Anesthetic Experience of Spinal Anesthesia after Sedation in Un-cooperated Elderly Patients

Regional anesthesia is mostly used in operations on the lower abdomen or lower extremities in elderly patients. It shows nearly no difference in long-term outcomes compared to general anesthesia, but it is used more often because of the several advantages. However, during the regional anesthetic procedures, the patient must cooperate and has to be lateral decubitus position without physical movement. Therefore, in the case of the patients who are not cooperated, it may be not easy to perform regional anesthesia. In this study, we present 3 case reports that regional anesthesia after sedation is performed in un-cooperated patients. Regional anesthesia after sedation may be a good method to improve outcomes in un-cooperated elderly patients.

A Pilot Study of the Correlation between the Numeric Rating Scale used to Evaluate "Geop" and Questionnaires on Pain Perception

BACKGROUND: The word "geop" is a unique Korean term commonly used to describe fright, fear and anxiety, and similar concepts. The purpose of this pilot study is to examine the correlation between the Numeric Rating Scale (NRS) score of geop and three different questionnaires on pain perception. METHODS: Patients aged 20 to 70 years who visited our outpatient pain clinics were evaluated. They were requested to rate the NRS score (range: 0-100) if they felt geop. Next, they completed questionnaires on pain perception, in this case the Korean version of the Pain Sensitivity Questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale (PASS). The correlations among each variable were evaluated by statistical analyses. RESULTS: There was no statistically significant correlation between the NRS score of geop and the PSQ score (r = 0.075, P = 0.5605). The NRS score of geop showed a significant correlation with the PCS total score (r = 0.346, P = 0.0063). Among the sub-scales, Rumination (r = 0.338, P = 0.0077) and Magnification (r = 0.343, P = 0.0069) were correlated with the NRS score of geop. In addition, the NRS score of geop showed a significant correlation with the PASS total score (r = 0.475, P = 0.0001). The cognitive (r = 0.473, P = 0.0002) and fear factors (r = 0.349, P = 0.0063) also showed significant correlations with the NRS score of geop. CONCLUSIONS: This study marks the first attempt to introduce the concept of "geop." The NRS score of geop showed a moderate positive correlation with the total PCS and PASS score. However, further investigations are required before the "geop" concept can be used practically in clinical fields.

Effect of Tetrahydroisoquinoline Alkaloids on the alpha-adrenoceptors in Rat Aorta and Brain Homogenates

Tetrahydroisoquinoline(THI) alkaloids can be considered as cyclized derivatives of simple pthylamines and many of them, especially with 6,7-disubstitution, demonstrate relatively high affinity for catecholamines. In the present study, pharmacological action of limited series of THI has been examined using rat isolated atria and aorta. In addition, (H) prazosin displacement binding study with THI compounds using rat brain homogenates was performed to find out if these probes to have a-adrenoceptor affinity. In isolated rat atria, all THls and dobutamine increased heart rate and contractile force. In the presence of propranolol, the concentration response curves of YS 49 and YS 51 shifted to the right resulting in 8.07+0.84 and 7. 93+0.11 of pA values, respectively. The slope of each compound was not deviated from unity, indicating that these chemicals are highly competitive at the cardiac beta1-adrenoceptors. YS 49, YS 51 and higenamine showed alpha1- adrenoceptor affinity in rat brain in which the dissociation constant(K,) was 2.75, 2.81 and 1.02pM, respectively. It is concluded, therefore, that THI alkaloids have considerable affiniyt to alpha1-adrenoceptors in rat aorta and atria. while these probes show relatively high affinity for cardiac beta1-adrenoceptors. The authors speculate that it is worthy investigating whether these chemicals are useful in the management of vasospasm of aneurysmal subarachnoid hemorrhage.