Search

A 63-year-old woman presented with a 4-hr history of sneezing, visual disturbance, and dyspnea after drinking foreign honey dissolved in hot water. Severe hypotension (56/30 mmHg) and bradycardia (55 beats/min) were identified on arrival. She was immediately administered intravenous atropine (0.5 mg) and a bolus injection of Ringer solution (2,000 mL). Circulatory abnormality dramatically improved immediately after atropine injection and she was discharged on hospital day 2. We speculate that the patient suffered from honey intoxication because of manifestations such as hypotension and bradycardia, which are commonly seen in patients intoxicated by honey.

Background: We investigated the efficacy of two types of Ringer's solutions, acetated Ringer (AR) and bicarbanated Ringer (BR), during and after high invasive abdominal surgery., Methods: We divided 16 patients scheduled for extended hystectomy into 2 groups of AR or BR infusion group. Either AR or BR solution was administered to keep CVP at 2-8 cmH2O and Hb above 7 g x dl(-1) during the entire anesthetic period. Acid base balance, serum magnesium (Mg) and metabolic products such as lactate, pyruvic acid, citric acid, acetoacetic acid and hydroxybutyric acid were measured during and after surgery. IL-6 was determined early on the next morning., Results: Metabolic products and IL-6 were not different between the two groups; however, base excess and HCO3- during surgery were kept higher in BR group than in AR group. Intraoperative serum Mg was also maintained higher in BR group., Conclusions: From the aspect of the ability to keep acid base balance and Mg level, BR seems to be a more suitable infusion fluid than AR in high invasive abdominal surgery such as extended hystectomy.

Background: Effect of bicarbonated Ringer's solution (BRS) on the liver function of rats with metabolic acidosis was compared with that of lactated Ringer's solution (LRS) and Ringer's solutions (RS). Furthermore, the effect of acidosis on the plasma protein binding ratio of propofol was examined., Methods: Partial hepatectomized rats were divided into three groups, and BRS, LRS or RS was intravenously administered at 20 ml x kg(-1) x hr(-1) with propofol (45 mg x kg(-1) hr(-1)) for 90 min. Immediately after the administration, indocyanine-green (ICG) was infused. Blood sampling was done at 30, 60, 90 and 120 min after the ICG infusion, and the ICG concentration in plasma was measured. Propofol was added to plasma of rats with ketoacidosis or normal rats (final conc. 5 microg x ml(-1)), and incubated for 30 min at 37 degrees C. After incubation, plasma propofol concentrations were measured., Results: The reduction of ICG in plasma of BRS group was the fastest among the three groups. Plasma protein binding ratio of propofol in plasma samples of rats with ketoacidosis tended to be lower than those of normal rats samples., Conclusions: These results suggest that metabolic acidosis induced the delay of awakening from anesthesia, suggesting that BRS accelerates recovery from anesthesia through amelioration of acidosis.

Background: We compared the effects on intraoperative acid-base balance of bicarbonated Ringer (BR) and those of acetated Ringer (AR) solutions as an intraoperative fluid during long-term laparotomy., Methods: Forty patients scheduled for laparotomy expected to take more than 5 hours were divided into two groups according to the type of infused solution, BR or AR. Each solution was intravenously administered at a rate between 8 and 10 ml x kg(-1) x hr(-1). Arterial blood gases were analyzed before and during surgery., Results: Intraoperative arterial blood HCO3- and base excess (BE) significantly decreased in the AR group but not in the BR group. HCO3- and BE 2 and 4 hrs after the start of surgery and at the end of surgery were significantly higher in the BR group than in the AR group., Conclusions: These results suggest that BR has superior effects on the acid-base balance during long-term laparotomy.

Two recently recognized issues are reviewed ; one is a hospital acquired hyponatremia in children treated with intravenous hypotonic maintenance fluids and the other is the pros and cons of glucose addition to these fluids. Children in the perioperative period are at risk for nonosmotic secretion of ADH and stress-induced insulin resistance, which necessitate reducing the volume of maintenance fluid to half the previously recommended volume, and the concentration of additive glucose to approximately 2%. While isotonic fluids are recommended intraoperatively, controversies still exist on the constitution of maintenance fluids in the postoperative period, where the choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is weak ; further investigations are needed to make a decision.

A 16-year-old man with mitochondrial encephalomyopathy underwent biopsy and nephrectomy under general anesthesia. Mitochondrial encephalomyopathy is caused by mitochondrial dysfunction, and frequently accompanies elevation of lactic and pyruvic acid levels in the blood. It has been considered that problems of anesthesia for the patient with mitochondrial encephalomyopathy are the probability of hyperlactacidemia, the relevance to malignant hyperthermia, the possibility of myocardial disease and dysfunction of heart conduction system, respiratory depression due to muscle weakness, and so on. Therefore, to prevent hyperlactacidemia, we prepared the extracellular fluid solution including bicarbonic acid but no lactic and acetic acid, and infused the solution to the patient during anesthesia. By use of this solution, his lactic acid level was kept within the normal range during anesthesia and no metabolic acidosis occurred. His hemodynamics was stable and he showed normal response to vecuronium, recovering from anesthesia smoothly and postoperative course was uneventful.

We investigated the effects of bicarbonated Ringer's solution (BR) on arterial blood acid-base balance, and compared these with the effects of lactated Ringer's solution (LR) and acetated Ringer's solution (AR) in rats in hemorrhagic shock. Rats underwent 70% reduction of hepatic blood flow and blood shedding of 1.5% of body weight. Each solution was infused through the femoral vein at a rate of shed blood volume x 8.hr-1 for 30 min under urethane anaesthesia. After the blood shedding, arterial blood pH and HCO3-decreased but plasma lactate concentration increased. These parameters improved significantly in the BR group compared with those in the LR group. However, the LR group showed the lowest blood pH and the highest plasma lactate concentration among the groups. These results suggest that BR has superior effects on the arterial blood acid-base balance and glucose metabolism in rats in hemorrhagic shock and with hepatic dysfunction.

Many cases of tissue injury caused by a button battery appearing as a foreign body have been reported in the otolaryngology field. However, there have been very few studies on the mechanism of tissue injury by batteries. In this study, we inserted a button-type battery into 4cm3 of Ringer's solution, which is similar to serous fluid, at both room temperature (20 degrees C) and body temperature (37 degrees C), and observed the electro-chemical reactions between the negative and positive terminals over 6 hours. We identified the products of these reactions, measured the remaining electromotive force (EMF), and observed the changes in pH and metallic ion concentrations over time. In conclusion, the following three major groups of factors causing tissue injury were suggested: 1) At the positive terminal the HCl acid and HClO produced broke down, and chlorine gas was dissolved into the solution. 2) At the negative terminal, the OH- radical was produced by reduction of water. 3) Potassium hydroxide (KOH), nickel (Ni2+), manganese (Mnn+), chrome (Crn+), and lead (Pb2+) leaked from the battery at the poles, due to oxidation, and were partially dissolved in the serous fluid. These factors may result in serious tissue injury. In addition, each electro-chemical reaction occurred in a very short time at these relatively high temperatures, and as a result, may be the cause of these tissue injuries.

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.

A series of 64 patients underwent surgical treatment for chronic subdural hematomas between 1980 and 1989. The procedure consisted of a single burr-hole, irrigation of the hematoma without subdural drainage and lumbar intrathecal injection of Ringer's solution. Irrigation was carried out until the washing was clear and the injection was continued until the brain was in contact with the edge of the burr-hole. Excellent outcome was achieved in 53 patients (82.8% of the total). Two of the patients died, thus making a 3.1% mortality rate. Such complications as tension pneumocephalus and intracerebral hematoma were not observed and no patient had a recurrence.

A decrease in extracellular potassium concentration [( K+]o) was caused by injecting a small amount of K+ -free Ringer's solution into the photoreceptor layer of the isolated frog retina. The response induced by K+ -free Ringer's solution was receptor side-positive, and the depth profile of the response resembled that of the response (slow P III) induced by spot illumination. This result supports the notion that the slow P III is generated by Müller cells as they hyperpolarize in response to a light-induced decrease in [K+]o in the photoreceptor layer.

The perioperative courses of 5 open heart operations in children of Jehovah's Witnesses are reviewed. The age of patients ranged from 6 to 13 years old and the body weight, from 21.5 kg to 38.5 kg. All the patients survived and are doing well now. The cardiopulmonary bypasses, primed with lactated Ringer's solution, were performed safely with the use of moderate hypothermia. Hemodilution techniques are the key for the safe exocorporeal circulation and we set the lowest limit of body weight at 20 kg. Postoperative bleeding occurred in one case and was treated by early exploration. All the cases did not receive any blood or blood products during hospitalization. Therefore we can conclude that cardiac operations over 20 kg of body weight can be safely performed without any blood or blood products. With regard to social aspects, especially in case of emergency, we should make the decision regarding transfusion under the guidance proposed by the Japanese Medical Association.

The occurrence and mechanism of IMC are still not completely elucidated. Base on the conjecture of that the region of intestine and its ingredients may be concerning with the conduction mechanism of IMC, following experiment was performed by author. Small intestine was cut into two parts. Anal side was closed as blind end, and the end of oral side was sutured to colon or anal part of intestine by end to side anastomosis. Gastric fistula and intestinal fistula of the blind ending intestine were also made, and six pieces of force transducers were sutured to the serosa of the intestine in order to observe the movement of intestine. Under non-anesthesia and non-restricted condition for whole day long, Ringer solution was injected into gastric or intestinal fistula by 50 ml one shot or continuous dripped infusion of 250 ml per hour. The result is: In upper part of intestine, the appearance of IMC in oral and anal side of intestine is continuously observed. However, in lower part of intestine, the IMC of oral and anal part of intestine appeared completely independent without any continuity. And, as one shot of 50 ml of Ringer solution was injected, the conduction of IMC was suppressed but still observable, while continuously infused of 250 ml/hr, the IMC was completely disappeared.