Objectives: To elucidate the kinetics of endotoxin and (1→3)-β-D-glucan (β-D-glucan) as well as to clarify the mechanisms of changes of these variables in patients undergoing cardiopulmonary bypass (CPB) or living donor orthotopic liver transplantation (OLT), we made prospective observational study. Methods: Fifteen patients undergoing CPB and 10 patients with OLT were investigated. Male Wister rats were used for experimental study. Plasma levels of endotoxin, β-D-glucan, prothrombin fragment₁₊₂ (PF₁₊₂), and soluble fibrin (SF) were measured at several points during the operations. Sterilized gauzes immersed in 2ml saline were administered in rats intraperitoneally. Blood was collected from jugular vein at 4 hours after the administration. Sham operated rats were used as control. Results: No endotoxin was detected throughout the studies, however β-D-glucan levels showed significant elevations during the CPB and OLT surgeries. In patients with OLT surgery, high levels of PF₁₊₂ and SF were also noted. There were significant correlations between the levels of β-D-glucan and the volume of blood loss or transfusion. We found marked elevations in the plasma levels of β-D-glucan from the rats administered gauzes intraperitoneally. Conclusions: No endotoxin but β-D-glucan could be detected during CPB and OLT surgeries. Exogenous β-D-glucan in surgical gauzes and impaired clearance from dysfunctioning liver might be one of the causes of the high β-D-glucan levels during the surgery.

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Purpose: It is aimed to determine the dust and bacteria colony counts in the air of the operating rooms (ORs) and intensive care unit before and after the clean-shoes were not required for the visiting staffs, patients and their family. Methods: For respective 12 months before/after the abolition of clean-shoes system, dust particle (>0.5μm) counts·feet^-3 near the operating table or ICU patient's bed and bacteria colony-forming unit (CFU·m^-3) were bimonthly determined using a handy particle counter and an air-sampler set respectively. In addition, dust particle count and bacteria colony number in agar plate were weekly determined for respective 5 weeks before/after the abolition of clean-shoes system. Results: The mean particle counts of ORs and ICU were unchanged while the frequency distribution of NASA class in the ICU was improved (P<0.05) after the abolition. The mean number of bacteria colonies in the sampled air and agar plate of the ORs and ICU were unchanged throughout the study. Discussion: The data indicated that the abolition of cleanshoes system did not cause the significant deterioration of the environmental cleanliness. Before the abolition, it should be educated that (1) the floor is always contaminated even under clean-shoes system, (2) the staffs should pay attention to keep clean surgical site, and (3) the floor should be swept routinely. Conclusion: The abolition of clean-shoes system will not affect the environmental cleanliness in the ORs and ICU under the legally-approved air-conditioning.

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We compared 38 chronic dialysis patients undergoing CABG between 2000 and 2003 with 231 other CABG patients who didn't have renal failure. Main concern was postoperative complication and hospital mortality. All patients except for those who had emergency operations were dialysed for two consecutive days before operation. In most instances, intraoperative hemodialysis could be avoided by correcting water and electrolyte imbalance properly by using extracorporeal ultrafiltration method (ECUM). In the postoperative period, when the circulatory conditions were stable, HD was started the day after the operation with no immediate postoperative hemorrhagic complications. When the circulatory conditions were unstable, we used continuous hemofiltration (CHF). Chronic dialysis patients undergoing CABG compared with non-dialysis CABG patients had an increased risk of postoperative mediastinitis, but didn't have that of postoperative reexploration due to bleeding and cerebral infarction. Hospital mortality was 15.8% in the dialysis group. The cause of their death was mainly sepsis. For the improvement of the results we have to pay more attention to the care of dialysis patients.

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Objectives: Internal jugular vein puncture for infants or small children is still not an easy technique. Recent investigations have shown the usefulness of ultrasound for identifying the internal jugular vein during puncture, specifically in adults. The present study established a simple marking technique using a new portable ultrasound device for vascular access (iLOOK25) and assessed whether the method improves success rate of internal jugular vein puncture performed by anesthesiologists in-training. Methods: Subjects comprised 64 infants and children (body weight<20kg) undergoing elective cardiac surgery. Patients were randomized into 2 groups. In Group A, the internal jugular vein was punctured only by a guide of palpating the carotid artery, without any ultrasound imaging. In Group B, the internal jugular vein was punctured according to a marking on the skin surface indicating the position of the internal jugular vein as detected by ultrasound. Results: The success ratio of internal jugular vein cannulation was significantly higher in Group B (97%) than in Group A (62%; P=0.0008) No clinically significant subcutaneous hematoma or pneumothorax were observed in both groups. Moreover, the cost of the ultrasound appears to be compensated if the ultrasound technique is used for approximately 600 patients. Conclusions: A skin-marking technique with guidance by portable ultrasound, but without real-time, is useful for improving the success of internal jugular vein cannulation in infants or small children for anesthesiologists in a teaching general hospital. This method contributes to improvements in patient safety.

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A 76-year-old woman underwent mitral valve replacement using a pulmonary artery catheter (PAC). We noted blood leaking from the temperature and the optical module connection port of the PAC when she was transferred to the intensive care unit. We tried to remove the PAC. However, a resistance was noted. A chest radiograph and trans-esophageal echocardiography revealed that the PAC was stitched to the wall of the right atrium. To remove the PAC, reopening the original incision was performed in the operating room. The sutures on the wall of the right atrium were released, and then the PAC was pulled back without resistance. It is necessary to suspect that the PAC is sutured when blood leaking from the PAC connection port.

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