Anti-inflammatory Activity of 1-docosanoyl Cafferate Isolated from Rhus verniciflua in LPS-stimulated BV2 Microglial Cells

Although various derivatives of caffeic acid have been reported to possess a wide variety of biological activities such as protection of neuronal cells against excitotoxicity, the biological activity of 1-docosanoyl cafferate (DC) has not been examined. The objective of the present study was to evaluate the anti-inflammatory effects of DC, isolated from the stem bark of Rhus verniciflua, on lipopolysaccharide (LPS)-stimulated BV2 microglial cells. Pretreatment of cells with DC significantly attenuated LPS-induced NO production, and mRNA and protein expression of iNOS in a concentration-dependent manner. DC also significantly suppressed LPS-induced release of cytokines such as TNF-alpha and IL-1beta . Consistent with the decrease in cytokine release, DC dose-dependently and significantly attenuated LPS-induced mRNA expression of these cytokines. Furthermore, DC significantly suppressed LPS-induced degradation of IKB, which retains NF-kB in the cytoplasm. Therefore, nuclear translocation of NF-kB induced by LPS stimulation was significantly suppressed with DC pretreatment. Taken together, the present study suggests that DC exerts its anti-inflammatory activity through the suppression of NF-kB translocation to the nucleus.

Propofol and Aminophylline Antagonize Each Other During the Mobilization of Intracellular Calcium in Human Umbilical Vein Endothelial Cells

This study examined whether propofol and aminophylline affect the mobilization of intracellular calcium in human umbilical vein endothelial cells. Intracellular calcium was measured using laser scanning confocal microscopy. Cultured and serum-starved cells on round coverslips were incubated with propofol or aminophylline for 30 min, and then stimulated with lysophosphatidic acid, propofol and aminophylline. The results were expressed as relative fluorescence intensity and fold stimulation. Propofol decreased the concentration of intracellular calcium, whereas aminophylline caused increased mobilization of intracellular calcium in a concentration-dependent manner. Propofol suppressed the lysophosphatidic acid-induced mobilization of intracellular calcium in a concentration-dependent manner. Propofol further prevented the aminophylline-induced increase of intracellular calcium at clinically relevant concentrations. However, aminophylline reversed the inhibitory effect of propofol on the elevation of intracellular calcium by lysophosphatidic acid. Our results suggest that propofol and aminophylline antagonize each other on the mobilization of intracellular calcium in human umbilical vein endothelial cells at clinically relevant concentrations. Serious consideration should be given to how this interaction affects mobilization of intracellular calcium when these two drugs are used together.

Maternal Social Separation of Adolescent Rats Induces Hyperactivity and Anxiolytic Behavior

Exposure to early stressful adverse life events such as maternal and social separation plays an essential role in the development of the nervous system. Adolescent Sprague-Dawley rats that were separated on postnatal day 14 from their dam and litters (maternal social separation, MSS) showed hyperactivity and anxiolytic behavior in the open field test, elevated plus-maze test, and forced-swim test. Biologically, the number of astrocytes was significantly increased in the prefrontal cortex of MSS adolescent rats. The hyperactive and anxiolytic phenotype and biological alteration produced by this MSS protocol may provide a useful animal model for investigating the neurobiology of psychiatric disorders of childhood-onset diseases, such as attention deficient hyperactive disorder.

A Study about Size and Shape of Bipolar Radiofrequency Lesions / 대한마취과학회지

BACKGROUND: Present limitations to monopolar RF include the small lesion size, difficulties in targeting, and questions about the reliability.In contrast with monopolar RF, bipolar RF create larger, more predictable, and more extensive ablative lesion. This study documents the optimal spacing of two needles, temperature, and time required to produce bipolar RF lesions. METHODS: Two 20-gauge 5 mm active tip needles and 10 mm active tip needles were secured in a parallel position 6, 8, and 10 mm apart and submerged in egg white that would allow visualization of the size and shape of the lesion.RF lesions were produced at 70, 80, and 90degrees C.At each temperature, photographs were taken at 30, 60, 90, and 120 seconds. RESULTS: When the 5 mm active tips with 6 mm distance were above 60 s and with 8, 10 mm distance above 120 s, continuous strip lesions were produced.10 mm active tips with 120 s were produced too.The others had discrete unipolar lesions around each cannula.The lesion size increased with a higher temperature and time.But time was the more important factor in determining lesion size. CONCLUSIONS: A continuous strip lesion was produced even though the electrode spaced 10 mm apart.And spacing the electrode 6 mm apart with 5 mm active tip and 8 mm apart with 10 mm active tip at 90degrees C for 90 s maximize the surface area of the lesions.

The Effect of the Addition of Fentanyl and Midazolam to Lidocaine in a Supraclavicular Brachial Plexus Block / 대한마취과학회지

BACKGROUND: This study was conducted to evaluate the effects of fentanyl and midazolam when used as adjuvant in a supraclavicular brachial plexus block. METHODS: 100 adult patients with an ASA status of I-II that were scheduled to undergo upper extremity surgery performed under a supraclavicular brachial plexus block were prospectively evaluated in this study.The patients were randomly divided into 4 study groups:Group 1, which received 40 ml of 1.5% lidocaine, Group 2, which received 3 mg of midazolam with 40 ml of 1.5% lidocaine, Group 3, which received 100microgram of fentanyl with 40 ml of 1.5% lidocaine, and Group 4, which received 3 mg of midazolam and 100microgram of fentanyl with 40 ml of 1.5% lidocaine.The onset time, as well as the duration of analgesia and motor blocks, proportion of successful blocks, hemodynamic parameters, and adverse events were then noted. RESULTS: The incidence of successful block was higher in group 4 (92%) than in any other groups (68-72%) (P = 0.185). In addition, the mean duration of analgesia was longer in groups 2 and 4 (165 min and 175 min) than in groups 1 and 3 (114 min and 131 min) (P < 0.05).Furthermore, the mean duration of motor block was longer in groups 2 and 4 (169 min and 180 min) than in groups 1 and 3 (123 min and 126 min) (P < 0.05).No significant difference was observed in the onset time of the sensory block and motor block when the groups were compared. CONCLUSIONS: Although the addition of 3 mg of midazolam and 100microgram of fentanyl to lidocaine in a supraclavicular brachial plexus block does not affect the onset of sensory or motor block, it does prolong the duration of analgesia and motor block.

Rupture of hepatic hemangioma during pregnancy : A case report

We report a case of hepatic hemangioma rupture in a 36-year-old woman with a 34-week twin pregnancy. Hemangiomas are the most common benign tumors of the liver and most of them are small and asymptomatic. However, they can induce severe abdominal pain or fatal hemorrhage when ruptured spontaneously during pregnancy. Because of non-specific symptoms and the presence of the large gravid uterus during pregnancy, it is difficult to reach this diagnosis. Under spinal anesthesia, a cesarean section for twin delivery and removal of the hematoma in the abdominal cavity were performed. However, the source of active bleeding was not found during the operation. The spontaneous rupture of hepatic hemangioma was diagnosed after postoperative hepatic angiography and treated successfully by embolization of the left hepatic artery.

Severe Hypotension Caused by Coronary Spasm during Recovery from Combined Spinal Epidural Anesthesia: A case report / 대한마취과학회지

In order that anesthesiologists may reduce the anesthetic and surgical stress on the heart, they frequently use regional anesthesia in patients with coronary artery disease, even though there is no evidence that it reduce the incidence of myocardial ischemia. We report a case of life-threatening cardiovascular collapse that occurred in a 47 years old male patient at the emergence from regional anesthesia. He underwent open reduction and internal fixation for femur fracture under combined spinal epidural anesthesia.The cause of serious hypotension is suspected of myocardial ischemia on the basis of ST segment elevation on EKG. We considered that these cardiovascular events were due to coronary spasm.The possible inducing factors of coronary spasm were altered autonomic balance and arteriosclerotic change related endothelial dysfunction.

Anterior Neck Approach for 4-vessel Occlusion in Rats: A Study for Immunohistological Changes and the Effects of Aminoguanidine on Neuronal Cell Death in the Hippocampus

BACKGROUND: Clinically relevant cerebral ischemia is encountered most frequently as a cardiac arrest or as single or multiple occlusions of the intracranial or extracranial cerebral arteries. Yamaguchi et al. has introduced a one-stage anterior approach to occlude the common carotid arteries (CCAs) and vertebral arteries (VAs). METHODS: We used a 2-stage anterior approach for producing transient global ischemia by 4-vessel occlusion (4-VO). Four to five days after electrocauterization of two VAs using the anterior neck approach, two CCAs were clipped for 10 min under anesthesia. Aminoguanidine (100 mg/kg) was administered intraperitoneally immediately after 4-VO, and then twice a day for three consecutive days. Cresyl violet staining and immunohistochemical analysis for the expression of GFAP, CD11b, nitrotyrosine, iNOS, and Bax were performed, using brain slices obtained from the rats that were sacrificed 1, 3, 5 and 7 days after reperfusion. RESULTS: Aminoguanidine reduced neuronal cell death in the CA1 region of the hippocampus. Expression of GFAP, CD11b, nitrotyrosine, iNOS, and Bax were significantly increased in the CA1 region of the hippocampus three days after 4-VO. CONCLUSIONS: We believe that modified 4-VO is a good method to study transient forebrain ischemia as it is simple and inexpensive to perform and can be utilized without stereotaxis, a pivoting dissection microscope, EEG, a laser flowmeter or the use of Mongolian gerbils.

Nicotinamide Reduces the Infarct Volume in a Rat Model of Transient Middle Cerebral Artery Occlusion

BACKGROUND: Cerebral ischemia depletes ATP and causes irreversible tissue injury. Nicotinamide is a precursor of NAD+ and it is also a poly (ADP-ribose) polymerase (PARP) inhibitor that increases the neuronal ATP concentration and so protects against stroke. Therefore we examined whether nicotinamide could protect against cerebral ischemia by using a model of transient middle cerebral artery occlusion (MCAO) (reperfusion 2 h post ischemia) in Sprague-Dawley rats. METHODS: Nicotinamide (500 mg/kg) or normal saline was administered intraperitoneally 24 and 0 h before and after MCAO, respectively. The infarction volumes were determined with triphenyltetrazolium chloride staining 24 h after reperfusion. The nitrotyrosine, PAR polymer and PARP-1 expressions were examined by immunohistochemistry with using brain slices obtained from the rats that were sacrificed at 0, 15, 30, 60 and 120 min after reperfusion. RESULTS: The infarction volumes were significantly attenuated (21.8%, p<0.05). The nitrotyrosine expressions were increased at 0, 15 and 30 min, and those expressions for PARP polymer and PARP-1 were increased at 60 and 120 min, respectively. Nicotinamide partly reduced the expressions for nitrotyrosine and PAR polymer except for PARP-1. CONCLUSIONS: These results suggest that nicotinamide may attenuate ischemic brain injury through its antioxidant activity and the inhibition of PARP-1.

Low Pressure (8 mmHg) Pneumoperitoneum does not Reduce the Incidence and Severity of Postoperative Nausea and Vomiting (PONV) following Gynecologic Laparoscopy / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is distressing complication of anesthesia and surgery, with a relatively high incidence in women undergoing gynecologic laparoscopy. Therefore, this study aimed to investigate occurrence and severity of PONV of low pressure (LP [8 mmHg]) in comparison to standard pressure (SP [13 mmHg]) pneumoperitoneum. METHODS: 46 consecutive patients qualified for elective gynecologic laparoscopy were randomly allocated to either SP group (n = 23) or LP group (n = 23). All the patients were separately evaluated at three intervals of 0-2 h, 2-6 h and 6-24 h during the first postoperative 24 hours with regard to emetic symptoms. Additionally, the degree of surgical exposure in LP group was rated in 4-point scale by surgeon. RESULTS: The overall incidence of PONV during the initial 24 postoperative hours did not differ between the groups (65.2% in LP group vs 82.6% in SP group, P = 0.314). There was also no difference between the groups in regard to the incidence and severity of PONV and postoperative nausea, consumption of analgesics and the need for rescue ondansetron at any separate observation periods. However, some degrees of surgical difficulties were rated in 12 patients (52.1%) from LP group. Furthermore, mean estimated blood loss in LP group was significantly increased than in SP group (P < 0.05). CONCLUSIONS: We conclude that lowering of the insufflation pressure to 8 mmHg can not reduce the incidence and severity of PONV after gynecologic laparoscopy and even increase the noticeable surgical difficulties and risks in some cases.

In Vitro Responses of SK-OV-3 Ovarian Cancer Cell Lines to Tamoxifen and Celecoxib / 대한산부인과학회지

OBJECTIVE: There are some evidences that some epithelial ovarian cancer cells respond to hormonal therapy. And in vitro studies have revealed that treatment of various human cancer cell lines with selective cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to evaluate the effects of tamoxifen and celecoxib, a selective COX-2 inhibitor, on the ovarian cancer cells and the benefits of combining these agents in the management of ovarian cancer. METHODS: SK-OV-3 epithelial ovarian cancer cells were exposed to increasing concentration of tamoxifen (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 h of continuous exposure. Concomitant treatment of SK-OV-3 cells with tamoxifen and celecoxib induced significant increase in apoptosis, comparing with single drug exposure. The pattern of apoptosis induced by these agents on SK-OV-3 cells seemed to be caspase-3 dependent. CONCLUSION: Our data suggest that combining tamoxifen with selective COX-2 inhibitor seems to have at least an additive tumoricidal effect. A more definitive role for this combination therapy in clinical settings in ovarian cancer will need to be defined through the conduct of clinical trials.

Convulsion, Symptomatic Hyponatremia and Paralytic Ileus Following Tonsillectomy: A case report / 대한마취과학회지

Severe symptomatic hyponatremia shows high mortality in association with cerebral edema and central nervous system dysfunction. Postoperative hyponatremia is usually attributed to administration of hypotonic fluids while antidiuretic hormone is acting. However, we experienced a severe symptomatic hyponatremia in spite of infusion of lactated Ringer's solution perioperatively in a case of 4-year-old girl's tonsillectomy. Inappropriate secretion of ADH caused by pain, stress, anxiety, nausea, vomiting. Paralytic ileus developed several hours after surgery, severe hyponatremia (Na 119 mmol/L) with convulsion notified. After prompt infusion of sodium supplement and fluid restriction, the patient recovered uneventfully.

Minocycline Attenuates the Development of Allodynia: An Immunohistochemical Study on CD11b, GFAP and c-Fos in the Spinal Dorsal Horn in SD Rat

BACKGROUND: Minocycline, a semisynthetic second-generation tetracycline, is an antibiotic that has excellent ability to penetration into the CNS via the brain-blood barrier. Minocycline has emerged as a potent inhibitor of microglial activation, and it is an effective neuroprotective agent in experimental brain ischemia. Glial cell activation and proliferation are known to be associated with neuropathic pain in the peripheral nerve injuries. METHODS: The fifty percent threshold of withdrawal responses was measured in the hindpaws of SD rats following tight ligation of left fifth lumbar spinal nerve. Rats were sacrificed at 1, 3, 5, and 7 days and at 0.5, 1, 2, and 4 h post ligation (n=5/group/time point). Immunohistochemistry for GFAP, CD11b and c-Fos was done on the spinal cord at the level of the fifth lumbar nerve. Minocycline (45 mg/kg) and normal saline (300-400 microL) were administered intraperitoneally, 1 day and 1 h before the operations, and every day postoperatively until the rats were sacrificed. RESULTS: Treatment with minocycline reduced allodynia and the expressions of CD11b at 5 days and c-Fos at 1 and 2 h post operation compared with the saline treatment (control). CONCLUSIONS: It was thought that minocycline reduced the allodynia induced by tight ligation of the fifth lumbar spinal nerve in rats through the inhibition of microglial activation and c-Fos expression.

Comparison of Three Modalities for Assessing Block Levels during Spinal or Combined Spinal Epidural Anesthesia for a Cesarean Delivery / 대한마취과학회지

BACKGROUND: Assessing block levels during regional anesthesia has been mainly performed by three sensory modalities: cold, sharp pinprick (analgesia), and pinprick touch (anesthesia). Though sharp pinprick is more commonly used, pinprick touch has been emphasized to be more accurate and predictive by some. We compared block levels and discriminating power between the three modalities in spinal anesthesia (SA) and combined spinal epidural anesthesia (CSEA). METHODS: Forty-six cesarean parturients were randomly given SA (n = 23) or CSEA (n = 23). SA was performed with intrathecal hyperbaric bupivacaine 0.5%-9 mg and fentanyl 20 microgram, and CSEA with intrathecal hyperbaric bupivacaine 0.5%-6 mg and fentanyl 20mug followed by epidural bupivacaine 0.25%-10 ml 5 min later. Upper block levels were measured with cold (alcohol swab), sharp pinprick (25G Whitacre) and pinprick touch (25G Whitacre) at 5, 10, 15, 20, 30, 60, 90, and 120 min after intrathecal injections. RESULTS: There were no complaints of pain through the operation by any patient. The maximum levels (median) using cold, sharp pinprick, or pinprick touch were T1, T2, and T4 in SA and T1, T3, and T4 in the CSEA group and there was no differences between groups. At every measuring time, there were significant differences in block heights of the three modalities in the upper mentioned order. In 5 patients (3 in SA, 2 in CSEA), there was a reverse order between the levels of cold sensation and analgesia. Pinprick touch was kept at the lowest levels at all times, and could discriminate the two blocks at two onset times (5, 10 min), sharp pinprick at one time (5 min) but cold sensation could not. CONCLUSIONS: There were marked differences in block heights measured by the three modalities in the decreasing order of cold, sharp pinprick, and pinprick touch. At the onset of the blocks, pinprick touch was the most discriminating to differentiate the two blocks, followed by a sharp pinprick.

The Comparison of Respiratory Mechanics after Laryngeal Mask Airway and Endotracheal Tube Insertion during Positive Pressure Ventilation / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) is relatively easy to use and may have advantages over an endotracheal tube (ETT). This randomized cross over study was performed to compare the respiratory parameters of a LMA and ETT in anesthetized mechanically ventilated patients. METHODS: Thirty ASA physical status I and II adult patients undergoing peripheral limb surgery were studied. Anesthesia was induced with fentanyl 1.5ng/kg and thiopental sodium 5 mg/kg. Anesthesia was maintained with O2 1 L/min - N2O 1 L/min - enflurane (end tidal concentration 1.0 1.5 vol%) and muscle relaxation was accomplished using vecuronium 0.12 mg/kg. A LMA and ETT were placed in a random sequence in each patient and connected to a ventilator. After 15 minutes of each insertion at the same ventilator setting, ventilatory variables and arterial CO2 partial pressure were measured and physiological dead space/tidal volume ratio was calculated by a CO2SMO plus! respiratory profile monitor. RESULTS: Physiological dead space/tidal volume ratio and airway dead space in the LMA group were significantly higher compared with those in the ETT group. There were no statistically significant differences in dynamic and static compliance. Inspiratory and expiratory airway resistance were lower in the LMA group. There were no significant differences in air leakage fraction and total inspiratory work done by the ventilator on the respiratory system. Airway pressure, arterial, end-tidal and mixed expired CO2 partial pressure were similar in both groups. CONCLUSIONS: Efficiency of ventilation is similar with a LMA and ETT during positive ventilation in patients without pulmonary disease. We found no differences of clinical importance in either group of patients in the range of measured parameters.

Amitriptyline, Desipramine, and Paroxetine Inhibit Nitric Oxide Production in Primary Schwann Cell Cultures of Rats / 대한마취과학회지

BACKGROUND: Antidepressants are being used as supplemental therapy in neuropathic and inflammatory pain. The mechanism of their inhibitory effect on experimental animal inflammation is not clear. Studies during the past few years clearly indicate an important role for nitric oxide (NO) in the inflammation and pain-processing system. We evaluated the effects of amitriptyline, desipramine and paroxetine on NO production in primary Schwann cell cultures. METHODS: Primary cultures of the Schwann cell were prepared from dorsal root ganglia of 1- to 3-day old Spraque-Dawley rats. Schwann cells were cultured in the presence or absence of interferon-gamma (500 ng/ml) plus tumor necrosis factor-alpha (500 ng/ml), amitriptyline, desipramine or paroxetine. Production of NO was determined in the supernatant of the culture media. RESULTS: Amitriptyline (10ng/ml), desipramine (10ng/ml) and paroxetine (10ng/ml) inhibited NO release by 29.8%, 51.4%, and 66.8%, respectively. No drug had a toxic effect on cultured cells, which was determined by an LDH assay. CONCLUSIONS: Inhibition of NO production by Schwann cells may be a mechanism by which some antidepressant medications affect inflammatory and neuropathic pain.

The Effects of Nonspecific Cation Blocker Gadolinium on Hypoxic Pulmonary Vasoconstriction in the Isolated Rabbit Lung / 대한마취과학회지

BACKGROUND: Hypoxic pulmonary vasoconstriction (HPV) is unique to pulmonary circulation. Recent hypotheses have emerged indicating that O2 levels per se can regulate ion channel activity. The modulation of both cation channels differs according to the conduit or resistance pulmonary vessel type. However, it is not yet studied that the cation channel blocker has the same effect in an animal experimental model, which can exclude several factors that may influence on HPV. The purpose of the present study was, therefore, to determine the effect of nonspecific cation blocker, Gadolinium, on HPV in a rabbit model of isolated lung perfusion. METHODS: In adult white rabbits (n = 6), lungs were isolated and perfused with the constant pulmonary perfusate flow. Acid-base status and electrolytes of perfusate also constantly maintained. Thirty minutes after, baseline hypoxic pulmonary vasoconstriction (HPV) was measured as the difference of pulmonary artery pressure between a period of 21% normoxic gas inhalation and that of 3% hypoxic gas inhalation. After another thirty minutes, Gadolinium 50microgram were mixed to the perfusate, and then HPV were measured three times. After then Gadolinium 100, 200, 400microgram were mixed to the perfusate and HPV were measured. RESULTS: Gadolinium decreased the HPV response according to the dose. The ED50 of the response was 143microgram/100 ml. CONCLUSIONS: The regulation of HPV is based on the cation channel in the isolated rabbit lung.

Analgesic Effect and Postoperative Cognitive Impairment of Patient Controlled Analgesia in Postoperative Elderly / 대한마취과학회지

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.

Analgesic Effect and Postoperative Cognitive Impairment of Patient Controlled Analgesia in Postoperative Elderly / 대한마취과학회지

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.

Effects of Body Temperature Changes on Hypoxic Pulmonary Vasoconstriction in Isolated Lungs of Rabbits / 대한마취과학회지

BACKGROUND: We studied the effects of body temperature changes and repeated hypoxic stimulation on hypoxic pulmonary vasoconstriction (HPV). METHODS: We isolated lungs from 15 rabbits and perfused them at a constant flow of 30 ml/kg/min with a 3% albumin-physiologic salt solution containing autologous blood. After a 30-minute stabilization, the temperature of the perfusate was changed from 38oC to 32oC gradually. The lungs were ventilated for 15 minutes with a hyperoxic gas mixture consisting of 95% oxygen and 5% carbon dioxide and then for 5 minutes with a hypoxic gas mixture consisting of 3% oxygen and 5% carbon dioxide with the balance being nitrogen. We repeated the hypoxic stimulation 3 times at the same temperature. The mean pulmonary artery pressure changes and ventilation-related parameters were measured at each hypoxic stimulation. RESULTS: With the first hypoxic stimulation, the hypoxic pressure response at the end of the 5-minute hypoxic period decreased significantly at 32oC. With the second and the third hypoxic stimulations, the hypoxic pressure responses at the end of the 5-minute hypoxic period decreased significantly at both 34oC and 36oC. With repeated hypoxic stimulations, the hypoxic pressure responses potentiated significantly at all temperatures. The baseline mean pulmonary artery pressure increased significantly below 34oC. CONCLUSION: The HPV decreased with the reduction in body temperature and was potentiated by repeated intermittent hypoxia; also, the pulmonary vascular resistance increased with the reduction in the body temperature.