Authors have been involved in the reconstruction procedure of three-dimensional computed tomography (3D-CT) by Synapse Vincent based on Artificial Intelligence (AI). The patient was a 62-year-old male, and 3D-CT images showed renal cysts and stones. His clinical problems included high blood pressure, cholelithiasis, alcohol consumption, obesity, liver dysfunction, renal cyst, renal stones, and left renal ureteral obstruction. As the transparent image of 3D-CT reconstruction, the right ureter was traceable, but the left ureter was not. The left kidney shows contrast medium accumulation in the renal calyx, with no urine flow due to the renal stone. Thus, 3D-CT reconstruction would be beneficial.

Delirium is an acute confusional state characterized by inattention, altered level of consciousness, and cognitive dysfunction, whereas dementia is an insidious, chronic, and progressive loss of previously acquired cognitive abilities. The occurrence of delirium is an independent risk factor for subsequent dementia, and conversely, patients with dementia have a significantly higher risk of developing delirium compared to the general population. Although the close relationship between the two is recognized, the specific mechanisms underlying their interaction remain unclear. In daily life and clinical practice, timely assessment of cognitive function and effective intervention in individuals experiencing delirium may potentially slow cognitive decline and even prevent the onset or progression of dementia. This article reviews the research on the correlation between delirium and dementia, exploring ways to mitigate or even reverse further cognitive deterioration in delirious patients.

Hip fractures occur frequently in elderly patients, and there is a broad clinical consensus favoring early surgical intervention. However, hip fracture surgery is often prolonged, and elderly patients commonly present with multiple comorbidities, reduced tolerance to anesthetic agents, diminished metabolic capacity, and delayed postoperative recovery. Inappropriate intraoperative anesthesia methods can therefore increase the risk of postoperative cognitive dysfunction and instability of vital signs, leading to greater financial burden and impaired postoperative quality of life. Consequently, the selection of an appropriate anesthesia method is of significant importance for improving surgical safety and clinical outcomes. Based on these considerations, this article reviews the selection of anesthesia methods for elderly patients undergoing hip fracture surgery.

Venous air embolism (VAE) is a rare but potentially fatal complication of laparoscopic surgery, particularly in procedures requiring Trendelenburg positioning and pneumoperitoneum. This case report describes the successful resuscitation of a 68-year-old male who developed VAE during laparoscopic resection for recurrent rectal cancer. Ninety-four minutes after the start of surgery, the patient developed acute hypotension, bradycardia, hypoxemia, and a marked decrease in end-tidal carbon dioxide (ETCO₂). Bedside transthoracic echocardiography revealed abundant gas echoes within all cardiac chambers, confirming the diagnosis of VAE. Immediate management included repositioning to Durant’s position, ventilation with 100% oxygen, intermittent external chest compressions, and vasopressor support. Despite the occurrence of transient ventricular fibrillation, sinus rhythm was restored within minutes, and the patient achieved full recovery without neurological or cardiac sequelae. This case highlights the critical importance of early recognition of VAE through integrated hemodynamic monitoring and echocardiography, and demonstrates the effectiveness of a multimodal resuscitation strategy in achieving favorable clinical outcomes. It also underscores the need for heightened vigilance and well-prepared emergency response protocols during high-risk laparoscopic procedures.

Perioperative sleep disorders (PSDs), affecting approximately 60% of surgical patients, are a significant yet often overlooked challenge that hinders recovery and increases the risk of complications. This paper provides a systematic analysis of the complex mechanisms and key risk factors contributing to PSDs from four distinct dimensions. It identifies preoperative vulnerabilities such as baseline insomnia, obstructive sleep apnea (OSA), anxiety, and chronic comorbidities as primary predisposing factors. Furthermore, it examines the direct impacts of intraoperative factors, including the suppression of sleep architecture by anesthetic drugs (propofol, opioids) and the disruption of circadian rhythms caused by surgical timing and trauma. The review also highlights the synergistic exacerbation of sleep disturbances in the postoperative phase due to pain–inflammation cycles, adverse ward environments (noise and light), and medication side effects. Based on these findings, the study concludes that a multidisciplinary strategy combining preoperative screening, optimized anesthetic management, and environmental interventions is essential to mitigate PSDs. By improving perioperative sleep quality, clinicians can significantly enhance patient satisfaction, reduce hospital stays, and promote rapid rehabilitation.

Trauma-induced hemorrhage is one of the primary causes of preventable mortality globally, accounting for a substantial proportion of prehospital deaths and underscoring the critical demand for prompt and effective blood management strategies during prehospital transport. This narrative review aims to synthesize the current state, key challenges, and future perspectives of prehospital blood management for trauma patients. This review evaluates established trauma assessment tools (e.g., Shock Index, ABC score), the global implementation of prehospital blood product transfusion—including low-titer group O whole blood, packed red blood cells, and plasma—by emergency medical services in the United States, Europe, and Australia, as well as non-transfusion interventions such as early tranexamic acid administration, crystalloid/colloid resuscitation, and physical hemostatic interventions.
Recent advances, including lyophilized plasma, point-of-care viscoelastic monitoring, telemedicine platforms, artificial intelligence–driven decision support systems, real-time blood-loss monitoring technologies, and automated transfusion devices, are reviewed for their potential to optimize trauma care delivery. Major challenges identified include resource constraints in remote or austere environments, marked heterogeneity in transfusion protocols and triggering criteria, suboptimal assessment and monitoring capabilities, and deficiencies in prehospital provider training and continuing education.
Optimization strategies encompass standardized operating procedures, strengthened interdisciplinary collaboration, enhanced public and professional trauma education initiatives, and structured competency-based training frameworks. By clarifying these key elements and outlining priority research directions—including personalized transfusion protocols and integration of large-scale data analytics—this review serves as a fundamental reference for the development of evidence-based clinical guidelines and consensus statements. Ultimately, this review seeks to advance protocol standardization and improve survival outcomes for patients with life-threatening traumatic hemorrhage.

The case was a 75-year-old male with hypertension, dyslipidemia, type 2 diabetes (T2D), mild cognitive impairment (MCI), and a general presence of arteriosclerosis for years. HbA1c remained stable at about 7.1–7.4%, and otherwise, no remarkable biochemical results were observed. Pulse wave velocity (PWV) showed an ankle-brachial index (ABI) of 0.96/1.12 and a cardio-ankle vascular index (CAVI) of 9.1/8.6 (right/left), respectively. CAVI values remained stable for 6 years.
These results suggested the presence of generalized arteriosclerosis due to his previous diseases. He has been treated with vildagliptin/metformin (EquMet). From summer 2025, he maintained a low-carbohydrate diet (LCD) satisfactorily, and then HbA1c decreased to 6.0% in 2026.

The case was a 75-year-old male with hypertension, dyslipidemia, type 2 diabetes (T2D), mild cognitive impairment (MCI), and a general presence of arteriosclerosis for years. HbA1c remained stable at about 7.1–7.4%, and otherwise, no remarkable biochemical results were observed. Pulse wave velocity (PWV) showed an ankle-brachial index (ABI) of 0.96/1.12 and a cardio-ankle vascular index (CAVI) of 9.1/8.6 (right/left), respectively. CAVI values remained stable for 6 years.
These results suggested the presence of generalized arteriosclerosis due to his previous diseases. He has been treated with vildagliptin/metformin (EquMet). From summer 2025, he maintained a low-carbohydrate diet (LCD) satisfactorily, and then HbA1c decreased to 6.0% in 2026.

Introduction: Massive goiter may compress the trachea, causing tracheal deviation and structural abnormalities, resulting in dyspnea. Most patients present with multiple cardiopulmonary complications. Therefore, airway management in such patients carries considerable risks during anesthesia and surgery, and perioperative anesthetic management is relatively complex.
Case Presentation: A 78-year-old woman was admitted to the Department of Thyroid Surgery with complaints of a cervical mass with dyspnea. Preoperative multidisciplinary evaluation, detailed airway assessment, and a personalized anesthetic plan were formulated. General anesthesia with awake fiberoptic bronchoscope intubation was adopted. Perioperative vital signs, airway patency, and thyroid-related hormone levels were closely monitored. The operation was completed smoothly, and the patient recovered well without perioperative airway complications, recurrent laryngeal nerve injury, or thyroid crisis.
Conclusion: This case summarizes the key points of anesthetic management for massive goiter resection, providing a clinical reference for similar cases.

The case is a 77-year-old female who was treated for arteriosclerosis and gastroesophageal reflux disease (GERD). In March 2025, type 2 diabetes (T2D) was detected, with HbA1c of 8.8%. Physical examination was negative, with BMI of 21.7 kg/m². Blood chemistry examination revealed LDL of 142 mg/dL, and pulse wave velocity (PWV) showed a cardio-ankle vascular index (CAVI) of 9.9/9.6 and ankle-brachial index (ABI) of 1.11/1.07.
She was advised to follow a petite low-carbohydrate diet (LCD), treated with imeglimin (Twymeeg), and subsequently received rosuvastatin, vildagliptin, and metformin. As a result, she showed improvement, with HbA1c of 7.0% and LDL of 78 mg/dL in March 2026, indicating remarkable clinical efficacy.

Laparoscopic extended pancreaticoduodenectomy is a radical surgical procedure for malignant tumors of the pancreatic head and periampullary region, characterized by extensive surgical trauma and complex anatomical dissection. Postoperative intra-abdominal hemorrhage is a life-threatening complication with rapid progression and can quickly lead to hemorrhagic shock. As a minimally invasive and precise hemostatic approach with less secondary trauma, transcatheter arterial embolization (TAE) has become the first-choice emergency treatment for postoperative arterial intra-abdominal hemorrhage.
However, these patients have usually just undergone major surgery and may present with severe hemorrhagic shock, coagulation dysfunction, and multiple organ impairment, posing enormous challenges to anesthetic management. This paper reports the anesthetic management process of a patient with intra-abdominal arterial hemorrhage after laparoscopic extended pancreaticoduodenectomy who underwent emergency digital subtraction angiography (DSA) and TAE under general anesthesia. The key points of perioperative circulatory management, airway management, coagulation regulation, and organ protection are summarized, providing references for anesthetic treatment of similar critical cases in clinical practice.