Objectives: ：Zolpidem is a common drug used in insomnia. However, there are several reports of side effects of the central nervous system or sleep related behavior in patients who took zolpidem. This study was conducted to investigate risk factors affecting sleep related behavior after taking zolpidem in inpatients. Methods: ：From January 1, 2019 to December 31, 2019, medical records of patients who took zolpidem hospitalized at Inha University Hospital were reviewed retrospectively. Results: ：907 patients who took Zolpidem, 102 (11.2%) showed sleep related behavior, and if they were 65years of age or older, men, taking antipsychotics, and taking antipsychotics and benzodiazepines at the same time, they were significantly more likely to show sleep related behavior. Conclusions ：Risk factors for sleep-related behavior after use of zolpidem are estimated gender, elderly, antipsychotics, and combination of antipsychotics and benzodiazepines.

This study was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc.
Chondrocytes/metabolism/pathology ; Collagen Type II/metabolism ; Comparative Study ; Diskectomy/*methods ; Endoscopy ; Humans ; Indigotindisulfonate Sodium/*diagnostic use ; Intervertebral Disk/metabolism/pathology/*surgery ; Intervertebral Disk Displacement/diagnosis/*surgery ; Proteoglycans/metabolism ; Sensitivity and Specificity

BACKGROUND: Massive increases in glutamate concentration in the spinal cord have been known to cause neurologic injury after spinal ischemia. However, changes in glutamate receptor subtype mRNA expression have not been evaluated. The purpose of this study was to elucidate changes of glutamate receptor subtype mRNA expressions after 15 minutes of transient spinal ischemia in the rat. METHODS: Rats were anesthetized with enflurane, and divided into 7 groups: Sham operation (S group), 1 hour reperfusion (H1 group), 3 hours reperfusion (H3 group), 1 day reperfusion (D1 group), 2 days reperfusion (D2 group), 1 week reperfusion (W1 group), and 2 weeks reperfusion (W2 group). Spinal ischemia was produced by inducing hypotension and by clamping the thoracic aorta. After spinal ischemia, neurologic scores were assessed and spinal cords were removed for glutamate receptor mRNA RT-PCR after various reperfusion times. RESULTS: No significant differences in the group were observed in physiologic variables and neurologic scores. mGluR2 and mGluR6 were up-regulated 1 day after ischemia and returned to baseline at 2 weeks. mGluR3 was up-regulated 1 week after reperfusion and returned at 2 week, and mGluR1 and mGluR4 were down- regulated 3 hours after reperfusion and returned to the control level at 1 2 weeks. NMDAR1 and 2A were down-regulated after reperfusion, but NMDAR2B was up-regulated 1 day after reperfusion and returned to the control level at 1 week. The GluR1, 2, 3, 4-flip were down-regulated 3 hours after reperfusion and returned to control level at 1 week. However, the GluR1, 2, 3-flop were up-regulated 2 days after reperfusion and returned to control level at 2 weeks. CONCLUSIONS: Changes in spinal cord glutamate receptor subtype mRNA expression after transient spinal ischemia were different for the receptor types and reperfusion times. The changes in glutamate receptor subtypes in the spinal cord differed from those in the brain.
Animals ; Aorta, Thoracic ; Brain ; Constriction ; Enflurane ; Glutamic Acid* ; Hypotension ; Ischemia* ; Rats* ; Receptors, Glutamate* ; Reperfusion ; RNA, Messenger* ; Spinal Cord ; Spinal Cord Ischemia

BACKGROUND: Patient awareness is a particular problem in cardiac anesthesia with cardiopulmonary bypass (CPB). Transformed electroencephalogram monitors, such as the Bispectral index (BIS) monitor, has been advocated as a tool that may reduce the incidence of unexpected intraoperative recall. The authors studied the effects of hypothermia during CPB on the BIS score and the BIS can be a useful monitor to measure anesthetic depth and requirement during hypothermic CPB. METHODS: Eighteen consenting volunteers scheduled for an elective cardiac surgery were studied. Volunteers were randomly allocated to one of two groups. All patients were given propofol by a target controlled infusion system, Diprifusor, with fentanyl (0.6 ug/kg/min). In group A, before and during CPB propofol was infused at a predetermined target plasma concentration (2.0 ug/ml), the BIS score and temperature were monitored. In group B, before and during CPB, to maintain the BIS score at 30 40 units, changing propofol plasma concentrations and temperature were monitored. Then we asked patients about intraoperative awareness. RESULTS: In group A, compared with before the start of CPB, the BIS score was decreased by the temperature (P < 0.05) during CPB (5 min, 10 min, 20 min, 30 min after the start of CPB) and after the stop of CPB. In group B, compared with before the start of CPB, the required propofol plasma concentration was decreased by the temperature during CPB (P < 0.05). In addition, no one experienced awareness during surgery. CONCLUSIONS: The BIS score was decreased by a decline in temperature during the hypothermic CPB, and bispectral analysis can be a relative indicator of anesthetic requirement and the hypnotic state under this conception.
Anesthesia ; Cardiopulmonary Bypass* ; Electroencephalography ; Fentanyl ; Fertilization ; Humans ; Hypothermia ; Incidence ; Intraoperative Awareness ; Plasma ; Propofol ; Thoracic Surgery ; Volunteers

BACKGROUND: Delayed neuronal injury after cerebral ischemia came major neurologic complication after stroke or cardiac arrest. Apoptosis formation after ischemia may be one of a mechanism of delayed neuronal injury. This study was conducted to evaluate the effect of moderate hypothermia on apoptosis formation after one hour of middle cerebral artery degrees Cclusion in rats. METHODS: Ten Sprague-Dawley rats (300 g) were freely fed till just before operation. Anesthesia was induced with 4 vol% isoflurane in oxygen and then maintained with 2 vol% isoflurane in oxygen. Middle cerebral artery degrees Cclusion (MCAO) was induced by intraluminal monofilament nylon with blunted tip. All rats were divided randomly into two groups. In group 1 (n=5), rectal temperature was maintained at 38 degrees C. In group 2 (n=5), rectal temperature was maintained at 32 degrees C. Rectal temperature was monitored during experiment. After 60 minutes of MCAO, intraluminal monofilament was removed and all rats were returned to cages. Brain were quickly removed and cerebral hemispheres were separated after 23 hours reperfusion. Apoptosis formation were counted with TUNEL stain. RESULTS: In group 1, after 60 minutes of MCAO and 23 hours reperfusion, 51 3.6% of hipp degrees Campal neurons were TUNEL-positive stained apoptotic cells. In group 2, TUNEL-positve neurons were 26.1 6.5% and significantly less than those of group 1 (p<0.05). CONCLUSIONS: Sixty minutes of MCAO and 23 hours reperfusion induce hipp degrees Campal neuronal apoptosis. Moderate hypothermia of 32 degrees C reduces apoptosis of hipp degrees Campal neurons after 60 minutes of MCAO and 23 hours reperfusion.
Anesthesia ; Animals ; Apoptosis* ; Brain ; Brain Ischemia* ; Cerebrum ; Heart Arrest ; Hypothermia* ; In Situ Nick-End Labeling ; Ischemia ; Isoflurane ; Middle Cerebral Artery ; Neurons ; Nylons ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Stroke

Dental Offices ; Dentistry ; Mouth ; Pathology

Hemorrhage ; Mouth Mucosa

BACKGROUND: Intravenous anesthetics such as propofol and ketamine have been known to have neuroprotective effects. However, the combination of these drug is not known. This study was conducted to determine the neuroprotective effects of propofol, ketamine or both after transient forebrain ischemia. METHODS: Twenty Sprague-Dawley rats (250-300 gm) were used. Anesthesia was induced with 4% isoflurane in oxygen and then maintained with 1 - 2% isoflurane in oxygen. Ischemic injury was induced by 10 minutes of both common carotid artery ligation and hypotension (MAP < 50 mmHg). All rats were randomly divided into four groups: group I; control group; group II; ketamine 10 mg/kg was administered 10 minutes before injury; group III; propofol (1 mg/kg/min) was administered until EEG isoelectricity; and group IV; ketamine 10 mg/kg and propofol 1 mg/kg/min was administered. The Rectal temperature was maintained at 38oC. After forebrain ischemia, neurologic scores were estimated at 1 hr, 2 hrs, 1 day and 2 days after recovery. The brain was removed 3 days after and stained with H-E stain. RESULTS: Neurologic and histologic scores of group II, III, IV were significantly lower than that of group I. However, there were no significant difference between group II, III and IV. CONCLUSIONS: Ketamine and propofol have neuroprotective effects in transient forebrain ischemia in rats. However, the combination of propofol and ketamine did not show any synergistic or additive effects.
Anesthesia ; Anesthetics, Intravenous ; Animals ; Brain ; Carotid Artery, Common ; Electroencephalography ; Hypotension ; Ischemia* ; Isoflurane ; Ketamine* ; Ligation ; Neuroprotective Agents* ; Oxygen ; Propofol* ; Prosencephalon* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Monitoring of "Depth of anesthesia" is an ongoing problem in anaesthesia. In this study, the author has compared the bispectral index (BIS) and Anemon monitor for monitoring depth of anesthesia in propofol or isoflurane anesthesia. METHODS: Anemon-1 and BIS index were obtained from 24 patients (ASA I, II) during general anesthesia with propofol or isoflurane. For patients in the propofol group, anesthesia was induced with fentanyl 100ng followed by propofol 2 mg/Kg. For patients in the isoflurane group, anesthesia was induced with thiopental 5 mg/Kg. The author observed changes of these values at 5 major times: before induction, during induction, after induction, at sKin incision, before extubation, after extubation. RESULTS: The anemon index showed a significant increase during induction (propofol group: 86.9 +/- 26.4, isoflurane group: 106.0 +/- 18.6) and at sKin incision (propofol group: 89.9 +/- 22.7, isoflurane group: 92.0 +/- 23.1), but this did not correlate with the level of consciousness. The BIS index showed a significant decrease in the score after induction (propofol group: 55.0 +/- 9.6, isoflurane group: 61.0 +/- 17.2), but no response to surgical stimuli. CONCLUSIONS: BIS had a good correlation with level of consciousness. The Anemon-1 index was recognized to reflect invasive stimulus. As the BIS and Anemon-1 had no correlation, it was not possible to assume changes of each index from the other. Both the anemon-1 index and BIS are useful to monitor the anesthesia level during surgery.
Anesthesia ; Anesthesia, General ; Consciousness ; Fentanyl ; Humans ; Isoflurane ; Propofol ; Skin ; Thiopental

BACKGROUND: Preemptive analgesia may improve postoperative antinociceptive treatment that prevents the development of central sensitization which contributes to post-injury pain hypersensitivity. However, beneficial effects of preemptive analgesia appear controversial. The purpose of this study was to examine the effect of pre- and post-incisional local infiltration of lidocaine and gabapentin on incisional pain in rats. METHODS: Thirty five male rats were divided into 7 groups; control group (n = 5), pre-lidocaine infiltration group (n = 5), post-lidocaine infiltration group (n = 5), pre-gabapentin 10 mg infiltration group (n = 5), post-gabapentin 10 mg infiltration group (n = 5), pre-gabapentin 30 mg infiltration group (n = 5), and post-gabapentin 30 mg infiltration group (n = 5). To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal thresholds were measured by calibrated von Frey filaments at 2 hrs, 1, 2, 3, 4, and 5 days after an incision. RESULTS: The pre-lidocaine infiltration group shows better analgesic effects than post-lidocaine infiltration group until postoperative day 1 (P < 0.05). The gabapentin infiltration groups were effective in postoperative pain management but there were no significant differences between pre- and post- incisional treatment. CONCLUSIONS: A preemptive lidocaine injection has a good analgesic effect on incisional pain. Gabapentin also has a good analgesic effect on incisional pain.
Analgesia ; Animals ; Central Nervous System Sensitization ; Foot ; Humans ; Hyperalgesia ; Hypersensitivity ; Lidocaine* ; Male ; Pain, Postoperative* ; Rats*