We studied the interaction of a β-adrenergic receptor agonist and an adenylyl cyclase activator with volatile anesthetics in combination with nitrous oxide (N2O). The whole-cell patch clamp technique was used to measure the amplitude of L-type Ca2＋ channel current(ICa,L) in rabbit ventricular myocytes. The effects of sevoflurane or halothane in combination with N2O were compared with their effects in the presence of β-adrenoceptor stimulation by isoproterenol or adenylyl cyclase activation by forskolin. The effects of sevoflurane plus N2O and halothane plus N2O under basal conditions significantly differed from their effects in the presence of isoproterenol. Isoproterenol and forskolin diminished the ability of two gas combinations to suppress ICa,L. Our findings suggest that both sevoflurane and halothane in the presence of N2O modulate the catecholamine sensitivity of the β-adrenergic cascade.
The patient was a 51-year-old woman who received CABG at 49 years old, and developed poor left ventricular cardiac function(EF, 26%; %FS, 14% and diffuse hypokinesis) after the surgery. The patient was scheduled to undergo thoracoscopy-guided left upper lobe resection. Prior to anesthetic induction, a Flotrac/Vigilleo SystemTM for an arterial pressure line was placed. After starting differential lung ventilation, hypotension and low cardiac index were confirmed by the system, and dobutamine administration was initiated. After that, systolic pressure fluctuated at around 90mmHg, and surgery was completed without any intraoperative complications.
We retrospectively investigated the incidence and risk factors of stroke after cardiovascular surgery. 137 patients(81 male, 56 female; aged 20 to 84 years old) underwent cardiovascular surgery from January to July 2007 in the Tokushima Red Cross Hospital. Stroke occurred in 6 patients(4.4%; 1 male, 5 female), 3 was after off-pump coronary artery bypass grafting, and the other 3 was after great vascular surgery. Univariate analysis revealed great vascular surgery(Odds ratio, 12.1; p＝0.010) and preoperative severe head and neck arterial stenosis(Odds ratio, 10.07; p＝0.024) were significant factors of stroke after surgery. There were not significant factors of high age(≧70), preoperative stroke, hypertension, diabetes mellitus and cardiopulmonary bypass. This study suggested that preoperative severe arterial stenosis may predict stroke after cardiovascular surgery.
An 88-year-old man receiving home oxygen therapy for about 10 years was admitted to our hospital in a shock state and the abdominal computed tomography scanning revealed ruptured abdominal aortic aneurysm(AAA) with a maximum diameter of about 70mm. We performed an emergency operation and the AAA was replaced with a straight vascular graft. He was extubated on the 1st postoperative day and received noninvasive positive pressure ventilation(NPPV) for hypercapnic respiratory failure. He received continuous hemodiafiltration(CHDF) for oliguria. He was discharged from our intensive care unit on the 3rd postoperative day and was discharged from our hospital on the 24th postoperative day.