[Intrathoracic blood volume during laparoscopic adrenectomy for primary aldosteronism under general anesthesia].

We used PiCCO (Pulsion Ltd) device to measure the intrathoracic blood volume by transpulmonary thermodilution method in order to estimate infusion rate in patients undergoing laparoscopic adrenectomy for primary aldosteronism. A systemic blood volume in patients with primary aldosteronism might increase by an oversecreted aldosteron and the patients usually suffer from hypertension, because of increasing systemic blood volume. During anesthesia, we should carefully perform fluid therapy in order not to cause pulmonary edema. After anesthesia induction, the intrathoracic blood volume increased. And, during surgery, the blood epinephrine concentration increased due to direct tumor manupulation by surgeon, leading to induced hypertension. Because of induced hypertension, it was difficult to estimate the systemic blood volume. Under these conditions, PiCCO device was a useful monitor to estimate the systemic blood volume during surgery in patients with primary aldosteronism.

Effects of sulfur amino acids on tyrosyl or serine/threonine phosphorylation and translocation of cytosolic compounds to cell membrane in stimulus-treated human neutrophils.

We investigated the effects of various sulfur amino acids on the phosphorylation of proteins and the translocation of cytosolic compounds to cell membrane in stimulus-treated human neutrophils using specific monoclonal antibodies. D,L-homocysteine and D,L-homocysteine-thiolactone enhanced fMLP-induced tyrosyl phosphorylation of proteins and the translocation of p47phox, p67phox, and rac to the cell membrane in a concentration-dependent manner. L-cystathionine, NAc-L-cysteine and carboxymethylcysteine suppressed the tyrosyl phophorylation and translocation of cytosolic compounds to the cell membrane. L-cystathionine, L-cysteine and NAc-L-cysteine suppressed PMA-induced serine/threonine phosphorylation and the translocation of cytosolic compounds to the cell membrane. L-cysteine, NAc-L-cysteine and D,L-homocysteine enhanced AA-induced serine/threonine phosphorylation and the translocation of cytosolic compounds to the cell membrane, but L-cystathionine had opposite effects. These results indicated that the effects of sulfur amino acids on tyrosyl or serine/threonine phosphorylation and the translocation of p47phox, p67phox, and rac to the cell membrane in the stimulus-treated human neutrophils were in parallel with those of the stimulus-induced superoxide generation reported in previous paper. L-cysteine, D,L-homocysteine and L-cystathionine weakly inhibited lipid peroxidation, but the other sulfur amino acids tested had no effect.

The effects of vasodilation on cardiac output measured by PiCCO.

OBJECTIVES: The purpose of this study was to investigate the effects of vasodilation on cardiac output (CO) measured by pulse contour method using PiCCO (Pulsion Medical Systems AG, Munich, Germany) in comparison with CO by the thermodilution method. DESIGN: A prospective observational study. SETTINGS: An operating room in a university hospital. PARTICIPANTS: Twenty patients scheduled for off-pump coronary artery bypass grafting. INTERVENTIONS: After anesthesia induction with midazolam, fentanyl, and vecuronium, the PiCCO catheter and pulmonary artery catheter were inserted. Before the initiation of surgery, progressively higher infusions of prostaglandin E1 (PGE1) were administered for vasodilation. MEASUREMENTS AND MAIN RESULTS: CO was measured before PGE1 (control); at PGE1 0.01, 0.02, and 0.04 microg/kg/min; and 15 minutes after stopping PGE1 infusion. Systemic vascular resistances (SVRs) at PGE1 0.02 and 0.04 microg/kg/min were significantly lower than the control value. The correlation coefficient (R(2)) at each point, percentage error, and limits of agreement (bias +/- 2 standard deviation of bias) were 0.89, 17, -0.21 +/- 0.53 before PGE1; 0.72, 27, -0.31 +/- 0.93 at 0.01 microg/kg/min; 0.53, 40, -0.62 +/- 1.41 at 0.02 microg/kg/min; 0.57, 34, -0.61 +/- 1.26 at 0.04 microg/kg/min; and 0.97, 21, -0.14 +/- 0.69 L/min 15 minutes after the end of infusion, respectively. CONCLUSIONS: PiCCO may not be an alternative to thermodilution measurement without recalibration when SVR decreases by infusion of PGE1 > or = 0.02 microg/kg/min.

Inhibitory effects of ginsenosides from the root of Panax ginseng on stimulus-induced superoxide generation, tyrosyl or serine/threonine phosphorylation, and translocation of cytosolic compounds to plasma membrane in human neutrophils.

The effects of five ginsenosides (G-Rh2, -Rd, -Rb1, -Rb2, -Rh1) isolated from the root of Panax gingseng on stimulus-induced superoxide generation in human neutrophils were evaluated by measuring the reduction of ferricytochrome c. The tyrosyl or serine/threonine phosphorylation of neutrophil proteins and translocation of p47phox, p67phox, and Rac to the plasma membrane were detected using specific monoclonal antibodies. G-Rh2 significantly suppressed superoxide generation induced by N-formylmethionyl-leucylphenylalanine (fMLP), phorbol 12-myristate 13-acetate (PMA), and arachidonic acid (AA) in a concentration-dependent manner. G-Rh1 showed a comparably lower suppression on fMLP-induced superoxide generation. G-Rd, -Rb1, and -Rb2 also suppressed AA-induced superoxide generation in high concentrations. G-Rd and G-Rb1 showed no effect on fMLP- and PMA-induced superoxide generation. FMLP-, PMA-, and AA-induced tyrosyl or serine/threonine phosphorylation and translocation of p47phox, p67phox, and Rac to the plasma membrane were in parallel with the suppression of the stimulus-induced superoxide generation.

Effects of vasodilation on cardiac output measured by PulseCO.

BACKGROUND: The instability of cardiac output (CO) measured by PulseCO (LiDCO Ltd.) during cardiac surgery has been reported. In the present study, we investigated the effects of vasodilation by prostaglandin E1 (PGE1) on the relation between cardiac output measured by PulseCO and that by thermodilution. METHODS: Twenty patients who underwent off-pump coronary artery bypass grafting (OPCAB) were enrolled in this study. After premedication with oral diazepam 10 mg, anesthesia was induced with midazolam, fentanyl and vecuronium. CO was measured after anesthesia induction, at PGE1 0.01, 0.02 and 0.04 microg/(kg min) and at 15 min after the stop of the infusion. RESULTS: Systemic vascular resistances (SVRs) by PGE1 at 0.02 and 0.04 microg/(kg min) were significantly lower than the control value. The correlation coefficient (R2) between the two techniques at each point, percentage error and limits of agreement (bias +/-2SD of bias) were 0.78, 3, 0.05 +/- 0.17 at 0.01 microg/(kg min), 0.20, 10, -0.18 +/- 0.12 at 0.02 microg/(kg min), 0.46, 28, -0.50 +/- 0.24 at 0.04 microg/(kg min) and 0.97, 1, 0.02 +/- 0.27 L/min at 15 min after stop of infusion, respectively. CONCLUSION: PulseCO might underestimate CO compared to that by bolus thermodilution method when simply decreasing the SVR by infusion of PGE1. Therefore, PulseCO might be unsuitable in cardiac surgery.

Efficacy of a heat and moisture exchanger in inhalation anesthesia at two different flow rates.

In general anesthesia with endotracheal intubation, a circle system with a heat and moisture exchanger (HME) and a low total flow is often used to prevent hypothermia and to maintain inspired gas humidity. The purpose of the present study was to compare the inspired gas humidity and body temperature, in general anesthesia with or without an HME at two different total flow rates. Eighty patients (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo either orthopedic or head and neck surgery were studied. They were divided into four groups, of 20 patients each: total flow of 2 lxmin(-1) with (group HME2L) or without (group 2L) HME, and a total flow of 4 lxmin(-1) with (group HME4L) or without (group 4L) HME. The relative and absolute humidity and pharyngeal and inspired gas temperatures were measured for 2 h after endotracheal intubation. The relative humidity was not significantly different among groups 2L, HME2L, and HME4L. Group 4L had significantly lower absolute humidity than group 2L. The pharyngeal temperature did not decrease significantly for 2 h in any of the groups. During general anesthesia with a total flow of 2 lxmin(-1) in 2 h, HME might not be necessary, while with a total flow of 4 lxmin(-1), HME could be useful to maintain inspired gas humidity.

[A case of sudden occurrence of complete left bundle branch block during emergency surgery].

We experienced a case of sudden occurrence of complete left bundle branch block during emergency surgery. A 59-year-old man suffered from facial bone fracture and eye ball injury. Repair of facial bone and removal of eye ball surgery were scheduled. Chest X-ray, echocardiography, blood counts and laboratory data were within normal limits. Awake intubation was performed. Anesthesia was maintained with 2-3% sevoflurane in 1 l x min(-1) of oxygen and 2 l x min(-1) of nitrous oxide. After induction of anesthesia, tracheostomy was performed with combined use of local anesthesia with 6 ml of 1% lidocaine with 1/200000 epinephrine. Then removal of eye ball surgery was started and finished uneventfully. During repair of facial bone fracture, we found an unexpected complete left bundle branch block. After rapid infusion of 1000 ml acetic Ringer's solution, the complete left bundle branch block disappeared. After surgery, mannitol administration at the previous hospital was noticed. Complete left bundle branch block in this case might have been induced by hypovolemia and hyperpotassemia due to osmotic diuresis by mannitol.

A comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers.

BACKGROUND: Prefilled disposable oxygen humidifiers are considered to prevent nosocomial pneumonia in hospital wards. However, their usefulness in intensive care units (ICUs) has not yet been established. In this study, we evaluated and compared contamination in prefilled disposable oxygen humidifiers and that in reusable oxygen humidifiers. METHODS: Six oxygen outlets in the ICU were used. Prefilled disposable oxygen humidifiers and reusable oxygen humidifiers were attached to each wall-mounted oxygen outlet using a 2-way connector. Nonsterile nasal cannulae and tubes were connected to the humidifiers through which 5 L/min of oxygen was delivered continuously. Water samples (5 mL) from each humidifier were collected on the first day and every 7 days thereafter for a period of 56 days. Each water sample was incubated aerobically at 35 degrees C for 48 hours and observed daily for bacterial growth. RESULTS: Bacterial growth was observed only once in one sample from each humidifier type. Gram-positive cocci, 40 colony-forming units in the disposable oxygen humidifier and 10 colony-forming units in the reusable oxygen humidifier, were detected. Dust was observed from the 35th day onward only in the reusable oxygen humidifier. CONCLUSION: In the ICU, bacterial contamination does not occur in oxygen humidifiers even after 56 days of continuous use. However, dust does accumulate in the reusable oxygen humidifier after 35 days of continuous use.

Cardiac output by PulseCO is not interchangeable with thermodilution in patients undergoing OPCAB.

PURPOSE: To investigate the reliability of cardiac output assessed by arterial pressure waveform (PulseCO) in comparison with bolus thermodilution measurements in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: 23 patients who underwent OPCAB were enrolled in this study. After premedication with oral diazepam 10 mg, anesthesia was induced with midazolam, fentanyl and vecuronium. After induction, radial artery and pulmonary artery catheters were inserted. Cardiac output was measured simultaneously by the PulseCO and the bolus thermodilution method using the Vigilance monitor: 1) after sternotomy, 2) after opening the mediastinum, and 3) at the end of surgery. The PulseCO was calibrated initially with cardiac output determined by the thermodilution method after induction of anesthesia. RESULTS: The correlation coefficients between the two techniques at the three measurement periods were: 1) R2 = 0.49, 2) R2 = 0.52, 3) R2 = 0.55. The limits of agreement (bias +/- 2 SD of bias) were: 1) 0.71 +/- 2.66, 2) 0.30 +/- 1.97, 3) 0.76 +/- 3.85 L.min(-1). CONCLUSIONS: Cardiac output by PulseCO is not interchangeable with cardiac output measured by thermodilution in patients undergoing OPCAB.