In Vivo Real-Time Monitoring System Using Probe Electrospray Ionization/Tandem Mass Spectrometry for Metabolites in Mouse Brain.

Recent improvements in ambient ionization techniques combined with mass spectrometry has enabled to achieve real-time monitoring of analytes of interest, even for biogenic molecules in living animals. Here, we demonstrate a newly developed system for in vivo real-time monitoring of metabolites in a living mouse brain. It consists of a semiautomated manipulation system and a unique probe electrospray ionization unit, which uses an extremely thin solid needle (tip dia.: 700 nm) for direct sampling and ionization, coupled to a conventional tandem mass spectrometer. The system successfully monitored 8 cerebrum metabolites related to central energy metabolism in an isoflurane-anesthetized mouse in real time with a 20 s interval. Moreover, our system succeeded in capturing dynamics of energy metabolism in a mouse administered with cannabinoid type-1 receptor agonist, which is known to disrupt cerebrum energy metabolism. The present system now opens the door to the next stage of cutting-edge technique in achieving in vivo real-time monitoring.

[Anesthetic management for cases of placenta accreta presented for cesarean section: a 7-year single-center experience].

BACKGROUND: Anesthetic management of cesarean section for placenta accreta is very challenging. The aim of our retrospective study was to review past placenta accreta cases in our hospital to suggest a strategy for anesthetic management for placenta accreta. METHODS: Placenta accreta cases were identified in our obstetric anesthesia data base. Their diagnosis, surgical procedure, amount of blood loss and anesthetic management were reviewed. RESULTS: Twenty-two cases of placenta accreta were identified. Of them 16 cases underwent cesarean hysterectomy. The amount of blood loss in the 22 cases ranged from 590 to 10500 ml. Neuraxial anesthesia alone was planned in 11 cases, 6 of which were converted to general anesthesia due to massive bleeding. In most of the cases, more than 2 large-bore intravenous lines and arterial line were placed prior to the beginning of surgery. All cases were well managed. CONCLUSIONS: We suggest the minimum requirements for anesthetic management in patients with placenta accreta as follows: (1) discussion with obstetricians to formulate a cesarean section plan, (2) early evaluation to formulate an anesthetic plan and to obtain informed consent, (3) two experienced anesthesiologists, (4) general anesthesia, (5) 2 large-bore intravenous lines, (6) an arterial line and (7) 10 units of both fresh frozen plasma and crossmatched packed red blood cells.

Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases.

PURPOSE: A low dose of morphine, given intrathecally is an effective postoperative analgesic technique and is widely used in cesarean section. Delayed respiratory depression is the most feared side effect of this technique. However, this side effect has not been thoroughly reported in the obstetric population. The aim of this study was to describe respiratory depression associated with intrathecal morphine in postcesarean women, and to estimate its incidence. METHODS: We retrospectively reviewed the obstetric anesthesia database at our institution from April 2000 to December 2006. Patients who were given 0.15 mg intrathecal morphine for cesarean section were identified. From this group, we identified patients who developed bradypnea (respiratory rate