Background: Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. Methods: We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus (‘gas-out time’) and defecation. The secondary outcome was stool types. Results: One-hundred and two patients participated (Group S, 49; Group P, 53). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36–20.25) h in Group S and 20.85 (16.34–25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. Conclusions Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

BACKGROUND: Maternal hypotension is a common complication during obstetric spinal anesthesia. This study was conducted to investigate the role of autonomic function testing in predicting maternal hypotension during spinal anesthesia induced to conduct Cesarean sections (C-section). METHODS: This study was conducted on 32 parturients undergoing C-section under spinal anesthesia. Sympathetic function tests included measuring diastolic blood pressure changes in response to hand gripping and systolic blood pressure changes response to moving from a supine to a standing position. Sympathetic dysfunction is said to exist when there are abnormal responses to both sympathetic function tests. Parasympathetic function tests included measuring heart rate responses to deep breathing and heart rate responses to moving from a supine to a standing position. Parasympathetic dysfunction is said to exist when there are abnormal responses to both parasympathetic function tests. After the onset of spinal anesthesia, blood pressure was measured every minute until childbirth. RESULTS: Hypotension occurred in 22 of the 32 parturients. There was no correlation between sympathetic dysfunction and hypotension incidence, but 12 of the 12 (100%) of the positive group and 10 of the 20 (50%) of the negative group experiencing parasympathetic dysfunction, respectively, experienced hypotension with a significant difference of P = 0.004. The group experiencing parasympathetic dysfunction had statistically significantly higher phenylephrine requirements were also greater in the parasympathetic dysfunction positive group (P < 0.003). CONCLUSIONS: This study's findings suggested that the parasympathetic function tests may be useful methods for predicting the incidence of maternal hypotension during spinal anesthesia induced for C-section.
Anesthesia, Spinal ; Autonomic Nervous System ; Blood Pressure ; Cesarean Section ; Female ; Hand ; Hand Strength ; Heart Rate ; Humans ; Hypotension ; Incidence ; Parasympathetic Nervous System ; Parturition ; Phenylephrine ; Pilot Projects ; Posture ; Pregnancy ; Respiration ; Sympathetic Nervous System

BACKGROUND: Peripheral neuritis caused by acrylamide is well-known, and many Korean grouting workers are frequently exposed to acrylamide in grouting agents that are injected into cracked concrete. We recently encountered two cases of dermal and neural toxicity in Korean grouting workers with exposure to grouting agents that contained a high concentration of acrylamide. CASE PRESENTATION: The first case involved a 44-year-old man with 8 years of waterproofing experience. The patient developed peeling skin on both hands while grouting, which progressed to systemic neurological symptoms, such as reduced sensory function and strength. The patient was diagnosed with peripheral neuropathy caused by acrylamide exposure, and fully recovered after conservative treatment and withdrawal of exposure to the grouting agent. The second case involved a 34-year-old man with 10 years of grouting experience. The patient initially experienced weakness in both legs, which progressed to weakness in his arms and uncontrolled phonation. After being hospitalized, he was diagnosed with cerebellar ataxia and peripheral neuropathy caused by acrylamide exposure, and was discharged after conservative treatment. Our follow-up investigation revealed that both workers were recently exposed to grouting agents that contained higher concentrations of acrylamide, compared to the agents that they had previously been using. CONCLUSIONS: Both workers had workplace acrylamide exposure through dermal contact plus inhalation of dust and vapor, which led to the neural toxicity and dermatitis. Therefore, government studies are needed to investigate the current status of workplace acrylamide use, and to protect workers from the hazardous effects of using acrylamide-containing grouting agents.
Acrylamide* ; Adult ; Arm ; Cerebellar Ataxia ; Dermatitis ; Dust ; Follow-Up Studies ; Hand ; Humans ; Inhalation ; Korea ; Leg ; Neuritis ; Peripheral Nervous System Diseases ; Phonation ; Sensation ; Skin

Recent studies have documented that testosterone relaxes several smooth muscles by modulating K+channel activities. Smooth muscles of seminal vesicles play a fundamental role in ejaculation, which might involve testosterone. This study was aimed to assess the role of testosterone in seminal vesicular motility by studying its effects on contractile agents and on the ion channels of single vesicular myocytes in a rabbit model. The contractile responses of circular smooth muscle strips of rabbit seminal vesicles to norepinephrine (10 micrometer), a high concentration of KCl (70 mM), and testosterone (10 micrometer were observed. Single vesicular myocytes of rabbit were isolated using proteolytic enzymes including collagenase and papain. Inside-out, attached, and whole-cell configurations were examined using the patch clamp technique. The applications of 10 micrometernorepinephrine or 70 mM KCl induced tonic contractions, and 10 micrometertestosterone (pharmacological concentration) evoked dose-dependent relaxations of these precontracted strips. Various K+channel blockers, such as tetraethylammonium (TEA; 10 mM), iberiotoxin (0.1 micrometer), 4-aminopyridine (4-AP, 10 micrometer, or glibenclamide (10 micrometer rarely affected these relaxations. Single channel data (of inside-out and attached configurations) of BK channel activity were also hardly affected by testosterone (10 micrometer). On the other hand, however, testosterone reduced L-type Ca2+currents significantly, and found to induce acute relaxation of seminal vesicular smooth muscle and this was mediated, at least in part, by Ca2+current inhibition in rabbit.
4-Aminopyridine ; Calcium ; Calcium Channels ; Collagenases ; Contracts ; Ejaculation ; Glyburide ; Hand ; Ion Channels ; Male ; Muscle Cells ; Muscle, Smooth ; Norepinephrine ; Papain ; Peptide Hydrolases ; Peptides ; Relaxation ; Seminal Vesicles ; Testosterone ; Tetraethylammonium

BACKGROUND: We examined the association between insulin resistance assessed by homeostatic model assessment-insulin resistance (HOMA-IR) and benign prostatic hyperplasia (BPH) in healthy middle-aged male subjects. METHODS: A cross-sectional study included 1,727 male subjects, aged 40-59 year, free of medication history for BPH who received a transrectal ultrasonography and completed a structured questionnaire in 2011. Multiple logistic regression analysis was performed to evaluate the relationships of HOMA-IR with BPH across the tertile of HOMA-IR. RESULTS: The prevalence of BPH was 24.4% (421 out of 1,727). It was increased across HOMA-IR tertiles in crude and age-adjusted models. In a multivariable-adjusted model after adjusting potential confounders such as age, body mass index (BMI), triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), alcohol consumption, smoking, exercise and meat consumption, odds ratios (95% confidence intervals, CIs) of BPH for 2nd tertile and 3rd tertile compared to 1st tertile were 1.76 (1.31-2.35), and 1.83 (1.34-2.48), respectively. CONCLUSIONS: In middle-aged, healthy men, higher HOMA-IR was significantly associated with higher prevalence of BPH, supporting insulin resistance as an independent risk factor for BPH.
Alcohol Drinking ; Body Mass Index ; Cholesterol, HDL ; Cholesterol, LDL ; Cross-Sectional Studies ; Humans ; Insulin Resistance* ; Insulin* ; Logistic Models ; Male ; Meat ; Odds Ratio ; Prevalence ; Prostatic Hyperplasia* ; Risk Factors ; Smoke ; Smoking ; Triglycerides ; Ultrasonography