BACKGROUND AND OBJECTIVES: Although pain resulting from thalamic stroke was described by D jerine & Roussy in 1906, its pathomechanism & anatomical substrate have not been defined yet. Several clinical & experimental studies suggest that laterality of lesion for generation of central pain is as important as location of lesion. We performed this study to evaluate clinical features of thalamic pain syndrome, including incidence, onset interval from stroke, nature, distribution, accompaniments, and to assess the relationships between laterality & location of lesion and occurrence of pain. METHODS: We reviewed the medical records and brain imaging of all patients with thalamic stroke from 1990 to 1997. Patients with thalamic pain syndrome due to a single well-demarcated thalamic stroke were included, and excluded tumoral, non-vascular etilogy, and patients with sensory deficit without pain and excluded patients who had multiple cerebral lesions even they have thalamic pain syndrome. RESULTS: One-hundred one cases were selected under the inclusion criteria, and twenty-four patients(24%) with thalamic pain syndrome were identified from 101 thalamic stroke. Pain onset within the first week poststroke was 17(71%). The patients with allodynia were 8(33%), increased by movement, stress, and thermal contact. The painful area distributed mainly limbs(50%), especially arm(35%), face plus hemibody(34%), and hemibody below face(8%). Thalamic pain syndrome accompanied with the pain and temperature loss was 17(71%). Thirteen patients had a right-sided lesion, 11 left-sided lesion. The lesion causing thalamic pain syndrome mainly located in the posterolateral areas(75%). CONCLUSIONS: We conclude that the thalamic pain syndrome resulting from mainly posterolateral thalamic lesion cause the spontaneous pain on the contralateral body, especially upper extrimity, and accompanied with pain & tempterature loss. The laterality of lesion is not represent for generation of thalamic pain syndrome. Key word : thalamic stroke, central pain.
Humans ; Hyperalgesia ; Incidence ; Medical Records ; Neuroimaging ; Stroke*

BACKGROUND: The potential adverse effects of ketamine in neurosurgical anesthesia have been well established. However, the effects of ketamine on intracranial pressure (ICP) and hemodynamics during general anesthesia remain unclear. The purpose of this study was to assess the effects of ketamine on hemodynamics and ICP in anesthetized, ventilated rabbits. METHODS: Thirty rabbits were divided into three groups: Group 1 (n=10) received 1 ml/kg normal saline iv; Group 2 (n=10) received 0.5 mg/kg ketamine iv; Group 3 (n=10) received 1.0 mg/kg ketamine iv. After induction with thiopental, anesthesia was maintained with isoflurane and nitrous oxide in oxygen. During controlled ventilation, ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and heart rate (HR) were measured. The ICP was measured using Ladd ICP monitoring system. All variables were evaluated at baseline and for 30 min following ketamine. RESULTS: In group 1, ICP, MAP, CPP and HR were unchanged over the course of the study. In group 2, ICP, MAP and CPP were unchanged. HR increased at 1, 3 and 5 min (p<0.01), 10 and 20 min (p<0.05) after injection. In group 3, ICP, MAP and CPP increased at 1 and 3 min (p<0.01) after injection. HR increased at 1, 3 and 10 min (p<0.01), 5 min (p<0.05) after injection. CONCLUSIONS: These results suggest that 0.5 and 1.0 mg/kg of ketamine don't significantly affect the hemodynamics and ICP in anesthetized, mechanically ventilated rabbits.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Intracranial Pressure* ; Isoflurane ; Ketamine* ; Nitrous Oxide ; Oxygen ; Perfusion ; Rabbits* ; Thiopental ; Ventilation

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

BACKGROUND: Rocuronium, a new nondepolarizing muscle relaxant, has been reported to develop a rapid onset of action and may be suitable as a component of a rapid-sequence induction of anesthesia. Therefore we have compared rocuronium with pancuronium and vecuronium about the onset time, intubation time, and tracheal intubating conditions. METHOD: Thirty patients were divided into three groups, who were receiving intravenously pancuronium 0.14 mg/kg, vecuronium 0.1 mg/kg and rocuronium 0.6 mg/kg respectively for tracheal intubation during induction of anesthesia. The onset time(Time from drug administration to zero count of PTC) and intubation time were checked using train of four responses of the adductor pollicis muscle after ulnar nerve stimulation(2 Hz, 40mA) every 10 seconds. The intubation conditions were recorded by a "blinded" assessor as excellent, good, fair or not possible. RESULT: The onset time of pancuronium, vecuronium and rocuronium was, 125.0+/-10.0, 256.0+/-18.4 and 90.0+/-22.1 sec. respectivly. The time of intubation was 94.0+/-12.6, 95.3+/-7.9, and 77.0+/-10.6sec.(pancuronium,vecuronium & rocuronium respectively). The onset time of rocuronium was significantly faster than the other two nondepolarizing muscle relaxants. The tracheal intubation with rocuronium was possible earlier than pancuronium or vecuronium but no statistical significance was observed and the condition of intubation was excellent compare to others in all ten patients. CONCLUSION: Rocuronium may have advantages over existing non-depolarizing neuromuscular blocking agents with faster rate of development of neuromuscular block with excellent intubation condition after administraction of a dose 0.6 mg/kg(ED 95 x 2).
Anesthesia ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium ; Ulnar Nerve ; Vecuronium Bromide

Pulmonary edema is a recognized complication of acute airway obstruction, laryngospasm, especially after endotracheal extubation. It usually follows relief of the obstruction and is likely to be of noncardiogenic origin. The mechanism by which an upper airway obstruction causes pulmonary edema is likely due to the combination of the increased reduction of intrapulmonary pressure, increased capillary permeability and hypoxia. We present a case of pulmonary edema that occurred in an adult patient after upper airway obstruction following extubation of the trachea.
Adult ; Airway Extubation* ; Airway Obstruction* ; Anoxia ; Capillary Permeability ; Edema ; Humans ; Laryngismus ; Lung ; Pulmonary Edema* ; Trachea

This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.
Alprostadil ; Anesthesia ; Animals ; Baroreflex* ; Dogs ; Heart Rate ; Hemorrhage ; Hypotension* ; Isoflurane ; Nitroprusside* ; Pressoreceptors* ; Reflex ; Sodium*

This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.
Alprostadil ; Anesthesia ; Animals ; Baroreflex* ; Dogs ; Heart Rate ; Hemorrhage ; Hypotension* ; Isoflurane ; Nitroprusside* ; Pressoreceptors* ; Reflex ; Sodium*

BACKGROUND & PURPOSE: Confirmation of etiology in various types of meningitis is the essential step for the treatment with respect to the underlying organism. Although the definite diagnosis of TBM depends on identifying M. tuberculosis in the CSF, the acid fast bacilli are rarely shown in smears of CSF and are cultured in only some patients. Increased levels of ADA in systemic tuberculous effusion have been observed. This study is to evaluate the diagnositc significance & value as a laboratory index of disease activity of ADA in TBM. METHODS: We assayed the activity of ADA in the CSF of 117 patients with various types of meningitis (tuberculous, viral, and bacterial) from 1995 through 1996 at Chungnam National University Hospital. We established several diagnostic criteria for TBM: characteristic CSF findings, such as lymphocytic pleocytosis, cloudy or ground-glass appearance, increased protein content, and decreased sugar level, positive acid fast bacilli in CSF smear, brain CT or MRI findings compatible with TBM. RESULTS: The mean ADA value in CSF was higher in TBM(15.5+/-4.6 U/liter) than in other meningitis. The sensitivity of the test for diagnosing TBM was 0.80 and specificity, 0.98. Increased CSF protein in TBM(271.23+/-78.2) showed in parallel with ADA activity in CSF(p<.05). A gradual decline in level of this enzyme was observed during the first two weeks of therapy in concordance with the clinical improvement. The mean interval for normalizing ADA activity was 37.6 days from the onset of treatment. CONCLUSION: The quantification of ADA in CSF is a rapid and economic test that is useful for early diagnosis of TBM and sensitive as an indicator for disease activity.
Adenosine* ; Brain ; Cerebrospinal Fluid* ; Chungcheongnam-do ; Diagnosis ; Early Diagnosis ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Meningitis ; Sensitivity and Specificity ; Tuberculosis

As an alphs-2 adrenergic agonist, clonidine, which is an antihypertensive drug, can reduce central sympathetic outflow. By regulation of presynaptic transmitter release, it also lowers blood pressure and amounts of anesthetic drugs used during anesthesia, causes sedation, and attenuates postoperative shivering. The authors studied the effects of transdermal clonidine as a premedicant, which is easy and simple to use and maintains constant plasma level. Sixty patients undergoing elective orthopedic surgery, with preoperative normal blood preesure, were seleeted and randomly divided into 2 groups, 30 subjects each. Placebo patch was placed on the shoulder of patients belonging to the placebo group, and clonidine patch for the clonidine group just 48 hours before operation. Cardiovascular effects such as changes in perioperative blood pressure and heart rate, the degree of sedation before to induction, amounts of anesthetic drugs during anesthesia, postoperative analgesic requirements, ratio of patients who experienced postoperative shivering were observed and compared between the two groups. Patients in the clonidine group showed more stable cardiovascular response perioperatively and amounts of anesthetic drugs required during operation were reduced as compared to the placebo group(p<0.05). Preinduction sedation score of clonidine group was definitely higher than that of placebo group. (p <0.05) All 30 patients in the placebo group required analgesics for 48 hours after operation(100%) and only 19 patients of the clonidine group required analgesics(63%). The amounts of postoperative analgesics were definetely reduced in the clonidine group(p<0.05). Postoperative shivering occurred in 12 patients of the placebo group(40%) and 5 patients of the clonidine group(16.6%). We concluded that transdermal clonidine can be used effectively as a premedicant privided close regulation of anesthetic drugs used during anesthesia is possible.
Adrenergic Agonists ; Analgesics ; Anesthesia ; Anesthetics ; Blood Pressure ; Clonidine* ; Heart Rate ; Humans ; Orthopedics ; Plasma ; Shivering ; Shoulder

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.
Animals ; Blood-Brain Barrier* ; Brain ; Carotid Artery, Internal ; Catecholamines ; Excitatory Amino Acids ; Isoflurane ; Mannitol ; Microspectrophotometry ; Neurotransmitter Agents ; Oxygen* ; Permeability ; Rats ; Respiration, Artificial ; Tracheostomy ; Vital Signs