ABSTRACT
Neuropathic pain is a complex state showing increased pain response with dysfunctional inhibitory neurotransmission. The TREK family, one of the two pore domain K+ (K2P) channel subgroups were focused among various mechanisms of neuropathic pain. These channels influence neuronal excitability and are thought to be related in mechano/thermosensation. However, only a little is known about the expression and role of TREK-1 and TREK-2, in neuropathic pain. It is performed to know whether TREK-1 and/or 2 are positively related in dorsal root ganglion (DRG) of a mouse neuropathic pain model, the chronic constriction injury (CCI) model. Following this purpose, Reverse Transcription Polymerase Chain Reaction (RT-PCR) and western blot analyses were performed using mouse DRG of CCI model and compared to the sham surgery group. Immunofluorescence staining of isolectin-B4 (IB4) and TREK were performed. Electrophysiological recordings of single channel currents were analyzed to obtain the information about the channel. Interactions with known TREK activators were tested to confirm the expression. While both TREK-1 and TREK-2 mRNA were significantly overexpressed in DRG of CCI mice, only TREK-1 showed significant increase (~9 fold) in western blot analysis. The TREK-1-like channel recorded in DRG neurons of the CCI mouse showed similar current-voltage relationship and conductance to TREK-1. It was easily activated by low pH solution (pH 6.3), negative pressure, and riluzole. Immunofluorescence images showed the expression of TREK-1 was stronger compared to TREK-2 on IB4 positive neurons. These results suggest that modulation of the TREK-1 channel may have beneficial analgesic effects in neuropathic pain patients.
Subject(s)
Animals , Humans , Mice , Blotting, Western , Constriction , Diagnosis-Related Groups , Fluorescent Antibody Technique , Ganglia, Spinal , Hydrogen-Ion Concentration , Neuralgia , Neurons , Polymerase Chain Reaction , Reverse Transcription , Riluzole , RNA, Messenger , Spinal Nerve Roots , Synaptic TransmissionABSTRACT
With the innovation and improvements in medical science, longer life expectancy has been achieved and growing population is being diagnosed and treated as chronic diseases such as diabetes, chronic pulmonary obstructive disease or hypertension. These chronic diseases often affect multiple organs of cardiovascular and neuroendocrine system and blunt regulatory function which is crucial for the defense response against external and internal harmful stresses. The risk of perioperative complications including cardiovascular events is also higher in poorly controlled diabetes or hypertension. Therefore it is very important to evaluate and manage these problems preoperatively. This paper reviews preoperative management of common chronic diseases such as diabetes, hypertension, and chronic pulmonary obstructive disease.
Subject(s)
Chronic Disease , Diabetes Mellitus , Hypertension , Life Expectancy , Neurosecretory Systems , Preoperative CareABSTRACT
BACKGROUND: Emergence agitation frequently occurs after desflurane anesthesia in children.Nalbuphine, because of its sedative and analgesic properties, might be useful for the management of this side effect.We studied the effect of nalbuphine on recovery characteristics and emergence agitation after desflurane anesthesia in children for strabismus surgery. METHODS: 41 patients (3-14 yr) scheduled for pediatric strabismus surgery were included.All children received ketamine 0.5 mg/kg intravenously before entering the operating room.After intravenous induction with thiopental and rocuronium to facilitate endotracheal intubation, patients were randomly assigned to receive saline, or nalbuphine 0.2 mg/kg respectively. Anesthesia was maintained with desflurane 4-6% with N2O : O2 = 2 : 1.At the end of anesthesia, time to cough, extubation, movement, eye opening and discharge were recorded.Emergence agitation was recorded by three point rating scale. RESULTS: Agitation scores were significantly different between the two groups (P < 0.01).Time to extubation and movement were similar between two groups.Time to eye opening was significantly increased in nalbuphine group (P < 0.05).But, there was no difference in time to discharge from the recovery room to the ward between the two groups. CONCLUSIONS: In children undergoing strabismus surgery with desflurane anesthesia, nalbuphine 0.2 mg/kg administered immediately after induction reduced incidence of emergence agitation without delaying discharge from recovery room.
Subject(s)
Child , Humans , Androstanols , Anesthesia , Cough , Dihydroergotamine , Eye , Eye Movements , Incidence , Intubation, Intratracheal , Isoflurane , Ketamine , Nalbuphine , Recovery Room , Strabismus , ThiopentalABSTRACT
Inguinal hernia repair can result in paresthesia and/or pain in the inguinal region. Pharmacological and surgical management often yield inconsistent results associated with considerable risks and side effects. Radiofrequency thermocoagulation (RF) is a neuro-destructive treatment for severe pain, but associated with hypoesthesia, neuritis-like reactions, and occasional neuroma formation. Pulsed radiofrequency (PRF), unlike RF, delivers high intensity currents in pulses, is non-neurodestructive, and therefore less painful, without the potential complications. Here we report on PRF in chronic postoperative inguinal pain. A 23-year-old male who received right inguinal hernia repair and complained of right sided groin pain for approximately 10 years underwent PRF at the L1 and L2 dorsal root ganglia (DRG). He then reported a decrease in pain from 80-90/100 mm to 15-30/100 mm on a visual analogue scale (VAS), which lasted for twelve months.