Effect of intraoperative amino acids with or without glucose infusion on body temperature, insulin, and blood glucose levels in patients undergoing laparoscopic colectomy: a preliminary report.

OBJECTIVE: Amino acid administration helps to prevent intraoperative hypothermia but may enhance thermogenesis when combined with glucose infusion. The aim of this study was to examine the effect of intraoperative amino acid administration, with or without glucose infusion, on temperature regulation during laparoscopic colectomy. METHODS: Twenty-one patients whose physical status was classified I or II by the American Society of Anesthesiologists, and who were undergoing elective laparoscopic colectomy were enrolled. The exclusion criteria were a history of diabetes and/or obesity, preoperative high levels of C-reactive protein, high blood glucose and/or body temperature after anesthesia induction, and surgical time >500 minutes. Each patient received an acetate ringer solution and was randomly assigned to one of three groups. Group A patients were given only amino acids. Group AG patients were given amino acids and glucose. Group C patients were given neither amino acids nor glucose. Tympanic membrane temperatures and blood glucose and insulin levels were measured intraoperatively. RESULTS: Intraoperative amino acid infusion significantly increased body temperature during surgery as compared with either Group AG or C. The blood glucose levels in Group AG were significantly higher than those in Groups A and C. However, there were no significant differences between Groups A and C. Two hours after anesthesia induction, serum insulin levels in Groups A and AG significantly increased compared with Group C. No significant differences in the postoperative complications or patient hospitalization lengths were detected between the groups. CONCLUSION: Intraoperative amino acid infusion without glucose administration maintains body temperature more effectively than combined amino acid and glucose infusion in patients undergoing laparoscopic colectomy, despite unaltered intraoperative insulin levels.

Evaluation of a disintegrin-like and metalloprotease with thrombospondin type 1 repeat motifs 13 (ADAMTS13) activity enzyme-linked immunosorbent assay for measuring plasma ADAMTS13 activity in dogs.

A disintegrin-like and metalloprotease with thrombospondin type 1 repeat motifs 13 (ADAMTS13) is a von Willebrand factor (vWF)-cleaving protease. Deficiencies in ADAMTS13 activity are known to cause thrombotic diseases in human beings. The present study evaluated whether the human ADAMTS13 activity enzyme-linked immunosorbent assay (ELISA) kit containing human vWF73 (a minimal substrate) and anti-N10 antibody (which specifically recognizes the decapeptide of the C-terminal edge of cleaved vWF by human ADAMTS13) is applicable to the measurement of canine plasma ADAMTS13 activity. Human vWF73 fused with a GST-tag and a His-tag (GST-hvWF73-His) was reacted with recombinant canine (rc)ADAMTS13, canine plasma, and human plasma, and then used in Western blotting using anti-N10 antibody. Linearity and intra- and interassay reproducibility of the human ADAMTS13 activity ELISA kit in canine plasma were further evaluated. Finally, plasma ADAMTS13 activity was measured in 13 healthy dogs and 6 dogs with bacteremia using the human ADAMTS13 activity ELISA kit. Cleaved products with a 28-kDa GST-hvWF73-His were detected specifically in rcADAMTS13 as well as in human ADAMTS13, and also in canine plasma by anti-N10 antibody, showing excellent linearity. Intra-assay coefficient of variation (CV) was 3.0-12.4%, and interassay CV was 11.5-12.5%. The ADAMTS13 activity was significantly lower in dogs with bacteremia than in healthy dogs (P = 0.0025). The current study revealed that the human ADAMTS13 activity ELISA kit is applicable for measurement of canine plasma ADAMTS13 activity to elucidate the pathology of thrombotic diseases in dogs.

[Effect of postoperative analgesia by repeated transversus abdominis plane blocks via a placed catheter in patients undergoing ovarian cystectomy].

BACKGROUND: We evaluated the effect of repeated transversus abdominis plane (TAP) blocks on postoperative analgesia over the first 48 postoperative hours in the patients undergoing lower abdominal gynecological surgery. METHODS: Four patients undergoing ovarian cystectomy via a transverse lower abdominal wall incision were selected. All patients received general anesthesia. After the operation, bilateral TAP blocks were performed by ultrasound-guided access using 0.375% ropivacaine 15 ml, and a catheter was placed on the plane. Repeated TAP blocks were performed every 12 hours using 0.375% ropivacaine 15 ml until the second postoperative day. Each patient was assessed for the analgesic effect and complications at 3, 6, 12, 24, 36, and 48 hours postoperatively. RESULTS: The postoperative visual analogue scale pain scores at rest and on movement were approximately under 20. The median frequency of additional nonsteroidal anti-inflammatory drugs until the second postoperative day was 0.5. We did not observe any complications such as nausea, vomiting and shivering in the postoperative period. CONCLUSIONS: These findings suggest that bilateral repeated TAP blocks via a placed catheter provide good analgesia without any complications in patients undergoing ovarian cystectomy.

[Effect of amino acid and glucose infusion on perioperative body temperature and postoperative infection in patients undergoing total knee arthroplasty].

BACKGROUND: We investigated whether the perioperative amino acid infusion with glucose is effective for preventing perioperative hypothermia and postoperative infection in patients undregoing total knee arthroplasty (TKA). METHODS: Forty patients undergoing TKA under general anesthesia were enrolled in this study. The patients were randomly allocated to two groups: AA group (n = 22), to which amino acid was infused, and AAGlu group (n = 18), to which amino acid and glucose were infused. The infusions were started before the anesthetic induction. Remifentanil was administered during the surgery, and the dose of remifentanil was adjusted to keep stable hemodynamics. The levels of blood glucose and body temperature were evaluated. We also recorded the frequency of additional use of nonsteroidal anti-inflammatory drugs, the days required until the wound closure, and complications in the post-operative period. RESULTS: The levels of blood glucose in AAGlu group were significantly higher than those of AA group (P < 0.05). However, no significant differences were found in perioperative body temperature, postoperative days required until the wound closure and the frequency of additional use of analgesics between the groups. CONCLUSIONS: These results suggest that in patients undergoing TKA receiveing amino acid infusion perioperatively, thermogenic effect and prevention of postoperative infection are similar whether exogenous glucose is infused or not.

[Effect of different perioperative analgesic methods on postoperative cognitive dysfunction in elderly patients undergoing upper abdominal surgery].

BACKGROUND: We investigated whether the early postoperative cognitive dysfunction (POCD) was affected by different perioperative analgesia methods using intravenous remifentanil or epidural ropivacaine in the elderly undergoing major upper abdominal surgery. METHODS: Twenty elderly patients (aged over 60 years) undergoing elective surgery for distal or pylorus-preserving gastrectomy under general anesthesia were enrolled in this study. The patients were randomly allocated to two groups : Group LV (n = 10) of intravenous remifentanil, and Group EPI (n = 10) of epidural ropivacaine. The dose of both analgesic agents was controlled to keep stable hemodynamics. We recorded postoperative outcome and complications, and assessed cognitive status at the preoperative period and on the 7th postoperative day using 6 cognitive assessment tests. RESULTS: POCD occurred in one case (10%) in group IV and two cases (20%) in group EPI (P = 0.50). VAS score, the days of hospital stay and the frequency of additional analgesics were similar between the groups. CONCLUSIONS: Perioperative analgesia using intravenous remifentanil and epidural ropivacaine showed no significant difference in the incidence of early POCD after upper abdominal surgery in elderly patients.

Comparison of physicians' compliance, clinical efficacy, and drug cost before and after introduction of Asthma Prevention and Management Guidelines in Japan (JGL2003).

BACKGROUND: This study investigated the variations in the clinical efficacy and drug cost following the introduction of the Asthma Prevention and Management Guidelines in Japan (JGL2003). METHODS: The medical charts of fifty outpatients treated continuously for asthma, aged 16-50 years, from October 2002 to October 2004 at Showa University Hospital were analyzed for physicians' compliance with asthma guidelines, symptom severity, episodes in various occasions, prescriptions and drug costs. RESULTS: Physicians' compliance with the guidelines, which were defined as the number of patient visits treated in conformity with the JGL over the total number of patient visits, was found to be high before (89.4%) and after (90.3%) the introduction of JGL2003, without a statistical difference. On the other hand, the distribution of asthma symptom severity varied significantly (P<0.0001). Fewer patients were recognized as having more severe asthma symptoms after the introduction of JGL2003. Significantly more patients with severe asthma symptoms were detected in the physicians' noncompliant group than in the compliant group (P<0.0001). The number of patients prescribed with oral corticosteroids, long-acting beta2-agonists containing patches, long-acting oral beta2-agonists, short-acting inhaled beta2-agonists, sustained-released theophylline and leukotriene receptor antagonists decreased after the introduction of JGL2003. Furthermore, the total annual drug cost per patient decreased significantly by an average of 16,259 yen (P=0.006). CONCLUSIONS: The JGL2003 was judged to have improved criteria, which thus resulted in the high compliance of physicians with the guidelines, in the remission of asthma symptoms and in the reduction in the total annual drug cost per patient.

[Studies on factors related to delayed discharge of elderly patients from university hospitals].

PURPOSE: To elucidate factors associated with delayed discharge of elderly patients from university hospitals in Japan. METHODS: Questionnaires were sent to all 125 Japanese university hospitals during the period from January, 18 through March, 25, 2004. Thirty-four possible reasons for the delayed discharge were analyzed. RESULTS: Family issues were the most common reason for delayed discharge nationwide. Medical treatment was a factor in delayed discharge in metropolitan areas where university hospitals were under pressure to reduce the mean hospital stay. The lack of chronic beds was identified as a factor associated with delayed discharge. However, the low quality of care at institutes in rural areas may possibly cause delayed discharge, despite adequate number of chronic beds. CONCLUSIONS: Despite the Japanese government encouraging the care of elderly people at home, the present study shows that the leading cause of delayed discharge is that families cannot accept elderly patients directly from university hospitals. Even if the number of chronic beds were to increase, the quality of care provided would not be adequate to allow a smooth transition of elderly patients from university hospitals to such chronic beds in some areas.