Safety of the inter-nipple line hand position landmark for chest compression.

Background: No previous study has investigated the safety of hand position during chest compression determined by the inter-nipple line, in which the heel of one hand is positioned on the centre of the chest between the nipples, from the standpoint of prevention of organ injury.

Methods: We measured the distance from the xiphisternal junction to the inter-nipple line (dN) in 1000 surgical patients and the heel length (H) of hands in 100 healthy volunteers, then used the formula H/2-dN to determine the amount of deviation when the heel of the rescuer's hand extended to the xiphoid process (D). Next, 100 surgical patients were randomly assigned to 18 anaesthesiologists, who placed the heels of their hands on the sternum for validation.

Assessment of internal thoracic artery patency with transesophageal echocardiography during coronary artery bypass graft surgery.

Objective: The purpose of this study was to evaluate intraoperative transesophageal echocardiography (TEE) for assessing patency of internal thoracic artery grafts.

Design: A retrospective study.

Setting: A university hospital.

Thiamylal and thiopental attenuate beta-adrenergic signaling pathway by suppressing adenylyl cyclase in rat ventricular myocytes.

The effects of intravenous anesthetics on myocytes have not been fully elucidated. To investigate the effects of various intravenous anesthetics such as fentanyl, morphine, ketamine, diazepam, midazolam, thiamylal, and thiopental on the beta-adrenergic signaling pathway, we measured isoproterenol-stimulated cyclic adenosine monophosphate (cAMP) production in freshly isolated rat ventricular myocytes. Fentanyl, morphine, ketamine, diazepam, and midazolam did not significantly affect isoproterenol-stimulated cAMP production.

Clinically relevant concentrations of olprinone reverse attenuating effect of propofol on isoproterenol-induced cyclic adenosine monophosphate accumulation in cardiomyocytes.

Propofol has been shown to attenuate beta-adrenoreceptor-mediated signal transduction in cardiomyocytes. Cyclic adenosine monophosphate (cAMP) is an essential second messenger of beta-signal transduction, while olprinone, a phosphodiesterase-III inhibitor, improves poor cardiac performance by increasing cAMP levels. In the present study, we investigated the effects of olprinone toward the reducing effect of propofol on beta-adrenoreceptor-mediated increases in cAMP production.

Systemic glucocorticoid therapy reduces pain and the number of endoneurial tumor necrosis factor-alpha (TNFalpha)-positive mast cells in rats with a painful peripheral neuropathy.

Clinical and experimental evidence suggests that glucocorticoids may be effective in the treatment of neuropathic pain, but their mechanism of action is unknown. We gave triamcinolone (3 mg/kg) to rats with an experimental post-traumatic painful peripheral neuropathy, chronic constriction injury (CCI), five days after nerve injury, when the abnormal pain syndrome is known to be present; and pain sensitivity was measured on postoperative days 7 - 14, a period during which symptoms are known to be at approximately peak severity. Additional CCI rats were treated similarly; and then they were sacrificed five days after the injection for an immunocytochemical analysis of endoneurial tumor necrosis factor-alpha (TNFalpha), macrophages, and mast cells in the sciatic nerve proximal to the site of injury.

Prothrombotic roles of substance-P, neurokinin-1 receptors and leukocytes in the platelet-dependent clot formation in whole blood.

A number of types of non-neuronal cells including leukocytes have been confirmed to possess substance-P and its specific neurokinin-1 receptor (NK1R), while the pathophysiological roles of substance-P in these cells remain to be established. Effects of substance-P through NK1R on platelet-dependent clot formation were evaluated by using an oscillating-probe viscoelastometer. The clot signal, indicative of the clot strength in blood-derived samples, was measured after the stimulation with celite and Ca(2+).

[Use of AirWay Scope for tracheal intubation in bright sunlight].

Background: The AirWay Scope (AWS), which is equipped with a wide-angle LCD monitor, has been developed to achieve accurate and safe tracheal intubation under various conditions, including emergency settings. However, since bright sunlight degrades the image quality of LCDs, we investigated its usefulness outdoors in bright sunlight.

Methods: A single anesthesiologist intubated a mannequin with an AWS and conventional direct laryngoscope indoors and in sunlight outdoors, using 6 trials for each condition.

[Usability of AirWay Scope for awake tracheal intubation in a burn patient with difficult airway].

The AirWay Scope (AWS; PENTAX Corporation, Tokyo, Japan) is a newly developed rigid video laryngoscope with a built-in LCD monitor that provides accurate verification of tube passage through the vocal cords during tracheal intubation procedures. The blade is shaped to fit the oropharyngeal anatomy, which enables operators to achieve an optimal view for tracheal intubation without requiring alignment of the oral, pharyngeal, and laryngeal axes. We used an AWS for awake intubation in a 34-year-old male burn patient with a difficult airway under conscious sedation obtained with infusion of dexmedetomidine (DEX).

Severe pompholyx following endoscopic thoracic sympathectomy for palmar hyperhidrosis.

Endoscopic thoracic sympathectomy has become the preferred method for treating intractable palmar hyperhidrosis because of its simplicity, though various complications have been reported. We report two patients suffered from severe palmar pompholyx-like eczema following this procedure. One was successfully treated with topical and oral steroids, however, the other had a wavelike continuation of eczema disturbing her daily activities.

Systolic arterial pressure variability reflects circulating blood volume alterations in hemorrhagic shock in rabbits.

Both the high-frequency component of systolic arterial pressure variability and systolic pressure variation (SPV) have been indicated to be strongly affected by respiratory effect and sensitively reflect circulating blood volume (CBV). We attempted to determine the best means reflecting CBV from various parameters using power spectrum analyses of systolic arterial pressure variability (PSSAPV) and heart rate variability (PSHRV), SPV, and pulse pressure variation during graded hemorrhaging and fluid resuscitation. Under isoflurane anesthesia and mechanical ventilation, rabbits in group S (n = 6) had hemorrhaging induced, whereas those in group H (n = 10) had hemorrhaging induced followed by fluid resuscitation.

[Dexmedetomidine is a useful concomitant anesthetic agent for perioperative management during tracheobronchial Dumon stent surgery].

We treated 2 patients, 1 undergoing placement and 1 removal of a tracheobronchial Dumon stent, both of whom required preservation of spontaneous breathing during the perioperative period to avoid life-threatening hypoxemia, with dexmedetomidine (DEX) as an anesthetic adjunct. In both cases, anesthesia was induced with 6 microg x kg(-1) x hr(-1) of DEX for 10 minutes and then maintained at 0.4-0.

Fulminant-type malignant hyperthermia in Japan: cumulative analysis of 383 cases.

We investigated the transition of clinical signs of fulminant-type malignant hyperthermia (f-MH) by analyzing a database consisting of 383 cumulative cases of f-MH from 1961 to 2004. The cases were divided by time period into group 1 (1961-1984), group 2 (1985-1994), and group 3 (1995-2004). The variables considered were age, sex, type of agents used (succinylcholine and volatile anesthetics), dantrolene administration, clinical signs, laboratory data, and mortality.

[Intracranial subdural hematoma following dural puncture].

Background: Intracranial subdural hematoma (SDH) following dural puncture (DP) is a life-threatening complication. However, the characteristics and prognosis are little-known.

Methods: Reports documenting intracranial SDH following DP were surveyed by using PubMed and the Igaku-chuou-zassi (Japana Centra Reveuo Medicina) database (1979-2005) and the cases were analyzed to clarify their characteristics and prognoses.

Intrathecally administered COX-2 but not COX-1 or COX-3 inhibitors attenuate streptozotocin-induced mechanical hyperalgesia in rats.

Members of the cyclooxygenase (COX) family are known to catalyze the rate-limiting steps of prostaglandins synthesis and reported to be involved in neuropathic pain. Diabetic neuropathy is a type of neuropathic pain, though it is not clear if COX is relevant to the condition. Recently, spinal COX-2 protein was found to be increasing in streptozotocin-induced rats as compared to the constitutive expression.

[Evaluation of the sedation level with propofol with electroencephalographic Entropy in comparison with bispectral index monitor].

Background: Entropy, a newly available electroencephalographic monitor, demonstrates two parameters, response entropy (RE) and state entropy (SE). The aim of this study is to compare RE and SE with bispectral index (BIS) during anesthetic induction with propofol.

Methods: Fifteen patients received target controlled infusion of propofol starting at 3 microg x ml(-1).

[Validity of intraoperative administration of dexmedetomidine in a patient with dermatomyositis-derived respiratory failure].

A 66-year-old female with dermatomyositis and severe respiratory failure from collagen lungs, dependent on domiciliary oxygen therapy, was scheduled for a mastectomy. Anesthesia was induced with dexmedetomidine (DEX) 6 microg x kg(-1) x h(-1) for 10 minutes and maintained at 0.7 microg x kg(-1) x h(-1), along with a target controlled infusion of propofol combined with epidural anesthesia.

Liver X receptor ligands inhibit the lipopolysaccharide-induced expression of microsomal prostaglandin E synthase-1 and diminish prostaglandin E2 production in murine peritoneal macrophages.

Microsomal prostaglandin E synthase (mPGES)-1, which is dramatically induced in macrophages by inflammatory stimuli such as lipopolysaccharide (LPS), catalyzes the conversion of cyclooxygenase-2 (COX-2) reaction product prostaglandin H(2) (PGH(2)) into prostaglandin E(2) (PGE(2)). The mPGES-1-derived PGE(2) is thought to help regulate inflammatory responses. On the other hand, excess PGE(2) derived from mPGES-1 contributes to the development of inflammatory diseases such as arthritis and inflammatory pain.

Synthetic peroxisome proliferator-activated receptor-gamma agonists restore impaired vasorelaxation via ATP-sensitive K+ channels by high glucose.

The present study was designed to examine whether in the human artery, synthetic peroxisome proliferator-activated receptor (PPAR)-gamma agonists restore vasorelaxation as well as hyperpolarization via ATP-sensitive K+ channels impaired by the high concentration of D-glucose and whether the restoration may be mediated by the antioxidant capacity of these agents. The isometric force and membrane potential of human omental arteries without endothelium were recorded. The production rate of superoxide was evaluated using a superoxide-generating system with xanthine-xanthine oxidase in the absence of smooth muscle cells.

[Anesthetic management of laser surgery with bronchial stenting for a tracheal tumor].

Anesthetic management during surgery for a tracheal tumor is extremely difficult in terms of airway management. We managed a patient with a tracheal tumor who was successfully treated without complication. The trachea of a 66-year-old woman was narrowed by a tumor to one-third of its original diameter, for which Nd-YAG laser surgery with insertion of an intratracheal Dumon stent was performed.

General anesthesia for patient with type III homocystinuria (tetrahydrofolate reductase deficiency).

Homocystinuria, a rare autosomal recessive genetic disease, is generally classified into 3 types (types I-III). Extremely rare type III is from a defect of the enzyme tetrahydrofolate reductase which converts homocysteine to methionine. The anesthetic problem of type III homocystinuria is the elevation of serum homocysteine and the deficiency of essential amino acid methionine, which result in the perioperative thromboembolic events and nitrous oxide-induced neurological impairment.

Suppression of inducible nitric oxide synthase and cyclooxygenase-2 gene expression by 22(R)-hydroxycholesterol requires de novo protein synthesis in activated macrophages.

Liver X receptors (LXRs) play an important role in lipid metabolism. Recently, a role for these proteins was identified in suppressing the inflammatory response. However, it is not known whether the natural ligands of LXRs, e.

[Perioperative use of recombinant activated factor VII (rF VIIa) in a patient with hemophilia A having inhibitors].

We experienced the perioperative management of a patient with hemophilia A having inhibitors using recombinant activated factor VII (rF VIIa). A 55-year-old man was scheduled for right total hip arthroplasty. Since he developed high titer of VIII inhibitor, rF VIIa was utilized for the hemostatic control for "bypass therapy".

Undisrupted pulse wave on pulse oximeter display monitor at cardiac arrest in a surgical patient.

We have encountered a case of cardiac arrest during anesthesia care in which an application of a new-generation pulse oximetry technology led to a misleading interpretation of the patient's true condition. Just after manipulation of the peritoneum, the heart rhythm suddenly became asystole, while the ECG showed a standstill and an arterial pressure wave was absent. However, the Datex-Ohmeda AS/3 Patient Monitor connected to the Masimo SatShare Waveform Generator feature continued to display a pulse wave with a reading of 99%.

Spinal orexin-1 receptors mediate anti-hyperalgesic effects of intrathecally-administered orexins in diabetic neuropathic pain model rats.

Orexin-A and orexin-B are endogenous ligands of orexin receptors that contain orexin-1 and orexin-2. Activation of the orexinergic system can produce antinociceptive effects in acute inflammatory, mono-neuropathic, and postoperative pain animal models, though the effects of orexins on diabetic neuropathic pain have not been previously investigated. In this study, we studied the anti-hyperalgesic effects of intrathecally administered orexins in a streptozotocin-induced diabetic rat.

CB(1) cannabinoid receptor stimulation modulates transient receptor potential vanilloid receptor 1 activities in calcium influx and substance P Release in cultured rat dorsal root ganglion cells.

Cannabinoids have been reported to have analgesic properties in animals of acute nociception or of inflammatory and neuropathic pain models, but the mechanisms by which they exert such alleviative effects are not yet fully understood. We investigated whether the CB(1)-cannabinoid-receptor agonist HU210 modulates the capsaicin-induced (45)Ca(2+) influx and substance P like-immunoreactivity (SPLI) release in cultured rat dorsal root ganglion (DRG) cells. HU210 attenuated the capsaicin-induced (45)Ca(2+) influx and this effect was reversed by the CB(1) antagonist AM251.