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Abstract Introduction This study aimed to determine the effects of the interaction between intravenous anesthetics and desflurane on the QT interval. Methods Fifty patients who underwent lumbar spine surgery were included. The patients received 3 μg/kg fentanyl and were randomly divided into two groups: group P patients received 1.5 mg/kg propofol and group T patients received 5 mg/kg thiamylal 2 min after fentanyl injection. All patients received rocuronium and desflurane (6% inhaled concentration) after loss of consciousness. Tracheal intubation was performed 3 min after rocuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiograms were recorded before fentanyl injection (T1), 2 min after fentanyl injection (T2), 1 min after propofol or thiamylal injection (T3), immediately before intubation (T4), and 2 min after intubation (T5). Results There were no significant intergroup differences in patient characteristics. BIS and MAP decreased after anesthesia induction in both groups. MAP values at T3, T4, and T5 in group T were higher than those in group P. HR did not change over time or differ between the groups. The QTc intervals at T4 and T5 in group T were longer than those at T1. In group P, the QTc interval at T3 was significantly shorter than that at T1. The QTc intervals at T3, T4, and T5 in group T were significantly longer than those in group P. Conclusions A propofol injection could counteract the QTc interval prolongation during desflurane anesthesia induction. Trial registration UMIN Clinical Trials Registry database reference number: UMIN000023707. This study was registered on August 21, 2016.

Background: The urinary albumin/creatinine ratio (ACR) is a significant neurologic prognostic predictor in patients with aneurysmal subarachnoid hemorrhage (SAH). B-type natriuretic peptide (BNP) plays an important role in body fluid regulation in patients with SAH. The present study was performed to determine whether ACR was independent predictor for unfavorable neurological outcome and ACR was associated with increased N-terminal pro-BNP (NT-pro-BNP) after SAH. Methods: We studied 61 patients undergoing surgery who were admitted within 48 h after aneurysmal SAH onset between July 2008 and June 2010. Hunt and Hess grade and Fisher grade were recorded at admission. The Glasgow Coma Scale (GCS) score was calculated at admission and daily for seven postoperative days. Arterial blood was sampled at admission and for seven postoperative days to determine the PaO2/FIO2 ratio, C-reactive protein level, troponin I level, and NT-pro-BNP level. Urine was sampled at admission and daily for seven postoperative days to determine ACR and vanillylmandelic acid/creatinine ratio (VMACR). Neurological outcomes were assessed at hospital discharge by using the Glasgow Outcome Scale. Receiver operating characteristic curves were constructed for the predictive variables of unfavorable neurological outcomes, and the area under the curve (AUC) was determined. Multivariate logistic regression analyses were performed for the significant predictors of unfavorable neurological outcomes after SAH. Associations with NT-pro-BNP were evaluated by using the Spearman rank correlation test. Results: Of the 61 patients, 24 had unfavorable outcomes. The prevalence rate of microalbuminuria was 85% (52/61). The highest NT-pro-BNP levels were above the normal range in 57 of 61 patients (93%). According to the AUC, the Hunt and Hess grade, GCS score, the highest ACR, and highest VMACR were significant predictors of neurological outcome. Multivariate logistic regression analyses showed that the highest ACR and Hunt and Hess grade are independent prognostic predictors of unfavorable neurological outcomes. The highest NT-pro-BNP significantly correlated with the highest troponin I, highest ACR, and VMACR on admission. Conclusions: The highest ACR is an independent prognostic predictor of unfavorable neurological outcomes after SAH. Moreover, plasma NT-pro-BNP elevation may be associated with the development of microalbuminuria. [ABSTRACT FROM AUTHOR]

Background: Allogenic blood transfusion accompa- nies the risks of infection, allergic reaction, and immune suppression. We analyzed the patients having autolo- gous blood transfusion in major orthopedic surgery in our hospital., Methods: We analyzed 2,262 patients scheduled for autologous transfusion for the last 22 years (from Sep- tember 1991 to September 2013) retrospectively. Autologous transfusion was scheduled alone or com- bined with two or three methods, that is, preoperative donation, acute hemodilution, or blood salvage, accord- ing to the type of surgery and intra- and post-opera- tive blood loss., Results: Almost all the cases were major orthopedic surgeries, e. g., total hip arthroplasty (primary, unilat- eral THA, 1,281 patients, revision THA, 84 patients), total knee arthroplasty (primary TKA, 519 patients), rotational acetabular osteotomy and curved periace- tabular osteotomy (RAO and CPO, 145 patients), and scoliosis surgery (44 patients). For predonation, autolo- gous blood of 400-800 ml was obtained from all patients and supplemented with 400-800 ml of acute hemodilution during preoperative period and 200-400 ml of salvage during the intra- and post-operative period. As a result, 260 cases (11%) received allogenic blood transfusion, and 13 cases (0.5%) developed vasovagal reflex during drawing blood, and one patient died the day after drawing blood not related with predonation., Conclusions: The use of autologous transfusion would be useful for avoiding or reducing homologous transfusion requirements in scheduled orthopedic major surgeries.