Tetsuo Omote

Prothiofos Metabolites in Human Poisoning

CASE REPORT A 63-year-old woman was admitted to a local hospital after the ingestion of 40% prothiofos preparation (Tokuthion) 370 mL. Gastric lavage was performed and cathartics, active charcoal, diuretics, atropine sulfate, and pralidoxime were administered. Serum cholinesterase activity was 1.3 IU/L (normal 200-460 IU/L). The patients consciousness was gradually restored after 4 hours of charcoal hemoperfusion and she was discharged 5 days after admission with no sequelae. METHOD Plasma and urine prothiofos and metabolites were detected by gas chromatography-flame photometry and gas chromatography-mass spectrometry. Two despropyl metabolites were synthesized for identification and estimation. RESULTS The main metabolites were identified with authentic prothiofos and methyl esters of synthesized des-S-propyl prothiofos oxon (O-2,4-dichlorophenyl O-ethyl phosphate), despropyl prothiofos oxon (O-2,4-dichlorophenyl O-ethyl phospholothiolate), and des-S-propyl prothiofos (O-2,4-dichlorophenyl O-ethyl phosphorothioate). Despropyl prothiofos (O-2,4-dichlorophenyl O-ethyl phosphorodithioate) was also identified in plasma. Large amounts of the hydrolyzed product, 2,4-dichlorophenol and its conjugate were also found. The metabolic pattern of prothiofos in humans appears to be different from that in rats.

Response differences of paretic and healthy extremities to pancuronium and neostigmine in hemiplegic patients.

The purpose of this study was to examine differences in train-of-four (TOF) ratios between paretic and healthy extremities after pancuronium and neostigmine administration in 31 patients with hemiparesis. The TOF ratios on the paretic side after pancuronium administration were greater than those on the healthy side in all patients. Patients were classified according to the size of the difference in the TOF ratio on both sides. In group I, differences in TOF ratios were greater than 20%, and in group 2, they were less than 20%. Fifteen of 17 patients in group 1 had hemiparesis for over three weeks, and in group 2, 10 of 14 patients had hemiparesis for less than three weeks. Patients with flaccid hemiparesis were distributed equally in both groups, while all patients with spastic hemiparesis belonged to group 1. The difference in increase in TOF ratios after neostigmine was the same as the difference in decrease produced by pancuronium.

Anesthetic management of a patient with acute fatty liver of pregnancy

A 35-year-old woman was admitted to our hospital at 23 weeks of gestation. She had a 5-day of history of general fatigue, appetite loss, nausea, vomiting, and abdominal pain. On physical examination, she appeared jaundiced. Her consciousness was alert. Blood pressure (BP) was 100/50mmHg, heart rate (HR) was 86bpm, temperature was 37.1~ and respiration was 20 breaths per minute. Abdominal examination revealed a 23-weekpregnant uterus. Continuous cardiotocography (CTG) monitoring revealed poor fetal HR variability with a late deceleration pattern. Laboratory data demonstrated acute hepatic impairment and coagulopathy (Table 1). Her previous pregnancy had required cesarean section for cephalopelvic disproportion at 40 weeks but was otherwise uneventful. Since becoming pregnant, she had been checked by an obstetrician regularly

THE EFFECT OF SCALP INFILTRATION WITH BUPIVACAINE ON BLOOD COAGULABILITY AND FIBRINOLYSIS IN NEUROVASCULAR SURGERY

We investigated the effect of scalp infiltration with bupivacaine on blood coagulability and fibrinolysis in neurovascular surgery. Patients were randomly divided into two groups: scalp infiltration group (who received scalp infiltration with 0.5% bupivacaine prior to surgical incision, n = 7) and control group (n = 6). The blood coagulability and fibrinolysis were measured before and after surgical incision using a thromboelastogram (Thromboelastograph C-3000, Haemoscope). In the control group, the reaction and coagulation times were significantly shortened (30% and 23%, respectively, P < 0.05) and the maximum amplitude, which reflects coagulability, increased significantly (21%, P < 0.01) compared to each presurgical value. The scalp infiltration prior to the surgical incision prevented these reactions (P < 0.05). The fibrinolytic rate did not change in either group. We conclude that scalp infiltration prior to surgical incision is beneficial for attenuating an increase in blood coagulability, which could induce perioperative complications due to associated systemic diseases (i.e. hypertension, diabetes, ischemic heart disease, etc.).

Effect of the lithotomy position on spinal anesthesia with hyperbaric tetracaine

This study was performed to determine the effects of lithotomy position on the spread of analgesia and hemodynamics following spinal anesthesia with 0.5% hyperbaric tetracaine. Thirty patients who underwent hysterectomy due to myoma uteri were studied. All patients received spinal anesthesia in the left lateral decubitus position and were turned supine immediately after intrathecal administration of the drug. Fifteen patients were then placed in the horizontal lithotomy position within 10 s, and the remaining 15 were kept in the horizontal supine position for 30 min. There were no significant differences between the groups in mean arterial pressure, heart rate, cardiac output, and in the cephalad spread of analgesia. The lithotomy position had no effect on the spread of analgesia or anesthetic course of spinal anesthesia with hyperbaric tetracaine.