BACKGROUND: Intrathecal sildenafil has produced antinociception by increasing the cGMP through inhibition of phosphodiesterase 5. Spinal opioid receptor has been reported to be involved in the modulation of nociceptive transmission. The aim of this study was to examine the role of opioid receptor in the effect of sildenafil on the nociception evoked by formalin injection. METHODS: Rats were implanted with lumbar intrathecal catheters. Formalin testing was used as a nociceptive model. Formalin-induced nociceptive behavior (flinching response) was observed. To clarify the role of the opioid receptor for the analgesic action of sildenafil, naloxone was administered intrathecally 10 min before sildenafil delivery, and formalin was then injected 10 min later. RESULTS: Intrathecal sildenafil produced dose-dependent suppression of flinches in both phases during the formalin test. Intrathecal naloxone reversed the analgesic effect of sildenafil in both phases. CONCLUSIONS: Sildenafil is active against the nociceptive state that's evoked by a formalin stimulus, and the opioid receptor is involved in the analgesic action of sildenafil at thespinal level.
Analgesia ; Animals ; Catheters ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Formaldehyde ; Naloxone ; Nociception ; Pain Measurement ; Rats* ; Receptors, Opioid* ; Sildenafil Citrate

BACKGROUND: Autonomic neuropathy is frequently developed in patients with diabetets mellitus (DM) and is associated with increased perioperative hemodynamic instability. This study investigated the effect of DM on vasoconstrictor requirement and hemodynamic parameters in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). METHODS: Seventy four patients undergoing OPCAB were divided into two groups; patients without DM (control, n = 51) and patients with DM (n = 23). Hemodynamic parameters were recorded at 10 min after induction of anesthesia (T1), at 10 min after stabilizer application for anastomosis of the left anterior descending coronary artery (T2), the obtuse marginalis branch (T3) and the right coronary artery (T4) and at 10 min after sternum closure (T5). The amount of norepinephrine requirement during the period of induction of anesthesia and grafting was also recorded. RESULTS: Pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure at T3, PCWP and central venous pressure at T4 were significantly higher in the DH group. Mixed venous oxygen saturation at T2 and T4 and cardiac output at T3 were also significantly lower in the DH group. Significantly greater amount of norepinephrine was infused during the induction of anesthesia in the DH group. CONCLUSIONS: Patients with coronary artery occlusive disease and concomitant DM required significantly greater amount of vasoconstrictor during the induction of anesthesia to maintain stable mean arterial pressure. In addition, more pronounced hemodynamic instability was observed during the period of grafing in these patients undergoing OPCAB.
Anesthesia ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Diabetes Mellitus* ; Hemodynamics* ; Humans ; Norepinephrine ; Oxygen ; Pulmonary Wedge Pressure ; Sternum ; Transplants*

OBJECTIVE: The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). METHODS: This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40–S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse’s pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. RESULTS: A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P < 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. CONCLUSION: ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.
Analgesics ; Education ; Electronic Health Records ; Emergencies* ; Emergency Service, Hospital* ; Extremities* ; Humans ; International Classification of Diseases ; Pain Management* ; Pain Measurement ; Prescriptions ; Quality Improvement* ; Retrospective Studies ; Triage