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Objective: This study was to prepare solid dispersions of lidocaine (Lid) with 5-sulfosalicylic acid dihydrate (SSA) by freeze-drying (freeze-dried [FD] Lid/SSA = 1/1) and to evaluate their physical properties. Methods: Here, we evaluated the physicochemical properties and solubility of solid dispersions of Lid and SSA prepared by freeze-drying (freeze-dried [FD] Lid/SSA = 1/1). Results: Differential scanning calorimetry measurements showed that after freeze-drying, the endothermic peak due to Lid melting, the dehydration peak, and the endothermic peak due to SSA melting disappeared. Powder X-ray diffraction results showed that the characteristic Lid and SSA peaks disappeared after freeze-drying, indicating a halo pattern. The near-infrared spectroscopy results suggested that Lid-derived –NH and –CH groups and the Lid-derived –OH and –CH groups from the SSA peak shifted and broadened after freeze-drying, suggesting their involvement in complex formation through Lid/SSA intermolecular interactions. Nuclear Overhauser effect spectroscopy-nuclear magnetic resonance (NMR) measurements showed a cross-peak due to the interaction between the Lid-derived –CH group and the SSA-derived –OH group, suggesting hydrogen bonding. Diffusion-ordered spectroscopy NMR measurements showed that the diffusion coefficients of Lid and SSA aggregated in FD Lid/SSA, suggesting a change in Lid dispersibility in the solvent owing to the formation of a complex with SSA. The solubility of FD Lid/SSA was approximately 88 mg/mL (∼20-fold higher than that of Lid). Conclusions: These findings suggest that complex formation occurred in FD Lid/SSA; this enhanced the solubility of this dispersion. [ABSTRACT FROM AUTHOR]

This paper reports the successful perioperative management of a patient with a giant bulla, who underwent radical prostatectomy under general anesthesia performed under combinet spinal-epidural anesthesia while maintaining spontaneous respiration. A 61-year-old man was scheduled for radical prostatectomy. He had undergone conservative treatment using a drainage tube for right-sided pneumothorax at the age of 23. Preoperative chest CT revealed the presence of a giant bulla in the left upper lobe, multiple bullae in the entire right lung, and emphysematous alterations in both lungs. On respiratory function testing, mild obstructive impairment was observed. In the operating room, an epidural catheter was inserted at T11-12, and spinal anesthesia was performed at L3-4. Under anesthesia with propofol and fentanyl, i-gel® was inserted. During anesthesia, spontaneous respiration was managed at oxygen concentration 40% and sevoflurane 1.5%, while continuing the epidural administration of levobupivacaine. The circulatory and respiratory conditions were stable during surgery. The durations of surgical and anesthetic procedures were 2 hours and 16 minutes and 3 hours and 33 minutes, respectively. In the absence of respiratory complications, the patient was discharged 8 days after surgery.

The patient was a 36-year-old man who had been aware of a mild bleeding tendency since childhood, but did not show any history of severe bleeding. After lumbar epidural block was performed for pain caused by lumbar disc herniation, the patient developed paraplegia due to an acute epidural hematoma, and rectovesical disorder. He was admitted to our hospital, and wide fenestration and hematoma evacuation were performed. Because of persistent bleeding, reoperation was performed to achieve hemostasis. Although factor VIII antigen was 138%, its activity was decreased to 18% of normal. A diagnosis of cross-reacting material positive mild hemophilia A was made. Postoperative injection of a factor VIII preparation resulted in complete hemostasis. The activated partial thromboplastin time was within normal range. A thrombin generation test showed reduced endogenous thrombin potential, peak thrombin levels, and prolonged time-to-peak levels. The thrombin generation test, which allows comprehensive assessment of the coagulation profile, was useful for diagnosis and treatment of this case.