Effects of sevoflurane and propofol on wound healing in rats: comparison of blood flow and wound size / 대한마취과학회지

BACKGROUND: As the wound healing is a multi-factorial process, the anesthetic agent and the duration of its exposure may influence the healing process after surgery. This study investigated the effect of anesthetic agents and duration of its exposure on the wound healing process after operation. METHODS: Total 32 rats weighing 200-300 g were randomly allocated to one of eight groups according to the exposure time (1, 2, 4, 8 hours) of sevoflurane or propofol (n = 4 each). After wounding under the each anesthetic, anesthesia was maintained for 1, 2, 4 and 8 hours in each group. We compared the skin blood flow around the wound and the wound size at baseline, 3 days, and 7 days postoperatively. RESULTS: In sevoflurane group, short exposure group (1, 2 hours) showed higher wound blood flow than long exposure (4, 8 hours) at 3 days after wounding (P < 0.05), but not at 7 days after wounding. For the wound size, there was no difference at 3 days after wounding in sevoflurane group, but 8 hours exposure group had the largest wound at 7 days after wounding. In propofol group, wound blood flow showed no difference at 3 days after wounding, but that of 4, 8 hours exposure group was higher than 2 hours exposure group at 7 days after wounding. There was no difference in wound size in propofol group. CONCLUSIONS: This study implicates that sevoflurane might influence the wound healing process more prominently than propofol according to the duration of exposure time.

Spinal alpha2 Adrenoceptor and Antiallodynic Effect by Clonidine after Chronic Administration of 4-Methylcatechol in Neuropathic Rat Pain Model / 대한통증학회지

BACKGROUND: The adrenergic nervous system in the spinal cord contributes to the development of neuropathic pain after nerve injury. Brain derived neurotrophic factor may facilitate the sympathetic change in the spinal cord and influence the state of neuropathic pain. We probed the effect of chronic repetitive administration of systemic 4-methylcatechol, which is known to be a neurotrophic factor inducer, in a spinal nerve ligation model. METHODS: We made the rat neuropathic pain model by the ligation of the L5 spinal nerve. Intraperitoneal 4-methylcatechol (10microgram/kg) or the same volume of saline wasadministrated twice daily just after the operation for 7 days. The tactile allodynia was measured by using von Frey filaments and its change was followed up from 3 days after SNL. The lumbosacral enlargement of the spinal cord was taken out and the mRNA contents of the alpha(2)-adrenoceptor subtypes were measured by real time polymerase chain reaction and this was then compared with the control groups. The antiallodynic effect of intrathecal clonidine (3, 10, 30 microgram) was evaluated and compared in the 4-methylcatechol treated rats and the control rats. RESULTS: The expression of the alpha(2A) and alpha(2C) adrenoceptor subtypes did not change after 4-methylcatechol treatment. Intrathecal clonidine showed an earlier and better effect at the highest dose (30 microgram intrathecal), but not with any other doses. CONCLUSIONS: Chronic intraperitoneal administration of 4-methylcatechol may improve the effect of intrathecal clonidine, but we could not prove the increase of alpha(2A) and alpha(2C) adrenoceptors in the spinal cord of 4-methylcatechol treated rats.

Effect of Oral Ramosetron for Postoperative Nausea and Vomiting in Surgical Patients using PatientControlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to evaluate ramosetron oral disintegrating tablet (ODT), a 5-HT3 receptor antagonist, for prophylaxis and treatment of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia using patient controlled analgesia (PCA). METHODS: 150 adult, ASA physical status I or II, aged 18-65 yr, patients undergoing elective surgery were enrolled (n = 50 in each). Patients were randomly assigned to one of three groups, group C (no prophylactic antiemetics), groups N (ramosetron ODT 30 minutes before the induction), and group Z (intravenous injection of ondansetron 4 mg at the end of surgery followed by continuous infusion of 8 mg added to the PCA solution). A standard general inhalation anesthesia and IV PCA with fentanyl and ketorolac were used. During the 48 hours after recovery, we assessed pain score by: using a visual analogue scale (VAS), a sedation scale, an incidence of PONV, and monitoring consumption of PCA drug, rescue drug consumption, adverse events, and overall satisfaction. RESULTS: The incidence of nausea and the consumption of rescue drug were significantly decreased in N and Z groups at each time point except 24-48 hours after recovery. There was no significant difference in incidence of vomiting. Overall satisfaction was superior in N and Z groups compared with C group. CONCLUSIONS: Preoperative administration of ramosetron ODT was an acceptable and effective way to prevent PONV in patients using PCA.

Laparoscopic Surgery for benign Gastric Tumor

PURPOSE: Laparoscopic surgery of the abdomen has grown rapidly in popularity due to the benefits, including a low level of post operative pain, early recovery, short hospitalization and excellent cosmetic results. Concerning tumor resection, most benign gastric tumors are ideal for the use of the non invasive method of a laparoscopic procedure. To evaluate the feasibility of laparoscopic surgery for benign gastric tumors, we analysed the clinicopathological findings, post operative course and prognosis. METHODS: Between January 1995 and August 2001, laparoscopic surgery was performed on 18 patients with benign gastric tumors at the Department of Surgery at Yonsei University Hospital. To evaluate the feasibility of laparoscopic surgery for these lesions, the sex, age, pathologic diagnosis, operative methods, tumor location, tumor size, operative time, recurrence, gas passing time and diet recovery time were analyzed. RESULTS: The patients group consisted of 3 men (16.7%) and 15 women (83.3%), with a mean age of 51.9+/-15.0 years (range, 23~80). The histopathological examinations showed 12 mesenchymal tumors (5 leiomyomas, 4 stromal tumors, 3 Schwannomas), 2 mucosa origin tumors (1 retention polyp, 1 villous adenoma), 2 ectopic pancreata, 1 carcinoid tumor and 1 lipoma. The operation methods were 14 laparoscopic wedge resections of stomach, 1 laparoscopic assisted partial gastrectomy and 1 gastrotomy and polypectomy. In 2 patients, a laparotomy was required following the laparoscopy due to difficulties in detecting the tumors. In one of the 2 converted cases, preoperative endoscopic marking of the tumor site was performed, but the dye was spread very widely from the mid body to the prepylorus. The other tumor was located on the lesser curvature of the upper third, around the esophagogastric junction, but it was not exactly identified. The tumors were located in the upper, middle, and lower third of the stomach in 7, 9 and 2 cases, respectively. As a circumferential location, 7 tumors were mainly situated on the anterior wall, 6 on the posterior wall, 3 on the greater curvature and 2 on the lesser curvature. All tumors, even those on the lesser curvature and posterior wall, were able to be resected with laparoscopy. The size of the resected tumors averaged 2.2+/-0.9 cm (range, 0.8~4.3). The resection margins were all negative. The operation time averaged 145.8+/-57.0 min (range 70~280). The time to passing gas averaged 2.2+/-0.9 days (range 1~4). The recovery time to a soft diet averaged 5.9+/-1.9 days (range, 2~9). The postoperative course of all the patients was uneventful, and there were no postoperative complications with the exception of one case of diet intolerance. During the follow up there have been no recurrences to date. CONCLUSION: With its proper application in benign gastric tumors, laparoscopic surgery needs to identify the exact site of a tumor, can contribute significantly to an improved patient outcome because it is less complicated and safer compared to conventional gastrectomy methods.

The Importance of Femoral Hernia in Children

Femoral hernias are very uncommon in children and very easily misdiagnosed. During a period of three years, three children of femoral hernia were treated by one pediatric surgeon at Severance Hospital. Only one case was diagnosed correctly before surgery; the other two were thought to be either an indirect inguinal hernia or groin mass. Only one patient had curative hernioplasty (McVay hernioplasty) at the first operation; the other two did not have curative hernioplasty at the first operation. Femoral hernia in childhood is a challenging clinical problem because of its rarity and similar clinical presentation as indirect inguinal hernia. The frequency with which an incidental indirect inguinal hernia sac or patent processus vaginalis can be found at surgery can perpetuate a misdiagnosis. The absence of an expected indirect inguinal hernia sac or an apparent recurrence of an indirect inguinal hernia should lead to consideration of possible femoral hernia.