Masui. The Japanese journal of anesthesiology
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We report, a case of aortic dissection after the termination of cardiopulmonary bypass (CPB), which was diagnosed by transesophageal echocardiography (TEE). A 70-year old male with aortic regurgitation received aortic valve replacement. ⋯ Furthermore wall motion abnormality was found by TEE, and aorto-coronary bypass was performed after observation by TEE. This case report suggests that TEE is useful not only for diagnosis but also for therapeutic orientation of aortic dissection.
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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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Clinical Trial Controlled Clinical Trial
[The optimum time interval for applying lidocaine containing adhesive tape is 6 to 8 hours for venipuncture pain relief].
Lidocaine containing adhesive tape (LT) is a pressure sensitive adhesive tape which contains 60% of lidocaine in base form. We investigated the optimum time interval for applying LT for venipuncture pain relief by using visual analogue scale (VAS). Six hundred seventeen cases were prospectively divided into 0.5, 1, 2, 3, 4, 6, 8, 12 hour groups. ⋯ When the punctures was smooth the median values of VAS in 6 and 8 hour groups were both less than 5%. Even with rough venipuncture, significant pain relief was observed in longer than 3 hour groups. We concluded that 6 to 8 hour applying of LT was optimum for pain relief of venipuncture.
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Spinal NMDA receptors are involved in hyperalgesia and chronic pain. The activation of spinal NMDA receptor results in the production of nitric oxide in the second order neurons in the spinal cord dorsal horn. We investigated the effects of intrathecally administered nitroglycerin (NTG) which releases nitric oxide in the cell. ⋯ MK given after formalin injection had significantly less effect on the phase 2 response. L-NAME (NOS inhibitor), MB (guanylate cyclase inhibitor) and HB (nitric oxide scavenger) significantly antagonized the hyperalgesic effect of NTG in the phase 2 of the formalin test. These results show that nitric oxide plays an important role in producing hyperalgesia in the spinal cord acting postsynaptically as well as pre-synaptically.
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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.