Acta anaesthesiologica Sinica
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Acta Anaesthesiol. Sin. · Dec 2003
ReviewImplications of intrathecal pertussis toxin animal model on the cellular mechanisms of neuropathic pain syndrome.
Like opioid tolerance, neuropathic pain syndrome manifested by hyperalgesia and allodynia responds poorly to opioids. Hitherto, its development is still not clear and its treatment and prevention are still disputable. Pertussis toxin (PTX) which ADP-ribosylates the alpha-subunit of inhibitory guanine nucleotide binding regulatory proteins (Gi/Go), is used to induce morphine tolerance through intrathecal (i.t.) injection. ⋯ PTX-induced neuropathic pain syndrome is accompanied by increasing of EAAs, decreasing of IAA release, and a selective increasing of PKC gamma expression in the spinal cord. Inhibition of PKC not only blocked thermal hyperalgesia, but also reversed the reduction of morphine's analgesic effect in PTX-rats. These results suggest that PTX-induced neuropathic pain syndromes are involved in EAAs, IAAs and PKC alternations.
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Selective spinal nerve block is a useful tool in today's multidisciplinary approach to the diagnosis and treatment of low back pain. The indications, sources of spinal pain, block technique, result interpretation, complications and clinical applications relevant to the subject are discussed. ⋯ In some cases, therapeutic effect including that from surgical intervention can be achieved selectively at the symptomatic root. However, controversy remains and therefore well designed clinical studies are needed to provide more information about the validity of this diagnostic and therapeutic modality.
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Opioids relieve painful stimuli by interacting with the opioid receptor subtypes, mu, delta, and kappa, in brain regions and spinal cord. Tolerance reduces medication effectiveness and causes a right-hand shift in the dose-response curve. The mechanisms involved in the development of opioid tolerance remain not clear. ⋯ The NMDA receptors can also induce the synthesis of NO (nitric oxide) through the activation of NOS (NO synthase). NOS inhibitors were also shown to prevent the development of opioid tolerance, therefore, NO was suggested to play a role in opioid tolerance development. Although much evidence indicates the reasons of opioid tolerance, it is still worth further investigation to explore the mechanisms of multiplicity of opioid receptors and complexity of intracellular biochemical events.
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Acta Anaesthesiol. Sin. · Dec 1995
ReviewClinical applications of excitatory amino acid antagonists in pain management.
Pain is an important indicator of stress particularly after surgical operation. It is not only a physical and mental suffering but also a main factor for postoperative complications. Relieving of postoperative pain is perquisite for improving outcome and shortening hospital stay. ⋯ Therefore, methods to avoid the narcotic-associated side effects are still being searched. Excitatory amino acid receptor antagonists, particularly the NMDA receptor, have been demonstrated to produce satisfactory analgesic effect under certain conditions. This article is an introductory overview of some possible applications of the excitatory amino acid receptor antagonists in future clinical pain management.
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Acta Anaesthesiol. Sin. · Mar 1995
Review Case Reports[Arytenoid subluxation following endotracheal intubation--a case report].
A previously healthy 39-yr-old man was scheduled for exploratory laparotomy due to acute abdomen. There was no sign of difficult intubation. After induction of anesthesia with thiopental and succinylcholine, the trachea was easily intubated with a 7.0 mm cuffed endotracheal tube. ⋯ Abnormal mobility of vocal cord, edema over arytenoid area found by indirect laryngoscopy should suggest the complication. Further confirmation is then needed. Although the result of our case is good, the reduction should ideally be done within 24-48 h after the incidence to avoid unfavorable long-term sequelae.