[Propofol anesthesia for ambulatory surgery in adults].

We reported 131 cases of ambulatory surgery in adults mainly anaesthetized with propofol infusion. Without any premedication, anesthesia was induced with propofol and fentanyl. A laryngeal mask airway was inserted using intravenous injection of vecuronium. Anesthesia was maintained with continuous infusion of propofol and intermittent fentanyl administrations, and local anesthetic infiltration was combined. All patients received air and oxygen mixture (FIO2 0.4) throughout the procedure. During surgery, metoclopramide and flurbiprofen axetil were given to prevent postoperative pain, nausea and vomiting. After surgery, patients were observed at the daycare unit in ward. Average age was 42 years and ASA risk was 1.3. Operation time and anesthesia time and hospital stay were 43.4 minutes, 70.6 minutes and 332 minutes, respectively. In 25 patients (19%) analgesics were needed for postoperative pain. Although 3 patients (2.3%) were unsuccessful as ambulatory surgery due to excessive pain, all patients including these three could be discharged within 24 hours after surgery. We conclude that combined anesthesia with propofol, fentanyl and local anesthetic is suitable for ambulatory surgery in adults.

[Activation of bradykinin formation cascade on receiving autologous blood transfusion through a white cell-reduction filter in a patient treated with an ACE inhibitor].

We have experienced a case of anaphylactoid reaction on receiving autologous blood transfusion through a WBC filter for packed red blood cell (PRBC). The patient was a 71-year-old man with a history of hypertension treated with oral antihypertensive drug; enalapril, an angiotensin converting enzyme (ACE) inhibitor, who received anesthesia for Y-graft replacement. Autologous blood was obtained after the induction of general anesthesia in the operating room. Upon starting to return the stored blood with an unintentional use of a WBC filter, arterial blood pressure (ABP) fell within the first minute of the transfusion. We obtained three blood samples; pre-filtered blood (PRE), postfiltered blood (POST) and arterial blood (CIRC) after the event, and analyzed concentrations of bradykinin (BK), high molecular weight kininogen (HMWK) and high molecular weight kininogen-light chain (HMWK-LC). BK was higher in POST than in PRE. HMWK was lower in POST than in PRE, while HMWK-LC was higher in POST than in PRE. HMWK in CIRC was lower than in PRE, and HMWK-LC was higher in CIRC than in PRE. HMWK and HMWK-LC changes after the event suggest that BK formation cascade in the patient was activated on receiving the transfusion. ACE inhibitors were reported to augment such activation. The WBC filter has the negatively charged surface on filteration material and may activate the cascade. While WBC filters can avoid transfusion related reactions, hemodynamic responses should be watched closely in patients treated with ACE inhibitors.

[Successful use of propofol for anesthesia for plasty of eyelids in epidermolysis bullosa].

A 21-year-old male with recessive dystrophic epidermolysis, required anesthesia for plastic surgery of eyelids. We took special care for the attachment of monitoring equipment and placing an intravenous cannula. Anesthesia was induced by intravenous propofol 1 mg.kg-1 and maintained with local injection of 1.0% lidocaine and continuous infusion of propofol 3-4 mg.kg-1.hr-1. Tracheal intubation was not performed and oxygen was given through a nasal cannula and spontaneous breathing was maintained throughout the anesthetic management. Respiratory condition was monitored by measuring Spo2 and end-tidal CO2 by capnography obtained from the nasal cannula. Operation was performed successfully and he was discharged without any major complications.

[Hyperbaric oxygen therapy in the Hokkaido University Hospital].

We surveyed the hyperbaric oxygen therapy during the past seven years in the Hokkaido University Hospital. The mean number of patients was 27 per year. The average number of the therapy was 328 per year. There were neither complications nor accidents attributable to the hyperbaric oxygen therapy. Three representative diseased states hypoxic brain damage, sudden deafness and occlusion of retinal arteries, showed remarkable recovery by this therapeutic modality. A safety standard has been revised in 1991. We have been operating the hyperbaric oxygen therapy according to the revised standard. The inter-departmental approach in this therapeutic modality is mandatory in order to achieve effective outcome.

[Polarized light irradiation near the stellate ganglion in a patient with Raynaud's sign].

Polarized light irradiation near the stellate ganglion was performed in a 55-year-old female with Raynaud's sign. She was suffering from cold and numb pain in bilateral fingers for 1 year. Stellate ganglion block and low reactive-level laser therapy near the stellate ganglion were not sufficient to relieve this symptom. Polarized light irradiation near the stellate ganglion induced a sting stimulation and warm sensation in her hands. Thermograms revealed a remarkable increase in temperature of her hands. The results imply that polarized light irradiation near the stellate ganglion increases blood flow of forearms and relieves Raynaud's sign.