Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study / 대한마취과학회지

BACKGROUND: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. METHODS: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. RESULTS: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. CONCLUSIONS: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.

Antinociceptive Effects of Intraperitoneal and Intrathecal Vitamin E in the Rat Formalin Test

BACKGROUND: Vitamin E is widely known to be one of the reactive oxygen species (ROS) scavengers and a drug that can easily be obtained, and it has been shown to attenuate the pain responses induced by various causes in animal pain models. Thus, this experiment was conducted to assess the antinociceptive effects of vitamin E by comparing intraperitoneal and intrathecal injections in rats subjected to the formalin test. METHODS: After the intraperitoneal and intrathecal injections of vitamin E were carried out, respectively (IP: 500 mg/kg, 1 g/kg, and 2 g/kg, IT: 3 mg/kg, 10 mg/kg, and 30 mg/kg), the formalin test was perfumed. As soon as 5% formalin was injected into left hind paw, the number of flinches induced by pain was measured at 5-minute intervals for 1 hour. RESULTS: Formalin injected into the left hind paw induced biphasic nociceptive behavior in all animals. Intraperitoneal injection of vitamin E diminished the nociceptive behavior in a dose-dependent manner during the early and late phase. Intrathecal vitamin E diminished nociceptive behavior dose dependently during the late phase but showed no significant difference in the early phase. CONCLUSIONS: Vitamin E attenuated acute nociception when it was injected systemically, while both systemic and intrathecal injection produced analgesia in a rat model of formalin-induced hyperalgesia.

Antinociceptive effect of phenyl N-tert-butylnitrone, a free radical scavenger, on the rat formalin test / 대한마취과학회지

BACKGROUND: Reactive oxygen species (ROS) such as superoxide radicals, hydrogen peroxide, nitric oxide, and nitroperoxide, cause oxidative stress which interferes with normal cell functioning, resulting in cell damage. It is reported to be associated with chronic pain, especially neuropathic pain, and inflammatory pain. ROS is also closely related to central sensitization. Therefore, this study was designed to explore the effects of Phenyl N-tert-butylnitrone (PBN), an ROS scavenger, in acute, continuous, and increasing pain caused by central sensitization. METHODS: Male Sprague-Dawley rats were divided into 2 groups, an intraperitoneal group (IP) and an intrathecal group (IT), and once again divided into an experimental group and a control group. The experimental group was injected with Phenyl N-tert-butylnitrone (PBN), a free radical scavenger, either intraperitoneally or intrathecally. After inducing pain by injecting formalin into the hind paw, pain behaviors were measured. Lumbar enlargement immmunohistochemistry was performed to assess nitrotyrosine, an oxidative stress marker, to identify the degree of protein nitration. RESULTS: Both experimental groups of IP and IT showed statistically significant decreases in the number of flinches compared to the control group in phase 1 and 2. Immunohistochemical evaluation in the control group revealed an increase in nitrated proteins in the gray matter of the lumbar spinal cord, but a significant decrease in nitrated proteins in the gray matter of lumbar spinal cord of the experimental group. CONCLUSIONS: Intraperitoneal and intrathecal administration of PBN decreases analgesic behaviors, allowing us to believe that ROS is mainly responsible for acute pain and central sensitization.

Antinociceptive effect of phenyl N-tert-butylnitrone, a free radical scavenger, on the rat formalin test / 대한마취과학회지

BACKGROUND: Reactive oxygen species (ROS) such as superoxide radicals, hydrogen peroxide, nitric oxide, and nitroperoxide, cause oxidative stress which interferes with normal cell functioning, resulting in cell damage. It is reported to be associated with chronic pain, especially neuropathic pain, and inflammatory pain. ROS is also closely related to central sensitization. Therefore, this study was designed to explore the effects of Phenyl N-tert-butylnitrone (PBN), an ROS scavenger, in acute, continuous, and increasing pain caused by central sensitization. METHODS: Male Sprague-Dawley rats were divided into 2 groups, an intraperitoneal group (IP) and an intrathecal group (IT), and once again divided into an experimental group and a control group. The experimental group was injected with Phenyl N-tert-butylnitrone (PBN), a free radical scavenger, either intraperitoneally or intrathecally. After inducing pain by injecting formalin into the hind paw, pain behaviors were measured. Lumbar enlargement immmunohistochemistry was performed to assess nitrotyrosine, an oxidative stress marker, to identify the degree of protein nitration. RESULTS: Both experimental groups of IP and IT showed statistically significant decreases in the number of flinches compared to the control group in phase 1 and 2. Immunohistochemical evaluation in the control group revealed an increase in nitrated proteins in the gray matter of the lumbar spinal cord, but a significant decrease in nitrated proteins in the gray matter of lumbar spinal cord of the experimental group. CONCLUSIONS: Intraperitoneal and intrathecal administration of PBN decreases analgesic behaviors, allowing us to believe that ROS is mainly responsible for acute pain and central sensitization.

Antinociceptive drug interaction between intrathecal vitamin E and gabapentin in the rat formalin test / 대한마취과학회지

BACKGROUND: Gabapentin is thought to exert an effect through the voltage-dependent calcium channel. Vitamin E is a widely known antioxidant which neutralizes the harmful effect of ROS which is considered to play a prominent role in various painful conditions. This study was therefore conducted to assess the antinociceptive effects of gabapentin and vitamin E and the interaction of these drugs in the modulation of pain in rats subjected to a formalin test. METHODS: Sprague-Dawley rats with a lumbar intrathecal catheter were tested for their paw flinches by 5% formalin injection after intrathecal injection of gabapentin or vitamin E. After obtaining dose-response curves for each drug, the effect of the combination was tested by the total dose fraction value and isobolographic analysis. RESULTS: When a single drug was injected intrathecally, significant dose-dependent decreases in flinches were shown only in the late phase. ED50 values of intrathecal gabapentin and vitamin E in the late phase were 75.3 +/- 9.58 microg, and 17.56 +/- 1.65 mg/kg respectively. The combination of gabapentin and vitamin E produced dose-dependent decreases in the number of flinches in both phases induced by the formalin test. The ED50 value of the combination was lower than the theoretical additive values in the late phase, but did not show a significant difference with the theoretical additive value. CONCLUSIONS: Gabapentin and vitamin E (by itself) have no antinociceptive effect in the early phase; however their combination has shown an antinociceptive effect. In addition, they show additive effects in the late phase of the formalin test.

Antinociceptive effects of vitamin E in formalin-induced nociceptive response in rats

BACKGROUND: Reactive oxygen species (ROS) are critically involved in generating pain in various painful conditions, including neuropathic and inflammatory pain. This experiment was conducted in order to assess the antinociceptive effects of vitamin E in the modulation of pain in rats subjected to the formalin test. METHODS: Five percent formalin was injected into the hind paw after intraperitoneal injection of either vitamin E 1 g/kg dissolved in olive oil or olive oil alone. The Number of flinches were measured in a 5 minute interval for 1 hour. RESULTS: Formalin injected into the left hind paw induced a biphasic nociceptive behavior. Intraperitoneal injection of vitamin E diminished the nociceptive behavior during phase 1 and 2. CONCLUSIONS: Systemic administration of vitamin E produces analgesia in a rat model of formalin-induced hyperalgesia. Furthermore, vitamin E affects pain of peripheral origin.

An anesthetic experience in a patient with Stickler sydrome: A case report

Stickler syndrome is a connective tissue dysplasia disorder with characteristic midface hypoplasia, retromicrognathia, cleft palate, and a moon-shaped appearance. Incidence of the syndrome is estimated at around 1/10000 and the disorder is considered to be caused by mutations in the COL2A1, COL11A1, COL11A2, COL9A1 procollagen genes of type 2 and 11 collagen. Patients with a mandibular hypoplasia like Stickler syndrome present the anesthesiologist with considerable problems when mask ventilation or endotracheal intubation is attempted. We report a successful anesthetic experience, including blind endotracheal intubation with rigid laryngoscope without neuromuscular blockade, in a 9-year-old boy with Stickler syndrome for scleral buckling with cryotherapy.

Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia / 대한마취과학회지

BACKGROUND: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used. METHODS: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 microl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA. RESULTS: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively. CONCLUSIONS: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.

Anesthetic experience for performing a cesarean section for a woman with refractory status epilepticus: A case report

The occurrence of seizure increases 15-30% in women who become pregnant while being treated for epilepsy, due to pharmacological changes in the antiepileptic drugs and, changes in the emotional status and hormones. It is reported that 1-2% of pregnant women experience status epilepticus. When refractory status epilepticus occurs in a pregnant woman, parturition may be an important method of treatment. We report here on a case of a 28 weeks pregnant woman who had epilepsy for 21 years and she had status epilepticus in a refractory status and so she underwent general anesthesia for cesarean section.

Assessment of airway length of Korean adults and children for otolaryngology and ophthalmic surgery using a fiberoptic bronchoscope / 대한마취과학회지

BACKGROUND: Knowledge regarding normal upper airway anatomy is essential for airway management and is required to prevent malpositioning of endotracheal tubes. We evaluated the length of the upper airway in Korean children and adults who had no abnormality of the upper airway using a fiberoptic bronchoscope. METHODS: Eighty seven patients aged 5 to 81 years undergoing noninvasive elective surgery were included in this study. After induction of anesthesia was complete, we measured the distance from the upper incisor to various components of the upper airway by fiberoptic bronchoscopy. RESULTS: In adults, the mean length between the upper incisor and midtrachea was found to be 21.8 +/- 1.8 cm in males and 19.9 +/- 1.3 cm in females, while the mean length of the trachea was 10.1 +/- 1.3 cm in males and 10.3 +/- 1.6 cm in females. The length between the upper incisor and midtrachea (IT) were correlated with height both in children (IT [cm] = 2.531 + 0.109 x height [cm]) and adults (IT [cm] = 0.167 + 0.127 x height [cm]), which shows that they differ from the western standard (length of tube [cm] = 5 + 0.1 x height [cm]). CONCLUSIONS: In adults and children, the length from the incisor to the midtrachea was significantly different when compared with western standards. Therefore, re-evaluation of the proper and precise depth of endotracheal tube in Koreans should be considered.