Recovery of psychomotor function after total intravenous anesthesia with remifentanil-propofol or fentanyl-propofol.

PURPOSE: Total intravenous anesthesia (TIVA) with propofol combined with remifentanil or fentanyl has commonly been used to achieve general anesthesia. The purpose of this study was to examine recovery of psychomotor function, by use of the Trieger dot test, after TIVA with remifentanil-propofol or with fentanyl-propofol. METHODS: Forty patients were randomly divided into two groups of 20, to receive TIVA with either remifentanil-propofol (group R) or fentanyl-propofol (group F). Anesthesia was induced by intravenous injection of propofol. In group R, remifentanil at 0.3 µg/kg/min was infused continuously during surgery. In group F, 3 µg/kg fentanyl was injected as an initial dose and 1 µg/kg fentanyl was administered intravenously every 30 min during surgery. Psychomotor function, as measured by the Trieger dot test, was evaluated before anesthesia and 30, 60, 90, 120, and 150 min after the end of TIVA. RESULTS: From assessment of the Trieger dot test, the number of dots missed in group R from 30 to 120 min after the end of TIVA was significantly lower than in group F. The maximum distance of dots missed in group R from 30 to 120 min after the end of TIVA was significantly shorter than in group F. The average distance of dots missed in group R from 30 to 120 min after the end of TIVA was significantly shorter than in group F. CONCLUSION: Recovery of psychomotor function in TIVA with remifentanil-propofol is faster than that in TIVA with fentanyl-propofol.

Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement.

STUDY OBJECTIVE: To examine the effects of landiolol on the QT interval, rate-corrected QT (QTc) interval, QT dispersion (QTD), and rate-corrected QTD (QTcD) during tracheal intubation using computerized measurement. DESIGN: Randomized, double-blinded study. SETTING: Dokkyo Medical University Hospital operating room. PATIENTS: 30 ASA physical status I patients scheduled for elective surgery. INVENTIONS: Patients were randomized to receive either normal saline (saline group) or landiolol (landiolol group; one-min loading infusion of 0.125 mg/kg followed by 0.04 mg/kg/min infusion). Immediately after the start of administration of saline or landiolol, anesthesia was induced with intravenous (IV) fentanyl two microg/kg, propofol 1.5 mg/kg, and vecuronium 0.1 mg/kg. Six minutes after administration of saline or landiolol, tracheal intubation was performed within 20 seconds. MEASUREMENTS: Mean arterial pressure (MAP), RR interval, QT interval, QTc interval, QTD, and QTcD were consecutively recorded during the induction. MAIN RESULTS: There was no significant difference in MAP between groups during the study. RR interval in the landiolol group was significantly longer than in the saline group from two minutes after the start of the landiolol infusion to the end of the study. The QT interval in the landiolol group was significantly shorter than in the saline group from start of the infusion to 4 minutes after tracheal intubation. The QTc interval, QTD, and QTcD in the landiolol group were significantly shorter than those in the saline group from immediately after tracheal intubation to the end of study. CONCLUSION: A bolus of landiolol 0.125 mg/kg followed by an infusion of landiolol 0.04 mg/kg/min may reduce the risk of cardiac arrhythmias during induction of anesthesia.

Influence of load of hepatitis A virus on disease severity and its relationship with clinical manifestations in patients with hepatitis A.

BACKGROUND AND AIM: The purpose of the present study was to investigate the influence of viral load on disease severity and analyze the possible relationship of the load of hepatitis A virus (HAV) with disease severity and laboratory findings. METHODS: Fifty-eight patients diagnosed with acute hepatitis A were used in the current study, of whom 12 patients progressed to severe acute hepatitis (s-AH) defined on the basis of a prothrombin time (PT) of <40% and 46 patients were diagnosed as having mild acute hepatitis (m-AH). The load of HAV was measured with real-time polymerase chain reaction. RESULTS: Peak viral load showed a significant correlation with alanine aminotransferase (ALT) (r = 0.363, P = 0.0048) and PT levels (r = -0.330, P = 0.0110). In terms of disease severity, there was a significant correlation with ALT (r = 0.462, P = 0.0012) and PT levels (r = 0.400, P = 0.0059) in the m-AH group, but not in the s-AH group. A significant positive correlation of peak viral load with the C-reactive protein level (r = 0.270, P = 0.0400) and a significant negative correlation of peak viral load with the platelet count (r = -0.313, P = 0.0015) was also found. CONCLUSIONS: The load of HAV was closely correlated with liver damage and disease severity in m-AH, but not in s-AH. The load of HAV was also closely associated with the increase in C-reactive protein level and enhancement of thrombocytopenia.

Pretreatment hepatitis C virus dynamics for predicting virological response to interferon-alpha2b monotherapy in patients with chronic hepatitis C virus infection.

One hundred and forty-one patients with chronic hepatitis C virus (HCV) infection treated with 6 MIU of interferon (IFN)-alpha2b for 24 weeks were studied to compare pretreatment viral dynamics during 1 month before the initiation of treatment (DeltaHCV) with other predictive factors. The patients were classified into three groups according to DeltaHCV: the Increase group (DeltaHCV >0.20log copies/ml/month), the Stable group (-0.20

Prevalence of HBV genotypes in asymptomatic carrier residents and their clinical characteristics during long-term follow-up: the relevance to changes in the HBeAg/anti-HBe system.

Randomly selected 50 asymptomatic hepatitis B virus (HBV) carrier residents who had been followed annually were enrolled in this study. The subject group comprised 25 males and 25 females with a mean age at the start of follow-up of 44.1+/-10.4 years. The mean follow-up period was 15.5+/-2.7 years. Genotyping revealed 27 (54%) of genotype B and 23 (46%) of genotype C. The prevalence of genotype B was clearly higher in asymptomatic HBV carrier redidents, which was contrary to the previous reports on chronic liver disease. At the start of follow-up, the ratio of carriers positive for anti-HBe was significantly higher in genotype B than genotype C (P<0.001). Furthermore, the ratio of carriers with reduced HBV-DNA levels was significantly higher in genotype B than genotype C (P<0.01), suggesting that most genotype B carriers had already undergone seroconversion from HBeAg to anti-HBe and were clinically stable at the start of follow-up. The subsequent follow-up observations demonstrated that levels of HBV-DNA and ALT were lower in genotype B than genotype C. Seroconversion from HBeAg to anti-HBe was less likely to occur in genotype C carriers, especially on 40-year-old generation, and these subjects were more likely to develop chronic liver disease.

Clinical significance of a highly sensitive enzyme immunoassay of hepatitis B surface antigen using a novel electron spin resonance technique.

We developed a highly sensitive enzyme immunoassay (EIA), the p-AP/HHTIO method, that detects serum hepatitis B surface antigen (HBsAg) by measuring stabilized nitroxide radicals using a novel electron spin resonance technique [Matsuo et al. (1998) Free Radic Biol Med 25:929-935]. To demonstrate the clinical significance of this method and to reveal occult hepatitis B virus (HBV) infection in patients, we used the method to analyze serum samples of 30 patients with acute or fulminant hepatitis who were negative for HBsAg by standard EIA, and those of seven chronic HBV carriers who became negative for HBsAg during a follow-up period by standard EIA. We also examined serum HBV DNA by amplification of the HBV S gene, using the polymerase chain reaction (PCR) technique. The p-AP/HHTIO method showed that 9 of 20 (45%) patients with acute hepatitis and 2 of 10 (20%) with fulminant hepatitis were positive for HBsAg; PCR detected HBV DNA in these HBsAg-positive patients. Antibody against hepatitis B core antigen was detected in one patient with fulminant hepatitis. The p-AP/HHTIO method demonstrated prolonged seropositivity of HBsAg even after standard EIA showed a loss of HBsAg in all seven HBV carriers. Our p-AP/HHTIO method is useful for screening and diagnosing HBV infection in patients with liver diseases who are negative for conventional HBV-related serological markers.