Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol

BACKGROUND AND OBJECTIVE: To investigate whether the administration of ketamine before induction with propofol produces a smaller decrease in arterial pressure. METHODS: Twenty-two patients were assigned to one of two groups to receive either propofol with ketamine (n = 11) or propofol alone (n = 11, control). Anaesthesia was induced with 2 mg kg-1 propofol and 0.5 mg kg-1 ketamine or 2 mg kg-1 propofol alone. Ketamine was administered 1 min prior to induction with propofol. Immediately after induction with propofol, vecuronium (0.15 mg kg-1) was administered. Four minutes after administration of vecuronium, tracheal intubation was performed. Anaesthesia was maintained using sevoflurane (0.5%) in 66% nitrous oxide until 3 min after intubation. Systolic, diastolic and mean arterial pressure and heart rate were recorded on arrival, directly before induction with propofol, prior to tracheal intubation, immediately after intubation and at 3 min after intubation. RESULTS AND CONCLUSIONS: Administration of ketamine before induction with propofol preserved haemodynamic stability compared with induction with propofol alone.     

A case of awareness during propofol anesthesia using bispectral index as an indicator of hypnotic effect

A 77-year old, woman weighing 44 kg with mild liver dysfunction underwent lower abdominal surgery. Anesthesia was induced with propofol 60 mg and fentanyl 0.1 mg. Tracheal intubation was facilitated with vecuronium 8 mg, and the lungs were ventilated with 33% oxygen in air. The bispectral index (BIS) was continuously monitored. Anesthesia was maintained with propofol infusion and analgesia was provided by thoracic epidural infusion of lidocaine 1.5%. The infusion rate of propofol was altered to maintain the BIS value between 40 and 50. The patient was hemodynamically stable with propofol 1.5 mg.kg-1.hr-1 and the BIS value was maintained about 40 during the operation. Near the end of the operation the patient moved suddenly. Suspecting inadequate anesthesia, a total of 40 mg of propofol i.v. and 5 ml of the epidural infusion were given. Immediately before the movement the BIS value was about 40. The operation was completed 30 min later. On discharge from the operating room the patient declared that she had been awake. She had heard voices and felt the surgeon working, but had suffered no pain. The BIS is a useful indicator for hypnotic effect, but this case demonstrates that awareness might occur even when BIS value indicates adequate hypnotic state.     

In vivo implant fixation of carbon fiber‐reinforced PEEK hip prostheses in an ovine model

Carbon fiber‐reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough‐textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone‐cement and cement‐stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA‐coated CFR/PEEK implants, even under load‐bearing conditions. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 485–492, 2013     

Prophylactic use of droperidol for postoperative nausea and vomiting following gynecological laparoscopic surgery under total intravenous anesthesia

BACKGROUND: Propofol and droperidol decrease the incidence of postoperative nausea and vomiting (PONV). We investigated the incidence of PONV after total intravenous anesthesia (TIVA) with propofol alone versus combined use of droperidol and propofol. METHODS: Eighty three patients, who had undergone laparoscopic gynecologic surgery with TIVA using propofol and fentanyl, were retrospectively evaluated whether droperidol had affected the incidence of early (up to six hours postoperatively) and late (6-24 hours postoperatively) PONV. Group D (46 patients) received droperidol intravenously at the end of surgery. Group N (37 patients) received no droperidol. RESULTS: The incidences of early nausea were 27% in Group N and 4% in Group D (P<0.01). The incidences of early vomiting were 0% in Group N and 8% in Group D. The incidences of late nausea were 14% in Group N and 13% in Group D. The incidences of late vomiting were 3% in Group N and 7% in Group D. CONCLUSIONS: Droperidol was useful in reducing the incidence of early nausea and vomiting after total intravenous anesthesia with propofol and fentanyl in the patients undergoing laparoscopic surgery.     

Relationship between serum albumin level before initiating haemodialysis and angiographic severity of coronary atherosclerosis in end-stage renal disease patients.

BACKGROUND: In patients with chronic kidney disease (CKD), although strong associations have been observed between malnutrition and atherosclerosis, the relationship between serum albumin concentration and angiographic changes of coronary artery disease (CAD) remains poorly explored. The goal of the present study was, in patients with CKD, to clarify the relationship between the angiographic severity of CAD and serum albumin concentration reflecting either inflammation or nutrition or both. METHODS: In this study, 100 end-stage renal disease (ESRD) patients were enrolled, who commenced long-term dialysis therapy at our hospital and underwent coronary angiography within 3 months of the first haemodialysis (HD) session. Mean age was 63+/-11 years, 20% of the subjects were female and 62% had diabetes. Severity of CAD was evaluated in terms of (i) number of vessels exhibiting CAD (>or=75% stenosis) and (ii) Gensini score (GS). Clinical characteristics and laboratory findings were recorded at initiation of long-term HD therapy. We then evaluated a possible association with the presence and degree of CAD. RESULTS: Sixty-four patients exhibited signs of CAD. Forty-one among them (64%) had multivessel disease. On univariate logistic regression analysis, age, diabetes and hypoalbuminaemia were significantly associated with multivessel CAD. Univariate linear regression analysis demonstrated a positive correlation of age and diabetes with GS, and an inverse correlation of BMI and serum albumin level with GS. Stepwise regression analysis showed age and serum albumin level to be independently associated with multivessel CAD and GS. The ROC curves demonstrated best cut-off levels of age and albumin for predicting multivessel CAD to be 70 years and 3.15 g/dl, respectively. CONCLUSION: Hypoalbuminaemia at the initiation of dialysis is an important predictor of advanced CAD, particularly in male and in diabetic patients. It may reflect mainly a state of inflammation. However, malnutrition as a confounding factor cannot be entirely excluded.     

Tongue pressure production while swallowing water and pudding and during dry swallow using a sensor sheet system

The tongue assumes an important role in bolus formation and transportation to the oropharynx and in retaining pharyngeal pressure during mastication and swallowing. Although the state of tongue-palate contact during swallowing is thought to change with bolus type, the details of these changes have yet to be clarified under normal physiological conditions. The purpose of this study was to examine the effect of bolus type on tongue pressure production against the hard palate during swallowing. Tongue pressures during swallowing 10 mL of water and 10 g of pudding and during dry swallow were measured with a sensor sheet system with five measurement points to evaluate normal physiological swallowing in 10 healthy dentate individuals. There was a common pattern in the sequential order of tongue pressure generation among the three swallowing conditions: tongue pressure was generated significantly earlier at the anterior-median part, followed by the posterior parts. During swallowing pudding and dry swallow, the duration of tongue pressure tended to increase at all channels except for the posterior-median part. The maximal magnitude of tongue pressure was significantly higher when swallowing pudding than when swallowing water at all channels except for the posterior-median part. The integrated value of tongue pressure was significantly higher when swallowing pudding than when swallowing water at all channels except for the posterior-median part. From these results, it was considered the tongue changed the sequential order, the duration and the magnitude of tongue pressure production according to the swallowing conditions (liquid swallowing, semisolid swallowing, dry swallow).     

Xeroderma pigmentosum variant associated with multiple skin cancers and a lung cancer.

A 65-year-old Japanese man with a xeroderma pigmentosum (XP) variant, XP127TO, is described. The XP127TO skin fibroblasts exhibited the typical XP variant characteristics of a 1.5-fold higher sensitivity than normal cells to the lethal effect of 254 nm ultraviolet (UV) light and the normal level of unscheduled DNA synthesis induced by 254 nm UV. Caffeine dose-dependently increased the cytotoxic effect of 254 nm UV on XP127TO cells. Clinically, the patient developed not only 3 cutaneous squamous cell carcinomas on sun-exposed areas but also an adenocarcinoma of the upper lobe of the right lung. A review of the 14 documented Japanese XP patients with nonskin malignancies indicates that the incidence of nonskin malignancy in XP patients is much lower than that of skin cancer in XP but higher than that in the general population.     

A clinicopathological study on tumor of the renal pelvis and ureter

We report 42 patients with urothelial tumors in upper tract admitted to our hospital between August, 1969 and August, 1988. The patients consisted of 33 males and 9 females; their ages ranged from 42 to 85 years with a mean of 66.2 years. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 24 cases, total nephroureterectomy without bladder cuff resection in 11 cases, total nephroureterectomy with total cystectomy in 2 cases and partial ureterectomy only in 2 cases. Tumor lesions had a positive correlation with grade and stage. The survival rate for all the patients at 1, 3 and 5 years was 76.0, 58.8 and 54.6%, respectively, as measured by the Kaplan-Meier's method. The prognosis of the patients with renal pelvic tumor and ureter tumor was dependent upon grade, stage and intravascular tumor-emboli. Vesical recurrence was observed in 10 cases and found frequently in low grade tumor and/or low stage tumor cases. The frequency of vesical recurrence was not positively correlated with cuff resection The 5-year survival rate was not different between the patients with vesical recurrence and those without vesical recurrence.     

Delayed Gastric Emptying by Helicobacter pylori Lipopolysaccharide in Conscious Rats

The present study was carried out to investigatethe possibility that lipopolysaccharide deprived fromHelicobacter pylori may alter gastric motility. Toaddress the question, we examined the effect of H. pylori lipopolysaccharide on gastricemptying in conscious rats. Gastric emptying wasevaluated by the phenol red method. Time-course anddose-related effects of intraperitoneal administrationof H. pylori lipopolysaccharide were investigated.Intraperitoneal injection of H. pylorilipopolysaccharide significantly suppressed gastricemptying of a liquid meal in a dose-dependent manner.The inhibitory action of H. pylori lipopolysaccharide wasobserved 2, 4, 8, or 12 hr after the injection. Theseresults suggest for the first time that H. pylorilipopolysaccharide may suppress gastric emptying in along-lasting fashion. It is also suggested that H. pylorimay influence gastric function through its cell wallstructure named lipopolysaccharide.     

Factors associated with frailty in Japanese patients with rheumatoid arthritis: results from the Institute of Rheumatology Rheumatoid Arthritis cohort study

Clinical Rheumatology - This study aimed to evaluate the prevalence of, and the factors associated with, frailty in Japanese patients with rheumatoid arthritis (RA). Patients with RA enrolled in...