We investigated how the protection of energy status by isoflurane in isolated hepatocytes varied with isoflurane dose, duration of anoxia, and reoxygenation. Hepatocytes were isolated from fed rats and incubated in Krebs buffer under O2/CO2 or N2/CO2 (95/5) for 30 or 90 min, followed by 5 or 30 min of reoxygenation. From measurements of adenosine tri-, di-, and monophosphate (ATP, ADP, AMP) in the cells, energy charge (= [ATP + 1/2 ADP]/[ATP + ADP + AMP]) was calculated to reflect the balance between ATP supply and demand, and total adenine nucleotide (= ATP + ADP + AMP) to indicate the potential maximum ATP level. During 30 min of anoxia, energy charge and total adenine nucleotide steadily increased with isoflurane dose from 0 to 2 minimum alveolar anesthetic concentration, then decreased from 2 to 3 minimum alveolar anesthetic concentration. In short incubations (30-35 min) at 1 minimum alveolar anesthetic concentration isoflurane, there was a modest decrease in energy charge during anoxia, partially prevented by isoflurane and completely reversed by reoxygenation, and no decrease in total adenine nucleotide. In long incubations (90-120 min), there were large decreases in both energy charge and total adenine nucleotide during anoxia, with partial and no reversal by reoxygenation, respectively. Isoflurane partly prevented decreases in both energy charge and total adenine nucleotide during both anoxia and reoxygenation. We conclude that at doses in the clinical range, isoflurane partially protected isolated hepatocytes against decreases in both energy charge and total adenine nucleotide occurring either during short (reversible) or long (irreversible) anoxia.(ABSTRACT TRUNCATED AT 250 WORDS)
Hemodialysis is the usual recommended treatment for severe lithium intoxication when emergent extracorporeal lithium removal is necessary. Intermittent hemodialysis has been chosen most frequently, however it has disadvantages such as postdialysis rebound elevation in lithium concentration, hemodynamic instability, tendency to develop hypovolemia and deteriolate renal function. On the other hand continuous hemodiafiltration (CHDF) offers an advantage of slow sustained removal of lithium without the adverse effects of conventional hemodialysis. The following is a report of a case of severe chronic lithium intoxication successfully treated with CHDF. A 69-year old woman, who had been diagnosed with manicdepressive psychosis 18 years previously, was transferred to our ICU because of unconsciousness during lithium maintenance therapy (lithium carbonate 800mg/day). On arrival her consciousness level was Japan Coma Scale 100 and the pulse rate was 30beats/min. Since she had a past history of cardiac failure, we conducted CHDF to accelerate lithium elimination. CHDF was continued for 64 hours and thereafter her condition improved uneventfully.
Oral and nasal intubation sometimes interferes with surgical procedures in maxillofacial trauma patients. In these cases, tracheostomy is usually selected for airway management. Submental tracheal intubation is an effective alternative to oral and nasal tracheal intubation or tracheostomy. Submental tracheal intubation provides a good view and correct articulation. Ten patients underwent submental tracheal intubation without complications since December 2015 at our hospital. Submental tracheal intubation avoids the severe complications of tracheostomy. Submental tracheal intubation is useful as an airway management surgical procedure in maxillofacial trauma patients.
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