[Two cases of parturients with intracranical hemorrhage accompanied by seizure].

Intracranial hemorrhage during pregnancy is a rare complication, and it results in a high perinatal mortality rate. We recently encountered 2 cases of intracranial hemorrhage during pregnancy. They underwent cesarean section under general anesthesia. Anesthetic management is difficult because we must avoid hemodynamic change and increasing intracranial pressure, and we have difficult airway management. It is also very difficult to prepare for the prevention before the onset because it develops suddenly, and quick action is important. We must prepare tools of airway management and assemble people. In addition, it is important to use the hypotensive drugs which do not affect placental blood-flow to keep systolic blood pressure around 120-140 if it is necessary to suppress the rise of the blood pressure.

The effects of the early administration of sivelestat sodium, a selective neutrophil elastase inhibitor, on the postoperative course after radical surgery for esophageal cancer.

PURPOSE: The goal of this retrospective study was to evaluate the effects of perioperative administration of sivelestat sodium hydrate, a selective neutrophil elastase inhibitor, on the clinical course after radical surgery for esophageal cancer. METHODS: The effects of sivelestat on postoperative systemic inflammatory reactions and respiratory function were examined in 53 patients who underwent radical surgery for esophageal cancer between April 2004 and March 2005 with (n = 26, sivelestat group) and without (n = 27, control group) the administration of sivelestat. RESULTS: The average age in the sivelestat group was higher than that in the control group, but there were no other differences in the background factors between the two groups. The postoperative oxygenation (PaO(2)/FiO(2) ratio) did not differ between the groups, but the decrease in oxygen saturation (SpO(2)) was significantly inhibited in the sivelestat group compared with the control group (p < 0.01). A significant inhibition of the increase in the CRP level also occurred in the sivelestat group (p < 0.01). The patients in the sivelestat group were also hospitalized for shorter periods compared to those in the control group. CONCLUSION: The early administration of sivelestat to patients receiving radical surgery for esophageal cancer can inhibit postoperative systemic inflammatory reactions and it might also have a beneficial effect on the prognosis.

Utilization of PCIA (patient-controlled intravenous analgesia) for postoperative analgesia of spine fusion.

We examined the effect of patient-controlled intravenous analgesia (PCIA) using metoclopramide hydrochloride and morphine hydrochloride in 30 patients (15 males, 15 females) who underwent spine fusion surgery under general anesthesia. The intravenous administration of 2 mg morphine hydrochloride was done prior to the completion of surgery. Subsequently, morphine hydrochloride was administed via venous injection at a dose of 1 ml/hr. Additionally, a 1 ml bolus dosage was administered at a 60-minute lockout interval employing a pump which contained 36 mg of morphine hydrochloride, 30 mg of metoclopramide hydrochloride in 62 ml of physiologic saline. At approximately 72 hours, we observed the resting VAS (visual analog scale) and the side effects of morphine hydrochloride and thereafter the button pressing frequency (1 button have 0.5 mg morphine hydrochloride) was investigated. The resting VAS was stable through 72 hours in 13 males and 15 females of the 30 cases exhibiting from 2 to 3. The frequency of button pressing was investigated regarding time and gender. One male and two female patients exhibited metastatic tumors of the spine but demonstrated no button manipulation. For the remaining 27 subjects the button pressing frequency increased in most instances furthermore, from 24-48 hours after surgery, the frequency for male patients clearly increased. From 48 hours after surgery, no gender differences were evident regarding the button frequency. However, differences were observed regarding the disease, gender and postoperative time course of analgesia. As a result, no alteration in the background dose appeared to provide the best result, as did a short duration lockout interval.