Effects of taurine and ginseng extracts on energy metabolism during exercise and their anti-fatigue properties in mice

BACKGROUND/OBJECTIVES@#Ginseng extract (GSE) and taurine (TR) are widely used antifatigue resources in functional foods. However, the mechanism underlying the antifatigue effects of GSE and TR are still unclear. Hence, we investigated whether GSE and TR have synergistic effects against fatigue in mice.MATERIALS/METHODS: L6 cells were treated with different concentrations of TR and GSE, and cell viability was determined using 2-(4-iodophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium. Oxidative stress was analyzed by immunocytochemistry using MitoTracker™ Red FM and an anti-8-oxoguanine antibody. Respiratory gas analysis was performed to investigate metabolism. Expression of an activated protein kinase was analyzed using immunohistochemistry. Gene expression of cluster of differentiation 36 and pyruvate dehydrogenase lipoamide kinase isozyme 4 was measured using reverse transcription– polymerase chain reaction. Mice were orally administered TR, GSE, or their combination for 30 days, and then fatigue-related parameters, including lactate, blood urea nitrogen, and glycogen, were measured after forced swimming. @*RESULTS@#TR and GSE reduced oxidative stress levels in hydrogen peroxide-stimulated L6 cells and enhanced the oxygen uptake and lipid metabolism in mice after acute exercise. After oral administration of TR or GSE for 30 days, the fatigue-related parameters did not change in mice. However, the mice administered GSE (400 mg/kg/day) alone for 30 days could swim longer than those from the other groups. Further, no synergistic effect was observed after the swimming exercise in mice treated with the TR and GSE combination for 30 days. @*CONCLUSIONS@#Taken together, our data suggest that TR and GSE may exert antifatigue effects in mice after acute exercise by enhancing oxygen uptake and lipid oxidation.

Severe bradycardia and transient asystole during epidural anesthesia: A case report / 대한마취과학회지

The severe bradycardia and asystole are uncommon complications of epidural anesthesia but can be life threatening if not managed properly. A 73-year-old, ASA class 3, male patient was admitted for a total knee replacement under epidural anesthesia. Approximately 10 minutes after epidural anesthesia, the heart rate decreased significantly to 20 beats/min with asystole. The heart rate returned to 80 beats/min after administering atropine, ephedrine, and external cardiac compression. Severe bradycardia and asystole may be induced by vagal activation as a result of the low venous return and sympathetic blockade.

Severe Oropharyngeal Angioedema Caused by Propofol: A case report / 대한마취과학회지

Although propofol is thought to be a relatively safe intravenous anesthetic with regard to histamine release reactions, anaphylactoid reactions to propofol may sometimes occur, especially in patients with a history of allergy, atopy, or asthma. Here we report a patient with allergies to sesame leaves and cold medications who experienced an anaphylactic reaction with severe oropharyngeal edema a few minutes after receiving propofol (Anepol(R)). This finding suggests that propofol should be used with caution in patients with a history of allergy. Because profound airway edema can occur, the airway should be evaluated before extubation of the trachea.

Factors Predicting Prolongation of the Prothrombin Time after Liver Donor Hepatectomy / 대한마취과학회지

BACKGROUND: The increasing shortage of liver donors has resulted in exponential growth of living donor liver transplantation (LDLT). There are obvious concerns about the increased risk to the donors. There has been study on the impact of donation as a function of the degree of resection. However, the effect of inhaled anesthetics combined with the degree of parenchymal loss on the liver function has not been quantified. We analyzed the prothrombin time (PT), as hepatic synthetic function, after donor hepatectomy (DH) with the recipient undergoing general anesthesia with different types of inhaled anesthetics. METHODS: One-hundred thirty-four patients who underwent DH were enrolled. The patients were randomly divided into four groups: enflurane (group E), isoflurane (group I), sevoflurane (group S), and desflurane (group D). Anesthesia was performed according to institutional standards. The PT was measured for 7 days before and daily after DH (POD). Total liver volume and resected liver volume were measured and fraction of the graft volume was calculated. RESULTS: The PT peaked on POD 1 in all groups. A significantly lower PT was observed in group D compared to the other groups until POD 3. The fraction of the graft volume showed significant correlation with the PT change. PT abnormalities were affected by the preoperative PT, the graft fraction and inhaled anesthetics. CONCLUSIONS: Desflurane induced lesser elevation of the PT than did the other inhaled anesthetics until POD 3. The preoperative PT, the graft fraction and the inhaled anesthetics may be key factors for inducing postoperative PT abnormalities.

Effect of Preoperative Renal Function on Preioperative Renal Function and Clinical Parameters in Liver Transplanted Patients / 대한마취과학회지

BACKGROUND: Liver transplantation (LT) has become the treatment of choice for advanced liver disease. However, renal dysfunction often complicates the course of liver transplant recipients. The preoperative serum creatinine level have been shown to be an important predictor of a short-term graft and patient survival rates and the need for perioperative dialysis. This study examined the impact of the pretransplant renal function on the anesthetic characteristics and renal function after LT. METHODS: Patients undergoing LT were divided two groups according to the creatinine (Cr) level at time of LT. The following information was collected for each patient: age, etiology, weight and height, serum Cr, Cr clearance, patient survival, and cause of death. The laboratory data was collected at preoperative day, operation day and postoperative 1, 7, 30 days and 6 months. The hemodynamic profile was collected during LT. RESULTS: There were 27 patients in the renal dysfunction (RD) group. Ascites, total blood transfusion and fluid administration was significantly higher in the RD group. The hemodynamic parameters were similar in both groups. The BUN and Cr levels were significantly higher in the RD group in the perioperative period. At the preoperative period, the AST, ALT, bilirubin and prothrombin time was significantly higher in the RD group. The postoperative ICU stay and mortality rate was higher in the RD group. CONCLUSIONS: A pretransplant renal dysfunction is the result of deterioration in the liver function in the preoperative period, and indicates a greater requirement of blood and fluid during surgery.

Antitumor activity of spinasterol isolated from Pueraria roots

We purified phytoestrogens from Pueraria root (Pueraria mirifica from Thailand and Pueraria lobata from Korea), which is used as a rejuvenating folk medicine in Thailand and China. Dried, powdered plant material was extracted with 100% ethanol and further separated by concentration, filtration, and thin layer silica gel chromatography. Using the fractions obtained during separation, we first investigated their cytotoxicity in several cancer cell lines from various tissues. The ethanol-extracted components (PE1, PE4) had significant antiproliferative effects on breast cancer cell lines, including MCF-7, ZR-75-1, MDA-MB-231, SK-BR-3, and Hs578T. Second, we compared these results with the cytotoxic effects of known flavonoids, sterols, and coumarins from Pueraria root. The known compounds were not as effective, and occurred in a different polarity region on HPLC. Third, further separation resulted in the isolation of eight different components (Sub PE-A to -H). One of these, PE-D, affected the growth of some breast cancer cell lines (MCF-7, MDA-MB-231) in a dose- and time-dependent manner, as well as the growth of ovarian (2774) and cervical cancer cells (HeLa). Finally, a transfection assay showed that this component had an estrogenic effect similar to 17beta-estradiol, which activates both estrogen receptor a (ER alpha) and ER beta. The NMR analysis determined that spinasterol (stigmasta-7, 22-dien-3beta-ol) is an active cytotoxic component of Pueraria root.

The Effect of Lithotomy-Trendelenburg Position and Carbon Dioxide Insufflation on the Distance from the Upper Incisor to the Carina / 대한마취과학회지

BACKGROUND: The carbon dioxide (CO2) insufflation and lithotomy-Trendelenburg position are required in the laparoscopic gynecologic surgery. However, they can change the distance from the upper incisor to the carina. This may increase the risk of endobronchial intubation. METHODS: Nineteen patients, aged 29-50 yr, who were undergoing laparoscopic surgery were enrolled. We measured the distance from the upper incisor to the carina of them with fiberoptic bronchoscope. Measurements were taken in the each point of lithotomy position, lithotomy-Trendelenburg position, and lithotomy-Trendelenburg position after CO2 insufflation. RESULTS: The average distance from the upper incisor to the carina was 23.1 +/- 1.4 cm in the lithotomy position (0 degree) and was significantly decreased to 22.6 +/- 1.4 cm in the lithotomy-Trendelenburg position (15 degrees) (P<0.05). After CO2 insufflation into the abdominal cavity, the mean distance in the lithotomy-Trendelenburg position (15 degrees) was significantly decreased to 22.1 +/- 1.4 cm (P<0.05). CONCLUSIONS: The lithotomy-Trendelenburg position and CO2 insufflation decrease the distance from the upper incisor to the carina.

Effect of Intraarticular Ketamine after Knee Arthroscopy / 대한통증학회지

BACKGROUND: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. METHODS: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. RESULTS: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. CONCLUSIONS: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.

Electrolyte and Gas Analysis from Dorsal Vein of Hand during General Inhalational Anesthesia / 대한구급학회지

BACKGROUND: To assess the acid-base status and to measure PO2 and PCO2, arterial blood gases (ABG) has been checked usually. We compared the venous blood gases (VBG) from dorsal vein of hand to ABG from radial artery, and tried to determine whether venous blood gas analysis (VBGA) could be the alternative of ABGA. METHODS: Thirty patients who needed continuous arterial pressure monitoring were chosen. At the completion of stability of HR and BP after induction of general inhalational anesthesia, the ABG from radial artery and VBG from dorsal vein of hand were compared. RESULTS: Laboratory findings were as follows (mean+/-SD): arterial pH, 7.44+/-0.04; venous pH, 7.43+/-0.04; arterial HCO3-, 25.56+/-2.39 mmol/L; venous HCO3-, 25.51+/-2.09 mmol/L. The mean values of arterial and venous PO2 were significantly different (247.8+/-48.9 mmHg versus 187.8+/-41.6 mmHg), but the arterial and venous PO2 values were significantly correlated (r=0.706). The PCO2 (r= 0.883), pH (r=0.912), and HCO3- (r=0.901) values, and base excesses of arterial and venous blood (r=0.926) were highly correlated. Also, arterial and venous serum electrolyte (sodium, potassium, and calcium) were highly correlated. CONCLUSIONS: Venous blood gas analysis from dorsal vein of hand can be effectively used as the alternative method to evaluate the acid-base status, PO2, and PCO2, instead of ABGA during general inhalational anesthesia.

Unpredicted Sudden Onset of Postobstructive Pulmonary Edema Complicating Adenotonsillectomy in a Child / 대한마취과학회지

We present the case of a 4-yr-old child who experienced pulmonary edema during adenotonsillectomy. The pulmonary edema occurred unexpectedly around 50 minutes into the operation. We suggest that postobstructive pulmonary edema can occur soon or sometime after the resolution of a chronic airway obstruction.

The Effect of Ephedrine on Blood Pressure and Heart Rate during Induction with Propofol and Fentanyl in Hysterectomy Patients / 대한마취과학회지

BACKGROUND: When given as an intravenous bolus for induction of anesthesia, propofol with fentanyl can induce moderate to severe preintubation hypotension and bradycardia. The goal of this study was to evaluate the effect of ephedrine to prevent hypotension and bradycardia and to compare methods of ephedrine administration. METHODS: Forty five patients of ASA physical status 1 or 2 were randomly assigned to one of three groups of 15 patients each to receive either normal saline (G I), ephedrine 0.2 mg/kg IV 2 min before the injection of propofol (G II), or propofol mixed with ephedrine 0.2 mg/kg (G III). Each group first received fentanyl 2ng/kg and 2 min later received propofol 2 mg/kg as an intravenous bolus to induce anesthesia. Anesthesia was maintained by a continuous infusion of propofol 20 mg for 8 min until intubation. The changes of systolic and diastolic arterial pressure, and heart rate were measured before induction (0 min), 2, 4, 6, and 8 min after induction, and post intubation (10 min). RESULTS: The decrease of systolic and diastolic pressure in G II and G III were attenuated compared with those of the control group. The difference was significant at 2, 4, and 6 min in G II, and at 2 and 4 min in G III (P < 0.05). The decrease of heart rate in G II (8 min) and G III (6 and 8 min) were also less marked than those in G I (P < 0.05). The increase of heart rate of post intubation (10 min) was greater in G II and G III than in G I (P < 0.05). There was no statistical difference among the groups in the increase of systolic and diastolic pressures after intubation. CONCLUSIONS: Prophylactic ephedrine significantly attenuated the decrease in blood pressure and heart rate during induction of anesthesia with fentanyl and propofol. There was no statistical difference between the ephedrine groups.

Low Dose Sufentanil with Esmolol in Reducing the Increase of Heart Rate and Blood Pressure after Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Laryngoscopy and tracheal intubation usually induce tachycardia and hypertension. Various drugs including esmolol and fentanyl have been employed to reduce the cardiovascular response accompanying laryngoscopy and intubation. The purpose of this study is to assess the efficacy of low dose sufentanil with esmolol in reducing hypertension and tachycardia induced by endotracheal intubation. METHODS: Forty surgical patients from Kosin medical hospital were randomly assigned to receive either normal saline (n = 20, control group) or sufentanil (0.3 microgram/kg) with esmolol (1 mg/kg) (n = 20, S & E group) before anesthetic induction. Anesthesia was induced intravenously with pentothal sodium 4 mg/kg followed by endotracheal intubation after succinylcholine 1 mg/kg. Changes in systolic blood pressure, mean arterial blood pressure, diastolic blood pressure, heart rate, and SpO2 (arterial oxygen saturation by pulse oximeter) were measured at 30 seconds, 1 minute, 2 minutes, 3 minutes, 4 minutes and 5 minutes following intubation. The values of each group were compared with preinduction baseline values, and the S&E group was compared with the control group. Data were analyzed for statistical significance using repeated measures of ANOVA and chi-square test. RESULTS: In the S&E group, the systolic and mean arterial pressures at 30 seconds and 1 minute, and diastolic blood pressure at 30 seconds after intubation were significantly lower than the values of the control group (P < 0.01). The heart rates at 30 seconds, 1 minute were significantly lower compared to the control group (P < 0.01 and P < 0.05, respectively). CONCLUSIONS: The results suggest that pretreatment of low dose sufentanil with esmolol is effective to reduce the elevation of blood pressure and heart rate due to laryngoscopy and intubation.