These results demonstrated that ketamine produced antinociceptive effects through an activation of the monoaminergic descending inhibitory system, whereas, in a unilateral peripheral inflammation-induced hyperalgesic state, the monoaminergic system did not contribute to the antihyperalgesic effects of ketamine. The mechanisms of the antinociceptive and antihyperalgesic properties of ketamine are different.
A 42-year-old man, who had worked as a welder for 20 years, was admitted to our hospital complaining of a dry cough. A chest radiograph showed diffuse small nodular shadows and chest computed tomography revealed small patchy opacities. A transbronchial lung biopsy specimen showed welding fume particles mainly located in alveolar space with mild fibrosis of alveolar septa. In order to prevent further fibrosis, bronchopulmonary lavage (BPL) was performed to eliminate the fume particles. The amount of iron particles derived from the total lavage fluid was 911.7mg. (Internal Medicine 37: 962-964, 1998)
The purpose of this study was to compare the Jackson-Rees circuit with the pediatric circle and MERA F breathing system (MERA F system) for pediatric anesthesia from the viewpoint of work of breathing (WOB). Twenty-three children (2-10 yr old) were studied during spontaneous breathing under endotracheal anesthesia with 4 L/min nitrous oxide, 2 L/min oxygen, and 1% end-tidal concentration of sevoflurane. WOB, inspiratory and expiratory airway resistance, dynamic compliance (CDYN), pressure time product (PTP), and arterial blood gasses were measured in the three circuits. The inspiratory WOB was estimated directly by measuring the esophageal pressure-volume loop using the Campbell technique. In a laboratory study, we measured the compliances of the Jackson-Rees circuit, the pediatric circle, the MERA F system, and the adult circuit. WOB differed among the three circuits (MERA F system > pediatric circle > Jackson-Rees circuit). Inspiratory and expiratory resistances, and arterial carbon dioxide tension in the Jackson-Rees circuit were significantly lower than those of both the pediatric circle and MERA F system. The CDYN and PTP in the MERA F system were significantly higher than those in both the Jackson-Rees circuit and the pediatric circle. The MERA F system had significantly higher compliance than the Jackson-Rees circuit and pediatric circle. It is concluded that the Jackson-Rees circuit is most efficient, the pediatric circle is intermediate, and the MERA F system is the least efficient from the viewpoint of WOB during spontaneous breathing for pediatric anesthesia.
We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.