Bolus oral or continuous intestinal amino acids reduce hypothermia during anesthesia in rats.

We hypothesized that, with oral or intestinal administration of amino acids (AA), we may reduce hypothermia during general anesthesia as effectively as with intravenous AA. We, therefore, examined the effect of bolus oral and continuous intestinal AA in preventing hypothermia in rats. Male Wistar rats were anesthetized with sevoflurane for induction and with propofol for maintenance. In the first experiment, 30 min before anesthesia, rats received one bolus 42 mL/kg of AA solution (100 g/L) or saline orally. Then for the next 3 h during anesthesia, they received 14 mL/kg/h of AA and/or saline intravenously. They were in 4 groups: I-A/A, both AA; I-A/S, oral AA and intravenous saline; I-S/A, oral saline and intravenous AA; I-S/S, both saline. In the second experiment, rats received 14 mL/kg/h duodenal AA and/or saline for 2 h. They were in 3 groups: II-A/S, duodenal AA and intravenous saline; II-S/A, duodenal saline and intravenous AA; II-S/S, both saline. Core body temperature was measured rectally. After the second experiment, serum electrolytes were examined. In both experiments, rectal temperature decreased in all groups during anesthesia. However, the decrease in rectal temperature was significantly less in groups receiving AA than in groups receiving only saline. In the second experiment, although there was no significant difference in the decrease in body temperature between II-A/S and II-S/A, Na(+) concentration was significantly lower in II-S/A. In conclusion, AA, administered orally or intestinally, tended to keep the body temperature stable during anesthesia without disturbing electrolyte balance. These results suggest that oral or enteral AA may be useful for prevention of hypothermia in patients.

[Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy].

We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. Orotracheal intubation was performed with a fiberscope and the excreta was suctioned through the endotracheal tube. The patient was admitted to the ICU after taking chest X-ray and the operation was postponed for one month. At the second attempt, awake intubation was planned for the patient under sedation with dexmedetomidine. Food intake and drinking were restricted for the patient from the previous night. After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.

Effects of quazepam as a preoperative night hypnotic: comparison with brotizolam.

PURPOSE: The purpose of this study was to evaluate the effects of quazepam, a long-acting hypnotic, as a preoperative night medication in comparison with brotizolam, a shortacting hypnotic. METHODS: Two hundred patients (aged 30 to 70 years) admitted for elective general anesthesia at various hospitals were enrolled. Quazepam 15 mg, 30 mg, or 45 mg, or brotizolam 0.25 mg (40 patients each), was administered orally at 9 p.m. in the evening of the day before surgery. The control group (40 patients) did not receive any drugs. The quality of night sleep between the night during hospitalization and the night before surgery was compared by using a questionnaire. In the first 8 patients who received quazepam 15 mg, 30 mg, and 45 mg, the plasma concentrations of quazepam and its metabolites were measured 12 h after the drug administration, when the patients were brought into the operating room. RESULTS: In all the drug-administered groups, the speed of falling asleep, sleeping state, and feeling of freshness in the morning improved compared to the previous night and compared to the control group; the frequency of nocturnal awakening and dreaming decreased, and the total duration of sleep the night before surgery increased. Total duration of sleep was significantly longer in the groups with quazepam 30 mg and 45 mg than in the control and brotizolam 0.25 mg groups. No patients were drowsy with plasma concentrations of quazepam of 30 to 65 ngxml(-1). CONCLUSION: The preoperative night hypnotics, quazepam and brotizolam improved sleep before surgery. As a preoperative night hypnotic, quazepam 30 mg and 45 mg increased the total duration of sleep compared to brotizolam 0.25 mg.

[Cardiac arrest during bilateral inguinal herniorrhaphy under epidural anesthesia].

A 73-year-old man with hyper gamma-globulinemia was scheduled for bilateral herniorrhaphy and hemorroidectomy. In preoperative examination, the serum concentrations of gamma-globulin and total protein were 7.31 g x dl(-1) and 11.9 g x dl(-1). Although platelet count was 6.5 x 10(4) x microl(-1), epidural anesthesia was selected to minimize hemodynamic changes which could increase a risk of thrombosis. Epidural catheters were inserted at T 12-L 1 and L 4-5. Analgesia level checked by a pin prick was T 4 after administering 10 ml of 2% lidocaine, 7 ml into T 12-L 1 and 3 ml into L 4-5. Bilateral herniorrhaphy started simultaneously. When bilateral peritoneum was stretched, heart rate suddenly decreased to 40 beats x min(-1). Although 0.5 mg of atropine was immediately administered intravenously, cardiac arrest was observed for several seconds and the patient was unconscious for about 10 seconds. After stopping surgery, heart beat and consciousness recovered immediately. By administration of 10 mg of ephedrine, blood pressure increased to 130/80 mmHg with heart rate of 55 beats x min(-1). Vagal reflex induced by bilateral inguinal herniorrhaphy might cause cardiac arrest. We should be careful for vagal reflex during bilateral herniorrhaphy.

[A case of dissociative stupor with decorticated posture after neck clipping of brain aneurysm].

We experienced a case of dissociative stupor with decorticated posture in a 71-year-old woman after neck clipping of the brain aneurysm. Decorticated posture is observed with severe midbrain disorder caused by brain herniation. In this case, therefore, severe brain stem damage was suspected, although light reflex was observed and respiration was stable. In addition, in this case, the aneurysm was located at the junction of the internal carotid artery and the posterior communicating artery. Therefore, surgical damage to midbrain was not likely to have happened. Postoperative computed tomography showed no abnormality in this region. Two days later, her symptom disappeared, and she could clearly recollect memory of these two days just after surgery. However, she could not follow directions because of a sense of fear. Thus her symptom might be based on a kind of mental disorder. Patients with conversion disorder react abnormally to stimulus or stress. Stupor was diagnosed as due to defect of reaction to stimulus of sound, light and touch. She was diagnosed as dissociative stupor of the conversion disorder type. In this case, decorticated posture was caused by mental disorder. We have to pay attention not only to brain tissue damage but also to psychological damage of patients.

[A simple lightweight device for measurement of low hemoglobin concentrations: the Hemo Cue Low Hemoglobin Photometer].

To determine low hemoglobin concentrations in the washed fluid is useful for calculation of blood loss and that in the supernatant is also useful for evaluation of hemolysis during extracorporeal circulation or in the blood preparations. The HemoCue Low Hemoglobin Photometer is a new lightweight device, which is easily movable anywhere and is able to determine hemoglobin concentration in low ranges (0.03-3.00 g.dl-1). We investigated the accuracy and reliability of the HemoCue Low Hemoglobin Photometer. Blood samples were diluted with saline containing heparin into six tubes. The hemoglobin concentrations of each diluted sample were measured by the HemoCue Low Hemoglobin Photometer, and were compared with the calculated values. A high positive correlation was found between the values measured by the HemoCue Low Hemoglobin Photometer (Y) and the calculated values (X); Y = 1.047 X, r = 0.999, P < 0.0001. It took only 11-54 seconds (mean value: 31.4 seconds) for the measurement. It is concluded that the HemoCue Low Hemoglobin Photometer is a reliable and useful device for measurement of low hemoglobin concentration.