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A sore throat is the most frequent adverse side effect of general anesthesia. The purpose of this study was to compare the different types and timing of lidocaine application based on the effectiveness of reducing postoperative sore throat (POST) after endotracheal intubation. In group A, 8% lidocaine was sprayed on laryngopharyngeal structures immediately before intubation, and the distal ends of the endotracheal tubes (ETTs) were lubricated with 2% lidocaine gel. In group B, 8% lidocaine was sprayed, and ETTs were lubricated with normal saline. In groups C and D, no lidocaine was sprayed, and the ETTs were lubricated with normal saline (C, control) or with 2% lidocaine gel (D). In group E, 8% lidocaine was sprayed 10 min prior to endotracheal intubation, and the ETTs were lubricated with normal saline. In 527 patients, 28.2% reported POST at 24 h following extubation. Statistically significant differences in the incidence of POST were found only between group E (16.0%) and each of the other groups (28.4-38.5%), except for group B (26.5%). In conclusion, 8% lidocaine spray significantly reduced the incidence of POST if it was sprayed on laryngopharyngeal structures 10 min prior to endotracheal intubation.

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We herein report two cases with postintubation granuloma of the larynx. Under general anesthesia, a 72-year-old man underwent off-pump coronary artery bypass grafting and a 67-year-old woman underwent AVR, MVR, and TVP. Both patients became unable to breathe for more than one month after extubation, and a granuloma of the larynx was found which thereafter disappeared with conservative therapy in both cases. We found that the two cases had following four points in common. Namely, they had both undergone cardiac operations for a low cardiac output, they were both intubated for over 96 hours, a Hi-Lo Evac tube was used for both cases, and finally, laryngeal glanuloma were observed to develop on the membranous wall of the trachea. We concluded that suctioning above the endotracheal tube cuff was the cause of postintubation granuloma of the larynx. We should keep in mind the fact that postintubation granuloma of the larynx might develop several months after extubation, and careful airway manipulation both during and after the operation is thus needed to avoid this potential complication.

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The purpose of this study was to determine whether recombinant human interleukin-11 (rhIL-11) could dose-dependently improve the hemodynamic function. Using a swine hemorrhagic shock model, rhIL-11 was given at the beginning of resuscitation. The animals were randomized to receive a single dose of rhIL-11 (5, 20, or 50 microg/kg, group I to III for respectively) or saline (group IV). Blood, urine and both pleural and peritoneal effusion were thus obtained and analyzed. The mean arterial pressure (MAP) was higher post-resuscitation (PR) in group III (62.9+/-8.2 mmHg) than in groups I, II and IV (54.9+/-1.7, 53.9+/-4.3, 55.9+/-9.4 mmHg, respectively) (P<0.01). The urine output (I: 999+/-428, II: 1249+/-180, III: 1434+/-325, IV: 958+/-390 ml) and the cardiac output (CO) (I: 3.01+/-0.66, II: 3.30+/-0.49, III: 3.43+/-0.57, IV: 2.73+/-0.49 L/min.) increased in a dose dependent manner of rhIL-11. CO level and urine output were significantly higher in group III than in group IV (P<0.05). In addition, the volume of third space fluid loss (pleural and peritoneal effusion) of group III was significantly lower than other groups (I: 157+/-32, II: 138+/-32, III: 82+/-21, IV: 125+/-32 ml) (P<0.05). In conclusion, even a low dose of rhIL-11 improved the hemodynamic functions dose-dependently in a porcine model of hemorrhagic shock, although the relationship did not demonstrate a simple linearity.

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This report describes a case of rectal cancer with severe interstitial pneumonia (IP) and chronic pneumothorax. Acute exacerbation of IP is a serious postoperative complication and the consequences are extremely poor. To provide less invasive surgery and to prevent acute exacerbation of the IP, the patient received chemo-radiotherapy for controlling locally advanced tumor following low anterior resection under combined spinal-epidural anesthesia. Adequate epidural analgesia during the postoperative period had been shown and the epidural catheter was removed on the 3rd postoperative day. The patient showed symptoms of intrapelvic abscess due to the anastomotic leakage at 10th postoperative day. In order to avoid complications due to spinal and epidural anesthesia (epidural abscess, meningitis), and to prevent acute exacerbation of the IP, general anesthesia was employed with minimal fraction of inspired oxygen (FIO(2)) to perform the colostomy for the anastomotic leakage. The patient recovered without any postoperative respiratory complications. We herein report the successful perioperative management of a rectal cancer patient with severe IP and chronic pneumothorax, with special attention paid to the respiratory functions.

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BACKGROUND: Rapid induction of profound hypothermic arrest (suspended animation) can provide valuable time for the repair of complex injuries and improve survival. The optimal rate for re-warming from a state of profound hypothermia is unknown. This experiment was designed to test the impact of different warming rates on outcome in a swine model of lethal hemorrhage from complex vascular injuries. METHODS: Uncontrolled lethal hemorrhage was induced in 40 swine (80-120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later (simulating transport time) by laceration of the descending thoracic aorta. Through a thoracotomy approach, a catheter was placed in the aorta and hyperkalemic organ preservation solution was infused on cardiopulmonary bypass to rapidly (2 degrees C/min) induce profound (10 degrees C) hypothermia. Vascular injuries were repaired during 60 minutes of hypothermic arrest. The 4 groups (n = 10/group) included normothermic controls (NC) where core temperature was maintained between 36 to 37 degrees C, and re-warming from profound hypothermia at rates of: 0.25 degrees C/min (slow), 0.5 degrees C/min (medium), or 1 degrees C/min (fast). Hyperkalemia was reversed during the hypothermic arrest period, and blood was infused for resuscitation during re-warming. After discontinuation of cardiopulmonary bypass, the animals were recovered and monitored for 6 weeks for neurologic deficits, cognitive function (learning new skills), and organ dysfunction. Detailed examination of brains was performed at 6 weeks. RESULTS: All the normothermic animals died, whereas survival rates for slow, medium and fast re-warming from hypothermic arrest were 50, 90, and 30%, respectively (p < 0.05 slow and medium warming versus normothermic control, p < 0.05 medium versus fast re-warming). All the surviving animals were neurologically intact, displayed normal learning capacity, and had no long-term organ dysfunction. CONCLUSIONS: Rapid induction of hypothermic arrest maintains viability of brain during repair of lethal vascular injuries. Long-term survival is influenced by the rate of reversal of hypothermia.

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UNLABELLED: Profound hypothermic arrest ("suspended animation") is a new strategy to improve outcome following uncontrolled lethal hemorrhage (ULH). However, the impact of this approach on the immune/inflammatory response is unknown. This experiment was conducted to test the influence of profound hypothermia on markers of immune/inflammatory system. METHODS: ULH was induced in 32 female swine (80-120 lb) by creating an iliac artery and vein injury, followed 30 min later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta using a cardiopulmonary bypass machine (CPB). Experimental groups were (1) normothermic controls (no cooling, NC), or hypothermia induced at the following rates: (2) 0.5 degrees C/min (slow, SC), (3) 1 degrees C/min (medium, MC) and (4) 2 degrees C/min (fast, FC). Vascular injuries were repaired during 60 min of profound (10 degrees C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during re-warming (0.5 degrees C/min). The surviving animals were monitored for 6 weeks. Levels of IL-1, TNFalpha, IL-6, IL-10, TGF-1 beta and heat shock protein (HSP-70) were measured by ELISA in serum samples collected serially during the experiment and post-operatively. RESULTS: Some of the immune markers were influenced by the use of CPB, independent of hypothermia (decrease in TGF-1 beta and increase in IL-1 beta). Hypothermia caused a significant decrease in IL-6, and an increase in HSP-70 expression compared to normothermic controls, independent of the cooling rate. An increase in IL-10 levels was noted which was influenced by the rate of cooling (p<0.05, MC versus NC). CONCLUSIONS: Profound hypothermia modulates the post-shock immune/inflammatory system by attenuating the pro-inflammatory IL-6, increasing anti-inflammatory IL-10 and augmenting the protective heat shock responses.

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We have previously demonstrated that the administration of recombinant human interleukin-11 (rhIL-11) during resuscitation improves the blood pressure in a rodent model of hemorrhagic shock. The purpose of this study was to determine whether the effects of rhIL-11 could be reproduced in a large animal model and to elucidate the impact of rhIL-11 administration on the intravascular volume status and the degree of third space fluid loss after resuscitation. A 40% blood volume hemorrhage was induced in swine (n = 45, weight of 25-35 kg) followed by a 1-h shock period and resuscitation with 0.9% sodium chloride (three times the shed blood volume). The animals were randomized to receive sham hemorrhage (group I, sham); sham hemorrhage and 50 microg/kg rhIL-11 (group II, sham + IL-11); no drug (group III, saline); or 50 microg/kg rhIL-11 (group IV, IL-11). Blood and urine samples were obtained and analyzed at baseline, at the end of hemorrhaging, and thereafter once every hour. The pleural and peritoneal effusions were precisely quantified by using clinically accepted criteria. The mean arterial pressure (MAP) was higher postresuscitation (PR) in groups I, II, and IV (71.4 +/- 7.5 mmHg, 71.0 +/- 8.9 mmHg, and 72.9 +/- 12.3 mmHg, respectively) than in group III (59.9 +/- 10.9 mmHg), and the cardiac output of PR was higher in group IV (3.46 +/- 0.56 L/min) than in group III (2.99 +/- 0.62 L/min; P < 0.01). The difference in MAP between groups I and II became statistically significant at 40 min after rhIL-11 injection and such a difference persisted for 90 min. After resuscitation, the urine output was higher, and the urine specific gravity and third space fluid loss were lower in group IV (1434 +/- 325 mL and 1.0035, 82 +/- 21 mL) than in group III (958 +/- 390 mL and 1.0053, 125 +/- 32 mL; P < 0.05). In a porcine model of hemorrhagic shock, the administration of rhIL-11 at the start of resuscitation significantly improved the cardiac output and blood pressure. This strategy also significantly reduced the extent of third space fluid losses while also having a favorable impact on the intravascular volume status as evidenced by the improved urine output.

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BACKGROUND: Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown. METHODS: ULH was induced in 32 female swine (80-120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later by laceration of the descending thoracic aorta. Through a left thoracotomy approach, total body hypothermic hyperkalemic metabolic arrest was induced by infusing organ preservation fluids into the aorta. Experimental groups were: normothermic controls (no cooling, NC), or hypothermia induced at a rate of 0.5 degrees C/min (slow, SC), 1 degrees C/min (medium, MC), or 2 degrees C/min (fast, FC). Vascular injuries were repaired during the 60 minutes of profound (10 degrees C) hypothermic arrest. Hyperkalemia was reversed by hypokalemic fluid exchange, and blood was infused for resuscitation during the re-warming (0.5 degrees C/ minute) period. The survivors were monitored for 6 weeks. RESULTS: The 6 week survival rates were 0% (NC), 37.5% (SC), 62.5% (MC), and 87.5% (FC) respectively (p < 0.05 MC&FC versus NC). All of the surviving hypothermic arrest animals were neurologically intact and displayed no long term organ dysfunction. CONCLUSION: Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.

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OBJECTIVES: We previously reported clinicopathological data on 78 patients who underwent a right hemicolectomy from 1990 to 1997. Our results indicated that the ileocaecal valve [ICV] and lymphoid tissue of the terminal ileum might, together, play a protective and local immune role against carcinoma invasion. Furthermore, we previously reported that mucin histochemical features of the transitional zone [TZ] might also play a role in predicting metastasis and, thus, prognosis. The aim of this study was to examine the clinicopathological correlation between lymphoid infiltration and mucin secretion in the terminal ileum with carcinoma of the right colon. METHODS: According to the proximity of the tumour to the ICV, a total of 16 specimens with lymphoid infiltration to and around [< 1 cm] the ICV were studied in order to identify the mucin expression and histochemical features of the TZ as a prognostic indicator. RESULTS: Patients with sulphomucin-staining tumours in the terminal ileum and ICV had a relatively favourable course. Even when the clinical staging was the same for different tumours, greater lymphoid infiltration in the ICV, greater staining for sulphomucin in the ICV and a relatively favourable course were observed in nine patients. The sulphomucin-type TZ showed a favourable course as well. On the other hand, patients with sialomucin staining of the ICV and the TZ tended to have low-grade lymphoid infiltration and a very poor course, although two patients with moderately high-grade lymphoid infiltration had a favourable course. Overall survival was significantly associated with the mucin type of the ICV [p < 0.01]. CONCLUSIONS: Our results indicated that lymphoid infiltration of the terminal ileum may lead to an alteration in mucin secretion and, thus, play a protective role in the invasive and metastatic process of advanced right colon carcinoma.

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