Functional mapping techniques including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and magnetoencephalography (MEG) can be used to study the function of the nervous system. Optical imaging is an emerging technique for functional imaging of the nervous tissue. Functional optical imaging can be classified into two major streams; intrinsic signal optical imaging (ISO) and voltage-sensitive dye optical imaging (VDO). ISO is related to hemodynamic changes such as hemoglobin concentration and oxygenation changes, cytochrome oxidation change, and light scattering. On the contrary, VOD measures changes in membrane potentials of neural cells. Therefore, ISO reflects metabolic activity of neurons, while VOD directly reflects neural activity. Recent advances in optical imaging opened the possibility of its application to clinical situations as well as basic researches. Further, development of optical imaging may greatly contribute to the understanding of the function of the nervous system.
Cytochromes ; Hemodynamics ; Hemoglobins ; Light ; Magnetic Resonance Imaging ; Magnetoencephalography ; Membrane Potentials ; Nervous System ; Neurons ; Optical Imaging ; Oxygen ; Positron-Emission Tomography

Heart transplantation is an accepted procedure for treatment of end-staged cardiac failure. A return to near-normal quality on life can be expected in many patients with a nonrejecting cardiac allograft, and many of these patients will return to the operating room for noncardiac surgical procedures. Anesthesiologists should be alert to recognizing problems caused by the presence of infection in immunosuppressed patients, modes of presentation of rejection phenomena and how transplanted organs, notably significantly denervated ones, may behave and respond under the pathophysiologic circumstance that arise during surgery, resuscitation and intensive care. The use of regional techniques require adequate preloading to avoid exaggerated hypotension and aseptic technique to avoid infection. Hypobaric spinal anesthesia has some benefit. It does not depress cardiovascular and respiratory system and keep adequate venous return by trendelenberg position. We report herein a case of successfully undergone total hip replacement in a patient who had previously undergone orthotopic heart transplantation under hypobaric spinal anesthesia.
Allografts ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Hypotension ; Critical Care ; Operating Rooms ; Respiratory System ; Resuscitation

BACKGROUND: The purpose of this study is to evaluate what kind of crystalloid solution could function as the best buffer and correct the metabolic acidosis most effectively in rabbits with hemorrhagic shock. METHODS: Twenty eight rabbits were bled until mean arterial pressure(MAP) became 70% of control. Thirty minutes after hemorrhagic shock fluid resuscitation was started with either plasmalyte or Hartmann's solution or 0.9% normal saline until MAP returned to 90% of the control. Hemodynamic and blood gas study, plasma lactate and electrolyte concentration were measured before, during, and 30 minutes after recovery from shock. RESULTS: The amount of shed blood to reduce MAP to 70% of control ranged 76~87 ml. And the volume for fluid resuscitation was 274~324 ml. There was no statistically significant difference among the three groups. The pH decreased during shock in all group and still decreased after resuscitation in Hartmann's solution and normal saline. But it increased significantly after resuscitation in plasmalyte. Lactate was increased in all group during shock and decreased by 22 and 23 mg/dl after resuscitation in plasmalyte and normal saline. But it still increased by 40 mg/dl in Hartmann's solution. Serum potassium level decreased significantly after resuscitation with normal saline. Serum calcium level decreased significantly after resuscitation with plasmalyte and normal saline. CONCLUSION: With the above results the plasmalyte which has pH closer to that of normal blood might be able to avoid the metabolic acidosis and maintain acid-base equilibrium effectively after fluid resuscitation in acute hemorrhagic shock.
Acid-Base Equilibrium ; Acidosis ; Calcium ; Hemodynamics ; Hydrogen-Ion Concentration ; Lactic Acid ; Plasma ; Potassium ; Rabbits* ; Resuscitation* ; Shock ; Shock, Hemorrhagic*

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

The study of pain has recently received much attention, especially in understanding its neurophysiology by using new brain imaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), both of which allow us to visualize brain function in vivo. Also the new brain imaging devices allow us to evaluate the patients pain status and plan to treat patients objectively. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow in the brain imaging studies. Regional cerebral blood flow increases to noxious stimuli are observed in second somatic (SII) and insular regions and in the anterior cingulate cortex and with slightly less consistency in the first somatic area (S1), motor area, supplementary motor area, prefrontal area, amygdala and contralateral thalamus. These data suggest that pain has multidimensions such as sensory-discrimitive, motivational-affective and cognitive-evaluative.
Amygdala ; Brain ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurophysiology ; Positron-Emission Tomography ; Thalamus

Hospital personnel are subject to various occupational hazards. Along with the development of modern medicine, novel and diverse medical appliances have been introduced to enhance the safety of the hospital environment. But paradoxically, some advancement of the appliances have led to exposure to greater risk for the personnel in the operation room. In the past, the greatest risk factor in the operation room was outbreak of fire and explosion, but the risk of explosion has vanished by the development of nonexplosive anesthetics. However, newly introduced electrical appliances and unknown infectious diseases appear to be new risk factors affecting health workers in the operation room. The goal of this review is to investigate the current risk factors and thereby prepare suitable preventive methods. We have reviewed the main occupational hazards affecting health workers in the operation room: accidents such as fires, explosions, electrical accidents; exposure to residual anesthetic gas; radiation; various infections; drug dependencies.
Anesthetics ; Communicable Diseases ; Explosions ; Fires ; Hazardous Substances ; History, Modern 1601- ; Humans ; Operating Rooms ; Personnel, Hospital ; Risk Factors ; Safety Management

Psoas compartment block for hip arthroplasty was evaluated clinically in 32, either sex, geriatric patients. To perform the block, the patient was placed in a lateral decubitus position and a line was drawn, connecting both iliac crests (intercristal line). 22G teflon-coated needle of 10cm-length was inserted at a point 3cm caudad to the intercristal line and 5cm lateral to the spinal midline on the side to be blocked. The nerve stimulator (1-3mA, 1Hz), Pajunk (GMBH, Geisingen, West-Germany), was used to elicit paresthesia or muscle twitching on the patient's ipsilateral leg. The block was performed with administration of a mixture of 15 ml of 1.5 % lidocaine, 15 ml of 0.5 % bupivacaine and 0.15 mg of epinephrine. The onset time of the block was 4.4+/-1.6 minutes and its duration was 3.8+/-1.5 hours. The mean value of the lowest mean arterial pressure during the first 1 hour after the injection of local anesthetics, 85.7+/-9.8 mmHg was lower, compared to the preanesthetic baseline value, 98.2+/-16.5 mmHg. The failure rate was 9.4% and any significant systemic toxicity was not seen. There were some intraoperative complaints such as the discomfort due to position bars. However, there was no remarkable problem intraoperatively. The results indicate that psoas compartment block is a recommendable safe anesthetic technique for hip arthroplasty in geriatric patients.
Anesthetics, Local ; Arterial Pressure ; Arthroplasty* ; Bupivacaine ; Epinephrine ; Geriatrics ; Hip* ; Humans ; Leg ; Lidocaine ; Needles ; Paresthesia

BACKGROUND: Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. However, reports on pain relief with intra-articular morphine after arthroscopic knee operations are conflicting. In this study we examined the analgesic effects of the intraarticular administration of morphine after knee surgery. METHODS: In a double-blind, randomized trial, we studied 26 patients who had received one of two injections at the end of surgery. The patients in group M(n=11) received 3 mg of morphine intraarticularly; those in group P(n=15), saline 20 ml intraarticularly as a placebo. RESULTS: Patients in the morphine group had significantly lower pain scores throughout the 24-h postoperative period compared with those in the placebo group(P<0.05). There was less requirement for supplementary analgesics in the morphine group. CONCLUSIONS: Low doses of intraarticular morphine can significantly reduce pain after knee surgery without any systemic side effect.
Analgesics ; Analgesics, Opioid ; Humans ; Knee* ; Morphine* ; Postoperative Period ; Receptors, Opioid

PURPOSE: Although the analgesic effects of corticosteroids have been well documented, little information is available on periarticular injection (PI) containing corticosteroids for early postoperative pain management after total knee arthroplasty (TKA). We performed a prospective double-blind randomized trial to evaluate the efficacy and safety of an intraoperative corticosteroid PI in patients undergoing TKA. MATERIALS AND METHODS: Seventy-six consecutive female patients undergoing bilateral staged TKA were randomized to receive steroid or non-steroid PI, with 3 months separating the procedures. The steroid group received PI with a mixture containing triamcinolone acetonide (40 mg). The non-steroid group received the same injection mixture without corticosteroid. During the postoperative period, nighttime pain, functional recovery [straight leg raising (SLR) ability and maximal flexion], patient satisfaction, and complications were recorded. Short-term postoperative clinical scores and patient satisfaction were evaluated at 6 months. RESULTS: The pain level was significantly lower in the PI steroid than the non-steroid group on the night of the operation (VAS, 1.2 vs. 2.3; p=0.021). Rebound pain was observed in both groups at POD1 (VAS, 3.2 vs. 3.8; p=0.248), but pain remained at a low level thereafter. No significant differences were seen in maximal flexion, frequency of acute rescuer, clinical scores, and patient satisfaction. The steroid group was able to perform SLR earlier than the non-steroid group (p=0.013). The incidence of complications was similar between the groups. CONCLUSION: PI containing a corticosteroid provided an additional pain-relieving effect on the night of the operation. In addition, corticosteroid PI did not increase the perioperative complications of TKA.
Adrenal Cortex Hormones ; Arthroplasty* ; Female ; Humans ; Incidence ; Knee* ; Leg ; Methods ; Pain Management* ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Period ; Prospective Studies ; Triamcinolone Acetonide

The spinal-epidural nerve block is widely used for anesthesia or postoperative pain control. The incidence of neurological complications after spinal and epidural anesthesia is increased although it is usually transient. Such complications may be caused by various mechanical, chemical, and ischemic factors. We experienced a case of motor weakness following combined spinal-epidural anesthesia and analgesia. The motor weakness and hypoesthesia were reversible on right leg, but persistent on left leg.
Anesthesia and Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Hypesthesia ; Incidence ; Leg ; Lower Extremity* ; Nerve Block ; Pain, Postoperative