Bupivacaine(BUP) has an advantage over other local anesthetics because of its long-acting sensory anesthesia, but because of its high affinity for the myocardial Na⁺ channel it can be cardiotoxic. Levobupivacaine(LBUP) is an S(-)-isomer of the racemate BUP, and dexbupivacaine(DBUP) is an R(+)-isomer. LBUP has less neuronal and cardiac toxicity than BUP and DBUP, but DBUP induces more negative chronotropism and arrhythmogenic effects than either LBUP or BUP.

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Beating coronary artery bypass graft in combination with right-heart bypass(RHB) has been reported to be a safer procedure, particularly in patients at a high risk for neurological complications. This retrospective study investigated whether beating coronary bypass with RHB is less minimally-invasive as off-pump coronary artery bypass graft(CABG) than on-pump CABG at the postoperative period. We included 41 patients(on-pump group 18, off-pump group 18, RHB group 5), who underwent CABG at Osaka Rosai Hospital between 2002 and 2004. We excluded the cases with heart valve disease, renal failure, and hepatic insufficiency. In both the RHB group and the off-pump group, patients could be extubated earlier after operation than the on-pump group patients. Postoperative 24h bleeding and catecholamine(dopamine, dobutamine) doses were less in both the RHB and off-pump groups than the on-pump group. Postoperative management of beating CABG in combination with RHB may be less minimally-invasive, as off-pump CABG group, than the on-pump CABG group.

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A 76-year-old man with a permanent pacemaker was scheduled for transurethral lithotripsy. He had a past history of drug allergy, which we were not informed preoperatively. About 40min after spinal anesthesia, he suddenly developed hypotension which did not respond to intravenous fluids and ephedrine. Subsequently, he became cardiopulmonary arrest and ventricular fibrillation. He was successfully resuscitated without any neurological sequelae. Erythema appeared on the lower abdomen, suggesting the occurrence of anaphylactic shock. The cause of anaphylactic shock was considered to be a disinfectant, chlorhexidine gluconate, or an additive agent, methylparaben.

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A 77-year-old man was scheduled for aortic valve replacement to treat his aortic stenosis. After induction of anesthesia with fentanyl and propofol, tracheal intubation was facilitated with vecuronium. A pulmonary artery catheter(PAC) was inserted via the right internal jugular vein without difficulty. The tip of the PAC was seen in the left pulmonary artery on a postoperative chest radiograph. The patient was separated from cardiopulmonary bypass(CPB). During protamine infusion, acute pulmonary hemorrhage occurred through the tracheal tube. Fiberoptic bronchoscopy revealed the right upper bronchus to be the source of bleeding. By this time, 500ml of blood had been lost through the endotrachel tube. The bleeding stopped within 30 minutes without any treatment. We administered aprotinin and antithrombin III to normalize blood clotting. No further bronchial bleeding occurred. We could not identify the cause of hemorrhage, although bronchiectasis, tracheal injury by tracheal intubation, PAC-related perforation of the pulmonary artery, perforation of pulmonary vein by ventricular vent catheter, or a metastatic pulmonary tumor from colon cancer were all considered.

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