The Ropivacaine Concentration Required for Ultrasound-Guided Rectus Sheath Block in Pediatric Patients Undergoing Single-Incision Laparoscopic Hernia Repair: A Sequential Allocation Dose-Finding Study.

BACKGROUND: The local anesthetic concentration required for ultrasound-guided rectus sheath block (RSB) in children remains unknown. Knowledge of appropriate ropivacaine concentration can help clinicians reduce local anesthetic toxicity risk when performing ultrasound-guided RSB in children. This study aimed to determine the appropriate ropivacaine concentration for ultrasound-guided RSB in children undergoing laparoscopic inguinal hernia repair. METHODS: In this single-arm prospective study with an up-down sequential allocation design of binary response variables, 18 consecutive children aged 11 months to 7 years undergoing single-incision laparoscopic percutaneous extraperitoneal closure were assessed. Orotracheal intubation was performed without intravenous anesthesia or a neuromuscular relaxant. After intubation, ultrasound-guided RSB was performed with a ropivacaine dose of 0.30 ml/kg (0.15 ml/kg per side). Dixon's up-and-down method was used to determine the concentration, starting from 0.25% in 0.05% increments. Surgery commenced ≥15 min following RSB. Body movement or a 20% increase in heart rate or systolic blood pressure within 1 min of surgery initiation determined an unsuccessful RSB. The 95% effective concentration of ropivacaine needed for successful RSB was calculated using the probit test. RESULTS: The 95% effective concentration of ropivacaine needed for successful ultrasound-guided RSB was 0.31% (95% confidence interval, 0.25-7.29). The highest concentration of ropivacaine required for successful ultrasound-guided RSB in the group of patients in this study was 0.3%. CONCLUSION: The 95% effective concentration of ropivacaine (0.30 ml/kg total, 0.15 ml/kg per side) for ultrasound-guided RSB was 0.31% in children undergoing single-incision laparoscopic surgery under general anesthesia.

Olanzapine attenuates postoperative cognitive dysfunction in adult rats.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is associated with poor quality of life and difficulty working. Its impact may be greater in middle-aged patients than in elderly patients. Neuroinflammation is reported to be a main cause of POCD. Olanzapine has been reported to improve learning and memory functions. We therefore investigated olanzapine's effectiveness and mechanisms in an adult rat POCD model. METHODS: Six-month-old rats underwent laparotomy and lipopolysaccharide (LPS group) or LPS + olanzapine (OLA group) intraperitoneal injection or anesthesia alone (CON group) 1 week after a Barnes maze training session. A Barnes maze test trial was then conducted the day after surgery or anesthesia. The microglial activity in the hippocampus and cytokine levels were measured by Iba1 staining and enzyme-linked immunosorbent assay, respectively. RESULTS: The OLA group had significantly higher success rates of Barnes maze trial than the LPS group. The success rate in time of the OLA group was inferior to that of the CON group. On the other hand, the success rate in distance of the OLA group was similar to that of the CON group. Iba1 staining areas in the LPS and OLA groups were larger than that in the CON group; however, the staining area in the OLA group was smaller than that of the LPS group. Plasma interleukin-1ß concentration in the LPS and OLA groups was significantly higher than that in the CON group; however, there was no significant difference between the LPS and OLA groups. CONCLUSION: Olanzapine attenuated both spatial cognitive dysfunction and microglial activity of the hippocampus, which were induced by surgery and LPS injection. These effects were unrelated to inflammatory cytokine concentrations in plasma and hippocampus.

Occlusion of the pulmonary artery by a primary pulmonary artery sarcoma resulting in cardiac arrest: a case report.

BACKGROUND: Primary pulmonary arterial sarcoma (PPAS) is a rare condition. Although resection is recommended to improve prognosis, optimal anesthesia management for these cases remains unclear. CASE PRESENTATION: A 62-year-old woman with a diagnosis of left pulmonary PPAS underwent surgical tumor resection and left lung pneumonectomy. Preoperative symptoms included a cough and hemoptysis. Computed tomography revealed a complete obstruction of the left pulmonary artery, with tumor extension into the right pulmonary artery, and mild tricuspid regurgitation was observed on the echocardiogram. Ninety minutes after anesthesia induction, the patient went into cardiopulmonary arrest. As the surgical field was sterilized, we proceeded with emergent sternotomy and cardiac massage. Extracorporeal circulation was established, and surgery proceeded once spontaneous circulation was recovered. The patient survived without neurological complications. CONCLUSIONS: Based on our experience and in the absence of evidence-based guidelines, the femoral artery and vein should be cannulated in all cases for extracorporeal circulation initiation before anesthesia induction.

[Tracheal Foreign Body Removal under Rigid Bronchoscope in a Child with Fistula-like Structure in the Trachea after Surgery of Congenital Esophageal Atresia.]

We report a case of 1-year-2-month old boy with tetralogy of Fallot who had a surgical history of Gross C-type of congenital esophagus atresia. Difficult ventila- tion occurred by aberrant placement of tracheal tube during previous general anesthesia. He suffered from a cyanosis four hours after dinner. Tracheal foreign body was suspected. General anesthe- sia was induced for an emergency foreign body re- moval under rigid bronchoscopy. After the insertion of a tracheal tube just below glottis, the stenosis and fistula-like structure were confirmed in the trachea by bronchofiberscopy. The tip of the tube was placed beyond them. A "natto" was found in the orifice of the left main bronchus, and taken out by a rigid bronchoscope. Although tracheal intubation was performed several times during procedure, aberrant placement of the tra- cheal tube could be avoided by using bronchofibers- copy. We have to consider the remaining anatomic abnormalities of the respiratory tract in children after surgery of congenital esophageal atresia.

[Relationship between the Landiolol Dose and Urinary Catecholamine Metabolites in the Perioperative Management of Patients Undergoing Pheochromocytoma Resection].

BACKGROUND: The amount of urinary catecholamine metabolites (metanephrine and normetanephrine) excreted in 24 hours correlates with catecholamine secretion by pheochromocytoma in a day and is considered an indicator of the strength of its hormonal activity. We investigated the existence of a relationship between the landiolol dose and urinary catecholamine metabolites in the perioperative management of patients with pheochromocytoma. METHODS: We retrospectively investigated the medical and anesthesia records of patients treated at University of Tsukuba Hospital between December 2007 and June 2012. Sixteen patients who underwent elective surgery for adrenal pheochromocytoma were divided into 2 groups according to their urinary catecholamine metabolites group A (higher amounts of urinary metanephrine adrenaline-dominated group) and group NA (higher amounts of urinary normetanephrine; noradrenaline-dominated group). RESULTS: Each group included 8 patients. The total intraoperative landiolol dose was significantly higher in group A (46.8 ± 34.5 mg) than in group NA (13.8 ± 21.3 mg; P = 0.04). The landiolol dose was significantly associated with higher amounts of urinary metanephrine (R = 0.592 P = 0.0123). CONCLUSIONS: High landiolol doses are required to treat tachycardia in the perioperative management of pheochromocytoma cases with higher urinary metanephrine during the preoperative period.