[Use of sugammadex in patients undergoing caesarean section using general anesthesia with rocuronium].

Recently, rocuronium is being used in patients for caesarean section undergoing general anesthesia instead of suxamethonium. An increased dose of rocuronium improves intubating conditions but prolongs neuromuscular blockade. Sugammadex reverses rapidly and predictably even profound rocuronium-induced neuromuscular blockade. We experienced 13 cases of caesarean section patients undergoing general anesthesia with thiopental (3.5 mg x kg(-1)) and rocuronium (0.9 mg x kg(-1)). At the end of surgery, sugammadex (2 mg x kg(-1)) was administered every 3 minutes repeatedly until TOF>0.9. In two patients, neuromuscular blockade spontaneously recovered to TOF>0.9 at the end of surgery. In most patients administered sugammadex, TOF recovered to more than 0.9 within a few minutes. However, in one patient who had chronic renal failure (creatinine clearance rate: 12 ml x min(-1)), 10 minutes were required for TOF to recover to more than 0.7, and TOF never reached 0.9. All patients were successfully intubated at the first attempt. No signs of recurarization or adverse effects related to sugammadex were noted in the perioperative period.

Sepsis is characterized by the increases in percentages of circulating CD4+CD25+ regulatory T cells and plasma levels of soluble CD25.

The function of immune system is to protect hosts from invading microorganisms by destroying infected cells while minimizing damage to tissues. Among immune cells, CD4(+)CD25(+) regulatory T cells (Treg cells) control immune responses by limiting infectious processes. However, it remains unclear whether Treg cells are induced in systemic inflammatory response syndrome (SIRS) or infectious SIRS (i.e. sepsis). SIRS and sepsis are associated with stressful inflammatory conditions. We therefore measured CD25(+) T cells and circulating CD4(+) T cells, along with plasma levels of CD25, interleukin (IL)-6, and IL-10, in 20 septic patients (64 +/- 11 years), 16 SIRS patients (59 +/- 16 years), and control subjects: 13 elderly (60 +/- 16 years) and 14 young volunteers (28 +/- 3 years). Septic patients (23.3 +/- 11.8%, p < 0.01) showed significantly higher percentages of CD25(+) cells among CD4(+) T cells (i.e. Treg cells) than did either young (10.6 +/- 3.7%) or elderly volunteers (11.1 +/- 3.8%). The percentages of Treg cells in septic patients were higher than those in SIRS patients (12.4 +/- 6.9%, p < 0.01). Moreover, plasma levels of soluble CD25 were significantly higher in septic patients, compared to the levels in SIRS patients or volunteers (p < 0.01). No significant difference in plasma levels of IL-6 or IL-10 was found between septic patients and SIRS patients. Thus, sepsis is associated with the increased percentages of Treg cells and elevated plasma level of soluble CD25. The elevation of these parameters might be a useful marker of infections in SIRS.

[Anesthetic management of concomitant off-pump coronary artery bypass grafting, pulmonary resection, and mastectomy].

Recently, an increasing number of patients with both ischemic heart disease and malignancy have underwent cardiac surgery and other operations simultaneously, as indication of off-pump coronary artery bypass grafting (OPCAB) has been expanded. A 66-year-old woman underwent OPCAB and other two operations for malignant diseases. General anesthesia was maintained by total intravenous infusion of propofol and fentanyl, and the patient's hemodynamics were kept stable throughout the operation under continuous administration of cardiotonics: dopamine, norepinephrine, and milrinone. The procedure for the operations was discussed in a conference with surgeons: 1. OPCAB 2. right middle and lower lobectomy and 3. right mastectomy. There were no postoperative complications.