[Effect of fibrinogen concentrate on coagulopathy patient with left ventricular assist system in surgical repair of thoracic abdominal aortic aneurysm (TAAA): a case report].

We describe a case in which fibrinogen concentrate was useful to improve anticoagulation after aortic graft replacement. A 44-year-old man with left ventricular assist system (LVAS) underwent thoracic abdominal aortic aneurysm (TAAA) graft replacement. LVAS requires anticoagulant therapy for thromboprophylaxis. Therefore, we supposed that it would be difficult to stop bleeding in TAAA graft replacement surgery. For this reason, we planned to administer fibrinogen concentrate during the surgery. When the patient was weaned from cardiopulmonary bypass, blood fibrinogen value decreased to 58.0 mg x dl(-1). At this time, we administered fibrinogen concentrate 6 g with other blood preparations. After the administration of fibrinogen concentrate, calculated blood fibrinogen level increased immediately to 120.0 mg x dl(-1). Three hours after administration of fibrinogen concentrate, TAAA graft replacement operation was finished. Ten days after the surgery, he was discharged from the ICU. Fibrinogen concentrate might be useful in difficult hemostasis reducing consumption of blood preparations.

[Time course changes in perfusion index and pleth variability index during electroconvulsive therapy].

BACKGROUND: Electroconvulsive therapy (ECT) is a widely acceptable therapy for psychiatric symptoms. ECT provokes abrupt hemodynamic changes, and sometimes induces serious cardiac complications. In this study, we examined the time course of changes in perfusion index (PI) and pleth variability index (PVI) during ECT using Radical-7 (Masimo Corp., USA). METHODS: Fifteen patients with psychiatric disease treated with ECT were enrolled in this study. The study was performed at three or four treatment points for 10-12 treatments. Anesthesia was induced by propofol 0.8-1.0 mg x kg(-1), and suxamethonium 0.8-1.0 mg x kg(-1). Thereafter patients were ventilated by facial mask with 100% oxygen, and ECT was performed. All patients were monitored using hemodynamic variables, PI and PVI. Variables including PI and PVI were measured before and 5 minutes after ECT. Anti-hypertensive agents were administered if necessary. RESULTS: Heart rate transiently increased after ECT. PI transiently decreased during ECT, but returned to baseline value 1 minute after ECT. PI was unchanged during the study period (awake state: PI 3.6 +/- 1.4, during ECT 1.6 +/- 0.9*, one minute after ECT 1.9 +/- 1.7,*: P < 0.05 compared with awake state). CONCLUSIONS: This finding suggests that tissue perfusion was transiently impaired during ECT.

[Removal of sevoflurane and nitrous oxide from waste anesthetic gases by using Anesclean, the system for treating waste anesthetic gases].

BACKGROUND: The system for treating waste anesthetic gases, Anesclean, has been developed recently. This system can collect volatile anesthetics from waste anesthetic gases, and then decompose nitrous oxide (N2O) into N2 and O2 immediately. The purpose of this study was to investigate the efficacy of this treating system, Anesclean, on removal of greenhouse effect gases in our university hospital. METHODS: The concentrations of sevoflurane and N2O from an outlet of the system were measured using gas-chromatography. The total amount of sevoflurane consumed in the past two years and the amount of sevoflurane collected by Anesclean in the same period were measured to calculate collection rate. RESULTS: The concentrations of anesthetics in the outlet were very low, suggesting that the system works effectively. The amount of sevoflurane consumed was 606.51, and 245.31 was collected. Thus, calculated collection rate was 40.4%, indicating that approximately 60% of sevoflurane is not collected in our current situation. CONCLUSIONS: The waste anesthetic gas treating system, Anesclean, was effective to some degree in collection of sevoflurane and decomposition of N2O. However, in order to increase collection rate of sevoflurane, we need to pay more attention to minimize gas leak during anesthetic procedure.

Comparison of the effects of vasopressin and norepinephrine on organ perfusion during septic shock in streptozotocin-induced diabetic rats.

PURPOSE: The purpose of this study was to compare the effects of norepinephrine (NE) and vasopressin on systemic hemodynamics, renal and mesenteric artery blood flow, inflammatory response and inducible nitric oxide synthase (iNOS) activity during endotoxin shock in streptozotocin-induced diabetic rats. METHODS: The study was designed to include three sets of experiments: (1) measurement of changes in systemic hemodynamics and mesenteric and renal artery blood flow; (2) measurement of biochemical variables; and (3) measurement of iNOS activity in the mesenteric artery. Systemic hemodynamics, regional artery blood flow changes and biochemical variables were assessed before treatment and 1, 2 and 3 h after treatment. RESULTS: Vasopressin, but not NE, prevented the decreases in aortic blood flow, but did not restore mesenteric artery blood flow. In addition, vasopressin partially restored renal artery blood flow in diabetic rats. Plasma nitrite levels and iNOS activity in the mesenteric artery were elevated after intravenous LPS in diabetic rats. Endotoxin-induced decreases in mesenteric arterial blood flow were partially restored by vasopressin with nonselective NOS inhibitor, N G-nitro-l-arginine methyl ester (l-NAME), in diabetic rats. Moreover, l-NAME prevented increases in plasma nitrite levels and iNOS activity in the mesenteric artery. In contrast, endotoxin-induced decreases in renal arterial blood flow were partially restored by vasopressin with l-NAME, but not by NE in diabetic rats. CONCLUSIONS: Nitric oxide may be one possible contributor to reduced sensitivity of the mesenteric and renal arteries to vasopressin during septic shock in streptozotocin-induced diabetic rats.