Objective To study the changes of metabolites in serum and tissues （kidney, liver and heart） of mice died of acute tetracaine poisoning by metabolomics, to search for potential biomarkers and related metabolic pathways, and to provide new ideas for the identification of cause of death and research on toxicological mechanism of acute tetracaine poisoning. Methods Forty ICR mice were randomly divided into control group and acute tetracaine poisoning death group. The model of death from acute poisoning was established by intraperitoneal injection of tetracaine, and the metabolic profile of serum and tissues of mice was obtained by ultra-high performance liquid chromatography-electrostatic field orbitrap high resolution mass spectrometry （UPLC-Orbitrap HRMS）. Multivariate statistical principal component analysis （PCA） and orthogonal partial least square-discriminant analysis （OPLS-DA） were used, combined with t-test and fold change to identify the differential metabolites associated with death from acute tetracaine poisoning. Results Compared with the control group, the metabolic profiles of serum and tissues in the mice from acute tetracaine poisoning death group were significantly different. Eleven differential metabolites were identified in serum, including xanthine, spermine, 3-hydroxybutylamine, etc.; twenty-five differential metabolites were identified in liver, including adenylate, adenosine, citric acid, etc.; twelve differential metabolites were identified in heart, including hypoxanthine, guanine, guanosine, etc; four differential metabolites were identified in kidney, including taurochenodeoxycholic acid, 11, 12-epoxyeicosatrienoic acid, dimethylethanolamine and indole. Acute tetracaine poisoning mainly affected purine metabolism, tricarboxylic acid cycle, as well as metabolism of alanine, aspartic acid and glutamic acid. Conclusion The differential metabolites in serum and tissues of mice died of acute tetracaine poisoning are expected to be candidate biomarkers for this cause of death. The results can provide research basis for the mechanism and identification of acute tetracaine poisoning.
Animals ; Biomarkers/metabolism* ; Chromatography, High Pressure Liquid ; Mass Spectrometry ; Metabolome ; Metabolomics ; Mice ; Mice, Inbred ICR ; Tetracaine

BACKGROUND: To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo. METHODS: Ten RCTs (574 patients) were included in this systemic review. Relevant studies were identified through searches of MEDLINE, SCOPUS and the Cochrane database library. The outcome was the adequacy of cutaneous anesthesia reflected in the patient's assessment of pain intensity during minor dermatologic procedures and adverse effects after application of the lidocaine/tetracaine medicated patch or peel versus placebo. RESULTS: The efficacy of the lidocaine/tetracaine patch or peel was consistently very significantly beneficial 30 or 60 minutes after the application compared to placebo (Relative risk, RR: 2.5; Number needed to treat, NNT: 2.2). We did not identify any difference in the effectiveness of adequate analgesia between the lidocaine/tetracaine patch and peel (the number needed to treat or to harm, NNT 2.4 vs. 2.0). No serious side effects or adverse events were observed with the lidocaine/tetracaine medicated patch or peel and placebo. Minor skin reactions were transient and resolved without treatment (Odd ratio, OR: 1.4 and 95% confidence interval, CI: 0.9-2.1; NNT: 14.9). CONCLUSIONS: The lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.
Adult ; Analgesia ; Anesthesia ; Child ; Humans ; Lidocaine ; Skin ; Tetracaine

PURPOSE: Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. MATERIALS AND METHODS: Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. RESULTS: The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). CONCLUSION: The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.
Aged ; Anesthesia, Spinal/*methods ; Female ; Humans ; Lumbar Vertebrae/*surgery ; Male ; Middle Aged ; Prospective Studies ; Tetracaine/*administration & dosage

OBJECTIVETo observe the anesthetic effect of combined superficial anesthesia and auricular point injection for nasal endoscopy surgery.

METHODSForty cases of grade I - II as ASA for nasal endoscopy surgery were randomly divided into a combined auricular point injection and superficial anesthesia group (group A) and a simple superficial anesthesia group (group B), 20 cases in each group. Both groups accepted superficial anesthesia 2 times on the bilateral nasal cavities with cotton pieces that was immersed in the mixed solution of 1% Tetracaine 30 mL and 0.1% Adrenaline 2 mL. In group A, bilateral auricular points of Shenmen and Waibi (externol nose) were injected with 0.1 mL Vitamin B1 solution before the superficial anesthesia. After 10 min of observation, surgery was carried out. During the surgery, the patients only accepted a small amount of vasoactive substance and Fentanyl according to the changes of patient's blood pressure, heart rate and pain feeling.

RESULTSThe total effective rate of 90.0% in the group A was significantly better than 75.0% in the group B (P<0.05). The rate of using analgetic and vasoactive substance in the group A was obviously less than that of the group B.

CONCLUSIONCombined auricular point injection and superficial anesthesia has good anesthetic effect for nasal endoscopy surgery.

Acupuncture Points ; Adult ; Aged ; Anesthesia ; methods ; Anesthetics, Local ; administration & dosage ; Ear ; Endoscopy ; Female ; Humans ; Injections ; Male ; Middle Aged ; Nose ; surgery ; Pain ; drug therapy ; Tetracaine ; administration & dosage

A 72-year-old man undergoing emergency arthroscopic irrigation and debridement of the left knee joint due to pyogenic arthritis developed cauda equina syndrome after spinal anesthesia with 0.5% hyperbaric tetracaine mixed with epinephrine. Epinephrine was added to local anesthetic to prolong the duration and to increase the quality of spinal anesthesia. There was no paresthesia on needle placement. We injected anesthetics twice because the first subarachnoid injection failed. The patient experienced impaired sensation in the perineal region and alterations in bowel and urinary habits. Magnetic resonance imaging revealed spondylolisthesis and disc protrusion (L4-5), with spinal stenosis (L5-S1), but did not show suspicious lesions such as hematoma and abscess. We suggest the causative factors are temporary neural compression due to his spinal diseases and spinal cord ischemia due to decreased spinal blood flow because of epinephrine. We also cannot rule out the tetracaine neurotoxicity.
Abscess ; Aged ; Anesthesia, Spinal ; Anesthetics ; Arthritis ; Cauda Equina ; Debridement ; Emergencies ; Epinephrine ; Hematoma ; Humans ; Hypesthesia ; Knee Joint ; Magnetic Resonance Imaging ; Needles ; Paresthesia ; Polyradiculopathy ; Spinal Cord Ischemia ; Spinal Diseases ; Spinal Stenosis ; Spondylolisthesis ; Tetracaine

Two cases showed intermittent myoclonic movements in the lower extremities after receiving combined spinal-epidural anesthesia (CSE). Case 1: A 73-year-old female patient, underwent CSE, for a total knee replacement of right leg. Anesthesia was performed at L3/4 interspace with 2.0 ml of 0.5% tetracaine, mixed with normal saline and patient's own cerebrospinal fluid and epinephrine 1 : 200,000. Epidural catheter was inserted 3 cm-cephalad. Patient-controlled analgesia regimen was made with sufentanil 100 ug, 0.75% ropivacaine 30 ml, and naloxone 0.55 mg, with normal saline. The infusion regimen began at the end of the surgery, finished uneventfully after one and half hours. After 3 hours, the patient developed symmetric hip adductions of large amplitude and extensions of both legs for 2 to 3 seconds. Until valproate 800 mg was given, the movements repeated at 1 to 2 minute intervals for 3 hours. Case 2: The anesthesia and analgesia for 74-year-old female patient was done in similar fashion. Three hours after the end of operation, the patient showed myoclonic movements on right leg for about 30 seconds. The movements occurred at 2-3 minute intervals for the subsequent 2 hours and resolved spontaneously.
Aged ; Analgesia, Patient-Controlled ; Anesthesia and Analgesia ; Anesthesia* ; Arthroplasty, Replacement, Knee ; Catheters ; Cerebrospinal Fluid ; Epinephrine ; Female ; Hip ; Humans ; Leg ; Lower Extremity ; Naloxone ; Sufentanil ; Tetracaine ; Valproic Acid

BACKGROUND: Intrathecal (IT) magnesium has antinociceptive effects on animals and has been reported to prolong spinal opioid analgesia in humans. This study examined the effect of IT magnesium on spinal anesthesia and postoperative epidural analgesia. METHODS: Sixty patients undergoing total knee replacement were enrolled in this study. Before the IT injection of 0.5% isobaric tetracaine (10 mg), group C and group M received 0.9% saline or 50% magnesium sulfate 0.1 ml, respectively. The epidural solution for postoperative analgesia contained 0.2% ropivacaine (100 ml) only in group M, and 0.2% ropivacaine plus morphine (50microgram/ml) in group C. The verbal rating scale (VRS) scores for pain, sensory block level, intensity of motor block and side effects were recorded at 5, 60, and 120 minutes after the IT injection and at 1, 12 and 36 hours after surgery in the post-anesthesia care unit (PACU). RESULTS: The VRS score at 120 minutes after the IT injection were lower in group M than in group C (P< 0.05). There were no differences in the VRS scores and the use of supplemental analgesics at the postoperative period. The incidence of PONV, pruritus and urinary retention was significantly lower in group M than in group C at 12 and 36 hours after surgery. CONCLUSIONS: IT magnesium can be used as a local anesthetic adjuvant to strengthen the analgesic effect of spinal local anesthesia and to intensify the analgesic effect of epidural local anesthesia for postoperative pain control to the extent of 5 mg epidural morphine.
Analgesia ; Analgesia, Epidural ; Analgesics ; Anesthesia, Local ; Anesthesia, Spinal ; Animals ; Arthroplasty, Replacement, Knee ; Humans ; Incidence ; Magnesium Sulfate* ; Magnesium* ; Morphine ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Postoperative Period ; Pruritus ; Tetracaine ; Urinary Retention

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.
Anaphylaxis* ; Anesthesia ; Anesthesia, Spinal ; Anesthetics ; Atracurium ; Female ; Fentanyl ; Humans ; Ketamine ; Laminectomy ; Lidocaine ; Microvascular Decompression Surgery ; Middle Aged ; Perioperative Period ; Propofol ; Skin ; Succinylcholine ; Tetracaine ; Thiopental ; Vecuronium Bromide

The use of anesthetic agents may induce a certain number of anaphylactic and anaphylactoid reactions. Anesthesiologists, therefore, are well advised to develop a rational approach to minimize risks and evaluate patients who present with histories of allergic drug reactions in the perioperative period. A 63-year-old female patient was withdrawn from operation due to anaphylactic reaction or life-threatening anaphylactoid reaction occurred during induction of anesthesia and successfully resuscitated. Thereafter, skin prick test to anesthetics including intravenous agents such as thiopental, propofol, ketamine, fentanyl and lidocaine, and muscle relaxants such as succinylcholine, vecuronium and atracurium revealed positive reactions to all the tested muscle relaxants. Next anesthetic experience was done for microvascular decompression surgery without use of muscle relaxants. Two years later, she underwent lumbar laminectomy successfully under isobaric spinal anesthesia using tetracaine.
Anaphylaxis* ; Anesthesia ; Anesthesia, Spinal ; Anesthetics ; Atracurium ; Female ; Fentanyl ; Humans ; Ketamine ; Laminectomy ; Lidocaine ; Microvascular Decompression Surgery ; Middle Aged ; Perioperative Period ; Propofol ; Skin ; Succinylcholine ; Tetracaine ; Thiopental ; Vecuronium Bromide

BACKGROUND: Pneumatic tourniquets are most frequently used during operations on the lower extremities, especially during knee operations, and provide a bloodless surgical field and prevent excessive blood loss. But tourniquets increase blood pressure, though the cause has not been identified. We thought that plasma catecholamine is increased by pneumatic tourniquet inflation. Troponin I is specific cardiac marker in myocardiac injury. So we measured plasma catecholamine and Troponin I under general and spinal anesthesia in patients undergoing total knee replacement. METHODS: We divided the patients into two groups, the first group (Group I, n = 25) was the general anesthesia group and second group (Group II, n = 26) the spinal anesthesia group. All patients underwent an operation for total knee replacement. Serum enzyme levels are instable so we tried to keep changes at a minimal level. Thus all operations were carried out by the same group of surgeons, in the same operating room, at the same time (AM 8:00 start operation). The same tourniquet was applied for all subjects (tourniquet pressure 350 mmHg, 9 cm width). Group I patients had general anesthesia with N2O - O2 - Enflurane. Group II patients had spinal anesthesia with 0.5% tetracaine: the dermatomal level of sensory blockade to pin-prick was T6 - T4. We measured blood pressure, heart rate, SpO2, ECG, serum catecolamine and trophonine I. Blood sampling were performed preoperation, 50 minutes after tourniquet application, and 30 minutes after operation to obtained serum catecholamine and trophonine I levesl. Result: Mean arterial pressure increased in group I during tourniquet inflation. The serum catecholamine level was higher in group I than in group II. The serum troponin I level was statistically significance in the general anesthesia groups (Group I). CONCLUSIONS: It might be suggested that an increased level of serum catecholamine causes tourniquet induced hypertension. Myocardial injury due to tourniquet induced hypertension was not affected by anesthesia type
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal* ; Arterial Pressure ; Arthroplasty, Replacement, Knee* ; Blood Pressure ; Electrocardiography ; Enflurane ; Epinephrine ; Heart Rate ; Humans ; Hypertension ; Inflation, Economic ; Knee ; Lower Extremity ; Norepinephrine ; Operating Rooms ; Plasma ; Tetracaine ; Tourniquets* ; Troponin I