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An 83-year-old woman was scheduled for a second transurethral resection of a bladder tumor. The preoperative electrocardiogram evaluation revealed atrial fibrillation with a slow ventricular response (ventricular rate: 59 /min). After intravenous injection of 1% lidocaine 40 mg and propofol 60 mg, the ventricular rate increased to 113 beats/min and then fell rapidly to 27 beats/min. Blood pressure was 70/40 mmHg. Later an atrial fibrillation rhythm, with a ventricular rate of 100-130 beats/min, was observed together with a sinus pause and sinus rhythm with a ventricular rate of 40-50 beats/min. An external pacemaker was applied and set at 60 mA, 40 counts. After the patient regained consciousness, she presented an alert mental state and had no chest symptoms. She was discharged 2 weeks later without complications after insertion of a permanent pacemaker.

CC We experienced a rheumatoid arthritis (RA) patient who developed acute pulmonary edema by hypoxia in the absence of spontaneous respiratory effort by sufficient muscle relaxation during anesthesia induction. A 61-year-old, 136 cm, 48 kg female patient was treated at our hospital for a bilateral total knee arthroplasty due to RA involving the knee joints. During preoperative evaluation of the patient, her chest radiograph showed a suspicious bronchitis at right lower lobe costophrenic angle area (Fig. 1A), whereas the other laboratory tests showed no specific abnormality. The patient was moved to the operating room to receive bilateral total knee replacement. After normal tidal breathing of 100% oxygen 6 L/min for 3 min using a tightly fitting face mask, anesthesia was induced by injecting 60 mg of propofol and 0.3 μg/kg/min of remifentanil and 30 mg of rocuronium. Under mask ventilation, intubation was performed after 3 min. Intubation was performed using Fiberoptic intubation due to difficulties with endotracheal intubation based on the preoperative cspine radiography finding of atlantoaxial subluxation. Fiberoptic intubation was tried for 3 min but failed, the subsequent mask ventilation was performed for 3 min, during which the patient’s ventilaton was not sufficient but maintained, at that time the SpO2, expired tidal volume and ETCO2 was between 90–95%, 200–400 ml and 40–45 mmHg, respectively. But, a few seconds later, mask ventilation was more inadequate, leading to a decrease in the SpO2 up to 70% and cyanosis. Thus, LMA was immediately inserted for adequate ventilation, and the SpO2 were measured as 90%, the patient’s ventilation was smooth and SpO2 increased to 100%, whereupon LMA-guided fiberoptic intuba tion was successfully performed. Five minutes later, a pinkish foamy secretion was observed in the endotracheal tube, and pulmonary edema was shown by a portable chest radiograph; however, no other abnormality was observed (Fig. 1B). Arterial blood gas analysis (ABGA) at an inspired oxygen fraction of 0.5 showed the following: pH 7.3, PCO2 45 mmHg, PO2 149 mmHg, and BE -2.5 mmol/L. Judging that the pulmonary edema was not serious based on the ABGA and chest radiograph, we proceeded with the surgery as planned and intermittent the endotracheal tube suction for 30 min after initiation of the surgery, until the secretion stopped. The total amount of secretion was

Background: The effect of chronic administration of 4-methylcatechol known as a neurotrophic factor inducer on the allodynia and spinal neurotrophic factors was investigated in chronic constrictive injury of sciatic nerve in rats. Methods: With the Sprague Dawly rat, sciatic nerve was loosely ligated with 4-0 chromic catgut and neuropathic pain model was made. The threshold for tactile allodynia was measured with von Frey hair by up-down method and cold allodynia was measured by dropping 20μl of 100% acetone on the dorsum of the injured foot. 4-Methylcatechol (100μg/kg, intraperitoneal) was injected once a day for 14 days and the effect on allodynia was compared with saline injected group. At 3, 7 and 14 days after injection, lumbar spinal cord was harvested and the mRNA content of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) was measure by real time PCR. Results: Mechanical and cold allodynia improved from 7 days after 4-methylcatechol administration. NGF and BDNF in spinal cord decreased compared to sham operated group. BDNF in lumbar spinal cord has increased tendency after treatment without statistical significance. Conclusions: Chronic intraperitoneal administration of 4-methylcatechol may improve tactile and cold allodynia in chronic constrictive injury rat model of neuropathic pain. The BDNF mRNA in spinal cord might increase after 4-methylcatechol treatment.

Background: Gabapentin is a novel anti-epileptic drug, which is used in clinical practice to treat epilepsy. This drug is also used as an analgesic in pain patients. The antinociceptive effect of this drug was assessed using the formalin test in the rat. Methods: In order to investigate the effects of gabapentin on the trigeminal nerve territory, we injected 0.5 % formalin into the upper lip. Adult, male, Sprague-Dawley rats received a 50l subcutaneous injection of 5% formalin into one vibrissal pad and the consequent, facial grooming behavior was monitored. Consistent with previous investigations using the formalin model, animals exhibited biphasic nocifensive grooming (phase 1, 0-12 min; phase 2, 12-60 min). Results: The intraperitoneal administration gabapentin 5 minutes prior to the formalin injection led to a significant, dose-dependent reduction in grooming time during phase 2. In high doses, gabapentin also reduced the time of grooming during phase 1. Conclusions: The Intraperitoneal injection of gabapentin has an analgesic effect in the facial formalin rat model and this analgesic effect increases dose-dependently.