High mobility group box 1 can be used to monitor perioperative course in patients with liver cancer.

OBJECTIVE: High mobility group box 1 (HMGB1) is produced by inflammation. Regarding liver injuries, HMGB1 is reportedly involved in liver regeneration. The present study investigated the use of HMGB1 as a postoperative marker of surgical course in patients with liver cancer. METHODS: Patients were enrolled if they had liver cancer, had undergone liver surgery, and did not develop postsurgical complications. Patients who received emergency surgery or patients with unresectable cancerous lesions were excluded. Blood samples were preoperatively obtained as well as at 1 day, 1 week, and 4 weeks following surgery; white blood cell count, serum C-reactive protein, serum albumin, and serum HMGB1 levels were measured. RESULTS: A total of 36 patients were included in this study. HMGB1 levels significantly changed over time, increasing from a median of 7.1 ng/ml (preoperatively) to 13.9 ng/ml at 1 week postoperatively, and then decreased to 6.3 ng/ml at 4 weeks postoperatively. Peak HMGB1 levels were delayed, and elevated HMGB1 levels persisted as compared with the changes in conventional markers. CONCLUSIONS: HMGB1 indicates a unique perioperative inflammatory state in patients with liver cancer. Serum HMGB1 may serve as a marker for monitoring surgical course in patients undergoing surgery for liver cancer.

Near-infrared spectroscopy might be a useful tool for predicting the risk of vascular complications after pediatric liver transplants: Two case reports.

In patients that have undergone liver transplants, a postoperative reduction in the blood flow of the liver graft represents a critical complication. We recently encountered an interesting phenomenon; that is, we found that the rSO2 level of the liver graft, as measured by NIRS, drops in patients that subsequently require an emergency liver biopsy. An 8-month-old female and an 8-month-old male underwent living donor liver transplants for biliary atresia. In both cases, a reduction in rSO2 was detected before an emergency liver biopsy was required. As a result of biopsy examinations, both patients were diagnosed with acute graft rejection. NIRS might be useful for graft management during the postoperative period in pediatric patients that undergo liver transplantation. After a liver transplant, a reduction in the rSO2 of the graft might be indicative of the onset of vascular complications.

Comparison of the analgesic effect between continuous wound infiltration and single-injection transversus abdominis plane block after gynecologic laparotomy.

PURPOSE: Both single-injection transversus abdominis plane (TAP) block and continuous wound infiltration (CWI) provide postoperative analgesia, but no study has compared the two regional techniques. We tested the hypothesis that CWI is more effective for controlling postoperative pain compared with single-injection TAP block after laparotomy. METHODS: We conducted a prospective randomized study of patients undergoing gynecologic laparotomy with midline incision through the umbilicus under general anesthesia. The patients were allocated to receive either single-injection TAP block (TAP group) or CWI (CWI group) for postoperative analgesia. All patients received intravenous patient-controlled analgesia with morphine and intravenous flurbiprofen twice daily after surgery. Postoperative pain at rest and on coughing, postoperative morphine consumption, incidence of postoperative nausea and vomiting (PONV), pruritus and urinary retention, ambulation, and satisfaction score were recorded. Patients were assessed at 3 h after surgery and twice daily on postoperative days (POD) 1 and 2. RESULTS: Data of 54 patients were analyzed. Compared to the TAP group (n = 27), pain score on coughing was significantly lower in the CWI group (n = 27) on POD1 and POD2 (P < 0.05). Pain score on coughing at 3 h after surgery, pain score at rest at all assessed time points, morphine consumption, incidence of PONV, pruritus and urinary retention, ambulation, and satisfaction score were not different between the two groups. CONCLUSION: CWI reduced pain on coughing after the day of surgery compared with single-injection TAP block when performed as part of multimodal analgesia in patients undergoing gynecologic laparotomy.

[A Case of Living Donor Liver Transplantation Complicated by Thrombosis due to a Central Venous Catheter in the Right Internal Jugular Vein].

Central venous catheter-related infection and throm- bosis frequently occur, leading to serious complications in some cases. We encountered a case of thrombosis developing on the sixth day after surgery, in a patient with a PreSep Central Venous Oximetry Catheter™ placed in the internal jugular vein. A 53-year-old woman with a height of 160.8 cm and weight of 52.9 kg, showing normal coagulation test results, was scheduled for living donor liver transplantation under general anesthesia with sevoflurane/remifentanil. The durations of surgery and anesthesia were 6 hours and 56 minutes and 8 hours and 24 minutes, respectively. Although central venous catheter insertion and postop- erative management were appropriately performed, the patient reported chest pain and dyspnea just after the removal of the central venous catheter on the sixth day after surgery, and was diagnosed with thrombosis on CT. This case highlights the importance of selecting appropriate catheters considering perioperative risks and removing them in the early stages.

[Continuous wound infiltration for upper abdominal surgery: 3 case reports].

We report three cases of continuous wound infiltration (CWI) for postoperative analgesia in upper abdominal surgery using the multi-holed epidural catheter. Ropivacaine 0.2% at a rate of 8 ml x hr(-1) was administered through the catheters after surgery. Intravenous-patient controlled analgesia was used as a rescue. The postoperative pain was well controlled, and all patients could walk the next day after surgery. The consumption of rescue morphine was little and no side effect of morphine was observed. CWI is an easy procedure and is indicated in the patients with hemostatic abnormality and a difficulty in the epidural anesthesia. CWI was an effective technique for postoperative pain control in the upper abdominal surgery patients.

Comparison of the analgesic effects of continuous extrapleural block and continuous epidural block after video-assisted thoracoscopic surgery.

DESIGN: A prospective, randomized, open study. The regional technique used was not blinded. SETTING: A university teaching hospital. PARTICIPANTS: Forty-eight patients undergoing video-assisted thoracoscopic surgery (VATS) for tumor resection. INTERVENTIONS: Patients received either continuous extrapleural block or continuous epidural block using ropivacaine for a period of 60 hours after surgery. MEASUREMENTS AND MAIN RESULTS: To evaluate postoperative pain control, the primary and secondary endpoints were the visual analog scale (VAS) on movement and the amount of rescue analgesia, respectively. There were no significant differences between the extrapleural and epidural block groups with regard to VAS at rest and during movement assessed at 4, 12, 24, 36, and 48 hours after surgery, dosage of intravenous morphine (extrapleural: 12.9 ± 11.3, epidural: 10.2 ± 6.9 mg), supplemental nonsteroidal anti-inflammatory drugs, incidence of postoperative nausea and vomiting (extrapleural: 12/20, epidural: 11/20), postoperative ambulation (extrapleural: 18 at postoperative day [POD] 1 and 20 at POD 2, epidural: 19 at POD 1 and 20 at POD 2) and hospital stay after surgery (extrapleural: 12.7 ± 6.3, epidural: 12.6 ± 4.7 days). CONCLUSIONS: Although this study did not show the superiority of continuous extrapleural block relative to continuous epidural in VATS patients, the results suggest that both methods provided effective analgesia with a relatively small dose of rescue morphine. Although the analgesic effects of these techniques were comparable, extrapleural block has the advantage of safety and precise placement of the catheter and can be considered an alternative to epidural block in VATS patients.

[Investigation of massive bleeding at Jichi Medical University Hospital].

We investigated the patients suffering from massive bleeding at the central surgical center, Jichi Medical University Hospital from April 2006 to March 2007. Of the 6401 patients who underwent surgical procedures, 72 patients (1%) received intraoperatively blood transfusion of more than 1400 ml (RCC-MAP Japan Red Cross). Of the 72 patients, 15 patients died within one month after surgery. Massive blood loss occurred during thoracoabdominal aortic aneurysm surgery (32 cases, 44%), major liver resections (10 cases, 14%), and surgical procedures in the pelvic organs (8 cases, 11%). Preoperative circulatory shock state affected the prognosis of the patients. The minimal hemoglobin concentration during anesthesia was significantly lower in the cases with worse prognoses than in those with recovery from illness, while amount of intraoperative blood loss, amount of blood transfusion, hemoglobin concentration before anesthesia or presence of blood coagulopathy did not influence the postoperative course of the patients.

[Airtraq optical laryngoscope].

BACKGROUND: We described an early experience of Airtraq laryngoscope in 20 patients receiving general anesthesia. METHODS: In all, 2 staff anesthesiologists, 3 anesthesia residents and 10 non-anesthesia residents performed endotracheal intubation with 14 polyvinyl chloride tubes with inside diameter of 7-8 mm, 5 double lumen 37-F tubes and 1 preformed nasotracheal tube. RESULTS: Every endotracheal intubation was achieved at the first trial, and the mean time to secure the airway was 46 +/- 18 seconds. CONCLUSIONS: Airtraq laryngoscope is a useful novel device for tracheal intubation.