A 53-year-old man ingested insecticide and stabbed himself in the upper abdomen in an attempt to commit suicide. He presented with nausea, vomiting, excessive salivation and urination as a result of organophosphate poisoning upon admission. He was planned to undergo an exploratory laparotomy under general anesthesia. After placing a neuromuscular monitor, atracurium 10 mg three times before intubation and additional 5 mg bolus were administered when the third twitch appeared during operation. The total dose of atracurium administered was 50 mg, and the total duration of anesthesia was 150 minutes. The patient was not extubated despite the adequate recovery from atracurium in order to protect the sutured liver and there being some concern of the intermediate syndrome. In the intensive care unit, atropine was discontinued 37 hours after poisoning. The patient was extubated successfully 48 hours after poisoning and was kept under close observations on respiration and supportive care. He was discharged 12 days after surgery without any sequela.
Abdomen ; Anesthesia ; Anesthesia, General* ; Atracurium* ; Atropine ; Humans ; Intensive Care Units ; Intubation ; Laparotomy ; Liver ; Middle Aged ; Nausea ; Organophosphate Poisoning* ; Poisoning ; Respiration ; Salivation ; Suicide ; Urination ; Vomiting

BACKGROUND: Nitric oxide (NO) is involved in the transmission and modulation of nociceptive information at the peripheral, spinal cord and supraspinal levels. We conducted this experiment to assess the antinociceptive effects of a nonselective nitric oxide synthase (NOS) inhibitor, N-nitro-L-arginine methyl ester (L-NAME), on the modulation of pain in rats subjected to the formalin test. METHODS: Formalin 5% was injected in the right hind paw after intraperitoneal (IP) injection of various doses of L-NAME (0.5 mg/kg, 1.5 mg/kg with and without L-arginine 100 mg/kg, 5.0 mg/kg). The number of flinches was measured. RESULTS: Formalin injected into the rat hind paw induced a biphasic nociceptive behavior. IP injected L-NAME diminished the nociceptive behaviors in a dose-dependent manner during phases 1 and 2. The concomitant injection of L-arginine reversed the antinocipetive effect of L-NAME. CONCLUSIONS: The data demonstrates that a nonselective NOS inhibitor, L-NAME, possesses antinociceptive properties in rats subjected to the formalin test, and the antinociceptive effect of L-NAME is reversed by the concomitant administration of L-arginine.
Animals ; Arginine ; Formaldehyde* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase* ; Nitric Oxide* ; Pain Measurement* ; Rats* ; Spinal Cord