[The Effectiveness of Two Anesthesia Machines in the Water Generation of the Anesthesia Circuit during the Prolonged Low Flow Desflurane Anesthesia].

BACKGROUND: Water is generated by a reaction of carbon dioxide and a carbon dioxide absorbent We evaluated the effectiveness of the anesthesia machines about the water generation which occurs to an anes- thetic circuit during the prolonged low flow anesthesia. METHODS: Fifteen patients were divided into three groups; group HHS (n=5) in which a hot heater system was equipped inside anesthesia machine, group WCD (n=5) in which a water catchment device was connected with anesthesia machine, and control group N(n=5)in which normal anesthesia machine was used without special device, and studies were performed with FGF 11 - min- low flow desflurane anesthesia for more than 6 hours. The water situation in an anesthe- sia circuit was observed during the operation and was compared after the operation between these groups. RESULTS: In an anesthesia circuit of the anesthesia machines inside there was no water in group HHS and WCD, but more water in group N. In an anesthesia circuit of the anesthesia machines outside there was little water in group WCD, but more water in group HHS and N. CONCLUSIONS: Two anesthesia machines, group HHS and WCD, were effective about reduction of water generation in an anesthesia circuit of the anesthesia machines inside during FGF 11 - min-I prolonged low flow desflurane anesthesia.

[Difficult airway management due to obesity and lingual tonsillar hyperplasia].

We experienced anesthesia for a female patient of BMI 39.2 with unanticipated lingual tonsillar hyperplasia. At the induction of anesthesia, both mask ventilation and tracheal intubation were difficult due to the lingual tonsillar hyperplasia. However, tracheal intubation was performed by Intubating LMA with the fiberoptic bronchoscopy. After the placing of TE (the catheter for tracheal tube exchanger), the tracheal tube was extubated without any airway trouble. Following the extubation, the opening of the respiratory tract was evaluated by TE and the fiberoptic bronchoscopy. In this case we confirmed that the ASA difficult airway algorithm was also useful in the presence of lingual tonsillar hyperplasia.

Plasma-induced endothelial oxidative stress is related to the severity of septic shock.

OBJECTIVE: To estimate the capacity of plasma from septic shock patients to induce in vitro reactive oxygen species (ROS) production by endothelial cells and to analyze whether ROS production is related to the severity of the septic shock. DESIGN: Prospective, observational study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Twenty-one patients with septic shock. INTERVENTIONS: The in vitro capacity of plasma from septic shock patients to induce ROS production by naive human umbilical vein endothelial cells (HUVEC) was quantified by using a fluorescent probe (2',7'-dichlorodihydrofluorescein diacetate). MEASUREMENTS AND MAIN RESULTS: Blood samples were collected on day 1, day 3, and day 5 from 21 consecutive septic shock adult patients and from ten healthy volunteers. Patients mean age was 58 yrs old, mean Sequential Organ Failure Assessment (SOFA) score at admission was 12, mean severity illness assessed by Simplified Acute Physiology Score (SAPS) II was 53, and the mortality rate was 47%. In addition to assessment of in vitro ROS generation by HUVEC, oxidative stress in blood was evaluated by measuring lipid peroxidation products and enzymatic and nonenzymatic antioxidants. Septic shock was associated with oxidative stress and an imbalance in antioxidant status. As compared with controls, plasma-induced ROS production by naive HUVEC was significantly higher in septic shock. Moreover ROS production was significantly correlated with SAPS II (p = .028) and SOFA values (p = .0012) and was higher in nonsurvivors than in survivors. In contrast, no correlation was found between the severity of the septic shock and any of the levels of lipid peroxidation products or enzymatic and nonenzymatic antioxidants. CONCLUSION: Plasma from septic shock patients induces ROS formation by naive HUVEC, and the extent of ROS formation correlates with mortality and with criteria of the severity of septic shock as SOFA score and SAPS II.