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Anxiety can affect acute and chronic postoperative pain after breast surgery. Nociceptive response during surgery might also be affected by preoperative anxiety even under unconscious state during general anesthesia. The aim of this retrospective study was to investigate nociceptive responses during breast surgery under general anesthesia in patients with or without preoperative anxiety. Patients (n = 45) were divided into a low-anxiety group (n = 25) and a high-anxiety group (n = 20) in accordance with preoperative scores for the State Trait Anxiety Inventory. We performed discriminant analysis to compare nociception during surgery using three intraoperative averaged values: heart rate; systolic blood pressure; and perfusion index. No significant differences in discriminant score were seen between groups (p = 0.10). Although we performed propensity score-matching to reduce the bias due to confounding variables in this retrospective study, there was also no significant difference in levels of nociceptive response between groups (p = 0.06). In conclusion, the level of nociception during breast surgery is not significantly affected by preoperative anxiety., Author(s): Kazuma Hashimoto[sup.1] , Sachiko Iwayama[sup.1] , Yuka Sano[sup.1] , Tsuneo Tatara[sup.1] , Munetaka Hirose[sup.1] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, [...]

Purpose One of the most exhausting complications of spinal anesthesia, especially in parturients, is post-dural puncture headache (PDPH). This headache is not responsive to the usual pain killers. Ondansetron is a 5-HT.sub.3 receptor antagonist which is generally used for the prophylactic management of nausea and vomiting; however, studies have found that ondansetron might decrease the incidence of PDPH. Therefore, we aimed to evalute the effect of ondansetron on decreasing the incidence of PDPH. Methods In this double-blind randomized placebo-controlled clinical trial, 210 parturients who underwent elective cesarean section under spinal anesthesia were randomly allocated to two groups. The intervention group received 0.15 mg/kg ondansetron, while the control group received 5 ml normal saline. Heart rate and mean arterial pressure (MAP) were recorded during surgery. Furthermore, postoperative nausea and vomiting (PONV) and PDPH in the two groups were noted by an anesthetic nurse for 3 days and compared. Results The incidence of PDPH in the intervention group was significantly lower than in the control group (P = 0.001). The incidence of PONV was also significantly lower in the intervention group compared to the control group (P < 0.05). However, MAP was significantly higher in the intervention group compared to the control group (P < 0.05). No significant difference was found between the two groups regarding heart rate (P > 0.05). Conclusion Ondansetron (0.15 mg/kg) appeared to reduce the incidence of PDPH, as well as the incidence of hypotension and PONV, in parturients undergoing spinal anesthesia for cesarean section., Author(s): Zainabosadat Fattahi[sup.1] , Seyed Mohammad Reza Hadavi[sup.1] , Mohammad Ali Sahmeddini[sup.1] Author Affiliations: (1) Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Introduction [...]

Purpose To determine whether continuous administration of nitrous oxide and remifentanil-either alone or together-alters blood flow in oral tissues during sevoflurane anesthesia. Methods Eight male tracheotomized Japanese white rabbits were anesthetized with sevoflurane under mechanical ventilation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), common carotid arterial blood flow (CCBF), tongue mucosal blood flow (TMBF), mandibular bone marrow blood flow (BBF), masseter muscle blood flow (MBF), upper alveolar tissue blood flow (UBF), and lower alveolar tissue blood flow (LBF) were recorded in the absence of all test agents and after administration of the test agents (50 % nitrous oxide, 0.4 [mu]g/kg/min remifentanil, and their combination) for 20 min. Results Nitrous oxide increased SBP, DBP, MAP, CCBF, BBF, MBF, UBF, and LBF relative to baseline values but did not affect HR or TMBF. Remifentanil decreased all hemodynamic variables except DBP. Combined administration of nitrous oxide and remifentanil recovered SBP, DBP, MAP, and CCBF to baseline levels, but HR and oral tissue blood flow remained lower than control values. Conclusions Our findings suggest that concomitant administration of nitrous oxide and remifentanil reduces blood flow in oral tissues without decreasing blood pressure during sevoflurane anesthesia in rabbits., Author(s): Masataka Kasahara[sup.1] , Tatsuya Ichinohe[sup.2] , Sota Okamoto[sup.2] , Reina Okada[sup.2] , Hiroaki Kanbe[sup.2] , Nobuyuki Matsuura[sup.2] Author Affiliations: (1) Department of Pharmacology, Tokyo Dental College, Misaki-cho 2-1-14, Chiyoda-ku, [...]

Purpose Subarachnoid hemorrhage is an acute neurological emergency requiring urgent confirmation of the diagnosis for planning definitive management. Due to altered consciousness, most patients require sedation for conducting this procedure smoothly. Currently, it is unclear if any one particular sedative drug has a favorable profile in patients undergoing cerebral angiography. The aim of this study was to compare the traditionally used sedative drug propofol with a newer alternative, dexmedetomidine, in patients with subarachnoid hemorrhage undergoing cerebral angiography. Methods Sixty adult patients with good grade subarachnoid hemorrhage undergoing diagnostic cerebral angiography were prospectively randomized to receive either propofol (n = 30) or dexmedetomidine (n = 30) following ethics committee approval and informed consent. Results Compared to dexmadetomidine, propofol was associated with an earlier time for onset of sedation (2.3 ± 1.9 min vs. 15.4 ± 5.7 min; P < 0.001), but with an increased number of adverse respiratory events (11/30 vs 1/30; P = 0.003) and movement during the procedure (5/30 vs. 0/30; P = 0.05), necessitating additional supplementation of sedation (13/30 vs. 7/30; P = 0.17) and repetition of the imaging sequences. The total procedure time and time for recovery were similar for the propofol and dexmedetomidine groups, while the heart rate was lower in patients in the dexmedetomidine group. Conclusion Dexmedetomidine appears to be superior to propofol as a sole sedative agent for sedation during cerebral angiography in patients with subarachnoid hemorrhage., Author(s): Kamath Sriganesh[sup.1] , Madhusudan Reddy[sup.1] , Sritam Jena[sup.1] , Mohit Mittal[sup.1] , G. S. Umamaheswara Rao[sup.1] Author Affiliations: (1) Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences [...]

Purpose Rho-kinase inhibitor is widely used for prevention of cerebral vascular spasm. However, the cerebral pial vascular action of Rho-kinase inhibitor has not been investigated. We therefore evaluated the direct effects of Y-27632, a Rho-kinase inhibitor, on pial microvessels. Method Experiments were performed on anesthetized rabbits. A closed cranial window was used to visualize the pial microcirculation. After baseline hemodynamic and pial vascular measurements, the cranial window was superfused with four increasing concentrations of Y-27632 (10.sup.-9, 10.sup.-7, 10.sup.-6, 10.sup.-5 mol l.sup.-1; n = 7) dissolved in artificial cerebrospinal fluid for 7 min each. We measured the diameters of pial vessels, mean arterial pressure (MAP), heart rate (HR), and rectal temperature at 7 min after application of each Y-27632 concentration. Results MAP, HR, rectal temperature, arterial pH, PaCO.sub.2, PaO.sub.2, and plasma Na.sup.+, K.sup.+ and glucose concentrations did not change significantly during the experimental period. Y-27632 at 10.sup.-9 to 10.sup.-7 mol l.sup.-1 did not produce any significant change in pial arterioles. Topical application of Y-27632 at 10.sup.-6 and 10.sup.-5 mol l.sup.-1 produced pial large (8.4 ± 5.7 and 19.8 ± 12.7 %) and small (10.1 ± 8.5 and 18.1 ± 12.3 %) arterioles dilation. However, Y-27632 did not produce any change in pial large and small venules. Conclusion We evaluated the direct effects of Y-27632 on pial microvessels. Y-27632 dilates only pial arterioles in a concentration-dependent manner, and most at a concentration of 10.sup.-5 mol l.sup.-1. Y-27632 is a potent cerebral pial arteriolar dilator but is not a venular dilator., Author(s): Masakazu Kotoda[sup.1] , Tadahiko Ishiyama[sup.2] , Noriyuki Shintani[sup.2] , Takashi Matsukawa[sup.1] Author Affiliations: (1) Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan [...]

Purpose Percutaneous tunneling (hydrodissection) in the neck and anterior chest in patients undergoing robotic thyroidectomy leads to significant hemodynamic responses such as increases in blood pressure and heart rate. We evaluated whether a single preoperative dexmedetomidine injection attenuated hemodynamic responses to hydrodissection by reducing the half-maximal effective concentration (EC50) of remifentanil needed to maintain hemodynamic stability during hydrodissection. Methods Forty-one patients undergoing robot-assisted endoscopic thyroidectomy were randomly allocated to one of the two groups-group D (n = 22) and group C (n = 19) patients received dexmedetomidine 1 [micro]g/kg and normal saline for 10 min before anesthetic induction, respectively. The EC50 of remifentanil for hemodynamic stability during hydrodissection was determined using Dixon's up-and-down method with initial dose (4 and 5 ng/mL in groups D and C, respectively). The concentration of remifentanil for consecutive patients in each group was determined by the response of the previous patient, using increments or decrements of 0.5 ng/mL. Hemodynamic stability during hydrodissection was defined as increased systolic blood pressure Results The EC50 of remifentanil for maintaining hemodynamic stability during hydrodissection was 0.8 ng/mL in group D and 7.3 ng/mL in group C (p = 0.002). Conclusions A single preoperative dexmedetomidine injection attenuated hydrodissection-induced hemodynamic responses in patients undergoing robotic thyroidectomy., Author(s): Mae-Hwa Kang[sup.1] , Ho-Jin Lee[sup.2] , Young-Jin Lim[sup.2] , Young-Tae Jeon[sup.3] , Jung-Won Hwang[sup.3] , Hee-Pyoung Park[sup.2] Author Affiliations: (1) Department of Anesthesiology and Pain Medicine, Hallym University Medical [...]

Purpose To evaluate the effect of sevoflurane or ketamine on the corrected QT (QTc) interval and the interval from the peak to the end of the T wave (Tp-e) during electroconvulsive therapy (ECT) in patients with major depression. Methods This prospective, randomized, double-blinded study included 24 patients that were randomly allocated to receive sevoflurane (group S) or ketamine (group K) for ECT session. Group S patients received 8 % sevoflurane for anesthesia induction, which was maintained at 2-4 % until delivery of the electrical stimulus. Group K patients received a bolus of ketamine (1 mg/kg). The mean arterial pressure (MAP) and heart rate (HR) and the electrocardiogram (ECG) were recorded before (T1) and after induction of anesthesia (T2) and 0, 1, 3, and 10 min after the electrical stimuli ended (T3, T4, T5, and T6, respectively). Results In both groups, the QTc interval was significantly longer at T2, T4, T5, and T6 than at baseline. The QTc interval was longer at T4, T5, and T6 in group S compared to that in group K, the Tp-e interval was significantly longer at T4 in group K both baseline and group S. The HR in group S was increased at T4 compared with group K. MAP was significantly higher after induction of anesthesia in group K compared to those in group S at all time points. Conclusions Although group S showed a prolonged QTc interval after ECT compared to group K, the Tp-e interval in both groups was not significantly affected clinically. Sevoflurane blunted MAP and peak HR., Author(s): Feray Erdil[sup.1] , Zekine Begeç[sup.1] , Gülay Erdogan Kayhan[sup.1] , Saim Yologlu[sup.2] , Mehmet Özcan Ersoy[sup.1] , Mahmut Durmus[sup.1] Author Affiliations: (1) Department of Anaesthesiology and Reanimation, Medical Faculty, [...]