Neurotrophins and neuropathic pain in patients with traumatic brain injury

백지석 대한통증학회 2020 The Korean Journal of Pain Vol.33 No.1

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Remifentanil dose for laryngeal mask airway insertion with a single standard dose of propofol during emergency airway management in elderly patients

유정희,백지석,김진희,박상헌,노재문,오아영 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.4

Background: This study determined the dose of remifentanil to use during insertion of a ClassicTM laryngeal mask airway (LMA, The Laryngeal Mask Co., Nicosia, Cyprus) in elderly patients during emergency airway management when combined with a single dose of propofol. Methods: Patients aged 65-80 years were enrolled. Anesthesia was induced with propofol 1 mg/kg, and then a blinded dose of remifentanil was infused over 30 s after confirming the patient’s loss of consciousness. The dose of remifentanil was determined using Dixon’s up-and-down method, starting at 0.5 μg/kg (a step size of 0.1 μg/kg). Insertion of the LMA was attempted 60 s after loss of consciousness. Results: In total, 23 patients were recruited and the mean age ± standard deviation was 72 ± 3 years. The effective dose for successful LMA insertion in 50% of the patients (ED50) was 0.20 ± 0.05 μg/kg. No patient needed more than 0.3 μg/kg. Conclusions: Remifentanil 0.20 ± 0.05 μg/kg with propofol 1 mg/kg resulted in excellent LMA insertion in 50% of elderly patients without significant hemodynamic changes during emergency airway management.

Fiberoptic Laryngeal Microsurgery in Patients with Cervical Spine Disease

장전엽,김효성,백지석,김해규 대한이비인후과학회 부산,울산,경남 지부회 2014 임상이비인후과 Vol.25 No.2

Laryngeal microsurgery using suspension laryngoscope is a common procedure for benign laryngeal lesions. However, suspension laryngoscope could not always guarantee adequate exposure of the vocal cord in patients having stiff neck. Here we present a novel operative method to overcome difficult laryngeal exposure in patients with cervical spine diseases. A 71-year-old man presented with hoarseness. Laryngeal evaluation showed a vocal polyp located at the anterior portion of right true vocal cord. He previously underwent partial laminectomy of cervical and thoracic vertebrae for ossified ligamentum flavum. During operation, suspension rigid laryngoscope was not able to be introduced at the true vocal cord level due to a limited neck extension caused by spine immobilization and further concern was taken for potential damage of spinal cord. We performed fiberoptic laryngeal microsurgery assisted with McGRATH® portable video laryngoscope and successfully removed the vocal polyp. Fiberoptic laryngeal microsurgery assisted with McGRATH® portable video laryngoscope might be an alternative approach in selected patients of difficult laryngeal exposure especially due to cervical spine disease.

Intrathecal dexmedetomidine attenuates mechanical allodynia through the downregulation of brain-derived neurotrophic factor in a mild traumatic brain injury rat model

Jeon Soeun,백지석,Kim Jisu,Lee Jiyoon,도왕석,김은수,이현정,김해규 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.1

Background: This study evaluated the effects of dexmedetomidine and propofol on brain-derived neurotrophic factor level in the cerebrospinal fluid (c-BDNF) and mechanical allodynia in a mild traumatic brain injury (TBI) rat model.Methods: After fixing the rat’s skull on a stereotactic frame under general anesthesia, craniotomy was performed. After impact, 10 µl of drug was injected into the cisterna magna (group S: sham, group D: dexmedetomidine 5 μg/kg, group P: propofol 500 μg/kg, and group T: untreated TBI). The 50% mechanical withdrawal threshold (50% MWT) and c-BDNF level were measured on postoperative days (PODs) 1, 7, and 14.Results: The 50% MWT measured on PODs 1, 7, and 14 was lower and the c-BDNF level on POD 1 was higher in group T than in group S. In group D, the c-BDNF level on POD 1 was lower than that in group T and was comparable with that in group S during the whole study period. The 50% MWT of group D was higher than that of group T throughout the postoperative period. In group P, there were no significant differences in the 50% MWT during the entire postoperative period compared with group T; the c-BDNF level was higher than that in group T on POD 1.Conclusions: Intrathecal administration of dexmedetomidine may attenuate TBI-induced mechanical allodynia for up to two weeks post-injury through immediate suppression of c-BDNF in mild TBI rats. The inhibition of c-BDNF expression in the acute phase reduced the occurrence of TBI-induced chronic neuropathic pain.

Pretreatmet with 5% lidocaine patch reduces cannula-induced and propofol-induced pain: a randomized, double-blind, placebo-controlled study

이현정,홍정민,조아름,백지석,이도원,지영태,유기찬,김해규 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5

Background: The purpose of this study was to determine the efficacy of 5% lidocaine patch in reducing propofol-induced pain and cannula-induced pain. Methods: In a randomized, double-blind study, 126 patients were divided into one of three groups: pretreatment with a 5% lidocaine patch (LidotopⓇ) and premixed 2 ml of normal saline with 1.5 mg/kg of 1% propofol (Group A); pretreatment with a placebo patch and premixed 2 ml of normal saline with 1.5 mg/kg of 1% propofol (Group B); or pretreatment with a placebo patch and premixed 2 ml of 2% lidocaine (40 mg) with 1.5 mg/kg of 1% propofol (Group C) for induction of anesthesia. Pain severity was evaluated on a four-point verbal rating scale during intravenous cannulation, propofol injection, and 24 h after the operation (recall). Results: Eighteen patients (47.4%) in Group A complained of cannula-induced pain compared with 35 (94.6%) in Group B and 36 (94.7%) in Group C (P < 0.001). Group A patients showed significantly lower incidence of propofol-induced pain and recall of propofol-induced pain compared with Group B (P < 0.001 and P = 0.01), whereas there was no difference compared with Group C. Conclusions: Preoperative transdermal administration of 5% lidocaine patch is an effective and simple method in reducing propofol-induced pain as well as cannula-induced pain.

Isoflurane은 인간 배아줄기세포에서 분화된 심장근육 전구세포의 산화스트레스에 의한 세포자멸사를 감소시킨다

구본욱,김진희,한성희,김미현,백지석 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.3

Background: Despite the great potential of human embryonic stem cell (hESC)-derived cardiac progenitor cells (CPCs) in the cardiac cell transplantation, the low graft survival still remains as one of the main obstacles in the way to its clinical application. We investigated whether pre-treatment with isoflurane can decrease apoptosis of hESC-derived CPCs under oxidative stress. Methods: Undifferentiated hESCs were differentiated in suspension media with 20% fetal bovine serum (FBS) and 20 ng/ml of bone morphogenetic protein (BMP)-4 through embryoid bodies and grown onto Matrigel-coated plates for 2 or 3 weeks. To identify the differentiated CPCs, immunostaining for nonspecific transcriptional marker (Nkx2.5) was performed. The CPCs were exposed to oxidative stress induced by Fenton reaction with H2O2 and FeSO4. For anesthetic preconditioning, CPCs were exposed to isoflurane (5 vol%) in an isolated chamber. Apoptosis of CPCs was determined by TUNEL staining and detection of activated caspase-3 cell. Results: hESC-derived CPCs stained with Nkx2.5 were 95 ± 3%of total cell number. Concentration of isoflurane in the media was 1.1 mM (2.2 MAC). Pretreatment of CPCs with isoflurane showed a significantly lower TUNEL (+) ratio as well as activated caspase-3cell number compared to control. Conclusions: Isoflurane decreased hESC-derived Nkx2.5+ CPCs apoptosis induced by oxidative stress. This result suggests that anti-apoptotic effect may play a role in the protective effect of isoflurane.

Targeted temperature management in a patient with suspected hypoxic-ischemic brain injury after successful resuscitation from cardiac arrest: a case report

Kang Christine,임원용,정영훈,백지석 고신대학교(의대) 고신대학교 의과대학 학술지 2023 고신대학교 의과대학 학술지 Vol.38 No.2

Hypoxic-ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurological disorders in survivors. Targeted temperature management (TTM) has been rigorously studied as a way to improve results compared to a normal body temperature for preventing secondary damage after HIBI. We report a case of successful TTM in a patient who was suspected to have HIBI after resuscitation from cardiovascular collapse due to respiratory failure during elective surgery under brachial plexus block with dexmedetomidine and remifentanil infusion. A 27-year-old male patient developed CA due to apnea during orthopedic surgery. TTM was performed in the surgical intensive care unit for 72 hours after resuscitation, and the patient recovered successfully. TTM application immediately after resuscitation from CA in patients with suspected HIBI may be an appropriate treatment.

The anti-nociceptive effect of BPC-157 on the incisional pain model in rats

정영훈,김해규,김혜진,김은수,백지석,강현종 대한치과마취과학회 2022 Journal of Dental Anesthesia and Pain Medicine Vol.22 No.2

Background: The pentadecapeptide BPC-157 has been shown to have anti-inflammatory and wound healing effects on multiple target tissues and organs. Peptides have potent anti-inflammatory effects on periodontal tissues in rats with periodontitis. Few studies have investigated the effect of BPC-157 on pain after dental procedures or oral surgeries. The purpose of the present study was to investigate the antinociceptive effects of BPC-157 on postoperative incisional pain in rats. Methods: Sprague–Dawley rats were randomly divided into five groups: control (saline with the same volume), BPC10 (10 μg/kg of BPC-157), BPC20 (20 μg/kg of BPC-157), BPC40 (40 μg/kg of BPC-157), and morphine (5 mg/kg of morphine). A 1-cm longitudinal incision was made through the skin, fascia, and muscle of the plantar aspect of the hind paw in isoflurane-anesthetised rats. Withdrawal responses were measured using von Frey filaments at 0, 2, 6 h and 4, 7 d after incision. The formalin test was also performed to differentiate its anti-nociceptive effect from an inflammatory reaction or central sensitization. Pain behavior was quantified periodically in phases 1 and 2 by counting the number of flinches in the ipsilateral paw after injection with 30 μL of 5% formalin. Results: The threshold of mechanical allodynia was significantly increased in the BPC10, BPC20, BPC40 and morphine groups compared with that in the control group at 2 h. These increasing thresholds then returned to the levels of the control group. The BPC-157 group showed a much higher threshold at 4 days after incision than the control group. The thresholds of the BPC groups, except the morphine group, were normalized 7 days after incision. The flinching numbers of the BPC10, BPC20, BPC40 and morphine groups were significantly decreased in phase 1, but there was no decrease in the BPC-157 groups except the morphine group in phase 2. Conclusions: BPC-157 was effective only for a short period after incision. It was also effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 might have a short antinociceptive effect, even though it has anti-inflammatory and wound healing effects.

The EZ-Blocker® for one-lung ventilation in a patient with Kartagener syndrome and tracheal bronchus -a case report-

Hwang Boo-young,Kwon Jae-young,김은수,백지석,Kim Hyae Jin,Heo Yun,이도원 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.1

Background: The tracheal bronchus in Kartagener syndrome is a rare case that may cause difficulty in one-lung ventilation (OLV). Here we reported a case of successful OLV using bronchial blocker in a patient with tracheal bronchus and Kartagener syndrome (KS).Case: A 66-year-old female patient with Kartagener syndrome was admitted for left-side diaphragmatic plication. The patient’s preoperative computed tomography image showed a tracheal bronchus of the apical segment in the right upper lobe. The patient received epidural analgesia and general anesthesia through total intravenous anesthesia. An EZ-Blocker® (Teleflex Life Sciences Ltd., Ireland) was used to perform OLV.Conclusions: OLV through an EZ-Blocker® can be successfully performed in tracheal bronchus patients with Kartagener syndrome without side effects.