Management of general anesthesia in a child with Miller-Dieker syndrome: a case report.

Miller-Dieker syndrome (MDS) is a rare disorder characterized by type I lissencephaly and a distinctive facial appearance that may include prominent forehead, bitemporal hollowing, and micrognathia. MDS is associated with epilepsy. We here report an 18-month-old girl with MDS who required general anesthesia.

[Plasma levels of anti-oxidant markers during general anesthesia--a comparison between remifentanil- and epidural-based anesthesia].

Background: Anesthesia may influence oxidative stress responses to surgical stress during surgery. We performed a prospective study to investigate the impact of anesthesia on oxidative stress responses between patients receiving ropivacaine-based epidural anesthesia and patients receiving remifentanil-based general anesthesia

Methods: Plasma levels of oxidative stress-related substances such as superoxide dismutase (SOD) and myeloperoxidase were measured during anesthesia in patients receiving ropivacaine-based epidural anesthesia (E group) and patients receiving remifentanil-based general anesthesia (R group).

Results: SOD, which catalyzes the reduction of superoxide anions to hydrogen peroxide and has anti-oxidative effects, was significantly lower in E group at the end of surgery whereas the levels of myeloperoxydase were not different between the groups.

Suspected intraoperative formation of left atrial thrombus in a patient with atrial fibrillation receiving bridging anticoagulation therapy.

We present a patient with atrial fibrillation (AF) in whom a left atrial (LA) thrombus might have formed during laparotomy despite bridging anticoagulation therapy. No evidence of thrombus was detected by transesophageal echocardiography (TEE) at the start of surgery; however, a thrombus measuring 13 × 10 mm was found in the LA appendage by the end of the procedure, suggesting that thrombus might develop intraoperatively in patients with AF even when bridging anticoagulation is properly established. Intraoperative TEE can assist in detecting intracardiac thrombus in patients with AF regardless of their anticoagulation status and provides a tool for intervention to prevent systemic embolization.

Perfusion index as a possible predictor for postanesthetic shivering.

Background: Postanesthetic shivering can be triggered by surgical stress and several aspects of anesthetic management and is frequently preceded by a decrease in peripheral blood flow due to thermoregulatory vasoconstriction. As perfusion index correlates with peripheral blood flow, we examined whether perioperative perfusion index, measured using pulse oximetry, might be correlated with postanesthetic shivering.

Methods: Twenty-eight patients presenting for elective abdominal surgery were enrolled.

Remifentanil temporarily improves renal function in adult patients with chronic kidney disease undergoing orthopedic surgery.

Purpose: The objective of this study was to confirm the renal protective effect of remifentanil-based anesthesia in perioperative adult patients with chronic kidney disease (CKD).

Methods: A total of 90 non-dialysis perioperative adult patients with CKD, with preoperative estimated glomerular filtration rate from creatinine (eGFRcreat) values of lower than 50 ml/min/1.73 m(2), who had undergone orthopedic surgery under general anesthesia were retrospectively selected.

Increased carboxyhemoglobin level during liver resection with inflow occlusion.

Controlling stress responses associated with ischemic changes due to bleeding and ischemia/reperfusion injury is essential for anesthetic management. Endogenous carboxyhemoglobin (COHb) is produced in the oxidative degradation of heme proteins by the stress-response enzyme heme oxygenase. Although the COHb level is elevated in critically ill patients, changes in endogenous COHb during anesthesia have not been well investigated.

Impact of skin incision on the pleth variability index.

Objective: The pleth variability index (PVI), which is calculated from respiratory variations in the perfusion index (PI), reportedly predicts fluid responsiveness. However, vasomotor tone fluctuations induced by nociceptive stimuli change the PI and may reduce the accuracy of PVI. The aim of this study was to confirm the effects of surgical stimuli on PVI.

Systematic evaluation of nitric oxide, tetrahydrobiopterin, and anandamide levels in a porcine model of endotoxemia.

Purpose: Using a lipopolysaccharide (LPS)-treated porcine model, we examined: (1) whether nitric oxide (NO), anandamide, and tetrahydrobiopterin (BH4) increased or not in early endotoxic shock; and (2) the location of the major site of production of these molecules, by comparing their concentrations in arteries and the portal and hepatic veins.

Methods: Ten pigs received an infusion of LPS at 1.7 microg x kg(-1)x h(-1) via the portal vein for 240 min.

Effects of olprinone on hepatosplanchnic circulation and mitochondrial oxidation in a porcine model of endotoxemia.

Purpose: This study was performed in order to assess the effects of olprinone, a phosphodiesterase III inhibitor, on hepatic oxygen delivery (DO2H), oxygen consumption (VO2H), and mitochondrial oxidation in the liver of a porcine endotoxemia model.

Methods: Fourteen pigs received continuous infusion of endotoxin via the portal vein for 240 min. From t = 150 to t = 240 min, animals were randomly divided into two groups to receive saline (control [CONT]; n = 7), or olprinone (OLP; n = 7) via the central vein.

Relationship between redox behavior of brain cytochrome oxidase and neurological prognosis.

Currently, no on-line method of assessing cerebral oxygenation is sufficiently accurate to be clinically helpful. In an attempt to find a good predictor of postoperative cerebral outcome, we retrospectively studied the relationship between the redox behavior of cytochrome oxidase (cyt. ox.