Dye-Containing Polymers with π-Extened Diketopyrropyrrole Derivatives for Semi-transparent Organic Photovoltaics.

Dye-containing polymers P1 (PEDPP-OT-BDT) and P2 (PEDPP-OT-BDTT) including a π-extended diketopyropyrrole (DPP) derivative and electron-rich thiophene fused ring units (4,8-bis((2-ethylhexyl)oxy)benzo[1,2-b:4,5-b']dithiophene for P1 and 4,8-bis(5-(2-ethylhexyl)thiophen-2-yl)benzo[1,2-b:4,5-b']dithiophene for P2) were synthesized as narrow band gap dyes. A π-extended DPP (EDPP-OT-BrPh), fragment of the polymers P1 and P2, was obtained by extending the π-conjugation of DPP using Ru(III)-catalyzed C-H and N-H activation reported by Gonka et al. in 2019, exhibiting a high quantum yield (φem = 0.84) and small HOMO-LUMO gap (Eg = 1.69 eV) due to the spatial overlap of the HOMO and LUMO orbitals. The solubility of the π-extended DPP was improved by introducing four 2-octylthophene side chains around the periphery of the planer dye moiety, while maintaining the high planarity of the dye molecule, which is essential to the function of optoelectronic devices. As a result, P1 and P2, polymerized with the π-extended DPP and BDT derivatives, exhibit carrier mobility of approximately 10-5 cm2/Vs in organic field-effect transistors (OFETs). In bulk heterojunction (BHJ) solar cells with [6,6]-phenyl-C61-butyric acid methyl ester (PCBM), they demonstrate a power conversion efficiency (PCE) of 1.0% with an average transmittance (AVTs) of around 60%.

A copper(I) thiocyanate-based photoresponsive semiconducting 2D coordination polymer.

A coordination polymer, [Cu(SCN)(iqi)]n (iqi = isoquinoline), containing copper(I) thiocyanate and a nitrogen-containing π-conjugated ligand, iqi, has been synthesized and its physical properties were evaluated. This coordination polymer has a two-dimensional (2D) sheet structure consisting of copper(I) thiocyanate and shows photoluminescence derived from 3MLCT and photoconductive properties.

Supraclavicular block vs. intravenous regional anaesthesia for forearm surgery.

BACKGROUND: The purpose of this study was to compare the analgesic effect between intravenous regional anesthesia (IVRA) and supraclavicular block in forearm surgery. METHODS: Eighty patients aged 30 to 70 years for forearm surgery were divided into Supraclavicular group and IVRA group. Supraclavicular block was performed with 1% lidocaine 20 mL. After analgesia was obtained, single tourniquet was used at 200 mmHg. For patients in the IVRA group, an intravenous catheter was inserted in the dorsum of the hand of surgery, double tourniquet was placed, an elastic bandage was wound up, then 1% lidocaine 20 mL was injected after proximal tourniquet was inflated at 200 mmHg. When analgesia did not occur in 30 minutes, the block was judged as a failure, and general anesthesia was administered. The onset time of analgesia, time to the first tourniquet pain, and duration of postoperative analgesia were measured. When patients felt pain at surgical site during surgery, fentanyl 50 µg was administered. Side effects were also checked. RESULTS: Onset time, duration of postoperative analgesia, and time to the tourniquet pain were significantly shorter in the IRVA group. Number of patients with tourniquet pain was significantly larger and number of patients with additional fentanyl was significantly smaller in the IRVA group. No patients showed any side effects. CONCLUSION: IVRA had shorter onset time and needed less additional anesthetics during surgery, but induced more tourniquet pain and shorter duration of postoperative analgesia than supraclavicular block when 1% lidocaine 20 mL was used for forearm surgery.

Effects of Premedication on Heart Rate Variability at Induction of Anaesthesia: Comparison between Midazolam and Hydroxyzine.

OBJECTIVE: The present study was performed to compare the effects of midazolam premedication, which is useful for its anti-anxiety and amnesic effects, with antihistamine hydroxyzine on cardiac sympathetic and parasympathetic activities using heart rate variability (HRV) at induction of anaesthesia. METHODS: Eighty patients aged 40-60 years, with an American Society of Anaesthesiologists (ASA) physical status of I or II and undergoing general anaesthesia for neck and body surface surgery were randomised equally into midazolam and hydroxyzine groups. As a premedication, midazolam 0.06 mg kg-1 with atropine 0.5 mg (midazolam group) or hydroxyzine 1 mg kg-1 with atropine 0.5 mg (hydroxyzine group) were intramuscularly administered 15 min and 30 min before anaesthesia induction, respectively. Anaesthesia was induced with midazolam 0.1 mg kg-1 and thiopental 3 mg kg-1. Oro-tracheal intubation was facilitated with vecuronium 0.15 mg kg-1. Blood pressure, heart rate and HRV were measured at predetermined time points for 10 min after intubation. RESULTS: Systolic blood pressure and heart rate significantly increased after intubation in both groups and the increase was greater in the hydroxyzine group. The high frequency (HF) component decreased significantly in both groups, and no difference was found between the two groups. The low frequency component/HF ratio significantly increased in the hydroxyzine group but did not change in the midazolam group. CONCLUSION: Midazolam but not hydroxyzine premedication inhibited sympathetic activation at induction of anaesthesia.

Is the change of percutaneous oxygen pressure available to judge the effects of brachial plexus block?

BACKGROUND: To know the objective methods of the effects of the brachial plexus block, we studied the changes in percutaneous oxygen pressure (tcPO2) with the hypothesis that tcPO2 increases significantly on the blocked arm in comparison with the non-blocked arm, a phenomenon which is connected with vasodilation following the brachial plexus block. METHODS: Fifteen patients scheduled for upper extremity surgery, aged 20 to 70 years, with ASA physical status I or II were included. Before anaesthesia, the electrodes used to measure tcPO2 were put on the radial side of the forearm and upper arm of both the right and left sides (a total of 4 electrodes). Oxygen at 6 L min⁻¹ was administered by a facial mask. Once midazolam 1-2 mg and fentanyl 50 µg had been administered intravenously, a propofol infusion was started at a dose of 2 mg kg⁻¹ h⁻¹. The interscalene block was performed by means of a nerve stimulator, using 20 mL of 1% lidocaine solution combined with 20 mL of 0.75% ropivacaine solution. TcPO2 was measured just before the block and 30 minutes after the block. RESULTS: TcPO2 in both forearm and upper arm significantly increased after the block in both sides namely, blocked and non-blocked. No difference was observed in tcPO2 between the blocked side and non-blocked side. CONCLUSION: Changes of tcPO2 are not useful in order to assess the effects of the interscalene block under oxygen administration.

Changes in heart rate variability during anaesthesia induction using sevoflurane or isoflurane with nitrous oxide.

BACKGROUND: The purpose of this study was to compare cardiac sympathetic and parasympathetic balance using heart rate variability (HRV) during induction of anaesthesia between sevoflurane and isoflurane in combination with nitrous oxide. METHODS: 40 individuals aged from 30 to 60 years, scheduled for general anaesthesia were equally divided into sevoflurane or isoflurane groups. After 100% oxygen inhalation for a few minutes, anaesthesia was induced with nitrous oxide 3 L min-1, oxygen 3 L min-1 and sevoflurane or isoflurane. Sevoflurane or isoflurane concentration was increased by 0.5% every 2 to 3 breaths until 5% was attained for sevoflurane, or 3% for isoflurane. Vecuronium was administered to facilitate tracheal intubation. After intubation, sevoflurane was set to 2% while isoflurane was set to 1% with nitrous oxide with oxygen (1:1) for 5 min. RESULTS: Both sevoflurane and isoflurane provoked a decrease in blood pressure, total power, the low frequency component (LF), and high frequency component (HF) of HRV. Although the heart rate increased during isoflurane anaesthesia, it decreased under sevoflurane. The power of LF and HF also decreased in both groups. LF was higher in the isoflurane group while HF was higher in the sevoflurane group. The LF/HF ratio increased transiently in the isoflurane group, but decreased in the sevoflurane group. CONCLUSION: Anaesthesia induction with isoflurane-nitrous oxide transiently increased cardiac sympathetic activity, while sevoflurane-nitrous oxide decreased both cardiac sympathetic and parasympathetic activities. The balance of cardiac parasympathetic/sympathetic activity was higher in sevoflurane anaesthesia.

The neuromuscular effects of rocuronium under sevoflurane-remifentanil or propofol-remifentanil anesthesia: a randomized clinical comparative study in an Asian population.

BACKGROUND: We conducted a prospective, randomized, multicenter study to evaluate the differences in the blocking effect of different doses of rocuronium between sevoflurane- or propofol-remifentanil anesthesia in an Asian population. METHODS: A total of 368 ASA I-II patients was enrolled. Anesthesia was induced with 2.0 mg/kg propofol and 0.1 µg/kg/min remifentanil (TIVA) or 5.0 vol.% sevoflurane with 0.1 µg/kg/min remifentanil (SEVO). Tracheal intubation was facilitated at 180 s after the administration of rocuronium at 0.3, 0.6, or 0.9 mg/kg and then intubation condition was evaluated. The time to maximum block and recovery profile were monitored by TOF stimulation of the ulnar nerve and by recording the adductor pollicis response using acceleromyography. RESULTS: The numbers of patients with clinically acceptable intubation conditions were 41, 82, and 97 % (TIVA) and 34, 85, and 90 % (SEVO) at each dose of rocuronium, respectively. There were no significant differences in the time to maximum block between groups at each rocuronium dose. There were significant differences in the recovery to a train-of-four ratio of 90 % between the groups: 42.7 (19.5), 74.8 (29.9), and 118.4 (35.1) min (TIVA) and 66.5 (39.3), 110.2 (43.5), and 144.4 (57.5) min (SEVO) at 0.3, 0.6, and 0.9 mg/kg, respectively (P < 0.001). CONCLUSIONS: There are no significant differences in intubation conditions between propofol-remifentanil and sevoflurane-remifentanil anesthesia at the same dose of rocuronium. The type of anesthetic does not significantly influence the time to maximum block by rocuronium. Rocuronium at a dose of 0.9 mg/kg should be used for better intubation conditions with both anesthesia regimens in an Asian population. TRIAL REGISTRATION: UMIN-CTR Clinical Trial ( http://www.umin.ac.jp/ctr/index.htm ; UMIN#000007289 ; date of registration 14(th) February 2012).

[A Case of Suspected Delayed Postoperative Malignant Hyperthermia].

Malignant hyperthermia occurred 10 hours after surgery in a 72-year-old man who had received emergency laparoscopic cholecystectomy for severe acute cholecystitis with cholelethiasis. He had a high fever (39.4 degrees C) with liver damage before surgery. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and epidural block using ropivacaine. Rocuronium was used as a muscle relaxant During surgery, body temperature decreased by cooling the body surface, but tachycardia continued. Ten hours after surgery, body temperature increased to the maximum of 40.6 degrees C and he went into shock. Then another 10 hours later, he developed cardiac arrest He recovered, but 22 hours later, second cardiac arrest occurred. After his second recovery, dantrolene was administered and body temperature decreased. He had hypoxic brain damage, but was dischanged from the hospital after tracheostomy on the 150th hospital day. From his clinical course, especially decrease in body temperature by dantrolene, he was suspected to have developed malignant hyperthermia. We should consider malignant hyperthermia when patient had a severe high fever postoperatively.

Composite auditory evoked potentials index is not a good indicator of depth of anesthesia in propofol-fentanyl anesthesia: Randomized comparative study.

BACKGROUND: The composite auditory evoked potentials index (cAAI) was considered a measure of overall balance between noxious stimulation, analgesia, and hypnosis; while bispectral index (BIS) shows only hypnosis, and auditory evoked potentials index (AAI) shows response to stimuli. The present study compared the performance of cAAI, BIS, and AAI in propofol-fentanyl anesthesia. MATERIALS AND METHODS: Forty-five patients for abdominal surgery aged 30-65 years with ASA physical status I or II were randomly divided into three groups by an envelope method. Anesthesia was induced with midazolam, propofol, and fentanyl alongwith an epidural block. When hemodynamics were stable during surgery, propofol infusion rate was fixed at 4 mg/kg/h for 10 min, then increased to 6 mg/kg/h and kept it for 10 min. AAI (AEP version 1.4), cAAI (AEP version 1.6), or BIS (A-2000) was monitored in each 15 patients, and the performance of three indices was compared. RESULTS: All three indices decreased significantly before intubation. Only the AAI increased significantly by intubation. During anesthesia except for at propofol 6 mg/kg/h, the cAAI was significantly higher than the AAI. Only the AAI was significantly lower at propofol 6 mg/kg/h than at 4 mg/kg/h. The cAAI had the largest and AAI had the smallest inter-individual variations. The cAAI was higher than the manufacturer's recommended range of general anesthesia. CONCLUSION: In propofol-fentanyl anesthesia, AAI might be better to discriminate anesthetic depth than cAAI and BIS.

[A case report of ultrasound guided peripheral nerve block for lower extremity amputation of a patient with anti-phospholipid syndrome].

A 60-year-old female with anti-phospholipid syndrome underwent amputation of her left lower limb. She had had a history of cerebral infarction, cerebral hemorrhage, coagulation abnormalities, thrombocytopenia, and pneumothorax, and just recovered from disseminated intravascular coagulation. After intravenous fentanyl 25 microg, ultrasound-guided sciatic, femoral and lateral femoral cutaneous nerve blocks were performed. We used 0.75% ropivacaine 15 ml and 1% lidocaine 15 ml for sciatic nerve block, 0.75% ropivacaine 5 ml and 1% lidocaine 5 ml for femoral nerve block and 0.75% ropivacaine 5 ml for femoral cutaneous nerve block. For femoral nerve block, a catheter was inserted and ropivacaine was infused at 4 ml x hr(-1) after surgery. Amputation at the left thigh was successfully performed and postoperative course was uneventful. The sciatic, femoral and lateral femoral cutaneous nerve blocks were useful for amputation of a patient with severe coagulopathy by anti-phospholipid syndrome.

Propofol results in higher incidence of bronchoconstriction in allergic patients.

INTRODUCTION: Some reports showed allergic reaction to propofol. However, propofol has bronchodilating effect. The purpose of this study was to elucidate whether propofol is safely used for patients with allergy or bronchial asthma. METHODS: Seventy females with bronchial asthma or allergic diseases and 70 females without any allergic diseases for mastectomy were randomly allocated to propofol group (Propofol-allergy group and Propofol-non-allergy group) or sevoflurane group (Sevoflurane-allergy group and Sevoflurane-non-allergy group). In the propofol group, anesthesia was induced with propofol and fentanyl, and maintained with propofol, fentanyl and 50% nitrous oxide in oxygen. In the sevoflurane group, anesthesia was induced with sevoflurane, 50% nitrous oxide in oxygen and fentanyl, and maintained with sevoflurane and 50% nitrous oxide in oxygen. Laryngeal mask airway was inserted. Wheezing detected by auscultation, increase of inspiratory pressure and change of the waveform of end-tidal carbon dioxide, and allergic reaction detected by skin rash during anesthesia were compared among the groups. RESULTS: The number of patients who had wheezing was significantly larger in Propofol-allergy group than in other groups. CONCLUSIONS: Propofol might induce bronchoconstriction with a higher incidence in allergic patients than in non-allergic patients, and than sevoflurane.

[A case of prolonged hypercapnea after interscalene brachial plexus block].

An 83-year-old woman was scheduled for surgery of the left upper and lower extremity fracture. She had past history of lung partial resection for lung cancer and rheumatoid arthritis, and recent history of pneumonia. She also had fluid retention in the thoracic cavity. Open resection of the femoral neck fracture was first performed uneventfully under spinal anesthesia with bupivacaine 0.5% 2 ml. Then, interscalene blaxioplexus block was performed with 0.75% ropivacaine 15 ml and 1% lidocaine 10 ml for tension band wiring of the fractured olecranon. Midazolam 1 mg and propofol 1.5 mg x kg(-1) x hr(-1) were administered for sedation. Thirty minutes after the block, oxgen saturation decreased to 92% under O2 3 l x min(-1) by a mask. She was intubated and arterial carbon dioxide tension was above 150 mmHg. A few hours later, she became conscious and mask CPAP was used after extubation for one day. Pa(CO2) was 90-100 mmHg for 3 days and decreased to 56.9 mmHg on the 6th day, but her consciousness had been clear. Phrenic nerve palsy and sedation in the patient with decreased lung function might have induced prolonged hypercapnea.

Effects of repeat exposure to inhalation anesthetics on liver and renal function.

BACKGROUND: Cross hypersensitivity to inhalation anesthetics has not been studied. The aim of this study was to investigate it by comparing liver and renal function after repeated anesthesia with sevoflurane and isoflurane retrospectively. MATERIALS AND METHODS: The adult patients who received general anesthesia twice within the interval of 14 days to 1 year were retrospectively analyzed. Those who received sevoflurane anesthesia twice (SS group, 53 cases), isoflurane anesthesia twice (II group, 31 cases), sevoflurane followed by isoflurane anesthesia (SI group, 29 cases), isoflurane followed by sevoflurane anesthesia (IS group, 35 cases), and propofol-fentanyl anesthesia twice (PP group, 58 cases) were enrolled. Serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Bil), gamma-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), and creatinine (Cr) measured 1-3, 5-8, and 12-16 days after surgery were investigated. RESULTS: In the IS group, the number of the patients with abnormal values of ALT and γ-GTP 5-8 days after surgery were significantly smaller at second anesthesia compared to the first anesthesia. The number of the patients with abnormal values of AST, ALT, and γ-GTP were significantly larger in the II group than the SS and PP groups. The number of patients who had higher values in each parameter at second anesthesia compared to the first anesthesia was not different among the groups. CONCLUSIONS: Sevoflurane and isoflurane might have no cross hypersensitivity. Both anesthetics might not have any additional risks to increase liver and renal damage by second anesthesia.

Composite-, plain-auditory evoked potentials index and bispectral index to measure the effects of sevoflurane.

The composite auditory evoked potentials index (cAAI) uses both cortical electroencephalogram (EEG) and response to auditory stimuli, while the bispectral index (BIS) uses only the cortical EEG and auditory evoked potentials index (AAI) uses only response to auditory stimuli. We expected that the cAAI was more useful to monitor anesthetic effect of sevoflurane than the BIS and AAI. The present study compared the changes of cAAI, AAI, and BIS in different sevoflurane concentration. Forty-five adult patients were anesthetized with sevoflurane in 50 % nitrous oxide. AAI (AEP version 1.4), cAAI (AEP version 1.6), and BIS (A-2000) were compared (each 15 patients in AAI, cAAI, and BIS groups) before induction, just before and after intubation, at 10 min since sevoflurane was set to 1.0, 1.5 and 2.0 %, and after extubation. All three indices decreased significantly before intubation. The cAAI was significantly higher than the AAI at sevoflurane 1.0 and 1.5 %. The AAI and BIS were significantly lower at sevoflurane 2.0 % than those at sevoflurane 1.0 %, but the cAAI did not. The cAAI had the largest and AAI had the smallest inter-individual variation. In sevoflurane-nitrous oxide anesthesia, cAAI was inferior to AAI and BIS to discriminate different anesthetic effect. The cAAI had larger inter-individual variation than the AAI and BIS.

[Anesthesia for open reduction of ankle fracture in a patient with giant pituitary adenoma].

A few cases of the pituitary apoplexy have been reported after spinal anesthesia in patients with pituitary tumor. A patient with giant pituitary adenoma underwent open reduction of the ankle fracture. This 69-year-old man had no symptoms related to pituitary adenoma. Femoral and sciatic nerve blocks were chosen to avoid pituitary apoplexy, cerebral herniation and other complications related to spinal anesthesia. The surgery was successfully done without any complications and the patient was discharged uneventfully 25 days after surgery. When patient has a giant pituitary tumor, peripheral nerve block might be a good choice for anesthesia.

[Is nitrous oxide useful for laryngeal mask airway insertion under 8% sevoflurane?].

BACKGROUND: The usefulness of nitrous oxide for laryngeal mask airway insertion under 8% sevoflurane anesthesia was investigated. METHODS: One hundred and fifty patients aged 40 to 60 years for general anesthesia were divided into GOS (nitrous oxide, oxygen, sevoflurane) and OS (oxygen, sevoflurane) groups. Anesthesia was induced with 8% sevoflurane and nitrous oxide 3 l x min(-1) and oxygen 3 l x min(-1) in the GOS group, or oxygen 6 l x min(-1) in the OS group. When verbal response disappeared, sevoflurane concentration was reduced to 3%. Five min after the start of induction, laryngeal mask airway was inserted. RESULTS: The changes in blood pressure and heart rate were significantly smaller and times to disappearance of eyelash response and verbal response were significantly shorter in the GOS group than those in the OS group. The frequencies of postoperative nausea, vomiting, and headache were not different between the groups. CONCLUSIONS: Nitrous oxide shortened induction time, decreased hemodynamic changes, but did not increase postoperative nausea, vomiting and headache when used for anesthesia induction with 8% sevoflurane to insert laryngeal mask airway.

Comparison of the motor and sensory block by ropivacaine and bupivacaine in combination with lidocaine in interscalene block.

INTRODUCTION: The effects of ropivacaine and bupivacaine in interscalene block have been studied, but we usually combine lidocaine with ropivacaine or bupivacaine to fasten the onset. However, the effects of these combinations are not studied. PURPOSE: To compare the effects of two different concentrations of the combination of ropivacaine or bupivacaine with lidocaine. MATERIALS AND METHODS: One hundred adult patients scheduled for repair of fracture of the upper extremity under interscalene block were randomly allocated into one of the groups receiving the combination of 15 mL of ropivacaine 0.375% (Ropivacaine 0.375 group), ropivacaine 0.75% (Ropivacaine 0.75 group), bupivacaine 0.25% (Bupivacaine 0.25 group), or bupivacaine 0.5% (Bupivacaine 0.5 group) with lidocaine 1.0% 15 mL. The onset and duration of motor and sensory blocks were compared among the 4 groups by Kruskal Wallis test followed by Mann-Whitney U test. RESULTS: Three patients in the Ropivacaine 0.375 group did not show any motor blocks. Ropivacaine groups had significantly slower onset of motor block and longer duration of motor and sensory blocks than Bupivacaine groups. Bupivacaine 0.5 group had significantly longer duration of both blocks than Bupivacaine 0.25 group, while Ropivacaine 0.375 and 0.75 groups had the similar duration of both blocks. CONCLUSIONS: In interscalene block combined with lidocaine, ropivacaine had slower onset of motor block and longer duration of both blocks than bupivacaine. Only bupivacaine showed the different duration of the blocks between two concentrations.

[Repeated anesthesia for a patient with Tako-Tsubo cardiomyopathy].

An 85-year-old woman recieved emergency repair of left obturator hernia under general anesthesia. The surgery was completed uneventfully. Shortly after the admission to the recovery unit, blood pressure dropped to 80mmHg and ECG showed negative T wave. Hypotension was successfully treated with colloid infusion and dopamine administration, but negative T wave was unchanged by nitrate infusion. The serum CK-MB examination indicated no cardiomyogenic problems. On postoperative day 13, she received emergency colostomy under general anesthesia. Large negative T wave still persisted. Immediately after induction of anesthesia, she showed hypotension, which recovered by fluid infusion and intravenous ephedrine. The UCG after surgery showed hypokinesis of the apex of left ventricle. She was diagnosed as Tako-tsubo myocardiopathy. One month after the second surgery, she received closure of colostomy under general anesthesia combined with continuous epidural anesthesia, when negative T wave was seen on the ECG. Negative T wave returned to normal 10 weeks after the first surgery. When unknown tachycardia and negative T waves are seen, Tako-tsubo cardiomyopathy should be considered.

The effects of prewarming the I-gel on fitting to laryngeal structure.

PURPOSE: The supraglottic airway, I-gel (Intersurgical, Wokingham, United Kingdom), has a noninflatable cuff, which softens at body temperature to fit to laryngeal structure. The present study was performed to investigate the hypothesis that the cuff of I-gel can fit to laryngeal structure faster when prewarmed to body temperature than kept at room temperature. METHODS: A total of 180 adult patients were assigned to the warm group (90 patients) or the control group (90 patients). Anesthesia was induced with propofol, remifentanil, or fentanyl. Vecuronium or rocuronium was administered as a muscle relaxant. The I-gel was warmed to 37 °C before insertion in the warm group and it was in the room temperature (approximately 20 °C) in the control group. Insertion time, number of attempt for successful insertion, inspiratory pressure, leak pressure, and leak volume were compared between the 2 groups. RESULTS: Insertion time was 12.9 ± 9.3 seconds in the warm group and 14.5 ± 12.3 seconds in the control group. Number of attempt for insertion was 1 in 77 cases, 2 in 4 cases, and 3 in 1 case in the warm group and 1 in 79 cases and 2 in 7 cases in the control group. Inspiratory pressure, leak pressure, and leak volume were not significantly different between the 2 groups, whereas leak volume had a tendency to be smaller in the warm group. CONCLUSION: Prewarming the I-gel to body temperature did not have any significant benefits in comparison with the I-gel kept at room temperature.

Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.

INTRODUCTION: Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness. METHODS: We designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring >48 hours intensive care admitted in 25 ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality. RESULTS: We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, P=0.028, acetaminophen: 2.05, P=0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, P=0.15, acetaminophen: 0.58, P=0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU ≥ 39.5°C increased risk of 28-day mortality in non-septic patients (adjusted odds ratio 8.14, P=0.01), but not in septic patients (adjusted odds ratio 0.47, P=0.11) [corrected]. CONCLUSIONS: In non-septic patients, high fever (≥39.5°C) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00940654.