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4. Response After Repeated Ketamine Injections in a Rat Model of Neuropathic Pain

Author

KIM, Na Eun, KIM, Byung Gun, LEE, Junhyung, CHUNG, Hee Tae, KWON, Hye Rim, KIM, Young Shin, CHOI, Jong Bum, and SONG, Jang Ho

Subjects
Male, Hyperalgesia, Physiology, Animals, Neuralgia, Ketamine, Articles, General Medicine, Rats, Wistar, Sciatic Nerve, Pain Measurement, Rats
Abstract

Ketamine, an N-methyl-D-aspartate antagonist, reduces pain by decreasing central sensitization and pain windup. However, chronic ketamine use can cause tolerance, dependency, impaired consciousness, urinary symptoms, and abdominal pain. This study aimed to investigate the effects of repeated ketamine injections and ketamine readministration after discontinuation in a rat model of neuropathic pain. To induce neuropathic pain, partial sciatic nerve ligation (PSNL) was performed in 15 male Wistar rats, and these animals were divided into three groups: PSNL (control), PSNL + ketamine 5 mg/kg (K5), and PSNL + ketamine 10 mg/kg (K10; n=5 each). Ketamine was injected intraperitoneally daily for 4 weeks, discontinued for 2 weeks, and then readministered for 1 week. Following PSNL, the mechanical withdrawal threshold was determined weekly using the Von Frey. The K10 group showed a significant increase in the mechanical withdrawal threshold, presented here as the target force (in g), at 21 and 28 days compared to the time point before ketamine injection (mean±SE, 276.0±24.0 vs. 21.6±2.7 and 300.0±0.0 vs. 21.6±2.7, respectively; P2 weeks, but this ketamine effect decreased after drug readministration.

Published
2022

6. Effect of intravenous dexamethasone on the duration of postoperative analgesia for popliteal sciatic nerve block: a randomized, double-blind, placebo-controlled study

Author

Kim, Byung-Gun, Lee, Woojoo, Song, Jang Ho, Yang, Chunwoo, Heo, Gyung A, and Kim, Hongseok

Subjects
medicine.medical_treatment, Analgesic, dexamethasone, sciatic nerve, nerve block, pharmaceutic adjuvants, Anesthesiology, ankle, medicine, Humans, RD78.3-87.3, Anesthetics, Local, Saline, Dexamethasone, Clinical Research Article, Pain, Postoperative, Ropivacaine, business.industry, Foot and ankle surgery, intravenous injections, analgesia, Effective dose (pharmacology), Anesthesiology and Pain Medicine, foot, Anesthesia, Nerve block, Sciatic nerve, business, medicine.drug
Abstract

BackgroundIntravenous (IV) dexamethasone prolongs the duration of a peripheral nerve block; however, there is little available information about its optimal effective dose. This study aimed to evaluate the effects of three different doses of IV dexamethasone on the duration of postoperative analgesia to determine the optimal effective dose for a sciatic nerve block.MethodsPatients scheduled for foot and ankle surgery were randomly assigned to receive normal saline or IV dexamethasone (2.5 mg, 5 mg, or 10 mg). An ultrasound-guided popliteal sciatic nerve block was performed using 0.75% ropivacaine (20 ml) before general anesthesia. The duration of postoperative analgesia was the primary outcome, and pain scores, use of rescue analgesia, onset time, adverse effects, and patient satisfaction were assessed as secondary outcomes.ResultsCompared with the control group, the postoperative analgesic duration of the sciatic nerve block was prolonged in groups receiving IV dexamethasone 10 mg (P < 0.001), but not in the groups receiving IV dexamethasone 2.5 mg or 5 mg. The use of rescue analgesics was significantly different among the four groups 24 h postoperatively (P = 0.001) and similar thereafter. However, pain scores were not significantly different among the four groups 24 h postoperatively. There were no statistically significant differences in the other secondary outcomes among the four groups.ConclusionsThis study demonstrated that compared to the controls, only IV dexamethasone 10 mg increased the duration of postoperative analgesia following a sciatic nerve block for foot and ankle surgery without the occurrence of adverse events.

Published
2021

9. Analysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia

Author

Hong, Sung-Jin, Kang, Yoo-Jin, Jeon, Young-Hun, Son, Ji-Seon, Song, Jang-Ho, Yoo, Chan-Seon, and Kim, Duk-Kyung

Subjects
Police administration -- Health aspects, Trade and professional associations -- Health aspects -- Management, Anesthesia -- Health aspects, Propofol -- Dosage and administration, Company business management, Health
Abstract

Purpose Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments. Methods In 2009, the Legislation Committee of the Korean Society of Anesthesiologists, based on expert consultation referrals provided by police departments, civil courts, and criminal courts, initiated the construction of database to compile all anesthesia-related adverse events. Using this database (July 2009 to April 2012), we have compared causative mechanisms and injury patterns in procedural sedation (Sedation) cases (N = 25) with those in general anesthesia (GA) cases (N = 29). Results The severity of injury in Sedation cases was similar to that in GA cases, with death occurring in 72.0 % of cases. Hypoxia secondary to airway obstruction or respiratory depression was the most common specific mechanism of Sedation-related injuries (64.0 %). In-depth analysis of pre-procedural evaluation and intraoperative monitoring revealed a common lack of vigilance in the Sedation cases, and most injuries were judged as preventable with better monitoring. Non-anesthesiologist administration of propofol (NAAP) was performed in the great majority of Sedation cases (88.0 %). Conclusion Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP. Keywords Deep sedation * Injuries * Malpractice * Propofol, Introduction The police, public prosecutors, and judges tend to accept the opinion of an independent expert medical board in most medico-legal cases involving potential medical negligence. As members of the [...]

Published
2013
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29. The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position.

Author

Hyo-Jin Byon, Jang-Ho Song, Kyung-Chul Song, Hyunkeun Lim, Hyunzu Kim, Byon, Hyo-Jin, Song, Jang-Ho, Song, Kyung-Chul, Lim, Hyunkeun, and Kim, Hyunzu

Abstract

Background and Objectives: The aim of this study was to examine whether shoulder rotation increases the length of the posterior longitudinal ligament (PLL) in the lateral decubitus position.Methods: Thirty-four adult male volunteers were placed in the right or left lateral decubitus and flexion position on a horizontal operating table. Thoracic spinal ultrasonography was performed using the paramedian oblique sagittal plane to obtain the optimal ultrasound view for the PLL on the dependent side. The lengths of the PLL were measured at the T6/7 and T9/10 interspaces before and after ipsilateral 30-degree shoulder rotation.Results: In the right lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 7.4 (2.8) to 8.4 (2.6) mm (P = 0.006) at the T6/7 level and from 8.4 (2.9) to 10.6 (2.8) mm (P < 0.0001) at the T9/10 level. Similarly, in the left lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 8.0 (2.6) to 9.1 (2.6) mm (P = 0.001) at the T6/7 level and from 9.3 (2.8) to 11.8 (3.1) mm (P < 0.0001) at the T9/10 level.Conclusions: Shoulder rotation significantly increased the dimension of the acoustic target window for paramedian thoracic epidural access in the lateral decubitus position at both T6/7 and T9/10 levels. Further clinical studies are needed to investigate the effect of shoulder rotation on thoracic epidural access. [ABSTRACT FROM AUTHOR]

Published
2016
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