Recently several papers have been published on the use of vancomycin (VCM) to prevent perioperative infection during open-heart surgery, but there have been few papers from Japan. In this study, we evaluated the pharmacokinetics of VCM in the serum and right atrial tissues of eight patients (4 men and 4 women) who underwent open-heart surgery, to prevent perioperative infection. Preoperatively all patients had neither hearing disorder nor renal dysfunction. A total of 1, 000mg of VCM was given intravenously over 40-50 minutes before a skin incision. The serum levels of VCM were measured every 20 minutes during open-heart surgery with enzyme-immunoassay. VCM levels in the right atrial tissues were also assayed before the start of extracorporeal circulation (ECC). The peak serum levels of VCM were 55.3±10.1μg/ml and decreased gradually to 10μg/ml prior to the ECC. During the ECC, the serum levels of VCM remained between 7.6 and 9.9μg/ml, while VCM levels in the right atrial tissues were 18.9±6.9μg/ml (serum/tissue ratio: 0.34). Staphylococcal infection is generally inhibited by VCM levels of 2.0-6.5μg/ml. This study suggests that 1, 000mg of VCM given intravenously before a skin incision may be effective to prevent perioperative infection during open-heart surgery.

Purpose: The purpose of this study was to develop and evaluate a training program for facilitators operating a support group (SG) for cancer patients. Methods: The training program was structured and implemented as a two-day program for members of the nursing profession with experience in providing care for cancer patients. An original questionnaire, developed to ascertain knowledge regarding SG operation, and for evaluating anxiety and self-efficacy was designed for use before and after going through the program to allow for comparative evaluation. The subjects of this analysis were 58 nurses taking part in the program. Results: As a result, the knowledge of how to operate SG increased significantly (p<0.05) following participation. Of the 12 items addressing anxiety and self-efficacy regarding SG operation, lessening of anxiety was noted in 3 items, and self-efficacy was seen to improve significantly in 7 items. Motivation and resolve concerning SG operation following participation in the program also increased significantly. Conclusion: This was a useful training program for facilitators operating support groups for beginners.

BACKGROUND: Venous thromboembolism (VTE) and the subsequent development of pulmonary embolism (PE) is a major cause of post-operative mortality in total knee arthroplasty (TKA). We evaluated whether the addition of an ultrasound-guided femoral nerve block with general anesthesia affected the incidence in the development of VTE following TKA. METHODS: This was a retrospective non-randomized comparative study with patients assigned to groups based on the surgery date (pre-femoral nerve block versus post-femoral nerve block periods). All anesthesia and medical records of the patients who had undergone computer-navigated TKA in our facility between January 2009 and March 2010 were retrospectively reviewed. RESULTS: Forty patients were identified; 15 patients underwent computer-navigated TKA under general anesthesia alone (Group G) and 25 patients underwent surgery under general anesthesia combined with ultrasound-guided femoral nerve block (Group F). The incidence of development of VTE post-operatively was significantly lower in Group F (P = 0.037). Logistic regression analysis identified the use of a femoral nerve block as the most significant variable correlating with the incidence of post-operative development of VTE, and the odds ratio for VTE development in Group G was 3.12 (95% CI, 0.57-20.56). CONCLUSIONS: We suggest the possibility that the addition of a femoral nerve block on general anesthesia may reduce the incidence of the development of VTE following TKA.
Anesthesia ; Anesthesia, General ; Arthroplasty ; Femoral Nerve ; Humans ; Incidence ; Knee ; Logistic Models ; Medical Records ; Nerve Block ; Odds Ratio ; Pulmonary Embolism ; Retrospective Studies ; Venous Thromboembolism