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The onset of tachyarrhythmia after the Fontan procedure (total cavopulmonary connection; TCPC) should be considered a medical emergency. Landiolol is an ultra-short-acting [beta]1-selective blocker whose effect on tachyarrhythmia after TCPC is unclear. We evaluated the efficacy and safety of landiolol for tachyarrhythmia after TCPC. Consecutive patients undergoing TCPC were enrolled from January 2007 to December 2011. Of 435 pediatric open heart surgeries, 28 patients underwent TCPC. Of the 28 patients, 13 were treated with landiolol for critical tachyarrhythmia. Excluding three patients who received landiolol during surgery, we investigated the remaining 10 patients and statistical analysis was performed without a 10-year-old patient as outlier. The median age was 4.08 years. The subjects comprised five patients with sinus tachycardia, four with junctional ectopic tachycardia and one with paroxysmal supraventricular tachycardia. The initial dose was 4.7 ± 2.3 [mu]g/kg/min, without a loading dose. Landiolol reduced the heart rate from 151.8 ± 23.2 at the start to 132.9 ± 20.0 at 1 h and 126.1 ± 24.9 at 2 h (P < 0.01 and P < 0.01, respectively), without blood pressure decrease (P = 0.235). Landiolol was effective in treating critical tachyarrhythmia without hemodynamic deterioration. We believe that landiolol is a promising option for postoperative tachyarrhythmia after the Fontan procedure., Author(s): Kentaro Miyake[sup.1] , Yoshihito Fujita[sup.2] , Saya Yoshizawa[sup.1] , Maiko Tomita[sup.1] , Mitsunori Miyazu[sup.1] , Yoshiki Sento[sup.1] , Shinichiro Yoshimura[sup.1] , Kazuya Sobue[sup.1] Author Affiliations: (1) Department of Anesthesiology [...]

It is recommended that the period of fasting before elective surgery should be shortened to facilitate a rapid recovery by preventing catabolism. We examined the effects of a short period of fasting on metabolism by performing indirect calorimetry (IC) under general anesthesia. A prospective observational study involving 26 consecutive patients who underwent elective surgery and whose metabolism was evaluated using IC during anesthesia was conducted. The patients were divided into two groups, those who fasted for 10 h (group L). Oxygen consumption, the volume of carbon dioxide emissions (VCO.sub.2), the respiratory quotient (RQ), resting energy expenditure (REE), and basal energy expenditure (BEE) were compared. The REE, VCO.sub.2, and RQ of group L (17.7 ± 2.3 kcal/kg/day, 118.5 ± 20.8 ml/min, and 0.71 ± 0.12, respectively) were significantly lower than those of group S (19.7 ± 2.3 kcal/kg/day, 143.6 ± 30.9 ml/min, and 0.81 ± 0.09, respectively) (P < 0.05). In group L, the relationship between REE and BEE was weaker (r.sup.2 = 0.501) and the BEE-REE slope was less steep (REE = 0.419BEE + 509.477) than those seen in group S (r.sup.2 = 0.749 and REE = 1.113BEE - 376.111, respectively). Our findings suggest that a short period of fasting (, Author(s): Shinichiro Yoshimura[sup.1] , Yoshihito Fujita[sup.1] , Hiroyuki Hirate[sup.1] , Nobuyoshi Kusama[sup.1] , Takafumi Azami[sup.1] , Kazuya Sobue[sup.1] Author Affiliations: (1) Department of Anesthesiology and Medical Crisis Management, Nagoya City [...]

For understanding the pathogenesis of Down syndrome (DS), it is important to identify and characterize the genes on Chromosome (Chr) 21, especially those in the Down syndrome critical region (DSCR) on Chr 21q22.2. Recently we have determined 33.5 Mb (more than 99%) of DNA sequence of Chr 21 and, from these sequence data, we identified a novel gene, DSCR5 (transcript = 0.8 kb), from DSCR by combination of computational gene prediction and cDNA screening. For functional analysis of DSCR5, we identified a mouse homolog of the DSCR5 cDNA, and termed it mDscr5 (transcript length = 0.8 kb). The gene was mapped to mouse Chr 16 C3-C4, the syntenic region of human Chr 21, and encodes an amino acid of 132 residues with 90% identity to DSCR5. In situ hybridization showed that mDscr5 is predominantly expressed in the developing tongue. To our best knowledge, no other gene in DSCR is reported to be expressed in tongue, so that DSCR5 may be the first candidate to elucidate the pathophysiology of tongue malformation observed in DS. [ABSTRACT FROM AUTHOR]

We report successful awake intubation using AWS combined with surface anesthesia of the upper airway via nebulizer. The two cases are suitable for awake intubation due to difficult airway. After inhaled lidocaine 4% and nebulized 4 ml, while giving fentanyl i. v, we performed awake intubation. As a preparatory step to the procedure described above, awake intubation was tested on the author himself with only surface anesthesia. The patients and author did not buck during intubation. The present case shows that it is possible to perform awake intubate safely with less stress with the combination of AWS and surface airway anesthesia via nebulizer.