Activation of alveolar phospholipase A2 after hydrochloric acid aspiration in rats.

PURPOSE: The present study was carried out to determine phospholipase A2 (PLA2) activity in the bronchoalveolar lavage fluid (BALF) in rats subjected to HCI aspiration. MATERIALS AND METHODS: Rats were allocated into one of five groups. Groups H-1 and H-3 received instillation of HCI into lungs. Groups S-1 and S-3 received saline instead of HCI. Group C received no instillation. BAL was performed according to the protocol, that is, 1 hour after the instillation in groups H-1 and S-1, 3 hours after the instillation in groups H-3 and S-3, and arbitrarily in group C. Obtain BALF was analyzed for the protein concentration, PLA2 activity, and the molecular mass of PLA2. RESULTS: The protein concentration in BALF showed an increase in groups H-1 and H-3. PLA2 activity decreased in group H-1, but increased in group H-3, compared with groups S-1 and S-3, respectively. PLA2 in groups C and H-1 revealed a high molecular mass (HM), but that in group H-3 revealed a low molecular mass (LM). CONCLUSIONS: There is an increase in the alveolar LM-PLA2 at inflammatory phase after HCI aspiration, suggesting the pathophysiologic role of LM-PLA2 in the acute lung injury.

[Postoperative recurrent laryngeal nerve palsy following a transesophageal echocardiography].

The postoperative recurrent laryngeal nerve palsy (RLNP) following transesophageal echocardiography (TEE) was retrospectively evaluated in 175 adult patients after cardiac surgery. The incidence of RLNP was not significantly different between TEE group and non TEE group, but the incidence in female TEE group was higher than that in female non TEE group. The mechanism of RLNP following TEE as well as the insertion of nasogastric tube may be compression injuries of the branches of the posterior division of the recurrent laryngeal nerves. The incidence of RLNP in female TEE group was higher because of the narrow female larynx. TEE is a useful monitor during cardiac surgery, but we must be careful about RLNP following TEE.

Phospholipase A2 is activated in the kidney, but not in the liver during ischemia-reperfusion.

Phospholipase A2 (PLA2) has been demonstrated to play an important role in the reperfusion injury of the kidney, gut, brain, heart and pancreas. This study was carried out to clarify whether PLA2 was involved in the ischemia-reperfusion injury of the liver. Rats were anesthetized and underwent laparotomy. They were allocated into one of 4 groups, i.e., the groups of renal ischemia (group RI), renal control (group RC), hepatic ischemia (group HI), and hepatic control (group HC). In group RI, the left renal pedicle was occluded for 1 hr, and the left kidney was removed after 1-hr reperfusion. In group HI, the portal and the hepatic artery supplying the left and middle lobes were clamped for 1 hr, followed by reperfusion. After predetermined periods of reperfusion up to 24 hr, the ischemic lobes were removed, homogenized and centrifuged. PLA2 activities in the mitochondrial fraction and the cytosolic fraction were measured with 14C-phosphatidylcholine (PC) and 14C-phosphatidylethanolamine (PE) as exogenous substrates. PLA2 activities of the both fractions in the kidney were significantly enhanced after 1-hr ischemia followed by 1-hr reperfusion. However, there was no enhancement of PLA2 activity of the either fraction in the group HI compared with the group HC. The results indicate that PLA2 is activated in the kidney but not in the liver during ischemia-reperfusion.

[Gas chromatographic determination of residual ethylene oxide in the endotracheal tube].

An accurate and simplified method has been developed for determination of residual ethylene oxide (EO) in the endotracheal tube using gas chromatography with a head space sampler. The endotracheal tube made of polyvinyl chloride was sterilized with EO and aerated. Residual EO after aeration was 6630 +/- 1915 ppm (mean +/- SD). It decreased to 72 +/- 46 ppm on 7th day. The endotracheal tube should be left unused for more than 7 days after sterilization and aeration. The safety level of residual EO in the endotracheal tube by U.S.FDA regulation is less than 250 ppm. The concentration of residual EO should be lower than 250 ppm, if this rule is observed.

[The effect of nitroglycerin ointment on cardiovascular functions in hypertensive patients during emergence from anesthesia].

The present study was designed to investigate the effect of nitroglycerin (TNG) ointment to attenuate the cardiovascular response of hypertensive patients during emergence from anesthesia compared with the effects of TNG infusion and nifedipine instillation in the nose. In addition, plasma TNG concentration was measured in the TNG ointment group and TNG infusion group. TNG 30 mg in ointment reduced the arterial pressure during extubation without producing hypotension and tachycardia. There was no significant difference in plasma TNG concentration between TNG ointment group and TNG infusion group each receiving 0.3 micrograms.kg-1.min-1. The study suggests that TNG ointment is useful for regulation of arterial pressure in hypertensive patients during emergence from anesthesia.

Comparison of the effects of amrinone and dobutamine on hemodynamics and myocardial oxygen balance in dogs with experimental left ventricular failure.

The purpose of the present study was to induce left ventricular failure in anesthetized dogs by repeated ventricular fibrillation and then to determine if amrinone is effective in circulatory support by comparing the effects of amrinone and dobutamine. After the repetitive ventricular fibrillation, mean arterial pressure and stroke volume index decreased, pulmonary capillary wedge pressure (PCWP) increased, and acute left ventricular failure occurred. Thereafter, dogs were divided into the following four groups. In Group C (n = 6), normal saline was administered; in Group D (n = 6), dobutamine was administered at 7 micrograms/kg/min; and in Groups A40 (n = 6) and A80 (n = 7), amrinone was administered at 40 micrograms/kg/min and 80 micrograms/kg/min, respectively. Stroke volume index increased by 78% in Group D and 46% in both Groups A40 and A80. Pulmonary capillary wedge pressure decreased by 44% in Group A40 and 38% in Group A80, but remained unchanged in Group D. Similarly, total peripheral resistance decreased by 32% in Group A40, 29% in Group A80, but remained unchanged in Group D. These results suggest that amrinone increased cardiac output and decreased both preload and afterload. In the coronary circulation, both drugs caused direct coronary vasodilation since they increased myocardial oxygen supply in excess of the increase in myocardial oxygen demand. Neither drug produced signs of myocardial ischemia, as indicated by myocardial lactate metabolism. Amrinone should be a useful drug after open heart surgery, especially in cases where significant adverse effects of catecholamines occur or where a low-output state with increased preload and afterload exists.

[Anesthetic management of a patient with acromegaly complicated with hyperthyroidism].

A rare anesthetic experience of a 30-year-old woman with acromegaly complicated with Basedow's disease is reported. After the thyroid function was successfully controlled by drug therapy, resection of pituitary adenoma was performed under general anesthesia. Anesthesia was induced and maintained with NLA. No problem was observed during the operation and postoperative period. Careful attention should be paid to the management of circulation, respiration, metabolism and endocrinium through the perioperative period.