Prediction of patients with higher order multifetal pregnancy at risk for postpartum pulmonary edema.

OBJECTIVE: This retrospective study aims to verify the factors for the development of maternal pulmonary edema in higher order multifetal pregnancy. STUDY DESIGN: We analyzed medical profiles of a total of 13 triplet, quadruplet and quintuplet pregnancies for the years 1992 through 1997. Some treatments were applied in attempts to promote these multifetal pregnancies. All underwent cesarean section, two of which developed pulmonary edema within a few hours of delivery. There had been no evidence for the development of pulmonary edema antepartum. RESULTS: In the patients affected by pulmonary edema, postoperative values of PaO2/FIO2<250 mmHg showed close association to a value perioperative fluid loading index (FLI)>0; the index consists of an intraoperative fluid balance and preoperative infusion volume within 24 h prior to surgery. Two patients with postoperative pulmonary edema had a perioperative FLI>0, whereas the others had values 0 may have a much higher risk for postoperative pulmonary edema, suggesting the predictive role of the perioperative FLI value.

[Anaphylactic shock associated with a central venous catheter impregnated with chlorhexidine and silver sulfadiazine].

A 28 year-old male patient developed anaphylactic shock on separate occasions, possibly due to the contact with a central venous catheter impregnated with chlorhexidine and silver sulfadiazine. He was successfully resuscitated. On the second operation, blood basophils disappeared and plasma histamine level increased extremely up to 80 ng.ml-1 soon after anaphylactic shock. One year after the first shock, he did not develop anaphylactic shock following the insertion of a central venous catheter without the impregnation. Pin prick test and scratch test showed positive reactions only to chlorhexidine. Latex-specific anti-IgE antibody was not detected. Therefore, chlorhexidine was confirmed as the causative agent of anaphylactic shock. Because chlorhexidine is extensively used as an antiseptic drug in emergency rooms and intensive care units, we should be aware of the possibility of chlorhexidine induced anaphylactic reactions.

[The concentration effects of isoflurane-N2O anesthesia on cardiovascular responses to skin incision].

To investigate the concentration effects of isoflurane-nitrous oxide anesthesia on cardiovascular responses to skin incision, we studied 24 non-premedicated patients undergoing lower abdominal operation. Anesthesia was induced with inhalation of 70% nitrous oxide and isoflurane, and maintained with 70% nitrous oxide and three different concentrations of isoflurane (1.25, 1.6, 1.95 MAC). Blood pressure and heart rate were recorded continuously before and after skin incision. Because more than half the patients with 1.95 MAC became hypotensive with systolic blood pressure of less than 80 mmHg just before the skin incision, it was difficult to define the values of MAC BAR (blocking adrenergic responses) in the present study. Cardiovascular responses at skin incision were not completely suppressed at 1.6 MAC isoflurane-N2O anesthesia and no further blocking effects were obtained at 1.95 MAC isoflurane-N2O anesthesia. These results suggest that higher concentration of isoflurane does not guarantee stronger protective effects on stimulation like skin incision.