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Author(s): Hanae Okajima[sup.1] , Osamu Tanaka[sup.1] , Masahiro Ushio[sup.2] , Yasuko Higuchi[sup.1] , Yukiko Nagai[sup.1] , Katsuhiro Iijima[sup.1] , Yoshio Horikawa[sup.3] , Kazuko Ijichi[sup.1] Author Affiliations: (1) Department of Anesthesiology, [...], Purpose Both paravertebral block (PVB) and thoracic epidural block (TEB) are recommended for postoperative pain relief after lung surgery. The addition of fentanyl to the anesthetic solution became popular for TEB because of the stronger effects; however, there have been few comparable trials about the addition of fentanyl to PVB. The purpose of this study was thus to compare postoperative analgesia, side effects, and complications between ultrasound-guided PVB (USG-PVB) and TEB with the addition of fentanyl to ropivacaine after lung surgery. Methods We examined 90 consecutive patients (age 18-75 years) scheduled for video-assisted thoracic surgery (VATS). In both groups, all blocks (four blocks in USG-PVB and one block in TEB) and one catheter insertion were performed preoperatively. Continuous postoperative infusion (0.1 % ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both groups. The recorded data included the verbal rating scale (VRS) for pain, blood pressure, side effects, complications for 2 days, and overall satisfaction score. Results There was no difference in the frequency of taking supplemental analgesics (twice or more frequently), or in VRS. Hypotension occurred significantly more frequently in TEB (n = 7/33) than in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV and pruritus, as well as overall satisfaction score, were similar. There were no complications in both groups; however, the catheters migrated intrathoracically in four patients in PVB. Conclusion USG-PVB achieved similar pain relief and lowered the incidence of hypotension compared with TEB. We conclude that both blocks with the same concentration of ropivacaine and fentanyl can provide adequate postoperative analgesia for VATS.

A 68-year man with severe Parkinson's disease who had been implanted with deep brain stimulators into both sides, received an emergency surgery uneventfully under general anesthesia with standard monitoring. During the operation, the surgeon turned off the impulse generators and used bipolar diathermy. Postoperatively, he had transient episodes of severe Parkinson symptoms, which were controled by levodopa drugs.

A 51-year-old woman with renal failure requring hemodialysis received a total of 446 mg of vecuronium over a period of 4 days to help mechanical ventilation and developed generalized muscle weakness after its discontinuation. It took 2 wks to wean her from mechanical ventilation and 3 wks for her to be able to walk. She did not receive drugs which might alter neuromuscular transmission such as corticosteroid and aminoglycoside antibiotics. Electromyogram and nerve conduction studies were normal. We believe that the cause is the accumulation of vecuronium and active metabolites due to renal failure. The case suggests that we should minimize the duration of neuromuscular block in patients with renal failure by aggressive use of sedatives and analgesics and the optimization of ventilator settings.

We report on a 42-year-old oliguric uremic man on regular hemodialysis who developed sudden cardiac arrest, secondary to severe hyperkalemia, with a plasma potassium concentration of 9.7 mEq x l(-1). The cardiac arrest persisted after the initiation of cardiopulmonary resuscitation and intensive treatment for marked hyperkalemia for an hour and 55 minutes. Therefore a portable percutaneous cardiopulmonary support (PCPS) system had to be instituted while the patient had very prolonged refractory ventricular fibrillation. His cardiac rhythm was restored immediately after application of PCPS and he recovered without neurological sequelae. We therefore suggest that PCPS should be considered as a therapeutic option during cardiopulmonary resuscitation for life-threatening cardiac arrest secondary to severe hyperkalemia.

Background: This study compared epidural and intravenous tramadol infusions for postoperative analgesia after gastrectomy., Methods: Twenty patients were assigned randomly to receive either tramadol epidurally and saline intravenously (group-E) or tramadol intravenously and saline, epidurally (group-I) in a double-blind fashion. At the end of the operation, each patient received a bolus of tramadol 2 mg x kg(-1) either epidurally or intravenously and 7 mg x kg(-1) x day(-1) tramadol infusion was begun via the same route. Concurrently, a saline bolus and its infusion were given via the alternate route., Results: Both groups obtained adequate pain relief and there was no difference between the groups in pain score. But one patient in E-group was excluded from the study for respiratory depression 8 hours after the operation. No other side effects were detected in either group except mild nausea., Conclusions: We conclude that intravenous tramadol infusion provides effective and safe postoperative analgesia. A futher examination is required for the suitable dose of tramadol in epidural infusion.