Search

Introduction A retrolaminar block (RLB) is a modified paravertebral technique with a local anesthetic injected at the retrolaminar site. The aim of this non-inferiority, parallel-group, prospective, and randomized study was to compare the analgesic efficacy of the paravertebral block (PVB) and RLB after lung surgery. Methods Eligible subjects were patients aged more than 20 years, with American Society of Anesthesiologists physical status Ⅰ or II, who were scheduled to undergo video-assisted thoracoscopic surgery (VATS) or limited thoracotomy because of lung disease. Patients were randomly allocated to receive either a PVB or RLB using a computer-generated sequence and sealed opaque envelopes. The PVB and RLB were induced by injecting 20 mL of 0.50% ropivacaine and 40 mL 0.25% ropivacaine, respectively. As the primary outcome variable, we considered the area under the curve (AUC) of the postoperative pain intensity using the trapezoidal method. Pain intensity was assessed using an 11-point numerical rating scale (NRS). We converted the NRS (0-10) into the visual analog scale (VAS) (0-100 mm) proportionally. We compared the AUC of the converted NRS (AUC-cNRS) on coughing between one and two hours after the operation. The non-inferiority margin was set at 25 mm × h in the AUC-cNRS. Patients and nurses were blinded to group assignments. Secondary outcomes included time to perform the block, NRS for pain intensity at rest and on coughing at one, two, four, 24, and 48 hours after the operation, the incidence of postoperative nausea and vomiting, time to first morphine use after the operation, and cumulative morphine consumption at 24 and 48 hours after the operation. Results In each group, 25 patients were randomized and analyzed. No significant difference in the AUC-cNRS was noted between the groups (P = 0.117). The mean difference in the AUC-cNRS (group RLB minus group PVB) was 13.42 mm × h, 95% confidence interval, -3.48 to 30.32 mm × h. However, when patients with unexpectedly extended skin incision were excluded from the analysis, the AUC-cNRS of group RLB was significantly higher as compared to group PVB (P = 0.0388). The time to perform the block was longer in PVB as compared to the RLB group (P < 0.0001). No significant differences were noted in the remaining secondary outcomes. Conclusion The non-inferiority of RLB as compared to PVB was not confirmed. Though RLB has the advantage of a shorter time to perform, RLB is not recommended for patients undergoing VATS or limited thoracotomy because of lack of efficacy as compared to PVB.

There is currently accumulating evidence for bidirectional communication between the neuroendocrine and immune systems. Various cytokines have been suggested to be involved in the stimulation of stress hormone secretion during the times of infection and inflammation. To assess the possible involvement and pathophysiologic significance of cytokines in the mechanisms responsible for the perioperative stress response of the hypothalamo-pituitary-adrenal axis, we observed the changes of plasma adrenocorticotropic hormone and cortisol levels together with those of plasma endotoxin and cytokine levels. In patients undergoing pancreatoduodenectomy, perioperative stimulation of adrenocorticotropic hormone and cortisol secretion was accompanied by a significant elevation of plasma cytokine levels. Application of epidural block up to the upper thoracic levels failed to suppress this stress response effectively. In patients undergoing unilateral total hip replacement, the response of plasma hormone levels was smaller and briefer with no significant increase of plasma cytokine levels. Application of epidural block up to the lower thoracic levels suppressed this hormonal response almost completely. In patients undergoing pancreatoduodenectomy, a significant elevation of plasma endotoxin level was followed by a gradual but significant elevation of plasma tumor necrosis factor alpha and interleukin-6 levels. It seems likely that the stimulatory effects of these cytokines on the secretion of adrenocorticotropic hormone and cortisol might be involved in the development of the greater and more prolonged stress response of hypothalamo-pituitary-adrenal axis. Our present study suggests that not only neural input from the surgical wound but also stimulation of cytokine production were responsible for the development of the stress response of the hypothalamo-pituitary-adrenal axis during and after upper abdominal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolates from various clinical materials in 13 hospitals in Akita prefecture and their drug susceptibility were investigated by the Chemotherapy Research Committee of Akita Prefecture during the period from Dec., 1987 to Feb., 1988. The results were as follows: 1. The total number of isolates was 8,387, including Staphylococcus aureus (18.9%), Pseudomonas aeruginosa (10.9%), Staphylococcus epidermidis (7.3%) and Enterococcus faecalis (6.6%). S, aureus and P. aeruginosa were detected more frequently in the larger hospitals. 2. The detection frequency of S. aureus from the sputum, throat swab and pus exudate was also very high. There was a diversity in isolates from the urine and the frequency of Escherichia coli was low. More than half of the isolates from the blood were S. epidermidis and S. aureus. Many kinds of bacteria were detected from pleural fluid and ascites, but the isolate showed no particular tendency. 3. The susceptibility of S. aureus to oxacillin were variable in hospitals, and the susceptibility to cefazolin were even lower. Low susceptibility were also seen with norfloxacin. S. aureus showed the highest susceptibility to minocycline. The susceptibility was lower for inpatients than for outpatients. P. aeruginosa showed low susceptibility to cefsulodin. The number of ampicillin-resistant Haemophilus influenzae isolates tended to decrease. Enterobacter cloacae showed a low susceptibility for cephems. Serratia marcescens showed low susceptibility to many drugs. Based on the above results, we concluded that attention should be paid to S. aureus, P. aeruginosa and Enterobacter in clinical practice.

We have studied the effects of flumazenil on sleep time and EEG in rats anaesthetized with 1.5% halothane, propofoi 20 mg kg−1, thiamylal 30 mg kg−1, or combinations of diazepam 5 mg kg−1 and anaesthetic agents. We also studied the effects of flumazenil 0.3, 3 and 30 mg kg−1 on behaviour and EEG. Flumazenil 0.3 and 3 mg kg−1 alone had no effect on behaviour or EEG, but flumazenil 30 mg kg−1 had depressive effects similar to those of diazepam on behaviour and EEG. Flumazenil 0.3, 3 and 30 mg kg−1 i.v., antagonized the effects of diazepam 10 mg kg−1 i.v. on behaviour and EEG. Flumazenil had no antagonistic effect on sleep time induced by anaesthetic agents, but flumazenil 30 mg kg−1 potentiated propofol-induced anaesthesia. Flumazenil did not affect anaesthesia-induced EEG changes. Diazepam 5 mg kg−1 potentiated anaesthesia. Flumazenil antagonism of diazepam potentiation varied with anaesthetic agent: flumazenil 0.3 mg kg−1 antagonized diazepam action in halothane anaesthesia, but 30 mg kg−1 was required in propofoi anaesthesia; this large dose was insufficient in thiamylal anaesthesia.

頸椎前方固定術308例の麻酔を経験し, 麻酔管理上の問題点について考察した. マイクロサージェリーであり, 術中の体動を避けるために全例筋弛緩薬を用いた全身麻酔で管理した. 挿管操作による頸髄損傷を避けるため,術前に安全な頸部の可動域を調べ, 原則として筋弛緩下に注意深く気管内挿管を行った. 循環系の不安定な症例が多いこと, 大出血の可能性があることを考え、循環系の抑制の少ないドロペリドール, ジアゼパムに調節性に富む吸入麻酔薬を低濃度で併用した. 術後は呼吸麻痺や上気道閉塞の恐れがあるため, 特に呼吸状態の観察が重要であり, 覚醒時に不穏状態にならず, 術後の呼吸抑制の少ない麻酔がよい.

Anemia-inducing substances were extracted from gastric juice of patients with gastric cancer and from human placenta. The immunological relationship of these substances was tested by the gel diffusion technique of Ouchterlony. The results were summarized as follows: 1) A rabbit was immunized with an anemia-inducing substance from the placenta (P-62) using Freund's adjuvant. The antiserum prepared was tested for the presence of antibodies against P-62 by complement fixation test. The test showed a high titer of 1:512. The antiserum was designated as P-62•Ab. 2) Analyses by Ouchterlony's method showed that P-62•Ab reacted markedly with P-62 and with an anemia-inducing substance from gastric juice (K-8) of patients with gastric cancer. But the corresponding fraction from normal gastric juice did not show the reaction with P-62•Ab. 3) These results indicated that there was a common antigenicity between anemia-inducing substances in the cancerous gastric juice (K-8) and in the human placenta (P-62).

Anemia-inducing substances have been prepared from gastric juice (K-7 and K-8) of patients with gastric cancer, cancerous gastric tissue (MK-62 and MK-63) and human placenta (P-62) by means of ethanol or acetone fractionation, and the effect of these substances on the osmotic fragility of rabbit red cells in vitro was studied. These substances, which are mucoproteins, decreased the osmotic resistance of the rabbit red blood cells in vitro.