[Anesthetic management of a hemodialysis-dependent patient implanted with a CRT-D device undergoing an operation for perforated peritonitis].

A 53-year-old man was admitted to our hospital for hematochezia, and an emergency operation was scheduled for his perforated sigmoid colon. He had received a CRT-D (cardiac resynchronization therapy with defibrillator) device for dilated cardiomyopathy two years before and had been receiving hemodialysis for the past year. Anesthesia was induced with midazolam and remifentanil and maintained with remifentanil and sevoflurane in oxygen. Before surgery, we disabled the defibrillation function of the CRT-D device and changed its pacing mode from VVI to VOO, and electrodes of an external defibrillator were attached to the chest wall. Dopamine and norepinephrine were administered via a central venous catheter, and systolic blood pressure was maintained between 70 and 80 mmHg and CVP between 8 and 13 mmHg. Sigmoidectomy was performed and he was transferred to the ICU intubated. Although intensive care procedures, such as mechanical ventilation, continuous hemodiafiltration, and direct hemoperfusion with polymyxin B-immobilized fibers were performed, he died of multiple organ failure on postoperative day 48. CRT-D has become mainstream cardiac resynchronization therapy and will require attention for anesthetic management of patients implanted with the CRT-D device.

Heat stress influences the attenuation of prostaglandin synthesis by interferon tau in bovine endometrial cells.

Heat stress (HS) reduces reproductive performance of cattle, possibly by disrupting endocrine regulation such as prostaglandin (PG) production from uterus and estradiol 17ß production from the dominant follicle. Prostaglandin F2α (PGF2α) secretion from endometrium surges during the luteal phase due to tumor necrosis factor (TNF) α stimulation and a positive-feedback loop with oxytocin (OT) from the corpus luteum, ultimately triggering luteolysis, while interferon τ (IFNT) inhibits upregulation of PGF2α production by TNFα and OT, thereby preventing luteolysis and triggering recognition of pregnancy. In the present study, we investigated the effect of OT, TNFα, and IFNT on PGF2α production in both types of endometrial cells under HS conditions. Stimulation of PGF2α production in endometrial epithelial cells by OT was unaffected by HS, while stimulation of PGF2α production in endometrial stromal cells by TNFα was enhanced by HS, and this increased PGF2α production was not significantly suppressed by IFNT. These results suggest that HS disrupted the regulation of PGF2α production by TNFα and IFNT in bovine endometrial stromal cells and it might be one of causes for low conception rate of cattle in summer.

[Uncrossmatched type O red blood cell transfusion and cell saver autologous blood transfusion effective for intraoperative massive bleeding].

We experienced rapid and massive bleeding in a 57-year-old woman undergoing resection of ovarian tumor metastasis. One hour after the start of operation, blood loss increased due to adhesion of the tumor. The blood hemoglobin level decreased from 11.7 to 4.6 g x dl(-1). Since available matched homologous blood had been consumed, we transfused type O uncrossmatched red blood cells followed by cell saver autologous blood. For the treatment of uncontrollable hyperkalemia and metabolic acidosis, continuous hemodiafiltration was started. A total of 66 U of red blood cells, 48 U of FFP, and 40 U of platelets were transfused intraoperatively. No neurological deficit, pulmonary edema, renal failure, or hemolysis was found postoperatively.