[Efficacy of simultaneous bolus injection of lidocaine with propofol on pain caused by propofol injection].

To investigate the effect of simultaneous bolus injection of 2% lidocaine 2 ml on preventing the pain on propofol injection, 80 patients were randomly assigned to one of four study groups; Group I received simultaneous bolus injection of 2% lidocaine 2 ml with infusion of propofol; Group II received bolus injection of saline 2 ml, 10 s before the start of infusion of propofol-lidocaine mixture; Groups III and IV received bolus injections of lidocaine and saline, separately 10 s before starting propofol infusion. Incidence of propofol-induced pain was significantly more frequent (P < 0.001) in Group IV (70%) than in the other groups (20% each). Number of patients who were satisfied with this anesthetic induction and requested for the same induction method in the next anesthesia was significantly larger in the groups receiving lidocaine (P < 0.05). Simultaneous bolus injection of lidocaine with propofol showed a similar clinical efficacy compared with both preadministration and premixing of lidocaine in preventing the propofol-induced pain.

Exhaled nitric oxide level decreases after cardiopulmonary bypass in adult patients.

OBJECTIVE: To measure exhaled nitric oxide (NO) and compare it with lung function after cardiopulmonary bypass (CPB) in adult patients. Pulmonary dysfunction is sometimes observed after CPB. Impaired production of NO may account for this dysfunction. DESIGN: Prospective, single-center, observational study. SETTING: University hospital operating room, intensive care unit. PATIENTS: Sixteen adult patients undergoing cardiac surgery with CPB. INTERVENTIONS: None except cardiac surgery with CPB. MEASUREMENTS AND MAIN RESULTS: Exhaled NO was measured continuously by the chemiluminescence method and was expressed as the peak and mean NO concentrations, and the NO output (VNO). These parameters were calculated by averaging four sequential tidal NO values. The data were obtained serially from before CPB to 16 hrs after CPB. Lung function was evaluated by monitoring lung compliance, pulmonary artery pressure, and alveolar-arterial oxygen difference (P(A-a)O2). The cardiac index did not change except for a significant increase at 16 hrs compared with 6 hrs after CPB. Peak NO, mean NO, and VNO decreased from 15.4 +/- 2.0 ppb (before CPB) to 8.2 +/- 0.8 ppb (6 hrs after CPB), from 5.7 +/- 0.7 ppb to 2.8 +/- 0.6 ppb, and from 29.2 +/- 3.1 nL/min to 15.7 +/- 2.2 nL/min, respectively. These changes were associated with the increases in pulmonary artery pressure and alveolar-arterial oxygen difference, and the decrease in lung compliance. VNO recovered to the level measured before CPB 16 hrs after CPB, which was consistent with the physiologic recovery in pulmonary hypertension, lung compliance, and gas exchange. CONCLUSION: Measurement of exhaled NO as VNO, which was associated with lung dysfunction, may be an indicator of lung injury in adult patients after cardiopulmonary bypass.

[A modified technique for insertion of the laryngeal mask airway in children].

We modified the technique for laryngeal mask airway (LMA) insertion in children. This modification involves inserting a two-thirds inflated LMA with its lumen facing laterally toward left and then rotating it 90 degrees clockwise as it passes downwards into position behind the larynx. Then the cuff is inflated fully. We conducted a survey on the use of LMA in ten consecutive children for minor superficial surgery. After slow induction, anesthesia was maintained with 3.0% of end-tidal sevoflurane concentration in 100% oxygen for 5 minutes before insertion of LMA. No muscle relaxant was used. Successful insertion was judged by the clinical integrity of the airway. The standard LMA insertion technique or another airway device was applied when three trials had failed. Traumatic insertion was observed by the attachment of blood clots to the surface of the removed LMA. A satisfactory airway was achieved in all of the children who participated in the survey. There were no significant differences in vital signs between pre- and post-insertion. Only one child was found to have attachment of blood clots on the surface of the removed LMA. We conclude that our technique would be one recommended method in pediatric practice.

Deconvolution of chemiluminescent emission curve associated with phagocytosis into three logarithmic normal distributions.

The chemiluminescent emission reaction dependence on the activity of phagocytosis is well known. However, this method is not used to diagnostically in clinical assessment because the relationship between phagocytizing activity and chemiluminescent intensity has not been clearly established. Therefore, we attempted to analyze quantitatively the chemiluminescent emission curve by the phagocytosis of leukocytes. Mathematical assessment of the emission curve with respect to time was performed by fitting the curve to several regression models using the unweighed non-linear least squares method. A triple logarithmic normal distribution model provided a reasonable goodness of fit to the measured emission curve. The first component, about 5% of the calculated total counts, was assumed to arise from monocytes activity, the second component, about 20% from eosinocytes activity and the third component, up to 75%, from neutrophils activity. This method seems promising as a means for assaying whole blood without the need for pretreatment and for the providing a valid index that is independent of the technical differences between laboratories.

[Isoflurane anesthesia for a child with myotonic dystrophy].

A 5 year-old boy with myotonic dystrophy was anesthetized with isoflurane for bilateral orchiopexy. Intubation was easily done without muscle relaxants, following slow induction using isoflurane, nitrous oxide and oxygen. Myotonia was not observed perioperatively and postoperative course was uneventful. It is concluded that isoflurane is an anesthetic of choice for a patient with myotonic dystrophy.

[A possible circadian rhythm of susceptibility to thiamylal].

A circadian rhythm of the susceptibility to thiamylal was evaluated in 30 patients. They were divided into two groups; 15 patients were induced around 9 AM (Morning-group) and the rest were in the early afternoon (Afternoon-group). The induction was performed by intravenous administration of thiamylal sodium. Parameters measured were the time and doses of thiamylal sodium to obtain the loss of consciousness and the loss of eyelash reflex. The results were as follows; the doses of thiamylal sodium to obtain the loss of consciousness were 3.5 +/- 0.6 mg.kg-1 (mean +/- SD) in Morning-group, and 4.1 +/- 0.4 mg.kg-1 in Afternoon-group, respectively. Thus, larger doses of thiamylal were necessary to obtain the loss of consciousness in Afternoon-group than in Morning-group (P less than 0.01). The doses of thiamylal sodium to obtain the loss of eyelash reflex were 4.4 +/- 0.8 mg.kg-1 in Morning-group and 5.0 +/- 0.6 mg.kg-1 in Afternoon-group, respectively. Also, larger doses of thiamylal were necessary to obtain the loss of eyelash reflex in Afternoon-group than in Morning-group (P less than 0.05). This study suggests that a circadian rhythm of the susceptibility to thiamylal exists in humans.