BACKGROUND: The alpha2-adrenergic agonist clonidine has been extensively studied as an adjunct to general and regional anesthesia. Clonidine has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of that using clonidine as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. METHODS: Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups as follows: Group I (n = 12) received only mepivacaine. Group II (n = 12) was given 0.5 microgram/kg clonidine as part of the IVRA solution. Group III (n = 12) received 1.0 microgram/kg clonidine as part of the IVRA solution. After the end of the operations, the analgesic effects were evaluated by using the visual analogous scale (0-10). Sedation scores (0-3), supplemental analgesic use, and side effects were also evaluated. RESULTS: The patients who received IVRA with 1.0 microgram/kg clonidine reported significantly lower pain score after tourniquet deflation compared with other groups, and a decreased need for analgesic in the postanesthesia care unit. No significant postoperative sedation, hypotension, or bradycardia developed in any of the patients. CONCLUSIONS: The addition of 1.0 microgram/kg clonidine to mepivacaine 0.5% for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation.
Analgesia ; Anesthesia and Analgesia ; Anesthesia, Conduction* ; Bradycardia ; Clonidine* ; Hand ; Humans ; Hypotension ; Mepivacaine* ; Peripheral Nerves ; Tourniquets

Intravenous anesthesia, using sedative for the rapid loss of consciousness and analgesic for the potent and short-acting effect, has been widely done. So tbis study is aimed to see if propofol-fentanyl are effective enough for extracorporeal shock wave lithotripsy(ESWL) used for outpatient and how it will effects on cardiovascular system. Above all, 45 patients were selected randomly and their blood pressure(BP), heart rate(HR), respiratory rate(RR) and arterial oxygen saturation(SaO2) were measured shortly before giving propofol and fentanyl. Then, after giving propofol and fentanyl, BP,HR, RR and SaO2 were measured as the adequate depth of anesthesia. And after 5 to 10 minutes, ESWL was done. Involuntary movements and pain were checked as additional depth of anesthesia. With the time, HR and SaO2 showed statistically significant decrease with no clnical meanings. And there was no special treatment for involuntary movements founded in 8 patients but 13 patients suffering from pain were given additional fentanyl. In conclusion, intravenous anesthesia with propofol and fentanyl works effectively for ESWL. Therefore if during ESWL, cardiopulmonary functions are monitored carefully, intravenous anesthesia with propofol and fentanyl will be an effective and safe anesthesia.
Anesthesia ; Anesthesia, Intravenous ; Cardiovascular System ; Dyskinesias ; Fentanyl ; Heart ; Humans ; Lithotripsy* ; Outpatients* ; Oxygen ; Propofol ; Shock ; Unconsciousness

Moyamoya disease is a rare, progressive, occlusive cerebrovascular disorder characterized by bilateral stenosis of the intracranial portion of the internal carotid artery. Symptoms including transient ischemic attacks, seizures, intracranial hemorrhage and cerebral infarction, are variable. There are few case reports of moyamoya disease in pregnancy. Since hyperventilation-induced cerebral ischemia and hypertension are provoked by active labor, cesarean section has been recommended to avoid neurologic complications for pregnant women with moyamoya disease. The optimal anesthetic management for cesarean section in these patients has not been discussed. We report a case of moyamoya disease in a patient presenting for cesarean section at 40 weeks' gestation. Epidural anesthesia was administered using 0.5% bupivacaine and fentanyl. Intraoperative hemodynamic state was stable. The patient has no significant postoperative complications.
Anesthesia* ; Anesthesia, Epidural ; Brain Ischemia ; Bupivacaine ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebrovascular Disorders ; Cesarean Section* ; Constriction, Pathologic ; Emergencies* ; Female ; Fentanyl ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Moyamoya Disease* ; Postoperative Complications ; Pregnancy ; Pregnant Women ; Seizures

BACKGROUND: Epinephrine itself interacts with adrenergic receptors to block pain transmission pathways. Intrathecal co-administration of morphine and epinephrine results in a near maximal increase in the nociceptive threshold. This study was designed to investigate the influence of different dosages of epinephrine on the postoperative pain relief through intrathecal morphine in lower extremity surgery. METHOD: Thirty patients, ASA physical status I or II, undergoing orthopedic surgery of lower extremities were selected and randomly divided into two groups as follows: Group I (n=15); bupivacaine, morphine 0.2 mg with epinephrine 0.12 mg. Group II (n=15); bupivacaine, morphine 0.2 mg with epinephrine 0.2 mg. With patients lateral in the decubitus position, a 25-gauge spinal needle was introduced into the subarachnoid space. Patients were turned to the supine position, and sensory levels were checked by pin-prick tests at the midclavicle level , and the degree of motor block by Bromage scale every 5 minutes. The two segment regression time was measured every 20 minutes. During the postoperative day and the second day, their analgesic effects were evaluated by use of the visual analogous scale (0~10). The side effects were also evaluated. RESULTS: There were no difference between both groups in sensory level and two-segment regression time. Motor block in 5, 10, 15 minutes was more intense in group II. Also, there were no significant difference in the analgesic effects and the incidence of side effects, such as nausea or pruritus. CONCLUSION: There were no significant dose effects of epinephrine added to intrathecal morphine for postoperative pain relief undergoing lower extremities surgery.
Analgesia* ; Bupivacaine ; Epinephrine* ; Humans ; Incidence ; Lower Extremity ; Morphine* ; Nausea ; Needles ; Orthopedics ; Pain, Postoperative ; Pruritus ; Receptors, Adrenergic ; Subarachnoid Space ; Supine Position

It has been reported that CLA decreases fat deposition in vivo and in vitro experiments. Among CLA isomers, c9t11 and t10c12 have been shown to exert active biological activities. For example, t10c12 reduces body weight and increases lean body mass, whereas, c9t11 has little effect on body fattness. However, the underlying molecular mechanism for the anti-obesity action of CLA isomers are not well understood. The purpose of this study was to examine the effects of t10c12 and c9t11 on lipid accumulation, cell proliferation, cell death and the expression levels of Ucp genes which are proposed as targets for anti-obesity in 3T3-L1 preadipocytes. Isomers of CLA at 50 micrometer were added into preadipocyte differentiation medium for 3, 6 and 9days. Control cells received only the vehicle in the differentiation medium. Cytochemical analyses for lipid accumulation, cell proliferation and apotosis were carried out to compare lipidogenesis and cellular activity. RT-PCR analysis of GAPDH, Ucp 2, 3 and 4 were also performed to find any modulatory effects of CLA isomers on the metabolic genes. Lipid accumulation indicated by Oil Red-O staining was inhibited in CLA isomers as compared to the control. T10c12 isomer showed less lipidogenesis than c9t11 did. A decrease occurred in CLA isomers as shown by BrdU incorporation. Apotosis has occured at higher level in t10c12 when compared to that of t9c11. Ucp 2, 3 and 4 genes were also upregulated in CLA isomers. T10c12 showed higher level of Ucp gene expressions than the c9t11 did. The biological activities of CLA isomers were also found to be different during differentiation of 3T3-L1 preadipocytes, suggesting that different isomers may be active in certain stage of lipidogenesis. The results indicate that both c9t11 and t10c12 CLA isomers decrease lipidogenesis, inhibit cell proliferation, increase cell death and upregulate in Ucp gene expressions during 3T3-L1 preadipocyte differentiation. T10c12 isomer was more effective than c9t11 in overall anti-obesity activity.
Body Weight ; Bromodeoxyuridine ; Cell Death ; Cell Proliferation* ; Gene Expression ; Linoleic Acid*

BACKGROUND: Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. Bupivacaine is potent analgesic with early peak onset in the postoperative period. The combination of intra-articular bupivacaine and morphine has been suggested as an ideal analgesic after knee arthroscopy. METHODS: Thirty patients scheduled for knee arthroscopy under general anesthesia were allocated randomly to two groups. Group 1 received morphine 5 mg in normal saline 25 ml, group 2 received morphine 5 mg in 0.25% bupivacaine 25 ml intraarticularly, and all solutions contained 1:200,000 epinephrine. Tourniquet was inflated above knee joint for 10 minutes after injection in each of the patients. Postoperative pain was assessed using the visual analogue scale at 1, 2, 3, 4, 6, 12 and 24 hours after the intra-articular injection. The need for supplemental analgesic was recorded. RESULTS: Patients in the group 2 had lower pain scores than group 1 at first and second hour. There were no significant differences from 3 hours to 24 hours postoperative period. Supplemental analgesic requirements were significantly greater in group 1 than group 2 for the first 3 hours. CONCLUSIONS: It is concluded that, after knee arthroscopy, intra-articular morphine 5 mg in 0.25% bupivacaine 25 ml results in satisfactory analgesia with small amount of supplementary analgesic.
Analgesia ; Analgesics, Opioid ; Anesthesia, General ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Injections, Intra-Articular ; Knee Joint* ; Knee* ; Morphine* ; Pain, Postoperative ; Postoperative Period ; Receptors, Opioid ; Tourniquets

BACKGROUND: It has been reported that ketamine induced contraction of the uterus. Therefore, it has been recommended as a suitable obstetric anesthetic agent. However, some investigators reported that ketamine inhibited contraction of rat uterine smooth muscle. There has been argument about its effect on the uterine contraction. The aim of the present study was to investigate the effect of ketamine on rat uterine contractile activity in vitro. METHODS: Uterine smooth muscle tissues were obtained from non-pregnant rats (n = 20). The uterine ring segments were mounted in organ bath filled with Krebs solution with 95% O2 and 5% CO2. After spontaneous activity had been accomplished, ketamine in various concentrations (10(-7) M to 10(-3) M) was added cumulatively to the bath and the effects were continuously registered. RESULTS: Ketamine in dose of 10(-5) M increased spontaneous myometrial contractile activity. But, ketamine in doses of 10(-4) to 10(-3) M induced a dose-dependent inhibition of spontaneous myometrial contractile activity. CONCLUSIONS: Ketamine constricted the uterine smooth muscle in concentration of 10(-5) M but, relaxed the uterine smooth muscle in high concentrations (10(-4) to 10(-3) M).
Animals ; Baths ; Humans ; Ketamine* ; Muscle, Smooth ; Rats* ; Research Personnel ; Uterine Contraction ; Uterus

BACKGROUND: Tramadol, an opioid n receptor agonist and monoaminergic reuptake inhibitor, has been studied as an adjunct to general and regional anesthesia. Tramadol has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of using tramadol as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. METHODS: Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups: Group I (n = 12) received only 0.5% mepivacaine 40 ml, Group II (n = 12) was given 0.5% mepivacaine 40 ml and 50 mg tramadol, and Group III (n = 12) received 0.5% mepivacaine 40 ml and 100 mg tramadol. After the completion of the operations, analgesic effects were evaluated by using the visual analogue scale (0 - 10). Sedation scores (0 - 3), supplemental analgesic use, and side effects were also evaluated. RESULTS: Patients who received IVRA with 100 mg tramadol reported a significantly lower pain score after tourniquet deflation compared with other groups, and a decreased need for analgesics in the postanesthesia care unit. No significant postoperative sedation, nausea, vomiting, or headache developed in any of the patients. CONCLUSIONS: The addition of 100 mg tramadol to 0.5% mepivacaine for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation.
Analgesia ; Analgesics ; Anesthesia and Analgesia ; Anesthesia, Conduction* ; Hand ; Headache ; Humans ; Mepivacaine* ; Nausea ; Peripheral Nerves ; Tourniquets ; Tramadol* ; Vomiting

PURPOSE: This cross-sectional study was designed to identify anger-expression typesof adolescent women and investigate the relation between the identified anger-expression types and their problem behaviors and health status. METHOD: One hundred ninety nine high school freshmen were recruited from September to November, 2003. Data wasanalyzed using descriptive statistics, cluster analysis, chi-square-test, ANOVA, and Duncan's multiple comparison test. RESULT: Three anger-expression types in adolescent women were found; Anger-out/in, Anger-control/in, and Anger- control type. Adolescent women with frequently using the anger-out/in type and with higher state anger reported more delinquent behaviors, more health risk behaviors, and higher psychosomatic symptoms. However, adolescent women with lower state anger and frequently using the anger-control type reported more depression scores. CONCLUSION: There is a need to further clarify the relationship between anger-expression typesand depression in adolescent women. The findings suggest the necessity of a development of the program for lowering the anger level and controlling the unfavorable anger expression types such as the anger-out in.
Adolescent ; *Adolescent Behavior ; *Anger ; Cross-Sectional Studies ; *Expressed Emotion ; Female ; *Health Status ; Humans ; Male ; Risk-Taking

BACKGROUND: Propofol injection pain is an unpleasant experience to patients and its prevalence can be influenced by age and gender. We determined the half maximal effective concentration (EC50) of remifentanil for preventing the microemulsion propofol injection pain in the male and female adult groups. METHODS: After institutional review board approval, a total of 60 patients were assigned into 2 groups depending on their gender: group M (male, 20-65 yr) and group F (female, 20-65 yr). Anesthesia was induced with propofol and remifentanil, by a target-controlled infusion. Target effect-site concentration (Ce) of propofol and remifentanil for the first patient started at 4.0 ug/ml and 4.0 ng/ml. Ce of remifentanil for each subsequent patient was determined by the response of the previous patient by the Dixon's up-and-down method (DUDM) with an interval of 0.2 ng/ml. After equilibration of plasma and effect site remifentanil concentration, propofol was administered, and the pain responses were observed. RESULTS: The remifentanil EC50 was 3.8 +/- 0.2 and 2.7 +/- 0.2 ng/ml in groups M and F, respectively, by DUDM. From Probit regression model, the remifentanil EC50 was 3.7 (3.0-4.3) and 2.7 (1.8-2.9) ng/ml in groups M and F, respectively. CONCLUSIONS: The remifentanil EC50 for preventing the moderate to severe injection pain of propofol was higher in males than in females.
Adult ; Anesthesia ; Ethics Committees, Research ; Female ; Gender Identity ; Humans ; Male ; Piperidines ; Plasma ; Prevalence ; Propofol