Effects of sevoflurane on collagen production and growth factor expression in rats with an excision wound.

BACKGROUND: Sevoflurane is a widely used inhalation anesthetic, but there are no studies on its effect on the wound-healing process. This study was undertaken to evaluate the effect of exposure time to sevoflurane on wound healing. METHOD: Male Sprague-Dawley rats were used. Two circular full-thickness skin defects 8 mm in diameter were made on the dorsum of the rats. The animals were divided into six groups according to exposed gas type and time: S1 (sevoflurane, 1 h), S4 (sevoflurane, 4 h), S8 (sevoflurane, 8 h), O1 (oxygen, 1 h), O4 (oxygen, 4 h), and O8 (oxygen, 8 h). The surface area of the wounds was measured 0, 1, 3, and 7 days after surgery. Separately, the mean blood pressures (MBP) and arterial oxygen pressures (PaO(2)) were monitored during the sevoflurane exposure. Collagen type I production and transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) expression on the wound surface were analyzed. Routine histological analysis was also performed. RESULT: Exposure duration to sevoflurane had no influence on MBP and PaO(2). The reduction in wound size and collagen type I production was delayed in S8. The expression of TGF-beta1 and bFGF on the wound surface in S8 was significantly attenuated in S8. The histology of the S8 demonstrated a delayed healing status. CONCLUSIONS: Prolonged exposure to sevoflurane might alter the inflammatory phase of the wound-healing process by attenuation of growth factor expression such as TGF-beta1 and bFGF and subsequently by reduced collagen production.

Preoperatively administered ramosetron oral disintegrating tablets for preventing nausea and vomiting associated with patient-controlled analgesia in breast cancer patients.

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the acceptability and therapeutic efficacy of a preoperative single administration of long-acting 5-hydroxytryptamine type 3 (5-HT 3) receptor antagonist in an orally disintegrating tablet formulation, ramosetron, in breast cancer patients. METHODS: Two hundred and forty women, ASA I-II, aged 24-60 yr, undergoing elective breast cancer surgery, were randomized. A standardized anaesthetic technique was used. Patients were assigned to receive one of three treatment regimens (n = 80 in each group): no prophylactic antiemetics (Group A), single prophylactic intravenous injection of ramosetron 0.1 mg at the completion of surgery (Group B) or preoperatively oral administration of 0.1 mg of ramosetron (Group C). Episodes of nausea and vomiting, the use of rescue antiemetic treatment, degree of pain, adverse events and level of satisfaction were recorded. RESULTS: The overall incidence of nausea and vomiting during the first 24 h after the recovery in Groups B (27.8%) and C (25%) was decreased significantly compared with Group A (75.3%). The frequency of the use of rescue antiemetics was significantly lower in Group C (5.0%) compared with Groups A (53.2%) and B (15.2%). The patients in Group C were more satisfied with control of postoperative nausea and vomiting than others. CONCLUSION: Preoperative oral administration of ramosetron at a dose of 0.1 mg is an acceptable and effective way of reducing the incidence of postoperative nausea and vomiting in breast cancer patients.

Critical care in Japan and Korea. The market of excellence.

Medical services in general are well advanced in Japan and Korea. However, intensive and critical care medicine is still on its way to further developments. One particular problem in both countries is the shortage of positions for intensive care physicians and nurses. Although they are well equipped with therapeutic and monitoring devices, there are a limited number of ICU beds. In Korea, the estimated number of ICUs is 122 or more. In Japan, the number of ICUs is estimated to be between 229 and 944.