[The effectiveness of ozonated water for hand washing before surgery]

Using an ozonated water-dispensing machine for sterilization of hands (Mediaqua MA-III; Core Medical Co., Ltd, Tokyo, Japan), we investigated the effectiveness of ozonated water as a disinfectant for hand washing before surgery. The effectiveness of this new hand-washing method, using 4 ppm of ozonated water, which is expected to have a short-term bactericidal effect, and 0.2% benzalkonium chloride/83% ethanol solution (Welpas), which is expected to have a long-term bactericidal effect, was compared with that of the conventional hand-washing method (Fürbringer's method using a scrubbing agent containing povidone-iodine). The results showed no significant differences in the numbers of live bacteria and exponential reduction rates in live bacteria. Thus, this new method for hand washing using ozonated water is an effective method for sterilization of the hands before surgery.

[Continuous epidural droperidol for postoperative pain]

We investigated the proper dosage of droperidol continuously infused into the epidural space. Sixty patients who received continuous epidural infusion of buprenorphine for 24 hours were divided into four groups (Group I: only buprenorphine, Group II: 1.25 mg of droperidol added to buprenorphine, Group III: 2.5 mg of droperidol added to buprenorphine, Group IV: 5 mg of droperidol added to buprenorphine). No significant difference was observed in prevention of nausea and vomiting among 4 groups. But in group II, III and IV, there was a tendency of increased analgesic effects of buprenorphine. Especially in group III, the pain level was significantly lower and number of doses of bupivacaine was significantly fewer than in group I. In conclusion, droperidol 2.5 mg continuously infused into epidural space increases analgesic effects of buprenorphine.

[The effect of dopamine and prostaglandin E1 on urine oxygen tension (PuO2)]

We reported that PuO2 reflects renal medullary perfusion and decreases during N2O-O2 isoflurane (GOI) or sevoflurane (GOS) anesthesia. In the present study, we examined the effect of dopamine (DOA) or prostaglandin E1 (PGE1) on PuO2 during GOI anesthesia. Twenty four patients from elective surgery with GOI anesthesia were randomly divided into three groups, i.e. control group (n = 8), DOA group (n = 8) and PGE1 group (n = 8). PuO2 decreased significantly in the control group, while in the DOA and PGE1 groups, PuO2 was unchanged. These results suggest that DOA and PGE1 maintain renal medullary perfusion under GOI anesthesia.

[A case of pulmonary infiltrates associated with a neutrophil-specific antibody transfusion reactions]

A normovolemic pulmonary edema associated with blood transfusion developed in a 38-year-old woman during gynecological operation. Bilateral pulmonary infiltrates and profound leucopenia (700.microliters-1) were observed. An antibody reactive with the recipient's neutrophils was found in a donor and an antibody reacting with the lymphocytes of the recipient was identified in another donor. Both donors were multiparous women. Respiratory failure was improved with mechanical ventilation but chest X-ray showed pulmonary infiltrates for the next 3 days. The white blood cell count rose to 2900.microliters-1 in the next day, and it took 2 weeks to be normalized. Transient pulmonary infiltrates can be caused by antileukocyte antibodies passively transfused by multiparous donors.

[Intraoperative fluid therapy during experimental laparotomy of long duration]

Intraoperative fluid therapy was studied using 18 adult mongrel dogs in which laparotomy of long duration was performed. The 18 mongrel dogs were divided into three groups (Group I: lactated Ringer solution (LR) infused at the rate of 10 ml.kg-1.h-1, Group II: LR infused at the rate of 20 ml.kg-1.h-1, Group III: LR infused at the rate of 5 ml.kg-1.h-1 and Salinhes infused at the rate of 5 ml.kg-1.h-1). The differences in hemodynamic status, plasma colloid osmotic pressure, O2 delivery, O2 consumption et al were investigated in the three groups. Mean arterial pressure, cardiac output and renal blood flow were maintained in all groups. In group I, skin blood flow decreased and O2 extraction ratio started to increase four hours later suggesting that there is trouble in the balance of O2 delivery and consumption. In group II, skin blood flow and urine volume were maintained, but plasma colloid osmotic pressure was lowest in this group. In group III, skin blood flow volume decreased as it did in group I, but plasma colloid osmotic pressure was maintained at a higher level than that in the two other groups, and O2 extraction ratio showed no significant changes. These findings indicate that colloid solution is useful for laparotomy of long duration. In conclusion, colloid solution should be added to the fluid used in laparotomy of long duration.

[Changes in urine oxygen tension (PuO2) during anesthesia with isoflurane and sevoflurane]

Leonhardt and coworkers have suggested that PuO2 may indicate degree of renal medullary perfusion and function. The changes in PuO2 during N2O-O2-isoflurane anesthesia (GOI) and N2O-O2-sevoflurane anesthesia (GOS) were studied in 20 patients (GOI group: 10 cases, GOS group: 10 cases) who underwent elective surgeries. In the GOI group, PuO2 decreased significantly 30 and 60 minutes after the beginning of surgical incision, and it returned to the previous value immediately after the cessation of isoflurane. In the GOS group PuO2 decreased starting 30 minutes after the beginning of surgical incision until 10 minutes after the cessation of sevoflurane. These results suggest that isoflurane and sevoflurane administration caused a reduction in renal medullary perfusion, and that the low perfusion during sevoflurane anesthesia lasted longer than during isoflurane anesthesia. Measurement of PuO2 has a number of problems, but we believe that PuO2 is useful as an indicator of renal medullary blood flow.

[Postoperative respiratory functions after laparoscopic cholecystectomy]

We studied the influences of the laparoscopic cholecystectomy (LC) on the postoperative pulmonary functions by performing respiratory function tests, blood gas analysis and the measurement of the rib cage contributions (RCC). LC resulted in less postoperative pulmonary dysfunctions compared with laparotomic cholecystectomy. After LC, vital capacity and PaO2 were not markedly affected, and RCC remained low. After LC, hospitalization was shorter, LC does not injure the abdominal muscles of the patients, and preserves the function of the diaphragm. In addition, it gives less wound pains. Therefore, we conclude that LC has many advantages for patients, especially for those with complications, and it will be used more in the near future.

[Clinical examination of acetated Ringer solution in patients with normal liver function and those with liver dysfunction]

Acetated Ringer solution (AR) was studied clinically to find its usefulness in patients with liver dysfunction compared with lactated Ringer solution (LR). The thirty-eight patients scheduled to be operated were divided into four groups (Group I: with normal liver function and AR infused, Group II: with normal liver function and LR infused, Group III: with liver dysfunction and AR infused, Group IV: with liver dysfunction and LR infused). AR or LR was administered to each group at a speed of 10 ml.kg-1.h-1, and we investigated the differences of these four groups clinically. L-lactic acid increased significantly in all groups after administration of AR or LR. D-lactic acid increased in LR groups, and acetic acid increased in AR groups. However, the other parameters, including the acid-base balance, electrolytes and liver function, showed no significant changes in any group. Therefore the status of liver dysfunction did not affect the metabolism of lactic acid in this study. These findings indicate that as an intraoperative fluid, AR is just as useful as LR. However, there was no significant difference between the data of AR groups compared with those of LR groups. In conclusion, AR is not necessarily a better fluid compared with LR as an intraoperative fluid in patients with liver dysfunction.