Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt

A PediaSat(TM) oximetry catheter (PediaSat : Edwards Lifesciences Co., Ltd., Irvine, CA, U.S.A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock- Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS(TM) 5100C, Covidien ; Boulder, CO, U.S.A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer

Recent Less-invasive Circulatory Monitoring during Renal Transplantation

For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTracTM system and a standard CV line were used. In the third patient, a standard arterial line and a PreSepTM CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTracTM and a PreSepTM were used. In the latest patient, FloTracTM and PreSepTM were connected to an EV1000TM Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation

Comparison of Ozone Production Regimes between Two Mexican Cities: Guadalajara and Mexico City

Ozone concentrations have been increasing in the Guadalajara Metropolitan Area (GMA) in Mexico. To help devise efficient mitigation measures, we investigated the ozone formation regime by a chemical transport model (CTM) system WRF-CMAQ. The CTM system was validated by field measurement data of ground-level volatile organic compounds (VOC) and vertical profiles of ozone in GMA as well as in the Mexico City Metropolitan Area (MCMA). By conducting CTM simulations with modified emission rates of VOC and nitrogen oxides (NOx), the ozone formation regime in GMA was found to lie between VOC-sensitive and NOx-sensitive regimes. The result is consistent with the relatively large VOC/NOx emission ratio in GMA compared to that in MCMA where the ozone formation regime is in the VOC-sensitive regime