Masui. The Japanese journal of anesthesiology
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To test the hypothesis that local anesthetic solution diffuses across the parietal pleura into the intercostal nerves in interpleural analgesia, tissue bupivacaine concentrations were assayed after interpleural injection of bupivacaine in rabbits. Thirty animals were killed at 10, 20, or 30 min after administration of 0.5% bupivacaine (1 ml.kg-1) into the left pleural cavity. The left intercostal muscle (lt-ICM), right intercostal muscle (rt-ICM) and femoral muscle (FM) were sampled immediately after killing the animals. ⋯ On the other hand, the bupivacaine concentrations in rt-ICM and FM were less than 2.0 micrograms.g-1 at any sampling time. (P < 0.01 vs. lt-ICM). These results indicate that bupivacaine administered interpleurally diffuses from the pleural space into the ipsilateral intercostal muscle. Direct diffusion of bupivacaine could cause intercostal nerve block following interpleural analgesia.
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A 2-year-old boy was scheduled for patch closures of ASD and VSD. After anesthesia induction, infection of a double lumen central venous catheter (5 Fr, Arrow) was tried into the superior vena cava through the right jugular vein by Seldinger's method. We confirmed the placement of the catheter by drawing a small amount of blood. ⋯ Following chest X-ray examination and an aspiration of intrapleural space revealed a severe hemothorax of the right side, where catheter had been inserted. The boy recovered without any disorders. This case suggests the importance to confirm the placement of CVP catheter, and to prevent the possible complications due to the malpositioned catheter.
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Low flow anesthesia (LFA) using a fresh gas flow (FGF) of 600 ml.min-1 with oxygen and nitrous oxide flow each set at 300 ml.min-1, and dial setting of sevoflurane 3% was administered to 30 patients for a duration of 5 hours. There were no problems such as unsuitable concentrations of nitrous oxide and sevoflurane in inspired and expired gases or low FIO2 below 0.3 during anesthesia in 15 patients of group A. Their body weight was 53 +/- 5 kg. ⋯ It was suggested that in group A the FGF per body weight was suitable; in group B though oxygen flow was larger than oxygen consumption, hypoxia occurred due to saturation of nitrous oxide in the body; and in group C the FGF was insufficient. The compound A was detected in the breathing circuit, and the concentration was around 20 ppm and it did not depend on the duration of LFA. It was concluded in this study that LFA using the FGF of 600 ml.min-1 with setting of 3% sevoflurane, 50% oxygen and nitrous oxide, could be performed safely without risks such as hypoxia and severe delay of induction for patients weighing 53 +/- 5 kg for a duration of 5 hours.