[The effects of intravenous nicardipine on jugular venous oxygen saturation].

We investigated the effects of intravenous nicardipine on jugular venous oxygen saturation (SjO2) in patients undergoing superficial temporal artery-middle cerebral artery anastomosis. Anesthesia was induced with intravenous thiamylal and fentanyl, and maintained by isoflurane and nitrous oxide in oxygen. In the presence of stable condition after the induction, nicardipine 0.5 microgram.kg-1.min-1 was administered intravenously for 180 minutes. Mean arterial pressure, heart rate, SjO2 and bladder temperature were recorded. Three hours after continuous infusion of nicardipine, plasma levels of nicardipine in artery and jugular vein were measured by liquid chromatography. The arterial concentration of nicardipine reached 23.9 +/- 8.06 ng.ml-1. The area under the curve between the arterial and jugular venous nicardipine during infusion was significantly different. Mean arterial pressure was reduced in response to administration of nicardipine. There were no significant changes in heart rate, bladder temperature and SjO2. We concluded that the current dose of nicardipine reached effective concentration for systemic hypotension without influencing SjO2.

[Pre-incisional administration of ketamine reduced the postoperative pain].

This study was designed to examine the postoperative analgesic effect of pre-/post-incisional administration of ketamine. Thirty-nine female patients scheduled for transabdominal hysterectomy were randomly allocated into 3 groups. Patients in group-K1 (n = 13) received intravenous ketamine 100 mg before surgical incision and patients in group-K2 (n = 13) received the same after laparotomy. Group-C (n = 13) did not receive any ketamine. All patients were anesthetized with combined spinal/epidural anesthesia supplemented with sevoflurane 0.5% and nitrous oxide in oxygen. Postoperative pain was controlled by epidural infusion of the mixture of fentanyl (25 mcg.ml-1) and bupivacaine (3.8 mg.ml-1) at 2.1 ml.hr-1. Analgesic effect was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). VAS and VRS in group-K1 were significantly lower compared with those in group-C, while there was no difference between group-K2 and C. The incidence of side effects and additional use of analgesics were similar among the three groups. In conclusion, pre-incisional administration of ketamine reduced the postoperative pain, but post-incisional ketamine was not effective.

[Anesthetic management of a patient with a right kidney tumor associated with complete occlusion of the inferior vena cava by tumor embolism].

We gave anesthesia to a patient with a right kidney tumor associated with complete occlusion of the inferior vena cava (IVC) by tumor embolism. The upper end of the tumor embolism was below the junction of the IVC and the hepatic vein, and the operation was considered possible by simply clamping the IVC. To prevent complications including pulmonary embolism, the circulatory change at the time of clamping of the IVC, and massive bleeding, monitoring was made by pulmonary artery catheter and transesophageal echocardiography, and extracorporeal circulation was prepared. The blood pressure was stable and massive bleeding did not occur at the time of clamping of the IVC, because the IVC was completely occluded. The monitor showed no signs of pulmonary embolism. In a case of kidney tumor with tumor embolism in the IVC, it is necessary to be fully prepared for pulmonary embolism, the change of blood pressure before and after clamping of the IVC and for the bleeding at the time of IVC excision.

[Effect of diltiazem on jugular bulb oxygen saturation (SjO2)].

We investigated the effect of diltiazem on jugular bulb oxygen saturation (SjO2) in patients undergoing superficial temporal artery-middle cerebral artery anastomosis. In the presence of stable vital signs, diltiazem was administered by continuous infusion (2 micrograms.kg-1.min-1). There was no significant change in blood pressure, heart rate, SjO2 in response to diltiazem administration. The arterial plasma concentration of diltiazem reached 75 +/- 14.2 ng.ml-1 after 180 min. The difference of areas under the curve between the arterial and jugular venous diltiazem concentrations from start of infusion to the end was significant. We conclude that this dose of diltiazem produced effective concentration and uptake in the brain tissue, but produced no significant effect on jugular bulb oxygen saturation (SjO2).

[Mild hypothermia anesthesia for carotid microendoarterectomy in a patient with ischemic heart disease].

A 69 year-old male with ischemic heart disease indicated for coronary artery bypass grafting was scheduled for carotid microendoarterectomy. We induced mild hypothermia technique with vasodilation and surface cooling by convecting warming device. We examined hemodynamics by pulmonary artery catheter. Anesthesia was induced with thiamylal, fentanyl, midazolam and isoflurane in nitrous oxide and oxygen. Following administration of vecuronium, trachea was intubated. Pulmonary artery catheter was inserted from the femoral vein. Dopamine, dobutamine 3-5 micrograms.kg-1.min-1 and PGE1 5-10 ng.kg-1.min-1 were continuously administered to keep peripheral blood circulation and cardiac output (CO). Systemic vascular resistance decreased from 1800 to 591 dyne.s.cm-5 and CO increased from 2.8 to 6.9 l.min-1. The occlusion of blood flow of the right carotid artery for 40 min at 34.5 degrees C of rectal temperature did not cause any neurological deficits. No other complications such as arrhythmia, myocardial ischemia and bleeding tendency were observed. Keeping peripheral blood circulation and uniform cooling and warming are important in inducing mild hypothermia safely in a patient with ischemic heart disease.

[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.