Divided use of remifentanil at 1 and 2 μg/kg combined with propofol 0.5 mg/kg produces an acceptable outcome in both seizure duration and hemodynamic stability during ECT compared with the standard hypnotic doses of propofol alone or remifentanil 1 μg/kg followed by propofol 0.5 mg/kg.

Genetic variants, such as single-nucleotide polymorphisms (SNPs), of the μ-opioid receptor gene (OPRM1) might be associated with individual differences in opioid sensitivity, as well as with the incidence and severity of postoperative nausea and vomiting (PONV). The goal of the present study was to determine, in a cohort of Japanese surgical patients, genotypes and haplotypes of several SNPs in the OPRM1 gene, and their association with PONV during the early (first 24 h) postoperative period. We examined the incidence and severity of PONV, during the first 24 h after surgery, in 85 Japanese patients receiving intravenous patient-controlled analgesia fentanyl analgesia for postoperative pain control. Eight tag SNPs of the OPRM1 gene (rs1799971, A/G; rs510769, G/A; rs4870266, G/A; rs3798683, G/A; rs1323042, A/C; rs609623, C/T; rs9397685, A/G; and rs644261, C/G) were selected based on their minor allele frequency (>10%) and linkage disequilibrium strength (<80%), and genotyped for haplotype analysis and determination of associations with PONV. Only one out of eight investigated SNPs, rs9397685, in the intronic part of the OPRM1 gene was associated with differences in the occurrence and severity of PONV. We also found four common haplotypes with a frequency of >10% in the investigated patients, including GGGAACAC (33%), AGGGACAC (19%), GGGAACGC (12%), and AGAGACAC (10%). The severity of PONV in carriers of the GGGAACGC haplotype was significantly lower than in the carriers of the other haplotypes (P < 0.05). One intronic SNP, rs9397685, and haplotypes constructed from eight SNPs within the OPRM1 gene locus might be involved in the severity of PONV associated with general anesthesia and opioid administration. This novel finding, if validated and verified in larger and additional ethnic cohorts, might contribute to better knowledge of the contribution of the OPRM1 gene to PONV.

Background Breastfeeding is beneficial for both the mother and infant. However, the factors impairing initiation of exclusive breastfeeding have not been sufficiently investigated in women that received labor neuraxial analgesia. This study aims to clarify the rate of successful initiation of exclusive breastfeeding in women that received labor neuraxial analgesia in our hospital, and any factors impairing it at one month postpartum. Methods We retrospectively reviewed the 376 women who had received labor neuraxial analgesia between January 2011 and May 2022. Univariate and multivariate logistic regression analyses were performed to determine factors influencing exclusive breastfeeding. Results The rate of exclusive breastfeeding at one month in women who received labor neuraxial analgesia was 43.1%. Exclusive breastfeeding was shown to have univariate association with multiparity (P = 0.0001), second stage of labor (P = 0.046), oxytocin use (P < 0.0001), vacuum extraction delivery (P = 0.001), amount of bleeding (P = 0.027), and neonatal birthweight (P = 0.010). Multivariate logistic regression analysis revealed that oxytocin use and vacuum extraction delivery were mother-related factors and lower birthweight was an infant-related factor that were significant predictors of impairment of the initiation of exclusive breastfeeding at one month after delivery. Conclusion Oxytocin use and vacuum extraction delivery as maternal factors and lower birthweight as an infant factor were shown to be a significant predictors of impairment of the initiation of exclusive breastfeeding at one month after delivery.

We report a case of hyperglycemic shock associated with hepatic portal venous gas. A 79-year-old woman with post-stroke depression developed severe tachycardiac atrial fibrillation and hypotension due to hypovolemia caused by severe hyperglycemia, as well as showing disseminated intravascular coagulation (DIC). Continuous intravenous infusion of insulin and volume loading with normal saline gradually achieved normalization of the serum glucose level and hemodynamic stability. However, the DIC did not resolve, and abdominal computed tomography (CT) revealed hepatic portal venous gas (HPVG) in the left lobe of the liver. Surgery was thus considered mandatory. However, because severe hemodynamic lability occurred again immediately after the CT examination, and persisted, surgery could not be performed, and the patient died of septic shock due to bowel perforation. It was concluded that the underlying causes of DIC should be sought promptly, without delay.

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