[General anesthesia for two patients taking methylphenidate (Ritalin)].

We experienced anesthesia care for two patients taking methylphenidate (Ritalin), which is a central nervous system stimulant of amphetamine analogues, usually administered for narcolepsy or refractory depression. The proper dose of methylphenidate is 20-60 mg per day. General anesthesia with epidural anesthesia was administered to both cases for total hip replacement. One patient could discontinue taking methylphenidate five days before the operation, but the other patient could not. Both cases needed more anesthetics than usual on induction, but very stable condition could be maintained during and after the operations. We consider that it is possible to perform general anesthesia safely for patients taking a usual dose of methylphenidate.

Analgesic effect of intravenous ATP on postherpetic neuralgia in comparison with responses to intravenous ketamine and lidocaine.

PURPOSE: No study has been performed on the analgesic effect of adenosine 5'-triphosphate (ATP) on postherpetic neuralgia (PHN). We conducted an open-label trial of ATP in patients with PHN, and compared ATP with ketamine and lidocaine. METHODS: Twelve patients with PHN were studied. On separate days, ketamine (0.3 mg.kg(-1)), lidocaine (2 mg.kg(-1)), and ATP (100 microg.kg(-1).min(-1) or less for 120 min) were administrated intravenously. The intensity of spontaneous pain as well as tactile allodynia was assessed using a visual analog scale (VAS). When the VAS score for spontaneous pain was decreased by more than 50%, the patient was classified as a responder. RESULTS: Five, 6, and 6 patients responded to ketamine, lidocaine, and ATP, respectively. In 6 ATP responders, pain relief developed slowly and lasted for 9 (median) h (range: 3-72 h). All 5 ketamine responders and only 1 of 7 ketamine nonresponders responded to ATP (5/5 vs 1/7, P < 0.05, chi2 test) whereas 2 of 6 responders to lidocaine and 4 of 6 nonresponders to lidocaine responded to ATP (2/6 vs 4/6, P > 0.05). The ketamine responders responded to ATP more often than did the lidocaine responders (5/5 vs 2/6, P < 0.05). CONCLUSION: Intravenous ATP exerted slowly developing and long-lasting analgesic effects in half of patients with PHN. Patients with ketamine-responsive PHN were likely to respond to ATP.

[A case of effective treatment with clonidine ointment for herpetic neuralgia after bone marrow transplantation in a child].

We report a case of effective treatment with clonidine ointment for herpetic neuralgia in a child. Clonidine hydrochloride is an alpha 2-agonist. It is generally administered intravenously, intramuscularly, intrathecally and orally. However, there have been only a few reports on transdermal usage. In our department, we have investigated the analgesic effect of topical application of clonidine in adults, and we have obtained sufficient evidence on the effects of clonidine. Therefore, we decided to use clonidine to a child. A 9-year-old child who had undergone BMT and developed herpes zoster was experiencing severe pain, itch, and insomnia. Many drugs were ineffective in relieving the pain, itch, and insomnia. To remove the symptoms, we tried clonidine ointment. Immediate improvement was observed in all the symptoms. Therefore, clonidine ointment was thought to be effective and we decided to prescribe clonidine ointment and amitriptyline hydrochloride. The application of clonidine showed no side effects such as bradycardia and low blood pressure. We conclude that clonidine can be administered to children without causing side effects.

[Intraoperative hemodynamics in elderly patients during abdominal aortic aneurysm operations].

An association between hemodynamics and age was assessed in abdominal aortic aneurysm resection and graft replacement. Changes in blood pressures and heart rates before and after clamping the aorta as well as before and after its declamping were compared in 34 cases of elective abdominal aortic resection from 1998 to 1999. The results were analyzed retrospectively reviewing their charts. The patients were divided into two groups: age under 70 and 70 or above. In the first group, the decrease in heart rate following clamping of the aorta was greater than that in the second group. On the contrary, after the aorta was declamped, a greater increase in the heart rate after declamping the aorta correlated with aging (R = 0.34, P < 0.05). However, the changes in blood pressure and heart rate were independent of preoperative coronary diseases. Whereas the people aged 70 or above showed different hemodynamics from those under 70, intraoperative hemodynamics did not reflect preoperative coronary diseases.