Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia.
Adjuvants, Anesthesia/administration & dosage/*therapeutic use ; Administration, Topical ; Adult ; Female ; Glycopyrrolate/administration & dosage/*therapeutic use ; Herpes Zoster/*drug therapy/pathology ; Humans ; Neuralgia/pathology/*physiopathology ; Pregnancy

OBJECTIVETo assess the feasibility of using subclinical doses of pentazocine in painless egg retrieval.

METHODSEighty-one patients undergoing painless egg retrieval were randomized into the observation group and the control group to receive 0.4 mg/kg pentazocine with 1.5 mg/kg propofol and 0.5 mg/kg pentazocine with 1.5 mg/kg propofol, respectively. The mean arterial pressure (MAP), heart rate (HR), SPO(2), respiratory rate (RR), unconsciousness time, awake time, hospital stay, complications, consciousness during the operation and adverse effects were compared between the two groups.

RESULTSThe two groups showed no significant differences in the analgesic effect, dosage of propofol, adverse effects, unconsciousness time, awake time, or hospital stay. But compared with the control group, the observation group showed greater intraoperative consciousness but with more stable respiration.

CONCLUSIONSubclinical doses of pentazocine can be used in the painless egg retrieval, but the dose of propofol should be increased to reduce the body activity during the operation.

Adjuvants, Anesthesia ; administration & dosage ; Adult ; Anesthetics, Intravenous ; Female ; Fertilization in Vitro ; Humans ; Intraoperative Complications ; prevention & control ; Oocyte Donation ; methods ; Pain ; prevention & control ; Pentazocine ; administration & dosage ; Propofol ; administration & dosage ; Vagina

OBJECTIVETo investigate the effects of administration of dexmedetomidine in anaesthesia for esophageal cancer operation.

METHODS100 patients (ASAI-II) who were undergoing to esophageal cancer operation were randomly divided into control group (group A) and dexmedetomidine group (group B) (n = 50). The scheme of induction and maintenance of aesthesia of the two groups were identical. Patients in group B administered dexmedetomidine at a dose of 1 microg/kg over 10 min and patients in group A were given a placebo infusion of normal saline. Patients in group B administered dexmedetomidine at a dose of 0.4 microg/(kg x h) was injected and stoped at 30 min by the end of operation. Mean artery pressure (MAP) and heart rate (HR) were detected before induction (T0), induction (T1), 1 min after extubation (T2), 5 min after extubation (T3) and 10 min after extubation (T4) Propofol comsumption, fentanlyl comsumption, and side effects were recorded as well.

RESULTSThe results showed that MAP and HR (T0, T1, T2, T3, T4) in group B were significantly different from those in group A which fluctuated more markedly (P < 0.05). Propofol comsumption in group A was much more than that in group B (P < 0.05). Incidence of pharynx and larynx ache and restlessness were higher in group A than those in group B (P < 0.05).

CONCLUSIONDexmedetomidine could effectively reduce the cardiovascular response to incubation and extubation in esophageal cancer operation patients. Propofol comsumption, fentanlyl comsumption and side effects were reduceed as well.

Adjuvants, Anesthesia ; administration & dosage ; Adult ; Aged ; Analgesics, Non-Narcotic ; administration & dosage ; Anesthetics, Intravenous ; administration & dosage ; Dexmedetomidine ; administration & dosage ; Esophageal Neoplasms ; surgery ; Female ; Fentanyl ; administration & dosage ; Humans ; Male ; Middle Aged ; Propofol ; administration & dosage

OBJECTIVETo prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function.

METHODSNinety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed.

RESULTSAs compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05).

CONCLUSIONThe magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

Acupuncture Analgesia ; Acupuncture, Ear ; Adjuvants, Anesthesia ; administration & dosage ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; drug therapy ; physiopathology ; therapy ; Postoperative Period ; Recovery of Function ; Young Adult

OBJECTIVETo explore the effect of intravenous injection rate and site of fentanyl on the incidence and onset time of fentanyl-induced cough.

METHODSeventy-five ASA class I or II patients were randomized into 3 groups and received intravenous fentanyl administration at 4 microg/kg in different manners. In group A, fentanyl was injected within 2 s into the forearm veins; in group B, fentanyl was injected in 2 s through the dorsal foot veins or the great saphenous vein anterior to the ankle; in group C, fentanyl was injected in 15 s by the same route as in group A.

RESULTSThe incidence of cough was 44%, 52% and 8%, with cough onset time of 16.1-/+2.7 s, 21.9-/+3.7 s and 23.3-/+3.2 s in groups A, B and C, respectively. Compared with group A, group B had a delayed onset of cough (P<0.05), and group C had both a lowered incidence of cough (P<0.05) and delayed onset of cough (P<0.05).

CONCLUSIONSThe rate of fentanyl injection through the same peripheral venous access at the same dose may affect the incidence and onset time of cough. At the same dose and injection rate of fentanyl, forearm venous access of injection resulted in earlier onset of cough than lower limb venous access, but the incidence is similar.

Adjuvants, Anesthesia ; administration & dosage ; adverse effects ; Adolescent ; Adult ; Aged ; Cough ; chemically induced ; Female ; Fentanyl ; administration & dosage ; adverse effects ; Humans ; Injections, Intravenous ; adverse effects ; Male ; Middle Aged ; Time Factors ; Young Adult

OBJECTIVETo evaluate the predictive performance of 'Diprifusor' TCI (target-controlled infusion) system for its better application in clinical anesthesia.

METHODSThe predictive performance of a 'Diprifusor' TCI system was investigated in 27 Chinese patients (16 males and 11 females) during upper abdominal surgery under total intravenous anesthesia (TIVA) with propofol/fentanyl. Measured arterial propofol concentrations were compared with the values predicted by the TCI infusion system. Performance was determined by the median performance error (MDPE), the median absolute performance error (MDAPE), the divergence (the percentage change of the absolute PE with time), and the wobble (the median absolute deviation of each PE from the MDPE).

RESULTSThe median (range) values of 14.9% (-21.6%-42.9%) for MDPE, 23.3% (6.9%-62.5%) for MDAPE, -1.9% h(-1) (-32.7%-23.0% h(-1)) for divergence, and 18.9% (4.2%-59.6%) for wobble were obtained from 227 samples from all patients. For the studied population, the PE did not increase with time but with increasing target propofol concentration, particularly following induction. conclusions: The control of depth of anaesthesia was good in all patients undergoing upper abdominal surgical operation and the predictive performance of the 'Diprifusor' target controlled infusion system was considered acceptable for clinical purposes. But the relatively bigger wobble showed that the pharmacokinetic model is not so suitable and requires improvement.

Abdomen, Acute ; blood ; surgery ; Adjuvants, Anesthesia ; administration & dosage ; Adolescent ; Adult ; Aged ; Anesthesia, Intravenous ; instrumentation ; methods ; Anesthetics, Intravenous ; administration & dosage ; blood ; Drug Therapy, Computer-Assisted ; instrumentation ; methods ; Female ; Fentanyl ; administration & dosage ; Humans ; Infusion Pumps ; Male ; Middle Aged ; Propofol ; administration & dosage ; blood ; Reproducibility of Results ; Sensitivity and Specificity

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.
Adjuvants, Anesthesia/*administration & dosage/pharmacology ; Adult ; Aged ; Antiemetics/*administration & dosage/pharmacology ; Female ; Gastrointestinal Motility/*drug effects/physiology ; Humans ; Injections, Intravenous ; Intestinal Pseudo-Obstruction/drug therapy/epidemiology/*prevention & control ; Lumbar Vertebrae/radiography/*surgery ; Male ; Metoclopramide/*administration & dosage/pharmacology ; Middle Aged ; Postoperative Complications/epidemiology ; Prevalence ; Prone Position ; Prospective Studies ; Republic of Korea ; Scopolamine Hydrobromide/*administration & dosage/*pharmacology ; Spinal Fusion/*adverse effects ; Supine Position ; Treatment Outcome

Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses; however, the effects of anesthesia with pentobarbital sodium on these responses are unclear. Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate. Increases in systolic blood pressure (SBP) and heart rate (HR) were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg·kg(-1)·h(-1). This response was associated with an increase in the low-frequency band of SBP variability (SBP-LF). As the infusion rate increased to 10 mg·kg(-1)·h(-1) or more, decreases in SBP and HR were observed. This response was associated with the reduction of SBP-LF. In conclusion, lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects, depending on the depth of pentobarbital anesthesia. The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.
Adjuvants, Anesthesia ; administration & dosage ; pharmacology ; Adrenergic alpha-Antagonists ; pharmacology ; Animals ; Autonomic Nervous System ; drug effects ; Cats ; Dose-Response Relationship, Drug ; Electric Stimulation ; Electrocardiography ; drug effects ; Hemodynamics ; drug effects ; Hexamethonium ; pharmacology ; Hypnotics and Sedatives ; administration & dosage ; pharmacology ; Infusions, Intravenous ; Lingual Nerve ; drug effects ; physiology ; Male ; Neural Inhibition ; Phentolamine ; pharmacology ; Trigeminal Nerve ; drug effects ; physiology

OBJECTIVE: To determine the effect of different doses of sufentanil on stress responses to tracheal intubation in patients undergoing heart valve replacement surgery. METHODS: Sixty patients undergoing heart valve replacement surgery were randomly divided into 4 groups (n=15). Before the tracheal intubation, patients received 10microg/kg fentanyl (Group A), 1microg/kg sufentanil (Group B ), 1.5micro/kg sufentanil (Group C), and 1.5microg/kg sufentanil (Group D), respectively, with midazolum and vecuronium intravenous injection. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded before the induction of anesthesia(T(0)), after the induction of anesthesia(T(1)), and at 1(T(2)), 3(T(3)), 5(T(4)), and 10 min after the tracheal intubation(T(5)). Rate-pressure product was derived from SBP and HR. Blood sugar was monitored at T(0), T(2) and T5. RESULTS: The SBP,DBP,MAP, HR and RPP at T(0) were not significantly different among the 4 groups (P>0.05). These parameters at T(1) were significantly lower than those at T(0) (P<0.01), but there was not significant difference among the 4 groups. The SBP, DBP, MAP in Group A increased significantly at T(2) and T(3) than those at T(1)(P<0.01 approximately 0.05), but were not significantly different than those at T(0)(P>0.05). The SBP,MAP in Group B,C,D at T(2) and T(3) were significantly lower than those in Group A (P<0.01 approximately 0.05 ). The SBP and MAP in Group D at T(4) were still lower than those in Group A (P<0.05). The HR at T(2) in Group A increased compared with that at T(1)(P<0.05),but was still lower than that at T(0). The HR at T(2) in Group B, C, and D was not significantly changed. The HR decreased significantly at T(2) in Group D compared with that in Group A(P<0.05), and the HR at T5 in Group A and D significantly decreased compared with that in Group B(P<0.05). The RPP at T(1) to T5 in Group B, C, and D significantly decreased compared with that at T(0)(P<0.01). The RPP at T(2) in Group A increased significantly compared with those in Group B, C, and D(P<0.01). The cases of using atropine during the induction and intubation in Group A,B,C, and D were 5(33.3%),0(0%),4(26.7%),5(33.3%),respectively, and the cases in Group B were significantly different compared with those in Group A and D(P<0.05). The change of blood sugar in Group A,B,C, and D was not significantly different(P>0.05). CONCLUSION Three doses of sufentanil may effectively control the stress responses to the tracheal intubation in patients undergoing heart valve replacement surgery, and the hemodynamics during the intubation at 1microg/kg is much more stable.
Adjuvants, Anesthesia ; administration & dosage ; Adolescent ; Adult ; Dose-Response Relationship, Drug ; Female ; Heart Valve Diseases ; surgery ; Heart Valve Prosthesis Implantation ; adverse effects ; methods ; Hemodynamics ; drug effects ; Humans ; Intubation, Intratracheal ; adverse effects ; methods ; Male ; Middle Aged ; Stress, Physiological ; etiology ; prevention & control ; Sufentanil ; administration & dosage ; Treatment Outcome