The Effects of NMDA Antagonists and Sympathectomy on the c-Fos mRNA Expression in the Neuropathic Rat / 대한마취과학회지

BACKGROUND: Neuropathic pain produced by nerve injury has the characteristics of enhanced pain responses - allodynia. To understand the pathophysiology of the neuropathic pain, We evaluated the effect of NMDA antagonists and chemical sympathectomy on the c-fos mRNA expression. METHODS: We have divided rats(Sprague-Dawley, N=24) that their left L5 and L6 nerve were tightly ligated into two groups. In NMDA antagonist group(N=17), We injected 10 g MK801 and 10 g 5-amino-phosphonovalerate in three ways, intrathecally before the ligation, after ligation and subcutaneous continuously. Then behavioral tests for mechanical allodynia and cold allodynia were performed. After the test of allodynia,the expression of c-fos were assessed by Northern blot hybridization. In chemical sympathectomy group(N=7), We injected 70 mg/kg guanethidine into the peritoneum in two ways, before the ligation and after ligation. Then same methods were performed in NMDA antagonist group as well. RESULTS: Intrathecal NMDA antagonists before the ligation supressed the elevation of c-fos mRNA expression. Intrathecal NMDA antagonists on the 7 days after the ligation reduced the c-fos mRNA expression and neuropathic pain. Continuous treatment of subcutaneous NMDA antagonists supressed the development of neuropathic pain and the elevation of c-fos mRNA expression. Chemical sympathectomy before the ligation did not supress the elevation of c-fos mRNA expression. Chemical sympathectomy on the 7 days after the ligation reduced neuropathic pain and the elevation of c-fos mRNA expression. CONCLUSIONS: NMDA receptor is related to the induction and maitenance of neuropatic pain, and sympathetic nervous system has a main role in the already induced neuropathic pain.

Intubation in the Patient with Congenital Absence of Epiglottis: A case report / 대한마취과학회지

A 27-yr old female patient who had a lumbar herniated nucleus pulposus was scheduled to undergo a laminectomy. In the past history, she has suffered from frequent upper respiratory infection and muffled voice. When we tried to intubate the patient for general anesthesia by routine method, we could not find the epiglottis and vocal cord. Fortunately we could intubate sucessfully through the folds were composed of hypertrophied aryepiglottic muscle and arytenoid cartilage between the tongue base and pharynx. In the postoperative period, we made observation of anatomical structure around the vocal cord by fiberoptic laryngoscope. We confirmed a congenital absence of epiglottis, hypertrophy of aryepiglottic fold and arytenoid region, elongated larynx and a large false vocal cord.

The Parascalene Technique of Brachial Plexus Block for the Operation of the Upper Extremity and Shoulder / 대한마취과학회지

BACKGROUND: Brachial plexus is invested by a fascial envelope, which forms a perineural and perivascular space that extends all the way from the cervical intervertebral foramen to the distal axilla. Therefore a single injection of a local anesthetic into any sites of this space can provide anesthesia of the entire brachial plexus. Nowadays many methods of brachial plexus block have been developed but there are some severe complications and they can't prevent tourniquet pain completely. METHODS: We have performed parascalene technique for brachial plexus block in 206 cases from Jan., 1992 to Dec.,1994. We studied the cases retrospectively by reviewing patients' anesthesia records. The technique for parascalene block is the injection of local anesthetic solution into the lower part of the posterior triangle of the neck at the point 1.5~2.0 cm above the clavicle at the lateral border of the anterior scalene muscle. RESULTS: We could provide the proper anesthesia for the upper extremity and shoulder operation without any remarkable complications except Honor's syndrome of 3 cases. And there were no tourniquet pain in all 96 cases who had used tourniquet. CONCLUSIONS: The parascalene approach is the useful, safe and reliable method for brachial plexus block.

Changes of Cardiovascular System and Blood Sugar to Endotracheal Intubation with Fentanyl - Diazepam / 대한마취과학회지

We selected at random 30 normotensive patients who had received operation under the general anesthesia with intubation at Chungnam national university hospital. They were divided into 3 groups. group I (Control) had received tracheal intubation with thiopental 5mgkg-1. (n=10), group II had received tracheal intubation with fentanyl 15 ugkg-1. (n=10), group III had received tracheal intubation with fentanyl 15ugkg-1 and diazepam 0.05mgkg-1 (n=10). The changes of systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure (MAP), heart rate (HR), and blood sugar were compared in each group. The results were as follows: 1) In group I, endotracheal intubation caused a significant riae in SBP(p<0.01) and blood glucose (p<0.01). 2) In group Il, endotracheal intubation caused a significant rise in SBP (p<0.05) and blood glucose (p<0.01). 3) In group III, endotracheal intubation cauaed little changes in SBP, DBP, MAP, HR and blood glucose.

Clinical Evaluation of Patients who Received a Blood Transfusion During Operation / 대한마취과학회지

Of a total of 11690 operative cases, 2111 patients who received a transfusion during operation were analyzed statistically at the Department of Anesthesiology, Chung-Nam University Hospital from January 1985 to December 1987 according to department, sex, preoperative hemoglobin, blood type, operation time and blood component therapy. The results as follows: 1) The percentage of transfused patients among all operative cases was 18.05 percent. 2) Of all the transfused patients, 477 cases(22.95%) were general surgery cases. 3) Of all the transfused patients, 1187 cases(56.2%) were male. 4) The mean value of hemoglobin measured preoperatively was 10~15g/dl (72.19%). 5) The most frequent cases of transfusion were done in operations requiring 2~3 hours. 6) Blood component therapy was preformed 11 percent in 1985, 26.73 percent in 1986, and 80.72 percent in 1987. The number of cases receiving blood component therapy has tended to increase year by year.