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Postoperative cognitive dysfunction (POCD) is a common postoperative complication observed in patients following. Here we tested the molecular mechanisms of memory loss in hippocampus of rat POCD model. We found that high-dose propofol anesthesia significantly alleviated spatial memory loss. The proteomes and transcriptomes in hippocampus showed that hippocampal cytoskeleton related pathways were abnormal in low group while not in high group. The protein assays confirmed that hippocampal actin cytoskeleton was depolymerized in low group while maintained in high group. This study confirms that high-dose propofol anesthesia could mitigate the development of POCD and provides evidences for actin cytoskeleton associated with this syndrome.

Si-Yu Lin,1,2 Shi-Zhong Zhang,1 Jian-Xiong An,1,2 Xiao-Yan Qian,2 Xin-You Gao,2 Yong Wang,2 Wen-Xing Zhao,2 Derek Eastwood,3 Doris K Cope,4 John P Williams4 1China Three Gorges, University School of Medicine, Yichang, China; 2Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; 3Department of Pain Services, Wirral University Teaching Hospital, Wirral, Merseyside, UK; 4Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: This study was to evaluate the effectiveness of ultrasound-guided percutaneous ozone injections around the cervical dorsal root ganglions of zoster-associated pain (ZAP) patients.Study design: Retrospective comparative study.Settings: The study was conducted at a pain center of a university hospital.Patients and methods: From June 2016 to July 2017, a total number of 30 patients with ZAP were treated with ultrasound-guided percutaneous ozone injection around the cervical dorsal root ganglion (DRG) at the injured nerve level (C2-C8). A volume of 3 mL ozone-oxygen mixture at a concentration of 30 µg/mL was injected into the area around the DRG. Patients were divided into two groups according to their disease duration: group A (at or 3 months). The pain severity was assessed according to a visual analog scale, and imaging changes were evaluated by ultrasound. Patient improvements in pain and neurologic function were evaluated during a follow-up period from 1 to 3 months.Results: The data showed that ozone injections reduced pain in patients with ZAP. However, the success rate of group A was higher than group B. After the injection, the vonFrey data demonstrated decreases in both groups, but, there were no significant differences between the groups. Moreover, univariate logistic regression analysis and multivariate regression analysis showed a history of diabetes mellitus had a significant effect on the treatment results.Conclusions: Percutaneous ozone injection around the DRG might be a useful method for treatment-resistant cases of ZAP at the cervical level. Institutional Review Board (IRB) approval number: HK2017-1130. Keywords: herpes zoster, neuropathic pain, post-herpetic neuralgia, ozone injection

To establish a new animal model for the study of neuropathic pain developed by administration of cobra venom to the brachial plexus (BP) lower trunk.Fifty-eight adult male Sprague-Dawley rats were randomly divided into 5 groups. Under pentobarbital sodium anesthesia, cobra venom was injected into the lower trunk or sham operation was performed in the animals. On postoperative day 1 and day 12, pregabalin was administered intragastricly at 30 mg/kg in two groups. Mechanical withdrawal thresholds (MWT) were tested with von Frey filaments. Video recordings were used to analyze the spontaneous behaviors. Meanwhile, our model was confirmed by observing ultrastructural alterations of the BP and cervical cord (C8-T1) via electron microscope examination.In comparison to the blank and sham-operated group, cobra venom-treated rats showed a profound decrease in the MWT, exploratory and increase in grooming behaviors (P0.05). The changes were long-lasting (up to 60 days), in both ipsilateral and contralateral paws. Furthermore, it was observed under microscopic examination that the myelin sheath was demyelinated in the BP and cervical cord (C8-T1) after injection of cobra venom to the lower trunk. Pregabalin group rats showed changes in MWT and spontaneous behaviors after pregabalin treatment at postoperative day 1 (P0.05), compared with the control and sham-operated groups. In pregabalin test POD12 group, the decreased MWT and the increased grooming behavior were improved at 20 days after operation. However, pregabalin had no effect on exploratory activity. Results indicate that pregabalin effectively attenuates mechanical hyperalgesia in acute period.The cobra venom model can be used as a model to induce neuropathic pain and to enable study of the mechanism and treatment.

Background: Postoperative pain, sore throat, hoarseness, early facial paralysis and pyrexia are common complications after microvascular decompression (MVD) for facial spasm. Dexamethasone (Dex) is used extensively in the perioperative setting as it is a high-potency, long-acting glucocorticoid with little mineralocorticoid effects. It may improve analgesia and decrease opioid consumption, significantly decrease the incidence and severity of sore throat and hoarseness after general anesthesia, and antagonize the inflammatory reaction in the postoperative period. We designed this study to determine the effects of Dex on these complications.Methods: A total of 1020 adult patients with hemifacial spasm who were scheduled to receive MVD, were randomly divided into three groups: Dex-0 (N=340), Dex-1 (N=340) and Dex-2 (N=340), respectively, and were administered normal sodium, Dex 0.1 mg/kg or 0.2 mg/kg before induction of anesthesia. Incision pain, sore throat and hoarseness, early facial paralysis, and pyrexia were evaluated. Postoperative incision pain was recorded during the first and second day after surgery; sore throat and hoarseness, early facial paralysis, and pyrexia were recorded from the day after surgery and until the end of the fifth day after surgery.Results: One thousand and fifteen patients completed this clinical trail. Within the 3 groups: Dex-0 group (N=337), Dex-1 group (N=339) and Dex-2 group (N=339), we found no significant differences concerning postoperative incision pain, sore throat, hoarse, early facial paralysis and the intensity of pyrexia (P>0.05).Conclusions: Administration of Dex (0.1 mg/kg or 0.2 mg/kg) before anesthesia induction did not limit adverse outcomes after MVD. Citation: Qi-Wu Fang, Xiao-Yan Qian, Jian-Xiong An, Hui Wen, Jian-Ping Wu, Doris K. Cope, et al. Pre-induction dexamethasone does not decrease complications after microvascular decompression for facial spasm. J Anesth Perioper Med 2015; 2: 192-6. doi: 10.24015/JAPM.2015.0026This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Ruo-Wen Chen,1,2 Hui Liu,2 Jian-Xiong An,1,2 Xiao-Yan Qian,2 Yi-De Jiang,2 Doris K Cope,3 John P Williams,3 Rui Zhang,1 Li-Na Sun1 1Department of Anesthesiology, Weifang Medical University, Weifang City, Shandong, 2Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The objective of this study was to investigate the effects of electro-acupuncture (EA) and pregabalin on cognition impairment induced by chronic trigeminal neuralgia (TN) in rats. Design: Controlled animal study. Setting: Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University. Subjects: Forty adult male Sprague Dawley rats. Methods: Rats were randomly divided into four groups. The TN model was induced by administration of cobra venom to the left infraorbital nerve. On postoperative day 14, either EA or pregabalin was administered, free behavioral activities were observed. Spatial learning and memory abilities were determined in the Morris water maze. The ultrastructural alterations of the Gasserian ganglion, medulla oblongata and hippocampus were examined by electron microscopy. The changes on long-term potentiation were investigated. Results: After treatment, the exploratory behavior increased and the grooming behavior decreased (P0.05). Vacuolar degeneration in the hippocampal neurons was mild in the EA group, while it was severe in the pregabalin group.Conclusion: EA and pregabalin could alleviate TN induced by cobra venom. EA could also inhibit the cognition deficit induced by TN, while pregabalin could not. Keywords: TN, cognition dysfunction, EA, pregabalin, LTP&nbsp

To investigate the effects of intravenous administration of dexamethasone on early postoperative cognitive dysfunction (POCD).In this prospective randomized trial, 1000 patients with facial spasm undergoing microvascular decompression (MVD) were randomly assigned to receive normal sodium (Dex-0 group, n=333), dexamethasone 0.1 mg/kg (Dex-1 group, n=333), or dexamethasone 0.2 mg/kg (Dex-2 group, n=334). Exclusion criteria included: a history of neurologic or mental disease, renal failure, active liver disease, cardiac or pulmonary dysfunction, endocrine, metabolic, or peptic ulcer disease, a history of past surgery,6 years of schooling, inability to complete neuropsychological testing, visual dysfunction, and auditory dysfunction. Patients were also excluded at any point if additional steroid was required. Propofol and sufentanil were administered for anesthetic induction, whereas propofol and remifentanil were given for maintenance of anesthesia. A battery of 9 neuropsychological tests was administered preoperatively and the on day 5 postoperatively. A postoperative deficit was defined as a postoperative decrement to preoperative score of1SD on any test. Patients who experienced2 deficits were considered to have experienced early POCD.Nine hundred and fifty-four patients completed both preoperative and postoperative neuropsychological testing. Within the 3 groups: Dex-0 group, n=319; Dex-1 group, n=320 and Dex-2, n=315. POCD occurred in 71 patients (22.3%) in the Dex-0 group, in 66 patients (20.6%) in the Dex-1 group, and 99 patients (31.4%) in the Dex-2 group. POCD was significant among the 3 groups (P=0.003). Partitions of χ method was applied for multiple comparisons showing that Dex-2 group was significantly different from Dex-1 and Dex-0 groups.Administration of higher dose of dexamethasone (0.2 mg/kg) increases the incidence of POCD in the early postoperative period after microvascular decompression under general anesthesia.

Background: A few studies on the depth from the skin to the cervical epidural space (DSES) have been reported from the United States, South Korea, Japan, and Taiwan. There are no published reports from mainland China. Objectives: The goal of this study was to collect standard data on Chinese adults from mainland China in a large medical center with a wide geographical range of patients. Study Design: A prospective study. Setting: Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Aviation General Hospital of China Medical University. Methods: The survey included 410 patients. Measurements were made of DSES, the dural sac, and the spinal cord by automatic measuring ruler on transverse and sagittal images of the cervical spine at the C5-6, C6-7, C7-T1, T1-2, and T2-3 intervertebral space obtained by magnetic resonance imaging (MRI). We also obtained the width of the epidural space by measuring the distance from the (LF) to the dural sac. Results: DSES at C5-6, C6-7, C7-T1, T1-2, and T2-3, respectively, was 4.69 ± 0.84 cm, 5.14 ± 0.98 cm, 5.56 ± 1.03 cm, 5.81 ± 0.94 cm, and 5.76 ± 0.86 cm on T2W (weighted) MRIs obtained in the sagittal plane (mean ± SD). The distance at C5-6, C6-7, and C7-T1 in transverse images was 4.67 ± 0.86 cm, 5.18 ± 1.02 cm, and 5.55 ± 0.97 cm, respectively. All measured distances from the skin to the epidural space were significantly greater in men than in women. Multivariate regression analysis revealed significant partial correlation between DSES and (BMI). Limitation: Limitations include the absence of healthy individuals as well as the influence of the difference in neck positioning during the MRI examination vs. active epidural puncture. Conclusion: DSES varied with the cervical intervertebral level in those patients studied from the population of mainland China. The greatest DSES was noted at C7-T1 in men and T1-2 in women, and the least was at C5-6 in both men and women. DSES had a significant relationship with neck circumference and BMI in both genders. We suggest that the DSES be measured with MRI before performing epidural puncture. The lower cervical and upper thoracic intervertebral spaces appear to provide a greater margin of safety for epidural puncture. Key words: Cervical epidural space, magnetic resonance imaging

Electroacupuncture (EA) is widely applied to treat neuropathic pain. Brachial plexus neuralgia (BPN) is a common form of chronic persistent pain. Few studies have evaluated the analgesic effects and mechanism of EA using the novel animal model of BPN.To observe the curative effects of repeated EA on curing BPN induced by administration of cobra venom to the lower trunk of the right brachial plexus.Controlled animal study.Department of Anesthesiology, Pain MedicineCritical Care Medicine, Aviation General Hospital of China Medical University.Sixty-six adult male Sprague-Dawley rats were equally and randomly divided into the following groups: normal control (NC), brachial plexus neuralgia (BPN), BPN with sham EA stimulation, BPN with EA stimulation starting on postoperative day 1 (EA1), and BPN with EA stimulation starting on postoperative day 12 (EA12). The BPN model was established by administration of cobra venom to the lower trunk of the right brachial plexus. On postoperative day 1 or day 12, EA (constant aquare wave, 2 Hz and 100 Hz alternating frequencies, intensities ranging from 1 - 1.5 - 2 mA) was applied to the right "Shousanli" (LI10) and "Quchi" (LI11) acupoints for 30 minutes, once every other day for 12 times in both groups. Mechanical withdrawal thresholds (MWT) were tested with von Frey filaments. Video recordings were conducted to analyze the spontaneous exploratory behaviors. Moreover, the organizational and structural alterations of the right brachial plexus and cervical cord (C8-T1) were examined via light and electron microscopy.Following the production of the BPN model, the MWT of both ipsilateral and contralateral paws demonstrated a profound decrease (P0.05). But after EA interventions, the MWT showed a significant increase (P0.05). In comparison to the EA12 group, the analgesic effects of the EA1 group were more significant, and similar results were observed in exploratory behaviors. However, grooming behaviors did not demonstrate significant differences. Meanwhile, on day 12 after surgery it was observed under light microscopy that the inflammatory response in the right brachial plexus and cervical cord (C8-T1) were significantly attenuated after EA stimulation. Furthermore, the demyelination of the brachial plexus and cervical cord (C8-T1) were also reversed.Limitations include the fact that there was demyelination of the cervical cord (C8-T1) in the control group because of inappropriate manipulation.Repeated EA contributes significant analgesic effects in the treatment of BPN.

Cancer pain is a distressing result of disease, both primary and metastatic, as well as complications caused by cancer treatment. Medication management often is insufficient to adequately treat the ensuing pain or the complications of medical management limit acceptable dosage for pain control. In these instances, interventional modalities are an additional tool in the pain physician's armamentarium. Most commonly employed are intrathecal opioids, local anesthetic and clonidine infusions, neurolytic-nerve and sympathetic-ganglion blockade, and radiofrequency techniques. These are discussed in this article concomitantly with current outcome data as reported in the medical literature.

A few studies on the depth from the skin to the cervical epidural space (DSES) have been reported from the United States, South Korea, Japan, and Taiwan. There are no published reports from mainland China.The goal of this study was to collect standard data on Chinese adults from mainland China in a large medical center with a wide geographical range of patients.A prospective study.Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Aviation General Hospital of China Medical University.The survey included 410 patients. Measurements were made of DSES, the dural sac, and the spinal cord by automatic measuring ruler on transverse and sagittal images of the cervical spine at the C5-6, C6-7, C7-T1, T1-2, and T2-3 intervertebral space obtained by magnetic resonance imaging (MRI). We also obtained the width of the epidural space by measuring the distance from the (LF) to the dural sac.DSES at C5-6, C6-7, C7-T1, T1-2, and T2-3, respectively, was 4.69 ± 0.84 cm, 5.14 ± 0.98 cm, 5.56 ± 1.03 cm, 5.81 ± 0.94 cm, and 5.76 ± 0.86 cm on T2W (weighted) MRIs obtained in the sagittal plane (mean ± SD). The distance at C5-6, C6-7, and C7-T1 in transverse images was 4.67 ± 0.86 cm, 5.18 ± 1.02 cm, and 5.55 ± 0.97 cm, respectively. All measured distances from the skin to the epidural space were significantly greater in men than in women. Multivariate regression analysis revealed significant partial correlation between DSES and (BMI).Limitations include the absence of healthy individuals as well as the influence of the difference in neck positioning during the MRI examination vs. active epidural puncture.DSES varied with the cervical intervertebral level in those patients studied from the population of mainland China. The greatest DSES was noted at C7-T1 in men and T1-2 in women, and the least was at C5-6 in both men and women. DSES had a significant relationship with neck circumference and BMI in both genders. We suggest that the DSES be measured with MRI before performing epidural puncture. The lower cervical and upper thoracic intervertebral spaces appear to provide a greater margin of safety for epidural puncture.

In treating superior laryngeal neuralgia (SLN), superior laryngeal nerve blocks (SLNBs) can provide immediate relief of persistent pain. Although SLNB was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. To avoid complications such as advertent intravascular injection, local anesthetic toxicity from intravascular absorption, and intratracheal injection, we successfully blocked the superior laryngeal nerve under ultrasound guidance in three patients suffering from SLN. The written informed consent before treatment was obtained for each patient participating in this study. A 58-year-old male was admitted to our hospital; he had a complaint of a fish bone that had stuck to his throat 6 months ago, and the bone was immediately removed (case 1). Subsequently, he experienced paroxysmal burning and stabbing pain in his left throat. Pain was associated with deep inspiration and coughing. Tenderness over the left thyrohyoid membrane was elicited by light pressure. Neurological examination was negative. The left SLNBs under ultrasound guidance using 3 ml of 2% lidocaine were done for four times, which was completed for every 2 days. The patient experienced no pain when we followed up 6 months following the procedures. A 70-year-old female who developed left-side SLN for 2 years was admitted to our hospital (case 2). She had had a cough for a week just before the onset of the neuralgia. She experienced paroxysmal stabbing pain in the left side of the throat, triggered by swallowing and aspiration. There was tenderness to pressure over the left thyrohyoid membrane. Neurological examination was negative, and 10 trials of SLNB were done. Although the paroxysms occurred once a year for a few months after the last block therapy, she was able to deal with the pain with carbamazepine alone. A 57-year-old male with complaints of right-side throat pain for the previous 5 months was admitted to our hospital (case 3). He had a history of severe smoking for about 20 years. The paroxysmal stabbing pain occurred almost every day. Neurological examination was negative. After 10 trials of SLNB, pain was alleviated. He remained asymptomatic for about 1 year after the last SLNB. A portable ultrasound machine, Venue 50, (GE Healthcare, Chalfont St. Giles, UK) was brought to the operating room, with the patient lying in the supine position with head turned away from the affected side and a pillow placed under the patient's neck. After preparation of the skin with antiseptic solution, ultrasound examination is performed using a high-resolution linear array transducer. The transducer is applied transversely to the middle aspect of the neck to obtain a short axis view of the thyrohyoid membrane. One can easily identify the thyroid cartilage and the common carotid artery. The superior laryngeal nerve is usually found medial to the artery between the hyoid bone and thyroid cartilage, and a block needle is inserted in the plane of the ultrasound beam in a medial to lateral orientation. It is often easy to visualize the needle. The needle was inserted with 35° to the skin and the depth was approximately 2 cm. When the needle located medial to the common carotid artery, with no blood or air of the aspirated, the test dose of 2 ml of 2% lidocaine was injected [Figure 1]. The procedure is completed for every 2 days until the pain disappeared. Figure 1 Transverse sonographic view of the patient's neck at the level of the thyrohyoid membrane. An in-plane method was used to block the superior laryngeal nerve. Arrow indicates the entry of the needle from the 10 o’clock direction. Triangle indicates ... The superior laryngeal nerve arises from the vagus nerve. It runs inferiorly and anteriorly behind the carotid artery to pass the lateral extent of the hyoid bone.[1] It divides into internal and external branches. The internal branch passes immediately inferior to the greater horn of the hyoid bone and approaches the thyrohyoid membrane accompanied by the superior laryngeal artery, a branch of the superior thyroid artery. The superior laryngeal nerve is so located that any regional inflammation or further local trauma,[2] aggravated by normal laryngeal movements, can produce localized neuritis at the thyrohyoid membrane and cause the throat pain. Aydin et al.[3] described a case of SLN after acute laryngitis and treatment with a single injection of a local anesthetic. The patient received a single nerve block near the right hypothyroid membrane and the symptoms decreased dramatically in a few minutes. He had no pain for 1 year following the procedure. Neuropathic pain is derived from abnormal afferent inputs caused by axonal damage, myelin disruption, and inflammatory processes. Local anesthetics can interrupt or alleviate pain and have been shown to suppress ectopic neural discharges from nerve fibers. It was posited that SLNB may be useful in the diagnosis and treatment of SLN.[4] Ultrasound has been used to image the human body for over half a century. The images can be acquired in “real time,” thus providing instantaneous visual guidance for many interventional procedures including those for regional anesthesia and pain management.[5] In these three cases, the use of ultrasound made it possible to perform SLNB in patients suffering from SLN. All of the three patients recovered from SLB without any complications. These cases illustrate a potential clinical application for ultrasound assistance in pain management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Pain, an experience that is both sensory and emotional, profoundly affects an individual’s physiological and psychological being. It should be managed in the context of the whole person. Interventional pain management is best practiced as an aspect of a multidisciplinary approach for pain relief. This chapter will provide an overview of the common peripheral nerve, neuraxial and sympathetic blocks, trigger point injection, and intrathecal therapy for chronic pain from diseases across the life course. Discussions will also provide sufficient details on how the procedures are performed, their efficacy and complications.

BACKGROUND Understanding the mechanism of trigeminal neuralgia may be elucidated by developing laboratory animal models that closely mimic the features of this specific type of neuropathic pain. We have developed an experimental animal model for trigeminal neuralgia using a technique of injecting cobra venom into the infraorbital nerve (ION) trunk. METHODS Male Sprague-Dawley rats were subjected to the administration of cobra venom or saline into the ION trunk. Mechanical stimuli were applied to the ION territory in consecutive days after surgery. Mechanical thresholds were measured over a 90-day period on the bilateral facial region. Vascular permeability in the ION territory was measured using Evans blue dye. RESULTS The cobra venom-treated rats developed mechanical allodynia 3 days after surgery that lasted for 60 days postoperatively at the ipsilateral side. The mechanical thresholds of the contralateral ION territory also showed a profound decrease but were sustained for only approximately 30 days. There was no change of mechanical thresholds in the control groups. The extravasation of Evans blue increased significantly in the skin after administration of cobra venom to the ION compared with control rats (P < 0.05). CONCLUSION The cobra venom model may provide a reasonable model for investigating the mechanism of trigeminal neuropathic pain.

The importance of recognizing, assessing, understanding, and treating pain is central to the role of any caregiver. When a patient presents to the physician, he rarely comes labeled with a given diagnosis; rather, he more often has a chief “complaint” that he suffers in some manner. To the patient, the symptom, not the pathology or disease, is the affliction. As such, it is imperative that we respect and understand that pain and suffering are the often primary reasons that patients seek medical care for.

Gene therapy shows great potential to assist numerous patients with inadequate relief of inflammatory or neuropathic pain, or intractable pain associated with advanced cancer. A brief overview is provided of the methods of gene therapy and of preclinical findings in animal models of prolonged inflammatory, neuropathic and cancer pain. Preclinical findings demonstrate no efficacy of gene therapy on basal thermal nociception and mechanical sensitivity, and almost universal effects on pathological nociception and hypersensitivity models. The status of human trials is provided with recommendations for future directions and precautions. This early stage of development of gene therapy for chronic pain will likely be followed by an increased number of human clinical trials aimed specifically at the relief of chronic, unrelenting pain.

Steroid therapy is frequently used for chronic pain, particularly inflammatory pain states. Steroid withdrawal syndrome can produce a broad array of signs and symptoms, some of which are not well recognized. High fever is among these. We describe several cases with this clinical scenario and review the syndrome in broader terms.

The Wood Library-Museum is presently in the process of soliciting nominations for the individual to be appointed as the WLM Laureate of the History of Anesthesia in the year 2008. The Laureate Program is evidenced by the selection of Dr. Gwenifer Wilson of Sydney, Australia, as the first Laureate in 1996; Drs. Norman Bergman and Thomas Boulton as Co-Laureates in 2000; and Dr. Donald Caton in 2004. As an international program, your readers would certainly like to be aware of the program and the fact that we are actively seeking and welcoming any and all nominations.

Background The influence of anesthetic agents on the infarction process in the ischemic myocardium is unclear. This study evaluated the effects of three intravenous and three inhalational anesthetic agents on myocardial infarction within a quantified ischemic risk zone in rabbit hearts subjected to a standardized regional ischemia-reperfusion insult. Methods Both in vitro and in situ rabbit models were used to investigate the effects of anesthetic agents on infarct size. In all rabbits the heart was exposed and a coronary artery surrounded with a suture to form a snare for subsequent occlusion. In in situ preparations, both intravenous and inhalational agents were tested, whereas only the latter were used in isolated hearts. Infarct size was determined by triphenyltetrazolium chloride staining. To determine whether an adenosine-mediated protective mechanism was involved, 8-(p-sulfophenyl)theophylline, an adenosine receptor blocker, was added to halothane-treated isolated hearts. Adenosine concentration in the coronary effluent was also measured in isolated hearts exposed to halothane. In other protocols, chelerythrine, a highly selective protein kinase C inhibitor, was administered to both halothane-treated and untreated isolated hearts. Results Infarcts in the three in situ groups anesthetized with halothane, enflurane, and isoflurane were about one half as large as infarcts in rabbits that underwent anesthesia with pentobarbital, ketamine-xylazine, or propofol. Volatile anesthetics also protected isolated hearts by a similar amount. Both adenosine receptor blockade and chelerythrine abolished cardioprotection from halothane in isolated hearts. Halothane treatment did not increase adenosine release. Conclusions The volatile anesthetics tested protected the ischemic rabbit heart from infarction, in contrast to the three intravenous agents tested. Protection was independent of the hypotensive effect of the inhalational agents because halothane also protected isolated hearts, in which changing vascular tone is not an issue and coronary perfusion pressure is constant. Cardioprotection by volatile anesthetics depended on both adenosine receptors and protein kinase C, and thus is similar to the mechanism of protection seen with ischemic preconditioning.

Objective: Preconditioning the heart with 5 min of ischaemia followed by reperfusion renders the myocardium resistant to infarction from subsequent ischaemia. This protection lasts for about 1 h. The aim of this study was to test whether the protection could be reinstated with a second episode of preconditioning after protection from an initial episode had worn off. Methods: To induce infarction animals experienced 30 min of coronary artery occlusion and then 3 h reperfusion. Ischaemic preconditioning was accomplished with 5 min of coronary branch occlusion. In one group of rabbits the subsequent reperfusion period was prolonged to 2 h to permit protection to wear off before the 30 min coronary occlusion was initiated. In another group a second 5 min coronary occlusion was performed at the end of the 2 h reperfusion. After 10 min of reperfusion the 30 min ischaemic period began. Control animals experienced only the 30 min ischaemia and 3 h reperfusion. Infarct volume was measured with tetrazolium and expressed as a percentage of the ischaemic zone volume. Results: Average infarct size in seven control rabbits [36.0(SEM 2.0)% of the ischaemic zone] was not significantly different from that in eight rabbits with the prolonged coronary occlusion occurring 2 h after the preconditioning stimulus [28.6(2.9)% infarction]. In contrast infarcts were significantly smaller in the re-preconditioned group of seven rabbits [8.3(4.2)%] and comparable to those previously seen with a single preconditioning stimulus followed 10 min later by the 30 min occlusion [6.1(1.8)%]. Conclusions: The rabbit heart can be protected with a second preconditioning stimulus after protection from an initial period of preconditioning has subsided. Cardiovascular Research 1993; 27 :556-558

“By whom pain in surgery was arrested and annulled, before whom, in all time, surgery was agony, since whom science has control of pain” This sculpture, with the above inscription, has been erected in a semi-circle of ten prominent people important to the welfare of man. It is the tenth in the group of ten that is prominently displayed at the Beijing International Sculpture Park, one of the important new parks established in Beijing, China in preparation for the Summer Olympic Games, 2008. As a Visiting Professor at Tsinghua University on August 31, 2007, Doris K. Cope, M.D. gave a lecture on the historical roots of Anesthesiology as a medical specialty and afterwards the residents, fellows, faculty and guests adjourned to this park across from the hospital to pay our respects to W. T. Morton. This enthusiastic group of more than 50 anesthesia students, residents, fellows, faculty members and private practitioners gathered around the Morton Statue taking pictures and sharing memories of their personal journeys in the specialty of Anesthesiology. W.T. Morton as interpreted by the sculptor

The Anesthesia History Association (AHA) strongly encourages academic study in the history of anesthesiology, pain medicine and critical care by presenting a yearly award to residents and fellows in training through an essay competition. This award, in recognition of the life time achievements of C. Ronald Stephen through leadership roles in the AHA, Wood Library-Museum, the Bulletin of Anesthesia History has exhibiting constant, kind and gentle mentoring, will be named in his honor. The support of each successive generation of medical historians is among the most important of the missions of the Anesthesia History Association. Family and friends are creating an endowment for this award to become perpetual. The total endowment goal is $15,000 which will directly provide the prize money for the competitors. Other administrative overhead costs are absorbed by the AHA. To date, we have received $4,875. Gifts will be tax exempt upon completion of the renewal process for AHA nonprofit tax status which is anticipated in the next 90 days. Any gifts will be held until that status is completed so donors can receive appropriate tax credits. Please send your designated gift towards this endowment to the Anesthesia History Association, 200 Delafield Road, Suite 2070, Pittsburgh, PA 15215. The relatively small investment in our trainees now will pay huge rewards in the future! C. Ronald Stephen Festive 90th Birthday Gala