Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment.</p><p><b>METHODS</b>Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed.</p><p><b>RESULTS</b>All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P < 0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks.</p><p><b>CONCLUSIONS</b>It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.</p>

Circulatory responses to nasotracheal intubation: comparison of GlideScope videolaryngoscope and Macintosh direct laryngoscope / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The GlideScope videolaryngoscope (GSVL) has been shown to have no special advantage over the Macintosh direct laryngoscope (MDL) in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation (NTI) using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL.</p><p><b>METHODS</b>Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline values) and immediately before intubation (post-induction values), at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP (SBP) and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes > 30% of baseline values were also noted. The product of HR and systolic BP, i.e. rate pressure product (RPP), and the areas under SBP and HR vs. time curves (AUC(SBP) and AUC(HR)) were calculated.</p><p><b>RESULTS</b>The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUC(SBP), maximum values of BP and incidence of SBP percent increase > 30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUC(HR) and incidence of HR percent increase > 30% of baseline value were significantly higher in the MDL group than in the GSVL group. Times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group.</p><p><b>CONCLUSIONS</b>The pressor response to NTI with the GSVL and the MDL was similar, but the tachycardiac response to NTI was lesser and of a shorter duration when using a GSVL than when using an MDL.</p>

Comparison of hemodynamic responses to nasotracheal intubations with Glide Scope video-laryngoscope, Macintosh direct laryngoscope, and fiberoptic bronchoscope / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the hemodynamic responses to nasotracheal intubation with Glide Scope video-laryngoscope (GSVL), Macintosh direct laryngoscope (MDLS), and fiberoptic bronchoscope (FOB).</p><p><b>METHODS</b>Sixty patients, with American Society of Anesthesiologists (ASA) physical status I - II, aged 18- 50 years, and scheduled for elective plastic surgery under general anesthesia requiring nasotracheal intubation, were randomly allocated equally to GSVL group, MDLS group, and FOB group. After the routine anesthesia induction, nasotracheal intubation was performed with the GSVL, MDLS, and FOB, respectively. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation, and subsequently at an interval of every 1 minute for a total of five minutes. The maximum and minimum values of BP and HR during the observation period were also noted. The rate pressure product (RPP) at each measuring time point was calculated. The areas under effect-time curve (AUE) of hemodynamics were calculated by time as X-axis and changes of BP and HR during the observation as Y-axis.</p><p><b>RESULTS</b>All the three groups were similar in the demographic data and intubation time. After anesthesia induction, BP and RPP in all the three groups decreased significantly compared to baseline values (P < 0. 05), while HR had no significant change. After nasotracheal intubation, BP, HR, and RPP in all three groups were significantly higher than the postinduction values (P < 0.05). In the FOB group, BP, HR, and RPP at intubation significantly increased when compared with the baseline values (P < 0.05). In the MDLS group, HR at intubation, and maximum values of diastolic blood pressure (DBP), mean arterial pressure (MAP), HR, and RPP during the observation were significantly higher than the baseline values (P < 0.05). In the GSVL group, all hemodynamic parameters at intubation and after intubation were not significantly different from the baseline values. BP, HR, and RPP at intubation, and the incidences of HR more than 100 bpm during the observation were significantly higher in the FOB group than in the other two groups (P < 0.05). BP was not significantly different during the observation between the MDLS and GSVL groups, but HR and RPP at intubation and after intubation as well as AUE(HR) were significantly higher in the MDLS group than in the GSVL group (P < 0.05). AUE(HR) and AUE(SBP) were significantly lower in the GSVL group than in the FOB group (P < 0.05).</p><p><b>CONCLUSION</b>The hemodynamic responses to nasotracheal intubation are most severe with FOB, followed by MDLS, and then GSVL.</p>

Comparison of hemodynamic responses to orotracheal intubation between using GlideScope videolaryngoscope and fiberoptic bronchoscope / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the hemodynamic responses to orotracheal intubation with GlideScope videolaryngoscope (GSVL) and with fiberoptic bronchoscope (FOB) after induction of general anesthesia.</p><p><b>METHODS</b>Totally 57 ASA physical status I - II adult patients undergoing elective plastic surgery and requiring orotracheal intubation were randomly allocated to either GSVL group (n = 29) or FOB group (n = 28). After a routine intravenous anesthetic induction, orotracheal intubation was performed. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, at intubation and thereafter at 1 minute interval for 5 minutes.</p><p><b>RESULTS</b>The intubation time was not significantly different between the two groups (P > 0.05). After intubation, BP and HR exhibited significant increases compared to the post-induction values in both groups, but the maximum values of BP did not exceed the pre-induction values while the maximum value of HR was higher than the pre-induction value. During the observation, BP and HR at all time points as well as the maximum values of BP and HR had no significant differences between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>The orotracheal intubations using FOB and GSVL result in similar hemodynamic responses.</p>