ABSTRACT
Inflammation following hemorrhagic shock/resuscitation (HS/RES) induces acute lung injury (ALI). Dimethyl sulfoxide (DMSO) possesses anti-inflammatory and antioxidative capacities. We sought to clarify whether DMSO could attenuate ALI induced by HS/RES. Male Sprague-Dawley rats were allocated to receive either a sham operation, sham plus DMSO, HS/RES, or HS/RES plus DMSO, and these were denoted as the Sham, Sham + DMSO, HS/RES, or HS/RES + DMSO group, respectively (n = 12 in each group). HS/RES was achieved by drawing blood to lower mean arterial pressure (40-45 mmHg for 60 min) followed by reinfusion with shed blood/saline mixtures. All rats received an intravenous injection of normal saline or DMSO immediately before resuscitation or at matching points relative to the sham groups. Arterial blood gas and histological assays (including histopathology, neutrophil infiltration, and lung water content) confirmed that HS/RES induced ALI. Significant increases in pulmonary expression of tumor necrosis factor-α (TNF-α), malondialdehyde, nuclear factor-kappa B (NF-κB), inducible nitric oxide synthase (iNOS), and cyclooxygenase 2 (COX-2) confirmed that HS/RES induced pulmonary inflammation and oxidative stress. DMSO significantly attenuated the pulmonary inflammation and ALI induced by HS/RES. The mechanisms for this may involve reducing inflammation and oxidative stress through inhibition of pulmonary NF-κB, TNF-α, iNOS, and COX-2 expression.
Subject(s)
Acute Lung Injury/drug therapy , Dimethyl Sulfoxide/pharmacology , Resuscitation/adverse effects , Shock, Hemorrhagic/complications , Acute Lung Injury/etiology , Animals , Cyclooxygenase 2/drug effects , Dimethyl Sulfoxide/therapeutic use , Male , NF-kappa B/drug effects , Nitric Oxide Synthase Type II/antagonists & inhibitors , Oxidative Stress/drug effects , Pneumonia/drug therapy , Rats , Rats, Sprague-Dawley , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
BACKGROUND: Pruritus is the most common side effect of intrathecal morphine. Gabapentin is an anticonvulsant and had been reported to be effective in some chronic pruritus conditions. Its effect in intrathecal morphine-induced pruritus has not yet undergone an evaluation. METHODS: We randomly allocated 86 patients scheduled for lower limb surgery under spinal anesthesia into two equal groups that received either gabapentin 1200 mg or placebo 2 h before operation in a prospective, double-blind manner. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. Pruritus was evaluated at 3, 6, 9, 12, and 24 h after intrathecal morphine administration. RESULTS: The incidence of pruritus was significantly more frequent in the placebo group compared with the gabapentin group (77.5% vs 47.5%; P = 0.01). The onset time of pruritus in the gabapentin group (6.2 +/- 1.8 h) was significantly delayed compared with that in the placebo group (3.1 +/- 0.8 h) (P < 0.0001). The severity of pruritus was significantly more in the placebo group compared with the gabapentin group at 3 and 6 h after intrathecal morphine injection. CONCLUSION: Preoperative gabapentin prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anesthesia.
Subject(s)
Amines/administration & dosage , Anesthesia, Spinal , Antipruritics/administration & dosage , Cyclohexanecarboxylic Acids/administration & dosage , Morphine/adverse effects , Narcotics/adverse effects , Orthopedic Procedures , Premedication , Pruritus/prevention & control , gamma-Aminobutyric Acid/administration & dosage , Adult , Anesthetics, Local , Bupivacaine , Double-Blind Method , Drug Administration Schedule , Female , Gabapentin , Humans , Injections, Spinal , Lower Extremity/surgery , Male , Morphine/administration & dosage , Narcotics/administration & dosage , Prospective Studies , Pruritus/chemically induced , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
Traumatic intubation, reintubation, intubation with endotracheal tube of inappropriate size, and failure to firmly secure the tube may contribute to the development of subglottic stenosis. Systemic factors such as sepsis, hypotension, autoimmune and granulomatous disorders have all been implicated as contributing causes. In addition, a risky circumstance that might be considered important in the development of airway damage is the occurrence of gastreoesophageal reflux (GER), particularly in thoracotomy operations, where the patients are placed in the lateral position. The purpose of this report is to describe a patient who developed subglottic stenosis following a thoracotomy. The possible causes are macrotrauma due to multiple intubations and microtrauma due to inappropriate tube size in the course of anesthesia. Furthermore, GER may worsen mucosal injuries, which may be precipitated by the lateral position.
Subject(s)
Intubation, Intratracheal/adverse effects , Laryngostenosis/etiology , Thoracotomy/adverse effects , Aged , Female , Glottis , Humans , PostureABSTRACT
We report a case of prominent postoperative macroglossia after posterior fossa surgery in the prone position. The potential risk factors predisposing to its generation, prophylactic measures to avoid it and treatments for its alleviation are reviewed and discussed.
