ABSTRACT
We report the anesthetic management for stents placement in patients with tracheobronchial stenosis. The subjects were 6 patients with lung cancer and one patient with tracheal invasion of esophageal cancer. Anesthesia was induced with propofol, fentanyl and vecuronium, and maintained with propofol and vecuronium. After intubation, tracheostomy was performed. The patients were kept apnic during insertion of stents. Three patients had dynamic stents inserted from tracheostomy site and one orally. Three patients had Dumon stents inserted orally, but the procedure in one patient was cancelled because her stent could not be placed at appropriate position. We recommend the anesthetic management through the tracheostomy site for the placement of Dumon tubes or dynamic stents.
Subject(s)
Anesthesia, Intravenous , Stents , Tracheal Stenosis/surgery , Adult , Aged , Esophageal Neoplasms/complications , Female , Fentanyl , Humans , Lung Neoplasms/complications , Male , Middle Aged , Propofol , Tracheal Stenosis/etiology , Tracheostomy , Vecuronium BromideABSTRACT
We applied a continuous intra-arterial blood gas monitoring system (Paratrend 7) to a patient with pulmonary alveolar proteinosis during pulmonary lavage. Lavage was performed under general anesthesia with one lung ventilation. We inserted the sensor of Patatrend 7 through a 20 G catheter into the radial artery, and monitored pH, PaCO2 and PaO2 continuously throughout the procedure. SpO2 and EtCO2 were also monitored. Saline 1000-1500 ml was instilled and drained repeatedly by volume limited methods. PaO2 values by Paratrend 7 increased during instillation and decreased during drainage of the irrigating fluid. In contrast, PaCO2 value by Paratrend 7 decreased slightly during instillation and increased during drainage. The change of SpO2 was almost the same as that by Paratrend 7, but the response time of pulse oxymetry was a little quicker than Paratrend 7. During the lavage procedure, respiratory and circulatory condition changed very rapidly, and it is necessary to monitor blood gas change intensively. Paratrend 7 is useful as a perioperative monitoring system, but pulse oxymetry might be sufficient during pulmonary lavage considering its cost.
Subject(s)
Blood Gas Analysis/methods , Bronchoalveolar Lavage , Monitoring, Intraoperative/instrumentation , Pulmonary Alveolar Proteinosis/therapy , Adult , Anesthesia, General , Humans , Male , Monitoring, Intraoperative/methods , Oximetry , Oxygen/blood , Partial PressureABSTRACT
We studied the effects of modified Calafiore technique that is intermittent antegrade warm blood cardioplegia including potassium solution and oxygenated with normothermic cardiopulmonary bypass. From January 1996 to March 1997, 45 patients who had undergone elective coronary artery bypass grafting were assigned retrospectively to two groups. Warm group: 25 patients received intermittent antegrade warm blood cardioplegia with normothermic cardiopulmonary bypass. Cold group: 20 patients received intermittent antegrade cold blood cardioplegia with slight hypothermic cardiopulmonary bypass. Preoperative variables were similar in both groups. The rate of sinus rebeating after aorta declamping with DC was lower in warm group than in cold group [warm group 2/25 (8%) versus cold group 8/20 (40%); P < 0.05]. The levels of CK and CK-MB were significantly lower in warm group than in cold group on postoperative day 0. On postoperative day 0 and day 1, the dosage of cathecholamines were significantly less for the warm group than in the cold group. Perioperative events of IABP, PMI and neurological dysfunction were not statistically different. These results show that intermittent antegrade warm blood cardioplegia is a safe and effective method for myocardial protection. But it requires further assessment.
Subject(s)
Heart Arrest, Induced/methods , Temperature , Aged , Cardiopulmonary Bypass , Catecholamines/administration & dosage , Coronary Artery Bypass , Creatine Kinase/blood , Female , Humans , Isoenzymes , Male , Middle Aged , Postoperative CareABSTRACT
The prophylactic effect of nicorandil on perioperative coronary spasm (CS) in CABG was examined retrospectively. The subjects were 313 patients who had undergone elective CABG. The patients were divided into two groups a control group receiving single administration of nitroglycerine (N = 196) and a nicorandil group receiving both nitroglycerine and nicorandil (4 mg.h-1-8 mg.h-1) (N = 107). The two groups were compared. The incidence of CS was 14 cases (7.1%) in the control group and 6 cases (5.6%) in the nicorandil group, demonstrating a significant difference. With the dose and the administration method employed in this study, no prophylactic effect of nicorandil on perioperative CS has been demonstrated.
Subject(s)
Coronary Artery Bypass , Coronary Vasospasm/prevention & control , Niacinamide/analogs & derivatives , Vasodilator Agents/therapeutic use , Elective Surgical Procedures , Humans , Niacinamide/therapeutic use , Nicorandil , Perioperative Care , Retrospective StudiesABSTRACT
Continuous cultivation of mouse-mouse hybridoma, T0405 cells producing an IgG monoclonal antibody (MAb) against hepatitis B surface antigen, was carried out in a membrane reactor with partial cell bleeding. By changing cell bleeding rate, viable cell concentrations were maintained at a high level in the range of 1.0 x 10(6) to 4.0 x 10(6) ml-1, which is difficult to attain in a conventional continuous culture. The characteristics of MAb production, and metabolism of glucose and glutamine at high cell density were investigated under steady state. This cell line's MAb production was found to be growth associated. The calculation of ammonia yield on glutamine showed that ammonia was mainly produced when glutamine was used for cell maintenance, while lactate yield on glucose used for cell growth was higher than that for cell maintenance.
