Clinical Evaluation and Metabolism of Sevoflurane in Patients

Sevoflurane was submitted to Phase II studies in patients following Phase I studies. Sevoflurane, 2% inspired during maintenance, was administered with 50% N2O in oxygen to produce surgical anesthesia in 9 orthopedic patients of ASA Physical Status I. Under controlled ventilation, endotracheal concentration of sevoflurane was recorded. The blood concentration of sevoflurane was measured during and after the inhalation. Serum, urinary inorganic fluoride, and glucuronide of hexafluoroisopropanol were analysed with ion chromatographic analyzer. The patient inhaled sevoflurane for 3.5 ± 1.6 hr. All the patients were anesthetized and operated uneventfully. Postoperative laboratory findings showed no unexplainable abnormality. The end expiratory concentration of sevoflurane reached a plateau in 4.0 ± 0.8 min and fell rapidly after discontinuation of sevoflurane. Blood concentration of sevoflurane was about 500 μM during inhalation. It decreased promptly after termination of sevoflurane and was not correlated with anesthetic time. The time for verbal response after discontinuation was 11.8 ± 4.2 min. The serum concentration of inorganic fluoride increased after inhalation and reached a plateau (13.7 ± 8.2 μM) in 120 min. The level lasted for 120 min after anesthesia and fell by half at 12 hr after anesthesia. Urinary fluoride concentration varied from 20 to 3,000 μM during the first 12 hr urine, and showed its maximum in the first postoperative 12 or 24 hr urine. The findings that sevoflurane with nitrous oxide and oxygen produced surgical anesthesia without any sequelae and that the serum fluoride level did not exceed the nephrotoxic level warrent the further clinical evaluation in a wider range of subjects.A part of this work was supported by a Research Grant from the Japanese Ministry of Education, Science and Culture and presented at the 8th European Congress of Anaesthesiology, Vienna, Austria, in September, 1986

Changes in the Respiratory Quotient during Surgery with or without Carbohydrate Loading

Usually glucose is used as an energy source intraoperatively, and recently maltose containing fluids was introduced as intraoperative fluid supply. However, the optimal dosage and form of intraoperative carbohydrate have not yet been known. The authors compared changes in the RQ during surgery without any energy source supply, and with administration of glucose or maltose in twenty eight males and females to know the effects of carbohydrates administration on RQ during surgery and to estimate the optimal dosage and form of intraoperative carbohydrates. Patients in group 1 received no carbohydrates during the operation; in groups 2 and 3, patients were given 0.25g glucose/kg and 0.5g glucose/kg/hr respectively, and patients in groups 4 and 5 received maltose at the speed of 0.25g/kg/hr, respectively. No differences in RQ were observed before the beginning of surgery among groups. In group 1, the RQ decreased from 0.85 ± 0.08 (X ± S.D.) to 0.72 ± 0.04 at 150 min after the beginning of the operation. In groups 2 and 3 (the glucose groups) and group 4 (the maltose group), the RQ also had fallen at 150 min, from 0.86 ± 0.06 to 0.74 ± 0.06 (group 2), 0.86 ± 0.05 to 0.80 ± 0.05 (group 3), 0.86 ± 0.03 to 0.81 ± 0.03 (group 4). Group 5 was the only group in which we could not observe any significant change of RQ during surgery (0.85 ± 0.06 to 0.84 ± 0.03). Without carbohydrates administration, the RQ decreased to nearly 0.7, indicating that the main energy source of the patients changed from carbohydrates to lipids. This reduction of RQ during operation can be inhibited with administration of carbohydrates, which suggests that the administered carbohydrates were utilized as the energy source during the time of surgery, and maltose 0.5g/kg/hr is thought to be suitable for intraoperative use as an energy source.This study was supported by a Research Grant from the Japanese Ministry of Education, Science and Culture (No. 61771129), and was presented at the 7th European Congress of Anesthesiologists held in Vienna, 1986.【Hiroshima J. Med. Sci.Vol.37, No.3, p149に掲載】 ERRATUM Page 83 In the Abstract section, 0.25g glucose/kg on line 8 should be read 0.25g glucose/kg/hr; and 0.25g/kg/hr on line 9 should be corrected to be 0.25g/kg/hr and 0.5g/kg/hr

パラコート中毒死の1例と生体試料中パラコートの迅速分析法

In a case of fatal paraquat poisoning, the distribution of paraquat was determined by a) the column chromatographic method developed by Tompsett, b) the ion-pairing method, c) the deproteinization method both developed by Jarvie et al, and d) the precipitation method developed by the authors. The precipitation method relies on the use of a precipitate of paraquat with Reinecke's salt to extract paraquat from biological material, and the dithionite color reaction to detect paraquat. The paraquat concentrations obtained by the precipitation method approximated to those obtained by the column chromatographic method. The results indicate that the use of the precipitation method followed by the dithionite color reaction is suitable not only for forensic practice but also emergency analysis. Since paraquat was not detected in the gastric contents collected at autopsy, and paraquat concentrations in the organs were much higher than the concentration in the heart blood, it seems that the hemodialysis and hemoperfusion were begun too late

Tuberculous pneumonia-induced severe ARDS complicated with DIC in a female child: a case of successful treatment

Abstract Background Tuberculous (TB) pneumonia can induce acute respiratory distress syndrome (ARDS). Although TB pneumonia is one of the causes of disease and death among children worldwide, the literature on TB pneumonia-induced ARDS is limited. We report herein on the successful treatment of a two-year-old female child with TB pneumonia-induced severe ARDS complicated with disseminated intravascular coagulation (DIC). Case presentation A two-year-old Vietnamese female child with sustained fever and cough for 20 days was transferred to our hospital. She had severe dyspnea and a chest X-ray showed bilateral infiltration without findings of heart failure. After tracheal intubation, her oxygenation index (OI) and PaO2/FiO2 (PF) ratio were 29 and 60 mmHg, respectively. Mycobacterium tuberculosis was detected by real-time polymerase chain reaction (rPCR) assay of tracheal lavage fluid. She was diagnosed as having severe ARDS that developed from TB pneumonia. Anti-tuberculous therapy and cardiopulmonary support were started. However, her respiratory condition deteriorated despite treatment with high-frequency oscillating ventilation (HFO), vasopressor support, and 1 g/kg of immunoglobulin. On the third day after admission, her International Society on Thrombosis and Hemostasis DIC score had increased to 5. Recombinant human soluble thrombomodulin (rTM) was administered to treat the DIC. After the administration of rTM was completed, OI gradually decreased, after which the mechanical ventilation mode was changed from HFO to synchronized intermittent mandatory ventilation. The DIC score also gradually decreased. Plasma levels of soluble receptor for advanced glycan end products (sRAGE) and high mobility group box 1 (HMGB-1), which are reported to be associated with ARDS severity, also decreased. In addition, inflammatory biomarkers, including interferon-gamma (IFN-γ) and interleukin-6 (IL-6), decreased after the administration of rTM. Although severe ARDS (P/F ratio ≦ 100 mmHg) continued for 19 days, the patient’s OI and P/F ratio improved gradually, and she was extubated on the 27th day after admission. The severe ARDS with DIC was successfully treated, and she was discharged from hospital on day 33 post-admission. Conclusions We successfully treated a female child suffering from TB pneumonia-induced severe ARDS complicated with DIC using multimodal interventions. (338/350)