[The effectiveness of a system using re-useable linens to reduce the expense of surgical operations].

We introduced a system that uses re-useable linens for surgical operations in 2008. After 3 years from introduction we were able to reduce the expense of about yen 4,340,000 per year and CO2 production of 9,548 kg CO2 x m(-2) per year. We were convinced of the effect on reducing the expense of surgical operations and of decreasing the level of CO2 production that leads to global warming.

[Effect on fetal umbilical arterial blood of administration of vasopressors for hypotension after spinal anesthesia during cesarean section].

Spinal anesthesia was performed in 40 patients undergoing cesarean section. When systolic blood pressure dropped below 100 mmHg, phenylephrine 100-200 microg (P group) or ephedrine 5-10 mg (E group) was administered. The pH of the umbilical arterial blood was collected after delivery of the baby. Apgar scores, and maternal systolic blood pressure and heart rate before and after each drug administration were compared retrospectively. The umbilical arterial pH and Apgar scores tended to be slightly higher in the P group, but there was no significant difference between the two groups. The rate of blood pressure elevation was 27% in the P group and 41% in the E group. The heart rate decreased significantly in the P group. There was no significant difference in the systolic blood pressure before administration of each drug. Recently, it is reported that the umbilical arterial pH is higher in cases in which phenylephrine is used for hypotension after spinal anesthesia during a cesarean section. However, the optimal dose of phenylephrine is debatable and has not been established. More studies are necessary to determine which drugs should be selected according to the maternal condition.

[Anesthetic management for a patient with anti-phospholipid antigen syndrome].

A 54-year-old man with anti-phospholipid antigen syndrome (APS) was to undergo artifitial vascular replacement for arteriosclerotic obliterans. APS is characterized by the presense of anti-phospholipid antibodies, hypercoagulability, and prolonged phospholipid dependent coagulation such as activated clotting time (ACT). Perioperative thrombotic complications are frequent among patients with anti-phospholipid antigen syndrome. In these cases, perioperative heparin titration for anticoagulation monitoring is very important. In this patient, preoperative coagulation testing revealed prolonged partial thromboplastin time (APTT) and antithrombin-III (AT-III). In the operating room, a base line ACT was 124 sec. We decided to administer a standard protocol heparine dose of 100 IU x kg(-1) of body weight. After the artifitial vascular replacement, the ACT was recorded at 249 sec. Therefore, a 75 mg dose of protamine was administered. In this particular case, it is difficult to decided to administer the heparin dose. When an adequate platelet count, normal bleeding time, normal TT, and normal AT-III level are shown, it would be decided to use the heparin monitoring systems; ACT, circulating heparin concentrations, according to some reports. In this case, with standard protocol heparin, he had no complications in the postoperative days. The perioperative management was succeseful.

[Anesthetic management of concomitant off-pump coronary artery bypass grafting and complete pneumonectomy for lung cancer].

A 69-year-old man was scheduled for combined surgery involving off-pump coronary artery bypass grafting (OPCABG) for coronary stenosis and total pneumonectomy for lung cancer. Anesthesia was maintained with fentanyl, thiopental, sevoflurane, nitrous oxide, and epidural anesthesia using 1.0% mepivacaine. Although a steady hemodynamic circulation was maintained during OPCABG, it was difficult to stabilize the circulation during the total pneumonectomy.

[Anesthetic management for cesarean delivery in a patient with May-Hegglin anomaly].

May-Hegglin anomaly (MHA) is a rare hereditary disorder characterized by thrombocytopenia and giant thrombocytes and continuous appearance of inclusion bodies (Dohle like corpuscles) in the cytoplasm of granulocytes. A 26-year-old woman with MHA underwent cesarean delivery under general anesthesia, although she had no history of bleeding. The platelet count was 4.9x10(4) microgl(-1) the day before surgery. There was no unusual bleeding during and after the operation and we did not give her platelet transfusion.

[The effect of repeated sevoflurane anesthesia on hepatic function and immunological system].

BACKGROUND: Sevoflurane is known as a useful and safe anesthetic because of its properties of fast uptake and elimination at the lungs and of no effects on hepatic function. In this study we examined the effect of repeated sevoflurane anesthesia on hepatic function and immunological system. METHODS: Eight patients (ASA, PS 2 or 3) received sevoflurane anesthesia three times in 6 months. Six patients had emergency operation for injuries. Aspirate transaminase (AST), alanine transaminase (ALT) and complements (CH50, C3, C4) were measured prior to anesthesia, and 1, 7 and 14 days after anesthesia. RESULTS: The values of AST and ALT were high prior to anesthesia at the first anesthesia. However, these were of no significant changes. CH50, C3, C4 increased significantly after the first anesthesia. However, there were no significant changes of these complements after the second and the third anesthesia. CONCLUSIONS: Our results suggest that sevoflurane is not likely to provide adverse effects on the liver and to suppress the production of complements accompanied by the surgical stress.