Masao Yamashita

Right internal jugular vein venography in infants and children.

We obtained venograms of the right internal jugular vein (RIJV) in 105 infants and children with congenital heart disease during cardiac catheterization. No major anomalies were found in the course of the RIJV. The diameter of the RIJV tended to increase with the patient’s age, weight, and height. However, some disproportionately small vessels were seen in 8% of the patients. The depth from the skin to the RIJV varied from 2.5 to 20 mm and did not significantly correlate with age, weight, or height. Confirmation of the diameter or the depth of the RIJV by venography may facilitate clinical decisions and may be useful for performing percutaneous cannulation.

Illicit use of modern volatile anaesthetics

Sixteen reported cases of abuse of modern volatile anaesthetics are summarized. Twelve of the sixteen subjects died. Halothane was ingested or injected intravenously for suicidal purpose, and sniffed for mood elevation. Abuse of modern volatile anaesthetics deserves more attention than it has received in the past.RésuméOn rapporte 16 cas d’abus d’agents anesthésiques volatils modernes. Douze des 16 patients sont décédés. L’halothane a été ingéré ou auto-injecté par voie intra-veineuse dans un but suicidaire ou inhalé pour provoguer une sensation de bien-être. On pense que l’abus des agents a” inhalation modernes mérite plus d’attention qu’il ne lui en a été accordé dans le passé.

Anaesthetic considerations in the Prader-Willi syndrome: Report of four cases

The anaesthetic management of four paediatric patients with the Prader-Willi syndrome is reported. The syndrome is characterized by obesity, mental retardation, genital hypoplasia, hypotonia, and diabetes mellitus. All patients were anaesthetized with halothane. Succinylcholine or pancuronium were usedfor muscle relaxation, without evidence of abnormal response. Common anaesthetic difficulties in this syndrome are obesity, hypotonia, disturbance in thermoregulation, arrhythmias, diabetes mellitus and convulsions.RésuméOn rapporte laconduite anesthésique de quatre patients présentant le syndrome de Prader-Willi. Ce syndrome est caractérisé par l’obésité, l’arriération mentale, l’hypoplasie génitale, l’hypotonie et le diabète mellitus. Tous les patients furent anesthésiés avec l’halothane. Lasuccinylcholine ou le pancuronium ont étv administrés comme curarisants et ne présentèrent pas de réponse anormale. Les difficultés anesthésiques de ce syndrome sont l’obésité, l’hypotonie, les troubles en thermorégulation, l’arythmie, le diabète mellitus et les convulsions.

Rebreathing and coaxial circuits: A comparison of the bain and mera F

This study compares the rebreathing characteristics of the Bain modification of the Mapleson ‘D’ type of T-piece circuit with those of the Mera F system which is used with the standard “circle” anaesthetic machine. Six healthy adults anaesthetized with halothane were studied breathing spontaneously. The volume of inspired carbon dioxide was measured on each breath as a measure of rebreathing. The tidal volume (Vt) frequency of respiration (f) and blood Pco2 were also noted. These measurements were made initially with either the BAIN or the Mera F system and then changed to the alternate circuit for further studies. All measurements were made with a fresh gas flow rate (FGF) of 100ml · kg-1· min-1 which is recommended with the Bain system.The inspired volume of carbon dioxide (rebreathing) with the Bain system was significantly greater than when the mera F was used. Although the mean blood Pco2 was not significantly lower when the mera F was used, some patients who cannot adequately compensate for this inspired carbon dioxide volume did become hypercapneic (maximum 8kPa [60torr]). This hypercapnia could be reduced by using a mera F system.The mera F is a co-axial system that combines the convenience of the tube-in-a-tube structure with the beneficial effects of controlled rebreathing during controlled ventilation. In these advantages it is no different from the Bain system. The mera F however, has the advantage of being adaptable to the commonly used “circle” anaesthetic machines for spontaneous respiration in adults. This eliminates the rebreathing of carbon dioxide at a fresh gas flow of 100ml · kg-1· min-1, which occurs in adults during spontaneous respiration. The only disadvantage of the mera F system that we used in adults was its length (90cm). However, from a functional viewpoint, it can be lengthened without altering the rebreathing characteristics of the system.RésuméCette étude compare les caractéristiques sur le rebreathing de la modification par Bain du circuit Mapelson D avec le mera F utilisé avec le système circulaire sur l’appareil d’anesthésie. Six adultes en bonne santé anesthésiés à l’halothane ont été étudiés en respiration spontanée. L’importance du rebreathing a été evalue par la mesure du volume de gaz carbonique a chaque respiration. Le volume courant, la frequence respiratoire et la Paco2 ont aussi été notes. Les études ont été effectuees d’abord avec le Bain ou le systeme mera F et on est ensuite passe a l’autre circuit pour étude subsequente. Toutes ces mesures ont été faite avec un debit de gaz frais de 100ml · kg-1· min-1 tel que recommande pour le systeme Bain.Le volume de gaz carbonique inspiré (rebreathing) avec le Bain a été plus eleve de façon significative qu’avec le Mera F. Bien que la Pco2 moyenne n’ait pas été plus basse de façon significative lorsqu’on employait le Mera F, certains patients qui ne pouvaient pas compenser adéquatement pour le volume de gaz carbonique inspiré sont devenus hypercapniques (maximum 8 kPa ou 60 torr). Cette hypercapnie n’est pas survenue lors de l’emploi du système Mera F.Le Mera F est un circuit co-axial qui combine les avantages du conduit d’alimentation cheminant à l’interieuret d’un rebreathing accessible pendant la ventilation contrôlée. Par ces caractéristiques il ne diffère pas du circuit Bain. Le systeme mera F a cependent cet avantage de pouvoir s’adapter aux systèmes circulaires communément employe sur nos appareils d’anesthésie en respiration spontanee chez les adultes. Ceci élimine la réinspiration du gaz carbonique qui survient chez les adultes en respiration spontanée même lorsque le debit d’alimentation de gaz frais est de 100 ml · kg-1. Le seul désavantage du système mera F utilisé chez l’adulte est sa longueur (90cm); toutefois on peut l’allonger sans en altérer les caractéristiques fonctionnelles.

Effect of corticosteroids on endocrine function in haemorrhagic shock.

SummaryThe effect of haemorrhage on endocrine function and the anti-shock effects of methylprednisolone were investigated in 32 mongrel dogs. Plasma concentrations of antidiuretic hormone (ADH), epinephrine, norepinephrine, aldosterone and cortisone were measured simultaneously during and following haemorrhagic hypotension. Other parameters, such as urine volume and osmolality, serum and urine electrolytes and blood glucose were also determined simultaneously during the procedure. Dogs anaesthetized with pentobarbitone were bled so that the mean arterial pressure decreased to 50 mm Hg, which was maintained for 15 minutes (group one) or for 30 minutes (groups two, three, and four). After the recovery of group one animals from the first hypotension by reinfusion of blood and hydroethylstarch, they were bled again to a mean arterial pressure of 50 mm Hg (second hypotension) and were allowed to remain at this pressure. In groups two, three and four there was no second hypotension.Plasma ADH concentrations were elevated 50 times control values on the first hypotension, but no appreciable increase was observed on the second hypotension. Plasma levels of epinephrine, norepinephrine and aldosterone increased 35, 7, and 5 times respectively during the first hypotension and 40, 10, and 5 times during the second hypotension, as compared to controls. Plasma osmolality correlated well with plasma ADH levels during the haemorrhage. Increased concentrations of plasma ADH, epinephrine and norepinephrine following haemorrhage had a tendency to decrease after the administration of fluids, but they were still higher than the preshock control levels. Methylprednisolone 15 mg/kg or 30 mg/kg administered intravenously before infusion of blood and hydroethylstarch caused a significant decrease of plasma levels of ADH and epinephrine to pre-shock control levels. Our data suggest that the administration of methylprednisolone could be beneficial in improving the shock state from an endocrinological point of view.RésuméĽinfluence ďun choc hémorragique sur la fonction endocrinienne et ľeffet antichoc de la méthylprednisolone ont été étudiés chez le chien. Trente-deux animaux formant quatre groupes ont été utilisés.Nous avons mesuré pendant et après une hypotension par saignée les concentrations plasmatiques ďADH, ďépinéphrine, de norépinéphrine, ďaldostérone et de Cortisol, la glycémie, ainsi que le volume et ľosmolalité urinaire et, enfin, les électrolytes sériques et urinaires.Après une anesthésie au pentobarbital, les chiens ont été saignés de façon à abaisser la pression moyenne à 50 mm Hg; cette pression a été maintenue 15 minutes chez les animaux du premier groupe, et 30 minutes chez ceux des trois derniers groupes, Après correction de ľhypotension au moyen de sang et ďune solution colloïdale (“hydroéthylstarch”), les animaux du premier groupe ont été saignés une deuxième fois jusqu’ à ce que la pression moyenne redescende à 50 mm, pression où ils ont été laissés. Après correction de leur hypotension, les animaux des trois derniers groupes n’ont pas été soumis è un deuxième épisode ďhypotension.Le taux ďADH plasmatique était 50 fois plus élevé que le taux des contrôles, au cours du premier épisode hypotensif, mais ľon n’a pas observé ďaugmentation appréciable au cours du second épisode. Comparés aux contrôles, les niveaux plasmatiques ďépinéphrine, de norépinéphrine et ďaldostérone étaient respectivement 35, sept et cinq fois plus grands au cours de la première hypotension et 40, dix et cinq fois plus grands au cours de la seconde. Les modifications de ľosmolalité urinaire coincidaient avec celles de ľADH. Les taux plasmatiques ďADH, ďépinéphrine et de norépinéphrine élevés après la saignée, avaient tendance à diminuer après ľadministration de volume, mais demeuraient plus élevés que les contrôles.Une dose de 15 ou de 30 mg/kilo de méthylprednisolone administrée par voie intraveineuse avant la correction liquidienne (sang + colloïdes) était suivie ďune diminution significative des taux ďADH et ďépinéphrine jusqu’aux niveaux contrôles. Nos résultats suggèrent que le méthylprednisolone peut avoir des effets bénéfiques au point de vue hormonal dans le choc.

Effect of the inhibitor of angiotensin i converting enzyme on endocrine function and renal perfusion in haemorrhagic shock

SummaryThe present study was undertaken to investigate the effect of inhibition of angiotensin I converting enzyme on endocrine responses and renal perfusion in haemorrhagic shock. Plasma levels of vasopressin (VP), aldosterone, and plasma renin activity (PRA), and renal cortical tissue blood flow were measured both in control dogs and in those treated with an inhibitor of angiotensin I converting enzyme (SQ20881). The drug was administered with an intention of preventing vasoconstriction induced by angiotensin II and to improve tissue perfusion.No significant differences were found in plasma levels of vasopressin, aldosterone and plasma renin activity between control and SQ20881-treated groups. Secondary elevation of blood pressure following haemorrhage was significantly delayed and reduced by the administration of the inhibitor. Decrease in renal cortical tissue blood flow was observed in the SQ20881-treated group. It is suggested that angiotension II appears to play a role in spontaneous recovery of arterial blood pressure following haemorrhage. Furthermore, angiotensin II does not seem to play an important role in the stimulation of secretion of vasopressin in response to haemorrhage. Our data failed to demonstrate any favourable effects of inhibition of angiotension I converting enzyme on renal perfusion during haemorrhagic shock in dogs.

UNUSUAL RESISTANCE TO PANCURONIUM IN SEVERELY BURNED PATIENTS: CASE REPORTS

Case 1 The patient was a 36-year-old female, weight 54 kg, height 155 cm. On the 8th day following a burn to 70 per cent of the body surface area due to an LP gas explosion, the patient had debridement and skin grafting under general anaesthesia, Thiamylal 300 mg intravenously was used for induction of anaesthesia, and tracheal intubation was facilitated by paneuronium 6 mg intravenously. Anaesthesia was maintained with droperidol 8.8 rag, pentazocine 75 mg (total dose) and pancuronium, with nitrous oxide 4 l/min and oxygen 2 1/min. A slight bucking was observed 40 minutes after the initial pancuronium administration, and 2 mg of pancuronium was added intravenously. After that, in 6 hours 15 minutes of anaesthesia, a total of 25 mg of pancuronium was needed to prevent her from fighting the ventilator. Extubation was possible immediately after the operation without reversal of muscle relaxant.

Plasma Vasopressin Response to Extracorporeal Circulation in Children

Plasma vasopressin levels were measured during open‐heart surgery in nine children. The control value of vasopressin was 5.5 ± 1.5 (s.e.mean) μU/ml. During extracorporeal circulation, a maximum 7.3‐fold increase of plasma vasopressin level was demonstrated. This high level of vasopressin was considered to have circulatory effects rather than anti‐diuretic effects.

PLASMA CATECHOLAMINE LEVELS DURING EXTRACORPOREAL CIRCULATION IN CHILDREN

Plasma adrenaline and noradrenaline concentrations have been measured in nine children undergoing cardiac operations involving extracorporeal circulation under neuroleptanaesthesia.Compared to control values, plasma adrenaline increased 34-fold and noradrenaline, 2.2-fold during extracorporeal circulation.The increase in plasma catecholamines reported in adults has been confirmed in these children and changes in plasma adrenaline concentrations during extracorporeal circulation were found to be much greater in paediatric patients.RésuméOn a mesuré les concentrations plasmatiques d’adrénaline et de noradrenaline sur neuf enfants opérés pour une chirurgie cardiaque sous circulation extra-corporelle et neuroleptancsthésie.Lorsque comparée aux valeurs de contrôle, l’adrénaline plasmatique a augmenté de 34 fois et la noradrenaline de 2.2 fois pendant la circulation extracorporelle.On confirme donc sur l’enfant l’augmentation des catécholamines plasmatiques déjà rapportée chez l’adulte avec cette différence que l’augmentation est beaucoup plus grande chez le malade pédiatrique.

An improved scavenger box for the cryoprobe

To the Editor: Some cryosurgical systems use nitrous oxide, and it has been pointed out that cryoprobe leakage produces excessive nitrous oxide concentrations in the OR, 1-3 with N20 levels as high as 900ppm. 3 Scavenger devices have been recommended, 1.2 and one scavenger box reported reduces the N20 concentrations by more than 50 per cent. 3 However, even with the scavenger box, N20 concentrations near the anaesthetist were in the range of t50 to 300 ppm, 3 considerably higher than NIOSH recommendation of 25 ppm. 4 99