According to the International Association for the Study of Pain (IASP), pain is un unpleasant sensory and emotional experience signaling the presence of actual or potential tissue damage, or described in terms of such damage. Clinically, however, pain without proven evidence for its origin, should also be considered and treated nonetheless. Pain is classified as acute and chronic, or nociceptive and neuropathic pain. Acute pain is an adaptive, beneficial response which is necessary for the preservation of tissue integrity. When it becomes a chronic pain, which is a pain that has outlived its usefulness, it may be a timeless, endless, and meaningless perception, bringing the subject a sense of isolation and despair. Therefore, adequate management of pain is absolutely mandatory using whatever modalities. Nociceptive pain is initiated by noxious stimuli, whereas the neuropathic pain is induced by injury to either peripheral or central nervous system. If the pain is not treated or undertreated, noxious stimuli evoke long-term and persistent changes in the dorsal horn neurons in the spinal cord. These changes engrave the memory of the stimuli and sensitize the dorsal horn neurons. Subsequent pain stimuli evoke a even greater response, which results in a centrally mediated secondary hyperalgesia, and is mediated through glutamate acting on the N-methyl-diaspartate (NMDA) receptors. Mechanisms and pathophysiology of each pain are described briefly.
Acute Pain ; Central Nervous System ; Chronic Pain ; Glutamic Acid ; Hyperalgesia ; Memory ; Neuralgia ; Nociceptive Pain ; Posterior Horn Cells ; Spinal Cord ; United Nations

No abstract available.
Animals ; Interleukin-2* ; Interleukin-6* ; Mice* ; Pseudomonas aeruginosa* ; Pseudomonas*

Celiac plexus block with neurolytic agents is widely recommended for the management of intraabdominal pain due to malignant disease as a simple, asafe and effective method. We performed neurolytic celia: plexus block with 60% ethanol in lidocaine in 8 patients: with gastric cancer(4), hepatoma(2), pancreatic cancer(1), and chronic pancreatitis(1). Good to excellent pain relief was obtained in the 2 hepatoma cases, 1 pancreatic cancer, and a gastric cancer patient. In one patient with gastirc cancer, analgesia lasted for about 3 months but the second block was entirely unsatisfactory. The result was uncertain in one patient with chronic pancreatitis because the pain was non-specific and responded even to saline solution(placebo). In the remaing 2 patients, the result was entirely negative and eventually, epidural morphine was given periodically through an indwelling catheter.
Analgesia ; Carcinoma, Hepatocellular ; Catheters, Indwelling ; Celiac Plexus* ; Ethanol ; Humans ; Lidocaine ; Morphine ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Stomach Neoplasms

Rabbits injected with ketamine, 2-8mg/kg, i.v. were subjected to positional manipulation. Rotation of the head to a unilateral direction (from the neutral to the right or left) and returning towards the neutral produced nystagmic responses in the bilateral eyeballs. The patterns of the nystagmus observed by ketamine were compared with those by alcohol(1-2 gm /kg). The following results were obtained. 1) Intravenous injection of ketamine did not cause spontaneous nystagmus when the animal was left in the neutral position. 2) Following the ketamine injection, positional manipulation such as lateral rotation of the head elicited nystagmus in the bilateral eyeballs. The directions of the nystagmus appeared to be specific to the direction of the rotation. 3) Returning of the head from the laterally rotated position to the neutral also caused nystagmus with specific directions. 4) The patterns of the positional nystagmus caused by ketamine were quite similar to those of "positional nystagmus" caused by alcohol; nystagmic patterns were almost identical between the animals injected with ketamine and alcohol when the direction of the head rotation was the same. 5) Destruction or removal of the bilateral vestibular systems abolished the nystagmic responses to the positional manipulation. These experimental results indicate that the ketamine does elicit positional nystagmus as alcohol, which has been known as a unique agent causing positional nystagmus in man and animals, and the vestibular system is basically related to the genesis of the positional nystagmus caused by ketamine.
Animals ; Head ; Injections, Intravenous ; Ketamine* ; Nystagmus, Physiologic* ; Rabbits*

This study was undertaken to investigate the effects of Thalamonal and enflurane on the blood glucose level. Anesthesia was maintained with Thalamonal (0.5~1ml/10kg), N2O(41/min), and pancuronium(0.1mg/kg) in group l patients and with enflurane(1.5~2.5vol%), N2O(41/min), pancuronium(0.1mg/kg) in group ll patients. Blood glucose levels were measured at ward, just before induction, 15 min after induction, 5 min and 40 min after skin incision and at recovery room respectively. The following results were obtained. 1) Blood plucose levels in both groups were not significantly changed during a period of fasting(p<0.05). 2) Blood glucose levels in both groups were more significantly increased during anesthesia and surgery than those measured at ward(p<0.01). 3) In group l patients, blood glucose levels measured at recovery room were more significantly increased than those measured at 40 min after skin incision(p<0.01), while in group ll patients blood glucose levels at recovery room were more significantly decreased than those measured at 40 min after skin incision(p<0.05). 4) Changes in blood glucose levels during anesthesia and operation were not significantly different in both groups. 5) Both groups did not show hypoglycemia or hyperglycemia beyond the clinically acceptable range. From above results, it is suggested that both Thalamonal and enflurane are safe anesthetic agents in the patients with diabetes mellitus as well as in the normal patients.
Anesthesia ; Anesthetics* ; Blood Glucose* ; Diabetes Mellitus ; Enflurane ; Humans ; Hyperglycemia ; Hypoglycemia ; Recovery Room ; Skin

The micelle solution of Triton X-100 has been used as one of the experimental analogues of biological membrane in the study of the mechanism of anesthesia. It is well known that the cloud point(Tc) of micelle solution is increased by the unionized species of local anesthetics which can penetrate and move into the micelle, and decreased by the ionized form of local anes- thetics which can not penetrate the membrane. Barbiturates(HA) ionize to H+ and A- . The degree of ionization of any drug depends on its own pKa and pH of the solution. The effect of thiobarbiturates on the Tc of micelle solution was studied to see if an unionized form is necessary for the drug to penetrate cell membrane as in local anesthetics. Thiobarbiturates decreased the Tc at low pH and increased at high pH. From the data obtained at pH around 4, the decrease in Tc(dT1) was regarded to be proportional to the concentration of [HA] in micelle, and the data obtained at pH around 10, the increase in Tc(dT2) was regarded to be proportional to the concen- tration of [A-] in aqueous phase. Assuming that the observed changes in Tc(dTc) at pH ranging from 4 to 10 were the summation of dT1 and dT, dTc was expressed as theoretical equation. The experimental data showed a perfect fit to the curve derived from the equation. This confirmed that thiobarbiturates, as local anesthetics, penetrate the micelle(membrane) in an unionized form.
Anesthesia ; Anesthetics, Local ; Cell Membrane ; Hydrogen-Ion Concentration ; Membranes ; Octoxynol ; Thiobarbiturates*

Safety for both mother and infant is an imperative element in anesthesia for cesarean section, and ketamine has been widely used in obstetrical anesthesia especially for analgesis for normal vagianl delivery. Small doses of ketamins(0.2~0.5mg/kg) provides satisfactory analgesia during delivery without significant marternal and fetal complications. We added nitrous oxide to the small dose of ketamine and applied it to the induction of anesthesia for cesarean section and the results were compared with those of thiopental. A small dose of ketamine with nitrous oxide may be superior to an ordinary dose of thiopental, in the effects on the maternal cardiovascular system and the Apgar score of the fetus although the Apgar score only is not sufficient to evaluate neonatal condition.
Analgesia ; Anesthesia* ; Anesthesia, Obstetrical ; Apgar Score ; Cardiovascular System ; Cesarean Section* ; Female ; Fetus ; Humans ; Infant ; Ketamine* ; Mothers ; Nitrous Oxide ; Pregnancy ; Thiopental

Several methods for the management of intractable pain for various conditions including malignant disorders, herpes zoster, and low back pain and/or sciatica in 80 patients were described and analyzed. Neurolytric blocks of celiac plexus were given to the patients suffering from intra-abdominal pain from malignant origin or chronic pancreatitis. Herpes zoster was treated mainly by chemical sympathectomy via paravertebral route and occassionaly corticosteroid was administered epidurally with the local anesthetic, bupivacaine. All the patients with low back pain and/or sciatica were given epidural corticosteroid one to three times. Other peripheral were blocks and regional corticosteroid therpy were given to the rest of the patients. Fair to excellent result was obtained in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that the earlier the patients were referred to the pain clinic, the better the results were.
Bupivacaine ; Celiac Plexus ; Herpes Zoster ; Humans ; Low Back Pain ; Pain Clinics ; Pain, Intractable ; Pancreatitis, Chronic ; Sciatica ; Sympathectomy, Chemical

Blood transfusion is a common clinical practice in the face of more complicated surgical procedures and in management of injured patients. Despite the apparent benefit that can be obtained from transfusions, several problems must be considered when we use massive cold banked blood. Before and during operation we performed massive transfusion to a patient with shock from hemorrhage due to uterine rupture. We observed a diffuse bleeding tendency and pulmonary changes which strongly suggested the acute respiratory distress syndrome with disseminated intravascular coagulation and that may be one of the most serious complications of massive transfusion.
Blood Transfusion ; Disseminated Intravascular Coagulation ; Hemorrhage ; Humans ; Respiratory Distress Syndrome, Adult ; Shock ; Uterine Rupture

Adult respiratory distress syndroms(ARDS) is a clinical syndrome of variable etiology and non specific complex pathophysiology with high mortality. But management would be successful leaving less than 1% of permanent impairment by intensive care including serial blood gas analysis. We experienced a case of ARDS developed after twice of cardiac arrest of which the outcome was favorable despite the conservative management with lack of various modernized equipments.
Adult* ; Blood Gas Analysis ; Heart Arrest* ; Humans ; Critical Care ; Mortality ; Respiratory Distress Syndrome, Adult*