Intraoperative high-dose remifentanil increases post-anaesthetic shivering.

BACKGROUND: Remifentanil is associated with increased incidence of post-anaesthetic shivering (PAS). The aim of this study was to compare the effects of intraoperative high and low doses of remifentanil on PAS. METHODS: We investigated 50 consecutive patients, aged <60 yr, who underwent gynaecological laparotomy. Patients who underwent prolonged surgery (>4 h) were excluded from the study. Anaesthesia throughout surgery was maintained with i.v. propofol and remifentanil, and epidural ropivacaine, and no nitrous oxide was used. Fifty patients were randomly assigned to receive intraoperative remifentanil at 0.1 microg kg(-1) min(-1) (low-dose group, n=25) or 0.25 microg kg(-1) min(-1) (high-dose group, n=25) until the end of surgery. Intraoperative analgesia was achieved by a fixed infusion rate of remifentanil and titrated epidural ropivacaine. PAS was evaluated by nursing stuff over the first hour after surgery. RESULTS: PAS occurred more frequently in the high-dose group than in the low-dose group (60% vs 20%, P=0.009). None of the patients complained of pain during the observation period due to epidural analgesia. There were no significant differences in rectal or palm skin temperature after extubation between the two dose groups. CONCLUSIONS: Remifentanil-induced PAS is not a phenomenon of intraoperative hypothermia. The higher incidence of PAS with higher doses of remifentanil probably reflects acute opioid tolerance and stimulation of N-methyl-d-aspartate receptors, similar to hyperalgesia. We conclude that patients administered high doses of remifentanil are sensitive to shivering after sudden drug withdrawal.

Analysis of postrevascularization syndrome after orthotopic liver transplantation: the experience of an Australian liver transplantation center.

BACKGROUND/PURPOSE: We investigated the causes and examined patient outcomes following the postrevascularization syndrome (PRS) during orthotopic liver transplantation (OLTx). METHODS: PRS was defined as a fall in the mean arterial pressure at 5 min after revascularization to less than 70% of the baseline and lasting for 5 min. Data from 100 adult patients who underwent OLTx between January 1998 and September 2000 were analyzed. Analyzed data included donor and recipient demographic data, recipient operative and postoperative courses, and recipient outcome. RESULTS: Twenty-nine patients (29%) exhibited PRS during OLTx (PRS group). There was a higher incidence of older donors (>50 years) in the PRS group (48% vs 23%; P < 0.05). Postrevascularization hyperkalemia and metabolic acidosis were observed in both the PRS and non-PRS groups. Transaminase and lactate levels after revascularization were significantly higher in the PRS group ( P < 0.05). Alkaline phosphatase and gamma-glutamyl transpeptidase levels on day 7 tended to be higher in the PRS group; although the difference was not significant (p > or = 0.05). Serum creatinine was significantly elevated on day 7 in the PRS group ( P < 0.01). CONCLUSIONS: Our results indicate that PRS following OLTx tended to be more common in liver allografts from older donors and was associated with posttransplantation liver and renal dysfunction.

Pathophysiological mechanisms of postrevascularization hyperkalemia in orthotopic liver transplantation.

The underlying mechanisms of hyperkalemia occurring immediately after revascularization in orthotopic liver transplantation (OLT) are unknown. We investigated the possible pathophysiological mechanisms of hyperkalemia in relation to the donor and recipient. The study included 64 consecutive patients undergoing OLT. Recipients were divided into two groups: Group 1 consisted of 47 patients with serum K(+) concentration <5.5 mmol/L at 1-min postrevascularization, and Group 2 consisted of 17 patients with serum K(+) exceeding 5.5 mmol/L. Increased serum K(+) concentration, more progressive metabolic acidosis, and decreased mean arterial blood pressure and cardiac index during the anhepatic phase were recognized in Group 2. Multiple regression analysis showed that cardiac index, serum lactate, and serum K(+) concentration during the anhepatic phase were independent and significant factors that could predict serum K(+) concentration 1-min postrevascularization. Hyperkalemia at 1-min postrevascularization did not correlate with the extent of preservation injury of the graft liver (represented by the peak value of aspartate aminotransferase measured within the first 72 h after OLT) or the duration of cold ischemia. We conclude that hyperkalemia occurring immediately after revascularization in OLT is mainly caused by metabolic acidosis as a result of insufficient cardiac output during the anhepatic phase.

[Causes of renal dysfunction during the anhepatic phase in patients for orthotopic liver transplantation and their postoperative renal function].

This study was carried out to clarify causes of renal dysfunction during the anhepatic phase in orthotopic liver transplantation (OLT) with venovenous bypass and to show how the deterioration impacted on postoperative renal function. The 44 consecutive patients with normal preoperative renal function who underwent OLT in Royal Prince Alfred Hospital were classified into two groups according to creatinine clearance (Ccr) during the anhepatic phase. Group 1 consisted of 27 patients whose Ccr levels levels were kept above 60 ml.min-1.m-2 and group 2 consisted of 17 patients under 60 ml.min-1.m-2. In group 2, preoperative International Normalized Ratio for prothrombin was higher and blood transfusion volume before revascularization was significantly lager than group 1. There were significant differences in haemodynamics just before revascularization (mean arterial pressure 95 +/- 14 vs 83 +/- 14 mmHg, pulmonary artery wedge pressure 16 +/- 5 vs 11 +/- 5 mmHg, cardiac index 4.6 +/- 1.3 vs 4.0 +/- 0.9 l.min-1.m-2, group 1 vs group 2, mean +/- SD, P < 0.05). Serum creatinine levels in group 2 were significantly higher postoperatively. It is suggested that bleeding due to insufficient preoperative coagulability caused haemodynamic instability which deteriorated renal function during the anhepatic phase and the deterioration impacted on postoperative renal function.

Biochemical bases in differentiation of a mouse cell line GSM06 to gastric surface cells.

A mouse gastric surface cell line GSM06 established from a transgenic mouse harboring temperature-sensitive simian virus 40 large T-antigen gene was subjected to the lipid and glycoprotein analysis. When GSM06 cells were cultured for a long time after formation of a confluent monolayer, they differentiated to resemble foveolar epithelial cells morphologically. Biochemical changes during culture were studied in cells harvested just when a monolayer had formed (day 0), on day 7, and on day 21. Content of total phospholipids, cholesterol, cholesterol sulfate, total sugar and sialic acid increased about 1.5-fold from day 0 to 7 and remained elevated till day 21. The fatty acid composition of phospholipids revealed increased relative levels of oleic acid in phosphatidylcholine and phosphatidylethanolamine, and an increased level of plasmenylethanolamine from day 0 to 7. The level of dolichylphosphate continued to increase in a time-dependent manner. Glycosylation of various proteins, detected with lectins, was enhanced from day 7. In addition, greater resistance to taurodeoxycholate and acetylsalicylic acid was observed on days 7 and 21 than on day 0. Thus, enhanced glycosylation of proteins and an overall increase in the area of cellular membranes were the major changes in GSM06 cells during culture, and they were accompanied by an enhancement of cytoprotective potential.

Gas Sensing Based on a Nonlinear Response: Discrimination between Hydrocarbons and Quantification of Individual Components in a Gas Mixture.

A novel sensing system is proposed based on the multidimensional information contained in a dynamic nonlinear response. A sinusoidal temperature change was applied to a SnO(2) semiconductor gas sensor, and the resulting output conductance of the sensor was analyzed by fast Fourier transformation (FFT). The higher harmonics of the FFT characterized the nonlinear properties of the response. The amplitudes of the higher harmonics of the FFT exhibit characteristic changes which depend on the chemical structure, concentration, and the kinetics of adsorption and the reaction of hydrocarbon gases and aromatic vapors on the sensor surface. In addition, it is possible to distinguish between gases in a gaseous mixture with a single detector using this dynamic nonlinear response. Nonlinear responses are discussed in relation to the kinetics of the reaction at the sensor surface and the temperature-dependent barrier potential of the semiconductor.

[A case in which the endotracheal tube was ignited by an electrocautery during tracheotomy].

Electrocautery is essential in the modern operation. But if we use it carelessly, a severe complication can occur. Tracheotomy was performed by surgeons after laparotomy and drainage in a patient with severe pancreatitis. Endotracheal tube was ignited during hyperoxidation immediately after trachea was incised by electrocautery. Trachea and bronchi was damaged by heat. After the tracheotomy we examined his trachea and bronchi with a bronchoscope periodically. Electrocautery should be used carefully during hyperoxidation.

Molecular weight-dependent lymphatic transfer of fluorescein isothiocyanate-labeled dextrans after intrapulmonary administration and effects of various absorption enhancers on the lymphatic transfer of drugs in rats.

We have developed a new method to evaluate the transfer of macromolecular drugs to intrapulmonary lymph nodes in rats after intrapulmonary administration. By using this method, we observed that the transfer of fluorescein isothiocyanate dextrans (FDs) to the intrapulmonary lymph nodes was markedly higher than that to iliac lymph node, a non-intrapulmonary lymph node. The transfer of FDs to the intrapulmonary lymph nodes increased with increasing their molecular weights and the threshold for a high lymph node-to-plasma level ratio (CLN/CP) was between 10 and 20 kDa. The effects of absorption enhancers on the transfer of FDs to intrapulmonary lymph nodes were also examined in rats. Absorption enhancers used in this study were EDTA, sodium glycocholate (Na-GC), mixed micelles (MM), N-lauryl-beta-D-maltopyranoside (LM), sodium caprate (Na-Cap). The transfer of FD-20, FD-40 and FD-70 to intrapulmonary lymph nodes after intrapulmonary administration increased in the presence of LM. In particular, the lymphatic transfer of FD-40 was remarkably increased in the presence of LM. Similarly, Na-GC and MM improved the transfer of FD-40 to intrapulmonary lymph nodes. These results suggest that absorption enhancers such as LM, Na-GC and MM are effective for improving the transfer of macromolecular drugs to intrapulmonary lymph nodes.

Major defect of carbohydrate-deficient-glycoprotein syndrome is not found in the synthesis of dolichyl phosphate or N-acetylglucosaminyl-pyrophosphoryl-dolichol.

The contents of dolichyl phosphate and UDP-N-acetylglucosamine:dolichyl phosphate N-acetylglucosamine 1-phosphate transferase (GlcNAc-1-P transferase) activity in fibroblasts from patients with carbohydrate-deficient-glycoprotein (CDG) syndrome were analyzed. The amount of dolichyl phosphate and GlcNAc-1-P transferase activity in CDG syndrome fibroblasts were similar to those in normal fibroblasts, suggesting that CDG syndrome may not be due to a deficiency of a biosynthetic enzyme for dolichol-oligosaccharide intermediates, but to a metabolic error in assembly of asparagine-linked oligosaccharide.

Induction of the fundic mucosa-specific glycolipid with dimethylformamide in gastric-cancer cell lines.

We have previously reported that a glycolipid GalNAc beta 1-4[NeuAc alpha 2-3]Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc-Cer named NGM-1 is present specifically in the human gastric fundic mucosa, but not in other organs. In gastric-cancer tissue and cancer cell lines, this glycolipid completely disappears. These findings imply that NGM-1 is expressed only in well-differentiated fundic mucosa. The purpose of this study is to examine the expression of NGM-1 as a differentiation-related molecule. A gastric cell line AZ521 was cultured in the medium with various reagents which had been reported to induce differentiation in cancer cells. The growth of AZ521 was suppressed by the addition of 0.8% dimethylformamide (DMF) to the medium, but not by addition of dimethylsulfoxide (DMSO), retinoic acid or butyric acid. In the ganglioside fraction of the cells cultured with DMF, a glycolipid regarded as NGM-1 which had not been present before treatment was detected using a monoclonal antibody. Suppression of the proliferation of AZ521 by eliminating the serum from the medium could not induce the expression of NGM-1. A colonic cell line treated with DMF also failed to express the glycolipid. The synthase activity of NGM-1 was elevated in the AZ521 cells treated with DMF, but not with DMSO. These results demonstrate that the expression of NGM-1 is induced by DMF specifically in gastric-cancer cells, and suggest the possibility that NGM-1 is a differentiation-related molecule.

A case of GM1-gangliosidosis type I: glycosphingolipid profiles of urine and transformed lymphocytes and beta-D-galactosidase activities in peripheral lymphocytes, cultured skin fibroblasts and transformed lymphocytes.

A female infant with early-onset GM1-gangliosidosis type I was investigated. The lymphocytes, transformed lymphocytes and cultured skin fibroblasts of the patient were demonstrated to have severe beta-D-galactosidase deficiency. The beta-D-galactosidase activities of these cells from the patient's father and mother were at the lower limit of the normal range. The oligosaccharide accumulation in urine of the patient showed the typical type I GM1-gangliosidosis pattern, but no GM1 ganglioside was detected in the patient's urine or transformed lymphocytes. The clinical features were compatible with infantile GM1-gangliosidosis. The mixture of homogenates from the cultured fibroblasts or transformed lymphocytes of the patient and controls showed no complementation of beta-D-galactosidase activity against the controls.

Biochemical mechanisms of aminoglycoside cell toxicity. II. Accumulation of phospholipids during myeloid body formation and histological studies on myeloid bodies using twelve aminoglycoside antibiotics.

Cultured human skin fibroblasts take up aminoglycoside antibiotics into lysosomes to form myeloid bodies. Gentamicin (GM), one such antibiotic, was taken up until the cellular concentration reached an estimated 64 mM on the 3rd day when cells were incubated with 2 mM gentamicin. The rate of release of intracellular GM was high on the first day of incubation and gradually slowed down over the next 4 d. About 50% of the GM remained in the cells even on longer incubation in GM-free medium, suggesting it may irreversibly bind to cellular components. With myeloid body formation, the cellular phospholipid content increased 1.5 times. Bis(monoacyl-glyceryl)phosphate, which is known as a marker of lysosomal phospholipid, phosphatidylcholine and phosphatidylserine showed 250, 162, and 153% increases, respectively. Sphingomyelin was not accumulated, while lysosomal sphingomyelinase was dramatically inhibited. Of 12 different aminoglycoside antibiotics, paromomycin is the most prominent myeloid body-forming antibiotic. The myeloid body-formation is not directly correlated to human nephrotoxicity. On the other hand, the number of myeloid bodies is well correlated to the affinity to the brush border membrane, suggesting that such aminoglycoside antibiotics are taken up easily through cellular endocytosis. The cytotoxic effects of aminoglycoside antibiotics may be due to by their binding to cellular organelles other than lysosomes.