ABSTRACT
BACKGROUND: Several studies have shown in animal models that remote ischemic preconditioning (rIPC) has a neuroprotective effect. However, a randomized controlled trial in human subjects to investigate the neuroprotective effect of rIPC after cardiac surgery has not yet been reported. Therefore, we performed this pilot study to determine whether rIPC reduced the occurrence of postoperative cognitive dysfunction in patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery. METHODS: Seventy patients who underwent OPCAB surgery were assigned to either the control or the rIPC group using a computer-generated randomization table. The application of rIPC consisted of four cycles of 5 min ischemia and 5 min reperfusion on an upper limb using a blood pressure cuff inflating 200 mmHg before coronary artery anastomosis. The cognitive function tests were performed one day before surgery and again on postoperative day 7. We defined postoperative cognitive dysfunction as decreased postoperative test values more than 20% of the baseline values in more than two of the six cognitive function tests that were performed. RESULTS: In the cognitive function tests, there were no significant differences in the results obtained during the preoperative and postoperative periods for all tests and there were no mean differences observed in the preoperative and postoperative scores. The incidences of postoperative cognitive dysfunction in the control and rIPC groups were 28.6% (10 patients) and 31.4% (11 patients), respectively. CONCLUSIONS: rIPC did not reduce the incidence of postoperative cognitive dysfunction after OPCAB surgery during the immediate postoperative period.
Subject(s)
Humans , Blood Pressure , Coronary Artery Bypass, Off-Pump , Coronary Vessels , Incidence , Ischemia , Ischemic Preconditioning , Models, Animal , Neuroprotective Agents , Pilot Projects , Postoperative Period , Random Allocation , Reperfusion , Thoracic Surgery , Transplants , Upper ExtremityABSTRACT
No abstract available.
Subject(s)
Humans , Heart-Lung Transplantation , Pulmonary Artery , SarcomaABSTRACT
No abstract available.
Subject(s)
Circulatory Arrest, Deep Hypothermia Induced , Thoracic SurgeryABSTRACT
Indigo carmine has been used for eight decades with few adverse effects. Several of our patients, however, experienced severe hypotensive episodes after indigo carmine administration within a period of one month. Analysis of the raw materials used to formulate the preparation of indigo carmine we used showed that they contained impurities. Following recall of these impure materials, none of our patients experienced further hypotensive episodes.
Subject(s)
Humans , Hypotension , Indigo Carmine , IndolesABSTRACT
OBJECTIVE: Excitatory amino acids play important roles in the development of secondary pathology following spinal cord injury (SCI). This study was designed to evaluate morphological changes in the dorsal horn of the spinal cord and assess profiles of pain behaviors following intraspinal injection of N-methyl-D-aspartate (NMDA) or quisqualate (QUIS) in rats. METHODS: Forty male Sprague-Dawley rats were randomized into three groups : a sham, and two experimental groups receiving injections of 125 mM NMDA or QUIS into their spinal dorsal horn. Following injection, hypersensitivity to cold and mechanical stimuli, and excessive grooming behaviors were assessed serially for four weeks. At the end of survival periods, morphological changes in the spinal cord were evaluated. RESULTS: Cold allodynia was developed in both the NMDA and QUIS groups, which was significantly higher in the QUIS group than in the NMDA group. The mechanical threshold for the ipsilateral hind paw in both QUIS and NMDA groups was significantly lower than that in the control group. The number of groomers was significantly higher in the NMDA group than in the QUIS group. The size of the neck region of the spinal dorsal horn, but not the superficial layer, was significantly smaller in the NMDA and QUIS groups than in the control group. CONCLUSION: Intraspinal injection of NMDA or QUIS can be used as an excitotoxic model of SCI for further research on spinal neuropathic pain.
Subject(s)
Animals , Humans , Male , Rats , Cold Temperature , Excitatory Amino Acids , Grooming , Horns , Hyperalgesia , Hypersensitivity , Injections, Spinal , N-Methylaspartate , Neck , Neuralgia , Quisqualic Acid , Rats, Sprague-Dawley , Salicylamides , Spinal Cord , Spinal Cord InjuriesABSTRACT
Renal cell carcinoma (RCC) rarely extends to the cardiac chambers, and the presence of an extension of tumor thrombus to the inferior vena cava or the right atrium has not been shown to determine the survival of patients with RCC.Although an aggressive surgical approach remains the primary treatment for RCC, the anesthetic management remains a difficult intraoperative challenge.We report here on a case of performing cavoatrial tumor thrombectomy and radical nephrectomy in a patient with RCC with an intracardiac extension, and we used cardiopulmonary bypass and intraoperative trans-esophageal echocardiography to assess and treat this tumor.
Subject(s)
Humans , Carcinoma, Renal Cell , Cardiopulmonary Bypass , Echocardiography , Heart Atria , Nephrectomy , Thrombectomy , Thrombosis , Vena Cava, InferiorABSTRACT
BACKGROUND: Neuropathic pain resulting from diverse causes is a chronic condition for which effective treatment is lacking. The goal of this study was to test whether dexamethasone exerts a preemptive analgesic effect with bupivacaine when injected perineurally in the spared nerve injury model. METHODS: Fifty rats were randomly divided into five groups. Group 1 (control) was ligated but received no drugs. Group 2 was perineurally infiltrated (tibial and common peroneal nerves) with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 3 was infiltrated with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) after surgery. Group 4 was infiltrated with normal saline (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 5 was infiltrated with only 0.4% bupivacaine (0.2 ml) before surgery. Rat paw withdrawal thresholds were measured using the von Frey hair test before surgery as a baseline measurement and on postoperative days 3, 6, 9, 12, 15, 18 and 21. RESULTS: In the group injected preoperatively with dexamethasone and bupivacaine, mechanical allodynia did not develop and mechanical threshold forces were significantly different compared with other groups, especially between postoperative days 3 and 9 (P < 0.05). CONCLUSIONS: In conclusion, preoperative infiltration of both dexamethasone and bupivacaine showed a significantly better analgesic effect than did infiltration of bupivacaine or dexamethasone alone in the spared nerve injury model, especially early on after surgery.
Subject(s)
Animals , Rats , Bupivacaine , Dexamethasone , Hair , Hyperalgesia , NeuralgiaABSTRACT
Spinal cord stimulation has been applied for some patients with failed back surgery syndrome or neuropathic pain. Tests for the spinal cord stimulation can be performed under local or general anesthesia. However, if this is done during an operation with the patient under general anesthesia, it would be impossible to recognize whether an electrode induces paresthesia in the concordant painful area by the patient's self report. A 79-year-old female patient with failed back surgery syndrome had a spinal cord stimulator implanted under spinal anesthesia and the stimulation led to paresthesia on the most painful area of the patient. We report here on a case that surgical implantation of a spinal cord stimulator was successfully performed under spinal anesthesia.
Subject(s)
Aged , Female , Humans , Anesthesia, General , Anesthesia, Spinal , Electrodes , Failed Back Surgery Syndrome , Laminectomy , Neuralgia , Paresthesia , Self Report , Spinal Cord , Spinal Cord StimulationABSTRACT
BACKGROUND: We examined the effects of varying inspiratory to expiratory (I : E) ratio on gas exchange and hemodynamics during high frequency partial liquid ventilation (HFPLV), a combination of high frequency ventilation (HFV) and partial liquid ventilation (PLV), in a rabbit model of acute lung injury. METHODS: Twelve rabbits treated with repeated saline lavage were divided into two groups. In the HFPL group (n = 6), 6 ml/kg of perfluorodecaline was administered through the endotracheal tube. Rabbits in this group and in the HFJ group (n = 6) were treated with high frequency jet ventilation (HFJV) at I : E ratios of 1 : 1, 1 : 2, and 1 : 3 for 15 minutes, and arterial blood gas, mixed venous blood gas and hemodynamic parameters were measured. RESULTS: We observed no significant respiratory and hemodynamic differences between the two groups. At an I : E ratio of 1 : 1, the PaO2 was significantly higher, and the shunt rate and PaCO2 were significantly lower in both groups, compared with I : E ratios of 1 : 2 and 1 : 3. Cardiac output at the 1 : 3 I : E ratio was significantly higher than at 1 : 1. CONCLUSIONS: These findings indicate that, in this model, a 1 : 1 I : E ratio was superior for oxygenation and ventilation than I : E ratios of 1 : 2 or 1 : 3, while having no detrimental effects on hemodynamics.
Subject(s)
Rabbits , Acute Lung Injury , Cardiac Output , Hemodynamics , High-Frequency Jet Ventilation , High-Frequency Ventilation , Liquid Ventilation , Oxygen , Therapeutic Irrigation , VentilationABSTRACT
BACKGROUND: Hypoperfusion during manipulation of the heart in off-pump coronary artery bypass (OPCAB) surgery may lead to postoperative neurological complications. Therefore, it will be necessary to monitor cerebral function during OPCAB surgery. In this study, we compared regional cerebral oxygenation (rSO2) by near-infrared spectroscopy (NIRS) with jugular bulb venous oxygen saturation (SjvO2) and assessed whether rSO2 measured by NIRS could be an alternative method of SjvO2 during OPCAB surgery. METHODS: A total of 20 patients who underwent OPCAB surgery were studied. A fiberoptic catheter was placed in the right jugular bulb to measure SjvO2 while a cerebral oximeter based on NIRS, INVOS 5100B was used to monitor rSO2. Radial arterial and jugular bulb blood samples were drawn simultaneously from baseline every hour during operation. The values of rSO2 were compared with SjvO2 values. RESULTS: For all data points (n = 78) for all patients combined, rSO2 values were significantly correlated with SjvO2 values (r = 0.513, P < 0.0001). There were significant correlations between arterial carbon dioxide and values of SjvO2 (r = 0.393, P = 0.0002) and rSO2 (r = 0.432, P < 0.0001). CONCLUSIONS: We concluded that NIRS correlates with SjvO2 in this patient population. These findings suggest that near-infrared spectroscopy may be useful in assessing cerebral oxygenation during OPCAB surgery.
Subject(s)
Humans , Carbon Dioxide , Catheters , Coronary Artery Bypass, Off-Pump , Heart , Organothiophosphorus Compounds , Oxygen , Spectroscopy, Near-InfraredABSTRACT
The bispectral index (BIS) has been developed as a measure for monitoring the hypnotic drug effect. EEG processing results in a BIS scale from 0 to 100, where 100 represents an awake and responsive patient, and the scale decreases when hypnotics are administered. Here we describe two patients in whom the BIS decreased to nearly 0 during cardiac surgery. Postoperatively both patients showed hypoxic brain injury. There are several possible causes for a decrease in the BIS during surgery, including deep anesthesia, hypothermia and cerebral ischemia. In the present cases, cerebral hypoperfusion was the likely cause. During cardiac surgery, hemodynamic changes such as acute hypotension and cardiac arrest can cause cerebral ischemia. Cerebral ischemia develops most commonly during cardiopulmonary bypass (CPB). Therefore, the BIS may be useful for detecting severe cerebral ischemia during CPB, although it has some limitations as a cerebral monitor.
Subject(s)
Humans , Anesthesia , Brain Injuries , Brain Ischemia , Cardiopulmonary Bypass , Electroencephalography , Heart Arrest , Hemodynamics , Hypnotics and Sedatives , Hypotension , Hypothermia , Thoracic SurgeryABSTRACT
Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient's blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation.
Subject(s)
Humans , Budd-Chiari Syndrome , Cardiac Output , Hemorrhage , Liver Cirrhosis , Liver Transplantation , Liver , Living Donors , OxygenABSTRACT
BACKGROUND: Remifentanil may be advantageous during induction of anesthesia in patient with heart disease because of rapid onset and hemodynamic stability. Some study reported that remifentanil showed complications such as profound bradycardia, severe hypotension and rigidity. The purpose of this study is to investigate the hemodynamic changes and side effects of remifentanil by using the methods of bolus administration during induction of anesthesia in cardiac surgery. METHODS: Fifty eight patients of ASA physical status 2~3 undergoing cardiac surgery were enrolled into 3 groups. We administered no remifentanil in Group A, 5microg/kg of remifentanil in Group B and 10microg/kg of remifentanil in Group C. After bolus administration of remifentanil over 30 sec, we infused 0.2microg/kg/min of remifentanil continuously. All group received continuous infusion of 100microg/ kg/min of propofol. After loss of consciousness, 0.15 mg/kg of vecuronium was administered. After the Bispectral index (BIS) value became lower than 60, intubation was done. Mean arterial pressure, heart rate, the incidence of cough, jaw and chest wall rigidity, and BIS value were measured initially and 1, 2, 3, 4, 5 minutes before intubation and 1, 2, 3, 4, 5 minutes after intubation. RESULTS: Mean arterial pressures of group B and C were significantly lower than those of group A (P < 0.05). Heart rate was similar among the groups. Group C showed a greater incidence of jaw rigidity (77%) compared with group A (35%) and group B (35%) (P < 0.05). The incidence of chest wall rigidity (66%) in group C was greater than group A (5%) and group B (15%) (P < 0.05). CONCLUSIONS: Remifentanil used as an induction agent (5microg/kg or 10microg/kg) may cause hypotension and jaw, chest wall rigidity with improper ventilation.
Subject(s)
Humans , Anesthesia , Arterial Pressure , Bradycardia , Cough , Heart Diseases , Heart Rate , Hemodynamics , Hypotension , Incidence , Intubation , Jaw , Propofol , Thoracic Surgery , Thoracic Wall , Unconsciousness , Vecuronium Bromide , VentilationABSTRACT
An inguinal hernia shows that the protruding viscus exits from the endoabdominal fascial sac through the internal inguinal ring. Because an inguinal hernia is usually associated with incarceration, obstruction and even strangulation, it must be quickly treated whenever observed. Although there are several predisposing factors of the development of inguinal hernia, relatively little is a case report of the inguinal hernia developed by the increased intra-abdominal pressure during general anesthesia. In this case, we report a patient who developed the unexpected recurrence of left inguinal hernia following lumbar spinal surgery in prone position by increasing intra-abdominal pressure. After manual reduction was performed promptly by general surgeon, the patient was discharged without any complication on the eighth postoperative day.
Subject(s)
Humans , Anesthesia, General , Causality , Hernia, Inguinal , Inguinal Canal , Prone Position , RecurrenceABSTRACT
Cerebral complication after cardiac surgery with cardiopulmonary bypass varies widely focal neurologic deficit, stupor, coma, dementia, memory deficit, or seizures. The incidence of visual loss from ischemic optic neuropathy is from 0.06% to 0.113%. Visual loss is a rare but devastating complication of cardiac surgery. This report describes a patient who had reversible visual loss in postoperative period. She had undergone the decrease of bispectral index, cerebral oxygen saturation and the increase of suppression ratio during mitral valvuloplasty.
Subject(s)
Humans , Cardiopulmonary Bypass , Coma , Delirium , Dementia , Hypertensive Encephalopathy , Incidence , Memory Disorders , Neurologic Manifestations , Optic Neuropathy, Ischemic , Oxygen , Postoperative Period , Seizures , Stupor , Thoracic SurgeryABSTRACT
A 37-year-old female was scheduled for minimally invasive mitral valve replacement and Maze operation using the robotically controlled camera (AESOP 3000, Computermotion(R), USA). Thoracic incision and carbon dioxide insufflation was started. The end tidal carbon dioxide suddenly decreased with hypotension and an increase in central venous pressure to 70 mmHg. Then, cardiopulmonary bypass was started and large amount of gas was aspirated. Carbon dioxide embolism was suspected, carbon dioxide insufflation was discontinued. The aspiration of carbon dioxide embolus from cannulae for cardiopulmonary bypass confirmed our diagnosis. The gas flowed out from the peritoneal cavity following diaphragmatic incision, we suspected that the insufflating needle was placed into peritoneal cavity. The operation was completed uneventfully. No neurologic and cardiopulmonary sequelae were noted. We experienced a case of carbon dioxide embolism incidentally induced by carbon dioxide insufflation into closed intraperitoneal cavity.
Subject(s)
Adult , Female , Humans , Carbon Dioxide , Carbon , Cardiopulmonary Bypass , Catheters , Central Venous Pressure , Diagnosis , Embolism , Hypotension , Insufflation , Mitral Valve , Needles , Peritoneal Cavity , Thoracic SurgeryABSTRACT
BACKGROUND: The effect of a muscle relaxant may differ in the elderly for pharmacokinetic and pharmacodynamic reasons. Rocuronium, a derivative of vecuronium is a non depolarizing neuromuscular blocker with a rapid onset and intermediate duration. The purpose of this study was to compare differences in the onset and duration of rocuronium in young adults and the elderly. METHODS: The study was approved by our instituitional review board, and informed consent was obtained from all patients. Twenty two young adults (15 59 yr) and 21 elderly (65 80 yr) patients, ASA physical status 1 2 underwent elective orthopedic surgery under general anesthesia. All were anesthetized with pentothal sodium, nitrous oxide, and isoflurane. Rocuronium (0.6 mg/kg) was given and then intubation was performed after TOF response had totally disappeared. Neuromuscular relaxation was measured by TOF response at the adductor pollicis muscle after a supramaximal stimulation of Train-of-four (TOF, 2 Hz every 12 sec) at the ulnar nerve. Onset (disappearance of T1) and the recovery times of T1, T2, T3 and T4 were recorded. RESULTS: The onset of neuromuscular block was slower in the elderly than the young adults (P < 0.05), and recovery times of T1, T2, T3, and T4 were prolonged in the elderly (P < 0.05). CONCLUSIONS: Rocuronium has a slower onset time and a delayed recovery in the elderly.
Subject(s)
Aged , Humans , Young Adult , Anesthesia, General , Geriatrics , Informed Consent , Intubation , Isoflurane , Neuromuscular Blockade , Nitrous Oxide , Orthopedics , Relaxation , Sodium , Thiopental , Ulnar Nerve , Vecuronium BromideABSTRACT
Central venous catheterization can have many complications. A pneumothorax, hemothorax, hemomediastinum, air embolism, cardiac tamponade, and major vascular laceration are complications that can be induced by internal jugular venous catheterization. A patient with Marfan syndrome had a soft connective tissue and variable characteristic major vascular anomaly. We report a case of an acute lethal extrapleural hematoma in a 14-year old female with Marfan syndrome resulting from a laceration of the subclavian artery during internal jugular venous catheterization.
Subject(s)
Adolescent , Female , Humans , Cardiac Tamponade , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Connective Tissue , Embolism, Air , Hematoma , Hemothorax , Lacerations , Marfan Syndrome , Pneumothorax , Subclavian ArteryABSTRACT
Central venous catheterization can have many complications. A pneumothorax, hemothorax, hemomediastinum, air embolism, cardiac tamponade, and major vascular laceration are complications that can be induced by internal jugular venous catheterization. A patient with Marfan syndrome had a soft connective tissue and variable characteristic major vascular anomaly. We report a case of an acute lethal extrapleural hematoma in a 14-year old female with Marfan syndrome resulting from a laceration of the subclavian artery during internal jugular venous catheterization.