Masui. The Japanese journal of anesthesiology
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Recently we reported a case of inadvertent migration of an epidural catheter into the endothoracic fascia. Anesthetic injection into the fascia brought a broad unilateral analgesia. To clarify the mechanism of anesthesia. ⋯ The crimson dye, the substitute of the anesthetic agent, reached the transversial fascia in the abdominal cavity through medial and lateral arcuate ligament. Subcostal nerve, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve and lateral femoral cutaneous nerve were found to be in the course of dye dispersion. The renal adiposal fascia plays a role of a reservoir for the anesthetic agent and prevents the further anesthetic dispersion.
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The effect of intraoperative stored blood transfusion on the changes in plasma neutrophil elastase (PMN-E) was studied in packed red cell, and in the patients transfused with stored blood (400-1000 ml) during surgery (n = 22), compared with the control in patients who had not received transfusion (n = 6). PMN-E was measured as elastase.alpha 1-antitrypsin complex (EAC) and the effect of ulinastatin (UTI) treatment on EAC was also evaluated. ⋯ There was no significant correlation between transfusion volume and EAC (r2 = 0.44, P > 0.05) in patients with UTI treatment during blood transfusion. These results and increased H2O2 concentration of expired breath in the patient whose plasma EAC exceeded 1,000 micrograms.l-1, suggested PMN-E is released from triggered neutrophil by increased EAC.