Effect of intravenous palonosetron on hypotension induced by spinal anesthesia for cesarean section: A randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. METHODS: Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. RESULTS: No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 µg [interquartile range, 291.3-507.8 µg versus 428.0 µg [interquartile range, 305.0-507.0 µg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. CONCLUSION: Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.

Effect of Flumazenil on Emergence Agitation after Orthognathic Surgery: A Randomized Controlled Trial.

Flumazenil, a gamma-aminobutyric acid receptor antagonist, can promote arousal even under general anesthesia without the use of benzodiazepines. We hypothesized that flumazenil could promote arousal and reduce emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia. One hundred and two patients were randomly allocated to the control or flumazenil group. Saline or flumazenil was administered at the end of the surgery. The incidence of emergence agitation was measured by using Aono's four-point scale, with scores of 3 and 4 indicating emergence agitation. The primary outcome was the incidence of emergence agitation. Secondary outcomes included duration of emergence agitation and time intervals between the discontinuation of anesthetics, first response, extubation, and post-anesthesia care-unit discharge readiness. The incidence of emergence agitation was 58.3% and 38.9% in the control and flumazenil groups, respectively, but it was not statistically significant. However, the duration of emergence agitation was shorter in the flumazenil group (p = 0.012). There were no significant differences in the time intervals between the discontinuation of anesthetics, first response, and extubation. Although flumazenil did not reduce the incidence of emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia, it can be considered as an option for awakening patients in terms of improving emergence profiles.

Effect of intraperitoneally administered propentofylline in a rat model of postoperative pain.

BACKGROUND: In this study, we sought to evaluate whether systemic propentofylline (PPF) has antiallodynic effects in a rat model of postoperative pain, and to assess the mechanism involved. METHODS: After plantar incision, rats were intraperitoneally injected with various doses of PPF to evaluate its antiallodynic effect. To investigate the involved mechanism, rats were intraperitoneally injected with yohimbine, dexmedetomidine, prazosin, naloxone, atropine or mecamylamine, following the incision of the rat hind paws, and then PPF was administered intraperitoneally. The mechanical withdrawal threshold (MWT) was evaluated using von Frey filaments at various time points and serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, and IL-6 were measured to determine the inflammatory response level. RESULTS: MWT was significantly increased after intraperitoneal injection of 30 mg/kg of PPF when compared with the control group. Injection of PPF and yohimbine, atropine or mecamylamine showed significant decreases in the MWT, while injection of PPF and dexmedetomidine showed a significant increase. Systemic administration of PPF inhibited the post-incisional increase in serum level of TNF-α and IL-1ß. CONCLUSIONS: Systemic administration of PPF following surgery presented antiallodynic effects in a rat model of postoperative pain. The antiallodynic effects against mechanical allodynia could be mediated by α-adrenergic and cholinergic receptors.

Relationship between Surgery under General Anesthesia and the Development of Dementia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the association between exposure to general anesthesia and the development of Alzheimer's disease (AD) and dementia by reviewing and integrating the evidence from epidemiological studies published to date. METHODS: We searched MEDLINE, EMBASE, and Google Scholar to identify all relevant articles up to April 2018 reporting the risk of AD/dementia following exposure to general anesthesia and finally updated in February 2020. We included patients older than 60 or 65 years who had not been diagnosed with dementia or AD before the study period. The overall pooled effect size (ES) was evaluated with a random-effect model. Subgroup analyses were conducted and possibility of publication bias was assessed. RESULTS: A total of 23 studies with 412253 patients were included in our analysis. A statistically significant positive association between exposure to general anesthesia and the occurrence of AD was detected in the overall analysis (pooled ES = 1.11, 95%confidence interval = 1.07-1.15), but with substantial heterogeneity (p χ 2 < 0.001, I 2 = 79.4). Although the overall analysis revealed a significant association, the results of the subgroup analyses were inconsistent, and the possibility of publication bias was detected. CONCLUSION: s. This meta-analysis demonstrated a significant positive association between general anesthesia and AD. However, considering other results, our meta-analysis must be interpreted with caution. Particularly, it should be considered that it was nearly impossible to discriminate the influence of general anesthesia from the effect of surgery itself on the development of AD. Further, large-scale studies devised to reduce the risk of bias are needed to elucidate the evidence of association between general anesthesia and AD. Trial registration. PROSPERO International prospective register of systematic reviews CRD42017073790.

A comparison of 2 intravenous patient-controlled analgesia modes after spinal fusion surgery: Constant-rate background infusion versus variable-rate feedback infusion, a randomized controlled trial.

BACKGROUND: Conventional intravenous patient-controlled analgesia (PCA), which usually involves constant-rate background infusion plus demand dosing, may cause adverse effects or insufficient analgesia. When variable-rate feedback infusion plus demand dosing mode is used, the infusion rate can be changed according to the patient's needs. METHODS: In this prospective randomized double-blind study, 78 adults who were undergoing spinal fusion surgery were randomly allocated to either the constant-rate background infusion plus demand dosing group (group C) or the variable-rate feedback infusion plus demand dosing group (group V). The number of demands, volume delivered, numerical rating scale (NRS) score, adverse effects and the use of rescue analgesics were examined at 30 minutes after the operation in the post-anesthesia care unit, and at 6, 12, 24, and 48 hours. RESULTS: The number of demands was significantly lower in group V than in group C at 12-24 hours (4.59 ±â€Š4.31 vs 9.21 ±â€Š6.79 times, P = .001) and over the total period. The volume delivered via PCA was significantly lower in group V than in group C at 12 to 24 hours (13.96 ±â€Š13.45 vs 21.19 ±â€Š8.66 mL, P = .006), 24 to 48 hours (13.39 ±â€Š12.44 vs 33.6 ±â€Š12.49 mL, P = .000), and over the total period. NRS scores, administration of rescue analgesics, and postoperative nausea and vomiting showed no between-group differences. CONCLUSIONS: Variable-rate feedback infusion plus the demand dosing mode can control postoperative pain more efficiently, with lower dosages of analgesics, than constant-rate background infusion plus demand dosing in patients who undergo spinal fusion surgery.

Comparison of supraglottic airway devices in laparoscopic surgeries: A network meta-analysis.

STUDY OBJECTIVE: To review all randomized controlled trials (RCTs) on supraglottic airway devices (SADs) used in laparoscopy and compare their oropharyngeal leak pressure (OLP) and peak inspiratory pressure (PIP) before and after pneumoperitoneum, and success rate of gastric tube insertion rate. DESIGN: Systematic review and network meta-analysis of RCTs. SETTING: Laparoscopic surgeries using SADs. PATIENTS: We searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar databases to detect all relevant RCTs on SADs for laparoscopic surgery published until March 2018. INTERVENTIONS: Use of different SADs. MEASUREMENTS: The primary endpoint was OLP before and after pneumoperitoneum. The secondary endpoints were PIP before and after pneumoperitoneum and gastric tube insertion success rate. MAIN RESULTS: Twenty-six studies involving 2142 patients with eight different SADs were evaluated. According to surface under the cumulative ranking curve value, the OLP before pneumoperitoneum was the highest in Ambu AuraGain (95.7%), followed by Laryngeal Mask Airway ProSeal (77.3%) and Streamlined Liner of the Pharynx Airway (75.6%); after pneumoperitoneum, the pressure was the highest in i-gel (95.8%). PIP was the highest in Ambu AuraGain (80.9%) before pneumoperitoneum and i-gel (69.4%) after pneumoperitoneum. CONCLUSION: Although all SADs available were not evaluated, and further studies are needed to establish our results, OLP was the highest in Ambu AuraGain before pneumoperitoneum and i-gel after pneumoperitoneum.

Antinociceptive and anti-inflammatory effects of ginsenoside Rf in a rat model of incisional pain.

BACKGROUND: Ginseng saponin has long been used as a traditional Asian medicine and is known to be effective in treating various kinds of pain. Ginsenoside Rf is one of the biologically active saponins found in ginseng. We evaluated ginsenoside Rf's antinociceptive and anti-inflammatory effects, and its mechanism of action on adrenergic and serotonergic receptors, in an incisional pain model. METHODS: Mechanical hyperalgesia was induced via plantar incision in rats followed by intraperitoneal administration of increasing doses of ginsenoside Rf (vehicle, 0.5 mg/kg, 1 mg/kg, 1.5 mg/kg, and 2 mg/kg). The antinociceptive effect was also compared in a Positive Control Group that received a ketorolac (30 mg/kg) injection, and the Naïve Group, which did not undergo incision. To evaluate the mechanism of action, rats were treated with prazosin (1 mg/kg), yohimbine (2 mg/kg), or ketanserin (1 mg/kg) prior to receiving ginsenoside Rf (1.5 mg/kg). The mechanical withdrawal threshold was measured using von Frey filaments at various time points before and after ginsenoside Rf administration. To evaluate the anti-inflammatory effect, serum interleukin (IL)-1ß, IL-6, and tumor necrotizing factor-α levels were measured. RESULTS: Ginsenoside Rf increased the mechanical withdrawal threshold significantly, with a curvilinear dose-response curve peaking at 1.5 mg/kg. IL-1ß, IL-6, and tumor necrotizing factor-α levels significantly decreased after ginsenoside Rf treatment. Ginsenoside Rf's antinociceptive effect was reduced by yohimbine, but potentiated by prazosin and ketanserin. CONCLUSION: Intraperitoneal ginsenoside Rf has an antinociceptive effect peaking at a dose of 1.5 mg/kg. Anti-inflammatory effects were also detected.

Myoclonic movement after general anesthesia: A case report and review of the literature.

RATIONALE: Myoclonic movement is a rare side effect after general anesthesia. Since we use various intravenous agents during general anesthesia recently, it is troublesome to find out the exact cause of this neurologic complication. PATIENT CONCERNS: A 31-year-old female patient without any past medical history underwent hip arthroscopic surgery under general anesthesia. DIAGNOSES: Although there was no specific event during the operation, she showed a sudden myoclonic movement confined to left upper extremity in recovery room. INTERVENTIONS: We administered anticonvulsant agents intrvenously, the myoclonus was stopped shortly but recurred over again. As we stopped the patient-controlled analgesia due to nausea, the symptom halted. OUTCOMES: There was no significant abnormality in electroencephalography or brain diffusion magnetic resonance imaging, which was taken after the event. LESSONS: Clinicians should carefully consider the pharmacologic characteristics and neurologic adverse effects of all administered agents when myoclonus occurs after general anesthesia.

Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta-analysis.

BACKGROUND AND AIM: Previous randomized controlled trials have reported conflicting findings comparing propofol combination therapy (PCT) with propofol monotherapy (PMT) for sedation of patients undergoing gastrointestinal endoscopy. Therefore, a systematic review was carried out to compare the efficacy and safety of PCT and PMT in such patients. METHODS: We searched MEDLINE, EMBASE and CENTRAL databases to identify all randomized controlled trials that compared the efficacy and safety of PCT and PMT for sedation of patients undergoing gastrointestinal endoscopy. Primary endpoints were incidence of respiratory complications, hypotension and arrhythmia, dose of propofol used, and recovery time. Procedure duration and the satisfaction of patients and doctors were also evaluated. RESULTS: A total of 2250 patients from 22 studies were included in the final analysis. The combined analysis did not show any difference between PCT and PMT in the incidence of respiratory complications (risk ratio [RR], 0.80; 95% CI, 0.52 to 1.23; I2 = 58.34%), hypotension (RR, 1.06; 95% CI, 0.63 to 1.78; I2 = 72.13%), arrhythmia (RR,1.40; 95% CI, 0.74 to 2.64; I2 = 43.71%), recovery time (standardized mean difference [SMD], 0.16; 95% CI, -0.49 to 0.81; I2 = 95.9%), procedure duration (SMD, 0.04; 95% CI, -0.05 to 0.14; I2 = 0.0%), patient satisfaction (SMD, 0.13; 95% CI, -0.26 to 0.52; I2 = 89.63%) or doctor satisfaction (SMD, 0.01; 95% CI, -0.15 to 0.17; I2 = 0.00%). However, the dose of propofol used was significantly lower in PCT than in PMT (SMD, -1.38; 95% CI, -1.99 to -0.77; I2 = 97.70%). CONCLUSION: PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.

Comparison of the accuracy of noninvasive hemoglobin monitoring for preoperative evaluation between adult and pediatric patients: a retrospective study.

We measured noninvasive hemoglobin (SpHb) levels during the pre-anesthesia visit in patients planning elective surgery. Differences between SpHb and laboratory-measured hemoglobin (Hblab) were compared between adult and pediatric patients. In the pre-anesthesia visiting office, we routinely monitor noninvasive Hb levels with oxygen saturation and heart rate using Masimo Radical-7® Pulse CO-Oximetry (Masimo Corp., Irvine, CA, USA). We attached the R1 20 (body weight, 10-50 kg) or R1 25 (body weight > 30 kg) probe on the index finger. After signal stabilization, SpHb and perfusion index (PI) were recorded. We retrospectively reviewed the recorded data and included patients who visited the anesthesiologist within 24 h after venous sampling. Bias was calculated by subtracting Hblab from SpHb. We compared the biases of adult and pediatric patients (< 18 years) and evaluated correlation coefficients between the bias and Hblab. Records of 105 patients were reviewed and 100 data points of 50 patients in each group were analyzed. The median ± interquartile range bias was - 2.6 ± 2.2 and - 1.2 ± 1.5 g/dL in adult and pediatric patients, respectively (P < 0.001); the corresponding mean ± standard deviation PIs were 4.4 ± 3.1 and 5.9 ± 2.7, respectively (P = 0.19). Bias was inversely proportional to Hblab irrespective of age. The correlation coefficient between the bias and Hblab was - 0.81 in adults and - 0.54 in pediatric patients (P < 0.001). SpHb and Hblab measured during pre-anesthesia visits showed a smaller difference in pediatric than in adult patients. Lower Hblab corresponded to higher accuracy.

Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia.

OBJECTIVE: This study aims to evaluate retrospectively the electronic medical records of surgical patients who received intravenous patient-controlled analgesia, to identify potential relationships between the incidence and risk factors of postoperative nausea and vomiting (PONV). METHODS: Records of 6773 adult patients who received fentanyl-based intravenous patient-controlled analgesia after surgery at Chung-Ang University Hospital between January 1, 2010 and December 31, 2015 were reviewed. Multiple logistic regressions were used to identify risk factors for PONV. RESULTS: Of 6773 patients, 1216 (18.0%) were recorded to have PONV. In multiple logistic regression analysis, female gender, nonsmoking status, history of motion sickness or PONV, use of desflurane and nitrous oxide, and preintubation use of opioid analgesia were independent risk factors for PONV. CONCLUSIONS: Despite the use of antiemetic prophylaxis, 18.0% of patients with intravenous patient-controlled analgesia had PONV. Use of desflurane and nitrous oxide, in addition to risk factors included in the Apfel score (female gender, nonsmoking status, history of PONV or motion sickness, and use of postoperative opioids) were identified as independent risk factors. As the incidence of PONV was 2.8%, 6.0%, 11.7%, 15.2%, 21.1%, 50.0%, and 100% for patients who had 0, 1, 2, 3, 4, 5, and all these risk factors, respectively, risk-adapted, multimodal, or combination therapy should be applied for patients receiving general anesthesia.

Comparison of Ramosetron with Palonosetron for Prevention of Postoperative Nausea and Vomiting in Patients Receiving Opioid-Based Intravenous Patient-Controlled Analgesia after Gynecological Laparoscopy.

We aimed to compare the effects of ramosetron and palonosetron in the prevention of postoperative nausea and vomiting (PONV) in patients that received opioid-based intravenous patient-controlled analgesia (IV-PCA) after gynecological laparoscopy. We reviewed the electronic medical records of 755 adults. Patients were classified into two groups, ramosetron (group R, n = 589) versus palonosetron (group P, n = 166). Based on their confounding factors, 152 subjects in each group were selected after the implementation of propensity score matching. The overall incidence of PONV at postoperative day (POD) 0 was lower in group R compared to group P (26.9% versus 36.8%; P = 0.043). The severity of nausea was lower in group R than in group P on postoperative day (POD) 0 (P = 0.012). Also, the complete responder proportion of patients was significantly higher in group R compared to that in group P on POD 0 (P = 0.043). In conclusion, ramosetron showed a greater efficacy in the prevention of postoperative nausea at POD 0 compared to palonosetron in patients after gynecological laparoscopy.

Optimal dose of intravenous oxycodone for attenuating hemodynamic changes after endotracheal intubation in healthy patients: A randomized controlled trial.

BACKGROUND: Intravenous oxycodone has been used as an adjunct to anesthetic agents. This study aimed to assess the optimal dose of intravenous oxycodone for the attenuation of the hemodynamic responses to laryngoscopy and endotracheal intubation. METHODS: A prospective, randomized, double-blind study was conducted. Ninety-five patients were randomly divided into 5 groups based on the oxycodone dose: 0, 0.05, 0.1, 0.15, 0.2 mg/kg. After administering the assigned dose of intravenous oxycodone, anesthesia was induced with thiopental. Heart rate (HR) and blood pressure (BP) were measured at baseline, before intubation, and 1, 2, and 3 minutes after intubation. The percentage increase of BP was calculated as (highest BP after intubation - baseline BP)/baseline BP × 100 (%). The percentage increase of HR was calculated in same formula as above. Hypertension was defined as a 15% increase of systolic BP from baseline, and probit analysis was conducted. RESULTS: Hemodynamic data from 86 patients were analyzed. The percentage increase of mean arterial pressure after intubation in groups 0.05, 0.1, 0.15, and 0.2 was significantly different from that in the control (P < 0.001). For HR, the percentage increase was lower than control group when oxycodone was same or more than 0.1 mg/kg (P < 0.05). Using probit analysis, the 95% effective dose (ED95) for preventing hypertension was 0.159 mg/kg (95% confidence interval [CI], 0.122-0.243). In addition, ED50 was 0.020 mg/kg (95% CI, -0.037 to 0.049). However, oxycodone was not effective for maintaining the HR in our study dosage. There were no significant differences in the incidence of hypotension during induction between groups. CONCLUSIONS: Using 0.1 mg/kg of intravenous oxycodone is sufficient to attenuate the increase of BP and HR during induction period in healthy patients. The ED95, which was 0.159 mg/kg, can be useful to adjust the dosage of IV oxycodone for maintain stable BP during induction of general anesthesia.

Relationship between general anesthesia and Alzheimer disease: A protocol for a systematic review and meta-analysis.

BACKGROUND: Alzheimer disease (AD) entails a long-term progressive decline in the cognitive ability to think and remember, and it has become a major concern for patients receiving surgery and anesthesia. However, studies investigating the relationship between general anesthesia and AD have yielded inconsistent results. Therefore, we plan to perform a systematic review and meta-analysis to determine the relationship between general anesthesia and AD, and to verify whether general anesthesia is an independent risk factor for AD. METHODS: A systematic and comprehensive search will be performed using MEDLINE, EMBASE, and Google scholar from their inception to August 2017. Peer-reviewed cohort and case-control studies including nested case-control studies reporting the relationship between general anesthesia and AD will be eligible for inclusion. The quality of included studies will be assessed using the Newcastle-Ottawa scale. Heterogeneity of estimates across studies as well as publication bias will be assessed. This systematic review and meta-analysis will be performed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. All statistical analyses will be conducted using the Stata SE version 15.0. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION: Our study will provide the evidence for the relationship between general anesthesia and dementia. The review will benefit patients and anesthesiologists, surgeons, and policymakers. ETHICS AND DISSEMINATION: Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. TRIAL REGISTRATION: The protocol for this review has been registered in the PROSPERO network (registration number: CRD42017073790).

A comparison of the effectiveness of the streamlined liner of pharyngeal airway in paralyzed and nonparalyzed patients undergoing gynecological surgery: a randomized trial.

STUDY OBJECTIVE: To compare the effectiveness of streamlined liner of pharyngeal airway (SLIPA) in paralyzed and nonparalyzed, anesthetized patients undergoing gynecological surgery. DESIGN: Prospective randomized double-blind clinical trial. SETTING: Intraoperative. PATIENTS: A total of 80 female patients with American Society of Anesthesiologists class I or II and who were undergoing gynecological surgery. INTERVENTIONS: The patients were randomly allocated to either the nonparalyzed group (group NR, n=40) or the paralyzed group (group R, n=40). MEASUREMENTS: Oropharyngeal leakage pressure was the primary outcome. Insertion time; number of insertion attempts; success rate at first insertion; involuntary movement; peak inspiratory pressure (PIP); leakage fraction; hemodynamic changes; complications, such as blood tinging, regurgitation, and sore throat; and recovery time were also evaluated for secondary outcomes. MAIN RESULTS: Oropharyngeal leakage pressure, which is primary outcome, was no difference among the groups. Insertion time, number of insertion attempts, success rate at first insertion, involuntary movement, leakage fraction, hemodynamic changes, and complications were not statistically different among the groups. The PIP in group NR was significantly increased compared to that of group R (P=.002). Recovery time was significantly longer in group R than in group NR (P<.001). CONCLUSIONS: SLIPA had good performance in both paralyzed and nonparalyzed patients. There was no difference in SLIPA performance or complications irrespective of muscle relaxant use, except decrease in PIP and prolong recovery time in paralyzed patients.

Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis.

Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view.

Antinociceptive Effects of Ginsenoside Rg3 in a Rat Model of Incisional Pain.

BACKGROUND: Ginsenoside Rg3 is an extract of total ginseng saponins, which accounts for 4.7% of all saponins. This study aimed to identify the mechanisms of the antinociceptive effects of ginsenoside Rg3. METHODS: Rats were randomly divided into six groups, which were treated with vehicle or 0.5, 1, 1.5, 2, or 4 mg/kg of ginsenoside Rg3 intraperitoneally 2 h after a plantar incision was made. To evaluate the mechanisms of antinociceptive effects, the rats were intraperitoneally injected with naloxone 5 mg/kg, atropine 1 mg/kg, yohimbine 2 mg/kg, mecamylamine 1 mg/kg, prazosin 1 mg/kg, and dexmedetomidine 5 µg/kg. Hyperalgesia produced by the plantar incision was assessed using von Frey filaments 1 day before the incision (BI) and 2 h after the plantar incision (AP); this measurement was repeated at 15, 30, 45, 60, 80, 100 and 120 min, and 24 and 48 h after the injection of ginsenoside Rg3. Serum interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) levels were measured 1 day before incision and 120 min, 24 h, and 48 h after the injection of ginsenoside Rg3 or vehicle. RESULTS: The mechanical withdrawal threshold (MWT) significantly increased in the group that received ginsenoside Rg3. The dose-MWT response showed a curvilinear, bell-shaped relationship. The maximum MWT was found with the administration of ginsenoside Rg3 at 1.5 mg/kg; MWT decreased to 2 and 4 mg/kg. Yohimbine diminished the analgesic effect of ginsenoside Rg3. Prazosin and dexmedetomidine increased the analgesic effect of ginsenoside Rg3. IL-1ß and IL-6 appeared significantly lower relative to control group. CONCLUSIONS: Ginsenoside Rg3 has an analgesic effect with a curvilinear dose-response relationship. Alpha 2 adrenergic receptor appeared to be related to the analgesic effect of ginsenoside Rg3. Also, the anti-inflammatory effect of ginsenoside Rg3 could be related to its analgesic effect.

Comparison of emergence after deep extubation using desflurane or desflurane with remifentanil in patients undergoing general anesthesia: a randomized trial.

STUDY OBJECTIVE: To compare recovery times and respiratory complications during emergence after deep extubation using either desflurane alone or a lower concentration of desflurane with remifentanil. DESIGN: Prospective randomized double-blind clinical trial. SETTING: Intraoperative. PATIENTS: A total of 62 patients between the ages of 20 and 60 years with American Society of Anesthesiologists class I or II and who underwent low- to intermediate-risk surgery of 2- to 4-hour duration were enrolled. INTERVENTIONS: Randomly assigned either 1.5 minimum alveolar concentration desflurane (group D; n = 31) or 1.0 minimum alveolar concentration of desflurane and 1.0 ng/mL effect-site concentration of remifentanil (group DR; n = 31). MEASUREMENTS: Recovery times, from the time of extubation to the time when the patients could breathe without assistance, were awake enough to maintain the airway independently, and exited the recovery room, as well as respiratory complications were compared between the groups. MAIN RESULTS: Recovery times were significantly reduced in the group DR (P < .001). The incidence of respiratory complications was also lower in group DR than in group D (48% vs 3.8%; P < .001). CONCLUSIONS: The combined use of remifentanil while lowering the concentration of desflurane improves recovery profiles during emergence after deep extubation.

Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair.

PURPOSE: Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR). METHODS: Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2%), UCISB75 (0.75%), and UCISB20 (0.2%) according to the initial ropivacaine dose (8 ml). The background infusion (0.2% ropivacaine at 5 ml/h), bolus (3 ml of 0.2% ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively. RESULTS: FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups. CONCLUSIONS: UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR. LEVEL OF EVIDENCE: Randomized controlled trials, Therapeutic study, Level I.

The changes of non-invasive hemoglobin and perfusion index of Pulse CO-Oximetry during induction of general anesthesia.

BACKGROUND: We hypothesized that induction of general anesthesia using sevoflurane improves the accuracy of non-invasive hemoglobin (SpHb) measurement of Masimo Radical-7® Pulse CO-Oximetry by inducing peripheral vasodilation and increasing the perfusion index (PI). The aim of this study is to investigate the change in the SpHb and the PI measured by Rad7 during induction of general anesthesia using sevoflurane. METHODS: The laboratory hemoglobin (Hblab) was measured before surgery by venous blood sampling. The SpHb and the PI was measured twice; before and after the induction of general anesthesia using sevoflurane. The changes of SpHb, Hbbias (Hbbias = SpHb - Hblab), and PI before and after the induction of general anesthesia were analyzed using a paired t-test. Also, a Pearson correlation coefficient analysis was used to analyze the correlation between the Hbbias and the PI. RESULTS: The SpHb and the PI were increased after the induction of general anesthesia using sevoflurane. There was a statistically significant change in the Hbbias from -2.8 to -0.7 after the induction of general anesthesia. However, the limit of agreement (2 SD) of the Hbbias did not change after the induction of general anesthesia. The Pearson correlation coefficient between the Hbbias and the PI was not statistically significant. CONCLUSIONS: During induction of general anesthesia using sevoflurane, the accuracy of SpHb measurement was improved and precision was not changed. The correlation between Hbbias and PI was not significant.