[Bradycardia and cardiac asystole immediately after abdominal incision for removal of a huge pyometra].

We report a patient who developed cardiac asystole, which may have been caused by Bezold-Jarisch reflex as a result of hypovolemia and compression of the inferior vena cava by a huge pyometra. A 61-year-old woman with a huge pyometra with occasional supine hypotension, tachycardia, and oliguria was scheduled for removal of the tumor. The systolic blood pressure decreased from 80 mmHg to 55 mmHg with simultaneous development of bradycardia 5 minutes after incision of the abdominal wall. Atropine was given but cardiac asystole occurred. Intravenous epinephrine restored systemic blood pressure and heart beats. There was no postoperative cardiorespiratory complication.

Reversal of neuromuscular effects of adenosine by specific adenosine A1-receptor antagonist in live rats.

Intravenous adenosine in-vivo was shown to potentiate the effects of non-depolarizing neuromuscular blocking agents. This study aimed to determine whether adenosine A1-receptors mediated this potentiation. The authors investigated the effects of intravenous adenosine, N6-cyclopentyladenosine, specific A1-receptor agonist, and 8-cyclopentyl-1,3-dipropylxanthine, specific A1-receptor antagonist, on neuromuscular block by vecuronium, in in-vivo rat sciatic nerve-tibialis anterior preparations. In the presence of 50% steady state block by vecuronium, adenosine, and N6-cyclopentyladenosine caused similar degree of depressions of twitch tension. Twitch tension returned to its pre-injection value more rapidly when 8-cyclopentyl-1,3-dipropylxanthine was given at the maximal block than when it was allowed to recover spontaneously. It was concluded that in in-vivo adenosine potentiated the neuromuscular effects of vecuronium through adenosine A1-receptors in rats.

[Severe hyponatremia during transurethral resection of prostate].

We report a case of severe hyponatremia (Na 82 mEq x l(-1)) during transurethral resection of the prostate for benign prostatic hypertrophy. A 61-year-old man was managed with epidural anesthesia and intravenous propofol. Three percent sorbitol (Uromatic S) solution was used for irrigation fluid. The serum sodium level 1 and 3 hours after the start of operation was 103 mEq x l(-1) and 82 mEq x l(-1), respectively. One hour after cessation of propofol administration he did not wake up, although he responded to mechanical stimulation. Saline (1.7%) and sodium bicarbonate (8.4%) were infused. Thirteen hours after the operation, serum sodium level rose to 114 mEq x l(-1), and he opened the eyes on verbal commands. Twenty-eight hours after the operation, serum sodium level was 132 mEq x l(-1). Postoperative neurological deficit did not occur.

[Manpower at private university hospitals in Japan].

We studied the numbers of teaching staff in anesthesiology departments and of patients operated on and managed by anesthesiologists at private university hospitals in 1999, in Japan. Questionnaires were sent to 49 institutions, and 36 responded (response rate, 73%). The mean number of patients managed by anesthesiologists in an institution was 3899 (range, 942-8135). The mean number of patients who were managed by a staff anesthesiologist was 428 cases (range, 118-980). The data indicate that a prompt increase in manpower at the private university hospitals is necessary to improve patient care, education, and research work.