RESUMO
BACKGROUND: Neuropeptide S (NPS) is an endogenous neuropeptide controlling anxiolysis, wakefulness, and analgesia. NPS containing neurons exist near to the locus coeruleus (LC) involved in the descending anti-nociceptive system. NPS interacts with central noradrenergic neurons; thus brain noradrenergic signaling may be involved in NPS-induced analgesia. We tested NPS analgesia in noradrenergic neuron-lesioned rats using a selective LC noradrenergic neurotoxin, N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4). METHODS: A total 66 male Sprague-Dawley rats weighing 350-450 g were used. Analgesic effects of NPS were evaluated using hot-plate and tail-flick test with or without DSP-4. The animal allocated into 3 groups; hot-plate with NPS alone intracerebroventricular (icv) (0.0, 1.0, 3.3, and 10.0 nmol), tail-flick NPS alone icv (0.0 and 10.0 nmol), and hot-plate with NPS and DSP-4 (0 or 50 mg/kg ip). In hot-plate with NPS and DSP-4 group, noradrenaline content in the cerebral cortex, pons, hypothalamus, were measured. RESULTS: NPS 10 nmol icv prolonged hot plate (%MPE) but not tail flick latency at 30 and 40 min after administration. DSP-4 50 mg/kg decreased noradrenaline content in the all 3 regions. The NA depletion inhibited NPS analgesic effect in the hot plate test but not tail flick test. There was a significant correlation between hot plate latency (percentage of maximum possible effect: %MPE) with NPS 10 nmol and NA content in the cerebral cortex (p = 0.017, r 2 = 0.346) which noradrenergic innervation arisen mainly from the LC. No other regions had the correlation. CONCLUSIONS: NPS analgesia interacts with LC noradrenergic neuronal activity.
Assuntos
Analgésicos/farmacologia , Benzilaminas/farmacologia , Norepinefrina/metabolismo , Dor/tratamento farmacológico , Animais , Encéfalo/metabolismo , Hipotálamo/metabolismo , Locus Cerúleo/metabolismo , Masculino , Neurônios/metabolismo , Medição da Dor , Ratos , Ratos Sprague-DawleyRESUMO
Regional anesthesia for lower limb surgery not only provides satisfactory analgesia, but also improves the overall postoperative outcome with less postoperative nausea and vomiting by decreasing the opioid con- sumption, encouraging early postoperative mobility. Therefore, high-quality anesthesia and postoperative analgesia accelerate the rehabilitation process and shorten the hospital stay. In the past decade, ultra- sound-guided lower extremity peripheral nerve blocks have become popular in Japanese hospitals. This tech- nique enables the visualization of thee target nerve structures, controlles needle movement and the spread of injected local anesthetic solution in a real real-time manner, and this has been adapted not only for tradi- tional blocks, but also in "new approach" blocks such as adductor canal blocks, depending solely on ultra- sound images. In the decades to come, we hope to obtain more established evidence supporting the utility of ultra- sound-guided techniques for lower extremity nerve blocks based on high-quality clinical studies. These findings may support the development of sustained- release formulation local anesthetics and new devices or techniques in the future.
Assuntos
Extremidade Inferior , Bloqueio Nervoso , Anestesia Local , Anestésicos Locais/uso terapêutico , Humanos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Nervos Periféricos , Náusea e Vômito Pós-OperatóriosRESUMO
BACKGROUND: Anesthesia and surgery disturb sleep. Disturbed sleep adversely affects postoperative complications involving the cardiovascular system, diabetes, and infection. General anesthetics share neuronal mechanisms involving endogenous sleep-wakefulness-related substances, such as orexin (OX) and melanin-concentrating hormone (MCH). We evaluated changes in sleep architecture and the concentration of OX and MCH during the peri-anesthetic period. METHODS: To examine sleep architecture, male Sprague-Dawley rats weighing 350-450 g received ketamine 100 mg/kg (n = 9) or propofol 80 mg/kg (n = 6) by intraperitoneal injection. Electroencephalography was recorded from 2 days pre- to 5 days postanesthesia. To quantify levels of OX and MCH, 144 similar rats received the same doses of ketamine (n = 80) or propofol (n = 64). Brain concentrations of these substances were determined at 0, 20, 60, and 120 min after anesthetic administration. RESULTS: Ketamine decreased OX content in the hypothalamus during the anesthesia period. OX content was restored to pre-anesthesia levels in the hypothalamus and pons. Both anesthetics increased brain MCH content in the postanesthetic period, with the degree of increase being greater with propofol. Ketamine enhanced wakefulness and inhibited non-rapid eye movement sleep (NREMS) immediately after anesthesia. Conversely, propofol inhibited wakefulness and enhanced NREMS in that period. Ketamine inhibited wakefulness and enhanced NREMS during the dark phase on the first postanesthesia day. CONCLUSIONS: Anesthetics affect various endogenous sleep-wakefulness-related substances; however, the modulation pattern may depend on the type of anesthetic. The process of postanesthetic sleep disturbance was agent specific. Our results provide fundamental evidence to treat anesthetic-related sleep disturbance.
Assuntos
Anestesia , Anestésicos Dissociativos/farmacologia , Anestésicos Intravenosos/farmacologia , Hormônios Hipotalâmicos/metabolismo , Ketamina/farmacologia , Melaninas/metabolismo , Orexinas/metabolismo , Hormônios Hipofisários/metabolismo , Propofol/farmacologia , Sono/efeitos dos fármacos , Animais , Eletroencefalografia , Hipotálamo/efeitos dos fármacos , Hipotálamo/metabolismo , Masculino , Ponte/efeitos dos fármacos , Ponte/metabolismo , Ratos , Ratos Sprague-Dawley , Fases do Sono/efeitos dos fármacos , Vigília/efeitos dos fármacosRESUMO
BACKGROUND: Non-invasively continuous total hemoglobin (SpHb) measurement has not been assessed adequately in acute bleeding and rapid blood transfusion during surgery. Thus, we have assessed the efficacy of SpHb during both acute normovolemic hemodilution (ANH) and autologous blood transfusion (ABT). METHODS: Twenty-four patients undergoing urological and gynecological surgery were enrolled. ANH was induced by withdrawing blood of 800 g with simultaneous fluid administration. When surgical hemostasis was completed, collected blood was reinfused. Measurement of SpHb, perfusion index (PI) and real total Hb (tHb) were done before and after each 400 ml blood removal (-0, -400, -800 ml) and reinfusion (+0, +400, +800 ml). RESULTS: A Bland-Altman analysis for repeated measurements showed a bias (precision) g/dl of 1.12 (1.25), 1.43 (1.24) and 1.10 (1.23) for all data, during ANH and during ABT, respectively. Additionally, a bias (precision) increased with a reduction in tHb (g/dl): ≥10.0; 0.74 (1.30), 8.0-10.0; 1.15 (1.12) and <8.0; 1.60 (1.28). Although the difference between SpHb and tHb was almost zero before anesthesia induction, it became significant just before ANH and did not change further by ANH and ABT. Significant correlations between SpHb and tHb for all data (r = 0.75, n = 228, p < 0.001) were observed. PI slightly correlated with the difference between SpHb and tHb (r = 0.38, n = 216, p < 0.001). Furthermore, before and after induction of anesthesia, PI also correlated with the difference between SpHb and tHb (r = 0.42, n = 23, p = 0.048 and r = 0.51, n = 22, p = 0.016, respectively). CONCLUSIONS: The present data suggest that SpHb may overestimate tHb during ANH and ABT. In addition, PI and tHb levels had an impact on the accuracy of SpHb measurements.
Assuntos
Transfusão de Sangue Autóloga/métodos , Hemodiluição/métodos , Hemoglobinas/análise , Oximetria/métodos , Idoso , Anestesia/métodos , Feminino , Hidratação/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos ProspectivosRESUMO
We investigated the anesthetic effects of propofol on the electrocardiogram (ECG) in mice. We also compared the effects of isoflurane (2%) inhalation anesthesia, intraperitoneal propofol (50 or 100 mg/kg), and pentobarbital (50 mg/kg) on ECG in mice. Isoflurane inhalation and pentobarbital anesthesia were both associated with an acceptable heart rate (HR) range (ca. 450 - 500 bpm). In contrast, high-dose propofol anesthesia significantly decreased the HR. Importantly, propofol anesthesia led to significantly reduced responses to propranolol, a ß-blocker, suggesting that it affects sympathetic tonus and is not suitable for the evaluation of cardiovascular or sympathetic function. Propofol also reduced the response to atropine, indicative of suppression of mouse parasympathetic nerve activity. Our data suggest that propofol anesthesia should not be the first choice for cardiovascular analysis in mice.
Assuntos
Anestésicos Intravenosos/farmacologia , Eletrocardiografia/efeitos dos fármacos , Propofol/farmacologia , Adjuvantes Anestésicos , Anestesia , Anestesia Local , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/administração & dosagem , Animais , Relação Dose-Resposta a Droga , Frequência Cardíaca/efeitos dos fármacos , Injeções Intraperitoneais , Isoflurano/farmacologia , Masculino , Camundongos Endogâmicos C57BL , Pentobarbital/farmacologia , Propofol/administração & dosagemRESUMO
PURPOSE: Patients with cancer suffer a wide range of physical symptoms coupled with psychological stress. Moreover, cancer chemotherapy induces immunosuppression and consequently causes respiratory infections. Massage therapy has been reported to reduce symptoms in cancer patients via an increase in psychosocial relaxation and to enhance and/or improve immune function. METHODS: In the present study, we determined whether leg massage could induce psychosocial relaxation and activate the first line of the host defense system. To assess effects of rest and leg massage, 15 healthy volunteers rested on a bed for 20 min on the first day, and 3 days later the subjects received a standardized massage of the legs for 20 min with nonaromatic oil. Twenty-nine cancer patients also received the same standardized massage of the legs. Anxiety/stress was assessed before and just after the rest or the massage using the State-Trait Anxiety Inventory (STAI-s) and visual analogue scale (VAS). To evaluate oral immune function, salivary chromogranin A (CgA) and secretory immunoglobulin A (sIgA) levels were measured. RESULTS: In healthy volunteers, rest significantly reduced VAS by 34% and increased sIgA by 61%. In contrast, leg massage significantly reduced both STAI-s and VAS by 24% and 63%, and increased both sIgA and CgA by 104% and 90%, respectively. In cancer patients, leg massage significantly decreased both STAI-s and VAS by 16% and 38%, and increased both salivary CgA and sIgA by 33% and 35%, respectively. CONCLUSION: Leg massage may promote psychosocial relaxation and reinforce a first-line host defense with an increase in secretion of antimicrobial peptides.
Assuntos
Perna (Membro)/fisiologia , Massagem , Neoplasias/imunologia , Neoplasias/psicologia , Terapia de Relaxamento , Adulto , Idoso , Ansiedade/prevenção & controle , Ansiedade/psicologia , Cromogranina A/metabolismo , Eletrocardiografia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Imunoglobulina A/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Saliva/química , Comportamento Social , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Adulto JovemRESUMO
Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (α-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity.
Assuntos
Dorso , Cromogranina A/metabolismo , Massagem/psicologia , Terapia de Relaxamento , Saliva/metabolismo , Ansiedade/metabolismo , Ansiedade/prevenção & controle , Ansiedade/psicologia , Biomarcadores , Cromogranina A/química , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/metabolismo , Testes Psicológicos , Saliva/química , Estresse Psicológico/metabolismo , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem , alfa-Amilases/metabolismoRESUMO
A 57-year-old man with lung tumor was scheduled for right middle lobectomy under general anesthesia. The patient received glycerin enema 2 hours before anesthesia. Anesthesia was induced with propofol, fentanyl, ketamine and vecuronium. After the induction, urine of dark-red color was drained through the urinary catheter. Massive (3+) occult blood and few erythrocytes in the urine sediment were observed. Furthermore, blood analysis showed hemolysis with mild renal dysfunction (Cr 1.3 mg x dl(-1)). Although serum CPK and myoglobin increased, there was no apparent symptom that supported the onset of rhabdomyolysis induced by anesthetics, acute myocardial infarction or malignant hyperthermia. At this time, we noticed that blood sample taken before the induction had been hemolysed. With all the above information in mind, we suspected that the main cause of the hemoglobinuria could be the enema and the surgery was canceled. The patient made a good progress with laboratory data normalized on the 4th postanesthesia day. However, rectal ulcer developed as a possible late complication of the enema. Although it is well-known that glycerin enema could cause hemolysis, renal failure and rectal ulcer, the increase of CPK and myoglobin in serum made the diagnosis difficult from other conditions leading to rhabdomyolysis in this case.
Assuntos
Enema/efeitos adversos , Glicerol/efeitos adversos , Hemoglobinúria/etiologia , Hemólise , Anestesia Geral , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Pneumonectomia , Doenças Retais/induzido quimicamente , Rabdomiólise , Úlcera/induzido quimicamenteRESUMO
OBJECTIVES: This study compared the hyperemic responses to adenosine triphosphate (ATP) administered by intravenous and by intracoronary injection in patients with impaired coronary microcirculation. METHODS: The hyperemic responses to intravenous and intracoronary administration of ATP in 107 patients (mean age 63 +/- 10 years, 77 males, 30 females) with impaired coronary circulation [including myocardial infarction (n = 68), cardiomyopath (n = 20) and diabetes mellitus (n = 11)] were compared by measurement of coronary flow reserve (CFR) using the Doppler guide wire. Patients with chest pain syndrome were used as the normal controls. The coronary blood flow velocity was measured at rest and during peak hyperemic responses to intravenous infusion (150 micrograms/kg/min) and intracoronary infusion of ATP (50 micrograms in the left coronary artery, 25 micrograms in the right coronary artery). The CFR was calculated as the ratio of averaged peak velocity during hyperemia to baseline averaged peak velocity. RESULTS: The CFR after intravenous administration of ATP (CFRi.v.) was well correlated with CFR by intracoronary administration of ATP(CFRic) (r = 0.77, p < 0.001). However, the CFRi.v. was also inversely correlated with the ratio of CFRic to CFRiv (CFRic/i.v.) (r = -0.36, p < 0.001). There were no relationships between the changes of hemodynamic parameters(blood pressure and heart rate) induced by ATP and CFRic/i.v. A lower CFRi.v. of less than 2.0 provided significantly greater CFRic/i.v. than that of CFRiv greater than 2.0. CONCLUSIONS: The maximal hyperemic response of coronary artery was not always induced by conventional intravenous administration of ATP, especially in patients with lower CFR than 2.0. High dose of intravenous ATP and/or intracoronary ATP should be administered in patients with lower CFR to attain maximum hyperemia in the impaired coronary circulation.