Formation of NV centers in diamond by a femtosecond laser single pulse.

The NV centers in a diamond were successfully created by the femtosecond laser single pulse. We also investigated the effect on the diamond lattice induced by the different laser pulse widths from both experimental and theoretical perspectives. Interestingly, in spite of the high thermal conductivity of a diamond, we found that there is a suitable pulse repetition rate of several tens kHz for the formation of NV center ensembles by the femtosecond laser pulse irradiation.

[Off-pump coronary artery bypasssurgery in patients with mitral regurgitation].

Introduction of off-pump coronary artery bypass grafting (off-pump CABG : OPCAB) makes it possible to shorten the bypass time and cardiac arrest time in patients with both ischemic heart disease and valvular disease. This may be beneficial in patients with poor cardiac function and renal dysfunction. However, it is unclear whether such patients can tolerate the changes of hemodynamics during vertical displacement of the heart. In 3 patients who had ischemic heart disease with non-ischemic mitral regurgitation, we performed OPCAB prior to mitral valve plasty. The changes of mitral regurgitation observed by transesophageal echocardiography and several hemodynamic parameters were monitored as the heart was moved to various positions during OPCAB. When a heart positioner (Starfish) was used, hemodynamic deterioration was not observed, and there was also no aggravation of mitral regurgitation. Based on these results, we conclude that it may be possible to carry out OPCAB safely in patients with associated mitral regurgitation.

Evidence for kappa 1 opioid receptor multiplicity in the guinea pig cerebellum.

Both [3H]U69,593 alone and [3H]ethylketocyclazocine (EKC) in the presence of mu and delta blockers ([D-Ala2,MePhe4,Glyol5]enkephalin (DAMGO) and [D-Pen2,D-Pen5]enkephalin (DPDPE)) label kappa receptors in the guinea pig cerebellum. Dynorphin A(1-17) and nor-binaltorphimine (nor-BNI) potently competed the binding of both radioligands with Hill coefficients of approximately unity, strongly supporting a kappa classification of binding. However, saturation studies revealed that the Bmax for [3H]EKC binding was 45% greater than that for [3H]U69593, suggesting that [3H]EKC might be labeling more than one site. Although nonlinear regression analysis of dynorphin A(1-17) and nor-BNI competition of [3H]EKC binding best fit the curves with a one site model, competitions by dynorphin B, dynorphin A(1-9) and alpha-neoendorphin revealed Hill coefficients less than unity and were best fit to a two site model. Kinetic analysis also supported [3H]EKC binding heterogeneity. Together, these studies imply that under these conditions [3H]EKC labels more than one site in the guinea pig cerebellum. The sensitivity of all specific [3H]EKC binding to the selective kappa ligands dynorphin A(1-17) and nor-BNI indicates that both component are kappa while the differing sensitivities of dynorphin B, alpha-neoendorphin and dynorphin A(1-9) for these components support our previous hypothesis of kappa 1a and kappa 1b binding subtypes.

Effects of pentazocine and other opioids on the potassium-evoked release of [3H]noradrenaline from guinea pig cortical slices.

Noradrenaline release and its modulation via presynaptic opioid receptors were examined in guinea pig cortical slices. Slices preloaded with [3H]noradrenaline were superfused in the presence of desipramine (1 microM) and were stimulated by 16 mM K+. 1-Pentazocine inhibited the K+-evoked release of [3H]noradrenaline in a dose-dependent manner (3 x 10(-7)-10(-5) M), while d-pentazocine did not inhibit. This inhibitory effect of 1-pentazocine was antagonized by Mr 2266 (10(-6) M) but not by naloxone (10(-6) M). Among other opioids, dynorphin A-(1-13) and ethylketocyclazocine (kappa agonists) decreased the K+-evoked release of [3H]noradrenaline. Tyr-D-Ala-Gly-NMe-Phe-Gly-ol (DAGO, mu agonist) also inhibited [3H]noradrenaline release but was less potent than the kappa agonists. [D-Pen2,D-Pen5]enkephalin (DPDPE, delta agonist) and phencyclidine (sigma agonist) had no effects on the stimulated release of [3H]noradrenaline. Thus, it was shown that kappa receptors are the major subtype of opioid receptor involved in modulation of noradrenaline release in guinea pig cortex, and that 1-pentazocine inhibits the K+-evoked release of noradrenaline through activation of these receptors.

Stereospecific effects of d- and l-pentazocine on contractions of the mouse vas deferens.

The effects of the d- and l-isomers of pentazocine were compared to that of racemic pentazocine on contractions of the mouse isolated vas deferens. L-pentazocine inhibited electrically evoked contractions of the mouse vas deferens (MVD) in a dose-dependent manner (ID50 0.37 +/- 0.04 microM). In contrast, d-pentazocine augmented field stimulated contractions dose-dependently; per cent increases in contractions at 10 and 30 microM were 57.8 +/- 18.0 and 98.0 +/- 15.1%, respectively. Racemic pentazocine produced an intermediate effect between the two isomers. The effect of 1-pentazocine was antagonized by naloxone, whereas that of d-pentazocine was not. L-pentazocine did not effect the response of the MVD to exogenous norepinephrine at any concentration tested, while d-pentazocine depressed the response of the MVD to exogenous norepinephrine at one dose (0.3 microM). These findings demonstrate that d- and l-pentazocine produce opposite effects on the MVD. The effects of l-pentazocine are opioid mediated, while those of d-pentazocine are not. In the racemic mixture the opposing effects of the two isomers modulate each other, resulting in a diminished effect.

Pentazocine-induced catecholamine efflux from the dog perfused adrenals.

This study has been undertaken to determine whether pentazocine induces catecholamine efflux from the adrenal medulla as a mechanism for its sympathomimetic effect. Dog isolated adrenals were perfused retrogradely with modified Locke's solution. The efflux of catecholamines from dog perfused adrenals was increased from the resting output of 0.18 +/- 0.04 micrograms min-1 (mean +/- s.e.), to 0.47 +/- 0.13 micrograms min-1 by the administration of pentazocine (50 microM). The pentazocine-induced catecholamine efflux was dose-dependent in the 50-400 microM dose range. This effect of pentazocine was not inhibited by either a combination of atropine and (+)-tubocurarine, or verapamil, in contrast to acetylcholine-induced catecholamine release. There was no significant difference in potency among stereoisomers, i.e. (+)-, (-)- and (+/-)-pentazocine, in inducing catecholamine efflux. Naloxone did not influence the effects of either (+)- or (-)-pentazocine. The interaction of pentazocine with acetylcholine-induced catecholamine release was also examined. Both (+)- and (-)-pentazocine inhibited acetylcholine-induced catecholamine release dose-dependently, and these inhibitory effects were not reversed by naloxone. Acetylcholine-induced catecholamine release was accompanied by increased dopamine-beta-hydroxylase release, whereas pentazocine-induced catecholamine efflux was not. These results suggest that pentazocine directly acts on the adrenal medulla to induce catecholamine efflux via a non-exocytotic mechanism, and that opioid receptors do not play a role in this action.

[Perioperative management of a neonate with aglossia-adactylia syndrome].

Aglossia-adactylia syndrome is a rare disorder characterized by aglossia and deformity of the limbs of variable degree. We managed a 2-day-old neonate with ileojejunal atresia with aglossia-adactylia syndrome. He was scheduled for the repair of the intestinal atresia, gastrostomy and palatal impression taking, under general anesthesia with sevoflurane supplemented with fentanyl. In this case we could achieve tracheal intubation by direct laryngoscopy with cricoid pressure applied, and could manage without any complications. But many of the patients with this syndrome are complicated with cleft palate and micrognathia, and we should be careful of the difficult airway at the induction of general anesthesia and aspiration during perioperative period.

[Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia].

We compared recovery characteristics of propofol anesthesia with those of sevoflurane anesthesia in pediatric outpatients. One hundred and four children, 3 months to 6 years of age, ASA physical status 1 or 2, were randomly assigned to following four groups; sevoflurane (group S), propofol (group P), sevoflurane with premedication (group MS), or propofol with premedication (group MP). Midazolam 0.5 mg.kg-1 and famotidine 1 mg.kg-1 were administered orally 30 min before the induction in the MS and MP group. Recovery from anesthesia, agitation, and postoperative pain were evaluated. The time intervals from the end of surgery to extubation and to discharge from the hospital were recorded. The incidence of vomiting and use of analgesic drugs were also checked. The emergence from anesthesia was slower with propofol anesthesia than with sevoflurane anesthesia, but the time to discharge from the hospital was not significantly different among the four groups. Incidence of agitation was higher in S group compared with P group, but there were no differences between MS and MP. Postoperative pain was similar among the four groups. There were no differences in the incidence of vomiting. Propofol anesthesia provided slower emergence and less agitation compared with sevoflurane anesthesia.

[Perioperative management of a child with congenital nephrogenic diabetes insipidus].

The key point in perioperative management of a patient with congenital nephrogenic diabetes insipidus is fluid and electrolytes management. Since the urine of these patients consists mainly of solute free water, replacement fluids should be fluids which provide free water. A 2-year-old girl with congenital nephrogenic diabetes insipidus was scheduled for dental extraction. Her daily fluid intake was 10 liter. She had a history of recurrent fever, polyuria and polydipsia since 2 months of age. Her previous perioperative course for gastric volvulus at another hospital was complicated with postoperative hyponatremia and convulsion. A venous line was secured the day before surgery and 5% dextrose in water was infused at a rate of 12 ml.kg-1.hr-1. Intraoperative infusion was mainly with 5% dextrose in water combined with maintenance fluid. Five hours after surgery oral intake was started. Her intraoperative electrolytes levels were low (Na 133 mEq.l-1, K 2.8 mEq.l-1), but otherwise her perioperative course was uneventful.

[Anesthetic management for the correction of pectus excavatum using pectus bar under video-assistance].

We report anesthetic management for a child undergoing Nuss operation, a minimally invasive operation which requires neither cartilage incision nor its resection for correction of pectus excavatum. The patient was a 7-year-old boy with the funnel index 5 and the mediastinal shift to the left. General anesthesia with endotracheal intubation was induced and maintained with nitrous oxide, sevoflurane and fentanyl. Thoracic epidural anesthesia was used with 0.125% bupivacaine to supplement analgesia. When the curved bar was passed under the sternum with the aid of an endoscope, sinus tachycardia occurred and continued for 5 minutes but subsided without medication. Otherwise operative course was uneventful with negligible blood loss. After surgery, the patient was kept at bed rest for 2 days, receiving epidural patient-controlled analgesia combined with sedation with midazolam with good results. He was allowed to sit 3 days, to walk 5 days and discharged 10 days postoperatively.

[Anesthetic management involving difficult intubation in a child with Gaucher disease].

Gaucher disease is the most common of the glycolipid storage disorders caused by the deficiency of glucocerebrosidase, an enzyme which hydrolyzes glucocerebroside to glucose and ceramide. Accumulation of the substrate leads to multiorgan dysfunction involving the brain, spleen, liver, lymph node and bone marrow. In anesthetic management, gastroesophageal reflux leading to recurrent aspiration, pancytopenia and airway difficulties due to trismus, neck extension and upper airway infiltration with glucocerebroside must be considered. We report a case of a 9-year-old boy presenting developmental delay, mild pancytopenia, splenomegary gastroesophageal reflux. He was scheduled for measurement of intra-esophageal pressure, total splenectomy and Nissen fundoplication. Preoperative examination showed trismus and opisthotonic posturing. We predicted difficult airway maintenance and assessed his airway with airway radiograph. Airway narrowing was not shown. For this difficult airway, we made a special mask that has an introducer port for fiberbronchoscope. For the first time, we tried to insert a laryngeal mask, but the insertion was difficult due to trismus and narrowed oral cavity. Then, we used this special mask for the next time. Tracheal intubation was much safer by using this mask for fiberoptic intubation. In Gaucher disease, preoperative assessment of airway difficulties and preparation for this situation are necessary and anesthesiologist must be concerned about aspiration and airway difficulties.

[Anesthetic management for newborn pharyngeal teratoma].

Epignathus (pharyngeal teratoma) is a rare disease of newborns associated with a high mortality secondary to airway obstruction in the neonatal period. We report anesthetic management of a newborn with epignathus who underwent tumor resection. He was delivered vaginally at 39 weeks of gestation and Apgar scores were 9 at 1 and 5 min. The tumor originated from the palate, almost filled the oral cavity and protruded through the mouth with its external part 6 x 7 cm in size. He could breathe with the head and mass turned to the left. The excision of the tumor was scheduled on the fifth day of life. Mask ventilation and laryngoscopy were considered impossible. Fiberoptic nasal intubation was successfully performed with topical anesthesia without sedation. Tumor was resected with blood loss of 103 gm. The trachea was extubated on the third postoperative day and the postoperative course was uneventful. For safe management of cases of pharyngeal teratoma, careful preoperative assessment of the airway is most important and sufficient preparation and careful intubation are mandatory to keep airway patent. The perioperative bleeding from the tumor and the airway obstruction by the tumor or its remnant after the excision could also be hazardous to the airway.

[A new bite block also serving as an endotracheal tube holder for infants].

We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. The rolled ends were diagonally cut to make an oblique slit of 3 mm width. A t-shaped flange made of soft vinyl plate was fixed at a third of the length of the roll to maintain the block's position relative to the lips and to make the fixation of the tube easier. In practical use, after endotracheal intubation is performed as usual, this bite block is put into the mouth and positioned at the oral angle with the flange on the patient's skin. The ETT is fit into the slit of the roll. The skin-facing surface of the flange is pasted to the skin with the double stick material usually used for colostomy stoma. The ETT and the bite block are fixed en bloc with fixing tapes around the mouth. Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.

[Congenital ventricular diverticulum in a neonate: anesthetic considerations].

Congenital diverticulum of the ventricle is a rare cardiac malformation and the reports of its surgical repair are scarce. We experienced anesthesia for a neonate with an isolated congenital left ventricular diverticulum diagnosed in utero. A male infant presented with ventricular arrhythmias and congestive heart failure. At 9 days of life the resection of the diverticulum was performed under moderately hypothermic cardio-pulmonary bypass (CPB) Major anesthetic considerations include the possible life-threatening arrhythmias, cardiac failure due to diverticulum and cardiac dysfunction after resection. Premature ventricular contractions were noted before CPB but greatly decreased under anesthesia. The operation was performed safely and arrhythmias disappeared completely after resection. Intra- and post-operative course was uneventful without any sign of cardiac dysfunction.

[Anesthesia and perioperative management in infants with Chiari type II malformation].

From July 1991 to June 1997. 15 neonates with Chiari type II malformation were treated at our institution. Four of them required posterior fossa decompression and cervical laminectomy for hindbrain decompression. We report anesthesia and postoperative management in these four patients. They had a fetal diagnosis of hydrocephalus and was delivered by caesarean section. They underwent Ommaya reservoir placement for drainage and repair of myelomeningocele in the neonatal period. They developed respiratory depression as apneic spells or retraction with or without swallowing difficulties and underwent posterior fossa decompression and cervical laminectomy at 20-87 days of life. One patient died of asthma at the age of 2 years and 8 days and others are doing well. Patients with this malformation may develop respiratory depression such as apneic spells and vocal cord paralysis even if the intracranial pressure is well controlled and they should be monitored carefully for the signs of apnea and the compromised airway.

[FIO2 and SpO2 during cardiac surgery in neonates and infants].

Fractional inspired oxygen (FIO2) applied before and after a repair or palliative procedure for cardiac defects along with SpO2 measured by pulse oximeter were reviewed from anesthetic records of 62 neonates and infants. Fentanyl was used for anesthesia, except in cases without i.v. route in which sevoflurane with nitrous oxide in oxygen was used for induction of anesthesia. FIO2 was adjusted using air and oxygen. The lower FIO2 was applied to the patients for a closure of ventricular septal defect, a reconstruction of coarctation or interrupted aortic arch, and pulmonary artery banding, while the higher FIO2 was used for systemic-to-pulmonary artery shunts and the repair of tetralogy of Fallot. In the congenital heart disease with the intracardiac shunt, the magnitude of the shunt flow and hemodynamics can be altered by changing systemic and pulmonary vascular resistance which could be induced by various ways. Since alveolar oxygen tension is a known determinant of pulmonary vascular resistance, an appropriate FIO2 should be applied to each patient with different pathophysiology. A low FIO2 should be set for the cases with nonrestrictive left-to-right shunting, since a high FIO2 may cause a torrential pulmonary blood flow. A high FIO2 is preferable for the cases with right-to-left shunting and a concomitant decreased pulmonary blood flow.

[The anesthetic management of cesarean section for multiple pregnant patients].

Anesthetic management of cesarean section for twenty multiple pregnant patients, who were pregnant with triplet or quadruplet, was compared with that for 325 single pregnant patients and 21 twin pregnant patients. For anesthetic methods, spinal anesthesia was chosen most frequently in the multiple pregnant patients, as in single and twin (more than 75 percent). In multiple pregnant patients, the incidence of emergency operation was less. In multiple pregnant patients who received spinal anesthesia, gestational age was lower; birth weight was lighter; length of fundus uteri was longer; and blood loss including amniotic fluid was larger. In triplets, the third infants' UID-time was prolonged and their Apgar score was lower.

[Two pediatric cases of malignant hyperthermia caused by sevoflurane].

We experienced two cases of malignant hyperthermia (MH) triggered by sevoflurane. Case 1 was a six-year-old girl, 15.8 kg, undergoing strabismus repair. She had flat back, elevated diaphragm and high arched palate. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Her trachea was intubated without the use of muscle relaxant. Thirty minutes after the induction of anesthesia, ETco2 was over 60 mmHg despite hyperventilation. Muscle rigidity of legs and the rise in temperature were noted. MH was diagnosed and dantrolene i.v. was administered. Her maximum esophageal temperature was 40.2 degrees C. ETco2 and temperature returned to baseline values after dantrolene administration. Creatine phosphokinase (CK) level was 252 U.l-1 preoperatively, and 1690 U.l-1 next day. Case 2 was a year-and-9-month-old boy undergoing accessory ear resection. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen. His trachea was intubated with an aid of vecuronium. Forty minutes after administration of sevoflurane his temperature rose to 38.6 degrees C with heart rate 191 bpm and Spo2 93%, and muscle rigidity of legs. MH was diagnosed and dantrolene was administered. His highest temperature was 39.3 degrees C and was reduced promptly after dantrolene. Postoperatively he was noted to have downslanting palpebral fissures, micrognathia, low set ears, and a single crease of the fifth finger and diagnosed as King syndrome which is reported to have association with MH. Both patients had no history of anesthesia nor abnormal family history. Both of them were rescued with dantrolene and recovered without sequelae.

[An extremely low birth weight infant with pulmonary atresia complicated with necrotizing enterocolitis].

We experienced an extremely low birth weight (ELBW) infant complicated with pulmonary atresia and necrotizing enterocolitis. She was born at 25 weeks of gestation with a birth weight of 752 g. Five hours after birth, she manifested cyanosis and was diagnosed as having pulmonary atresia with intact ventricular septum (PAIVS). Infusion of lipo-prostaglandin E1 (PGE1) was started to keep the ductus open along with infusion of dopamine and dobutamine. At 8 days of life she developed hypotension and metabolic acidosis, and the diagnosis of intestinal perforation was made by free air in the abdomen. The excessive shunt flow to the pulmonary vasculature via the ductus was suspected to have caused an inadequate systemic flow leading to the intestinal ischemia and necrotizing enterocolitis. Lipo-PGE1 was discontinued to decrease the shunt flow through the ductus. Brock's operation (closed transventricular pulmonary valvotomy) was performed at the age of 8 and 11 days and the ligation of the ductus arteriosus was performed at the age of 13 days. Propranolol was administered to inhibit the pulmonary outflow tract constriction along with catecholamines to stabilize hemodynamics. She recovered slowly and her trachea was extubated at 58 days of life.

[Perioperative management of twins with prenatally diagnosed congenital diaphragmatic hernia].

Congenital Diaphragmatic Hernia (CDH) occurs in one of every 2000-3000 births, and most of them are sporadic, and therefore recognized as a circumstantial event. But its occurrence in 85 children among the 40 families is also reported, and some reports suggest that an autosomal recessive gene may be responsible for this disease. We experienced identical twins (babies A and B) both with prenatally diagnosed CDH. They were delivered by emergent cesarean section at 33 weeks of gestation with birth weight of 1857 g and 1561 g, respectively. They were intubated immediately after birth, and ventilated with high frequency oscillation. Baby A presented persistent pulmonary hypertension of newborn, and received nitric oxide inhalation. At the age of 2 days, both of them were stabilized and underwent repair of CDH. After the repair, baby A developed perforation of ileum, airway bleeding and retinopathy of prematurity (ROP), and needed 28 days before extubation. Baby B also developed ROP, but had no other problem, and the trachea was extubated at the age of 12 days. They are the seventh pair reported in the world literature.