Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2004
Case ReportsA severe complication after laser-induced damage to a transtracheal catheter during endoscopic laryngeal microsurgery.
Subcutaneous emphysema and pneumothorax is a rare and severe complication of percutaneous transtracheal jet ventilation, usually caused by obstruction of the upper airway or displacement of the tracheal catheter. Nevertheless, it is our preferred technique for endoscopic laryngeal laser surgery. We report a patient with acute subcutaneous emphysema and pneumothorax during laser surgery, caused by unobserved laser damage and discuss the associated risk factors. ⋯ The percutaneous transtracheal jet ventilation for elective laryngeal laser surgery reduces the risk of airway fires and gives a free endoscopic operative field. This case report suggests that, even when using a teflon catheter, laser-induced damage with severe complications might occur.
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Anesthesia and analgesia · Jun 2004
Case ReportsChange in bispectral index during epileptiform electrical activity under sevoflurane anesthesia in a patient with epilepsy.
We observed abnormal fluctuation in Bispectral Index (BIS) caused by repeated alternations between two electroencephalographic (EEG) waveform patterns in a patient with a recent history of epileptic seizure under sevoflurane anesthesia. The repetitive development of the abnormal EEG changes (slow delta with or without spike) and the fluctuation in BIS disappeared almost immediately after administration of anticonvulsants. BIS may give useful information not only on the sedative-hypnotic state, but also on the development of and recovery from abnormal epileptiform EEG activity. ⋯ During epileptiform electroencephalographic activity (EEG), the Bispectral Index shows an abnormal fluctuation caused by repeated abrupt alterations between normal EEG and abnormal epileptiform EEG patterns.
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Anesthesia and analgesia · Jun 2004
Case ReportsThe use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant.
Prolonged use of opioids and benzodiazepines for the care of critically ill infants and children can generate physical dependence. We present a case of an 8-mo-old infant with Hunter's syndrome who was maintained on very large doses of fentanyl and midazolam and who could not be weaned from these drugs by conventional taper. We used dexmedetomidine, an alpha(2)-adrenergic agonist, to facilitate opioid and benzodiazepine withdrawal. A processed electroencephalogram (Bispectral Index) was used to guide the titration of dexmedetomidine in this neurologically impaired infant. This is the first report of this drug being used in an infant to manage chemical dependence withdrawal. ⋯ Dexmedetomidine was used to facilitate opioid and benzodiazepine withdrawal in an 8-mo-old infant. A processed electroencephalogram (Bispectral Index) was used to guide the titration of dexmedetomidine in this neurologically impaired infant. This is the first report of dexmedetomidine use in an infant to manage chemical dependence withdrawal.
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Anesthesia and analgesia · Jun 2004
A platelet activating factor receptor antagonist inhibits cytokine production in human whole blood by bacterial toxins and live bacteria.
We previously reported that a platelet-activating factor receptor (PAFR) antagonist (TCV-309) suppressed lipopolysaccharide (LPS)-induced mortality and tumor necrosis factor (TNF) production in mice. However, the effect of TCV-309 on cytokine production induced by Staphylococcus enterotoxin B (SEB) or live bacteria has not been reported. In this study we investigated the effect of TCV-309 on cytokine production in human whole blood induced by LPS, SEB, and both Gram-positive and -negative bacteria. Human whole blood diluted 5:1 (980 microL) was placed in the wells of a 24-well plate. Ten microliters of LPS, SEB, Escherichia coli O18 K(+), or Staphylococcus aureus were added to each well. After incubation at 37 degrees C for 6 h, TNF, interleukin (IL)-6, and IL-8 in the culture medium were measured. TCV-309 did not affect the growth of either E. coli or S. aureus bacteria in the culture medium for the 6 h incubation. LPS, SEB, and both E. coli and S. aureus induced TNF, IL-6, and IL-8 in human whole blood. TCV-309 significantly inhibited the production of TNF, IL-6, and IL-8 induced by LPS, SEB, and bacteria. A PAFR antagonist suppressed cytokine production induced by LPS, SEB, and both Gram-positive and -negative bacteria in human whole blood. A PAFR plays an important role of producing proinflammatory cytokines induced by both toxins and live bacteria. ⋯ The platelet-activating factor receptor plays an important role in producing proinflammatory cytokines induced by bacterial toxins, such as lipopolysaccharide,Staphylococcus enterotoxin B, and live Gram-positive and Gram-negative bacteria.
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Anesthesia and analgesia · Jun 2004
The effect of propofol on cytotoxicity and apoptosis of lipopolysaccharide-treated mononuclear cells and lymphocytes.
IV anesthetics may inhibit proper immune responses and further compromise an already depressed defense system. To assess the possible role of propofol on human immune function in sepsis, we studied cytotoxicity, and apoptosis of mononuclear cells (MNCs). Peripheral blood MNCs were preincubated in 1 microg/mL of lipopolysaccharide (LPS) and then reincubated in different concentrations of propofol (1 microg/mL, 5 microg/mL, 10 microg/mL, or 50 microg/mL). To determine cytotoxicity, lactate dehydrogenase release was assayed by mixing MNCs (4 x 10(5)/100 microL) with K-562 tumor cells as target cells (1 x 10(4)/100 microL)(E: T ratio of 40:1). Apoptosis was determined by measuring the annexin positive cells using flow cytometry. Cytotoxicity and apoptosis of LPS-treated MNCs were unchanged by clinically acceptable concentrations of propofol (1 microg/mL, 5 microg/mL, and 10 microg/mL). However, significant differences were observed in cytotoxicity (P = 0.004) and apoptosis (P = 0.002) with propofol 50 microg/mL. By gating MNCs, we found that lymphocyte apoptosis was significantly increased at 50 microg/mL of propofol, but monocytes were unaffected (P = 0.02). In terms of cytotoxicity and apoptosis, propofol allowed MNCs to retain their cytotoxicity in septic conditions by protecting immune cells from apoptosis. ⋯ Propofol at acceptable therapeutic concentrations, and under experimentally contrived septic conditions, did not affect the cytotoxic activity of mononuclear cells or the apoptosis level of mononuclear cells, lymphocytes, and monocytes from peripheral blood.