[Effects of intravenous vasopressor on spread of spinal anesthesia with 0.5% hyperbaric bupivacaine for caesarean delivery].

BACKGROUND: It is known that when isobaric bupivacaine is applied for Caesarean delivery, phenylephrine is superior to ephedrine in preventing rostral spread of spinal anesthesia. In this study, we prospectively investigated whether phenylephrine can prevent rostral spread of spinal hyperbaric bupivacaine. METHODS: We randomly divided 32 patients undergoing Caesarean delivery into two groups: phenylephrine group and ephedrine group. In both groups, after the spinal injection of 2.0 ml of hyperbaric 0.5% bupivacaine, we started continuous intravenous infusion of phenylephrine or ephedrine. Blood pressure and heart rate were recorded every minute. Block height of cold sensation was assessed at 5, 10 and 15 minutes after the spinal injection. We measured umbilical artery pH after birth. Data were analyzed using a statistical software package. RESULTS: Block height was significantly lower with phenylephrine than with ephedrine at 10 and 15 minutes. Umbilical artery pH was significantly higher with phenylephrine than with ephedrine. Haemodynamic changes were significantly different between the two groups. There were no significant differences in age, BMI and spinal-delivery intervals. CONCLUSIONS: 1. Phenylephrine prevented rostral spread of spinal hyperbaric bupivacaine. 2. Haemodynamic changes were significantly different between the two groups. 3. Umbilical artery pH was significantly higher with phenylephrine than with ephedrine.

Lateral position prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal lymphoblastic lymphoma.

Lymphoblastic lymphoma, an aggressive mediastinal mass, is recognized as serious threat to the patient in developing cardiac tamponade or airway obstruction. Surgical procedure is often required to relieve clinical emergency and to establish prompt pathological diagnosis. However, in such a patient, acute respiratory occlusion in the spine position can be a life-threatening complication during general anesthesia. We describe a 17-year-old man whose cardiac tamponade was treated by pericardial-pleural window through a left anterior thoracotomy in the lateral position. The patient recovered from hemodynamic compromise without showing respiratory occlusion during general anesthesia and remained in the lateral position until extubation. Pathological diagnosis was precursor T-lymphoblastic lymphoma. There were no complications attributable to the operative procedure. Further chemotherapy reduced the mediastinal mass in size after two weeks when the patient developed sepsis and died. Lateral position prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal tumor with airway obstruction.

[Intraoperative management for a patient with heparin-induced thrombocytopenia (HIT) undergoing off-pump coronary bypass surgery using argatroban, a direct thrombin inhibitor].

HIT type II is one of the severe complications of heparin therapy. The antibody for the heparin-PF 4 complex, which causes thrombocytopenia of less than 100 x 10(3).microliter-1, thrombosis and DIC-like symptoms, is produced. We managed the patient with HIT type II, who underwent off-pump CABG using argatroban, a direct thrombin inhibitor, as an anticoagulant. Intraoperative activated coagulation time (ACT) was maintained above 250 sec with 5.0 micrograms.kg-1.min-1 of argatroban infusion and all the procedures were successful. We also investigated the platelet count in the 100 patients with heparin therapy in CCU. The incidence of the platelet depression after heparin administration was as high as 59%, and in 12% of the patients the platelet count dropped below 100 x 10(3).microliter-1. In conclusion, thrombocytopenia by heparin therapy is not rare, and argatroban as an anticoagulant during off-pump CABG is thought to be useful.