Roles of Opioid Receptor Subtype in the Spinal Antinociception of Selective Cyclooxygenase 2 Inhibitor

BACKGROUND: Selective inhibitors of cyclooxygenase (COX)-2 are commonly used analgesics in various pain conditions. Although their actions are largely thought to be mediated by the blockade of prostaglandin (PG) biosynthesis, evidences suggesting endogenous opioid peptide link in spinal antinociception of COX inhibitor have been reported. We investigated the roles of opioid receptor subtypes in the spinal antinociception of selective COX-2 inhibitor. METHODS: To examine the antinociception of a selective COX-2 inhibitor, DUP-697 was delivered through an intrathecal catheter, 10 minutes before the formalin test in male Sprague-Dawley rats. Then, the effect of intrathecal pretreatment with CTOP, naltrindole and GNTI, which are micro, delta and kappa opioid receptor antagonist, respectively, on the analgesia induced by DUP-697 was assessed. RESULTS: Intrathecal DUP-697 reduced the flinching response evoked by formalin injection during phase 1 and 2. Naltrindole and GNTI attenuated the antinociceptive effect of intrathecal DUP-697 during both phases of the formalin test. CTOP reversed the antinociception of DUP-697 during phase 2, but not during phase 1. CONCLUSIONS: Intrathecal DUP-697, a selective COX-2 inhibitor, effectively relieved inflammatory pain in rats. The delta and kappa opioid receptors are involved in the activity of COX-2 inhibitor on the facilitated state as well as acute pain at the spinal level, whereas the micro opioid receptor is related only to facilitated pain.

Comparison of Anesthetic Techniques for Preventing Postoperative Nausea and Vomiting Undergoing Thyroidectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the anesthetic techniques for preventing postoperative nausea and vomiting (PONV) in the patients undergoing thyroidectomy. METHODS: Sixty patients of ASA status I or II, undergoing thyroidectomy were studied. Patients were allocated randomly to one of three groups. Group 1 (n = 22): anesthesia was induced by propofol (2 mg/kg) and maintained with desflurane and 50% nitrous oxide in oxygen. Group 2 (n = 22): anesthesia was induced and maintained propofol and alfentanil using a computer controlled infusion system in 60% medical air in oxygen. Group 3 (n = 16): anesthesia was induced propofol using computer controlled infusion system in combination 50% nitrous oxide in oxygen. The incidence of PONV was assessed at 6 and 24 hours after the surgery and standardized by Rhodes index of nausea, vomiting and retching (RINVR) score. RESULTS: In group 3, the incidence of PONV within the first 6 hours after surgery, was significantly lower as P < 0.05. But, there was no statistical differences among the three groups in the 6 to 24 hours' RINVR score after surgery. CONCLUSIONS: The use of propofol for induction and maintenance with combination 50% N2O is the most effective technique at preventing PONV among the three groups within the first 6 hours after thyroidectomy. This study found no statistically significant difference between the RINVR score, using desflurane-N2O and propofol-alfentanil.

Considerations of Adequate Inspiratory Sevoflurane Concentrations in General Anesthesia for Caesarean Section / 대한마취과학회지

BACKGROUND: In cases that receive inhalation anesthesia for cesarean section, there is a high risk of recall. So the bispectral index (BIS) is useful for measuring the depth of anesthesia. This study was designed to determine optimal inspiratory sevoflurane concentrations and BIS index values during cesarean section. METHODS: We randomized 30 patients scheduled for elective cesarean section to receive inspiratory sevoflurane 1.0 vol% (group 1, n = 10), inspiratory sevoflurane 1.5 vol% (group 2, n = 10), inspiratory sevoflurane 2.0 vol% (group 3, n = 10) in a 50% nitrous oxide oxygen mixture. Each group was assessed for BIS, blood pressure, heart rate, and end tidal sevoflurane concentration at the point of preinduction, skin incision, uterine incision, delivery, and at 1, 2, 3, 5 and 10 minutes after delivery. Responsiveness to verbal commands using the Tunstall isolated forearm technique, was detected throughout the study period. Neonatal effect was assessed using Apgar scores at 1 and 5 minutes. RESULTS: The BIS index was lower in group 3 than in group 1 from the point of delivery (P<0.05) and the BIS index in group 2 was lower than in group 1 from 1 minute after delivery (P<0.05). However blood pressures, heart rates, and Apgar scores were not significantly different among the groups. No awareness was observed any subject. CONCLUSIONS: We found that the use of inspiratory sevoflurane 2.0 vol% (endtidal 1.2 vol%) maintained a BIS index of under 60.

Effects of Gabexate Mesilate (Foy(R)) on Endotoxin-Induced Acute Lung Injury in Rabbit / 대한마취과학회지

BACKGROUND: This study was to clarify the effects of gabexate mesilate (Foy(R)), a synthetic protease inhibitor, on endotoxin induced acute lung injury in rabbit. METHODS: Animals were randomly assigned to one of four groups: saline only (n = 7), saline and Escherichia coli endotoxin 5 mg/kg over 30 mins (n = 7), Foy(R) 1 mg/kg bolus, followed by infusion of Foy(R) at 1 mg/kg/h and endotoxin (n = 7), Foy(R) 2 mg/kg bolus, followed by infusion of Foy(R) at 2 mg/kg/h and endotoxin (n = 7). Infusion of saline or Foy(R) was started 0.5 hour before the start of infusion of saline or endotoxin and continued for 6.5 hours. At the end infusion animals were sacrificed, and the wet to dry (W/D) weight ratio of lung, lung injury score and leukocyte counts, percentage of polymorphonuclear leukocyte (PMNL), and concentrations of albumin and interleukin-8 (IL-8) in bronchoalveolar lavage fluid (BALF) were evaluated. RESULTS: Endotoxin decreased the PaO2 and peripheral blood leukocyte and platelet counts. And it increased the W/D weight ratio of lung, lung injury score and leukocyte counts, percentage of PMNL, and concentrations of albumin and IL-8 in BALF. Foy(R) attenuated all these changes except the decreased peripheral blood leukocyte count. CONCLUSIONS: These findings suggest that Foy(R) attenuates endotoxin-induced acute lung injury in rabbit by inhibiting neutrophil, IL-8 and platelet responses which may play a central role in sepsis related lung injury.

Re-expansion Pulmonary Edema after Chest Tubing: A Case Report / 대한구급학회지

Re-expansion pulmonary edema (RPE) is a rare complication associated with the treatment of collapsed lung caused by pneumothorax, atelectasis, pleural effusion in which a large amount of air or effusion fluid is evacuated. In general RPE is resulted from more than 3 days of lung collapse and application of high negative intrapleural pressure. However, it is reported that RPE could be developed despite the collapse period is short and negative pressure suction is not performed. It also has been known that the rate of reexpansion is more important than amount of evacuated air, or collapse period in the development of RPE. Seventeen-year-old female was undergone suture hemostasis for liver laceration, in which RPE was occurred after closed thoracostomy for pleural effusion on postoperative-27 day. We present a case report with review of related articles.

Normal Size of Fetal Kidneys: Sonographic Measurements / 대한산부인과학회잡지

OBJECTIVE: To establish size ranges of normal fetal kidneys by ultrasonogram during pregnancy. METHODS: The A-P diameter and length of each of 450 kidneys in 225 consecutive fetuses between 19 and 41 weeks of gestation were measured on sonogram from March to August 2001 in Samsung Medical Center. Gestational ages were determined by last menstrual period and Crown-Rump Lengths of early stage of pregnancy. Abnormal fetuses, twins, offspring of diabetic mothers, and fetuses with renal pelvic dilatation of 5 mm or greater were excluded to avoid any questionable measurements. RESULTS: The results showed normal distribution and results were similar to previous reports. There was a strong correlation between fetal renal size and gestational age, but no significant difference between right and left renal sizes in fetuses. Average A-P diameter and renal lengths were significantly different when compared across the range of gestational ages (p<.001). CONCLUSION: As long as we know, this was the first report of size of the normal fetal kidney sonographically during pregnancy in Korea. We think that these results can be used to detect abnormality of fetal kidney and to estimate uncertain gestational age.