Journal of anesthesia
-
Journal of anesthesia · Jan 2008
Peroxynitrite affects lidocaine by acting on membrane-constituting lipids.
Inflammation frequently decreases local anesthetic effects, especially in dental anesthesia in patients with pulpitis and periodontitis. The pharmacokinetics and the mode of action of local anesthetics are closely associated with the hydrophobic interactions between these drugs and lipid bilayers that change the membrane physicochemical property, fluidity. A lipid oxidant, peroxynitrite, is produced by inflammatory cells, and it may act on nerve cell membranes and affect anesthetic efficacy. ⋯ Peroxynitrite (0.1-50 microM) rigidified nerve-cell model membranes consisting of unsaturated phospholipids, as well as liposomal membranes consisting of 1,2-dioleoylphosphatidylcholine and 1-stearoyl-2-arachidonylphosphatidylcholine, but peroxynitrite did not rigidify 1, 2-dipalmitoylphosphatidylcholine liposomal membranes. The pretreatment of nerve-cell model membranes with peroxynitrite (0.1-50 microM) decreased the membrane-fluidizing effects of lidocaine (5.0 mg x ml(-1)) to 63%-86% of the control (not treated with peroxynitrite) depending on the peroxynitrite concentration. As one of the mechanisms of the local anesthetic failure associated with inflammation, inflammatory peroxynitrite may affect local anesthesia by acting on membrane-constituting unsaturated phospholipids.
-
Journal of anesthesia · Jan 2008
Case ReportsAnesthetic management of two cases of Beckwith-Wiedemann syndrome.
Two cases of children with Beckwith-Wiedemann syndrome are presented. This syndrome consists of various abnormalities, including macroglossia, visceromegaly, omphalocele, and gigantism. These abnormalities frequently require operative correction during the neonatal period. ⋯ Our two patients also showed larger sized tracheas than those estimated by their age and height. A cuffed tube, though still controversial, has recently been used in children. We recommend using a cuffed tube in patients with this syndrome, because the appropriate tracheal size may not be predictable, tracheal intubation might be difficult, and risks incurred during changing of a tracheal tube should be avoided.
-
Journal of anesthesia · Jan 2008
Different recovery of the train-of-four ratio from rocuronium-induced neuromuscular blockade in the diaphragm and the tibialis anterior muscle in rat.
To clarify differences between the diaphragm and the limb muscles in terms of the effects of neuromuscular blockers concerning train-of-four (TOF) ratios, we compared the recovery of twitch tensions and TOF ratios in the diaphragm and in the tibialis anterior muscle in rats in vivo. ⋯ Our method of simultaneous in vivo evaluation of TOF ratios in both the diaphragm and the tibialis anterior confirmed significant differences between the two muscles in relationships between first-twitch tension and the TOF ratio.
-
Journal of anesthesia · Jan 2008
Case ReportsUse of initial distribution volume of glucose to determine fluid volume loading in pulmonary thromboembolism and right ventricular myocardial infarction.
We report a case of acute right ventricular myocardial infarction (right AMI) following pulmonary thromboembolism (PTE). Following percutaneous coronary intervention, the patient was treated in our intensive care unit (ICU) with intraortic balloon pumping, anticoagulants, and plasma expansion. Fluid overload may cause a further leftward shift of the interventricular septum in patients with PTE, resulting in decreased cardiac output (CO). ⋯ At 12 h thereafter, IDVG became normal, and both CO and blood pressure became improved. However, the cardiac filling pressures remained increased. Although the patient died on the subsequent day, this case report could support the usefulness of IDVG as a fluid volume marker in critically ill patients, especially those with right AMI.