Editorial Type:
Article Category: Meeting Report
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Online Publication Date: Jan 01, 2011

JDSA Abstracts

Page Range: 94 – 105
DOI: 10.2344/0003-3006-58.2.94
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Copyright: © 2011 American Dental Society of Anesthesiology
Figure 1.
Figure 1.

Chemical formulae of (A) 3H-ropivacaine and (B) 14C-lidocaine.

(A) Ropivacaine hydrochloridemonohydrate [dimethylphenyl-3H(N)].

(B) Lidocaine hydrochloride [carbonyl-14C].

*Asterisks indicate radioisotope labelled positions.

Figure 2.
Figure 2.

Concentrations of (A) ropivacaine or (B) lidocaine in the brain, liver, and kidney.

After 0.5% 3H-ropivacaine or 2% 14C-lidocaine was infiltrated into the right palatal mucosa proximal to the first molar of rats, each radioactivity in the brain (□), liver (•), or kidney (▵) was measured with a liquid scintillation counter (LSC-6100, Aloka). The concentration (ng/mg wet weight) of ropivacaine or lidocaine was included the metabolites, and was calculated by these specific radioactivity.

(A) The maximum values of ropivacaine were 0.7 ± 0.2 ng/mg in the brain (2 min), 1.4 ± 0.1 ng/mg in the liver (5 min), and 2.3 ± 0.2 ng/mg in the kidney (5 min). Data are mean ± SD (n  =  8). The degree of significance of difference was measured with the 10 min value to the maximum value. Brain; 10 min vs 2 min, liver and kidney; 10 min vs 5 min: p<0.01. (B) The lidocaine concentration in the brain reached the maximum (2.3 ± 0.3 ng/mg) 5 min after the injection (5 min vs 2 min: p<0.01). The lidocaine concentration in the liver and kidney markedly increased 2 min later (2 min vs 0.5 min: p<0.01).

Figure 3.
Figure 3.

Concentrations of radioactivity derived from (A) 3H-ropivacaine or (B) 14C-lidocaine in the serum.

After 0.5% 3H-ropivacaine or 2% 14C-lidocaine was infiltrated into the right palatal mucosa proximal to the first molar, the radioactive concentration (dpm/ml) in the serum was measured with the liquid scintillation counter.

(A) The serum concentration of radioactivity derived from 3H-ropivacaine reached the maximum (11,610 dpm/ml) 0.5 min after injection, and rapidly decreased until 12 hr later (12 hr vs 0.5 min: p<0.01). (B) The radioactivity concentration originated from 14C-lidocaine reached the maximum (938 dpm/ml) 2 hr after the injection, and sharply decreased by 6 hr later (6 hr vs 2 hr: p<0.01). No radioactivity was detected 48 hr after the injection.

Data are mean ± SD (n  =  8).

Figure 4.
Figure 4.

Concentrations of radioactivity derived from (A) 3H-ropivacaine or (B) 14C-lidocaine in the urine.

After 0.5% 3H-ropivacaine or 2% 14C-lidocaine was infiltrated into the right palatal mucosa proximal to the first molar, the radioactive concentration (dpm/ml) in the urine was measured with the liquid scintillation counter.

(A) The concentration of radioactivity reached the maximum (489,367 dpm/ml) after 2 hr and hardly changed until 4 hr after injection. The concentration thereafter gradually decreased, and was 15.7% of the maximum after 24 hr (24 hr vs 2 hr: p<0.01). (B) The maximum concentration (56,180 dpm/ml) was observed after 1 hr. The concentration after 3 hr rapidly decreased to 4.7% of the maximum at 24 hr after injection 24 hr vs 1 hr: p<0.01).

Data are mean ± SD (n  =  8).

Figure 5.
Figure 5.

Chromatogram of radioactive metabolites derived from 3H-ropivacaine in the (A) liver, (B) serum, and (C) urine.

Radioactive substances which were extracted from the liver, serum, and urine at 1 hr (□) or 24 hr (▪) after injection with 0.5% 3H-ropivacaine into the right palatal mucosa proximal to the first molar, were separated by thin layer chromatography (TLC). The TLC plate was Silicagel 60F254® (Merck, Germany). The area from the lower end of the plate to the solvent front was divided into 1 to 9 zones. A spot of ropivacaine on the plate was confirmed with UV lamp (253.7 nm). Authentic ropivacaine was detected in zone No. 5. Ropivacaine or the metabolite in each silica gel zone was scratched from the plate and 3H-radioactivity in the zone was measured with the liquid scintillation counter. The radioactivity in each zone as a percentage of the total radioactivity on the TLC plate was calculated.

Amounts of 3H-radioactivity measured in zone No. 5 after 1 hr were 23.0%, and more radioactivity was detected in zones No. 3 and No. 4 in the liver (No. 3 vs No. 5: p<0.01, No. 4 vs No. 5: p<0.01), 67.3% in the serum (No. 5 vs No. 6: p<0.01) and 63.0% in the urine (No. 5 vs No. 6: p<0.01). After 24 hr, more than 80% of the total radioactivity was detected in zones except zone No. 5.

Data are mean ± SD (n  =  4).

Figure 6.
Figure 6.

Chromatogram of radioactive metabolites derived from 14C-lidocaine in the (A) liver, (B) serum, and (C) urine.

Radioactive substances which were extracted from the liver, serum, and urine at 1 hr (□) or 24 hr (▪) after injection with 2% 14C-lidocaine into the right palatal mucosa proximal to the first molar were separated by TLC. Authentic lidocaine was detected in zone No. 4 on the TLC plate. Lidocaine or the metabolite in each silica gel zone was scratched from the plate and 14C-radioactivity in the zone was measured with the liquid scintillation counter. Amounts of 14C-radioactivity in zone No. 4 1 hr after the injection were 67.5% in the liver, 75.0% in the serum and 56.6% in the urine (Liver, serum and urine; No. 4 vs No. 3: p<0.01). After 24 hr, radioactivity was not detected in the TLC samples extracted from the liver and serum except from the urine.

Data are mean ± SD (n  =  4).

Figure 1.
Figure 1.

Changes in rectal temperature in each group according to the preoperative behavior grade.

The figure shows the means and standard deviations. Preoperative behavior grade had the greatest effect on rectal temperature at the 15 min time point after anesthesia induction. The mean rectal temperature of the patients in group 3 or 4, who showed definite refusal behavior, increased to about 37.4°C. Although the difference among the groups was maintained, the mean value of rectal temperature in each group decreased and settled to normal levels for as long as the anesthesia was maintained.

Figure 2.
Figure 2.

Changes in rectal temperature in each group according to the season in which the operation was performed.

The figure shows the means and standard deviations. Climate had the greatest effect on rectal temperature at the 120 min time point after anesthesia induction. The mean temperature was approximately 37°C in all the groups at the 15 min time point after anesthesia induction. However, the difference in rectal temperature between groups gradually increased. The mean value of rectal temperature in the cold season markedly decreased to below 36.0°C 60 min after anesthesia induction.

Figure 1.
Figure 1.

Comfort and amnesia during postoperative sedation.

DEX: Dexmedetomidine alone.

DEX + PCS: Dexmedetomidine and propofol PCS (Patient-Controlled Sedation).

* p  =  0.045.

Figure 1.
Figure 1.

A chest X-ray on the previous day of operation.

Figure 1.
Figure 1.

Electrocardiogram on 5th intravenous sedation.

ECG showed asystole after failure of inserting the catheter into the vein. Spontaneous heart beats recovered to normal sinus rhythm after about 20 sec asystole.

Figure 2.
Figure 2.

Protocol for diagnostic syncope utilized at the Emergency Department22) We considered that this case was neurally mediated syncope based on this algorithm.

Figure 1.
Figure 1.

The device, the monitor and the battery.

Figure 2.
Figure 2.

The procedure for intubation with this device.

The top of the device is inserted into the oropharyngeal cavity.

The top of the device is turned to the glottis by the wire.

The introducer is inserted into the trachea.

The device is withdrawn.

The intubation is performed using the introducer.

Figure 3.
Figure 3.

The comparison of the CCD device and the CMOS device.

The length of the device with CCD camera.

The length of the device with CMOS camera.

Figure 4.
Figure 4.

The wire enables the top of the device to be turned by a maximum of the 30 degrees.

Figure 5.
Figure 5.

The intubation system device with a CMOS camera.

The shortening of the top of the device.

Notching a curve for bending in the correct direction.

A wire that enabled the top of the device to be turned.

A groove for fixing the wire in place.