Sevoflurane in combination with propofol, not thiopental, induces a more robust neuroapoptosis than sevoflurane alone in the neonatal mouse brain.

PURPOSE: Sevoflurane is the most widely used volatile anesthetic of general anesthesia. In children and neonates, it is commonly used alone or in combination with thiopental or propofol. A few recent studies reported that sevoflurane induced neuronal death in the developing rodent brain. We measured the neurotoxicity of these anesthetics at clinical doses, alone and in combination, in the developing mouse brain. METHODS: Seven-day-old C57BL/6 mice were randomly assigned to 6 treatment groups. Three groups were exposed to 3% sevoflurane for 6 h after injection of saline, thiopental (5 mg/kg), or propofol (10 mg/kg), whereas three groups were exposed to room air for 6 h after injection of equal doses of saline, thiopental, or propofol. Apoptosis in the hippocampal CA1 region (CA1) and retrosplenial cortex (RC) was assessed using caspase-3 immunostaining. RESULTS: Sevoflurane alone caused significantly higher apoptosis in the CA1 compared with saline plus air (P = 0.04). Sevoflurane in combination with propofol resulted in significantly greater numbers of apoptotic neurons than sevoflurane alone in both the CA1 and the RC (P = 0.04). However, there was no significant difference in apoptotic neuron density in both the regions between the groups treated with sevoflurane alone and in combination with thiopental (P = 0.683). CONCLUSION: Sevoflurane alone can induce neuronal apoptosis, and this effect is enhanced by propofol. Thiopental did not exacerbate the neurotoxicity of sevoflurane. There is the possibility that the combination of sevoflurane and propofol is a more harmful anesthetic technique than sevoflurane alone in pediatric patients.

[Two cases of diaphragmatic surgery in children under artificial pneumothorax].

We reported two cases of thoracoscopic diaphragm repair in children. The first case was a 6-day old neonate undergoing thoracoscopic repair of congenital diaphragmatic hernia under general anesthesia. During operation, CO2 was insufflated with a pressure of 4 cmH2O into the thoracic cavity. Although end-tidal CO2 increased to 90 mmHg, Sp(O2) and blood pressure were maintained within normal ranges. The second case was a 20-month-old infant undergoing thoracoscopic repair of diaphragmatic laxity. During operation, end-tidal CO2 increased to around 50 mmHg. Sp(O2) and blood pressure were normal. But during the procedure, insufflation pressure increased up to 10 cmH2O accidentally and arterial blood pressure curve disappeared. Insufflation pressure was corrected quickly and the arterial blood pressure recovered to normal within 10 seconds. The physiological changes of CO2 insufflation in thoracic cavity is similar to tension pneumothorax and we must take care to keep insufflation pressure under 4 cmH2O.

Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion.

Upper airway obstruction resulting from overflexion fixation of the cervical spine is a rare but life-threatening complication after cervical spine surgery. There are few reports of dyspnea after a posterior cervical fusion. We present the case of a 63-year-old woman with rheumatoid arthritis who developed an upper airway obstruction immediately after an O-C4 fusion. She was reintubated with a fiberoptic scope. Revision surgery allowing the angle to return to the neutral position was performed to ameliorate the overflexion of the cervical spine fixation and the consequent upper airway obstruction. After revision surgery, the upper airway obstruction disappeared. Our experience suggests that intraoperative use of fluoroscopy and extubation with a tube exchanger are recommended to avoid this complication, especially in patients at high risk of upper airway obstruction.

Acute massive pulmonary embolism treated by urgent pulmonary embolectomy: A case report.

The management of acute massive pulmonary embolism presents a clinical challenge as currently there is no consensus for definitive treatment. Early decision-making regarding surgical intervention is essential when the risk of mortality is high.

Anesthetic management of a neonate with type IV laryngotracheo-esophageal cleft.

Laryngotracheo-esophageal cleft is a rare congenital anomaly that occurs when the trachea and esophagus fail to separate during fetal development. Clinical severity varies greatly in anatomic cleft extent. We report the successful management of the airway of a neonate with type IV laryngotracheo-esophageal cleft for the gastric division surgery by dividing the esophagogastric continuity between the esophageal orifice and the stomach using the balloon catheter and remaining spontaneous breathing through the large cuffed tracheal tube inserted into the esophageal orifice.

Intraoperative diagnosis of an unsuspected ruptured left ventricular aneurysm using transesophageal echocardiography: A case report.

Transesophageal echocardiography (TEE) enables a more accurate visualization of left ventricular posterior aneurysms than transthoracic echocardiography due to the close proximity of the esophagus to the posterior ventricular wall. Therefore, TEE is essential for the accurate diagnosis of posterior aneurysm, particularly in urgent settings where preoperative assessments may be insufficient.