Masui. The Japanese journal of anesthesiology
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We have reported that the Japanese herbal medicine "Saiko-Keishi-To" (SK) which is often used for treating epileptic patients activates the GABAA receptor-mediated chloride current (Icl). In the present study, we examined whether the SK-induced Icl could be potentiated by several intravenous anesthetics known to interact with the GABAA receptor, and also examined whether SK could potentiate the GABA-induced Icl. Whole-cell patch-clamp recordings were made from cultured rat dorsal root ganglion cells. ⋯ The peak amplitude of the Icl evoked by GABA (10 microM) increased after propofol (5 microM) to 617 +/- 189% of the control (n = 4), but decreased to 84 +/- 7% of the control by SK (0.2 mg.ml-1, n = 4). These results indicate that the SK-induced Icl can be potentiated by the intravenous anesthetics, positive allosteric modulators of the GABAA receptor-Cl- channel complex and that SK is not a positive allosteric modulator, but a partial agonist for the GABAA receptor. Our study thus suggests that the combined use of SK and anticonvulsants such as barbiturates and benzodiazepines may be more effective in treating epileptic patients than SK alone.
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Postoperative analgesia by continuous epidural morphine infusion after spinal surgery was investigated in a retrospective study. An epidural catheter was placed by surgeons at the time of surgery. ⋯ There were no severe complications except for respiratory depression in a patient with chronic obstructive pulmonary disease. Our study demonstrated the ease of insertion of an epidural catheter at the time of surgery and the good quality of epidural analgesia after spinal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of preoperative epidural morphine on postoperative pain].
Postoperative analgesia was assessed by examining nurses' records of 421 gynecological operative cases between January, 1989 and November, 1990. The criterion used in the analysis was the need for analgesics for pain within 24 hours postoperatively. After receiving morphine (2 mg, 4 mg, 5 mg, 6 mg) with local anesthetics or physiological saline solution into the epidural space (lower thoracic, lower lumbar, or both regions), the patient was intubated with thiopental, diazepam, and a muscle relaxant (vecuronium or pancuronium). ⋯ The percentage of patients without pain was significantly larger in the group receiving 6 mg of morphine even in comparison with the groups receiving lesser doses. No serious complications occurred postoperatively in any group. In conclusion, preoperative morphine administered into the epidural space is effective for postoperative analgesia in gynecological operation, especially when morphine 6 mg was administered in the lower epidural (4 mg) and lower lumbar epidural (2 mg) space.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Insertion characteristics and complications of a new spinal needle 26-gauge Atraucan].
We evaluated the insertion characteristics and complications of a new spinal needle 26-gauge Atraucan (group A) compared with 27-gauge Whitacre (group W) in 100 patients undergoing orthopedic surgeries of the lower extremities. Spinal anesthesia was performed in the lateral decubitus position and 0.40-0.5% tetracaine 1.6-2.5 ml was injected through the L 3/4 or L 4/5 interspace. The tactile appreciation of dural presentation with the needle (dural click) was higher in group W (89.8%) than in group A (42.6%) which the back flow of cerebrospinal fluid was not recognized within three punctures was in 2 cases (4%) in group A and in 1 case (2%) in group W. ⋯ In group A, the spinal needle could be inserted without using an introducer in 35 cases (70%). The incidence of the postoperative headache or back pain was low and postdural puncture headache (PDPH) did not occur in both groups. We conclude that 26-gauge Atraucan can be handled easily and useful for preventing PDPH.
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Review
[Adrenergic receptor and alpha 2 agonist--4: Applied and clinical pharmacology of alpha 2 agonist].
Alpha 2 adrenergic agonists currently are used in the anesthetic management of the surgical patient for their sedative/hypnotic, anesthetic-sparing, analgesic, and sympatholytic properties. Experimental and clinical studies have progressed to the point where anesthesiologists are now focusing on the use of these agents for their analgesic and anesthetic effects. This interest has coincided with the development and clinical introduction of dexmedetomidine. Clinical studies using existing alpha 2 agonists have revealed a tremendous potential for these agents that will be fully realized when more selective and specific compounds become available.