Masui. The Japanese journal of anesthesiology
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A 28 year-old male patient developed anaphylactic shock on separate occasions, possibly due to the contact with a central venous catheter impregnated with chlorhexidine and silver sulfadiazine. He was successfully resuscitated. On the second operation, blood basophils disappeared and plasma histamine level increased extremely up to 80 ng.ml-1 soon after anaphylactic shock. ⋯ Latex-specific anti-IgE antibody was not detected. Therefore, chlorhexidine was confirmed as the causative agent of anaphylactic shock. Because chlorhexidine is extensively used as an antiseptic drug in emergency rooms and intensive care units, we should be aware of the possibility of chlorhexidine induced anaphylactic reactions.
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Randomized Controlled Trial Clinical Trial
[Preventive effect of fluid warmer system on hypothermia induced by rapid intravenous infusion].
The changes in body temperature induced by rapid intravenous infusion of lactated Ringer solution and the effect of a fluid warmer system (HOT LINE, Level 1 Technologies, Inc., Rockland, MD) were investigated in 35 patients undergoing cardiovascular surgery. The patients were divided into 5 groups by categories of the fluid temperature (-19 or -38 degrees C), infusion route (radial or right subclavian vein), and infusion rate of lactated Ringer solution (1000 or 250 ml for 30 min). Pulmonary arterial, esophageal, bladder, and forehead deep temperatures, which reflect core temperature, were significantly decreased by the rapid infusion of unwarmed solution (0.8-1.0 degree C, P < 0.05). ⋯ With regard to the infusion route, there was no significant difference in the temperature between the radial vein and subclavian vein groups. Plantar deep temperature showed no significant change during this study. In conclusion, infusion of warmed solution using HOT LINE could prevent hypothermia induced by rapid intravenous infusion, and this effect is not greatly influenced by route of venous infusion.
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Case Reports
[A patient with drug abuse who developed multiple psychotic symptoms during sedation with propofol].
We report a patient with drug abuse who developed multiple psychotic symptoms including euphoria, excitement, hallucination and delirium during sedation with propofol under spinal anesthesia. A 37-year-old man who had abused methamphetamines, thinner, phychomimetics and alcohol for 20 years was scheduled for skin transplant as day-case surgery. He was treated with cholorpromazine, haloperidol and flunitrazepam just before the surgery. ⋯ He also demonstrated excitement, hallucination and delirium under propofol 6-8 mg.kg-1.h-1. His symptoms were suppressed by intravenous injection of haloperidol 5 mg. We speculate that propofol may produce psychotic symptoms when it is used in patients with a history of drug abuse.
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Case Reports
[Bronchodilator aerosol propellant interferes with an photoacoustic spectrophotometer respiratory gas analyzer].
A patient with bronchial asthma was scheduled for an operation under nitrous oxide-isoflurane anesthesia. We monitored isoflurane concentrations continuously using an anesthetic gas analyzer (BK 1304). ⋯ The BK 1304 uses infrared photoacoustic spectrophotometry and it is susceptible to interferences caused by Freon propellants in bronchodilator aerosols. We should take care in monitoring inhalational anesthetics when using aerosols containing Freon propellants.
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Case Reports
[General anesthesia in a patient with Cornelia de Lange syndrome with restricted opening of the mouth].
Patients with Cornelia de Lange syndrome have many anomalies including micrognathia with a small mouth, a high arched palate, and a short neck, which might make laryngoscopy for tracheal intubation difficult during induction of general anesthesia. General anesthesia was performed in a patient with Cornelia de Lange syndrome, and restricted opening of the mouth, which had not been reported previously, was found during laryngoscopy. The possible causes were thought to be temporo-mandibular joint disorders, contracture of the masseter muscle due to injury by self-destructive tendencies, or elogated coronoid process. The potential difficulty with laryngoscopy should be considered for tracheal intubation in a patient with Cornelia de Lange syndrome.