BackgroundStellate ganglion block (SGB) is a widely used procedure for treatment of pain in the head and upper body, but the clinical signs used to verify the effectiveness of SGB can be ambiguous or variable in some patients. We observed the chronological changes in perfusion index (PI) from pulse oximetry to determine if these changes correlated with the clinical signs associated with an effective SGB. We hypothesized that PI could provide an easy method to assess the effectiveness of SGB.MethodWe compared the chronologies in PI on the treated and untreated sides of 21 patients in whom treatment by SGB was found to be effective. The SGB was performed by administering 6 mL of 1% mepivacaine. The effectiveness of the SGB was confirmed on the basis of clinical signs. Additionally, in two patients we tested whether increased PI on the treatment side correlated with increased microcirculation as measured by laser-Doppler blood flowmetry.ResultsOn the side treated by SGB, PI increased 61.4% in the earlobe and 60.5% from baseline values in the upper limbs, at 5 minutes after initiation of the procedure. Differences in PI before and after treatment were significant at both sites. No time-course increases in PI were found on the untreated side at either site. Following SGB, increases in PI correlated with increases in blood flow as measured by laser-Doppler flowmetry.ConclusionPI increased in the earlobe and upper limbs on the treated side of 21 patients who received an effective SGB but not on the untreated side. The positive correlations between changes in PI and both presence of clinical signs and changes in blood flow in the skin microcirculation indicate a sympatholytic effect, suggesting that the PI could be useful in determination of the efficacy of SGB.

A sensitized thermal cell makes it possible to obtain stable electric power by only burying the cell in a heat source and turning a switch on and off.

The early administration of sivelestat to patients receiving radical surgery for esophageal cancer can inhibit postoperative systemic inflammatory reactions and it might also have a beneficial effect on the prognosis.

As the result of a locking phenomenon that may occur in a guidewire inside a metal puncture needle when using the Seldinger technique to insert a central venous catheter, the guidewire can break and cause an embolism. To counter this possibility we devised a guidewire with a structure that made it difficult for locking to occur and compared it to conventional guidewires. Conventional guidewires are wound lengthways with a spring. The improved version has a special multi-ply structure. A series of 100 cases were divided into two groups: group A, the conventional guidewire group; and group B, the improved guidewire group. We punctured the internal jugular vein and attempted insertion of the guidewire through the side hole of a 22-gauge metal needle. We then compared the frequency of locking and the frequency of bending of the guidewire tips that have been withdrawn. In group A, locking occurred in 72% of the cases where the guidewire was unable to be inserted, but this figure was 0% in group B. The improved guidewire has the advantage of reducing the risk of locking and of guidewire breakage.

Surgical positions can result in various complications in the perioperative period. When nonanesthetized patients are placed in a nonphysiological position and feel numbness and pain, they can move their bodies to prevent disorders. However, it is difficult to confirm whether anesthetized patients are in a forced position, occasionally causing serious disorders. As anesthesiologists, we need to acquire correct knowledge regarding surgical positions, understand factors that cause various complications associated with surgical positions, and take appropriate preventive measures. In this manuscript, we explain perioperative peripheral neuropathy and tissue/organ functional impairment as complications associated with surgical positions and describe points requiring attention in the management of the anesthetic stage to prevent various complications.