Pretreatment with stellate ganglion blockade before ischemia reduces infarct size in rat hearts

To investigate the role of stellate ganglion blockade [SGB] in cardio-protection against ischemia reperfusion injury. This prospective randomized, experimental study was carried out between August and October 2008 in the Department of Anesthesia, Abant Izzet Baysal University, Bolu, Turkey. Twenty-one rats were randomly divided into 3 groups; group 1 -SGB group [rats with percutaneous ganglion blockade], group 2 - preconditioned [P] group [rats that were subjected to ischemia and then reperfusion periods for 5 minutes], and group 3 - control group [rats that were injected with normal saline]. During the ligation period, the length of arrhythmia was significantly shorter in group 2 compared with group 3 [p<0.001]. The arrhythmia score in groups 1 and 2 was significantly lower compared with group 3 [p<0.001]. In the reperfusion period, the length of arrhythmia was not significantly different in all study groups [p>0.05]. But the arrhythmia score was significantly lower both in group 1 and group 3, compared with group 2 [p<0.02]. Both in the ischemic and reperfusion periods, the incidence of arrhythmia was lowest in group 1. The infarct size was measured significantly less in groups 1 and 2 compared with group 3 [p<0.001]. Pretreatment with the left SGB leads to lower arrhythmia scores and reduced infarct size in the Langendorff-perfused rat hearts compared with group 3, but not with group 2

Manejo quirúrgico del cáncer gástrico / surgical Manejo of the gastric cancer

El incremento observado en la incidencia de cáncer gástrico entre los ecuatorianos, hasta convertirse en la primera causa de muerte entre los tumores malignos y la sexta entre todas las causas, así como el incremento considerable de nuevos cirujanos en el país, nos ha llevado a realizar una revisión de los principales aspectos de esta patología, especialmente los tratamientos, que ofrecen las mejores posibilidades de sobrevida, tanto en estadíos tempranos como avanzados. El objetivo principal es el de estandarizar procedimientos y evitar, en lo posible, las cirugías innecesarias que, lamentablemente producen desastrosos resultados. Se resalta la importancia del diagnóstico temprano las vías de diseminación: la resección amplia con adecuados márgenes de seguridad y la remoción radical de las diferentes barreras ganglionares. Se determinan en forma precisa los criterios de inoperabilidad.

Antinociception induced by stimulating amygdaloid nuclei in rats: changes produced by systemically administered antagonists

The antinociceptive effects of stimulating the medial (ME) and central (CE) nuclei of the amygdala in rats were evaluated by the changes in the latency for the tail withdrawal reflex to noxious heating of the skin. A 30-s period of sine-wave stimulation of the ME or CE produced a significant and short increase in the duration of tail flick latency. A 15-s period of stimulation was ineffective. Repeated stimulation of these nuclei at 48-h intervals produced progressively smaller effects. The antinociception evoked from the ME was significantly reduced by the previous systemic administration of naloxone, methysergide, atropine, phenoxybenzamine, and propranolol, but not by mecamylamine, all given at the dose of 1.0 mg/kg. Previous systemic administration of naloxone, atropine, and propranolol, but not methysergide, phenoxy-benzamine, or mecamylamine, was effective against the effects of stimulating the CE. We conclude that the antinociceptive effects of stimulating the ME involve at least opioid, serotonergic, adrenergic, and muscarinic cholinergic descending mechanisms. The effects of stimulating the CE involve at least opioid, beta-adrenergic, and muscarinic cholinergic descending mechanisms.

Hipotensión controlada en la cirugía de las malformaciones vasculares cerebrales / Controlled hypotension in the surgery of brain vessels malformations

Se comenta la frecuencia de la patología de las malformaciones vasculares cerebrales, su tasa de mortalidad y secuelas y la modificación en las mismas que ha tenido la moderna cirugía y anestesia, según las estadíticas recientes, nacionales y extranjeras. Se pasa somera revista al tipo de anestesia utilizada por nosotros. Se hace hincapié en la técnica de hipotensión controlada, drogas utilizadas para tal fin, principios fisiopatológicos de acción de las distintas drogas sobre la circulación y metabolismo cerebral, sus riesgos y principales cuidados a tener en cuenta. Describimos la técnica de administración de Nitroprusiato de Sodio utilizada por nosotros y lo que consideramos contraindicaciones para el uso de la Hipotensión Controlada.

Autonomic Hyperreflexia - Case report / 대한마취과학회지

Autonomic hyperreflexia in spinal cord lesion is due to interruption of inhbitory im from higher centers. Especially, dramatic disturbance is seen in cord lesions above the fifth thoracic se and consist of hypertension, bradycardia and sweating. Sometimes marked hypert results in fatal cerebral hemorrhage or subarachnoid hemorrhage ao that the anesthesic gets used to its control and treatment. In current methods of control of hypertension, there are general anesthesia with halothane or enflurane, spinal anesthesia and ganglionic blockers. Ganglionic blockers, such as hexamethonium, drsmatically suppress marked arterial hypertension, also. We have experienced 3 cases of tetraplegic patients. Two cases given local anesthesia developed autonomic hyperreflexia but one case given general anesthesia did not have the hyperreflexia.

Deep Hypothermia for Total Correction of Tetralogy of Fallot / 대한마취과학회지

Early correction of congenital cardiac defects has been facilitated by the use of deep hypothermia and cardiorespiratory arrest. Simple deep hypothermia has a number of advantages for infant open heart surgery, such as a quiet heart and bloodless operative field, reduced blood requirement, elimination of pulmonary and coagulation problems following cardiopulmonary bypass, elimination of cannulation, simple anesthetic technique, no neccessity of complicated facilities, and stable postoperative course. Deep ether anesthesia is the ideal agent for induction of deep hypothermia by surface cooling, especially when combined with ganglionic blocking agents in large quantities to elimiminate some of the undesirable effects of ether, thus improving and maintaining good peripheral perfusion. We have performed a total correction of TOF on March, 1979. Anesthesia was induced with intravenous thiopental and succinylcholine for intubation and maintained by a tight closed circuit system with ether. As soon as routine EKG, direct intra-arterial pressure, esophageal and rectal temperature monitoring devices were installed, slow intravenous administration of triflupromazine was followed by surface cooling. Surface cooling was done by the technique of covering the child with bags of crushed ice after placing the infant on an ice water blanket. After cooling, the intracardiac procedure was performed under circulatory occlusion and cardiac arrest, following cardioplegic infusion, for 45 minutes. After the intracardiac procedure, cardiac resuscitation and rewarming were accomplished by cardiopulmonary bypass technique. The patient recovered satisfactorily and was discharged on POD14 without any complication.