Backgrounds: Brief noxious stimuli are found to produce long-lasting neuronal sensitization. This cumulative depolarization results from the activation by glutamate of N-methyl-D-aspartic acid (NMDA) receptor. Ketamine at subanesthetic doses blocks the channel associated with the NMDA receptor. The aim of this study was to investigate the pre-emptive effect of ketamine in children after circumcision with unilateral hydrocelectomy. MATERIALS AND METHODS: We have compared the effect of preoperative ketamine (0.3 mg/kg) in a double-blind, randomized study, which was approved by the local Ethics Committee. Informed consents were obtained from their parents. After induction of anesthesia, patients were allocated randomly to receive a ketamine (n=20) or placebo (n=20) intravenously before surgery. Postoperative pain was rated on a faces scale for the first 24 hours. If pain occurred, children received tiaprofenic acid in a dose related to body weight. The cumulative pain score, the time of the first requirement of analgesics, and total requirement of analgesics for 24 hours were also checked. RESULTS: The pain scores at 4, 5, 6, 7, 8, 9, and 12 hours after operation were significantly low in ketamine group. The cumulative pain scores for the first 8 hours and the total requirements of analgesics were significantly low in ketamine group. The time of the first requirement of analgesic was significantly delayed in ketamine group. CONCLUSIONS: Preoperative ketamine in the pediatric circumcision with unilateral hydrocelectomy is effective on the reducing the intensity of the postoperative pain. The results of this study support the theory of pre-emptive analgesia of ketamine.
Analgesia* ; Analgesics ; Anesthesia ; Body Weight ; Child* ; Circumcision, Male* ; Ethics Committees ; Female ; Glutamic Acid ; Humans ; Ketamine* ; Male ; N-Methylaspartate ; Neurons ; Pain, Postoperative* ; Parents

Oral medication is one of the most frequent treatment in clinical care, and frequently refused by children. Children's refusal spends unuseful time and require nurses' patience. So this study was attempted to develop token economy program which promote children's medication, and to evaluate its' effect to construct the experimental ground. This study was a quasi experimental study under the nonequivalent control group non-synchronized design. The subjects of this study were 48 children who were aged 3-12 years and admitted pediatric ward because of their respiratory disease. Token economy program was consisted of cartoon record paper with stickers which expresses the better medication is taken the more germs die, and gift was given for back up reinforcer. To evaluate this program, time spent for oral medication was measured six time to both experimental group and control group, and measured the perceived effectiveness of this program by nurses. To determine the effect of the program, the data were analyzed by the SAS 6.12 program with t-test and mean, standard deviation. The results of this study were as follows: 1. In experimental group, time spent for oral medication was significantly shorter than in control group(t=5.24, p=0.0001). Therefore, the hypothesis of this study was strongly accepted. 2. Nurses perceived this program as an effective one(mean=3.125 ~ 3.792). The effectiveness occurred before, during and after medication as well as in parental responses, especially in using verbal dissatisfaction after medication. In conclusion, it was found that the token economy program for admitted children was effective in inducing the children's behavior of oral medication. There was no effectiveness in very highly anxious children. Whereas, it is recommended that this program should not be used for such children until they settle down. If the token economy program was made in various situation with creative thinking, it will be very useful nursing measurement, especially in caring for children. To improve the quality of nursing care, the various programs, which can give joyfulness to stressed patients should be developed.
Child ; Disulfiram ; Humans ; Nursing ; Nursing Care ; Parents ; Thinking ; Token Economy* ; Child Health

No abstract available.
Adult* ; Humans ; Lung* ; Pneumocytes* ; Pneumonectomy* ; Rabbits*

BACKGROUND: Skin thickness for parameter of skin aging has been analysed with various methods. Skin thickness variations between the young and the old has been studied with various methods such as biopsies, calipers, micrometers, computer tomography, ultrsonography. But none of these methods evaluates skin thickness exactly. OBJECTIVE: For the evaluation of age-dependent skin thickness changes, we compared the skin thickness of an old-aged group and a young group with 20MHz-ultrasonography. METHODS: In order to identify the skin thickness variation between different age groups, 60 subjects, 30 aged 23-33, and 30 over 60, were studied with 20MHz-high frequency ultrasonogrphy (Dermascan C, Cortex Technology, Hadsund, Denmark) on fourteen skin sites. This machine was designed to measure the thickness from the top of the epidermis to the bottom of the dermis. After storage of cross-sectional skin imaging, skin thickness was calculated with a computer assisted image-analysis program. Skin thickness of the old was analysed by age, sex, height and weight.
Biopsy ; Dermis ; Epidermis ; Humans ; Skin Aging ; Skin* ; Ultrasonography*

BACKGROUND: Studies on the mechanism of ketamine preemption have led to conflicting results. The purpose of this study was to compare behavioral antinociceptive responses with spinal fos-like immunoreactivity (FLI) in intravenous ketamine injection between pre- versus post-formalin administration in the rat. METHODS: Sprague-Dawley rats (250 300 g) were prepared to receive either saline or ketamine. Formalin (5%) 100mul was injected into the hindpaw. All rats were randomly divided into 4 groups; basal, control, pretreatment and posttreatment group. Pain related behavior was quantified by counting the incidence of flinches of the injected hindpaw for 60 minutes. The effect of pre- versus posttreatment with the ketamine on FLI in the lumbar spinal cord was examined by immunohistochemistry using specific antibodies. RESULTS: Flinches of phase 2 were 0.5 +/- 0.3, 239.3 +/- 22.8, 118.6 +/- 7.5 (P < 0.05 vs. control) and 186.7 +/- 16.6 in the basal, control, and pre-, posttreatment group respectively. Similarly, the pretreatment group virtually inhibited a formalin-induced expression of FLI (P < 0.05 vs. control, posttreatment) in the laminae I-II and III-VI ipsilateral to the formalin injection. FLI expression significantly correlated with the phase 2 flinching behavior (P < 0.001). CONCLUSIONS: Pretreatment of intravenous ketamine inhibits inflammatory pain behavior and FLI expression in the lumbar enlargement following formalin injection in rats, suggesting that pretreatment of ketamine plays an important role in preemptive analgesia.
Analgesia ; Animals ; Antibodies ; Formaldehyde* ; Immunohistochemistry ; Incidence ; Ketamine* ; Pain Measurement ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord

No abstract available.
Humans ; Quintuplets*

BACKGROUND: N-methyl-D-aspartate (NMDA) antagonists can be useful as preemptive analgesic agents and effective in reducing established central sensitization. The purpose of this study was to evaluate the preemptive effect of intrathecal ketamine and compare the behavioral antinociceptive responses between pre- versus post-formalin ketamine administration in a rat pain model. METHODS: Sprague-Dawley rats (250 - 300 g) were prepared with a PE 10 indwelling intrathecal catheter to receive either saline (control) or ketamine. Rats received ketamine 100ng intrathecally through a catheter either 7 min before or 5 min after formalin. The formalin test was performed with 5% formalin 100nl. The control (n = 8), pre-treatment (n = 7), and post-treatment (n = 7) groups were studied. Pain related behaviors were quantified by counting the incidences of flinching of the formalin injected paw for 60 minutes. RESULTS: Intraplantar formalin injection produced a biphasic (phase 1, 0 - 10 minutes; phase 2, 10 - 60 minutes after formalin injection) response of flinching behavior in control, pre-treatment, and post-treatment groups. The post-treatment group showed less frequent phase 2 flinching than the control group (P < 0.05). CONCLUSIONS: Post-treatment of intrathecal ketamine 100ng was effective on inhibition of phase 2 nociceptive behaviors following the formalin injection. These results suggested that intrathecal ketamine shows an analgesic effect when administered as a post-treatment.
Analgesics ; Animals ; Catheters ; Central Nervous System Sensitization ; Formaldehyde* ; Incidence ; Ketamine* ; N-Methylaspartate ; Pain Measurement* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: N-methyl-D-aspartate (NMDA) antagonists can be useful as preemptive analgesic agents and effective in reducing central sensitization. The purpose of this study was to evaluate the preemptive effect of intravenous (IV) ketamine on the behavioral responses between a pre- versus post-formalin test in a rat model. METHODS: Sprague-Dawley rats (250 - 300 g) were prepared with a PE-50 indwelling IV catheter to receive either saline or ketamine. Rats received ketamine 1 mg/kg intravenously through a catheter either 1 min before or 5 min after formalin. The formalin test was performed with 5% formalin 100nl. All rats were randomly divided into one of three groups; a control (n = 8), pre-treatment (n = 7), or post-treatment (n = 7) group. Pain related behaviors were quantified by counting the numbers of flinching of the injected paw for 60 minutes. RESULTS: Intraplantar formalin injection produced a biphasic (phase 1, 0 - 10 minutes; phase 2, 10 - 60 minutes after formalin injection) appearance of flinching behavior in the control, pre-treatment, and post- treatment groups. The pre-treatment group showed less flinching in phase 2 than the control group (P < 0.05), but the post-treatment group didn't. CONCLUSIONS: These results suggest that pre-treatment of IV ketamine 1 mg/kg showed a preemptive analgesic effect.
Analgesics ; Animals ; Catheters ; Central Nervous System Sensitization ; Formaldehyde* ; Ketamine* ; Models, Animal ; N-Methylaspartate ; Pain Measurement* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of ketamine pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n=30), lidocaine group (n=30) and ketamine group (n=30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% ketamine) via 18G angiocatheter inserted in the antecubital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assessment of pain was made at the induction of anesthesia and in the recovery room, and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the ketamine group compared with the saline group at the induction of anesthesia (p<0.05) and there was no significant difference between the lidocaine group and the ketamine group. We had similar results in the recovery room and one patient from the saline group and the ketamine group had no recall regarding injection pain. CONCLUSION: Intravenous ketamine pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Arm ; Female ; Humans ; Incidence ; Injections, Intravenous ; Ketamine* ; Lidocaine* ; Propofol* ; Recovery Room ; Tourniquets

Postdural puncture headache is one of the well-known complications of spinal anesthesia. The sitting position is adequate for perineal and urologic operations, or when obesity makes difficult identification of midline anatomy in the lateral position. This study was done to see the effect of position (lateral or sitting position during spinal anesthesia), needle bevel direction (parallel or vertical to longitudinal dural fiber), and angle of approach (paramedian or midline) on the incidence, onset, location, severity of postdural puncture headache in the 160 patients underwent spinal anesthesia with 25-gauge Quincke needles. We observe the following results: 1) The total incidence of postdural puncture headache was 8.1%(13 cases). 2) The incidence of postdural puncture headache were 6%(lateral position), l0%(sitting position), 3%(parallel to longitudinal dural fiber), 11%(vertical to longitudinal dural fiber), 8%(paramedian approach) and 9%(midline approach). A significant increase in incidence was found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers. 3) The onset of postdural puncture headache were within 3 days after spinal anesthesia in the almost cases (92.3%). 4) The location of postdural puncture headache were frontal(31%), occipital(15%), temporal(8%), and whole region(46%). 5) According to the duration of postdural puncture headache, two day headache was 31%, four day one was 15%, six day one was 15%, and over six day one was 38%. A significant increase in duration was found with sitting position when the bevels were oriented so as to bc vertical rather than parallel to the longitudinal dural fibers. 6) The treatments of postdural puncture headache were bed rest(20%), analgesics(54%), and epidural blood patch(31%). In conclusion, the significant increase in incidence and duration were found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers.
Anesthesia, Spinal* ; Headache ; Humans ; Incidence ; Needles* ; Obesity ; Post-Dural Puncture Headache*