Explore the vast range of titles available.

The aim of this study was to compare the incidences of leakage from the catheter insertion site during continuous femoral nerve block when using the catheter-through-needle, Contiplex Touhy™ (CT) and the newly developed catheter-over-needle, Contiplex C™ (CC). Forty adult patients who were scheduled to undergo continuous femoral nerve block for pain control following knee surgery were enrolled and were randomly assigned to a CT group or a CC group. After finishing surgery, a catheter for continuous femoral nerve block was placed using ultrasound. A catheter was advanced along the femoral nerve 5–6 cm beyond the needle tip. Then 0.25% levobupivacaine was continuously administered at a rate of 5 ml/h until 9:00 am on postoperative day 1. The incidence of leakage of the local anesthetic from the insertion site in the CT group was significantly higher than that in the CC group. In the CT group, leakage from the catheter insertion site was observed in 11 of 20 patients during the observation period. On the other hand, none of the patients in the CC group showed leakage. Contiplex C™ is more effective than Contiplex Touphy™ for prevention of leakage of local anesthetics from the insertion site during continuous femoral nerve block.

PurposeArginine vasopressin (AVP) is a potent vasoconstrictor that is sometimes used for the treatment of refractory vasodilatory shock. AVP constricts vascular smooth muscle by increasing both intracellular calcium concentration ([Ca2+]i) and myofilament Ca2+ sensitivity. However, the modulation of AVP-mediated vasoconstriction by volatile anesthetics remains to be determined. This study investigates the effects of isoflurane and sevoflurane on AVP-induced vasoconstriction and elucidates the underlying mechanisms, with an emphasis on the Ca2+-mediated pathways and Ca2+ sensitization pathways of rat aortic smooth muscle.MethodsThe effects of isoflurane and sevoflurane on AVP-induced vasoconstriction and on the AVP-induced increase in [Ca2+]i and Rho activity in rat aorta were investigated by isometric force recording, by measuring [Ca2+]i using fluorescence dye, and by Western blotting techniques.ResultsArginine vasopressin (10−7 M) elicited a transient contractile response that was inhibited by isoflurane and sevoflurane in a concentration-dependent manner. AVP (10−7 M) induced a transient increase in intracellular Ca2+ concentration ([Ca2+]i). Isoflurane and sevoflurane also inhibited an AVP-induced increase in [Ca2+]i in a concentration-dependent manner. AVP (10−7 M) increased the Rho activity that was attenuated by 2 minimum alveolar concentration of sevoflurane (P < 0.01), but not by an equipotent concentration of isoflurane.ConclusionArginine vasopressin-induced vasoconstriction is mediated by an increase in [Ca2+]i and by the activation of the Rho-Rho kinase pathway in rat aortic smooth muscle. Although both isoflurane and sevoflurane, at clinically relevant concentrations, attenuate AVP-induced contraction, the cellular mechanisms of their inhibitory effects appear to differ.

Methemoglobinemia is a fatal complication of local anesthesia. We describe a case report of female neonate who developed severe methemoglobinemia after extraction of neonatal teeth conducted with general anesthesia plus local injection of Citanest-Octapressin® (propitocaine of approximately 10 mg/kg). Central cyanosis appeared within an hour after surgery. The percentage of methemoglobin reached up to 43.9%. Not only pediatric dentists but also anesthesiologists generally agree with the idea that local anesthesia provides various benefits in painful procedures in neonates. However, this case may serve as a warning when using Citanest-Octapressin®, which is still commercially available for neonatal patients.

Beta-adrenergic receptor antagonists (beta-antagonists) have long been used to control perioperative tachyarrhythmias. The effects of a beta(1)-antagonist, landiolol, on perioperative hemodynamics are unknown. We aimed to determine the appropriate dosage of landiolol for the treatment of hemodynamic changes in response to endotracheal intubation. Sixty-four patients without heart disease or hypertension, were assigned to receive saline (group C) or landiolol (0.1 or 0.3 mg.kg(-1); groups L1 and L3). Anesthesia was induced with propofol (2 mg.kg(-1) iv) followed by saline or landiolol iv. After ventilation with facemask using 2% sevoflurane in 100% oxygen for 90 sec, endotracheal intubation was performed. After intubation, anesthesia was maintained using 1% sevoflurane in combination with 50% nitrous oxide. Values of heart rate and mean arterial blood pressure were recorded before induction to five minutes after intubation. In group C, heart rate and mean blood pressure increased simultaneously after tracheal intubation, compared with baseline values. Heart rate values were attenuated immediately before as well as after intubation in group L3, compared with groups C and L1. Heart rate did not increase after tracheal intubation in group L1, compared with baseline. In contrast, mean arterial blood pressure values did not differ among groups. The newly developed beta(1)-antagonist landiolol (0.1 and 0.3 mg.kg(-1)) may help prevent tachycardia without affecting blood pressure during the induction of anesthesia.