BACKGROUND Individual variation in the sensitivity to anesthetics induces the delayed awakening and the severe postoperative pain at an inappropriate dose. We designed the study to see the correlation of the individual sensitivity to fentanyl and that to propofol which have different mechanism. METHODS General anesthesia was induced using target controlled infusion system of fentanyl and propofol. Fentanyl effect-site concentration gradually increased towards a target plasma concentration of 3 ng x ml(-1) until the appearance of the subjective symptom such as dizziness, a sensation of warmth and other reactions. After this, propofol effect-site concentration gradually increased towards a target plasma concentration of 4 microg x ml(-1) until loss of consciousness (LOC). The effect-site concentrations of fentanyl at the symptom and propofol at loss of consciousness were measured. RESULTS The correlation between the estimated effect-site concentration of fentanyl and propofol is not significant in the whole patient. However, a positive correlation between fentanyl and propofol was found in patients from 50s to 70s years of ages (r = 0.59). CONCLUSIONS The correlation of the individual sensitivity to fentanyl and propofol was found in older age groups.
Plasma lipid peroxide measured as thiobarbituric acid reactive substances (TBARS) and alpha-tocopherol levels in 24 critically ill patients were compared with those of control subjects. The mean plasma alphatocopherol level was significantly lower and the mean TBARS level was significantly higher in critically ill patients. Eight ICU patients developed disseminated intravascular coagulation (DIC); the mean TBARS level during DIC was significantly above the mean pre-DIC level. These results indicate that lipid peroxidation may contribute to the development of DIC in critically ill patients.
A 34-year-old male patient, who had fallen from a balcony suffering liver injury, underwent emergency laparotomy for right liver lobectomy and portal vein repair. For the first two hours of operation, the blood loss exceeded 12,000 ml, and his hemoglobin level dropped to 2.6 g x dl(-1) despite administration of 30 units of packed red cells (MAP). At this point, no more MAP was available in our hospital. Then we decided to initiate intraoperative blood salvage in order to minimize the further loss of hemoglobin. For 26,200 ml of the total blood loss, 1160 ml of packed red cells were restored from 7600 ml of salvaged blood, and 46 units of MAP, 40 units of fresh frozen plasma and 20 units of platelets were administered. His postoperative course was not complicated by systemic infection. Although intraoperative blood salvage is proved to be useful for reducing allogenic transfusion, it is not recommended to be used in surgery for trauma because of a potential risk of serious systemic infection. Our experience, however, suggests that intraoperative blood salvage could be utilized as a life-saving means even in trauma surgery.
We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol decreased significantly, while lipid peroxide in plasma and major organs significantly increased. Serum transaminases also increased significantly. Traumatized rats had a significant but transient decrease in platelet count and a continuous decrease in plasma alpha-tocopherol; lipid peroxide did not change significantly in the plasma but increased significantly in the lung and kidney. Serum transaminases of traumatized rats showed transient increases. Thus, although traumatic stress caused lipid peroxidation similar to sepsis in the major organs, plasma lipid peroxide did not change.
BACKGROUND: Trachlight is a light-tipped stylet designed to guide tracheal intubation. It obviates the need for direct laryngoscopy and is reported to be particularly useful for managing difficult tracheal intubation. Its clinical application, however, is not limited to difficult airway management. METHODS: Here we report our experience of the use of Trachlight in 64 adult patients who were at risk of dental injury during direct laryngoscopy because of unstable teeth around the incisors or severe alveolar disease. RESULTS: Of 64 patients (33 men and 31 women) aged between 30 and 85, the trachea was successfully intubated using Trachlight without dental damage in 63 patients. In 1 patient, a tracheal tube was smoothly placed, but a tooth was injured after the removal of the stylet. No other complications associated with the use of Trachlight were noted. CONCLUSIONS: Our experience suggests that Trachlight can be a helpful tool for intubation in patients having dental problems. Because of the blind nature of the technique, but preexisting lesions of the larynx and vocal cords might be overlooked in intubation using Trachlight. Further investigation is warranted to recommend Trachlight as a intubation technique of choice in patients with unstable dentition.
