This study compared the effect of intraperitoneal CO2 insufflation with abdominal wall lift on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QTD (QTcD) using computerized measurement during laparoscopic cholecystectomy. Thirty patients scheduled for laparoscopic cholecystectomy were randomly assigned to 2 groups: intraperitoneal CO2 insufflation (CO2 group) or abdominal wall lift (lift group). A 12-lead electrocardiogram was monitored to measure parameters. The RR interval, QT interval, and QTc interval did not change significantly during the study in both groups. The QTD and QTcD in the CO2 group increased significantly during CO2 insufflation, and were significantly higher than those of the lift group. Statistically significant increases of QTD and QTcD, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO2 insufflation, and QTD and QTcD in the CO2 group were significantly higher than those of the lift group.

We investigated the relationship between the generation of Superoxide radicals and histopathological changes on delayed neuronal death in the hippocampal CA1 subfield. Seventy gerbils were randomly assigned to two groups, a sham group and an ischaemia/reperfusion (I/R) group. In the I/R group, transient forebrain ischaemia was induced by occluding the bilateral common carotid arteries for four minutes. The cerebrum was removed after reperfusion at intervals of one minute, six, twelve and twenty-four hr and at three, five and seven days. Each forebrain was cut into two portions including the hippocampus. The quantity of Superoxide radicals was measured by using chemiluminescence, and histopathological changes in the hippocampal CAI subfield were examined. In the I/R group, Superoxide radicals increased on the 3rd and 5th days compared with the sham group (16.1 ±3.4vs3.2± 1.0 on the third day (P < 0.0001 ); 10.9 ± 1.9 vs 3.3 ± 0.8 on the fifth day (P < 0.0001)). In the I/R group, the pyramidal cells were atrophic and pycnotic; vacuolation, and structural disruption of the radial striated zone were observed from the third through the seventh day. In the sham group, these changes were not observed. There were differences of degenerative ratios in the pyramidal cells between the two groups from the third to seventh days (5.6 ± 2.0 vs 80.9 ± 3.3 on the third day (P < 0.05); 6.9 ± 0.4 vs 93.6 ± 2.4 on the fifth day (P < 0.05); 6.2 ± 1.5 vs 95.0 ± 1.3 on the seventh day (P < 0.05)). There is a correlation between the generation of Superoxide radicals and histopathological changes of the pyramidal cells in the hippocampal CAI subfield. Investiguer la relation entre la production des radicaux superoxydes et les changements histopathologiques sur le décès neuronal retardé dans le champ hippocampique CAL. Soixante-dix gerbilles ont été aléatoirement réparties en 2 groupes, un groupe contrôle et un groupe ischémie/reperfusion (I/R). Dans le groupe I/R, une ischémie transitoire du prosencéphale était induite par l’occlusion bilatérale des carotides communes pour quatre minutes. Après reperfusion, le cerveau était retiré de l’animal après une minute de même qu’à six, douze et vingt-quatre heures ainsi qu’à trois, cinq et sept jours. Chaque prosencéphale était coupé en deux parties incluant l’hippocampe. La quantité de radicaux superoxydes était mesurée par chemiluminescence et les changements histopathologiques dans le champ hippocampique CAI étaient observés. Dans le groupe I/R, les radicaux superoxydes ont augmenté aux jours 3 et 5 comparativement au groupe témoin (16,1 ±3,4 vs 3,2± 1,0 au jour 3 (P< 0,000l); 10,9 ± 1,9 vs 3,3 ± 0,8 au jour 5 (P< 0,000l)). Dans le groupe I/R, les cellules pyramidales étaient atrophiques et picnotiques; du 3e au 7e jour, on a observé de la vacuolisation et de la destruction structurale de la zone striée radiaire, et ces changements n’ont pas été retrouvés dans le groupe témoin. On a observé des différences dans le pourcentage dégénératif des cellules pyramidales entre les deux groupes à partir du jour 3 au jour 7 (5,6 ± 2,0 vs 80,9 ± 3,3 au jour 3 (P< 0,05); 6,9 ± 0,4 vs 93,6 ± 2,4 au jour 5 (P< 0,05); 6,2 ± 1,5vs 95,0 ± 1,3 au jour 7 (P< 0,05)). Il y a une corrélation entre la production de radicaux superoxydes et les changements histopathologiques des cellules pyramidales du champ CAI de l’hippocampe.

Background: Diagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors.Methods: This prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Periop-erative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse.Results: In 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0-17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5-8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P<0.001]).Conclusions: The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.Clinical trial registration: UMIN000035350.