Hyperinsulinism caused by a functioning islet cell tumor of the pancreas is an uncommon but well established metabolic entity which can usually be diagnosed accurately. We treated a patient with functioning insulinoma recently. The outline of the particular management given for the course of the anesthesia of the patient was as follows: 1) Control of blood glucose a) pre- and intraoperative hypoglycemia; Glucose was administered through intravenous drip or orally. b) postoperative transient hyperglycemia; Insulin was administered if necessary and a small amount of glucose uptake, occurred. 2) Anesthetics, and supplemental drugs Drugs with no or little effect in increasing blood glucose were used. 3) Beta-adrenergic blockers These drugs were not used in the hypoglycemic state because of potentiating insulin activity.
Adenoma, Islet Cell ; Adrenergic beta-Antagonists ; Anesthesia* ; Anesthetics ; Blood Glucose ; Glucose ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Infusions, Intravenous ; Insulin ; Insulinoma* ; Pancreas

This study examined whether propofol and aminophylline affect the mobilization of intracellular calcium in human umbilical vein endothelial cells. Intracellular calcium was measured using laser scanning confocal microscopy. Cultured and serum-starved cells on round coverslips were incubated with propofol or aminophylline for 30 min, and then stimulated with lysophosphatidic acid, propofol and aminophylline. The results were expressed as relative fluorescence intensity and fold stimulation. Propofol decreased the concentration of intracellular calcium, whereas aminophylline caused increased mobilization of intracellular calcium in a concentration-dependent manner. Propofol suppressed the lysophosphatidic acid-induced mobilization of intracellular calcium in a concentration-dependent manner. Propofol further prevented the aminophylline-induced increase of intracellular calcium at clinically relevant concentrations. However, aminophylline reversed the inhibitory effect of propofol on the elevation of intracellular calcium by lysophosphatidic acid. Our results suggest that propofol and aminophylline antagonize each other on the mobilization of intracellular calcium in human umbilical vein endothelial cells at clinically relevant concentrations. Serious consideration should be given to how this interaction affects mobilization of intracellular calcium when these two drugs are used together.
Aminophylline/*antagonists & inhibitors/pharmacology ; Anesthetics, Intravenous/*antagonists & inhibitors/pharmacology ; Bronchodilator Agents/*antagonists & inhibitors/pharmacology ; Calcium/*metabolism ; Cells, Cultured ; Endothelial Cells/*drug effects/metabolism ; Endothelium, Vascular/cytology ; Humans ; Lysophospholipids/pharmacology ; Microscopy, Confocal ; Propofol/*antagonists & inhibitors/pharmacology ; Umbilical Veins/cytology

The present study was designed to investigate the inhibitory effects of intravenous general anesthetic propofol (0.1-3.0 mmol/L) on excitatory synaptic transmission in supraoptic nucleus (SON) neurons of rats, and to explore the underlying mechanisms by using intracellular recording technique and hypothalamic slice preparation. It was observed that stimulation of the dorsolateral region of SON could elicit the postsynaptic potentials (PSPs) in SON neurons. Of the 8 tested SON neurons, the PSPs of 7 (88%, 7/8) neurons were decreased by propofol in a concentration-dependent manner, in terms of the PSPs' amplitude (P < 0.01), area under curve, duration, half-width and 10%-90% decay time (P < 0.05). The PSPs were completely and reversibly abolished by 1.0 mmol/L propofol at 2 out of 7 tested cells. The depolarization responses induced by pressure ejection of exogenous glutamate were reversibly and concentration-dependently decreased by bath application of propofol. The PSPs and glutamate-induced responses recorded simultaneously were reversibly and concentration-dependently decreased by propofol, but 0.3 mmol/L propofol only abolished PSPs. The excitatory postsynaptic potentials (EPSPs) of 7 cells increased in the condition of picrotoxin (30 µmol/L, a GABA(A) receptor antagonist) pretreatment. On this basis, the inhibitory effects of propofol on EPSPs were decreased. These data indicate that the presynaptic and postsynaptic mechanisms may be both involved in the inhibitory effects of propofol on excitatory synaptic transmission in SON neurons. The inhibitory effects of propofol on excitatory synaptic transmission of SON neurons may be related to the activation of GABA(A) receptors, but at a high concentration, propofol may also act directly on glutamate receptors.
Anesthetics, Intravenous ; pharmacology ; Animals ; Excitatory Postsynaptic Potentials ; drug effects ; GABA-A Receptor Antagonists ; pharmacology ; Glutamic Acid ; pharmacology ; In Vitro Techniques ; Neurons ; drug effects ; Propofol ; pharmacology ; Rats ; Receptors, Glutamate ; metabolism ; Supraoptic Nucleus ; cytology

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.
Adult ; Androstanols/*administration & dosage/adverse effects ; Anesthetics, Intravenous/administration & dosage ; Double-Blind Method ; Female ; Histamine H1 Antagonists/*pharmacology ; Humans ; Incidence ; Injections, Intravenous ; Male ; Middle Aged ; Movement/drug effects/physiology ; Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects ; Pain/chemically induced ; Pain Measurement ; Pheniramine/*pharmacology ; Thiopental/administration & dosage

To investigate the effects of novel intravenous general anesthetic propofol on membrane electrophysiological characteristics and action potential (AP) of the supraoptic nucleus (SON) neurons and possible ionic mechanisms, intracellular recordings were conducted in SON neurons from the coronal hypothalamic slice preparation of adult male Sprague Dawley (SD) rats. The results showed that bath application of 0.1 mmol/L propofol induced a significant decline in resting potential (P < 0.01), and higher concentrations of propofol (0.3 and 1.0 mmol/L) decreased time constant and slope resistance of cell membrane (P < 0.01). Under the hyperpolarizing current pulses exceeding 0.5 nA, an anomalous rectification was induced by hyperpolarization-activated cation channel (I(h) channel) in 11 out of 18 tested SON neurons. Bath of propofol reversibly decreased the anomalous rectification. Moreover, 0.1 mmol/L propofol elevated threshold level (P < 0.01) and decreased Max L. slope (P < 0.05) of the spike potential in SON neurons. Interestingly, 0.3 and 1.0 mmol/L propofol nullified APs in 6% (1/18) and 71% (12/17) tested SON neurons, respectively. In the SON neurons where APs were not nullified, propofol (0.3 mmol/L) decreased the amplitude of spike potential (P < 0.05). The higher concentrations of propofol (0.3 and 1.0 mmol/L) decreased firing frequencies evoked by depolarizing current pulses (0.1-0.7 nA), and shifted the current intensity-firing frequency relation curves downward and to the right. These results suggest that propofol decreases the excitability of SON neurons by inhibiting I(h) and sodium channels.
Action Potentials ; drug effects ; Anesthetics, Intravenous ; pharmacology ; Animals ; Cyclic Nucleotide-Gated Cation Channels ; antagonists & inhibitors ; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels ; Hypothalamus ; drug effects ; physiology ; In Vitro Techniques ; Male ; Potassium Channels ; Propofol ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Sodium Channel Blockers ; pharmacology ; Supraoptic Nucleus ; drug effects ; physiology