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With the surgical improvement of congenital heart disease, Fontan operation has been applied to many complicated patients in recent years. This is the first report of a child with panhypopituitarism who underwent Fontan operation. A 5-year-old boy was scheduled for Fontan operation. He previously underwent Blalock-Taussig shunt and bidirectional Glenn operations for univentricular heart with double-outlet right ventricle and pulmonary atresia. He was receiving hydrocortisone and 1-desamino-8-D-arginine vasopressin (DDAVP) for panhypopituitarism secondary to removal of craniopharyngioma performed at the age of three years. Although urine output and serum sodium concentration were adequately controlled by adjustment of vasopressin infusion rate during surgery, massive pleural effusions and ascites developed postoperatively, which required several days for control by adjusting the dose of oral DDAVP and normalize the serum sodium level. Intraoperative management of Fontan operation for a patient with panhypopituitarism was controllable by appropriate hormone replacement. However, postoperative fluid management was complicated by the clinical features of panhypopituitarism and Fontan physiology., Author(s): Kohei Sunoki [sup.1], Yoji Otsuka [sup.1], Hidetaka Iwai [sup.1], Tatsuya Nagano [sup.1], Naoyuki Taga [sup.1], Masaaki Kawada [sup.2], Mamoru Takeuchi [sup.1] [sup.3] Author Affiliations: (1) grid.410804.9, 0000000123090000, Department of [...]

Byline: Tomoyo Nishida (1), Masaji Nishimura (2), Kiyokazu Kagawa (3), Yukio Hayashi (4), Takashi Mashimo (4) Keywords: Dexmedetomidine Respiratory depression Respiratory response to carbon dioxide Abstract: Abstract Objective. Dexmedetomidine is a highly selective [alpha].sub.2-adrenergic agonist that can reduce anesthetic requirements. This study, to assess its effect on respiration, examined the effects of various doses of dexmedetomidine (1, 10, 30 and 50 Aug/kg) on the respiratory response to carbon dioxide (CO.sub.2) breathing in rabbits. Design. Randomized prospective study. Setting. Animal laboratory at a university school of medicine. Intervention. From 28 animals, four groups of seven were randomly assigned to receive different doses of dexmedetomidine (groups D1, D10, D30 and D50). Under inhalation of sevoflurane, each animal was tracheostomized and intubated with a 4 mm internal diameter (i.d.) endotracheal tube. Measurements and results. After end-tidal sevoflurane concentration had decreased below 0.03% and during quiet breathing (QB) respiratory rate (RR), tidal volume (V.sub.T) and inspiratory time (T.sub.I) were measured, from which minute ventilation (MV) and mean inspiratory flow (V.sub.T/T.sub.I) were calculated. After these measurements had been completed, each animal breathed the balloon gas (5% CO.sub.2 and 95% O.sub.2) until the end-tidal CO.sub.2 (ETCO.sub.2) reached 10%. The respiratory measurements were repeated during the latter period. After the collection of these data, dexmedetomidine was infused intravenously and the same measurements were repeated 15 and 45 min after dexmedetomidine infusion. The slope of the ventilatory response to hypercapnia in D50 was significantly higher compared with D30 animals. In the range 1--30 Aug/kg, during both QB and at 10% ETCO.sub.2, MV was decreased in a dose-dependent manner. Dexmedetomidine depressed both V.sub.T and RR during QB and at 10% ETCO.sub.2. Conclusion. Dexmedetomidine depressed resting ventilation and the respiratory response to CO.sub.2, but it did not induce profound hypoxemia or hypercapnia in rabbits. Author Affiliation: (1) Saiseikai Nakatsu Hospital, 2--10--39 Shibata, Kita-ku, Osaka, Japan 530--0012 (2) Intensive Care Unit, Osaka University Hospital, 2--15 Yamadaoka, Suita, Osaka, Japan 565--0871 (3) Department of Anesthesiology, National Cardiovascular Center, 5--7-1 Fujishirodai, Suita, Osaka 565--0873, Japan (4) Department of Anesthesiology, Osaka University Medical School, 1--1 Yamadaoka, Suita, Osaka 565--0871, Japan (5) Present address: Intensive Care Unit, Osaka University Hospital, 2--15 Yamadaoka, Suita, Osaka 565--0871, Japan Article History: Received Date: 04/06/2001 Accepted Date: 12/04/2002 Article note: Electronic Publication

Byline: Priyamvada. Gupta, Samrat. Joshi, Durga. Jethava, Ankit. Kumar Background and Aims: Monitored anaesthesia care (MAC) is meant for procedures under local anaesthesia. Various drugs have been used for this [...]

Byline: Surjya. Upadhyay, Piyush. Mallick, Waleed. Elmatite, Manish. Jagia, Salah. Taqi Many patients are admitted to the intensive care unit (ICU) for acute intoxication, serious complication of overdose, or withdrawal [...]