BACKGROUND: While the effects of excitatory amino acids have been characterized in the central nervous system, relatively little is known about their possible modulation of elements responsible for hyperalgesia within peripheral tissue. The purpose of this study was to investigate the role of excitatory amino acid receptors in mechanical hyperalgesia induced by a subcutaneous injection of Freund's complete adjuvant (FCA) into the rat hind paw. METHODS: Inflammations were induced by injecting FCA on the dorsal surface of the right hind paw of rats. Effects of excitatory aminoacid agonists or antagonists on mechanical hyperalgesia were investigated by a subcutaneous injection of a drug to the inflamed paw. Mechanical hyperalgesia was expressed as percent change in paw withdrawal threshold compared to baseline value that was measured before drug injection after inflammation was induced with FCA. RESULTS: In normal rats, an intraplantar (i.pl.) injection of L-glutamate, but not of D-glutamate (3 pmol/0.1 ml each) produced a mechanical hyperalgesia in the hind paw with a lowered paw paw-withdrawal threshold to pressure. In rats that developed the mechanical hyperalgesia associated with inflammation in the hind paw following an i.pl. injection of FCA (0.15 ml), the injection of a N-methyl-D-aspartate (NMDA) receptor antagonist, MK-801 (1 pmol/0.1 ml) into the inflamed paw increased the paw pressure threshold (24.24.6% increase from baseline, P < 0.05). On the other hand, the injection of a non-NMDA receptor antagonist, 6-cyano-7-nitroqiunoxaline-2,3-dione (CNQX, 10 pmol/0.1 ml) into the inflamed paw had no effect on the FCA-induced lowering of the paw pressure threshold. CONCLUSIONS: The results suggest that NMDA, but not non-NMDA receptors play a substantial role in mediating the development of mechanical hyperalgesia induced in the inflamed paw following an i.pl. FCA injection.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Animals ; Central Nervous System ; Dizocilpine Maleate ; Excitatory Amino Acids ; Glutamic Acid ; Hand ; Hyperalgesia* ; Inflammation ; Injections, Subcutaneous ; N-Methylaspartate* ; Negotiating ; Rats* ; Receptors, Glutamate

BACKGROUND: A nerve ligation injury may produce a tactile allodynia. The effects of intrathecally delivered lamotrigine on allodynia induced due to fifth and sixth lumbar spinal nerves ligation in rats, using lumbar intrathecal catheters were examined. METHODS: Sprague-Dawley rats (body weight 160-180 g) were prepared by tightly ligating the fifth and sixth left lumbar spinal nerves, with the implantation of a chronic intrathecal catheter for drug administration. Mechanical allodynia and allodynic threshold were measured using von Frey filaments and the updown method, respectively. After the baseline hind paw withdrawal thresholds had been obtained, lamotrigine (10, 30, 100 and 300microgram) was administered intrathecally. Thereafter, the dose-response curves and 50% effective dose (ED50) were obtained. Motor dysfunction was assessed by observing the righting/stepping reflex responses and abnormal weight bearing. RESULTS: Intrathecal administration of lamotrigine produced a dose-dependent antiallodynic action (ED50 = 61.7microgram). Mild motor weakness was observed with 300microgram lamotrigine, but no severe motor impairment was found. CONCLUSIONS: It is suggested that intrathecal lamotrigine could produce moderate antagonism of mechanical allodynia at the spinal level in a rat neuropathic pain model with minimal motor weakness.
Animals ; Catheters ; Hyperalgesia ; Ligation* ; Neuralgia ; Rats* ; Rats, Sprague-Dawley ; Reflex ; Spinal Nerves* ; Weight-Bearing

Accelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration.
Accelerated Idioventricular Rhythm ; Anesthesia ; Arrhythmias, Cardiac ; Cardiomyopathies ; Digitalis ; Isoflurane ; Methyl Ethers ; Myocardial Ischemia ; Rheumatic Fever ; Tachycardia, Ventricular ; Ventricular Fibrillation

Seckel syndrome, also called bird-headed dwarfism, is an extremely rare, inherited, autosomal recessive disorder. The patients with Seckel syndrome are characterized by growth retardation, microcephaly with mental retardation, proportional dwarfism, bird like faces, and beak-like triangular nose. A literature review reveals that they have multiple anesthetic problems such as difficult airway management, difficult venous cannulation and concomitant medical diseases. We describe our experience in anesthetic management of a 21-month-old male patient with Seckel syndrome associated with pneumonia who underwent orchiopexy for bilateral cryptochidism.
Airway Management ; Birds ; Catheterization ; Dwarfism ; Humans ; Infant ; Intellectual Disability ; Male ; Microcephaly ; Nose ; Orchiopexy ; Pneumonia

BACKGROUND: The transplantation of adrenal medullary tissue into the CNS of the rat can reduce pain. This results from the release of opioid peptides and catecholamines from the transplanted chromaffin cells. However, whether the adrenal gland transplanted in peripheral tissue can also reduce the pain is not well documented. The purpose of this study was to assess the potential for theadrenal gland implanted into the peripheral tissue of the rat to reduce mechanical hyperalgesia induced by inflammation. METHODS: Fifteen male Wistar rats were divided into three groups; one for implantation of the adrenal gland (AG), another for the kidney (Kd), and the other for a Sham operation (S). Tissues for transplantation were harvested from Sprague-Dawley rats. Two weeks after surgery, inflammation was induced by injecting 0.05 ml of Freund's Complete Adjuvant (FCA) into the dorsum of the rat's hind paw. Mechanical hyperalgesia was assessed using automated Randall-Sellito algesiometer at 6 hr, 1, 2, 3, 7 and 14 days after injecting FCA. RESULTS: Paw withdrawal thresholds against mechanical stimuli were 84.8 6.9%, 112.1 4.6%, 86.3 8.5%, 93.6 7.4%, 90.5 3.8%, 96.9 3.8%, respectively, in the AG group, and 71.3 10.8%, 93.3 11.3%, 79.1 10.3%, 73.7 8.1%, 62.6 6.4%, 77.7 6.2%, respectively, in Kd group, and 67.2 8.3%, 88.1 11.7%, 67.7 8.1%, 69.6 8.2%, 74.5 8.5%, 81.2 6.6%, respectively, in the S group. The AG group showed less pain sensitivity compared with that of the Kd and S groups especially 7 and 14 days after injecting the drug. CONCLUSIONS: This study indicates that the transplanted adrenal gland into the peripheral tissue may provide analgesic effect for a long time after it is transplanted in the rat.
Adrenal Glands* ; Animals ; Catecholamines ; Chromaffin Cells ; Humans ; Hyperalgesia* ; Inflammation ; Kidney ; Male ; Opioid Peptides ; Rats* ; Rats, Sprague-Dawley ; Rats, Wistar

BACKGROUND: The transplantation of adrenal medullary tissue into the CNS of the rat can reduce pain. This results from the release of opioid peptides and catecholamines from the transplanted chromaffin cells. However, whether the adrenal gland transplanted in peripheral tissue can also reduce the pain is not well documented. The purpose of this study was to assess the potential for theadrenal gland implanted into the peripheral tissue of the rat to reduce mechanical hyperalgesia induced by inflammation. METHODS: Fifteen male Wistar rats were divided into three groups; one for implantation of the adrenal gland (AG), another for the kidney (Kd), and the other for a Sham operation (S). Tissues for transplantation were harvested from Sprague-Dawley rats. Two weeks after surgery, inflammation was induced by injecting 0.05 ml of Freund's Complete Adjuvant (FCA) into the dorsum of the rat's hind paw. Mechanical hyperalgesia was assessed using automated Randall-Sellito algesiometer at 6 hr, 1, 2, 3, 7 and 14 days after injecting FCA. RESULTS: Paw withdrawal thresholds against mechanical stimuli were 84.8 6.9%, 112.1 4.6%, 86.3 8.5%, 93.6 7.4%, 90.5 3.8%, 96.9 3.8%, respectively, in the AG group, and 71.3 10.8%, 93.3 11.3%, 79.1 10.3%, 73.7 8.1%, 62.6 6.4%, 77.7 6.2%, respectively, in Kd group, and 67.2 8.3%, 88.1 11.7%, 67.7 8.1%, 69.6 8.2%, 74.5 8.5%, 81.2 6.6%, respectively, in the S group. The AG group showed less pain sensitivity compared with that of the Kd and S groups especially 7 and 14 days after injecting the drug. CONCLUSIONS: This study indicates that the transplanted adrenal gland into the peripheral tissue may provide analgesic effect for a long time after it is transplanted in the rat.
Adrenal Glands* ; Animals ; Catecholamines ; Chromaffin Cells ; Humans ; Hyperalgesia* ; Inflammation ; Kidney ; Male ; Opioid Peptides ; Rats* ; Rats, Sprague-Dawley ; Rats, Wistar

A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 microg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation.
Airway Obstruction ; Epiglottis ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngeal Nerves ; Laryngoscopy ; Lidocaine ; Male ; Midazolam ; Middle Aged ; Oropharynx ; Oxygen ; Pancreaticoduodenectomy ; Recovery Room ; Thoracic Surgery, Video-Assisted

Kounis syndrome is an acute coronary syndrome concurrently occurs with allergic or hypersensitivity reactions. In patient with this syndrome, inflammatory mediators released due to an allergic reaction implicate to induce coronary artery spasm and atheromatous plaque rupture. We describe a patient with coronary artery disease who developed acute perioperative myocardial infarction leading to cardiac arrest after the anaphylactic reaction to cisatracurium, which led to a suspicion of Kounis syndrome. Anesthesiologists should be aware that anaphylaxis or allergic reactions can progress to acute coronary syndrome, thereby significantly change the course of the disease.
Acute Coronary Syndrome ; Anaphylaxis* ; Coronary Artery Disease ; Coronary Vessels ; Heart Arrest ; Humans ; Hypersensitivity ; Myocardial Infarction ; Rupture ; Spasm

No abstract available.
Catheterization, Central Venous* ; Central Venous Catheters* ; Diagnostic Errors* ; Humans ; Pneumothorax* ; Ultrasonography*

Background: Tachycardia-polyuria syndrome is characterized by polyuria occurring because of tachycardia with a heart rate of ≥ 120 beats/min lasting ≥ 30 min. We report such a case occurring after swan-ganz catheterization.Case: A 41-year-old male was scheduled for living-donor liver transplantation. After general anesthesia, atrial fibrillation occurred during swan-ganz catheterization, and polyuria developed 1 h later. During the anhepatic phase, the patient’s heart rate increased further, and cardioversion was performed. After a normal sinus rhythm was achieved, the patient’s urine output returned to normal. Conclusions The patient’s polyuria seemed related to the iatrogenic atrial fibrillation occurring during swan-ganz catheterization. Although we did not measure atrial natriuretic peptide, an increase in its concentration may have been the main mechanism of polyuria, as natriuresis was observed.