Fentanyl-associated anaphylaxis in an infant with tetralogy of Fallot: a case report.

BACKGROUND: Anaphylactic reactions to opioids are rare. We report a case of an infant who experienced fentanyl-induced anaphylaxis. CASE PRESENTATION: A 2-month-old male was scheduled to undergo a Blalock-Taussig shunt. Following uneventful anesthetic induction, he experienced profound hypotension and generalized erythema. Anaphylaxis was clinically diagnosed, and he was treated with epinephrine, vasopressin, and fluids. The surgery was canceled, and he was transferred to the intensive care unit after restoration of his hemodynamic status. Intradermal testing was performed for all of the drugs given during the anaphylactic event on postoperative day (POD) 3. The results showed a positive reaction to fentanyl. For the second anesthesia scheduled on POD 5, morphine sulfate was selected as an alternative opioid. Anesthesia was maintained uneventfully with sevoflurane, morphine, and rocuronium. CONCLUSION: Intradermal testing revealed fentanyl anaphylaxis. We were able to manage the patient by using of morphine as an alternative opioid for the subsequent anesthesia.

Empiric Antibiotic Therapy for Severe Sepsis and Septic Shock.

BACKGROUND: A retrospective study was conducted to investigate the validity and the effectiveness of early empiric antibiotic and de-escalation therapy for the treatment of severe sepsis and septic shock patients in the intensive care unit (ICU). METHODS: Patients admitted to the ICU at Chiba University Hospital from January 1, 2010, to December 31, 2012, for the treatment of severe sepsis or septic shock were selected for analysis. RESULTS: One-hundred and ten patients were enrolled for the analysis. Carbapenems were selected most frequently (57.3%), followed by cephalosporins (22.7%), and penicillins (21.8%). Empiric antibiotic therapy was appropriate for 85 (77.3%) patients. Mortality rates for patients with inappropriate empiric therapy was 36.8%, whereas mortality rates for patients with appropriate empiric therapy was 17.5%. Among the patients with appropriate empiric antibiotic administration, de-escalation was associated with lower mortality rates of 5.0% for severe sepsis and 9.7% for septic shock patients. The mortality rates for the no de-escalation group were 19.0% and 35.7%, respectively. CONCLUSION: Empiric antibiotic therapy was acceptable for severe sepsis and septic shock patients treated in the ICU. The appropriate selection of empiric antibiotics was related to a greater rate of de-escalation and better survival. The risk of multi-drug-resistant bacterial infections was not as high as expected, but will need further attention in the future.

Development of the novel pre-emergence herbicide pyroxasulfone.

Pyroxasulfone, which was discovered and developed by K-I Chemical Research Institute Co., Ltd.; Kumiai Chemical Industry Co., Ltd.; and Ihara Chemical Industry Co., Ltd., is a novel pre-emergence herbicide for wheat, corn, and soybean. Pyroxasulfone inhibits the biosynthesis of very-long-chain fatty acids in plants and has shown excellent herbicidal activity against grass and broadleaf weeds at lower application rates compared with other commercial herbicides. This pesticide has been registered in Japan, Australia, the USA, Canada, Saudi Arabia, and South Africa, and we sell pyroxasulfone products through domestic partner companies in each of these countries. With its high efficacy and relatively low application rates, we believe that pyroxasulfone will contribute to efficient global food production in the future.

Soil and environmental factors affecting the efficacy of pyroxasulfone for weed control.

Pyroxasulfone inhibits very-long-chain fatty acid elongase in susceptible weeds and facilitates preemergence weed control. Pyroxasulfone showed 98% control of Echinochloa crus-galli (ECHCG) for up to 63 days at a use rate lower than that of chloroacetamide herbicides. ED90 of pyroxasulfone against ECHCG in soil with high organic matter (OM) content did not differ significantly from that in lower OM soils. The low water solubility and the low vapor pressure of pyroxasulfone resulted in limited horizontal diffusion on the soil surface and low risk of volatilization, respectively. The herbicidal efficacy of pyroxasulfone was affected by clod size and improved with smooth soil surface preparation.