[Anesthetic management using auto-transfusion and hypothermia for massive bleeding].

A 51-year-old woman was scheduled for emergency enterectomy and vascular repair under general anesthesia for active bleeding from internal iliac artery caused by repeated radiotherapy for cervical cancer and subsequent hypovolemic shock. For the first two hours of operation, the blood loss exceeded 6,000 ml and the hemoglobin level decreased to a low of 3.8 g x dl(-1) despite administration of 38 units of packed red cells. Intraoperative blood salvage was used in order to minimize further loss of hemoglobin. Mild hypothermia technique was also introduced to prevent brain ischemia. Total bleeding volume was approximately 10,000 ml, and total transfused volume was 8,740 ml. No neurological deficit and no systemic infection were found during the postoperative course. Although clinical risks of cell salvage in patients undergoing surgery for malignant tumor remain controversial, we conclude intraoperative blood salvage using Cell Saver could be utilized as a life-saving means and mild hypothermia might have been efficacious for protecting the brain from ischemia in our case.

[Anaphylactic reaction to epidural block in an outpatient].

A healthy 29-year-old woman received epidural block for severe lumbago in an outpatient clinic. Fifteen minutes after injection of mepivacaine 0.5% with dexamethasone into the epidural space, the patient complained of itching of eyelids followed by generalized pruritus. Hypotension, erythema and generalized urticaria were observed. Initial treatment was with 100% oxygen through face mask, and additional intravenous fluids, followed by administration of adrenaline, chlorpheniramine and dopamine. Cardiac ultrasound examination showed mildly impaired movement of inferior to septal wall. Her plasma histamine level was transiently elevated during the anaphylactic event; however the serum tryptase level was not. Biological assays for confirming the causative agent and cutaneous test were all negative, but clinical symptoms positivity showed nonimmunological anaphylactic reaction to mepivacaine or dexamethasone. This case report confirms the need for systematic allergological investigation in a case of immediate hypersensitivity reaction occurring during nerve block in patients who had even received similar nerve blocks repeatedly. Pain clinician should be aware of the possibility of anaphylactic reactions involving any drug or substance used for an outpatient.

[Assessment of the quality of the newly developed rapid oscillometric blood pressure measurement].

BACKGROUND: The purpose of this study is to examine the accuracy of the Fukuda Denshi DS-7000 noninvasive blood pressure measurement device equipped with two cuff deflation mode: a normal mode and quick mode. METHODS: Twenty-one patients undergoing elective surgery were divided into two groups by using cardio-ankle vascular index (CAVI): no atherosclerotic group and atherosclerotic group. During anesthesia, two modes of blood pressure measurements were examined with the normal mode followed by the quick mode. RESULTS: All the patients completed the study, resulting in a total of 1034 paired blood pressure measurements. In both no atherosclerotic group and atherosclerotic group, there were statistically significant correlations among systolic, diastolic and mean blood pressure in two modes. This results certified the accuracy of the quick mode measurement. CONCLUSIONS: The newly developed rapid oscillometric blood pressure measurement can be useful for perioperative management especially in atherosclerotic patients.

[Successful control of rapid heart rate in a patient with atrial fibrillation by continuous intravenous administration of landiolol hydrochloride].

A 79-year-old man with atrial fibrillation underwent total pharyngolaryngectomy and free flap reconstruction for hypolaryngeal cancer under general anesthesia. He developed tachyarrhythmia with ST depression and inverted T wave. The treatment including sufficient fluid therapy, continuous administration of vasodilator and intravenous digoxin failed to control the abnormalities. Then landiolol hydrochloride, a new cardioselective ultra-short acting beta-blocker, was continuously administered. Despite the relatively low doses with 1 min loading infusion at 0.04 mg.kg-1.min-1 and continuous infusion at 0.016 mg.kg1.min-1, rapid control of heart rate occurred in a few minutes and inverted T waves were normalized in fifteen minutes. There was no significant change of peripheral blood pressure. The present case suggests that landiolol hydrochloride is effective in controlling heart rate in a patient with atrial fibrillation and that the optimal dose should be carefully evaluated for each case.

[A novel whole blood aggregometer].

We examined ADP-induced platelet aggregability in 45 patients by novel whole blood aggregometer based on the screen filtration pressure method. Platelet aggregation could be easily and immediately checked without preparing platelet rich plasma. This aggregometer was useful for determination of anesthetic methods for a patient with an anti-platelet therapy. However, PATI (platelet aggregately threshold index) demonstrated the lowest value 5 minutes after blood collection and the valve was stabilized at higher level for 30 to 120 minutes. Time-dependent change should be considered for assessment of platelet aggregability in a clinical study.