Ultrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques.

The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably.

IM droperidol as premedication attenuates intraoperative hypothermia.

PURPOSE: Perioperative hypothermia results largely from core-to-peripheral heat redistribution. Droperidol, which is often used for premedication, promotes vasodilation, and thus may affect redistribution of heat. Accordingly, we tested the hypothesis that preanesthetic droperidol would affect perioperative hypothermia. METHODS: Twenty-three ASA physical status I patients scheduled for arthroscopic ligament reconstruction were randomly assigned to two groups to receive no premedication or im droperidol 0.1 mg x kg(-1) 30 min before anesthesia. Anesthesia was induced and maintained with propofol and fentanyl. We monitored core (tympanic) and peripheral (palm) temperatures, and skin (fingertip) blood flow for two hours after the induction of anesthesia during surgery. RESULTS: Before the induction of anesthesia, patients given droperidol were more deeply sedated than those given no premedication. Core temperature, which was similar in both groups before induction, decreased significantly more in the control than in the droperidol patients (0.75 +/- 0.34 degrees C and 0.37 +/- 0.20 degrees C, respectively, at 75 min after induction; P <0.01). Preinduction peripheral temperature and skin blood flow were lower in the control group than in the droperidol group, but the two variables became similar in both groups after induction. CONCLUSION: The results of the present study confirm our hypothesis that premedication with droperidol affects perioperative hypothermia. Droperidol may prevent core-to-peripheral heat redistribution after the induction of anesthesia.

Does hyperthermia induce peritoneal damage in continuous hyperthermic peritoneal perfusion?

To investigate the mechanisms of the peritoneal damage induced by continuous hyperthermic peritoneal perfusion (CHPP), protein and fluid loss during and after CHPP and continuous normothermic peritoneal perfusion (CNPP) was studied. Sixteen patients with advanced gastric cancer underwent peritoneal perfusion therapy with saline solution containing 150 to 300 mg cisplatin and 30 to 60 mg mitomycin C for 60 minutes. The temperature in Douglas' pouch was maintained at 42.0 degrees C in the CHPP group (n = 9) and 37.0 degrees C in the CNPP group (n = 7) during perfusion. No statistical differences were found in patients' characteristics between the groups except the maximum temperature in Douglas' pouch during perfusion (41.6 degrees +/- 0.4 degrees C and 37.6 degrees +/- 0.4 degrees C in CHPP and CNPP groups, respectively, p < 0.05). The amount of protein lost into the perfusate was 0.35 +/- 0.22 g/kg body weight in the CHPP group and 0.37 +/- 0.19 g/kg in the CNPP group, showing no significant difference. On the day of surgery, there was no significant difference in the amount of protein and fluid lost through the abdominal drains between the CHPP group (27.9 +/- 24.6 mg/kg/hr and 0.94 +/- 0.63 ml/kg/hr, respectively) and the CNPP group (25.9 +/- 8.6 mg/kg/hr and 1.03 +/- 0.31 ml/kg/hr, respectively). We could not find any significant differences in postoperative protein and fluid loss between the groups on the following 3 days either. We conclude that the peritoneal damage by CHPP is not caused by the hyperthermia but by the peritoneal perfusion with saline solution containing anticancer drugs.

The critical concentration of surfactant in fetal lung liquid at birth.

Various doses (0-4.8 mg) of porcine surfactant were administered into the airways of immature newborn rabbits delivered at a gestational age of 26 days and 17-23 h. When the estimated concentration of exogenous surfactant in the lung liquid was less than or equal to 0.75 mg/ml (dose 0.6 mg), an average tidal volume of no more than a 3.0 ml/kg was obtained by mechanical ventilation with a peak insufflation pressure of 25 cm H2O, but when the estimated concentration was increased to 1.5 mg/ml (dose 1.2 mg), an average tidal volume of 17.7 ml/kg was attained, and the survival rate during a 30-min period of artificial ventilation improved significantly, from 14% to 53%. Even larger average tidal volumes, about 25 ml/kg, were recorded in animals with estimated surfactant concentrations of 3 and 6 mg/ml (doses 2.4 and 4.8 mg, respectively). In vitro observations revealed that the surface adsorption time of the surfactant suspension decreased non-linearly from 20 to 1 sec when the concentration was increased from 1 to 3 mg/ml. The minimum surface tension during cyclic film compression also decreased non-linearly from greater than 15 to less than 3 mN/m with the same increments in concentration. This led us to conclude that, under the present experimental conditions, the critical concentration of surfactant in fetal lung liquid at birth (about 3 mg/ml) is close to the concentration required in vitro for rapid adsorption and optimal dynamic surface properties.