[A case of anaphylactic shock by multiple causes].

We experienced anaphylactic shock after introduction of the general anesthesia twice in the same patient. After the first incidence of anaphylactic shock, we judged that the allergen was a latex. For the second time we planned the latex free environment, but the anaphylactic shock occurred again. As a result of the investigation, it turned out that the allergens were due to latex and sevoflurane. After the first incidence, it was necessary to retrieve the antigen from all the agents used. When we encounter the anaphylactic shock, it is necessary to examine all the medicines, and should have two or more suspectible medicines in mind.

Combined spinal-propofol anesthesia with noninvasive positive-pressure ventilation.

Twenty-three adult patients undergoing repair of inguinal hernia under spinal anesthesia received propofol infusion for sedation with the assist of noninvasive positive-pressure ventilation (NPPV). Circulatory and respiratory parameters, such as percutaneous oxygen saturation, transcutaneous carbon dioxide tension, respiratory rate, tidal volume, blood pressure, and heart rate, were maintained within physiological ranges during the anesthesia. There were no adverse effects. These findings suggest that the application of NPPV in patients receiving propofol infusion for sedation is clinically practicable during anesthesia.

Mechanism of injection pain with long and long-medium chain triglyceride emulsive propofol.

PURPOSE: t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared. METHODS: Two hundred adult patients randomly allocated to two groups were given 1.5 mg x kg(-1) iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg x min(-1) in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol. RESULTS: There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results. CONCLUSIONS: LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase.

Changes in femoral vein blood flow velocity by intermittent pneumatic compression: calf compression device versus plantar-calf sequential compression device.

Intermittent pneumatic compression has become widely used to prevent deep venous thrombosis potentially causing fatal pulmonary embolism. Although uniform compression has been commonly applied, a new method of sequential compression from plantar to calf has recently been developed. In this report, changes in maximum blood flow velocity in the femoral vein were compared with compression of only the calf uniformly and compression from plantar to calf sequentially in 10 healthy adult volunteers. A compression pressure of 60 mm Hg was applied for 5 min, and the velocity was measured before and after this treatment by ultrasound echography. There was no statistically significant difference in the change in maximum velocity between calf compression and plantar-calf sequential compression. The maximum velocity increased significantly with both compressions. However, plantar-calf sequential compression tended to have a greater effect. Although the results did not demonstrate an advantage of plantar-calf sequential compression compared with calf compression only, if the former compression is applied for a long time, it may have a greater effect.

A survey of combined epidural-propofol anesthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol.

BACKGROUND: Combined epidural-propofol anesthesia with use of noninvasive positive pressure ventilation (NPPV) via the nose has been used routinely in our operating theaters. The purpose of this report was to present a survey of this anesthesia. MATERIAL/METHODS: 265 adult patients undergoing lower extremity or lower abdominal gynecological surgery during 1999 were examined. After epidural anesthesia, patients were given propofol infusion. NPPV was applied with an inspiratory/expiratory positive airway pressure of 14/8 cm H2O, a respiratory rate of 10 breaths/min, and oxygen delivery into the nasal mask resulting in a concentration of 40% or an inspiratory oxygen fraction of 0.35. Epidural anesthesia was continuously applied after surgery for postoperative pain relief. Various data related to the surgery or anesthesia were evaluated both on the day of surgery and on postoperative day 1. RESULTS: Of 265 patients, 3 patients could not receive our anesthetic protocol. Of the residual 262 patients, no patients showed serious clinical problems during anesthesia, excluding for hypotension, which was observed in 31-56% patients and was treated with ephedrine injection. Patients informed us of good analgesia (98%), feelings (78%) and dreams (47%). On postoperative day 1, postoperative analgesia and mood conditions were satisfactory. There were no patients complaining of intraoperative awareness. CONCLUSIONS: The principle of our anesthesia consists of epidural anesthesia, sole propofol infusion and noninvasive airway management, so as to provide an anesthetic technique with minimal invasiveness. Although airway maintenance by NPPV is not always suitable, our anesthesia is practicable for certain kinds of operations.

Inspired superoxide anions attenuate blood lactate concentrations in postoperative patients.

OBJECTIVE: Low concentrations of superoxide (O(2)(-)) constitute a portion of atmosphere negative ions in the form of O(2)-(H(2)O)(n), which has been reported to have a stimulatory effect on superoxide dismutase activity. If superoxide dismutase is activated by inspired negative ions containing O(2)(-), aerobic metabolism could be improved. To test this hypothesis, we examined blood lactate concentrations in postoperative patients with or without inhalation of air from a home humidifier that generates O(2)-(H(2)O)(n). DESIGN: Prospective, randomized, controlled trial. SETTING: Neurosurgical intensive care unit of a general hospital. PATIENTS: Twenty postneurosurgical patients with arterial blood lactate concentrations >1.5 mmol/L were studied and were divided randomly into two groups. INTERVENTIONS: One group received 40 L/min 40% oxygen flow from a home humidifier as an oxygen therapy for 4 hrs, followed by almost the same flow from a jet nebulizer, which generates positive ions, for 4 hrs. The other group received the reverse combination. MEASUREMENTS AND MAIN RESULTS: During the 8-hr study, arterial blood lactate concentrations were measured every hour. There was a significant difference in the time course of blood lactate concentrations between the groups. In the group in which negative ions were first initiated for 4 hrs and positive ions thereafter, the lactate concentration decreased slightly at 3, 4, and 5 hrs and returned to the baseline concentration thereafter. In the group with the reverse combination, the lactate concentration did not change during the first 4 hrs but decreased thereafter after inhalation of negative ions. CONCLUSIONS: Inspired O(2)(-) attenuates blood lactate concentrations. This may be attributed, in part, to the systemic stimulatory effect on superoxide dismutase activity, which accelerates oxidative phosphorylation in the mitochondria, thus attenuating lactate generation.