Yoonki Lee

The effects of botulinum toxin A on mechanical and cold allodynia in a rat model of neuropathic pain

PurposeBotulinum toxin type A (BoNT-A) has been used to treat many disorders related to excessive muscle contraction, but there are few studies evaluating its effects on neuropathic pain. The aim of this study was to evaluate the analgesic effects of BoNT-A in a rat model of neuropathic pain.MethodsMale Sprague-Dawley rats were prepared by ligating the left L5 and L6 spinal nerves to produce neuropathic pain. Seventy neuropathic rats were randomly assigned into seven groups. Either normal saline or BoNT-A (10, 20, 30 and 40 U·kg-1) was administered to the plantar surface of the affected left hind paw, and BoNT-A (30 and 40 U·kg-1) was administered into the unaffected right paw in order to determine the druginduced systemic effect. Mechanical and cold allodynia were observed at pre-administration, one, three, five, seven and 15 days after drug administration, and were quantified by measuring withdrawal frequencies to stimuli with von Frey filament and 100% acetone, respectively. Rotarod performance was measured to detect drug-induced adverse motor effects.ResultsThe mean minimum withdrawal frequencies to mechanical and cold stimuli were 77 ± II and 90 ± 4.5%, 46 ± 5 and 66 ± 7%, 33 ± 7 and 62 ± 7%, 12 ± 2.9 and 54 ± 7.3% with 10, 20, 30 and 40 U·kg-1 BoNT-A respectively (P < 0.05). Doses of 30 and 40 U·kg-1 BoNT-A resulted in reduced rotarod performance time.ConclusionWe conclude that peripherally administered BoNT-A reduces mechanical and cold allodynia in a rat model of neuropathic pain.RésuméObjectifLa toxine botulique de type A sert à traiter de nombreux troubles reliés à la contraction musculaire excessive, mais peu ďétudes ont évalué ses effets sur la douleur neuropathique. Nous voulions évaluer les effets analgésiques de la BoNT-A sur un modèle de douleur neuropathique chez le rat.MéthodeLes nerfs rachidiens gauches L5 et L6 de rats mâles Sprague-Dawley ont été ligaturés pour produire une douleur neuropathique. Soixante-dix rats ont été randomisés en sept groupes. Une solution salée ou la BoNT-A (10, 20, 30 et 40 U·kg-1) a été administrée sous la surface plantaire de la patte arrière gauche affectée et la BoNT-A (30 et 40 U·kg-1) dans la patte droite intacte pour déterminer ľeffet systémique induit par le médicament. Ľallodynie mécanique et au froid a été observée avant ľadministration du médicament, puis un, trois, cinq, sept et 15 jours après et a été quantifiée par les mesures des fréquences de retrait aux stimuli avec le filament von Frey et 100 % ďacétone, respectivement. La performance au test de la tige tournante a été mesurée pour détecter les effets moteurs indésirables induits par le médicament.RésultatsLa moyenne des fréquences de retrait minimales aux stimuli mécaniques et au froid a été de 77 ± 11 et 90 ± 4,5 %, 46 ± 5 et 66 ± 7 %, 33 ± 7 et 62 ± 7 %, 12 ± 2,9 et 54 ± 7,3 % avec 10, 20, 30 et 40 U·kg-1 de BoNT-A respectivement (P < 0,05). Les doses de 30 et 40 U·kg-1 de BoNT-A ont réduit le temps de performance au test de la tige tournante.ConclusionĽadministration périphérique de BoNT-A réduit ľallodynie mécanique et au froid dans un modèle de douleur neuropathique chez le rat.Objectif La toxine botulique de type A sert a traiter de nombreux troubles relies a la contraction musculaire excessive, mais peu ďetudes ont evalue ses effets sur la douleur neuropathique. Nous voulions evaluer les effets analgesiques de la BoNT-A sur un modele de douleur neuropathique chez le rat.

Les effets de la toxine botulique a sur ľallodynie mécanique et ľallodynie au froid chez un modèle de douleur neuropathique chez le rat

PurposeBotulinum toxin type A (BoNT-A) has been used to treat many disorders related to excessive muscle contraction, but there are few studies evaluating its effects on neuropathic pain. The aim of this study was to evaluate the analgesic effects of BoNT-A in a rat model of neuropathic pain.MethodsMale Sprague-Dawley rats were prepared by ligating the left L5 and L6 spinal nerves to produce neuropathic pain. Seventy neuropathic rats were randomly assigned into seven groups. Either normal saline or BoNT-A (10, 20, 30 and 40 U·kg-1) was administered to the plantar surface of the affected left hind paw, and BoNT-A (30 and 40 U·kg-1) was administered into the unaffected right paw in order to determine the druginduced systemic effect. Mechanical and cold allodynia were observed at pre-administration, one, three, five, seven and 15 days after drug administration, and were quantified by measuring withdrawal frequencies to stimuli with von Frey filament and 100% acetone, respectively. Rotarod performance was measured to detect drug-induced adverse motor effects.ResultsThe mean minimum withdrawal frequencies to mechanical and cold stimuli were 77 ± II and 90 ± 4.5%, 46 ± 5 and 66 ± 7%, 33 ± 7 and 62 ± 7%, 12 ± 2.9 and 54 ± 7.3% with 10, 20, 30 and 40 U·kg-1 BoNT-A respectively (P < 0.05). Doses of 30 and 40 U·kg-1 BoNT-A resulted in reduced rotarod performance time.ConclusionWe conclude that peripherally administered BoNT-A reduces mechanical and cold allodynia in a rat model of neuropathic pain.RésuméObjectifLa toxine botulique de type A sert à traiter de nombreux troubles reliés à la contraction musculaire excessive, mais peu ďétudes ont évalué ses effets sur la douleur neuropathique. Nous voulions évaluer les effets analgésiques de la BoNT-A sur un modèle de douleur neuropathique chez le rat.MéthodeLes nerfs rachidiens gauches L5 et L6 de rats mâles Sprague-Dawley ont été ligaturés pour produire une douleur neuropathique. Soixante-dix rats ont été randomisés en sept groupes. Une solution salée ou la BoNT-A (10, 20, 30 et 40 U·kg-1) a été administrée sous la surface plantaire de la patte arrière gauche affectée et la BoNT-A (30 et 40 U·kg-1) dans la patte droite intacte pour déterminer ľeffet systémique induit par le médicament. Ľallodynie mécanique et au froid a été observée avant ľadministration du médicament, puis un, trois, cinq, sept et 15 jours après et a été quantifiée par les mesures des fréquences de retrait aux stimuli avec le filament von Frey et 100 % ďacétone, respectivement. La performance au test de la tige tournante a été mesurée pour détecter les effets moteurs indésirables induits par le médicament.RésultatsLa moyenne des fréquences de retrait minimales aux stimuli mécaniques et au froid a été de 77 ± 11 et 90 ± 4,5 %, 46 ± 5 et 66 ± 7 %, 33 ± 7 et 62 ± 7 %, 12 ± 2,9 et 54 ± 7,3 % avec 10, 20, 30 et 40 U·kg-1 de BoNT-A respectivement (P < 0,05). Les doses de 30 et 40 U·kg-1 de BoNT-A ont réduit le temps de performance au test de la tige tournante.ConclusionĽadministration périphérique de BoNT-A réduit ľallodynie mécanique et au froid dans un modèle de douleur neuropathique chez le rat.Objectif La toxine botulique de type A sert a traiter de nombreux troubles relies a la contraction musculaire excessive, mais peu ďetudes ont evalue ses effets sur la douleur neuropathique. Nous voulions evaluer les effets analgesiques de la BoNT-A sur un modele de douleur neuropathique chez le rat.

Neurogenic pulmonary edema following intracranial coil embolization for subarachnoid hemorrhage -A case report-

Neurogenic pulmonary edema (NPE) is a well-known complication of acute central neurologic injury, particularly aneurysmal subarachnoid hemorrhage. Both increased intracranial pressure and severe over-activation of the sympathetic nervous system seem to be pathogenetic for the onset of NPE. Although intracranial endovascular therapy is minimally invasive, it may affect brain stem regions and result in sympathetic activation. We now report the case of a 70-year-old woman who suddenly developed pulmonary edema during coil embolization of a ruptured aneurysm. During the intervention, oxygen saturation declined suddenly and a chest radiograph revealed pulmonary edema. The delayed appearance of NPE in this patient implies a risk for sympathetically mediated NPE during endovascular therapy.

Emergence delirium is related to the invasiveness of strabismus surgery in preschool-age children

Objectives To investigate the correlation between preoperative anxiety and emergence delirium (ED), and to identify other factors that contribute to ED (such as invasiveness of surgery), in preschool-age paediatric patients undergoing strabismus surgery. Methods This prospective observational study enrolled Korean children (aged 2–5 years), scheduled for strabismus surgery. After completing the modified Yale Preoperative Anxiety Scale, general anaesthesia was induced. Postoperatively, Pediatric Anesthesia Emergence Delirium (PAED) scores (used as an index of the degree of ED) and a four-point delirium scale (ED incidence), were collected and measured every 5 min. Patients were categorized according to the degree of surgical invasiveness: group U-S, single-muscle correction in a unilateral eye; group U-M, multiple-muscle correction in a unilateral eye; group B-S, single-muscle correction in bilateral eyes; group B-M, multiple-muscle correction in bilateral eyes. Results A total of 90 paediatric patients participated in the study. Maximum PAED scores did not correlate with the presence of preoperative anxiety. The maximum PAED score of group B-M was significantly higher than scores observed in other groups. Conclusions Preoperative anxiety was not related to ED in preschool-age paediatric patients undergoing strabismus surgery. The incidence and severity of ED was higher in patients who underwent more complicated strabismus surgery, compared with those undergoing simpler procedures.

Cardiac arrest with pulmonary edema in a non-parturient after ergonovine administration recovered with extracorporeal membrane oxygenation -A case report-

Ergonovine have been used for the prevention and treatment of postpartum or postabortion hemorrhage. Although this modality has been considered relatively safe in the obstetric patients, there were a few cardiac events associated with this drug in the post-delivery or post-abortion patients, especially in patients with cardiovascular risk factors. We experienced cardiac arrest in a non-parturient with no discernible risk factors. Although resuscitated, she also suffered from pulmonary edema with unstable hemodynamics and low oxygenation. To manage the patient, extracorporeal membrane oxygenation was used and she recovered successfully without cardiopulmonary complications. Therefore, we recommend that when ergonovine is chosen as a modality, special caution should be paid to the pulmonary events, as well as cardiac, especially when administered by intravenously even in patients with no cardiovascular risk factors. If cardiac events occur, extracorporeal membrane oxygenation or other measures, such as intra-aortic balloon pump can be helpful when conventional cardiopulmonary resuscitation is not effective.

Pulmonary edema after catastrophic carbon dioxide embolism during laparoscopic ovarian cystectomy.

Laparoscopy is a surgical procedure used both for diagnosis and for various treatments. A rare but sometimes fatal complication of laparoscopy is pulmonary embolism with CO2 resulting in pulmonary edema. During laparoscopic gynecological surgery in a 29-year-old woman who had previously undergone lower abdominal surgery, the end-tidal CO2 suddenly increased from 40 mmHg to 85 mmHg and then decreased to 13 mmHg with hemodynamic deterioration. These events are characteristic of a CO2 embolism. When this occurred, CO2 insufflation was immediately stopped and the patient was resuscitated. The patients condition gradually improved with aggressive treatment, but the clinical course was complicated by bilateral pulmonary edema. This case of pulmonary edema was soon resolved with supportive management. The formation of a CO2 embolism during laparoscopy must be suspected whenever there is a sudden change in the end-tidal CO2. In addition, the possibility of pulmonary edema should be considered when a CO2 embolism occurs.

Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion

Propofol and remifentanil are widely used anesthetics due to rapid onset and offset even after prolonged infusion. However, these agents are known to have vagomimetic effects and may cause conduction delays [1,2]. We describe a case of alternating asystole and atrial fibrillation occurred immediately after start of target-controlled infusion (TCI) of propofol and remifentanil, and late diagnosis of sick sinus syndrome.