Tunneling Does Not Prevent Dislodgment of Epidural Catheters: A Randomized Trial.

BACKGROUND: Epidural analgesia is preferred in postoperative pain control, but dislodgment is a major factor for failure. Tunneling is well known to control displacement of catheters. In this study, we evaluated if we can depend on tunneling in preventing dislodgment of epidural catheters. AIMS: The aim is to study if tunneling is effective and safe in reducing the rate of epidural catheters' dislodgment. SETTING AND DESIGN: The study was carried out at a single tertiary cancer center. The trial was parallel, simple randomized, controlled, and single blind. Allocation of treatments was generated using random number tables. SUBJECTS AND METHODS: Two hundred patients undergoing major surgeries were randomized. Epidural catheters were affixed to the skin through subcutaneous tunneling to a length of 5 cm or using standard adhesive tape without tunneling. Patients were on follow-up for 6 days postsurgery according to policy. STATISTICAL ANALYSIS USED: Categorical variables were analyzed by Chi-square and Fisher's exact test. Student t-test was used for continuous variables. RESULTS AND CONCLUSION: A total of 200 patients were randomized, 92 patients received tunneled catheters and 108 received nontunneled catheters. Patients were between 20 and 85 years; 63% were male. The mean days of epidural analgesia were similar in both groups (2.7 compared to 2.5 days). About 7.6% of epidurals were dislodged in the tunneled group compared to 10.2% in the nontunneled group (P = 0.699). No differences were identified in the incidence of pain or adverse events between the groups. Tunneling did not improve the rates of dislodgment in epidural catheters. There were no safety concerns associated with tunneling epidural catheters.

Thromboangiitis obliterans (Buerger's disease).

Thromboangiitis obliterans (TAO) is a nonatherosclerotic segmental inflammatory obliterative disease that most commonly affects the small- and medium-sized arteries and veins in both upper and lower extremities. In the past, TAO was exclusively a disease confined to men; however, recently more women have been diagnosed with TAO. Most patients are heavy users of tobacco, and usually cigarette smokers.

Effects of the volatile oil of Nigella sativa seeds on the uterine smooth muscle of rat and guinea pig.

The effects of the volatile oil of Nigella sativa seeds on the uterine smooth muscle of rats and guinea pigs was tested in vitro using isolated uterine horns. The volatile oil of Nigella sativa seeds inhibited the spontaneous movements of rat and guinea pig uterine smooth muscle and also the contractions induced by oxytocin stimulation. These effects were concentration-dependent and reversible by tissue washing. These data suggest that this volatile oil may have some anti-oxytocic potential.

Hyperglycemic and insulin release inhibitory effects of Rosmarinus officinalis.

The effects of the volatile oil extracted from the leaves of Rosmarinus officinalis on glucose and insulin levels were investigated in normal rabbits, after the administration of an intraperitoneal glucose tolerance test (GTT). Also, the effects of the volatile oil on fasting plasma glucose levels, were studied in alloxan diabetic rabbits. In normal rabbits, the intramuscular (i.m.) administration of the volatile oil (25 mg/kg) produced 20% (P < 0.05), 27% (P < 0.01) and 55% (P < 0.001) increases in plasma glucose levels, above those of control animals, at the 60, 90 and 120 min intervals, respectively, following the administration of the intraperitoneal (i.p.) glucose test. The same treatment also resulted in a 30% (P < 0.002) decrease in serum insulin level, in comparison with that of control rabbits at the 30 min interval. In alloxan diabetic rabbits, R. officinalis volatile oil increased fasting plasma glucose levels by 17% (P < 0.05) above those of untreated animals 6 h after its administration. These data suggest that the volatile oil of R. officinalis has hyperglycemic and insulin release inhibitory effects in the rabbit.

Direct relaxant effects of garlic juice on smooth and cardiac muscles.

The effects of garlic juice on smooth and cardiac muscles of rabbit and guinea pig were tested in vitro using isolated segments of aorta, trachea and intestines and isolated rabbit hearts. Garlic juice inhibited the contractions of rabbit and guinea pig aortic rings induced by norepinephrine in Ca(2+)-free and Ca(2+)-containing Krebs-Henseleit solutions. Also, garlic juice inhibited the contractions of rabbit and guinea pig tracheal smooth muscles induced by acetylcholine and histamine, respectively, in both Ca(2+)-free and Ca(2+)-containing Krebs-Henseleit solutions. Furthermore, garlic juice inhibited the spontaneous movements of rabbit jejunum and guinea pig ileum and inhibited the force of contraction of isolated rabbit hearts in a concentration-dependent manner. All inhibitions were reversible. These data suggest that the hypotensive action of garlic juice may be due, at least in part, to a direct relaxant effect on smooth muscles.

Relaxant effect of the volatile oil of Rosmarinus officinalis on tracheal smooth muscle.

The effects of the volatile oil of Rosmarinus officinalis leaves on the tracheal smooth muscle of rabbit and guinea pig were tested in vitro using isolated tracheal strips. The volatile oil of R. officinalis leaves inhibited the contractions of rabbit tracheal smooth muscle induced by acetylcholine stimulation and the contractions of guinea pig tracheal smooth muscle induced by histamine stimulation. Also, the volatile oil inhibited the contractions of rabbit and guinea pig tracheal smooth muscle induced by high potassium (K+) solution. This inhibition was dose-dependent and reversible. Furthermore, the volatile oil inhibited the contractions of rabbit and guinea pig tracheal smooth muscle induced by acetylcholine and histamine stimulation, respectively, in Ca(2+)-free solution. These data suggest that the volatile oil of R. officinalis leaves has a calcium antagonistic property.

Effects of a Ferula sinaica root extract on the uterine smooth muscle of rat and guinea pig.

The effects of an ethanolic extract of Ferula sinaica roots on the uterine smooth muscles of rats and guinea pigs were tested in vitro using isolated uterine horns. The extract inhibited the spontaneous movements of rat and guinea pig uterine smooth muscle and also the contractions induced by oxytocin stimulation. These effects were concentration-dependent and reversible by tissue washing. These data suggest that this plant extract may have some antioxytocic potential.

Relaxant effects of Ferula sinaica root extract on rabbit and guinea pig smooth muscle.

The effects of an ethanol extract of Ferula sinaica roots on the smooth muscles of rabbit and guinea pig were tested in vitro using isolated segments of intestine, trachea and aorta. The extract inhibited the spontaneous movements of rabbit jejunum and guinea pig ileum and acetylcholine-induced contractions. The extract also inhibited the contractions of rabbit tracheal smooth muscle induced by acetylcholine stimulation and the contractions of guinea pig tracheal smooth muscle induced by histamine stimulation. Furthermore, the extract inhibited the contractions of rabbit aorta induced by norepinephrine stimulation. These inhibitions were concentration-dependent and reversible.

Effects of an aqueous extract of Ferula ovina on rabbit and guinea pig smooth muscle.

The effects of an aqueous extract of Ferula ovina were tested in vitro using isolated segments of rabbit and guinea pig intestine, trachea and aorta. The extract inhibited the spontaneous movements of rabbit jejunum and guinea pig ileum and the contractions induced by acetylcholine. The aqueous extract also inhibited the contractions of rabbit trachealis muscle induced by acetylcholine and the contractions of guinea pig trachealis muscle induced by histamine. These inhibitions were dose-dependent and reversible. However, the aqueous extract did not inhibit the contractions of rabbit and guinea pig aortic rings induced by norepinephrine. These data suggest that this plant has non-specific anticholinergic and antihistaminic antispasmodic effects.

Increased 45Ca influx in response to alpha 1-adrenoceptor stimulation in spontaneously hypertensive rat caudal artery.

The isometric tension development and 45Ca influx in response to norepinephrine (NE) and methoxamine stimulation were investigated in caudal arteries of spontaneously hypertensive rats (SHR) and Wistar Kyoto normotensive rats (WKY). The maximum isometric tension developed as well as 45Ca influx in response to NE and methoxamine stimulation were significantly increased (p less than 0.05) in SHR caudal arteries as compared with WKY. On the other hand, neither the isometric tension developed nor the 45Ca influx in response to K+ depolarization were different between WKY and SHR caudal arteries. Estimation of [3H]prazosin binding to the membranes isolated from caudal artery of WKY and SHR showed a single class of high-affinity binding sites with Kd values for SHR 128 +/- 14 pM and for WKY 141 +/- 19 pM, and Bmax values for SHR 108 +/- 14 fmol/mg protein and for WKY 113 +/- 21 fmol/mg protein. From these results, we conclude: (a) Increased contractile response of SHR caudal artery rings to alpha 1-adrenoceptor stimulation appears at least in part to be due to an increased Ca2+ influx through receptor-operated Ca2+ channels; (b) the affinity or density of alpha 1-adrenoceptors estimated by [3H]prazosin binding is not altered in the SHR caudal artery.

Increased norepinephrine sensitive intracellular Ca2+ pool in the caudal artery of spontaneously hypertensive rats.

The contractions evoked by norepinephrine (NE) and caffeine in Ca2+-free solution were determined using denervated caudal artery rings from normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). The magnitude of contractions produced by different concentrations of NE was significantly greater (P less than 0.05) in SHR caudal artery rings compared to WKY. The contractions evoked by NE in Ca2+-free solution were mediated primarily through the activation of postsynaptic alpha 1-adrenoceptors. In addition to alpha 1-adrenoceptor stimulation, caffeine also evoked significantly greater (P less than 0.05) contractions in Ca2+-free solution in SHR caudal arteries compared to WKY. From these observations it is concluded that intracellular Ca2+ pool (presumably sarcoplasmic reticulum, SR) is increased in SHR caudal arteries which, at least in part, may account for the increased contraction observed in response to NE and caffeine stimulation in the absence of extracellular Ca2+.

Alpha 1-adrenoceptor-mediated responses in the vascular smooth muscle of spontaneously hypertensive rats.

The isometric tension development and 45Ca influx in response to norepinephrine (NE) and methoxamine stimulation were significantly (P less than 0.05) increased in spontaneously hypertensive rat (SHR) caudal arteries compared with Wistar-Kyoto (WKY) rats. However, there were no differences between WKY and SHR caudal artery rings, either in isometric tension or development of 45Ca influx in response to K+ depolarization. The Ca2+ sensitivity of NE- and methoxamine-stimulated arterial rings was significantly higher in the SHR caudal artery than in that of the WKY. Norepinephrine-stimulated contraction of both WKY and SHR caudal artery rings occurred mainly through activation of alpha 1-adrenoceptors. The number and affinity of alpha 1-adrenoceptors, estimated by 3H-prazosin binding, were comparable between WKY and SHR. It is concluded from these results that increased Ca2+ sensitivity to alpha 1-adrenoceptor stimulation in the SHR caudal artery rings appears to be caused by increased Ca2+ influx through receptor-operated Ca2+ channels.

Increased Ca2+ sensitivity of alpha 1-adrenoceptor-stimulated contraction in SHR caudal artery.

Potassium and alpha-receptor-stimulated contractile responses of caudal artery rings of spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) were measured under conditions in which norepinephrine (NE) uptake and K+-induced NE release by nerve terminals were eliminated. The maximum isometric tension developed by SHR arterial rings was significantly more compared with WKY arterial rings when arteries were stimulated with NE but not when stimulated with K+. The Ca2+ sensitivity of NE-stimulated arterial rings was about twofold higher compared with WKY arterial rings. However, the Ca2+ sensitivity of K+-depolarized arterial rings was comparable between WKY and SHR. This increase in Ca2+ sensitivity was specifically due to changes in the alpha 1-receptor-mediated mechanisms in SHR. The 50% effective concentration (EC50) values for both NE and alpha 1-specific agonist, methoxamine hydrochloride, were comparable between WKY and SHR, suggesting that alpha 1-receptor sensitivity is not altered in SHR. The relative contributions of postsynaptic alpha 1- and alpha 2-receptors in caudal artery contractions as calculated from the experiments with alpha 1- and alpha 2-receptor agonist and antagonists were 80 and 20% in WKY and 95 and 5% in SHR, respectively. Nifedipine inhibition of caudal artery contractions was significantly greater (P less than 0.05) in SHR when stimulated with NE but not when stimulated with potassium. Our results indicate that the mechanisms involved in K+ depolarization-dependent contractions are not altered in SHR. However, the mechanisms involved in the coupling of alpha 1-adrenergic receptor and smooth muscle contractions may be altered in SHR caudal artery rings.