The effects of beta-adrenoceptor antagonists on proinflammatory cytokine concentrations after subarachnoid hemorrhage in rats.

BACKGROUND: Proinflammatory cytokines increase in cerebrospinal fluid (CSF) after subarachnoid hemorrhage (SAH). Recent evidence suggested that beta-adrenoceptor antagonist could reduce proinflammatory cytokines. We conducted the present study to examine whether beta-adrenoceptor antagonists would reduce proinflammatory cytokine concentrations after SAH in rats. METHODS: In Experiment 1, to investigate the time course of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), rats were randomized into groups: 1, 3, 6, and 12 h after SAH or sham operation. CSF and blood samples were obtained at each time point. In Experiment 2, to investigate the effects of beta-adrenoceptor antagonists on the IL-6 and TNF-alpha concentrations, rats were randomized into groups: 1) control group: SAH + normal saline, 2) propranolol group: SAH + propranolol, 3) metoprolol group: SAH + metoprolol, and 4) butoxamine group: SAH + butoxamine (beta(2)-adrenoceptor antagonist). CSF and blood samples were obtained 6 h after SAH. IL-6 and TNF-alpha concentrations in samples were measured. RESULTS: In Experiment 1, CSF IL-6 concentrations in the SAH groups increased markedly and peaked at 6 h after SAH, whereas CSF TNF-alpha concentrations in the SAH groups were consistently low. In Experiment 2, CSF IL-6 concentrations in the propranolol and butoxamine groups were significantly lower compared with those in the control group (P < 0.01 and P < 0.05 for each group). Plasma IL-6, CSF TNF-alpha, and plasma TNF-alpha concentrations were comparable in all four groups. CONCLUSIONS: CSF IL-6 concentrations increased in the acute stage of SAH and beta-adrenoceptor antagonists with a beta(2)-adrenoceptor blocking action suppressed this elevation of IL-6 concentrations after SAH in rats.

[Difficult airway management during emergency tracheostomy in a patient with severe rheumatoid arthritis].

We experienced difficult airway management in a 65-year-old woman with acute dyspnea due to bilateral recurrent nerve palsy suffering from severe rheumatoid arthritis for fifty years. Her cervical spine was ankylosed and could not be extended at all. Tracheostomy was planned under local anesthesia because of difficulty of endotracheal intubation, possibility of airway obstruction and laryngeal edema. In this condition, the surgical area was narrow and difficult to approach. The surgical bleeding and blood-aspiration into the tracheostomy site occurred followed by airway obstruction. A rigid tracheal tube could not be inserted through the tracheal incision and SpO2 decreased to 81%. We inserted a percutaneous cricothyroidotomy cannula through the tracheal incision and superimposed HFJV on her spontaneous ventilation. Assisting the ventilation in this way finally, a spiral endtracheal tube was inserted and her oxygenation became stable.

[The effects of propofol on left ventricular systolic and diastolic function during induction of anesthesia--a transthoracic echocardiographic study].

BACKGROUND: The effects of clinical doses of propofol on left ventricular (LV) systolic function remain controversial and LV diastolic function has not been evaluated during induction of anesthesia with propofol. We assessed the effects of propofol on LV systolic and diastolic function during induction of anesthesia in adult patients with transthoracic echocardiography. METHODS: Twenty-three patients, ASA 1-2 and age < 70 y.o., received propofol 2 mg x kg(-1) for induction of anesthesia. LV systolic function was evaluated by fractional shortening (FS), ejection fraction (EF), rate-corrected mean velocity of circumferential fiber shortening (Vcfc) and a contractile index, LV end-systolic wall stress (ESWS) versus Vcfc relation (ESWS-Vcfc relation). LV diastolic functions were assessed by analysis of transmitral flow velocity, peak early diastolic and late diastolic filling velocities (E wave and A wave), E/A ratio and E wave deceleration time (DT). RESULTS: After induction, propofol preserved FS, EF, Vcfc and ESWS-Vcfc relation and caused a significant decrease in E wave and A wave, and a significant increase in E/A ratio and maintained DT. CONCLUSIONS: During induction of anesthesia in adult patients, propofol preserved LV systolic and diastolic functions.

[The effect of inhalation induction with sevoflurane on left ventricular systolic and diastolic function. A transthoracic echocardiographic study].

BACKGROUND: The effect of inhalation induction with sevoflurane on left ventricular(LV) function has not been evaluated in adults. We assessed the effect of inhalation induction with sevoflurane on left ventricular systolic and diastolic function in adult patients using transthoracic echocardiography. METHODS: Twenty-five patients (ASA 1-2 and age < 70 years) received inhalation induction with 5% of sevoflurane. LV systolic function was evaluated by fractional shortening (FS), ejection fraction (EF), rate-corrected mean velocity of circumferential fiber shortening (Vcfc) and a contractile index, LV end-systolic wall stress (ESWS) versus Vcfc relation (ESWS-Vcfc relation). LV diastolic function was assessed by analysis of transmitral flow velocity, peak early diastolic and late diastolic filling velocities (E wave and A wave), E/A ratio and E wave deceleration time (DT). RESULTS: After induction, sevoflurane caused significant decreases in FS, EF, Vcfc, ESWS-Vcfc relation, E wave, and A wave, and a significant increase in E/A and maintained DT. CONCLUSIONS: During inhalation induction with sevoflurane in adult patients, sevoflurane caused negative inotropic effects, but preserved LV diastolic function.