Effect of amaranth seed extracts on glycemic control in HepG2 cells / 한국영양학회지

Purpose@#This study was carried out to investigate the effect of amaranth seed extracts on glycemic regulation in HepG2 cells. The 80% ethanol extracts of amaranth seeds were used to evaluate α-amylase and α-glucosidase activities, cell viability, glucose uptake and messenger RNA (mRNA) expression levels of acetyl-CoA carboxylase (ACC), glucose transporter (GLUT)-2, GLUT-4, insulin receptor substrate (IRS)-1 and IRS-2. @*Methods@#The samples were prepared and divided into 4 groups, including germinated black amaranth (GBA), black amaranth (BA), germinated yellow amaranth (GYA) and yellow amaranth (YA). Glucose hydrolytic enzyme, α-amylase and α-glucosidase activities were examined using a proper protocol. In addition, cell viability was measured by MTT assay. Glucose uptake in cells was measured using an assay kit. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1 and IRS-2 were measured by reverse transcription polymerase chain reaction. @*Results@#The inhibitory activities of α-amylase and α-glucosidase were highly observed in GBA, followed by BA, GYA and YA. Similar results were observed for glucose. The GBA effect was similar compared to the positive control group. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 were significantly increased. The potential hypoglycemic effects of amaranth seed extracts were observed due to the increase in glucose metabolic enzyme activity, and glucose uptake was mediated through the upregulation of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 expression levels. @*Conclusion@#Our findings suggest that the amaranth seed is a potential candidate to prevent a diabetes. The present study demonstrated the possibility of using amaranth seeds, especially GBA and BA for glycemic control.

Effect of intravenous induction agents on emergence delirium after sevoflurane anesthesia in pre-school aged children undergoing adenotonsillectomy

BACKGROUND: In pre-school aged children, the occurrence of emergence delirium (ED) is increased after sevoflurane anesthesia. The purpose of this study was to evaluate if intravenous inducting agents such as propofol, ketamine or thiopental sodium affected the development of ED. METHODS: A total of 62 children between 3 and 6 years of age scheduled for elective tonsillectomy and adenoidectomy were divided into 3 groups in a double-blinded manner. Anesthesia was induced using one of the three drugs intravenously: 5 mg/kg of sodium thiopental, 1 mg/kg of ketamine or 2 mg/kg of propofol. Anesthesia was then maintained with sevoflurane. The development of ED was assessed in the post-anesthetic care unit. RESULTS: The propofol and ketamine group showed a significantly lower pediatric anesthesia emergence agitation (PAEA) score and a lower incidence of ED compared with the thiopental group. CONCLUSIONS: Propofol and ketamine decreased the development of emergence delirium when used as an induction agent.

Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy / 대한마취과학회지

BACKGROUND: This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. METHODS: In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received either 0.3 mg of ramosetron or 4 mg of ondansetron, IV. All patients received fentanyl-based IV PCA during the 48 h postoperative periods. The incidences of PONV and side effects of 5-HT3 antagonists (headache and dizziness) were assessed at 3 intervals (<2 h, 2-24 h and 24-48 h) postoperatively. RESULTS: Patients in the ramosetron group showed a significantly higher ratio of complete response and lower incidence of nausea during the 24-48 h interval after surgery compared with those the ondansetron group. CONCLUSIONS: Ramosetron (0.3 mg) is more effective in preventing delayed PONV in highly susceptible women undergoing abdominal hysterectomy compared with ondansetron (4 mg).

Effects of preoxygenation with the three minutes tidal volume breathing technique in the elderly / 대한마취과학회지

BACKGROUND: Preoxygenation with tidal volume breathing for 3 min is commonly used technique. An end tidal expiratory oxygen concentration greater than 90% is considerd to be adequate for preoxygenation. The aim of this study was to check the effects of preoxygenation on elderly patients through the comparison with young patients during the 3 min tidal volume breathing technique. METHODS: Sixty patients from ASA class I or II who were scheduled for elective orthopedic general surgery were divided into an elderly (>65 yr) group and a control (25-65 yr) group. Patients were instructed in the technique of preoxygenation. Preoxygenation was accomplished with an appropriately sized face mask connected to an anesthesia machine with 100% oxygen during 3 min with patients in both groups. Expired O2, CO2 concentration and oxygen saturation were recorded simultaneously for 3 min. RESULTS: The elderly group showed significantly lower end tidal oxygen concentration than the control group from 50 sec to the end of study (180 sec) with the 3 min tidal volume breathing technique (P < 0.05). In 180 sec, the control group had over 90% (91.5%) end tidal oxygen concentration, but in the elderly group end tidal oxygen concentration could not reach 90% (86.2%). In oxygen saturation, the elderly group showed a significantly lower level until 40 sec from the start of study, and then two groups showed a similar levels of oxygen saturation until the end of study. CONCLUSIONS: End tidal oxygen concentration did not reach 90% in 180 sec in the elderly group during preoxygenation with the 3 min tidal volume breathing technique.

The influence of age and gender on remifentanil EC(50) for preventing rocuronium induced withdrawal movements / 대한마취과학회지

BACKGROUND: Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC(50) of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. METHODS: We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patient's response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixon's up-and -down method. RESULTS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 +/- 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 +/- 1.0 ng/ml [1.3-3.2] in the female group, 0.5 +/- 0.4 ng/ml [0.2-0.8] in the old group and 2.8 +/- 0.8 ng/ml [2.1-3.5] in the child group. CONCLUSIONS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC(50) of remifentanil was seen between male and female adult patients.

The optimal preemptive dose of gabapentin following gynecologic surgery / 대한마취과학회지

BACKGROUND: Gabapentin decreases acute nociceptive pain in animal and human studies when given before surgical incision. Various doses of gabapentin have been used (300-1,200 mg) to measure this preemptive effect. Here, we evaluated the optimal dose of gabapentin for reducing fentanyl consumption and the adverse effects of gabapentin following gynecologic surgery. METHODS: We recruited 100 patients who underwent laparotomy for gynecologic surgery. Patients were randomly divided into 4 groups and received a placebo (control), gabapentin 300 mg (G 300), gabapentin 600 mg (G 600), or gabapentin 1,200 mg (G 1200) 2 h before surgery. Postoperatively, patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses were recorded 2, 6, 12, 24 h, and 48 h postoperatively, and the sedation scale was recorded in the post anesthetic care unit (PACU). RESULTS: The postoperative fentanyl requirement was lower with gabapentin treatment, but there was no significant differences for the different doses. PACU sedation scores were not different in any group. CONCLUSIONS: Gabapentin has a preemptive effect in gynecologic surgery, but there were no additional fentanyl-sparing benefits at doses above 300 mg. Thus, 300 mg is an optimal dose for decreasing fentanyl consumption following gynecologic surgery.

Common peroneal nerve palsy after robotic assisted laparoscopic colectomy: A case report / 대한마취과학회지

Common peroneal nerve palsy after surgery with lithotomy position has been widely reported, but it is an unexpected complication after surgery with supine position. We report a patient who developed common peroneal nerve palsy after surgery with supine position. A 55-year old man is planed for robotic assisted laparoscopic right hemicolectomy because of colon cancer. The patient was placed supine with Trendelenburg position at an angle about 5 degrees and tilted left about 15 degrees. The operation is uneventful, but he developed common peroneal nerve palsy on the first postoperative day. The patient was fully recovered with conservative treatment after 2 months. We consider that nerve palsy as a result of compression of common peroneal nerve related to patient positioning. So we should be careful not to develop common peroneal nerve palsy even if the patient was placed in the supine position during robotic assisted surgery.

The changes of the sternomental distance under general anesthesia and with increasing age

BACKGROUND: Because the sternomental distance (SMD) is evaluated in conscience patients and in the sitting position, this could change under general anesthesia, which is a state that the patient is unconscious and fully relaxed in the supine position. Increasing age also affects the SMD. We investigated the change in the SMD with the patients under general anesthesia and we also investigated the effect of age on the SMD. METHODS: A total of 108 patients were allocated to Group Y (20-30 yr), Group M (31-50 yr) and Group O (51-70 yr). The SMD, as measured when the patients were awake and sitting, was defined as baseline. The SMD was measured in the supine position, the shoulder-suppressed supine position, at the time of loss of consciousness (LOC), 4 min after vecuronium administration and in the sniffing position. The percent change of the SMD (%) was defined as (the baseline SMD - the measured SMD)/the baseline SMD x 100. RESULTS: Compared with the baseline, the SMD decreased significantly in the supine position, the shoulder-suppressed supine position, at the time of LOC, during neuromuscular blockade and in the sniffing position in all the groups. Group O showed a shorter SMD than did Groups Y and M for all the measurements. There was no significant difference in the percent change of the SMD between the groups. CONCLUSIONS: This study demonstrated that the SMD was significantly reduced by the supine position, the sniffing position, at the time of loss of consciousness and during neuromuscular blockade with the patient under general anesthesia and also with the increasing age of the patient.

The influence of ABCB1 and OPRM1 genetic polymorphism on fentanyl requirements for postoperative pain control / 대한마취과학회지

BACKGROUND: Fentanyl, which is a potent synthetic micron-opioid receptor agonist, is one of the most widely used opioids in anesthesia and pain control. However, the pharmacodynamics of fentanyl show wide inter-individual variability. Therefore, this study was conducted to evaluate the influence of the blood-brain barrier transporter protein, p-glycoprotein, and micron-opioid receptor genetic polymorphism on fentanyl pharmacodynamics. METHODS: Seventy-nine patients who underwent posterior lumbar interbody fusion (PLIF) were included in this study. Postoperatively, the patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses and other pharmacodynamic data were then recorded at 2 h, 6 h, 12 h, 24 h and 48 h after the operation. In addition, genomic DNA was isolated from the patient's peripheral leukocytes and then evaluated for the presence of OPRM1 A118G and ABCB1 C3435T genetic polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The results of this study indicated that ABCB1 C3435T genetic polymorphism may be related to the cumulative fentanyl requirement for postoperative pain control. However, these findings were not statistically significant (P = 0.09). In addition, no relationship was observed between OPRM1 A118G and the cumulative postoperative fentanyl requirement. However, the cumulative postoperative fentanyl requirement was lower in the TTAA group (ABCB1 3435 TT, OPRM1 118 AA) than in the CCGG group (ABCB13435 CC, OPRM1 118 GG). CONCLUSIONS: The ABCB1 C3435T polymorphism may affect fentanyl pharmacodynamics. However, further studies are required to confirm the relationship between p-glycoprotein and fentanyl.

Comparison of the Effects of Intrathecal Fentanyl and Meperidine on Shivering after Cesarean Delivery under Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Meperidine has proved a far more effective treatment for shivering after spinal anesthesia than equianalgesic doses of opioid agonist. We performed this prospective, double-blinded, randomized study to compare the antishivering effect of fentanyl and meperidine when added to intrathecal hyperbaric bupivacaine during Cesarean delivery under spinal anesthesia. METHODS: Sixty ASA I or II patients undergoing Cesarean delivery under spinal anesthesia were randomly assigned into three groups. Fentanyl 12.5 ug (group F) or meperidine 12.5 mg (group M) or normal saline 2.5 ml (group C) were added to 0.5% hyperbaric bupivacaine 8.5 mg for spinal anesthesia. Data including mean arterial pressure, heart rate, sensory block level, core temperature, shivering incidence and intensity were collected every 2 min for 10 min and then every 5 min until the end of surgery. RESULTS: There were no significant statistical differences in patient characteristics, the mean arterial pressure, heart rate and core temperature among the groups. The incidences of shivering in fentanyl and meperidine group were significantly lower than in the control group, but there were no significant differences between fentanyl and meperidine group. Shivering intensity was significantly lower in fentanyl and meperidine group than in the control group. CONCLUSIONS: Intrathecal fentanyl and meperidine added to 0.5% hyperbaric bupivacaine are effective in reducing the incidence and intensity of shivering associated with spinal anesthesia.

Effects of Ischemic Preconditioning and Propofol on Cardiac Function and Coronary Flow following Cold Cardioplegia and Reperfusion in Isolated Rat Heart / 대한마취과학회지

BACKGROUND: The interaction between ischemic preconditioning (IPC) and propofol-induced cardioprotective effects during prolonged cold ischemia has not been studied yet. The purpose of this study is to investigate the effects of ischemic preconditioning and propofol on cardiac function and the development of endothelial injury after 4 hours of cold cardioplegia and reperfusion. METHODS: After suspension of the isolated heart on the Langendorff perfusion system, we took a stabilizing period for 15 minutes, perfusion period for 15 minutes, global cold (4oC) ischemic period for 4 hours, and then reperfusion period for 60 minutes. There were 4 groups: (1) CONTROL group, no intervention; (2) IPC group, two 2-minute total coronary occlusions interspaced with 5 minutes of normal reperfusion; (3) PROPOFOL group, propofol (2micrometer) was infused during reperfusion period; (4) BOTH group, ischemic preconditioning and postischemic propofol treatment group. The measurements of cardiac performances, such as left ventricular developed pressure (LVDP), rate of ventricular pressure generation (dp/dt), and heart rate (HR) was obtained at pre- and postischemic periods. For the evaluation of endothelial injury during reperfusion period, coronary flow responses to bradykinin were tested. Infarct size was measured using the triphenyl tetrazolium stain. RESULTS: IPC, PROPOFOL, and BOTH groups showed better outcome of LVDP, dp/dt, HR, and flow responses to bradykinin than CONTROL group did. But there is no statistically significant difference in variables among the three groups. CONCLUSIONS: Ischemic preconditioning and postischemic propofol have cardioprotective effect respectively but no additive effect after 4 hours cold cardioplegia and reperfusion.

Delayed Recovery after Continuous Infusion of Midazolam in Hepatic Dysfunction: A case report / 대한마취과학회지

Benzodiazepines are frequently administered for sedation to surgical intensive care unit patients who require postoperative intubation and mechanical ventilation. Midazolam is the most commonly used drug, which is water soluble, short-acting benzodiazepine and rapidly metabolized by the liver. Continuous intravenous infusion of midazolam was administered to the man who was 40 years old for mechanical ventilation in the intensive care unit for 58 hours. After discontinued midazolam, patient who had acute hepatic dysfunction had been sedated with endotracheal intubation for 5 days. Even flumazenil was tried twice to reverse the effect of midazolam, the response was limited by the time. Finally he awaked as recovery of his hepatic function.

Decrease in Arterial Oxygen Partial Pressure by Pleural Opening in Thoracotomy during One-Lung Ventilation / 대한마취과학회지

BACKGROUND: One-lung ventilation (OLV) is commonly used in the majority of thoracotomies and thoracoscopic surgeries. During OLV, a decrease in partial pressure of arterial oxygen (PaO2) occurs due to the right-to-left transpulmonary shunt that develops in the non-dependent lung, and is aggravated just after pleural opening. Here, we examined the occurrence, cause, and means of preventing drops in PaO2 caused by pleural opening. METHODS: Seventy patients, ASA PS I or II, who were scheduled for elective thoracotomy or thoracoscopic surgery, were prospectively examined. After OLV, patients were randomly allocated to one of four groups. In the Control group (n = 10), pleurae were not opened during studies. In the Open group (n = 20), pleurae were opened with the plug of the double-lumen endobronchial tube of the non-dependent lung opened. In the Closure group (n = 20), the plug was closed just before pleural opening. And in the continuous positive airway pressure (CPAP) group (n = 20), pleurae were opened after applying 5 cmH2O CPAP of medical air to the non-dependent lung. Arterial blood gas analyses, hemodynamics, end-tidal CO2, peak inspiratory airway pressure, lung compliance, and airway resistance were recorded 15 min after two-lung ventilation, 20 min after transition to OLV, just before pleural opening, and 1, 3, and 20 min after pleural opening. In the control group, data were recorded 15 min after two-lung ventilation and in seven intervals after transition to OLV (1, 3, 5, 10, 20, 25, and 45 min). RESULTS: A significant decrease in PaO2 was detected just after pleural opening in the Open and Closure groups. PaO2 decreased in the Open group more than in the Closure group. However, in the CPAP group, no significant PaO2 reduction was detected after pleural opening. CONCLUSIONS: We found that PaO2 decreased when pleurae were opened during OLV. This may be due to the sudden development of atelectasis in the non-dependent lung by exposure to atmospheric pressure. This decrease in PaO2 can be relieved by closing the double-lumen endobronchial tube's plug of the non-dependent lung or by applying CPAP to the non-dependent lung when pleurae are opened.

Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report / 대한마취과학회지

A 37-year-old male was admitted for a hemorrhoidectomy. He received uneventfully spinal anesthesia for a hemorrhoidectomy. He had no previous history of any allergic tendency. By the request of the general surgeon, a cefotetan was intravenously administered slowly to reduce the incidence of infection. A few minutes later, anaphylactic reaction developed with hypotension, tachycardia, consciousness change and urticaria. After appropriate management, he recovered without any complication.

Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report / 대한마취과학회지

A 37-year-old male was admitted for a hemorrhoidectomy. He received uneventfully spinal anesthesia for a hemorrhoidectomy. He had no previous history of any allergic tendency. By the request of the general surgeon, a cefotetan was intravenously administered slowly to reduce the incidence of infection. A few minutes later, anaphylactic reaction developed with hypotension, tachycardia, consciousness change and urticaria. After appropriate management, he recovered without any complication.

Effect of Etomidate on the Expressions of c-JUN and Heat Shock Protein 70 Induced by Kainic Acid in Rats / 대한마취과학회지

BACKGROUND: The present investigation was undertaken to evaluate the neuroprotective effect of etomidate against kainic acid (KA) induced neurotoxicity in rats by Western immunoblotting for heat shock protein 70 (HSP-70), c-JUN, and by acid-fuchsin histochemistry. METHODS: Etomidate (20 mg/kg, i.p.) was administered in sequence, first being just one hour after KA (10 mg/kg, i.p.) injection, then three times one hour intervals. Neuronal damage in hippocampus was evaluated by using acid-fuchsin stain to detect cell death and HSP-70 and c-JUN induction as an index of cell injury at 3, 6, 24 and 48 h after the administration of KA. RESULTS: Acid fuchsin positive neurons were increased in the CA1 and CA3 regions of the hippocampus after KA injection, but were significantly decreased by etomidate injection (P <0.01). Etomidate administration also significantly suppressed the KA-induced induction of c-JUN and HSP-70 in both regions of the rat hippocampus. CONCLUSIONS: These results suggest that etomidate has a protective effect on hippocampal neurons against KA-induced neurotoxicity.

Effect of Ear Mushroom (Auricularia) on Functional Constipation / 대한소화기학회지

BACKGROUND/AIMS: Constipation is one of the most prevalent gastrointestinal complaints. High fiber intake is recommended as an initial therapy for constipation. Ear mushroom is known to have higher fiber contents about 50% than other mushroom. The aim of this study was to evaluate the effect of fiber supplements using ear mushrooms on the improvement of functional constipation. METHODS: We conducted a double blind study with 3 groups (placebo, ear mushrooms alone, and ear mushrooms with additives including cascara sagrada, etc.), which were randomly assigned out of 34 patients with functional constipation, defined by modified Rome II criteria. Number of bowel movement, straining, sense of incomplete evacuation, stool consistency, satisfactory relief, abdominal pain/discomfort and colon transit time were evaluated and analyzed before, during and after the treatment. RESULTS: Both ear mushrooms alone and ear mushrooms with additives significantly improved number of bowel movement, straining, sense of incomplete evacuation, stool consistency and satisfactory relief in patients with functional chronic constipation (p<0.05). Although the use of ear mushrooms with additives was found to be more effective on the improvement of constipation than ear mushrooms alone, it may induce abdominal discomfort or pain. CONCLUSIONS: In patients with functional constipation, fiber supplements using ear mushrooms significantly improved constipation related symptoms without serious side effect.

Comparison of Hypoxanthine-Guanine Phosphoribosyltransferase Activity between Normal and Gout Patients / 대한류마티스학회지

OBJECTIVE: It has been known that the enzyme deficiency associated with uric acid production is the minor cause of gout. The purpose of this study is to evaluate the role of hypoxanthine- guanine phosphoribosyltransferase (HGPRT) activity deficiency in the development of gout. METHODS: Assay of HGPRT activity was performed on 38 gout patients and 107 controls compromising 82 men and 25 women. In the patients with gout, age of onset, sex, family history of gout, duration of disease, serum uric acid level, and uric acid concentration of 24-hour urine were analyzed. RESULTS: In gout patients and control male group, the HGPRT activity was lowest in the age of forties. But, in female, there was no decreasing tendency with aging. In 4 gout patients, HGPRT activities were severely deficient and their ages of onset were less than 30 years old, and all have a family history of gout. CONCLUSION: In men, the lowest HGPRT activity in the age of forties could be one of the factors that make the onset of gout is highest in the fifth decade of age. The deficiency of HGPRT enzyme and family history of gout are the important factors in the pathogenesis of early onset gout.

Peripheral Effect of Neostigmine and L-NAME on Acute Arthritis in the Rat / 대한마취과학회지

BACKGROUND: The spinal administration of neostigmine has been shown to produce analgesia, but this analgesia is limited by adverse effects. This study was designed to determine whether intra-articular neostigmine results in an analgesic effect in a rat inflamed knee joint model, and to investigate the possible involvement of nitric oxide in neostigmine-induced analgesia. METHODS: Male Sprague Dawley rats were divided into three groups; control group, neostigmine group (1, 3, 10micro gram), and L-NAME group (neostigmine 1, 3, 10micro gram + L-NAME 500micro gram). Inflammation was induced by injecting 2% carageenan into the right knee joint. Intraarticular drugs were injected at an hour after the injection of carageenan. Effects of these drugs were assessed before and at 4, 8, 12, 24, 60, and 120 hours after inflammation using a Dynamic plantar aesthesiometer. RESULTS: There were significant differences between the neostigmine 3, and 10micro gram group and the control group. There were no significant differences between the neostigmine group and the L-NAME group except for in the neostigmine 10micro gram L-NAME group at 24 hours. There were no significant differences between the neostigmine 3micro gram L-NAME group and the control group. This result shows that injection of L-NAME partially reverses the anlgesic effects of the neostigmine. CONCLUSIONS: Intra-articular neostigmine results in an analgesic effect at the site of inflammation. Although this study could not prove the involvement of nitric oxide in the peripheral analgesic effect of neostigmine, it demonstrates the possible involvement of nitric oxide in neostigmine-induced analgesia.