The present study was undertaken in an attempt to explore the spinal cord after injection of a tracer substanee into the coe1iac plexus. We studied two groups of rabbits weighing 2.0 to 2.3 kg ; a normal control group and the experimental group. The animals were anesthetized with 20 % urethane 7 ml/kg body weight intraperitoneally. To make an injectable mixture of the tracer substance, 0.5 gm of ferric oxide (Iron sesquioxide) was mixed with 2 ml of lactated Ringer's solution just prior to injection. In normal control group (N=3), animals were killed after anesthetization by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. The experimental group was subdivided into a subgroup of perineurial injection of the tracer mixture to the bilateral coeliac ganglia (the perineurial injection subgroup, N=5), a subgroup of intraneural injection of tracer mixture to the bilateral coeliac ganglia (the coeliac ganglion subgroup, N=5) and a subgroup of intraneural injection of the tracer mixture to the bilateral superior mesenteric ganglia (the superior mesenteric ganglion subgroup, N=3). In the perineurial injection subgroup, the bilateral coeliac ganglia were exposed under surgical microscope and 1 ml of the tracer mixture was injected bilaterally exterior to the perineurial connective tissue of coeliac ganglion. After the injection, the abdominal wall was closed and animals were then allowed to rest in the lateral position for 2 hours. In the coeliac ganglion subgroup and the superior mesenteric ganglion subgroup 0.6 to 0.7 ml of the tracer mixture was injected bilateraUy into the coeliac ganglia or the superior mesenteric ganglia. After the injection, the aMominal wall of the animals were closed and then allowed to rest in the lateral position for 90 minutes. At the end of experiment, animals of the experimental group were killed by shedding blood and the segment of vertebrae from the 6th thoracic to 11th thoracic were removed and fixed in 10% formalin solution. Following decalcification in 50% formic acid, histological study was performed with hematoxilin-eosin(H-E) stain or iron stain in transverse sections and sagittal plane of specimen which was obtained in one animal of the coeliac ganglion group. The results were as follows ; 1. In the perineurial injection subgroup, moderate density of the tracer substance was diffused into the dura mater. There was minimally infiltrated tracer in the area of lateral side of the formatio reticularis and the perivascular space of the white matter and pia mater. 2. In the coelic ganglion subgroup many tracer were diffused into the perineurial epithelial space of unmyelinated fibers and around the Schwann's sheath of fibers in the ventral and dorsal roots. The white matter was infiltrated uniformly with the tracer substance. there was evidence of diffusion of the tracer substance through the glia limitans of the white matter in the transversely or sagittally sectioned slides. 3. The superior mesenteric ganglion was tightly encased with the connective tissue capsule, thus we experienced moderate resistance to injection of the tracer mixture. There was most extensive diffusion of the tracer substance in the ventral and dorsal roots, dorsal horns of the gray matter, the area of the lateral side of the formatio reticularis and the remaining whole area of the white matter. And the tracer substance was infiltrated around the peripherally situated cells of gray matter. Our observation demonstrate that the tightly encased ganglion like the superior mesenteric ganglion is the candidate for paralysis when a neurolytic agent was injected intraneura1ly. In discussion we indicated the existance of small ganglion on the wall of upper abdominal aorta which is prone to produce paraplegia of the distal extremities in case of neurolytic coeliac plexus block.
Abdominal Wall ; Animals ; Aorta, Abdominal ; Body Weight ; Celiac Plexus* ; Connective Tissue ; Diffusion ; Dura Mater ; Extremities ; Formaldehyde ; Ganglia ; Ganglion Cysts ; Horns ; Iron ; Neuroglia ; Paralysis ; Paraplegia ; Pia Mater ; Rabbits ; Spinal Cord* ; Spinal Nerve Roots ; Spine ; Urethane

Sugammadex is a modified gamma-cyclodextrin which is showing favorable outcomes regarding reversal of neuromuscular blockade, especially by rocuronium. It is designed to encapsulate rocuronium and being considered a new class of drugs as selective relaxant binding agents. It has given countless benefits to the patients at risk of incomplete or delayed recovery after neuromuscular block and has renown for another milestone in anesthesia practice. Recurrence of neuromuscular block has not been reported to be associated with the provided doses of sugammadex that are adequate for selected for reversal. Acceptable profiles are brought to light telling safety of sugammadex. However, some questions related to the twitch characteristics those resembled succinylcholine when reversal, the application for rocuronium anaphylaxis, and the hypersensitivity or anaphylaxis to sugammadex remain and are need of further investigation. It is imperative that potential problems that we need attention may include the patient's history of pulmonary disease and allergic disease for using sugammadex.
Anaphylaxis ; Androstanols ; Anesthesia ; gamma-Cyclodextrins ; Humans ; Hypersensitivity ; Light ; Lung Diseases ; Neuromuscular Blockade ; Patient Safety ; Recurrence ; Succinylcholine

BACKGROUND: The purpose of this study was to investigate whether the effects of mivacurium on onset and recovery were affected by the duration of more than 2 weeks after injury of the lower motor neuron in rabbits. METHODS: The animals were divided into five groups. The control group was without lower motor neuron injury. In the experimental groups, the lower motor neuron injury was made by denervating with a 75 - 80% lesion on the common peroneal nerve to the right anterior tibialis muscle. The experimental groups were subdivided as 1, 2, 3 and 4 week groups (named group 1 wk, 2, 3 and 4 wks) according to the duration of the denervation of the common peroneal nerve. The response relationship of mivacurium on the muscle twitches induced by TOF (train of four) stimulation (supramaximal stimulus of 0.2 ms duration, square-wave pulses, 2 Hz rate and 10 mA, repeated every 10 seconds) was studied in the anterior tibialis muscles and compared between all groups. Neuromuscular responses (onset, recovery time to T1(1), T1(25), T1(75), T1(95) and recovery index) of muscle twitches to intravenous mivacurium (0.18 mg/kg) were studied. After recording the muscle twitches, macroscopic findings were observed. RESULTS: The recovery time, T1(1) of group 4 wks was significantly longer than those of group 1, 2 and 3 wks (P < 0.05), but not different from the control group. The recovery time, T1(25), T1(75) and T1(95) of group 4 wks was significantly longer than those of all other groups (P < 0.05), but the onset times of all groups were not significantly different. The recovery index of group 4 wks was significantly higher than that of the control group (P < 0.05), but those of groups 1, 2 and 3 wks were not significantly different from that of the control group. The mass of the anterior tibialis muscle was significantly decreased at 4 weeks after the lower motor neuron injury (P < 0.05). CONCLUSIONS: Our results therefore suggest that the neuromuscular response to intravenous mivacurium on recovery in rabbits becomes prolonged according to the durations of the denervation and represents sensitivity at 4 weeks after the lower motor neuron injury.
Animals ; Denervation ; Motor Neurons* ; Muscles ; Peroneal Nerve ; Rabbits

BACKGROUND: The purpose of this study was to investigate whether the effects of mivacurium on muscular relaxation were similar by the duration of more than 2 weeks after the injury of lower motor neurons in rabbits. METHODS: The animals were divided into five groups. The control group was without lower motor neuron injury. In the experimental groups, the lower motor neuron injury was made by denervating with 75 - 80% lesion on the common peroneal nerve to the right anterior tibialis muscle. The experimental groups were subdivided as 1, 2, 3 and 4 week groups (referred to ad the 1 wk, 2, 3 and 4 wks group) according to the durations of the denervation of common peroneal nerve, respectively. The dose-response relationship of mivacurium on the muscle twitches induced by TOF (train of four) stimulation (supramaximal stimulus of 0.2 ms duration, square-wave pulses, 2 Hz rate, repeated every 10 seconds) was studied by calculating ED50 and ED95 in the anterior tibialis muscles and compared between all groups. After recording the muscle twitches, microscopic findings were observed. RESULTS: The effective dose for 95% twitch depression (ED95) of mivacurium at 1week after denervation was significantly higher than that of the control group (P <0.05), but the ED95 of 2, 3 and 4wks groups were not significantly different from that of the control group. However, the ED95 of 3 and 4wks group were inclined to be lower than that of the control and significantly lower than 1wk group (P < 0.05). There was no significant difference in the effective dose for 50% twitch depression (ED50) of mivacurium in all groups. The size of the anterior tibialis muscle was significantly decreased at 4weeks after the lower motor neuron injury (P <0.05), but the number of its sarcoplasmic nuclei was increased, according to the duration after the denervation. CONCLUSIONS: Our results therefore suggest that neuromuscular response of denervated anterior tibial muscle was resistant to intravenous mivacurium in early periods of 1 or 2 weeks but sensitive 4 weeks after the lower motor neuron injury.
Animals ; Denervation ; Depression ; Motor Neurons* ; Muscle, Skeletal ; Muscles ; Peroneal Nerve ; Rabbits* ; Relaxation*

Critical illness often results in renal dysfunction. Renal disease includes acid base imbalance, electrolyte shift and neuromuscular disturbances in critically ill patients, who are influenced by the pharmacodynamics and pharmacokinetics of muscle relaxants, with kidney dependent metabolism and excretion. In terms of renal dysfunction, not only decreased circulating levels of normal cholinesterase, but also cholinesterase depletion after plasmapheresis and dialysis draw the attention of clinicians, when administering a muscle relaxant to critically ill patients who are compromised with renal function. These patients have a lower clearance of renal excreted drugs, changes of the volume of distribution, water retention, and pH changes that alter the protein bond and degree of ionization of the drugs. Immobilization of the limb and respiratory muscles, leading to muscle atrophy and the up-regulation of nicotinic acetylcholine receptors, associated with critical illness, is observed in many patients hospitalized in the intensive care unit with renal dysfunction. Disease related conditions or iatrogenically induced factors, including sedation, lead to immobilization of skeletal muscles. Aside from systemic inflammation, immobilization is a key contributing factor to the development of critical illness myopathy. Physicians who care for critically ill patients with renal dysfunction should pay attention to the adequate choice of muscle relaxants and their antagonists.
Acid-Base Imbalance ; Cholinesterases ; Critical Care ; Critical Illness ; Dialysis ; Extremities ; Humans ; Hydrogen-Ion Concentration ; Immobilization ; Inflammation ; Intensive Care Units ; Kidney ; Muscle, Skeletal ; Muscles ; Muscular Atrophy ; Muscular Diseases ; Plasmapheresis ; Receptors, Nicotinic ; Respiratory Muscles ; Retention (Psychology) ; Up-Regulation ; Water

Signs and Symptoms consistent with the irritation of the cauda equina developed during epidural morphine therapy for the relief of pain from osteosarcoma in a 10-year-old female patient. This was considered to be due to a subarachnoid diffusion of the epidurally administrated morphine through the dural opening formed by a previous inadvertent dural puncture. The subarachnoid diffusion of the drug was confirmed by fluoroscopy following injection of the contrast media through the indwelling epidural catheter. The chemical inflammation of the cauda equina might be due to substances formed by chemical reactions with a certain preservative vehicle rather than the morphine itself. Spinal steroid therapy may be effective for the suppression of a chemical inflammatory reaction.
Catheters ; Cauda Equina ; Child ; Contrast Media ; Diffusion ; Female ; Fluoroscopy ; Humans ; Inflammation ; Morphine* ; Osteosarcoma ; Punctures*

No abstract available.
Beckwith-Wiedemann Syndrome*

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare but the most common genetic cause of ischemic strokes. Very little is known about perioperative implications of this syndrome. We present a case of anesthesia for a patient with CADASIL, considering protection from further cerebral ischemia.
Anesthesia ; Brain Ischemia ; CADASIL ; Humans ; Stroke

In this article, the statement of ethical statement about animal experiment was omitted.

BACKGROUND: The aim of study is to investigate the initial functional changes of muscle in rats induced to have myasthenia gravis, experimental autoimmune myasthenia gravis (EAMG). The authors investigated the functional changes of muscle evaluated by mechanomyography (MMG) and the expression of acetylcholine receptors (AChRs). METHODS: After the institutional approval, 39 male Lewis rats were randomly allocated into study. 26 animals were immunized to induce EAMG by Torpedo AChR (T-AChR) emulsified with complete Freund's adjuvant (CFA) and phosphate buffer saline (PBS)/bovine serum albumin (BSA) 0.01% at the base of tail, and received booster immunizations twice by T-AChR with incomplete Freund's adjuvant (IFA) and PBS/BSA 0.01% at all different site on the upper back. 13 animals were sham immunized as control group by the same method of EAMG except T-AChR. Clinical EAMG scores were examined. Anti T-AChR and anti rat-AChR (R-AChR) antibodies (Ab) were compared by using (125)I-alpha-bungarotoxin ((125)I-alpha-BuTx) radioimmunoassay. Under the anesthesia, neuromuscular functions were monitored by MMG using single twitch (ST) and TOF. AChRs were quantitated using (125)I-alpha-BuTx. RESULTS: Overall weight gain and final body mass, muscle force (ST), specific muscle force of ST, TOF fade ratio and AChRs were reduced in EAMG score 3 compared to control (P < 0.0001). Anti T-AChR Ab and anti R-AChR Ab were increased in score 3 EAMG (P < 0.0001). CONCLUSIONS: EAMG score 3 rats showed characteristic neuromuscular functions as depressed initial ST and its specific force, initial TOF fade and increased anti AChR Abs. Those above characteristics had significant correlations with the clinical EAMG scores. AChRs were significantly down-regulated according to their functional characteristics and clinical EAMG scores.
Acetylcholine* ; Anesthesia ; Animals ; Antibodies ; Freund's Adjuvant ; Humans ; Immunization, Secondary ; Male ; Myasthenia Gravis* ; Myasthenia Gravis, Autoimmune, Experimental ; Radioimmunoassay ; Rats* ; Receptors, Cholinergic* ; Serum Albumin ; Tail ; Torpedo ; Weight Gain