[The efficiency of a new porous type leukocyte removal filter for red cell blood components, Terumo Imuguard III-RC, in the rapid transfusion conditions].

We evaluated the efficiency of a new porous type leukocyte removal filter for red cell blood components, Terumo Imuguard III-RC, in the rapid transfusion conditions. One leukocyte removal filter was used for 2 units of RC-M.A.P (red cell mannitol-adenine-phosphate). Filtration methods employed were gravity infusion, high pressure infusion (300 mmHg), pumping infusion and 20 ml.min-1 infusion under high pressure (300 mmHg). Blood samples were taken before and after the filtration to measure white blood cell (WBC), red blood cell (RBC) and platelet content. Blood samples before filtration and after filtration with WBC excluded, were examined by automated hematology analyzer (Coulter counter STKS-Retic). WBC after filtration was counted by the hemacytometer method using Nageotte Chamber. The removal rate of WBC was found to be more than 99.99% and residual WBC content was less than 4 x 10(4) with every method. The recovery rate of RBC was not significantly decreased in all filtration methods. The removal rate of platelet was equal in all filtration methods. In conclusion, Imuguard III-RC could be useful for effective homologous blood transfusion.

[A case of life-threatening anaphylactoid reaction caused by povidone-iodine].

A 64 year-old man developed life-threatening anaphylactoid reaction caused by povidone-iodine during induction of anesthesia for elective coronary artery bypass graft surgery. While he had a history of cardiac arrest caused by iodine, he could tolerate contrast material and povidone-iodine for pre-operative coronary angiography with pretreatment of H1 and H2 receptor blockades and methylprednisolone. During the operation and postoperative care we could manage cardiac failure by continuous monitoring of cardiac output (CCO) using pulsed-thermodilution method. We recommend prophylactic use of H1 and H2 receptor blockades for surgical patients who may be at risk for anaphylaxis or anaphylactoid reaction.

[Acute brain expansion during emergency neck clipping surgery for cerebral aneurysms in a patient with dilated cardiomyopathy].

A 61-year-old male with coma and undiagnosed dilated cardiomyopathy received emergency cerebral aneurysm surgery. Anesthesia was induced with thiamylal, fentanyl and vecuronium and maintained with 66% N2O and 1.0% isoflurane. Five hundred ml of 20% mannitol was infused in 30 min. At the end of the infusion, hypotension occurred. Immediately after the injection of ephedrine, acute brain swelling was observed. The operation was switched to external decompression. Post-operative echocardiography revealed the presence of dilated cardiomyopathy (DCM). The ejection fraction was 34%. Two weeks later, the second operation was scheduled. The anesthesia was induced with fentanyl, midazolam and vecuronium and maintained with N2O and 0.7% isoflurane. Nitroglycerine, lidocaine, PGE1, dopamine and dobutamine were infused throughout the operation. Five hundred ml of 20% mannitol was infused in 60 min. There were no considerable hemodynamic changes and no episode of brain expansion during operation. We conclude that the rapid infusion of mannitol can trigger acute cardiac failure and brain edema in patients with DCM.

[The influence of blood oxygen tension on the glucose level measured by a handy blood glucose analyzer (Toecho Super)].

A handy blood glucose analyzer (Toecho Super), using disposable enzyme electrodes, is widely used not only for the self-control of diabetes but also for critical care settings such as the ICU or the operating room. Recently we reported that the measured glucose value was lower compared with the true reference data, when oxygen tension was high. We investigated the interaction between the blood glucose levels and oxygen tension in vitro using 5 levels of glucose and 5 levels of oxygen tension. Measured glucose value decreased linearly as oxygen tension rose with a high correlation factor (0.816-0.996). The measured glucose level (mg.dl-1) could be estimated by the reference data minus one tenth of oxygen tension (in mmHg). Therefore we conclude that the measured glucose value is dependent only on oxygen tension but not on the range of glucose level. The reference glucose value can be estimated when oxygen tension is available.

Volatile metabolites of halothane in the rabbit.

To date, carbon dioxide is the only volatile metabolite that has been identified to result from the biotransformation of halothane. This study was undertaken to determine whether other volatile metabolites might be formed. Expiratory gas from four rabbits given halothane by inhalation and from three rabbits into which the halothane was injected intraperitoneally was analyzed by gas chromatography. Qualitative analysis of the metabolites was made by injecting 50-70 microliter of the expired halothane condensed in an ultralow-temperature device (-80 C) attached to the mass spectrometer. Gas chromatography revealed two volatile metabolites between the air peak and the halothane peak. They were identified by mass spectra to be CF2:CHCl and CF2CH2Cl. These volatile metabolites appeared immediately after the beginning of anesthesia. The present investigation suggests the possible existence of a previously unknown metabolic pathway of defluorination and debromination occurring in the early stage of halothane biotransformation. These volatile metabolites may be toxic, highly reactive intermediates that undergo further biotransformation.