Pain at the site of intravenous injection of propofol is a common clinical problem. This study was designed to evaluate the efficacy of pretreatment with a different concentration of lidocaine, with or without a tourniquet, to decrease the intensity of injection pain when providing intravenous sedation using 1% Diprivan Injection-Kit (PFS) administered by the Target Controlled Infusion (TCI) method.
Methods: 147 female patients undergoing oral day care surgery under local anesthesia with intravenous sedation were randomly assigned to one of 7 groups. No premedication was administered. Patients in group C (n = 21) serving as the control group were pretreated with 0.9% normal saline solution and immediately infused with propofol (PFS) using the TCI mode of a Diprifusor; Patients in group L0.5 (n = 21), L1.0 (n = 21) and L2.0 (n = 21) were pretreated with 0.5%, 1.0% or 2.0% lidocaine (0.5 mg/kg) respectively and immediately infused with propofol (PFS) using the TCI mode of the Diprifusor; Patients in group TL0.5 (n = 21), TL1.0 (n = 21) and TL2.0 (n = 21) were pretreated with 0.5%, 1.0% or 2.0% lidocaine (0.5 mg/kg) respectively along with tourniquet application for 60 seconds followed by propofol (PFS) infusion using the TCI mode of a Diprifusor.
Within 20-60 seconds of starting propofol injection, patients were asked to report any discomfort and rate their pain as being absent, mild, moderate or severe. The degree of pain was subsequently scored as: 0: no pain; 1: mild pain; 2: moderate pain; 3: severe pain.
Results and Conclusions: There were significant changes in all groups except group L0.5 in the median value of the pain score compared to group C. No significant change of the median value of the pain score was found among groups L0.5, L1.0 and L2.0, and among groups TL0.5, TL1.0 and TL2.0. The median value of the pain score in group TL1.0 was significantly lower than in group L1.0 and the highest incidence of no pain was found in group TL1.0. Consequently, in cases without application of a tourniquet, both 1.0% and 2.0% lidocaine were equally effective for reducing injection pain of propofol, and application of a tourniquet with pretreatment with 0.5%, 1.0% or 2.0% lidocaine is expected to be even more effective in reducing injection pain of propofol. When using 1% lidocaine, it is suggested that applying a tourniquet would produce a significant difference in attenuating injection pain.

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This study was planned to investigate whether bispectral index (BIS) value, calculation intracerebral concentration and the elapsed time from propofol (PPF) stop serve as an index of the recovery from amnesia. The amnesia effect was evaluated by the rate of the memory of visibility memory load which was shown a set of five-sheet pictures. A set of pictures were loaded in the maintenance and recovery term. After the full recovery from sedation, the pictures memorized by the object were counted. In Control group, research was done on the same schedule as PPF group but by saline instead of PPF. A correlation between the BIS value and OAA/S scale was observed. BIS recovered to control value was 10 minutes after stopping PPF. The rate of the memory kept about the control value 10 minutes after stopping PPF, there was no significant difference between control values. Calculation intracerebral concentration fell to about 0.7μg/ml by the stop, and had a correlation with the rates of the memory. In conclusion, these results suggest that the recovery from amnesia by PPF is obtained on the following conditions. 1) Over 10 minutes after PPF administration stop 2) BIS value over 86 3) Calculation intracerebral concentration under 1.1μg/ml

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既往歴のない38歳男性が痙攣を主訴に救急搬送され，症候性てんかんの診断で前医へ入院となった。第2病日，悪性症候群疑いで当院へ紹介となった。来院時，痙攣発作および筋強剛は認めず，38℃の発熱と炎症反応上昇（WBC 21,300/μL，CRP 32.5mg/dL），高CK血症（50,985U/L），ミオグロビン尿を認めた。身体所見，全身CT検査，髄液検査で感染症を示唆する所見は認めなかった。前医で

が200mg/時間で40時間以上持続静注されていたため，注入症候群を疑った。を中止したところ，すべての臨床症状および検査所見の改善を認めた。なお，本症例では診断基準の1つとして知られている代謝性アシドーシスは認めなかった。集中治療領域以外でもが使用される機会があり，われわれ救急医・集中治療医がその合併症について広く啓発していく必要がある。

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