The Synergistic Effect of Intrathecally Administered Dexmedetomidine and Ketorolac on Mechanical Allodynia in Rats with Spinal Nerve Ligation / 고신대학교의과대학학술지

OBJECTIVES: This research was carried out to identify the synergistic effect of dexmedetomidine and ketorolac on neuropathic pain alleviation. METHODS: The anti-allodynic effect of intrathecal dexmedetomidine and ketorolac was investigated in rats after L5 spinal nerve ligation (SNL). Mechanical allodynia was assessed using Von Frey filaments. Every day for 3 consecutive days, beginning on the 10th day after SNL, behavioral tests were carried out at 1, 2, and 4 hr after drug injection. RESULTS: Significant increases in ipsilateral paw withdrawal thresholds (PWTs) were observed 1, 2, and 4 hr after drug injection in the groups of rats which received intrathecal injection of either dexmedetomidine (group D) or ketorolac (group K), compared to group S (P < 0.05). And group DK, which received simultaneous intrathecal injection of both dexmedetomidine and ketorolac, showed statistically significantly higher ipsilateral PWTs than groups D and K, which received only one of them (P < 0.05). CONCLUSIONS: The results of this research demonstrated the anti-allodynic effect of dexmedetomidine and ketorolac on neuropathic pain induced by SNL in rats. They also suggest that synergistic analgesia can be induced by the simultaneous injection of dexmedetomidine and ketorolac, and that combination therapy is an effective approach to treating chronic neuropathic pain syndrome.

The effect of intrathecal curcumin on mechanical allodynia in rats after L5 spinal nerve ligation / 대한마취과학회지

No abstract available.

The Analgesic Effect of Nefopam with Fentanyl at the End of Laparoscopic Cholecystectomy

BACKGROUND: Nefopam is a centrally acting analgesic that is used to control pain. The aim of this study was to find an appropriate dose of nefopam that demonstrates an analgesic effect when administered in continuous infusion with fentanyl at the end of laparoscopic cholecystectomy. METHODS: Ninety patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive analgesia with fentanyl alone (50 microg, Group 1, n = 30), or with fentanyl in combination with nefopam 20 mg (Group 2, n = 30) or in combination with nefopam 40 mg (Group 3, n = 30) at the end of surgery. Pain and side effects were evaluated at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours, and 12 hours after arrival in the post-anesthesia care unit (PACU). RESULTS: Pain was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes, 2 hours, and 6 hours after arrival in the PACU. Nausea was statistically significantly lower in Group 2 than in Groups 1 and 3 at 10 minutes after arrival in the PACU. Shivering was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes after arrival in the PACU. CONCLUSIONS: Nefopam is a drug that can be safely used as an analgesic after surgery, and its side effects can be reduced when fentanyl 50 microg is injected with nefopam 20 mg.

Pneumocephalus in a Patient with No Cerebrospinal Fluid Leakage after Lumbar Epidural Block: A Case Report

Several complications are possible after a lumbar epidural block. However pneumocephalus are rare. In this case, we report a case of pneumocephalus. A 68-year-old male patient received lumbar epidural block with the loss of resistance technique using air, and after 35 minutes, apnea, unconsciousness, hypotension, and bradycardia occurred. Immediately, brain CT was done, and we found pneumocephalus. The patient complained of severe occipital headache and itchiness due to pneumocehalus. After conservative treatment, the patient recovered without neurologic complications, and on the seventh day of his hospitalization, he was discharged from the hospital.

Treatment of Intractable Hiccups With an Oral Agent Monotherapy of Baclofen: A Case Report

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups that are caused by gastric distention, spicy foods and neural dysfunction can resolve themselves without any treatment. Some hiccups are associated with certain diseases or they occur postsurgically, and life-restricting intractable hiccups should be treated. The cause of hiccups should be quickly determined so as to administer the proper treatment. Hiccups often remit spontaneously within a short period of time, but they may also occur without remission for a prolonged period in some cases. We report here on a 36-year-old man who suffered with intractable hiccups for 5 years. We administered a single oral dose of baclofen, and then the hiccups disappeared. We conclude that a single dose of baclofen is a good treatment for intractable hiccups.

The preventive effect on postanesthetic shivering according to the dosages of ketamine / 대한마취과학회지

BACKGROUND: Postanesthetic shivering affects up to 65% of patients after general anesthesia, and it can be very distressing. Various drugs have been used to treat or prevent postanesthetic shivering, but the ideal drug has not yet been found. The aim of this study was to find the minimum dose of ketamine that would show an antishivering effect. METHODS: Ninety patients scheduled for total or subtotal thyroidectomy under general anesthesia were randomly allocated to three groups: Patients received saline 3 cc (Group 1; n = 30), ketamine 0.5 mg/kg (Group 2; n = 30) or ketamine 1.0 mg/kg (Group 3; n = 30) at the end of surgery. The postanesthetic shivering was evaluated by an blind investigator who was "blinded" to the dose of ketamine. The grade of shivering was assessed using a five-point scale at 0, 10, 20 and 30 minutes after the arrival to the recovery room. RESULTS: The number of patients shivering on arrival to the recovery room, and at 10 minutes after the arrival of recovery room was significantly less in Groups 2 and 3 than in Group 1 (P < 0.05). However, at 20 and 30 minutes, the number of patients was not different among the groups. There was no difference within the groups that received ketamine. CONCLUSIONS: The prophylactic use of 0.5 mg/kg intravenous ketamine was effective in preventing shivering after general anesthesia.

Delayed Recovery of Neuromuscular Blockade by Rocuronium in a Patient with Charcot-Marie-Tooth Disease: Case reports / 대한마취과학회지

Charcot-Marie-Tooth disease, which is also known as hereditary motor and sensory neuropathy, is a heterogenous group of inherited diseases of the peripheral nerve. The spectrum of severity varies from asymptomatic individuals to those with severe limb abnormalities requiring corrective surgery. We report two brothers who had previously been diagnosed with Charcot-Marie- Tooth disease 3 years earlier and were scheduled to undergo a correction osteotomy of both feet under general anesthesia. General anesthesia was induced with propofol 2 mg/kg, rocuronium 0.8 mg/kg and was maintained with O2-N2O-Sevoflurane. The younger brother showed no delay in recovery of the neuromuscular blockade but the elder brother showed a delay.

The Trial of Continuous Intravenous Infusion of Magnesium in Patients with Postherpetic Neuralgia Refractory in Conventional Treatment: A report of 2 cases / 대한마취과학회지

Postherpetic neuralgia is one of the most troublesome diseases in pain clinics. The N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium, reduces the level of neuropathic pain and hyperalgesia in patients with postherpetic neuralgia. Magnesium has been shown to exert a physiological block of the ion channel on the NMDA receptor, thereby preventing extracellular calcium ions from entering the cell and contributing to secondary neuronal changes. Accordingly, we attempted to administer a continuous intravenous infusion of magnesium, which resulted in a decrease in the VAS without side effects.

The Effect of Preoperative Dexamethasone on Profopol Injection Pain, Postoperative Nausea and Vomiting Undergoing Otolaryngology-Head and Neck Surgery / 대한마취과학회지

BACKGROUND: Induction with propofol has a high incidence of pain, as well as postoperative nausea and vomiting (PONV). The aim of this study was to assess the effect of a course of dexamethasone on the pain, postoperative nausea and vomiting associated with a Propofol injection, in patients undergoing otolaryngology-head and neck surgery. METHODS: One hundred twenty adults, 20-60 years of age, ASA physical status I or II, were allocated to one of two groups. Either dexamethasone 5 ml (8 mg) or saline 5 ml was administered intravenously to each group. After 60 seconds, propofol was injected into the patients' hand veins over a 30 second period and the patient was asked questions regarding the injection pain after 10 seconds. Postoperative nausea, vomiting and post-tonsilectomy pain were recorded in the recovery room (1 h after surgery) and in the hospitalization area (6 h after surgery). RESULTS: The severity and incidence of pain at the time of the propofol injection, PONV, and the level of post-tonsillectomy pain were significantly lower in the dexamethasone group than in the control group. CONCLUSIONS: The prophylactic intravenous administration of 8 mg dexamethasone is effective in reducing the severity of pain after a propofol injection and after the tonsillectomy, and decreased the incidence of PONV.

The Trial of Continuous Intravenous Infusion of Ketamine in Patients with Phantom Limb Pain: A case report / 대한통증학회지

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.

A Case of Postoperative Acute Hepatic Dysfunction after Sevoflurane Anesthesia: A case report / 대한마취과학회지

We report a case of a suspected acute hepatic dysfunction after general anesthesia with sevoflurane. A 71 year old female underwent a laparoscopic appendectomy under O2-N2O-sevoflurane anesthesia. She had no history of anesthesia, allergy, hypertension, diabetes or hepatitis. Four hours after surgery, she developed a conscious disturbance and became comatose. There was a marked increase in the serum aspartate aminotransferase, alanine aminotransferase, activated partial thromboplastin time and prothrombin time level, but the platelet and eosinophil counts were within the normal range. Her hepatic dysfunction improved after conservative therapy. She recovered gradually and was discharged after 24 days of hospitalization. Sevoflurane is believed to be the possible cause of the acute hepatic dysfunction in this case.

The Analgesic Effect of Continuous Intraarticular Infusion of Ropivacaine and Fentanyl after Arthroscopic Shoulder Surgery / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery can result in moderate to severe postoperative pain. This study compared the postoperative analgesic effects of an intra-articular patient-controlled analgesia (PCA) infusion of 0.25% ropivacaine used with or without fentanyl after arthroscopic shoulder surgery. METHODS: Sixty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. After surgery, normal saline 21 ml (group 1; n = 20), and 0.25% ropivacaine 21 ml (group 2 and group 3; n = 20 respectively), was infused into the articular space through a PCA catheter, which was followed by an infusion of normal saline 99 ml (group 1), 0.25% ropivacaine 99 ml (group 2), or 0.25% ropivacaine 99 ml, including fentanyl 400microgram (group 3) through the intra-articular PCA catheter at 2 ml/hr with a bolus dose of 0.5 ml with a lock out time of 15 minutes. The level of pain was assessed using a visual analogue scale (VAS) and a verbal pain score (VPS) 2, 4, 6, 8, 12, 24 and 36 hours after the intra-articular bolus injection. RESULTS: The pain scores were significantly lower after 2, 4, 6 hours in group 2 and 3 than in group 1. However, after 8 hours, the pain scores were significantly lower in group 3 than in the other two groups. CONCLUSIONS: An intra-articular continuous infusion of 0.25% ropivacaine after arthroscopic shoulder surgery is more effective when used in conjunction with 400 microgram fentanyl.

Transient Global Amnesia Developed in Recovery Room following General Anesthesia: A case report / 대한마취과학회지

Transient global amnesia is characterized by a sudden inability to form new memories (anterograde amnesia) that usually last for minutes to several hours but never longer than 24 hours. and there are no other focal neurologic signs or symptoms. Retrograde amnesia from a few hours to many years may also be associated with this condition. We report a case of a 56-year-old female patient who experienced transient global amnesia in the recovery room after general anesthesia. She repeated the same queries several times to persons nearby and appeared perplexed. A detailed neurologic examination was otherwise entirely normal. Her symptoms resolved completely the next day.

Effects of Adusted Dose of Local Anesthetic Considered Patient's Characteristics for Spinal Anesthesia for Elective Cesarean Section / 대한마취과학회지

BACKGROUND: Dosage influences distribution of a local anesthetic solution in cerebrospinal fluid. The dose of intrathecal local anesthetic was investigated, taking into account the patient's weight and height, to see whether this would stabilize the hemodynamics and provide adequate spinal anesthesia for Cesarean section. METHODS: In this double-blind prospective study, 60 patients undergoing elective Caesarean delivery were randomized to receive either fentanyl 25microgram in hyperbaric 0.5% bupivacaine 2.5 ml (Group 1) or fentanyl 25microgram and 0.9% normal saline in a volume of hyperbaric 0.5% bupivacaine, taking into account the patient's weight and height (Group 2). The patient's hemodynamics, time to sugical incision, supplementary analgesia and conversion to general anesthesia, etc were recorded. RESULTS: The incidence of hypotension and use of ephedrine were decreased, and the administration of fluid and the duration of motor blockade were significantly shorter in Group 2. The time to surgical incision was faster and the peak sensory level was higher in Group 1. Others effects were similar in both groups. CONCLUSIONS: The dose of intrathecal local anesthetic, taking into account the patient's weight and height stabilized the hemodynamics and provided adequate spinal anesthesia for elective Cesarean section.

A Case of Malignant Hyperthermia during General Anesthesia with Sevoflurane: A case report / 대한마취과학회지

We experienced a malignant hyperthermia in 24-year-old male with sevoflurane during the mandibular prognathism surgery. The malignant hyperthermia emerged 150 minutes after induction of general anesthesia using propofol, rocuronium, sevoflurane, N2O and O2. Sevoflurane has been reported that it can induce delayed onset of malignant hyperthermia under absence of succinylcholine. The prognosis of malignant hyperthermia is determined by early recognition, vigorous treatment and the time of dantrolene injection. In our case, when we suspected episode, all anesthetics were stopped and dantrolene injection was immediately given intravenously. The patient recovered normal temperature and consciousness without any complication.

Protective Effect of PKC Affecting Gliotoxin-induced Cytotoxicity in Rat Smooth Muscle Cells / 대한해부학회지

Aspergillus funigatus and other pathogenic fungi synthesize a toxic epidithi-odiopiperzine (ETP) metabolite, namely gliotoxin. Gliotoxin commonly react with sulfhydryl groups, and then, forms hydrogen peroxide. These fungal toxins induce apoptotic cell death in various cells. Apoptosis induced by gliotoxin need calcium. Effect of calcium preconditioning was not reported in gliotoxin-induced apoptosis. To examine the effect of protein kinase C (PKC) and calcium which was regulate caspase-3, PKC and calcium preconditioning before gliotoxin treatment, apoptotic agents such as bcl-2 family, caspase-3 and DNA fragmentation in A7r5 cell line from rat smooth muscle cell were studied. These results showed that gliotoxin induces the expression of bad of bcl-2 family, caspase-3 activation and DNA fragmentation in A7r5 cells. Gliotoxin treatment followed by calcium and PKC preconditioning suppress the Bad of bcl-2 family, and inhibited caspase-3 activation, respectively. These results suggest that PKC and calcium preconditioning protect the gliotoxin-induced apoptosis, through the protection of pro-apoptotic bcl-2 family in A7r5 cells.