[A two-year-old patient who received readministration of rocuronium for re-operation 30 minutes after sugammadex reversal].

Little is known about doses and onset times of rocuronium after sugammadex reversal. We report a 2-year-old girl receiving readministration of rocuronium for reoperation 30 minutes after sugammadex reversal. The patient underwent ventriculoperitoneal shunting for hydrocephalus under general anesthesia with muscle relaxation by rocuronium. After completion of surgery, muscle relaxation was antagonized by sugammadex 4 mg x kg(-1). Thirty minutes after extubation, reintubation and readministration of rocuronium were required for additional surgery. Rocuronium was administered again under monitoring of muscle relaxation. As the efficacy of rocuronium was definitively reduced, a higher dose (2 mg x kg(-1)) and a longer onset time (6 minutes) were required to establish maximal block (T1 0%). There were no apparent problems with the clinical duration of rocuronium or repetitive antagonization by sugammadex. Under appropriate monitoring, repetitive muscular relaxation by rocuronium can be safely established.

The effective time and concentration of nitrous oxide to reduce venipuncture pain in children.

STUDY OBJECTIVE: To investigate the time of administration and concentration of inhaled nitrous oxide (N(2)O) needed to reduce the pain associated with intravenous (i.v.) cannulation in children. DESIGN: Prospective, randomized study. SETTING: Operating room of a children's hospital. PATIENTS: 73 ASA physical status I and II children, aged 6-15 years, scheduled for elective day or non-day surgery. INTERVENTIONS: Children were randomly allocated to one of 4 groups prior to i.v. insertion of a 24-gauge catheter in the dorsum of the hand: Group 1 (n = 18): 50% N(2)O in O(2) for three minutes; Group 2 (n = 18): 50% N(2)O in O(2) for 5 minutes; Group 3 (n = 18): 70% N(2)O in O(2) for three minutes; or Group 4 (n = 19): 70% N(2)O in O(2) for 5 minutes. MEASUREMENTS: Just after the venous cannulation, degree of pain was assessed by examining the faces of the patient by the parent and an operating room nurse. MAIN RESULTS: Pain scores obtained from parents of children in Groups 3 and 4 were significantly lower than from those in Groups 1 and 2. Pain scores from the nurse in Group 3 was significantly lower than those in Group 1. However, there was no significant difference in pain score between Group 3 and Group 4. Frequency of side effects was similar among the 4 groups. CONCLUSIONS: Seventy percent N(2)O in O(2) given for three minutes was effective for reducing venipuncture pain in children.

Three new furoquinoline alkaloids from the leaves of Boninia glabra.

Three novel furoquinoline alkaloid oxogeranyl ethers (1-3) and one known furoquinoline alkaloid (4) were isolated from the leaves of Boninia glabra, an endemic plant of the Bonin Islands. Their structures were elucidated on the basis of spectroscopic analysis.

Which is a better position for insertion of a high thoracic epidural catheter: sitting or lateral decubitus?

OBJECTIVE: The purpose of this study was to compare the safety and success rates associated with the placement of a high thoracic epidural catheter in the sitting vs. the lateral decubitus position. DESIGN: Prospective randomized study. SETTING: University hospital. PARTICIPANTS: Forty-one patients scheduled for off-pump coronary artery bypass graft surgery (OPCAB) by means of high thoracic epidural anesthesia at Th 1/2. INTERVENTIONS: The epidural catheter was placed into the patients in the sitting or lateral decubitus position. The success rates, the time for catheter insertion, the incidence of adverse events, and the accuracy of the catheterization in both groups were compared. MEASUREMENTS AND MAIN RESULTS: The success rates in both groups were comparable, whereas 20% of patients showed a vagal reflex during epidural catheterization in the sitting group (p < 0.05). The insertion time in the sitting group was significantly shorter than in the lateral decubitus group (p < 0.05). Accuracy at the first attempt to the Th1/2 epidural space was 93% in the sitting group and 73% in the lateral decubitus group, but there was no statistically significant difference (p = 0.186). CONCLUSIONS: It is recommended to use the lateral decubitus position for high thoracic epidural catheterization in patients scheduled for OPCAB to avoid vagal reflexes.

[Spontaneous hemothorax in a patient with lung metastases of osteosarcoma].

A 6-year-old girl with right lung metastases of osteosarcoma was scheduled for insertion of a central venous catheter and a femoral arterial catheter under general anesthesia for arterial injection chemotherapy. The central venous catheter was easily inserted through the right subclavian vein without arterial puncture. However, restlessness occurred on the first postoperative day. Chest X-ray examination revealed massive fluid collection in the right pleural space, which was identified as hemothorax by chest drainage. Chemotherapy started after the hemothorax had improved. However, restlessness occurred again on the 60 th postoperative day. Chest computed tomography examination revealed a right hemothorax and rupture of the growing lung metastatic tumor. Chest drainage was performed again. Some cases of pneumothorax complicated with rupture of lung metastases of osteosarcoma have been reported. Spontaneous rupture of lung metastases occurs regardless of tumor size, and occurs easily during chemotherapy because of necrosis of the tumor or disability of its repair function. In our case, rupture of the lung metastatic tumor involving tumor blood vessel was thought to have caused the hemothorax. Anesthesiologists should pay attention to spontaneous hemothorax in patients with lung metastases of osteosarcoma during whose perioperative management.

Comparison of polybrominated diphenyl ethers in fish, vegetables, and meats and levels in human milk of nursing women in Japan.

At present, little is known about the occurrence of polybrominated diphenyl ethers (PBDEs) in fish and food products sold in Japan. To investigate whether human exposure to PBDEs through the diet is significant, the concentrations of PBDEs were determined in fish and in meat and vegetables sold in two food markets in the city of Hirakata, Osaka prefecture. The concentrations of PBDEs in the breast milk of 12 primiparae nursing women at one month after delivery also were determined to ascertain the relationship between the levels found in the diet and levels in humans. sigma PBDE concentrations ranged between 21 and 1650 pg/g fresh weight in the edible tissues of five species of fish and one shellfish species. The highest concentrations were measured in yellow-fin tuna, followed by short-necked clam, salmon, yellowtail, mackerel and young yellowtail. Interestingly, sigma PBDE concentrations were not statistically significantly different in two cultured mackerel samples from Japan and mackerel collected from northern European waters. sigma PBDE concentrations in beef, pork and chicken meat (ranging between 6.25 and 63.6 pg/g fresh weight) and in three different vegetables (ranging between 38.4 and 134 pg/g fresh weight) were significantly lower than the concentrations in fish. In human milk, sigma PBDE concentrations ranged between 668 and 2840 pg/g lipid basis, which is comparable to the levels in populations of nursing women reported in Sweden and elsewhere. There was a strong positive relationship between PBDE concentrations in human milk and dietary intake of fish and shellfish, which was established in the women from responses to a questionaire on food consumption habits. The results of this study of food products commonly consumed in Japan and the levels found in nursing women raise a concern about low level PBDE contamination of fish and other foods intended for human consumption.