Infusion rate of propofol and jugular venous oxygen saturation.

We compared jugular venous blood oxygen saturation (Sj(O) (2)) and the arterial-to-jugular-bulb venous oxygen content difference (AjD(O) (2)) between bispectral index (BIS) values of 40 and 60, adjusted by the infusion rate of propofol. Eighteen postoperative neurosurgical patients (Glasgow Coma Scale [GCS] scores, 11-15) were enrolled. Normocapnia, normothermia, and a mean arterial blood pressure greater than 70 mmHg were maintained. At BIS values of 40 and 60, hemoglobin, oxygen saturation, and the oxygen partial pressure of arterial and jugular venous blood were measured. Sj(O) (2) at BIS40 (58 +/- 9%) was significantly (P < 0.01) lower than that at BIS60 (63 +/- 10%), and AjD(O) (2) at BIS40 (6.3 +/- 1.5 ml.dl(-1)) was significantly (P < 0.01) higher than that at BIS60 (5.7 +/- 1.5 ml.dl(-1); mean +/- SD). At BIS40, status defined as Sj(O) (2) less than 50% was observed in 3 patients, while this status was observed in 1 patient at BIS60. In conclusion, in patients with postoperative neurosurgical surgery (GCS scores, 11-15), decreases of propofol infusion to adjust the BIS value from 40 to 60 increase the cerebral oxygen balance.

[A case of bilateral diaphragmatic injury following resection of anterior mediastinal tumor].

A 58-year-old woman was scheduled for resection of anterior mediastinal tumor. Prolonged mechanical ventilation was required following surgery because of bilateral diaphragmatic injury. Pleural effusion, atelectasis, and syndrome of vena cava superior were observed during the treatment. BiPAP was useful for respiratory support. The patient was discharged from our hospital nine months after surgery. Oxygen therapy was not necessary in the day time. But the patient required respiratory support with BiPAP at night.

Measurement of cerebral reserve capacity using acetazolamide loading xenon CT CBF before carotid endarterectomy.

BACKGROUND AND PURPOSE: Brain swelling and/or hemorrhage can occur after carotid endarterectomy. This phenomenon is called the hyperperfusion syndrome. Several factors contribute to this syndrome. One is reperfusion in a maximally dilated vessel which means disappearance of cerebral reserve capacity (CRC). The aim of the study was to determine whether CRC measurement was useful for intraoperative and postoperative management of carotid endarterectomy. PATIENTS AND METHODS: We studied 64 cases (male 53, female 11), 49-79 years. CRC was measured preoperatively using acetazolamide loading Xenon CT CBF examination (XeCT). Hypothermia (34-35 C) was induced during surgery in a patient with no CRC. Anesthesia was maintained the night after surgery and the systolic blood pressure was controlled below 120 mmHg. RESULTS: CRC was absent in 10 patients. Postoperative CT did not reveal any hemorrhage or brain swelling. One patient experienced a transient restless state. DISCUSSION: and conclusions: Cerebral hyperperfusion syndrome has been reported in 0.3 approximately 6.0% of patients following carotid endarterectomy (vs 1.6% in our study without hemorrhage or brain swelling). These data suggest that information on CRC could be useful for selection and perioperative management of patients during carotid endarterectomy.

[Spinal anesthesia with isobaric 0.5% bupivacaine for lower limb surgery: effects of different volumes].

BACKGROUND: The effects of different volumes (2.4, 2.6, 2.8 and 3.0 ml) of isobaric 0.5% bupivacaine used for spinal anesthesia were compared in 206 patients scheduled for lower limb surgery. METHODS: The spinal anesthesia was performed with the patients in the lateral position and the isobaric 0.5% bupivacaine was injected intrathecally at the L3-4 interspace. RESULTS: The time to maximum cephalad spread of anesthesia (loss of cold sensation) varied between 25 and 40 min. A significant difference was found in cephalad spread between 2.4 ml group and 3.0 ml group (T11 vs T7), and between 2.6 ml group and 3.0 ml group (T11 vs T7). Severe hypotension did not occur during the study. CONCLUSIONS: Spinal anesthesia with 2.8 ml of isobaric 0.5% bupivacaine proved satisfactory for lower limb surgery.

[Postoperative nausea and vomiting after open heart surgery].

We investigated the incidence of the postoperative nausea and vomiting (PONV) following cardiac surgery with cardiopulmonary bypass. We conducted a prospective study of 65 cases with direct interviews by anesthesiologists who are blind to this protocol every 6 hours during ICU stay. There were no differences in age, body mass index, dose of fentanyl, operating time, cardiopulmonary bypass time and ventilation time in ICU between PONV(+) and PONV(-). Incidence of PONV was 43%, but 70% of female patients complained of PONV. Prophylactic antiemetic strategy might be clinically relevant to female patients who are to undergo open heart surgery with cardiopulmonary bypass.