Toshiko Sakai

The morbidity, time course and predictive factors for persistent post-thoracotomy pain.

After thoracotomy, patients often suffer from a persistent pain syndrome called post‐thoracotomy pain. To elucidate morbidity, time course, and predictive factors for this syndrome, we analyzed follow‐up data for 85 post‐thoracotomy patients. We used a four‐point scale to assess pain: none, slight, moderate and severe. Of 85 patients, 50 reported pain (39 slight, 11 moderate) one day after surgery. A year after surgery, the patients were polled using a simple questionnaire received by the mail. Sixty patients reported persistent pain (34 slight, 14 moderate, 12 severe) a month after surgery, and 35 patients reported persistent pain (33 slight, two moderate) around the time of the poll (1 year after surgery). Although pain deterioration was observed in 40% (34/85) of patients during month 1 after surgery, pain alleviation was seen in 48% (41/85) of patients during months 2–12. Stepwise regression analysis revealed that female gender and pain at postoperative day 1 were predictive for persistent pain both 1 month and 1 year after thoracotomy. Among 35 patients with persistent pain 1 year after surgery, 24 cases reported paresthesia–dysesthesia, and 14 cases reported hypoesthesia. The present data thus suggests that persistent pain is common and often severe 1 month after surgery but is alleviated after 1 year. Clinical time course and symptoms indicate that nerve impairment rather than simple nociceptive impact may be involved in this syndrome.

Plasma lipid peroxides and alpha-tocopherol in critically ill patients

Plasma lipid peroxide measured as thiobarbituric acid reactive substances (TBARS) and alpha-tocopherol levels in 24 critically ill patients were compared with those of control subjects. The mean plasma alphatocopherol level was significantly lower and the mean TBARS level was significantly higher in critically ill patients. Eight ICU patients developed disseminated intravascular coagulation (DIC); the mean TBARS level during DIC was significantly above the mean pre-DIC level. These results indicate that lipid peroxidation may contribute to the development of DIC in critically ill patients.

Lipid peroxidation in experimental septic rats.

We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alphatocopherol decreased significantly, while lipid peroxide in plasma and major organs significantly increased. Serum transaminases also increased significantly. Traumatized rats had a significant but transient decrease in platelet count and a continuous decrease in plasma alpha-tocopherol; lipid peroxide did not change significantly in the plasma but increased significantly in the lung and kidney. Serum transaminases of traumatized rats showed transient increases. Thus, although traumatic stress caused lipid peroxidation similar to sepsis in the major organs, plasma lipid peroxide did not change.

The Effects of Preanesthetic Oral Clonidine on Total Requirement of Propofol for General Anesthesia

STUDY OBJECTIVE To investigate the effects of preanesthetic oral clonidine on total propofol requirement for uniform minor surgery (breast conservative surgery: breast cancer removal with axillary lymph node dissection), and to compare the action of clonidine with that of preanesthetic oral diazepam, a commonly used benzodiazepine. DESIGN Randomized double-blinded study. SETTING Operating room ASA physical status I and II room and recovery room of the cancer center. PATIENTS 80 breast cancer patients scheduled for surgery. INTERVENTIONS Patients were randomized to one of four treatment groups (placebo, clonidine 75 micrograms, or 150 micrograms of clonidine, or 10 mg of diazepam were orally administered 60 min before induction of anesthesia); n = 20 per group. After evaluating the sedation and anxiety levels of patients using a visual analog scale, anesthesia was induced with propofol (1.5 mg/kg), and maintained with oxygen (O2): nitrous oxide (N2O) (30:70) with a continuous infusion of propofol. The propofol infusion was started at 10 mg/kg/h for 10 minutes, then decreased to 8 mg/kg/h, and 6 mg/kg/h thereafter, and the rate of infusion was adjusted to obtain adequate anesthesia (maintaining hemodynamic parameters within 20% of that prior to premedication). Fentanyl 0.2 mg (each 0.1 mg was given for intubation and axillary lymph node dissection, respectively) was administered. MEASUREMENTS AND MAIN RESULTS Preanesthetic oral clonidine (150 micrograms) and diazepam (10 mg) induced anxiolysis without sedation. The total requirement (the mean infusion rates) of propofol in placebo, clonidine 75 micrograms, clonidine 150 micrograms, and 10 mg of diazepam groups were 841 +/- 70 (9.0 +/- 0.3), 720 +/- 63 (7.1 +/- 0.4), 491 +/- 39 (5.6 +/- 0.2), and 829 +/- 77 mg (7.9 +/- 0.4 mg/kg/h), respectively. The cost of propofol in these groups was

Continuous epidural, not intravenous, droperidol inhibits pruritus, nausea, and vomiting during epidural morphine analgesia

51.0 +/- 3.8,

Midazolam premedication reduces propofol requirements for sedation during regional anesthesia

45.5 +/- 3.2,

Premedication modifies the quality of sedation with propofol during regional anesthesia.

33.5 +/- 2.3, and

Surfactant for adults with respiratory failure

50.5 +/- 4.4, respectively. CONCLUSIONS Preanesthetic oral clonidine (150 micrograms) but not diazepam (10 mg) reduced the total requirement of propofol while stabilizing hemodynamic parameters. In addition, 150 micrograms of oral clonidine attenuates the hemodynamic responses associated with tracheal intubation.

Vocal Cordal Bowing as a Cause of Long-lasting Hoarseness after a Few Hours of Tracheal Intubation

PURPOSE To investigate whether continuous epidural droperidol and intravenous (IV) intraoperative droperidol inhibit pruritus and postoperative nausea and vomiting (PONV) during epidural morphine analgesia. DESIGN Randomized, double-blinded, controlled study. SETTING Metropolitan cancer center. PATIENTS 120 ASA physical status I and II patients undergoing thoracic or abdominal surgery with general anesthesia combined with epidural anesthesia. INTERVENTIONS Patients received an intraoperative epidural injection of 2 mg morphine hydrochloride, followed postoperatively by a continuous epidural infusion of morphine hydrochloride 4 mg/day for 4 days. Patients were randomly allocated to four groups: Group A = control group, Group B = intraoperative single IV injection of droperidol (2.5 mg), Group C = postoperative continuous epidural droperidol infusion (2.5 mg/day), and Group D = intraoperative IV injection of droperidol (2.5 mg) and postoperative continuous epidural droperidol infusion (2.5 mg/day). MEASUREMENTS AND MAIN RESULTS The frequency and severity of pruritus and PONV in each group were evaluated during the postoperative period. Continuous epidural infusion of droperidol significantly reduced the frequency and severity of pruritus and PONV induced by epidural morphine without causing significant side effects. Intraoperative single IV injection of droperidol was effective for PONV (p < 0.05) but not for pruritus. CONCLUSION Postoperative epidural droperidol infusion significantly decreased both the frequency and severity of pruritus and PONV during postoperative continuous epidural morphine analgesia. IV intraoperative droperidol significantly reduced the frequency and the severity of PONV but not pruritus.

Lipid Peroxidation In Critically-ill Patients.

PurposePropofol is often used for sedation during spinal anesthesia. We investigated the effects of midazolam pre-medication on the propofol requirements and incidence of complications during sedation.MethodsIn a prospective randomized, controlled, and single-blinded study, 50 patients undergoing elective gynecological surgery were randomly divided into control and midazolam groups. Patients in the midazolam group received 2 mg midazolamim 30 min before arrival at the operation room. After spinal anesthesia was instituted with intrathecal injection of hyperbaric tetracaine, we provided sedation using continuous infusion of propofol. The level of sedation was controlled at a level between “eyes closed but rousable to command” and “eyes closed but rousable to mild physical stimulation” by adjusting the infusion rate. During sedation, the propofol requirements and complications were recorded and patients were asked, two hours after the end of operation, whether they remembered intraoperative events.ResultsIn the midazolam group, the loading dose, steady state infusion rate, and overall infusion rate of propofol were 0.74 mg·kg−1, 2.86 mg·kg−1·hr−1, and 3.32 mg·kg−1·hr−1, respectively, which were about 17% lower than those in the control group (P < 0.05). Moreover, midazolam premedication reduced the incidence of intraoperative memory (P < 0.05), but had no effects on other complications.ConclusionMidazolam premedication reduced propofol requirements and the incidence of intraoperative memory during sedation. These effects on sedation using propofol during spinal anesthesia are considered beneficial for patients.RésuméObjectifLe propofol est souvent utilisé pour la sedation pendant la rachianesthésie. Nous avons exploré les effets de la prémédication avec du midazolam sur les besoins en propofol et sur l’incidence de complications pendant la sédation.MéthodeLors d’une étude prospective, randomisée, contrôlée et à simple insu, 50 patientes pour qui une intervention gynécologique avait été prévue ont été réparties de façon aléatoire en un groupe témoin et un groupe midazolam. Les patientes du groupe midazolam ont reçu 2 mg de midazolamim, 30 min avant l’arrivée en salle d’opération. Après la mise en route de la rachianesthésie avec une injection intrathécale de tétracaïne hyperbare, nous avons administré la sédation par une perfusion continue de propofol. La sédation a été contrôlée à un niveau se situant entre le moment où les patientes ont «les yeux fermés mais peuvent être éveillées sur commande’ et le moment où elles ont «les yeux fermés mais peuvent être éveillées sous une légère stimulation physique’, en ajustant la vitesse de perfusion. Pendant la sédation, les besoins de propofol et les complications ont été notés et on a demandé aux patientes, deux heures avant la fin de l’opération, si elles se rappelaient des événements peropératoires.RésultatsDans le groupe midazolam, la dose de charge, la vitesse de perfusion à l’état d’équilibre et la vitesse globale de perfusion du propofol ont été de 0,74 mg·kg−1; 2,86 mg·kg−1·h−1 et 3,32 mg·kg−1·h−1, respectivement, mesures qui sont de 17 % plus basses que celles du groupe témoin (P < 0,05). De plus, la prémédication avec du midazolam a réduit l’incidence de rappel peropératoire (P < 0,05), mais n’a pas eu d’effet sur d’autres complications.ConclusionLa prémédication avec du midazolam a réduit les besoins de propofol et l’incidence de souvenir de la période peropératoire pendant la sédation. Ces effets sur la sédation utilisant le propofol pendant la rachianesthésie sont considérés comme bénéfiques pour le patient.