Yoshiro Toyoda

Evaluation of selective bronchial suctioning in the adult.

In the present study, the highest success rate in suctioning of the left main bronchus was achieved when curved-tip catheters of both Portex (40%) (Portex Limited, Hythe, Kent, England) and Rüsch (50%) (Willy Rüsch Gmph & Co. KG, West-Germany) were inserted with the patients head in the midline position. The second most successful rate in reaching the left main stem bronchus occurred when the head was turned to the right using straight catheters of both Portex (31%) and Rüsch (29%). The third but lesser success rate in suctioning the left main stem bronchus was achieved with the head turned to the right, using curved-tip catheters of both Portex (25%) and Rüsch (23%). the lowest success rate in suctioning the left main stem bronchus was with the head in the midline position using straight catheters of both Portex (19%) and Rüsch (15%). The possible factors which influence success or failure to introducing suction catheters into the bronchi selectively were discussed.

Device for determining location of an endotracheal catheter tip.

The location of a catheters tip in the bronchi may be determined using a stethoscope and an audible sound that has a frequency of 558 Hz and a sound pressure of 136 dB for the adult. The device is easy and safe to use, and has been used in a broad range of patients for over 4 yr without sequelae.

Coronary Artery Spasm Induced by Trigeminal Nerve Stimulation and Vagal Reflex During Intracranial Operation

This report describes a case of ventricular fibrillation resulting from coronary vasospasm during intracranial operation under general anesthesia. An autonomic response associated with the intracranial procedure caused a coronary spasm, which was worsened by alpha-agonists. Nitroglycerin effectively resolved the coronary spasm and co-complications persisted.

Selective bronchial suctioning in the adult using a curve-tipped catheter with a guide mark

Our results of previous and successive studies indicate that torque control of curve-tipped catheters is easily accomplished by placing a guide mark on the catheter. Thus, a guide mark was made on a curve-tipped 14 FG Portex suction catheter using a felt pen. The efficacy of selective bronchial suctioning using this catheter was studied in 50 patients. Directed suctioning of the left and right bronchial passages was performed in each patient 3 times and once, respectively, with the head in the midline position. The success rate of left bronchial suctioning was 92% (138/150 attempts) and success in right bronchial suctioning 98% (49/50 attempts). The curve-tipped catheter with a guide mark significantly improved the success rate of left bronchial entry over the previous rate from 50% to 92%.

Jacoby's line rather than Tuffier's line as a guide to lumbar puncture.

“The results from three studies in which propofol was injected until anesthesia was induced. Stokes and Hutton (1) and Peacock and coworkers (4): infusion at 50, 100, or 200 mg/min until loss of verbal contact; Venn and coworkers (5): 5, 10, or 20 mg every 5 s until drop of syringe. Induction dose was calculated by multiplying reported mean milligrams per kilogram by reported mean weight. Residual dose was calculated by subtracting the calculated amount in transit from the induction dose.

The use of intravenous nitroglycerin in a case of spasm of the sphincter of Oddi during laparoscopic cholecystectomy.

Spasm of the sphincter of Oddi still occurs during cholecystectomy. Some reports indicate that the spasm, induced by morphine, can be reversed by injection of naloxone, nalbuphine, and glucagon. Others maintain that nitroglycerin or nifedipine can relax the sphincter of Oddi muscle. We recently encountered spasm of the sphincter of Oddi during a laparoscopic cholecystectomy and treated it successfully with intravenous nitroglycerin.

Electrocardiographic artifacts during shoulder arthroscopy using a pressure-controlled irrigation pump.

E lectrocardiographic interference which mimics cardiac arrhythmias is reportedly caused by a variety of medical equipment (1–4). Recently, we encountered puzzling baseline electrocardiographic artifacts that simulated atrial flutter or atrial fibrillation during shoulder arthroscopy using a pressurecontrolled irrigation pump (Fig. 1). We concluded that a new technique or equipment using a roller pump can create electrocardiographic artifacts that can mimic atrial flutter or atrial fibrillation.

Sterilization pouches for perioperative thermal insulation.

vehicle control in showing dose dependency of resiniferatoxin in Figures 1 and 2. Because they dissolved resiniferatoxin in dimethyl sulfoxide and Tween 80, it may be necessary to know if these substances have any effect on animal behaviors. The first sentence in the Results section was “Resiniferatoxin-induced hyperalgesia was dose dependent.” However, the authors, in fact, discussed resiniferatoxin-induced hypoalgesia but not hyperalgesia in the text and in Figures 1 and 2, although this could be a printing error. In the fourth paragraph of Results, the authors stated, “Perineural resiniferatoxin prevented mechanical incision-induced hyperalgesia.” The correct sentence may be “Perineural resiniferatoxin prevented incision-induced mechanical hyperalgesia”.

Another spinal anesthesia given with the patient supine.

colloid osmotic pressure gradient, and the hydraulic permeability of the filtration barrier (1). Consequently, hypovolemia has a deleterious on the glomerular filtration rate mainly because of the decrease in perfusion pressure, and not because of the decrease in renal blood flow (2). On the other hand, one must admits that the diagnostic of intraoperative hypovolemia is difficult in clinical practice. The normal volemic status of a patient is difficult to define and impossible to evaluate. Instead of trying to determine subjectively whether the patients were or not hypovolemic, we included in the analysis objective parameters of hypovolemia: hypotension and the need for vasopressors. A very few patients were receiving nonsteroidal antiinflammatory drug treatment, in the perioperative period. Many patients were receiving antiplatelet doses of aspirin, which are much smaller than the antiinflammatory class. Thus, since all the confounding factors pointed out in your letter have been considered in our study, the conclusion concerning the deleterious effect of ACEIs on renal function in this period is maintained (3).

One drop of morphine added to local anesthetics by means of a 23-gauge injection needle can relieve postoperative pain under spinal anesthesia.

We read with great interest the article by Slappendel et al. (1). We agree with that the optimum dose of intrathecal morphine in total hip surgery is 0.1 mg. Another report (2) has shown excellent postoperative pain relief under spinal anesthesia obtained with a small dose of subarachnoid morphine. However, it was not clear how exactly a small dose of morphine was added to the local anesthetic. We assume that the morphine after repeated dilutions has to be added to the local anesthetic and that this troublesome procedure may cause contamination of the drugs. Moreover, the increase in volume as a result of the addition of morphine could have an undesirable influence on the extent of the spinal blockade. We have routinely used a 23-gauge injection needle (MN-2325R, TERUMO, Tokyo, Japan) for adding 0.15 mg of morphine to local anesthetics when we perform spinal anesthesia. Our technique of using this needle means that one drop equals 0.015 mL of morphine (10 mg/mL), as shown in Figure 1. Our method offers two major advantages. First, the procedure is clean and simple, and second, one drop of morphine doesn’t result in a change in the total volume of local anesthetics.