The Neuroprotective Effect and Inflammatory Gene Expression of Hypothermia and Lamotrigine in Transient Spinal Ischemia in the Rat / 대한마취과학회지

BACKGROUND: Although rare, paralysis secondary to spinal cord ischemia after aortic aneurysm surgery is a devastating complication. Many papers have been published on this topic but without a clear consensus on the best way of minimizing the problem. Mild hypothermia and lamotrigine have been neuroprotective in several models of cerebral ischemia. In this study we compared the effects of mild hypothermia and the lamotrigine on neurologic and histopathologic outcomes, and inflammatory gene expression in transient spinal ischemia. METHODS: Rats were anesthetized with halothane, and divided into 4 groups; the Sham-operated (S) group; the Normothermic ischemic (N) group; the Hypothermic ischemic (H) group; and the Lamotrigine- treated (L) group. Spinal ischemia was produced by induced hypotension and thoracic aortic cross clamping. After spinal ischemia neurologic scores were assessed at 1, 2, 3, 24, and 48 hours after reperfusion. After 48 hours the rats were euthanized and their spinal cords were removed for histopathologic assessment. Also, spinal cords were removed at 1, 3, and 48 hours after reperfusion for the assay of TNF-alpha, IL-1 mRNA. RESULTS: The neurologic scores of the H group were significantly lower than from the N group. There was no significant difference between the L group and the N group. The histopathologic scores in the H and L groups were significantly lower than in the N group, and the histopathologic scores of the L group were higher than those of the H group. The TNF-alpha and IL-1 gene expression was increased in the N group. In the H group, the gene expression was significantly less than in the N group. The L group was not significantly different than N group in gene expression. CONCLUSIONS: The inflammatory gene expressions were increased in transient spinal ischemia. Hypothermia was neuroprotective in transient spinal ischemia. However, the lamotrigine showed only partial neuroprotective effects in transient spinal ischemia.

Postoperative Analgesia for Arthroscopic Knee Surgery with Intraarticular Bupivacaine and Clonidine / 대한마취과학회지

BACKGROUND: A randomized, double-blind, controlled study was conducted in patients undergoing elective knee arthroscopy to assess the analgesic effect of intraarticular bupivacaine alone and the combination of bupivacaine and clonidine. METHODS: Patients in bupivacaine group (n=15) received 0.125% bupivacaine 20 ml, patients in the bupivacaine and clonidine group (n=15) received a combination of 0.125% bupivacaine 20 ml and 150 microgram clonidine. These drugs were injected each other intraarticularly. We assessed postoperative pain by visual analogue scale (VAS) score at 1, 2, 3, 6, 12 and 24h after intraarticular injection. The need for supplemental analgesia was recorded. And the side effects of two groups were evaluated. RESULTS: VAS scores were significantly increased at 6hr after surgery than other times in bupivacaine group (p<0.05), but there was no significant difference of VAS score in bupivacaine and clonidine group. And in bupivacaine and clonidine group, VAS scores were significantly lower than that in bupivacaine group at 6 hr and 12 hr after surgery (p<0.05). Analgesic requirment was not used in bupivacaine and clonidine group, but 9 patients in bupivacaine group requires analgesics. Side effect in both groups, like hypotension and bradycardia, did not occur. CONCLUSIONS: Intraarticular 150 microgram clonidine with 0.125% bupivacaine 20 ml was significantly reduced postoperative pain following knee arthroscopy without side effect.