The effect of lidocaine on apoptotic neurodegeneration in the developing mouse brain / 대한마취과학회지

BACKGROUND: General anesthetics induce neuronal apoptosis in the immature brain. Regional anesthesia using local anesthetics can be an alternative to general anesthesia. Therefore, this study investigated the possible effect of lidocaine on neuronal apoptosis. METHODS: Fifty-one 7-day-old C57BL6 mice were allocated into control (group C), lidocaine (group L), lidocaine plus midazolam (group LM) and isoflurane (group I) groups. Group C received normal saline administration. Groups L and LM were injected with lidocaine (4 mg/kg, subcutaneously) only and the same dose of lidocaine plus midazolam (9 mg/kg, subcutaneously). Group I was exposed to 0.75 vol% isoflurane for 6 h. After 6 h, apoptotic neurodegeneration was assessed using caspase-3 immunostaining and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) staining. RESULTS: For the entire brain section, neuronal cells exhibiting caspase-3 activation were observed more frequently in group I than in group C (P < 0.001). In the thalamus, apoptosis of group L was more frequent than that of group C (P < 0.001), but less freqent than that of groups LM and I (P = 0.0075 and P < 0.001, respectively). In the cortex, group I experienced more apoptosis than group L and C (all Ps < 0.001). On TUNEL staining, the difference in apoptosis between the lidocaine and control groups was marginal (P = 0.05). CONCLUSIONS: Lidocaine induced minimal apoptosis in the developing brain compared with isoflurane and lidocaine plus midazolam. However, we cannot fully exclude the possible adverse effect of subcutaneously administered lidocaine on the developing brain.

Application of the continuous autotransfusion system (CATS) to prevent transfusion-related hyperkalemia following hyperkalemic cardiac arrest in an infant: A case report / 대한마취과학회지

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K+) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K+ concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.

Transfusion-free anesthetic management for open heart surgery in a neonate: A case report / 대한마취과학회지

In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized.

Repeated cardiac arrests caused by transfusion-related hyperkalemia and massive bleeding : A case report

Transfusion-related hyperkalemic cardiac arrest (TRHCA) is a serious complication of administration of packed red blood cell (P-RBC). We present a case of repeated TRHCAs in a 13 month-old girl, who was undergoing intra-abdominal huge mass excision. There were three consecutive TRHCAs during the operation. The first (11.7 mM of K+) and the second (9.5 mM of K+) cardiac arrests were successfully resuscitated. However, the last cardiac arrest (8.9 mM of K+) was failed to be recovered with conventional treatment. Risk factors of TRHCA such as hypocalcemia, hypoxemia, acidosis, hyperglycemia, hyperlactatemia, and low cardiac out state were combined. The transfused P-RBCs were all irradiated. In this situation, processing of P-RBC using an autotransfusion device before the transfusion should be considered to prevent hyperkalemia in addition to conventional treatment of TRHCA.

The Effect of Intraoperative Autotransfusion using a Continuous Autotransfusion System (CATS(R)) on for Homologous Transfusion in Children / 대한마취과학회지

BACKGROUND: Until recently, it was not easy to conduct intraoperative autotransfusion in children due to technical limitations, however, due to advanced technology this is now possible. This study was conducted to determine if the intraoperative use of the continuous autotransfusion system (CATS(R)) can reduce homologous transfusion during pediatric orthopaedic surgery. METHODS: Fifty-five children scheduled for elective orthopaedic surgery were reviewed and divided into two groups according to the availability of the CATS(R). The control group (n = 29) had surgery without the cell saver, whereas the CATS(R) group (n = 26) had surgery with the cell saver. The amounts of perioperative homologous transfusion were then compared between the two groups. RESULTS: The amount of homologous blood transfusion required during the operation was significantly less in the CATS(R) group 5 +/- 10 (ml/kg) than in the control group 15 +/- 13 (ml/kg) (P < 0.01). There was no difference in the amount of homologous blood transfusion required after operation between the groups. CONCLUSIONS: CATS(R) can reduce the need for intraoperative homologous transfusion during pediatric orthopaedic surgery.

Use of ECMO (Extracorporeal Membrane Oxygenation) in Cardiac Arrest during Spinal Anesthesia: A case report / 대한마취과학회지

We experienced a case where extracorporeal membrane oxygenation ECMO was used for a cardiac arrest that occurred during spinal anesthesia. An 84-year-old man underwent total hip replacement surgery. The patient developed sudden cardiac arrest at around 40 minutes after the administration of spinal anesthesia. The cardiac arrest was difficult to manage with ordinary CPR (cardiopulmonary resuscitation) and went on to complete cardiac arrest. ECMO (venoarterial ECMO from the right femoral artery to the right femoral vein) was immediately applied while performing cardiac massage. Heparin was infused with ACT (activated coagulation time) monitoring during ECMO. We also found multiple rib fractures and hemothorax resulting from the chest massage as seen on a chest X-ray. On the third day after resuscitation, communication with the patient was possible. Hemodialysis was performed due to acute renal failure on the same day. On the seventh day, the vital signs became stable. The flow of the pump was lowered and the patient was weaned from ECMO. However, the patient could not be weaned from ventilatory support due to the hemothorax caused by the CPR. Thereafter, weaning from ventilatory support was delayed due to a decline of pulmonary function. The patient organ functions (kidney, lung, liver, heart) were gradually getting worse. The patient expired due to multiple organ failure on day 92. ECMO can be considered in case of cardiac arrest due to reversible causes.

Epidural and Psoas Abscesses Recognized after Paravertebral Trigger Point Injection: A case report / 대한통증학회지

The trigger point injection technique is widely used in pain clinics for the treatment of acute and chronic pain. Yet it has a variety of complications such asvasovagal syncope, total spinal anesthesia, paralysis, root block, pneumothorax, needle breakage, skin infection, and hematoma formation. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report here on a patient who was diagnosed with epidural and psoas abscesses after paravertebral trigger point injection.

Listeria seeligeri Gene Encoding Heme-containing Catalase Produces No Activity in Streptococcus pneumoniae

Streptococcus pneumoniae is a facultative anaerobe lacking catalase enzyme and requires exogenous catalase supplemented to culture media for aerobic growth. We introduced a catalase gene (kat) of Listeria seeligeri into S. pneumoniae and tried to see if this listerial kat gene was expressed within the pneumococcal host. To clone the listerial kat gene in the pneumococcal chromosome, a non-replicating plasmid pAHA-LSt3, along with its original promoter region was used for integration the chromosome via homologous recombination. One of three resulting transformants was confirmed to contain the kat gene and designated as EHS2. In addition, the kat gene was subcloned in Escherichia coli in frame to the lac promoter of a shuttle vector to generate pDL-Kat, which was subsequently used for pneumococcal transformation. Four identical recombinants were identified to contain the plasmid with the kat gene. By performing RT-PCR, it was observed that the listerial kat gene was indeed transcribed within pneumococcal recombinants from its original promoter in the chromosome of EHS2 and from the lac promoter in the plasmid pDL-Kat. In contrast to the E. coli kat+ recombinants, however, the pneumococcal kat+ recombinants failed to reveal any catalase activities detectable by ferricyanide staining on non-denaturing PAGE. When the pDL-Kat plasmid DNA purified from pneumococci was allowed to transform E. coli again, many kat+ recombinants were obtained, ruling out the possibility of the defective kat E. coli transformants gene within pneumococci. The observation that the listerial kat gene in pneumococci was unable to produce the functional catalase enzyme, which requires a heme group at its active site and a cofactor NADPH, suggests pneumococcal defect in heme production.

Stereological Analysis of gamma-Glutamyl Transpeptidase Positive Foci in Diethylnitrosamine-Induced Hepatocarcinogenesis of Sprague-Dawley Rats / 대한간학회지

BACKGROUND/AIMS: Hepatocarcinogenesis of microscopically altered foci could be shown to be progressed into a trabecular pattern of hepatocellular carcinoma. And it is reported that down-regulation of TGF beta II receptor and up-regulation of TGF alpha and c-myc reveal the progression of diethylnitrosamine-induced foci into liver cell cancer. Up-regulation of TGF beta II receptor, however, causes apoptosis of foci. To determine characteristic morphology and growth kinetics of putatively precancerous y glutamyl transpeptidase (GGT) positive foci and hyperplastic nodules, a stereological quantification was attempted in the Peraino's neonatal rat model initiated by diethylnitrosamine and promoted by phenobarbital. MATERIALS/METHODS: Fifteen Sprague-Dawley rats were I.p. injected with 0.15 pmole/g of body weight of diethylnitrosamine mixed in corn oil at one day after birth. From weaning at 4 weeks of life, the rats were continuously fed 0.035% phenobarbital in drinking water and sacrified 5 rats at each time point of 8 weeks, 16 weeks, and 32 weeks. Teklad standard diet was fed after weaning. The livers obtained were fixed in freshly prepared, cold ethanol-acetic acid (99:1 vo1%). For the GGT histochemical staining, Rutenberg's method was modified, and counterstained with H & E or toluidine blue. For the stereological analysis GGT positive foci and nodules were traced in 200 consecutive tissue sections and quantified the 3 dimensional volumes by computer assisted planimetry. Either spheroidal or non-spheroidal morphology was determined by parabola 2nd degree equation ' y=ax+bx+c (sphere a=-P,). RESULTS: Thirty nine (55.71%) out of 70 representative lesions were nonspheroidal. Especially at 8 weeks, the 28 out of 40 GGT positive foci were irregular, nonspheroidal shape. Later times, however, GGT positive foci and reprogrammed nodular lesions were become spheroidal. Lilliefors probabilities test for spheroidal frequency was statistically significant (p<0.05). CONCLUSION: Stereologically non-spheroidal characteristics of the early GGT positive foci limit growth kinetic estimation by 3 dimensional volume quantitation but permit in later times in spheroidal, GGT positive foci and reprogrammed nodules showing fade-out of GGT activity. In other words, GGT positive foci may be clonally selected for growing into hyperplastic nodules and hepatocellular carcinoma or regressed by apoptosis.

What`s the optimal timing of pretreatment with pancuronium before succinylcholine to prevent muscle fasciculation? / 대한마취과학회지

Succinylcholine(SCh)-induced muscle fasciculations may be prevented by pretreatment with small doses of nondepolarizing muscle relaxants. The optimal timing of pretreatment to abolish fasciculation varies according to the drug used and dose. In this study, we determined the optimal timing of pretreatment of pancuronium to prevent muscular fasciculation in 100 patients. Each group (n=20) was received pancuronium 0.015 mg/kg at 1, 2, 3, 4, 5 minutes before SCh 3 mg/kg administration, respectively. The degree of fasciculations after SCh administration was observed and classified into one of 4 grade. There were significant differences between each groups (Ridit scores=10.078, p<0.01) To compare observed fasciculations of one grpup with those of the others, the degree of fasciculations was summed according to an arbitrary scale. The summation of grade in 4 minute group was lowest in this scale. It was concluded that the optimal timing of pretreatment, pancuronium 0.015 mg/kg, was 4 minutes before SCh 3 mg/kg injection.