Pseudomyxoma peritonei (PMP) is a rare disease, presenting with large amounts of mucinous ascites, and treatment with intraperitoneal irrigation with mucolytic agents has been tried. We report a patient with PMP who underwent intraperitoneal irrigation with sodium bicarbonate and exhibited marked alkalosis. The patient was a 78-year-old woman who had mucinous ascites, and an appendiceal and an ovarian tumor. Bilateral salpingo-oophorectomy and appendectomy were performed, and she then underwent intraperitoneal irrigation with sodium bicarbonate (7%, 1000 ml). Shortly after the irrigation, blood gas analysis showed critical alkalosis (pH, 7.66; base excess [BE], 24 mEq x l(-1); HCO3 (-), 50 mEq x l(-1)) with electrolyte imbalance (Na+, 153 mEq x l(-1); K+, 2.8 mEq x l(-1); Ca2+, 0.98 mEq x l(-1), Cl(-1), 99 mEq x l(-1)). The alkalosis and electrolyte imbalance were ameliorated with the administration of potassium chloride and calcium chloride intravenously, and the patient was extubated after the 2-h surgical procedure. The patient was discharged home after 15 days without problems. Sodium bicarbonate may be an effective mucolytic agent for PMP. However, during irrigation with sodium bicarbonate, careful evaluation of the acid-base balance and serum electrolytes, and prompt treatment of alkalosis or electrolyte imbalance, should this occur, are of great importance.
Our results suggest that neither i.v. fentanyl nor i.v. remifentanil added to 0.5 MAC isoflurane exacerbated ischemic spinal cord injury in rabbits when compared to 1 MAC isoflurane.
There is controversy as to whether opioids can aggravate ischemic injury of the spinal cord during thoracoabdominal aortic surgery. Kakinohana et al. demonstrated that intrathecal morphine worsened ischemic injury after transient spinal cord ischemia in rats. However, the dose of morphine that worsened ischemic injury was more than ten times the ordinary analgesic dose. In contrast, we demonstrated that ischemic injury was not worsened by fentanyl (100μg/kg) or remifentanil (1μg/kg/min) doses that were twice as large as the clinical maximum dose added to a low concentration of isoflurane (0.5 MAC) in transient spinal cord ischemia in rabbits. Although the possibility still remains that administration of opioids in extremely large quantities aggravates ischemic spinal cord injury, clinically relevant doses of opioids do not seem to aggravate it.
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