Acta Anaesthesiologica Taiwanica[JOURNAL]
Sun
200 papers
The role of transesophageal echocardiography in transplantation of an adult-sized kidney to a small child.
Lin IH, Lin CP, Lin FS … +3 more , Liu CC, Hung MH, Fan SZ
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385043 · Publisher ↗
Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challenge to both surgical and anesthetic management. For survival of the graft, a large-size kidney graft transferred to a pedia...
Transplantation of adult-sized kidneys to pediatric patients weighing less than 10 kg is a challenge to both surgical and anesthetic management. For survival of the graft, a large-size kidney graft transferred to a pediatric patient needs extraphysiological cardiac output to compensate for adequate renal blood flow. We report here a boy weighing 8.4 kg who received transplantation of a kidney donated by his 56.4-kg mother. Since monitoring of the central venous pressure was not accurate enough and Swan-Ganz catheterization was not feasible in this patient for monitoring the fluid status and cardiac function, we used transesophageal echocardiography to guide intravascular volume expansion and to titrate inotropic support during the surgery. It was demonstrated to be a useful tool for optimization of renal perfusion in this scenario. The transplanted graft served its function well.
Hypersensitivity reaction probably induced by sugammadex.
Asahi Y, Omichi S, Adachi S … +2 more , Kagamiuchi H, Kotani J
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385042 · Publisher ↗
We report here an intellectually compromised 7-year-old boy with cerebral palsy who developed a hypersensitivity reaction several minutes after the administration of sugammadex for subsequent extubation. He developed sig...
We report here an intellectually compromised 7-year-old boy with cerebral palsy who developed a hypersensitivity reaction several minutes after the administration of sugammadex for subsequent extubation. He developed signs of upper airway stenosis and decreased oxygen saturation, as well as wheals on his neck, chest, and both upper extremities. He was successfully treated with immediate administration of adrenaline and hydrocortisone. A hypersensitivity reaction to sugammadex was suspected on the basis of the patient's clinical course.
Role of neuroinflammation in morphine tolerance: effect of tumor necrosis factor-α.
Shen CH, Tsai RY, Wong CS
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385041 · Publisher ↗
Opioids have been used as potent analgesics in clinics for decades; however, their long-term administration leads to tolerance. Two possible mechanisms for drug tolerance are postulated as within-system and between-syste...
Opioids have been used as potent analgesics in clinics for decades; however, their long-term administration leads to tolerance. Two possible mechanisms for drug tolerance are postulated as within-system and between-systems adaptation. The within-system tolerance is involved in the signal transduction of opioid receptors, including downregulation of opioid receptors, uncoupling of G-protein from opioid receptors, and β-arrestin recruitment to opioid receptors, which causes receptor desensitization and internalization/endocytosis. The between-systems tolerance comprehends the glutamatergic receptor system and glial activation with the release of proinflammatory cytokines, and thus the analgesic effect of morphine is reduced. Tumor necrosis factor-α (TNF-α) is a vital proinflammatory cytokine and exerts either a neurotoxic or neuroprotective effect on different diseases of the central nervous system. TNF-α has also been demonstrated to correlate with neuronal plasticity via activation of spinal glial cells and enhancement of glutamatergic transmission. Previous studies had revealed an increased expression of TNF-α in morphine tolerance. This review article focuses on the role of TNF-α in neuroinflammation and the glutamatergic receptor system in morphine tolerance. It may provide another adjuvant therapy for morphine tolerance, which extends the effectiveness of opioids in clinical pain management.
Mechanisms of ketamine-induced immunosuppression.
Liu FL, Chen TL, Chen RM
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385040 · Publisher ↗
Ketamine, a noncompetitive N-methyl-d-aspartate receptor antagonist, is widely used as an intravenous anesthetic agent. It is known to produce increases in blood pressure and stroke volume, which implies its importance i...
Ketamine, a noncompetitive N-methyl-d-aspartate receptor antagonist, is widely used as an intravenous anesthetic agent. It is known to produce increases in blood pressure and stroke volume, which implies its importance in clinical practice. Ketamine has also been shown to possess anti-inflammatory effects. Our previous studies showed that ketamine, at clinically relevant concentrations, can downregulate endotoxin-induced macrophage activation through toll-like receptor-dependent activation of mitogen-activated protein kinases and the transcription factors nuclear factor-kappa B and activator protein-1. As to the responsible mechanisms, considerable attention was devoted to ketamine-involved regulation of proinflammatory gene expression. The assessment of how ketamine regulates proinflammatory gene expressions is significant in determining the signal cascades that are influenced by this anesthetic agent and its clinical application in the tactical use of ketamine in preventing sepsis. Herein, we review the literature on the pharmacodynamics, pharmacokinetics, and possible mechanisms involved in ketamine's immunology.
Phenothiazine-type antipsychotics may attenuate naloxone-precipitated withdrawal jumping in morphine-dependent mice.
Wu SZ, Chen KT, Chen JY … +4 more , Sung KC, Wang JJ, Liu KS, Chu CC
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385039 · Publisher ↗
OBJECTIVES: Withdrawal of opioids is usually associated with intolerable aversive symptoms. Our objective was to evaluate the efficacy of phenothiazine-type antipsychotics for reducing withdrawal symptoms during morphine...
OBJECTIVES: Withdrawal of opioids is usually associated with intolerable aversive symptoms. Our objective was to evaluate the efficacy of phenothiazine-type antipsychotics for reducing withdrawal symptoms during morphine abstinence. METHODS: Adult NRL mice were rendered physically dependent on morphine by escalating the doses of subcutaneous morphine for 3 days. Withdrawal jumping was precipitated by a subcutaneous injection of naloxone (50 mg/kg) on day 4. In study I, on an equimolar basis, we compared the efficacy of six phenothiazine antipsychotics in saline on reducing morphine withdrawal symptoms. One hour before naloxone injection, the mice were assigned to receive intramuscular (i.m.) saline or one of the six phenothiazine-type antipsychotics (0.3 μmol/kg). After naloxone injection, the tested mouse was immediately placed in a transparent acrylic cylinder, and the severity of withdrawal symptoms was assessed, via a computer connected to the floor of the cylinder, by counting the number of the withdrawal jumps over a 30-minute interval. In study II, we performed a dose-response test in these six phenothiazine antipsychotics (0.03, 0.3, and 3 μmol/kg, i.m., for each test drug) on the inhibition of naloxone-precipitated morphine withdrawal jumping. RESULTS: We found that all six phenothiazine-type antipsychotics attenuated the morphine withdrawal jumps, as compared with saline (p < 0.05). The effect is dose-dependent, with the potency ranking order as follows: fluphenazine ＝ triflupromazine > chlorpromazine ＝ perphenazine > promazine ＝ thioridazine (p < 0.05). CONCLUSIONS: All six phenothiazine-type antipsychotics could attenuate morphine withdrawal symptoms; in particular, fluphenazine and triflupromazine may potentially be the more appropriate candidates for the treatment of morphine withdrawal symptoms.
Differential influence of propofol on different cell types in terms of the expression of various oxidative stress-related enzymes in an experimental endotoxemia model.
Tsai YC, Huang CC, Chu LM … +1 more , Liu YC
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385038 · Publisher ↗
OBJECTIVES: Both overproduction of nitric oxide and oxidative injury to the cardiovascular and pulmonary systems contribute to fatal pathophysiology during endotoxemia. We investigated the effect of propofol on oxidative...
OBJECTIVES: Both overproduction of nitric oxide and oxidative injury to the cardiovascular and pulmonary systems contribute to fatal pathophysiology during endotoxemia. We investigated the effect of propofol on oxidative stress-related enzymes in lung (L2), heart (H9C2) and macrophage (NR8383) cells during endotoxemia. METHODS: Experimental endotoxemia was induced by co-culture of Escherichia coli lipopolysaccharide (15 μg/mL) in the abovementioned three types of cells that were under the effect of propofol (15 or 30 μM for 1 or 4 hours). Cellular expression of induced nitric oxide synthase (iNOS), superoxide dismutase (SOD) 1 and 2, and p47phox (representing NADPH oxidase) were determined by immunoblotting. The cellular oxidative burst activity was determined using a dihydroethidium method via flow cytometry to represent the level of reactive oxygen species. The in vivo endotoxemia model was also employed for comparison using a systemic injection of lipopolysaccharide (15 mg/kg) under propofol maintenance (15 or 30 mg/kg/h). The Student t test (two groups) was used for statistical evaluation among the means, and the Newman-Keuls test was used for analysis of variance in the statistical analysis. RESULTS: In lung L2 cells, propofol significantly reduced the expression of iNOS, SOD1, SOD2, and p47phox under LPS-induced endotoxemia. However, in H9C2 cardiac cells and NR8383 macrophages, only the expression of iNOS was significantly suppressed, but not that of SOD1, SOD2, or p47phox. The level of reactive oxygen species was suppressed in all three kinds of cell. In in vivo animal tissue, except for the suppression of iNOS expression in lung and heart cells, propofol in lung cells produced only SOD1 suppression, but in rat heart the expression of both SOD1 and SOD2 was suppressed. CONCLUSION: These results suggest that propofol may have a protective role for lung cells. This effect is associated with its suppression of oxidative-related enzymes, including iNOS, SOD1, SOD2, and p47phox. In cardiac myocytes and macrophages, propofol also provides an antioxidative effect, probably via its inhibition of iNOS. The overall effect of propofol in the organs may be a combination of its effects on various cells. In addition, a reduction in reactive oxygen species plays a major role in the beneficial effect of propofol on experimental endotoxemia.
Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglion.
Chen CY, Luo CF, Hsu YC … +2 more , Chen JF, Day YJ
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385037 · Publisher ↗
BACKGROUND: A significant abrupt drop in heart rate is the most frequent complication during percutaneous microballoon compression of the trigeminal ganglion. It is suggested that co-activation of the sympathetic and par...
BACKGROUND: A significant abrupt drop in heart rate is the most frequent complication during percutaneous microballoon compression of the trigeminal ganglion. It is suggested that co-activation of the sympathetic and parasympathetic nervous systems plays an important role in this occurrence. We hypothesized that not only atropine, but also labetalol might be effective in preventing this cardiovascular reflex during percutaneous microballoon compression of the trigeminal ganglion. METHODS: Patients who underwent percutaneous microballoon compression for trigeminal neuralgia between September 2007 and December 2009 were prospectively evaluated. The relationship between the hemodynamic changes and intraoperative use of atropine (0.01 mg/kg) or labetalol (0.05 mg/kg) was compared. One-way analysis of variance with Bartlett's and Tukey's post-tests was used, and a value of p < 0.05 was considered statistically significant. RESULTS: In total, 119 patients who received percutaneous microballoon compression for trigeminal neuralgia were studied, of whom 38 received atropine before ganglion compression, 36 received labetalol, and 45 received normal saline as a control. Of the patients who received normal saline, 31.3% had moderate bradycardia (heart rate < 50 beats/min), 13.3% had severe bradycardia (heart rate < 40 beats/min), and 7% had arrhythmia. Of the patients who received atropine, 7.8% had moderate bradycardia, 7.8% had arrhythmia, and 5.3% had postcompression tachycardia by the end of ganglion compression. Of the patients who received labetalol, 16.7% had moderate bradycardia, 5.6% had severe bradycardia, and 2.8% had arrhythmia. Systemic blood pressure was markedly elevated straight after compression in all groups and tended to normalize 3 minutes afterwards. CONCLUSION: Both atropine and labetalol were able to lower the frequency of bradycardia. Neither of them could abolish episodes of bradycardia during the procedure. Patients receiving labetalol before microballoon compression were subject to a smaller change in hemodynamics. Our findings verified that the sympathetic and parasympathetic nervous systems may be involved in the complex interneuronal interaction of the trigeminocardiac reflex.
A placebo-controlled, double-blind, randomized study of single-dose intravenous diclofenac for pain relief after a cesarean section.
Thienthong S, Chongsomchai C, Kemthong W
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385036 · Publisher ↗
BACKGROUND: This study was conducted to avoid the pain of an intramuscular injection of diclofenac after a cesarean section, by modifying it to an intravenous infusion by diluting it with 5% dextrose in 100 mL of water....
BACKGROUND: This study was conducted to avoid the pain of an intramuscular injection of diclofenac after a cesarean section, by modifying it to an intravenous infusion by diluting it with 5% dextrose in 100 mL of water. OBJECTIVE: The aim of this study was to determine the efficacy of a single-dose modified diclofenac being given intravenously, instead of intramuscularly, for pain relief after a cesarean section. STUDY DESIGN: A double-blind, randomized controlled trial was conducted. PARTICIPANTS: We enrolled 30 patients who underwent cesarean sections with Pfannenstiel skin incision. METHODS: All patients received 2.2-2.5 mL of 0.5% bupivacaine with 0.2 mg morphine for spinal anesthesia. The participants were equally and randomly allocated to two groups to receive intravenous diclofenac or placebo at 12 hours postoperatively. Both groups received the same regimen for postoperative pain control. MAIN OUTCOME MEASUREMENTS: The severity of postoperative pain was measured directly using a verbal numerical rating scale (0-10) and a pain-relief scale (1-4), and indirectly from the amount of tramadol used. RESULTS: The characteristics of the two groups of patients were similar. The mean postoperative pain relief at 24 hours in the study group was better than that in the control group (3.14 ± 0.66 vs. 2.13 ± 0.99; p < 0.05). The severity of postoperative pain at 24 hours and the amount of tramadol used were not different between groups. CONCLUSION: Intramuscular diclofenac (75 mg), modified by diluting it with 5% dextrose in 100 mL of water, for intravenous administration in combination with spinal morphine (0.2 mg) provided good analgesia after a cesarean section within 24 hours when assessed by the pain-relief scale; however, the mean pain intensity was not different.
Priming dose of intravenous rocuronium suppresses fentanyl-induced coughing.
Horng HC, Lin BF, Wang TC … +4 more , Lin SL, Liaw WJ, Wang HJ, Wong CS
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385035 · Publisher ↗
OBJECTIVES: An intravenous bolus of fentanyl often induces a cough reflex. This study investigates whether priming with rocuronium can effectively attenuate fentanyl-induced coughing. METHODS: The study involved 260 part...
OBJECTIVES: An intravenous bolus of fentanyl often induces a cough reflex. This study investigates whether priming with rocuronium can effectively attenuate fentanyl-induced coughing. METHODS: The study involved 260 participants, aged between 18 and 80 years of age, who were undergoing various elective surgeries. They were randomly assigned to two groups. Patients in the study group (the rocuronium group) were treated with intravenous (IV) 0.06 mg/kg rocuronium, whereas those in the control group were treated with the same volume of normal saline. Fentanyl (1.5 μg/kg IV, given over 2 seconds) was administered 30 seconds after the injection of rocuronium or normal saline. We recorded the number of coughs for 1 minute after the fentanyl injection. RESULTS: Patients in the rocuronium group showed a significantly lower incidence of coughing (8.5% vs. 23.1%, in the control group; p < 0.05) and a milder severity of cough in comparison with the patients in the control group. CONCLUSION: Pretreatment with IV rocuronium (0.06 mg/kg) suppressed the cough reflex induced by fentanyl. Therefore, priming with rocuronium may be a clinically useful method for preventing fentanyl-induced cough.
Modulating effects of ketamine on inflammatory response in sepsis.
Tsao CM, Wu CC
Acta Anaesthesiol Taiwan · 2012 Dec · PMID 23385034 · Publisher ↗
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Successful tracheal intubation with Airtaq optical laryngoscope for severe ankylosing spondylitis.
Ali QE, Amir SH, Siddiqui OA … +1 more , Ahmed ZS
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026176 · Publisher ↗
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Aphonia induced by conversion disorder during a Cesarean section.
Ng KO, Lee JF, Mui WC
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026175 · Publisher ↗
Aphonia induced by conversion disorder during surgery is a rare event. We report a woman 28 years of age who was undergoing a Cesarean section under epidural anesthesia. The patient sustained aphonia without detected neu...
Aphonia induced by conversion disorder during surgery is a rare event. We report a woman 28 years of age who was undergoing a Cesarean section under epidural anesthesia. The patient sustained aphonia without detected neurologic deficits. Emergency consultations of a psychiatrist and neurologist were carried out in the operating room postoperatively. After a thorough medical and neurologic work-up, the consultative psychiatrist and the neurologist unanimously made the diagnosis of conversion disorder. Thirty-six hours after the operation, the patient's voice started to return. We venture on sharing the findings of this case with our fellow anesthesiologists in order to highlight discussion and illuminate the differential diagnosis. We have reviewed the literature and excluded an organic lesion as the culprit of the event.
Anesthesia for oncogenic osteomalacia--a rare paraneoplastic syndrome.
Ramachandran R, Rewari V, Trikha A … +1 more , Singh PM
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026174 · Publisher ↗
Two patients with a diagnosis of oncogenic osteomalacia are described. This rare disease, characterized by secretion of fibroblast growth factor-23 by the tumor cells, causes myopathy, extreme debilitation and severe ost...
Two patients with a diagnosis of oncogenic osteomalacia are described. This rare disease, characterized by secretion of fibroblast growth factor-23 by the tumor cells, causes myopathy, extreme debilitation and severe osteopathy because of severe hypophosphatemia. Both patients presented with severe bone pain, pathological fractures and proximal muscle weakness. Multiple diagnostic tools had to be utilized to settle the diagnosis of this rare disease. Although supplemental therapy for hypophosphatemia is usually started preoperatively, surgical excision of the causative tumor is the only definite treatment. Surgery is almost always curative; however, there is a lack of discourse in the literature regarding the anesthetic implications for the disease. The complete pathophysiology of the disease, clinical picture, its diagnostic intricacies as well as the salient points in its anesthetic management are discussed in this report.
Combinations of fentanyl and levobupivacaine for post-thoracotomy pain.
Tekelioglu UY, Gurses EL, Serin S … +1 more , Sungurtekin H
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026173 · Publisher ↗
The aim of the present study is to evaluate the analgesic activity, patient satisfaction, and side effect profile of different concentrations of levobupivacaine plus fentanyl administered through thoracic epidural patien...
The aim of the present study is to evaluate the analgesic activity, patient satisfaction, and side effect profile of different concentrations of levobupivacaine plus fentanyl administered through thoracic epidural patient-controlled analgesia in patients undergoing thoracotomy. The study included 60 patients who were randomly divided into three groups. At the end of the surgery, group I (n = 20) received 0.125% levobupivacaine plus 3 mg fentanyl, group II received 0.1% levobupivacaine plus 3 mg fentanyl, and group III received 0.05% levobupivacaine plus 3 mg fentanyl via an epidural catheter placed at the level of T(10-11) or T(11-12). For all groups, the patient-controlled analgesia device was programmed to deliver a loading dose of 14 mL at an infusion rate of 4 mL/h, and a bolus dose of 2 mL/h, with a locked out interval of 15 minutes and 60 mL of a 4-hour limit. The following parameters were evaluated at 5, 10, 15, 20, 30, and 40 minutes and at 1, 2, 4, 8, 16, and 24 hours after admission to the intensive care unit, at which nausea and vomiting scales, Visual Analog Scale I-II, Ramsay sedation scale, Bromage scale, pupil diameter, arterial blood pressure, heart rate, respiratory rate, and SpO(2) were measured and recorded. Any side effect was also documented. As the result of the evaluation, visual Analog Scale I-II scores, patient satisfaction scores, mean arterial blood pressure, and heart rate significantly differed in group I as compared with groups II and III. No side effects were encountered except mild nausea, which was seen in group III and did not require treatment. Motor blockage, pupil size, respiratory rate, and SpO(2) were not monitored in any of the patients in all groups. In conclusion, our study suggested that the use of 0.125% levobupivacaine, together with 3 mg/mL fentanyl, constitutes a good combination, and can be used safely without causing hemodynamic change and motor block.
Anesthesia for awake video-assisted thoracic surgery.
Kao MC, Lan CH, Huang CJ
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026172 · Publisher ↗
Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anestheti...
Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.
Dental anesthesia for patients with special needs.
Wang YC, Lin IH, Huang CH … +1 more , Fan SZ
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026171 · Publisher ↗
To offer individualized dental treatment to certain patients who cannot tolerate dental treatment, sedation or general anesthesia is required. The needs could be either medical, mental, or psychological. The most common...
To offer individualized dental treatment to certain patients who cannot tolerate dental treatment, sedation or general anesthesia is required. The needs could be either medical, mental, or psychological. The most common indications for sedation or general anesthesia are lack of cooperation, multiple morbidities, and pediatric autism. In adults, cognitive impairment and multiple morbidities are most commonly encountered indications. Because of suboptimal home care, incomplete medical history, poor preoperative management, lack of cooperation, and developmental abnormalities, it is a challenge to prepare anesthesia for patients with special needs. The American Society of Anesthesiology (ASA) has proposed guidelines for office-based anesthesia for ambulatory surgery. In patients with ASA physical status IV and V, sedation or general anesthesia for treatment in the dental office is not recommended. The distinction between sedation levels and general anesthesia is not clear. If intravenous general anesthesia without tracheal intubation is chosen for dental procedures, full cooperation between the dentist, dental assistant, and anesthesiologist is needed. Teamwork between the dentist and healthcare provider is key to achieve safe and successful dental treatment under sedation or general anesthesia in the patient with special needs.
Levobupivacaine differentially suppresses platelet aggregation by modulating calcium release in a dose-dependent manner.
Liou JT, Mao CC, Liu FC … +4 more , Lin HT, Hung LM, Liao CH, Day YJ
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026170 · Publisher ↗
OBJECTIVE: Levobupivacaine, an amide local anesthetic widely used in regional anesthesia, is reported in recent studies that it is a potent inhibitor of platelet functions. However, the concentrations of levobupivacaine...
OBJECTIVE: Levobupivacaine, an amide local anesthetic widely used in regional anesthesia, is reported in recent studies that it is a potent inhibitor of platelet functions. However, the concentrations of levobupivacaine were limitedly estimated in these reports. Additionally, the mechanisms by which it affects platelet function and blood coagulation is still not entirely known. The purpose of this study was to further investigate its effects on platelet function and the possible signaling mechanisms under various concentrations of levobupivacaine. METHODS: Blood samples collected from healthy volunteers were separated into whole blood, platelet-rich-plasma and washed platelets. The effect of levobupivacaine on platelet aggregation was studied using platelet function analyzer (PFA-100) and platelet aggregometer. Agonist-induced platelet adenosine triphosphate (ATP) release, cytosolic calcium mobilization, thromboxane B2 (TxB2) secretion and platelet P-selectin translocation under various concentrations of levobupivacaine were investigated. RESULTS: Our results indicated that levobupivacaine possessed negative effect on platelet aggregation. The closure times of (PFA-100) were lengthened and the agonist-induced platelet aggregation was significantly attenuated by levobupivacaine even at a low dose (50 μgml(-1)). Pretreatment with levobupivacaine produced significant changes in agonist-induced platelet P-selectin translocation, ATP release, thromboxane A2 (TxA2) production, and calcium mobilization in a dose-dependent manner. The p38 mitogen-activated protein kinases (MAPK), protein kinase C (PKC) δ subtype, cytosolic phospholipase A2 (cPLA2), and protein kinase B (PKB or Akt) were involved in collagen-induced platelet signaling, which would be responsible for antiplatelet effects of levobupivacaine. CONCLUSION: We explored possible targets of levobupivacaine on platelets aggregation signaling mechanisms. Our data revealed that p38 MAPK, PKC δ subtype, cPLA2, and Akt were pathways involved in collagen-induced platelet signaling, which might be responsible for antiplatelet effects of levobupivacaine. Our study did provide direct evidence bolstering the critical mechanisms of levobupivacaine within different contexts. Additionally, levobupivacaine imposed a negative effect on platelet aggregation through multiple signaling pathways.
Ultra-low-dose naloxone enhances the antinociceptive effect of morphine in PTX-treated rats: regulation on global histone methylation.
Tsai RY, Shen CH, Feng YP … +5 more , Chien CC, Lee SO, Tsai WY, Lin YS, Wong CS
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026169 · Publisher ↗
OBJECTIVE: Epigenetic reprogramming may have a possible role in neuropathic pain development; the present study examined the global patterns of lysine histone modification. In this serial study we analyzed the levels of...
OBJECTIVE: Epigenetic reprogramming may have a possible role in neuropathic pain development; the present study examined the global patterns of lysine histone modification. In this serial study we analyzed the levels of histone 3 lysine 4 monomethylation, histone 3 lysine 4 dimethylation, and histone 3 lysine 9 trimethylation in pertussis toxin (PTX)-induced thermal hyperalgesic rat spinal cords. METHODS: Male Wistar rats implanted with an intrathecal catheter received a single intrathecal PTX (1 μg in 5 μl saline) injection. Four days later, they were randomly assigned to receive either a single injection of saline, or ultra-low-dose naloxone (15 ng in 5 μl saline), followed by morphine (10 μg in 5 μl saline) injection 30 minutes later. RESULTS: The results showed that PTX injection induced thermal hyperalgesia and significant increase of global histone methylation in the spinal cords. Intrathecal morphine alone did not affect the thermal hyperalgesia and global histone methylation. In contrast, intrathecal administration of ultra-low-dose naloxone plus morphine significantly attenuated the PTX-induced thermal hyperalgesia and down-regulated the global histone methylation. CONCLUSION: The results suggest that ultra-low-dose naloxone might be clinical valuable for neuropathic pain management via regulating global histone modification.
An open label trial of the effects and safety profile of extended-release tramadol in the management of chronic pain.
Hsu SK, Yeh CC, Lin CJ … +1 more , Hsieh YJ
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026168 · Publisher ↗
OBJECTIVES: Tramadol is a synthetic centrally-acting opioid analgesic. The newly developed extended-release formulation of tramadol offers a more stable plasma concentration and could improve patients' compliance. The pu...
OBJECTIVES: Tramadol is a synthetic centrally-acting opioid analgesic. The newly developed extended-release formulation of tramadol offers a more stable plasma concentration and could improve patients' compliance. The purpose of this study was to evaluate the efficacy, safety, and adverse events of extended release tramadol in Taiwanese patients with moderate to severe chronic noncancer pain. METHODS: Sixty-six patients with moderate to severe chronic noncancer pain previously treated with conventional tramadol but unsatisfied with its efficacy were enrolled from four medical centers. The patients received the extended-release tramadol once daily for a week. RESULTS: The usage of extended-release tramadol was more efficacious as the patients' visual analog scale score dropped significantly (-16 ± 14.1). In this study, the reported adverse events were similar to those of previous studies. Thirty patients reported adverse events and one patient reported a serious adverse event but was justified unrelated to the study drug. The most common adverse event was dizziness, followed by vomiting, nausea, somnolence, and constipation in sequence. In this study, patients with dizziness were observed to have a lower initial pain score (p = 0.032). Furthermore, the rate of premature termination and dizziness was closely correlated (p = 0.027). CONCLUSION: Patients with chronic pain could obtain significantly better pain relief after the switch to larger doses of extended-release tramadol with safety and without severe adverse effects in a short period of time. Less severe adverse effects (no life-threatening event) was the leading cause of premature termination.
Perioperative transfusion-related acute lung injury: a retrospective analysis.
Tsai HI, Chou AH, Yang MW
Acta Anaesthesiol Taiwan · 2012 Sep · PMID 23026167 · Publisher ↗
OBJECTIVE: Transfusion-related acute lung injury (TRALI) is the leading morbidity and mortality in hemotherapy in the United States. Although it is a serious complication of blood transfusion, it is still underestimated...
OBJECTIVE: Transfusion-related acute lung injury (TRALI) is the leading morbidity and mortality in hemotherapy in the United States. Although it is a serious complication of blood transfusion, it is still underestimated and under-reported because of under-recognition and misdiagnosis. In this report, we present 15 surgical patients who developed pulmonary complications secondary to blood transfusion during the perioperative period. METHODS: A 3-year retrospective analysis of 14,441 patients who received blood transfusion intraoperatively in our Taoyuan center was carried out. 15 patients suspected to be subject to TRALI perioperatively were sorted out for analysis of their clinical characteristics. RESULTS: All of the 15 patients received inhalational general anesthesia, of whom 10 were anesthetized with sevoflurane, four with desflurane, and one with isoflurane. One patient died on the first postoperative day due to multiorgan failure whereas 14 others who were managed with oxygen therapy or mechanical ventilation recovered uneventfully within 72 hours. CONCLUSIONS: TRALI must be recognized as one of the leading causes of mortality related to blood transfusion. Oxygen support is often sufficient in mild TRALI while ventilatory support is required in severe TRALI. The strategy to minimize such a risk using blood products from male donors or from female donors without history of pregnancy or having a negative leukocyte antibody screening can help reduce severe immune mediated TRALI.
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