randomized controlled trial to verify the efficacy of alkalinized local anesthetics in ultrasound-guided supraclavicular brachial plexus block

Purpose: Alkalinization of local anesthetics to enhance their efficacy is controversial in peripheral nerve block. To define the efficacy of alkalinized mepivacaine 1% for supraclavicular brachial plexus block, we verified the onset and duration of sensory block using an ultrasound-guided technique

Methodology: A randomized, double-blinded, controlled, prospective trial was conducted at our hospital after ethical committee approval and informed consents. Twenty patients, 47 - 82 years old and ASA physical status 3, scheduled for vascular access surgery, were randomly divided into Group M [n = 10], receiving 20 ml of mepivacaine 1% alone for nerve block, and Group MSB [n = 10], receiving mepivacaine 1% with sodium bicarbonate for nerve block. Supraclavicular brachial plexus block was performed with a 22-gauge, 50 mm insulated peripheral block needle, peripheral nerve stimulator and ultrasound imaging. Needle placement was confirmed at 0.5 mA, and the drugs were injected. Time to onset of sensory block and duration of sensory block were recorded. Data were statistically analyzed with the t test and Fisher's exact test, as appropriate, using SPSS Statistics version 22.0 software [SPSS, Chicago, IL]. Values of p < 0.05 were considered significant

Results: Time to onset of sensory block was 9.5 +/- 5.5 min in Group M and 7.8 +/- 3.4 min in Group MSB, showing no significant difference. Likewise, no difference in duration of sensory block was observed between groups; 257.3 +/- 198.0 min vs. 197.3 +/- 90.6 min in Group M and Group MSB respectively

Conclusions: Alkalinization of mepivacaine does not provide faster onset or longer duration of ultrasound-guided supraclavicular brachial plexus block

case of successful treatment with vasopressin for severe acute pancreatitis in a melancholic patient administrated antipsychotic agents

We report a 50-year-old woman with severe acute pancreatitis induced shock, who was successfully treated with vasopressin. She took some antipsychotic agents for depression. Although treatment was started with continuous intravenous dopamine and noradrenaline, hypotension was not controlled. After continuous intravenous vasopressin was initiated, arterial blood pressure [BP] was raised and maintained. Vasopressin was effective to catecholamine-resistant shock in severe acute pancreatitis of the melancholic patient

Successful treatment of septic shock with disseminated intravascular coagulation using combined polymyxin-B direct hemoperfusion and recombinant thrombomodulin therapy

We report successful treatment of septic shock accompanied by disseminated intravascular coagulation [DIC] resulting from infection of liver abscess in a patient using a combination of polymyxin-B direct hemoperfusion [PMX-DHP] and recombinant thrombomodulin [rTM]. Although hepatic cyst had been observed over 2 years previously, drainage was not performed due to limited findings of abscess on current abdominal computed tomography and ultrasonography. Control of the focus of infection therefore took time. After initiating PMX-DHP and rTM, arterial blood pressure increased and remained high. Combination therapy with PMX-DHP and rTM provides an effective approach for septic shock with DIC

Effect of removal of subglottic blood during endoscopic sinus surgery

Postoperative pulmonary complications may occur after endoscopic sinus surgery, secondary to leakage of blood into the trachea from the surgical field. We investigated the effects of removal of subglottic fluid, including blood, during endoscopic sinus surgery on the incidence of postoperative hypoxia and high fever. We first retrospectively confirmed whether the incidence of fever >38°C and hypoxia [SpO[2]< 95%] in the first 24 h after endoscopic sinus surgery was higher than that after tympanoplasty [total n=99]. Next, the amount and characteristics of subglottic fluid were prospectively evaluated in the two groups, and the incidences of fever and hypoxia in the first 24 h postoperatively were compared between the two groups [total n=90].Data were analyzed using SPSS for Windows version 11.0 [SPSS Inc., Chicago, IL, USA]. Normally distributed continuous data were analyzed using Student's /-test. Continuous data not normally distributed were analyzed using the Mann-Whitney U-test. Categorical data were analyzed using the x[2] test. Statistical significance was defined as p< 0.05. The retrospective study showed that the incidences of fever and hypoxia were significantly higher after endoscopic sinus surgery than tympanoplasty [fever, p=0.001; hypoxia, p=0.024]. The prospective study showed that the amount of subglottic secretions was significantly higher after endoscopic sinus surgery than tympanoplasty [p=0.006]. The pH values of subglottic and oral fluid were significantly higher after endoscopic sinus surgery than tympanoplasty [subglottic fluid, p=0.04; oral fluid, p<0.001]. However, there were no significant differences between the two groups in the incidence of fever over 38°C and hypoxia in the first 24 h postoperatively. An increase in subglottic fluid, including blood, during endoscopic sinus surgery might cause fever and hypoxia postoperatively. Removal of the fluid is likely an effective technique for preventing pulmonary complications

Successful treatment of severe legionella pneumonia and acute kidney injury with polymyxin B-immobilized fiber column direct hemoperfusion

Legionella pneumonia is often complicated by multiple organ failure. Although acute kidney injury is relatively rare in the context of Legionella pneumonia, it is associated with an increase in mortality rate. This report describes a case of a patient with Legionella pneumonia and acute kidney injury who was successfully treated with polymyxin B-immobilized fiber column direct hemoperfusion [PMX-DHP]. We conclude that PMX-DHP may be a useful therapeutic modality in patients with Legionella infection and acute kidney injury