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PubMedDate not supplied

Evaluation of combined spinal-epidural anesthesia using two different techniques.

BACKGROUND AND OBJECTIVES: This investigation was designed to evaluate combined spinal-epidural anesthesia with a needle-through-needle technique using two different needle sets. One kit has a standard 16-gauge Tuohy needle and a 26-gauge spinal needle that extends 13 mm beyond the tip of the Tuohy needle (set A). The other kit consists of a 16-gauge Tuohy needle with an aperture in its curve (back hole) for the insertion of a 26-gauge spinal needle that protrudes 10 mm beyond the tip of the epidural needle (set B). METHODS: Combined spinal-epidural anesthesia was used in 40 consecutive consenting patients scheduled for elective total knee arthroplasty who were randomized into two groups. Needle set A was used in group A, and needle set B was used in group B. Special attention was paid to difficulties in performing the blocks and to any complications of the technique. RESULTS: The length of the spinal needle was inadequate in 15% of patients from group B, whereas the length in group A was adequate in all. The aperture on the back of the Tuohy needle from group B provides a better "feel" of dural puncture. There was no difficulty in the insertion of the epidural catheter. There was no evidence of subarachnoid placement of the epidural catheter in either group. None of the patients had unexpectedly extensive spinal block. No patient developed postdural puncture headache. All patients had adequate surgical anesthesia. Infusion of bupivacaine (0.1%) with fentanyl (2 micrograms/mL) provided adequate postoperative analgesia. No respiratory depression was noted. CONCLUSIONS: Combined spinal-epidural provides satisfactory surgical and postoperative analgesia for total knee arthroplasty. An improved needle set for the needle-through-needle technique would be one with a modified Tuohy needle having an aperture at the back and a spinal needle protruding more than 13 mm beyond the Tuohy needle.

Aged↗
PubMed1986

The induction of a regenerative propensity in sensory neurons following peripheral axonal injury.

Injury of the peripheral axons of primary sensory neurons has been previously shown to increase the probability that the corresponding central axons would grow from the injured spinal cord into a peripheral nerve graft. This phenomenon has been used to investigate the nature of extrinsic cues from injured nerves that enhanced regenerative propensity within sensory neurons. In 13 groups of rats, a segment of the right sciatic nerve was grafted to the dorsal columns of the spinal cord and the left sciatic nerve was subjected to mechanical injury, injection of colchicine or infusion of nerve growth factor. Subsequently, neurons in lumbar dorsal root ganglia with axons growing from the spinal cord into a graft were identified by retrograde perikaryal labelling and compared for the two sides. The aim was to mimic or modify the inductive effect of nerve transaction by alternative or additional manipulation of the nerve. Growth of central axons was less enhanced by peripheral axonal interruption if the length of the proximal stump was increased or if a distal stump was present to permit rapid regeneration. However, the regenerative response following nerve transection was altered little by crushing the proximal stump or injecting it with colchicine or nerve growth factor. It is suggested that sensory neurons are stimulated to regenerate by peripheral axonal injuries that reduce some normal retrograde regulatory influence of Schwann cells.

Animals↗
PubMed2005

Acute transverse myelitis in a 7-month-old boy after diphtheria-tetanus-pertussis immunization.

STUDY DESIGN: Case report of a 7-month-old boy, who developed acute transverse myelitis after diphtheria-tetanus-pertussis immunization. OBJECTIVES: To describe the clinical course of acute transverse myelitis in an infant and to review the literature regarding the association of acute transverse myelitis and vaccinations. SETTING: Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA. METHODS: Case report. RESULTS: Magnetic resonance imaging (MRI) on admission demonstrated diffuse spinal cord edema with increased signal on T-2 weighted images and faint enhancement with gadolinium infusion. Urologic symptoms improved with steroids but motor function was never fully regained. Repeat MRI of the spinal cord several months later showed diminution of cord diameter with resolution of edema and signal abnormality. CONCLUSION: Based on the clinical course and MRI findings, the daignosis of acute transverse myelitis was made. The association of previously received DPT immunization and the genesis of transverse myelitis is explored.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMed2003

[Morpho-functional changes of the spinal cord neurons after epidural administration of lidocaine].

The analysis of morphological and histoezymological changes of spinal cord neurons has been performed in outbred dogs following epidural infusion of isobaric 2% lidocaine solution. In the control group the animals received epidural infusion of 0.9% saline. The results obtained indicate the absence of pathological structural and metabolic changes in the nervous tissue after lidocaine application. Certain signs of morpho-functional reorganization were noted in spinal cord neurons of animals in both experimental and control groups. The registered changes were found to vary within the physiological fluctuation limits and are rather indicative of the functional reaction of the studied structures of the nervous tissue to the epidural injections of either saline and lidocaine.

Anesthetics, Local↗
PubMed1998

Characteristics of tolerance to somatic and visceral antinociception after continuous epidural infusion of morphine in rats.

UNLABELLED: A continuous epidural infusion of morphine may cause a complicated tolerance to develop, depending on the spinal and supraspinal sites. We designed this study to clarify the characteristics of the tolerance to somatic and visceral antinociception after epidural morphine infusion. Rats received epidural infusion of morphine at the rates of 50 or 100 microg kg(-1) h(-1), or isotonic sodium chloride solution for 7 days. The tail-flick (TF) test and colorectal distension (CD) test were used to measure the somatic and visceral antinociceptive effects, respectively. Nociceptive tests were performed on Days 1, 2, 3, 4, and 7. After 7 days, time-response curves after epidural morphine (10 microg) or intraperitoneal morphine (3 mg) challenge tests were conducted to assess the magnitude of tolerance. Epidurally infused morphine significantly increased percent maximal possible effects (%MPEs) (P < 0.05) in both the TF and CD tests, depending on the concentration of morphine. In the epidural morphine challenge test, increases in %MPEs were significantly attenuated (P < 0.05) in the morphine-infused group compared with the isotonic sodium chloride solution-infused group. The increases in %MPEs in the intraperitoneal challenge test were also attenuated in the morphine-infused group. We conclude that morphine tolerance to both somatic and visceral antinociception develops rapidly during epidural infusion and is based on the development of tolerance at the systemic, as well as the epidural, level. IMPLICATIONS: A continuous epidural infusion of morphine rapidly induces tolerance to visceral and somatic antinociception in rats. This development is based on the development of tolerance at the systemic, as well as the epidural, level.

Analgesics, Opioid↗
PubMed1976

Ouabain cardiotoxicity, a reassessment of methodology.

The capacity of ouabain (1 mug/kg/min and 2 mug/kg/min) to induce cardiotoxicity was explored in control cats and cats after spinal cord transection. In cats receiving 1 mug/kg/min, a higher dose of ouabain was needed to produce lethal arrhythmias in spinal cats compared to intact cats. However, in cats receiving 2 mug/kg/min, there was no difference in dose to death between intact and spinal cats. At death, the serum level and ventricular contents of ouabain was higher in animals with spinal cord transection regardless of the rate of ouabain infusion. Thus it appears that determination of the myocardial tissue digitalis concentration more accurately reflects the state of digitalis sensitivity than the administered dose. Additionally, seemingly paradoxical findings with regard to dose are explicable when serum and tissue concentration are simultaneously evaluated.

Animals↗
PubMed1990

Spinal cord substance P mediates carbachol-induced cardiovascular responses from the rostral ventrolateral medulla.

Intrathecal (i.t.) infusion of substance P (SP) antagonist, (D-Pro2, D-Trp7,9)-substance P (20 micrograms), lowered blood pressure profoundly without any significant change of heart rate. The hypertensive and tachycardic responses elicited by microinjection of carbachol (25 ng/site) into the bilateral rostral ventrolateral medulla (rVLM) were blocked by i.t. infusion of SP antagonist. These data provided evidence that an excitatory cardiovascular effect induced by cholinergic system in rVLM may be mediated mainly by the SP receptors in spinal cord.

Animals↗
PubMed1987

Propofol emulsion for induction and maintenance of anaesthesia. A combined technique of general and regional anaesthesia.

To provide general anaesthesia with endotracheal intubation during regional blockades, three dose regimens of propofol emulsion were studied: induction 2 mg kg-1, infusion rate 9 mg kg-1 h-1 (Group 1); induction 2.5 mg kg-1, infusion rate 12 mg kg-1 h-1 (Group 2); induction 2.5 mg kg-1, infusion rate 9 mg kg-1 (Group 3). Each group comprised 10 healthy (ASA class 1 or 2) unpremedicated patients. The induction times measured from the start of injection until counting ceased (+/- 50 s) and until eye-lash reflex disappeared (+/- 80 s) showed no statistical differences between groups. In five patients in Group 1 and one patient in each of Groups 2 and 3 the induction dose was too low for intubation. Pain on injection was seen in 13 cases (mild 6, moderate 6 and severe 1). Cough accompanied by hypersalivation was the most important side-effect. Recovery times varied widely and showed no statistical differences. Answering simple questions was possible after 14 min in Group 1, 23 min in Group 2 and 19 min in Group 3. Apart from a short period of euphoria, recovery was uneventful. There was no tendency to fall asleep again. None of the combinations of induction doses and infusion rates provided good anaesthesia conditions for an acceptable number of patients.

Adult↗
PubMed1999

The neuropeptide FF analogue, 1DME, enhances in vivo met-enkephalin release from the rat spinal cord.

Behavioural studies have suggested that endogenous opioids mediate the antinociceptive action of neuropeptide FF (FLFQPQRF-NH2) at the spinal level in the rat. This hypothesis was directly assessed by investigating the effects of a NPFF analogue, 1DMe ([D-Tyr1,(NMe)Phe3]NPFF), on the spinal outflow of met-enkephalin-like material (MELM) in halothane-anaesthetised rats. Intrathecal infusion (0.1 ml/min) of 1DMe (0.1 microM-0.1 mM, for 45 min) produced a concentration-dependent increase in spinal MELM outflow which persisted for at least 90 min at the highest concentration tested. Intrathecal coadministration of the micro-opioid receptor antagonist CTOP (1 microM) did not significantly affect the spinal MELM overflow due to 0.1 mM 1DMe. In contrast, both naltrindole and nor-binaltorphimine, at concentrations (10 microM) that allow the selective blockade of alpha- and kappa-opioid receptors, respectively, significantly reduced the stimulatory effect of 1DMe on spinal MELM outflow. These data provide the first direct demonstration that met-enkephalin (among other opioid peptides) can mediate the antinociceptive action of NPFF at the spinal level in rats. In addition, they suggest that reciprocal excitatory interactions between opioids and opioid-modulatory factors (such as NPFF) participate in the physiological control of nociception.

Analgesics↗
PubMed1992

Epidural narcotics: mechanism of action and nursing implications.

Patients who receive narcotics by epidural injection or infusion have the potential to develop pharmacological side effects. Theories of epidural pain control and a brief review of spinal anatomy and pain physiology are presented in this article. Narcotic medications used for epidural infusion are pharmacologically distinguished by their hydrophilic or lipophilic character. Important side effects of epidurally administered narcotics, clinical presentation, manifestations, and appropriate nursing interventions are discussed.

Analgesia, Epidural↗
PubMed1982

[Clinical studies on prevention of spinal hypotension and aortocaval compression during elective cesarean section (author's transl)].

Maternal blood pressures, maternal and fetal blood-gas values, induction delivery intervals (I-D intervals) and Apgar scores were determined in 60 cases of elective cesarean section under spinal anesthesia. The procedures were as follows: In the right lateral position on an operating table, the intravenous drip infusion of 6 per cent hydroxyethyl starch solution (12 ml/kg) for 30 minutes prior to spinal anesthesia and the intramuscular injection of ephedrine (0.5 mg/kg) 15 minutes before spinal anesthesia were performed. Immediately after the anesthesia, on the left semilateral position the operation was started (group S). The same studies as group S were made in cases of no reduced blood pressure without ephedrine (group E), and cases of combined use of oxygen inhalation (group O and OII). No significant reduction of blood pressure was noted in group S and O. Fetal acid-base status and Apgar scores were favorable and had no correlation with I-D intervals in any groups. It is suggested that the uteroplacental circulation in group O and E was maintained more or less smoothly than that in group S. Oxygen inhalation led to a significant increase in fetal PO2 and the improvement of 5 minutes Apgar score. On performing elective cesarean section under spinal anesthesia, it may be advisable to take the procedures of group OII (Oxygen flow: 31/min., through a nasal cannula) and to make mother respire closing their mouths.

Acid-Base Imbalance↗
PubMed1984

Effects of CL 115,347, (+/-)-15-deoxy-16-hydroxy-16-vinyl-PGE2 methyl ester, on cardiovascular responses and plasma catecholamines in pithed stroke-prone spontaneously hypertensive rats during sympathetic stimulation.

The effect of CL 115,347, a topically active antihypertensive PGE2 analog, and PGE2 on changes in blood pressure (BP), heart rate (HR) response and plasma epinephrine (E) and norepinephrine (NE) levels induced by stimulation of the sympathetic spinal cord outflow were studied in pithed stroke-prone spontaneously hypertensive rats (SHRSP). Surgical pithing significantly reduced plasma E but not NE levels suggesting that the sympathoadrenal medullary system differentially affects E and NE release. Sympathetic stimulation of the spinal cord of pithed SHRSP increased HR, BP, plasma E and NE levels. Topically applied CL 115,347 (0.001-0.2 mg/kg) dose-dependently decreased BP, while intravenously infused PGE2 (30 micrograms/kg/min) did not alter BP except for a brief initial drop. Topical application of CL 115,347 (0.1 mg/kg) also inhibited BP responses to sympathetic stimulation without effects on HR or plasma E or NE levels. Intravenous infusion of PGE2 (30 micrograms/kg/min) inhibited both BP and HR responses to spinal cord stimulation but did not alter plasma catecholamine levels. These studies in SHRSP suggest that CL 115,347 and PGE2 modulate cardiovascular responses mainly via postjunctional effects, but act differently on the cardiovascular elements, viz. CL 115,347 acts primarily on blood vessels while PGE2 acts on blood vessels and heart.

Animals↗
PubMed1998

Oxytocin-induced stimulation and inhibition of bladder activity in normal, conscious rats--influence of nitric oxide synthase inhibition.

The role of the oxytocin-containing projections to the autonomic nuclei of the spinal cord for lower urinary tract function has not been clarified. The hypothesis was tested that oxytocin acts as a mediator of bladder contraction at the spinal cord level. In conscious female rats undergoing continuous cystometry, intrathecal oxytocin (30 ng approximately 30 pmoles) significantly increased micturition pressure (P<0.001), and decreased bladder capacity (P<0.01) and micturition volume (P<0.01). Residual volume increased (P<0.05), and so did the amplitude and frequency of non-voiding contractions (P<0.01). Immediately after administration of oxytocin, the animals showed frequent stretching movements and yawning, and they licked their tails. The effects of oxytocin were dose-dependent; high concentrations (100 ng) were ineffective. Intra-arterial injection of oxytocin (30 ng) near the bladder had no effect. In isolated detrusor strips, oxytocin caused a concentration-dependent contraction; the concentration response curve was concentration-dependently shifted to the right by the oxytocin antagonist, 1-deamino, 2-D-Tyr(OEt), 4-Thr, 8-Orn-OT. Intrathecal injection of the antagonist (500 ng), had per se no effect on micturition. However, when the antagonist was given intrathecally 4-5 min prior to intrathecal oxytocin (30 ng), the effects of oxytocin were reduced or completely prevented. When given after intrathecal administration of the nitric oxide synthase inhibitor, N(omega)-nitro-L-arginine methyl ester, intrathecal oxytocin (30 ng) abolished micturition within 5-7 min; all animals developed overflow incontinence, and paralysis of the hindlimbs. These results suggests that in the rat, oxytocin, released from descending pathways, may act as a modulator of the micturition reflex at the spinal level, and that it may interact with nitric oxide. The physiological implications of the findings remain to be established.

Animals↗
PubMed2003

Sustained spinal cord compression: part II: effect of methylprednisolone on regional blood flow and recovery of somatosensory evoked potentials.

BACKGROUND: The efficacy of methylprednisolone in the treatment of traumatic spinal cord injury is controversial. We examined the effect of methylprednisolone on regional spinal cord blood flow and attempted to determine whether recovery of electrophysiological function is dependent on reperfusion, either during sustained spinal cord compression or after decompression. METHODS: The effects of methylprednisolone therapy on recovery of somatosensory evoked potentials and on spinal cord blood flow were examined in a canine model of dynamic spinal cord compression. Methylprednisolone (30 mg/kg intravenous loading dose followed by 5.4 mg/kg/hr intravenous infusion) or saline solution was administered to thirty-six beagles (eighteen in each group) five minutes after cessation of dynamic spinal cord compression and loss of all somatosensory evoked potentials. After ninety minutes of sustained compression, the spinal cords were decompressed. Somatosensory evoked potentials and spinal cord blood flow were evaluated throughout the period of sustained compression and for three hours after decompression. RESULTS: Seven dogs treated with methylprednisolone and none treated with saline solution recovered measurable somatosensory evoked potentials during sustained compression. After decompression, three more dogs treated with methylprednisolone and seven dogs treated with saline solution recovered somatosensory evoked potentials. Four dogs treated with methylprednisolone lost their previously measurable somatosensory evoked potentials. In the methylprednisolone group, spinal cord blood flow was significantly higher (p < 0.05) in the dogs that had recovered somatosensory evoked potentials than it was in the dogs that had not. Reperfusion blood flow was significantly higher (p < 0.05) in the saline-solution group than it was in the methylprednisolone group. Spinal cord blood flow in the saline-solution group returned to baseline levels within five minutes after decompression. It did not return to baseline levels in the dogs treated with methylprednisolone. CONCLUSIONS: The methylprednisolone administered in this study did not provide a large or significant lasting benefit with regard to neurological preservation or restoration. Methylprednisolone may reduce regional spinal cord blood flow through mechanisms affecting normal autoregulatory blood-flow function.

Animals↗
PubMed2001

Exogenous NT-3 and NGF differentially modulate PACAP expression in adult sensory neurons, suggesting distinct roles in injury and inflammation.

Expression of pituitary adenylate cyclase-activating polypeptide in sensory neurons varies with injury or inflammation. The neurotrophins NGF and NT-3 are profound regulators of neuronal peptidergic phenotype in intact and injured sensory neurons. This study examined their potential for modulation of PACAP expression in adult rat with intact and injured L4-L6 spinal nerves with or without immediate or delayed intrathecal infusion of NT-3 or NGF. Results indicate that in L5 DRG, few trkC neurons express high levels of PACAP mRNA in the intact state, but many do following injury. The elevated expression in injured neurons is mitigated by NT-3 infusion, suggesting a role for NT-3 in returning the 'injured phenotype' back towards an 'intact phenotype'. NGF dramatically up-regulated PACAP expression in trkA-positive neurons in both intact and injured DRGs, implicating NGF as a positive regulator of PACAP expression in nociceptive neurons. Surprisingly, NT-3 modulates PACAP expression in an antagonistic fashion to NGF in intact neurons, an effect most evident in the trkA neurons not expressing trkC. Both NT-3 and NGF infusion results in decreased detection of PACAP protein in the region of the gracile nuclei, where central axons of the peripherally axotomized large sensory fibers terminate. NGF infusion also greatly increased the amount of PACAP protein detected in the portion of the dorsal horn innervated by small-medium size DRG neurons, while both neurotrophins appear able to prevent the decrease in PACAP expression observed in these afferents with injury. These results provide the first insights into the potential molecules implicated in the complex regulation of PACAP expression in sensory neurons.

Afferent Pathways↗
PubMedDate not supplied

Postoperative analgesia and antiemetic efficacy after subarachnoid neostigmine in orthopedic surgery.

BACKGROUND AND OBJECTIVES: The efficacy of operatively administered spinal neostigmine to provide analgesia and that of different antiemetics to prevent neostigmine-related nausea and vomiting were evaluated in patients undergoing tibial or ankle reconstruction. METHODS: One hundred patients were randomized to five groups (n = 20). The intravenous antiemetic test drug (except propofol) was given as premedication in the holding room, after intravenous midazolam, 0.05 mg/kg. The subarachnoid drugs administered were 20 mg bupivacaine (0.5%) in conjunction with 100 micrograms neostigmine, except for the saline group (S group), which received bupivacaine and saline. The S group, the neostigmine group (N group), and the propofol group (P group) received saline as the intravenous test drug. The droperidol group (D group) received intravenous droperidol 0.5 mg, and the metoclopramide group (M group) received intravenous metoclopramide 10 mg. The P group had a continuous intravenous propofol infusion (2-4 mg/kg/hr), started 10 minutes after the spinal injection. Nausea, emetic episodes, and the need for analgesic (disclofenac) or antiemetic medication were recorded for the first 24 hours following surgery and scored by a 10-cm visual analog scale (VAS). RESULTS: Subarachnoid neostigmine 100 micrograms did not affect subarachnoid bupivacaine analgesia as measured by time to first rescue analgesic in most patients, but it decreased the overall 24-hour visual analog scale (VAS) scores and the need for postoperative analgesics in 24 hours (P < .001). The incidence of intraoperative nausea and vomiting was higher in the N, D, and M groups than in the S group (P < .001). Following surgery, the 3-hour VAS assessment for emesis was higher for the N, P, and M groups than for the S group (P < .05). The overall 24-hour assessment was similar among groups. CONCLUSIONS: Subarachnoid neostigmine reduced postoperative pain scores and analgesic requirements. Whether it prolonged the duration of action of diclofenac or enhanced the mechanisms involved in spinal analgesia cannot be determined from these data. Although propofol and droperidol appeared to be more effective during and after surgery, respectively, all neostigmine groups were associated with a high consumption of antiemetics.

Adult↗
PubMed1988

Gentamicin bioavailability and single-dose pharmacokinetics in spinal cord injury.

The rate and completeness of absorption of gentamicin from muscle (healthy and paralyzed) and gentamicin disposition kinetics following a single intravenous infusion were studied in nonobese, healthy male volunteers with functionally complete, chronic (greater than one year duration) spinal cord injury (SCI) and in able-bodied controls. Pharmacokinetic parameters were derived using compartmental and model-independent analyses. The absolute bioavailability of gentamicin was complete and did not differ from control values using both model-independent (LAGRAN) and model-dependent (ADAPT) analyses. The rate of gentamicin absorption in patients with SCI was, however, significantly slower, with a mean absorption time of 2.55 h compared with 0.96 h in able-bodied controls (p less than or equal to 0.05). Mean volume of distribution steady-state (Vssd) of gentamicin was demonstrated to be 33-47 percent greater in spinal cord injury than in controls (p less than 0.05). We conclude that the absorption of gentamicin from paralyzed muscle is significantly impaired, and in conjunction with an increase in Vssd results in delayed, decreased peak serum levels in patients with SCI.

Adult↗