Radiofrequency Thermocoagulation of Splanchnic Nerve in Patients with Upper Abdominal Pain / 대한마취과학회지

The splanchnic nerve block can be an alternative method for the pain control in the upper abdomen, when the celiac plexus block does not work. And the radiofrequency thermocoagulation has benefits over alcohol or phenol block because its effect is more localized and predictable. This report describe two patients with metastatic cancer pain in the abdominal cavity who successfully treated with the splanchnic nerve block by using radiofrequency thermocoagulation.

Effect of L-NAME on Neuropathic Pain Developed after Peripheral Nerve Injury / 대한마취과학회지

BACKGROUND: Nitric oxide is known to play an important role in development of the neuropathic pain after peripheral nerve injury. However, it has not yet been investigated whether the role of nitric oxide differs in different modalities of neuropathic pain, such as mechanical, thermal, or cold. Neither has it been investigated whether nitric oxide has different roles in different stages of neuropathic pain, such as its development or maintenance. METHODS: Neuropathic pain was induced by resection of the sciatic nerve branches. A nitric oxide synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME), was injected intrathecally in one group, and around the resected nerve in the other. For half of each group, it was done before resection of the nerves, whereas it was done after the resection for the other half of each group. Responses to mechanical, thermal, and cold stimuli were observed for all of them. For another two groups of rats, L-NAME was administered intraperitoneally for two weeks before or after nerve resection. Influence of L-NAME on histologic change was investigated using both HE staining and immunohistochemcal staining. RESULTS: Pain behavior was significantly attenuated or decreased for those who were treated with L-NAME before the nerve resection, either intrathecally or locally. Those who were treated with L-NAME after a nerve resection, there was no effect for the locally injected group and limited effect for the intrathecally injected group. Duration and intensity of pain behaviors differed with respect to pain modalities. Microscopic findings from HE staining showed that inflammatory reaction was significantly reduced in the pretreatment group, and the evidence of severe inflammation was seen in both the posttreatment group and the control group. I mmunohistochemical study showed no iNOS staining in the pretreatment group, whereas it showed staining in both the posttreatment group and the control group. CONCLUSIONS: Nitric oxide plays an important role in the development of neuropathic pain, and it seems to work at both the spinal cord level and at the site of the injured nerve. However, its role in the injured nerve does not seem to be crucial in the maintenance of neuropathic pain. It is suggested that nitric oxide may have different mechanisms of action for different modalities of pain. Inflammatory reaction and iNOS at the site of nerve injury seem to play an important role in the development and/or maintenance of neuropathic pain.

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy / 대한구급학회지

BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.