Keiichi Tajima

A case of acute pulmonary edema and bulbar paralysis after local epinephrine infiltration

An unusual case in which pulmonary edema and intracranial hemorrhage occurred during adenotonsillectomy is presented. The possible causes of this intracranial hemorrhage are discussed, especially in relationship to local epinephrine infiltration.

Prolongation of Epidural Anesthesia in the Rabbit with the Use of a Biodegradable Copolymer Paste Containing Lidocaine

Prolongation of the drug effect using a drug-delivery system has recently been introduced in local anesthesia. In this study, we investigated the prolonging effect of an epidurally injected biodegradable copolymer paste containing 10% lidocaine (Lid-CoPol). Twenty-nine rabbits were studied. A catheter was placed in the epidural space at the level of L6-7 in each animal. A solution of 10% lidocaine (Group I, n = 12), or a copolymer containing 10% lidocaine (Lid-CoPol), (Group II, n = 12) or copolymer paste only (Group III, n = 5) was injected epidurally at a dose of 0.15 mL/kg. The effect of each drug was assessed by evaluation of response to pain stimulation and of the degree of motor block produced. The plasma lidocaine concentration was also measured consecutively in five animals of both Groups I and II. The duration of sensory and motor block of Lid-CoPol was 800% and 975% longer, respectively, than that of plain lidocaine solution. Plasma lidocaine concentration reached a maximum 5 min after injection (5.5 +/- 0.5 micro gram/mL) in Group I. In Group II, the level reached a maximum 30 min aftter injection (3.7 +/- 1.5 micro gram/mL). The findings are attributed in part to the slow release of lidocaine from the biodegradable copolymer paste, which is suggested as a new drug-delivery system for local anesthetics. (Anesth Analg 1995;80:97-101)

A rare case of perineal pain : intestinal perforation caused by a press-through package

atients with advanced rectal cancer sometimes complain of perineal or pelvic pain, or both P (1,2). One patient who had undergone surgery for rectal cancer 10 yr earlier visited our pain clinic complaining of perineal pain. We assumed that the pain was due to a local invasion of recurrent cancer, and caudal blocks were performed. A laparotomy was performed because a vesicointestinal fistula was suspected during the pain management. A pressthrough package (PTP) was found within a mass of abscess in the pelvic cavity, with one portion of the intestine perforated. After the laparotomy, the patient was discharged and was pain free. A case of fatal fecal peritonitis resulting from colon perforation caused by plastic sheeting has been reported (3). We present a rare case of perineal pain caused by intestinal perforation that had occurred 12 mo earlier after the accidental ingestion of a PTP.

Effect of intravenous prostaglandin E1 on pial vessel diameters and intracranial pressure in rabbits.

Background: The main advantages of prostaglandin E1 (PGE1) for induced hypotension during neurosurgery include a rapid onset of action, a quick recovery from hypotension, lack of toxicity, maintenance of adequate perfusion to vital organs, and maintenance of cerebral blood flow reactivity to carbon dioxide during hypotension. However, there is no report that shows the effect of PGE1 on cerebral microvessel diameter and only a few data are available that show the effect of PGE1 on intracranial pressure. The aim of this study was to measure cerebral arteriole and venule diameters and intracranial pressure (ICP) during PGE1‐induced hypotension to evaluate whether PGE1 is suitable for neuroanesthesia.

Hemodynamic effects of oral clonidine premedication in lumbar epidural anesthesia

Clonidine, an α2-adrenergic agonist, has a potent sympatholytic effect and augments the pressor effect of ephedrine during general anesthesia. We evaluated whether oral clonidine premedication would alter the hemodynamic changes and enhance the pressor response to intravenous ephedrine during epidural anesthesia in 35 adult patients. They were randomly administered either premedication with clonidine approximately 5 μg·kg−1 po (n=17) or no clonidine medication (n=18). After establishment of epidural anesthesia, the hemodynamic response to ephedrine iv was measured in the awake state at 1-min intervals for 10 min. Then, the same hemodynamic measurement was repeated in the asleep state induced with midazolam iv. There were no differences in blood pressure (BP) and heart rate values between groups during the onset of epidural anesthesia, except that BP before epidural anesthesia was lower in the clonidine group than the control group (P<0.05). The magnitude and duration of pressor responses to ephedrine were comparable between groups in awake and asleep states. In conclusion oral clonidine premedication 5 μg·kg−1 alters neither the hemodynamic changes nor the pressor response to intravenous ephedrine during epidural anesthesia.

Olprinone, a phosphodiesterase III inhibitor, does not affect hypoxia-induced pial arteriolar dilatation in rabbits

PurposeOlprinone, a phosphodiesterase III inhibitor, is used for the treatment of heart failure or asthma. Such patients may suffer from hypoxia. However, the effect of olprinone on the cerebrai vasodilator response to hypoxia remains unclear.MethodsRabbits were anesthetized and ventilated mechanically. The pial arteriolar diameter was determined using a cranial window and intravital microscopy. Hypoxia was induced twice in the same animal by reducing FiO2, to 0.1. The first episode was induced during an infusion of saline, and the second during an infusion of saline (saline group;n = 8) or olprinone (1 μg· kg−1· min−1, OLP 1 group;n = 8 or 10 μg· kg−1· min−1, OLP 10 group;n = 8). The pial arteriolar responses to hypoxia were recorded and compared between the two episodes of hypoxia in each group.ResultsBlood gas data in the first hypoxic challenge were identical to those in the second challenge in each group, Pial arteriolar diameter increased significantly during hypoxia. In arterioles between 50–100 μm diameter, first and second hypoxia-induced pial arteriolar dilatation in OLP l were 13 ± 6% and 10 ± 7% respectively (P = 0.574) and those in OLP 10 were 16 ± 6% and 15 ± 7% respectively (P = 0.606). In arterioles between 25–50 μm, the results were the same as in arterioles between 50–100 μm.ConclusionOlprinone does not affect the hypoxia-induced dilatation of pial arterioles in pentobarbital anesthetized rabbits.RésuméObjectifL’olprinone, un inhibiteur de la phosphodiestérase III, est utilisé comme traitement de l’insuffisance cardiaque ou l’asthme. L’hypoxie est aussi possible dans ces cas. Cependant, l’effet de l’olprinone sur la réponse vasodilatatrice cérébrale à l’hypoxie n’est pas encore très clair.MéthodeDes lapins ont été anesthésiés et ventilés mécaniquement. Le diamètre artériolaire pie-mérien a été déterminé grâce à une fenêtre crânienne et à la microscopie intravitale. L’hypoxie a été induite deux fois chez le même animal en réduisant la FlO2 à 0,1. Le premier épisode a été induit pendant la perfusion d’une solution saline et le second, pendant la perfusion d’une solution saline (groupe saline; n = 8) ou d’olprinone (1μg· kg−1· min−1, groupe OLPI; n = 8 ou 10 μg· kg−1· min−1, groupe OLP 10 ; n = 8). Les réponses artériolaires piemériennes à l’hypoxie ont été enregistrées et comparées pour les deux épisodes d’hypoxie dans chacun des groupes.RésultatsLes données sur la gazométrie du premier épisode d’hypoxie ont été identiques à celles du second épisode dans les deux groupes. Le diamètre artériolaire pie-mérien a augmenté de façon significative pendant l’hypoxie. Dans les artérioles de 50–100 μm de diamètre, la première et la seconde dilatation artériolaire pie-mérienne induite par l’hypoxie ont été, dans le groupe OLPl, de 13 ± 6 % et de 10 ± 7 % respectivement (P = 0,574 ) et dans le groupe OLP10, de I6 ± 6% et de 15 ± 7 % respectivement ( P = 0,606). Dans les artérioles de 25–50 μm, les résultats ont été les mêmes que pour les artérioles de 50–100 μm.ConclusionL’olprinone ne modifie pas la dilatation des artérioles pie-mériennes induite par l’hypoxie chez des lapins anesthésiés au pentobarbital.