Effects of amino acid solution on changes in intraoperative body temperature of patients undergoing surgery for abdominal aortic aneurysm

In this study, we compared the effectiveness of an amino acid solution and a second intravenous solution containing glucose in preventing intraoperative hypothermia. Twenty patients undergoing scheduled surgery for abdominal aortic aneurysm were randomly divided into two groups of ten. The first group was given an infusion of amino acid solution, while the second was given acetated Ringer\u27s solution with glucose. Each solution was administered over two hours after the induction of anesthesia, and intraoperative body temperature and blood glucose levels were measured. No significant change from preoperative levels was observed in either body temperature or blood glucose level after 180 minutes in the group given the amino acid solution, and postoperative shivering did not occur. In contrast, there was a significant fall in body temperature in the group that received acetated Ringer\u27s solution with glucose, and postoperative shivering occurred. Blood glucose levels also rose significantly in the second group. These results suggest that administration of amino acid solution following induction of anesthesia is useful in preventing intraoperative hypothermia and postoperative shivering.Oh, Jinsei , Hatta, Kouj

Usefulness of perfusion index in evaluation of stellate ganglion block

Clinical conditions such as Horner\u27s syndrome and conjunctival injection have conventionally been used post-treatment to evaluate stellate ganglion block (SGB). Recently, there have been occasional reports of using a perfusion index (PI) obtained using a pulse oximeter to evaluate improved peripheral blood flow. In this study, we investigated whether the PI value from the blocked side is useful in evaluating the effects of SGB following treatment. A pulse oximeter sensor was placed on the fingertip of a patient diagnosed with glossalgia, and after measuring the PI value to use as the control value, SGB was performed 10 times. PI values before and after the procedure were compared, and while the PI value fell significantly immediately following the procedure, it then rose significantly between 2 and 20 minutes after treatment, peaking at about the 5-minute mark. In the post-SGB evaluation, conditions such as Horner\u27s syndrome and conjunctival injection were acknowledged on the blocked side. SGB blocks the sympathetic nerves and increases the volume of blood flow in the head and neck, face, and extremitas thoracica of the affected side, improving peripheral circulation. Accordingly, the PI value, which is said to correlate with peripheral blood flow, can be considered useful in evaluating the effects of SGB. In this case, the PI value in the fingertips on the blocked side rose following the SGB, peaking at approximately the 5-minute mark, clearly indicating increased peripheral blood flow from the initial phase after the SGB. The PI value was therefore considered useful in evaluating the effects of SGB.Oh, Jinse

A case of infectious erector spinae myositis during treatment of lumbar disk herniation

We recently treated a patient who developed unilateral erector spinae myositis during inpatient treatment with continuous epidural block. The patient was diagnosed with radicular sciatica. A catheter was inserted (3.5cm cephalad from L3/4) for continuous epidural block, and left L5 nerve root block was performed. The catheter site was disinfected and the dressing was changed every other day. Intradiscal pressurized injection was performed on day 8. Lower back and leg pain gradually improved, and then erythema and tenderness at the catheter insertion site was noted on day 13. Blood tests yielded severe inflammatory findings, so cefazolin sodium was started by infusion. Urgent contrast-enhanced MRI confirmed left erector spinae myositis. Erector spinae myositis was attributed to contamination of the catheter insertion site. In cases of suspected infection like this, early diagnosis by MRI and prompt treatment are considered to be necessary

〈Originals〉The effect of sevoflurane or propofol with or without an anti-emetic dose of droperidol on the QTc interval and the transmural dispersion of repolarization

[Abstract]　Purpose : Sevoflurane and droperidol but not propofol induce QTc interval prolongation, but there are several conflicting reports. We investigated the effects of sevoflurane and propofol with or without an anti-emetic dose of droperidol on the QTc interval and the transmural dispersion of repolarization for 2 hours, and the QT interval was adjusted for the patient\u27s heart rate using 3 formulae. Methods : One hundred two American Society of Anesthesiologists (ASA) physical status I-II patients, aged 20-70, were randomly allocated to one of four groups : Group 1 (n＝25) receiving sevoflurane anesthesia without droperidol (1.25 mg), Group 2 (n＝26) receiving sevoflurane anesthesia with droperidol, Group 3 (n＝ 25) receiving propofol anesthesia without droperidol, or Group 4 (n＝26) receiving propofol anesthesia with droperidol. RR intervals, QT intervals, and Tp-e intervals, which indicates the dispersion of ventricular repolarization (TDR), were mea-sured. The QT interval was adjusted for the patient\u27s heart rate using the formulae of Bazett, Fridericia, and Matsunaga. Results : Sevoflurane significantly prolonged the QTc, but droperidol did not enhance sevoflurane- induced QTc prolongation in all the formulae. Conversely, propofol did not affect the QTc in all formulae. Tp-e intervals were not affected in any of the groups. Conclusion : Although it significantly prolongs the QTc interval, sevoflurane, even with droperidol, does not seem to cause lethal arrhythmias associated with QT prolongation, because it does not induce Tp-e prolongation. Propofol is safer than sevoflurane in terms of arrhythmias associated with QT interval prolongation. Bazett\u27s formula is reliable for detecting anesthetic- induced QT prolongation