Effects of Seasonal Differences in Testosterone and Cortisol Levels on Pain Responses Under Resting and Anxiety Conditions

PURPOSE: This study investigated whether hormones and pain perception are associated with exam anxiety, and also whether exam anxiety is affected by seasonal differences in testosterone and cortisol levels. MATERIALS AND METHODS: Forty-six healthy males were recruited from a medical college. Anxiety was induced by having participants perform the Objective Structured Clinical Examination. Pressure was applied to the participants to induce pain. Pain thresholds, pain ratings, anxiety ratings, blood pressure, heart rate, salivary testosterone and cortisol levels were measured under resting and anxiety conditions in the spring and summer. Data were collected from 46 participants during the spring (n=25) and summer (n=21). RESULTS: Pain thresholds and testosterone levels were significantly lower under anxiety than at rest for all participants (n=46), while cortisol levels, pain ratings, and anxiety ratings were significantly higher under anxiety than at rest. In the spring (n=25), testosterone levels were significantly higher at rest than under anxiety, while there was no difference in cortisol levels between resting and anxiety conditions. In the summer (n=21), cortisol levels were significantly higher under anxiety than at rest, while there was no difference in testosterone levels between resting and anxiety conditions. There were no significant seasonal differences in pain and anxiety ratings and pain threshold. CONCLUSION: These results indicate that seasonal differences in testosterone and cortisol levels under anxiety and at rest may affect pain responses. These results also suggest that acute clinical pain may be relieved by managing anxiety that is related to a decrease of testosterone in spring and a large increase of cortisol in summer.

Ankle-brachial blood pressure differences before and during anesthesia

BACKGROUND: In surgeries involving the upper extremities and breast, the blood pressure is frequently measured at the ankles. As the blood pressure is used as a pain indicator in the full surgical anesthesia, the ankle blood pressure higher than the brachial blood pressure may be misinterpreted by the anesthesiologist, in determining the depth of the anesthesia. This paper investigated whether the ankle blood pressure is significantly higher than the brachial blood pressure before the anesthesia induction, during induction, and after tracheal intubation. METHODS: Two hundred seventeen patients requiring general anesthesia for elective surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before the anesthesia induction, during induction, and after tracheal intubation. RESULTS: The ankle blood pressure was higher than the brachial blood pressure before induction, during induction, and after tracheal intubation. Ankle-brachial blood pressure differences were significantly higher before induction and after intubation as compared to that during induction. The correlation coefficient between the systolic ankle-brachial blood pressure difference before induction and that after tracheal intubation was 0.623. In 33 child patients with an ankle-brachial blood pressure index > or =1 before induction, there were no significant differences in the ankle-brachial blood pressure during induction. The brachial systolic blood pressure could be predicted by simple and multiple regression equations (R2 = 0.349-0.828). CONCLUSIONS: The results of the study suggest that the anesthesiologists need to consider the ankle-brachial blood pressure differences in monitoring the anesthesia, in cases where the brachial blood pressure cannot be measured during surgery.

Cardiac arrest in the elderly with silent myocardial ischemia during general anesthesia / 대한마취과학회지

No abstract available.

Anesthetic complications due to extremely low ankle blood pressure caused by peripheral arterial disease / 대한마취과학회지

No abstract available.

Ankle-brachial blood pressure differences in the beach-chair position of the shoulder surgery / 대한마취과학회지

BACKGROUND: During shoulder surgery, blood pressure is frequently measured at the ankle. Anesthetic complications may result when ankle blood pressure is higher than brachial blood pressure and anesthesiologists misinterpret ankle blood pressure as brachial blood pressure. Therefore, we investigated whether ankle blood pressure is significantly higher than brachial blood pressure before anesthesia induction, during induction, after tracheal intubation, before beach chair position, and in the beach chair position. METHODS: Thirty patients requiring general anesthesia for shoulder surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before induction, during induction, after intubation, before beach chair position, and in the beach chair position. RESULTS: Ankle blood pressure was higher than brachial blood pressure before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Ankle-brachial blood pressure differences in the beach chair condition were much higher than in four other conditions. The correlation coefficient between mean ankle-brachial blood pressure differences before the beach chair position and mean ankle-brachial blood pressure differences in the beach chair position was 0.616. Brachial systolic blood pressure could be predicted by regression equations (R2 = 0.306-0.771). CONCLUSIONS: These results suggest that anesthesiologists should consider these ankle-brachial blood pressure differences when monitoring anesthesia in the beach chair position.

Acute liver injury after desflurane anesthesia: A case report

Most general anesthesia procedures are performed without any complications, but volatile agents may have adverse effects on various organ systems. Volatile anesthetic agents can cause mild to fulminant liver failure. However, while desflurane is a theoretical cause of hepatotoxicity, such cases have rarely been reported. We present here a 49-year-old man who developed hepatic dysfunction after laparoscopic cholecystectomy and this procedure was done under desflurane anesthesia.

Aging impairs vasodilatory responses in rats / 대한마취과학회지

BACKGROUND: Aging causes profound changes of stiffness and compliance in the cardiovascular system, which contributes to decreased cardiovascular reserve. Mechanisms of the underlying endothelial vasodilator dysfunction in vasodilator signaling pathways may occur at multiple sites within any of these pathways. METHODS: Age-related changes in the vasculature were investigated in adult young (3-6 months, Y) and old (26-29 month, O) Wistar rats (n = 6). The aortas were carefully dissected from the rat and cut into rings 1.5-2.0 mm in length to measure in vitro isometric tension. Vasorelaxant responses of aortic rings to acetylcholine (ACh), sodium nitroprusside (SNP) and P1075 were examined using Dose Response software (AD Instruments, Mountain View, CA). RESULTS: Endothelium-dependent vasodilator function was impaired. The endothelium of aging rats impaired endothelial NO dependent vasodilation, but the machinery for vasodilation was not impaired. CONCLUSIONS: Age-related NO-mediated vasorelaxation in the aging endothelium was inhibited and appears to be major mechanism of vascular change and impaired vascular regulation.

Dilutional hyponatremia developed during hysteroscopic myomectomy: A case report / 대한마취과학회지

Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium. Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death. We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia. Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM. She was treated with furosemide and recovered without sequelae.

The Effect of Doxapram Hydrochloride on Bispectral (BIS) Index and Recovery from Desflurane Inhalational Anesthesia / 대한마취과학회지

BACKGROUND: Doxapram hydrochloride is a respiratory stimulant that produces arousal effects in patients under anesthesia. We investigated the effects of doxapram on the recovery time and BIS index of patients administered desflurane inhalational anesthesia. METHODS: 40 patients who underwent general anesthesia using desflurane that had an ASA physical status of I or II received either 1 mg/kg of doxapram hydrochloride (doxapram group, n = 20) or normal saline (control group, n = 20) IV at end of surgery. Anesthetic recovery after the injection of doxapram was then determined based on the time to eye opening in response to verbal command, hand squeezing on command, time to extubation, and Aldrete recovery score. BIS index, systolic blood pressure, tidal volume and heart rate were recorded every minute for up to thirteen minutes. RESULTS: The doxapram group showed significantly shorter times to emergence based on eye opening in response verbal command (sec) (409 +/- 114 vs 320 +/- 116), hand squeezing on command (sec) (458 +/- 119 vs 351 +/- 114) and extubation (sec) (491 +/- 103 vs 418 +/- 79) compared to control group. The BIS score was not significantly different between the two groups. CONCLUSIONS: The Bis index was not significant higher in the doxapram group, with the exception of the measurement recorded at 2 minutes, however the recovery time from desflurane inhalational anesthesia was faster in the doxapram group than the control group.

Impaired but reversible vascular reactivity in a rat model of microgravity / 대한마취과학회지

BACKGROUND: The hindlimb unweighting (HLU) rat model mimics cardiovascular deconditioning following microgravity or human bed rest, particularly for the development of orthostatic intolerance. We have examined vascular responses to alpha1 adrenergic and non-alpha1 adrenergic agonists in vitro. We have also explored the reversibility of the contractile abnormalities observed. METHODS: Dose-response curves were generated to phenylephrine (PE) and norepinephrine (NE) (10(-9) to 10(-4) M), U46619 (U4) (10(-10) to 10(-6) M) at one-half log order intervals in controls (n = 6), HLU (n = 6), or recovered rats (n = 6). EC(50)s and maximal responses (E(max)) were calculated by nonlinear logistic regression analysis with PRIZM software (Graphpad, Mountain View, CA). RESULTS: Simulated microgravity results in attenuated contractile responses to both alpha1 adrenergic and non-alpha1 adrenergic agonists, but the impaired contractile phenomenon reverses with time. CONCLUSIONS: The decreased vascular reactivity after microgravity and prolonged bed rest could cause attenuated baroreflex function and produce orthostatic intolerance, but that problem resolved with time.

Impaired but reversible vascular reactivity in a rat model of microgravity / 대한마취과학회지

BACKGROUND: The hindlimb unweighting (HLU) rat model mimics cardiovascular deconditioning following microgravity or human bed rest, particularly for the development of orthostatic intolerance. We have examined vascular responses to alpha1 adrenergic and non-alpha1 adrenergic agonists in vitro. We have also explored the reversibility of the contractile abnormalities observed. METHODS: Dose-response curves were generated to phenylephrine (PE) and norepinephrine (NE) (10(-9) to 10(-4) M), U46619 (U4) (10(-10) to 10(-6) M) at one-half log order intervals in controls (n = 6), HLU (n = 6), or recovered rats (n = 6). EC(50)s and maximal responses (E(max)) were calculated by nonlinear logistic regression analysis with PRIZM software (Graphpad, Mountain View, CA). RESULTS: Simulated microgravity results in attenuated contractile responses to both alpha1 adrenergic and non-alpha1 adrenergic agonists, but the impaired contractile phenomenon reverses with time. CONCLUSIONS: The decreased vascular reactivity after microgravity and prolonged bed rest could cause attenuated baroreflex function and produce orthostatic intolerance, but that problem resolved with time.

Oral Alprazolam Attenuates Preoperative Stress Responses to Regional Anesthesia / 대한마취과학회지

BACKGROUND: Preoperative anxiety activates the hypothalamo-pituitary-adrenal axis and the sympathetic nervous system, and also affects immune responses. Therefore, there is a need to reduce the anxiety. METHODS: Forty-eight healthy patients scheduled for elective knee arthroscopic and reconstructive surgery under spinal anesthesia (SA) were randomly allocated into the control (CG, n = 24) and the alprazolam group (AG, n = 24). Oral 0.25 mg alprazolam in the evening before SA and 0.5 mg alprazolam 90 min before SA were administered to patients of the AG. Visual analogue scale (VAS) scores of anxiety were measured in the operating room before SA (ORSA) and operating room during operation and discharge day (DD). Serum ACTH and cortisol in the ORSA and DD, systolic and diastolic blood pressure and heart rate in the ward and ORSA, sleep time and number of night awakenings in the night before SA were measured. RESULTS: Age (31.9 +/- 10.8 yr), sex, height, weight, and sleep time were not significantly different between the two groups. The number of night awakenings in the AG were significantly lower than in the CG. VAS scores of anxiety in the ORSA were significantly higher in the CG than in the AG. ACTH and cortisol levels in the CG were significantly higher in the ORSA than in the DD. ACTH and cortisol levels in the AG were not significantly different between the ORSA and the DD. Cortisol level in the ORSA were significantly lower in the AG than in the CG. Diastolic blood pressure and heart rate in the ORSA were significantly lower in the AG than in the CG. CONCLUSIONS: These indicate that oral alprazolam attenuates preoperative stress responses to regional anesthesia.

A Comparative Study of the RecoveryCharacteristics for the Use of Propofol-Remifentanil Anesthesia or Sevoflurane-Remifentanil Anesthesia under Bispectral Index Guidance

BACKGROUND: The bispectral index (BIS) is a measure of the hypnotic component of anesthesia and can be used to guide the administration of anesthetics. This study compares the emergence and recovery characteristics of total intravenous anesthesia using propofol/remifentanil with sevoflurane/remifentanil anesthesia under bispectral index guidance. METHODS: Fifty-six patients (ASA 1, 2) were randomly assigned to two groups, receiving either propofol/ remifentanil (Group P) or sevoflurane/remifentanil (Group S) anesthesia. Following induction with propofol and remifentanil, anesthesia was maintained with propofol/remifentanil or sevoflurane/ remifentanil. After the induction of anesthesia, the target effect-site concentration of remifentanil was constantly maintained at 3 ng/ml. Propofol and sevoflurane administration was guided using the bispectral index (40-60). Thirty minutes before the end of surgery, ketorolac was administered (0.5 mg/kg intravenously). At the end of surgery, the anesthetic agents were discontinued. Patients in the groups were compared for recovery characteristics (eye opening, response to command, extubation, orientation, time in the Operating room after the end of surgery, Aldrete score >9) using the unpaired t-test (P < 0.05). RESULTS: There were no significant differences in the demographic data between patients in the two groups. Recovery data was not different between the two groups. CONCLUSIONS: BIS-guided anesthesia with propofol or sevoflurane plus remifentanil both provided satisfactory anesthesia for lower abdominal surgery in gynecologic patients.

Cardiovascular Effects of Hind-limb Unweighing in Mice / 대한마취과학회지

BACKGROUND: Orthostatic intolerance is a debilitating problem that can occur after prolonged bed-rest, exposure to microgravity, and in the elderly. This study examined the integrated cardiovascular response to baroreceptor activation in a hind-limb unweighing (HLU) mouse model of microgravity to test the hypothesis that both the pressor and contractility response are attenuated in HLU mice. METHODS: C57BL/6 mice (25-30 g body wt, 8-10 wk old) were exposed to HLU for 2 weeks. A bilateral carotid artery occlusion and open-loop baroreceptor stimulus was performed to measure the myocardial contractile responses using a left ventricular micromanometer-conductance catheter in the mice. In isolated myocytes simultaneous sarcomere shortening and calcium transient were measured in response to increasing concentrations of the beta-agonist isoproterenol. RESULTS: In the controls, bilateral carotid artery occlusion increased the heart rate and mean arterial pressure. These responses were markedly attenuated in the HLU mice. A bilateral carotid artery occlusion also increased the slope of the end-systolic pressure volume relationship (Ees) by 70 +/- 11% and the slope was markedly attenuated to 10 +/- 8% in the HLU mice. Isoproterenol increased the sarcomere shortening in both control and HLU mice in a dose-dependent manner. However the contractile response to isoproterenol was significantly attenuated in the HLU mice than the controls. CONCLUSIONS: Both the pressor and myocardial contractile responses appear to be impaired in a mouse model of microgravity.

The Aortic Reactivity to Nitric Oxide after Cardiopulmonary Bypass in Rats / 대한마취과학회지

BACKGROUND: We evaluated whether vessel reactivity to nitric oxide changed after cardiopulmonary bypass, which would play an inportant role in temporary vital organ perfusion. METHODS: We used the distal aortas of five rats weighing 400-500 g after cardiopulmonary bypass in experimental group. We also used the distal aortas of five rats before cardiopulmonary bypass under sham operation in control group. All cumulative concentration-effect curves were performed in the aortic rings and EC50 and maximal response (Emax) were calculated by using nonlineal logistic regression analysis with the software PRISM (Graphpad, Mountain View, CA). RESULTS: CPB inhibited acetylcholine induced relaxation in aortic rings and also inhibited sodium nitroprusside (SNP) induced relaxation in ones. It was similar to depression of acetylcholine induced relaxation. CONCLUSIONS: The depression of aortic rings relaxation after CPB may be associated with attenuated sensitivity of them to NO in rats.

Comparison of the Efficacy of Interpleural Block and Paravertebral Block after Video-assisted Endoscopic Thoracic Sympathectomy / 대한마취과학회지

BACKGROUND: Video-assisted thoracic surgery (VATS) is widely used as a less invasive procedure for thoracic surgery. However, there is still significant postoperative pain, although less severe than with conventional thoracic surgery. The aim of this study was to assess the efficacy of an interpleural block and a paravertebral block for postoperative pain control and the recovery of the pulmonary function. METHODS: Fifty-one patients with similar demographic and preoperative physiologic parameters were divided randomly into interpleural or thoracic paravertebral block groups. The visual analogue pain score (VAS) was assessed at 30 min, and 2, 6, 12, and 24 hours after surgery and the forced vital capacity was tested preoperatively, the pulmonary function was evaluated at 30 min, and 2, 6, 12, and 24 hours. RESULTS: The pain scores were significantly lower in the paravertebral block group at 30 min, 2, 6 and 12 hours after surgery during rest (6.4 +/- 1.8, 5.1 +/- 1.1, 4.2 +/- 1.5, 2.8 +/- 0.8 vs 2.9 +/- 1.8, 2.5 +/- 1.6, 2.1 +/- 1.6, 1.9 +/- 1.7, P < 0.05), and only within 2 hours after operation for coughing (7.8 +/- 1.0, 6.4 +/- 0.8 vs 4.7 +/- 2.2, 4.2 +/- 2.1, P < 0.05) than in the interpleural block group. There was significant recovery of the pulmonary function 30 min, 2, and 6 hours after surgery (32%, 43%, 56%, 67%, 75% vs 59%, 59%, 71%, 75%, 84%, P < 0.05) in the paravertebral block group. CONCLUSIONS: A thoracic paravertebral block is more effective in decreasing the level of post-VATS pain, and allows earlier recovery of the forced vital capacity compared with an interpleural block.

The Pulmonary Arterial Reactivity to Nitric Oxide after Cardiopulmonary Bypass and Reperfusion in Pigs / 대한마취과학회지

BACKGROUND: We hypothesized that the decreased nitric oxide after cardiopulmonary bypass and reperfusion would play an important role in temporary pulmonary hypertension. METHODS: We used the pulmonary arteries of three pigs weighing 40-50 kg after cardiopulmonary bypass and reperfusion in experimental group. We also used the pulmonary arteries of five pigs before cardiopulmonary bypass under sham operation in control group. All cumulative concentration-effect curves were performed on vessel rings beginning at their optimum resting zone. EC50 and maximal response (Emax) were calculated by using nonlineal logistic regression analysis with the software PRISM (Graphpad, Mountain View, CA). RESULTS: CPB inhibited endothelium-dependent relaxation to acetylcholine in pulmonary arterial rings, but did not affect SNP induced relaxation in ones. CONCLUSIONS: The Ability of pulmonary arterial relaxation after CPB and reperfusion in pigs was decreased without attenuated pulmonary arterial sensitivity to NO.

The Effect of Pretreatment with Thiopental on Reducing Pain Induced by Rocuronium Injection

We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.

Prejunctional Phenomenon during Succinylcholine Onset in Cats / 대한마취과학회지

BACKGROUND: Succinylcholine (Sch) has been generally reported not to produce tetanic stimulation fade on train of four in phase I block, except phase II block. But, the prejunctional phenomenon of Sch during onset is rarely reported these days, and so we investigated whether the prejunctional phenomenon of Sch during onset exists in cats. METHODS: We checked train of four ratios (TOF-R) and tetanic fade ratios (TF-R) by using a nerve stimulator before and after 50microgram/kg of Sch less than ED95 was administered, and during recovery in anesthetized cats. We analyzed TOF-R and TF-R before drug administration as a control and during onset and recovery time in order to estimate the statistic significance of fade. RESULTS: TOF fade and tetanic stimulation during the onset of Sch appeared like those in the partial block of nondepolarizing neuromuscular blockades TOF-R and TF-R during Sch onset compared with those in control and recovery time of Sch had statistical significance (P <0.05). CONCLUSIONS: The prejunctional phenomenon appeared only during Sch onset in cats and then disappeared during recovery to the control level.

Effect of Diltiazem and Lidocaine on Cardiovascular Response to Tracheal Intubation / 대한마취과학회지

BACKGROUND: Transient cardiovascular responses are frequently associated with direct laryngoscopy and tracheal intubation. The aim of this study was to investigate the change of hemodynamic response in laryngoscopy and intubation after injection of diltiazem and lidocaine. METHODS: We studied eighty adult patients (ASA 1-3). After intravenous injection of thiopental sodium, each patient received saline (Control), 1 mg/kg lidocaine (Group L), 0.3 mg/kg diltiazem (Group D), or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine (Group DL) 90 seconds before a laryngoscopy. Heart rate and arterial blood pressure were obtained at baseline, just before the laryngoscopy, immediately after intubation, 1, 2, 3 and 4 minutes after intubation. RESULTS: There were no significant differences in the changes of heart rate among all groups. Patients who received saline and lidocaine showed a significant increase in mean arterial pressure associated with tracheal intubation, and these responses were attenuated in diltiazem and diltiazem + lidocaine treated patients. However, there was no significant difference between the diltiazem group and diltiazem + lidocaine group. CONCLUSIONS: This data suggests that 0.3 mg/kg diltiazem or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine treatment are effective methods to attenuate the hypertensive response to laryngoscopy and tracheal intubation. However, injection of diltiazem + a low dose of lidocaine was not more effective than the diltiazem alone group.