[Preoperative evaluation, preparation and prognosis in depressed patients].

Depressed patients have some problems before, during and after anesthesia such as hypotension, and torsade de pointes during anesthesia, postoperative confusion, serotonin toxicity, increased intraoperative bleeding by selective serotonin reuptake inhibitors. Depressed patients treated by antidepressants have decreased plasma cortisol and interleukin-6 response to surgery and are more at risk for developing postoperative confusion, that is associated with abnormal cortisol response to surgery and more frequent in patients discontinued antidepressants 72 hours before surgery. Depressed patients treated by antidepressants have high postoperative pain score, that depend on their depressed state.

[Preoperative assessment, preparation and prospect of prognosis in schizophrenic patients].

Schizophrenic patients are at increased risk for perioperative complications such as hypotension and hypothermia during anesthesia, postoperative ileus, confusion and pneumonia. In addition, schizophrenic patients are predisposed to developing pulmonary thromboembolism, torsade de pointes, water intoxication and rhabdomyolysis. The increased complications are associated with physical disorders, antipsychotic agents, hazardous health behaviors, and interactions between antipsychotic agents and anesthetic drugs.

[Severe hypoxia during right lateral position induced by mediastinal shift].

An 87-year-old woman with osteoarthrosis of her left hip joint was scheduled for total hip arthroplasty. After induction of anesthesia the patient was put into the right lateral position for surgery. Oxygen saturation had decreased gradually and the respiratory sound of the right lung was not auscultated.

A history of aggression is a risk factor for postoperative confusion in elderly male drinkers.

Purpose: We investigated the relationship between preoperative psychological state and postoperative confusion in elderly drinkers.

Methods: We studied 81 male patients, ranging in age from 65 to 80 years, who were scheduled to undergo total hip arthroplasty and total knee arthroplasty. The patients were divided into two groups; non-drinkers and patients who drank 25 g or more of alcohol daily.

Perioperative management for chronic schizophrenic patients.

Schizophrenic patients are at increased risk for perioperative complications, as their biological response to stress is impaired. The increased complications are associated with physical disorders, antipsychotic or hazardous health behaviors, and interactions between antipsychotics and anesthetic drugs. Thus, anesthesiologists must not only be aware of the perioperative problems of these patients but must also learn how to manage their perioperative course.

Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion.

Objective: To investigate changes in plasma interleukin (IL)-6, cortisol or noradrenaline concentrations after surgery in elderly patients with postoperative confusion.

Methods: We studied 80 patients aged 70-90 years undergoing abdominal surgery and measured plasma IL-6, cortisol or noradrenaline concentrations before surgery, at the end of surgery, and 24 and 48 h after surgery.

Results: Plasma IL-6 concentrations in elderly patients with postoperative confusion were 83.

A comparison of anesthetic quality in propofol-spinal anesthesia and propofol-fentanyl anesthesia for total knee arthroplasty in elderly patients.

Study Objective: To compare propofol plus spinal anesthesia during spontaneous ventilation using the Laryngeal Mask Airway and propofol plus fentanyl anesthesia during mechanical ventilation with an endotracheal tube on quality of recovery after anesthesia.

Design: Prospective, randomized study.

Setting: Hirosaki National Hospital.

Postoperative confusion increases in elderly long-term benzodiazepine users.

We investigated the relationship between postoperative confusion and duration of benzodiazepine exposure, preoperative anxiety, depressive state, and cognitive function in elderly patients regularly taking benzodiazepines. We studied 328 patients ranging in age from 65 to 80 yr who underwent orthopedic surgery. Information on benzodiazepine use was obtained by face-to-face interview and visual assessment of the patient's medicine chest.

Endocrine response to surgical stress and postoperative confusion in depressed patients with alcohol abuse.

Both alcohol drinking and depression are risk factors for postoperative confusion and are associated with alteration of pituitary-adrenal function. We investigated the incidence of postoperative confusion, plasma cortisol and ACTH response to surgical stress in depressed patients with alcohol abuse. We studied sixty depressed patients with and without alcohol abuse who underwent abdominal surgery.

Increased cortisol response to surgery in patients with alcohol problems who developed postoperative confusion.

Background: Patients with alcohol problems often develop postoperative confusion and have impaired cortisol, ACTH, and norepinephrine. However, the relationship between neuroendocrine responses to surgical stress and postoperative confusion remains unclear in patients with alcohol problems.

Methods: Plasma cortisol, ACTH, and norepinephrine concentrations during and after surgery in 30 patients with alcohol problems and 30 control patients who underwent lower abdominal surgery were measured before the induction of anesthesia, 15 and 60 min after skin incision, 60 min after the end of surgery, the next day, and the second day after the operation.

Chronic treatment with antipsychotics enhances intraoperative core hypothermia.

Unlabelled: Antipsychotics can induce hypothermia, but intraoperative temperature regulation in schizophrenic patients taking antipsychotics remains unclear. We investigated intraoperative temperature regulation and postoperative shivering in chronic schizophrenic patients receiving antipsychotics. We studied 30 schizophrenic patients and 30 control patients who underwent orthopedic surgery.

Postoperative confusion in schizophrenic patients is affected by interleukin-6.

Study Objective: To investigate whether epidural analgesia with local anesthetics affects postoperative confusion in schizophrenic patients or the relationships between cortisol or interleukin-6 (IL-6) and postoperative confusion.

Design: Prospective, randomized study.

Setting: Hakodate Watanabe Hospital and Hirosaki National Hospital.

[A case of severe bradycardia and AV block during administration of propofol].

A 69-yr-old man underwent emergency laparotomy. He was in endotoxic shock. Preoperative evaluation including a full blood count, chest X-ray and ECG were normal.

Ketamine inhibits endotoxin-induced inositol 1,4,5-triphosphate in rat ventricular cardiomyocytes.

Objective: To investigate the effect of ketamine on endotoxin modulation of inositol 1,4,5-triphosphate (IP3) formation in cardiomyocytes.

Design: A prospective observational cell culture study.

Setting: A research laboratory in the University of Hirosaki School of Medicine.

Norepinephrine-induced inositol 1,4,5-trisphosphate formation in atrial myocytes is regulated by extracellular calcium, protein kinase C, and calmodulin.

We investigated whether alteration of extracellular and intracellular Ca2+ concentrations, protein kinase C, and calmodulin modulate norepinephrine (NE)-induced inositol 1,4,5-trisphosphate (IP3) formation in neonatal rat atrial myocytes. NE-induced IP3 production in atrial myocytes was stimulated by elevation of extracellular Ca2+ in a dose-dependent manner. However, TMB-8 (an intracellular calcium antagonist) and A23187 (an intracellular calcium agonist) did not significantly affect NE-induced IP3 production.

Chronic treatment with antidepressants decreases intraoperative core hypothermia.

Unlabelled: We investigated temperature regulation during anesthesia and postoperative shivering in chronically depressed patients given antidepressant drugs. We studied 35 depressed patients and 35 control patients who underwent orthopedic surgery. Tympanic membrane temperatures 60, 75, and 90 min after induction in the depression group were significantly (P < 0.

Increased postoperative pain scores in chronic depression patients who take antidepressants.

Study Objective: To investigate postoperative pain and current perception thresholds in chronic depression in patients who are treated with antidepressants.

Design: Prospective, randomized study.

Setting: Hakodate Watanabe Hospital and Hirosaki National Hospital.

Atrial natriuretic peptide increases glucose uptake during hypoxia in cardiomyocytes.

The action of atrial natriuretic peptide on glucose uptake during hypoxia was investigated in neonatal cardiomyocytes. When the cultures were exposed to 100 n and 1 and 10 micro M of atrial natriuretic peptide for 60 min, hypoxia-induced glucose uptake significantly increased from 20.4 +/- 1.

Cortisol response to surgery and postoperative confusion in depressed patients under general anesthesia with fentanyl.

The purpose of this study was to investigate the relationship between postoperative confusion and plasma cortisol response to surgery in depressed patients. We studied 80 depressed patients and 40 control patients who had undergone orthopedic surgery and perioperatively measured plasma cortisol and adrenocorticotropin levels. Postoperative confusion in the first 3 postoperative days occurred in 5 (13%) depressed patients given fentanyl during anesthesia, 13 (33%) patients without fentanyl and 1 (3%) control patients.

Schizophrenic patients who develop postoperative confusion have an increased norepinephrine and cortisol response to surgery.

The purpose of this study was to investigate the relationship between postoperative confusion and the plasma norepinephrine (NE), adrenocorticotropin (ACTH) or cortisol response to surgery in schizophrenic patients. We studied 50 schizophrenic patients and 35 control patients who underwent orthopedic surgery and perioperatively measured plasma NE, ACTH and cortisol levels. Postoperative confusion during 72 h after the end of the operation occurred in 14 of 50 schizophrenic patients (28%) and in 2 of 35 control patients (6%).

Sevoflurane increases glucose transport in skeletal muscle cells.

Unlabelled: Sevoflurane activates phospholipase C and protein kinase C, leading to an increase in intracellular Ca(2+) concentration, which modulates glucose transport. We studied in vitro the effect of sevoflurane on the uptake of 2-deoxyglucose in rat skeletal muscle cells and the mechanism that modulates the glucose transport. Sevoflurane 0.

Small-dose ketamine improves the postoperative state of depressed patients.

Unlabelled: We investigated whether ketamine is suitable for depressed patients who had undergone orthopedic surgery. We studied 70 patients with major depression and 25 patients as the control (Group C). The depressed patients were divided randomly into two groups; patients in Group A (n = 35) were induced with propofol, fentanyl, and ketamine and patients in Group B (n = 35) were induced with propofol and fentanyl, and all patients were maintained with 1.

[A successfully treated case of aspiration pneumonia with adult respiratory distress syndrome and shock].

Right hip replacement was scheduled for a 74-year-old man who was treated with morphine for cancer pain. As the patient developed dyspnea and hypoxia after anesthesia, he was intubated and kept under mechanical ventilation. A diagnosis of aspiration pneumonia with adult respiratory distress syndrome was made based on the detection of gall obtained from the endotracheal tube.