The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt's lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.
Bacteremia ; Burkitt Lymphoma ; Cardiomyopathies ; Colectomy ; Echocardiography ; Escherichia coli ; Gastroenteritis ; Hemodynamics ; Hemoperfusion* ; Humans ; Intraabdominal Infections ; Klebsiella pneumoniae ; Lactic Acid ; Mortality ; Neutropenia ; Peritonitis ; Polymyxin B* ; Resuscitation ; Shock ; Shock, Cardiogenic ; Shock, Septic*

BACKGROUND: Not many recent studies have shown that morphine antinociception may be directly expressed in forebrain structures. It is generally accepted that c-fos is a marker of neuronal activity and its expresson is correlated with nerve pathway activated by nociceptive stimuli. The aim of this study is to examine the effect of morphine on c-fos expression in the incisional pain rat brain. METHODS: A 1 cm longitudinal incision was made through the skin, fascia and muscle of the plantar aspect of the hindpaw in enflurane-anesthetized rats. 10 mg/kg of morphine was injected intraperitoneally 1 hour before (pre-morphine group; n = 15) and 30 minutes after surgery (post-morphine group; n = 15). The same amount of saline was injected 30 minutes after surgery (control group; n = 15). Two hours later c-fos protein expressions in the thalamus, hypothalamus, cerebral cortex and amygdala were examined by immunohistochemistry using a specific antibody. RESULTS: Numerous c-fos positive cells were observed in thalamus, hypothalamus, cerebral cortex, and amygdala in all groups. There were no significant differences in c-fos expression between pre-morphine, post-morphine and control group (P <0.05). CONCLUSIONS: In this study we expected to decreased c-fos expression in incisional pain rat brain by morphine injection. But no differences were observed compared to control group in thalamus and cortex which transmitting pain to CNS, also in hypothalamus and amygdale which transmitting emotional stress to CNS. These results suggests that intraperitoneal morphine can not protect the c-fos expression of ascending pathway to thalamus, hypothalmus, amygdala and cerebral cortex. Also we can not support the effect of morphine on the descending pathway of pain. So we thought for the more information, additional study, for example, behavior test, PCR (polymerase chain reaction)study, may be needed.
Amygdala ; Animals ; Brain* ; Cerebral Cortex ; Fascia ; Hypothalamus ; Immunohistochemistry ; Morphine* ; Neurons ; Polymerase Chain Reaction ; Prosencephalon ; Rats* ; Skin ; Stress, Psychological ; Thalamus

No abstract available.
Dislocations*

BACKGROUND: Rocuronium can cause pain on injection in awake patients. We compared the effect of ketamine at three different small doses (0.1 mg/kg, 0.2 mg/kg, 0.3 mg/kg) and saline (placebo) for reducing pain on injection in awake patients. METHODS: 80 patients (aged 19-63 yr) scheduled for elective surgery were randomized to four groups in double-blind manner. Patients received the study drug intravenously, with venous occlusion for 20 seconds, followed by rocuronium 0.6 mg/kg into the dorsal vein over 10 seconds. Patient's response torocuronium injection was graded by four-point verbal rating scale. RESULTS: The incidence of pain was significantly less in patients receiving ketamine 0.3 mg/kg (55%) than in patients receiving saline (85%)(P < 0.05). But, No difference was found between ketamine 0.1 mg/kg, 0.2 mg/kg and saline groups. The pain score was significantly less in patients receiving ketamine 0.2 mg/kg and 0.3 mg/kg than in patients receving saline (P < 0.05). CONCLUSIONS: We concluded that pretreatment of ketamine 0.3 mg/kg with venous occlu-sion for 20 seconds, effectively decreases the incidence of pain caused by rocuronium injection.
Humans ; Incidence ; Ketamine* ; Veins

BACKGROUND: Damage to teeth has long been associated with endotracheal intubation. But, no rules designed to predict dental injuries have been formulated. In this prospective study, we undertook to identify relationships between anatomic airway measurements used customarily in bedside practice, and blade-tooth distance during laryngoscopy, to assess the usefulness of these anatomic measurements as predictors of dental injury. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were included. During a preoperative visit, a number of measurements and assessments of features that might predict difficult intubation were performed. When optimum visibility of the glottis was obtained during laryngoscopy, the distance between the flange of the blade and the upper incisor was measured. We determined which of the individual airway characteristics correlated with the blade-tooth distance and best predicted the potential of dental injury. RESULTS: The blade-tooth distance was found to correlate with the individual scales of the Mallampati classification (Spearman's correlation coefficient, r = - 0.356, P < 0.01), mandibular protrusion (r = - 0.390, P < 0.01), head and neck movement (r = - 0.276, P < 0.01), interincisor gap (r = - 0.648, P < 0.01), and the condition of the upper teeth (r = - 0.313, P < 0.01). The frequency of direct blade-tooth contact significantly increased as the scales of these five anatomic measurements increased (P < 0.01). CONCLUSIONS: This study shows for the first time that some airway measurements are correlated with blade-tooth distance, and that they can be considered as useful predictors of dental injury during laryngoscopy.
Anesthesia, General ; Classification ; Glottis ; Head ; Humans ; Incisor ; Intubation ; Intubation, Intratracheal ; Laryngoscopy* ; Neck ; Prospective Studies ; Tooth ; Weights and Measures

BACKGROUND: Cytokines are important mediators of immune response to surgery and pain.The aim of the study was to investigate the effect of remifentanil on serum levels of cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), in patients undergoing laparoscopic hysterectomy. METHODS: Twenty four patients scheduled for laparoscopic hysterectomy were randomly assigned to control or remifentanil group.Both groups received 1.5-2.5% end tidal concentration of sevoflurane and air in 50% oxygen.Remifentanil group received a bolus of remifentanil 1microgram/kg over 1 min and an infusion of remifentanil at a rate of 0.1microgram/kg/min.Control group received 10 ml saline (placebo) and an infusion of saline at the same rate. Venous blood samples for measurement of serum cytokine concentrations were taken before anesthesia (T1), at 2 h after infusion (T2), and at the 1 hour after surgery (T3). RESULTS: Serum TNF-alpha concentration did not differ significantly over time in both groups.Serum TNF-alpha concentration was higher in remifentanil group at T3 (9.76 +/- 1.19 pg/ml vs.8.53 +/- 0.71 pg/ml) than in control group (P < 0.05). In both groups, serum IL-6 concentrations were significantly higher at T3, when compared to those at T1 and T2 (P < 0.05). CONCLUSIONS: Remifentanil did not attenuate early postoperative change of serum TNF-alpha and IL-6 concentrations in patients undergoing laparoscopic hysterectomy. Serum IL-6 level increased at postoperative 1 h, regardless of remifentanil use.
Anesthesia ; Cytokines ; Humans ; Hysterectomy ; Interleukin-6 ; Methyl Ethers ; Piperidines ; Tumor Necrosis Factor-alpha

BACKGROUND: Monitored anesthetic care can provide patient safety and optimal surgical conditions. However, propofol and fentanyl decrease the hypoxic ventilatory response and heart rate. Ketamine has less respiratory depression and blocks bradycardia. Furthermore, ketamine can reduce the amount of opioid use but it delays discharge in the outpatient anesthesia. Therefore, this study retrospectively examined the effects of combined fentanyl and ketamine administered during monitored anesthetic care on the use of opioids, cardiorespiratory side effects, and patient discharge. METHODS: The anesthetic room, the recovery room and day surgery center records of ambulatory strabismus surgery with monitored anesthetic care was reviewed by anesthesiologists from Oct. 2004 to July 2005. The patients were classified as those receiving either fentanyl (F group: n = 32) or fentanyl and ketamine (FK group: n = 19) with a propofol infusion. The fentanyl dose used, the need for airway support, anticholinergics and naloxone were compared. The stay in the recovery room and the day surgery center was also examined. RESULTS: The FK group used significantly less fentanyl than the F group (P < 0.05). Although airway support was needed, there was less anticholinergics and naloxone used in the FK group, but this difference was not significant. The stay in recovery room and the day surgery center were similar. CONCLUSIONS: Co-administered ketamine reduces the amount of fentanyl-needed, but it does not reduce the need for airway support and anticholinergics. In addition, co-administered ketamine does not affect the number of days in the recovery room and day surgery center.
Ambulatory Surgical Procedures ; Analgesics, Opioid ; Anesthesia ; Bradycardia ; Cholinergic Antagonists ; Fentanyl* ; Heart Rate ; Humans ; Ketamine* ; Naloxone ; Outpatients ; Patient Discharge ; Patient Safety ; Propofol ; Recovery Room ; Respiratory Insufficiency ; Retrospective Studies ; Strabismus*

General treatment of short bowel syndrome is long-term total parenteral nutrition (TPN). But long-term TPN therapy produces thrombus, infection and obstruction of central veins and results in the life-threatening complications. Recently we experienced first case of small bowel transplantation in a 57-year old female with only 30 cm jejunum and distal part of colon to the splenic flexure who was suffering short bowel syndrome due to previous wide resection of small bowel. We report successful anesthetic management of small bowel transplantation in the patient with short bowel syndrome who has been suffered from life threatening complications due to long-term TPN therapy.
Colon ; Colon, Transverse ; Female ; Humans ; Jejunum ; Middle Aged ; Parenteral Nutrition, Total ; Short Bowel Syndrome* ; Thrombosis ; Veins

A 35-year old woman was scheduled to undergo a total hystectomy due to uterine myoma. She had been diagnosed with Charcot-Marie-Tooth disease 2 years ago. In addition, she had previously received a Cesarean section under epidural anesthesia 10 years ago and reported a prolonged motor blockade at that time. General anesthesia was induced with propofol 120 mg in a divided dose and the intubating condition was achieved with vecuronium 3 mg. Anesthesia was maintained with 1.5-2.5% enflurane with air and O2. During surgery, the body temperature and end tidal concentration of CO2 were maintained within the normal range. Despite the continuous monitoring of the train-of-four (TOF) response, no more muscle relaxants were required during surgery and the patient recovered without a delay in awakening. In the management of patients with Charcot-Marie-Tooth disease, it is desirable to evaluate the patient carefully, select the appropriate anesthetics and adjust the dosage of the drug according to the patients requirements.
Adult ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Body Temperature ; Cesarean Section ; Charcot-Marie-Tooth Disease* ; Enflurane ; Female ; Humans ; Leiomyoma ; Pregnancy ; Propofol ; Reference Values ; Vecuronium Bromide

BACKGROUND: Although ischemic preconditioning (IPC) or propofol is generally known to confer the cardioprotective effect on ischemic-reperfused hearts, especially in patients subjected to operation such as cardiopulmonary bypass and heart transplantation, the exact effects of IPC and propofol are still controversial. Furthermore, the interaction between IPC- and propofol-induced cardioprotective effects has not been studied yet. The aims of this study are to examine 1) whether IPC and propofol demonstrates the cardioprotective effect against ischemic-reperfusion injury in the isolated rat hearts, and if so, 2) whether the combination of IPC and propofol shows the additive effects. METHODS: Isolated rat hearts were subjected to 30 min global ischemia followed by 60 min of reperfusion. Four groups of hearts (n = 7 per group) were studied. Group control (no intervention); group IPC, two 2-min total coronary occlusions (ischemic preconditioning) interspersed with 5 min and 6 min of normal perfusion before global ischemia; group propofol, propofol 2microgram/ml (11.1microM) administered before global ischemia and during reperfusion; group propofol/IPC, propofol 2microgram/ml administered before IPC and during reperfusion. Left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), + dP/dtmax and - dP/dtmin were recorded and creatinine kinase (CK) in coronary effluent perfusate and coronary flow also were measured. RESULTS: There were significant differences in recovery of postischemic systolic function between control and IPC, propofol and propofol/IPC as assessed by LVDP, expressed as a percentage of preischemic value (22.2 +/-8.4 vs 59.4 +/- 6.8, 69.4 +/- 7.9 and 66.0+/- 7.1%, respectively; P <0.05) at the end of reperfusion. The propofol and propofol/IPC showed better recovery in postischemic relaxation than IPC or control as asse ssed by LVEDP (11.3 +/- 2.2 and 11.3 +/-6.1 vs 56 +/- 6.0 or, 25.2 +/- 7.6 mmHg, respectively; P < 0.05). There were significant differences in attenuation of myocardial damage between propofol/IPC and control as assessed by % change of CK (135.5 +/- 54.7 vs 602.3 +/- 225.1%, P < 0.05) and % change of coronary flow (66.6 +/- 4.0 vs 39.2 +/-5.2%, P < 0.05). CONCLUSIONS: These results suggest that ischemic preconditioning combined with propofol may not show any additive effect on IPC-and propofol-induced attenuation of postischemic ventricular dysfunction, however it show the tendency to attenuate the myocardial damage.
Animals ; Cardiopulmonary Bypass ; Coronary Occlusion ; Creatinine ; Equidae ; Heart Transplantation ; Heart* ; Humans ; Ischemia ; Ischemic Preconditioning* ; Perfusion ; Phosphotransferases ; Propofol* ; Rats* ; Relaxation ; Reperfusion ; Ventricular Dysfunction