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Introduction: Hyperalgesia frequently occurs after surgery and is associated with adverse effects on surgical outcomes. Thus, we aimed to examine whether the hypothalamus-pituitary-adrenal (HPA) axis function after surgery is involved in the development of postoperative hyperalgesia. Methods: Surgery- and pain-related variables were measured 24 and 48 h after the first and second total knee arthroplasties (TKAs) in postmenopausal patients undergoing 1-week-interval staged bilateral TKA. Two sets of saliva samples were consecutively collected from patients before (pre-T1) and 1 week after (post-T1) the first TKA (n = 69). HPA axis function was analyzed in a subgroup of 20 patients with a typical cortisol awakening response (CAR) in both the sets of saliva samples. Results: Surgery-related variables were comparable between the first and second TKAs. However, pain-related variables (pain ratings and the amount of opioid analgesics consumed) were greater after the second than the first TKA. Cortisol and dehydroepiandrosterone (DHEA) secretion during the post-awakening period (CARauc and Daucawk, respectively) was higher at post-T1 than at pre-T1, but the molar CARauc/Daucawk ratio was comparable between the time points examined. No relationship was observed between the pre-T1 CARauc and pain ratings after the first TKA. However, post-T1 CARauc showed a positive correlation with pain ratings after the second TKA. Postoperative pain ratings were negatively correlated with Daucawk and positively correlated with the molar CARauc/Daucawk ratio at all examined time points. Discussion/Conclusion: The results suggest that adrenocortical steroidogenic activity favoring the production of cortisol over DHEA after surgery may contribute to the development of hyperalgesia during the early postoperative period. [ABSTRACT FROM AUTHOR]

Prolonged tourniquet inflation during total knee arthroplasty (TKR) could lead to ischemic muscle injury. The aim of this study was to investigate the effects of spinal and sevoflurane anesthesia on arterial lactate levels, acid-base status, and on hemodynamic variables in elderly women undergoing TKR. Forty women more than 65 years of age scheduled for elective TKR were enrolled in this study. Patients were allocated to receiving either sevoflurane anesthesia (sevoflurane group, n = 20) or spinal anesthesia (spinal group, n = 20) according to the patient's decision. Arterial lactate levels were significantly higher in the sevoflurane group than in the spinal group at 5 and 65 min after tourniquet deflation (P < 0.001 and P = 0.033, respectively), but there were no intergroup differences in the increment of arterial glucose levels at any time point. Mean arterial pressure and heart rate were significantly higher at 5 min before tourniquet inflation (P < 0.001, P = 0.029, respectively) and lower at 65 min after tourniquet deflation (P = 0.009, P = 0.033, respectively) in the spinal group than in the sevoflurane group. Our results suggest that spinal anesthesia is associated with lower production of ischemic metabolites than sevoflurane anesthesia after pneumatic tourniquet deflation in elderly women undergoing TKR. Keywords Total knee arthroplasty * Elderly women * Arterial lactate, Although spinal anesthesia for total knee arthroplasty (TKR) is known to reduce oxidative stress compared to sevoflurane anesthesia [1], use of sevoflurane before tourniquet inflation optimizes the interstitial release of [...]

Purpose The use of opioids following surgery is associated with a high incidence of postoperative nausea and vomiting (PONV). We conducted a prospective, randomized, double-blind, placebo-controlled study to investigate the effect of orally administered aprepitant, a neurokinin-1 receptor antagonist, for reducing PONV in patients with fentanyl-based, patient-controlled analgesia (PCA) given intravenously after gynecological laparoscopy. Methods One hundred and twenty female patients (ages 21-60) undergoing laparoscopic hysterectomy were randomly allocated to receive 80 mg (A80 group, n = 40) or 125 mg aprepitant (A125 group, n = 40) or placebo (control group, n = 40) orally 2 h before anesthesia induction. Anesthesia was maintained with isoflurane and remifentanil, and PCA IV using fentanyl and ketorolac were provided for 48 h after surgery. Incidences of nausea, vomiting/retching, and use of rescue antiemetics were recorded at 2, 24, and 48 h after surgery. Complete response was defined as no PONV and no need for rescue treatment. Results The incidence of complete response was significantly lower in the A80 and A125 groups than in controls, 56 % and 63 %, vs. 28 %, respectively, P = 0.007 and P = 0.003, respectively, during the first 48 h, and 65 % and 65 % vs. 38 %, respectively, both P = 0.025, during the first 2 h. However, there were no statistically significant differences between A80 and A125 groups in the incidences of complete response and PONV during the study period. Conclusions Aprepitant 80 mg orally was effective in lowering the incidence of PONV in the first 48 h after anesthesia in patients receiving fentanyl-based PCA after gynecological laparoscopy. Keywords Aprepitant * Gynecological laparoscopy * Neurokinin-1 receptor antagonists * Postoperative nausea and vomiting, Introduction Postoperative nausea and vomiting (PONV) is one of the most common distressing symptoms after general anesthesia and can lead to significant clinical problems, such as postoperative pain, dehydration, electrolyte [...]

Purpose We investigated the effect of alfentanil and ketamine on the intubation condition and hemodynamic parameters during propofol anesthesia with low-dose rocuronium in children. Methods Fifty-four children, aged 3-9 years undergoing tonsillectomy, were randomly allocated to receive either alfentanil 20 lg/kg (alfentanil group, n = 27) or ketamine 0.5 mg/kg (ketamine group, n = 27) 1 min before anesthesia induction. Anesthesia was induced with propofol 2.5 mg/kg and rocuronium 0.3 mg/kg and maintained with propofol infusion (6 mg/kg/h). The neuromuscular relaxation was monitored, and intubation conditions, hemodynamic changes, and recovery time were assessed. Results All patients were successfully intubated and there were no significant differences in the intubation conditions between alfentanil and ketamine groups. At the time of tracheal intubation, the median [inter-quartile range] twitch height was similar between two groups (37 [4-48] % in the alfentanil group vs. 29 [4--43.5] % in the ketamine group, p = 0.326). Conclusions This study showed that both ketamine 0.5 mg/kg and alfentanil 20 µg/kg provided adequate intubation condition during propofol induction with lowdose rocuronium in children. The mean arterial pressure and heart rate were higher in the ketamine group after propofol injection but they remained within the normal limit in both groups throughout the study period. Keywords Alfentanil * Children * Ketamine * Low-dose rocuronium * Propofol, Introduction Adeno-tonsillectomy is a common, elective, short surgical procedure that requires general anesthesia in children. For short surgeries, minimum dose of rocuronium to produce an acceptable intubation condition is preferred [...]