There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.

BackgroundThe urinary albumin/creatinine ratio (ACR) is a significant neurologic prognostic predictor in patients with aneurysmal subarachnoid hemorrhage (SAH). B-type natriuretic peptide (BNP) plays an important role in body fluid regulation in patients with SAH. The present study was performed to determine whether ACR was independent predictor for unfavorable neurological outcome and ACR was associated with increased N-terminal pro-BNP (NT-pro-BNP) after SAH.MethodsWe studied 61 patients undergoing surgery who were admitted within 48 h after aneurysmal SAH onset between July 2008 and June 2010. Hunt and Hess grade and Fisher grade were recorded at admission. The Glasgow Coma Scale (GCS) score was calculated at admission and daily for seven postoperative days. Arterial blood was sampled at admission and for seven postoperative days to determine the PaO2/FIO2 ratio, C-reactive protein level, troponin I level, and NT-pro-BNP level. Urine was sampled at admission and daily for seven postoperative days to determine ACR and vanillylmandelic acid/creatinine ratio (VMACR). Neurological outcomes were assessed at hospital discharge by using the Glasgow Outcome Scale. Receiver operating characteristic curves were constructed for the predictive variables of unfavorable neurological outcomes, and the area under the curve (AUC) was determined. Multivariate logistic regression analyses were performed for the significant predictors of unfavorable neurological outcomes after SAH. Associations with NT-pro-BNP were evaluated by using the Spearman rank correlation test.ResultsOf the 61 patients, 24 had unfavorable outcomes. The prevalence rate of microalbuminuria was 85 % (52/61). The highest NT-pro-BNP levels were above the normal range in 57 of 61 patients (93 %).According to the AUC, the Hunt and Hess grade, GCS score, the highest ACR, and highest VMACR were significant predictors of neurological outcome. Multivariate logistic regression analyses showed that the highest ACR and Hunt and Hess grade are independent prognostic predictors of unfavorable neurological outcomes. The highest NT-pro-BNP significantly correlated with the highest troponin I, highest ACR, and VMACR on admission.ConclusionsThe highest ACR is an independent prognostic predictor of unfavorable neurological outcomes after SAH. Moreover, plasma NT-pro-BNP elevation may be associated with the development of microalbuminuria.

We found that saline or 1.25 mg droperidol did not prolong QTc interval, whereas 2.5 mg droperidol prolonged the QTc interval significantly, and that propofol injection counteracted the prolongation of the QTc interval induced by 2.5 mg droperidol.

Aims: Introduction: Spinal fusion surgery is often associated with severe postoperative pain. This study aimed to determine whether intravenous acetaminophen produces equivalent analgesic effects to flurbiprofen under fentanyl patient-controlled analgesia (PCA) after one-level lumbar spinal fusion surgery. Study Design: Rondomized controlled trial. Place and Duration of Study: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo Japan, between October 2015 to March 2017. Methodology: We studied 75 patients who underwent one-level lumbar spinal fusion surgery. Patients were randomly allocated to 1 of 3 groups: Group A (n = 25), which received 15 mg/kg acetaminophen intravenously every 6 hr. Group F (n = 25), which received 1 mg/kg flurbiprofen intravenously every 8 hr; and Group C (n = 25), which received saline every 6 hr as the control. Urabe et al.; JAMMR, 28(11): 1-7, 2018; Article no.JAMMR.46982 2 Each drug was started from prior to skin closure to 24 hr after surgery. All patients received fentanyl at a fixed dose of 0.33 μg/kg/hr continuously after a bolus administration of 250 μg fentanyl. A bolus of 0.33 μg/kg of fentanyl was administered on demand by PCA (lockout interval 15 min). Postoperative pain was evaluated using a numerical rating scale (NRS) at 1, 2, 6, 12, 24 hr postoperatively and fentanyl consumption was recorded for 6 and 24 hr after surgery. The frequency of bolus fentanyl administration were also recorded. Results: There were no significant differences in NRS scores among the 3 groups. Acetaminophen and flurbiprofen did not show opioid sparing-effects under fentanyl PCA. However, the frequency of fentanyl boluses were significantly less in group A than in group C. Conclusions: Acetaminophen may produce equivalent analgesic effects to flurbiprofen after onelevel lumbar spinal fusion surgery. Original Research Article

要約： 【目的】 くも膜下出血 (subarachnoid hemorrhage, SAH) では脳脊髄液中 S100β蛋白濃度 が上昇している。SAH 患者において，髄液中 S100β蛋白と神経学的予後との関連性について 検討した。 【方法】 2006 年 6 月から 2008 年 5 月までの期間に，SAH 発症 48 時間以内に全身麻酔 後，手術前に脳脊髄腔ドレーンを留置し，脳外科手術を施行された 55 名を対象とした。手術 前の髄液中 S100β蛋白を測定した。退院時の神経学的予後は Glasgow outcome scale で評価し た。 【結果】 55 名中 25 名は神経学的予後不良だった。術前の髄液中 S100β蛋白は予後不良群に おいて予後良好群よりも高値を示した。神経学的予後不良に対する髄液中 S100β蛋白の受信 者動作特性曲線の曲線下面積は 0.65 であった。 【結論】 SAH 発症後の術前髄液中 S100β蛋白の 増加が神経学的予後の悪化と関連している可能性が示唆されたが，正確な予後予測因子では なかった。