Oral gastric tube-guided insertion of the ProSeal™ laryngeal mask is an easy and noninvasive method for less experienced users

PURPOSE

The ProSeal™ laryngeal mask airway (PLMA) can be more difficult to insert than the classic laryngeal mask, especially in patients who have a thin palate with a steep oropharyngeal curve. Here, an oral gastric (OG) tube-guided technique is considered as a method that makes it easier to successfully insert a PLMA.

METHODS

Sixty patients who were scheduled to undergo general anesthesia without neuromuscular blocking were randomly allocated into two groups: 30 patients with PLMA inserted by the standard digital technique, and 30 with the PLMA inserted by an OG tube-guided technique. Most PLMA insertions were performed by less experienced users. The success rate at the first attempt, the time taken to insert the PLMA, the difficulty of the procedure, and the incidence of oropharyngeal trauma and postoperative sore throat were compared between the two groups.

RESULTS

PLMA insertion was successfully achieved at the first attempt using the OG tube-guided technique in all 30 patients. The OG tube-guided insertion required fewer attempts (P = 0.04) and led to a less difficult insertion procedure (P = 0.02) than the standard digital insertion. Effective ventilation during anesthesia was achieved in all patients, with a lower mean cuff pressure in the OG tube-guided technique group (P = 0.02). The frequency of blood sticking to the PLMA tube (P < 0.001) and the incidence of postoperative sore throat (P = 0.003) were lower in the OG tube-guided group than the standard digital technique group.

CONCLUSIONS

OG tube-guided PLMA insertion is easier for less experienced users, trainees, and experts as well as less invasive for patients than the standard digital insertion.

Quantitative analysis of deuterium in zircaloy using double-pulse laser-induced breakdown spectrometry (LIBS) and helium gas plasma without a sample chamber

A crucial safety measure to be strictly observed in the operation of heavy-water nuclear power plants is the mandatory regular inspection of the concentration of deuterium penetrated into the zircaloy fuel vessels. The existing standard method requires a tedious, destructive, and costly sample preparation process involving the removal of the remaining fuel in the vessel and melting away part of the zircaloy pipe. An alternative method of orthogonal dual-pulse laser-induced breakdown spectrometry (LIBS) is proposed by employing flowing atmospheric helium gas without the use of a sample chamber. The special setup of ps and ns laser systems, operated for the separate ablation of the sample target and the generation of helium gas plasma, respectively, with properly controlled relative timing, has succeeded in producing the desired sharp D I 656.10 nm emission line with effective suppression of the interfering H I 656.28 nm emission by operating the ps ablation laser at very low output energy of 26 mJ and 1 μs ahead of the helium plasma generation. Under this optimal experimental condition, a linear calibration line is attained with practically zero intercept and a 20 μg/g detection limit for D analysis of zircaloy sample while creating a crater only 10 μm in diameter. Therefore, this method promises its potential application for the practical, in situ, and virtually nondestructive quantitative microarea analysis of D, thereby supporting the more-efficient operation and maintenance of heavy-water nuclear power plants. Furthermore, it will also meet the anticipated needs of future nuclear fusion power plants, as well as other important fields of application in the foreseeable future.

Variable field-of-view visible and near-infrared polarization compound-eye endoscope

A multi-functional compound-eye endoscope enabling variable field-of-view and polarization imaging as well as extremely deep focus is presented, which is based on a compact compound-eye camera called TOMBO (thin observation module by bound optics). Fixed and movable mirrors are introduced to control the field of view. Metal-wire-grid polarizer thin film applicable to both of visible and near-infrared lights is attached to the lenses in TOMBO and light sources. Control of the field-of-view, polarization and wavelength of the illumination realizes several observation modes such as three-dimensional shape measurement, wide field-of-view, and close-up observation of the superficial tissues and structures beneath the skin.

[Remifentanil provides fast recovery and hemodynamic stability in laryngomicrosurgery anesthesia]

BACKGROUND

Stressful procedures such as intratracheal intubation and direct laryngoscopy in very short operations make anesthetic management for laryngomicrosurgery difficult. This study was conducted to evaluate which anesthetic agent, remifentanil or fentanyl, is suitable in anesthesia for laryngomicrosurgery.

METHODS

After obtaining informed consent prior to the study, 18 patients undergoing elective laryngomicrosurgery were randomly allocated to one of two groups to receive remifentanil (R group) or fentanyl (F group). Patients with ages above 76 years and moderate abnormalities in cardiovascular system or respiratory system were excluded.

RESULTS

Average infusion rate of remifentanil was 0.24 +/- 0.02 microg x kg(-1) x min(-1) and total infused dose of fentanyl was 0.27 +/- 0.05 mg. Average bispectral index values in both groups were comparable. Cases needing sevoflurane inhalation to control blood pressure were significantly more in F group than in R group. Heart rate was significantly lower in R group than in F group. Duration from the end of operation to responses to verbal commands and extubation was significantly shorter in R group than in F group.

CONCLUSIONS

Remifentanil provided faster recovery and hemodynamic stability. Therefore, remifentanil seems to be more suitable than fentanyl in anesthesia for laryngomicrosurgery.

[Internal jugular vein cannulation guided by pulsation]

BACKGROUND

We are accustomed to right internal jugular vein (IJV) cannulation guided by pulsation for 20 years or more. This study was conducted to evaluate whether this method is a safe and certain method.

METHODS

After obtaining informed consent, 100 elective surgical patients requiring central venous catheterization during perioperative period were randomly assigned to either the pulsation group in which IJV pulsation was used for a landmark of puncture or the US group in which IJV was recognized with ultrasonography before puncture.

RESULTS

Pulsation was observed in 98 patients. Successful rate of first attempt with a 23 G seeking needle was 85.7% in the pulsation group and 86% in the US group. IJV was successfully cannulated at 1 pass in the entire pulsation group and 92% in the US group. The frequency of puncture with cannula was significantly lower in the pulsation group than that of the US group. Arterial puncture with the seeking needle was recorded in 3 patients in the US group. Successful rate of first attempt in this study was comparable to other studies using ultrasonographic guidance.

CONCLUSIONS

Internal jugular vein cannulation by pulsation method is a safe and certain method.

[Prophylactic strategies for perioperative pulmonary thromboembolism in cancer patients]

BACKGROUND

Our previous reports showed that elastic stockings (ES) combined with intermittent pneumatic compression (IPC) significantly decrease the incidence of perioperative pulmonary thromboembolism (PTE). This study was conducted to investigate whether ES with IPC is useful to prevent PTE in cancer patients.

METHODS

No prophylactic strategies were employed from January 1998 to December 1999 (4511 cases). ES combined with ICP apparatuses was employed from May 2000 to April 2008 (20,383 cases). Details of the methods were described in our previous reports.

RESULTS

Age, anesthesia duration and operation duration increased statistically without clinical significances after the induction of prophylactic strategies. About 90 per cent of surgical patients had malignant disease. Seven patients developed PTE without any interventions and 5 patients with treatments. The incidence of PTE decreased significantly from 15.51 persons/10,000 cases to 2.45 persons/10,000 cases. Cardiac arrest occurred in two untreated patients but in no treated patient. Intervention also significantly decreased the incidence of cardiac arrest.

CONCLUSIONS

The combination of ES and ICP seems to be useful to decrease the incidence and severity of perioperative PTE in cancer patients in Japan.

[Intra-atrial vegetation removal in a 14-month-old boy complicated with postoperative infective endocarditis and left middle cerebral artery embolism]

We report a case of the intra-atrial vegetation removal under cardiopulmonary bypass (CPB) in a case complicated with left middle cerebral artery embolism caused by postoperative infective endocarditis. The patient was a 14-month-old boy. Two months after intracardiac repair for a complex congenital heart disease, he presented with low-grade fever and was placed on oral antibiotics. A month later an echocardiography revealed 2 vegetations on the tricuspid valve. Although the vegetations became smaller with intravenous antibiotics, right hemiplegia was noted 5 weeks later. Brain CT and MR-angiography demonstrated left middle cerebral artery embolism. For fear of another embolism caused by a remaining movable vegetation on the tricuspid valve, intra-atrial vegetation removal under CPB was performed 5 days after cerebral infarction. Intraoperative transesophageal echocardiography was utilized to locate the vegetation and confirm its removal. His postoperative course was uneventful without a recurrence of cerebral infarction or bleeding. He was weaned from the ventilator on postoperative day (POD) 1, started to move the right extremities on POD 5 and was discharged home on POD 66.

[Perioperative management of airway foreign bodies in 35 pediatric patients]

We retrospectively reviewed 33 patients (35 cases) who underwent foreign body removal at our institution from 1995 through 2003. Male-female ratio was 21 : 12 and the most frequent age was one year. The most common foreign bodies (FBs) were nuts (n = 14) and plastics (n = 7). A repeater (3 cases) had mental retardation. Patients were referred to our institution with an average interval of 90 hours, and after 1.3 hospitals. All the patients were managed with general anesthesia. Direct laryngoscopy was performed to extract FBs in 11 cases suspected of having pharyngeal or laryngeal FBs. In 24 cases suspected of having tracheobronchial FBs, the trachea was intubated and a flexible fiberoptic bronchoscopy was performed to locate the FBs. FBs were found in the trachea in 2 cases and in the bronchus in 18 patients and were successfully extracted by rigid bronchoscopy in 10 cases. All the patients were admitted for fear of laryngotracheal edema. There were no significant postoperative complications.

Laboratory investigation of microelectronics-based stimulators for large-scale suprachoroidal transretinal stimulation (STS)

This paper describes the technological developments underlying the realization of a reliable and reproducible microchip-based stimulator with a large number of stimulus electrodes. A microchip-based stimulator with over 500 electrodes for suprachoroidal transretinal stimulation (STS) is proposed in this paper, and an example is presented. To enhance reliability and reproducibility for such a large array, we introduce a flip-chip bonding technique and place microchips on the reverse side of a substrate. A square microchip of size 600 microm was fabricated using 0.35 microm standard CMOS process technology. Twelve microchips were flip-chip bonded on a polyimide substrate through Au bumps. To evaluate the feasibility of the proposed device, we successfully fabricated a stimulator with 12 microchips and 118 electrodes made of Pt/Au bumps, and demonstrated their operation in a saline solution for 2 weeks. Also, to evaluate the device operation in vivo, a stimulator with one active IrO(x) electrode was implanted into the scleral pocket of a rabbit and electrical evoked potential (EEP) signals with a threshold of 100 microA were obtained. We also fabricated a simulator with 64 microchips that has 576 electrodes (9 electrodes in a microchip times 64 microchips).

A green tea polyphenol, epigalocatechin-3-gallate, induces apoptosis of human hepatocellular carcinoma, possibly through inhibition of Bcl-2 family proteins

BACKGROUND/AIMS

A major polyphenol of green tea, epigallocatechin-3-gallate (EGCG), has previously been shown to induce cell-cycle arrest and apoptosis in various cancers. However, little is known about its effects on hepatocellular carcinomas (HCCs).

METHODS

Four HCC cell lines, HLE, HepG2, HuH-7 and PLC/PRF/5, were treated with EGCG or vehicle. Cell viability was assessed by trypan blue staining and WST-8 assay. Cell-cycle, apoptosis and apoptosis-related proteins in HLE cells were evaluated by flow cytometry and Western blotting. The effect of EGCG was also studied in vivo using a xenograft model. The effect of co-treatment with EGCG and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) was also assessed.

RESULTS

EGCG inhibited the growth of all HCC cell lines at concentrations of 50-100 microg/ml. In HLE cells, EGCG induced apoptosis but not cell-cycle arrest and appears to have down-regulated Bcl-2alpha and Bcl-xl by inactivation of NF-kappaB. Oral administration of EGCG showed similar effects in HLE xenograft tumors. Co-treatment with EGCG and TRAIL synergistically induced apoptosis in HLE cells.

CONCLUSIONS

EGCG induced apoptosis in HLE cells, both in vitro and in vivo. Moreover, it enhanced TRAIL-induced apoptosis. Therefore, EGCG treatment may be useful for improving the prognosis of HCCs.

[Perioperative management for laparoscopic repair of congenital duodenal atresia]

BACKGROUND

Laparoscopic surgery has been applied even to neonates. To examine the safety and efficacy of laparoscopic repair of neonatal congenital duodenal atresia, we compared the 5 laparoscopic cases with the 5 conventional surgical cases.

METHODS

The charts were retrospectively reviewed to investigate the anesthetic management, perioperative status and complications in the most recent 5 cases each of laparoscopic and conventional surgeries.

RESULTS

There was a tendency to avoid laparoscopic repair in the patients with congenital heart disease. There were no intraoperative complications in both groups. Laparoscopic group exhibited less blood loss but longer operation time. In the two out of five laparoscopic cases re-operation was required due to technical issues, and the group needed a longer period before starting enteral feeding and longer hospitalization.

CONCLUSIONS

Up to this time, laparoscopic repair of congenital duodenal atresia exhibited few advantages over conventional open repair.

A multi-chip-architecture based flexible stimulation device for retinal prosthesis with a flip-chip packaging technique

In the present work, we designed a multi-chip-architecture based flexible neural stimulation device for retinal prosthesis. Based on the multi-chip architecture, a novel CMOS stimulation device was successfully designed and characterized. A packaging technique for thin, flexible neural stimulation device was also proposed and demonstrated. Flip-chip bonding technology plays an essential role in the fabrication of the present thin and flexible neural stimulation device.

Identification of the Central Imidazoline Receptor Subtype Involved in Modulation of Halothane-Epinephrine Arrhythmias in Rats

We previously reported that imidazoline receptors in the central nervous system are involved in modulation of halothane-epinephrine arrhythmias. These receptors have been subclassified as I1 and I2 subtypes, but it is not known which receptor subtype is involved in halothane-epinephrine-induced arrhythmias. We designed the present study to clarify the involvement of central imidazoline receptor subtype in the modulation of halothane-epinephrine-induced arrhythmias. Rats were anesthetized with halothane and monitored continuously for systemic arterial blood pressure and premature ventricular contractions. The arrhythmogenic dose of epinephrine was defined as the smallest dose that produces three or more premature ventricular contractions within a 15-s period. Intracisternal moxonidine dose-dependently inhibited the epinephrine-induced arrhythmias during halothane anesthesia. Intracisternal efaroxan, a selective I1 antagonist with little affinity for I2 subtype, but not rauwolscine, an alpha2 antagonist without affinity for imidazoline receptors, blocked the antiarrhythmic effect of moxonidine. Intracisternal BU 224 and 2-BFI, selective I2 ligands, also inhibited the epinephrine-induced arrhythmias dose-dependently; however, these effects were abolished by efaroxan. We conclude that central I1, but not I2, receptors play an important role in inhibition of halothane-epinephrine arrhythmia.

[Anesthetic management of a 1.7-kg premature infant undergoing thoracoscopic thoracic duct ligation]

We report successful anesthetic management of a 1.7-kg premature infant who underwent thoracoscopic thoracic duct ligation under general anesthesia. She was born at 30 weeks gestation with birth weight of 1,546 g and was suffering from respiratory distress due to persistent right chylothorax for two months after birth. Chest tube drainage, fasting and intrapleural fibrin glue did not reduce her right chylothorax. Thoracoscopic thoracic duct ligation was scheduled on her day 64 under general anesthesia. The tracheal tube end was placed in the midtrachea and carbon dioxide was insufflated into the operative side of the thorax. During thoracoscopy her left lung was ventilated with the right lung pressed with spatulaes, but her respiratory status did not deteriorate so much despite of unilateral ventilation. We speculate that, due to massive right chylothorax, her pulmonary blood flow had already shifted to the left lung, therefore intraoperative substantial left unilateral lung ventilation exerted minimal effect on her respiratory status. The operation was successful and she was weaned from the ventilator on the following day.

DNA modification in chick heart and cerebrum

Heart muscle cells and cerebral neurons are known to lose the ability to proliferate and are called terminally differentiated cells. They are generated in appropriate numbers during embryogenesis and retained throughout adult life without turnover. We are interested in such a long-lived DNA. We isolated DNA from chick heart and cerebrum and compared it with DNA from other organs after incubation with DNase I. Single-strand breaks were assessed using a reaction system composed of DNA and Escherichia coli DNA polymerase. The DNA of both organs was relatively resistant to DNase I, and DNA modification occurred during embryogenesis. CIMS (chemical ionization mass spectrometry) indicated that the molecular mass of the deoxynucleoside of both DNAs was larger than that of the corresponding canonical deoxyribonucleoside by m/z 28 (or 30 for the protonated form). The difference between these deoxynucleosides is based on a difference in sugar constituents. Cerebral deoxynucleotides were analyzed by (13)C NMR. An extra signal near 173 ppm was observed, which was assigned to the amide carbonyl. We propose a model of the deoxynucleoside where a carbonyl residue exists between the base and the 2-deoxyribose moiety of the canonical deoxyribonucleoside.

[Anesthetic management of the ex-utero intrapartum treatment (EXIT) procedure for congenital high airway obstruction syndrome (CHAOS)]

We report an experience of anesthetic management of the ex-utero intrapartum treatment (EXIT) procedure performed in a fetus with congenital high airway obstruction syndrome (CHAOS) due to laryngeal atresia at 30 weeks' gestation. Anesthesia of the mother was induced with rapid sequence, and maintained with 3.5% sevoflurane in 100% oxygen and fentanyl before delivery. Two minimum alveolar concentration (MAC) sevoflurane provided excellent uterine relaxation without maternal hypotension. After hysterotomy, a sterile pulse oxymeter was placed on the fetus hand for monitoring fetal SpO2 and pulse rate, and a Doppler ultrasound transducer was applied to monitor fetal heart rate. Fentanyl (5 microg x dl(-1)) and pancuronium (0.2 mg x dl(-1)) were injected into the fetal upper arm in addition to transplacental anesthetic agents. The fetal heart rate and SpO2 were stable throughout the fetal manipulations, but the rise in SpO2 after initiating ventilation via tracheostomy was very slow. The uterine tone improved soon after discontinuing sevoflurane and oxytocin infusion was started after delivery. Surfactant administration before first ventilation is recommended in preterm babies undergoing EXIT procedure, and capnometer may be useful to confirm the adequate ventilation before cutting the umbilical cord.

Acute effects of direct cell implantation into the heart: a pressure–volume study to analyze cardiac function

BACKGROUND

To safely implant cells into the myocardium, we must establish a volume that prevents compromising cardiac performance. We studied pressure-volume (PV) to investigate the adverse effects of direct cell implantation in the acute phase.

METHODS

We used 21 minipigs. In the normal heart model, we studied PV by measuring various parameters (including end-systolic pressure, end-systolic elastance, dp/dtmax, end-diastolic volume, and time constant of isovolumetric left ventricular pressure fall [Tau]). We injected solutions into the left ventricular free wall (15 cm(2)). Sampling points were at baseline and after injection of saline (Group I, n = 4) or of blood (Group II, n = 4) at volumes of 1 ml and 10 ml up to 30 minutes after injection. In Group II, we injected additional blood (10 ml) 4 times. In the ischemic heart model, 1 month after ligating the left anterior descending artery, we injected 1 ml saline (Group III, n = 4), bone marrow mononuclear cells (10(8) cells/1 ml; Group IV, n = 4), or bone marrow stromal cells (10(8) cells/1 ml; Group V, n = 3). We studied PV before and after injection.

RESULTS

In Group I, we found no significant changes in parameters. In Group II, end-diastolic volume after 10-ml injection (24.4 +/- 3.6 ml) was smaller than end-diastolic volume at baseline (29.5 +/- 5.8 ml, p < 0.01). Tau after 10-ml injection (39.4 +/- 5.3 msec) was greater than at baseline (35.6 +/- 4.0 msec, p < 0.01). One pig died of ventricular fibrillation after a 20-ml injection of blood. We observed no detrimental effects in Groups III, IV, and V.

CONCLUSIONS

More than 10 ml cell suspension compromised diastolic function. We safely performed direct injection of bone marrow cells (1 x 10(8)/1 ml).