[Intraoperative assessment of cardiac function with transesophageal echocardiography during the Batista operation].

We experienced anesthetic management for six cases of the Batista operation and measured cardiac function before and after cardiopulmonary bypass (CPB) with transesophageal echocardiography. In the successful three patients, left ventricle ejection fraction and ejection time were maintained over 25% and 200 msec after CPB, respectively. In the other three resulting in implantation of left ventricular assist device, ejection fraction remained below 20% and ejection time under 200 msec after CPB. Intraoperative transesophageal echocardiography may be useful not only for monitoring of cardiac function but also for the prediction of prognosis.

[Neuraxial blockade using image intensifier in patients after spinal instrumentation].

There is scant information in the literature regarding central neuraxial blockade in patients with previous back surgery or severe kyphoscoliosis. This report describes a 58-year-old female and an 84-year-old female with spinal instrumentation who presented for orthopedic surgery under neuraxial blockade. In both cases, multiple attempts of needle insertion using standard technique were unsuccessful, whereas spinal combined with epidural anesthesia was performed successfully using image intensifier. The anatomical considerations and difficulties in achieving reliable neuraxial blockade after spinal instrumentation are reviewed. Neuraxial blockade using image intensifier may provide less technical difficulty and a more reliable result in such patients.

Does adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery?

The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. Patients were randomly divided into two groups to receive a postoperative epidural infusion of fentanyl 5 micrograms/ml in bupivacaine 0.2%, with or without adrenaline 5 micrograms/ml, at a rate of 2 ml/h for more than 48 hours. Postoperative pain relief was assessed using visual analog scales (VAS), both at rest and during coughing, at 2, 24, and 48 hours after surgery. The number of rescue analgesics and side-effects such as nausea, vomiting, pruritus, respiratory depression, headache, muscle weakness, and hypotension were recorded. Patients who received adrenaline (n = 40) reported significantly lower mean VAS scores than those who received no adrenaline (n = 37), both at rest at 24 hours postoperatively and during coughing at 24 and 48 hours. The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.

The assessment of dermatomal level of surgical anesthesia after spinal tetracaine.

UNLABELLED: Transcutaneous electrical stimulation (TES), a 60-mA, 50-Hz continuous square wave, has been considered equivalent to surgical incision. We examined whether TES at a smaller current (10 mA) can be used to predict surgical anesthesia and compare the results with sensory block to cold, pinprick, and touch after the administration of spinal tetracaine. Two groups of 40 consecutive patients, 17-69 yr old and 70 yr old or older received a subarachnoid injection of 0. 5% tetracaine in 10% glucose or saline according to the type of surgery. Patients undergoing abdominal surgery received glucose solution, and those scheduled for lower extremities surgery received saline solution, and thus, the resultant four groups of patients were studied. Neural block was assessed by the loss of sensation to cold, pinprick, touch, and TES at 10 mA (T10s), and tolerance (i.e., the loss of pain or discomfort) to TES at 10 (T10p) and 60 (T60) mA. Dermatomal levels of sensory block to cold, pinprick, and touch that were cephalad to T60 varied widely. In contrast, dermatomal levels of T10s and T10p cephalad to T60 were less variable, and the difference between T10s and T60 was the smallest among all the differences in any groups. Our results demonstrate that, regardless of patient age and baricity of a local anesthetic solution, T10s is a good predictor of T60 equivalent to the dermatomal level of surgical anesthesia. IMPLICATIONS: Our results show that the loss of sensation to transcutaneous electrical stimulation at 10 mA, but not cold, pinprick, or touch, is a good predictor of the dermatomal level of block to transcutaneous electrical stimulation at 60 mA, which is considered equivalent to the dermatomal level of surgical anesthesia after the administration of spinal anesthesia.