in the visual feedback. The proportion of increased expectations immediately after hydrodissection was 90.8% (95% CI: 83.7–97.9) in visual feedback group and 38.0% (95% CI: 26.7–49.3) in non-visual feedback group (p < 0.001). In the visual feedback group, 67.7% of patients showed improvement in pain numerical rating scale score by 50% or more at day 14, whereas such improvement was observed in only 36.6% of the non-visual feedback group (p < 0.001). Based on path analysis, the visual feedback had the greatest influence on pain numerical rating scale reduction at 14 days, indirectly due to increased expectations for treatment as a mediator (β = 0.434). However, the adjusted R2 values, which is the overall fit of the model, was low at 0.298. Visual feedback during ultrasound-guided hydrodissection increases the expectations for treatment immediately after hydrodissection, which could be one of the related factors for pain reduction in patients with myofascial pain syndrome.

Background: Expectations for treatment have a favorable effect on the subsequent course of pain and behavior in patients. It is not known whether receiving interfascial injection while patients view their ultrasound image with doctors (visual feedback) is associated with positive treatment expectations. Methods: This was a prospective, multicenter, observational clinical trial. We evaluated whether visual feedback during ultrasound-guided interfascial injection affects treatment expectations and the subsequent course of pain in patients with myofascial pain syndrome. Treatment expectations were set as mediators of pain using path analysis. The primary endpoint was the proportion of patients who showed improvement in pain numerical rating scale score by 50% or more 14 days after initiation of treatment. Results: During 2019 and 2020, 136 outpatients received ultrasound-guided interfascial injection for myofascial pain syndrome. Of these, 65 (47.8%) patients received visual feedback during ultrasound-guided interfascial injection. Compared with the non-visual feedback group, the visual feedback group had higher expectations for treatment, immediately after interfascial injection, and their expectations were maintained at day 14 of treatment (p < .001). In the visual feedback group, 67.7% of patients showed improvement in pain numerical rating scale score by 50% or more at day 14 (95% confidence interval: 56.5–78.9), whereas such improvement was observed in only 36.6% of the non-visual feedback group (95% confidence interval: 25.3–47.9; p < .001). Path analysis revealed that visual feedback had the largest influence on pain numerical rating scale reduction at 14 days, which was indirectly via higher expectations for treatment (β = 0.434).Conclusions: Visual feedback during ultrasound-guided interfascial injection had a positive effect on the subsequent course of pain in patients with myofascial pain syndrome by increasing patients’ treatment expectations.Trial registration: UMIN000043160. Registered 28 January 2021 (registered retrospectively).