Metabolomics Changes of Serum and Tissues in Mice Died of Acute Tetracaine Poisoning / 法医学杂志

Objective To study the changes of metabolites in serum and tissues （kidney, liver and heart） of mice died of acute tetracaine poisoning by metabolomics, to search for potential biomarkers and related metabolic pathways, and to provide new ideas for the identification of cause of death and research on toxicological mechanism of acute tetracaine poisoning. Methods Forty ICR mice were randomly divided into control group and acute tetracaine poisoning death group. The model of death from acute poisoning was established by intraperitoneal injection of tetracaine, and the metabolic profile of serum and tissues of mice was obtained by ultra-high performance liquid chromatography-electrostatic field orbitrap high resolution mass spectrometry （UPLC-Orbitrap HRMS）. Multivariate statistical principal component analysis （PCA） and orthogonal partial least square-discriminant analysis （OPLS-DA） were used, combined with t-test and fold change to identify the differential metabolites associated with death from acute tetracaine poisoning. Results Compared with the control group, the metabolic profiles of serum and tissues in the mice from acute tetracaine poisoning death group were significantly different. Eleven differential metabolites were identified in serum, including xanthine, spermine, 3-hydroxybutylamine, etc.; twenty-five differential metabolites were identified in liver, including adenylate, adenosine, citric acid, etc.; twelve differential metabolites were identified in heart, including hypoxanthine, guanine, guanosine, etc; four differential metabolites were identified in kidney, including taurochenodeoxycholic acid, 11, 12-epoxyeicosatrienoic acid, dimethylethanolamine and indole. Acute tetracaine poisoning mainly affected purine metabolism, tricarboxylic acid cycle, as well as metabolism of alanine, aspartic acid and glutamic acid. Conclusion The differential metabolites in serum and tissues of mice died of acute tetracaine poisoning are expected to be candidate biomarkers for this cause of death. The results can provide research basis for the mechanism and identification of acute tetracaine poisoning.

Comparative analyses of response surface methodology and artificial neural networks on incorporating tetracaine into liposomes

This study evaluated the incorporation of tetracaine into liposomes by RSM (Response Surface Methodology) and ANN (Artificial Neural Networks) based models. RCCD (rotational central composite design) and ANN were performed to optimize the sonication conditions of particles containing 100 % lipid. Laser light scattering was used to perform measure hydrodynamic radius and size distribution of vesicles. The liposomal formulations were analyzed by incorporating the drug into the hydrophilic phase or the lipophilic phase. RCCD and ANN were conducted, having the lipid/cholesterol ratio and concentration of tetracaine as variables investigated and, the encapsulation efficiency and mean diameter of the vesicles as response variables. The optimum sonication condition set at a power of 16 kHz and 3 minutes, resulting in sizes smaller than 800 nm. Maximum encapsulation efficiency (39.7 %) was obtained in the hydrophilic phase to a tetracaine concentration of 8.37 mg/mL and 79.5:20.5% lipid/cholesterol ratio. Liposomes were stable for about 30 days (at 4 ºC), and the drug encapsulation efficiency was higher in the hydrophilic phase. The experimental results of RCCD-RSM and ANN techniques show ANN obtained more refined prediction errors that RCCD-RSM technique, therefore, ANN can be considered as an efficient mathematical method to characterize the incorporation of tetracaine into liposomes.

Assessment of non-invasive tear break-up time and tear meniscus height after instillation of three different formulations of anesthetic eye drops by Oculus Keratograph 5M / Avaliação do tempo de ruptura lacrimal não invasivo e da altura do menisco lacrimal após a instilação de três diferentes formulações de colírio anestésico por Oculus Keratograph 5M

Abstract Purpose: To assess the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) after instilling the three different types of anesthetic eye drops by Oculus Keratograph 5M. Methods: In this prospective study, 85 healthy subjects (85 eyes) were randomly divided into three groups. The groups were randomly received lidocaine hydrochloride 2%, proparacaine hydrochloride 0.5%, and tetracaine hydrochloride 0.5%. The qualitative and quantitative parameters of tear film were assessed using NITBUT and TMH, respectively. In all groups, the quantity of tear film using TMH was measured in the right eye of subjects, while the quality of tear film using NITBUT was assessed in the left eye. The analysis of variance (ANOVA) was used to compare the difference between before and after the intervention. A P-value < 0.05 was considered significant. Results: Differences for TMH and NITBUT between before and after applying lidocaine hydrochloride 2% were not statistically significant (P > 0.05). The mean values of NITBUT and TMH after the instillation of proparacaine hydrochloride 0.5% showed a significant decrease than before the intervention (P < 0.05). Also, after the use of tetracaine hydrochloride 0.5%, the mean value of NITBUT was significantly increased (P < 0.05), but the mean value of TMH was significantly decreased than before the intervention (P < 0.05). Conclusion: Our study showed that lidocaine hydrochloride 2% as an anesthetic eye drops can be an appropriate choice for eye examinations due to a lack of significant effect on the quantity and quality of tear film.

Resumo Objetivo: Avaliar o tempo de ruptura lacrimal não invasivo (NITBUT) e a altura do menisco lacrimal (TMH) após instilar os três tipos diferentes de colírio anestésico pelo Oculus Keratograph 5M. Métodos: Neste estudo prospectivo, 85 indivíduos saudáveis (85 olhos) foram divididos aleatoriamente em três grupos. Os grupos receberam aleatoriamente cloridrato de lidocaína a 2%, cloridrato de proparacaína a 0.5% e cloridrato de tetracaína a 0.5%. Os parâmetros qualitativos e quantitativos do filme lacrimal foram avaliados utilizando NITBUT e TMH, respectivamente. Em todos os grupos, a quantidade de filme lacrimal utilizando TMH foi medida no olho direito dos sujeitos, enquanto a qualidade do filme lacrimal usando NITBUT foi avaliada no olho esquerdo. A análise de variância (ANOVA) foi utilizada para comparar a diferença entre antes e depois da intervenção. Um valor de P < 0.05 foi considerado significativo. Resultados: Diferenças para TMH e NITBUT entre antes e depois da aplicação de cloridrato de lidocaína a 2% não foram estatisticamente significantes (P > 0.05). Os valores médios de NITBUT e TMH após a instilação de cloridrato de proparacaína a 0.5% mostraram uma diminuição significativa do que antes da intervenção (P < 0.05). Além disso, após o uso de cloridrato de tetracaína a 0.5%, o valor médio de NITBUT foi significativamente aumentado (P < 0.05), mas o valor médio de TMH foi significativamente menor do que antes da intervenção (P < 0.05). Conclusão: Nosso estudo mostrou que o cloridrato de lidocaína a 2% como colírio anestésico pode ser uma escolha apropriada para exames oftalmológicos devido à falta de efeito significativo sobre a quantidade e a qualidade do filme lacrimal.

Anatomic and anaesthetic considerations of greater palatine nerve block in Indian population

Background: Greater palatine nerve block holds its importance for anaesthesia and analgesia in different maxillofacial surgical procedures. Accuracy in localization of greater palatine foramen is required for its successful implication in regional block, although racial variations exist in various population groups

Aims: To study the morphometry of greater palatine foramen and its location with nearby anatomical landmarks in Indian population. Material and Methods: A total of one hundred dry skulls [60 males and 40 females] were collected and observed for the study. Various parameters were noted from greater palatine foramen on both sides, together with its location with respect to maxillary molar tooth. Along with that the angle between midline maxillary suture and Incisive foramen-Greater palatine foramen is measured

Results: 198 sides were measured and the most common location of greater palatine foramen was found to be medial to third molar tooth [71.21%]. The mean distance from greater palatine foramen to midline maxillary suture on right and left sides were 14.82 +/- 1.34 mm and 14.79 +/- 1.57 mm, statistically insignificant. The angle between midline maxillary suture and incisive foramen-greater palatine foramen was 20.81 degree +/- 2.47 degree on right side and 20.58 degree +/- 2.69 degree on left side.The direction of the opening of greater palatine canal onto the hard palate was observed to be antero-medial in 60.10% of cases

Conclusions: Our study reveals the importance of usage of various anatomical parameters for precise location of greater palatine foramen, establishment of specific measurements in each population group and thereby applying such measurements for successful greater palatine nerve block

Estudo clínico e histológico das pálpebras e conjuntiva hígidas submetidas ao tratamento tópico com soluções anestésicas em coelhos / Clinical and histological evaluation of healthy eyelid and conjunctiva subject to local treatment with anesthetic solutions in rabbits

Avaliaram-se as apresentações comerciais de colírios anestésicos aplicados em 63 coelhos da raça Nova Zelândia, distribuídos em três grupos (G1, G2 e G3) de 21 animais cada e que receberam instilação de uma gota em cada olho seis vezes ao dia. Os animais do G1 foram tratados com colírio de cloridrato de proparacaína a 0,5%; os do G2, com colírio de cloridrato de tetracaína a 1% associado à fenilefrina a 0,1%; e os do G3, com solução fisiológica. Cada grupo foi subdividido em três subgrupos com sete animais cada, os quais foram tratados por três, sete e 15 dias. No final de cada tratamento, dois animais de cada subgrupo foram sacrificados para exame histológico de fragmentos retirados da conjuntiva, da terceira pálpebra e das pálpebras. Observou-se, ao exame clínico, episclerite em graus diversos em 100% dos animais do G1, no terceiro, sétimo e 15º dia, e em apenas 17,8% nos do G2, nestes mesmos dias. Ao exame microscópico, observaram-se aumento do número de células califormes, proliferação de folículos linfoides, aumento do número de eosinófilos e aumento do espaço intersticial nas pálpebras dos animais do G1. Pôde-se concluir que o colírio de tetracaína a 1% associado à fenilefrina a 0,1% promoveu maior toxicidade à conjuntiva ocular e às pálpebras de coelhos quando comparado ao colírio de proparacaína a 0,5%.

This work aimed to evaluate commercial presentations of anesthetic eye drops in sixty three New Zealand rabbits which were separated equally in three groups (G1, G2 and G3). The G1 group was treated with 0.5% proparacaine chloridrate eye drop, G2 group with 1% tetracaine chloridrate associated with 0.1% phenylephrine eye drop and G3 group with 0.9% physiologic solution eye drop. All of them received one drop in each eye six times a day. Each group was subdivided into three subgroups (seven rabbits), which are treated for 3, 7 and 15 days. At the end of each treatment, two animals in each subgroup were subject to euthanasia, for the purpose of conjunctiva, eyelids and third eyelids histological evaluation. At the clinical exam, different grades of episcleritis were found in all rabbits in G2 group and only in 17.8% of the rabbits in G1 group. Eye and eyelid histologic evaluation of G2 group revealed an upgrade of goblet cells and eosinophil number, lymphoid follicle proliferation and increase of interstitial space in the eyelids. We could conclude that 1% tetracaine associated with 0.1% phenylephrine eye drop caused more eyelid and ocular conjunctiva toxicity than 0.5% proparacaine eye drop.

Effect of tetracaine on intraocular pressure in normal and hypertensive rabbit eyes

Purpose: To evaluate the effect of tetracaine on intraocular pressure [IOP] in normal and hypertensive rabbit eyes

Methods: The study was conducted on 12 healthy rabbits as controls and 6 healthy rabbits in which an experimental model of ocular hypertension [OHT] was induced by administration of 70 mL/kg of tap water through an orogastric tube. One drop of tetracaine was instilled in the left eye while a drop of normal saline [placebo] was applied to the right eye of the control group. IOP was measured before and 0, 5, 10, 15, 20, 25, 30, 35 and 40 minutes after drop administration in this group. The OHT group also received one drop of tetracaine and normal saline in the left eyes and right eyes respectively, immediately after water loading; the instillation of drops was repeated after 55 minutes. IOP was measured before and 0, 5, 10, 15, 20, 25, 30, 35, 40, 55, 70, 85, 100 and 115 minutes after water loading in this group

Results: Tetracaine treated eyes in both groups [ocular hypertensive and normal controls] demonstrated significant IOP reduction at time zero [immediately after drop instillation] which was sustained up to 20 minutes, as compared to placebo treated eyes [P<0.05]. In ocular hypertensive rabbits, repeat instillation of tetracaine significantly reduced IOP at 55 minutes up to 30 minutes thereafter

Conclusion: Topical tetracaine can reduce IOP; this fact should be considered in experiments evaluating IOP reducing agents

[Systemic side-effects of topical ophthalmic drops in a 17-year old boy candidate for deep viterectomy: a case report]

Drugs applied topically to the eye may be absorbed systemically to a substantial degree, with the potential to cause serious systemic side-effects. Children may be particularly vulnerable to systemic effects of topically applied agents as topical doses are often not weight-adjusted. This article describes a case of serious systemic side-effect by the use of topical phenylephrine, tetracaine, tropicamide and atropine in a 17-year old boy candidate for deep viterectomy in Farabi Hospital in 1389. Following application of the aforesaid eye drops, the patient developed hypertension and subsequent loss of conciseness. Several types of eye drops and their repeated use can lead to their systemic absorption and medical complications due to overdose. Strategies to minimize systemic absorption should be applied, including use of low concentrations of ophthalmic drugs, administration of one type of the drug, use of microdrops and punctal occlusion to minimize absorption via the nasolacrimal duct. While administering ophthalmic drops, one should take these precautions to minimize the systemic effects of the drugs to prevent subsequent complications

Efficacy and safety of a lidocaine/tetracaine medicated patch or peel for dermatologic procedures: a meta-analysis / 대한마취과학회지

BACKGROUND: To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo. METHODS: Ten RCTs (574 patients) were included in this systemic review. Relevant studies were identified through searches of MEDLINE, SCOPUS and the Cochrane database library. The outcome was the adequacy of cutaneous anesthesia reflected in the patient's assessment of pain intensity during minor dermatologic procedures and adverse effects after application of the lidocaine/tetracaine medicated patch or peel versus placebo. RESULTS: The efficacy of the lidocaine/tetracaine patch or peel was consistently very significantly beneficial 30 or 60 minutes after the application compared to placebo (Relative risk, RR: 2.5; Number needed to treat, NNT: 2.2). We did not identify any difference in the effectiveness of adequate analgesia between the lidocaine/tetracaine patch and peel (the number needed to treat or to harm, NNT 2.4 vs. 2.0). No serious side effects or adverse events were observed with the lidocaine/tetracaine medicated patch or peel and placebo. Minor skin reactions were transient and resolved without treatment (Odd ratio, OR: 1.4 and 95% confidence interval, CI: 0.9-2.1; NNT: 14.9). CONCLUSIONS: The lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.

Evaluation of the effect of tetracaine 1% on central corneal thickness obtained by ultrasound and SP-3000P

To study the effect of tetracaine 1% on central corneal thickness measurements obtained by the ultrasound pachymetry and Topcon SP-3000P specular microscope. In the following sequence, SP-3000P before anaesthesia, Ultrasound pachymetry before anaesthesia, SP-3000P 10 minutes after anaesthesia, Ultrasound pachymetry 10 minutes after anaesthesia, central corneal thickness measurements were obtained from 100 randomly selected eyes of 50 oculovisually young adults in two measurement sessions. The central corneal thickness before instilling anaesthesia did not vary significantly in each technique within-session [p>0.05] and between sessions [p>0.05]. Baseline central corneal thickness measurements obtained by Ultrasound pachymeter was significantly [P<0.0001] higher than that of SP-3000P by about 28 micro m and 29 micro m in sessions one and two respectively. A small but statistically insignificant decrease in CCT [P>0.05] was observed 10 minutes after instilling one drop of 1% tetracaine in sessions 1 whereas a statistically insignificant increase [P>0.05] in CCT in session two measurements of SP-3000P was observed. There was a statistically significant increase in CCT [p<0.05] obtained by ultrasound pachymeter 10 minutes after instilling one drop of 1% tetracaine in sessions I and an increase that was not quite significant [P>0.05] also observed in the second measurement session of ultrasound pachymetry. The precision of the effects of anaesthesia in ultrasound pachymeter for sessions 1 and 2 were+l5 micro m and+31 micro m, and in SP-3000P sessions 1 and 2 respectively were+16 micro m and +/- 13 micro m. Topical anaesthesia might have an effect on CCT measurements made with the ultrasound pachymeter. Such an effect could be due to instability of the tear film caused by the anaesthetic, and this effect was not measurably with the SP-3000P suggesting that the difference in the principles of operation of both pachymeters might play a significant role in the detection of changes in CCT induced by topical anaesthesia

[Prevalence of abuse of ophtalmic anesthetic drops among welders in Kerman city [2007]]

Abuse of topical anesthetic drops causes serious ocular complications. Obtaining information about the prevalence of anesthetic drops abuse among high risk groups specially welders is necessary for taking appropriate strategies for prevention. The present study aimed at determining the prevalence of anesthetic drops abuse among welders in Kerman. In this cross-sectional study, 390 welders selected randomly were asked for the consumption of anesthetic drops by using a questionnaire. Data were analyzed by SPSS 11.5 software. In whole, 314 ones [80.5%] said that they use tetracaine and of whom 295 ones [93.9%] had used the drug frequently. Lack of time for referring to Physician, high cost of visiting by physicians, spontaneous relief of symptoms and no other therapeutic measure by physicians were the most important reasons of self-treatment in welders. In whole, 216 ones [69.3%] had heard about these drugs from their coworkers, 85 ones [27.2%] from physicians, 51 ones [16.3%] from pharmacy personnel and 9 ones [2.9%] from their family members. The prevalence of abuse was significantly higher in those with post secondary educational level [P<0.05]. Most of the subjects [97.4%] had got the drugs from pharmacies and without prescription. High prevalence of anesthetic drops abuse among welders and probably other similar jobs and educated people, their prescription by general practitioners and their selling in pharmacies without prescription requires more serious measures for prevention

Spinal Anesthesia with Isobaric Tetracaine in Patients with Previous Lumbar Spinal Surgery

PURPOSE: Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. MATERIALS AND METHODS: Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. RESULTS: The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). CONCLUSION: The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.

Clinical observation on effect of auricular point injection combined with superficial anesthesia for nasal endoscopy surgery / 中国针灸

<p><b>OBJECTIVE</b>To observe the anesthetic effect of combined superficial anesthesia and auricular point injection for nasal endoscopy surgery.</p><p><b>METHODS</b>Forty cases of grade I - II as ASA for nasal endoscopy surgery were randomly divided into a combined auricular point injection and superficial anesthesia group (group A) and a simple superficial anesthesia group (group B), 20 cases in each group. Both groups accepted superficial anesthesia 2 times on the bilateral nasal cavities with cotton pieces that was immersed in the mixed solution of 1% Tetracaine 30 mL and 0.1% Adrenaline 2 mL. In group A, bilateral auricular points of Shenmen and Waibi (externol nose) were injected with 0.1 mL Vitamin B1 solution before the superficial anesthesia. After 10 min of observation, surgery was carried out. During the surgery, the patients only accepted a small amount of vasoactive substance and Fentanyl according to the changes of patient's blood pressure, heart rate and pain feeling.</p><p><b>RESULTS</b>The total effective rate of 90.0% in the group A was significantly better than 75.0% in the group B (P<0.05). The rate of using analgetic and vasoactive substance in the group A was obviously less than that of the group B.</p><p><b>CONCLUSION</b>Combined auricular point injection and superficial anesthesia has good anesthetic effect for nasal endoscopy surgery.</p>

Cauda equina syndrome after spinal anesthesia: A case report / 대한마취과학회지

A 72-year-old man undergoing emergency arthroscopic irrigation and debridement of the left knee joint due to pyogenic arthritis developed cauda equina syndrome after spinal anesthesia with 0.5% hyperbaric tetracaine mixed with epinephrine. Epinephrine was added to local anesthetic to prolong the duration and to increase the quality of spinal anesthesia. There was no paresthesia on needle placement. We injected anesthetics twice because the first subarachnoid injection failed. The patient experienced impaired sensation in the perineal region and alterations in bowel and urinary habits. Magnetic resonance imaging revealed spondylolisthesis and disc protrusion (L4-5), with spinal stenosis (L5-S1), but did not show suspicious lesions such as hematoma and abscess. We suggest the causative factors are temporary neural compression due to his spinal diseases and spinal cord ischemia due to decreased spinal blood flow because of epinephrine. We also cannot rule out the tetracaine neurotoxicity.

Myoclonic Movements Occurred after Combined Spinal-epidural Anesthesia : Two cases report / 대한마취과학회지

Two cases showed intermittent myoclonic movements in the lower extremities after receiving combined spinal-epidural anesthesia (CSE). Case 1: A 73-year-old female patient, underwent CSE, for a total knee replacement of right leg. Anesthesia was performed at L3/4 interspace with 2.0 ml of 0.5% tetracaine, mixed with normal saline and patient's own cerebrospinal fluid and epinephrine 1 : 200,000. Epidural catheter was inserted 3 cm-cephalad. Patient-controlled analgesia regimen was made with sufentanil 100 ug, 0.75% ropivacaine 30 ml, and naloxone 0.55 mg, with normal saline. The infusion regimen began at the end of the surgery, finished uneventfully after one and half hours. After 3 hours, the patient developed symmetric hip adductions of large amplitude and extensions of both legs for 2 to 3 seconds. Until valproate 800 mg was given, the movements repeated at 1 to 2 minute intervals for 3 hours. Case 2: The anesthesia and analgesia for 74-year-old female patient was done in similar fashion. Three hours after the end of operation, the patient showed myoclonic movements on right leg for about 30 seconds. The movements occurred at 2-3 minute intervals for the subsequent 2 hours and resolved spontaneously.

The Analgesic Effect of Single Dose of Intrathecal Magnesium Sulfate / 대한마취과학회지

BACKGROUND: Intrathecal (IT) magnesium has antinociceptive effects on animals and has been reported to prolong spinal opioid analgesia in humans. This study examined the effect of IT magnesium on spinal anesthesia and postoperative epidural analgesia. METHODS: Sixty patients undergoing total knee replacement were enrolled in this study. Before the IT injection of 0.5% isobaric tetracaine (10 mg), group C and group M received 0.9% saline or 50% magnesium sulfate 0.1 ml, respectively. The epidural solution for postoperative analgesia contained 0.2% ropivacaine (100 ml) only in group M, and 0.2% ropivacaine plus morphine (50microgram/ml) in group C. The verbal rating scale (VRS) scores for pain, sensory block level, intensity of motor block and side effects were recorded at 5, 60, and 120 minutes after the IT injection and at 1, 12 and 36 hours after surgery in the post-anesthesia care unit (PACU). RESULTS: The VRS score at 120 minutes after the IT injection were lower in group M than in group C (P< 0.05). There were no differences in the VRS scores and the use of supplemental analgesics at the postoperative period. The incidence of PONV, pruritus and urinary retention was significantly lower in group M than in group C at 12 and 36 hours after surgery. CONCLUSIONS: IT magnesium can be used as a local anesthetic adjuvant to strengthen the analgesic effect of spinal local anesthesia and to intensify the analgesic effect of epidural local anesthesia for postoperative pain control to the extent of 5 mg epidural morphine.

General and Spinal Anesthetic Experiences in a Patient Suspected with a History of Anaphylactic Reaction to Muscle Relaxants: A case report / 대한마취과학회지

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.

General and Spinal Anesthetic Experiences in a Patient Suspected with a History of Anaphylactic Reaction to Muscle Relaxants: A case report / 대한마취과학회지

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.

Effect of receptor solution specific conductivity on iontophoresis of tetracaine hydrochloride / 药学学报

<p><b>AIM</b>To examine the quantitative relationship between solution specific conductivity and the permeability of tetracaine HCl, and to investigate the effect of receptor solution specific conductivity on the iontophoretic transport.</p><p><b>METHODS</b>An in vitro study was carried out to determine the iontophoretic permeability of tetracaine hydrochloride through rat skin. Iontophoretic flux of tetracaine hydrochloride through excised rat skin was determined using Valia-Chien two-chamber diffusion cells with a constant d.c. current and Ag/AgCl electrodes. The specific conductivities of donor and receptor solution were also measured.</p><p><b>RESULTS</b>Iontophoretic flux of tetracaine hydrochloride increased with a decrease of anion (chloride ion) concentration in receptor. And the iontophoretic permeability (ER, ER is the enhancement ratio, and ER = iontophoretic flux/passive flux) for tetracaine hydrochloride was directly related to the conductivity of receptor solution when other conditions were held constant. Linear regressions confirmed that ER was related to inverse of overall specific conductivity of donor and receptor solution [1/(ks.d + ks.r), ks.d and ks.r are the specific conductivity of donor and receptor solution].</p><p><b>CONCLUSION</b>The results suggest that specific conductivity of receptor solution may be a important factor for the iontophoretic permeability of a solute.</p>